Surgical instrument
A surgical instrument includes a tubular stem section which extends from a handle. A tubular articulated section connects a surgical instrument with the stem section. An actuator assembly is connected with the handle and is operable to bend the articulated section to change the orientation of an instrument on an outer end portion of the articulated section relative to body tissue. The instrument on the outer end of the articulated section may be a rotatable cutting tool which is driven by a tubular drive element having a flexible section which extends through the articulated section. The articulated section is bent or flexed by a plurality of flexible elongated elements (wires). In one embodiment of the invention, a pair of elongated elements are provided to flex the articulated section in opposite directions. In another embodiment of the invention, four flexible elongated elements are provided to flex the articulated section in any one of four directions.
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The present invention relates to a new and improved arthroscopic/endoscopic surgical instrument, and more specifically, to an arthroscopic/endoscopic surgical instrument which may be used to remove tissue from a joint or other body space.
Surgical instruments which may be used to remove tissue or perform other operations on tissue are disclosed in U.S. Pat. Nos. 4,499,899; 4,517,977; 4,649,919; and 4,834,729. The surgical instruments disclosed in these patents have stem sections which extend outwardly from a handle. A cutting tool or other device is disposed at the outer end of the stem section. The stem section is rigid. Therefore, the orientation of the cutting tool can not be changed relative to the stem section.
SUMMARY OF THE INVENTIONThe present invention relates to a surgical instrument which is particularly well adapted for arthroscopic and/or endoscopic surgery. The surgical instrument has a stem section which is attached to a handle. A suitable instrument, such as a cutting tool, is connected with an outer end portion of the stem section by an articulated section. An actuator is provided to bend the articulated section to change the orientation of the instrument relative to the stem section and body tissue.
In one embodiment of the invention, a pair of flexible elongated elements, such as wires, are provided to bend the articulated section in opposite directions from an initial position. In this embodiment of the invention, the articulated section may be constructed so as to freely flex in a direction transverse to the direction in which the articulated section is bent by the elongated elements. In another embodiment of the invention, a plurality of elongated elements, such as wires, are provided to flex or bend the articulated section in any one of four directions.
The foregoing and other objects and features of the present invention will became room apparent upon a consideration of the following description taken in connection with the accompanying drawings, wherein:
General Description
A surgical instrument 20, constructed in accordance with the present invention, is illustrated in FIG. 1 and may be used during the performance of arthroscopic and/or endoscopic surgery. A control apparatus 22 is connected with the surgical instrument 20 through a cord system 24. The surgical instrument 20 includes a handle 28 of known construction, which is connected with a tubular stem section 30. A known instrument 32 is connected with a rigid portion 33 of the stem section by an articulated section 34 constructed in accordance with the present invention.
In accordance with one of the features of the present invention, an actuator assembly 38 is manually operable to bend the articulated section 34 to move the instrument 32 between my one of many positions relative to the rigid portion 33 of the stem section 30. The actuator assembly 38 can be operated to bend the articulated section 34 from a straight or initial condition shown in
Of course, operation of the actuator assembly 38 could be interrupted with the instrument 32 in any one of the positions illustrated in
In accordance with another feature of the embodiment of the invention illustrated in
The actuator assembly 38 can be operated to change the orientation of the instrument 32 relative to the rigid portion 33 of the stem section 30 and body tissue during an operation. The actuator assembly 38 can be operated to positively change the orientation of the instrument 32 through a range of 180°, that is through 90° upwardly (as viewed in
It is believed that the surgical instrument 20 will be particularly advantageous for removing tissue from between vertebra in the human spinal column during an operation. Thus, the instrument 32, articulated section 34 and part of the rigid portion 33 of the stem section 30 can be inserted through a very small opening in the skin adjacent to the spinal column of a patient. As this is done, the articulated section 34 is straight in the initial orientation shown in
After the stem section 30 has been partially inserted through an opening in the skin adjacent to the spinal column, the actuator assembly 38 is operated to bend the articulated section 34 and move the surgical instrument 32 transversely to a longitudinal central axis of the rigid portion 33 of the stem section 30. This enables the instrument 30 to be moved to a desired position to engage tissue located between adjacent vertebra. As the instrument 32 is being moved by operation of the actuator assembly 38, the articulated section 34 can also be deflected sideways under the influence of forces applied against the instrument 32. Of course, the surgical instrument 20 can be used during the performance of many different types of arthroscopic and/or endoscopic operations.
During use of the surgical instrument 20, it is contemplated that it will be desirable to convey tissue removed from between vertebra or other locations away from the instrument 32. Accordingly, a suction pump (not shown) is connected with the handle 28 at a connection 44. Suction is conducted through a central conduit or passage 45 (
In addition, water or other fluid can be utilized to irrigate the area where tissue is removed by the instrument 32. Thus, a source of water or other irrigation fluid is connected with the handle 28 at a connection indicated at 46 in FIG. 1. The irrigation fluid is conducted through the handle 28 and the central conduit 45 in the stem section 30 to the instrument 32. Irrigating fluid, along with the removed tissue, is then withdrawn from the area around the surgical instrument 32.
Articulated Section
The articulated section 34 includes a plurality of relatively movable sections 50, 52, 54 and 56 (FIGS. 4 and 5). The sections 50, 52, 54 and 56 are interconnected for pivotal movement about perpendicular axes. Thus, the section 50 is pivotal relative to the section 52 about a vertical axis indicated at 60 in FIG. 4. The section 50 is connected with the section 52 at pivot connections 62 and 64. Similarly, the section 54 is pivotal relative to the section 56 about a vertical axis indicated at 66 in FIG. 4. The section 54 is connected with the section 56 at pivot connections 68 and 70.
The section 52 is pivotal relative to the section 54 about a horizontal axis indicated at 72 in FIG. 5. The section 52 is connected with the section 54 at pivot connections 74 and 76. Similarly, the section 56 is pivotal relative to an end portion 78 of the rigid stem section 33 about a horizontal axis indicated at 82 in FIG. 5. The section 56 is connected with the rigid portion 33 of the stem section 30 at pivot connections 84 and 86.
The instrument 32 is pivotal relative to the section 50 about a horizontal axis indicated at 92 in FIG. 5. The instrument 32 is connected with the section 50 at pivot connections 94 and 96.
The axes 60 and 66 (
Initial operation of the actuator assembly 38 in one direction pivots the instrument 32 upwardly (as shown in
Continued operation of the actuator assembly 38 pivots the sections 50 and 52 together while the instrument 32 is maintained in a deflected position. Thus, the sections 50 and 52 pivot upwardly from the initial position shown in solid lines in
Continued operation of the actuator assembly 38 pivots the sections 54 and 56 upwardly (as viewed in
During deflection of the articulated section 34 about the axes 72, 82 and 92 (
Actuator Assembly
The actuator assembly 38 includes a pair of flexible wires 102 and 104 (
Tension in the upper wire 102 (as viewed in
When the actuator assembly 38 (
Continued operation of the actuator assembly 38 continues to shorten the wire 102 and lengthen the wire 104. This results in the sections 54 and 56 being pulled in a clockwise direction (as viewed in
Operation of the actuator assembly 38 in the opposite direction is effective to shorten the wire 104 and lengthen the wire 102. As the actuator assembly is operated in the opposite direction to shorten the wire 104, the instrument 32 is pivoted downwardly or in a counterclockwise direction (as viewed in
Continued operation of the actuator assembly 38 results in further lengthening of the wire 102 and shortening of the wire 104. This results in the sections 50 and 52 being pivoted downwardly or in a counterclockwise direction (as viewed in
The actuator assembly 38 has been shown schematically in FIG. 6. The actuator assembly 38 includes a pair of pulleys or drams 108 and 110 to which end portions of the wires 102 and 104 are connected The wires 102 and 104 are wound in opposite directions about the drums 108 and 110. The drums 108 and 110 rotate together about a common axis. Therefore, when one of the wires 102 or 104 is wound onto a drum 108 or 110, the other wire is unwound from the other drum.
Upon pivotal movement of a handle 114, a gear train 116 is actuated. The gear train 116 has been illustrated schematically in FIG. 3. The gear train 116 includes a gear 118 which is fixedly connected with the handle 114 and a gear 120 which is fixedly connected with the pulleys or drums 108 and 110 (FIG. 6).
Upon pivotal movement of the lever 114 toward the left or in a counterclockwise direction as viewed in
Continued operation of the actuator assembly 38 results in continued shortening or winding up of the wire 102 and lengthening or unwinding of the wire 104 until the instrument 32 has been moved through 90° from the original orientation shown in solid lines in
Pivotal movement of the handle 114 in a clockwise direction (as viewed in
It should be understood that although one specific preferred embodiment of the actuator assembly 38 has been illustrated schematically and described herein, it is contemplated that the actuator assembly 38 could have a somewhat different construction if desired Thus, many different types of mechanisms could be provided lengthening one of the wires 102 or 104 while simultaneously shortening one of the wires.
Regardless of the type of actuator assembly 38 which is utilized to deflect or bend the articulated section 34, the actuator assembly is operable to apply force to the articulated section to deflect the articulated section from a straight initial configuration to an upwardly or downwardly (as viewed in
The actuator assembly 38 can also be operated to bend or deflect the articulated section 34 to move the instrument 32 downwardly from the Z axis into alignment with the Y axis in the manner shown in dashed lines in FIG. 8. At this time, the instrument 32 extends downwardly from and perpendicular to the X and Z axes.
The actuator assembly 38 is operable to deflect the articulated section 34 to move the instrument 32 in either one of two directions, that is upwardly or downwardly as viewed in
Instrument
In the embodiment of the invention illustrated in
Other known surgical instruments may be substituted for the cutter 124. Thus, a generally spherical rotatable burr or muter may be used to abrade tissue. If desired, a probe or a basket biter having (mown constructions could be substituted for the cutter 124. Of course, the particular type of instrument 32 which is connected with the outer end portion of the articulated section 34 will depend upon the surgical operation to be performed.
The cutter 124 is rotatable about the longitudinal central axis of the stem section 30 to cut tissue. A rigid tubular metal drive shaft 128 extends axially from the drive shaft 126 through the rigid portion 33 of the stem section 30 to the articulated section 34 (
The rigid drive shaft 129 is connected with the drive shaft 126 (
The wires 102 and 104 (
The wires 102 and 104 are disposed radially outwardly of the rigid metal drive shaft 128 and the flexible drive shaft 130. This allows the outer end portions of the wires 102 and 104 to be fixedly secured to diametrically, opposite portions of the instrument 32 in the manner indicated schematically at 142 and 144 in FIG. 7.
Fluid for irrigating an area adjacent to the cutter 124 is conducted through the conduit 45 formed in the tubular rigid drive shaft 128 and the tubular flexible drive shaft 130 (
It is contemplated that a thin flexible polymeric sheet my be provided around the articulated section 34. However, the sheet has been omitted in the drawings for purposes of clarity of illustration
Second Embodiment
In the embodiment of the invention illustrated in
It is contemplated that it my be desirable to have the actuator assembly 38 constructed in such a manner as to be operable to bend the articulated section 34 in any desired direction. An embodiment of the invention having an actuator assembly constructed so as to deflect the articulated section 34 in my desired direction is illustrated in FIG. 9. Since the embodiment of the invention illustrated in
In the embodiment of the invention illustrated in
In accordance with a feature of this embodiment of the invention, an actuator 38a is provided to move the instrument 32a in a plane containing the Z and Y axes (FIG. 8). A second actuator assembly 152 is provided to move the instrument 32a in the plane containing the X and Z axes (FIG. 8). Thus, the two actuator assemblies 38a and 152 function as an actuator system which enables a surgeon to move that instrument 32a anywhere within a hemisphere by operating the actuator assemblies.
The actuator assembly 38a is connected with the instrument 32a by wires 102a and 104a. The actuator assembly 152 is connected with the instrument 32a by wires 156 and 158. The wires 102a, 104a, 156 and 158 are connected with the instrument 32a at locations which are offset from each by 90° about the circumference of the instrument 32a. The wires 102a and 104a are connected with the instrument 32a at locations which are diametrically opposite from each other. The wires 156 and 158 are connected with the instrument 32a at locations which are located diametrically opposite from each other and on a diameter which extends perpendicular to a diameter extending through the connections of the wires 102a and 104a to the instrument 32a. The combination of the four wires 102a, 104a, 156 and 158 and the actuator assemblies 38a and 152 enable the instrument 32a to be pivoted in my desired direction relative to the rigid stem 33a.
In the embodiment of the invention illustrated in
Conclusion
The present invention relates to a surgical instrument 20 which is particularly well adapted for arthroscopic and/or endoscopic surgery. The surgical instrument 20 has a stem section 30 which is attached to a handle 28. A suitable instrument 32, such as a cutting tool, is connected with an outer end portion of the stem section 30 by an articulated section 34. An actuator 38 is provided to bend the articulated section 34, to change the orientation of the instrument 32 relative to the stem section 30 and body tissue.
In one embodiment of the invention, a pair of flexible elongated elements 102 and 104, such as wires, are provided to bend the articulated section 23 in opposite directions from an initial position. In this embodiment of the invention, the articulated section 34 may be constructed so as to freely flex in a direction transverse to the direction in which the articulated section is bent by the elongated elements 102 and 104. In another embodiment of the invention (FIG. 9), a plurality of elongated elements 102a, 104a, 156 and 158, such as wires, are provided to flex or bend the articulated section 34a in any one of four directions.
Claims
1. A surgical instrument comprising a stem section extending from a handle, a cutting tool, said cutting tool including a rotatable cutter a hollow articulated section connected with said cutting tool and said stem section, a rotatable drive shaft connected with said cutter and disposed in and extending axially through said stem section and said articulated section, said drive shaft having a flexible portion disposed in said articulated section, and actuator means connected with said handle for bending said articulated section and said flexible portion of said drive shaft to change the orientation of said cutter relative to time from a first orientation to a second orientation, said actuator means including first and second elongated elements which extend through said stem section and articulated section and are connected with said cutting tool, said elongated elements being disposed between an outer side surface of said flexible portion of said drive shaft and an inner side of said articulated section, said actuator means including means for pulling on one of said elongated dements to bend said articulated section and said flexible portion or said drive shaft to change the orientation of said cutter from the first orientation to the second orientation, said drive shaft being rotatable relative to said articulated section to rotate said cutter when said cutter is in the first orientation and when said cutter is in the second orientation;
- said surgical instrument further including passage means extending axially through said drive shaft for conducting tissue from a location adjacent to said cutter through said articulated section and said stem section toward the handle.
2. A surgical instrument comprising a stem section extending from a handle, a cutting tool, said cutting tool including a rotatable cutter, a hollow articulated station connected with said cutting tool and said stem section, a rotatable drive shaft connected with said cutter and disposed in and extending axially through said stem section and said articulated section, said drive shaft having a flexible portion disposed in said articulated section, and actuator means connected with said handle for bending said articulated section and said flexible portion of said drive shaft to change the orientation or said cutter relative to time from a first orientation to a second orientation, said actuator means including first and second elongated elements which extend through said stem section and articulated section and are connected with said cutting tool, said elongated elements being disposed between an outer side surface of said flexible portion of said drive shaft and in inner side of said articulated section, said actuator means including means for pulling on one of said elongated elements to bend said articulated section and said flexible portion of said drive shaft to change the orientation of said cutter from the first orientation to the second orientation, said drive shaft being rotatable relative to said articulated section to rotate said cutter when said cutter is in the first orientation and when said cutter is in the second orientation;
- said surgical instrument further including passage means extending through said drive shaft for conducting irrigating fluid through said drive shaft from said handle to said cutter.
3. A surgical instrument comprising a hollow rigid stem section extending from a handle, a cutting tool, said cutting tool including a rotatable cutter, a hollow articulated section connected with said cutting tool and said stem section, a rotatable drive shaft connected with said cutter and disposed in and extending axially through said stem section and said articulated section, said drive shaft including a rigid section disposed in said stem section and a flexible section disposed in said articulated section, and actuator means connected with said handle for bending said articulated section and said flexible section of said drive shaft to change, the orientation of said cutter relative to tissue from a first orientation to a second orientation, said drive shaft being rotatable relative to said articulated section when said cutter is in the first orientation and when said cutter is in the second orientation, said actuator means extending through substantially the entire length of said articulated section, said cutting tool being prevented from moving in an axial direction relative to said articulated section;
- said surgical instrument further including passage means extending axially through said drive shaft for conducting tissue from a location adjacent to said cutter through said articulated section and said stem section toward the handle.
4. A surgical instrument comprising a hollow rigid stem section extending from a handle, a cutting tool, said cutting tool including a rotatable cutter a hollow articulated section connected with said cutting tool and said stem section, a rotatable drive shaft connected with said cutter and disposed in and extending axially through said stem section and said articulated section, said drive shaft including a rigid section disposed in said stem section and a flexible section disposed in said articulated section and actuator means connected with said handle for bending said articulated section and said flexible section of said drive shaft to change the orientation of said cutter relative to tissue from a first orientation to a second orientation, said drive shaft being rotatable relative to said articulated section when said cutter is in the first orientation and when said cutter is in the second orientation;
- wherein said actuator means includes first and second elongated elements which extend through said stem section and articulated section and are connected with said cutting tool, said elongated elements being disposed between an outer side surface of said flexible section of said drive shaft and an inner side of said articulated section, said actuator means including means for pulling on said first elongated element to bend said articulated section and the flexible section of the drive shaft in a first direction, said actuator means including means for pulling on said second elongated element to bend said articulated section and said flexible section of said drive shaft in a second direction opposite to said first direction.
5. A surgical instrument comprising a hollow rigid stem section extending from a handle, a cutting tool, said cutting tool including a rotatable cutter, a hollow articulated section connected with said cutting tool and said stem section, a rotatable drive shaft connected with said cuter and disposed in and extending axially through said stem section and said articulated section, said drive shaft including a rigid section disposed in said stem section and a flexible section disposed in said articulated section, and actuator means connected with said handle for bending said articulated section and said flexible section of said drive shaft to change the orientation of said cutter relative to tissue from a first orientation to a second orientation, said drive shaft being rotatable relative to said articulated section when said cutter is in the first orientation and when said cutter is in the second orientation, said actuator means extending through substantially the entire length of said articulated section, said cutting tool being prevented from moving in an axial direction relative to said articulated section;
- said surgical instrument further including passage means extending axially through said drive shaft for conducting irrigating fluid from said handle to said cutter.
6. A surgical instrument comprising a stem section extending from a handle, a movable member, a hollow articulated section connected with said movable member and said stem section, a drive shaft connected with said movable member and disposed in and extending axially through said stem section and said articulated section, said drive shaft having a flexible portion disposed in said articulated section and actuator means a connected with said handle for bending said articulated section and said flexible portion of said drive shaft to change the orientation of said movable member relative to tissue from a first orientation to a second orientation, said actuator means including first and second elongated element which extend through said stem section and substantially the entire length of said articulated section and are connected directly with said movable member, said actuator means including means for pulling on one of said elongated elements to bend said articulated section and said flexible portion of said drive shaft to change the orientation of said movable member from the first orientation to the second orientation, said drive shaft being movable relative to said articulated section to move said movable member when said movable member is in the first orientation and when said movable member is in the second orientation;
- said surgical instrument further including passage means extending axially through said drive shaft for conducting tissue from a location adjacent to said movable member through said articulated section and said stem section toward the handle.
7. A surgical instrument comprising a stem section extending from a handle, a movable member, a hollow articulated section connected with said movable member and said stem section, a drive shaft connected with said movable member and disposed in and extending axially through said stem section and said articulated section, said drive shaft having a flexible portion disposed in said articulated section, and actuator means connected with said handle for bending said articulated section and said flexible portion of said drive shaft to change the orientation of said movable member relative to tissue from a first orientation to a second orientation, said actuator moms including first and second elongated elements which extend through said stem section and substantially the entire length of said articulated section and are connected directly with said movable member, said actuator means including means for pulling on one of said elongated elements to bend said articulated section and said flexible portion of said drive shaft to change the orientation of said movable member from the first orientation to the second orientation, said drive shaft being movable relative to said articulated section to move said movable member when said movable member is in the first orientation and when said movable member is in the second orientation;
- said surgical instrument further including passage means extending through said drive shaft for conducting irrigating fluid through said drive shaft from said handle to said movable member.
8. A surgical instrument comprising a handle, a stem section extending from add handle, means for acting on tissue including a movable member, a hollow articulated section connected with said movable member and said stem section, means connected with said movable member for moving said movable member relative to said articulated section, said mesas being disposed in and extending axially through said stem section and said articulated section, said means having a flexible portion disposed in said articulated section, said actuator means connected with said handle for bending said articulated section and said flexible portion of acid means for moving said movable member to change the orientation of said movable member relative to tissue from a first orientation to a second orientation, said actuator means including a least one elongate element which extends through said stem section and articulated section and is connected with said movable member, said means for moving said movable member being movable relative to said articulated section to move said movable member relative to said articulated section when said movable member is in the first orientation and when said movable member is in the second orientation;
- said surgical instrument further including passage means extending axially through said means for moving said movable member for conducting tissue from a location adjacent to said movable member through said articulated section and said stem section toward said handle.
9. A surgical instrument comprising a handle, a stem section extending from said handle, means for acting on tissue including a movable member, a hollow articulated section connected with said movable member and said stem section, means connected with said movable member for moving said movable member relative to said articulated section, odd means being disposed in and extending axially through said stem section and said articulated section, said means having a flexible portion disposed in said articulated section, and actuator means connected with said handle for bending said articulated section and add flexible portion of said means for moving said movable member to change the orientation of said movable member relative to tissue from a first orientation to a second orientation, said actuator means including a least one elongate element which extends through said stem section and articulated section and is connected with said movable member, said means for moving said movable member being movable relative to said articulated section to move said movable member relative to said articulated section when said movable member is in the first orientation and when said movable member is in the second orientation;
- said surgical instrument further including passage means extending through said means for moving said movable member for conducting irrigating fluid from said handle to said movable member.
10. A surgical instrument comprising:
- a handle;
- a stem section extending from said handle;
- means for acting on tissue including a movable member;
- a hollow articulated section connected with said movable member and said stem section;
- means connected to a portion of said movable member for moving said portion relative to said articulated section, said means being disposed in and extending axially through said stem section and said articulated section, said means having a flexible portion disposed in said articulated section; and
- actuator means connected to said handle for bending said articulated section and said flexible portion of said means for moving said portion of said movable member to change the orientation of said movable member relative to tissue from a first orientation to a second orientation, said actuator means including at least one elongated element which extends through said stem section and substantially the entire length of said articulated section and is connected directly to said movable member;
- said means for moving said portion of said movable member being movable relative to said articulated section when said movable member is in the first orientation and when said movable member is in the second orientation;
- said surgical instrument further including passage means for conducting tissue from a location adjacent to said movable member to said handle, said passage means extending axially from said movable member through said articulated section and said stem section to said handle, said passage means extending through said means for moving said portion of said movable member.
11. A surgical instrument comprising:
- a handle;
- a stem section extending from said handle;
- means for acting on tissue including a movable member;
- a hollow articulated section connected to said movable member and said stem section;
- means connected to a portion of said movable member for moving said portion relative to said articulated section, said means being disposed in and extending axially through said stem section and said articulated section, said means having a flexible portion disposed in said articulated section; and
- actuator means connected to said handle for bending said articulated section and said flexible portion of said means for moving said portion of said movable member to change the orientation of said movable member relative to tissue from a first orientation to a second orientation, said actuator means including at least one elongated element which extends through said stem section and substantially the entire length of said articulated section and is connected directly to said movable member;
- said means for moving said portion of said movable member being movable relative to said articulated section to move said movable member relative to said articulated section when said movable member is in the first orientation and when said movable member is in the second orientation;
- said surgical instrument further including passage means for conducting irrigating fluid from said handle to said movable member, said passage means extending axially from said handle through said articulated section and said stem section to said movable member, said passage means extending through said means for moving said portion of said movable member.
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Type: Grant
Filed: Nov 6, 2000
Date of Patent: Jun 27, 2006
Assignee: Endius Incorporated (Plainville, MA)
Inventors: Gilbert M. Aust (Huntsville, AL), Timothy E. Taylor (Huntsville, AL)
Primary Examiner: Michael H. Thaler
Attorney: Tarolli, Sundheim, Covell & Tummino L.L.P.
Application Number: 09/707,445
International Classification: A61B 17/32 (20060101);