US20040049217A1 - Apparatus and method for performing ophthalmic procedures - Google Patents

Abstract

A surgical cutting system. The cutting system includes a cutter which has an inner sleeve that moves adjacent to an aspiration port of an outer sleeve. The inner sleeve is coupled to a source of vacuum that pulls tissue into the outer port when the inner sleeve is moved away from the port. The inner sleeve then moves across the outer port and severs the tissue in a guillotine fashion. The tip of the inner sleeve may exert a spring force that assist in the cutting action of the cutter. The cutter includes a motor which creates an oscillating translational movement of the sleeve. The motor can be controlled by a controller that is coupled a foot pedal. The foot pedal and controller can be configured so that the motor decreases speed as the pedal is depressed by the operator. The inner sleeve is coupled to an aspiration line that pulls the severed tissue out of the cutter. The level of the aspiration vacuum pressure can be controlled by a variable regulator valve. The regulator valve is coupled to the controller and the foot pedal. The foot pedal may have a switch that allows the system to operate in either a variable speed mode or a variable pressure mode. In the variable speed mode the actuation of the foot pedal changes the speed of the motor. In the variable pressure mode the actuation of the foot pedal changes the vacuum level within the aspiration line.

Description

BACKGROUND OF THE INVENTION
• 1. Field of the Invention[0001]
• The present invention relates to a surgical system for cutting tissue.[0002]
• 2. Description of Related Art[0003]
• There are many surgical procedures that require the cutting and aspiration of tissue. For example, in a retina re-attachment procedure the surrounding vitreo tissue must be removed before the retina is repaired. The cutting device must be delicate enough to remove the tissue without further damaging the retina. Prior art ophthalmic cutting devices include an inner sleeve that moves relative to an outer port of an outer sleeve. The sleeves are coupled to a vacuum system which pulls tissue into the outer port when the inner sleeve moves away from the port. The inner sleeve then moves in a reverse direction past the outer port to sever the tissue in a guillotine fashion. The vacuum system draws the severed tissue away from the outer port so that the process can be repeated.[0004]
• The inner sleeve is driven by a motor located within a hand piece that is held by the surgeon. The inner sleeve is typically coupled to the motor by a rotating lever mechanism. Rotating lever mechanisms of the prior art are relatively large and complex. Additionally, the stroke and duty cycle of the inner sleeve is fixed for each device. It would be desirable to provide a surgical guillotine cutter that is inexpensive to produce, small in size and would allow a surgeon to vary the stroke and duty cycle of the inner cutter.[0005]
• Guillotine cutters are typically provided with a control system that allows the surgeon to vary the vacuum pressure of the aspiration line. U.S. Pat. Nos. 4,395,258; 4,493,698; 4,706,687 and 4,838,281 issued to Wang et al. and Rogers et al., respectively, disclose systems for controlling the vacuum pressure of a guillotine cutter. The Wang/Rogers systems include a solenoid actuated valve that is coupled to the hand piece and controls the flow of fluid in the aspiration system. The position of the valve and the corresponding vacuum of the system is controlled by an input signal provided to the solenoid by a control circuit. The input signal is typically the summation of a feedback signal and a control signal that is generated by a potentiometer. The feedback signal corresponds to the actual vacuum pressure measured in the system. The potentiometer is typically a foot pedal that is manipulated by the surgeon.[0006]
• The surgeon controls the vacuum pressure by depressing the foot pedal and varying the amount of air flow through the solenoid control valve. Because of the inertia within the system, there is typically a lag between the input command of the surgeon and the actual variation of vacuum pressure at the tip of the cutter. It would be desirable to provide a vacuum control system that has a more rapid response time than systems of the prior art.[0007]
• Additionally, prior art guillotine cutters typically do not have many control functions, or safety features to prevent inadvertent damage to the eye. For example, prior art systems do not automatically compensate for variations in the load on the cutter. The surgeon must observe a reduction in cutting rate and then manipulate the cutter and the vacuum pressure to overcome the increased load. Additionally, with a prior art cutter, if the cutter ceases to operate while the vacuum pressure is applied to the system, the tissue may be pulled into the aspiration port of the outer sleeve. Such an event may damage the eye. It would be desirable to provide a guillotine cutter which has a number of control functions and safety features.[0008]
• Cutting tissue sometimes causes undesirable bleeding which must be coagulated. Coagulation can be performed with an electro-cautery device. To coagulate the tissue the cutter is removed and an electro-cautery device is inserted into the patient. To continue cutting, the electro-cautery device must be removed to allow re-insertion of the cutter. Such a procedure is time consuming and may reduce the safety of the procedure. It would be desirable to provide a cutter that can also cauterize tissue.[0009]
SUMMARY OF THE INVENTION
• The present invention is a surgical cutting system. The cutting system includes a cutter which has an inner sleeve that moves adjacent to an aspiration port of an outer sleeve. The inner sleeve is coupled to a source of vacuum that pulls tissue into the outer port when the inner sleeve is moved away from the port. The inner sleeve then moves across the outer port and severs the tissue in a guillotine fashion. The tip of the inner sleeve may exert a spring force that assist in the cutting action of the cutter.[0010]
• The cutter includes a motor which creates an oscillating translational movement of the inner sleeve. The motor can be controlled by a controller that is coupled a foot pedal. The foot pedal and controller can be configured so that the motor decreases speed as the pedal is depressed by the operator.[0011]
• The inner sleeve is coupled to an aspiration line that pulls the severed tissue out of the cutter. The level of the aspiration vacuum pressure can be controlled by a variable regulator valve. The regulator valve is coupled to the controller and the foot pedal. The foot pedal may have a switch that allows the system to operate in either a variable speed mode or a variable pressure mode. In the variable speed mode the actuation of the foot pedal changes the speed of the motor. In the variable pressure mode the actuation of the foot pedal changes the vacuum level within the aspiration line.[0012]
BRIEF DESCRIPTION OF THE DRAWINGS
• The objects and advantages of the present invention will become more readily apparent to those ordinarily skilled in the art after reviewing the following detailed description and accompanying drawings, wherein:[0013]
• FIG. 1 is a cross-sectional view of surgical guillotine cutter of the present invention;[0014]
• FIG. 2 is an enlarged cross-sectional view of the tip of the cutter;[0015]
• FIG. 3 is an enlarged view similar to FIG. 2 showing tissue being drawn into an outer port of the cutter;[0016]
• FIG. 4 is a an enlarged view similar to FIG. 2 showing an inner sleeve severing the tissue drawn into the outer port;[0017]
• FIG. 5 is a schematic of a vacuum control system for the cutter;[0018]
• FIG. 6 is a side cross-sectional view of an alternate cutter;[0019]
• FIG. 7 is a side cross-sectional view of an alternate cutter;[0020]
• FIG. 8 is a perspective view of a cutter system of the present invention which has an electrical generator coupled to a cutter;[0021]
• FIG. 9 is an enlarged view of a cutter tip which functions as an electrode;[0022]
• FIG. 10 is a schematic of a system for controlling the motor speed of a cutter;[0023]
• FIG. 11 is a schematic of a system that terminates the vacuum supply when the cutter no longer cuts;[0024]
• FIG. 12 is a schematic of a system that can terminate a flow of irrigation fluid;[0025]
• FIG. 13 is a schematic of a system which contains a plurality of vacuum pumps;[0026]
• FIG. 14 is a schematic of a system that contains a vacuum pressure pump and a positive pressure pump;[0027]
• FIG. 15 is a schematic of a system that contains a pump which has electronically controlled intake and exhaust valves;[0028]
• FIG. 16 is a schematic of a rotary valve that controls the flow of aspiration fluid;[0029]
• FIG. 17 is a schematic showing a solenoid driven guillotine cutter;[0030]
• FIG. 17[0031]ais a schematic of a solenoid that is coupled to an inner sleeve of a cutter by a spring;
• FIG. 18 is a side view of a bent tip;[0032]
• FIG. 19 is a side view of a tip that has a plurality of aspiration ports;[0033]
• FIG. 20 is side view showing a transmitter that tracks the location of a cutter within tissue;[0034]
• FIG. 21 is a schematic of an alternate embodiment of the system;[0035]
• FIG. 22 is graph showing input signals to a motor;[0036]
• FIG. 22[0037]ais a schematic view of a stop mechanism for a motor of the cutter;
• FIG. 23 is a graph showing a feedback signal from the motor;[0038]
• FIG. 24 is a side view of a slider and an inner sleeve;[0039]
• FIG. 25 is a bottom view of the slider;[0040]
• FIG. 26 is a perspective view of an alternate embodiment of the system;[0041]
• FIG. 27 is a perspective view of an inner sleeve of the cutter;[0042]
• FIG. 28 is a perspective view of an alternate embodiment of the inner sleeve;[0043]
• FIG. 29 is a perspective view of an alternate embodiment of the inner sleeve.[0044]
DETAILED DESCRIPTION OF THE INVENTION
• Referring to the drawings more particularly by reference numbers, FIGS. 1 and 2 show a[0045]surgical guillotine cutter10 of the present invention. Thecutter10 is used to remove and aspirate tissue. For example, thecutter10 can be used to remove intraocular tissue during an ophthalmic procedure to re-attach a retina of an eye. Although use in an ophthalmic procedure is described, it is to be understood that thecutter10 can be used to cut and aspirate other tissue, such as removing polyps, fibroids and other vascularized human tissue.
• Referring to FIG. 2, the[0046]cutter10 includes anouter sleeve12 that has anouter port14. Theouter port14 is in fluid communication with aninner channel16 of thesleeve12. Located within theinner channel16 of theouter sleeve12 is aninner sleeve18. Theinner sleeve18 has aninner channel20 that is in fluid communication with an aspiration system. The aspiration system creates a vacuum pressure that pulls tissue into theouter port14 when theinner sleeve18 is located away from theport14. Theinner sleeve18 moves within theinner channel16 of theouter sleeve12 to cut tissue that is pulled into theouter port14 by the aspiration system.
• FIGS. 3 and 4[0047]show tissue22 that is cut by thecutter10. Theinner sleeve18 is initially moved away from theouter port14 and the vacuum pressure pullstissue22 into theport14 and theinner channel16. Theinner sleeve18 then moves toward theouter port14 and severs thetissue22 within theinner channel16. The severed tissue is pulled through theinner channel20 of theinner sleeve18 by an aspiration system. Theinner sleeve18 then moves away from theouter port14 wherein the cutting process is repeated.
• The movement of the[0048]inner sleeve18 also controls the flow of fluid through theouter port14 and into the aspiration system. Increasing the cutting speed decreases the flow rate and vice versa. The flow of fluid through theopening14 may vary the vacuum pressure within the aspiration system. In addition to varying the cutting speed the surgeon may also vary the vacuum pressure by changing the speed of the motor and the flow of fluid through theopening14. The cuttingdevice10 of the present invention can thus control the vacuum pressure within the aspiration system by controlling the oscillation speed of theinner sleeve14.
• Referring to FIG. 1, the[0049]cutter10 includes amotor24 that is located within ahand piece26. Extending from an end of themotor24 is arotating output shaft28. Themotor24 is preferably an electrical device that is coupled to an external power source bywires30 that are attached to aplug32 screwed into thehand piece26. The rotational speed of theoutput shaft28 is a function of the amplitude of an input signal that is provided bywires30. Although an electrical motor is described, it is to be understood that the motor may be a pneumatic device.
• The[0050]cutter10 has awobble plate34 that is attached to theoutput shaft28 of themotor24. Thewobble plate34 is located within agroove36 of aslider38. Theslider38 is attached to theinner sleeve18. Rotation of theoutput shaft28 spins thewobble plate34, which induces an oscillating translational movement of both theslider38 and theinner sleeve18. Themotor24 andwobble plate34 move theinner sleeve18 in an oscillating manner to cut tissue as shown in FIGS. 3 and 4.
• The[0051]slider38 moves within a bearing sleeve40 that is captured by aninner cap42 and anouter cap44 of thecutter10. Theouter cap44 is screwed onto thehand piece26. Theslider38 may have an aperture46 that extends therethrough to allow air to flow out of the area between theslider38 and theinner cap42. The aperture46 prevents the formation of a back pressure that may impede the movement of theslider38. Theslider38 further has achannel48 that is coupled to anaspiration line50 by atube52. Thechannel48 provides fluid communication between theaspiration line50 and theinner channel20 of theinner sleeve18.
• The stroke and the duty cycle of the[0052]inner sleeve18 are related to the cam angle and profile of thewobble plate34. The stroke and/or duty cycle can be varied by removing thecap44 and replacing thewobble plate34 with a new part which has a different cam angle and/or profile. The present invention thus allows a surgeon to readily change the duty cycle and stroke of thedevice10.
• FIG. 5 shows a system[0053]60 for controlling the vacuum pressure within thecutter10. The system includes apositive pressure source62 which creates a positive pressure. The output of thepositive pressure source62 may be regulated by aregulator64. Theregulator64 may be coupled to a shut-offvalve66 that can de-couple thesource62 from the remaining portion of the system60. Thewobble plate34,slider38 andouter cap44 are preferably constructed from an electrically insulative material so that an electrical current does not flow from the handpiece to the patient. Thewobble plate34,slider38 andouter cap44 are preferably constructed from a molded plastic material.
• The positive pressure created by the[0054]pump62 is converted into a negative vacuum pressure by aconverter68. Theconverter68 may be a venturi pump that is relatively linear in operation. The system60 may have areservoir70 that is coupled to theconverter68 and theaspiration line50 of thecutter10. Theconverter68 creates a vacuum pressure within theaspiration line50 of thecutter10, to pull the tissue into theouter port14 of theouter sleeve12, and to aspirate the severed tissue.
• The system[0055]60 includes apotentiometer72 which provides a variable input signal to themotor24 of thecutter10. Thepotentiometer72 is typically a foot pedal which can be manipulated by the surgeon to vary the input signal and the speed of themotor24. Varying the speed of themotor24 changes the oscillation frequency of theinner sleeve18, the flow of fluid through theouter port14 and the vacuum pressure within the system. The surgeon can therefore control the flow of fluid through the aspiration system by manipulating thefoot pedal72 and varying the motor speed of thecutter10.
• The[0056]potentiometer72 may be coupled to the motor by acontrol circuit74. Thecontrol circuit74 is coupled to the output of adifferential amplifier76. One input of thedifferential amplifier76 is coupled to atransducer78 that senses the vacuum pressure within the system. Thetransducer78 provides an output signal that corresponds to the magnitude of the vacuum pressure. The other input of thedifferential amplifier76 may be connected to avacuum limit control80 which limits the level of the vacuum pressure. Thedifferential amplifier76 andtransducer78 provide a closed loop feedback signal for the aspiration system.
• The[0057]control circuit74 compares the feedback signal provided by thedifferential amplifier76 with the control signal provided by thepotentiometer72 and generates the input signal for the aspiration system. Thecontrol circuit74 typically adds, the difference between the feedback signal and the control signal from the foot pedal, to the control signal. Thecontrol circuit74 may include a differential amplifier and adder connected as shown in U.S. Pat. No. 4,838,281, which is hereby incorporated by reference. The system60 may include a variable cut ratelimit control circuit82 that limits the amplitude of the motor input signal and allows the surgeon to control the minimum and maximum cutting speed of thecutter10.
• The system[0058]60 may have a firstsolenoid exhaust valve84 that bleeds off the vacuum line to decrease the magnitude of the vacuum pressure. Thevalve84 may be coupled to thecontrol circuit74 to lower the magnitude of the vacuum pressure when the actual pressure level exceeds a desired pressure level. The system60 may also have a secondsolenoid exhaust valve86 that quickly returns the system to atmospheric pressure. The shut-offvalve66 andsecond exhaust valve86 can be coupled to thepotentiometer72 so that the shut-offvalve66 is closed and theexhaust valve86 is opened when the surgeon releases thefoot pedal72 and moves the potentiometer to an off position. Returning the system to atmospheric pressure prevents a sudden vacuum surge when the surgeon again utilizes thecutter10 at a surgical site.
• The[0059]system10 may also have an off detectcircuit88 which drives themotor24 and moves theinner sleeve18 to close theouter port14 when the surgeon releases thefoot pedal72. Closing theouter port14 prevents the residual vacuum of the system from pulling in tissue when thecutter10 has been inactivated. The detectcircuit88 may drive one of the motor coils when the foot pedal is released to move theinner sleeve18 to an extended position that closes theouter port14.
• In operation, a surgeon may insert the[0060]outer sleeve12 into an eye to perform an ophthalmic procedure. The surgeon may remove intraocular tissue by depressing thefoot pedal72 and initiating the cutting action of thecutter10. The cutting speed and fluid flow can be varied by manipulating thefoot pedal72 and varying the motor speed of the cutter. Valving the vacuum pressure at theouter port14 of the cutter provides an almost instantaneous response time for varying the fluid flow at the surgical site. Releasing thefoot pedal72 closes the shut-offvalve66 and opens theexhaust valve88 to return the system60 to atmospheric pressure.
• By way of example, the[0061]aspiration line50 and/orreservoir70 may be directly coupled to the intake port of a linear pump. Thepotentiometer72 and/orcontrol circuit74 may provide an input signal to control the output of the linear pump and the vacuum pressure within system. The linear pump may be a device sold by Medo of Woodale, Ill. under the part designation VP0660. In this embodiment, the vacuum pressure may also be further regulated by controlling the motor speed of thecutter10.
• Although a[0062]control circuit74 is shown and described, it is to be understood that thefoot pedal72 can be connected directly to themotor24 without a feedback input. Additionally, although afoot pedal72 is shown and described, it is to be understood that themotor24 could be controlled by a handpiece or other input device.
• FIG. 6 shows an alternate embodiment of a[0063]cutter100. Thecutter100 includes an outer sleeve102 and aninner sleeve104. Theouter sleeve104 has an aspiration port106 that is in fluid communication with aninner channel108. Theinner sleeve104 is driven in a reciprocating manner by a motor (not shown). Movement of theinner sleeve104cuts tissue110 that is pulled into the aspiration port106.
• The[0064]inner sleeve104 has a circumferential slit112 that allows the distal end of thesleeve104 to bend toward the aspiration port106 when engaging and cutting thetissue110. The bending of theinner sleeve104 assist in cutting thetissue110.
• FIG. 7 shows another embodiment of a[0065]flexible cutter120 which has a flexibleouter sleeve122 and a flexibleinner sleeve124. Theouter sleeve122 has an aspiration port126 that is in fluid communication with an inner channel128. Theouter sleeve122 is preferably constructed from a flexible plastic or curved metal material that can bend and conform to the shape of a body passage or cavity. Theinner sleeve124 is preferably constructed from a metal material that can cut tissue pulled into the aspiration port126.
• The[0066]inner sleeve124 has a plurality ofcircumferential slits130 that reduce the stiffness of thesleeve124. Theslits130 allow theinner sleeve124 to follow the shape of theouter sleeve122. The mostdistal slit130 allows the distal end of theinner sleeve124 to bend into the aspiration port126 to assist in the cutting of thetissue110. Theflexible cutter120 can function as a cutting catheter that is inserted into cavities and passages of a body. For example, theflexible cutter120 can be used to cut polyps, fibroids and other vascularized human tissue.
• FIG. 8 shows a[0067]cutter130 coupled to a radio frequency (RF)electrical generator132. Thecutter130 includes atip134 that is connected to a motor (not shown) located within ahandpiece136. Thehandpiece136 has anaspiration line138 that is coupled to a vacuum source (not shown). Thehandpiece136 is coupled to thegenerator132 by a pair ofconnectors140 and142. One of theconnectors140 provides power to the motor. Theother connector142 supplies electrical energy to thetip134 so that the surgeon can cauterize tissue with thecutter130. The electrical energy may be controlled by a foot pedal (not shown) that can be manipulated by the surgeon.
• A surgeon can thus both cut and cauterize tissue with the same device. By way of example, the[0068]cutter130 may be used to cut polyps or fibroids in a laparoscopic procedure. Thegenerator132 may have a plurality of control functions that allow the surgeon to vary the frequency, pulse rate or time duration of electrical energy provided to thecutter130.
• FIG. 9 shows the[0069]cutter tip134 constructed as an electrode. Thetip134 has aninner sleeve144 that reciprocates across anaspiration port146 within aninner channel148 of anouter sleeve150. Thetip134 also has an outerconductive layer152 that is separated from theouter sleeve150 by a layer ofinsulation154. The outerconductive layer152 is covered with an layer ofinsulation156. Theouter sleeve150 and outerconductive layer152 are connected to electrical terminals of thegenerator132. Electrical current flows through tissue between theouter sleeve150 and the outerconductive layer152.
• As an alternate embodiment, the[0070]inner sleeve144 can be connected to thegenerator132 instead of theouter sleeve150. Thecutter130 may then provide pulses of current to the tissue as theinner sleeve144 reciprocates across theaspiration port146. The system may also have a voice system which provide input on the present mode of the system. By way of example, the system may provide an audio indication that the electro-cautery function is active, or provide an audio indication that the some component was not set-up or assembled correctly.
• FIG. 10 is a schematic of a system[0071]160 which controls the motor speed of amotor162 and a tip164. In general the system160 provides more power to themotor162 with an increase in the load on the tip164. For example, when the tip164 engages a more fibrous tissue, the resistance of the tissue will slow down the tip164 and themotor162. The system160 senses the reduction in speed and automatically increases the power to themotor162.
• The[0072]motor162 is preferably a brushless DC motor device which contains three coils that drive an internal rotor (not shown). The system160 includes amotor controller166 that provides power to themotor162. Themotor controller166 preferably provides three sinusoidal drive signals to the coils of themotor162. The sinusoidal signals provide a relatively smooth control of the motor.
• The system[0073]160 has adifferential amplifier168 that senses the input voltage of themotor162 online170 and the output current of themotor162 online172. The output of the differential amplifier provides a feedback control signal to themotor controller166 online174. The system160 monitors the speed of themotor162 by sensing the output current. It being understood that the current may increase or decrease with a change in motor speed. The system160 varies the input voltage to themotor162 to maintain a constant voltage to current ratio and compensate for different loads on the motor. Although a differential amplifier is shown and described, it is to be understood that the system may control the power provided to the motor as a function of speed in a variety of ways. For example, the motor may contain a Hall sensor that directly measures the speed of the motor and provides a feedback signal that is processed by themotor controller166 to increase power with a reduction in motor speed.
• FIG. 11 shows an alternate embodiment of a system[0074]180 which automatically disconnects thecutter182 from avacuum source184 when thecutter182 is no longer cutting. The system180 prevents thevacuum source184 from pulling tissue into the aspiration port of thecutter182 when the inner sleeve is no longer reciprocating relative to the port. Continued aspiration while thecutter182 is no longer properly functioning may result in tissue damage.
• The system[0075]180 includes a speed (RPM)sensor186 which senses the speed of the cutter motor. Thesensor186 provide a feedback signal to acontroller188. Thecontroller188 controls a solenoid actuated on/offvalve190 located between thevacuum source184 and avacuum reservoir192. When the motor speed falls below a threshold level thecontroller188 drives thevalve190 to an off position to terminate the flow of aspiration fluid from the cutter. When the cutting speed increases above the threshold value thecontroller188 opens thevalve190 to resume normal operation.
• FIG. 12 shows a[0076]fluid irrigation system200 that provides irrigation fluid to the patient. In an ophthalmologic procedure the irrigation fluid is typically introduced to the cornea through a secondary incision.
• The[0077]system200 includes afluid reservoir202 that typically provides fluid through the force of gravity to atip204 located within the patient. The flow of irrigation fluid from thefluid reservoir202 to the patient is controlled by avalve206. Thevalve206 may be a solenoid actuated on/off device that is controlled by afoot pedal208. Thefoot pedal208 can be manipulated by the surgeon to control the flow of irrigation fluid to the patient. As an alternate embodiment, thevalve206 may be a proportional device that allows the surgeon to control the amount of irrigation fluid that flows to the patient.
• FIG. 13 shows a[0078]vacuum control system210 that contains a plurality ofvacuum sources212,214,216 and218 connected in parallel with avacuum reservoir220 and acutter222. The multiple vacuum sources are actuated sequentially to provide greater flowrate and sensitivity than a single unit system.
• The[0079]system210 includes avacuum transducer224 that senses the vacuum pressure provided to thecutter222, and afoot pedal226 that allows the surgeon to control the vacuum pressure. The output of thetransducer224 and thefoot pedal226 are provided to adifferential amplifier228. Theamplifier228 provides an error signal that is processed by acontroller230. Thecontroller230 provides control signals to actuate and control thevacuum sources212,214,216 and218. In the preferred embodiment, the vacuum sources are variable speed diaphragm vacuum pumps.
• In operation, the[0080]controller230 may actuate and drive one of thepumps212,214,216 or218. The surgeon may request a lower vacuum pressure by depressing thefoot pedal226. Depressing thefoot pedal226 varies the error signal provided by thedifferential amplifier228. Thecontroller230 processes the error signal and actuates, or changes the speed, one or more of the inactive vacuum pumps to decrease the vacuum pressure provided to thecutter222. Further depressing the foot pedal may induce the actuation of the other pumps and so forth and so on. Thecontroller230 may also vary the speeds of thepumps212,214,216 and218 to further obtain a desired vacuum level. As an alternate embodiment, the system may have a plurality of orifices that each have a different diameter. The different orifices can be coupled to one or more pumps.
• FIG. 14 shows an alternate embodiment of the system shown in FIG. 13. The intake and exhaust lines of[0081]pump214 are switched so that the pump provides a positive pressure to thevacuum reservoir220. Thepositive pressure source214 allows thecontroller230 to rapidly increase the pressure within the system when the surgeon releases thefoot pedal226. The push-pull dual pump configuration provides a vacuum system with a quick response to commands for increasing or decreasing the vacuum pressure.
• FIG. 15 is another alternate embodiment of a vacuum system with an electronically controlled[0082]pump assembly240. Thepump assembly240 includes anintake valve242 and anexhaust valve244 that control the flow of fluid from a pumpingassembly246. Thepump assembly246 may contain a flexible diaphragm or piston that pumps fluid within an internal pumping chamber of the assembly. Theintake valve242 is open during an intake stroke of the pumpingassembly246 and closed during an exhaust stroke of theassembly246. Conversely, theexhaust valve244 is closed during the intake stroke and open during the exhaust stroke.
• The[0083]valves242 and244 are preferably solenoid actuated devices that are driven by thecontroller230. Thecontroller230 can vary the timing on the opening and closing of thevalves242 and244 to control the flowrate through thepump assembly246 and the vacuum pressure provided to thecutter222. As an alternate embodiment, thevalves242 and244 may be proportional devices that allow thecontroller230 to control the flowrate and vacuum pressure of the system.
• FIG. 16 is a[0084]valve250 that can control the vacuum pressure provided to a cutter252 from avacuum source254 and reservoir255. Thevalve250 includes a core256 that rotates within avalve housing258. Thecore256 has aninner channel260 that periodically becomes aligned with aninlet port262 and anoutlet port264 of thevalve housing258. Fluid flows through thevalve250 when theinner channel260 is aligned with theports262 and264. Thecore256 can be rotated by amotor266 that is controlled by acontroller268. Themotor266 can vary the rotational speed of thecore256. Varying the core speed changes the flowrate through thevalve250 and the vacuum pressure provided to the cutter252. Thevalve250 can be utilized in a system that does not control the vacuum pressure by varying the speed of the cutter.
• FIG. 17 is an alternate embodiment of a[0085]variable port cutter270. Thecutter270 includes anouter sleeve272 that has anaspiration port274 in fluid communication with aninner channel276. Aninner sleeve278 is located within theinner channel276 of theouter sleeve272. Mounted to theouter sleeve272 is afirst solenoid280 and asecond solenoid282. Thesolenoids280 and282 are connected to acontroller284 and coupled to theouter sleeve272 by amagnetic core286.
• The[0086]controller284 provides a current to one of thesolenoids280 and282 which creates a electromagnetic force on theinner sleeve272. Thefirst solenoid280 is wound to move theinner sleeve278 toward theaspiration port274. Thesecond solenoid282 moves thesleeve278 away from theport274. Thecontroller284 sequentially drives thesolenoids280 and282 to reciprocate theinner sleeve278 across theaspiration port274. Thecontroller284 can provide control signals to thesolenoids280 and282 to control how far theinner sleeve278 moves across theport274 and the size of the aspiration opening. For example, thecontroller284 may control the solenoids so that theinner sleeve278 moves only half-way across theaspiration port274. The variation in sleeve movement will change the flowrate within theinner channel276.
• FIG. 17[0087]ashows another embodiment of a surgical cutter which has a single solenoid. The solenoid includes anarmature287 that moves relative to acoil288. Thearmature287 is coupled to aninner sleeve289 by acantilevered spring290. The movement of thespring290 is limited by astop291. Thestop291 also limits the movement of theinner sleeve289 relative to the outer sleeve292. Thestop291 prevents theinner sleeve289 from striking the end of the outer sleeve292.
• In operation, the[0088]coil288 is energized to move thearmature287. Thearmature287 moves thespring290 and theinner sleeve289. When thecoil288 is de-energized thespring290 moves theinner sleeve289 back to the original position. As an alternate embodiment thecoil288 may move relative to a stationary magnet.
• FIG. 18 shows a tip[0089]295 which has a bend at the proximal end. When inserted through an incision to perform an ophthalmic procedure, the bent tip295 may provide more transverse energy to the eye without damaging the incision. The bent tip295 may utilize the flexible inner sleeve shown in FIG. 7.
• FIG. 19 shows an alternate embodiment of a cutter[0090]300 which has anouter sleeve302 that has a plurality ofaspiration ports304 that are in fluid communication with aninner channel306. The cutter300 further has an inner sleeve308 that is reciprocated by a motor (not shown) to cut tissue pulled into the aspiration ports. Themultiple aspiration ports304 are desirable when removing large amounts of tissue. By way of example, such a cutter300 would be preferable when performing a liposuction procedure.
• FIG. 20 shows a[0091]transmitter310 that monitors the location of acutter312 placed withintissue314. Thetransmitter310 may provide audio frequency (sonar) waves that are received by thecutter312. Thetransmitter310 and cutter/receiver312 can be coupled to acomputer316 which processes the transmitted signals to determine the location of thecutter312 within thetissue314.
• FIG. 21 shows an alternate embodiment of a[0092]surgical system400. Thesystem400 may include ahandpiece402 which contains a variableelectric motor404 that moves aninner sleeve406 relative to anouter sleeve408. Theouter sleeve408 has anaspiration port409. Theinner sleeve406 can be coupled to themotor404 by a wobble plate and slider assembly that is the same or similar to the configuration depicted in FIG. 1.
• The[0093]motor404 is coupled to acontroller410. Thecontroller410 can be a microprocessor that is coupled to a memory device(s)411. Thecontroller410 performs software routines and computations in accordance with instructions retrieved from memory411. The instructions may be embedded in ROM, stored on a mass storage device and/or retrieved from an external source such as a floppy disk, and/or downloaded from a network.
• The[0094]controller410 is coupled to afoot pedal412. Thefoot pedal412 can be depressed from an upward position to a downward position. Thefoot pedal412 may contain a microprocessor (not shown) which generates digital signals that are transmitted to an RS-232 interface (not shown) coupled to thecontroller410. Thecontroller410 interprets the input signal(s) from thefoot pedal412 and provides output signals to drive themotor404, typically in accordance with a software routine. Alternatively, thefoot pedal412 may have a potentiometer or other sensor (not shown) that provides an output signal which varies with the position of the pedal.
• In one embodiment, the software routine of the[0095]controller410 provides output signals so that themotor404 andinner sleeve406 are moving at a maximum speed when thepedal412 is in the upward position. By way of example, the maximum speed may be 2500 cuts per minute (cpm). The software routine may be such that thecontroller410 reduces the speed of themotor404 when thefoot pedal412 is depressed by an operator. Thefoot pedal412 can be depressed to a point where themotor404 operates at a minimum speed. By way of example, the minimum speed may be 1000 cpms. The upper and lower speed limits may be adjustable through a control button(s) (not shown) on a console (not shown) that houses the electronics of the system. Providing the maximum cutting speed at the released position of thefoot pedal412 insures that theinner sleeve406 is operating at a safe condition when the operator releases the pedal. At slower speeds the cutter tends to pull and tear tissue. Themotor404 may be turned off when the operator releases thefoot pedal412. A slight depression of thepedal412 energizes themotor404 to the maximum speed. A further depression of the pedal reduces the speed of themotor404.
• The[0096]controller410 may be coupled to themotor404 by a sourcesink driver circuit418 and alow pass filter420. Although onecontroller410 is shown and described, it is to be understood that there may be an additional controller (not shown) that is dedicated to themotor404 and coupled to thedriver circuit418 and a main controller. Thesource sink driver418 provides output signals that correspond to the different phases Ø1, Ø2 and Ø3 of themotor404. Thelow pass filter420 filters the output of thedriver circuit418. Thecontroller410 provides output signals to thedriver418 which define the shape of the waveform generated by thecircuit418.
• FIG. 22 shows an output waveform for one phase of the[0097]driver circuit418. The processor controlleddriver circuit418 may initially provide a short pulse separated from a longer pulse by a relatively long interval. Thedriver circuit410 provides a series of gradually increasing pulses separated by gradually decreasing time intervals until a maximum pulse is provided to themotor404. Thedriver circuit410 then provides a series of gradually increasing pulses separated by gradually increasing time intervals. Thelow pass filter420 filters the output of thedriver circuit418 to create the sine-wave (shown in dashed lines) which is provided to themotor404. Thecontroller410 can thus control themotor404 without a digital to analog (D/A) converter.
• As shown in FIG. 21, the[0098]motor404 may have asensor416 that provides a motor position feedback signal to thecontroller410. Thecontroller410 may utilize the feedback information in computing the output signals for themotor404. The software routine may be such that thecontroller410 drives themotor404 so that theinner sleeve406 is at a predetermined start and/or stop position relative to theouter sleeve408. By way of example, theinner sleeve406 may be stopped in a position to close theport409 of the outer sleeve, or stopped in a position that opens the outer sleeve port, or any other intermediate position. The start position may be the same as the stop position.
• As shown in FIG. 22[0099]a, themotor404 may contain threecoils421 and a four polemagnetic rotor422 that is coupled to the inner sleeve of the cutter. Therotor422 may have two adjacent N magnetized poles and two adjacent S magnetized poles. Themotor404 may have astop magnet423 which is magnetized to attract the N poles and repel the S poles. Thus when themotor404 is stopped thestop magnet423 will always orient therotor422 in the position shown in FIG. 22a. The attached inner sleeve of the cutter will therefore always stop in the same position. By way of example, the inner sleeve may always stop in an open port position. Themotor404 may have anadditional stop magnet424 that is magnetized to attract the S poles of therotor422.
• The conventional Hall Effect sensors that are typically located in a quadrant of the motor may be removed. An external two pole magnet (not shown) may be connected to the rotor and coupled to the[0100]sensor416. The sensor may be a single Hall Effect sensor. The two pole magnet rotates with the motor rotor relative to theHall Effect sensor416.
• FIG. 23 shows a digital feedback signal of the[0101]motor sensor416. Thesensor416 provides a “high” output signal when themotor404 is in the first180ofrotation and a “low” output when the motor rotates through the next1800. Thecontroller410 utilizes the feedback signal to determine the position of themotor404 and the timing of the commutation signals.
• When the[0102]motor404 is stopped thecontroller410 may enter a routine to initially determine the motor position from the feedback signal. If themotor404 is not in the desired start/stop position thecontroller410 can provide the appropriate output signals to move themotor404 into the desired start/stop position.
• The[0103]controller410 can also provide load compensation for themotor404. Thecontroller410 can compare a desired motor movement with the actual movement of themotor404 from the feedback signal of thesensor416, and then vary the output signals of thedriver418 to compensate for any discrepancy between the desired and actual values. For example, thecontroller404 can provide signals to adjust the current to the motor by comprising a lead or lag between the feedback signal from thesensor416 with a desired value. Referring to FIG. 22, thecontroller410 may change the frequency and/or width(s) of the pulses to vary the amount of energy provided to themotor404 to compensate for varying motor loads.
• Referring to FIG. 21, the[0104]inner sleeve406 of the handpiece can be coupled to a vacuum source425 and avacuum reservoir426 by a vacuum line427. The pressure of thevacuum line426 and reservoir425 are controlled by avariable regulator valve428. Thevalve428 may be a device sold by Coast Pneumatics of Fullerton, Calif. under the product designation V800.
• The[0105]valve428 has anelectronic interface430 that is coupled to thecontroller410. Thecontroller410 provides output signals to theinterface430 to control the position of thevalve428 and the pressure within the vacuum line427.
• The system may further have a[0106]pressure transducer432 that is coupled to thecontroller410. Thepressure transducer432 provides a feedback signal that corresponds to the actual pressure within the vacuum line427. Thecontroller410 may have a closed loop feedback routine to vary the output signals to theregulator valve428 to insure that the vacuum pressure is maintained at a desired level or within a desired bandwidth.
• The[0107]controller410 may operate to control the effective size of theport409 and the cutting action of the device. Thecontroller410 can vary the effective port opening by changing the commutation signals so that themotor404 does not rotate 360° and theinner sleeve406 does not move to the full distal position. By way of example, thecontroller410 can drive themotor404 to rotate 90° in a clockwise direction and then drive the motor 90° in a counterclockwise direction so that theinner sleeve406 moves one-half of the full sleeve stroke.
• The[0108]foot pedal412 may have a switch(es)434 which allows the system to operate in one of two modes. In one mode, referred to as a variable speed mode, thecontroller410 varies the speed of themotor404 through the operator input of thepedal412. When the variable speed mode is selected the operator can vary the speed of the motor by depressing thepedal412. The vacuum pressure is typically held at a constant level in this mode.
• In another mode, referred to as a variable pressure mode, the[0109]controller410 varies the vacuum pressure of the system through thevalve428 in response to input through thefoot pedal412. In this mode, the operator is allowed to vary the vacuum pressure of the system through thepedal412. The speed of themotor404 is typically held at a constant level in this mode.
• The system may further have an[0110]exhaust valve436 that is connected to thevacuum line424. Theexhaust valve436 can be opened to rapidly return the system to atmospheric pressure. The software routine may be such that theexhaust valve436 is opened and themotor404 is no longer driven when thecontroller410 determines that themotor404 is no longer moving theinner sleeve406. Such a mode of operation prevents vacuum pressure withinline426 from pulling tissue into the device if themotor404 malfunctions or some other event prevents theinner sleeve406 from the moving.
• FIGS. 24 and 25 show an alternate embodiment of a[0111]slider450 that is attached to an inner sleeve452. Theslider450 has agroove454 that receives a wobble plate (not shown) of a handpiece. The wobble plate can be the same or similar to the component shown in FIG. 1. Theslider450 has a pair of flat keying surfaces456 that cooperate with corresponding surfaces of the handpiece to insure that theinner sleeve454 is assembled in a correct orientation. To insure that theslider454 can be readily attached to the wobble plate thecontroller410 moves themotor404 to a start position when themotor404 is turned off so that the wobble plate is aligned with thegroove454.
• FIG. 26 shows an alternate embodiment of a system which has a[0112]console460 that contains themotor404 and the electronics to operate the system. Themotor404 is coupled to a wobble plate or other inner sleeve drive mechanism within ahandpiece462 by acable464. Themotor404 rotates thecable462. Thecable462 actuates the drive mechanism and induces a cutting action of the surgical device. Thecable464 may be located within aprotective sheath466. Placing themotor404 within theconsole460 may reduce the size and vibration of thehandpiece462.
• FIG. 27 shows an alternate embodiment of an[0113]inner sleeve470 which has atip472 that exerts a spring force on anouter sleeve474. Theinner sleeve470 has alip476 located adjacent to anaspiration port478 of theouter sleeve474. Thelip476 is bent at the base480 so that thetip472 is slightly deflected in a direction toward theouter sleeve474. The bend and amount of spring deflection can be varied for different inner sleeves. Different tissues may be severed more effectively with different spring forces. With the present invention, a surgeon may assemble aninner sleeve470 which has a spring force that is optimal for a particular tissue.
• FIG. 28 shows another[0114]inner sleeve490 which has a pair oflongitudinal slits492 in thetip494 to create twolips496. Thelips496 are bent in an outward radial direction to create a spring deflection of thetip494. The length and/or width of theslits492 can be varied to change the spring force of thetip494.
• FIG. 29 shows an alternate embodiment of an[0115]inner sleeve500 which has twolongitudinal slits502 which create aspring lip504. Thespring lip504 is typically located opposite an aspiration port506 of anouter sleeve508. Thelip504 exerts a spring force that pushes thetip510 ofsleeve500 toward theouter sleeve508. The spring force of thelip504 can be varied for differentinner sleeves500.
• While certain exemplary embodiments have been described and shown in the accompanying drawings, it is to be understood that such embodiments are merely illustrative of and not restrictive on the broad invention, and that this invention not be limited to the specific constructions and arrangements shown and described, since various other modifications may occur to those ordinarily skilled in the art.[0116]

Claims (26)

What is claimed is:

1. A surgical system, comprising:

an outer sleeve which has an aspiration port that is in fluid communication with an inner channel of said outer sleeve;

an inner sleeve that is located within said inner channel of said outer sleeve;

a motor that moves said inner sleeve within said inner channel, said motor can operate at a maximum speed and a reduced speed; and,

a foot pedal that is coupled to said motor and moves between an upward position where said motor operates at the maximum speed and a depressed position where said motor operates at the reduced speed.

2. The system as recited inclaim 1, further comprising a vacuum line that is coupled to said inner sleeve, a variable regulator valve that is coupled to said vacuum line and said foot pedal, and a controller that is coupled to said variable regulator valve and said foot pedal, said foot pedal having a switch that can be actuated to place said controller in a variable speed mode so that said motor speed can be controlled through said foot pedal or a variable pressure mode so that a pressure of said vacuum line is controlled through said foot pedal.

3. The system as recited inclaim 1, further comprising a controller that is coupled to said motor and said foot pedal and which controls a distal movement of said inner sleeve.

4. The system as recited inclaim 2, further comprising an exhaust valve that couples said vacuum line to an atmosphere when said motor speed reaches a predetermined speed.

5. The system as recited inclaim 1, further comprising a controller and a driver circuit which provide a series of digital pulses to said motor.

6. The system as recited inclaim 1, further comprising a slider that has a groove and a key surface, a wobble plate that is coupled to said motor and extends into said groove, and a controller which controls said motor so that said wobble plate is aligned within said groove when said motor is in a start condition.

7. The system as recited inclaim 1, further comprising a cable that couples said motor to said inner sleeve.

8. A surgical system, comprising:

a surgical cutter;

a vacuum source that provides a vacuum pressure to said surgical cutter;

a variable regulator valve that controls the vacuum pressure;

a controller that provides an output signal to said variable regulator valve; and,

an input device that provides an input signal to said controller.

9. The system as recited inclaim 8, further comprising a pressure transducer that provides a feedback signal to said controller.

10. The system as recited inclaim 8, further comprising an exhaust valve that couples said vacuum source to an atmosphere.

11. The system as recited inclaim 8, wherein said input device is a foot pedal.

12. A surgical device, comprising:

a handpiece;

a motor that is attached to said handpiece;

a wobble plate that is connected to said motor;

a slider that is coupled to said wobble plate, said slider having a key surface;

an outer sleeve that is coupled to said handpiece;

an inner sleeve that is attached to said slider and can move relative to said outer sleeve.

13. The system as recited inclaim 12, further comprising a controller that aligns said wobble plate with said groove of said slider when said motor is in a start condition.

14. A surgical system, comprising:

an outer sleeve that has an aspiration port which is in fluid communication with an inner channel of said outer sleeve;

an inner sleeve that is located within said inner channel;

a motor that moves said inner sleeve within said inner channel; and,

a cable that couples said motor to said inner sleeve.

15. A surgical system, comprising:

an outer sleeve that has an aspiration port which is in fluid communication with an inner channel of said outer sleeve;

an inner sleeve that is located within said inner channel;

a motor that moves said inner sleeve relative to said outer sleeve, said motor operates at a motor speed;

a vacuum system that provides a vacuum pressure at said aspiration port;

a valve that controls the vacuum pressure;

a controller that controls said motor and said valve, said controller being operative in either a variable speed mode which controls said motor speed or a variable pressure mode which controls the vacuum pressure; and,

an input device that is coupled to said controller, said foot pedal having a switch that can switch said controller between said variable speed mode and said variable pressure mode.

16. The system as recited inclaim 15, further comprising an exhaust valve that is coupled to said vacuum system and said controller.

17. The system as recited inclaim 15, wherein said valve is a variable regulator valve.

18. The system as recited inclaim 15, wherein said input device is a foot pedal.

19. A surgical device, comprising:

an outer sleeve that has an aspiration port which is in fluid communication with an inner channel of said outer sleeve; and,

an inner sleeve that is located within said inner channel, said inner sleeve having a tip that exerts a spring force on said outer sleeve.

20. The device as recited inclaim 19, wherein said inner sleeve has a pair of slits.

21. A motor comprising:

a rotor;

a coil that is coupled to said rotor;

a stop magnet that is coupled to said rotor to stop said rotor in a stop position.

22. The motor as recited inclaim 21, further comprising an inner sleeve that is coupled to said rotor.

23. A surgical device, comprising:

a handpiece;

an outer sleeve that is coupled to said handpiece;

an inner sleeve that can move relative to said outer sleeve;

a solenoid that is attached to said handpiece; and,

a spring that couples said solenoid to said inner sleeve.

24. The device as recited inclaim 23, wherein said handpiece includes a stop that limits the movement of said spring and said inner sleeve.

25. A surgical device, comprising:

a handpiece;

a motor located within said handpiece, said motor having an output shaft;

an electrically insulative wobble plate that is attached to said output shaft;

an electrically insulative slider that is coupled to said wobble plate;

an outer sleeve that is coupled to said handpiece; and,

an inner sleeve that is coupled to said slider and which moves relative to said outer sleeve.

26. The device as recited inclaim 25, further comprising an electrically insulative cap that is attached to said handpiece and which encloses said slider and said wobble plate.

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