1. Field of the Invention
In one aspect, the invention relates generally to an apparatus for implanting a localization wire and more particularly to an apparatus comprising a retractable cannula for implanting a preloaded localization wire. In another aspect, the invention relates generally to a method for implanting a localization wire and more particularly to a method for implanting a preloaded localization wire by retracting a cannula relative to the localization wire.
2. Description of the Related Art
Localization wires are common devices for marking nonpalpable lesions in a tissue mass, usually breast tissue. When such a lesion is identified with a medical imaging technique, such as radiography and ultrasonography, it is often desirable to position a localization wire or other type of marker near the lesion to facilitate locating the lesion during later procedures, such as biopsy. Alternatively, a localization wire can be placed in the tissue mass after a biopsy has been taken. In this case, the localization wire marks the location of the biopsy cavity for future procedures, such as removal of the surrounding tissue or therapeutic treatment. It is critical that the localization wire is accurately implanted in the correct location. Localization wires, which typically comprise an anchor portion and a wire portion that extends from the anchor and through the skin surface, are especially effective for identifying lesions or biopsy sites because a practitioner can use the wire as a physical guide to the lesion rather than solely relying on imaging techniques. For the surgical excision of the lesion, the localization wire is the preferred way for the surgeon to locate the lesion.
To implant a localization wire, a needle is inserted into the tissue mass and, with guidance from imaging systems, the needle is positioned with its tip near a predetermined location. Once the needle is in place, the localization wire is manually threaded through the needle and inserted into the predetermined location. Thereafter, the needle is removed from the tissue mass, and the localization wire remains in place at the predetermined location. Alternatively, the needle is positioned with its tip at the predetermined location, the localization wire is manually advanced to the end of the needle, and the needle is manually withdrawn from the tissue mass. During either process, the wire can be inadvertently displaced from the predetermined location as the needle is removed. As a result, the localization wire can be positioned deeper or shallower than intended and, therefore, can inaccurately mark the predetermined location. Further, if ultrasonography is utilized for imaging, the procedure requires three hands: one to position the needle, a second to hold the ultrasonography transducer, and a third to feed the localization wire into the needle and tissue mass. If the three hands are not properly coordinated, then it can be difficult for the practitioner to accurately position the localization wire.
Devices containing preloaded wires have been developed to eliminate the need to thread the needle with the wire when the needle is inserted into the tissue mass. The localization wires of such devices can be implanted into the predetermined location by manual distal displacement of the localization wire. The practitioner can grasp the wire portion that extends from the proximal end of the needle and push the localization wire distally to insert the anchor portion into the tissue mass; however, this process still requires three hands. Alternatively, the device can comprise a plunger in operative communication with the localization wire. Displacement of the plunger into the needle forces the distal end of the localization wire past the tip of the needle and into the predetermined location. The force applied to the plunger can affect the final location of the localization wire. In order to correctly position the anchor, the practitioner must accurately place the tip of the needle a sufficient distance from the predetermined location and apply a suitable force to the plunger to displace the localization wire into the predetermined location.
There remains a desire amongst medical practitioners for a device that can accurately implant a localization wire and requires only a single hand, thus freeing the other hand to hold the imaging device. Such a device would make it possible for a single person to accurately place the localization wire.
The invention, in one form thereof, is directed to an apparatus for percutaneously implanting a localization wire within a tissue mass. The apparatus includes a handle, and a cannula mounted to the handle. The cannula defines a lumen and has a distal end forming an insertion tip. The cannula is movable relative to the handle between an insertion position and a retracted position. A localization wire is positioned to extend from the handle and into the lumen of the cannula. The localization wire has a distal end that is positioned near the insertion tip and is contained within the lumen when the cannula is in the insertion position. The localization wire includes at least one anchor adapted to hold the localization wire in the tissue mass. The cannula and the localization wire are configured such that each of the at least one anchor remains completely contained in the cannula when the cannula is in the insertion position prior to the cannula being moved to the retracted position. An actuator is in operable communication with the cannula. The actuator is configured for operation between a charged condition and a discharged condition to retract the cannula toward the retracted position to expose the distal end of the localization wire to the tissue mass and expose each of the at least one anchor to the tissue mass, without inducing movement of the localization wire, and with the cannula being removable from the localization wire in its entirety.
The invention, in another form thereof, is directed to an apparatus for percutaneously implanting a localization wire within a tissue mass. The apparatus includes a handle with a hollow interior and an end. A cannula defines a lumen and has a distal insertion tip. The cannula is movable relative to the handle between an insertion position and a retracted position. A localization wire is located within the lumen and has a distal end near the distal insertion tip when the cannula is in the insertion position. The localization wire includes at least one anchor adapted to hold the localization wire in the tissue mass. The cannula and the localization wire are configured such that each of the at least one anchor remains completely contained in the cannula when the cannula is in the insertion position prior to the cannula being moved to the retracted position. An actuator is operable between a charged condition and a discharged condition to effect retraction of the cannula relative to the localization wire. The handle, the cannula, the localization wire, and the actuator form a self-contained implanting apparatus configured for implanting the localization wire into the tissue mass, whereby the cannula is inserted into the tissue mass and the actuator is placed in the discharged condition to effect retraction of the cannula relative to localization wire to expose the distal end of the localization wire to the tissue mass and expose each of the at least one anchor to the tissue mass, without inducing movement of the localization wire, and with the cannula being removable from the localization wire in its entirety.
In the drawings:
The invention provides an apparatus for accurately implanting a localization wire within a tissue mass. The apparatus comprises a preloaded localization wire and a cannula that retracts proximally to expose the localization wire. Implantation of a localization wire with the apparatus requires only one hand.
Referring now to the figures,
The handle 20 includes a grip portion 22 slidably mounted to a base portion 24 with a hollow interior 26, a closed proximal end 28, and an open distal end 30. The base portion 24 further comprises diametrically opposed L-shaped grooves 36 adjacent the hollow interior 26. Each groove 36, best viewed in
The grip portion 22 defines a hollow interior 40 (
The handle 20 is slidable between an uncocked condition, as illustrated in
Referring now to
With particular reference to
The cannula 60 is movable between an insertion position, as illustrated in
The localization wire 80 and the cannula 60 are sized such that they are independently moveable. In other words, movement of the cannula 60 does not induce movement of the localization wire 80, and the localization wire 80 is free to move within and relative to the cannula 60. As a result, the localization wire 80 is stationary during retraction of the cannula 60, and inadvertent displacement of the localization wire 80 is avoided.
To ensure that the localization wire 80 does not move in response to the movement of the cannula 60, the localization wire 80 can have a portion that is fixed relative to the handle or some other structure that does not move with the cannula 60.
When the cannula 60 is in the insertion position, the localization wire 80 is preloaded within the lumen 62 and extends into the hollow interior 26 of the handle base portion 24, as seen in
The actuator 90 for automatically moving the cannula 60 from the insertion position to the implant position comprises a biasing element, which is shown as a spring 94 with a proximal end 93 and distal end 95, and a trigger 92 in operable communication with the key 66. The trigger 92 includes a hollow finger 96, which has open proximal and distal ends 98 and 100, rotatably disposed in the grip portion 22. Diametrically opposed longitudinal grooves 104 sized to receive the diametrically opposed key projections 70 extend from the proximal end 98 of the finger 96. The spring 94 extends through the hollow finger 96, with the proximal and distal ends 93 and 95 of the spring 94 abutting the key collar 67 and the wall 43 of the grip portion 22, respectively.
The trigger 92 further comprises a trigger arm 106 that extends radially from the finger 96 and through the transverse slot 50 in the grip portion 22. Movement of the trigger arm 106 within the transverse slot 50 rotates the trigger 92 between a ready position and a release position. When the trigger arm 106 is adjacent the first trigger arm stop 52 (
The actuator 90 is operable between a charged condition and a discharged condition. When the actuator 90 is in the charged condition, as in
Referring again to
To move the handle 20 to the cocked condition in
With the apparatus 10 in the condition shown in
Referring now to
A second embodiment of an implanting apparatus 10′ according to the invention is illustrated in
Referring to
The operation of the second embodiment is substantially the same as, if not identical to, the operation of the first embodiment, excluding the cocking step. Because the second embodiment apparatus 10′ is initially in a cocked condition, the operation begins with the step of inserting the cannula 60′ into the tissue mass 150′. Once the cannula 60′ and the localization wire 80′ are at the predetermined location, the practitioner rotates the trigger arm 106′ within the transverse slot 50′ to move the trigger 92′ from the ready position to the release position and thereby align the key projections 70′ with the longitudinal keyways 32′. Upon alignment, the spring 94′ expands and forces the cannula 60′ to the implant position to expose the distal end 82′ of the localization wire 80′ to the tissue mass 150′. After the anchor 84′ is secured in the tissue mass 150′, the apparatus 10′ is removed from the localization wire 80′.
A third embodiment of an implanting apparatus 10″ according to the invention is illustrated in
When the cannula 60″ is in the insertion position shown in
The operation of the third embodiment is substantially the same as the operation of the second embodiment; the primary difference is the operation of the actuator 90″, particularly the trigger 92″. Rather than rotating the trigger arm 106′ through the transverse slot 50′, the trigger 92″ is actuated by pushing on the surface 302 to slide the trigger 92″ through the transverse slot 304 from the ready position to the release position.
A fourth embodiment of a implanting apparatus 10′″ according to the invention is illustrated in
When the trigger 92′″ is in the ready position shown in
The operation of the fourth embodiment is substantially the same as the operation of the second and third embodiments; the primary difference is the operation of the actuator 90′″, particularly the actuation trigger 92′″. To discharge the actuator 90′″, the practitioner simply applies a downward force to the surface 400 of the trigger 92′″.
In the descriptions of various embodiments of the implanting apparatus 10, the localization wire 80 has been shown as being completely disposed within the cannula 60 and the handle 20. However, it is within the scope of the invention for the localization wire 80 to extend through and beyond the proximal end 28 of the handle base portion 24. Such a configuration would facilitate implantation of a longer localization wire 80 with the same size apparatus 10.
To avoid accidental injury prior to insertion of the cannula 60 into the tissue mass 150, the apparatus 10 can optionally include a removable sheath or removable safety cap that encases the exposed portion of the cannula 60 or at least the insertion tip 65 of the cannula 60.
Referring to
Preferably, and as illustrated, the opposing barbs are angled in opposite directions relative to the shaft. That is, each barb forms an acute interior angle relative to the shaft, but the acute interior angle faces towards an opposite end of the shaft. The opposing barb structure is ideal for use in less dense or structurally strong tissue, such as fatty tissue.
The opposing barbs can be arranged in a variety of different ways. They can be arranged in cooperative sets, individual barbs or a combination of both. There can be an equal or unequal number of opposing barbs. The barbs can be radially aligned or unaligned.
The barbs can also be formed in a variety of ways. For example, the barbs can be integrally formed with the shaft of the localization wire, such as in bending a portion of the shaft. Alternatively, the barbs can be separate pieces affixed to the shaft, such as by laser welding separate wire elements to the shaft.
A cannula 560 is slidably received within the passageway 527 and can reciprocate relative to the handle. A trigger 592 in the form of a slide is received within the slot 529 and is slidably moveable between the opposing ends of the slot. A proximal end of the cannula 560 is mounted to the trigger, such that the sliding movement of the trigger in the slot 529 effects the sliding movement of the cannula 560 relative to the handle 520.
A localization wire 580 is preloaded into the cannula. The sliding of the cannula into the handle results in the exposing of the localization wire to the environment previously surrounding the cannula.
In operation, the apparatus 510 is grasped by the user in the condition as illustrated in
The main difference between the fifth embodiment and the prior embodiments is that the cannula is manually moved from the insert position to the implant position. The prior embodiments automatically, not manually, moved the cannula. While the manual movement of the fifth embodiment is a more simple implementation, it is not preferred over the automatic implanting. It is believed that the automatic implanting is more accurate in that the user will be less like to move the apparatus relative to the tissue mass, thereby increasing the accuracy of the placement of the localization wire.
The inventive apparatus for percutaneously implanting a localization wire offers several advantages. Because the process of implanting the localization wire involves retracting the cannula without axial displacement of the localization wire, the practitioner can position the localization wire, which only requires positioning the insertion tip of the cannula, at the desired implantation location during insertion of the apparatus into the tissue mass. This feature facilitates accurate placement of the localization wire within the tissue mass, which is critical to pinpointing the predetermined location during future procedures. Retraction of the entire cannula, including the insertion tip, into to the handle prevents accidental injury during removal of the device. Additionally, the actuator of the inventive apparatus retracts the cannula automatically, thereby ensuring that a suitable force is applied to the cannula and reducing the possibility of human error. Because the inventive apparatus has a preloaded localization wire and can be operated with a single hand, the practitioner can utilize the other hand to control an imaging system and does not require the assistance of a third hand. Furthermore, the first embodiment of the apparatus is provided in an uncocked condition wherein the spring is in an expanded state, which not only prevents accidental discharge but also increases the shelf life of the spring and, therefore, the apparatus.
While the invention has been specifically described in connection with certain specific embodiments thereof, it is to be understood that this is by way of illustration and not of limitation, and the scope of the appended claims should be construed as broadly as the prior art will permit.
This application is a continuation of U.S. patent application Ser. No. 14/530,186, filed Oct. 31, 2014, now U.S. Pat. No. 9,707,042, which is a continuation of U.S. patent application Ser. No. 13/357,872, filed Jan. 25, 2012, now U.S. Pat. No. 8,886,292, which is a continuation of U.S. patent application Ser. No. 10/707,043, filed Nov. 17, 2003, now U.S. Pat. No. 8,131,346, which claims the benefit of U.S. provisional application Ser. No. 60/427,020, filed Nov. 18, 2002, and U.S. provisional application Ser. No. 60/427,024, filed Nov. 18, 2002, each of which is incorporated herein in its entirety.
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Number | Date | Country | |
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Parent | 14530186 | Oct 2014 | US |
Child | 15618867 | US | |
Parent | 13357872 | Jan 2012 | US |
Child | 14530186 | US | |
Parent | 10707043 | Nov 2003 | US |
Child | 13357872 | US |