WO2008080148A2 - Disposable vitrectomy handpiece - Google Patents

Disposable vitrectomy handpiece Download PDF

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Publication number
WO2008080148A2
WO2008080148A2 PCT/US2007/088745 US2007088745W WO2008080148A2 WO 2008080148 A2 WO2008080148 A2 WO 2008080148A2 US 2007088745 W US2007088745 W US 2007088745W WO 2008080148 A2 WO2008080148 A2 WO 2008080148A2
Authority
WO
WIPO (PCT)
Prior art keywords
motor
handle
cutter according
vitreous
vitreous cutter
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/US2007/088745
Other languages
English (en)
French (fr)
Other versions
WO2008080148A3 (en
Inventor
Aaron Barnes
Charles De Boer
Matthew Mccormick
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Doheny Eye Institute of USC
Original Assignee
Doheny Eye Institute of USC
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Doheny Eye Institute of USC filed Critical Doheny Eye Institute of USC
Priority to DK07865997.6T priority Critical patent/DK2094173T3/en
Priority to JP2009543284A priority patent/JP5226005B2/ja
Priority to EP07865997.6A priority patent/EP2094173B1/en
Priority to ES07865997T priority patent/ES2571580T3/es
Publication of WO2008080148A2 publication Critical patent/WO2008080148A2/en
Publication of WO2008080148A3 publication Critical patent/WO2008080148A3/en
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

Classifications

    • 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
    • A61B17/32—Surgical cutting instruments
    • A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/0023—Surgical instruments, devices or methods disposable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00477—Coupling

Definitions

  • the invention is directed to electric vitrectomy handpieces, and more particularly, the invention is directed to disposable electric vitrectomy handpieces that are small in size and light in weight.
  • Vitreous is a normally clear, gel-like substance that fills the center of the eye. Certain problems affecting the eye may require a vitrectomy, or surgical removal of all or a part of the vitreous.
  • various instruments are used including a vitrectomy handpiece, a light pipe and an infusion line or port.
  • the vitrectomy handpiece includes a cutter for removing all or a portion of the eye's vitreous.
  • the light pipe is used as a light source, and the infusion line or port is used to replace fluid and maintain proper pressure in the eye.
  • a vitrectomy handpiece includes an electric motor, a clutch mechanism, an oscillating drive mechanism and a cutting tip.
  • the motor is attached to the clutch which is attached to the oscillating drive mechanism.
  • the motor may be any electric motor suitable for use in vitrectomy handpieces.
  • the oscillating drive mechanism may be any mechanism capable of converting rotational motion of the motor to reciprocating motion of the cutting tip. 59063P/D614 [0006]
  • the clutch mechanism engages the oscillating drive mechanism when the motor is running and is stationary when the motor is at rest. When the motor is at rest, the clutch mechanism allows aspiration, and when the motor is running, the clutch mechanism engages the oscillating drive mechanism, which converts the rotational motion of the clutch to reciprocating motion of the cutting tip.
  • the vitrectomy handpiece is disposable.
  • the disposable vitrectomy handpiece according to this embodiment is manufactured using low cost parts for assembly and manufacture.
  • an inexpensive, disposable motor may be used to manufacture a disposable vitrectomy handpiece according to an embodiment of the present invention.
  • inventive vitrectomy handpieces are small in size and light in weight, enabling greater maneuverability of the device by the surgeon.
  • inventive vitrectomy handpieces are ergonomically designed, making the handpiece comfortable to handle during surgery.
  • FIG. 1 is a photograph comparing a vitrectomy handpiece according to an embodiment of the present invention with a vitrectomy handpiece according to the prior art
  • FIG. 2A is a partial cross-sectional view of a vitrectomy handpiece according to one embodiment of the present invention
  • FIG. 2B is an exploded view of area B in FIG. 2A
  • FIG. 2C is an exploded view of area C in FIG. 2A;
  • FIG. 3 is a partially cut-away side view of a vitrectomy handpiece according to one embodiment of the present invention.
  • FIG. 4 is an exploded schematic view of a motor, clutch mechanism, drive mechanism and cutting tip of a vitrectomy handpiece according to one embodiment of the present invention
  • FIGs. 5A through 5E are schematic diagrams depicting the motion of a clutch mechanism and drive mechanism during a cutting process of a vitrectomy handpiece according to one embodiment of the present invention.
  • FIG. 6 is an exploded view of a vitrectomy handpiece according to one embodiment of the present invention. 59063P/D614 1 DETAILED DESCRIPTION OF THE INVENTION
  • Embodiments of the present invention are directed to disposable electric vitrectomy handpieces.
  • the handpieces are useful with, for example, 20-gauge or smaller instrumentation (e.g. 23, 25-gauge).
  • the handpieces are small in size and cost-efficient.
  • the small size is achieved by a disposable tool including a cutter tip integrated into the tool handle.
  • cost efficiency is achieved by a tool using plastic components and an inexpensive, disposable motor.
  • the drive mechanism and vitreous cutting tip have performance characteristics that are equivalent to or better than existing handpieces. Moreover, the vitrectomy handpiece maintains a substantially constant aspiration duty cycle over a range of operating speeds, such as, for example, about 3,000 to about 10,000 cpm or about 600 to
  • the vitrectomy handpiece is well balanced, light in weight and has low rotational and line torque. Accordingly, the handpiece is easily maneuverable by the surgeon.
  • the vitrectomy handpiece is smaller than conventional electric handpieces, thereby facilitating mobility. According to
  • the pneumatic lines are incorporated into the handle or fully enclosed within the handle, reducing clutter and improving ease of manipulation by the surgeon.
  • the electrical lines are much lighter than those in conventional cutters, reducing the amount of external torsion experienced by the surgeon.
  • the electrical lines may be disposable lines that are integral with the
  • a reusable line connecting a machine (external or otherwise) to the handpiece may be used.
  • an internal power supply may be used instead of electrical lines.
  • the vitrectomy handpiece according to embodiments of the present invention is an inexpensive surgical tool providing an electric alternative to pneumatic cutters.
  • the vitrectomy handpiece is inexpensive and disposable, eliminating the need for replacement parts.
  • the vitrectomy handpiece may be provided as a sterile package with the cutting tip incorporated directly into the handpiece. As the handpiece may be provided fully assembled, the time needed to prepare for surgery may be significantly reduced. Also, with disposable designs, the surgeon may bill directly for the tools used in the procedure,
  • ⁇ ⁇ - which option is not available when using a reusable vitrectomy tool with replacement parts.
  • cost is a 59063P/D614 concern.
  • the components of the vitrectomy handpiece may be manufactured in high volume, using low cost techniques such as injection molding, CNC machining, overmolding, deep drawing, EDM, and the like. Additionally, reducing part count and handpiece size significantly reduces the total cost of the handpiece.
  • a vitrectomy handpiece 100 according to one embodiment of the present invention is smaller than the Alcon Innovit handpiece 102.
  • Another consideration in designing vitrectomy handpieces is minimizing noise and vibration. High levels of noise and vibration adversely affect maneuverability of the tool during surgery, and makes it difficult for the surgeon to make precise cuts.
  • the drive mechanism according to one embodiment has balanced components, smooth transitions as the cutter is extended and retracted, and good alignment of the drive components.
  • the vitrectomy handpiece has an invariable cutting duty cycle at a wide range of operating speeds.
  • a vitrectomy handpiece according to one embodiment of the present invention has a maximum cut speed targeted between about 6000 cpm and about 10,000 cpm.
  • Another way to dampen vibration includes providing a rubber, foam, silicon, or other like tube around the motor.
  • FIGs. 2 through 4 are detailed diagrams of various vitrectomy cutters 20 according to certain embodiments of the present invention.
  • the cutter 20 includes a motor 1, a clutch mechanism 2, an oscillating drive mechanism 7, and a cutter tip 10 mounted inside a handle 14.
  • the handle 14 is used to mount and align the various components, provide ergonomic design for the surgeon, and route aspiration lines.
  • the cutter tip 10 is directly integrated into the handle 14. This integration helps reduce complexity and part count by eliminating the interface components between the tip and the handle.
  • the motor 1 is attached to the clutch 2.
  • the clutch expands to engage the oscillating drive 7 and cutter tip 10 when the motor 1 is operational and retracts to allow aspiration via the aspiration line 15 when the motor 1 is at rest.
  • the oscillating drive 7 converts the motor 1 rotation into a smooth reciprocating motion of the cutter tip 10.
  • the oscillating drive may be any device capable of converting rotary to oscillating linear motion, such as, for example, a crankshaft.
  • the clutch is described as allowing aspiration when the motor is off, it is understood that the vitrectomy handpiece aspirates during the cutting process as well.
  • the aspiration port 201 opens and closes repeatedly as the cutter is extended 59063P/D614 and retracted. Aspiration occurs through the open aspiration port 201 throughout the cutting process.
  • the cutter when the motor is turned off, the cutter may either be extended to close the aspiration port or retracted to open the aspiration port, and the position of the cutter is random depending on when during the cutting process the motor is turned off.
  • the clutch mechanism 2 retracts the cutter when the motor is turned off, ensuring that the aspiration port is open when the motor is turned off.
  • the actuation of the clutch 2 may be achieved in different ways.
  • the clutch 2 may retract by reversing the motor 1.
  • the motor automatically runs in reverse for a short period when the motor turns off.
  • the reverse motion of the motor causes the clutch to retract, thereby allowing aspiration via the aspiration line 15.
  • a spring return may be employed so that when the motor 1 is off, the clutch 2 retracts.
  • This alternative clutch mechanism may be used in conjunction with a spring to retract the clutch and open the aspiration port when the cutter is turned off.
  • the design of the previous embodiment uses slow reversed motion of the motor to open the aspiration port. A design with light springs allows the clutch to retract without any reverse motion of the motor.
  • the clutch mechanism 2 is used to engage the cutter tip 10 when the handpiece is operated, and allow aspiration when the cutter is stationary.
  • Existing electric vitrectomy handpieces use a positional sensor to monitor the position of the motor to determine when to initiate aspiration. In such conventional handpieces, the motor is rotated to a position where the aspiration port is open when the cutter is at rest. This allows full aspiration through the tip of the instrument when it is not being used to cut.
  • the vitrectomy handpieces according to embodiments of the present invention use clutching mechanisms to reduce cost and part count, as well as to improve maneuverability of the instrument.
  • the clutch mechanism 2 includes two components that rotate relative to each other when torque is transmitted across them.
  • a groove 200 is cut in the first component 3.
  • the groove may have any suitable profile, and in one embodiment, is half of a sinusoidal groove.
  • the second component 5 captivates a ball 4 which rides in the groove 200.
  • the clutch may include a pin riding on a cam (not shown), or the like. Regardless of the embodiment, however, the clutch/cam may be implemented as a single component to reduce cost, or be separated into two elements. [0031] FIGs.
  • FIG. 5 A to 5E illustrate portions of the oscillating drive mechanism 7 and clutch mechanism 2 during a cutting process.
  • the cutter tip 10 at each step is shown in a box 104a - 104e below the drive and clutch mechanisms.
  • the motor provides rotary motion which is depicted by curved arrows 106a - 106e.
  • the cutter is starting from rest and beginning to cut. In this position, both the clutch 2 and cutter tip 10 are retracted and the aspiration port 201 is open.
  • the clutch expands until it reaches the engaged position (the position illustrated in FIG. 5B). The clutch remains engaged as long as the cutter is cutting (the positions illustrated in FIGs. 5B through 5E).
  • the oscillating drive mechanism 7 travels enough to move the cutter across the aspiration port 201.
  • the clutch 2 is engaged, and the oscillating drive 7 is opening and closing the cutter.
  • the oscillating drive mechanism 7 closes the cutter for the first cut. The cutter is then open at the position illustrated in FIG. 5D and closed again at the position illustrated in FIG. 5E.
  • the motor may be any suitable motor known in the art, and in one embodiment, may be a disposable motor.
  • Using disposable motors which are generally less expensive than their reusable counterparts, reduces not only the cost of the motor but also the cost of the vitrectomy handpiece.
  • a disposable design also allows use of plastic components and gearing. When purchased in high volumes, high quality, miniature DC motors with gearing may cost about $30 or more.
  • Such disposable motors typically have shorter lifespans than their non-disposable counterparts, because the motor is disposable, the lifespan requirement is reduced compared to non-disposable motors. For a disposable instrument, the longevity of the motor is not as stringent, and more cost effective motors can be considered.
  • Small DC motors generally require gearing due to the output speed range (which may be about 600cpm to about ⁇ OOOcpm), and the high torque needed (stall torque of about 7mNm).
  • Typical small DC motors run at speeds above about 5000 rpm, with many of them having free running speeds above about 15000 rpm.
  • Pre-geared motors meet the shaft speed and torque requirements, but they increase both price and footprint.
  • Gearing small DC motors is another option to optimize overall cost. One method of achieving this includes using a motor with relatively high torque (stall torque of about 2 to about 3mNm) and relatively low free running speed (about 10,000 rpm), and incorporating minimal gearing to obtain the desired speed.
  • Gearing may include a frictional drive, a single 59063P/D614 set of spur gears, a plastic planetary gear, or a harmonic drive.
  • a motor with high torque and low free running speed will be larger than the faster running lower torque models.
  • the cost of the different motors will be similar.
  • a smaller motor may be used with gearing similar to a harmonic drive. This type of gearing has a relatively low part count and allows for high reduction ratios in a small space.
  • the gearing decision will be a cost trade-off analysis of the various designs and projected cost of manufacture.
  • the handle 14 of the vitrectomy handpiece not only holds the motor 1 and drive mechanisms 2 and 7, but also the aspiration line 15. Routing the aspiration line through the handle reduces clutter and improves maneuverability of the tool.
  • the aspiration line begins inside the handle and is routed to a port in the back of the handle.
  • a small electrical line is bundled with the aspiration line at the back of the handle in a single cord.
  • the cord (including the aspiration line and electrical line) may be integrated with the handpiece to form a single component.
  • the vitrectomy handpiece interfaces with existing cutter tips 10a as is illustrated in FIG. 6. As shown in FIG.
  • a vitrectomy handpiece including a motor Ia, clutch mechanism 2a and oscillating drive mechanism 7a interfaces with a commercially available cutter tip 10a.
  • the vitrectomy handpiece incorporates the cutter tip 10 into the handle 14 and the aspiration line 15 is routed through the handle 14. This configuration eliminates the need for an externally connected aspiration line, and thus improves maneuverability of the handpiece.
  • the aspiration line 15 may be routed around the motor, as shown in FIGs. 2A and 3.
  • a speed sensor may be incorporated into the handpiece for sensing speed, proper operation of the handpiece, and the like.
  • the speed sensor may include a sensor and a magnet.
  • speed may be measured by measuring a current ripple as the motor rotates, measuring current/voltage curves and extrapolating speed based on the measured data, and the like.
  • stall of the handpiece may be detected by looking at the current draw to find failure.
  • a seal is provided. As shown in FIGs. 2 and 3, the seal may include a seal housing 11, an o-ring or diaphragm seal 12 and a seal retainer 13. [0042] To be viable alternatives to pneumatic cutters, the cost of the inventive vitrectomy handpieces should be comparable to or less than existing cutter tips. To reduce cost, according to one embodiment, all components in the design are made of plastic. However, it is understood that the present invention is not limited to plastic, and that any other material that lends itself to high volume and low cost manufacturing techniques may be employed in lieu of or in addition to plastic.
  • the components of the vitrectomy handpiece may be manufactured by molding or CNC techniques conventional in the art. Molding may have a higher upfront tooling cost, but provides low unit cost unit when purchased in large volumes. CNC parts provide improved component tolerances, but unit cost is increased when purchased in large volumes. If high tolerance is required for the clutch mechanism, molding may be used in conjunction with a CNC finishing pass (bored hole or a sinusoidal cam cut). A study on performance versus part tolerance may be evaluated to understand the exact specifications for the mold and/or CNC parts.
  • Optimal gearing of the handpiece may be achieved by testing traction and cutting efficiency as a function of cutter rate. This testing will allow optimization of top speed. With this information, the gearing of the handpiece may be modified for operation at an optimal cut rate.

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  • Health & Medical Sciences (AREA)
  • Ophthalmology & Optometry (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Surgical Instruments (AREA)
PCT/US2007/088745 2006-12-21 2007-12-21 Disposable vitrectomy handpiece Ceased WO2008080148A2 (en)

Priority Applications (4)

Application Number Priority Date Filing Date Title
DK07865997.6T DK2094173T3 (en) 2006-12-21 2007-12-21 Disposable vitrectomy handpiece
JP2009543284A JP5226005B2 (ja) 2006-12-21 2007-12-21 使い捨て硝子体切除術ハンドピース
EP07865997.6A EP2094173B1 (en) 2006-12-21 2007-12-21 Disposable vitrectomy handpiece
ES07865997T ES2571580T3 (es) 2006-12-21 2007-12-21 Pieza de mano desechable para vitrectomía

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US87679606P 2006-12-21 2006-12-21
US60/876,796 2006-12-21

Publications (2)

Publication Number Publication Date
WO2008080148A2 true WO2008080148A2 (en) 2008-07-03
WO2008080148A3 WO2008080148A3 (en) 2008-10-16

Family

ID=39563257

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US2007/088745 Ceased WO2008080148A2 (en) 2006-12-21 2007-12-21 Disposable vitrectomy handpiece

Country Status (8)

Country Link
US (3) US20080208233A1 (enExample)
EP (1) EP2094173B1 (enExample)
JP (1) JP5226005B2 (enExample)
DK (1) DK2094173T3 (enExample)
ES (1) ES2571580T3 (enExample)
PL (1) PL2094173T3 (enExample)
PT (1) PT2094173T (enExample)
WO (1) WO2008080148A2 (enExample)

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EP2883508A1 (en) * 2013-12-11 2015-06-17 DePuy Mitek, LLC Tissue shaving device having a fluid removal path
CN105873548A (zh) * 2013-12-20 2016-08-17 诺华股份有限公司 组织感应玻璃体切除术外科手术系统和方法
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US10716614B2 (en) 2017-06-28 2020-07-21 Ethicon Llc Surgical shaft assemblies with slip ring assemblies with increased contact pressure
USD854151S1 (en) 2017-06-28 2019-07-16 Ethicon Llc Surgical instrument shaft
US10258418B2 (en) 2017-06-29 2019-04-16 Ethicon Llc System for controlling articulation forces
US10398434B2 (en) 2017-06-29 2019-09-03 Ethicon Llc Closed loop velocity control of closure member for robotic surgical instrument
US10765429B2 (en) 2017-09-29 2020-09-08 Ethicon Llc Systems and methods for providing alerts according to the operational state of a surgical instrument
US10796471B2 (en) 2017-09-29 2020-10-06 Ethicon Llc Systems and methods of displaying a knife position for a surgical instrument

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DK2094173T3 (en) 2016-06-06
WO2008080148A3 (en) 2008-10-16
EP2094173A4 (en) 2011-06-22
US9750639B2 (en) 2017-09-05
JP5226005B2 (ja) 2013-07-03
EP2094173A2 (en) 2009-09-02
US20080208233A1 (en) 2008-08-28
ES2571580T3 (es) 2016-05-26
JP2010514481A (ja) 2010-05-06
US20170319387A1 (en) 2017-11-09
EP2094173B1 (en) 2016-03-30
PT2094173T (pt) 2016-07-11
US20140296900A1 (en) 2014-10-02
PL2094173T3 (pl) 2016-09-30

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