Methods and devices for soft tissue dissection
Inventors
Moody, Ryan • Pell, Charles Anthony • Espenhahn, Eric Torr • Crenshaw, Hugh Charles
Assignees
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Publication Number
US-9592069-B2
Publication Date
2017-03-14
Expiration Date
Abstract
An instrument for differentially dissecting complex tissue is disclosed, comprising a handle, a central longitudinal axis, and an elongate member, with a differential dissecting member (DDM) configured to be rotatably attached to a distal end. The DDM comprises at least one tissue engaging surface, a first torque-point disposed to a first side of an axis of rotation, and a mechanism configured to rotate the DDM around the axis of rotation, causing the tissue engaging surface to move in at least one direction against the complex tissue. The mechanism comprises at least one force-transmitting member attached to the first torque-point member and to a motive source configured to oscillate the DDM. The tissue engaging surface is configured to selectively engage the complex tissue such that it disrupts at least one soft tissue in the complex tissue, but does not disrupt firm tissue in the complex tissue.
Core Innovation
The invention relates to a differential dissecting instrument (DDI) for differentially dissecting complex tissue. The instrument includes a handle and an elongate member, and a differential dissecting member is rotatably attached to the distal end of the elongate member. The differential dissecting member includes at least one tissue-engaging surface and an axis of rotation.
The differential dissecting member is mechanically rotated around the axis of rotation using force-transmitting members connected to torque-points on the differential dissecting member and driven by a motive source, including cam shaft and cam follower arrangements and a linear oscillator-driven configuration. When the differential dissecting member is pressed into the complex tissue, the at least one tissue-engaging surface moves across the complex tissue and selectively disrupts at least one soft tissue while not disrupting firm tissue.
The invention further includes overload-related features configured to limit motion and/or stop rotation in response to applied force exceeding threshold values. These features include compressed spring loading, tension in opposed force-transmitting members, and overload mechanisms configured to stop rotation and/or withdraw the differential dissecting member away from complex tissue when respective threshold forces are exceeded.
Multiple instrument embodiments are disclosed, including laparoscopic pistol-style DDI variants, robot-mounted DDI concepts, and thin flexible-tube SILS/NOTES versions. The document also provides tunneling/dissection systems using endoscope visibility with an inflatable balloon/insufflation system to expand and seal a cavity for improved visualization and maneuverability.
Claims Coverage
The provided claim set includes independent claims directed to a differential dissecting instrument (DDI). Across the independent claims, the coverage centers on selective differential disruption of soft versus firm tissue, mechanical rotation via torque points and force-transmitting members, overload and tissue-force limiting to stop rotation or withdraw under threshold forces, and an omnidirectional control switch in one claim.
Differential soft-tissue selectivity for complex tissue
A differential dissecting member is configured so that, when pressed into complex tissue, at least one tissue-engaging surface moves across the complex tissue and disrupts at least one soft tissue, but does not disrupt firm tissue.
Opposed torque points with camshaft-driven opposed force-transmitting members
A first torque-point and a second torque-point disposed on opposite sides of the axis of rotation provide counter-torque through an opposed pair of force-transmitting members, including cam follower engagement with a single cam shaft.
Tension-limited output shaft and tip assembly travel using compression spring and opposed tension
A compressed compression spring forces the output shaft and tip assembly toward the distal end, while travel toward the distal end is resisted and limited by tension in the opposed pair of force-transmitting members.
Linear-oscillator-driven force-transmitting member with overload stopping rotation
At least one force-transmitting member has a distal end attached to the first torque-point and a proximal end attached to a linear oscillator, and at least one overload mechanism stops rotation when a force exceeding a first threshold force is applied.
Motor-cam plus omnidirectional control switch with tissue-force-limiting spring
A cam shaft is associated with the proximal end of at least one flexible tension member and engages a cam follower, a motor turns the cam shaft, a power source supplies the motor, an omnidirectional control switch is accessible from substantially any direction, and a tissue-force-limiting spring maintains a non-zero tension of the at least one tension member.
Proximal-direction overload mechanism that stops rotation
At least one overload mechanism responds to a force applied in a proximal direction and stops rotation of the differential dissecting member when the force exceeds at least a first threshold force.
Across the independent claims, the DDI is defined by selective disruption of soft versus firm tissue using a rotatable differential dissecting member driven by torque points and force-transmitting members, with overload or tissue-force limiting structures that stop rotation and/or control force response when threshold forces are exceeded. One independent claim additionally specifies an omnidirectional control switch accessible from substantially any direction and a tissue-force-limiting spring maintaining non-zero tension.
Stated Advantages
Avoids tissue heating associated with electrosurgery, reducing thermal iatrogenic trauma.
Provides differential disruption such that soft tissue is disrupted while firm tissue is not disrupted when pressed into complex tissue.
Limits travel toward the distal end by tension in an opposed pair of force-transmitting members.
Stops rotation of the differential dissecting member when a force exceeding a threshold force is applied.
Provides overload response to proximal-direction force exceeding a threshold force.
Uses a tissue-force-limiting spring maintaining a non-zero tension of the at least one tension member.
Documented Applications
Separating tissue planes while skeletonizing vasculature/perforators and collagenous bundles with minimal bleeding, described as blood-free and safe dissection claims with demonstrably safe ex vivo/in vivo/human cadaver results.
Tunneling/dissection systems using an endoscope for visibility with an optional electrosurgical hook insertion and an inflatable balloon/insufflation system to expand and seal a cavity for improved visualization and maneuverability.
Laparoscopic pistol-style DDI variants.
Robot-mounted DDI concepts for a da Vinci robot.
Thin flexible-tube SILS/NOTES versions.
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