WO2009120206A1 - Echantillon tissulaire de dispositif de biopsie à tambour - Google Patents

Echantillon tissulaire de dispositif de biopsie à tambour Download PDF

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Publication number
WO2009120206A1
WO2009120206A1 PCT/US2008/058627 US2008058627W WO2009120206A1 WO 2009120206 A1 WO2009120206 A1 WO 2009120206A1 US 2008058627 W US2008058627 W US 2008058627W WO 2009120206 A1 WO2009120206 A1 WO 2009120206A1
Authority
WO
WIPO (PCT)
Prior art keywords
sample
biopsy device
cutter
probe
tissue
Prior art date
Application number
PCT/US2008/058627
Other languages
English (en)
Inventor
John A. Hibner
Trevor W. V. Speeg
Bennie Thompson
Richard P. Nuchols
Wells D. Haberstich
Gavin Monson
Robert F. Weikel
Original Assignee
Ethicon Endo-Surgery, Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Ethicon Endo-Surgery, Inc filed Critical Ethicon Endo-Surgery, Inc
Priority to PCT/US2008/058627 priority Critical patent/WO2009120206A1/fr
Publication of WO2009120206A1 publication Critical patent/WO2009120206A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
    • A61B10/02—Instruments for taking cell samples or for biopsy
    • A61B10/0233—Pointed or sharp biopsy instruments
    • A61B10/0266—Pointed or sharp biopsy instruments means for severing sample
    • A61B10/0275—Pointed or sharp biopsy instruments means for severing sample with sample notch, e.g. on the side of inner stylet
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; 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
    • A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
    • A61B10/02—Instruments for taking cell samples or for biopsy
    • A61B10/0233—Pointed or sharp biopsy instruments
    • A61B10/0283—Pointed or sharp biopsy instruments with vacuum aspiration, e.g. caused by retractable plunger or by connected syringe
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
    • A61B10/02—Instruments for taking cell samples or for biopsy
    • A61B2010/0208—Biopsy devices with actuators, e.g. with triggered spring mechanisms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; 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
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00535—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated
    • A61B2017/00544—Surgical instruments, devices or methods, e.g. tourniquets pneumatically or hydraulically operated pneumatically

Definitions

  • the present invention relates in general to biopsy devices, and more particularly to biopsy devices having a cutter for severing tissue, and even more particularly to biopsy devices for multiple sampling with a probe remaining inserted.
  • a biopsy procedure may be performed using an open or percutaneous method.
  • An open biopsy is performed by making a large incision in the breast and removing either the entire mass, called an excisional biopsy, or a substantial portion of it, known as an incisional biopsy.
  • An open biopsy is a surgical procedure that is usually done as an outpatient procedure in a hospital or a surgical center, involving both high cost and a high level of trauma to the patient.
  • Open biopsy carries a relatively higher risk of infection and bleeding than does percutaneous biopsy, and the disfigurement that sometimes results from an open biopsy may make it difficult to read future mammograms. Further, the aesthetic considerations of the patient make open biopsy even less appealing due to the risk of disfigurement. Given that a high percentage of biopsies show that the suspicious tissue mass is not cancerous, the downsides of the open biopsy procedure render this method inappropriate in many cases.
  • Percutaneous biopsy is much less invasive than open biopsy.
  • Percutaneous biopsy may be performed using fine needle aspiration (FNA) or core needle biopsy.
  • FNA fine needle aspiration
  • a very thin needle is used to withdraw fluid and cells from the suspicious tissue mass.
  • This method has an advantage in that it is very low-pain, so low-pain that local anesthetic is not always used because the application of it may be more painful than the FNA itself.
  • FNA fine needle aspiration
  • a very thin needle is used to withdraw fluid and cells from the suspicious tissue mass.
  • This method has an advantage in that it is very low-pain, so low-pain that local anesthetic is not always used because the application of it may be more painful than the FNA itself.
  • a shortcoming of FNA is that only a small number of cells are obtained through the procedure, rendering it relatively less useful in analyzing the suspicious tissue and making an assessment of the progression of the cancer less simple if the sample is found to be malignant.
  • a biopsy instrument marketed under the trade name MAMMOTOME is commercially available from ETHICON ENDO-SURGERY, INC. for use in obtaining breast biopsy samples.
  • This device generally retrieves multiple core biopsy samples from one insertion into breast tissue with vacuum assistance.
  • a cutter tube is extended into a probe to cut tissue prolapsed into a side aperture under vacuum assistance and then the cutter tube is fully retracted between cuts to extract the sample.
  • the present invention addresses these and other problems of the prior art by providing a biopsy device that has a probe cannula that is inserted into tissue to obtain a core biopsy sample by translating a cutter with the probe cannula.
  • a pneumatic pressure differential is used to draw a severed tissue sample proximally from the probe cannula into an individual sample container. Thereafter, another empty sample container is moved into position to accept the next tissue sample.
  • FIGURE 1 is an isometric view of a biopsy device with an attached sample revolver drum assembly consistent with the present invention.
  • FIGURE 2 is an isometric view of the biopsy device of FIG. 1 with a disposable probe assembly that includes the sample revolver drum assembly disengaged from a reusable handpiece that has a lower tray removed to expose a carriage frame assembly and a motor drive assembly.
  • FIGURE 3 is an isometric view of the reusable handpiece of FIG. 1 with a top cover detached with a left half cut away and with the lower handle tray detached to expose the motor drive assembly operatively engaged to the carriage frame assembly.
  • FIGURE 4 is an isometric view of the motor drive assembly removed from the carriage frame assembly of FIG. 3.
  • FIGURE 5 is a bottom isometric view of the top cover of the reusable handpiece of FIG. 2.
  • FIGURE 6 is a top, left and aft isometric view of the carriage frame assembly of FIG. 4.
  • FIGURE 7 is a top, left and forward view of the carriage frame assembly of FIG. 4 with an upper frame disassembled.
  • FIGURE 8 is a top, left and front isometric view of the carriage frame assembly of FIG. 4 with the upper frame removed.
  • FIGURE 9 is a bottom isometric view of the carriage frame assembly of FIG. 8 with the upper frame removed.
  • FIGURE 10 is a top, left and front isometric exploded view of the carriage frame assembly of FIG. 4.
  • FIGURE 11 is a right front view of a transmission section of the motor drive assembly of FIG. 4 with a distal bulkhead removed.
  • FIGURE 12 is a front left exploded view of the transmission section of the motor drive assembly of FIG. 4.
  • FIGURE 13 is a left front isometric view of the disposable probe assembly of FIG. 1 with a hand-held distal portion partially disassembled from the sample revolver drum assembly.
  • FIGURE 14 is an isometric view from below and to the left of the hand-held distal portion of the disposable probe assembly of FIG. 13 with cover components omitted.
  • FIGURE 15 is an isometric view of an exploded portion of the disposable probe assembly.
  • FIGURE 16 is an isometric view of the sample revolver drum assembly of FIG. 1.
  • FIGURE 17 is an exploded view of the sample revolver drum assembly of FIG. 16.
  • FIGURE 18 is an isometric detail view of an indexer gear cover of the sample revolver drum assembly of FIG. 16.
  • FIGURE 19A is a left side diagrammatic view of a left cyclic arm shown in phantom down for engagement during a proximal stroke engaged to the indexer gear cover of FIG. 18.
  • FIGURE 19B is a left side diagrammatic view of the left cyclic arm shown in phantom at a proximal most position on the indexer gear cover of FIG. 18.
  • FIGURE 19C is a left side diagrammatic view of the left cyclic arm shown in phantom during a return distal stroke rotated upward for disengagement.
  • FIGURE 20 is an isometric view of a revolver cylindrical drum assembly of the sample revolver drum assembly of FIG. 16.
  • FIGURE 21 is an isometric view of the revolver cylindrical drum of the revolver cylindrical drum assembly of FIG. 20.
  • FIGURE 22 is an isometric view of a revolver drum belt with a couple of removed sample vials of the revolver cylindrical drum assembly of FIG. 20.
  • FIGURE 23 is a diagrammatic view of the hand-held distal portion of the disposable probe assembly of FIG. 1 with both carriages advanced for closing a side aperture in a probe cannula for insertion into tissue.
  • FIGURE 24 is a diagrammatic view of the hand-held distal portion of the disposable probe assembly of FIG. 1 with an aft carriage retracted to vent the probe cannula to the atmosphere to begin a new sample taking cycle.
  • FIGURE 25 is a diagrammatic view of the hand-held distal portion of the disposable probe assembly of FIG. 1 with a front carriage beginning to retract, opening the side aperture and beginning to switch to supplying vacuum to the probe cannula.
  • FIGURE 26 is a diagrammatic view of the hand-held distal portion of the disposable probe assembly of FIG. 1 with both carriages retracted supplying vacuum pressure to the side aperture to prolapse tissue into the probe cannula.
  • FIGURE 27 is a diagrammatic view of the hand-held distal portion of the disposable probe assembly of FIG. 1 with the front carriage being distally advanced to sever tissue.
  • FIGURE 28 is a diagrammatic view of the hand-held distal portion of the disposable probe assembly of FIG. 1 with the front carriage fully distally translated to complete severing of a tissue sample with atmosphere pressure supplied to the side aperture through a lateral lumen.
  • FIGURE 29 is a diagrammatic view of the hand-held distal portion of the disposable probe assembly of FIG. 1 with the aft carriage distally advanced to retract the tissue sample with vacuum pressure.
  • a biopsy device 10 includes a reusable handpiece 12, and a disposable probe assembly 14.
  • a lower handle tray 16 is disassembled from upper portions of the reusable handpiece 12 to expose portions that operably engage the disposable probe assembly 14.
  • a sample revolver drum assembly 18 is prepared to receive the next tissue sample by an indexing assembly 19 attached to a hand-held distal portion 21 of the disposable probe assembly 14 that mounts to and is actuated by the reusable handpiece 12.
  • Tissue that is drawn by vacuum assistance into a side aperture 20 of a probe cannula 22 of the disposable probe assembly 14 is severed by a DC motor 24 (FIG. 3) in the reusable handpiece 12 that also powers rotation and staging of the sample revolver drum assembly 18 to segregate and store the tissue samples in the order received.
  • insertion of the probe cannula 22 into tissue is integrally supported by a piercing tip 26 attached at a distal end as well as a longitudinal jack hammer motion to the probe cannula 22 selected by positioning a slide button 28 distally and depressing a forward motor button 30.
  • the DC motor 24 drives a transmission section 31 (FIG. 2) grounded to a top cover 34 of the reusable handpiece 12 to longitudinally reciprocate an internal carriage frame assembly 32 (FIG. 2) that is engaged for movement with the probe cannula 22 (FIG. 3).
  • depression of the forward motor button 30 causes the DC motor 24 to advance and rotate a cutter tube 36, depicted in FIG.
  • a reverse motor button 38 causes the cutter tube 36 to retract. Depression of a mode button 40 may cause other functions to be performed.
  • An external conduit 42 extends from the disposable probe assembly 14 and is terminated by a filter/tube fitting 43. Vacuum assistance passes through a lateral lumen 44 of the probe cannula 22 and distally communicates via internal vent holes 47 (FIG. 23) and then enters a cutter lumen 46 that encompasses the cutter tube 36 and includes the side aperture 20.
  • An additional feature contemplated but not depicted includes using the mode button 40 to selectively communicate a saline supply to lateral lumen 44 to flush the probe cannula. It should be appreciated that the biopsy device 10 includes a minimum of "tethers" that would impede use, pose a tripping hazard, or extend set-up time.
  • applications consistent with the present invention may have a cylindrical probe cannula wherein the cutter tube 36 is positioned off-center to translate across a side aperture.
  • a "soft-walled” lateral lumen may then be defined as a space between an outer diameter of the cutter tube and an inner diameter of the cylindrical probe cannula.
  • the disposable probe assembly 14 has a bottom cover 48 with a distal probe mount cover 50 that assists in supporting the probe cannula 22 while allowing the longitudinal jack hammer motion.
  • a plurality of locking tabs 52 with locking edges 54 extend upwardly through pass-through slots 56 formed in the periphery of the lower handle tray 16 to resiliently extend outwardly into engaging contact with the slots 56.
  • Relieved areas 58 are formed behind each locking tab 52 in a top extension member 59 that surrounds a probe support body 60.
  • the combination covers a cavity defined by the bottom cover 48, which allows depression of the locking tabs 52 to unlock the disposable probe assembly 14 to install another identical or similar assembly.
  • a proximal end of the cutter tube 36 receives a cutter gear 62 having distal and proximal reduced diameter bearing surfaces 64, 66 on each longitudinal side of a rotation spur gear section 68, which engage the reusable handpiece 12 for rotation and for longitudinal translation through a distally open longitudinal aperture 70 formed in the lower handle tray 16.
  • FIGS. 3-13 the reusable handpiece 12 is depicted in various states of disassembly to illustrate its operation.
  • the transmission section 31 is part of a rigidly mounted motor drive assembly 76 that includes the motor 24 in between a planetary gearbox 78 and an encoder 80.
  • the battery or other power source and control circuitry are omitted in the depictions.
  • the motor drive assembly also includes a right guide pin 82 and a left guide pin 84.
  • the motor drive assembly 76 is shown operably engaged to the longitudinally reciprocating carriage frame assembly 32 in FIG. 3 and is disassembled from the longitudinally reciprocating carriage frame assembly in FIG. 4.
  • the right guide pin 82 is inserted proximally through a right front pin guide 86 and then through a right rear pin guide 88, both part of an upper frame 90 of the carriage frame assembly 32.
  • a proximal end of the right guide pin 82 resides within a distally projecting right pin receptacle 92 (FIG. 12) formed as part of a distal bulkhead 94 of the transmission section 31.
  • a distal end of the right guide pin 82 is received by a right pin recess 96 (FIG. 5) formed in the top cover 34.
  • the left guide pin 84 is inserted proximally through a left front pin guide 98 and then through a left rear pin guide 100, both part of the upper frame 90 of the carriage frame assembly 32.
  • a proximal end of the left guide pin 84 resides within a distally projecting left pin receptacle 102, respectively formed as part of the distal bulkhead 94 of the transmission section 31.
  • a distal end of the left guide pin 84 is received by a left pin recess 104 (FIG. 5) formed in the top cover 34.
  • a right front rmg bearing 106 is inserted over a distal portion of the right guide pin 82 and is received within a cylindrical recess 108 formed on a distal side of the right front pin guide 86.
  • a right aft ring bearing 109 is inserted over a proximal portion of the right guide pin 82 and is received within a cylindrical recess 111 (FIG. 6) formed on a proximal side of the right aft pin guide 88.
  • a left front ring bearing 110 is inserted over a distal portion of the left guide pin 84 and is received within a cylindrical recess 112 formed on a distal side of the left front pin guide 98.
  • a left aft ring bearing 113 (FIG. 9) is inserted over a proximal portion of the left guide pin 84 and is received within a left cylindrical recess 115 (FIG. 6) formed on a proximal side of the left rear pin guide 100
  • a right compression spring 114 is proximally received over the right guide pin 82 between the right front and rear pin guides 86, 88. More particularly, the right compression spring 114 is distally positioned against the right front pin guide 86 and at its proximal end by a right downwardly projecting structure 116 (FIG. 5) formed on an interior of the top cover 34 that closely encompasses a top portion of the right guide pin 82 without contacting other portions of the carriage frame assembly 32.
  • a left compression spring 118 is proximally received over the left guide pin 84 between the left front and rear pin guides 98, 100. More particularly, the left compression spring 118 is distally positioned against the left front pin guide 98 at its distal end by a left downwardly projecting structure 120 (FIG. 5) formed on the interior of the top cover 34 that closely encompasses a top portion of the left guide pin 84 without contacting other portions of the carriage frame assembly 32. Thereby, the carriage frame assembly 32 is biased to a distal position relative to the top cover 34 and lower handle tray 16.
  • a forward projecting cylindrical resilient member 122 fastened to the upper frame 90 reduces noise by contacting the front interior of the top cover 34 slowing distal movement of the carriage frame assembly 32 prior to reaching full travel.
  • the distal bulkhead 94 is restrained by being proximal to a top ridge 123, aright ridge 125, and a left ridge 127 (FIG. 5) formed in the interior of the top cover 34 and to a bottom ridge 129 formed on an upper surface of the lower handle tray 16.
  • the upper frame 90 has right and left front shaft apertures 124, 126 that respectfully receive for rotation a distal end of a rotation shaft 128 and a translation shaft 130.
  • the right front shaft aperture 124 is closed by the front portion of a right lower frame 131 of the carriage frame assembly 32.
  • the left front shaft aperture 126 is closed by the front portion of a left lower frame 132 of the carriage frame assembly 32.
  • a front (cutter) carriage 134 and an aft (straw) carriage 136 are received on the translation shaft 130 and are encompassed by the upper and lower frames 90, 132.
  • a proximal beveled and slotted end 138 of the rotation shaft 128 extends out of right aft shaft aperture 140 formed in the upper frame 90 for engagement to the transmission section 31 and is closed by an aft portion of the right lower frame 131.
  • a proximal slotted end 142 of the translation shaft 130 extends out of a left aft aperture 144 formed in the upper frame 90 for engagement to the transmission section 31 and is closed by the lower frame 132.
  • a threaded receptacle 146 on the aft end of the upper frame 90 receives a proximally projecting bolt 148 having an upwardly directed strike pin 148 at its proximal end.
  • the carriage frame assembly 32 sequences translation of the front and aft carriages 134, 136.
  • the front and aft carriages 134, 136 respectively include lower longitudinal grooves 152, 154 that slide upon a lower rail 156 upwardly presented on the left lower frame 132.
  • the front and aft carriages 134, 136 respectively include an upper longitudinal groove 158, 160 that slides upon a rail (not shown) downwardly presented on the upper frame 90.
  • the translation shaft 130 has a distal overrun portion 162 and a center overrun portion 164 separated by a front threaded portion 166 that a threaded bore 168 of a front main body portion 169 of the front carriage 134 traverses in response to rotation of the translation shaft 130.
  • a front translation compression spring 170 on the translation shaft 130 distal to the front carriage 134 compresses to allow the front carriage 134 to free wheel when being distally advanced and then biases the front carriage 134 aft to engage the front threaded portion 166 for being retracted upon reversal of rotation of the translation shaft 130.
  • proximal to the center overrun portion 164 is an aft threaded portion 172 and then a proximal overrun portion 174 that a threaded bore 176 of a back main body portion 177 of the aft carriage 136 traverses in response to rotation of the translation shaft 130 as well as in response to a connection to the front carriage 134.
  • a front bracket 178 mounted on a right side of the front carriage 134 has a rightward front pin guide 180 that receives a distal end of a longitudinally aligned carriage limiting rod 182.
  • a distal threaded end 184 of the carriage limiting rod 182 extends distally out of the rightward front pin guide 180 and is prevented from backing out by a front nut 186.
  • a long compression spring 188 is received over a shaft 190 of the carriage limiting rod 182 proximal to the rightward front pin guide 180.
  • An aft bracket 192 is attached to a right side of the back main body portion 177 of the aft carriage 136 to extend a rightward aft pin guide 194 that receives the carriage limiting rod 182, which extends a proximal threaded end 196 proximally out of the rightward aft pin guide 194 to receive an aft nut 198 that limits forward movement.
  • a lengthwise engagement aperture 200 defined between the right and left lower frames 131, 132, presents engaging structures that actuate the disposable probe assembly 14 and the revolver drum assembly 18.
  • the rotation (spur) gear 128 exposes its left side to the lengthwise engagement aperture 200 for engagement with the rotation spur gear section 68 of the cutter gear 62 to impart a rotation.
  • the front bracket 178 has a downward distal half cylinder recess 202 sized to grip the distal reduced diameter bearing surface 64 of the cutter gear 62 (FIG. 2).
  • the front bracket 178 further has a downward proximal half cylinder recess 204 proximally spaced and sized to grip the proximal reduced diameter bearing surface 66 of the cutter gear 62 (FIG. 2) as well as a downwardly projecting front actuation finger 206 to the left side and below of the cutter gear 62 for effecting atmospheric pressure to the probe cannula 22.
  • the aft bracket 192 has a downward distal half cylinder recess 208 and a downward proximal half cylinder recess 210 proximally spaced and sized to nonobstructively translate overtop of a tissue retraction tube 211, as well as a downwardly projecting aft actuation finger 212 that selects vacuum pressure for communicating to the probe cannula 22.
  • the motor drive assembly 76 rotates rotation and translation shafts 128, 130 at a fixed ratio to optimize cutting performance of the cutter tube 36 when the slide button 28 is back.
  • the motor drive assembly 76 imparts a jackhammer vibration to the carriage frame assembly 32 when the slide button 28 is forward.
  • the planetary gearbox 78 extends proximally a keyed motor drive shaft 214 (FIG. 12) through a drive shaft hole 216 formed in the distal bulkhead 94.
  • a slide spur gear 218 is received upon the keyed motor drive shaft 214 remaining engaged for rotation between a first distal (jack hammer) position and a second proximal (translation) position in accordance with a position of the slide button 28 whose distal and proximal feet 220, 222 straddle the slide spur gear 218.
  • the slide spur gear 218 is close to a proximal bulkhead 224 of the transmission section 31, engaging a small spur 226 of a multiplier gear assembly 228.
  • the multiplier gear assembly 228 includes a longitudinal shaft 230 centrally attached to the small spur gear 226. Proximal thereto, a cylindrical hub 232 is pinned to the longitudinal shaft 230 and in turn is encompassed by and pinned to a large spur gear 234 that rotates within a correspondingly sized, distally open recess 236 formed in proximally projecting container 237 integral to the proximal bulkhead 224. A front cylinder bearing 238 received on a distal portion of the longitudinal shaft 230 is received by the proximal surface of the distal bulkhead 94.
  • a first output drive shaft 240 distally presents a right angle prismatic end 242 shaped to engage the beveled and slotted end 138 of the rotation shaft 128 that passes through a lower right hole 244 in the distal bulkhead 94.
  • a cylindrical spacer 246 is received over a distal cylindrical portion 248 of the first output shaft 240, taking up the space between the rotation shaft 128 and the proximal bulkhead 224.
  • a distally open recess 250 formed as part of the container 237 that communicates from below with the recess 236, is shaped to receive a proximal cylindrical end 252 of the first output drive shaft 240 and encompasses cylindrical bearing 254 as well as a small spur ' gear segment 256, which is distal thereto and engages the large spur gear 234 of the multiplier gear assembly 228.
  • a second output drive shaft 258 distally presents a right angle prismatic end 260 to engage the proximal slotted end 142 of the translation shaft 130 that extends through a low left hole 262 in the distal bulkhead 94.
  • a cylindrical spacer 264 is received over a distal cylindrical portion 266 of the second output drive shaft 258 proximal to the right angle prismatic end 260 and distal to a wider diameter hub segment 268 that is encompassed by and pinned to a large spur gear 270 that engages the small spur gear 226 of the multiplier gear assembly 228.
  • Proximal to the hub segment 268 is a wide spacer segment 272 and then a narrow cylindrical end 274 that receives a cylindrical bearing 276 that resides within a correspondingly-sized, distally open recess 278 that communicates from the left with the recess 236 and is formed as part of the same container 237.
  • the distal and proximal bulkheads 94, 224 are structurally attached to one another in parallel alignment traverse to the longitudinal axis of the biopsy device 10 by cylindrical legs 280 molded to and proximally projecting from rectangular corners of the distal bulkhead 94 and fastened to the proximal bulkhead 224.
  • a pin 282 passes through holes 281, 283 longitudinally aligned in the distal and proximal bulkheads 94, 224 respectively along a top surface.
  • a camming shaft 286 from distal to proximal includes a distal cylindrical end 288, a cam wheel 290, a mid-shaft portion 292 that receives the upwardly directed strike pin 150 of the proximally projecting bolt 148, a wide diameter hub 294 that is encompassed by and pinned to the large spur gear 284, and a proximal cylindrical end 296.
  • a distal cylindrical bearing 298 is received within a proximally open container 300 projecting distally from the distal bulkhead 94 and in turn receives the distal cylindrical end 288 of the camming shaft 286.
  • a proximal cylindrical bearing 302 is received within a distally projecting and open cylinder 304 formed on the proximal bulkhead 224 and in turn receives the proximal cylindrical end 296 of the camming shaft 286.
  • the cam wheel 290 presents a proximal surface to the distal edge of the strike pin 150 that is more proximal until the interrupted portion of the camming wheel 290 is presented, allowing the strike pin 150 to return to a distal position under the urging of the distal biasing of the right and left compression springs 114, 118.
  • the disposable probe assembly 14 has movable components that respond to the actuating motions of the reusable handpiece 12.
  • the distal portion 21 of the disposable probe assembly includes the probe cannula 22 that is supported by the probe support body 60.
  • the probe support body 60 includes a distal probe mount 306 that is received within the distal probe mount cover 50 of the bottom cover 48.
  • the front carriage 134 controls a vacuum valve 307.
  • a vertically open longitudinal trough 310 is formed into a necked portion 312 of the probe support body 60.
  • a cutter carriage-driven vacuum valve driver 313 has an elongate driver body 314 that longitudinally translates within the longitudinal trough 310 and upwardly presents an elongate slot 315 for being indirectly moved by the downwardly projecting front actuation finger 206 of the front carriage 136.
  • a proximal block portion 316 is attached to the necked portion 312 of the probe support body 60.
  • a lower mounting 317 extends from the elongate driver body 314 distal to and longitudinally aligned with a distally open, longitudinally aligned vacuum valve bore 318 (FIG. 23) formed in proximal block portion 316 of the probe support body 60.
  • Central and proximal ports 320, 321 communicate with the vacuum valve bore 318 from an underside of the proximal block portion 316 and a distal port 322 communicates laterally from a right side of the proximal block portion 316.
  • a right distal 90-degree fitting 319 communicates between the distal port 322 and an intake filter 323 within an outer hose fitting 324.
  • a vacuum valve control rod 325 has a distal actuating portion 326 extending distally out of the valve bore 318 with a distal end positionable under the downwardly open portion of the longitudinal trough 310 and attached to the lower mounting 317 of the vacuum valve driver 313.
  • the vacuum valve control rod 325 also has a valve spool portion 327 that longitudinally translates within the valve bore 318 to selectively position between a first position and a second position.
  • a proximal O-ring 328 near a proximal end of the valve spool portion 327 and a distal O-ring 329 are spaced such that the first position entails the O-rings 328, 329 bracketing the central and distal ports 320, 322 and the second position entails the O-rings 328, 329 bracketing the proximal and central ports 321, 320, respectively.
  • the aft carriage 136 controls an air valve 351.
  • an air valve body 330 is attached to a left side of the proximal block portion 316 and includes a distally open longitudinal air valve bore 331 (FIG. 23) depicted in FIG. 14 as accessed by a distal left port 332, a left center port 333, and a left proximal port 334.
  • An air valve control rod 335 has a distal actuating portion 336 extending distally out of the air valve bore 331.
  • the valve control rod 335 also has a valve spool portion 337 that longitudinally translates within the air valve bore 331 to selectively position between a first position and a second position.
  • a proximal O-ring 338 near a proximal end of the valve spool portion 337 and a distal O-ring 339 are spaced such that the first position entails the O- rings 338, 339 bracketing the central and distal ports 333, 332 and the second position entails the O-rings 338, 339 bracketing the proximal and central ports 334, 333, respectively.
  • a valve connecting vacuum conduit 340 has one end attached to a lower center ninety-degree fitting 341 attached to the central port 320 of the vacuum valve bore 318 and the other end attached to an aft left ninety-degree fitting 342 that communicates with the left proximal port 334 of the air valve bore 331.
  • a distal conduit 343 is attached at one end to a center ninety-degree fitting 344 that communicates with the left center port 333 and at the other end at a probe union ninety-degree fitting 345 that communicates with the lateral lumen 44.
  • a vacuum supply conduit 346 is attached at one end to a distal ninety-degree fitting 347 that communicates with the proximal port 321 and at the other end to a vacuum supply (not shown).
  • An air supply conduit 348 is attached at one end to a distal ninety-degree fitting 349 that communicates with the distal left port 332 and the other end to an air supply (not shown).
  • the front actuation finger 206 of the front carriage 136 (FIGS. 9-10) is received within an upwardly open socket 350 formed on a left side of a cutter carriage-driven indexing shuttle 352 having a lateral concave recessed band 354 shaped to encompass with a clearance a lower portion of the rotation spur gear section 68 of the cutter gear 62.
  • An indexing arm 355 attached to the indexing shuttle 352 includes a proximally directed portion that proximally terminates in a rightward portion that terminates in an upward portion.
  • a downwardly projecting vacuum actuator lug 356 (FIG.
  • An air shuttle 358 longitudinally rides on a left edge of the necked portion 312 of the probe support body 60 and upwardly projects an air valve tab socket 360 positioned to receive the aft actuating finger 212 of the aft carriage 138.
  • a downward mounting arm 362 of the air shuttle 358 is attached to the distal actuating portion 336 of the air valve control rod 335 extending distally out of the air valve bore 331.
  • a straw hook wire 364 supports a midpoint of a sample retraction tube 363 in place upon the probe support body 60 prior to engagement with the reusable handpiece 12.
  • a curled lower right end passes into leftwardly opening 365 along the top right surface of the proximal block portion 316 of the probe support body 60 into a small mounting block 366 extending upwardly from a right side with a downwardly inserted pin 368 passing through the curled lower right end to hold the straw hook wire 364 in place.
  • the straw hook wire 364 has a horizontal portion attached to the curled end that passes under the sample retraction tube 363, bending upward and then bending leftward and horizontally again through a lateral slot 370 in a vertical wire support member 372 formed onto a left side of the top surface of the proximal block portion 316. It should be appreciated that engagement of the reusable handpiece 12 forces the left portions of the straw hook wire 364 out of engagement with the midpoint indented feature 350 as a rib feature 373 (FIG. 9) deflects the left portion of the straw hook wire 364. This facilitates commonality with disposable probe assemblies in which the straw hook wire 364 keeps a translating sample retraction straw in place prior to mounting to the reusable handpiece 12 (not shown).
  • the sample revolver drum assembly 18 includes a revolver cylindrical drum 380 encompassed by a detachable revolver drum belt 382 that in turn holds removable sample vials 384 forming a revolver cylindrical drum assembly 386 (FIG. 20).
  • a drum base 388 includes a half cylinder recess 389 which holds the sample revolver drum assembly 386 for rotation about the longitudinal axis and is closed by a top drum cover 390, which may be transparent for monitoring progress in tissue collection or opaque.
  • An indexer support base 392 of the indexing assembly 19 has a proximal surface fastened to a distal surface of the drum base 388 and extends a mounting flange 394 distally to attach to a proximal end of the hand- held distal portion 21 of the disposable probe assembly 14.
  • the sample retraction tube 363 passes over the mounting flange 394 and is gripped within a longitudinal groove 396 formed along a top, left side of the indexer support base 392 and passes through a hole 398 on a top left corner of a distal face of the drum base 388.
  • a slotted distal drum axle 400 of the revolver cylindrical drum 380 is received within a smaller distal portion of the half cylinder recess 389 and a proximal drum axle 401 (FIG. 21) is received within a smaller proximal portion of the half cylinder recess 389.
  • the slotted distal drum axle 400 receives an angled proximal end 402 of a shaft 404 that passes through a shaft hole 406 in the drum base 388.
  • a distal portion of the shaft 404 is received within a shaft recess 408 across the top of the indexer support base 392 that communicates with a half cylindrical gear recess 410 that encompasses a lower half of a large bevel gear 412 mounted on the shaft 404.
  • a small half cylindrical gear recess 414 receives a transversely oriented small bevel gear 416 that engages the large bevel gear 412.
  • a transverse shaft 418 has a left end mounted to the small bevel gear 416 and a right end mounted to a dual spur gear assembly 420 that rotates within a rightward transverse half cylindrical recess 422 formed in the indexer support base 392.
  • a top indexer gear cover 424 mounts overtop of the indexer support base 392 that contacts the top surfaces of the shaft 404 and left and right axle ends 426, 428 of the dual spur gear assembly 420 with a leftward slot 430 that exposes a top portion of the large bevel gear 412 and distally open left and right vertical slots 432, 434 that expose top surfaces of a left and right spur gear 436, 438 of the dual spur gear assembly 420.
  • a central beam 440 defined between the left and right vertical slots 432, 434, has a T-shaped hold down spring 442 mounted on top with its narrow end 444 mounted to a proximal end of the central beam 440.
  • a laterally wider end 446 extends overtop of both vertical slots 432, 434.
  • a cyclic spring gate 448 extends laterally to the left and right from a proximal end of the T- shaped hold down spring 442 and ramps downwardly and proximally.
  • each side of the central beam 440 has a respective left and right lower pin guides 462, formed as an upper surface of a wider lower portion.
  • An upper pin guide 449 extends laterally out from the central beam 440 on each side and is spaced respectively above the lower pin guides 462, 470 to form a lower pin channel 451.
  • the left upper pin guide 449 is depicted, it should be appreciated that the right side includes a mirror image upper pin guide.
  • a rear ramped portion 453 of the upper pin guide 449 underlies and supports the cyclic spring gate 448.
  • Left and right cyclic arms 450, 452 have distal ends mounted on respective ends of a transverse cyclic axle 454 whose central portion passes through a top end 456 of the index arm 355.
  • Left fore and aft cyclic pins 458, 460 extend rightward out of the left cyclic arm 450.
  • Right fore and aft cyclic pins 466, 468 extend leftward out of the right cyclic arm 452.
  • Each cyclic arm 450, 452 includes a respective left and right bottom rack segment 472, 474 close to the distal rotating end positioned to engage a respective spur gear 436, 438 under the downward urging of the laterally wider distal end 446 of the T-shaped hold spring 442.
  • the left cyclic arm 450 is at its distal most position. It should be appreciated that the left aft cyclic pin 460 is distal to the upper pin guide 449. In FIG. 19A, proximal movement of the right cyclic arm 450 presents the rack segment 472 to rotate the left spur gear 436 (not shown in FIG. 19A) top aft, held in engagement by the T-shaped hold down spring 442.
  • Proximal movement of the cyclic arms 450, 452 causes the dual spur gear assembly 420 and thus the small bevel gear 416 to rotate top aft, which in turn causes the large bevel gear 412 and revolver cylindrical drum assembly 386 to rotate top right, indexing the sample vial 384 to the sample retraction tube 363 in the hole 398.
  • the right cyclic arm 450 has reached its proximal most position, wherein the left aft pin 460 has pushed through the cyclic spring gate 448 and out of the lower pin channel 451.
  • the revolver cylindrical drum 380 includes radially spaced longitudinal recesses 476 shaped to receive respective cylindrical vial holders 478 formed in the revolver drum belt 382 that hold the sample vials 384.
  • Each vial holder 478 includes an elongate outward aperture 480 so that contents of the retained vial 384 may be viewed.
  • the revolver drum belt 382 terminates in first and second belt retaining ears 482, 484 that are drawn into longitudinal abutment and inserted into a longitudinal indexing and retention slot 486 formed in the revolver cylindrical drum 380 as the circled revolver drum belt 382 is slid longitudinally onto the revolver cylindrical drum 380.
  • a V-shaped slot 488 of the slotted distal drum axle 400 assures that the angled proximal end 402 of the shaft 404 is in an initial condition with a narrow aspect upward to receive the open side of the V-shaped slot 488, which registers the retaining ears 482, 484 to a known position prior to commencing sampling.
  • FIGS. 23-29 the operation of the reusable handpiece 12 and the hand-held distal portion 21 of the disposable probe assembly 14 are depicted sequentially in diagrammatic form to illustrate how the indexing assembly 19 and revolver drum assembly 18 are operated in conjunction with the taking of vacuum assisted core biopsy samples.
  • FIG. 23-29 the operation of the reusable handpiece 12 and the hand-held distal portion 21 of the disposable probe assembly 14 are depicted sequentially in diagrammatic form to illustrate how the indexing assembly 19 and revolver drum assembly 18 are operated in conjunction with the taking of vacuum assisted core biopsy samples.
  • the hand-held distal portion 21 of the disposable probe assembly 14 has both carriages 134, 136 distally advanced in an initial state for closing the side aperture 20 in the probe cannula 22 for insertion into tissue.
  • the front carriage 134 also advances the cutter carriage-driven vacuum valve driver 313 to its distal position, switching the vacuum valve 307 distally to provide atmospheric pressure to the air valve 351 (i.e., atmosphere in distal port 322 and out center port 320 to left proximal port 334).
  • the aft carriage 136 positions the air valve 351 to shut off the input from the vacuum valve 307, instead causing the air supply conduit 348 to communicate through the left distal port 332 to the left center port 333 to the distal conduit 343 to pressurize the lateral lumen 44.
  • the aft carriage 136 has proximally retracted, switching the air valve 351 so that the atmospheric pressure provided by the vacuum valve 307 now communicates through the left proximal port 334 to the left center port 334 to the distal conduit 343 to the lateral lumen 44, venting the probe cannula 22 to begin a new sample taking cycle.
  • the front carriage 134 has begun to proximally retract while the aft carriage 136 remains at its proximal most position.
  • the cutter tube 36 retracts exposing a portion of the side aperture 20 of the probe cannula 22 while the vacuum and air valves 307, 351 remain in the same state with the probe cannula 22 vented to the atmosphere.
  • the front carriage 134 has reached its proximal most position, fully retracting the cutter tube 36 to expose the side aperture 20 of the probe cannula 22, which is now under vacuum pressure to prolapse tissue by having the front carriage 134 position the vacuum valve 307 to pass vacuum supply from the proximal port 321 through the center port 320 to the left central port 330 to the left distal port 332 to the lateral lumen 44, drawing air through the internal vent holes 47.
  • FIG. 27 the front carriage 134 has begun to distally advance, severing tissue, while the vacuum valve 307 remains switched to vacuum supply and the air valve 351 remains in the state of passing the vacuum pressure through to the lateral lumen 44.
  • FIG. 28 the front carriage 134 has been fully distally advanced, causing the cutter tube 36 to completely sever the prolapsed tissue into a tissue sample and switching the vacuum valve 307 to vent to the atmosphere. With the aft carriage 136 still back, the air valve 351 passes the atmospheric pressure to the lateral lumen 44 to vent the probe cannula 46.
  • FIG. 29 the aft carriage 136 has been distally advanced, switching the air valve 351 to pass air pressure from the left distal port 332 to the left center port 333 to the lateral lumen 44.
  • the increased air pressure passes through the holes 47 to the distal end of the cutter lumen 47 causing the tissue sample to be blown proximally back up the cutter tube 36 out of the distal hand-held portion 21 of the biopsy device 10 into the sample revolver drum assembly 18.
  • the clinicians benefit from being able to visually or diagnostically image the tissue samples while still being able to maintain the probe cannula 22 in tissue to take additional samples, insert therapeutic agents, deposit a marker, etc.
  • a minimum of reinsertions and verifications of position are necessary, yet the clinician is reassured that proper samples are being taken.
  • avoidance of biohazards is provided by encasing the tissue samples for convenient transport for pathology assessment.
  • the individual storage allows correlating a particular sample taken at a specific position in the patient's breast.
  • the apparatus is portable with a minimum of needed interconnections.
  • applications consistent with the present invention may include an uncircled belt that is drawn into a proximal portion of a biopsy device and then indexed to a next sample container with the filled sample containers on the belt moved out.
  • applications consistent with the present invention may include a revolver drum assembly coupled by flexible attachments, such as communicating a flexible drive capable for indexing motion.
  • a detachable belt and detachable sample vials provide clinical flexibility, it should be appreciated that applications consistent with the present invention may include vials or similarly shaped sample containers that are immovably attached to a belt or a rigid outer cylinder wall structure.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Medical Informatics (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Pathology (AREA)
  • Molecular Biology (AREA)
  • Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Sampling And Sample Adjustment (AREA)

Abstract

L’invention concerne un dispositif de biopsie et un procédé pour l’obtention d’un échantillon tissulaire, comme un échantillon pour biopsie de tissu du sein. Le dispositif de biopsie comprend un assemblage de sonde jetable avec une canule externe (22), ayant une pointe de percement distale (26), une lumière de lame, un tube de lame (36), qui tourne et se déplace hors d’une ouverture latérale (20) dans la canule externe pour séparer un échantillon tissulaire. Le dispositif de biopsie comprend également un manche réutilisable, avec un moteur intégré (76) et une source d’énergie pour effectuer un contrôle approprié, libre à utiliser avec une imagerie aux ultrasons. Le manche réutilisable comprend un mode d’oscillation de sonde pour faciliter l’insertion de la pointe distale de percement dans le tissu. Le moteur actionne également un assemblage de tambour de roulement d’échantillon (18) en coordination avec le mouvement du tube de lame pour disposer les échantillons de tissus stockés séquentiellement dans une cartouchière de stockage d’échantillon, qui tourne autour d’un tambour cylindrique de roulement.
PCT/US2008/058627 2008-03-28 2008-03-28 Echantillon tissulaire de dispositif de biopsie à tambour WO2009120206A1 (fr)

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PCT/US2008/058627 WO2009120206A1 (fr) 2008-03-28 2008-03-28 Echantillon tissulaire de dispositif de biopsie à tambour

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Cited By (10)

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WO2014196876A1 (fr) 2013-06-05 2014-12-11 Snpshot Trustee Limited Dispositif de prélèvement de tissus
US10299768B2 (en) 2013-10-18 2019-05-28 Snpshot Trustee Limited Biopsy sampler and sample collector
JP2020518806A (ja) * 2017-05-03 2020-06-25 ホロジック, インコーポレイテッドHologic, Inc. 生検システム撮像品質を改善するために組織取り扱い装置の撮像フィールド内の流体を低減させるデバイス
US11317881B2 (en) 2017-09-11 2022-05-03 Faxitron Bioptics, Llc Imaging system with adaptive object magnification
CN114451934A (zh) * 2022-03-03 2022-05-10 张高高 一种肿瘤内科临床用活检取样装置
US11358149B2 (en) 2014-03-05 2022-06-14 Faxitron Bioptics, Llc System and method for multi-axis imaging of specimens
US11566981B2 (en) 2015-09-04 2023-01-31 Faxitron Bioptics, Llc Multi-axis specimen imaging device with embedded orientation markers
US11730434B2 (en) 2016-11-04 2023-08-22 Hologic, Inc. Specimen radiography system comprising cabinet and a specimen drawer positionable by a controller in the cabinet
CN116968119A (zh) * 2023-09-20 2023-10-31 山东冠达医药科技有限公司 一种片纸连续化分切装置
EP4278984A3 (fr) * 2018-07-31 2024-01-17 Devicor Medical Products, Inc. Dispositif de biopsie à aiguille centrale pour collecter de multiples échantillons en une seule insertion

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WO2007112751A2 (fr) * 2006-03-31 2007-10-11 Sonion Roskilde A/S Système de prélèvement d'échantillon de tissu avec inspection visuelle de l'échantillon

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US20070239067A1 (en) * 2005-08-05 2007-10-11 Hibner John A Tissue Sample Revolver Drum Biopsy Device
WO2007021904A2 (fr) * 2005-08-10 2007-02-22 C.R. Bard Inc. Dispositif de biopsie a echantillonnage multiple et introduction unique compatible avec divers systemes de transport et marqueurs integres
WO2007112751A2 (fr) * 2006-03-31 2007-10-11 Sonion Roskilde A/S Système de prélèvement d'échantillon de tissu avec inspection visuelle de l'échantillon

Cited By (19)

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Publication number Priority date Publication date Assignee Title
EP3004834A4 (fr) * 2013-06-05 2017-01-04 Snpshot Trustee Limited Dispositif de prélèvement de tissus
AU2014275573B2 (en) * 2013-06-05 2018-05-17 Snpshot Trustee Limited Tissue sampler
US10667797B2 (en) 2013-06-05 2020-06-02 Snpshot Trustee Limited Tissue sampling
WO2014196876A1 (fr) 2013-06-05 2014-12-11 Snpshot Trustee Limited Dispositif de prélèvement de tissus
US10299768B2 (en) 2013-10-18 2019-05-28 Snpshot Trustee Limited Biopsy sampler and sample collector
US10646207B2 (en) 2013-10-18 2020-05-12 Snpshot Trustee Limited Biopsy sample storage container and related sampler
US10842471B2 (en) 2013-10-18 2020-11-24 Snpshot Trustee Limited Biopsy collector with identifier
US11358149B2 (en) 2014-03-05 2022-06-14 Faxitron Bioptics, Llc System and method for multi-axis imaging of specimens
US11566981B2 (en) 2015-09-04 2023-01-31 Faxitron Bioptics, Llc Multi-axis specimen imaging device with embedded orientation markers
US11730434B2 (en) 2016-11-04 2023-08-22 Hologic, Inc. Specimen radiography system comprising cabinet and a specimen drawer positionable by a controller in the cabinet
JP7204669B2 (ja) 2017-05-03 2023-01-16 ホロジック， インコーポレイテッド 生検システム撮像品質を改善するために組織取り扱い装置の撮像フィールド内の流体を低減させるデバイス
JP2020518806A (ja) * 2017-05-03 2020-06-25 ホロジック, インコーポレイテッドHologic, Inc. 生検システム撮像品質を改善するために組織取り扱い装置の撮像フィールド内の流体を低減させるデバイス
US11317881B2 (en) 2017-09-11 2022-05-03 Faxitron Bioptics, Llc Imaging system with adaptive object magnification
US11877877B2 (en) 2017-09-11 2024-01-23 Faxitron Bioptics, Llc Imaging system with adaptive object magnification
EP4278984A3 (fr) * 2018-07-31 2024-01-17 Devicor Medical Products, Inc. Dispositif de biopsie à aiguille centrale pour collecter de multiples échantillons en une seule insertion
CN114451934A (zh) * 2022-03-03 2022-05-10 张高高 一种肿瘤内科临床用活检取样装置
CN114451934B (zh) * 2022-03-03 2023-06-27 张高高 一种肿瘤内科临床用活检取样装置
CN116968119A (zh) * 2023-09-20 2023-10-31 山东冠达医药科技有限公司 一种片纸连续化分切装置
CN116968119B (zh) * 2023-09-20 2023-12-05 山东冠达医药科技有限公司 一种片纸连续化分切装置

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