Abstract: A trocar obturator includes a hollow tube having a substantially solid, optically clear tip attached thereto. A distal cutting end of the tip is formed by a pair of opposing, angularly oriented surfaces which converge to a line at that point with a cutting element disposed along the line. For electrosurgical operation, an electrode is positioned along the line. The tip serves as a viewing window and defines a viewing port at its proximal end for an endoscope inserted into the hollow obturator tube for viewing a tissue wall as it is penetrated. The trocar obturator tip may include an axial bore extending between its proximal and distal ends with a viewing rod within the bore for viewing the area ahead of the tip. Here again, the distal cutting end of the tip may be formed by a pair of opposing angularly oriented surfaces which converge to a line. Two cutting elements extend linearly along the distal end of the tip, one on either side of the bore.

Abstract: An electrosurgical selectively controllable loop electrode for laparoscopic surgery is set forth which includes a housing having a longitudinal axis and an axially extending cavity forming a passageway through the housing. A shaft member is slideably mounted to the housing within the cavity so as to permit axial and rotational displacement of the shaft member relative to the housing. A wire electrode which has a first end segment and a second end segment is in electrical communication with the shaft member and extends distally therefrom; the wire electrode also has a bridge segment integrally interconnecting the first and second end segments to form a loop. The end segments are biased by a pair of leaf springs of predetermined curvature where the springs are internally biased to open upon extension of the springs distally from the housing and to close upon external forces exerted against the springs by the housing during retraction.

Abstract: A bipolar coagulation device suitable for use in endoscopic surgery is disclosed which reduces the adhesion of tissue to the electrodes and enables the user to clean the electrodes during the procedure without removal from the body. Bipolar electrocautery forceps are located at the distal end of a sheath suitable for use in endoscopic surgery. The tips of the forceps are manipulated using controls located at the control end of the sheath which remains outside the patient's body. The tips of the forceps are made of material having phosphorous in combination with metals of high thermal conductivity, which reduces the adhesion of tissue during cauterization. In addition, the device has a cleaner which acts to free the forceps of any adhering debris. This cleaning can be done inside the patient's body, without the need for any additional instrumentation. In a preferred embodiment, the tips of the bipolar coagulation device can also be pivoted to an angularly disposed position.

Abstract: An apparatus for electrosurgical incision of a stricture within or adjacent to a body lumen, which comprises an electrically conducting, deflectable wire associated with an introducer for introducing the apparatus into the body lumen, wherein a proximal portion of the wire is deflectable outwardly relative to the introducer, and a source of RF electric current connected to the wire whereby RF electric current may be transmitted through the wire when it is in the deflected position.

Abstract: A laparoscopic surgical device comprises an elongate shaft having a plurality of electrically conductive flexible ribs connected to the distal end of the shaft and to one another to form a cage or basket. Upon placement of an organic body in the cage, the ribs are electrically energized. The organic body is pressed against the ribs to dissect the ribs in a single cauterization operation.

Abstract: A method and an apparatus is disclosed for delivering controlled heat to perform ablation to treat the benign prosthetic hypertrophy or hyperplasia (BPH). According to the method and the apparatus, the energy is transferred directly into the tissue mass which is to be treated in such a manner as to provide tissue ablation without damage to surrounding tissues. Automatic shut-off occurs when any one of a number of surrounding areas to include the urethra or surrounding mass or the adjacent organs exceed predetermined safe temperature limits. The constant application of the radio frequency energy over a maintained determined time provides a safe procedure which avoids electrosurgical and other invasive operations while providing fast relief to BPH with a short recovery time. The procedure may be accomplished in a doctor's office without the need for hospitalization or surgery.

Abstract: A medical device has a body, an actuating member mounted to move relative to the body, a working element, and an elongated force-transmitting member capable of transmitting actuating force between the actuating member and the working element. The force-transmitting member includes a flexible cable portion, the force-transmitting member is attached, on one side of the cable portion, to the body and associated in a driving relationship on the opposite side of the cable portion with the working element. According to the invention the actuating member includes a pulley surface bodily movable therewith, the cable portion is trained about the pulley surface such that movement of the actuating member a given distance, relative to the body, causes the working element to move a substantially greater distance than the given distance. Another aspect of the invention is a medical snare with the above features.

Abstract: According to the present invention, a sheath has flexibility, and includes a first lumen for guiding a conducting wire in the sheath and a second lumen for injecting contrast medium, which are made of insulating material. The wire exposes itself outside at openings formed in the terminal position of the first lumen, and thus forms a dissecting section for dissecting a contact tissue with supplied high-frequency current. The proximal portion of the sheath is connected to a bifurcating section for bifurcating the sheath into a first path having substantially the same cross-sectional area as the first lumen and communicating with the first lumen for guiding the wire so that the wire will not buckle up and a second path communicating with the second lumen. An operation handle for advancing or withdrawing the wire is connected externally to the back of the first path.

Abstract: An electrosurgical loop comprising an insulated shaft with an electrical contact at its proximate end and a pair of extending insulated prongs at its distal end. The extending prongs are configured to give the loop a "Y" shape and each end of a thin wire are connected to each prong to provide a wire loop. Disposed over the shaft in longitudinal sliding engagement is a depth gauge comprising a clasp, a longitudinal intermediate portion, and a transverse cross bar. The clasp may be retrofit to an existing electrosurgical loop and permits the removal of the depth gauge from the loop, if desired. The transverse cross bar is wider than the breadth of the wire loop and has a transverse slot oriented in the same plane as the wire loop through which the wire loop passes as the depth gauge is adjusted for various cutting depths. Disposed on the insulated shaft are markings serving as depth indicators to which the depth gauge may be moved slidably to effect cut depth control for the loop.

Abstract: A bipolar snare instrument for use in surgery is provided. The snare instrument has a snaring loop comprising a flexible continuous electrically-insulating loop for supporting bipolar electrodes. The electrodes may be arranged in various geometries on the insulating loop to provide localized selective necrosis and hemostasis of a patient's protruding tissue. Methods of performing surgery with such devices are also provided.

Abstract: Medical instruments are provided having end effectors and end effector actuator apparatus which are rotatable relative to the end effectors. The instruments generally include a tube which is typically coupled to the end effectors via a clevis around which the end effectors pivot, a push rod extending through the tube and coupled to the end effectors, and an actuator apparatus engaging the tube and the push rod with the actuator apparatus including a handle which surrounds and rotatably engages the proximal end of the tube, and a lever arm which pivotally engages the handle and is coupled to the push rod such that pivotal movement of the lever arm relative to the handle effects axial movement of the push rod relative to the tube and pivotal movement of the end effectors.

Abstract: An improved endoscopic instrument suitable for performing internal procedures through a trocar in which the instrument handle is provided with a control mechanism for rotating the instrument thereby enabling a surgeon to manipulate and utilize the instrument with one hand.

Abstract: The wire loop of a surgical snare is constructed so as to include a weakened or frangible region. When it is desired to open the loop so as to move it from its entrapped position on a polyp, an additional force is exerted on the loop to draw it further into the sheath. This causes the frangible region to break, thereby opening the loop and permitting the wire to slide free of the polyp. In accordance with an alternate embodiment, the wire loop is constructed so as to fold back on itself, with the folded back end being captured by a retaining element inside the sheath. When the loop becomes entrapped on a polyp, it is extended out of the sheath somewhat further than during normal use, at which point the captured end of the loop is released, opening the loop and permitting its removal from within the patient.

Abstract: A bipolar sphincterotomy for use in endoscopic retrograde sphincterotomy procedures includes an elongated, flexible, plastic tube having either a single or a double lumen extending between its distal and proximal ends. At least one, but preferably two, aperture(s) is formed through the wall of the plastic tubular member a predetermined distance proximal of the distal end of the plastic tubular member. A pair of conductive wires extend through the lumen from the proximal end and exit the lumen through the aperture(s). The distal ends of pair of wires are mechanically joined to the tube so that the portions of the wires extending exteriorly of the lumen are in parallel, spaced relation with a predetermined gap therebetween. The exposed portions of the wires comprise a bipolar pair of electrodes.

Abstract: A surgical instrument assembly for use in snare cauterization operations comprises a tubular sheath member, a metallic cauterization loop, and a metal wire operatively connected to the loop, the wire passing longitudinally through the sheath. An electrical supply is operatively connectable to the wire for feeding an electrical current to the loop via the wire, while a manually actuatable shifter is operatively connected to the wire for longitudinally sliding the wire along the sheath in alternately opposite directions. A flexible web member is connected to the loop to form a capture pocket, the loop defining a mouth opening of the pocket. During use of the snare cauterization instrument, the loop is at least partially expanded from a collapsed configuration and passed over the selected internal body tissues to be removed, so that the web member substantially surrounds the selected internal body tissues.

Abstract: A surgical instrument assembly for use in snare cauterization operations comprises a tubular sheath member, a metallic cauterization loop, and a metal wire operatively connected to the loop, the wire passing longitudinally through the sheath. An electrical supply is operatively connectable to the wire for feeding an electrical current to the loop via the wire, while a manually actuatable shifter is operatively connected to the wire for longitudinally sliding the wire along the sheath in alternately opposite directions. A flexible web member is connected to the loop to form a capture pocket, the loop defining a mouth opening of the pocket. During use of the snare cauterization instrument, the loop is at least partially expanded from a collapsed configuration and passed over a polyp to be removed, so that the web member substantially surrounds the selected polyp.

Abstract: A conductive wire 3 is inserted into a flexible sheath 2 with a wiring portion thereof exposed at a distal end portion of the sheath. Upon the pull of the wire 3, the distal end portion is curved and the exposed wire portion is pull taut to provide a wire portion for incision. A restricting member 5 is provided within the sheath 2 to restrict the direction in which the distal end portion of the sheath 2 is curved. As viewed from the proximal end side to the distal end side of the sheath 2, the wire portion 6 is located within an angle range of 0.degree. to 90.degree. leftwise from the aforementioned direction in a manner to diagonally follow the outer surface of the sheath 2 in a counterclockwise direction to the longitudinal axis of the sheath. An affected region in the body cavity of a human being is incised with a high-frequency current carried through the conductive wire.

Abstract: A monopolar electrosurgical instrument for excising polyps from the gastrointestinal tract comprises an elongated flexible plastic tube having a first monopolar electrode mounted a small predetermined distance from the distal end of the tubular member and a conductive wire loop affixed to a pull-wire, the pull-wire extending through the lumen of the tubular member and being connected at its proximal end to a plunger-type handle whereby the loop can be opened and closed by extending and retracting the loop relative to the distal end of the tubulr member. By incorporating both the surface electrode and the loop on the same instrument, polyps may be severed electrosurgically using the snare and the wound then immediately cauterized using the surface electrode, thus obviating the need to do an instrument exchange in the endoscope to accomplish both functions.

Abstract: A biopsy instrument comprises an elongated flexible tube having a sharpened metal sleeve affixed to its distal end. An anvil member is affixed to the distal end of an elongated rod or wire which fits through the lumen of the tube and which is reciprocally moveable in the longitudinal direction by appropriately manipulating a handle device affixed to the proximal end of the tube. Affixed to the anvil member and electrically connected to the rod is an electrode. Means are provided for connecting an RF voltage between the electrode and metal sleeve for coagulating blood at the site where a tissue sample is excised from the internal wall of a body organ. The tissue sample is excised by positioning it against the sharpened edge of the metal sleeve and drawing back on the anvil to sever the sample and draw it into the interior of the sleeve where it remains until removed.

Abstract: The present invention relates to surgical instruments for removing protruding tissue such as tonsils, warts, polyps and like, from the body, more specifically, it relates to loop type snare instruments supplying a high frequency electrical current for coagulation and cutting during the removal of these body growths.In a primary embodiment of the invention, a loop is provided which is made of electrically conductive wire connected to a loop made of electrically conductive wire within a tubular insulated sheath. The wire is connected to a handle assembly that will allow the loop to be extended from or retracted into the distal end of the tubular insulated sheath. The loop is covered over a major portion of its circumference by an insulating material, leaving only a minor portion of its circumference uninsulated at the portion of the loop most distal from the tubular sheath, and electrically active.

Abstract: The invention provides an improved surgical snare having an operating cable freely rotatable while the handle is maintained steady, having a rotating assembly mounted in the handle so that the axis of rotation of the assembly is essentially coaxial with the longitudinal axis of the handle and having a quick disconnect-connect means for attaching the operating cable to the rotating assembly without external clamping means.

Abstract: An operating insert to be passed through a resectoscope shaft comprises a channel for an axially displaceable cutting loop which extends parallel to an optical system through the operating insert. The cutting loop has branches secured within a tube and merging at their proximal ends into an electrode stem which extends beyond the shaft as far as an electrode carrier. An annular cylindrical sealing element of plastics material or the like is secured on the stem or on the inner side of the channel and bears via sealing projections against the inner surface of the cutting loop so as to prevent the passage of fluid to the proximal end of the channel while allowing axial movement of the stem and the tube within the channel.

Abstract: A bioplar sphinctertome for use in endoscopic retrograde sphincterotomy procedures includes an elongated, flexible, plastic tube having either a single or a double lumen and includes a segment near its distal end which is both flexible and conductive. This segment is connected by a wire extending through the lumen to a terminal at the proximal end of the device adapted to be coupled to an electrosurgical generator. A second, longitudinally movable wire passes through the lumen and is connected at the proximal end to a finger-operated slide mechanism while its distal end passes through a small aperture formed in the tube just proximal of the flexible conductive segment. That wire is then anchored distally of the flexible conductive segment so that when a tensioning force is applied to the wire, the distal end portion of the instrument will bow, with the exposed wire comprising the active electrode and the flexible conductive segment functioning as the return electrode.

Abstract: An improved handle for a polypectome snare for use in excising polyps from an internal body cavity. The apparatus generally comprises a radio frequency polypectome snare which includes a hand grip assembly, a flexible tubing assembly capable of fitting within an endoscope, an electrode loop portion and a power supply means. The hand grip assembly is made of molded pieces of inflexible plastic comprising a longitudinal housing portion and a slide member having opposing finger grip members. When the slide member is in its most proximal position, the electrode loop portion is withdrawn into the flexible tubing. As the slide member is advanced toward the distal end of the longitudinal housing, the electrode wires are advanced out of the flexible tubing, forming a loop that can be placed around the stem of a polyp. Once again withdrawing the loop into the end of the flexible tubing while simultaneously applying RF voltage shears the polyp at its base.

Abstract: A sphincterotome, such as a papillotome, is disclosed for surgical cutting using an electrically conductive cutter wire. The sphincterotome includes a multi-lumen tubular member, with one lumen having an electrical conductor disposed therein, and the other lumen having a reinforcing wire disposed therein. The reinforcing wire is preferably rectangular in cross-section, providing a greater moment of inertia in a resisting axis than in a bending axis. Accordingly, the cutting edge of the cutting wire may be oriented to the 12 o'clock position of the papillary orifice to avoid injury to the duodenal wall or pancreatic duct in the patient, and to maintain the cutting edge in a predetermined cutting plane. Fluoroscopic indicating stripes may be provided at the distal end of the sphincterotome. A method of use and method of fabrication of the present invention is also disclosed.

Abstract: An electrosurgical instrument for use in combination with an endoscope for cutting tissue and cauterizing/coagulating the resulting wound area is described. The instrument comprises an elongated flexible tubular member having a proximal end, a distal end, and plural lumens extending therebetween. Affixed to the distal end of the tube is a bullet-shaped ceramic tip member having a centrally-disposed longitudinal bore passing through the side wall of the tip member. The ceramic exterior surface of the tip member is covered with a conductive layer forming a first inactive electrode. An electrical conductor joined to that electrode surface feeds back through a lumen of the tube to its proximal end where it may be coupled to an electrosurgical generator. Also running through a lumen in the tube is another conductor which can be made to project outwardly through the opening in the tip member.

Abstract: A polypectome snare whose loop comprises a pair of electrodes mechanically joined but electrically insulated from one another at their distal ends and adapted to be energized by a source of RF voltage for excising polyps on the inside of a body cavity is described. The polypectome snare is designed to be used with an endoscope and includes two concentric flexible plastic tubes each having proximal and distal ends and a lumen running the length thereof. At the proximal end is a hand grip which is secured to the wires leading to the bipolar electrodes with one of the wires passing through the lumen of the outermost tube and the other wire extending through the lumen of the inner tube. In this fashion, the wires remain insulated from one another over the length of the instrument and due to this same arrangement, the conductors comprising the bipolar electrodes cannot become twisted at the distal end of the implement to thereby create a short which would render the snare inoperative.