Abstract: There is provided an operating instrument insertion apparatus capable of easily inserting an operating instrument into the tissue. The operating instrument insertion apparatus includes a hollow tubular member for receiving an operating instrument therein, and a plurality of scoop-like members provided at a distal end of the hollow tubular member. The plurality of scoop-like members can be opened in such a manner that distal ends of the scoop-like members are moved away from each other in a direction transverse to an axial direction of said hollow tubular member, and the plurality of scoop-like members can be closed in such a manner that the distal ends of the scoop-like members are moved toward each other in this transverse direction, wherein the scoop-shape members in the opened condition cooperate so that an outside diameter formed thereby is no greater than an outside diameter of the hollow tube member.

Abstract: An electrosurgery medical device is enhanced with unique solution-assistance, and comprises, in combination, co-operating device jaws including jaw portions for manipulating tissue, and a plurality of solution infusion openings defined and spaced along each of the jaw portions, for receiving electrolytic solution and infusing the solution onto and into tissue to be manipulated, along said jaw portions. As preferred, the device further comprises at least one, and most preferably, many, longitudinal groove(s) along at least one and most preferably, both, of the jaw portions, with the solution infusion openings located in the groove or grooves. The solution is energized with RF energy and contributes to the functions and beneficial effects of the instrument. The solution exits the openings in the grooves at sufficient flow rates to separate substantially all the operative surfaces of the device from tissue, thereby substantially completely preventing adherence between the operative surfaces and tissue.

Abstract: An ultrasonic dissection and coagulation system for surgical use is provided. The system includes an ultrasonic instrument, a control module, and a remote actuator. The ultrasonic instrument has a housing and an elongated body portion extending from the housing. An ultrasonic transducer supported within the housing is operatively connected to a cutting jaw by a vibration coupler. The vibration coupler conducts high frequency vibration from the ultrasonic transducer to the cutting jaw. The cutting jaw has a blade surface which is curved downwardly and outwardly in the distal direction with respect to the longitudinal axis of the elongated body portion along its length such that an angle defined by a line drawn tangent to the blade surface and the longitudinal axis of the elongated body portion varies between 5 degrees and 75 degrees.

Abstract: Bipolar electrosurgical scissors are disclosed having a pair of blades joined for relative movement in a scissor-like action between open and closed positions. The blades comprise a tissue contacting surface and first and second spaced apart electrodes extending along the surface. Current flow between the first and second electrodes of each blade and between each blade to promote hemostasis in tissue contacting the surface.

Abstract: A medical instrument is provided for cutting tissue or vessels in the human or animal body. The instrument comprises two scissor arms pivotal with respect to one another, each having a cutting edge. The cutting edges slide across one another when the scissor arms are pivoted. The first and second scissor arms are configured as electrodes to be supplied with high frequency current and pivotal about a stationary pivot axis arranged at the scissor arms. At least one of the scissor arms comprises at least one bracket connected thereto, which at least partially extends over the outer side of the other scissor arm.

Abstract: An improved articulation mechanism is described in conjunction with a therapeutic ultrasound instrument. Ultrasonic vibrations, when transmitted to organic tissue at suitable energy levels and using a suitable end-effector, may be used for the safe and effective treatment of many medical conditions. The mechanism includes an actuating arm with a collar operatively connected to the actuating arm. The collar converts rotation of the actuating arm into a plurality of actuations of the surgical instrument. In one embodiment the collar includes two ranges of motion, where the first range is used to articulate the surgical instrument, and the second range is used to actuate the surgical instrument. Such instruments are particularly suited for use in minimally invasive procedures, such as endoscopic or laparoscopic procedures.

Abstract: An improved tool for endoscopic disruption of lower esophageal ring generally comprises scissors adapted to be inserted into a patient's esophagastric junction through a flexible endoscope. The scissors pair comprises a blunt tipped instrument having a pair of short cutting edges operable through an axially disposed cable or the like. In practice, the instrument is inserted into a flexible endoscope and thereby orally inserted into the patient's lower esophagus. Once inserted into the lower esophagus, the instrument is utilized to precisely sever a lower esophageal ring at a plurality of radial locations. Once effectively disrupted, any associated shelf effect will generally self-correct. Other procedures, such as hiatal hernia repair, may then be completed, whereafter the endoscope may be removed from the patient. The procedure should require only about 20 minutes to complete and will result in a minimum of patient discomfort as well as instant relief from the symptoms of LER.

Abstract: An instrument for directing the insertion of a penetration member urged through tissue. The instrument includes a shaft, and a backstop positioned at a distal end of the shaft. The backstop and shaft are configured such that the backstop may be positioned adjacent one side of the tissue to be penetrated, and a penetration member may thereafter be urged through the opposite side of the tissue into the backstop. A method of penetrating the tissue wall of an anatomical cavity is also provided.

Abstract: An arteriotomy scissors for a surgical system including a sleeve, a fixed blade fixedly mounted to a distal end of the sleeve, a movable blade pivotally mounted to the fixed blade and the distal end of the sleeve, and an actuation rod extending through the sleeve. The movable blade is mounted to a distal end of the actuation rod. The actuation rod is driven in a reciprocal manner within the sleeve to drive the movable blade between a fully open cutting position and a fully closed cutting position with respect to the fixed blade.

Abstract: The present invention is directed to a surgical instrument such as, for example, an ultrasonic surgical cutting and coagulating device, wherein the gripping movement of the surgeon is mechanically translated into lateral movement for actuating, for example, an actuating rod. One embodiment of the present invention includes a camming pivot for use in surgical instruments, wherein the camming pivot comprises an actuation mechanism, including; a lever arm; a first cam at a distal end of the lever arm; and a second cam positioned distally from the first cam.

Abstract: Medical scissors have handle parts and blades and are characterized in that they are coated, at least in the area of the blades, with an amorphous thin layer containing silicon, carbon and hydrogen, where the proportion of silicon is up to 100% atom parts in the boundary layer to the metallic body of the scissors, and up to 30% atom parts in the area of the outer surface of the layer.

Abstract: An apparatus and method for minimally invasive surgery using a cutting tool with rotational cutting edges. The surgical instrument includes a tube having a distal end and a cutting edge at the distal end. A handle is attached to the proximal end of the tube. Within the tube is a shaft having a longitudinally extending blade at its distal end that is adjacent to the distal end of the tube. The blade is revolvable about the longitudinal axis of the instrument to provide rotational cutting action. One or both of the blade and the cutting edge on the tube can be electrically energized to provide for electrocauterization of the body tissue being cut.

Abstract: In an endoscopic surgical instrument for the coagulation, by high frequency energy, and for the severing of coagulated tissue areas, a coagulation pliers and a scissors structure are provided, which are mounted on the distal end of an instrument and which are operated by a handle with operating levers in such a way that, upon actuation of the handle, first the pliers is closed for grasping the tissue while the scissors are closed in a delayed fashion. After coagulation of the tissue engaged by the pliers, actuation of a second lever at the handle end of the instrument fully closes the scissors structure for cutting the tissue in the coagulation area.

Abstract: This invention relates to a surgical device and methods for accessing and retrieving a tissue mass from a body cavity through a minimally invasive laparoscopic procedure. The device consists of a handle comprising an inner rod, which is rotatably engaged within a tubular member, and a loop adapted to hold a surgical bag. The loop comprises first and second bowed leaf elements, wherein the first bowed leaf element is attached to the inner rod and the second bowed leaf element is attached to the tubular member. The device further has a rotatable articulation, such as a hinge, joining the first and second bowed leaf elements, wherein rotation of the inner rod causes the first bowed leaf element to rotate about the articulation, such that the surgical bag may be opened and closed by rotation of the inner rod.

Abstract: A micro-surgical forceps having a handle and integral spring arms that are interconnected at the end of the forceps remote from said blades in a tongue and groove arrangement that allows for operation of the forceps with a minimum of finger pressure. Plastic covers for the handle for securing the forceps blades is a further embodiment of the invention. The forceps are fabricated of a non-heat treatable metal and the gripping platforms are manually adjustable. A scissors having sharpened curved blades that form an arc across one another and are fabricated of non-heated metal that is flexible.

Abstract: Hand-held instruments which may be employed to actuate a distally mounted tool by application of radial compressive force about the instrument circumference (i.e., omni-actuatable). In preferred forms, hand-held instruments have a handle which includes an actuator assembly for actuating a tool, wherein the actuator assembly has a generally V-shaped circumferential channel in which an actuator band is seated. A slide ring assembly is provided which defines the generally V-shaped circumferential channel and has at least one slide ring mounted for longitudinal movements relative to the handle. The actuator band is radially flexible. Thus, in response to a compressive force, the actuator band seated within the generally V-shaped channel will be flexed radially inwardly to thereby moves the slide ring longitudinally. The slide ring, in turn, coacts operatively with the distally mounted tool (e.g., through a longitudinally slidable actuator pin).

Abstract: The invention relates to a device for carrying out surgical operations. The device includes a distal part, a middle part extending from the distal part, and a proximal part mounted on the middle part opposite to the distal part. A gripping element of the device is for gripping body tissue and the like. Another element of the device, near the distal part of the device, is for operating the gripping element. Near the distal part of the device is an element for operating a severing component.

Abstract: Bipolar electrosurgical scissors are disclosed having a pair of blades joined for relative movement in a scissor-like action between open and closed positions. The blades comprise a tissue contacting surface and first and second spaced apart electrodes extending along the surface. Current flow between the first and second electrodes of each blade and between each blade to promote hemostasis in tissue contacting the surface.

Abstract: A surgical instrument has a pair of opposed jaws constructed and arranged to open and close relative to one another. Each jaw has a proximal end connected to part of the surgical instrument, an opposite jaw tip end, and a confronting surface arranged facing the opposite jaw. A perimeter defines a boundary of the respective confronting surface and jaw tip end for each jaw. At least a first cutting edge portion is provided on a part of each jaw perimeter whereby that part defines the jaw tip end. Each first cutting edge portion is oriented extending toward the corresponding first cutting edge portion of the opposite jaw. Each first cutting edge portion is curved concavely inward toward the proximal end of the respective jaw. The curved first cutting edge portions are oriented precisely as desired relative to the longitudinal axis of the instrument.

Abstract: A novel, monopolar, electrosurgical instrument is provided with one active and one non-active end effector. Current is passed through a conductive portion of one effector into tissue of a patient. The active blade may be partially or totally conductive. The non-active blade may be utilized to shield current from the active electrode effector.

Abstract: Open surgery and endoscopic versions of an electrosurgical cutting instrument incorporating a unique cutting arrangement for opening and closing the cutting edge parallel to an anvil surface resulting in a simultaneous cutting of a linear section of tissue, large vessels, or a group of vessels. Simultaneous with the cutting, the instrument further being capable of either a monopolar or bipolar cauterization of tissue. Also disclosed herein, are methods for use of the various electrosurgical cutting instruments.

Abstract: Open surgery and endoscopic versions of an electrosurgical cutting instrument incorporating a unique cutting arrangement for opening and closing the cutting edge parallel to an anvil surface resulting in a simultaneous cutting of a linear section of tissue, large vessels, or a group of vessels. Simultaneous with the cutting, the instrument further being capable of either a monopolar or bipolar cauterization of tissue. Also disclosed herein, are methods for use of the various electrosurgical cutting instruments.

Abstract: Open surgery and endoscopic versions of an electrosurgical cutting instrument incorporating a unique cutting arrangement for opening and closing the cutting edge parallel to an anvil surface resulting in a simultaneous cutting of a linear section of tissue, large vessels, or a group of vessels. Simultaneous with the cutting, the instrument further being capable of either a monopolar or bipolar cauterization of tissue. Also disclosed herein, are methods for use of the various electrosurgical cutting instruments.

Abstract: A surgical cutting tool which is provided with means enabling suction to be applied to the site of operation of the tool. The tool may for example be a pair of surgical scissors or a surgical scalpel. The tool may be provided with a mechanism for effecting cauterization, and/or clamping tissue on which the surgeon is operating.

Abstract: A method for treating a hair shape comprising the steps of: subjecting hair to softening treatment by applying or spraying a softening agent or applying a hair-treating agent, and giving vibration of predetermined frequency of not exceeding 20 KHz being lower than a frequency of ultrasonic wave to hair to give a desired shape to hair. It is possible to cause cutting of cystine linkage, salt linkage, hydrogen linkage or the like in keratin of the hair, which was hard to be done in a conventional permanent treatment, to every portion of hairs by making an effect of the first liquid (softening agent) being sufficiently exhibited in permanent treatment.

Abstract: A kit including a patch laden with topical anti-fungal medication and a set depth nail notcher for cutting a notch of predetermined depth in a nail plate comprising a handle having a smooth flat surface, a longitudinal cutting edge protruding from the smooth flat surface to a height equal to the predetermined depth of the notch. A method for treating nail, especially toenail, fungus comprising cutting a notch to a predetermined depth in a nail or a toe of finger infected with fungus and applying a topical anti-fungal medication to the toe or finger from a patch through the notch.

Abstract: A finger-guided surgical instrument is described and includes (a) a thimble-like element being adapted to surround at least a portion of a surgeon's finger while at least partially exposing the ventral tactile portions of the distal phalanx thereof, so as to enable the surgeon to tactile sense a body location to be treated; (b) an ejectable surgical tool being engaged within a housing being formed within, or connected to, a wall of the thimble-like element; and (c) a mechanism for ejecting the surgical tool from the thimble-like element, so as to enable the surgeon to operate the body location.

Abstract: Microsurgical instruments for performing extremely small-scale, minimally-invasive microsurgery such as thoracoscopic coronary artery bypass grafting. The instruments utilize a symmetrical, forcep-like actuator which provides extremely precise actuation and control of the instrument and which mimics the feel of instruments used in conventional open surgical procedures. The instruments generally include a pair of coaxially arranged shafts, an end-effector at the distal ends of the shafts, and an actuator at the proximal ends of the shafts. The actuator includes a pair of arms pivotally coupled to one of the outer and inner shafts, and a pair of links pivotally coupled at one end to the arms, and at a second end to the other of the shafts. The links are coupled to a proximal portion of the arms to maximize mechanical advantage and reduce interference. The actuator may be easily adapted for either pull-type or push-type actuation, and for either outer shaft or inner shaft translation.

Abstract: A bipolar electrosurgical instrument having an improved pivot screw design is disclosed. The bipolar electrosurgical instrument has a first half which has a first pivot surface and a first bore. The first bore has a first stepped portion and an elongated portion proximate to the first pivot surface. A second half has a second pivot surface and a second bore having a second stepped portion. An insulating material is disposed on the first pivot surface and the elongated portion of the first bore. A first insert having a third bore in which the third bore has first threads is disposed in the second bore and prevented from entering the first bore by the second stepped portion. A second insert having a fourth bore is disposed in the second bore between the second stepped portion and the first insert and prevented from entering the first bore by the second stepped portion.

Abstract: A surgical sliding shaft instrument (10) comprising a guide element (12), which is provided with a carriage (14). It further includes a grip part element (16), which is comprised of a stationary grip part (18), one end of which is provided with a grip trunk (20) pivotably linked to the guide element (12) and also releasably inter-locked with the guide element (12). It further includes a movable grip part (22), which is pivotally connected to the grip trunk (20) and, via a push part (24) extending through a slit in the grip trunk (20), is in operable engagement with the carriage (14). A compression spring (28) tensions or biases the movable grip part (22) in a rest position. An inter-locking element (26) serves for releasable connecting of the grip trunk (20) and guide element (12). The compression spring (28) is integrated in the carriage (14) and pretensions both the carriage (14) as well as the movable grip part (22) in a rest position.

Abstract: A novel, bipolar, electrosurgical instrument is provided with two end effectors. Current is passed through the second end effector and through an insulated conduit to the distal tip of the first end effector. The first and second end effectors allow the current to travel along exposed conductive strips which are spaced apart cutting surfaces by a gap of preferably approximately 0.020-0.040 inches when the first and second blade supports are brought into contact with tissue. Current flows between the exposed metal strip on the first blade and the exposed metal strip on the second blade thereby effecting cauterization, preferably slightly in advance or at the point of cutting between the ceramic and metal blades. The first and second end effectors may be partially insulated to direct current between the conductive strips, and both may have gaps at their respective surfaces.

Abstract: A medical instrument is provided for cutting tissue or vessels in the human or animal body. The instrument comprises two scissor arms pivotal with respect to one another, each having a cutting edge. The cutting edges slide across one another when the scissor arms are pivoted. The first and second scissor arms are configured as electrodes to be supplied with high frequency current and pivotal about a stationary pivot axis arranged at the scissor arms. At least one of the scissor arms comprises at least one bracket connected thereto, which at least partially extends over the outer side of the other scissor arm.

Abstract: Instruments including a pair of scissors (1) for removing the bump from an aquiline nose, wherein the scissors have cutting blades (5,6) with mutually facing concave cutting edges (7,8) matching the shape of the bump, as well as a clamp with two cutting blades each having a double curvature in two perpendicular planes so that the clamp fits the lateral bones of the nose. The clamp enables lateral osteotomy of the nose once the bump has been removed by means of the scissors (1), whereby the surgeon can reconstruct the shape and profile of the nose. The number of instruments needed may thus be reduced considerably relative to the prior art, while the reliability, accuracy and safety of the operation may be substantially enhanced.

Abstract: Endoscopic surgery nippers have a proximal end body to which is detachably affixed the proximal end zone of a tube forming the nippers' shank, the end zone being detachably fixed in the axial position while rotatable about the axis of the end body. A grip is fixed in place on the end body and another grip is pivotally supported on the first grip and has a swivel socket along the tube axis on the proximal side of the end body. A nipper head supports nipper arms and is detachably connected in rotatably and in axially geometrically interlocking manner with the distal tube end. A rod driving the nipper arms and affixed in axially displaceable and non-rotatable manner to the nipper head extends through the tube and is detachably supported at its distal end in the swivel socket.

Abstract: An endoscopic instrument has an external tube and a hollow cylinder coaxially extending along a longitudinal axis and actuatable to move axially in opposite directions to rotate a distal end of the instrument provided with an engaging element between angular positions. The distal end actuated by the outer tube is rotatable about a pin having an axis of rotation which is spaced radially from the longitudinal axis as another pin formed on and extending radially from the cylinder is guided along an arcuate groove provided on the distal end of the instrument.

Abstract: A treating instrument for operative endoscopy has a pair of treating members provided at the distal end of a sheath. The pair of treating members are simultaneously opened or closed in a beaklike manner by remote control from the proximal end of the sheath. A driving device is provided at the distal end of the sheath for driving the pair of treating members to perform respective opening and closing actions through different rotation angles.

Abstract: A scissor comprises a rigid blade with a fixed shape and an adjustable spring blade both pinned together at the end of the blade portions. The blades also comprise elongated leg portions extending outwardly from the junction with the blade portions and terminating in curved finger loops or a manipulating handle. The adjustable spring blade comprises a blade with spring like properties of the cutting edge which is continuously maintained in rotation around the fixed axis of the non-cutting edge of said rigid blade. When the scissors are open, the line of the cutting edge of the spring blade penetrates the plane of the opposing blade. This penetration stops when the scissors are closed. The rotation of the spring blade cutting edge may be clockwise or counter-clockwise but is always directed towards the sharp edge of the opposing blade of the scissors and thus continuously engages the sharp edge of the opposing blade at the cutting point.

Abstract: A laparoscopic surgical scissors for cutting tissue is disclosed. The laparoscopic surgical scissors has a handle body assembly having an actuation member moveable toward and away from the handle body assembly. An elongated shaft having a proximal and a distal end that define a longitudinal axis is connected to the handle body assembly at the proximal end of said shaft. A pair of cutting blades have a first blade member and a second blade member that are co-operably connected about a common pivot member adjacent to the distal end of the elongated shaft. The common pivot member defines a common pivot axis perpendicular to the elongated shaft. The first blade member has a first cutting edge and the second blade member has a second cutting edge facing the first cutting edge. The blade members have a single point of blade contact translating proximally and distally as the blade members open and close in response to movement of the actuation member away from and toward the handle body assembly.

Abstract: An endoscopic bipolar forceps comprises an elongated tubular member dimensioned to fit through the working lumen of an endoscope where the tubular member includes a handle at its proximal end and a pair of end effectors at its distal end and with a lumen extending between them. The end effectors each have a metal tissue cutting and tissue sample capturing and retaining element facing one another and capable of being open and closed by manipulating the handle. Each of the end effectors includes an electrode supported by and insulated from it. A push rod coupling the handle to the end effectors for inducing the pivotal movement thereof also serves as an electrical conductor for applying a first potential to the metal tissue cutting and tissue sample capturing and retaining element. A second conductor extends through the lumen of the tubular member and is electrically connected to the electrodes on each of the end effectors.

Abstract: A scissor sharpener has a recurved frame forming a U-shaped channel and an opening for receiving four fingers of a hand for grasping. A sharpening stone spans the channel at a predetermined angle to the adjacent surfaces of the frame. Surgical scissors can be wedged within the channel while their cutting edges are drawn over the stone for sharpening.

Abstract: Umbilical scissors having birth-related indicia associated therewith. In this regard, the umbilical scissors may be labeled with the birth data or provided with engraved or embossed birth data or indicia in the form of a color-coded handle to indicate the gender of a baby. Further, birth data may be provided on a label, such as a gummed label or plate, which may be mounted directly to the scissors or to a container or frame in which the scissors are placed for permanent storage and/or display.

Abstract: An ergonomic and proprioceptive handle design for instruments is disclosed. The handle can be used with a wide variety of medical instruments, such as a rongeur, as well as other instruments, such as guns and staplers.

Abstract: A liposuction apparatus is provided which contains a shaft having a reinforced swan neck structure. The apparatus has a suction channel for removing fatty tissue and a channel for introducing cooling fluid material. Optionally, the tip of the shaft has a bezel for better separation of tissue and a sonic or ultrasonic generator.

Abstract: Open surgery and endoscopic versions of an electrosurgical cutting instrument incorporating a unique cutting arrangement for opening and closing the cutting edge parallel to an anvil surface resulting in a simultaneous cutting of a linear section of tissue, large vessels, or a group of vessels. Simultaneous with the cutting, the instrument further being capable of either a monopolar or bipolar cauterization of tissue. Also disclosed herein, are methods for use of the various electrosurgical cutting instruments.

Abstract: An surgical instrument comprises a movable actuation element, at least one working part moved by said actuation element, an apparatus for limiting a transfer of a force transferred via said actuation element to said at least one working part. Said apparatus has at least one wedge surface associated to said actuation element, said wedge surface rising perpendicular to its movement when moving said actuation element. A housing is provided which can be spread apart by said wedge surface by movement thereof, and an elastically spreadable ring circumferentially surrounds said housing in its spreading section, said elastically spreadable ring can close said spread housing when said wedge surface is moved out of its spreading engagement with said housing.

Abstract: A manually-operable surgical tool, suitable for laparoscopic operations, has separable parts which cooperate to move a pair of end effector elements which can be readily replaced by another pair of end effector elements. A handle portion enables controlled longitudinal movement of an elongate inner element relative to an outer surrounding tubular element. The tubular element has a distal end with a first cleft and a pair of parallel cantilevered inwardly-oriented opposed cam pins. The distal end of the elongate inner element is provided with a second cleft and a transverse force-application pin. The selected end effector elements rotatably fit inside the cleft of the inner element to receive an applied force via the force-application pin. Each end effector element has a blind-ended cutout having an open end for engaging at least with a corresponding one of the cam pins.

Abstract: An apparatus and method for determining the motor type of an electric intraocular surgical handpiece. A circuit including a voltage divider, opto-isolators and amplifiers receives signals from the motor of the handpiece to determine its type. The circuit provides a signal, which can be visual or auditory, to the user concerning the motor type of the handpiece so that the user may choose the proper controls compatible with the motor type.

Abstract: An endoscopic instrument having a ball and socket connection for releasably attaching a front end assembly to an actuating handle assembly comprising of a base having a downwardly extending stationary handle and a pivoting handle. The socket comprising a plurality of resilient prongs to create a friction fit that can be disengaged by the surgeon retracting the pivoting thumb handle. The socket disposed in the base and linkage provided for actuating the instrument.

Abstract: What is described here is an instrument having a shaft element carrying an engaging element disposed on the distal end thereof, which is operated via a proximally disposed actuator element which is integrated into a handle for being mobile in such a way that the angle enclosed by the axis of said handle and by the axis of said shaft element may be varied. The invention is characterized by the provision that the handle is connected to the shaft element via a universal joint.

Abstract: A biopsy forceps device is provided for obtaining tissue samples at a site within the body, while maintaining access to the site through an access lumen of the biopsy forceps. The device includes an elongate tubular body for introduction into the body and navigation to an area of interest. An inner tubular member having a lumen, or a plurality of lumens, extends through or adjacent the outer tubular member, from the proximal end to the distal end, where cutting jaws are provided. The cutting jaws are rotatably mounted at the distal end of the device and are controlled by movement of the inner tubular member. The inner tubular member is coupled with a handle portion allowing control of the cutting jaws at the proximal end. Access to the lumen of the inner tubular member is gained at the proximal end, where a luer fitting is provided.