WO2014018447A1

WO2014018447A1 - Surgical instrument that, in real time, is adjustably bendable

Info

Publication number: WO2014018447A1
Application number: PCT/US2013/051489
Authority: WO
Inventors: Daniel L. Mccombs; David S. Goldenberg
Original assignee: Stryker Corporation
Priority date: 2012-07-24
Filing date: 2013-07-22
Publication date: 2014-01-30

Abstract

A surgical instrument with an outer tube, an inner tube and a head adjacent the distal ends of the tubes. One of the tubes is formed with a bent section that is flexible. The other tube is formed with a section that is at least flexible. The tubes can be moved relative to each other to place the flexible section in and out of registration with the bent section. When the two sections are in registration, the instrument is the bent state. When the two sections are not in registration the instrument is in the unbent state.

Description

SURGICAL INSTRUMENT THAT,

IN REAL TIME, IS ADJUSTABLY BENDABLE

Field Of The Invention

[0001] This invention relates generally to surgical instruments. More specifically, this invention is related to a surgical instrument that, during the procedure in which the instrument is used, can be selectively angled, bent, to facilitate positioning of the instrument.

Background Of The Invention

[0002] The ability to perform surgery has greatly

improved over the years by the development of rotary cutting instruments, sometimes referred to as a cutting accessory. Generally a cutting instrument includes a shaft to which a cutting head is mounted. One such head is a drill head. A drill head typically includes a pointed tip from which cutting flutes extend helically outwardly. A drill is used to form a bore in the tissue, typically bone, to which the drill is applied. A second common type of cutting head is a bur head. A bur head often includes cutting flutes that project outwardly from the rotating shaft. A bur is applied to tissue to remove tissue that is often located to the side of the rotational axis of the bur head. A third common type of cutting head is a shaver. A shaver includes an inner shaft that is hollow. An outer shaft extends over the inner shaft. The inner shaft has a head with blade edges that define an opening into the inner shaft. The outer shaft is provided with a complementary head. The head of the outer shaft has an opening with blade edges. The rotation of the inner shaft relative to the outer shaft causes the shafts blade edges to function a scissors. These scissors cut tissue, typically soft tissue. A suction pump draws the tissue through the hollow of the inner shaft.

[0003] Still other surgical instruments have shafts that are moved longitudinally. Clamps are a form of instrument that have these shafts. Clamps, it should be understood are manually operated surgical instruments.

[0004] Many powered surgical instruments are designed for rotation by a powered handpiece. The handpiece includes a motor that rotates the shaft. A coupling assembly integral with the handpiece facilitates the releasable coupling of the instrument shaft to the output shaft of the motor.

[0005] Many surgical instruments, both manually operated and powered, have longitudinal axes that are straight.

While this type of instrument is useful, it has a

limitation. If the tissue to which the instrument is applied cannot be accessed along a linear path of travel from a location outside the patient, it can be difficult to apply the cutting head to the tissue. This makes the instrument unusable for application to tissue that can only be accessed by going through an angled path. One such tissue is sinus tissue that may be located adjacent a sinus cavity that is offset from the nasal opening.

[0006] To provide a solution to this problem, some surgical instruments are bendable. These instruments often include an outer tube. This tube is bendable. A flexible rotating or reciprocating shaft is disposed in the outer tube. To use this instrument, the practitioner initially determines the geometry of the access path to the location to which the cutting head of the instrument is to be

applied. Here access path geometry is understood to mean the length of the sections of the path as well as the angle of the adjacent path sections to each other. The

practitioner bends the outer tube so it has one or more sections that approximate the geometry of the access path. Once the tube is bent, the practitioner advances the tube down the access path to the location at which the cutting head is to be applied.

[0007] Surgical instruments with prebent shafts can be applied to tissue that cannot be accessed by straight cutting accessories. One limitation of this type of accessory is that owing to its bent shape, it can be

difficult to insert the instrument through the passageway that leads to the tissue to which the cutting head is applied .

[0008] Accordingly, there is an interest in providing surgical instruments that are bendable in real time as the accessory is advanced through the patient to the target tissue. It is proposed, for example, to provide an

instrument with one or more steering cables. This type of instrument has a bendable tube to which the steering cables are attached. The selective tensioning and relaxing of the steering cables causes the selective bending of the tube. This type of instrument, in theory, makes it possible to provide a real time adjustment of the bends of a surgical cutting instrument as the instrument is advanced through the patient. A disadvantage of this instrument is that it has proven both difficult and expensive to make all the

components required to form this assembly, the rotating shaft, the outer shaft and steering cables, compact enough that the accessory can fit through the access passage that is relatively small in diameter, typically 1 cm or less.

Summary Of The Invention

[0009] This invention is related to a new and useful surgical instrument, sometimes called a surgical tool or a cutting accessory. Many versions of this invention have a rotating shaft to which a cutting head is attached. The instrument of this invention, while formed from relatively few components is bendable in real time, that is, while the instrument is being advanced through a passageway in a patient to the tissue to which the instrument is to be applied .

[00010] The instrument of this invention includes inner and outer elongated components. The outer component

surrounds the inner component. Often each component has a section that is both flexible and shaped to define a bend. In some versions of the invention, a flexible actuating shaft is disposed in the inner component. The flexible section of the outer component surrounds the flexible section of the inner component. One component is moveable relative to the other component. Often one component is static while the other tube able to rotate relative to the static component.

[00011] As a result of the ability to position the inner and outer components relative to each other, the components can be positioned between a position in which the so that the bends are essentially in registration, overlap, to a position in which the bends are essentially completely out of registration, symmetric relative to an axis extending through both components. When the bent sections are in registration, the instrument has the bend formed by the bent sections. As a consequence of the movement of the

adjustably positionable component away from the in

registration state, the resistive forces of the sections of the components distal to the bent sections work against each other. Owing to the flexible nature of the material from which the bent sections are formed, the forces these

component distal sections impose on each other bend bent sections. This causes the component distal sections to align with the component sections located proximal to the bent sections. When component bent sections are so aligned, the inner and outer components are unbent. In many but not all constructions of the invention, when the inner and outer components are completely unbent they are substantially straight. This means that the sections of the instrument on either side of the unbent instrument are essentially

collinear .

[00012] Thus an instrument of this invention can initially be inserted in an access passageway in a straight shape. Once the bent portions of the components forming the

accessory reach a bend in the passageway, one of the

components can be rotated or otherwise moved so as to bring the bends into registration. This component movement causes the bend to form in the instrument. The practitioner selectively positions one of the inner or outer elongated components to set the magnitude of the bend.

[00013] In some versions of the invention, one both of the flexible components are formed from metal. One such metal from which the tubes can be formed is a nickel titanium alloy known as Nitinol.

[00014] In some versions of the invention the actuating shaft internal to the inner elongated component rotates. This is the case if the cutting accessory has a rotating head. In these versions of the invention the cutting accessory is often configured to be attached to a powered surgical handpiece with a motor. In some versions of the invention the actuating shaft is moved longitudinally. This is the case if the cutting accessory is some form of

scissors or forceps, or saw. If the cutting accessory is manually actuated, such as scissors or a forceps, the cutting accessory extends forward from finger grips. If the cutting accessory is a powered reciprocating saw, the cutting accessory extends forward from a powered surgical handpiece able to reciprocate the actuating shaft.

[00015] Other constructions of the instrument of this invention have inner components that are solid. Some constructions of this instrument are constructed so as to form plural bends. Other constructions of this instrument have distal end features that make it possible to employ the instrument of this invention to perform other than a medical procedure on tissue or a medical diagnostic procedure.

[00016] In still other versions of the invention, one of the inner or outer elongated component moves translationally relative to the other of the outer or inner component. The elongated components are designed so that at least one has a flexible section that is formed with a bend section and the other component has at least one rigid section and at least one flexible section. As a result of the translational movement of the one elongated component the plural section component can be positioned so the rigid section is in registration with the bent section of the other component. The rigid section constrains the bending of the bent

section. The instrument will thus have a straight shape. When it is desired to bend the instrument, the plural section component is positioned so the flexible section of the component goes into registration with the bent section of the other component. The relative positioning of the elongated components results in the bending of the

instrument .

Brief Description Of The Drawings

[00017] The invention is pointed out with particularity in the claims. The above and further features and benefits of this invention are understood from the following Detailed Description taken in conjunction with the accompanying drawings in which:

[00018] Figure 1 is a side view of a surgical instrument of this invention attached to powered handpiece when the instrument is in the unbent state;

[00019] Figure 2 is a cross sectional view of the instrument ;

[00020] Figure 3 is a side view of the inner tube of the instrument ;

[00021] Figure 4 is a side view of the outer tube of the instrument ;

[00022] Figure 5 is a side view of the instrument of

Figure 1 when the instrument is in the bent state; and

Figure 5 is a side and partial cross sectional view of an alternative instrument of this invention.

[00023] Figure 6A is a plan view of an alternative surgical instrument of this invention;

[00024] Figures 6B, 6C and 6D are plan views of, respectively, the outer, middle and inner tubes of the instrument of Figure 6A;

[00025] Figure 6E is a plan view of the instrument of Figure 6A bent to have a single bend in the middle of the tube ;

[00026] Figure 6F is a plan view of the instrument of Figure 6A bent to have a single bend located towards the distal end of the instrument;

[00027] Figure 6G is a plan view of the instrument of Figure 6A bent to have two bends;

[00028] Figure 7 is a side plan and partial cross sectional view of a second alternative surgical instrument of this invention;

[00029] Figure 8 is a plan view of a third alternative surgical instrument of this invention. [00030] Figure 9 is a cross sectional view of the outer elongated component, the outer tube of the instrument of Figure 8 ;

[00031] Figure 10 is a cross sectional view of the inner elongated component of the instrument of Figure 8 ;

[00032] Figure 11 is a cross sectional view of the inner and outer elongated members of the instrument of Figure 8 when the instrument is in the straight state; and

[00033] Figure 12 is a cross sectional view of the inner and outer elongated member of the instrument of Figure 8 when the instrument is in the bent state.

Detailed Description

[00034] Figure 1 depicts a surgical instrument 30 of this invention attached to a powered handpiece 40. Internal to the handpiece 40 is a motor 42 (shown as dashed rectangle.) A shaft 44 with coupling features (collectively shown as a dashed line unit.) extends from the motor 42. A coupling assembly, represented by ring 46, releasably holds the instrument 30 to the handpiece 40. A cable 48 is shown connected to the handpiece 40. The cable 48 supplies the power, electrical, hydraulic or pneumatic, necessary to power the motor 42. When instrument 30 is connected to handpiece 40, a shaft 58 integral with the instrument, seen in Figure 2, engages the handpiece shaft 44. The actuation of the motor 42 results in the rotation of the handpiece shaft 44. Instrument shaft 58 consequently rotates in unison with the handpiece shaft 44.

[00035] The structures of handpiece 40, motor 44 and the one or more coupling assemblies integral with the handpiece are understood to not be part of the present invention.

[00036] As seen in Figure 2, instrument 30 includes shaft 58. Shaft 58 is disposed in and is able to move within an inner tube 68. Inner tube 68 is disposed inside an outer tube 82. When the instrument 30 of this invention is attached to a motorized surgical handpiece, the

instrument is sometimes referred to as a cutter or a cutting accessory .

[00037] Shaft 58 in addition to being moveable, is

flexible. In some versions of the invention, the shaft is formed from a thin cylinder of metal such as a nickel titanium alloy (Nitinol) or instrument steel. In these versions of the invention, the shaft has an outer diameter of approximately 1 mm. Alternative, if the shaft, in addition to being flexible, is designed to rotate, the shaft may be in the form of a helical spring.

[00038] A hub 54 is attached to the proximal end of the shaft 58. (Here "proximal" is understood to mean towards the practitioner holding the handpiece 40; away from the instrument. "Distal" is understood to mean away from the practitioner, towards the site to which the instrument 30 is applied.) Shaft hub 54 is formed with features that

facilitate the releasable engagement of the shaft hub to the handpiece shaft 44 so the two shafts will rotate in unison. In Figure 2, these features are represented as the

notches 56. In many versions of the invention, shaft hub 54 is formed from plastic.

[00039] A tissue working member 60 is attached to the distal end of instrument shaft 58. The tissue working member is the component of the instrument that is applied to the patient to accomplish a specific medical or surgical task. In the Figures, the tissue working member 60 is shown as a sphere. This is to represent that the tissue working member 60 may be a bur head. It should be recognized that instruments of this invention are not just limited to burs. If the instrument is device with a shaft 58 that rotates, the tissue working member could be a drill bit or part of a shaver .

[00040] The inner tube 68, now described by reference to Figures 2 and 3, is formed from material that is flexible. In one version of the invention, inner tube 64 is formed from a flexible metal, specifically a nickel titanium alloy known as Nitinol. A hub 64 is attached to the proximal end of tube 68. Inner tube hub 64 is typically formed from a rigid plastic. The inner tube hub 64 is formed with

features that cooperate with the handpiece coupling assembly so that the handpiece coupling assembly is able to

releasably hold the inner tube 60 to the handpiece 40. In the Figures these features are represented by a notch 66 formed in the hub. The exact structure of these features is not part of the present invention.

[00041] Inner tube 68, in addition to being flexible, is formed to have a bend 74. Bend 74 is an intermediate portion of the tube 68 that separates the tube into a proximal section 72, the portion of the tube closest to the hub 64 and a distal section 76, the distal portion of the tube 68. Owing to the present of bend 74 it should be understood that, in the absence of other forces, the

longitudinal axes of the proximal section 72 and distal section 76 are angularly offset from each other.

[00042] The inner tube 68 is further formed to have around the most distal end of the distal section 78 a lip 80. Lip 80 extends radially outwardly and circumferentially around the body of the tube 68.

[00043] Not identified is the lumen that extends axially through the inner tube 68. Collectively, instrument

shaft 58 and the inner tube 68 lumen are formed so that the shaft 58 can rotate, with a minimal amount of wobble within the lumen. The inner tube hub 64 is formed with a bore, also not identified, that extends coaxially proximally rearward from the proximal end of the shaft lumen. Shaft 58 extends through both the hub bore and the tube lumen. The shaft hub 54 is located proximal to inner tube hub 64.

[00044] Outer tube 82, now described by reference to

Figures 2 and 4, is like inner tube 68, formed out of material that is flexible. Often tubes 68 and 82 are formed from the same material. In versions of the invention designed for sinus surgery, outer tube 82 may have a maximum diameter of 8 mm and more often a maximum diameter of 5 mm. The outer tube 82 is formed with an axially extending lumen, not identified. Collectively, the tubes 68 and 82 are formed so the one tube can rotate relative to the other tube with a tolerable amount of wobble of the inner tube 68 within the outer tube 82.

[00045] Outer tube 82 is formed to have a bend 86.

Bend 86 has the same angle as inner tube bend 74. The outer tube is formed so that, when inner tube 68 is seated in the outer tube 82, the outer tube bend 86 is located at the same position along the length of the instrument 30 as inner tube bend 74. Bend 86 separates the outer tube into proximal and distal sections 85 and 87, respectively. In the absence of other forces, the outer tube proximal and distal sections 85 and 87 are axially offset from each other.

[00046] A knob 81 is mounted to the proximal end of the outer tube. Knob 81 is disc-like in shape. The knob 81 may be made from material different from which the outer tube 82 is formed. For example, knob 81 may be formed from a rigid plastic or a rigid metal. In the version of the invention depicted in Figure 2, the proximal end of the outer tube 82 is mounted to the distally directed face of the knob 81. Knob 81 is formed with a center bore, not identified, through which instrument shaft 58 and the inner tube 68 extend.

[00047] Instrument 30 can be assembled by initially fabricating shaft 58, inner tube 68 and outer tube 82.

Tissue working member 60 is attached to the distal end of shaft 58. Knob 81 is attached to the proximal end of the outer tube 82. Shaft 58 is fit in the lumen of the inner tube 68. The shaft 58 and inner tube 68 are fit in the lumen of the outer tube 82. The proximal movement of the inner tube 68 is limited by the tube lip 80 abutment against the distally directed face of the outer tube 82. Inner tube hub 64 is then secured to the exposed proximal end of the inner tube 68. Hub 54 is then secured to instrument

shaft 58. The means by which hub 54, hub 64 and knob 81 attached the components with which they are integral is not part of the present invention.

[00048] Instrument 30 is prepared for use by coupling the instrument to handpiece 40. As a result of this process, instrument hub 54 engages handpiece shaft 44. The

instrument coupling assembly releasably holds the inner tube hub 64 to the handpiece 40. It should be appreciated that the inner tube proximal section 72 and outer tube proximal section 85 are coaxial.

[00049] Once instrument 30 is attached to the

handpiece 40, the bend of the instrument can be selectively set. The bend is selectively set by using knob 81 to rotate the outer tube 82 relative to the inner tube. Often, the practitioner initially sets the instrument so it is

straight. Instrument 30 is so set by rotating the outer tube so the, relative to the common longitudinal axis of the tube proximal sections 72 and 85, the tube bends 74 and 86 are symmetric around a common longitudinal axis that extends through the tube proximal sections 72 and 85. When the tubes 68 and 82 are so positioned, the tube bends 74 and 86 are considered to be completely out of registration, As a result of the tubes 68 and 78 being so positioned, each tube distal section 74 and 87 places a side loading force on the opposed tube distal section 87 and 74. These forces bend the tube distal sections 74 and 87 so they are essentially axially aligned with the tube proximal sections 72 and 85. Instrument 30 thus assumes the linear shape as depicted in Figure 1.

[00050] The passageway through the patient to which the tissue working member is to be applied may not be straight. To advance the instrument 30, it may be necessary to bend the instrument. To accomplish this action, the outer tube 82 is rotated relative to the inner tube 68. The practitioner rotates the outer tube 82 by rotating knob 81. As a result of this rotation from when the instrument is in the unbent state, the outer tube moves towards a position in which, the outer tube proximal section 87, if not subjected to a side load force would be in registration with the inner tube distal section 76. This rotation of outer tube 82 reduces the side loading forces the tube distal sections 76 and 87 place on each other. The tube distal sections 76 and 87 start to bend relative to the tube straight sections 72 and 85.

[00051] Outer tube 82 can be rotated so the outer tube bend 86 goes into complete registration with inner tube bend 74. Bend "registration" is understood to mean that if the tubes were laid one on top of the other, the tube proximal sections 72 and 85 would overlap and the tube distal sections 76 and 87 would also overlap. When

instrument 30 is in this state, the tube distal sections 76 and 87 do not impose side loading forces on each other. When instrument 30 is in this state, the instrument is in a fully bent state, has a bend 36, seen in Figure 5.

[00052] Given that shaft 58 is flexible, it should be understood that the bending and unbending of the shaft does not affect the transmission of the mechanical energy from the proximal end of the shaft to the tissue working

member 60.

[00053] Instrument 30 of this invention can thus, as it is advanced to the site to which the instrument is to be applied, bend. This makes it possible to advance the tissue working member to the site to which it is to be applied through a non-linear passageway. Another feature of this invention is that, while the instrument can be bent in real time, the bending is not performed by tensioning steering cables. Thus, the instrument of this invention, while bendable, does not include steering cables and the added complexity and expense the presence of these cables and their associated components can add to an instrument.

[00054] It should be appreciated that the extent to which the instrument is bent can be selectively set. Thus, by the selective rotation of the outer tube relative to the inner tube the instrument can be set to have a bend of an

intermediate angle from the straight state of Figure 1 to the fully bent state of Figure 5.

[00055] Instrument 30 can be advanced through passageways not appreciably larger in size than the diameter of the outer tube. Given that the outer tube may have a diameter of 6 mm or less, this means that the instrument can be advanced through small passageways such as sinus passages or the spinal foramen or portals formed using arthroscopic and endoscopic instruments.

[00056] A further feature of instrument 30 is that when the instrument bends, while the inner radii of the inner and outer tubes 68 and 82, respectively, shorten, the outer radii of these tubes lengthen. The mid line radii of the tubes 68 and 82, which overlap therefore does not length either relative to each other or to their lengths in

comparison to when these sections of the tube are straight. Consequently, the bending of the instrument does not result in the exposing of more of shaft 58 in comparison to when the instrument is the straight shape. This exposure, if allowed to occur, could increase the likelihood that tissue that to which the instrument is not be applied is

unintentionally placed in contact with the rotating shaft.

[00057] It should also be understood that when

instrument 30 is straight, there is a small clearance between the inner tube lip 80 and the distally directed face of the outer tube 82. This clearance closes when, as a consequence of the bending of the inner radius portion of the outer tube 82 projects forward of the underlying inner radius portion of the inner tube 68.

[00058] Figure 6A is a plan view of an alternative

instrument 120 of this invention. Instrument 120 is

attached to handpiece 40. While not fully illustrated, instrument 120 includes the shaft hub 54, the inner shaft 58 and the tissue working member 60 of instrument 30.

[00059] Instrument 120 includes an outer tube 130 now described by reference to Figure 6B . A knob 128 is attached to the proximal end of the outer tube 130. Outer tube 130 is shaped to have a proximal section 132, a middle

section 136 and a distal section 140. A proximal bend 134 forms an angular separation between the longitudinal axes of the proximal section 132 and the middle section 136. A distal bend 138 forms an angular separation between the longitudinal axes of the middle section 136 and distal section 140. Not illustrated is a lumen that extends through both knob 128 and outer tube 130.

[00060] Instrument 120 includes a middle tube 146 seen in Figure 6C. A knob 142 is attached to the proximal end of the middle tube 146. In the depicted version of the invention knob 142 is larger in diameter than knob 128.

Middle tube 146 is designed to slip fit and rotate within the lumen of outer tube 130. The middle tube 146 has a proximal section 148 and a distal section 152. A bend 150 forms an angular separation between the longitudinal axes of tube sections 148 and 152. The middle tube 146 is further formed so that so that when the tube 146 is seated in the outer tube 130, the outer tube proximal bend 134 extends over the middle tube bend 150.

[00061] While not illustrated, tube knobs 128 and 142 are often provided with complementary components that facilitate the selectively simultaneous rotation of the knobs. These components can take the form of providing one of the

knobs 128 or 142 with a retractable pin and the other knob 142 or 128 with one or more openings for receiving the pin.

[00062] An inner tube, tube 158 seen in Figure 6D, is disposed in the lumen of the middle tube 146, (middle tube lumen not illustrated) . A hub 156 is attached to the proximal end of inner tube 158. Hub 158 performs the same functions as hub 64 of the first embodiment of the

invention. Inner tube 158 is formed to have bend 162.

Bend 162 separates the inner tube 152 into a proximal section 160 and a distal section 164. The bend 162 forms an angular separation between the longitudinal axes of tube sections 160 and 164. Inner tube 158 is further formed so that so that when instrument 120 is assembled, the outer tube distal bend 138 extends over the inner tube bend 162. A lip 168 projects radially outwardly from the most distal end of inner tube distal section 164. A lumen (not

illustrated, ) extends from the proximal end of the inner tube 58 to the distal end of the tube. This lumen is coaxial with a bore, (not illustrated, ) that extends through hub 156.

[00063] Tubes 130, 146 and 158 are formed from the

flexible material. This can be the same material from which tubes 68 and 82 are formed.

[00064] Instrument shaft 58 extends through the lumen of the inner tube 158. Hub 54 is located proximal to inner tube hub 156. Tissue working member 60 is located forward of tube lip 168.

[00065] When instrument 120 is attached to handpiece 40, hub 54 is releasably coupled to motor shaft 44. The

engagement of the inner tube hub 156 with the handpiece coupling assembly releasably holds the instrument to the handpiece 40. Lip 168 prevents the outer tube 130 and middle tube 146 from being sliding away from the rest of the instrument 120.

[00066] Instrument 120 is selectively bent by rotating tubes 130, 146 and 158 relative to each other. The

instrument can be bent to have a straight shape. The instrument is so bent by rotating the tubes so that (1) relative to the common longitudinal axis of the outer tube proximal section 132 and the middle tube proximal

section 148, the outer tube proximal bend 134 and the middle tube bend 150 are diametrically opposed to each other, completely out of registration; and (2) relative to the common longitudinal axis to the outer tube middle section 136 and the inner tube proximal section 158, the outer tube distal bend 138 and the inner tube bend 160 are

diametrically opposed to each other. As a result of this orienting of the tubes, the opposed side loads the outer tube middle section 136 and the middle tube distal section 154 place on each other bend the tubes 130 and 146, so the outer tube middle section 136 aligns with the outer tube proximal section 132. Simultaneously, the side loads the outer tube proximal distal section 140 and the inner tube distal section 164 place on each other bend these sections so that the outer tube distal section 140 goes into axial alignment with the adjacent outer tube middle

section 136. Instrument 120 thus has the straight shape depicted in Figure 6A.

[00067] Knobs 128 and 142 are selectively rotated to, while the instrument 120 is being advanced towards the site to which the instrument is to be applied, selectively bend the instrument. The instrument can be bent to have a single bend 122 located towards the middle of the instrument as depicted in Figure 6D. Instrument 120 is so bent by

rotating knob 142 while simultaneously holding knob 128. When the instrument is so bent, the locking mechanism that facilitates the simultaneous rotation of knobs 128 and 142 is in the released state. In other words, middle tube 146 is rotated while outer tube 130 and inner tube 158 are held static. This results in the middle tube bend 150 rotating into registration with the outer tube proximal bend 134. The side loading forces the outer tube middle section 136 and middle tube distal section 152 impose one each other decrease. The instrument therefore develops the bend 122 as depicted in Figure 6D.

[00068] During the above described rotation of the middle tube 146, the rotational positions of the outer and inner tubes 130 and 158, respectively, relative to each remains constant. Tube bends 138 and 162 remain diametrically opposed, completely out of registration, with each other. This is why the instrument does not also develop a distally located bend.

[00069] Alternatively, instrument 120 can be bent so that there is a single bend located towards the distal end of the instrument. Instrument 132 is so bent by simultaneously rotating knobs 128 and 142. To facilitate this rotation of the knobs 128 and 142 the look assembly that holds the knobs together for simultaneous rotation is engaged. The

simultaneous rotation of knobs 128 and 142 result in the rotation of outer tube 130 relative to inner tube 158. This rotation brings outer tube distal bend 138 into registration with the inner tube bend 162. Instrument 120 therefore develops a distal end bend 124 as depicted in Figure 6E .

[00070] During the above described rotation of the outer tube 130, middle tube 146 rotates with the outer tube 130. Tube bends 134 and 150 remain completely out of registration with each other. This is why the instrument 120 does not develop a middle-located bend.

[00071] If required by the procedure, instrument 120 can be set to have two bends, bends 122 and 124. This is accomplished by first rotating the middle tube 146 while holding the outer tube static 130 so the instrument develops the above-described middle-located bend. Then, the outer and middle tubes 130 and 146 are rotated together so the instrument develops the above described proximal located bend 124. Instrument 120 thus has two bends as depicted in Figure 6F.

[00072] Figure 7 depicts a second alternative

instrument 180 of this invention. Instrument 180 is a clamp, a manually operated medical/surgical instrument.

Instrument 180 includes first and second finger grips 182 and 184, respectively. The first finger grip 182 is pivotally attached to the second finger grip 184 at the top of the grips.

[00073] A flexible inner tube 190 extends forward from the second finer grip 184. Inner tube 190 is similar in basic construction to inner tube 68 of instrument 30. A

difference between tubes 68 and 190 is that a jaw 192 extends forward from inner tube 190. Jaw 192 may be formed from material different from which tube 190 is formed. For example, jaw 192 may be formed from stainless steel. In one versions of the invention, jaw 192 is generally in the form semi-circular in cross sectional shape and further formed to have a closed distal end. Jaw 192 is formed with teeth 194.

[00074] An outer tube 204 is rotatably disposed over inner tube 190. The outer tube is generally the same as outer tube 82 of instrument 30. A knob 202 is attached to the proximal end of the outer tube 204.

[00075] While not illustrated it should be understood that tubes 190 and 204 are each formed with a bend.

Instrument 180 is constructed so the bend integral with the inner tube 190 is disposed within the bend integral with outer tube 204.

[00076] A lower jaw 220 is pivotally mounted to upper jaw 192. Shown in phantom is a tab 219 that extends from the lower jaw into upper jaw 192. The pivot pin that extends through the upper jaw and the lower jaw tab is not illustrated. Jaw 220 is similar in basic shape to the upper jaw. The lower jaw 220 is formed with teeth 224 similar to the teeth 194 of the upper jaw.

[00077] The open/closed state of the jaws 192 and 220 is set by a flexible drive shaft 208. Drive shaft 208 extends through extends the lumen integral with the inner tube 190 (lumen not identified). Shaft 208, while flexible, resists compression. A proximal end of shaft 208 is pivotally attached to first finger grip 182. The distal end of drive shaft 208 is attached to a pin (not illustrated) internal to the lower jaw 220 that is laterally spaced from the axis along which the jaws are connected together.

[00078] Instrument 180 thus represents a manually operated surgical instrument of this invention. A manually operated surgical instrument is sometimes referred to as a surgical instrument. Lower jaw 220 is pivoted relative to the upper jaw 192 by the pivoting of the finger grips 182 and 184 towards and away from each other. The pivoting of the finger grips results in the longitudinal displacement of shaft 208 within the lumen of inner tube 190. The

displacement of the shaft 208 pivots the lower jaw 192 towards and away from the upper jaw 220.

[00079] By the selective rotation of the outer tube 204 relative to the inner tube 190, the bends integral with the tubes can be placed in and out of registration with each other. When the bends are completely out of registration, symmetric around the common axis through the proximal sections of the tubes, the instrument is straight as is depicted in Figure 7. Should it be desirable to bend the instrument, the outer tube 204 is rotated so the bend integral with the tube goes out of registration with the bend integral with inner tube 190. This results in the real time bending of instrument 120. The distal end of

instrument 120 can thus have the bent shape of the distal end of instrument 30 as depicted in Figure 5.

[00080] Figure 8 depicts a third alternative surgical instrument 230 of this invention. Instrument 230 is a monopolar electrosurgical instrument. The instrument 230 has a handle 236. One elongated component that extends forward from handle 236 is an outer tube 238. A conductive tip or electrode 248 extends forward from the distal end of outer tube 238. Some form of electrical energy or RF energy is emitted from electrode 248 to the tissue against which the electrode is applied. Electrode 248 is thus the tissue working member of instrument 230, the component of the instrument that is applied to tissue to perform a medical or surgical task. Current is sourced to electrode 238 through a power cable 228 that extends to the proximal end of the handle 236.

[00081] Handle 236 is formed from a non-conductive

material such as plastic. A switch 239 attached to the handle is manually set by the practitioner in order to regulate the application of a power signal to the

electrode 248. The operation of switch 239 is not part of this invention. Also not part of this invention and not shown is a ground pad. Since instrument 230 is a monopolar electrode, the ground pad functions as the return electrode to the console to which the instrument is connected. The console is not shown and not part of this invention.

[00082] Handle 236 is formed to define an elongated slot 237 that extends longitudinally through at least a portion of the handle.

[00083] From Figure 9 and 11 it can be seen that the outer tube 238 is formed from a number of different sections.

Tube 238 has a proximal section 242. The proximal

section 242 is tube like in structure and is formed from a rigid material, such as an unyielding plastic or metal.

Tube 238 has a distal section 246 that is spaced distally forward and away from proximal section 242. Distal

section 246, like proximal section 242 is formed from an unyielding structure. An elbow 244 connects tube distal section 246 to proximal section 242. Elbow 244 is formed from flexible material that is prebent to form an angle. Elbow 244 can be formed from the same material from which tubes 68 and 72 of instrument 30 are formed. Tube proximal section 242, elbow 244 and distal section 246 are each formed with an axially extending center bore, (bores not identified) . These bores are coaxial and collectively define the lumen of outer tube 238.

[00084] Electrode 248 is a solid member that extends forward from the distal end of tube distal section 246. The electrode is formed from conductive material. While not illustrated, in many versions of the invention an

electrically insulating sleeve or electrically insulating coating is disposed over the exposed surfaces of the

components forming the outer tube 238 that extend proximally from the electrode 248.

[00085] Instrument 230 includes an inner elongated

component, rod 256, seen in Figures 10 and 11, that is slidably disposed in tube 238. Rod 256 includes a proximal section 258, an elbow 260 and a distal section 262.

Proximal section 256 and distal section 262 are both formed from as unyielding components. Sections 256 and 262 may be formed from the same material from which sections 242 and 246 of tube 238 are formed. Proximal section 256 is formed with a tab 257. Distal section 262 has a length that is at least as long if not longer than the length of tube elbow 244 when the tube elbow is bent straight.

[00086] Elbow 260 integral with rod 256 is formed from the same flexible material from which tube elbow 244 is formed. Rod elbow 260 is typically bent to have the same arc the tube elbow 244. Not illustrated is an electrically

insulting sleeve that may be disposed over any one or all of tube proximal section 258, elbow 260 and distal section 262.

[00087] While not illustrated, a bore extends through the proximal section 258, elbow 260 and distal section 262 of rod 256. An insulated conductor 268, a portion of which is seen in Figure 11, extends from handle 236, through the rod bore to the instrument electrode 248. Conductor 268 is the component over which current is sourced to/sunk from

electrode 248.

[00088] When instrument 230 of this invention is

assembled, rod 256 is slidably disposed in the lumen of tube 238. Rod tab 257 extends through handle slot 237. A finger pad 270 mounted to the tab 257 above the handle facilitates the longitudinal movement of the tab and, by extension the rod 256.

[00089] Instrument 230 of this invention can set so the outer tube 238 and rod 256 are straight as is depicted in Figure 8. To so set instrument 230, the rod 256 is set so that the rod distal section 262 is disposed within the lumen of tube elbow 244, as seen in Figure 11. When

instrument 230 is in this state, rod proximal section 258 may be partially disposed in handle 236. As a result of this positioning of the rob 256, rod elbow 260 is disposed in tube proximal section 242. Elbows 244 and 260 are thus out of registration with each other. When the instrument is so set, tube proximal section 242 constrains rod elbow 260 from bending. Simultaneously, rod distal section 262 constrains the tube elbow 244 from bending. Instrument 230 thus has the straight shape of Figures 8 and 11.

[00090] In regard to this constriction, it should be understand that since the rod distal section 262 extends completely through tube elbow 244, the tube elbow is

prevented from bending should the instrument be subjected to side loading.

[00091] When it is desirable to bend the instrument 230, finger pad 270 is moved forward. This results in a like motion of the rod 256 relative to tube 238. This brings the elbows 244 and 260 into registration with each other as depicted in Figure 12. The instrument thus develops the bent shape as depicted in this Figure.

[00092] It is a further feature of this version of the invention is that since tube distal section 246 is formed from rigid material, side loading of this section 246 and electrode 248 does not result in the immediate flexure of the instrument from the bent state. Thus, this version of the invention can be used to position a tissue working member such as a bur or shaver against tissue and have the instrument apply some forces against the tissue. These are the forces that facilitate the proper action of the working member against the tissue to which the member is applied.

[00093] From the foregoing it should be clear that alternative versions of this invention are also

contemplated. The invention, for example is not limited to instruments with just one or two bends. Other instruments of this invention may be designed to have three or more bends. It is likewise clear that instruments that have plural bends may be formed so that the instrument bends may or may not be at equal angles.

[00094] Likewise, in some versions of the invention, one elongated component may have a bend that is neither disposed over or under a complementary bend in another elongated component. In these versions of the invention, the

instrument thus has one constant bend the position of which is already established.

[00095] Similarly, there is no requirement that in all versions of the invention, when the instrument is placed in the unbent state that the sections of the instrument on either side of the bend be essentially collinear. In some versions of the invention when the instrument is in the unbent state, a bend may still exist such that the

longitudinal axes of the sections of the instrument on either side of the bend in the instrument are not collinear. It is possible to provide this version of the invention, by forming the components that go in and out of registration with each other with bends of different angles.

[00096] Further, there is no requirement that in each version of the invention the bendable sections of the elongated components are both flexible, bendable and shaped to have extend from the proximal end of the instrument handpiece, handle or finger grip. In some versions of the instrument of this invention, one or both of the elongated components that extend from the proximal end may be formed form material that is not prebent or not flexible.

Similarly, in some versions of the invention, distally forward from where the elongated component section is flexible and bendable, the tube may be formed from material that is not bendable or not flexible.

[00097] Thus in some versions of this invention each bendable section may consist of plural sections formed materials that are not bendable or not flexible. These sections are joined by a section that is flexible and prebent. Further there is no requirement that the inner elongated component always have a lumen or a through bore.

[00098] The flexible prebent sections of the elongated components of the instrument need not be formed of metal, let alone a nickel titanium alloy. In some versions of the invention one or both of these sections may be formed from a plastic that while flexible, in the absence of a side loading force returns to its prebent shape.

[00099] It should further be understood that there is no requirement that when one elongated component is rotated relative to the other elongated component that it always be the outer component that is rotated. In some versions of the invention, the outer component may be held static and the inner component mounted for rotation. In these versions of the invention it may not be possible to rotate the inner component a complete 360°. This is because there would typically be at least one tab that extends from an outer hub to the outer elongated component to hold the outer elongated component static. Likewise in versions of the invention in which one component translates relative to the outer

component, it may be the inner elongated component that is held static and the outer elongated component that is selectively positioned.

[000100] As should be clear from the description of

instrument 180, a component of the tissue working member of the instrument may be attached to one of the elongated components of the instrument that bends. Another example of such a instrument of this invention is a shaver. This type of instrument may be constructed so a cap that extends forward from the inner tube is formed to have the window defined by edges that is typically part of a shaver.

[000101] From the description of instrument 230 it is clear there is no requirement that internal to the bendable components there is a shaft that engages in some sort of motion. For example, in an alternative version of this invention the tissue working member is some sort of head from which a form of photonic energy, thermal energy or sonic energy is output. In these versions of the invention some sort of member capable of transmitting the conductive energy extends through the tubes. This member may be a wire or a fiber optic cable. It should likewise be understood that the tissue working member of an instrument of this invention is not limited to the described, shaver, drill bit, bur head and jaw. The exact nature of this member is a function of the instrument. As described with regard to instrument 230, the tissue working member may be an electrode. If the instrument emits photonic energy, the tissue working member may be a lens through which the light is emitted. In alternative versions of the invention wherein the instrument emits light energy, the tissue working member may be a light emitting device, such as an LED, that is energized by a current sourced through the tubes .

[000102] If the instrument emits sonic energy, the tissue working member may be a tip. The tip may have a proximal end in which piezoelectric elements are mounted and a head that that extends forward of the distal end of the elongated components. The tip vibrates in response to the expansion and contraction of the piezoelectric elements. In some versions of this invention, the tip may have an elongated body that forms the inner component of the instrument that is selectively bent or is rotated.

[000103] In versions of the invention wherein electrical signals are applied to or obtained from the tissue working member, one or both of the elongated components may function as the conductors over which these signals are transmitted. In these versions of the invention, electrically insulating sleeves and/or electrically insulating coatings may be disposed over the inner and/or outer surfaces of the tubes forming the instrument. In these versions of the invention the electrodes, the tissue working members of the

instruments, may be sleeves or tips attached to the tubes. Alternatively surface sections of the elongated components may function as one or more of the electrodes, tissue working members, of the instrument. In these versions of the invention, a surface of a tube that functions as an electrode is not covered with an electrically insulating layer. In some of these versions of the invention, these surfaces may be covered with a material such as iridium oxide. This material provides a low impedance bridge to tissue to which it is applied.

[000104] Further, the instrument of this invention is not limited to medical/surgical instruments capable of

performing a therapeutic procedure on a patient. The tissue working member may be a device that performs a diagnostic process. Thus, the tissue working member may be a

transducer used to measure some aspect of the physiology of the patient. Still another version of this invention may include plural fiber optic cables. One cable includes a head that emits light that is directed to the site to which the instrument is applied. The second fiber optic cable functions as the conduit for which the light that forms the image of the site is transmitted back to either an eyepiece or a camera.

[000105] Further while the instrument of this invention is generally described as being useful for performing a medical or surgical procedure or diagnostic function, this invention is not so limited. Alternative constructions of the

instrument of this invention may have applications outside of the fields of medicine and surgery. For example, the instrument may be a robotic finger that is selectively bended in order to perform a grasping function or a part placement function. In these constructions of the

invention, a component that extends forward from one of the elongated components is able to perform a part grasping function or a part working function

[000106] Therefore, it is the goal of the appended claims to cover all such modifications and variations that come within the true spirit and scope of this invention.

Claims

What is claimed is:

1. A surgical instrument (30, 120, 180, 230), said instrument including:

an elongated member (82, 130, 204, 238) having opposed proximal and distal ends and capable of being selectively flexed at at least one location between the proximal or distal ends; and

a head (60, 192, 220, 248) located adjacent the distal end of the elongated member for attachment application to site on the patient, the head configured to perform a therapeutic task or a diagnostic task on the patient,

characterized in that:

the elongated member (82, 130, 204, 238) is an outer tube ;

an inner elongated component (68, 146, 158, 256) is disposed in the outer tube and said inner elongated member is able to be selectively positioned relative to the outer tube ;

at least one of the outer tube (82, 130, 204, 238) and said inner elongated component (68, 146, 158, 256) is formed with a bent section (74, 86, 134, 138, 244, 260) that is capable of flexing between an unbent state and a bent state; and

the other of inner elongated component (68, 146, 158, 256) and said outer tube (82, 130, 204, 238) is formed with flexible section (74, 86, 134, 138, 244, 260) that is positioned so that:

when the inner elongated component is in a first position relative to the outer tube, the flexible section is not in registration with the bent section so that the bent section is held in the unbent state; and when the inner elongated component is in a second position relative to the outer tube, the flexible section is in registration with the bent section so that the bent section is able to flex to the bent state so as to cause the bending of both said outer tube and said inner elongated component .

2. The surgical instrument of Claim 1, wherein one of said outer tube (82, 130, 204) and said inner elongated component (68, 146, 158, 256) is rotatable relative to the other of said inner elongated component or said outer tube, the rotation of said outer tube or said inner elongated component placing the flexible section (74, 86, 134, 138, 244, 260) in and out of registration with the bent section (74, 86, 134, 138, 244, 260) .

3. The surgical instrument of Claims 1 or 2, wherein: said bent section of one of said outer tube (82, 130,

204, 238) or said inner elongated component is a first bent section (86, 134, 138, 244);

said flexible section of the other one of said inner elongated component or said outer tube is a second bent section (74, 152, 164) that, in addition to being flexible, is bent;

said first and second bent sections are positioned relative to each other so that when said bent sections are in registration, said bent sections overlap and, when said bent sections are not in registration, said bent sections do not overlap.

4. The surgical instrument of any one of Claims 1 to

3, wherein:

said head (60, 192, 220, 248) is movable; and

a drive member (58, 208) extends through the outer tube and is connected to said head to actuate said head.

5. The surgical instrument of Claim 4, wherein:

at least one of said outer tube (82, 130, 204, 238) or said inner elongated component (68, 146, 158, 256) is formed with a coupling feature for engaging a complementary

coupling feature integral with a powered handpiece (40); and said drive member (58) is formed with a coupling feature (54) for engaging a drive unit (42) internal to the powered handpiece (40) so that the drive unit can actuate said drive member.

6. The surgical instrument of Claim 4, wherein:

a drive component (182) is moveably attached to the distal end of said outer tube, said drive component being configured for manual actuation; and

said drive member (208) is attached to said drive component for actuation upon actuation of said drive

component .

7. The surgical instrument of any one of Claims 1, 3,

4, 5, or 6 wherein , one of said outer tube (82, 130, 204, 238) and said inner elongated component (68, 146, 158, 256) is able to move longitudinally relative to the other of said inner elongated component or said outer tube, the

longitudinal movement of said outer tube or said inner elongated component placing the flexible section (74, 86, 134, 138, 244, 260) in and out of registration with the bent section (74, 86, 134, 138, 244, 260) .

8. The surgical instrument of any one of Claims 1 to

7, wherein the one of said inner elongated component or said outer tube to which said flexible section (244, 260) is attached further includes a rigid section (242, 262), said rigid section positioned so that when the flexible section (244, 260) goes out of registration with the bent section (260, 244), the rigid section goes into registration with the bent section.

9. The surgical instrument of any one of Claims 1 to

8, wherein head attached to at least one of the outer tube or the inner elongated section.

10. The surgical instrument of any one Claims 1 to 9, wherein said bend is in the unbent state, portions of said outer tube on opposed sides of said bend are substantially coaxial .

11. The surgical instrument of any one of Claims 1 to 10, wherein:

said outer tube (120) and said inner elongated

component are formed to have plural pairs of bent and flexible sections, wherein each flexible section is capable of being placed in and out of registration with a bent section, so that depending on position of said inner elongated component relative to said outer tube said outer tube will have none or at least one of a plurality of different bends.

12. The surgical instrument of any one of Claims 1 to 11, wherein said head is one from the group consisting of: a bur (60); a clamp (192, 220); or an electrode (248).

13. The surgical instrument of any one of Claims 1 to 12, wherein at least one of said outer tube and said inner elongated component is formed as a single piece unit such that the said bent section or said flexible section of said inner tube or said elongated components is formed with the section of said inner tube or said inner elongated component adjacent said bent section or said flexible section .

14. The surgical instrument of any one of Claims 1 to 13, wherein at least one of said outer tube or said inner elongated component is a single piece of metal that is formed to have either said bent section (74, 86, 134, 138, 244, 260) or said flexible section flexible section (74, 86, 134, 138, 244, 260) .

15. The surgical instrument of any one of Claims 1 to 14, wherein said inner elongated component is an inner tube (68, 146, 158) .