Patent Application
20080039883
Referring initially to
The conventional surgical morcellator further includes a cylindrical inner sleeve 14, also having an axial bore. Inner sleeve 14 is received by the axial bore of rotating cutting blade 12. Tissue morsels cut from an anatomical body are pulled through the axial bore of inner sleeve 14 by the tissue grasping instrument, or tenaculum.
As is described in the aforementioned Savage et al. patent, inner sleeve 14 is axially moveable with respect to the sharpened edge 18 of cutting blade 12 and, accordingly, acts as a blade guard which protects the blade from inadvertent contact with other surgical instruments and which also prevents inadvertent cutting of tissues during positioning and movement of the laparoscopic surgical morcellator. A sliding guard actuator 94 (not shown in
Inner sleeve 14 of the conventional surgical morcellator may be advanced distally to a first position in which it extends beyond the periphery of the sharpened edge 18 of cutting blade 12, and may be withdrawn axially within rotating cutting blade 12 to a second position in order to expose the full circumference of sharpened edge 18 during the laparoscopic surgical procedure. Inner sleeve 14 in the conventional morcellator shown in the Savage et al. patent does not prevent unintentional coring into the anatomical body being removed when the preferred “orange peeling” technique is being employed.
The surgical morcellator further preferably includes a cylindrical outer sleeve 104 having a bore formed axially therethrough for receiving at least a portion of the rotatable cutting blade 100. The outer sleeve 104 has a distal end situated in proximity to the distal end of the cutting blade 100, and is preferably axially moveable on the rotatable cutting blade 100. The outer sleeve 104 is also preferably made from stainless steel, such as 300 series medical grade stainless steel, but may also be made from other materials such as polyethylene or fiberglass.
The surgical morcellator may also include an inner sleeve 106 which is received within the axial bore of the rotatable cutting blade 100 so that the rotatable cutting blade 100 is disposed between the inner sleeve 106 and the outer sleeve 104 of the morcellator. The inner sleeve 106 also has a bore formed axially therethrough. The bore is provided for passing therethrough tissue morsels transected from an anatomical body of a patient during a laparoscopic surgical procedure, and grasped and pulled through the bore by a tissue grasping instrument, such as a tenaculum. The inner sleeve 106 may also be formed from stainless steel, such as 300 series medical grade stainless steel, or, like the outer sleeve 104, may be formed from a polyethylene or fiberglass material. Preferably the inside surface of the inner sleeve 106 may be made lubricious either in the selection of material used for the inner sleeve 106 or by coating the inside surface of the inner sleeve 106 with a hydrophilic or other coating to reduce friction between the inside surface of the inner sleeve 106 and tissue morsels being withdrawn by the tenaculum therethrough.
It should be noted here that it is envisioned to be within the scope of the present invention to construct the surgical morcellator without an inner sleeve 106 so that the tissue morsels are grasped and withdrawn through the axial bore of the rotatable cutting blade 100.
In accordance with one form of the present invention, and as shown in
More specifically, the shield 108 is situated at the distal end of the cutting blade 100 and axially moveable with respect thereto. The shield 108 includes a main body 110 having a bore formed axially therethrough for receiving a portion of the cutting blade 100, and a protrusion 112 or “tooth” extending axially from the main body 110 and partially about the circumference of the cutting blade 100. The shield 108 is axially moveable with the outer sleeve 104 to selectively cover and at least partially uncover the sharpened edge 102 of the rotatable cutting blade 100.
Even more specifically, the shield 108 is axially positionable with respect to the cutting blade 100 in a first position (shown in
The selected arcuate first portion of the circumference of the sharpened edge 102 of the rotatable cutting blade 100 covered by the protrusion 112, or “tooth,” is preferably between about ninety degrees (90°) and about one hundred twenty degrees (120°) when the shield 108 is in the second position. However, it is preferred that the selected arcuate first portion of the circumference of the sharpened edge 102 of the rotatable cutting blade 100 that is covered by the protrusion 112 is at least about fifty-four degrees (54°) when the shield 108 is in the second position. Stated in another way, it is preferred if about two-thirds (⅔) to about three-quarters (¾) of the circumference of the sharpened edge 102 of the cutting blade 100 is exposed, and at least about fifteen percent (15%) of the sharpened edge 102 is covered, for efficient tissue morcellation using the preferred “orange peeling” technique while providing enough resistance to coring to promote the cutting blade 100 sliding along the surface of the organ being morcellated. If the arcuate extent of the protrusion 112 or “tooth” is too small, that is, somewhat less than fifteen degrees (15°) or about fifty-four percent (54%) in its coverage of the sharpened edge 102 of the rotatable cutting blade 100, the protrusion 112 may not be blunt enough to prevent the protrusion 112 from digging into the tissue, and this may prevent the surgeon from efficiently using the “orange peeling” surgical technique.
It is also preferred that at least a portion of the protrusion 112 of the shield 108 extends at least about 0.030 inches, but more preferably between about 0.070 inches and about 0.100 inches, axially beyond the sharpened edge 102 of the rotatable cutting blade 100, when the shield 108 is in the second position. If the protrusion 112 extends too far beyond the sharpened edge 102 of the cutting blade 100, it may prevent the cutting blade 100 from taking a full “bite” out of the organ when the morcellator is at a steep angle to the tissue being transected. If the protrusion 112 does not extend sufficiently beyond the sharpened edge 102 of the rotatable cutting blade 100, it is possible that the shield 108 will not prevent coring of the organ during the “orange peeling” procedure.
The surgical morcellator of the present invention and, in particular, the anti-coring device used thereon, allow faster, more controlled and safer morcellation of anatomical bodies during a laparoscopic surgical procedure by facilitating the “orange peeling” technique, as shown in
With the anti-coring device of the present invention fitted on a surgical morcellator, a full “bite” of tissue may be taken while maintaining the device along the surface of the organ without the sensitivity, aim or skill required by conventional surgical morcellators, as a morcellator having the anti-coring device of the present invention can maintain its engagement along the surface of the organ with a much greater range in the angle at which the morcellator is held to the organ surface during the surgical procedure. The morcellator, having the anti-coring device of the present invention mounted thereon, further enables the tissue to be compressed as it is cut, leading to thicker transected tissue strips and faster morcellation procedures.
The shield 108 of the anti-coring device of the present invention may be locked in preferably three positions. As stated previously, the shield 108 in one position (shown in
The shield 108 may be formed from stainless steel or other material, such as a polymer (e.g., polyethylene) or fiberglass, and may be mounted on the distal end of the outer sleeve 104. Alternatively, the shield 108 may be integrally formed with the outer sleeve 104 at the distal end thereof. In the former situation, the distal end of the outer sleeve 104 may include a plurality of slots 114 formed through the thickness thereof and spaced apart from each other about its circumference. The main body 110 of the shield 108 may include a plurality of resilient tabs 116 extending radially outwardly from the outer surface of the main body 110, which tabs 116 are also spaced apart from one another the same distance that the slots 114 are spaced apart on the circumference of the morcellator outer sleeve 104 so that the tabs 116 may be aligned with and lockingly received by the outer sleeve slots 114 to secure the shield 108 in place on the distal end of the outer sleeve 104 of the morcellator. Thus, the shield 108 may be mounted to the distal end of the outer sleeve 104 with a portion of the main body 110 of the shield being received within the axial bore of the outer sleeve, as shown in
With the latter situation, where the shield 108 is integrally formed with the outer sleeve 104, the main body 110 of the shield 108 may be defined by the distal end portion of the cylindrical outer sleeve 104, with the protrusion 112 being defined by an axially extending portion of the outer sleeve 104, as shown in
Also, it is envisioned to be within the scope of the present invention to form the inner sleeve 106 of the morcellator, if such is provided, with anti-coring structure. As shown in
When operating a surgical morcellator outfitted with the anti-coring device of the present invention, the surgeon would position the shield 108 of the anti-coring device in its first position in which the shield 108 covers the entire circumference of the sharpened edge 102 of the cutting blade 100. The surgeon would then insert the distal end of the outer sleeve 104 of the surgical morcellator through a small incision and into the patient's body cavity either with or without using a trocar. When performing an “orange peeling” technique in removing an organ, the shield 108 of the anti-coring device on the morcellator is positioned in the second position, as shown in
As can be seen from the foregoing description, the anti-coring device of the present invention can be positioned to cover only portions of the sharpened edge 102 of the cutting blade 100 and act as a “tool guide” to allow the maximum size tissue strip to be removed from the organ in an “orange peeling” surgical procedure by having the exposed sharpened edge 102 riding along the organ's outside surface, thus keeping the maximum amount of cutting edge diameter engaged with the organ's surface at all times. A surgical morcellator having such an anti-coring device requires less skill on the part of the surgeon while delivering the maximum tissue volume through the morcellator and, therefore, requiring less surgical time to complete the morcellation procedure. The anti-coring device of the present invention also enhances safety. Since the cutting blade 100 will not “core” into the organ, the blade 100 can be constantly seen by the surgeon through an endoscope, and the blade 100 location in the body cavity with respect to the organ being morcellated will always be observed. Furthermore, the tissue removed through the morcellation process may be stronger due to its larger cross-section, and longer strips of tissue may be withdrawn without breakage. If light pressure is maintained on the morcellator cutting blade 100 to force it partially into the organ being morcellated or an angle to the surface of the organ while pulling the transected tissue through the axial bore of the inner sleeve 106 or cutting blade 100, the tissue being morcellated is under slight compression due to the action of the anti-coring device. This leads to an even greater tissue volume removed by the cutting blade 100 of the morcellator and a quicker and more efficient morcellation procedure.
As is further evident from the foregoing description, the anti-coring device of the present invention may be suitably used with other forms of cutting elements, which broadly include the rotatable, sharpened edge cutting blade described previously, but also electrosurgical cutting devices, such as an electrosurgical coil through which is selectively passed an electric current. The anti-coring device of the present invention would be positioned to selectively cover and uncover an arcuate portion, or the entire circumference, of the electrosurgical coil, in a similar manner and operating in a similar way to that described previously with the rotatable cutting blade, the electrosurgical coil essentially replacing the sharpened cutting blade of the morcellator, with transected tissue morsels passing through the central opening of the electrosurgical coil.
Although illustrative embodiments of the present invention have been described herein with reference to the accompanying drawings, it is to be understood that the invention is not limited to those precise embodiments, and that various other changes and modifications may be effected therein by one skilled in the art without departing from the scope or spirit of the invention.
