Delivery and Extraction Devices
This invention provides a device for delivering substances such as medical implants and tissues. The device comprises a mandrel and a mandrel guide whereby substances are delivered by retracting the mandrel guide relative to the mandrel. Included among the various embodiments are devices specialized for delivering retinal pigment epithelial (RPE) cells or nanoplates containing RPE cells to the retina, devices with precise control of delivery, devices with specialized mandrels and/or nozzles, and multifunctional devices adapted to provide additional functions such as infusion and/or suction, illumination, and diathermy.
This application is a continuation of U.S. patent application Ser. No. 13/525,336 filed 17 Jun. 2012, which is a continuation of PCT/US2010/060622, filed 16 Dec. 2010, which claims priority from Provisional Application 61/286,788 filed 16 Dec. 2009.
TECHNICAL FIELDThe present invention relates to delivery and extraction devices.
BACKGROUNDMedical implantation procedures generally involve the delivery of a desired substance (e.g. tissue, drug, microchip, etc) to a target site in a subject. One type of tool that has found use in certain procedures is the plunger-barrel type device. The use of a plunger-barrel type device for delivery typically involves the steps of loading a barrel with a desired substance, placing the distal end of the barrel at or near the target site in a subject, and ejecting the substance from the barrel by sliding a plunger through the barrel towards the distal end at the target site. Plunger-barrel type devices have also found use in extraction procedures, where a desired substance is extracted from a target site in a subject, essentially by reversing the steps used for delivery such that the substance is loaded into the barrel from the target site.
Difficulty can arise when the substance intended for extraction or delivery is fragile and/or when the target site is blocked or partially blocked by a delicate environment. Trauma to the surrounding environment or the substance itself can occur during the procedure in the event of off-target placement or unintentional movement of the device or extended duration of device use within the subject. Further tissue insult can ensue from the additional bulk of secondary devices such as cameras or fluid jets sometimes used to aid the procedure.
Thus far, plunger-barrel type devices have fallen short on a number of levels including their precision of device mobility and placement, ability to perform multiple functions, and simplicity of use in applications where the substance itself or the environment surrounding the target is delicate, for example, implantation/extraction procedures for nervous, cardiac, vascular, bone, and joint tissue.
Perhaps one of the more sensitive applications is the delivery or extraction of target substances to or from the eye, for example, implantation of retinal tissue into the subretinal space. Unfortunately, this type of surgery is rendered extremely difficult by both a delicate surrounding environment and a fragile target substance.
The subretinal space is the area between the retinal pigment epithelium (RPE) and the photoreceptors of the retina. The transparent, layered retina processes light images projected by the cornea and lens. The photoreceptor layer in the back of the retina transforms the light into electrical impulses. Other retinal layers transfer these impulses through the optic nerve to the brain which interprets the impulses into what we perceive as sight.
Normally, the photoreceptors are in close contact with the RPE. The RPE has many functions. It provides nutrition for the photoreceptors, and also removes waste products from the photoreceptors. In many diseases, the photoreceptors and retinal pigment epithelium degenerate. Such diseases include retinitis pigmentosa, dry age-related macular degeneration, Stargardt's disease, choroideremia, rod cone dystrophy, and Sjögren's reticular dystrophy. In a normal eye, there are no blood vessels in the subretinal space. However, in some retinal diseases, blood vessels and connective tissue can grow in this space. These abnormalities in the subretinal space under the retina can damage the retina in the back of the eye and can lead to blindness. Under certain disease conditions, the photoreceptors can detach very easily from the RPE. The photoreceptors will then degenerate, resulting in vision loss or blindness, while the other layers of the retina may remain functional. After removing the abnormal blood vessels, vision may be restored by replacing the diseased RPE and/or photoreceptors which may then integrate with the functional part of the retina.
Frequent causes of blindness are dry age-related macular degeneration and retinitis pigmentosa. The macula is located in the back of the eye in the central portion of the retina and is responsible for central vision. In subjects with dry age-related macular degeneration and retinitis pigmentosa, there is initially a dysfunction of the photoreceptors and/or RPE in the macular region. This results in impairment of central and/or peripheral vision. Age related macular degeneration is a disease that has been treated with piston-barrel type devices.
Retinitis pigmentosa is a term for genetically caused photoreceptor degeneration. In these subjects, the photoreceptors must be replaced. Again, such delivery can be accomplished by piston-barrel type devices.
Surgical correction of diseases in the subretinal space between the retina and the RPE is rendered extremely difficult by the environment in which the surgery must take place. Moreover, the surgical procedure disclosed herein to implant retinal tissue into the subretinal space of the eye is complicated by the fact that fetal retinal tissue is in the nature of a transparent gelatinous mass with two non-interdigitated layers, the photoreceptors and RPE, and therefore extremely fragile.
Difficulties of implanting retinal tissue have been previously noted, as discussed in U.S. Pat. No. 5,941,250; U.S. Pat. No. 6,159,218; and U.S. Pat. No. 6,156,042, which describe delivery devices for implanting retinal tissue into the subretinal space of the eye. These devices are of the plunger-barrel type and provide a “mandrel” as the plunger and a mandrel sleeve as the barrel. A tubular nozzle is telescoped over the distal end of the mandrel sleeve and is longitudinally slidable over the mandrel and onto the mandrel sleeve to eject the loaded retinal tissue. In the loaded position, the nozzle is positioned at the far distal end of the sleeve, but biased to slide back over the sleeve by a flat spring toggle having its distal end connected to the nozzle and its proximal end connected to the handpiece. However, none of U.S. Pat. No. 5,941,250; U.S. Pat. No. 6,159,218; and U.S. Pat. No. 6,156,042 teach a device with sensitive, error-reducing delivery control, a device having a nozzle that enables precise control of placement, or a device having a multifunctional mandrel.
U.S. Pat. No. 7,468,065 to Weber et al. describes a device for delivery of ocular implants, but like other devices discussed above, this device fails to meet the needs of applications involving fragile substances to be delivered or extracted, or where the target site is blocked by a delicate environment.
What are needed in the art are high-precision devices that are capable of rapid, non-invasive, delivery and/or extraction, yet simple to use and less prone to user error.
SUMMARY OF THE INVENTIONThe present invention relates to mandrel/mandrel-guide type devices for delivering or extracting substances. A device of the present invention comprises a delivery unit comprising a mandrel guide and a mandrel disposed internally to the mandrel guide, wherein the delivery unit is supported by a delivery unit support (e.g. a handpiece), and wherein the delivery unit is operably linked to a delivery controller (e.g. a delivery toggle), whereby engagement and operation of the delivery controller by the user's operating member (e.g. a finger) induces longitudinal movement of the mandrel relative to the mandrel guide. Delivery of a substance from a delivery device is optionally achieved by loading the substance into the mandrel guide, placing the distal end (e.g. nozzle tip) of the mandrel guide at or near the target site in an environment (e.g. subretinal space of the eye) by partially inserting the mandrel guide (e.g. inserting the nozzle portion) into the environment (e.g. an eye) and ejecting the substance from the mandrel guide. This ejection is optionally accomplished, for example, by operating the delivery controller to induce longitudinal movement of the mandrel relative to the mandrel guide such that the mandrel slides through the mandrel guide towards the distal end and forces the substance form the distal end. Conversely, extraction of a substance into an extraction device (or loading a delivery device) is optionally achieved essentially by reversing the steps for delivery discussed above.
The present invention contemplates various embodiments, for example, those described below, which are optionally applied to mandrel/mandrel-guide type devices independently or in combination. For example, the present invention provides improved delivery controllers, mandrels, and mandrel guides which are optionally applied independently or in combination to mandrel/mandrel-guide type devices such as those taught herein.
In one embodiment, the mandrel of the device comprises one or more conductive members for performing one or more secondary activities during delivery or extraction procedures (e.g. aspiration or infusion of a fluid; light projection; viewing through a scope, and/or reducing bleeding by for example, diathermy using electrodes). In one embodiment, the device comprises means for interfacing the mandrel with a secondary device for performing said activities. For example, a Luer lock-type fitting is optionally provided for interfacing with a fluid pump such as a syringe.
In one embodiment, the mandrel guide comprises a removable or disposable nozzle at the distal end, wherein the delivery controller is operably linked to the delivery unit, wherein the operable linkage is configured such that the nozzle is allowed to be fully inserted (e.g. past a nozzle coupler) into the entry site of the environment (e.g. the eye without causing further trauma). Optionally, the nozzle is non-cylindrical (e.g. shaped for delivering sheets and/or nanoplates) and/or curved when in position for delivery. The nozzle is optionally coupled to a proximal length of guide, for example, by a low profile coupler such as a low profile reversible coupler.
In one embodiment, the mandrel guide of the device comprises a proximal length of guide and a nozzle coupled to the distal end of the proximal length of guide, wherein the nozzle is longitudinally fixed relative to the proximal length of guide and the delivery controller is operably linked to the delivery unit at a location proximal to the nozzle, optionally wherein the delivery controller is operably linked to the delivery unit inside the delivery unit support. Optionally, such a configuration allows for full insertion of the nozzle (e.g. past a low-profile nozzle coupler). Optionally, the device comprises a nozzle which is non-cylindrical (e.g. shaped for delivering sheets and/or nanoplates) and/or curved (e.g. longitudinally arched), for example, when in position for delivery. Optionally, the nozzle is non-cylindrical (e.g. flattened or oblate) through the entire length (or a substantial portion) of the nozzle is alternatively cylindrical at the proximal end but non-cylindrical at the distal tip (e.g. oblately flared).
In one embodiment, the mandrel guide of the device comprises a removable or disposable nozzle and a proximal length of guide, wherein the proximal end of the nozzle is coupled to the distal end of the proximal length of mandrel guide by a reversible coupler, such as gripping members (e.g. jaws or inner gripping members which are serrated) extending from the proximal length of guide to secure the nozzle, or other reversible coupling means. Such a configuration optionally provides a low profile coupler. Optionally, the device further comprises a sliding jaw lock. Optionally, the device comprises a flexible nozzle which is curved (e.g. longitudinally arched) when in position for delivery. Optionally the nozzle is substantially non-cylindrical (e.g. flattened or oblate). Optionally, the mandrel guide is configured for full insertion of the nozzle when in position for delivery (e.g. using a low-profile coupler and/or a nozzle of appropriate length).
In one embodiment, the device comprises: a delivery unit biasing member (e.g. spring) or a delivery unit biasing means for providing or applying (‘applying’ or ‘imparting’) a force to the delivery unit to bias the delivery unit for longitudinal movement (e.g. to deliver a loaded substance), wherein the device further comprises delivery unit engagement means for preventing said longitudinal movement of the delivery unit upon engagement, and wherein the delivery controller is configured to engage and disengage the delivery unit engagement means from said delivery unit. The delivery unit engagement means optionally inhibits said longitudinal movement by applying an opposing force such a frictional force (e.g. using a traction pad) or a normal force (e.g. using a ratchet teeth/knife edge lock), or a combination of both. In such an embodiment, the delivery controller optionally comprises biasing means to disengage the delivery unit engagement means from the delivery unit, for example, by configuring the delivery controller such that engagement and operation of the delivery controller by the user (e.g. depression of a lever or other toggle linked to the delivery unit engagement means) disengages the delivery unit engagement means, thereby allowing said longitudinal movement, while disengagement of the delivery controller (e.g. releasing pressure from the toggle) engages the delivery unit engagement means with the delivery unit. Optionally, the device further comprises a safety switch (e.g. safety pin configured to freely move longitudinally and move laterally into and out of a safety latch) to oppose the bias of the delivery unit basing means, thereby preventing said longitudinal movement of the delivery unit, regardless of whether or not the delivery unit engagement means is engaged or disengaged with the delivery unit.
In one embodiment, the delivery unit is operably linked to a delivery controller, wherein upon engagement and operation of the delivery controller by a user's operating member, a net longitudinal force is applied or imparted to the mandrel or mandrel guide, thereby moving the mandrel or mandrel guide from a first longitudinal position towards a second longitudinal position at a desired rate; and wherein, at one or more intermediate positions between said first and second positions, the mandrel or guide immediately discontinues longitudinal movement (e.g. within about 1 mm of longitudinal movement) upon the user's operating member disengaging or releasing pressure from the delivery controller. Optionally, the user's operating member is a finger or finger tip. Optionally, the device further comprises a conductive mandrel, as taught herein. Optionally, the device further comprises a non-cylindrical (e.g. oblate or flattened) nozzle and/or a nozzle that is curved (e.g. longitudinally arched) when in position for delivery. Such a configuration is optionally obtained in a number of manners, for example, by providing a slidable delivery controller coupled to the delivery unit, or providing both a delivery unit biasing means (e.g. spring) and a delivery unit engagement means (e.g. traction pad or knife edge lock).
In one embodiment, the mandrel guide is a modular mandrel guide comprising a proximal length of guide comprised of two reversibly coupled members: a modular mandrel guide base and a nozzle holder, wherein the nozzle holder is coupled to or configured to be coupled to a nozzle, for example, by a reversible nozzle coupler. Optionally such a device is provided with a plurality of nozzle holders, each configured for a respective mandrel.
As used here, the following definitions and abbreviations apply.
“Exemplary” (or “e.g.” or “by example” or “[numbered component of a figure]”) means a non-limiting example. References to specific examples are merely for illustrative purposes only and are not intended to limit the invention to species of components or orientations depicted in the figures.
“High precision” or “High precision device” refers to one or more features of the present invention, namely precise placement of the nozzle tip at the target site; precise longitudinal movement of the mandrel relative to the mandrel guide, precise movement and/or placement of a target substance, precise loading of a target substance, or precise manipulation of the device (e.g. rotation). Similarly, use of the word “precise” optionally refers to precision with respect to one or more of the above mentioned features.
“Operably linked”, with respect to a delivery controller or component thereof, means that a delivery controller (e.g. toggle) is linked to at least one component of the delivery unit (e.g. mandrel or mandrel guide) such that activation or operation of the delivery controller causes the mandrel to move longitudinally, relative to the mandrel guide, for example, to cause the mandrel to forcibly eject a substance loaded in the mandrel guide. With respect to a conductive mandrel and secondary device, “operably linked” means conductively linked.
The present invention provides devices for delivering or extracting a substance. Although the device is not limited to any particular configuration, the following exemplary embodiments are provided to illustrate the principle functional components of a device according the present invention.
One embodiment provides a device (e.g. hand-held device) for delivering a substance, as depicted in
Devices of the present invention comprise a delivery unit (e.g. 5) for delivery (e.g. implantation) and/or extraction (e.g. loading) of a substance. The delivery unit (e.g. 5) comprises a mandrel guide (e.g. 2) and a mandrel (e.g. 1) disposed about (e.g. disposed internally to) the mandrel guide (e.g. 2), wherein the mandrel (e.g. 1) and mandrel guide (e.g. 2) move longitudinally, relative to each other. The delivery unit (e.g. 5) is supported by the delivery unit support (e.g. 4) (e.g. a handpiece). At least one of the components 1 or 2 of the delivery unit (e.g. 5) is not longitudinally fixed to the delivery unit support (e.g. 4) to allow longitudinal movement of the mandrel (e.g. 1) relative to the mandrel guide (e.g. 2). The relative longitudinal movement of the mandrel (e.g. 1) and the mandrel guide (e.g. 2) is controlled by a delivery controller (e.g. 3) (e.g. a toggle switch), which is operably linked to the delivery unit (e.g. 5) (e.g. by providing a linkage between the unfixed component and the delivery controller (e.g. 3)).
One embodiment provides a delivery unit (e.g. 5) comprising a mandrel guide (e.g. 2), wherein the mandrel guide has an open distal end for discharge of a substance if loaded in the mandrel guide (e.g. 2); and a longitudinally elongated mandrel (e.g. 1) disposed internally to the mandrel guide (e.g. 2), whereby relative longitudinal movement of the mandrel through the mandrel guide towards the open distal end biases the loaded substance to move longitudinally towards the open end. The device further comprises a delivery unit support (e.g. 4) (e.g. handpiece) providing support to the delivery unit (e.g. 5), wherein at least one of the mandrel (e.g. 1) and the mandrel guide (e.g. 2) is not fixed to the delivery unit (e.g. 5) to allow longitudinal movement there about. The mandrel (e.g. 1) or mandrel guide (e.g. 2) further comprises means for operably linking the delivery unit (e.g. 5) to a delivery controller (e.g. 3). For example, the mandrel or mandrel guide optionally comprises a means for engaging a delivery unit-engaging means, such as any of: a) teeth of a ratchet (e.g. 16) for engaging and disengaging a knife edge lock (e.g. 15); b) a threaded hole (e.g. 29), for receiving a screw securing the delivery controller there to; or c) a member or material (e.g. the surface of mandrel (e.g. 1) or mandrel guide (e.g. 2)) which provides traction when engaged with a traction pad or clamp of the delivery controller.
Optionally, the device further comprises a delivery unit-biasing member, such as a spring (e.g. tension spring or coaxial spring such as part 17 of
In one embodiment, the device comprises a delivery unit-biasing member as described above, or other delivery-unit biasing means, and the device further comprises force-adjusting means (e.g. a spring bushing with an adjustable position such as part 19 of
In one embodiment, the delivery unit biasing member or delivery unit biasing means comprises any member or collection of members which cause the mandrel and mandrel guide to move longitudinally relative to each other.
In one embodiment, the delivery unit biasing member or delivery unit biasing means is a spring based, motor-based, magnet-based (e.g. repulsion based), electromagnet-based, hydraulic-based, or pneumatic-based delivery unit biasing means. Optionally, the delivery unit biasing member is a non-electric member (e.g. is a spring). Optionally, the delivery unit biasing member does not comprise a motor. Optionally, the delivery unit biasing member does not comprise an electric motor. Optionally, the delivery unit biasing member is non-hydraulic. Optionally, the delivery unit biasing member is non-fluid pressure based.
Although certain specific examples taught herein provide a spring as a delivery unit biasing member, the present invention is not limited to such spring-based delivery unit biasing members. Accordingly, for any embodiment which is taught herein as including a spring as a delivery unit biasing member, the invention also contemplates an alternative embodiment in which the delivery unit biasing member is any delivery unit biasing member or delivery unit biasing means. For example, as an alternative to a spring, the delivery unit biasing member can comprise a motor-based, magnet-based (e.g. repulsion based), electromagnet-based, hydraulic-based, or pneumatic-based delivery unit biasing means.
In one embodiment, a substance loaded in the mandrel guide moves longitudinally as a result of force applied directly from the mandrel (e.g. 1), i.e. there is a direct interface of the substance with the distal end of the mandrel (e.g. 1). Alternatively or additionally, the substance moves longitudinally as a result of an indirect force applied from the mandrel, e.g. by fluid pressure (e.g. for delivery) or vacuum (e.g. for extraction) created in the mandrel guide (e.g. 2) by longitudinal movement of the mandrel. Alternatively or additionally, the substance moves longitudinally by infusion or suction force induced through ports optionally present on the mandrel (i.e. on a a conductive mandrel).
Mandrel
The mandrel (e.g. 1) comprises an elongated member that moves longitudinally about (e.g. slides through) the mandrel guide (e.g. 2) and interfaces the substance intended for delivery at the distal end (e.g. 9) of the mandrel (e.g. 1).
In one embodiment, the mandrel (e.g. 1) comprises an elongated conductive member. Additionally or alternatively, the mandrel comprises an elongated solid member. Optionally, the mandrel comprises an elongated flat member. Optionally, the mandrel comprises an elongated cylindrical member.
In one embodiment, the mandrel (e.g. 1) comprises an elongated steel member.
In one embodiment, the mandrel comprises an elongated rubber or plastic member.
In one embodiment, the mandrel is made of stainless steel tubes and electrically conductive members or optical fibers.
In one embodiment, the mandrel is autoclavable. Optionally, the mandrel comprises optical fibers or other conductive member and is autoclavable without the optical fibers or other conductive member.
In one embodiment, the mandrel (e.g. 1) is flexible.
In one embodiment, the mandrel (e.g. 1) is not flexible. In one embodiment, the mandrel is malleable.
In one embodiment, the mandrel comprises both flexible and rigid portions. Optionally, at least the distal portion of the mandrel is curved (or curvable), optionally wherein the mandrel is curved to slide under the retina into the subretinal space when the device is inserted through the pars plana of the eye. Optionally, at least the distal portion of the mandrel is flexible (e.g. further comprising a rigid nozzle), optionally wherein the mandrel is flexible enough to slide under the retina into the subretinal space when the device is inserted through the pars plana of the eye.
In one embodiment, the distal end of mandrel is configured or shaped to deliver a particular substance (e.g. match fitted to a nozzle shaped there for). Optionally, the substance is retinal cells or tissue (sometimes simply referred to as retinal tissue). Optionally, the substance is a nanoplate or other sheet (e.g. comprising retinal tissue). For example, the mandrel described in
In one embodiment, the distal end of the mandrel is match fitted to the nozzle (e.g. a nozzle for delivering sheets or nanoplates) such that longitudinal movement therein is smooth without binding yet providing a leak-free tip and/or suction induced by withdrawing the mandrel relative to the nozzle. Optionally, the distal end of the mandrel is match fitted by use of a surface-area increasing member, as taught herein (e.g. for a non-cylindrical nozzle). Such a mandrel optionally further comprises one or more conductive members, as taught herein.
In one embodiment, the mandrel comprises a conductive member (e.g. a tubular member) for conducting a fluid such as a gas or liquid, or other material such as fiber optic fibers. Optionally, a tubular conductive is constructed from a stainless steel or plastic tube (e.g. autoclavable).
In one embodiment, the mandrel comprises a conductive mandrel for conducting light, electricity, sonic waves, and/or other waveforms. Optionally, the tubular conductive member comprises a means for conducting a waveform, such as a fiber optic cable, wire, or tube (e.g. polyimide tube) with wire inserts. Optionally, the mandrel comprises a plurality of electrodes, for example, for performing diathermy (e.g. to stop bleeding).
In one embodiment, the mandrel comprises a conductive mandrel conductively linked to an external device to, for example, drive aspiration, infusion, suction, air jetting, wave transmission, and the like. For example, the mandrels detailed in any of (e.g. as detailed in Example 3, Example 4). In one embodiment, a conductive mandrel is conductively linked to an external device, such as a fluid pump or wave transmitter by an interface, for example, at the proximal end of the mandrel. Optionally, the conductive mandrel comprises one or more distal ports, wherein the conductive mandrel is capable of conducting a fluid or wave between the fluid pump or wave transmitter and the environment at the one or more distal ports.
In one embodiment, the mandrel comprises a tubular conductive member for conducting a fluid and the mandrel optionally comprises an interface for conductively linking the mandrel to a secondary device such as a fluid pump. Optionally, the interface comprises one of a Luer lock type fitting (sometimes referred to as a Luer housing), a tube coupler, and the like. Optionally, the tubular mandrel is optionally conductively linked to an external device to drive aspiration, dispensation, suction, air jetting, liquid infusion, drug infusion, wave transmission, and the like. Although certain specific examples taught herein provide a Luer type fitting as an interface (e.g. to interface a fluid pump), the present invention is not limited to devices comprising such Luer type fittings. Accordingly, for any embodiment which is taught herein as including a Luer fitting, the invention also contemplates an alternative embodiment in which the interface is any interface configured to conductively link a tubular mandrel to a fluid pump. For example, as an alternative to a Luer fitting, the interface can comprise a threaded coupler, tapered nozzle, or any other interface for linking a tube to a fluid pump. For example, in some embodiments, a useful fluid pump interface is a port on the tubular mandrel to which second tube can be connected. Further, when reference is made to a “male” or “female” Leur fitting, the invention also contemplates an alternative embodiment, wherein the interface is any fluid-pump interface, for example, any type of Luer fitting or tube coupler.
Surprisingly, a conductive mandrel (e.g. fluid conductive mandrel) can optionally be configured to allow easier and more precise loading and/or discharge of a substance (e.g. retinal tissue such as in the form of a sheet or nanoplate).
Surprising, a light- or fiber optic-conducting mandrel can optionally be configured to provide more targeted and/or precise lighting or viewing of the target site and/or substance delivered or loaded than the light- or fiber optic conducting secondary devices used in the prior art, for example, because the port(s) are more directly aligned with and/or proximal to the substance and/or target site.
In one embodiment, a conductive mandrel is conductively linked to an external device, such as a fluid pump or wave transmitter by an interface, for example, at the proximal end of the mandrel, wherein the conductive mandrel further comprises one or more distal ports, wherein the conductive mandrel is capable of conducting a fluid or wave between the fluid pump or wave transmitter and the environment at the one or more distal ports. Optionally the conductive mandrel comprises tubular conductive member. Optionally the conductive mandrel comprises tubular conductive member and the fluid pump is gas or liquid pump. Optionally the distal end of the conductive mandrel comprises a surface area increasing member (e.g. filler weld) that increases the lateral surface area of the conductive mandrel (e.g. when match fitted to, for example, a non-cylindrical nozzle). Optionally, the distal end of the conductive mandrel comprises a plurality of conductive members disposed laterally of each other and the surface area increasing member is disposed between or among the plurality of conductive members (e.g. when match fitted to a non-cylindrical nozzle). Such configurations are useful, for example, where the conductive members conduct a liquid, such as for infusion and/or aspiration, gas, such as for aeration and/or jetting, light, or electricity, such as for diathermy, and combinations thereof (e.g. where outer conductive members conduct a fluid and inner conductive members conduct light and/or cauterizing waves).
In one embodiment, the mandrel (e.g. 1) comprises a plurality of tubular conductive members that are laterally joined at the distal end by one or more joining members, such as a filler weld (e.g. 11), for example, as shown in
When multiple conductive members are provided that conduct the same fluid or wave, the members are optionally connected to a secondary device (e.g. wave transmitter or fluid pump) in any manner which allows the members to conduct the same wave of fluid. Optionally, the mandrel (e.g. 1) comprises a plurality of serially linked tubular conductive members. Optionally, the mandrel (e.g. 1) comprises a plurality of conductively linked conductive members. Optionally, the mandrel (e.g. 1) comprises a plurality of tubular conductive members 10, wherein a plurality of tubular conductive members are linked in series and a plurality of tubular conductive members are linked in parallel, for example, as shown in
In one embodiment, the mandrel (e.g. 1) comprises a plurality of tubular conductive members are each conductively linked to a different external device or conductive means. In one embodiment, a plurality of tubular conductive members provide the same conductivity or conduct the same material. In such a configuration, each tubular conductive member is optionally conductively linked to a different external device or conducting means or each is optionally linked to the same external device or conducting means.
Optionally, the mandrel (e.g. 1) comprises a plurality of tubular conductive members at the distal end of the mandrel and a reduced number of proximal tubular conductive members, such as a single proximal tubular conductive member, wherein the plurality of distal tubular conductive members are conductively linked to the reduced number of tubular conductive members. Optionally, the mandrel (e.g. 1) comprises two tubular conductive members at the distal end of the mandrel (e.g. 1) conductively linked to a distal single tubular conductive member, wherein the single tubular conductive member is conductively linked to an external device or conductive means, for example, as shown in
The mandrel (e.g. 1) is optionally constructed from any material that induces longitudinal movement of the substance intended for delivery or extraction in the same direction as the mandrel (e.g. 1) (or force induced thereby; e.g. infusion or suction) when the mandrel (e.g. 1) moves (or when a force is applied) longitudinally relative to the mandrel guide (e.g. 2).
Mandrel Guide
The mandrel guide (e.g. 2) is disposed about (e.g. telescoped over) the mandrel (e.g. 1) and comprises at least two functional sections: a proximal length of guide (e.g. 6) and a distal nozzle 8, for example, as shown in
The mandrel guide (e.g. 2) is optionally provided in any shape or configuration, so long as a loaded substance is guided towards and out of the distal nozzle from operation of the delivery controller (e.g. 3). For example, the mandrel guide (e.g. 2) is optionally provided as a cannula, barrel, sleeve, tubular member, or track, wherein the mandrel (e.g. 1) moves longitudinally about (e.g. through) the mandrel guide 1. The nozzle (e.g. 8) of the mandrel guide is optionally shaped for delivering a particular substance (e.g. non-cylindrical or oblate for delivering sheet-like substances), for example, and a proximal length of guide is minimally sized to house the mandrel or proximal portion thereof.
In one embodiment, the mandrel guide (e.g. 2) comprises two or more members (e.g. a proximal length of guide and a distal nozzle) coupled together to form a functional mandrel guide (e.g. as set forth in
In one embodiment, the mandrel guide (e.g. 2) comprises an aperture in a sidewall of the mandrel guide for the acceptance of a substance, for example, tissue (e.g. retinal tissue). Examples of such a mandrel guide are described in U.S. Pat. No. 6,156,042 which is hereby incorporated by reference.
In one embodiment, the fit between the nozzle and the distal end of mandrel permits relative movement, but induces suction in the tip portion of the nozzle when the nozzle is advanced over the mandrel to thereby induct a substance (e.g. rectangular piece of retinal tissue). Optionally, the distal end of the nozzle is match fitted to slide over the distal end of the mandrel such that longitudinal movement is smooth without binding yet providing a leak-free tip. Optionally, relatively hard implants are inserted manually into the tip of the nozzle.
In one embodiment, the mandrel guide is flexible. In one embodiment, the mandrel guide is rigid. In one embodiment, the mandrel guide comprises a flexible region and a rigid region. Optionally, the nozzle is flexible (e.g. made of fluorinated ethylene propylene or elastic plastic with an appropriate thickness to retain flexibility) and proximal length of guide is rigid (e.g. made of steel). Optionally, the nozzle is flexible, optionally wherein the nozzle is flexible enough to slide under the retina into the subretinal space when the device is inserted through the pars plana of the eye. Alternatively, the nozzle is rigid but curved (e.g. longitudinally arched) to slide under the retina into the subretinal space when the device is inserted through the pars plana of the eye.
In one embodiment, the nozzle is transparent.
In one embodiment, the nozzle is molded of elastic plastic, for example fluorinated ethylene propylene with an appropriate thickness, so as to have a curvature at the tip thereof in order to slide under the retina into the subretinal space. Surprisingly, fluorinated ethylene propylene optionally provides a superior nozzle compared to nozzles constructed with other elastic plastics. For example, nozzles constructed from fluorinated ethylene propylene can not only optionally be constructed as a transparent or translucent member, thereby allowing visualization of the loaded substance or position thereof about the nozzle, but are optionally reusable and/or autoclavable, or are optionally disposable because they are cheap and/or easy to construct. Because of its elasticity, the curved nozzle tip may, when retracted, straighten out over the mandrel so as to deposit implant tissue at the target area behind the retina. Optionally, the tip of the nozzle has smooth edges and, to facilitate uptake of the retinal tissue, is optionally provided with a small lip to aid in induction of the retinal tissue, for example, as described in U.S. Pat. No. 6,156,042 which is hereby incorporated by reference.
In one embodiment, the nozzle is configured or shaped to deliver a particular substance. Optionally, the substance is retinal tissue. Optionally, the substance is a sheet, for example, a sheet of RPE or nanoplate. Optionally, the substance is a nanoplate comprising retinal tissue or stem cells. Optionally, the substance is a nanoplate and the nozzle is sized and shaped to fit the nanoplate. Optionally, the nozzle has rectangular lateral cross section, for example, a rectangle with curved edges. Optionally, the nozzle has lateral cross section at the distal end which comprises a rectangle and a lateral cross section at the proximal end which comprises a circle, for example, for coupling to a cylindrical proximal length of guide (e.g. by a nozzle lock).
In one embodiment, the nozzle is made from a biocompatible polymer.
In one embodiment, the nozzle is made from a biocompatible polymer with a wall thickness of less than about 0.2 in, for example, less than about any of: 0.1 in, 0.05 in, or 0.1 in such as approximately 0.005 to 0.006 in.
In one embodiment, the nozzle is made from a biocompatible polymer with a wall thickness of less than about 0.2 in, for example, less than about any of: 0.1 in, 0.05 in, or 0.1 in such as approximately 0.005 to 0.006 in, and features a thin wall section to minimize trauma and a tapered tip to facilitate entry into the subretinal space.
Optionally, the mandrel guide is configured to be prone to induce tissue trauma. Surprisingly, such mandrel guides are less prone to induce tissue trauma than those described by the prior art, especially, for example, when delivering non-cylindrical substances, such as sheets (e.g. sheets or nanoplates of retinal cells) and/or when using curved nozzles, which optionally also provide for a high precision device. For example, one embodiment of a mandrel guide of the present invention provides a distal nozzle having a flexible, non-cylindrical length at the distal end (e.g. for delivering sheets or nanoplates) and proximal length of guide comprising a cylindrical length (or length with a circular cross section) proximal thereto, wherein the nozzle is configured to be insertable into the patient past the non-cylindrical length such that the length of guide having a circular cross section protrudes from the insertion site (e.g. surface of the eye). Optionally, the cylindrical length (or length with a circular cross section) that protrudes from the eye is not flexible. Surprisingly, such a configuration is far superior to prior art devices, for example, the nozzle on the device described in U.S. Pat. No. 6,159,218, which has a rectangular cross section for delivering RPE sheets, protrudes from the eye when in position for delivery. The movement (e.g. rotation) of such a rectangular cross section while inserted through tissue (e.g. an eye) can be very dangerous as leakage or even deflation can occur. For applications which use a non-circular nozzle or guide, a guide having a circular cross section at the portion which extends through the insertion point (e.g. surface of the eye) would be provide a safer proceeded which, for example, is less likely to cause leakage or deflation. Although the proximal portion of the nozzle described in U.S. Pat. No. 6,159,218 is cylindrical (see component 110 of FIG. 7 of U.S. Pat. No. 6,159,218) its larger diameter precludes insertion up to this cylindrical section—note that the proximal portion of the prior art nozzle is sized to fit over the distal portion of a guide component (see component 108 of FIG. 7 of U.S. Pat. No. 6,159,218), which is in-turn sized to slide over the guide support (see component 104 of FIG. 7 of U.S. Pat. No. 6,159,218). The prior art three-layer design prohibits the construction of a smaller diameter for the proximal, cylindrical portion of the nozzle. However, certain mandrel guides of the present invention enable a two-layer design, as will be readily appreciable to a skilled artisan with the teachings provided herein, where the proximal end of the nozzle is placed relatively flush with the distal end of the proximal length of guide and where the nozzle and proximal length of guide a coupled by a nozzle lock. With the teachings provided herein, the skilled artisan can now provide various low-profile configurations (e.g. using a nozzle coupler) to allow insertion into a patient without substantial trauma.
In one embodiment, the delivery device comprises a mandrel guide comprising a nozzle and a proximal length of guide, wherein the proximal length of guide and the proximal end of the nozzle have about the same diameter or other cross section length (e.g. where a nozzle lock is configured for placement over both components). Optionally, the distal end of the proximal length of guide and the proximal end of the nozzle are cylinders or have circular or circle-like cross sections. Optionally, a nozzle lock is provided which has an inner or luminal diameter substantially the same width as the outer surface of the distal end of the proximal length of guide and the proximal end of the nozzle.
In one embodiment, the delivery device comprises a disposable or removable nozzle. Such a device is optionally used with nozzles of different shapes and/or sizes in order to use the same device for different applications.
In one embodiment, the device comprises a delivery unit comprising a mandrel guide, wherein the mandrel guide has an open distal end for discharge of a substance if loaded in the mandrel guide; and a longitudinally elongated mandrel disposed internally to the mandrel guide, whereby relative longitudinal movement of the mandrel through the mandrel guide towards the open distal end biases the loaded substance to move longitudinally towards the open end. In one embodiment, the mandrel guide comprises a proximal length of guide and a distal nozzle removably fixed to the proximal length of guide (e.g. as set forth in
Optionally, the distal nozzle is removably fixed to the proximal length of guide by a coupler (e.g. a low profile coupler for allowing insertion without trauma), wherein the coupler comprises interacting members, wherein the first member of the pair is fixed to the nozzle and the second member of the pair is fixed to the proximal length of guide. Optionally, the first member of the pair is permanently fixed to the nozzle and/or the second member of the pair is fixed to the proximal length of guide. Optionally, the first member is made of the same material as the nozzle or at least the proximal portion thereof (e.g. formed together from a mould).
Optionally, the second member is made of the same material as the proximal length of guide or at least the distal portion thereof (e.g. formed together from a mould). Optionally, the proximal length of guide is made of steel. Optionally the second member of the pair comprises one or more jaws, opposing members, or gripping members extending from the distal end of the proximal length of tube, optionally wherein the second member comprises a pair of opposing jaws. Optionally, the one or more jaws comprise one or more gripping members for securing the nozzle. Optionally, the one or more gripping members comprise one or more teeth. Optionally, the one or more jaws, opposing members, or gripping members are secured onto the nozzle by a lock (e.g. a sliding nozzle lock or threaded nozzle lock), for example, a nozzle lock with a cylindrical lumen (threaded or unthreaded), which biases or forces the members into securing position (e.g. together upon being placed thereon). Optionally the nozzle is formed from a flexible material.
Optionally, the first member comprises one or more tooth holes for receiving one or more teeth, and the second member comprises one or more teeth for securing the nozzle by the one or more tooth holes. Optionally, the proximal length of guide comprises a removable jaw lock (e.g. sliding lock or threaded nozzle lock) for locking the jaws in a nozzle-securing position, optionally wherein the jaws are biased in a nozzle-non-securing position. Optionally, the jaw lock is a sliding jaw lock, whereby sliding the sliding jaw lock onto the jaws closes the jaws extending onto the nozzle to secure the nozzle to the proximal length of guide. Optionally, the second member of the pair comprises a sliding jaw lock engaging member, wherein the engaging member is biased to engage and immobilize the sliding jaw lock, and wherein the engaging member is positioned to engage the sliding jaw lock when the sliding jaw lock is in position for securing the jaws to the nozzle.
In one embodiment, the nozzle is coupled to the proximal length of guide (e.g. 6) by a locking member (e.g. a low profile coupler or locking member for allowing insertion without trauma) that secures the nozzle to the proximal length of guide (e.g. 6) to form the mandrel guide (e.g. 2). Optionally, the locking member is a sliding nozzle lock (e.g. 33), for example, as shown in
Optionally, the sliding nozzle lock is held in locking position by engaging one or more members fixed to one or more of the proximal length of guide (e.g. 6) and nozzle 8. Optionally, the sliding nozzle lock is threaded on the lumen and held in locking position by threads on the surface of the proximal length of guide and/or nozzle. Other locking mechanisms include a bushing with set screw or a disposable instrument with lock glued in place. Optionally, the one or more members comprise a lock engaging member, such as a pin (e.g. 39), which engages the nozzle lock, for example, as shown in
In one embodiment, the nozzle is coupled to the proximal length of guide (e.g. 6) by a coupler (e.g. a low profile coupler for allowing insertion without trauma) gripping members such outer jaws (e.g. as seen in
Optionally, the jaws are biased in the open position. Optionally, the jaws are biased for securing the coupled member. Optionally, the jaws are biased by spring. Optionally, the jaws are constructed as a plurality of members that are biased inward or outward. Optionally, the jaws are constructed as two opposing members 38 that are biased in opposing directions, for example, as shown in
Optionally, the jaws are locked or otherwise fixed in position for securing the coupled member (e.g. 6 or 8) by a locking member. Optionally, the locking member is a sliding lock 33, for example, as shown in
Optionally, the nozzle is reversibly secured to the proximal length of the guide by two mechanisms. Optionally, the two mechanisms comprise jaws (e.g. 35) and a locking member (e.g. 33), for example, as shown in
Optionally, one or more of the jaws have a gripping member that engages the coupled member. Optionally, the gripping member comprises a tooth (e.g. 37). Optionally, the coupled member (e.g. 6 or 8) has one or more gripping members receivers that engage the one or more gripping members. Optionally, the gripping member receiver comprises a hole (e.g. 34) that engages a tooth (e.g. 37) of the gripping member, for example, as shown in
Optionally, jaws secure the nozzle (e.g. 8) to the proximal length of the guide by two gripping members. Optionally the two gripping members provide force in two different directions. Optionally the different directions of force are lateral and longitudinal force. Optionally, two arms of respective jaws (e.g. 35) provide lateral force while teeth (e.g. 37) of the jaws (e.g. 35) provide longitudinal and/or lateral force to the coupled member.
In one embodiment, the nozzle is coupled to the proximal length of guide by a reversible coupler (e.g. a low profile coupler for allowing insertion without trauma) comprising inner gripping members. Optionally, the inner gripping members are serrated, for example, to enhance grip on the nozzle. Optionally, the inner gripping members are rigid. Optionally, the inner gripping members are rigid and serrated. For example, the nozzle 86 of depicted in
In one embodiment the mandrel guide is a modular mandrel guide. The proximal length of sleeve of a modular mandrel guide comprises two members which are reversibly coupled to each other such as by a key/keyway type coupler. Optionally, the first member is mandrel guide base (‘modular mandrel guide base’) and the second member is a nozzle holder, for example, a nozzle holder comprising nozzle coupler. A key/keyway coupler is optionally any key/keyway type coupler known in the art such as those of the male-female interaction type. A key/keyway coupler is optionally provided, for example as male member having prism or prism-like shape (e.g. a rectangular prism) and female member having prism or prism-like bore, hallow, or void, that is match fit to accept the first member. The key/keyway coupler is configured to “snaps” into coupling position, for by providing one or more of a groove, lip, collar, or clip. For example, as detailed in Example 15 and illustrated in
The modular mandrel guide allows, for example, the alternative use of a plurality of nozzles, each associated with a different nozzle holder. For example, nozzle holder 81 (
The reversible coupler of the modular mandrel guide is optionally provided as a key/keyway coupler such that the base of the modular mandrel guide is optionally assembled with interchangeable nozzle holders and their respective nozzles and mandrels. For example, a delivery device is optionally provided as depicted in
Accordingly, the delivery device is optionally provided in a kit comprising the modular mandrel guide base and one or more sets, wherein each set comprises a mandrel and its respective nozzle (e.g. a nozzle which is size matched for the mandrel) and nozzle holder. If a plurality of sets are provided, each set is optionally different or the same. As an alternative to the kit or full device, a partial delivery device is provided comprising the delivery unit support, delivery controller, and modular mandrel guide, i.e. the delivery device without the mandrel, nozzle, and/or nozzle holder. Although the delivery device is optionally provided as a disposable device, the user can then use a single partial delivery device with his choice of the mandrel, nozzle, and/or nozzle holder.
Delivery ControllerLongitudinal movement of the mandrel relative to the mandrel guide is controlled by operably linking the delivery unit to a delivery controller and providing the delivery controller to be engagable and operable by the user's operating member, whereby activation or operation of the delivery controller induces the mandrel to move longitudinally relative to the mandrel guide.
The delivery controller is optionally configured in any manner that provides an interface between the delivery unit and the user's operating member. The operating member is optionally a part of a human user, such as an appendage of a physician, or is optionally a component of a robotic instrument or other tool used as an operating member. In one embodiment, a delivery controller is provided that interfaces with a user's finger. Optionally, a delivery unit support (e.g.) comprises a handpiece and a delivery controller is provided that interfaces with a finger of the wielding hand. Optionally, the configuration of the delivery controller allows precise control and ease of rotation within the eye.
Surprisingly, devices of the present invention which include delivery controller taught herein optionally have one or more of the following properties: allow more precise movement of the delivery unit support; allow more precise placement of the nozzle tip at the target site; allow more precise longitudinal movement of the mandrel relative to the mandrel guide; and are less interfered with by secondary devices (e.g. scopes) than those described by the prior art, for example, those described in U.S. Pat. No. 6,159,218 and U.S. Pat. No. 6,156,042. This is especially true for, for example, eye implantation devices such as retinal tissue delivery devices.
For example, when the nozzle (e.g. a curved nozzle) is inserted into a subject (e.g. at a given depth), the delivery devices are sometimes rotated or otherwise manipulated in order to place the nozzle tip at the target site. While using the devices described in, for example, U.S. Pat. No. 6,159,218 and U.S. Pat. No. 6,156,042, the user may not release his or her finger from the finger-interface without causing retraction of the nozzle (or longitudinal movement of the mandrel relative to the nozzle or mandrel guide). However, non-limiting delivery controllers taught herein allow disengagement of release of pressure (e.g. finger pressure) from the delivery controller without further allowing substantial longitudinal movement of the mandrel relative to the mandrel guide. Surprisingly, this feature can be especially useful when combined with conductive mandrels that perform secondary activities because it protects against unwanted movement of the loaded substance while performing the secondary activities (e.g. infusion/aspiration or diathermy). Further surprising is that this feature is especially useful when the user wishes to rotate his or her hand (e.g. to correctly place the tip of a curved nozzle), as it becomes even more difficult to apply a steady pressure with the finger while moving or rotating the delivery unit support, for example, when using eye implantation devices such as retinal tissue delivery devices. This feature is not present in devices which use the linkage described in U.S. Pat. No. 6,159,218 and U.S. Pat. No. 6,156,042, e.g. where longitudinal distance of the mandrel relative to the nozzle or mandrel guide is a function of the lateral distance of the user interface of the delivery controller.
In one embodiment, the delivery unit is operably linked to a delivery controller, wherein upon engagement and operation of the delivery controller by a user's operating member, a longitudinal force is applied to the mandrel or mandrel guide, thereby moving the mandrel or mandrel guide from a first longitudinal position towards a second longitudinal position at a desired rate; and wherein, at one or more intermediate positions between said first and second positions, the component immediately discontinues longitudinal movement (e.g. within 1 mm of longitudinal movement) upon the user's operating member disengaging or releasing pressure from the delivery controller. Optionally, the user's operating member is a finger or finger tip. Optionally, the delivery controller is configured to be operated with a force of less than about 3 lbs (e.g. less than about any of: 2 lbs, 1 lb, or ¾ lb; or about any of: 0.25 lb to 2 lb, 0.25 lb to 1 lb, or 0.25 lb to 0.75 lb; or about 200 g to about 500 g; or about 300 g). Optionally, the device further comprises a mandrel with conductive members, as taught herein. Optionally, the device further comprises a non-cylindrical nozzle and/or a nozzle that is curved when in position for delivery.
Surprisingly, certain devices of the present invention comprise delivery controllers which extend a minimal distance laterally from the delivery unit support (e.g. handpiece), thereby reducing bulk and potential interference or obstruction to or with secondary devices (e.g. a scope), and allowing more precise manipulation of the device. Additionally or alternatively, delivery controllers taught herein provide devices which impart a reduced angle formed between the user's interacting member (e.g. a finger) and the delivery unit support or user (e.g. hand, palm, wrist, or non-interacting finger), and which are less awkward to manipulate and more precisely manipulated, especially while, for example, rotating the delivery unit support (e.g. handpiece). This is especially true when using, for example, eye implantation devices such as retinal tissue delivery devices. These features are not present in devices which use the linkage described in U.S. Pat. No. 6,159,218 and U.S. Pat. No. 6,156,042, e.g. where longitudinal distance of the mandrel relative to the nozzle or mandrel guide is a function of the lateral distance of the user interface of the delivery controller. Optionally, the delivery controller is configured to be operated with a force of less than about 3 lbs (e.g. less than about any of: 2 lbs, 1 lb, or ¾ lb, or about any of: 0.25 lb to 2 lb, 0.25 lb to 1 lb, or 0.25 lb to 0.75 lb, or about 200 g to about 500 g, or about 300 g).
When the delivery unit (e.g. 5) is in the loaded position, the mandrel (e.g. 1) is in a retracted state relative to the mandrel guide (e.g. 2). Delivery of the substance is accomplished by advancing the mandrel (e.g. 1) relative to the mandrel guide (e.g. 2) until the substance is ejected from the device. Such advancement and retraction is achieved by operating the delivery controller (e.g. 3).
With the teachings provided herein, one skilled in the art can now readily design function operably linkages between the delivery controller (e.g. 3) and the delivery unit (e.g. 5) such that activation or operation of the delivery controller (e.g. 3) induces force to move the mandrel (e.g. 1) to move longitudinally relative to the mandrel guide (e.g. 2). For example, the delivery controller (e.g. 3) is optionally operably linked to the delivery unit (e.g. 5) by providing linkage from the delivery controller (e.g. 3) to either the mandrel (e.g. 1) or the mandrel guide (e.g. 2) while the other member 2 or 1 is relatively fixed to the delivery unit support (e.g. 4).
Relative to the force applied to the delivery controller (e.g. 3), the force induced on the mandrel (e.g. 1) or mandrel guide (e.g. 2) is optionally direct (e.g. operably linking the delivery controller (e.g. 3) to the delivery unit (e.g. 5) by locking the mandrel to the delivery controller (e.g. 3)) or indirect (e.g. operably linking the delivery controller (e.g. 3) to the delivery unit (e.g. 5) through levers, pulleys, motors, etc). The indirect force is optionally an actuated force, an assisted force, or an unassisted force. An actuated force is an indirect force experienced by the delivery unit that is set in motion by activation the delivery controller (e.g. 3) by the user's operating member but is exerted by another member of the device (of spring, air, pressurized gas, or motor). An assisted force is an indirect force where the work applied to the delivery unit (e.g. 5) is greater than the work applied to the delivery controller (e.g. 3) from the user's operating member (e.g. by use of spring, air, pressurized gas, or motor) or unassisted, i.e. where the operable linkage merely changes the direction of applied force (e.g. by use of only a pulley or lever).
In one embodiment, the device comprises a delivery unit comprising a mandrel guide, wherein the mandrel guide has an open distal end for discharge of a substance if loaded in the mandrel guide; and a longitudinally elongated mandrel disposed internally to the mandrel guide, whereby relative longitudinal movement of the mandrel through the mandrel guide towards the open distal end biases the loaded substance to move longitudinally towards the open end. The delivery controller comprises a sliding member operably linked (e.g. fixed) to the delivery unit, whereby sliding the sliding member imparts a force on the delivery unit to bias the delivery unit for the relative longitudinal movement (e.g. as set forth in
Optionally, the delivery unit support comprises a handpiece and the sliding member is configured to interface a with a user's finger. Optionally, the sliding member slides longitudinally about the delivery unit. Optionally, the sliding member has lateral height (e.g. extending from the handpiece) of less than about one inch, or less than about or about the width of the interfacing finger. Optionally, the sliding member is mounted on the mandrel guide, whereby sliding the sliding member towards the proximal end of the mandrel imparts a force on the mandrel guide to move the mandrel guide longitudinally towards the proximal end of the mandrel to discharge a loaded substance (e.g. as set forth in
In one embodiment, the delivery controller (e.g. 3) comprises a sliding member (e.g. 11) disposed externally of the delivery unit support (e.g. 4), for example, as shown in
In one embodiment, the device comprises a delivery unit comprising a mandrel guide, wherein the mandrel guide has an open distal end for discharge of a substance if loaded in the mandrel guide; and a longitudinally elongated mandrel disposed internally to the mandrel guide, whereby relative longitudinal movement of the mandrel through the mandrel guide towards the open distal end biases the loaded substance to move longitudinally towards the open end.
In one embodiment, the device comprises a delivery unit comprising a mandrel guide, wherein the mandrel guide has an open distal end for discharge of a substance if loaded in the mandrel guide; and a longitudinally elongated mandrel disposed internally to the mandrel guide, whereby relative longitudinal movement of the mandrel through the mandrel guide towards the open distal end biases the loaded substance to move longitudinally towards the open end. The device further comprises a delivery unit biasing member, such as a spring (e.g. tension spring or coaxial spring such as part 17 of
In one embodiment, the device comprises a delivery unit comprising a mandrel guide, wherein the mandrel guide has an open distal end for discharge of a substance if loaded in the mandrel guide; and a longitudinally elongated mandrel disposed internally to the mandrel guide, whereby relative longitudinal movement of the mandrel through the mandrel guide towards the open distal end biases the loaded substance to move longitudinally towards the open end. The device further comprises a delivery unit biasing member, such as a spring (e.g. tension spring or coaxial spring such as part 17 of
In such an embodiment, the delivery unit engagement means, for example, prevents delivery unit movement by imparting an opposing force selected from a normal force using a knife edge lock or a frictional force using a traction pad. Although the present invention provides examples of knife edge locks which interact with ratchet racks, such knife edge locks are not limited thereto. With the teachings provided herein, the skilled artisan can now readily provide functional knife edge locks that prevent longitudinal movement of a delivery unit when engaged. For example, a knife edge lock is optionally any member which contacts the delivery unit to impart a normal force thereto, to prevent longitudinal movement. Although the present invention provides examples of traction pads which comprise a layer of friction-inducing pad (e.g. silicon tubing), such traction pads are not limited thereto. With the teachings provided herein, the skilled artisan can now readily provide functional traction pads that prevent longitudinal movement of a delivery unit when engaged. For example, a traction pad is optionally any member which contacts the delivery unit to impart a frictional force to prevent longitudinal movement. The skilled artisan will also realize that the configuration of either a knife edge lock or a traction pad may, in some cases, be dependent on the choice of material, the shape, or the configuration of the delivery unit engagement means and/or delivery unit.
Optionally, the delivery unit engagement means comprises a knife edge lock configured for engaging and disengaging one or more ratchet teeth provided on a delivery unit, whereby operation of the delivery controller engages and/or disengages the knife edge lock from the delivery unit, for example, from one or more ratchet teeth (e.g. as set forth in
Optionally, the delivery unit engagement means comprises a traction pad or other length of material which provides traction on a member of the delivery unit (e.g. the mandrel or mandrel guide) to impede, slow, or halt (e.g. immediately halt such as within 1 or 0.5 mm of) movement induced by the delivery unit biasing member (e.g. as shown in
In one embodiment, the device comprises a delivery unit comprising a mandrel guide, wherein the mandrel guide has an open distal end for discharge of a substance if loaded in the mandrel guide; and a longitudinally elongated mandrel disposed internally to the mandrel guide, whereby relative longitudinal movement of the mandrel through the mandrel guide towards the open distal end biases the loaded substance to move longitudinally towards the open end. The device further comprises a delivery unit biasing member, such as a spring (e.g. tension spring or coaxial spring such as part 17 of
In one embodiment, the device further comprises a delivery unit biasing member (e.g. a spring such as a coaxial or tension spring) imparting a force on the delivery unit to bias the delivery unit for delivery (e.g. imparting a force on the mandrel to move towards the distal end of the mandrel guide or imparting a force on the mandrel guide to move towards the proximal end of the mandrel). Optionally, a means for engaging the delivery unit engagement means, for example, one or more ratchet teeth, is mounted the mandrel guide; and the biasing member imparts a force on the mandrel guide to move longitudinally towards the proximal end of the mandrel to discharge a loaded substance (e.g. as set forth in
When a delivery unit engagement means is provided for preventing longitudinal movement of a delivery unit, the delivery controller optionally comprises a biasing member for biasing (or other delivery controller biasing means) the delivery unit engagement means (e.g. biasing member for a knife edge or traction pad) to engage the delivery unit. For example, the biasing member is optionally configured for biasing the knife edge lock to engage one or more teeth (e.g. forming the delivery controller as a flat spring toggle (e.g. 14), as set forth in
In one embodiment, the delivery unit support comprises a handpiece, wherein the delivery controller comprises a toggle configured to interface a user's finger (e.g. as set forth in
In one embodiment, means for engaging the delivery unit engagement means comprises one or more ratchet teeth and comprises at least a first ratchet tooth and a second ratchet tooth; wherein when the first ratchet tooth is aligned for engagement of the knife edge lock, the relative longitudinal movement causes the first ratchet tooth to move out of a position of alignment for engagement while causing the second tooth to move towards a position of alignment for engagement of the knife edge lock. Optionally, upon releasing the user force from the knife edge biasing member, the mandrel moves a longitudinal distance of less than about 1 mm relative to the mandrel before the knife edge lock engages a ratchet tooth and substantially halts the longitudinal movement of the mandrel relative to the mandrel guide.
In one embodiment, the delivery controller (e.g. 3) comprises a toggle (e.g. 14) disposed externally of the delivery unit support (e.g. 4), for example, as shown in
In one embodiment, such operable linkage comprises a means for engaging the delivery unit engagement means comprising a rack (e.g. ratchet rack 48, traction pad-interfacing member, or other member or material for engaging the delivery unit engagement means) mounted on the mandrel (e.g. 1) or mandrel guide (e.g. 2). Optionally, the operable linkage comprises members of ratchet, such as members 44, 16 of a linear ratchet, for example, as shown in
The toggle (e.g. 14) optionally interfaces the delivery unit (e.g. 5) through a delivery unit engagement means (e.g. a knife edge lock 15 that engages/disengages teeth 16 of a rack 44, for example, mounted on a mandrel or mandrel guide of the delivery unit (e.g. 5), as shown in
Optionally, a means for biasing the delivery unit comprises a spring, such as a tension spring (e.g. 17). The spring is optionally housed by a pair of bushings Ie.g. 19, 20), for example, as shown in
In a positive action setup, the mandrel guide (e.g. 2) is longitudinally relatively fixed to the delivery unit support (e.g. 4) while the mandrel (e.g. 1) advances through the mandrel guide (e.g. 2) to deliver the substance, for example, as shown in
In a passive action setup, the mandrel (e.g. 1) is longitudinally relatively fixed to the delivery unit support (e.g. 4) while the mandrel guide (e.g. 2) retracts over the mandrel (e.g. 1) to deliver the substance, for example, as shown in
A device of the present invention comprises a delivery unit support (e.g. 4). The delivery unit support (e.g. 4) is not limited to any design, structure, or configuration, so long as it provides one of: structural support for the delivery unit (e.g. 5), a means for arranging the mandrel and mandrel guide of the delivery unit (e.g. 5) in the appropriate configuration, and/or housing device components. The delivery unit support (e.g. 4) optionally provides a means for interfacing the device with the user, for example, by providing a graspable structure to the user for placement or manipulation of the device. Optionally, the user is a human, a tool, or a robotic instrument. The delivery unit support (e.g. 4) optionally provides a structure for coupling the device with other devices, such as vacuums, fluid pumps, optic devices, and the like. The delivery unit support (e.g. 4) optionally provides a means for interfacing with other devices, such as vacuums, liquid pumps, optic devices, and the like.
In one embodiment, the delivery unit support (e.g. 4) provides substantial casing of the inner components to provide greater surface area for user interface and/or protect the components from physical damage and/or pathogens. Optionally, the delivery unit support (e.g. 4) is provided with ports, slots, or other openings, for example, to allow passage of operable linking means between inner and outer components or to allow user access to inner components.
In another embodiment, the delivery unit support (e.g. 4) is constructed from the structure required to provide a means for arranging components of the device in the appropriate configuration, providing structural support thereto, and/or housing device components. For example, the delivery unit support (e.g. 4) is optionally provided merely as a frame or guide for device components.
The delivery unit support (e.g. 4) is optionally made from any material that provides the required functions taught herein. In one embodiment, the delivery unit support (e.g. 4) is made of stainless steel to facilitate autoclaving. In another embodiment, the delivery unit support (e.g. 4) is manufactured primarily from plastic. Optionally, the delivery unit support (e.g. 4) is manufactured from a mold. The use of plastic and/or molds in the manufacturing process is especially useful to provide a disposable delivery unit support (e.g. 4).
In one embodiment, the delivery unit support (e.g. 4) comprises an ergonomic member to optimize its use with respect to the orientation to and/or grip by the user while the device is wielded.
In one embodiment, the delivery unit support (e.g. 4), or portion thereof, comprises a housing, such as a tubular housing. Optionally, the housing, or portion thereof, is substantially cylindrical or constructed as an elongated prism or prism-like shell or shell-like structure. Optionally, the delivery unit support (e.g. 4) is constructed as a handpiece. Optionally, the handpiece is constructed for delivery of retinal tissue (e.g. has a diameter of less than 1 in, for example, less than about aby of: 0.8, 0.7 in, 0.6 in, or 0.5 in).
In one embodiment, the delivery unit support (e.g. 4) is constructed as a handpiece comprising a housing, such as a tubular housing. Optionally, the housing comprises at least one flat surface for interface with a portion of the user's hand, such as for interfacing with a finger or fingers. Optionally, the housing comprises a plurality of flat surfaces disposed about the housing. Optionally, the housing comprises three flat surfaces disposed about the housing that forms a triangular prism or prism-like portion of the housing for providing an ergonomic interface with the user's hand. Optionally, a triangular prism or prism-like portion comprises a triangular prism having blunted corners for ergonomic interface with the user's hand.
In one embodiment, a delivery unit support (e.g. 4) comprises a housing, such as a tubular housing, and is provided with a distal endcap (e.g. 24) having a port 25 to allow longitudinal acceptance and lateral or radial support of the mandrel guide (e.g. 2), for example, as shown in
In one embodiment, a delivery unit support (e.g. 4) comprises a housing, such as a tubular housing, and is provided with a proximal endcap (e.g. 43) having a port, partial port, or fixation point for longitudinal acceptance and/or support and/or lateral or radial support of the mandrel (e.g. 1), for example, as shown in
Optionally, a proximal endcap is provided as a Luer lock (e.g. 43) or Luer housing, as shown in
In one embodiment of a passive action setup, a proximal endcap (e.g. 43) is provided that longitudinally secures the mandrel (e.g. 1) relative to the delivery unit support (e.g. 4), for example, as shown in
In one embodiment of a positive action setup, a proximal endcap (e.g. 43) is provided that allows longitudinal movement of the mandrel (e.g. 1) relative to the delivery unit support (e.g. 4), for example, as shown in
In one embodiment, an interface (e.g. Luer lock) is provided for interfacing the mandrel with a secondary device such as a fluid pump.
Optional ConfigurationsMandrels and mandel guides are optionally customized in different sizes and shapes for delivery or extraction of different kinds of tissue, gels containing different trophic factors or drugs, electronic microchips, and other implantable or extractable substances. Mandrels and mandrel guides are optionally produced in sterile packages for one-time use.
In one embodiment, the mandrel guide (e.g. 2) comprises a 0-40 gauge tube. Optionally, the mandrel guide (e.g. 2) comprises a 10-40 gauge tube, such as a 10-30, 15-25, or 16-20 gauge tube (e.g. 18 gauge).
In one embodiment, the mandrel (e.g. 1) comprises a 0-40 gauge member. Optionally, the mandrel guide (e.g. 2) comprises a 10-40 gauge member, such as a 10-30, 15-25, or 18-22 gauge member.
In one embodiment, the mandrel (e.g. 1) comprises an elongated member at the proximal end that forks into a plurality of elongated members (e.g. 30 gauge) at the distal end. Optionally, the conductive members are positioned laterally of each other (e.g. for use with a nanoplate and/or sheet-shaped or rectangular nozzle) Optionally, the members are conductive members. Optionally, the conductive members are tubes. Optionally, an elongated member at the proximal end comprises 0-40 gauge tube, for example, a 10-40 gauge member, such as a 10-30, 15-25, or 18-22 gauge member and a plurality of elongated members at the distal end comprise smaller lateral cross sections, for example, a plurality of elongated members of 10-50 gauge, such as a 20-40, 25-35, or 28-32 gauge. Optionally, the members at the proximal and distal end are tubes and the plurality of elongated members at the distal end are capable of at least partially sliding into the tube at the distal end to form a functional mandrel. For example, the device detailed Example 3 or Example 4 can be configured as such.
The mandrel and mandrel guide are optionally constructed of any length, as long as they together form a functional delivery unit. Optionally, the device is configured for positive action and the mandrel guide is 2-20 cm, such as 6-15 cm, and the mandrel is 10-40 cm, such as 20-30 cm. Optionally, the device is configured for passive action and the mandrel guide has a length of 10-20 cm, such as 12-16 cm, and the mandrel has a length of 10-40 cm, such as 20-30 cm. Optionally, the nozzle has a length of 2-15 cm, such as 4-10 cm.
In one embodiment, the device is useful for delivery of a substance into an eye, for example, delivery of retinal tissue. Optionally, the mandrel guide (e.g. 2) and the mandrel (e.g. 1) each comprise a 10-40 gauge tube, such as a 10-30, 15-25, or 16-20 gauge tube, wherein the mandrel (e.g. 1) is sized to slide through the mandrel guide (e.g. 2). Optionally, the mandrel guide (e.g. 2) comprises a 16-22 gauge tube and the mandrel (e.g. 1) comprises an 18-35 gauge member, such as a conductive member. Optionally, the device comprises a delivery unit support comprising a handpiece.
Devices of the present invention are not limited to any particular size. For example, a device taught above, or any component thereof such as the mandrel, mandrel guide, and nozzle, or any dimension thereof (e.g. lateral or longitudinal dimension) is optionally scaled down to 1%-10%, such as 1% or 10% (e.g. for prenatal applications), or is optionally scaled up to 500%-1500% (for applications in large animals such as elephants). Also envisioned is a device scaled up or down (eg. 1%-10% or 500%-1500) in the lateral dimensions (e.g. to facilitate more or less bulky substances or for insertion into smaller or larger environments) but not substantially scaled in the longitudinal cross sections. Also envisioned is a device scaled down (eg. 1%-10% or 30%-60%) in the lateral dimensions (e.g. to facilitate entry into a vein or artery) but scaled up (e.g. 500%-1500%) in the longitudinal length (e.g. of the nozzle) to deliver or extract a substance to/from a target site that is remote from the insertion site
In one embodiment, the delivery device has one or more (e.g any 1, 2, 3, 4, or 5) of the following features:
-
- (a) A substantial portion (e.g. entire) delivery device is designed for single-use and/or is disposable;
- (b) A substantial portion (e.g. entire) delivery device is be fabricated of materials suitable for sterilization by gamma irradiation;
- (c) The diameter of the delivery device assembly does not exceed 1 in, for example, less than about aby of: 0.8, 0.7 in, 0.6 in, or 0.5 in;
- (d) The length of of the delivery device does not exceed 10 in, e.g. 9 in, 8, or 7.0 in. long, including the nozzle and mandrel assembly;
- (e) The implantation comprises luer lock
In one embodiment, the delivery device comprises a handpiece having one or more (e.g any 1, 2, 3, 4, 5, or 6) of the following features:
-
- (a) designed for one-handed operation.
- (b) include a means for securing a nozzle and mandrel assembly in a nonpermanent manner;
- (c) include a means of locking the nozzle in the extended position to prevent inadvertent retraction such as a safety mechanism.
- (d) includes a release lever (e.g. toggle) for retracting the nozzle in a smooth, but incremental, manner as desired by the user.
- (e) the force required to actuate the nozzle retraction release lever does not exceed 3 lbs (e.g. less than about any of: 2 lbs, 1 lb, or ¾ lb, or about any of: 0.25 lb to 2 lb, 0.25 lb to 1 lb, or 0.25 lb to 0.75 lb; or about 200 g to about 500 g, or about 300 g).
- (f) includes an integral luer lock (e.g. female luer fitting), for example, at the prosimal end for connection of a user-provided syringe, with or without tubing.
In one embodiment, the nozzle and mandrel have one or more (e.g any 1, 2, 3, 4, 5, or 6) of the following features:
-
- (a) are not integral to the hand piece; i.e. is removable from the hand piece without damage to either assembly;
- (b) are be fabricated of materials which are inert when exposed to human tissue.
- (c) accommodate tissue specimens up to 2.25 mm wide×7.5 mm long×0.25 mm thick.
In one embodiment, the delivery device is a device for delivering ocular tissue such as RPE cells and comprises technical features of at least two (e.g. each of) of the three previous embodiments described above.
In one embodiment, the nozzle and mandrel are configured to accommodate any size and shape of nanoplate platform. For example, nanoplates can be configured in rectangular or disc shaped platforms.
In one embodiment, the nozzle and mandrel are configured to accommodate a nanoplate platform in the micro-sized range.
In one embodiment, the nozzle and mandrel are configured to accommodate a nanoplate platform in the macro-sized range.
In one embodiment, the nozzle and mandrel are configured to deliver nanoplates, sheets, and/or other substances, wherein the substance is less than 5 mm wide×14 mm long×2 mm thick, such as those which are less than 3.5 mm wide×11 mm long×0.5 mm thick, or less than 2.25 mm wide×7.5 mm long×0.25 mm thick.
In one embodiment, the device, including the nozzle, mandrel, delivery controller, and/or delivery unit support is configured to deliver fragile nanoplates, tissue, and/or cells without damaging the implant. For example, nanoplates can be provided as cell-loaded membranes which are designed for therapeutic use such as insertion into the sub-retinal space. With the teachings provided herein, the skilled artisan can now provide devices configured as such.
Examples of devices useful according to the present invention are those listed in Table 1.
As shown in Table 1, the present invention contemplates many different configurations of components taught herein.
In one embodiment, the invention provides a device listed in Table 1, wherein at least one the delivery unit, mandrel, mandrel guide, nozzle, proximal length of guide, delivery controller, or delivery unit support is further modified in accordance with another embodiment taught herein. In another embodiment, the invention provides a device listed in Table 1, wherein at least one component selected from the delivery unit, mandrel, mandrel guide, nozzle, proximal length of guide, delivery controller, or delivery unit support is replaced with another component taught herein.
The devices taught herein are not limited to any particular configuration or device components and modifications which alternatively provide components having the same property or function are also contemplated. Accordingly, the invention provides an alternative embodiment in which a component that performs a specific function is replaced by a means for performing said function.
UtilityDevices of the present invention are useful for delivering or extracting a substance into/from an environment. Devices of the present invention are further useful for delivering or extracting a substance into/from an environment where the target site is blocked or partially blocked by a delicate environment and/or the substance intended for extraction or delivery is fragile.
Accordingly, one embodiment of the present invention provides a method for delivering a substance from device of the present invention into an environment, the method comprising loading a substance into the mandrel guide, orienting the open end of the mandrel guide at a target site in the environment, and retracting the mandrel guide relative to the mandrel to discharge the substance at the target site. Optionally, the method comprises inserting the mandrel guide into the environment. Optionally, retracting the mandrel guide comprises retracting both the nozzle and the proximal length of guide.
Optionally, the environment is an organism. Optionally, the organism is an animal, optionally a mammal, optionally a human or horse. Optionally, the mammal is a companion mammal, for example, a cat or dog. Optionally, the mammal is a laboratory mammal, for example, a mouse or a rat. Optionally, the environment is an organ, cavity, or joint. Optionally, the environment is an eye (e.g. the subretinal space of the eye).
Optionally, the substance is a tissue specimen, cellular specimen, an electronic chip, a drug, or a gel. Optionally, the tissue specimen is nervous, cardiac, vascular, bone, joint tissue, or the like, for example, radioactive seeding. Optionally, the nervous tissue is ocular tissue, for example, retinal tissue (e.g. fetal retinal tissue).
Optionally, the environment is an electronic device or a mechanical device, such as a circuit board, computer or computer component, automobile, medical implant (e.g. prosthetic tissue or organ).
Examples of such a substance are tissue specimens, gels, microchips, drugs, manufactured materials (e.g. supports) further comprising a drug or biological sample. Other substances include radioactive seeding.
Some delivery devices of the present invention provide a delivery device having a removable nozzle, wherein the nozzle is fully insertable into the environment, for example, insertable to the proximal length of guide. Optionally, the nozzle is substantially non-cylindrical (e.g. fit for nanoplates) and the proximal length of guide is cylindrical. Optionally, the environment is an eye. Accordingly, one embodiment provides a method of delivery a substance into an environment, the method comprising fully inserting the nozzle of a device having a removable nozzle into the environment before discharging the substance, wherein the insertion site is not substantially traumatized by said insertion.
Some delivery devices of the present invention provide a device having a conductive mandrel for performing a secondary activity. Accordingly, one embodiment of the present invention provides a method of delivering a substance into an environment, the method comprising placing the open end of the mandrel guide at the target site, discharging the substance, and performing a secondary activity with the delivery device before, during, or after said placing or said discharging. Optionally, the secondary activity comprises aspiration or infusion of a fluid at the target site. Optionally, the secondary activity comprises illumination visualizing the target site or environment. Optionally, the secondary activity comprises cauterization (e.g. diathermy or laser). Optionally, the secondary activity comprises infusion/aspiration, and one or more of cauterization and illumination.
Some delivery/extraction devices of the present invention provide a device having a removable or disposable quick-connect nozzle. Accordingly, one embodiment of the present invention provides a method of delivering a substance into an environment, the method comprising assembling the mandrel guide by fixing a nozzle to the proximal length of guide, placing the open end of the mandrel guide at the target site, and discharging the substance. Optionally, the step of fixing a nozzle to the proximal length of guide comprises placing the nozzle on or at the proximal length of guide and locking the nozzle to the proximal length of guide by at least one of jaws and a sliding nozzle lock. Alternatively, the step of fixing a nozzle to the proximal length of guide optionally comprises placing a nozzle on inner grippiers (e.g. rigid and/or serrated inner grippers). Optionally, the substance is ocular tissue, such as retinal tissue (e.g. a nanoplate comprising retinal tissue or stem cells).
Some delivery/extraction devices of the present invention provide a device having a delivery controller operable with reduced force (e.g. less than about 3 lbs), perpendicular force (e.g. less than about 3 lbs, such as less than about any of: 2 lbs, 1 lb, or ¾ lb, or about any of: 0.25 lb to 2 lb, 0.25 lb to 1 lb, or 0.25 lb to 0.75 lb, or about 200 g to about 500 g, or about 300 g), and/or perpendicular motion (e.g. less than about 4 mm) relative to the angle of the length of mandrel guide that protrudes from the insertion site. Such devices reduce tissue trauma, for example, by allowing the user to keep the device absolutely still. Accordingly, one embodiment of the present invention provides a method for delivery a substance from a device of the present invention, the method comprising, the method comprising loading a substance into the mandrel guide, inserting the mandrel guide into an environment, and operating the delivery controller to discharge the substance by imparting a perpendicular motion on the delivery controller of less than 4, 3, 2, or 1 mm, relative to the angle length of mandrel guide that protrudes from the insertion site.
Device configurations of the present invention are especially useful for ocular surgery because target site is blocked or partially blocked by a delicate environment and the substance intended for extraction or delivery is often fragile. Accordingly, one embodiment of the present invention provides a method for delivering a substance (e.g. retinal tissue, for example a sheet of retinal tissue or a nanoplate comprising retinal tissue or stem cells) from a device of the present invention to a target site in an ocular environment (e.g. subretinal space), the method comprising loading a substance into the mandrel guide, inserting the mandrel guide into an eye, orienting the open end of the mandrel guide at a target site in the eye, and moving the mandrel through the mandrel guide towards the open end to discharge the substance at the target site. Optionally, the target site is the subretinal space of the eye. Optionally, the substance is a tissue specimen such as retinal tissue (e.g. fetal retinal tissue). Optionally, the method comprises making an incision in the eye before inserting the mandrel guide through the incision. Optionally, the method comprises inserting the mandrel guide through the pars plana in the region of the ciliary body at the periphery of the retina. Optionally, the method comprises incising the retina near the diseased target site giving access to the subretinal space. Optionally, the delivery device comprises a removable nozzle and the method comprises fully inserting the nozzle into the eye before discharging the substance, wherein the insertion site is not substantially traumatized by said insertion. Optionally, moving the mandrel through the mandrel guide towards the open end to discharge the substance at the target site comprises operating a delivery controller which comprises a sliding member or ratchet, as taught herein.
EXAMPLES Example 1 Device with Delivery Controller Linked InternallyOne embodiment of the present invention provides a device for delivering a substance, as depicted in
Surprisingly, such a configuration provides for easier maneuverability in the presence of other devices such as scopes and less obstruction of vision, for example, thereby reducing tissue trauma during a procedure. Such a configuration reduces bulk in comparison to prior art devices in which the delivery controller is linked, for example, directly to the nozzle externally of the mandrel guide. Surprisingly, prior art devices with external linkage are very awkward and dangerous to manipulate around other devices such as scopes.
Example 2 Device with Fully Insertable NozzleOne embodiment of the present invention provides a device for delivering a substance, as depicted in
One embodiment of the present invention provides a device for delivering a substance, as depicted in
In addition to delivery and/or extraction, a device having such a configuration performs additional functions that were previously performed by separate devices, thereby lessening tissue trauma by reducing the total device volume inserted into the patient and facilitating a simplified medical procedure using only a single device.
Example 4 Conductive MandrelAn example of a conductive mandrel of the present invention is shown in
The mandrel can optionally be made from a metal, for example, stainless steel such as 304 stainless steel, or other inert material (i.e. inert to biological tissue and/or pharmaceutically acceptable material) such as inert polymers.
The tubular conductive members can optionally be made from SS hypodermic tubing such as TW 304 SS hypodermic tubing.
The tubular conductive members 31 at distal end 9 of the mandrel can optionally be made from hypodermic tubing (e.g. TW 304 SS hypodermic tubing) or other inert tubing and/or sized for delivering substances to the eye, for example, using 30 gauge tubing.
The proximal elongated tubular conductive member 30 can optionally be made from hypodermic tubing (e.g. TW 304 SS hypodermic tubing) or other inert tubing and/or sized for delivering substances such as 20 gauge tubing for delivering substances to the eye.
Although
The filler weld can optionally be made from metal or other inert material, for example, from 304 stainless steel.
Such a mandrel performs additional functions that were previously performed by separate devices, yet effectively performs the function of a mandrel and/or extraction (i.e. to bias the substance for discharge upon movement through the mandrel guide) by interfacing the substance at the filler weld 11. The forked configuration of such a mandrel is especially well suited for substances in the form of a sheet, for example, retinal tissue or a nanoplate (e.g. comprising stem cells or retinal tissue for implantation into the eye).
Surprisingly, infusion/aspiration conductive members are optionally configured to eliminate the need for external venting of the instrument during delivery. Further surprising is that infusion/aspiration conductive members are optionally used to load a substance into the device with gentle suction, which is significantly less damaging to delicate substances such as RPE cells and/or sheets and nanoplates.
Example 5 Conductive MandrelA conductive mandrel is provided, as in Example 4. More specifically, the mandrel comprises one or more tubular conductive members for aspiration/infusion, and additionally comprises one or more additional conductive members for light (e.g. fiber optic cables) and/or conductive members for cauterization (e.g. diathermy cables or a laser). An example of such a conductive mandrel is depicted in
-
- a. fiber optic cables (e.g. all fiber optic cables);
- b. diathermy cables;
- c. a mixture of fiber optic cables and diathermy cables (e.g. two fiber optic cables and two diathermy cables);
- d. a mixture of at least one laser fiber and one or more fiber optic cables; and
- e. arthroscope or camera.
In addition to the superior properties discussed in Example 4, the incorporation of fiber optic cables surprisingly allows illumination and/or visualization of the tip of the nozzle under the target site (e.g. retina) to provide far more accurate placement of substance to reduce trauma. In addition, the fiber optic cables allow better visualization during loading to ensure loading of the substance (e.g. RPE cells and/or nanoplates) in the proper orientation of the substance in the nozzle, and to ensure proper position within the nozzle during a procedure. The nozzle can optionally be provided as a translucent or transparent nozzle, for example, to enhance such surprising properties.
Additionally or alternatively, the use of diathermy cables is surprisingly effective in stopping bleeding, for example, at the edge of the retinotomy during in-vivo use.
Example 6 Mandrel Guide with Quick-Connect NozzleAn example of a mandrel guide of the present invention is shown in
The nozzle is optionally non-cylindrical (e.g. shaped to fit nanoplates), for example, as shown in
Such a configuration not only provides ease of entry into and exit from the eye, but also facilitates rapid yet sturdy on-site assembly of the mandrel guide. In addition, this configuration provide a minimally evasive, low profile coupler which is optionally inserted through an insertion site (e.g. the eye).
As an alternative to the jawed configuration illustrated in
The proximal end of the mandrel 1 is fixed to the delivery unit support 4 in a Luer lock 27, which is itself fixed to the distal end of the delivery unit support 4 by a locking screw 28. The Luer lock 27 is optionally connected to an external device through a Luer housing of the external device (not shown).
The delivery controller 3 comprises a sliding member 11 disposed externally of the delivery unit support 4. The delivery controller 3 is operably linked to the delivery unit 5 by fixing sliding member 11 to the mandrel guide (e.g. 2). The sliding member 11 is fixed to the mandrel guide (e.g. 2) by a locking screw 13 inserted through the sliding member 11 and screw locked into a rack 12 mounted on the proximal length of guide 6 and having a threaded hole 29 for acceptance and locking of the locking screw 13. In such a configuration, sliding member 11 longitudinally towards the proximal end of the device causes the mandrel guide (e.g. 2) to also slide longitudinally over the mandrel 1 towards the proximal end of the device until the substance to be delivered is ejected from the nozzle 8 of the mandrel guide (e.g. 2).
Surprisingly, such a configuration provides a high precision device that is readily maneuverable, smooth delivery of delicate tissue, and simple to use.
Such a configuration allows the device to be operated with little or no force or motion perpendicular to the mandrel guide at the insertion site, thereby reducing trauma to the patient.
Surprisingly, such a configuration provides high precision device that is capable of easy maneuverability, smooth delivery of delicate tissue, and simple to use to provide more accurate placement of the substance (e.g. beneath the retina) and less trauma to the target site (e.g. retina) and its environment.
Example 8 Device with Positive Action Sliding Delivery ControllerThe proximal end of the mandrel 1 is not fixed to delivery unit support 4, but is inserted in a Luer lock 27, which slides longitudinally through the proximal end of the delivery unit 4. The Luer lock 27 is optionally connected to an external device through a Luer housing of the external device (not shown).
The delivery controller 3 comprises a sliding member 11 disposed externally of the delivery unit support 4. The delivery controller 3 is operably linked to the delivery unit 5 by fixing sliding member 11 to the mandrel 1. The sliding member 11 is fixed to the mandrel 1 by a locking screw 13 inserted through the sliding member 11 and screw locked into a rack 42 mounted on the mandrel 1 and having a threaded hole 29 for acceptance and locking of the locking screw 13. In such a configuration, sliding member 11 longitudinally towards the proximal end of the device causes the mandrel guide 1 to also slide longitudinally through the mandrel guide (e.g. 2) towards the distal end of the device until the substance to be delivered or extracted is ejected from the nozzle 8 of the mandrel guide (e.g. 2).
Surprisingly, such a configuration provides high precision devices that are readily maneuverable, can smoothly deliver delicate tissue, and are simple to use to provide more accurate placement of the substance (e.g. beneath the retina) with less trauma to the target site (e.g. retina) and its environment.
Such a configuration allows the device to be operated with little or no force or motion perpendicular to the mandrel guide at the insertion site, thereby reducing trauma to the patient.
Example 9 Device with Positive Action Push-Button ControlThe proximal end of the mandrel 1 is not fixed to the delivery unit support 4, but is inserted in a Luer housing 43, which slides longitudinally through the proximal end of the delivery unit 4. The Luer housing 43 is optionally connected to an external device through a Luer lock of the external device (not shown).
The delivery controller 3 comprises a toggle (e.g. 14) disposed externally of the delivery unit support 4. The toggle (e.g. 14) is operably linked to the delivery unit 5 through a knife edge lock 15 that engages/disengages teeth 16 of a rack 44 mounted on the mandrel 1.
In the loaded position, the mandrel 1 is forcibly biased towards the distal end for delivery by a tension spring 17 such that a tooth 16 of the rack 44 contacts the knife edge lock 15, thereby locking the mandrel 1 with respect to its longitudinal position. The knife edge lock 15 of the toggle (e.g. 14) is forcibly biased into a tooth 16 of the rack 44 by a flat spring 45 of the delivery controller 3 mounted to delivery unit support 4 by a pair of locking screws 47. Activation of the toggle (e.g. 14) disengages the knife edge lock 15 from the teeth 16, thereby allowing distal longitudinal movement of the mandrel 1 due to the biasing force of the tension spring 17.
The tension spring 17 is housed by a pair of bushings 19, 20. Bushing 19 is secured to the mandrel 1 by locking screw 21 but remains unsecured to the delivery unit support 4 to allow advancement of the mandrel 1 upon disengagement of the knife edge lock 15 from the teeth 16. Bushing 20 is secured to the delivery unit support 4 by locking screws 47 to resist expansion of tension spring 17 while the mandrel 1 is retracted to the loaded position, but is unsecured from the mandrel 1 to allow longitudinal movement of the mandrel 1 relative to bushing 20 and delivery unit support 4. Because the locking screw 21 reversibly secures the bushing 19 to the mandrel 1, the tension, delivery speed, and loaded position of the mandrel 1 are optionally adjusted by changing the longitudinal position that bushing 19 is secured to the mandrel 1.
Surprisingly, such a configuration provides a high precision device that is capable of easy maneuverability, smooth delivery of delicate tissue, and simple to use to provide more accurate placement of the substance (e.g. beneath the retina) and less trauma to the target site (e.g. retina) and its environment.
Such a configuration allows the device to be operated with little or no force or motion perpendicular to the mandrel guide at the insertion site, thereby reducing trauma to the patient.
An adjustable rate of delivery speed controlled by an internal coaxial spring and an delivery unit engaging means (e.g. ratcheting system) allows superior delivery of delicate tissue, which is optionally protected in the nozzle to be placed in the subretinal space without damage to the tissue or retina.
Example 10 Device with Passive Action Push-Button ControlThe proximal end of the mandrel 1 is fixed to the delivery unit support 4 in a Luer housing 43, which is itself fixed to the distal end of the delivery unit support 4 by a locking screw 28. The Luer housing 43 is optionally connected to an external device through a Luer lock of the external device (not shown).
The delivery controller 3 comprises a toggle (e.g. 14) disposed externally of the delivery unit support 4. The toggle (e.g. 14) is operably linked to the delivery unit 5 through a knife edge lock 46 that engages/disengages teeth 49 of a rack 48 mounted on the proximal length of guide 6.
In the loaded position, the proximal length of guide 6 is forcibly biased towards the proximal end for delivery by a tension spring 17 such that a tooth 49 of the rack 48 contacts the knife edge lock 46, thereby locking the mandrel guide (e.g. 2) with respect to its longitudinal position. The knife edge lock 46 of the toggle (e.g. 14) is forcibly biased into a tooth 49 of the rack 48 by a flat spring 45 of the delivery controller 3 mounted to delivery unit support 4 by a pair of locking screws 47. Activation of the toggle (e.g. 14) disengages the knife edge lock 46 from the teeth 49, thereby allowing proximal longitudinal movement of the mandrel guide (e.g. 2) due to the biasing force of the tension spring 17.
The tension spring 17 is housed by a pair of bushings 50, 51. Bushing 50 is secured to the proximal length of guide 6 by set screws but remains unsecured to the delivery unit support 4 to allow retraction of the mandrel guide (e.g. 2) upon disengagement of the knife edge lock 46 from the teeth 49. Bushing 51 is secured to the delivery unit support 4 by locking screw 52 to resist expansion of tension spring 17 while the mandrel guide (e.g. 2) is advanced to the loaded position. Because the locking screw 52 reversibly secures the bushing 51 to the mandrel delivery unit support 4, the tension and delivery (retraction) speed of the mandrel guide (e.g. 2) are optionally adjusted by changing the longitudinal position that bushing 51 is secured to the delivery unit 4.
Surprisingly, such a configuration results in a high precision device that is readily maneuverable, can smoothly deliver delicate tissue, and is simple to use to provide more accurate placement of the substance (e.g. beneath the retina) with less trauma to the target site (e.g. retina) and its environment.
Such a configuration allows the device to be operated with little or no force or motion perpendicular to the mandrel guide at the insertion site, thereby reducing trauma to the patient. Such a configuration is also advantageous because it provides regulated delivery, and immediate stoppage on release of finger pressure.
An adjustable rate of delivery speed controlled by an internal coaxial spring and a delivery unit engaging means (e.g. ratcheting system) allows superior delivery of delicate tissue, which may be protected in the nozzle to be placed in the subretinal space without damage to the tissue or retina.
The device is optionally provided with an 18 gauge proximal length of guide 6, optionally provided with a 15 gauge rack 48 in order to, for example, deliver RPE cells under the retina.
Example 11 Preparation of an ImplantAn implant was prepared to be delivered using a device of the present invention. Although any method of preparing a substance may be used, the following method was used to prepare RPE cells.
RPE cells were harvested as sheets using dispase as described previously [Tezel T H, Del Priore L V, Kaplan H J. Harvest and storage of adult human retinal pigment epithelial sheets. Current eye research 1997; 16:802-809]. In brief, following removal of the sclera, eyes were treated with 2% dispase for 40 minutes at 37 degrees C. Dispase-treated eyes were washed in DMEM and an incision was made into the subretinal space. RPE sheets were isolated, gently placed on Transwell membrane insert [Corning Life Sciences, Wilkes Barre, Pa.], and were cultured in growth media consisting of DMEM supplemented 10% FBS, 1001 U/ml penicillin, and 100 g/ml streptomycin. Monolayer cell sheets were harvested one week later for retinal implantation.
Example 12 Precise Delivery with Reduced TraumaVarious devices of the present invention were used to deliver a substance to a target site. Although any device configurations taught herein may be used for delivery, we selected for this example devices having sliding member or push-button delivery controllers of the present invention, conductive mandrels of the present invention with infusion/aspiration (30 gauge tubes) and fiber optics, and flexible, transparent nozzles (e.g. made from fluorinated ethylene propylene) for delivering RPE cells which had been prepared by the method set forth in Example 11. The porcine RPE cells on the Transwell membrane were cut to pieces 2 millimeters by 5 millimeters and placed in a fluid in a petri dish for loading into the nozzle.
The lighted nozzle allowed superior visualization of the orientation of the pig RPE cells on the membrane, so it could be loaded correctly with RPE cells on top of the membrane, and so its position in the nozzle could easily be seen. For animal and human, neural retina together with the RPE was provided on top of a nanoplate. The device was especially useful because it provided for placement with proper orientation which is important for integration and synaptic connection to occur between the host and the transplant.
The suction on the instrument allowed loading of the tissue into the instrument with no damage to the tissue because of the very controlled gentle infusion/aspiration conductive members. Visualization of the transplant (porcine RPE cells on the Transwell membrane) 103 in the nozzle 8 was excellent, after loading and prior to transplantation into the human cadaver eye both because of the clear plastic nozzle 8, as seen in
The tip was readily introduced through the scleral opening in the human cadaver eye. Retraction of the nozzle 8 relative 1 to the mandrel allowed the delicate monolayer stem cells carried on the nanoplate to be delivered gently out of the open end of the nozzle into the target area under the retina. Surprisingly, delivery of the nanoplate using the push-button or the push-pull controller allowed precise placement of the tissue beneath the retina and minimal trauma to the retina with a complete preservation of the RPE cells on the Transwell membrane observed after it had been placed under the retina. Even more surprisingly, the use of infusion/aspiration mandrels during delivery further enhanced these properties of the instruments. This eliminated any need for external venting of the instrument. Further, the instrument prevented subretinal bleeding because of the ease with which it was able to maneuver subretinally.
The 30-gauge tube that formed the ports that perform the aspiration/infusion function was extremely efficient and its location was at a most critical position of the instrument, i.e. at the distal end of the mandrel, behind the loaded substance. The fiber optic light at the distal end of the mandrel allowed for visualization of the tissue under the retina when placing the transplant beneath the retina of the cadaver eye. In addition to this, the light provided very good illumination of the porcine RPE Transwell membrane in the loading stage, and in the fluid in the petri dish, to assure proper orientation of the RPE cells transplantation.
The distal end of the mandrel in the nozzle was matched to fit the nozzle such that movement was done smoothly without binding yet providing a leak-free tip.
The health and viability of the RPE cells prior to transplantation were maintained after transplantation in the cadaver eye as documented by microscopic histopathology after the subretinal placement.
These data on the cell growth and instrument performance for transplantation of porcine RPE cells (e.g. on a Transwell membrane and/or nanoplate and the like) into the subretinal space of a human cadaver eye demonstrates examples of superior properties of devices taught herein.
Example 13 Nozzle Coupler with Gripping MembersAn example of a nozzle coupler for a mandrel guide is shown in
The nozzle is made from stainless steel, for example.
Surprisingly, a nozzle coupler with gripping members is optionally configured to provide a minimally evasive, low profile coupling means which is optionally inserted through an insertion site (e.g. the eye).
Such a configuration can not only be configured to provide ease of entry into and exit from the eye, but also to facilitate rapid yet sturdy on-site assembly of the mandrel guide.
Example 14 Conductive MandrelAn example of a conductive mandrel 84 of the present invention is shown in
As depicted in
As depicted in
In one embodiment, the mandrel 84 is combined with the nozzle 80 depicted in
Such a mandrel can optionally be configured and used to perform additional functions that were previously performed by separate devices, yet effectively performs the function of a mandrel and/or extraction (i.e. to bias the substance for discharge upon movement through the mandrel guide). The oblate- or elliptical-like flare is especially well suited for substances in the form of a sheet, for example, retinal tissue or a nanoplate (e.g. comprising stem cells or retinal tissue for implantation into the eye).
Further, such a conductive mandrel can optionally be combined with a transparent nozzle.
Surprisingly, infusion/aspiration conductive members mandrel can optionally be configured eliminate the need for external venting of the instrument during delivery. Further surprising is that infusion/aspiration conductive members are optionally used to load a substance into the device with gentle suction, which is significantly less damaging to delicate substances such as RPE cells and/or sheets and nanoplates.
Example 15 Modular Mandrel GuideIn the non-limiting example illustrated in
The nozzle holder is made from, for example, from stainless steel hypodermic tubing such as 18 gauge stainless steel hypodermic tubing for delivering substances to the eye.
The base 59 is made from, for example, stainless steel, for example, 13 gauge 304 ss hypodermic tubing for delivering substances to the eye.
The key way 57 is made from, for example, brass seamless telescoping tubing, for example, 3/32″ brass seamless telescoping tubing, for delivering substances to the eye.
The modular mandrel guide allows, for example, the alternative use of a plurality of nozzles, each associated with a different nozzle holder 95. For example, nozzle holder 81 (
In the loaded position, delivery unit 5 is biased for delivery (e.g. a mandrel guide positioned distally but biased towards the proximal end), for example, by a first spring (delivery unit biasing means not shown). The traction pad 96 is biased to engage and inhibit movement of the delivery unit 5 by a delivery controller biasing means (construction of delivery controller biasing means is not illustrated), for example, by a second spring attached the toggle (e.g. 14) (e.g. the toggle (e.g. 14) is optionally attached to or constructed as a flat spring, as illustrated in in
Surprisingly, this delivery controller provides a high precision device that is readily maneuverable, can smoothly deliver delicate tissue, and is simple to use to provide more accurate placement of the substance (e.g. beneath the retina) with less trauma to the target site (e.g. retina) and its environment.
Such a configuration allows the device to be operated with little or no force or motion perpendicular to the mandrel guide at the insertion site, thereby reducing trauma to the patient. Such a configuration is also advantageous because it provides regulated delivery, and immediate stoppage on release of finger pressure.
The delivery controller is optionally configured to require less than about 3 lbs. (e.g. less than about any of: 2 lbs, 1 lb, or ¾ lb, or about any of: 0.25 lb to 2 lb, 0.25 lb to 1 lb, or 0.25 lb to 0.75 lb, or about 200 g to about 500 g, or about 300 g) to disengage traction pad 96 from delivery unit 5 and allow movement of the delivery unit 5, for example, by configuring the force of delivery controller biasing means (e.g. flat spring).
Example 17 Traction Pad Delivery ControllerThe delivery unit engagement means is a traction pad 65 comprising a hook 76 (or other configuration) with frictional surface 77. By way of example, the toggle (e.g. 14) is attached to the traction pad 65 by inserting the traction pad into the delivery unit support 4 and threading nut 78 onto screw 67 of the toggle (e.g. 14).
The toggle (e.g. 14) is mounted to the delivery unit support 4, for example, by inserting a toggle-mount 66 into the delivery unit 4 such that it aligns with the toggle (e.g. 14) and screwing screws 47 into female threaded holes (‘tapped holes’) of toggle-mount 66. The non-limiting example of the toggle-mount 66 depicted in
The delivery unit is optionally combined with any delivery unit member such as a proximal length of mandrel guide, for example, a mandrel guide base 59, as depicted in
Screw 56 (or other set-pin) optionally provides a means of setting the delivery unit to the loaded position by moving it screw 56 forward (distally) while the traction pad 65 is disengaged from the delivery unit. As depicted in
The hook 76 is made from, for example, hypodermic tubing (e.g. 9 gauge tw).
The frictional surface 77 is made from, for example, silicon tubing 9 (e.g. medical) such as tubing with 0.065″ o.d.×0.030″ i.d.
The delivery unit member (depicted as mandrel guide base 59) optionally comprises a frictional surface 62 to aid in braking (i.e. inhibiting movement) when the traction pad engages the delivery unit member. The frictional surface 62 is optionally provided, for example, as a textured surface such as a plurality of grooves in the delivery unit member, as illustrated in
Surprisingly, this delivery controller of the traction pad type provides a high precision device that is readily maneuverable, can smoothly deliver delicate tissue, and is simple to use to provide more accurate placement of the substance (e.g. beneath the retina) with less trauma to the target site (e.g. retina) and its environment.
Such a configuration allows the device to be operated with little or no force or motion perpendicular to the mandrel guide at the insertion site, thereby reducing trauma to the patient. Such a configuration is also advantageous because it provides regulated delivery, and immediate stoppage on release of finger pressure.
Toggle (e.g. 14) is optionally configured to require less than about 3 lbs. (e.g. less than about any of: 2 lbs, 1 lb, or ¾ lb, or about any of: 0.25 lb to 2 lb, 0.25 lb to 1 lb, or 0.25 lb to 0.75 lb, or about 200 g to about 500 g, or about 300 g) to disengage traction pad 65 from delivery unit (e.g. mandrel guide base 59), for example, by configuring the force of delivery controller biasing means (e.g. flat spring type lever).
Example 18 Delivery Device with Modular Mandrel Guide and Conductive MandrelOne embodiment of the present invention provides a delivery device comprising a modular mandrel guide, for example, as described in Example 15 and a conductive mandrel, for example, as described in Example 4 or Example 14. The delivery unit support comprises an interface such as a Luer lock for conductively linking the conductive mandrel to a fluid pump. The coupler of the modular mandrel guide is optionally provided as a key/keyway coupler such that the base of the modular mandrel guide is optionally assembled with interchangeable nozzle holders and their respective nozzles and mandrels. For example, a delivery device is optionally provided as depicted in
In one embodiment, the delivery device, kit, or partial delivery device is provided with a Luer lock (Luer fitting) and tubing 100 comprising Luer fittings 99, 100 on each end, as depicted in
In either embodiment, the delivery device, kit, or partial delivery device is delivery of a substance into an eye (e.g. into the subretinal space), for example, delivery of retinal tissue and/or nanoplates.
Example 19 Optional ConfigurationsA device is provided as in any of the previous examples and configured for delivering therapeutic substances such as retinal tissue and/or nanoplates into a subject (e.g. into the eye such as into the subretinal space). More specifically, the device is configured to any of the following specifications:
-
- a) Is fabricated from components which are suitable for sterilization by gamma radiation, for example, the mandrel, the mandrel guide, the nozzle, the proximal length of guide, the delivery unit support, or the entire device are fabricated from materials suitable for sterilization by gamma radiation (e.g. using stainless steel or gamma-compatible polymers);
- b) the size of the device does not exceed about: 1 inches diameter×12 inches in longitudinal length, optionally wherein the diameter does not exceed about 0.5 inches, optionally, optionally wherein the longitudinal length does not exceed about 7 inches;
- c) the device is configured for one-handed operation;
- d) the delivery controller is configured for longitudinal movement of the mandrel relative to the mandrel guide in a smooth and incremental, manner as desired by the user;
- e) the nozzle and mandrel are configured to be removed from the delivery unit support without damage to either the nozzle or mandrel, respectively;
- f) the nozzle and mandrel assembly are fabricated of materials which are inert when exposed to human tissue;
- g) the device comprises a transparent nozzle;
- h) the nozzle and mandrel are configured to accommodate tissue specimens up to 3.5 mm wide×11 mm long×0.5 mm thick or up to 2.25 mm wide×7.5 mm long×0.25 mm thick;
- i) a and b;
- j) a and c;
- k) a and d;
- l) a and e;
- m) a and f;
- n) a, b, and c;
- o) a, b, and d;
- p) a, b, c, and d;
- q) a e, and f;
- r) a, b, and g;
- s) a, c, and g;
- t) a, d, and g;
- u) a, e, and g;
- v) a, f, and g;
- w) a, b, and g c;
- x) a, b, d, and g;
- y) a, b, c, d, and g;
- z) a, e, f, and g;
- aa) a and g;
- bb) g and c;
- cc) g and d;
- dd) g and e;
- ee) g and f;
- ff) a, g, and h;
- gg) a and h;
- hh) g and h;
- ii) a and b;
- jj) h, a and c;
- kk) h, a and d;
- ll) h, a and e;
- mm) h, a and f;
- nn) h, a, b, and c;
- oo) h, a, b, and d;
- pp) h, a, b, c, and d;
- qq) h, a e, and f;
- rr) h, a, b, and g;
- ss) h, a, c, and g;
- tt) h, a, d, and g;
- uu) h, a, e, and g;
- vv) h, a, f, and g;
- ww) h, a, b, and g c;
- xx) h, a, b, d, and g;
- yy) h, a, b, c, d, and g;
- zz) h, a, e, f, and g;
- aaa) h, a and g;
- bbb) h, g and c;
- ccc) h, g and d;
- ddd) h, g and e; or
- eee) h, g and f.
The citations provided herein are hereby incorporated by reference for the cited subject matter.
Claims
1. A device for implanting a substance comprising:
- (a) a delivery unit comprising: (i) a mandrel guide, wherein the mandrel guide has an open distal end suitable for discharging a substance loaded therein; (ii) a longitudinally elongated mandrel disposed internally to the mandrel guide, whereby relative longitudinal movement of the mandrel through the mandrel guide towards the open distal end biases the loaded substance to move longitudinally towards the open end; and
- (b) a delivery unit support providing support to the delivery unit, wherein at least one of the mandrel and the mandrel guide is not fixed the delivery unit to allow longitudinal movement there about;
- (c) a delivery unit biasing member imparting a force on the delivery unit to bias the delivery unit for the relative longitudinal movement;
- (d) a delivery unit engagement means for opposing said force on the delivery unit when the delivery unit engagement means is engaged with the delivery unit, wherein the relative longitudinal movement is prevented when the delivery unit engagement means is engaged with the delivery unit;
- (e) a delivery controller configured to engage and disengage the delivery unit engagement means from the delivery unit;
- optionally, wherein the delivery unit support is a handpiece; and
- optionally, wherein the device is configured for implanting a substance into an eye.
2. The device of claim 1, wherein the longitudinally elongated mandrel is a conductive mandrel comprising: optionally, wherein the at least first proximal port comprises an interface configured for linking the conductive mandrel to one or more of a fluid pump and a wave transmitter.
- (a) at least a first distal port positioned at the distal end;
- (b) at least a first proximal port positioned proximal to the at least first distal port; and
- (c) a conductive member linking the at least first distal port and the at least first proximal port, wherein the conductive member is configured to conduct one or more of a fluid and a wave between the at least first distal port and the at least first proximal port;
3. The device of claim 2, wherein the conductive member comprises:
- (a) a fluid-conducting tube;
- (b) an electrically conductive wire;
- (c) a wave-transmitter;
- (d) a fiber optic cable;
- (e) a combination of (a) and (b);
- (f) a combination of (a) and (c) or (a) and (d); or
- (g) a combination of (a), (b), and (c) or of (a), (b), and (d).
4. The device of claim 2, wherein the distal end of the conductive mandrel comprises a plurality of fluid-conducting tubes disposed laterally of each other at the distal end of the mandrel and a surface area-increasing member that increases the lateral surface area of the conductive mandrel.
5. The device of claim 1, wherein the delivery controller comprises a toggle configured to interface a finger of a user thereof.
6. The device of claim 1, wherein the delivery controller comprises an engagement biasing means for biasing the delivery unit engagement means to engage the delivery unit; whereby applying a user force to the delivery controller disengages delivery unit engagement means from the delivery unit to allow the relative longitudinal movement.
7. The device claim 6, wherein the delivery controller comprises a toggle configured to interface a finger of a user thereof.
8. The device of claim 7, wherein disengagement of the delivery unit engagement means requires less than about 3 lbs of force on the delivery controller from the user, optionally, wherein said less than about 3 lbs of force is:
- less than about 2 lbs of force, less than about 1 lb of force, or less than ¾ lb of force; or
- about any of: 0.25 lb to 2 lb, 0.25 lb to 1 lb, or 0.25 lb to 0.75 lb; and about 200 g to about 500 g of force.
9. The device of claim 7, further comprising a reversible safety mechanism configured to be engaged and disengaged by the user, wherein: optionally, the reversible safety mechanism comprises:
- when engaged, the safety mechanism opposes the bias of the delivery unit basing means, thereby preventing said relative longitudinal movement of the delivery unit irrespective of whether the delivery unit engagement means is engaged; and
- when disengaged, the safety mechanism does not oppose the bias of the delivery unit basing means, thereby allowing said relative longitudinal movement of the delivery unit when the delivery unit engagement means is disengaged from the delivery unit; and
- a pin fixed to the delivery unit and configured to move along a longitudinal path with the delivery unit, and
- a latch disposed laterally of said longitudinal path, wherein the pin is configured to be movable into the latch, and thereby become longitudinally immobilized, wherein said relative longitudinal movement is prevented when the pin is longitudinally immobilized.
10. The device of claim 9, wherein the delivery controller comprises an engagement biasing means for biasing the delivery unit engagement means to engage the delivery unit; whereby applying a user force to the delivery controller disengages delivery unit engagement means from the delivery unit to allow the relative longitudinal movement.
11. The device of claim 1, wherein the delivery unit engagement means comprises a traction pad or a knife edge lock.
12. The device of claim 1, wherein at least the distal portion of at least of one of the elongated mandrel and the mandrel guide are flexible or curved, optionally wherein said distal portion is flexible or curved enough to slide under the retina into the subretinal space when inserted through the pars plana of the eye.
13. The device of claim 1, wherein the mandrel guide comprises a proximal length of guide and a nozzle coupled thereto, wherein the proximal length of guide comprises:
- a modular mandrel guide base; and
- a nozzle holder, wherein: the modular mandrel guide base and the nozzle holder are reversibly coupled to each other; and the nozzle holder is coupled to a nozzle or is configured to be coupled to a nozzle.
14. The device of claim 1, wherein the nozzle is transparent.
15. A device for implanting a substance comprising:
- (a) a delivery unit comprising: (i) a mandrel guide, wherein the mandrel guide has an open distal end for discharge of a substance loaded therein; and (ii) a longitudinally elongated conductive mandrel disposed internally to the mandrel guide, whereby relative longitudinal movement of the mandrel through the mandrel guide towards the open distal end biases the loaded substance to move longitudinally towards the open end, wherein the conductive mandrel comprises an interface for conductively linking the conductive mandrel to a fluid pump or wave transmitter; and one or more distal ports, wherein the conductive mandrel is capable of conducting a fluid or wave between the fluid pump or wave transmitter and the environment at the one or more distal ports;
- (b) a delivery unit support providing support to the delivery unit, wherein at least one of the mandrel and the mandrel guide is not fixed to the delivery unit to allow longitudinal movement there about; and
- (c) a delivery controller operably linked to the delivery unit whereby operating the delivery controller imparts a force on the delivery unit to bias the delivery unit for the relative longitudinal movement.
16. The device of claim 15, wherein the delivery unit support comprises a handpiece.
17. The device of claim 15, wherein:
- the interface is disposed at the proximal end of the conductive mandrel; or the interface is disposed proximal to the open distal end.
18. The device of claim 15, wherein the distal end of the conductive mandrel comprises a surface area-increasing member that increases the lateral surface area of the conductive mandrel.
19. The device of claim 15, wherein the distal end of the conductive mandrel comprises a plurality of conductive members, optionally disposed laterally of each other at the distal end of the mandrel.
20. A method of delivering cells to the subretinal space of a patient's eye, the method comprising:
- (a) loading the cells into the mandrel guide of a device of claim 1;
- (b) inserting the mandrel guide through the surface of the eye;
- (c) orienting the open end of the mandrel guide in proximity to the retina;
- (d) sliding the open end of the mandrel guide under the retina and into the subretinal space; and
- (e) discharging the cells by retracting the mandrel guide relative to the Mandrel,
- optionally wherein the cells are RPE cells.
Type: Application
Filed: May 27, 2016
Publication Date: Dec 1, 2016
Inventors: Dyson Hickengbotham (Wake Forest, NC), Norman Radtke (Louisville, KY)
Application Number: 15/167,826
