Patent Application
20190247067
This application claims the benefit of priority under 35 U.S.C. § 119 of European Application 18 157 011.0, filed Feb. 15, 2018, the entire contents of which are incorporated herein by reference.
The present invention refers to a tool for a microinvasive surgical instrument and to a microinvasive surgical instrument comprising such tool.
In a typical endoscopic and other microinvasive surgical procedure, a number of different actions or measures are performed consecutively, comprising elevation, grasping or gripping, cutting etc. For these different actions or measures, different tools are used. When changing from a first tool to a second tool, the surgeon typically withdraws a first instrument comprising the first tool and inserts a second instrument comprising the second tool. Each and every change of instrument can cause trauma, consumes time and increases the period of anesthetization for the patient.
Therefore, a number of attempts have been made to develop multifunctional tools and instruments which can carry out multiple tasks and allow performance of a number of different actions or measures without the need of exchange of instrument.
In U.S. Pat. No. 5,456,684, a multifunctional minimally invasive surgical instrument is described. The instrument 10 comprises jaws 18, 20 and a blade 22 slidable between a retracted position within a support tube 14 and an extended cutting position on jaw 18 (column 3, lines 60 through 66, FIGS. 3, 9, 12).
In U.S. Pat. No. 5,984,939, a multifunctional grasping instrument with a cutting member is described. The multifunctional grasping instruments 10 comprises two jaws 18, 20 with laterally opposed inner surfaces 114, 116 at a grasping portion and blades 120, 122 proximally spaced from the grasping surfaces 114, 116 (column 5, lines 48 through 60; FIG. 4).
In US 2007/0179525 A1, a multifunctional tool is described. The multifunctional tool comprises two jaws (paragraph [0024]). The jaws include surfaces that can effectuate grasping or dissecting or surfaces that can effectuate cutting by scissors action. Both jaws 68, 68′ are pivotable about a pivot axis 52, thereby generating a clamping movement (paragraph [0177], FIGS. 17b, 19b). Both jaws 68, 68′ are pivotable about pivot axes 54, 54′ orthogonal to the pivot axis 52 thereby accomplishing scissors action (paragraphs [0179], [0186], FIGS. 17a, 17c).
In WO 2007/120063 A2 (also published as EP 2 160 139 B1), a multifunctional surgical instrument is described. The multifunctional surgical instrument comprises replaceable working parts (page 3, lines 10 through 13). Depending on the shape of the working parts, the multifunctional instrument can be used for different purposes (page 3, lines 24 through 30).
In WO 2014/049543 A2, a multifunctional surgical device is described. The multifunctional surgical device comprises at its distal end a multifunctional tool 000 with a multifaceted jaw 001 (paragraph [036] and FIGS. 1a through 1e). The multifaceted jaw 001 can be rotationally indexed along its longer axis to achieve 2, 3, 4 or more positions. Each indexation or orientation of the jaw 001 couples one of its facet profiles with the complementary surface of a pivotable jaw 004, thus allowing for a different surgical function chosen among grasping, scissoring, dissecting, needle driving.
In US 2013/0006242 A1, an electrosurgical tissue dissecting device 60 is described (title, paragraph [0004]). The device 60 comprises a first jaw 62a, a second jaw 62b and a pivotable electrosurgical blade 64 rotationally joined to the second jaw 62b (paragraph [0060], FIGS. 10A, 10B, 10C). The electrosurgical blade 64 can be stowed within a profile of the second jaw 62b (FIG. 10A) and can in pivoted to either direction (paragraph [0061], FIGS. 10B, 10C).
In WO 95/15124 A1, a cutting and coagulating forceps is described (title, page 2, lines 10, 11). The forceps comprises a lower, fixed jaw 224, an upper jaw 224 pivotable about a pivot pin 225 (page 8, lines 23 through 25, FIG. 6a) and a scissors blade 262 also mounted on the pivot pin 225 (page 8, lines 33 through 34). When actuated, the scissors blade 262 plunges into a gap in the upper jaw 224, to cut tissue grasped between the jaws (page 8, 37, through page 9, line 1, FIGS. 7, 8, 9).
It is an object of the present invention to provide an improved tool for a microinvasive surgical instrument and a microinvasive surgical instrument, in particular accomplishing multiple surgical tasks.
A tool for a microinvasive surgical instrument comprises a body member, the proximal end of the body member being mechanically connected to or being configured to be mechanically coupled to a distal end of a shaft of a microinvasive surgical instrument; a first jaw mechanically connected to the body member in an articulated manner; a second jaw mechanically connected to the body member in an articulated manner, wherein the first jaw and the second jaw are configured to be pivoted independently from each other, wherein the second jaw provides the shape of a ‘U’ or ‘O’ at least partially encircling a fenestration, wherein the tool provides open configurations with an angular distances between the first jaw and the second jaw, and wherein the tool provides a closed configuration with the first jaw at least partially accommodated in or capping the fenestration of the second jaw.
In particular, the tool is provided and configured for a microinvasive surgical instrument for applications in otorhinolaryngology. The proximal end of the body member of the tool can be configured for a detachable mechanical coupling to the distal end of the shaft of the microinvasive surgical instrument, for instance by means of a bayonet joint or by two corresponding threads at the distal end of the shaft and at the proximal end of the body member. As an alternative, a permanent mechanical connection between the proximal end of the body member and the distal end of the shaft can be provided. In particular, the body member can be soldered or welded or glued to the distal end of the shaft or the body member and the shaft can be monolithic.
One or two hinges connect the first jaw and the second jaw to the body member. In particular, a first hinge directly connects the first jaw to the body member and a second hinge directly connects the second jaw to the body member. As an alternative, a first hinge directly connects the first jaw to the body member and a second hinge directly connects the second jaw to the first jaw. As an alternative, a first hinge directly connects the first jaw to the second jaw and a second hinge directly connects the second jaw to the body member.
In particular, the first jaw is pivotable about a first axis, and the second jaw is pivotable about a second axis, wherein the first axis and the second axis are parallel or essentially parallel or identical. When the first axis and the second axis are identical, the first hinge and the second hinge can be integrated. In particular, the first axis and the second axis are orthogonal to the longitudinal axis of a shaft mechanically connected or coupled to the body member.
In particular, the tool does not provide any direct mechanical coupling between the first jaw and the second jaw that would directly couple both jaws angular motions about their respective pivot axes. However, the tool can be part of a microinvasive surgical instrument or can be integrated into a microinvasive surgical instrument which couples the first jaw's and the second jaw's angular motions about their respective pivot axes. For instance, the tool can be coupled to a handle assembly (via the shaft mentioned above and transmission members within the shaft) which handle assembly mechanically couples both jaws' angular motions about their pivot axes to each other. For example, the handle assembly can provide a first manually moveable handle or control controlling the angular distance between the jaws and a second manually moveable handle or control controlling the orientation of both jaws or of a median orientation of the jaws. In this case manipulation of the first movable handle or control can cause angular motions of both jaws in opposite directions or of a single jaw, and manipulation of the second handle or control can cause angular motions of both jaws in the same direction.
If the second jaw provides the shape of a ‘U’, the open ends of the ‘U’ can be oriented towards the pivot axis of the second jaw. In this case, the second jaw together with its pivot axis or, to be more precise, with the axle defining the second jaw's pivot axis encircles the fenestration. In this case, the first jaw pivoting about the same pivot axis can be configured to be completely passed through the fenestration.
As an alternative, the second jaw can provide the shape of an ‘O’ entirely encircling the fenestration.
In particular, the tool provides a continuous range of open configurations with a continuous range of angular distances between the first and second jaws. In the open configurations of the tool, tissue or another object can be positioned between the first and second jaws and can be grasped or cut by moving the jaws towards each other. When tissue or another object is positioned between the first and second jaws of the tool in an open configuration, and the tool is transformed to its closed configuration by approaching the first and second jaws to each other, the jaws can be configured to cut or punch out a piece of tissue.
In particular, the shape of the second jaw corresponds to the shape of a lateral edge of the first jaw.
The shape of the second jaw corresponds or essentially corresponds to the shape of the lateral edge of the first jaw when there is at least one configuration in which the second jaw essentially or entirely abuts on the lateral edge of the first jaw or in which the distance between the lateral edge of the first jaw and the surface of the second jaw is less than a predetermined small value of 100 micrometer or 50 micrometer or 20 micrometer or 10 micrometer or less.
In particular, the shape of the second jaw corresponds to or essentially corresponds to the shape of the edge of the first jaw, when in at least one configuration of the tool the first jaw fills or essentially fills the entire fenestration in the second jaw.
In particular, each of the first jaw and the second jaw is monolithic.
A jaw is monolithic, if such jaw is originally made from a single part or workpiece. As an alternative, a jaw is also monolithic, if such jaw is made from a plurality of parts or workpieces which are rigidly and permanently connected to each other, for instance welded, soldered or glued.
In particular, each of the first jaw and the second jaw comprises merely one member and this member of each jaw is rigid.
In particular, each of the first jaw and the second jaw provides exactly one degree of freedom relative to the body member.
In particular, the single degree of freedom of each first and second jaw is the rotation about the pivot axis already mentioned above.
In particular, one or more axles, shafts or pins guided in one or more holes connect the first jaw and the second jaw to the body member in an articulate manner.
In particular, in the closed configuration of a tool, the second jaw can essentially abut on a U-shaped or O-shaped region extending along a lateral edge of the first jaw.
In particular, the first jaw provides, at sides averted from each other, a first surface area and a second surface area, the second jaw provides two elongate surface areas at parallel or essentially parallel regions of the second jaw, and the tool provides configurations in which edges of each of the elongate surface areas at the second jaw face corresponding edges of the first surface area at the first jaw.
The two elongate surface areas can be part of one contiguous U-shaped or O-shaped surface area. In this case, the edges of each of the elongate surface areas at the second jaw are part of a U-shaped or O-shaped edge extending at the inner side of the second jaw and encircling the fenestration in the second jaw.
In particular, the first surface area at the first jaw and the two elongate surface areas or the contiguous U-shaped or O-shaped surface area at the second jaw are grasping surface areas provided to exert moderate pressure on a piece of tissue grasped by the tool. Friction between the grasping surface areas and tissue can be increased by corrugation of the grasping surface areas.
Edges of the grasping surface areas can be blunt or cutting. In the latter case, it depends on the force or pressure exerted on tissue whether the tissue is merely grasped or cut by the tool.
In a tool as it is described herein, the first jaw and the second jaw can be grasping jaws, tissue between the first jaw and the second jaw being grasped when the tool is transformed from at least one of the open configurations towards the closed configuration.
In addition, the first jaw and the second jaw can be cutting jaws when used in a different way as described below.
In a tool as it is described herein, the first jaw and the second jaw are, in particular, the only jaws of the tool.
When the first jaw and the second jaw are the only jaws of the tool, the tool does not provide a third jaw or any further jaw.
In a tool as it is described herein, the first jaw provides, in particular, a grasping surface area and a U-shaped or O-shaped edge of the grasping surface area.
The tool provides open configurations with the grasping surface area of the first jaw facing the second jaw.
In a tool as it is described herein, the second jaw provides, in particular, a cutting edge exposed and averted from the first jaw in at least one configuration of the tool.
In particular, the cutting edge at the second jaw is exposed and averted from the first jaw and, therefore, ready to cut or scrape tissue like a curette in all configurations of the tool or in a predetermined range of configurations of the tool. The configuration is, in particular, a open or semi-open configuration of the tool. When used as a curette, the first jaw may be used to conveniently eject any accumulated tissue from the second jaw by closing the jaws together.
In particular, each of the first and second jaws is essentially wedge-shaped.
In particular, the height of each of the first and second jaws decreases from its pivot axis to the distal end of the tool.
The height of a jaw is measured in a direction orthogonal to the pivot axis of the jaw and orthogonal to the longitudinal direction of the jaw.
In a tool as it is described herein in the closed configuration of the tool, the contour of the first and second jaws is, in particular, essentially wedge-shaped.
Essentially wedge-shaped jaws and, in particular, a wedge-shape of both jaws together in their closed configuration facilitates the utilization of the tool for elevation or blunt dissection of tissue. Furthermore, because the first jaws fits inside of the second jaw when closed, the total height of the closed jaws may be kept very small. When the jaws are closed together, any sharp cutting edges are shielded from contact with tissue. Thus, the tool can be utilized both for blunt dissection and for grasping and/or cutting tissue.
In a tool as it is described herein, the cross section of the fenestration at least partially encircled by the second jaw is, in particular, complementary to the cross section of the first jaw such that the first jaw can be passed through the fenestration from a first side of the second jaw to a second side of the second jaw averted from the first side of the second jaw.
When the first jaw can be passed through the fenestration in the second jaw, the tool can provide two completely different open configurations (viz. configurations with angular distance between the jaws), wherein the first jaw is situated at two opposite sides of the second jaw.
In a tool as it is described herein, in particular, the first jaw provides, at sides averted from each other, a first surface area with a first U-shaped or O-shaped edge and a second surface area with a second U-shaped or O-shaped edge; the second jaw provides, at sides averted from each other, a first U-shaped or O-shaped surface area with a first U-shaped or O-shaped edge and a second U-shaped or O-shaped surface area with a second U-shaped or O-shaped edge; in a first configuration of the tool, the first edge at the second jaw faces the first edge at the first jaw, and in a second configuration of the tool, the second edge at the second jaw faces second edge at the first jaw.
In particular, the tool is transformed from the first configuration to the second configuration by passing the first jaw through the fenestration at least partially encircled by the second jaw.
In a tool as it is described herein, in particular, the first jaw provides, at sides averted from each other, a first surface area with a U-shaped or O-shaped cutting edge and a second surface area with a U-shaped or O-shaped blunt edge; the second jaw provides, at sides averted from each other, a first U-shaped or O-shaped surface area with a U-shaped or O-shaped cutting edge and a second U-shaped or O-shaped surface area with a U-shaped or O-shaped blunt edge; in a cutting open configuration of the tool, the cutting edge at the second jaw faces the cutting edge at the first jaw; and in a grasping open configuration of the tool, the blunt edge at the second jaw faces the blunt edge at the first jaw.
Both the first and second surface areas at both the first jaw and the second jaw can be smooth (in particular planar or essentially) or corrugated, wherein corrugated surface areas can reduce the risk that tissue intended to be grasped or cut by the tool slips away when the jaws approach each other.
The tool can be transformed from the cutting open configuration to the grasping open configuration by passing the first jaw through the fenestration at least partially encircled by the second jaw.
In particular, in a cutting action transforming a tool as it is described herein from the cutting open configuration towards the closed configuration, the cutting edge at the first jaw slides against or passes the cutting edge at the second jaw in a tissue cutting manner.
In particular, in a grasping action transforming a tool as it is described herein from the grasping open configuration to the closed configuration, the blunt edge at the first jaw is moved towards the blunt edge at the second jaw.
In a tool as it is described herein, in particular, both the first jaw and the second jaw are pivotable about the same pivot axis.
In particular, both the tool's grasping action mentioned above and the tool's cutting action mentioned above are conducted by pivoting the first jaw relative to the second jaw and/or the second jaw relative to the first jaw about the same axes or about the same axis.
A tool as it is described herein provides, in particular, at least two of configurations of an elevating closed configuration in which the first jaw is arranged at least partially inside the fenestration in the second jaw, wherein the second jaw, by abutting on or being located close to a cutting edge at the first jaw, prevents the cutting edge at the first jaw from cutting tissue, and the first jaw, by abutting on or being located close to a cutting edge at the second jaw, prevents the cutting edge at the second jaw from cutting tissue; a grasping open configuration, tissue being grasped between the first jaw and the second jaw when the first and second jaws are moved towards each other from the grasping open configuration towards the closed configuration; a cutting open configuration, tissue being cut between cutting edges at the first and second jaws sliding against or passing each other when the first and second jaws are moved towards each other from the cutting open configuration towards the closed configuration; a curettage configuration in which a cutting edge at the second jaw averted from the first jaw is exposed and configured to cut tissue when the tool is moved parallel to a surface of the tissue.
The tool providing two or more different functional configurations is able to replace a corresponding number of different tools or medical instruments. Thus, the tool can reduce the number of exchanges or replacements of microinvasive instruments during surgery.
In a tool as it is described herein, in particular, in the elevating closed configuration, the first and second jaws are in any angular position within a first predetermined range of angular positions relative to the body member, with a first predetermined angular relation between the first jaw and the second jaw; in the grasping open configuration, each of the first jaw and the second jaw is in any angular position within a respective second predetermined range of angular positions relative to the body member, with a second predetermined angular relation between the first jaw and the second jaw; in the cutting open configuration, each of the first jaw and the second jaw is in any angular position within a respective third predetermined range of angular positions relative to the body member, with a third predetermined angular relation between the first jaw and the second jaw; in the curettage configuration, the first and second jaws are in any angular position within a fourth predetermined range of angular positions relative to the body member, with a fourth predetermined angular relation between the first jaw and the second jaw.
The different functional configurations of the tool require different angular relations between the first and second jaws. In each of the different functional configurations, the angular positions of both jaws relative to the body member (and, thus, to the shaft of a microinvasive surgical instrument comprising the tool), can be varied or set to arbitrary values the surgeon prefers or requires). Since both jaws are pivotable, the tool allows the surgeon to set optimum angles between the jaws and the body member or the shaft for almost every application.
A microinvasive surgical instrument comprises a shaft with a proximal end and a distal end; a tool as it is described herein, wherein the proximal end of the body member of the tool is mechanically connected to or is configured to be mechanically coupled to the distal end of the shaft; and a handle assembly comprising a fixed handle mechanically connected to or configured to be mechanically coupled to the proximal end of the shaft and controls manually movable relative to the fixed handle and mechanically coupled to the first and second jaws.
In particular, the microinvasive surgical instrument is provided and configured for applications in otorhinolaryngology. The shaft of the microinvasive surgical instrument can be flexible (elastically and/or plastically bendable) or rigid, straight or curved.
Each of the tool and the handle assembly can be permanently connected to or detachably coupled to the respective end of the shaft. Transmission means inside the shaft mechanically couple the controls of the handle assembly to the jaws of the tool.
In a microinvasive surgical instrument as it is described herein, the handle assembly is, in particular, configured to fix at least one of the first jaw and the second jaw in a manually adjustable position within a predetermined range of positions relative to the body member.
In particular, the handle assembly comprises two controls each of which is exclusively coupled to one of the first and second jaws of the tool. As an alternative, the handle assembly can comprise two controls both of which are coupled to both jaws of the tool, wherein a first control controls a direction or orientation or angular position of both jaws in the closed configuration of the tool and the second control controls a more or less symmetric motion of both jaws towards each other or away from each other. As another alternative, the handle assembly can comprise two controls wherein a first control is coupled to both jaws of the tool and controls a direction or orientation or angular position of both jaws, and a second control is coupled to one jaw so that it may be used to open or close that jaw relative to the other jaw. In all cases and in further cases not mentioned here, one control can be, for instance, a wheel manually rotatable about the longitudinal axis of the proximal end of the shaft or about another axis, and the other control can be, for instance, a handle pivotable relative to the fixed handle about an axis orthogonal to the longitudinal axis of the proximal end of the shaft. In any case, at least one control can be coupled to one jaw or to both jaws in a selflocking manner, for instance via a lead screw.
The various features of novelty which characterize the invention are pointed out with particularity in the claims annexed to and forming a part of this disclosure. For a better understanding of the invention, its operating advantages and specific objects attained by its uses, reference is made to the accompanying drawings and descriptive matter in which preferred embodiments of the invention are illustrated.
In the drawings:
Referring to the drawings,
The proximal end 15 of the shaft 14 is permanently mechanically connected or detachably coupled to a handle assembly 20 forming the proximal end 11 of the instrument 10. The handle assembly 20 comprises a fixed handle 23 which is rigidly and permanently connected or rigidly but detachably coupled to the proximal end 15 of the shaft 14. Furthermore, the handle assembly 20 comprises controls (25, 26) manually movable relative to the fixed handle and mechanically coupled to the first and second jaws (50, 60). On of the controls is a moveable handle 25 which is pivotable relative to the fixed handle 23 about an axis orthogonal to the longitudinal axis 18 of the shaft 14 and orthogonal to the plane of projection of
The distal end 16 of the shaft 14 is permanently mechanically connected or detachably coupled to a tool 30. To be more specific, a proximal end 31 of the tool 30 is permanently connected or detachably coupled to the distal end 16 of the shaft 14. A distal end 32 of the tool 30 forms the distal end 12 of the instrument 10.
The tool 30 comprises a body member 40. The proximal end 41 of the body member 40 forms the proximal end 31 of the tool 30. Close to the distal end 42 of the body member 40, an axle 44 is provided. The axle 44 defines an axis 48 orthogonal to the plane of projection of
Both jaws 50, 60 can be moved (pivoted about the axis 48) independent from each other. The jaws 50, 60 are mechanically coupled to the moveable handle 25 and the control 26 of the handle assembly 20. For instance, the first jaw 50 is coupled to the moveable handle 25, and the second jaw 60 is coupled to the control 26 of the handle assembly 20. A surgeon can pivot the second jaw 60 by manually rotating the control 26 about the axis 18 of the shaft 14 and pivot the first jaw 50 by manually moving the moveable handle 25 relative to the fixed handle 23 of the handle assembly 20. As an alternative, the control 26 of the handle assembly 20 can be mechanically coupled to both the first jaw 50 and the second jaw 60 such that any motion of the control 26 of the handle assembly 20 causes both first and second jaws 50, 60 to pivot in the same direction, while the movable handle 25 causes the first jaw 50 to pivot without moving the second jaw 60. This alternative configuration allows the second jaw to be fixed in place while it is used for curettage.
The first jaw 50 provides, at two sides averted from each other, a first surface area 52 and a second surface area 55 averted from the first surface area 52. In the configuration displayed in
The second jaw 60 provides the shape of a ‘U’ the ends of which are mechanically connected to the body member 40 by means of the axle 44 in an articulated manner. The second jaw 60 (to be more specific: together with the axle 44) encircles a fenestration 61. Two arms of the U-shaped second jaw 60 are parallel or essentially parallel to the plane of projection of
The second jaw 60 provides, at two sides averted from each other, a first U-shaped surface area 62 and a second U-shaped surface area 65. In the configuration displayed in
An edge 53 at the first jaw 50 forms a lateral boundary of the first surface area 52 of the first jaw 50. An edge 63 at the second jaw 60 forms a lateral boundary between the first surface 62 of the second jaw 60 and the fenestration 61 encircled by the first jaw 60. Both the edge 53 of the first surface area 52 at the first jaw 50 and the edge 53 at the second surface area 62 at the second jaw 60 are configured as cutting edges.
Another edge 56 at the first jaw 50 is blunt and forms a lateral boundary of the second surface area 55 of the first jaw 50. In the example displayed in
When the tool 30—together with the entire instrument 10—is moved parallel to a surface of tissue in a proximal direction (in
In the example displayed in
In the closed configuration displayed in
When, in the open configuration of the tool 30 displayed in
The configuration displayed in
The configuration in
Thus, the tool 30 facilitates blunt dissection of tissue at a range of different angular positions of the first and second jaws 50, 60 relative to the shaft 14. If tissue needs to be elevated at different angles, the surgeon does not need to exchange the instrument but can simply adjust the tool by altering the angular position of the first and second jaws 50, 60 relative to the shaft 14.
Similar to the closed configurations displayed in
In particular, the lateral edge 56 of the second surface area 55 of the first jaw 50 is blunt rather than cutting. In this case, tissue between the first and second jaws 50, 60 is not cut but merely grasped when the first and second jaws 50, 60 are, starting from the open configuration displayed in
In
In
In the example displayed in
The instrument displayed in
In the configuration displayed in
In all the embodiments and variations described with reference to
In the instrument displayed in
A proximal end 72 of the first coupling member 71 is mechanically coupled to the movable handle 25 of the handle assembly 20. In the example shown in
The distal end 74 of the first coupling member 71 is coupled to the first jaw 50 by a pair of connecting rods 70 as described above with reference to
In the instrument displayed in
In the example shown in
The distal end 84 of the second coupling member 81 is coupled to the second jaw 60 by a pair of connecting rods 80 as described above with reference to
As an alternative, each of the coupling members 71, 81 can be or can comprise a Bowden cable or a cable pull.
While specific embodiments of the invention have been shown and described in detail to illustrate the application of the principles of the invention, it will be understood that the invention may be embodied otherwise without departing from such principles.
| Number | Date | Country | Kind |
|---|---|---|---|
| 18 157 011.0 | Feb 2018 | EP | regional |
