The present invention relates generally to medical devices, systems, and methods, and more particularly, to a surgical introducer with a window for surgical instrumentation to treat various disorders such as disorders of the paranasal sinuses, ears, nose, and/or throat (ENT).
Image-guided surgical techniques and devices were developed for neurosurgery and have now been adapted for use in certain ear, nose and throat surgeries, including sinus surgeries. See, Kingdom T. T., Orlandi R. R., Image-Guided Surgery of the Sinuses: Current Technology and Applications, Otolaryngol. Clin. North Am. 37(2):381-400 (April 2004). Generally, image-guided surgery involves obtaining images prior to surgery and then using the images to help the surgeon perform the surgery. Often, during the course of image guided surgery, electromagnetic sensors/tracking systems and/or radiofrequency electromagnetic sensors (e.g., electromagnetic coils) are placed on the surgical instruments and on a localizer frame worn by the patient.
U.S. Patent Application Publication No. 20090216196 to Drontle et al. discloses an apparatus and method for accessing a sinus cavity. Drontle does not disclose a unitary, single lumen or a window (e.g., a side-slit) feature and lacks a built-in imaging system (e.g., one or more cameras).
U.S. Pat. No. 6,527,704 to Chang et al. discloses an endoscopic camera system integrated with a trocar sleeve, having a side groove that channels devices parallel to the catheter. The present disclosure describes a different structure, a window (e.g. a side-slit) which channels devices perpendicular to the body of the device.
U.S. Patent Application Publication No. 2015/0141755 to Tesar discloses surgical visualization systems. Tesar discloses a plurality of cameras, but does not disclose the placement of at least two cameras in specific positions.
Osteotomy is a surgical procedure that is performed to treat (e.g., cut, reshape, excise, or otherwise alter) tissue (e.g. bone), to repair a damaged joint, or to shorten or lengthen a bone (e.g., to change alignment of the bone). Osteotomy systems typically include several standalone devices that perform different functions including, for example, cauterization, irrigation, aspiration, cutting, and imaging, among others, which are generally used in pairs and occasionally in threes. Imaging during an osteotomy procedure conventionally includes the use of external sensors with tagged instruments and/or image-collection, either prior to or during the surgical procedure. For example, a separate instrument supporting one or more imaging devices is often inserted into the patient to allow images of the target area to be captured during the course of the osteotomy procedure.
The lack of osteotomy devices that provide built-in irrigation and/or aspiration systems requires the insertion and removal of separate systems, which not only delays the surgical procedure, but results in movement of the sensor(s) mounted on proximal portions of the instruments (e.g., on the handpiece) to be moved away from the target area and, thus, a reduction in the accuracy of the information provided by the sensor(s). The use of multiple, separate systems also increases the overall amount of anatomical space required, resulting in a more invasive patient experience that often requires the administration of general anesthesia, particular in the context of sinus surgery and other ENT procedures.
The present disclosure addresses this shortcoming, among others, and describes minimally invasive systems, devices, and surgical procedures that may not only eliminate the need for general anesthesia (and the associated risks), but reduce the complexity, time, and overall cost of the surgical procedures, as well as any iatrogenic impact and the patient's recovery time. By reducing invasiveness and obviating the need for general anesthesia, it is envisioned that the surgical procedures described herein may be performed in an office setting, rather than in a hospital operating room or other such surgical theater. While select balloon sinuplasty procedures are sometimes performed in such (nonhospital) settings, these procedures are less effective at relieving symptoms and carry an elevated risk of recurrent symptomatic sinus blockages and/or infections.
The systems, devices, and surgical procedures described herein also protect (shield) the collateral tissue adjacent to (surrounding) the tissue that is the target of the surgical procedure to reduce (if not entirely eliminate) any iatrogenic impact on the collateral tissue that may otherwise result during treatment (e.g., cutting, reshaping, excision, or other such alteration of the target tissue). While systems, devices, and surgical procedures are known that offer some protection of collateral tissue, the techniques used to shield collateral tissue are often cumbersome and employ devices which are not only difficult to position, but tend to migrate out of position, which can cause tissue irritation and other complications.
The present disclosure describes various systems, devices, and methods that find wide applicability in a variety of minimally invasive surgical procedures, particularly in the context of osteotomies, sinus procedures, and other ENT procedures. The systems and devices described herein include an elongated member (e.g., an introducer, a sheath, or the like) that facilitates the introduction of various medical instruments therethrough (e.g., a tissue cutter, an imaging device, a cauterization device, an aspiration device, and/or an irrigation device) to a surgical site to treat (e.g., cut, reshape, excise, or otherwise alter) target tissue. The systems and devices described herein facilitate the simultaneous treatment, irrigation, and aspiration of the target tissue while providing live, visual information to the clinician by integrating multifunctionality into a single system (device). The target tissue can include for example bone, soft tissue, calcified tissue, mucosa, etc.
In one aspect of the present disclosure, an osteotomy device is described that includes an integrated imaging system (e.g., one or more imaging devices that are supported on or are movable through the osteotomy device) and a window defining a recessed treatment area (chamber) that is configured to receive (accommodate) the target tissue to thereby shield and protect the collateral tissue and reduce (if not entirely prevent) any iatrogenic impact on the collateral tissue that may otherwise result during treatment of the target tissue. To increase control and/or accuracy during the surgical procedure, it is also envisioned that the systems and devices described herein may be configured for deflection (reconfiguration) to improve navigation through the patient's anatomy (e.g., the patient's sinuses). For example, in various embodiments, it is envisioned that the systems and devices described herein may be malleable (e.g., bendable) and/or steerable.
In another aspect of the present disclosure, an osteotomy system is disclosed for performing a surgical procedure on a patient. The osteotomy system includes an elongated introducer defining a lumen and including a window formed in an outer wall thereof that is in communication with the lumen, a first imaging device that is fixedly supported on the elongated introducer distally of the window, a second imaging device that is fixedly supported on the elongated introducer proximally of the window, and at least one medical instrument that is configured for insertion into the patient through the elongated introducer such that the at least one medical instrument is positionable within the window. The window is configured to receive target tissue such that the target tissue extends into the lumen, whereby the elongated introducer shields collateral tissue from the at least one medical instrument to reduce any unintended effect on the collateral tissue during the surgical procedure.
In certain embodiments, the first imaging device and the second imaging device may be embedded in the outer wall of the elongated introducer.
In certain embodiments, the at least one medical instrument may include a tissue treatment device (e.g., a tissue cutter, a drill, etc.) that is configured for insertion through the lumen of the elongated introducer and into the window to facilitate treatment of the target tissue when the target tissue is positioned within the window.
In certain embodiments, the at least one medical instrument may further include an aspiration system that extends into the patient through the elongated introducer such that the aspiration system is integrated into the elongated introducer.
In certain embodiments, the at least one medical instrument may further include an irrigation system that extends into the patient through the elongated introducer such that the irrigation system is integrated into the elongated introducer.
In certain embodiments, the at least one medical instrument may further include a cauterization system that extends into the patient through the elongated introducer such that the cauterization system is integrated into the elongated introducer.
In certain embodiments, the osteotomy system may further include a handle that is connected to the elongated introducer.
In certain embodiments, the handle may be fixedly connected to the elongated introducer.
In certain embodiments, the handle may be configured for disconnection from and reconnection to the elongated introducer.
In certain embodiments, the handle may include a first port that is configured to receive the aspiration system such that the aspiration system extends into the elongate introducer through the first port, a second port that is configured to receive the irrigation system such that the irrigation system extends into the elongate introducer through the second port, and a third port that is configured to receive the cauterization system such that the cauterization system extends into the elongate introducer through the third port.
In certain embodiments, the elongated introducer may define a transverse cross-sectional dimension (e.g., a diameter) that is (generally) uniform between the proximal and distal ends of the elongated introducer.
In certain embodiments, a second medical instrument is configured for insertion into the patient through the elongated introducer such that the second medical instrument is extendable distal of a distal end hole of the introducer and visualized by the first imaging device.
In another aspect of the present disclosure, an osteotomy system is disclosed for use in performing a surgical procedure on a patient. The osteotomy system includes an elongated introducer, a first imaging device, a second imaging device, and at least one medical instrument. The elongated introducer includes a window that is configured to receive target tissue such that the target tissue extends into the elongated introducer and a visualization port that is located proximally of the window. The first imaging device is positioned adjacent to the visualization port such that the target tissue is viewable through the visualization port via the first imaging device and the second imaging device is positioned distally of the window. The at least one medical instrument is configured for insertion into the patient through the elongated introducer such that the at least one medical instrument is positionable within the window. The window is configured to receive the target tissue such that the target tissue extends into the elongated introducer, whereby the elongated introducer shields collateral tissue adjacent to the target tissue from the at least one medical instrument to reduce any unintended effect on the collateral tissue during the surgical procedure.
In certain embodiments, the first imaging device may extend through the visualization port such that the first imaging device protrudes laterally from the elongated introducer.
In certain embodiments, the first imaging device and the second imaging device may be embedded in an outer wall of the elongated introducer.
In certain embodiments, the elongated introducer may include a primary lumen, a first ancillary lumen that is discrete from the primary lumen, a second ancillary lumen that is discrete from the primary lumen and the first ancillary lumen, and a third ancillary lumen that is discrete from the primary lumen, the first ancillary lumen, and the second ancillary lumen.
In certain embodiments, the osteotomy system may further include a tissue treatment device (e.g., a tissue cutter, a drill, etc.) that is configured for insertion into the primary lumen such that the tissue treatment device is positionable within the window to treat the target tissue, an irrigation system that extends through the first ancillary lumen such that the irrigation system is integrated into the elongated introducer, e.g., built into the wall, an aspiration system that extends through the second ancillary lumen such that the aspiration system is integrated into the elongated introducer, and a cauterization system that extends through the third ancillary lumen such that the cauterization system is integrated into the elongated introducer.
In certain embodiments, the osteotomy system may further include a handle that is connected to the elongated introducer (either fixedly or releasably such that the handle is disconnectable from and reconnectable to the elongated introducer).
In certain embodiments, the handle may include a first port that is configured to receive the irrigation system such that the irrigation system extends into the elongated introducer through the first port, a second port that is configured to receive the aspiration system such that the aspiration system extends into the elongated introducer through the second port, and a third port that is configured to receive the cauterization system such that the cauterization system extends into the elongated introducer through the third port.
In another aspect of the present disclosure, a method of performing an osteotomy procedure on a patient's sinuses is disclosed that includes inserting an elongated introducer defining a window that is configured to receive target tissue into the patient's sinuses, visualizing tissue using an imaging device that extends through the elongated introducer and is positioned proximally of the window, inserting a tissue treatment device into the patient's sinuses through the elongated introducer such that the tissue treatment device is positioned within the window, positioning the elongated introducer such that the target tissue is received within the window and extends into the elongated introducer to thereby shield collateral tissue from the tissue treatment device to reduce any unintended effect on the collateral tissue during the osteotomy procedure, and altering the target tissue using the tissue treatment device.
In some embodiments, the method allows safe minimally invasive permanent expansion of a paranasal sinus (such as the maxillary sinus) by removing bone and mucosa around the ostium to enlarge it.
In certain embodiments, the method may further include inserting an irrigation system into the patient's sinuses through the elongated introducer such that the irrigation system extends into the window.
In certain embodiments, the method may further include inserting an aspiration system into the patient's sinuses through the elongated introducer such that the aspiration system extends into the window.
In certain embodiments, the method may further include simultaneously applying irrigation and aspiration during alteration of the target tissue via the tissue treatment device.
The present disclosure will be better understood, and objects other than those set forth above will become apparent when, consideration is given to the detailed description and the drawings.
Referring now to the drawings, wherein like reference characters identify similar structural components and features, various embodiments of the present disclosure will be described. As used herein, the term “proximal” should be understood as referring to that portion or section of the pertinent structure that is closer to the user during proper use and the term “distal” should be understood as referring to that portion or section of the pertinent structure that is further from to the user during proper use. Additionally, the terms “apparatus,” “instrument,” “device,” and “system” (and variations thereof), and the terms “hole,” “aperture,” and “opening” (and variations thereof) may be used interchangeably herein.
With reference to
The tubular body 104 includes a proximal opening (end hole) 110 (e.g., located outside the patient's body), a distal opening (end hole) 112 (e.g., located within the patient's body), and one or more lumens 114 (
In the particular embodiment seen in
Advancing the medical instrument(s) 200 to the surgical site S through the tubular body 104, as opposed to externally of the osteotomy device 100, allows for the elimination of external systems or devices. The elimination of external systems and devices lessens the space required by the surgical system 10 and allows the surgical procedure to be conducted in a minimally invasive manner that reduces any iatrogenic impact on the patient and, thus, the patient's recovery time, while simplifying the surgical procedure by confining the medical instrument(s) to a smaller, more efficient operative space within the tubular body 104. Advancing the medical instrument(s) 200 through the tubular body 104 also protects the medical instrument(s) 200 from the patient's anatomy, blockages, debris, etc., that may otherwise damage the medical instrument(s) 200 (e.g., imaging devices or other such sensitive or delicate components) and guides the medical instrument(s) 200 so as to achieve and/or maintain the medical instrument(s) 200 in a particular orientation.
The tubular body 104 may include any suitable biocompatible material or combination of materials. For example, it is envisioned that the tubular body 104 may include (e.g., may be formed partially or entirely from) one or more metallic materials, plastic materials, polymeric materials, composite materials, etc. It is envisioned that the tubular body 104 may be flexible and/or resilient in construction to facilitate the navigation of various cavities and/or channels in the patient's anatomy (e.g., the patient's sinuses) and access to the target tissue T. To assist insertion and advancement of the tubular body 104 through the patient's body and further inhibit (if not entirely prevent) irritation and/or damage to the patient and/or the medical instrument(s) 200, it is envisioned that the tubular body 104 may include a protective outer coating 116 (e.g., a hydrogel or the like) on an outer surface 118 thereof. In such embodiments, it is envisioned that the coating 116 may extend along a portion of the axial length L of the tubular body 104 or along the entirety of the axial length L.
In the particular embodiment illustrated, the tubular body 104 includes a non-linear configuration having a (pre-formed) curvature that defines an inner curved surface 120 and an outer curved surface 122. Embodiments of the tubular body 104 including a (generally) linear configuration devoid of any pre-formed curvature, however, are also envisioned herein.
The tubular body 104 includes an outer wall 124 with a window 126 (
Depending upon the particular context of the surgical procedure, the patient's anatomy, the configuration of the target tissue T, the location of the target tissue T, etc., it is envisioned that the window 126 (and the treatment area 128) may include any suitable configuration. For example, it is envisioned that the window 126 be configured as a side hole, an opening, an aperture, a side slit, a cutout, or the like. Additionally, although envisioned as including a (generally) annular (e.g., circular) cross-sectional configuration, it should be appreciated that the particular geometrical configuration of the window 126 may be varied without departing from the scope of the present disclosure. For example, it is envisioned that the window 126 may including a cross-sectional configuration that is (generally) rectangular, (generally) square, (generally) elliptical, (generally) linear, etc.
As seen in
The window 126 extends into the tubular body 104 so as to define a proximal end wall 130, an (opposing) distal end wall 132, and an inner wall 134 that extends between the end walls 130, 132. More specifically, in the particular embodiment of the osteotomy device 100 seen in
To allow for extension of the medical instrument(s) 200 into the window 126, the proximal end wall 130 and/or the inner wall 134 defines one or more openings 136 that are in communication with the lumen(s) 114, which allows the medical instrument(s) 200 to extend through the lumen(s) 114 and into the window 126 (via the opening(s) 136) to access the treatment area 128. In the particular embodiment illustrated, the distal end wall 132 is closed (e.g., devoid of any openings 136), which provides an operative (bracing) surface that supports the target tissue T and limits continued distal advancement of the medical instrument(s) 200. Embodiments in which the distal end wall 132 may define one or more openings 136, however, are also contemplated herein.
In certain embodiments of the disclosure, it is envisioned that the osteotomy device 100 may include a door 138 (or other such covering) that is configured to close the window 126 and thereby conceal the treatment area 128, as seen in
In certain embodiments, such as that seen in
It is envisioned that the handle 140 may be fixedly (e.g., non-removably) connected to the tubular body 104 or, alternatively, that the handle 140 may be releasably (removably, detachably) connected to the tubular body 104. For example, it is envisioned that certain medical instruments 200 may include a handle similar (or identical) in structure and/or function to the handle 140. In such embodiments and methods of use, the handle 140 may be omitted or removed from the tubular body 104 to eliminate redundancy and simplify the surgical system 10.
The handle includes a series of ports 142 that are configured for connection to and/or the receipt of one or more medical instruments 200. For example, in the particular embodiment illustrated, the handle 140 includes a (first) port 142i, a (second) port 142ii, and a (third) port 142iii. Depending upon the specific intended use of the surgical system 10, however, it should be appreciated that the number of ports 142 may be increased or decreased to support a wide variety of functionality. It is also envisioned that some or all of the ports 142 may be utilized during a given procedure and that the ports 142 may each be configured to accommodate more than one medical instrument 200, thereby allowing for a reduction in the overall size of the handle 140. One or more of the ports could alternatively be positioned at the proximal opening of the tubular body 104. The handle and/or ports could alternatively be longitudinally aligned with the proximal opening 110 rather than laterally positioned as shown in
With continued reference to
More specifically, in the illustrated embodiment, the imaging system 300 includes a (first, proximal) imaging device 302 that is supported proximally of the window 126 and a (second, distal) imaging device 304 that is supported at (e.g., adjacent to, inside) the distal opening 112 to facilitate forward visualization during the surgical procedure (e.g., to guide the osteotomy device 100 during insertion and advancement towards the target tissue T). Although generally illustrated and described as endoscopic cameras throughout the present disclosure, it should be appreciated that the imaging devices 302, 304 may be configured in any manner suitable for the intended purpose of capturing images, video, or other such data. For example, in various embodiments, it is envisioned that the imaging devices 302, 304 may be configured to capture high-definition images and/or video, three-dimensional images and/or video, etc.
The imaging device 302 is spaced proximally a distance A (
The imaging devices 302, 304 are fixed (e.g., embedded within or otherwise secured to) the tubular body 104 in a manner that inhibits (if not entirely prevents) relative movement between the imaging devices 302, 304 and the tubular body 104. The imaging devices 302, 304, can be independent of the instruments inserted through the tubular body and out of contact with such instruments. Thus, in these embodiments, the instrument positioning and/or movement is independent of the position of the imaging devices 302, 304. Embodiments are also envisioned in which the imaging device 302 and/or the imaging device 304 may be movable in relation to the tubular body 104 (e.g., through the primary lumen 114 (
In the particular embodiment illustrated in
With reference to
In the embodiment seen in
To support functionality of the imaging devices 302, 304, the imaging system 300 may include a variety of additional components. For example, in the particular embodiment seen in
The external image-collection circuit 308 facilitates communication between the image-collection controller 306 and the internal image-collection circuit 310 and extends into the handle 140 (e.g., via the port 142i). In various embodiments of the disclosure, it is envisioned that the external image-collection circuit 308 may be either fixedly or releasably connected to the image-collection controller 306.
The internal image-collection circuit 310 extends through the tubular body 104 (e.g., via the primary lumen 114 (
While the external image-collection circuit 308 and the internal external image-collection circuit 310 are illustrated as being separate, discrete structures in the particular illustrated embodiment seen in
To support and/or enhance the capture of images, video, and other such data at the surgical site S (
It is envisioned that the (electrical) power may be communicated to the light sources 402 in any suitable manner. For example, in one embodiment, it is envisioned that the light sources 402 may be connected to the internal image-collection circuit 310 (
While the imaging devices 302, 304 and the light sources 402 are illustrated as being separate, discrete structures in
It is envisioned that the imaging system 300 and the illumination system 400 may include (or may be connected to) any suitable power source 320 to thereby supply the necessary power to the imaging devices 302, 304 and the light sources 402. For example, it is envisioned that the imaging system 300 may include (or may be connected to) an external battery 322 via the conduit 404 or any suitable transmission media (e.g., one or the image-collection circuits 308, 310 (
With reference again to
The external aspiration tube 504 is in fluid communication with the aspiration controller 502 and extends therefrom into the handle 140 (e.g., via the port 142ii). In various embodiments of the disclosure, it is envisioned that the external aspiration tube 504 may be either fixedly or releasably connected to the aspiration controller 502. The internal aspiration tube 506 is in fluid communication with external aspiration tube 504 (e.g., via the port 142ii) and extends into the handle 140 and through the tubular body 104 (e.g., via the primary lumen 114 or one of the aforementioned ancillary lumens), thereby integrating the aspiration system 500 into the osteotomy device 100. More specifically, the internal aspiration tube 506 is configured such that a distal end 508 thereof extends into the window 126 to facilitate the application of aspiration to the target tissue T (
While the external aspiration tube 504 and the internal aspiration tube 506 are illustrated as being separate, discrete structures in the particular illustrated embodiment seen in
With reference to
To support operation of the cautery device 800, the cauterization system 600 includes a cauterization-communication controller 602 and one or more cauterization-communication circuits. In the particular embodiment illustrated, for example, the cauterization system 600 includes an external cauterization-communication circuit 604 and an internal cauterization-communication circuit 606 that is in (electrical) communication the external cauterization-communication circuit 604. The external cauterization-communication circuit 604 is in (electrical) communication with the cauterization-communication controller 602 and extends therefrom into the handle 140 (e.g., via the port 142i). The internal cauterization-communication circuit 606 is in (electrical) communication with the external cauterization-communication circuit 604 and extends into the handle 140 and through the tubular body 104 (e.g., via the primary lumen 114 or one of the aforementioned ancillary lumens), thereby integrating the cauterization system 600 into the osteotomy device 100. More specifically, in the particular embodiment illustrated in
To facilitate the communication of energy to the distal end 802 of the cautery device 800, in certain embodiments, it is envisioned that the tubular body 104 may include non-insulated sections or components that terminate at various locations at, within, or adjacent to the window 126. It is also envisioned that the non-insulated sections or components may terminate at various locations at or adjacent to the distal opening 112.
While the external cauterization-communication circuit 604 and the internal cauterization-communication circuit 606 are illustrated as being separate, discrete structures in the particular illustrated embodiment seen in
It is envisioned that the cautery device 800 may be inserted into the tubular body 104 through the handle 140 (e.g., via the port 142i) such that the cautery device 800 is electrically connectable to an external power source 804 (e.g., via electrical wiring extending through the handle 140). Alternatively, it is envisioned that the cautery device 800 may be connected to the power source 320 (
In another embodiment of the disclosure, it is envisioned that the cautery device 800 may be configured for insertion into the tubular body 104 through the proximal opening 110 and connected to either the external power source 804 (e.g., via electrical wiring extending from the tubular body 104) or to the power source 320 (
With reference to
The external irrigation tube 904 is in fluid communication with the irrigation controller 902 and extends therefrom into the handle 140 (e.g., via the port 142iii). In various embodiments of the disclosure, it is envisioned that the external irrigation tube 904 may be either fixedly or releasably connected to the irrigation controller 902. The internal irrigation tube 906 is in fluid communication with the external irrigation tube 904 (e.g., via the port 142iii) and extends into the handle 140 and through the tubular body 104 (e.g., via the primary lumen 114 or one of the aforementioned ancillary lumens), thereby integrating the irrigation system 900 into the osteotomy device 100. More specifically, in the particular embodiment illustrated in
It is envisioned that the irrigation system 900 may include (or may be connected to) a source of fluid 910. For example, in the illustrated embodiment, the irrigation system 900 is connected to the source of fluid 910 by a fluid conduit 912 that extends between the source of fluid 910 and the irrigation controller 902. Alternatively, it is envisioned that the fluid conduit 912 may extend between the source of fluid 910 and the port 142iii. It is also envisioned that the source of fluid 910 may be in fluid communication with one of the aforementioned ancillary lumens extending through the tubular body 104 or, alternatively, that an additional irrigation tube (not shown) may be provided within the tubular body 104.
With reference now to
In the particular embodiment illustrated in
The distal end 1006 includes (integrated) imaging devices 1014, 1016 (e.g., endoscopic cameras) as well as an end effector 1018 and a series of openings 1020. More specifically, the distal end 1006 includes one or more (first) openings 1022 and one or more (second) openings 1024.
The imaging devices 1014, 1016 are similar (or identical) to the imaging devices 302, 304 (
To support imaging, the imaging devices 1014, 1016 may be connected to any suitable transmission media 1026. In the particular embodiment seen in
During use, the tissue cutter 1000 is advanced through the tubular body 104 (
To facilitate operation of the end effector 1018, the tissue cutter 1000 includes a (first, upper) element 1032 that extends from (e.g., is connected to) the handle element 1008 and a (second, lower) element 1034 that extends from (e.g., is connected to) the handle element 1010 such that actuation of the handle 1004 causes relative axial (longitudinal) movement (e.g., sliding) of the elements 1032, 1034 along an interface 1036. More specifically, upon closure of the handle 1004 (e.g., approximation of the handle elements 1008, 1010), the element 1034 is retracted (relative to the element 1032), whereby respective distal ends 1038, 1040 of the elements 1032, 1034 are approximated to thereby act upon (e.g., cut) the target tissue T (
In certain embodiments, such as that seen in
In the particular embodiment illustrated, to support additional functionality, the tissue cutter 1000 includes the aforementioned ports 142 discussed in connection with the handle 140 (
The port 142i is configured to receive one or more conductive elements 1046 that extend from a power source 1048 to the end effector 1018 to thereby energize the end effector 1018 and facilitate cauterization of the target tissue T (
The port 142ii is configured for connection to an aspiration source 1050 to apply aspiration to the target tissue T (
The port 142iii is configured for connection to an irrigation source 1052 to provide irrigation fluid to the target tissue T (
In various embodiments of the disclosure, it is envisioned that certain functionality may be allocated between the osteotomy device 100 and the tissue cutter 1000. For example, it is envisioned that the cutting and cauterization may be performed by the tissue cutter 1000 while irrigation and aspiration may be performed by the osteotomy device 100. It is also envisioned that the osteotomy device 100 and the tissue cutter 1000 may include common (e.g., overlapping) functionality. For example, it is envisioned that visualization, irrigation, and/or aspiration may be performed by both the osteotomy device 100 and the tissue cutter 1000 during the course of the surgical procedure. To support robust functionality of the surgical system 10, it is thus envisioned that the ports 142 may be provided on the osteotomy device 100 and/or the tissue cutter 1000.
With reference now to
In the particular embodiment and method illustrated, the bone cutter 1100 is shown with the aforementioned cauterization system 600, each of which extends through the tubular body 104 (e.g., via the lumen 114 (
During treatment of the target tissue T, the collateral tissue C is shielded (protected) from the bone cutter 1100 and the cauterization system 600 by the tubular body 104 of the osteotomy device 100 via confinement of the applied treatment to the treatment area 128 defined by the window 126. During treatment, the target tissue T is monitored by the imaging device 302 located proximally of the window 126 and distal sections of the tissues are monitored by the imaging device 304. The tissue being treated, e.g., cut, is shielded with the window (slit/recessed region) which receives a tip of the cutting or other treatment instrument. The tip of the instrument is also shielded within the window 126. The treatment, e.g., drilling, is thus in a narrow area as the slit (window) protects surrounding tissue.
In the particular embodiment illustrated, the distal end 1202 of the bone drill 1200 extends into the window 126 through an opening 136 that is positioned so as to (generally) bisect the inner wall 134. It should be appreciated, however, that the particular location of the opening 136 may be varied without departing from the scope of the present disclosure. For example, it is envisioned that the opening 136 may be located along the inner wall 134 such that the distance defined between the opening 136 and the proximal end wall 130 is less than or greater than the distance defined between the opening 136 and the distal end wall 132. In additional embodiments, it is also envisioned that the opening 136 through which the distal end 1202 of the bone drill 1200 extends may instead be formed in the proximal end wall 130 defined by the window 126.
In the particular embodiment illustrated, the bone drill 1200 is connected to (in communication with) a controller 1204 that is configured to regulate operation (e.g., power, speed, mode, etc.) of the bone drill 1200. Alternatively, however, it envisioned that the controller 1204 may be omitted and that the bone drill 1200 may be configured for manual operation.
With general reference now to
Initially, the osteotomy device 100 is inserted into the patient's sinuses and is advanced towards the surgical site S (
Thereafter, one or more of the medical instruments 200 (e.g., the tissue treatment device 700) may be utilized to either directly treat the target tissue T or support treatment of the target tissue T. For example, in the particular embodiment illustrated, the bone cutter 1100 and the bone drill 1200 are inserted into the tubular body 104 via the proximal opening 110 and the aspiration system 500 and the irrigation system 900 are inserted into the tubular body 104 through the handle 140 via the ports 70 and 80, respectively. It should be appreciated, however, that dependent upon the particular surgical procedure being performed, one or more of the bone cutter 1100, the bone drill 1200, the aspiration system 500, and the irrigation system 900 may be omitted and/or replaced by one or more other medical instruments 200. For example, in certain surgical procedures, it is envisioned that the bone cutter 1100 and/or the bone drill 1200 may be replaced with or supplemented by the cauterization system 600 (
Following insertion into the tubular body 104, the medical instruments 200 are advanced through the primary lumen 114 towards the window 126 and the target tissue T. More specifically, in the illustrated embodiment, the bone cutter 1100, the bone drill 1200, and the irrigation system 900 are advanced through the tubular body 104 and into the treatment area 128 through corresponding openings 136i, 136ii, 136iii formed in the proximal end wall 130 of the window 126 and the aspiration system 500 is advanced through the tubular body 104 and into the treatment area 128 through an opening 136iv formed in the inner wall 134 of the window 126, thus integrating the bone cutter 1100, the bone drill 1200, the irrigation system 900, and the aspiration system 500 into the osteotomy device 100.
As indicated above, it is envisioned that one or more of the medical instruments 200 (e.g., the aspiration system 500 and/or the irrigation system 900) may be fixedly (e.g., non-removably) integrated into the osteotomy device 100, thereby obviating any need for insertion and advancement of the medical instruments 200 in such embodiments during the surgical procedure.
During treatment (alteration) of the target tissue T (
Following treatment of the target tissue T, each of the medical instruments 200 (e.g., the bone drill 1200, the bone cutter 1100, the irrigation system 900, and the aspiration system 500) can be deactivated. In those embodiments of the disclosure in which the medical instrument(s) 200 are removably integrated into the osteotomy device 100, the medical instrument(s) 200 can be then be withdrawn and removed from the tubular body 104 and the osteotomy device 100 can be withdrawn and removed from the patient.
To facilitate access to various locations within the patient's sinuses or other surgical site S (e.g., a blood vessel, etc.) and/or anchoring (bracing) of the osteotomy device 100 within the patient, it is envisioned that the osteotomy device 100 and the medical instrument(s) 200 (e.g., the tissue treatment device 700) may be configured for deflection (reconfiguration). For example, it is envisioned that the osteotomy device 100 and the medical instrument(s) 200 (e.g., the tissue treatment device 700) may include (e.g., may be formed partially or entirely from) one or more flexible (e.g., malleable, bendable, and/or resilient) materials. For example, the treatment devices, e.g., the drills can be malleable to go around the curve of the introducer. Additionally, or alternatively, it is envisioned that the osteotomy device 100 and the medical instrument(s) 200 may be configured for controlled articulation to deflect one or more segments (sections) thereof. For example,
In the particular embodiment illustrated, the osteotomy device 100 includes a first inactive segment 148i; a first active segment 150i that is located distally of the segment 148i; a second inactive segment 148ii that is located distally of the segment 150i; and a second active segment 150ii that is located distally of the segment 148ii. Thus, in the particular embodiment illustrated, the inactive segments 148 and the active segments 150 are arranged in a staggered pattern in which the tubular body 104 alternates between inactive segments 148 and active segments 150. It should be appreciated, however, that the particular arrangement of the inactive segments 148 and active segments 150 may be varied without departing from the scope of the present disclosure. For example, embodiments are also envisioned in which the tubular body 104 may include two or more inactive segments 148 or active segments 150 that are arranged in successive (e.g., adjacent) relation.
In the particular embodiment shown, each active segment 150 is connected to a corresponding (single) pull wire 152 that extends through (e.g., within) the outer wall 124 of the tubular body 104 such that the number of pull wires 152 corresponds to the number of active segments 150. More specifically, the osteotomy device 100 includes a first pull wire 152i that is connected to the first active segment 150i and a second pull wire 152ii that is connected to the second active segment 150ii. Upon the application of an axial (pulling) force to each of the pull wires 152, the corresponding active segment 150 is deflected (articulated) to thereby reconfigure (actively steer) the osteotomy device 100 between a first (initial, normal) configuration (
In the particular embodiment illustrated, the tubular body 104 includes one or more ancillary lumens 114a that are configured to receive the pull wires 152. The ancillary lumen(s) 114a are discrete from the primary lumen 114 and extend within the outer wall 124 such that the pull wires 152 are embedded within and are integrated into the tubular body 104. Although shown as including a single ancillary lumen 114a in the embodiment illustrated in
While the ancillary lumen 114a is illustrated as including a (generally) linear configuration that extends in (generally) parallel relation to the primary lumen 114 in the particular embodiment seen in
To facilitate the application of axial force to the pull wires 152, in certain embodiments, the osteotomy device 100 may include (or may be connected to) a plurality of corresponding activating mechanisms 154 (e.g., such that the number of pull wires 152 corresponds to the number of activating mechanisms 154). In the particular embodiment illustrated, the osteotomy device 100 includes a (first) activating mechanism 154i that is connected to the pull wire 152i and a (second) activating mechanism 154ii that is connected to the pull wire 152ii. The activating mechanisms 154 may include any structure or mechanism suitable for the intended purpose of applying the axial force to the pull wires 152 required to deflect the tubular body 104 as necessary or desired, such as, for example, rotating wheels, pulley systems, or the like. In certain embodiments, it is envisioned that the active segments 150, the pull wires 152, and the activating mechanisms 154 may be configured (and connected) such that each pull wire 152 may be individually acted upon to deflect (steer) the corresponding segment 150 in a single direction only.
The pull wires 152i, 152ii are connected to the segments 150i, 150ii at connection points 156i, 156ii (in addition to the activating mechanism 154i, 154ii), respectively, so as to facilitate reconfiguration of the osteotomy device 100 between the first configuration (
In the particular embodiment illustrated, the connection points 156i, 156ii are shown as being in (general) angular alignment (e.g., along a circumference of the tubular body 104), which facilitates deflection of the segments 150i, 150ii in similar (e.g., identical) directions, as seen in
With reference now to
As mentioned above, it is envisioned that the tubular body 104 may include one or more ancillary lumens 114a that extend in (generally) parallel, discrete relation to the primary lumen 114. Throughout the present disclosure, the primary lumen 114 is illustrated as defining a (first) transverse cross-sectional dimension (e.g., a diameter) Dp and the ancillary lumens 114a are illustrated as defining a (second) transverse cross-sectional dimension (e.g., a diameter) Da that is less than the transverse cross-sectional dimension (e.g., a diameter) Dp, wherein the transverse cross-sectional dimension Da of each ancillary lumen 114a is (approximately) equal. It should be appreciated, however, that the particular transverse cross-sectional dimensions defined by the primary lumen 114 and the ancillary lumens 114a may be altered in various embodiments without departing from the scope of the present disclosure. For example, embodiments are envisioned in which the transverse cross-sectional dimensions Dp, Da may be (approximately) equivalent, as are embodiments in which the transverse cross-sectional dimension Da may exceed the transverse cross-sectional dimension Dp as well as embodiments in which the transverse cross-sectional dimensions Da defined by the ancillary lumens 114a may be unequal.
In the particular embodiment seen in
In the particular embodiment illustrated in
In the particular embodiment illustrated, the ancillary lumens 114ai, 114aii are spaced by an angular distance of (approximately) 90°. It should be appreciated, however, that the particular relative orientation of the ancillary lumens 114ai, 114aii may be varied in alternate embodiments without departing from the scope of the present disclosure. For example, it is envisioned that the ancillary lumens 114ai, 114aii may be spaced by an angular distance of (approximately) 180° such that the ancillary lumens 114ai, 114aii are positioned in (generally) diametric opposition on opposite sides of the primary lumen 114.
The ancillary lumens 114ai, 114aiii extend through the outer wall 124 of the tubular body 104 and respectively terminate in the respective openings 136i, 136ii formed in the proximal end wall 130 defined by the window 126 such that the imaging device 302 extends into the window 126 (and the treatment area 128) through the opening 136i and the cautery wires 608i, 608ii extend into the window 126 (and the treatment area 128) through the opening 136ii. In an alternate embodiment, it is envisioned that the cautery wire 608i may extend into the window 126 through the opening 1136ii and that the cautery wire 608ii may continue distally to the distal opening 112. The cautery wires can be built into the wall of the introducer in some embodiments.
In the particular embodiment illustrated, the ancillary lumens 114ai, 114aiii are spaced from the ancillary lumen 114aii by an angular distance of (approximately) 180° such that the ancillary lumens 114ai, 114aiii and the ancillary lumen 114aii are positioned in (generally) diametric opposition on opposite sides of the primary lumen 114. It should be appreciated, however, that the particular relative orientation of the ancillary lumens 114ai, 114aii, 114aiii may be varied in alternate embodiments without departing from the scope of the present disclosure. For example, it is envisioned that one or more of the ancillary lumens 114ai, 114aiii may be spaced from the ancillary lumen 114aii by an angular distance of less than 180° (e.g., (approximately) 90°).
In a variation on the embodiment seen in
While the ancillary lumens 114aiii, 114aiv are illustrated as extending into the window 126 through the proximal end wall 130, it should be appreciated that either or both of the lumens 114aiii, 114aiv may instead extend into the window 126 through the inner wall 134 in alternate embodiments without departing from the scope of the present disclosure.
In the particular embodiment illustrated, the ancillary lumens 114ai-114aiv are spaced from each other by an angular distance of (approximately) 90°. It should be appreciated, however, that the particular relative orientation of the ancillary lumens 114ai-114aiv may be varied in alternate embodiments without departing from the scope of the present disclosure. For example, it is envisioned that the ancillary lumens 114aii, 114aiiv may be spaced from the ancillary lumens 114ai, 114aiii by an angular distance of (approximately) 180°, as seen in
In another embodiment of the disclosure, it envisioned that the irrigation system 900 may include a first internal irrigation tube 906i that extends into the window 126 (e.g., through the proximal end wall 130) and a second internal irrigation tube 906ii that continues distally to the distal opening 112.
It is also envisioned that aspiration may be applied via the proximal opening 110 (
In the particular embodiment illustrated, the ancillary lumens 114ai-114avi are spaced from each other by an (approximately) equal angular distance of (approximately) 60°. It should be appreciated, however, that the particular relative orientation of the ancillary lumens 114ai-114avi may be varied in alternate embodiments without departing from the scope of the present disclosure. For example, it is envisioned that angular spacing between the ancillary lumens 114ai-114avi may be unequal.
In some embodiments, the distal end hole could also allow irrigation and aspiration into the sinus, and biopsy, lesion removal, etc. without the need to remove or reposition the elongated device (introducer). This is facilitated under direct visualization via an imaging device positioned at or near the distal end hole, and one or more of aspiration, irrigation and/or cautery ports, etc. adjacent the distal end hole. Thus, such instruments/devices can be inserted through a distal end hole of the instrument, e.g., distal hole 112, for accessing tissue through the same introducer used to treat tissue at the side window wherein the introducer can remain in position if desired. Such tissue access and treatment at the distal end hole can be in addition or in lieu of the instruments for treatment at the side window. These instruments can each exit through the distal end hole or alternatively or additionally one or more ports can be provided adjacent the distal end of the elongated introducer for exit of one or more of the instruments. The port exit openings can be aligned with the distal end hole or alternatively recessed therefrom or extending distally therefrom. Separate lumens can be provided in some embodiments communicating with respective exit ports.
Where a range of values is provided, it is understood that each intervening value, to the tenth of the unit of the lower limit unless the context clearly dictates otherwise, between the upper and lower limit of that range and any other stated or intervening value in that stated range is encompassed within the scope of the present disclosure. The upper and lower limits of these smaller ranges which may independently be included in the smaller ranges is also encompassed by the scope of the present disclosure, subject to any specifically excluded limit in the stated range. Where the stated range includes one or both of the limits, ranges excluding either both of those included limits are also included within the scope of the present disclosure.
It will be understood that the above particular embodiments are shown and described by way of illustration only. The principles and the features of the present disclosure may be employed in various and numerous embodiments thereof without departing from the scope and spirit of the disclosure as claimed. The above-described embodiments illustrate the scope of the disclosure but do not restrict the scope of the disclosure and it should be understood by those skilled in the art that various changes may be made (and equivalents may be substituted) without departing from the true spirit and scope of the present disclosure. In addition, many modifications may be made to adopt a particular situation, material, composition of matter, process, process step or steps, to the objective spirit and scope of the present disclosure. All such modifications are intended to be within the scope of the claims appended hereto. For example, persons skilled in the art will understand that the elements and features shown or described in connection with one embodiment may be combined with those of another embodiment without departing from the scope of the present disclosure and will appreciate further features and advantages of the presently disclosed subject matter based on the description provided.
Throughout the present disclosure, terms such as “approximately,” “generally,” “substantially,” and the like should be understood to allow for variations in any numerical range or concept with which they are associated. For example, it is intended that the use of terms such as “approximately” and “generally” should be understood to encompass variations on the order of 25% (e.g., to allow for manufacturing tolerances and/or deviations in design).
Although terms such as “first,” “second,” “third,” etc., may be used herein to describe various operations, elements, components, regions, and/or sections, these operations, elements, components, regions, and/or sections should not be limited by the use of these terms in that these terms are used to distinguish one operation, element, component, region, or section from another. Thus, unless expressly stated otherwise, a first operation, element, component, region, or section could be termed a second operation, element, component, region, or section without departing from the scope of the present disclosure.
Additionally, as used herein, the singular forms “a,” “and,” and “the” should be understood to include plural references unless the context clearly dictates otherwise.
Each and every claim is incorporated as further disclosure into the specification and represents embodiments of the present disclosure. Also, the phrases “at least one of A, B, and C” and “A and/or B and/or C” should each be interpreted to include only A, only B, only C, or any combination of A, B, and C.
This application is a continuation-in-part of application Ser. No. 16/602,133, filed Aug. 12, 2019, which is a continuation-in-part of application Ser. No. 16/151,335, filed Oct. 3, 2018. The entire contents of each of these applications are incorporated herein by reference.
Number | Date | Country | |
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Parent | 16602133 | Aug 2019 | US |
Child | 17308133 | US | |
Parent | 16151335 | Oct 2018 | US |
Child | 16602133 | US |