CA2290159A1 - Device for forming holes in tissue - Google Patents

Device for forming holes in tissue Download PDF

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Publication number
CA2290159A1
CA2290159A1 CA002290159A CA2290159A CA2290159A1 CA 2290159 A1 CA2290159 A1 CA 2290159A1 CA 002290159 A CA002290159 A CA 002290159A CA 2290159 A CA2290159 A CA 2290159A CA 2290159 A1 CA2290159 A1 CA 2290159A1
Authority
CA
Canada
Prior art keywords
tissue
spring
ablating device
catheter
lumen
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Abandoned
Application number
CA002290159A
Other languages
French (fr)
Inventor
David R. Holmes
Robert A. Vantassel
Robert S. Schwartz
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Transvascular Inc
Original Assignee
TriCardia LLC
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority to US09/009,135 priority Critical patent/US6015405A/en
Priority to EP99308759A priority patent/EP1097676A1/en
Priority to JP35219299A priority patent/JP2001128989A/en
Priority to AU58349/99A priority patent/AU768035B2/en
Application filed by TriCardia LLC filed Critical TriCardia LLC
Priority to CA002290159A priority patent/CA2290159A1/en
Publication of CA2290159A1 publication Critical patent/CA2290159A1/en
Abandoned legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3476—Powered trocars, e.g. electrosurgical cutting, lasers, powered knives
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3478—Endoscopic needles, e.g. for infusion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
    • A61B18/24—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor with a catheter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00238—Type of minimally invasive operation
    • A61B2017/00243—Type of minimally invasive operation cardiac
    • A61B2017/00247—Making holes in the wall of the heart, e.g. laser Myocardial revascularization
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00345—Vascular system
    • A61B2018/00351—Heart
    • A61B2018/00392—Transmyocardial revascularisation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/03—Automatic limiting or abutting means, e.g. for safety
    • A61B2090/032—Automatic limiting or abutting means, e.g. for safety pressure limiting, e.g. hydrostatic
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/03—Automatic limiting or abutting means, e.g. for safety
    • A61B2090/033—Abutting means, stops, e.g. abutting on tissue or skin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/03—Automatic limiting or abutting means, e.g. for safety
    • A61B2090/033—Abutting means, stops, e.g. abutting on tissue or skin
    • A61B2090/034—Abutting means, stops, e.g. abutting on tissue or skin abutting on parts of the device itself
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N7/00—Ultrasound therapy
    • A61N7/02—Localised ultrasound hyperthermia
    • A61N2007/025—Localised ultrasound hyperthermia interstitial

Abstract

A surgical instrument for creating holes of a predetermined diameter and depth in body tissue comprises a tubular catheter having a compression spring affixed at its distal end and attached to the distal end of that spring is a tissue ablating device which may, for example, comprise an electrosurgical monopolar or bipolar electrode that is connected by conductors extending through the lumen of the catheter to an electrosurgical generator at its proximal end. When the instrument is brought in contact with target tissue with a force sufficient to compress the coils of the spring against one another and then ablating energy applied, tissue will be removed as the spring is allowed to expand out to its uncompressed length. The depth of the hole thus created is equal to the difference between the lengths of the spring when compressed and uncompressed. If desired, a suitable drug can be delivered into the thus created hole via a lumen in the catheter.

Description

DEVICE FOR FORMING HOLES IN TISSUE
BACKGROUND OF THE INVENTION
I. Field of the Invention: This invention relates generally to surgical instruments, and more particularly to a device for creating holes of a predetermined depth into body tissue.
II. Discussion of the Prior Art: In conducting various surgical procedures, it often becomes desirable to form a hole of a given diameter through tissue in such a way that the depth of penetration can also be accurately controlled. ~~ procedure referred to as transmyocardial revascularizat_Lon (TMR) may be applied endocardially or epicardially in revascularizing ischemic tissue. Here, small holes are drilled in the myocardium to allow blood to reach areas of: the heart normally served by arteries or arterioles but. which may have become occluded due to coronary artery disease. Also, where an artery has become so obstructed that. a guide wire commonly used in percutaneous t:ransluminal coronary angioplasty procedures cannot be passed, a need exists for an instrument to bore through the stenotic lesion in a controlled fashion so that the affected a~~tery is not perforated.
Instrument=s especially designed for carrying out atherectomy procedures in larger arteries generally involve a catheter sup~~orting~ a rotatable cutting blade on a distal end thereof for cutting through stenotic lesions and with suction being applied to remove the debris created during the cutting procedure. Generally speaking, the depth of penetration i~~ cont.rolled strictly by the operator in advancing the catheter. The instrument itself has no built-in structure for controlling the depth of penetration.
A need thereforE: exists for a surgical instrument that can safely be used in either open surgical procedures or in laparoscopic or intravascular procedures to create a hole of a predeterm~_ned diameter and desired depth dimension in multiple incremental uniform steps in target tissue structures.
SUMD~IARY OF THE INVENTION
The present invention provides a surgical instrument for forming holes o:E a predetermined diameter and depth dimension in selected tissue. In accordance with a preferred embodiment, it comprises an elongated catheter or tubular sheath having a proximal end, a distal end and a lumen extending between these two ends. A compression spring or sprang-loaded cutting tip of a predetermined length dimension, when uncompressed is affixed to and extends from the distal end of the catheter. A tissue ablating device is carried by the compression spring and is adapted to be pressed against the selected tissue in which a hole is to be bored. with sufficient force to compress the spring. When the tissue ablating device is energized, a portion of the selected tissue abutting the ablating device is removed, allowing the spring to expand to its uncompressed length. dimension. Thus, the depth of penetration is equal to the difference between the compressed and uncompressed length of the coil spring.
The tissue ablating device may comprise an electrode on the spring t:ip adapted to be energized by RF energy or, alternatively, an opt=ical fiber adapted to be energized by a source of la:~er energy. A third alternative would be to use an ultrasonic transducer on the spring tip capable of crushing and emulsif=ying animal tissue which then can be aspirated thro~.zgh the lumen of the catheter.
DESCF:IPTION OF THE DF;AWINGS
The foregoing features, objects and advantages of the invention will become apparent to those skilled in the art from the following detailed description of a preferred embodiment, especially when considered in conjunction with the accompanying drawings in which:
Figure 1 is a side elevational view of the tissue drilling instrument of the present invention;
Figure 2 is a right end view of the instrument of Figure 1;
Figure 3 is a partial side view of an alternatively shaped electrode for use with the instrument of Figure 1;
Figure 4 is a partial side view of the distal end portion of a.n alt=ernative embodiment in which the penetration de~~th of the instrument can be varied; and Figure 5 is a partial side view of the distal end portion of a further alternative embodiment having a telescoping ab:Lation member.
DESCRIPTIOl~f OF THE PREFERRED EMBODIMENT
Referring to Figure 1, there is indicated generally by numeral 10 a surgi,~al instrument for forming holes in tissue structures where the holes are of a predetermined diameter and depth dimension. It comprises an elongated tubular member 12 having a proximal end 14 and a distal end 16 and with a 7_umen :L8 extending therebetween. Affixed to the proximal end of i~he tubular body member 12 is a molded plastic hub 19 which may take on a variety of configurations but in Figure 1 is shown as a simple female Luer connector.
Affixed to the distal end of the tubular body member 12 is a compression. spring 20 of a predetermined length dimension such. that the difference, d, between its fully compressed condition and its uncompressed condition will control the depth oi= the hole to be formed in the tissue, all as will be described in greater detail below.
Affixed to the distal end of the compression spring 20 is a tissue ab7_ating device 22. The tissue ablating device 22 may comprisE~ an electrosurgical electrode (monopolar or bipolar) that is adapted to be coupled, via an insulated conductor, passing through the lumen 18 to a radio frequency elec~~rosurgical generator of conventional design (not shown).
The tissue ablating device 22 may alternatively comprise a lens for focusing laser energy delivered through the tubular catheter body 12 by an optical fiber whose proximal end i:~ coupled to a source of laser light.
The tissue ablating device 22 may also be an ultrasonic transducer that is connected by electrical conductors passing through the lumen 18 of the catheter for connection to a. ultrasound power supply (not shown) coupled to the proximal end of the instrument 10.
The catheter 12 may be rigid when intended for use in an open surgical procedure or a laparoscopic procedure, but for intravascu.lar applications, the catheter body 12 is preferably for~~ed frc>m a flexible plastic material, such as are commonly used in the manufacture of diagnostic coronary catheters that may be introduced, for example, into the femoral arter~~ and advanced over a guide wire until the tissue ablating device is disposed adjacent target tissue to be penetrai:ed. To accommodate passage over a guide wire, such as guide wire 26 in Figure 1, it is preferable that the tissue ablating device 22 be provided with an opening 28 therethrough, as shown in the distal end view of Figure 2. Al~~o, thf~ opening may permit drug delivery to the target site via the guidewire lumen.
Figure 3 illustrates an alternative shape configuration which may be advantageously used when being advanced against tissue that is at an angle to the longitudinal axis of the catheter. By providing a sharpened tip 30 on. the tissue ablating device 22', any tendency for the tissue ablating device to slide along the tissue structure will be inhibited.
In using the hole forming instrument 10 of Figure 1, the operator wall advance the catheter 12 until the tissue ablating device 22 on the distal end thereof is brought into engagemenl~ with the target tissue. The catheter will then continue to be advanced with sufficient force to compress the s~~ring 20 so that its coils abut one another.
Now, by energizing the tissue ablating device 22 while holding the c<~thete:r stationary, the tissue structure in which it is in contact will be ablated allowing the spring 20 to extend its full length, creating a hole in the tissue whose depth is the difference between the compressed length and uncompressed length of the spring 20. If it is desired to increase the depth of penetration into the tissue, after de-energizing the tissue ablating device 22, the catheter 12 can again be advanced in the distal direction to the point where the spring 20 is again fully compressed. At this point, a second energization of the tissue ablating device 22 will again result in the expansion of the spring 20 to its full length. thereby effectively doubling the hole depth. Because each step is of a precise, known length, the composite hole depth can be accurately determined.
In the embodiment of Figure 1, the extent of advancement of the tissue ablating device into the target tissue upon en.ergization is determined by the particular spring 20 employed on the catheter. Figure 4, which shows only the distal. end portion of the instrument of Figure 1, is designed to allow the surgeon to set the distance that the spring is allowed to expand. Here, the catheter body 12 has an end cap ;32 having a clearance bore 34 formed through it and an annular pattern of ratchet teeth formed on its proximal facing side. A spring 20' is affixed to the end cap 32 and ai~tached to the opposite end thereof is a tissue ablating device 22'. Completing the assembly is a threaded screw 36 that is affixed to the device 22' and that passes through the center of the helix comprising compression spring 20' and through the clearance bore 34 of the end cap 32 into a nut 38 having matching ratchet teeth on its distal facing surface. By rotating the device 22', the degree of extension of the spring and its attached tissue ablat~~ng device becomes adjustable. More particularly, with the teeth on the nut 38 mating with those on the e:nd cap 32, rotation of screw 36 adjusts the span between tree end cap and the ablating device 22'. With the device abutting the target tissue, a pushing force applied to the catheter 12' will disengage the ratchet teeth on the nut i_rom those on the end cap and will compress the spring to the point where its coils abut one another. Now, when the energy is applied to the ablating device 22' and tis:~ue is removed, the spring can only expand to the extent permitted by the screw 36.
Figure 5 is a c:ross-sectional and partial view of the distal end portion o:E the hole forming catheter comprising a further preferred embodiment. In this arrangement, the tissue ablating device 22' is slidingly received within the lumen 18" of t:he cat=heter body 12 " and a portion thereof projects beyond the distal end 16 " of the catheter body.
Formed internally of the lumen 18 " is an annular stop 40 against which the p=roximal end of the spring member 20' ' abuts. The distal end of the spring 20' cooperates with the tissue ablating device 22', normally urging it in the distal direction. Depending on the nature of the tissue ablating device, energization therefore may be conveyed either over elEactric<~l conductors 24 " that extend through the lumen 18 " or vi.a an optical fiber where laser energy is employed.
As with t:he above-described embodiments, when used, the catheter 10 " is percutaneously inserted into the body and routed the:rethrough until the tissue ablating device 22 " abuts the target: tissue where a hole is to be created.
The catheter is continued to be advanced until the spring 20 " is fully compressed such that its coils abut one another. While: holding the catheter stationary, the tissue ablating device 22 " is appropriately energized with electrical or light Energy to thereby ablate tissue against which it is placed. As the tissue disintegrates, the spring 20 " i:~ allowed to expand and advance the tissue ablating device 22 " until the spring is fully extended.
If a hole of an increased depth is desired, the foregoing step may be repeated a number of times with each iteration resulting in a penetration distance equal to the difference between the compressed length and uncompressed length of the spring 20 " .

With either embodiment, it is possible to inject a drug into the newly created tissue perforation by coupling a syringe to 1=he Luer fitting 19 and injecting the drug through the lumen 18 and out the central opening of the annular tissue ablating device 22.
This in~rention has been described herein in considerable detail in order to comply with the patent statutes and to provide those skilled in the art with the information needed to apply the novel principles and to construct and use such specialized components as are required. However,, it is to be understood that the invention can be carried out by specifically different equipment and cievice~>, and that various modifications, both as to the equipment and operating procedures, can be accomplished ~Nithout departing from the scope of the invention itself.

Claims (11)

1. Apparatus for forming holes of a predetermined depth and diameter dimension in selected tissue comprising:
(a) an elongated catheter having a proximal end, a distal end arid a lumen extending therebetween;
(b) a compression spring having first and second ends, the spring being of a predetermined length dimension when uncompressed with the first end being affixed proximate the distal end of the catheter and with the spring extending longitudinally therefrom; and (c) a tissue ablating device operatively coupled to the second end of said compression spring such that upon actuation, said spring expands linearly to provide longitudinal displacement of said tissue ablating device, and adapted to be pressed against said selected tissue with sufficient force to compress said spring with subsequent energization of the tissue ablating device ablating tissue distal to the tissue ablating device and allowing the spring to expand to its uncompressed length dimension.
2. The apparatus as in Claim 1 wherein the tissue ablating device comprises an electrosurgical electrode.
3. The apparatus as in Claim 2 and further including at least one electrical conductor passing through said lumen and conductively connected to the electrosurgical electrode.
4. The apparatus as in claim 1 wherein the tissue ablating device comprises an optical fiber and a source of laser energy coupled to said optical fiber.
5. The apparatus as in Claim 4 wherein the optical fiber extends through said lumen.
6. The apparatus as in Claim 2 wherein the electrosurgical electrode is an annulus.
7. The apparatus as in Claim 2 wherein the electrosurgical electrode includes a sharp point.
8. The apparatus as in any one of Claims 2 and 4 wherein the compression spring and at least a portion of said tissue ablating device is contained within said lumen.
9. A method for forming holes of a predetermined length in selected tissue in a patient comprising the steps of:
(a) providing a catheter having a proximal end, a distal end and a lumen extending therebetween, said catheter having a compression spring of said predetermined incremental length when uncompressed disposed on said distal end of the catheter with the spring supporting a tissue ablating device thereon;
(b) routing said catheter percutaneously to reach said selected tissue;
(c) pressing the tissue ablating device against the selected tissue with a force sufficient to fully compress the sharing;
(d) energizing the tissue ablating device to ablate the selected tissue sufficient to allow the spring to expand to its predetermined incremental length; and (e) repeating steps (c) and (d) until a hole of a desired length in the tissue has resulted.
10. The method of claim 9 and further including the step of injecting a drug through the lumen and into the hole following step (e).
11. Apparatus for forming holes of a predetermined depth and diameter dimension in a selected tissue comprising:
(a) an elongated catheter having a proximal end, a distal end and a lumen extending therebetween;

(b) a compression spring of a predetermined length dimension when uncompressed affixed proximate the distal end of the catheter; and (c) a tissue ablating device operatively coupled to said compression spring, the tissue ablating device including an optical fiber extending through said lumen and a source of laser energy coupled to the optical fiber, the tissue ablating device adapted to be pressed against said selected tissue with sufficient force to compress said spring and with subsequent energization of the source of laser energy, ablating tissue distal to the compression spring and allowing the spring to extend to its uncompressed length dimension.
CA002290159A 1998-01-20 1999-11-16 Device for forming holes in tissue Abandoned CA2290159A1 (en)

Priority Applications (5)

Application Number Priority Date Filing Date Title
US09/009,135 US6015405A (en) 1998-01-20 1998-01-20 Device for forming holes in tissue
EP99308759A EP1097676A1 (en) 1998-01-20 1999-11-04 Device for forming holes in tissue
JP35219299A JP2001128989A (en) 1998-01-20 1999-11-05 Device for forming opening in tissue
AU58349/99A AU768035B2 (en) 1998-01-20 1999-11-08 Device for forming holes in tissue
CA002290159A CA2290159A1 (en) 1998-01-20 1999-11-16 Device for forming holes in tissue

Applications Claiming Priority (5)

Application Number Priority Date Filing Date Title
US09/009,135 US6015405A (en) 1998-01-20 1998-01-20 Device for forming holes in tissue
EP99308759A EP1097676A1 (en) 1998-01-20 1999-11-04 Device for forming holes in tissue
JP35219299A JP2001128989A (en) 1998-01-20 1999-11-05 Device for forming opening in tissue
AU58349/99A AU768035B2 (en) 1998-01-20 1999-11-08 Device for forming holes in tissue
CA002290159A CA2290159A1 (en) 1998-01-20 1999-11-16 Device for forming holes in tissue

Publications (1)

Publication Number Publication Date
CA2290159A1 true CA2290159A1 (en) 2001-05-16

Family

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Family Applications (1)

Application Number Title Priority Date Filing Date
CA002290159A Abandoned CA2290159A1 (en) 1998-01-20 1999-11-16 Device for forming holes in tissue

Country Status (5)

Country Link
US (1) US6015405A (en)
EP (1) EP1097676A1 (en)
JP (1) JP2001128989A (en)
AU (1) AU768035B2 (en)
CA (1) CA2290159A1 (en)

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US6015405A (en) 2000-01-18

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