JPH06503238A - Surgical instruments for material removal - Google Patents

Abstract

(57) [Summary] This bulletin contains application data before electronic filing, so abstract data is not recorded.

Description

[Detailed description of the invention] Surgical instruments for material removal Background of the invention The present invention has hitherto found primary use in endoscopic, particularly arthroscopic, surgical procedures. Concerning the types of surgical instruments that have been used. Such devices, especially shoulder, knee, etc. Many parts of the half-moon cutter utilized in surgical procedures are Due to technical problems associated with positioning the meniscal tissue within the mouth or fenestra, It is considered that the level is not acceptable. This problem is mainly due to Spatial limitations encountered in endoscopic surgical procedures and can be eliminated. This results from the difficulty in tilting and moving the instrument into the semilunar material. .

Therefore, suction to the location where it is cut or removed from the patient's body. Association with a half-moon cutter to produce an end that can be brought by , making multiple skin incisions as well as the use of secondary instruments such as knife blades. The need for There is no need to wear a belt.

U.S. Patent No. 4.646.738 describes the prior art and conventional arthroscopic instruments and and the limitations of commonly performed surgical procedures. referenced This patent primarily discloses that the cutting unit ( By equipping the device with positioning elements), the conventional technology at the time Special devices have been mentioned to overcome the inadequacies of A surgical instrument is disclosed. This device extends the length of the device and Contains a continuous outer tubular member that is bent during manufacturing to achieve a defined angle . An in-depth flexible transmission system extending through the outer tube connects the inner spiral Consisting of a spiral part, a middle spiral part, and an outer spiral part. Contains a composite spirally wound tube. Multiple spirals tack welded The arrangement of the tubes is such that each one alternates with respect to adjacent spiral sections. This allows the transmission tube to rotate in the opposite direction. This de The mechanical complexity of the vise makes its manufacture and therefore procurement unreasonably expensive; I can understand that this makes the equipment more likely to break down.

Summary of the invention The working end of the instrument or cutter head should be predetermined according to the procedure involved. Arthroscopic and to provide surgical instruments that are compatible with both common (open) surgical procedures. and to allow access to the surgical site with minimal trauma. This is one object of the present invention. It should be practical for such equipment to be structurally stable. Yes, with precision for both clockwise and counterclockwise rotational movement of the cutter device. Built-in dynamic drive, fits with minimal suction path disruption, and is easily sterilized. It is inexpensive both in terms of material cost and assembly procedure, which makes it easier to use over time. should be made available as economically viable disposable items.

In the surgical instrument of the present invention, the angular orientation of the cutter head is straight lateral sides each attached to a leg oriented in the angular direction of the elbow Hollow connector nirbow ( This is achieved by providing an elbow). Fixtures at different angles can help the rest of the component If the part is standardized, it will be exactly the same regardless of the angle of its nirbow, or the actual Properly angled, rigidly preformed nilbonds of qualitatively similar construction. It is easily manufactured by using cormorant.

The cutter rotates its cutter shaft to laterally move the cutter through the sheath of the cutter. In cooperation with the blade end, tissue is removed from the patient's body in a window demarcated by the or other substances that provide a combined ablation action that can be adapted for use in removing with a mouth end generally directed laterally; Includes a hollow cutter shaft with a "Cutter" and "excision" used here term, or other derivatives thereof, should be used in the context appropriate to the subject. The forward motion of the target device causes separation of body matter from the source of matter. Encompasses various equipment and processes for performing ricing, shaving, and exfoliation. Ru. The proximal end of the cutter shaft is the proximal end of the shaft that bounds the driven gear. As a continuation of the inner and outer peripheries, around the end portion of the shaft, as well as within its range. a plurality of evenly spaced, medially positioned peripherally within a It is equipped with a set of gears. The driven gear is arranged at an elbow angle and has a long hollow It is in a meshing drive arrangement with a gear similarly formed on the distal end of the drive shaft. Ru. The angle bounded by the connector nirbow is approximately 180 degrees (where from approximately 90 degrees (where the legs are in a straight alignment) to about 90 degrees (where the legs are in a general alignment with respect to each other). It is desirable that the angle be at right angles to Depth of driving gear and driven gear and geometry to provide positive drive engagement at any desired angle within the ranges described above. It is the kind of thing that must be secured. considered the most practical for standard arthroscopic surgery. The preferred angle that can be obtained is about 165 degrees.

The outer tube and the cutter can be attached to the outer tube and the cutter without separate support means. For rotational support of the drive shaft and cutter shaft within the confines of the sheath, along their length. A smooth outer surface bounded by the outer surfaces of the drive shaft and cutter shaft. It is desirable to provide a smooth, continuous internal support surface that cooperates with the support surface of the Yes. The gear-joined drive shaft and cutter shaft are interrupted only at the meshing gears. , for reliable rotation in both clockwise and counterclockwise directions through meshing gears A smooth, continuous internal material is applied to delimit the entry passageway. .

The outer tube and cutter sheath each have two legs on the connector elbow. Telescopically interlocked, preferably by welding, permanently attached to the Fixed. However, other suitable fixing means can also be provided. Assemble When erected, both the drive shaft and cutter shaft are freely rotatable while along substantially its entire length, or at one or more supports. Can be supported by minutes, longitudinally within the outer tube and cutter sheath This prevents the vehicle from moving in the opposite direction.

Other features and advantages of the invention will be described in more detail hereinafter. It will be understood from the details of the construction of the instrument and its method of use.

Brief description of the drawing Figure 1 shows how to access the posterior meniscal material using a straight shaft. 1 is a schematic diagram of a prior art device illustrating the difficulties; FIG.

FIG. 2 is a schematic diagram similar to FIG. 2 illustrating the angled instrument of the present invention; Ru.

FIG. 3 is an enlarged side exploded view of the anterior angled portion of the instrument.

4 is a longitudinal cross-sectional view through the structure of FIG. 3;

FIG. 5 is a view of one end of the cutter in FIG. 4 with the cutter shaft rotated 90 degrees; Partially presented as an exploded view.

FIG. 6 is an enlarged sectional detail illustrating the positioning means for the drive shaft.

Figure 7 is a cross-sectional view similar to Figure 4 with a less angled connector nirbow. be.

FIG. 8 is an exploded perspective view of the components of the instrument. Furthermore, FIGS. 9 to 12 show various FIG. 4 is a perspective view of various alternative cutter head arrangements;

Description of preferred embodiments More specifically with regard to drawings, similar reference characters may be used interchangeably throughout the various drawings. 1, the working end portion of which is straight. A conventional arthroscopic instrument is illustrated in linear alignment with the shaft of . The problem with accessing angularly offset portions is that the instrument 10 Pass through the curved linear path between Ilb and Ilc. It is clear from a schematic cross-section through the structure of the knee that it is not possible.

FIG. 2 shows a surgical environment that is the same or substantially similar to that shown in FIG. 1 illustrates a surgical instrument 12 of the present invention, in which the conventional surgical instrument 12 of FIG. angular offsets such as path 11a in a way that was not possible with straight instruments. Preparations have been made to access the parts.

The instrument 12 has an angled cutter head or working end portion at its distal end. Consists of a long, thin, linear or straight shank (shank) 14 in the state of be done. The body end of the shank 14 is shown schematically at 18 in a conventional manner. associated with a vacuum or suction source and a drive motor 20.

As an alternative to the use of a drive motor, a manual drive hand for the cutter head 16 It can also be equipped with steps.

The shank 14 has a bore (hollow part) 24 with a smooth surface processed through it. It includes a hollow cylindrical outer tube 22 having a bore therein. It defines a continuous support surface along substantially its entire length. outer chew The distal or forward end portion of the tube 22 is countersunk, as shown in FIG. An annular radial, inwardly extending, forwardly directed shoulder 28 It delimits an annular recess 26 terminating in the groove.

the instrument, more specifically the cutter head 16, for its tube 22; angle is determined by the connector elbow 30, as shown more clearly in FIG. The boundaries have been drawn. Erhou 30 has a solid hollow tubular structure. approximately 90 degrees, consistent with the specific area that will be accessed by the instrument. shaped to provide any of a range of angles ra between approximately 180 degrees from It is possible to As a practical matter, furthermore, the communication shown in Figures 4 and 7 Most surgical sites to which the present invention pertains are at angles between approximately 105 degrees (Figure 7) and approximately 165 degrees (Figure 7). Access with cutter head oriented anywhere from the range of Figure 4) You can.

With reference to FIG. 4, the connector elbow 30 has its angularly related elongated The legs 32 of the main body, the legs 34 of the tip, and the angular joint between them. Both have smooth inner and outer surfaces and are assembled into an outer tube 22. When pressed, it demarcates a smooth continuous portion of the inner and outer surfaces of tube 22. Ru.

The legs 32 of the body are externally recessed around their body ends and are recessed externally around their body ends. A counterbore 26 in the outer tube 22 for coop-like reception and seating therein. It delimits an elongated external recess 36 which complements the . As noted in the details of Figure 6. The body end 38 of the nirbow leg 32 of the body is slightly in front of the shoulder 28 of the counterbore 26. It terminates at one end, and with it delimits an annular depression or groove 40.

The front end of the outer tube 22 is attached to the legs 32 of the body, as shown in FIGS. 4 and 7. around an external annular shoulder 42 delimited by a recess 36; I'm dating. Within the range of the tip of the outer tube 22 The engagement of the end portions of the concave body of the elbow leg 32 is preferably welded. Therefore, it is solidified, and as mentioned above, with the exception of the annular recess 40, it is substantially continuous. It is the kind of thing that provides an external and internal surface.

The tip of the tip leg portion 34 of the connector nirbow similarly has a recess on the outside. It borders an elongated annular depression 44. Corresponds to the depth of depression 44 An elongated cutter sheath 46 having a thickness of a continuation of the smooth external surface of the distal leg 34 with its body end received in the distal leg 34; It demarcates the boundaries of the department. The sheath 46 projects beyond the distal end of the distal nirbow leg 34. and at least partially straddles the front or tip of the cutter sheath 46 and extends laterally. It terminates in a retaining end 48 that is oriented in the direction shown in FIG. The sheath of the cutter is located at the tip of the sheath. or directly adjacent the cutter window 5 with the blade end. Contains 0. The window 50 extends over at least a portion of the linear extent of the cutter sheath 46. fully or partially open laterally.

Mounted in the cutter sheath 464 (Fig. 4) is a main body portion with distal legs. a supporting engagement with the inner surface of the leg 34 along its length; an elongated hollow cutter shaft 52 having a smooth outer surface 54; . The tip portion 56 of the cutter shaft 52 is thicker in the radial direction than its main body portion. The shape is set to hold up against the front edge of the distal leg 34 of the Nirbow 30. It delimits an annular shoulder 58 oriented in an external, inward direction. cutter The outer side of the distal end portion 56 of the shaft 52 with respect to the linear extent of the sheath 46 in front of the leg 34 , and in supporting engagement with the inner surface of the sheath 46 relative to the retaining end 48. Ru. A bore 60 extending substantially radially through the cutter shaft 52 has a smooth surface, has a constant diameter, and is held against the retaining end 48 of the sheath 46. It terminates at an end wall 62 with a resilient exterior surface.

With particular reference to FIGS. 4 and 5, a cup including a mouth 64 with a peripheral cutting end is shown. The cutter shaft 52 immediately behind the tip 62 is shown in the drawing. a sheath window 50 formed through and generally laterally oriented; More specifically, it cooperates with a cutting edge 65 demarcated around it. .

at least one of the mouth of the cutter and the edge of the window, and preferably Both are made of properly honed and selectively hardened surgical grade stainless steel. Formed from steel. The cutter shaft 52 extends within the working end portion 16 of the instrument. This cooperation produces a thrust effect as it is rotated clockwise or counterclockwise within the provide. The preferred rotational speed of motion depends on surgeon preference, cutter head geometry. , the type of drive motor 2o used with the instrument 12, and the type of surgery. From about 100 rpm to about 7,000 rpm depending on the type and location of the surgical site. . The instrument 12 has a range of cutter blade rotational speeds that can be controlled by the user. Preferably used with a drive motor 2o that can be controlled to provide Delicious.

The cutter sheath 46 is secured to the nirbow leg 34 by conventional fastening means such as welding. It is desirable that the concave tip and the telescopic overlapping part be firmly joined. Yes. The cutter shaft 52 is aligned within the cutter sheath 46 and the nirbow leg 34. and in a stable supporting engagement along at least substantially its entire length. While freely rotatable, the retaining end 48 of the sheath 46 as well as the nirbow leg alignment by a shoulder on the cutter shaft 52 that engages the leading edge or tip of the cutter shaft 34. between them, with respect to longitudinal movement or shirtting (axis system). Retained.

The cutter shaft 52 has a boundary integrally defined at the end of the main body of the shaft 52, and A driven gear 66 located at the angle of the bow connector 30 is used to Directly carved or formed in the main body end portion of the tar shaft 52, As a result, the formed gear 68 is connected to the inner and outer sides of the cutter shaft 52, respectively. a plurality of gears 68 with inner and outer surfaces delimiting smooth continuous surfaces; It is preferable that it be formed so as to be driven by a gear.

The rotational drive of the cutter shaft 52 is linearly adjusted between the outer tube 22 and the connector 30. longitudinally received within the centered body legs 32; This is implemented by an elongated hollow drive shaft 7o that can extend together. Drive shaft 7 The outer surface 72 of the outer tube 22 extends along the inner surface of the outer tube 22 as well as along its entire length. Engages with the inner surface of the nirbow legs 32 of the body to define a smooth support surface. do. This outer surface 72 includes an annular groove 74 that is radially aligned with groove 4o. , forming therewith a closed path surrounding the drive shaft 70. This closed path is , an annular meridian extending into and bounded by both grooves 40 and 74; receiving a steel wire retaining ring 76 that substantially completely fills the channel; It is. Retaining ring 76 resists longitudinal movement with respect to outer tube 22. holding the drive shaft 70, on the other hand, the supporting surfaces 2 which are engaged over substantially the entire length. 4 and 72, with the shaft set, the outer tube The drive shaft 72 is allowed to rotate within the drive shaft.

The distal end portion of the drive shaft 70 includes a drive gear 78 formed therein, the gear being Complementing the driven gear 68 formed on the end of the cutter shaft 520 body, the It includes a series of equally spaced circumferential gears 8o, the opposite surfaces of which are A smooth continuous surface, or a bore of the drive shaft 7o and its outer support surface 72. is formed.

The gears 68 and 80 mesh at the angular joint of the legs of the Nirbow 3o and are Provides a positive drive engagement regardless of the angle of the nirbow within the It is formed like this. The compatibility of gear meshing is determined by the structures depicted in Figures 4 and 7. This will be understood from the comparison.

Although not described in detail, the drive A motor means 2o for driving the shaft 70 as well as the surgical instrument 12. Therefore, the vacuum positioning of the material to be cut and the adjustment of the drive shaft and cutter shaft are possible. A suitable suction generating device for effecting the removal of cutting material through the centered bore. 18, the main body end of the drive shaft 7o and the main body end of the outer tube 22 are connected. It will be understood that the

All ranges of angular instruments constructed in the manner described above, except elbows, Other components of the are standardized, thus facilitating assembly and ensuring consistent uniformity. can be manufactured through the use of preformed nilbows that ensure will be understood.

As described, the individual components include the outer tube 22, elbow 3o and With respect to the outer components of the cutter, including the sheath 46, therein and A rigid, welded or otherwise It is a rigid element that is firmly fixed. The inner and outer components themselves are Provides interlocking support surfaces along the entire length without additional support means and is made of stainless steel ・Steel, brass or combination of stainless steel and plastic It can be constructed from a wide variety of surgical grade materials, including laminated materials. alternatively , one or more support sections are mounted along each of the inner and outer components. It is possible to prepare. Similarly, as well as again additional means such as separate gears etc. Without, the drive shaft and cutter shaft are connected through integral gears formed at their adjacent ends. It is a direct drive mesh. The meshed gears have a fixed angle within a certain range. Can be driven through degree orientation, with both clockwise and counterclockwise drive engagement equally effective in terms of

With respect to FIGS. 9-12, the instrument of the present invention can be used for specific cutting or material storage situations. Consistently, it is contemplated that a variety of cutter heads may be utilized. Ru. For example, rather than the flat end mouth and window arrangement proposed in Figure 5. Rather, both the sheath window and the cutter shaft are continuous, as shown in Figure 9. It can have a generally elliptical shape with a curved surface. Alternatively, The sheath window may be oval or circular in shape, as shown in FIG. , with the rotation of the cutter axis, by sweeping through each of the separate windows, as shown in FIG. A system of the kind that counteracts the wide cutting effect achieved by the cutter head of FIG. shaped with multiple apertures 90 of certain reduced dimensions to achieve a waving effect. can be achieved. For the cutter head arrangement depicted in Figure 11, the sheath The end surface 65 of the window 50 is aligned with the longitudinal axis of the cutter head. a plurality of opposing gears 9 with a notched surface along their opposite ends; 2, whose gears are integral with the rotational movement of the cutter element. , which can be generally contrasted with that provided by the arrangement depicted in FIG. Alternatively, it facilitates a wider range of cutting effects. Shown in Figure 12 As shown, the cutter head is rotatably received within the cutter window 50. It can be made into a 64° abrasion tester (abrader). depicted In this arrangement, the tip 96 of the abrader 64' is connected to the cutter window 50. The abrader 6 extends beyond the release tip 98 of the abrader 6 against the material to be removed. 4" axial or lateral extension, or any combination thereof On this basis, it is possible to remove body materials such as bone or cartilage. but However, the shape of the abrader and cutter window, including the shape of the closing window, It is understood that a variety of shapes can be provided according to the technique of application of the present invention. will be done. In each case, the angle of the cutter head is part of the cutting procedure. as the material is being drawn into the cutter head. Determined by a fixed angle elbow and, if cut, centered It is effectively retracted through the smooth bore of the cutter shaft and drive shaft.

The surgical instrument of the invention is shown in FIG. 2 being used in performing an arthroscopic procedure on the knee. Although it has been illustrated as a device that can be used as a device, this device has a substantially wider range of uses.

For example, the angled instruments of the present invention have been used in a wide variety of surgical applications. Particularly applicable for use in shoulder surgery involving dissection of the lower part of the neck It is. Similarly, this instrument requires proper scaling of each component of the surgical instrument. Based on the It is expected that it will have practical utility in a wide range of surgical procedures other than arthroscopic surgical procedures. be done.

From the above, it can be seen that the instrument described does not arrive in a conventional, i.e. linear, instrument. Gaining access to areas that are normally difficult to access, as well as using multiple instruments or in the surgical department compared to that experienced in traditional procedures requiring complex instrumentation. How to solve problems that are difficult to do so in a way that minimizes trauma to the body. It will be understood that this is unique. As will be appreciated, the hon. Principles of the Invention and Particularly Rigid Connector Elbows with Direct Support Surfaces The long and rigid shaft can be used with various cutters of different shapes, drive means, and in conjunction with suction devices, all of which are described in detail above. Within the scope of the invention as defined in the description and accompanying claims It becomes 2k, which is considered as something to enter.

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Claims (6)

[Claims] 1. an elongated thin-walled cylindrical sheath having a body portion and a tip portion , said distal portion is provided with at least one aperture, and the sheath is disposed within it. This bore is formed between the main body part and the tip part. With the above sheath extending between: an elongated thin-walled cylindrical driven section received within the bore of said sheath a cutter member received in said aperture at one end thereof; short with respect to their length, arranged at their second end; It is equipped with a plurality of gears arranged in the circumferential direction of the radial dimension, and is The above-mentioned hole delimits the lumen (hole) for receiving the cut material. a driven member; disposed circumferentially at one end thereof to a drive power input source and at a second end thereof; An elongated thin-walled cylindrical drive that can be connected to a gear on a cut driven member. a member, the driving member being in fluid communication with the driven lumen; The lumen is cut by the cutter member. can be connected to a negative pressure source to draw the collected material through the lumen. A minimally invasive surgical procedure comprising: the driving member as described above, and; A rotationally driven surgical cutting instrument arranged to perform a procedure. 2. wherein said cutter member includes at least one cutting end; A surgical instrument according to claim 1, which is received within one seven percher. 3. Furthermore, a thin-walled tubular connector is interposed between the main body portion and the tip portion of the tubular member. Connector elbows are included therein, and the connector elbows mentioned above are connected to each other. The elongated driving member and the driven member interlock with each other at an angle of about 90° to about 180°. Dimensions are determined to accept and position the gears arranged in the circumferential direction of the moving member. Surgical device according to claim 1, characterized in that it delimits a defined bore. Surgical instruments. 4. The connector elbow runs along the inner side of the main body and tip of the sheath. demarcates a generally uniform support surface that coexists with the formed support surface. 4. A surgical instrument according to claim 3. 5. Cutting the patient using a surgical instrument that has a rotatably driveable cutting surface. A method for removing substances from internal parts located within the body, the method The tip is: The surgical hand makes small incisions on the patient's body and moves from the surface of the patient's body to the internal parts of the patient's body. demarcating the surgical path; having a rotatable drivable cutting surface angled with respect to the body end of the instrument; a radial surgical instrument whose cutting surface is less than or equal to the length of the gear mentioned above; through a plurality of intermeshed gears arranged circumferentially with dimensions in the direction of rotatably driven by a cylindrical drive member rotatably coupled to the The above characterized in that it is provided along a cylindrical tubular driven member capable of provide equipment; Rotatably drive the cutting surface to propel the cutting surface against the body material to severing the quality; and Cut through multiple lumens extending through the tubular drive and driven members. sucking out body matter that has been removed; The above method consists of: 6. The cutting surface is mounted so that it can be recessed inside the aperture, and the cutting surface is The material to be cut is received into said aperture prior to cutting. 5. A method according to claim 4.