The present disclosure relates to a biopsy device and, more particularly, to a biopsy device having hemostatic control.
This section provides background information related to the present disclosure which is not necessarily prior art.
Bleeding from biopsy is a major problem in many areas of medicine but particularly in nephrology where the risk of serious bleeding from the kidney, although infrequent, may become life-threatening. While methods of performing kidney biopsies have improved over the last two decades renal biopsies still entail inherent bleeding risk such that fully a third of patients have post biopsy hematoma. Even though most of these hematomas don't become life threatening, the current strategy of monitoring for and managing complications is woefully inadequate. The current standard of practice is to study risk factors associated with bleeding such as hypertension and amyloidosis, mitigating some modifiable risk factors and choosing not to biopsy most patients at increased risk. This is far from optimal medical practice since the risk of bleeding is greater in many patient populations where renal biopsy would be most helpful, such as in autoimmune diseases and renal dysfunction manifested by elevated creatinine to >2 mg/dl. In addition, even mild coagulopathies increase the risk to the point where conventional (percutaneous) renal biopsy is significantly risky. While the published data tend to indicate that the serious bleeding complications may occur only 1 to 2% of the time, these data are inherently biased by physician practice patterns excluding the riskiest patients from percutaneous renal biopsy. This approach has led to the current practice of close clinical observation, with escalating anxiety, especially when transfusions become necessary when the patient's hematocrit is falling. In this setting, the next step is to proceed with invasive and risky treatments to address the excessive bleeding by performing renal arteriography and segmental embolization or surgery.
In order to respond to the bleeding risk, physicians appropriately limit percutaneous renal biopsy to cases where the diagnostic information exceeds the potentially life threatening risk to the patient. In settings where conventional biopsy is considered too risky, high risk patients needing kidney biopsy are referred to interventional radiologists and surgeons to perform more complicated invasive procedures such as open (surgical) biopsy or transjugular renal biopsy. The open procedure has considerably more morbidity and cost, still entails bleeding risk, and the transjugular procedure is much more invasive than conventional biopsy and merely serves to keep the bleeding that does occur within the vascular space (i.e., bleeding is directed into the venous system). Advances in laparoscopic procedures have allowed a less morbid surgical approach to be used, but this remains considerably more involved and costly than the percutaneous approach and is reserved for cases where the standard percutaneous approach is contra-indicated.
The alternative transjugular procedure entails inserting a wire, followed by a biopsy device into the neck (jugular vein) and navigating the device using fluoroscopic (video X-ray) guidance through the veins in the chest, right atrium of the heart, into the inferior vena cava, and finally into the renal vein, inserting the device up though the central regions of the kidney, where the needle can be pushed through the interior portions of the kidney, eventually making its way up into the outer regions of the kidney cortex, where the diagnostically useful region of the kidney is located. The reason this more invasive, less desirable approach is used is because the bleeding that does occur is bleeding within the venous system that remains in the circulation rather than outside of the kidney. This procedure requires costly equipment and a highly skilled operator, but if performed correctly, then bleeding risk is reduced. However, systematic study at leading institutions shows this procedure causes intraperitoneal bleeding just as does the standard percutaneous biopsy. The transjugular procedure has a yield (samples containing renal tissue with glomeruli) of only about 80%. Therefore, while the transjugular approach has allowed renal biopsies to be obtained with greater safety, there is still need to improve the safety of this procedure and the added complexity clearly keep it from being an acceptable alternative to percutaneous biopsy.
This section provides a general summary of the disclosure, and is not a comprehensive disclosure of its full scope or all of its features.
A biopsy device assembly that performs a biopsy of an anatomical tissue of a patient is disclosed. The biopsy device assembly includes a housing and a biopsy device that extends out of the housing and that collects and cuts anatomical tissue from the patient. The biopsy device assembly further includes a hemostatic agent removably housed in the biopsy device. Moreover, the assembly includes an actuator assembly that moves the biopsy device relative to the housing from a first position to an extended position such that the biopsy device collects and cuts the anatomical tissue from the patient. The actuator assembly also retracts the biopsy device relative to the housing toward a retracted position. Furthermore, the assembly includes an ejection device that ejects the hemostatic agent from the biopsy device as the actuator assembly retracts the biopsy device toward the retracted position.
Moreover, a method of performing a biopsy is disclosed. The method includes locating a biopsy device relative to a target location within a patient. The biopsy device extends from a housing. The method also includes actuating the biopsy device relative to the housing from a first position to an extended position such that the biopsy device collects and cuts an anatomical tissue from the patient. Furthermore, the method includes retracting the biopsy device relative to the housing toward a retracted position. Still further, the method includes ejecting a hemostatic agent from the biopsy device as the biopsy device is retracted toward the retracted position.
Further areas of applicability will become apparent from the description provided herein. The description and specific examples in this summary are intended for purposes of illustration only and are not intended to limit the scope of the present disclosure.
The drawings described herein are for illustrative purposes only of selected embodiments and not all possible implementations, and are not intended to limit the scope of the present disclosure.
Corresponding reference numerals indicate corresponding parts throughout the several views of the drawings.
Example embodiments will now be described more fully with reference to the accompanying drawings.
Referring initially to
The biopsy device assembly 10 can generally include a housing 12 as shown in
The biopsy device assembly 10 can also include a biopsy device, generally indicated at 17 in
As shown in
It will be appreciated that the biopsy device 17 can be of any suitable type for collecting, cutting, and/or retaining the tissue of the anatomical feature 26 to perform the biopsy. As such, the biopsy device 17 may or may not include both the collection member 18 and the cutting member 22.
In addition, the biopsy device assembly 10 can include an actuator assembly, which is generally indicated at 30 in
More specifically, the actuator assembly 30 can move the collection member 18 from a respective first position (
Furthermore, as will be discussed, the actuator assembly 30 can retract the collection member 18 and the cutting member 22 from the respective extended positions (
Moreover, the biopsy device assembly 10 can further include a hemostatic agent 28, best illustrated in
Additionally, the biopsy device assembly 10 can include an ejection device 32, which is generally indicated at 32 in
Thus, because the hemostatic agent 28 is housed substantially completely within the cannula 21 of the collection member 32 during extension of the collection member 18 and cutting member 22 into the anatomical feature 26, the hemostatic agent 28 can remain protected until it is ready to be ejected. Then, the hemostatic agent 28 can be automatically ejected into the void as the collection member 18 and the cutting member 22 are retracted, such that the hemostatic agent 28 is likely to be placed accurately and effectively to reduce bleeding.
Referring now to
The first member 14 can include two semi-circular ends 34a, 34b and an outer curved wall 35 that extends between the ends 34a, 34b. Furthermore, the first member 14 can include a first substantially semi-circular wall 36 and a second substantially semi-circular wall 38 that are spaced apart from each other and that are spaced apart axially from the ends 34a, 34b. In addition, the first member 14 can include a triangular stop 40 that extends radially from an inner surface of the outer wall 35 between the second wall 38 and the end 34b.
The second member 16 of the housing 12 can be substantially similar to the first member 14 and can include ends 41a, 41b and an outer wall 42. Moreover, the second members 16 can include a first wall 43 and a second wall 44. In addition, as shown in
When the first and second members 14, 16 of the housing 12 are joined (
Moreover, when the first and second members 14, 16 of the housing 12 are joined, the housing 12 can include a first end opening 52, a second end opening 54, a first central opening 48, and a second central opening 50. (The second end opening 54 is shown in
Referring now to
As shown in
Referring back to
Moreover, referring to
As shown in
The inner cylinder 71 can be substantially cylindrical and can be made out of any suitable material, such as plastic (e.g., DELRIN plastic). The inner cylinder 71 can include a conical recess 81 on one end, and the recess 81 can be centered on the axis X. The first retainer 72 can extend axially from the opposite end of the inner cylinder 71. In some embodiments, there are a plurality (e.g., two) of resilient, spaced apart first retainers 72 with enlarged retaining heads 75. The inner cylinder can also include a protrusion 78, such as a peg that extends transverse (e.g., perpendicular) to the axis X.
Moreover, the outer cylinder 73 can be substantially hollow and cylindrical and can moveably receive the inner cylinder 71 therein. Furthermore, the outer cylinder 73 can include a track 76. The track 76 can be generally L-shaped to include a portion that extends circumferentially about the outer cylinder 73 and a portion that extends parallel to the axis X. As will be discussed, the protrusion 78 can be moveably received within the track 76 of the outer cylinder 73. Furthermore, the outer cylinder 73 can include a holder 80, which extends outward from the axis of the outer cylinder 73. The holder 80 can receive and fixably retain the proximal end 58 of the collection member 18.
Additionally, the first biasing member 74 can be of any suitable type and can be made of any suitable material. In some embodiments, the first biasing member 74 is a helical compression spring made out of stainless steel. The first biasing member 74 can be wound about the inner cylinder 71.
As shown in
Thus, the first portion 64 of the actuator assembly 30 can have a first position (i.e., locked, spring-loaded position), which is represented in
As shown in
When the second portion 66 is in its respective first position (i.e., locked, spring-loaded position) represented in
Referring now to
The third portion 68 can have a respective first position (i.e., locked, spring-loaded position) represented in
As shown in
Moreover, as shown in
As shown in
Referring now to
Moreover, the ejection device 32 can include a length of tubing 116. In some embodiments, the tubing 116 can be flexible. The tubing 116 can be in fluid communication at one end to the tube 113 and can be in fluid communication with the proximal end 58 of the cannula 21 of the collection member 18.
Thus, as will be discussed, movement of the third stage 106 can cause the plunger 112 to advance into the cavity of the tube 113 to increase pressure in the cavity of the tube 113. As a result, pressure can increase in the cannula 21 of the collection member 18, thereby causing the hemostatic agent 28 to be pushed out of the cannula 21 and into the anatomical feature 26.
The hemostatic agent 28 can be of any suitable type. For instance, as shown in
The hemostatic agent 28 can also include a stiffener 122. The stiffener 122 can include an elongate backbone 124 and a plurality of ribs 126. The ribs 126 can be spaced apart from each other and can each be coupled to the elongate backbone 124. Furthermore, as shown in
It will be appreciated that the stiffener 122 can reinforce the hemostatic agent 28 to withstand the pressure of deployment from the cannula 21 and to advance against any friction into the anatomical feature 26. Also, the hemostatic foam 120 can substantially reduce bleeding of the anatomical feature 26. It will be appreciated that both the foam 120 and the stiffener 122 can reduce (e.g., resorb) within the anatomical feature 26 after the anatomical feature 26 has healed.
In addition, the biopsy device assembly 10 can include a handle member 118 (
Referring now to
Then, the user can depress the button 84 to move the control 82 along the axis X. Eventually, the retaining heads 75 of the first retainers 72 will be received within the recess 86 of the control 82. Further axial movement of control 82 can cause the first retainers 72 to resiliently move toward the axis X, eventually causing the retaining heads 75 to release the walls 36, 43 and to move through the first central opening 48. As such, the first biasing member 74 can push against the first walls 36, 43 of the housing 12 and the inner cylinder 71, thereby biasing the inner cylinder 71, the outer cylinder 73, and the collection member 18 toward the extended position shown in
It will be noted that as the inner cylinder 71 is biased to the extended position, the first cam member 45 of the housing 12 can cam against the protrusion 78 of the inner cylinder to camingly rotate the inner cylinder 71 about the axis X relative to the outer cylinder 73. As such, the protrusion 78 can move within the track 76 until the protrusion 78 reaches the portion of the track 76 that is parallel to the axis X. As such, this camming motion can cause the outer cylinder 73 to become disengaged from the inner cylinder 71 for purposes that will discussed in greater detail below.
Axial movement of the inner cylinder 71 also subsequently causes the recess 81 of the inner cylinder 71 to receive the second retaining heads 95 of the second portion 66 of the actuator assembly 30. Thus, similar to the first portion 64, the second retaining heads 95 release from the second walls 38, 44, and the second biasing member 96 biases the inner and outer cylinders 90, 92 toward the stop 40 (
In addition, this also causes the abutment member 107 to move toward the third retainer 108 (
Once the third stage 106 is released, the third biasing member 110 biases the third stage 106 away from the plate 109. As a result, the third stage 106 abuts and pushes both the abutment member 107 and the arm 115 along the axis X away from the plate 109. Because both outer cylinders 73, 92 are disengaged from the respective inner cylinders 71, 90, the outer cylinders 73, 92 slide along the axis X and over the first and second biasing members 74, 96. This causes both the collection member 18 and the cutting member 22 to simultaneously move from the extended position (
Moreover, as shown in
It will be appreciated that “ejection” of the hemostatic agent 28 can include a positive force and/or pressure being applied to the hemostatic agent 28 to move the hemostatic agent 28 out of the cannula 21 and such that the hemostatic agent 28 moves relative to the anatomical feature 26 during ejection. It will also be appreciated that “ejection” of the hemostatic agent 28 can include the collection member 18 merely withdrawing from the anatomical feature 26 and leaving the hemostatic agent 28 in a fixed position relative to the anatomical feature 26.
Next, the user can remove the assembly 10 from the patient. The user can then use the handle member 118 as discussed above to extend the collection member 18 out of the cutting member 22 in order to remove the tissue sample located in the collection recess 20.
Accordingly, the assembly 10 allows biopsy procedures to be performed conveniently and accurately. In addition, the hemostatic agent 28 can be shielded within the collection member 18 as the biopsy is collected and cut from the patient. Furthermore, the hemostatic agent 28 can be automatically inserted into the void created by the collection member 18 and cutting member 22 after the collection member 18 and cutting member 22 are retracted and withdrawn from the anatomical feature 26. Accordingly, the hemostatic agent 28 can be conveniently and accurately positioned within the anatomical feature 26, and excessive bleeding is unlikely to occur.
Referring now to
As shown in
The first portion 264 can include a first stage 270, a first retainer 272, and a first biasing member 274 (
The third portion 268 can include a third stage 306, a third retainer 308, and a third biasing member 310 (
In the first position shown in
Moreover, the ejection device 232 includes a head member 515 that is slidingly disposed within the first stage 270 (
Assuming the assembly 210 is in the position shown in
Subsequently, the first stage 270 releases the second retainer 294 similar to the embodiments of
Eventually, the second stage 288 releases the third retainer 308 from the first projections 511, thereby allowing the third biasing member 310 to bias the third stage 306 along the axis X relative to the housing 212 (
Because the clips 517 of the head 515 have previously engaged the projections 519, the head 515 and the ram rod 523 remains in a fixed position relative to the housing 212 as the collection member 218 retracts. Accordingly, the ram rod 523 ejects the hemostatic agent 228 from the collection member 218 as the collection member 218 retracts.
It will be appreciated that the biopsy device assembly 10, 210 can be modified in various ways. For instance, in some embodiments, the assembly 10, 210 can include a plurality of independent biopsy devices 17, 217 that are each independently actuated by the actuator assembly 30, 230. The control 82, 282 can be configured to allow the user to select which of the biopsy devices 17, 217 to actuate at selected times. Also, the actuator assembly 30, 230 (e.g., via a ratcheting system) to sequentially move each of these biopsy devices 17, 217 into and out of engagement with the first and second portions 64, 264, 66, 268 for sequentially performing the biopsies.
Moreover, the assembly 10, 210 can be configured such that the biopsy device 17, 217 is detachably connected to the other portions of the assembly 10, 210. For instance, the user may wish to detach the biopsy device 17, 217 from the assembly 10, 210 after an initial biopsy procedure and may wish to attach a fresh biopsy device 17, 217 to the assembly 10, 210 to perform a subsequent biopsy procedure.
Still further, the assembly 10, 210 may be configured to allow the user to load and reload the hemostatic agent 28, 228. In some embodiments, the biopsy device 17, 217 may be manufactured and marketed with the hemostatic agent 28, 228 preloaded therein, and after an initial biopsy procedure, the user can reload a fresh hemostatic agent 28, 228 within the same biopsy device 17, 217.
The foregoing description of the embodiments has been provided for purposes of illustration and description. It is not intended to be exhaustive or to limit the invention. Individual elements or features of a particular embodiment are generally not limited to that particular embodiment, but, where applicable, are interchangeable and can be used in a selected embodiment, even if not specifically shown or described. The same may also be varied in many ways. Such variations are not to be regarded as a departure from the invention, and all such modifications are intended to be included within the scope of the invention.
Example embodiments are provided so that this disclosure will be thorough, and will fully convey the scope to those who are skilled in the art. Numerous specific details are set forth such as examples of specific components, devices, and methods, to provide a thorough understanding of embodiments of the present disclosure. It will be apparent to those skilled in the art that specific details need not be employed, that example embodiments may be embodied in many different forms and that neither should be construed to limit the scope of the disclosure. In some example embodiments, well-known processes, well-known device structures, and well-known technologies are not described in detail.
The terminology used herein is for the purpose of describing particular example embodiments only and is not intended to be limiting. As used herein, the singular forms “a”, “an” and “the” may be intended to include the plural forms as well, unless the context clearly indicates otherwise. The terms “comprises,” “comprising,” “including,” and “having,” are inclusive and therefore specify the presence of stated features, integers, steps, operations, elements, and/or components, but do not preclude the presence or addition of one or more other features, integers, steps, operations, elements, components, and/or groups thereof. The method steps, processes, and operations described herein are not to be construed as necessarily requiring their performance in the particular order discussed or illustrated, unless specifically identified as an order of performance. It is also to be understood that additional or alternative steps may be employed.
When an element or layer is referred to as being “on”, “engaged to”, “connected to” or “coupled to” another element or layer, it may be directly on, engaged, connected or coupled to the other element or layer, or intervening elements or layers may be present. In contrast, when an element is referred to as being “directly on,” “directly engaged to”, “directly connected to” or “directly coupled to” another element or layer, there may be no intervening elements or layers present. Other words used to describe the relationship between elements should be interpreted in a like fashion (e.g., “between” versus “directly between,” “adjacent” versus “directly adjacent,” etc.). As used herein, the term “and/or” includes any and all combinations of one or more of the associated listed items.
Although the terms first, second, third, etc. may be used herein to describe various elements, components, regions, layers and/or sections, these elements, components, regions, layers and/or sections should not be limited by these terms. These terms may be only used to distinguish one element, component, region, layer or section from another region, layer or section. Terms such as “first,” “second,” and other numerical terms when used herein do not imply a sequence or order unless clearly indicated by the context. Thus, a first element, component, region, layer or section discussed below could be termed a second element, component, region, layer or section without departing from the teachings of the example embodiments.
Spatially relative terms, such as “inner,” “outer,” “beneath”, “below”, “lower”, “above”, “upper” and the like, may be used herein for ease of description to describe one element or feature's relationship to another element(s) or feature(s) as illustrated in the figures. Spatially relative terms may be intended to encompass different orientations of the device in use or operation in addition to the orientation depicted in the figures. For example, if the device in the figures is turned over, elements described as “below” or “beneath” other elements or features would then be oriented “above” the other elements or features. Thus, the example term “below” can encompass both an orientation of above and below. The device may be otherwise oriented (rotated 90 degrees or at other orientations) and the spatially relative descriptors used herein interpreted accordingly.
This application claims the benefit of U.S. Provisional Application No. 61/200,787, filed on Dec. 3, 2008, the entire disclosure of which is incorporated herein by reference.
This invention was made with government support under DK062848 awarded by the National Institutes of Health. The government has certain rights in the invention.
Filing Document | Filing Date | Country | Kind | 371c Date |
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PCT/US09/66578 | 12/3/2009 | WO | 00 | 5/26/2011 |
Number | Date | Country | |
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61200787 | Dec 2008 | US |