US20060206134A1 - Method for removing material from a patient's body - Google Patents

Abstract

The invention comprises a method for removal of material from a patient's body. The method generally comprises the steps of providing an apparatus comprising an elongate member for receiving material. The elongate member defines a lumen and comprises a distal end defining an aperture and a proximal end. The apparatus further comprises an elongate tissue removal member for conveying material through the lumen. The tissue removal member is rotatably disposed within the lumen. The method further comprises gathering a sample of said material into said lumen; and conveying with said tissue removal member at least a portion of the material sample proximally along said lumen. The step of gathering may be accomplished by advancing the apparatus through the material.

Description

REFERENCES TO PARENT AND CO-PENDING APPLICATIONS
• This application claims priority from and is a continuation-in-part of co-pending U.S. patent application Ser. No. 11/128,342, filed May 13, 2005. In addition, this application claims the benefit of: U.S. provisional application No. 60/594,109 filed Mar. 1, 2005. The aforementioned applications are all herein incorporated by reference.
TECHNICAL FIELD
• The invention relates to methods for removal of material from a patient's body. More particularly, the invention relates to such methods that are minimally invasive.
BACKGROUND OF THE ART
• A number of medical conditions exist that may require material to be removed from a patient's body. U.S. Pat. No. 6,673,023 B2 (Jan. 6, 2004), as well as U.S. patent applications Ser. Nos. 10/093,765 (Mar. 8, 2002), 10/093,774 (Mar. 8, 2002), 10/667,768 (Sep. 22, 2003), and 11/134,569 (May 20, 2005), all to Pflueger, describe a device and methods for removal of tissue from a body. The device generally includes a handpiece coupled to a tissue removal device having a cannula and a rotable element with helical threading. In all the embodiments shown, the rotable element extends beyond the distal tip of the cannula, and the apparatus is designed to draw tissue into the cannula upon rotation of the rotable element. The rotable element, however, may pose the threat of damage to body tissue that it contacts, in that it may penetrate, screw in to, or puncture such tissue. Thus there exists a need for minimally invasive devices for removing tissue from a patient's body that overcome some or all of the deficiencies of the prior art.
BRIEF DESCRIPTION OF THE DRAWINGS
• In order that the invention may be readily understood, embodiments of the invention are illustrated by way of examples in the accompanying drawings, in which:
• FIG. 1A is a perspective view of one embodiment of the device of the invention.
• FIG. 1B is a side-view of one embodiment of the device of the invention.
• FIG. 1C is a top-view of one embodiment of the device of the invention.
• FIGS.2A-D are perspective views of several embodiments of the distal portion of the elongate member.
• FIG. 3 is a sectional view of the distal portion of one embodiment of the apparatus.
• FIGS.4A-E are perspective views of several embodiments of the slits of the apparatus.
• FIG. 5 is a sectional view of one embodiment of the apparatus.
• FIG. 6 is a sectional view of one embodiment of one portion of the apparatus.
• FIG. 7 is a cutaway view of the distal portion of one embodiment of the distal portion of the apparatus.
• FIGS. 8A-8L are illustrations of one embodiment of an application of the method of the invention.
DETAILED DESCRIPTION OF THE INVENTION
• With specific reference now to the drawings in detail, it is stressed that the particulars shown are by way of example and for purposes of illustrative discussion of certain embodiments of the present invention only, and are presented in the cause of providing what is believed to be the most useful and readily understood description of the principles and conceptual aspects of the invention. In this regard, no attempt is made to show structural details of the invention in more detail than is necessary for a fundamental understanding of the invention, the description taken with the drawings making apparent to those skilled in the art how the several forms of the invention may be embodied in practice.
• Before explaining at least one embodiment of the invention in detail, it is to be understood that the invention is not limited in its application to the details of construction and the arrangement of the components set forth in the following description or illustrated in the drawings. The invention is capable of other embodiments or of being practiced or carried out in various ways. Also, it is to be understood that the phraseology and terminology employed herein is for the purpose of description and should not be regarded as limiting.
• Definitions
• As used herein, the term “at”, for example when referring to something being located “at” a specific location, is intended to include any one or more of: proximate, on, near, adjacent to or within the specific location.
• As used herein, the terms “distal” and “proximal” are defined with respect to the user. In other words, the term “distal” refers to the part or portion further away from the user, while the term “proximal” refers to the part or portion closer to the user.
• As used herein, the “posterior portion” of the nucleus pulposus refers to the approximately half of the nucleus pulposus that is closest to the dorsal side of the body, and the “anterior portion” of the nucleus pulposus refers to the approximately half of the nucleus pulposus that is closest to the ventral side of the body.
• As used herein, the term “shaft” refers to an elongate element having either a closed or open distal end.
• As used herein, the term “bent” refers to any deviation from a longitudinal axis.
• As used herein, the term “slot” refers to an outcutting, slit, gap, or hole and is not limited in size or shape.
• As used herein, the term “obturator” refers to any item that substantially fills or blocks a lumen.
• As used herein, the term “cannula” is defined as an elongate device defining a lumen.
• As used herein, the term “coring” refers to advancing an elongate member defining a lumen and having an open distal end into a tissue, wherein the advancement results in the incorporation or gathering of at least a portion of the tissue into the lumen of the elongate member.
• As used herein, the phrase “operatively connected” is intended to mean “coupled or connected, either directly or indirectly, such that the connected structures are operable to perform a desired function”.
• As used herein, the term “conveyance” refers to facilitation of movement of a material from one location to another.
• Finally, as used herein, the term “fully disposed” refers to a first member being substantially fully received within a second member such that, under normal use, it is not intended to be inserted into the other member any further.
• Device
• In one broad aspect, the present invention comprises an apparatus for removal of materials from the body of a patient. In one specific embodiment of the method, the apparatus is used for removal of nucleus pulposus tissue from an intervertebral disc. The apparatus may generally comprise a tissue removal member housed at least partially within an elongate member defining a lumen, for example a sheath. The tissue removal member may be any device that functions to convey tissue from the distal end of the elongate member to a portion exterior to the patient's body. In one embodiment, the tissue removal member is a shaft with at least one projection extending outwardly from the shaft. The shaft may have a plurality of projections extending outwardly therefrom. In one embodiment, the tissue removal member is operatively connected to a motor or other source of rotational energy which provides the motion required to remove the tissue.
• In the general embodiment shown inFIG. 1, the apparatus comprises anelongate member102, ahandpiece140, and areceptacle138 for collection or visualization of tissue.
• In one embodiment of the present invention,elongate member102 comprisesproximal portion104 ending in openproximal end106, anddistal portion108 ending in opendistal end110. In other embodiments, described in more detail below,proximal end106 may be closed andproximal portion104 may define one or more apertures in a lateral wall thereof. Opendistal end110 definesaperture112. In one specific embodiment, the cross-sectional shape ofelongate member102 is substantially circular, however alternate embodiments are possible, wherein the shape may be ovoid, square, or rectangular, andelongate member102 is not limited in this regard. The plane in whichaperture112 is defined may be substantially perpendicular to the longitudinal axis ofelongate member102; howeverdistal end110 ofelongate member102 may be beveled or otherwise oriented, in which case the plane ofaperture112 would not necessarily be perpendicular to the longitudinal axis of the shaft.
• In one specific embodiment,elongate member102 is sized to be percutaneously directed to an interior tissue of the body. The length ofelongate member102 is generally between about 15.0 and about 25.0 cm, more specifically between about 17.0 and about 19.0 cm; however it may be otherwise sized to reach any target tissue within the body. The diameter ofelongate member102 is generally between about 0.5 and about 5.0 mm, more specifically between about 1.0 and about 2.0 mm, however it may be otherwise sized to fit within the space defined by the target tissue.
• In one embodiment,elongate member102 may be bent or curved, as shown inFIGS. 2A-2D. This may allow for easier access to a target site. The bend or curve may be applied by the user prior to or during the procedure, or may be applied during manufacture. Many angles are possible depending on the nature of the target tissue. For example, if the target tissue is the nucleus pulposus of an intervertebral disc, the curve may be at such an angle that the posterior portion of the nucleus pulposus may be reached with the device while allowing for an approach that reduces risk of damage to the spinal canal. In this example, the angle of curvature would generally be between about 1.0 and about 5.0°. Furthermore, the curve or bend may be located at various points along the length of the elongate member.Distal end110 ofelongate member102 may additionally comprise a variety of geometries such as blunt, sharp, beveled, crown-shaped, fishhook shaped, or any other shape that will not interfere with the proper functioning ofapparatus100.
• Elongate member102 may be manufactured from a number of different materials. These include, but are not limited to, stainless steels, shape-memory materials such as nickel titanium alloys, polyesters, polyethylenes, polyurethanes, polyimides, nylons, copolymers thereof, and medical grade plastics. In one specific embodiment,elongate member102 is made from a clear, transparent or translucent plastic or other material. This embodiment may allow the user to visualize the contents ofelongate member102 to ensure that it is operating properly.
• In one embodiment,elongate member102 is structured to define at least one slot indistal portion108. The at least oneslot114 may function to allow more tissue to enterelongate member102, and may allow for ease of movement through the target tissue, while still maintaining the separation of the non-target tissues fromtissue removal member116. Referring now toFIG. 4, slot(s)114 may extend proximally fromdistal end110 ofelongate member102. Slot(s)114 may extend to a point onelongate member102 that is substantially coplanar withdistal end136 ofshaft128 whenshaft128 is fully inserted intosheath102. As used herein, the term ‘substantially coplanar’ may include any deviation from coplanarity that would not interfere with the functioning of the apparatus. Therefore, slot(s)114 may extend to a point that is either proximal or distal todistal end136 ofshaft128. In one embodiment, slot(s)114 may be between about 0.5 mm and about 3 mm in length. Referring now toFIGS. 4A-4E, slot(s)114 may be defined in a variety of shapes including rectangular, square, triangular, or any other shape that would not interfere with the proper functioning ofapparatus100. When a plurality of slots is included, the slots may be circumferentially arranged in any manner that will not interfere with theproper functioning apparatus100. For example,elongate member102 may include2 slots that are diametrically opposite each other, or substantially adjacent to each other. In another example,elongate member102 may include 3 slots that are equidistant from each other, or that are all arranged on one hemisphere of the distal end of the elongate member. In other embodiments, different arrangements and shapes of slots may be included. Furthermore, when a plurality of slots is included, the shape, positioning, or size of each of the slots need not be identical.
• Slot(s)114 may be created in a number of ways. For example, a Dremel or other rotary tool may be used to cut orsand slot114 intoelongate member102. Alternatively,sheath102 may be manufactured withslots114 included.
• With respect toFIGS. 3, 5, and7,apparatus100 comprisestissue removal member116, which is structured to be disposed withinelongate member102.Tissue removal member116 comprises a proximal portion ending in a proximal end, anddistal portion122 ending indistal end124. In one embodiment,tissue removal member116 may be coaxial withelongate member102; howevertissue removal member116 may be otherwise aligned. In one embodiment, the length oftissue removal member116 is such that the proximal portion oftissue removal member116 extends proximally beyondproximal end106 ofelongate member102; however proximal ends ofelongate member102 andtissue removal member116 may be flush or otherwise aligned. In a specific embodiment,distal end124 oftissue removal member116 is recessed proximally from the distal end ofelongate member102. This structure allows fordistal portion122 oftissue removal member116 to be substantially shrouded withinelongate member102. This arrangement may protect surrounding tissues from being damaged by contact withtissue removal member116. The distance by whichtissue removal member116 is recessed fromdistal end110 ofelongate member102 is generally between about 0.5 and about 4.0 mm, more specifically between about 0.5 and about 2.0 mm; however, in this embodiment, the distance may be any amount such thattissue removal member116 does not contact tissue until after the tissue has already enteredelongate member102. Further details regarding the recession oftissue removal member116 are discussed hereinbelow.
• In one embodiment,tissue removal member116 comprises ashaft128 having outwardly extendingprojections126. In a more specific embodiment, the outwardly extending projections may comprise a helical flighting or helical element disposed at least partially aroundshaft128. This arrangement may functionally form an auger, wherein the term auger refers to a device for moving or displacing material or liquid by means of a rotating helical flighting. However, any other structure that functions as an auger may be used, such as a screw or a drill bit. In one embodiment, outwardly extendingprojections126 extend fromdistal portion136 ofshaft128 and may end inproximal portion130 ofshaft128. In a specific embodiment, outwardly extendingprojections126 may end at a point located withinreceptacle138, as described hereinbelow.Tissue removal member116 is not limited to having one continuous helical projection; it may comprise a plurality of discrete projections that are either continuous or discontinuous over the length of the shaft, as shown inFIG. 3B. The geometry of the outwardly extending projections may vary in the thickness of the projections, the distance between projections, or in any other way that does not affect the functionality of the device. In addition, the diameter ofprojections126 may be constant or may vary. In the case of a constant diameter,projections126 may be sized such thattissue removal member116 fits exactly withinsheath102, orprojections126 may be sized such that the diameter oftissue removal member116 is smaller than the inner diameter ofsheath102. Furthermore,shaft128 is not limited to one continuous shaft, and may comprise a plurality of shaft segments as shown inFIG. 3C.
• Distal end136 ofshaft128 oftissue removal member116 may have many shapes, and the invention is not limited in this regard. For example,distal end136 may be blunt, sharp, rounded, or otherwise shaped. Furthermore,distal portion134 may be straight, bent, curved, beveled, or otherwise fashioned.
• In one specific embodiment, outwardly extendingprojections126 may be welded toshaft128. In another embodiment, outwardly extendingprojections126 may be integrally formed withshaft128.Shaft128 can be manufactured from a number of different materials. These include, but are not limited to, stainless steels, shape-memory materials such as nickel titanium alloys, polyesters, polyethylenes, polyurethanes, polyimides, nylons, copolymers thereof, and medical grade plastics. Furthermore, any combination of the above materials may be used to optimize the physical properties ofapparatus100. For example, a plastic coating disposed on a metal core may optimize flexibility and strength. Outwardly extendingprojections126 may be manufactured from a number of different materials, including but not limited to stainless steels, nitinol, and various plastics and polymers. Outwardly extendingprojections126 may be attached toshaft128 by welding, for example laser welding, or by any other suitable method of joining two such components, such as crimping, soldering, or the use of adhesives. Alternatively, as mentioned above,projections126 may be integrally formed withshaft128 during the manufacturing process. In other words,shaft128 andprojections126 may be manufactured or machined as one single device, such as the case of a screw or a drill-bit.
• In one specific embodiment,shaft128 may be at least partially coated with a substantially lubricious material. Such a material would be one that facilitates movement ofshaft128 throughelongate member102. In addition, the inner surface ofelongate member102 may be coated with such a material. Suitable lubricious materials include, but are not limited to, polytetrafluoroethylene, parylene, or tungstenite.
• Tissue removal member116 may generally be between about 6 inches and about 18 inches in length, more specifically between about 10.0 inches and about 13.5 inches. The diameter ofshaft128 may generally be between about 0.012 inches and about 0.042 inches, more specifically between about 0.016 inches and about 0.028 inches. The width of outwardly extendingprojections126 may generally be between about 0.003 inches and about 0.025 inches, more specifically between about 0.005 inches and about 0.010 inches.
• As previously mentioned,apparatus100 may comprise a receptacle for housing and/or viewing the tissue that is removed from the body. Herein, such a receptacle may be referred to as a collection chamber.Collection chamber138 may be manufactured in a variety of sizes depending on the application. In one embodiment,collection chamber138 may be structured to be coaxial withelongate member102 andtissue removal member116. In such an embodiment,collection chamber138 may be located at, for example adjacent to,proximal portion104 ofelongate member102, whereinproximal end106 ofelongate member102 anddistal portion604 ofcollection chamber138 are operatively connected, for example joined by a hub orlock144. Hub or lock144 may be a luer lock, snap fit, or any other type of hub or joining mechanism that does not interfere with the functioning ofapparatus100. In some embodiments,proximal portion104 ofelongate member102 may define an opening such that tissue may exit therethrough and entercollection chamber138. In the embodiment shown inFIG. 6, the opening is defined byproximal end106 ofelongate member102. In other embodiments,proximal portion104 ofelongate member102 may comprise one or more openings, for example in a lateral wall thereof, for allowing tissue to pass therethrough intocollection chamber138. It is to be noted that a means for tissue to exitproximal portion104 ofelongate member102 is not limited to openings, and may include other means such as tubing, for example. In such embodiments,collection chamber138 may be structured to receive tissue exitingproximal portion104 ofelongate member102. For example,distal portion604 ofcollection chamber138 may define a hole or other opening that is aligned with openproximal end106 ofelongate member102, such that tissue may exitelongate member102 through openproximal end106 and entercollection chamber138 through the hole defined bydistal portion604. In some embodiments,tissue removal member116 may extend through openproximal end106 ofelongate member102 into, and optionally through,collection chamber138, such that tissue may be deposited or viewed therein. In this embodiment, hub or lock144 may be structured such that it does not interfere with the passage of tissue fromelongate member102 intocollection chamber138, and such that it allowstissue removal member116 to extend from within the lumen ofelongate member102, through openproximal end106, and intocollection chamber138. In a specific embodiment, outwardly extendingprojections126 oftissue removal member116 may end at a position withincollection chamber138. This may help to ensure that the tissue is deposited withincollection chamber138.Shaft128 oftissue removal member116 may further extend throughproximal portion602 ofcollection chamber138. In some embodiments, collection chamber may be structured to be coupled tohandpiece140. In these embodiments,proximal portion602 ofcollection chamber138 may be joined to the distalmost portion ofhandpiece140 with hub orlock146. Hub or lock146 may be a luer lock, snap fit, or any other hub or mechanism of joining that does not interfere with the functioning ofapparatus100. In a further embodiment, the collection chamber assembly may comprise agasket600 or any other device that would prevent tissue from exitingproximal portion602 ofcollection chamber138. In the specific embodiment shown inFIG. 6,distal portion604 ofcollection chamber138 is operatively connected to elongatemember102,proximal portion602 ofcollection chamber138 is operatively connected tohandpiece140, andshaft128 oftissue removal member116 runs throughcollection chamber138 and intohandpiece140. In yet another embodiment,collection chamber138 may be located withinhandpiece140.
• In some embodiments,collection chamber138 may be structured to allow the user to visualize the contents of the chamber. This may be accomplished by manufacturingcollection chamber138 from a material that is clear, translucent, transparent, or otherwise pervious to light. Such materials include, but are not limited to, polycarbonate, polyvinylchloride, and polypropylene. In another embodiment,collection chamber138 may include means for measuring the amount of tissue that is contained therein. The means may comprise, but are not limited to, volume markings on the chamber, a movable indicator that may be displaced by the tissue, or an electrically conductive marker that may lead to auto-shutoff when a certain amount of tissue has been removed. Furthermore, the moveable indicator may be structured such that it can be preset by the user at a particular location, thus facilitating the removal of a particular predetermined amount of tissue.
• In one embodiment,collection chamber138 may be structured to be detached fromapparatus100 while still maintaining the tissue withincollection chamber138. This may be accomplished by unscrewing or otherwise detachingcollection chamber138 fromhandle140 andelongate member102, and slidingcollection chamber138 off ofapparatus100.Collection chamber138 can then be capped or otherwise closed or sealed with a snap-on cap, screw-cap, or any other means of sealing or closingcollection chamber138. This embodiment may allow for the tissue to be sent for further analysis, for example to a pathology laboratory. Persons skilled in the art will recognize that in some cases, tissue may stick toshaft128 oftissue removal member116. In these cases, aftercollection chamber138 has been removed fromapparatus100, the user may simply manually remove the tissue fromapparatus100, and place it in a separate vial for collection. Alternatively,shaft128 may be structured to be removed fromhandpiece140 such that tissue can be slid or pulled off the proximal end ofshaft128. In one specific embodiment, a non-stick coating, such as Teflon, may be included on the portion of the shaft that is withincollection chamber138 to prevent tissue from sticking.
• In another embodiment,collection chamber138 may comprise a removable collection vessel, sac, or pouch for ease of tissue removal. This would be particularly useful in cases wherecollection chamber138 is multi-use and requires sterilization
• As shown inFIG. 1,apparatus100 may includehandpiece140. The shape ofhandpiece140 as shown in the embodiment ofFIG. 1 may allow for the user to grip and manipulate the apparatus in a number of different ways. For example, the user may grasphandpiece140 using an overhand “screwdriver” grip. This grip may be beneficial for coarse movements such as insertion. In another example, the user may employ a “pencil” grip. This grip may be beneficial for fine or delicate movements, such as the navigation ofapparatus100 to the appropriate tissue. These techniques for grippinghandpiece140 are given as examples only, and are not meant to limit the manner in which the user may grip the handpiece. In one embodiment, aswitch142 may be recessed radially onhandpiece140, as shown inFIG. 1, thereby helping to preventapparatus100 from being inadvertently engaged. In another embodiment,handpiece140 may comprise a latch or guard to preventswitch142 from being inadvertently engaged.
• Handpiece140 may generally be sized to accommodate a number of hand sizes. In a specific embodiment,handpiece140 may be structured to allow a user to easily grasp and manipulate the apparatus.
• The internal structure of one embodiment ofhandpiece140 is shown inFIG. 5. In such an embodiment,handpiece140 may be structured to house abattery502, amotor500, andelectrical connections110 therebetween. In addition,switch142 may be located onhandpiece140, thereby renderingapparatus100 self contained and/or wireless. In this embodiment,handpiece140 may include anopening504 forproximal end130 ofshaft128 to enterhandpiece140. Alternatively, in an embodiment where the shaft does not enterhandpiece140,handpiece140 may include an aperture for the electrical connections joining the motor to the shaft to exit therethrough. In one embodiment, the distalmost portion ofhandpiece140 may connected toproximal end106 ofelongate member102. This connection may be temporary via a luer lock, a snap fit, or any other type of anchoring, or may be permanent via the use of adhesives. The connection may allowshaft128 of thetissue removal member116 to extend therethrough. In these embodiments,handpiece140 is preferably hollow and defines a lumen.
• Handpiece140 may be manufactured from a number of different materials, including, but not limited to, molded plastics. In oneembodiment handpiece140 may be formed from two pieces of molded material that are sealed together with an adhesive or other appropriate sealing technique. This would allow formotor500,battery502, or any other desired items to be contained within the handpiece.
• In some embodiments,tissue removal member116 may be operatively connected to a source of motorized rotational energy, for example amotor500, to allow for rotation oftissue removal member116.Proximal end118 oftissue removal member116 may be operatively connected tomotor500 by any one or more of a variety of means for connecting, including but not limited to, flexible tubing, a ball bearing joint, and a spring. The means for connecting may be flexible such thattissue removal member116 may pivot with respect tomotor500. In one specific embodiment,motor500 may be connected tobattery502 via standardelectrical connections110; howevermotor500 may use an alternative source of power, such as a plug or cable for connecting directly to a power outlet or other power supply.Switch142 is under the control of the user and allows current to flow from the source of power tomotor500 whenswitch142 in engaged. Whenswitch142 is engaged,motor500 may causeshaft128 oftissue removal member116 to rotate, thereby rotating outwardly extendingprojections126 and conveying tissue from thedistal portion122 oftissue removal member116 toproximal portion118.Motor500 may be one of several types of motors including, but not limited to, a direct current motor, an alternating current motor, an air driven motor, or a piezoelectric motor.Battery502 may be disposable or rechargeable, and may further be one of several types of battery including, but not limited to, alkaline, nickel-cadmium, or lithium.Switch142 may be one of several types of switches including, but not limited to, a toggle, a button, a rocker, a single throw switch, or a double throw switch. Furthermore, switch142 may be configured such that the user must hold the switch in the ‘on’ position for the motor to remain engaged.
• In one embodiment,motor500 may be configured to rotate over a range of speeds rather than being limited to an ‘on’ or ‘off’ position. In this embodiment, switch142 may be configured to permit adjustment of the speed by the user. The speed may generally range from about 200 to about 15,000 rotations per minute (RPM). Alternatively, the motor may include gears to adjust the torque or speed of rotation of the shaft. In a further embodiment,motor500 and switch142 may be configured to allowtissue removal member116 to rotate in an opposite direction. This may facilitate removal of tissue fromapparatus100.
• In embodiments comprising a bent sheath, as described hereinabove,apparatus100 may be modified to accommodate the bent sheath. In one embodiment,helical projections126 may be absent over the portion ofshaft128 that is within the bend. In another embodiment, segments ofshaft128 may be absent at regions within the bend. In another embodiment, the diameters of the shaft or helical projections or both the shaft and helical projections may be reduced within the region of the bend with respect to the diameter of the sheath. In another embodiment, the thickness ofhelical projections126 may be variable over the length ofshaft128. In another embodiment, the finish on the interior surface ofsheath102 may be modified to reduce any friction that may occur betweensheath102 andtissue removal member116. In another embodiment, the speed of rotation of the shaft may be slowed, by using a geared motor, for example, in order to reduce any friction that may occur betweensheath102 andtissue removal member116.
• In some embodiments,apparatus100 may comprise an introducer apparatus that will aid in introducingelongate member102 into the target tissue. The introducer apparatus may include a hollow elongate introducer or cannula and an obturator.Cannula700 may be substantially stiff or rigid, such that it may assist in piercing skin or other body tissues, or such that it may provide support forapparatus100.Obturator801 may be structured to cooperatively engage withcannula700. In other words,obturator801 may be sized to fit within the lumen ofcannula700 and may comprise means for securingobturator801 tocannula700. In one embodiment, the outer diameter ofobturator801 may be such that whenobturator801 is fully disposed withincannula700,obturator801 sufficiently fills the lumen such that tissue is prevented from entering the lumen when the introducer device is inserted into the body. In some embodiments the distal tip ofobturator801 may be sharp. In these embodiments, the distal tip ofobturator801 may be conical, beveled, or more specifically, tri-beveled. The lengths ofobturator801 andcannula700 may vary depending on the application. In one embodiment,cannula700 will be sized such thatdistal end702 can reach the target tissue within the body while the proximal end remains outside of the body. More specifically,cannula700 may be between about 5.5 and about 7.5 inches in length, andobturator801 may be between about 5.5 and about 7.5 inches in length. When the target tissue is an intervertebral disc,cannula700 may be about 6.4 inches in length, andobturator801 may be about 6.6 inches in length.Obturator801 may be slightly longer than thecannula700, so thatdistal end810 of the obturator may protrude fromcannula700 when fully disposed. The lumen ofcannula700 may be sized to accommodate the diameter ofelongate member102 andobturator801, while remaining as small as possible in order to limit the invasiveness of the procedure. In a specific embodiment, the proximal regions ofcannula700 andobturator801 are structured to be locked together with hub orlock808. In other words, the hub or lock comprises means for securingcannula700 toobturator801.
• In one embodiment,cannula700 andobturator801 may be made from a stainless steel. In other embodiments,cannula700,obturator801, or both may be made from other materials, such as nickel-titanium alloys for example.
• As previously mentioned,elongate member102 may be inserted through the lumen ofcannula700 in order to reach the target tissue. In such an embodiment,elongate member102 may comprise a marking812 onproximal portion104, such that whendistal end110 ofelongate member102 anddistal end702 ofcannula700 are aligned, the marking will be aligned with the proximal end ofcannula700. The marking may take the form of a colored band, a dot, or a notch, for example. The use of the marking is discussed further hereinbelow.
• In one embodiment, the length ofcannula700 may comprise depth markings to aid the user in the placement of introducer apparatus. Such markings would be spaced at specific distances along the length ofcannula700, for example at every inch. Such depth markings may be colored bands, notches, or dots for example.
• In one embodiment,cannula700 includes aradiopaque marker704 for visualizing the location of the cannula with respect to the target tissue using x-ray fluoroscopic imaging. In such an embodiment,radiopaque marker704 may be located on the distal portion ofcannula700. In another embodiment, a radiopaque marker may be included ondistal tip810 ofobturator801. Examples of such markers are disclosed in U.S. patent applications US2005000079318 (publication number US20050159797A1), and US2003000382836 (publication number US20040176759A1), both of which are incorporated herein by reference.
• In another embodiment, the distal portion ofcannula700 may have one of a variety of configurations, including, but not limited to, straight, bent, or beveled. In one specific embodiment,cannula700 is straight, whiledistal portion108 ofelongate member102 is curved. In such an embodimentelongate member102 may flexibly conform to the shape ofcannula700 while disposed within the introducer, but as it is passed throughdistal end702 ofcannula100 it may reform to its curved shape.
• In another embodiment,cannula700 may include a port such that a liquid may be delivered to the target tissue viacannula700. Such a port may be located on the proximal region of the cannula, and may comprise a hub for joining a supply of liquid thereto.
• As persons of skill in the art will recognize, the introducer device described hereinabove may be used with other devices that are structured to remove tissue from a nucleus pulposus. The use of the introducer device is therefore not limited to use withapparatus100.
• In a further embodiment,apparatus100 may be operable to deliver energy to a portion of the target tissue to further treat the tissue. This energy may comprise radiofrequency electrical energy, thermal energy, microwave energy, ultrasound energy, or optical energy (e.g. laser energy). In a further embodiment,apparatus100 may further comprise a probe operable to deliver energy, wherein probe refers to any element designed to deliver energy to a tissue. In the case of a herniated intervertebral disc, the application of radio frequency energy may cause the heating of the tissue surrounding the probe. This may result in the shrinkage of the nucleus pulposus tissue, which may act to further treat the herniated disc. Examples of the use of energy to treat an intervertebral disc are disclosed in U.S. Pat. No. 6,896,675 (filed on 05 Mar. 02) and U.S. patent application publication No. US20050234445A1, incorporated herein by reference.
• In another embodiment,apparatus100 may comprise means for measuring pressure within a patient's body. Examples of means for measuring pressure are a pressure transducer,. or a fluid filled lumen for transmitting pressure. For example, in the case of an intervertebral disc, there is an intrinsic pressure associated with the nucleus pulposus tissue, and the pressure may be heightened in the case of a diseased disc. The initial pressure, change in pressure, or final pressure may be used to determine the amount of tissue to be removed from the disc. In this embodiment, a pressure sensor may be located indistal portion108 ofelongate member102 ordistal portion134 ofshaft128, or alternatively, on a separate instrument introduced into the target tissue. Furthermore, electronic circuitry may be provided to cause an auto-shutoff ofapparatus100 when a certain pressure has been reached.
• In another embodiment,apparatus100 may comprise means for measuring the electrical impedance within a patient's body. This feature may be useful, for example, in ensuring the proper placement ofapparatus100 in the target tissue. In the case of an intervertebral disc, the impedance within the annulus fibrosis of an intervertebral disc may be different from that within the nucleus pulposus of the disc. Thus, by measuring the impedance betweendistal end110 ofelongate member102 and a return electrode, for example, it may be possible to determine whetherdistal end110 ofelongate member102 is in the annulus fibrosis or nucleus pulposus. The impedance may be measured between a variety of elements on the apparatus, for example betweenelongate member102 and a return electrode,elongate member102 andtissue removal member116,tissue removal member116 and a return electrode,obturator801 and a grounding pad, or between any other desired elements of the apparatus.
• In another embodiment,apparatus100 may comprise sensing means for indicating whethertissue removal member116 is contacting or engaging tissue. Such means may include, but are not limited to, an element for measuring the torque required to turnmotor500, an element for measuring the forces exerted onelongate member102, or an element for measuring the current drawn bymotor500. The sensing means may be coupled to an indicator, such as a light or an LED, for indicating to the user that the tissue has been engaged.
• In some embodiments,apparatus100 may comprise means for guidingdistal end110 ofelongate member102 in a desired direction. For example, a pull-wire may be coupled todistal end110 ofelongate member102, and may extend proximally to a point located outside of the patient's body. By pulling on the pull-wire, the user may causedistal end110 ofelongate member102 to deflect to a location that is closer to a target site.
• In yet another embodiment,apparatus100 may comprise an observation system for visualizing the location or operation ofapparatus100. Such a system may include, but is not limited to, an ultrasonic or fiber-optic visualization apparatus disposed atdistal end110 ofelongate member102 ortissue removal member116.Apparatus100 may alternatively be configured for use with an endoscope.
• In another embodiment,apparatus100 may comprise measuring means for measuring the temperature at a particular position on the apparatus. Such means may include a thermocouple, thermistor, or resistance thermometer, for example. The temperature measurement means may be located ondistal end110 ofsheath102, ordistal end136 ofshaft128 for example.
• Method
• In one broad aspect, the invention comprises methods for removal of tissue from a body, wherein the methods are a combination of coring and conveyance. The methods described herein may be used to remove various types of materials from a patient's body. Examples of such materials include, but are not limited to, tissue of an intervertebral disc (for example, the nucleus pulposus), tumor tissue (including, but not limited to, material from breast, colon, stomach, or liver tumors), bone tissue (for example, bone marrow), cyst material, adipose tissue, eye material, cartilage, or atherosclerotic material.
• While the general method for removing material may substantially comprise similar steps (i.e. coring and conveyance of material) regardless of the material being removed, the method of introducing the apparatus into, or removing the apparatus from, the target site, may vary depending on the material and/or target site. For example, in the case of bone marrow an instrument for penetrating bone, for example a hammer or a reamer, may be used to access the portion of the bone where the marrow is located. In the case of tumor material, extra caution may be required to ensure that malignant cells do not track along the removal path of the sheath of the tissue removal member so that tumor material is not spread within the patient's body. In such an application, it may be useful to cauterize the removal path of the sheath so that tissue surrounding the path is destroyed. If a cannula is used to introduce the device and remains in place during the procedure, as discussed herein below, the cauterization step may not be necessary, since the sheath of the tissue removal member doesn't contact tissue as it's removed from the patient's body.
• In one embodiment, the method of the present invention may be practiced usingapparatus100, includingtissue removal member116 disposed withinelongate member102, as described hereinabove. Alternatively, embodiments of the method of the present invention may be practiced using any device that provides substantially similar functionality with respect to the steps of coring and conveying material. The steps of one embodiment of the method may be described generally as follows: patient preparation, insertion of the apparatus, activation of the apparatus, removal of the apparatus and patient recovery. In addition, a user may desire to analyze the tissue removed during the procedure. These steps will presently be discussed in greater detail. In order to illustrate the steps of this embodiment, reference will be made to a specific application of this embodiment in removal of tissue from an intervertebral disc (shown inFIGS. 8A-8L). It should be noted that the steps described herein are not intended to be exclusive and further steps may be performed in conjunction with embodiments of the method of the present invention. In addition, some of the steps described herein may be omitted and the invention is not limited in this regard.
• The step of patient preparation may comprise acquiring patient data in order to prepare for the procedure as well as positioning the patient appropriately. Pertinent data to be acquired may include, but is not limited to, a medical history of the patient, standard diagnostic test results (e.g. blood tests), physical function and pain assessments and medical imaging assessments of the patient's condition. In some embodiments, the patient may be assessed using various imaging modalities such as MRI, X-ray, CT scan or ultrasound prior to the tissue removal procedure. These assessments may aid in determining the appropriate location of the target site for tissue removal as well as the amount of tissue to be removed. Prior to commencing the procedure, the patient may be positioned in a prone position (depending on the target site and the material being removed) and prepared using standard pre-surgical techniques.
• Once preparations for the procedure have been completed, the apparatus may be inserted to the target site within the patient's body. The location and angle of insertion may depend on the target site and the specific material being removed. For example, in the case of an intervertebral disc, the physician may insert the apparatus into the foraminal and pedicle zones, superior to the articular process, below the exiting spinal nerve, 20° to 40° from the sagittal plane, and roughly equidistant from the superior and inferior endplates.
• In some embodiments, the placement ofdistal end110 ofelongate member102 at the target site may be aided with the use of an introducer apparatus. Referring now to the example illustrated inFIGS. 8A and 8B, the introducer apparatus comprises anobturator801 disposed within acannula700. The introducer apparatus is advanced either percutaneously or in an open surgical procedure into the body of the patient and towards the target site. When the target site has been reached,obturator801 is withdrawn proximally fromcannula700, leaving adistal end702 ofcannula700 at the target site, for example as shown inFIGS. 8C and 8D. In the illustrated embodiment,distal end702 ofcannula700 is positioned at the boundary between theannulus fibrosis804 and the nucleus pulposus806 (i.e. the inner wall of the intervertebral disc).
• In some embodiments,cannula700 may comprise aradiopaque marker704 to aid in the placement of the introducer apparatus. In such an embodiment,radiopaque marker704 may be included atdistal end702 ofcannula700. In alternate embodiments,radiopaque marker704 may be located elsewhere oncannula700. The placement ofcannula700 may then be performed under fluoroscopy, such that the visibility ofdistal end702 ofcannula700 may be enhanced on the fluoroscopic image byradiopaque marker704. Alternatively or in addition, various sensors may be used to assist in placing the introducer apparatus appropriately. For example, in the case of an intervertebral disc, an impedance measurement device may be included ondistal end702 ofcannula700. As the annulus fibrosis of an intervertebral disc may be of different electrical impedance than the nucleus pulposus, the user may measure the electrical impedance atdistal end702 ofcannula700 while inserting the cannula. When the electrical impedance measurement indicates thatdistal end702 ofcannula700 has passed through the annulus fibrosis and is within the nucleus pulposus, the user may stop the insertion process. In further embodiments, a contrast solution may be injected at the target site through the lumen ofcannula700 in order to verify proper placement. For example, if the target site is located within an intervertebral disc, the contrast solution, when viewed under fluoroscopy, may allow a user to visualize the boundary between thenucleus pulposus806 andannulus fibrosis804. In addition, other substances may be injected throughcannula700 to the target site. The substance may be injected through an injection port or hub coupled tocannula700. For example, it may be desirable to inject a fluid, including but not limited to an antibiotic, an anesthetic or an analgesic substance, prior to removing tissue from the target site.
• Oncecannula700 is properly placed and any injections have been completed,elongate member102 may be inserted through the lumen ofcannula700. For example, and referring now toFIGS. 8E and 8F,elongate member102 andtissue removal member116 may be advanced through the lumen ofcannula700, such thatdistal end110 ofelongate member102 is located distal todistal end702 ofcannula700.
• The device having been inserted to the target site, the procedure may proceed by activating the tissue removal member in order to remove tissue. This step of activating the device may generally include engaging the motor to rotate the device and advancing the device, includingelongate member102, through the target site to core and convey a desired amount of material away from the target site. More specifically, in one embodiment, the user may advancedistal end110 ofelongate member102 into the target site, engagemotor500, usually viaswitch142, and whilemotor500 is engaged,advance apparatus100 distally through the target site. Whenapparatus100 has been advanced a particular distance, to be determined by the user depending on the size of the target site and/or the amount of material to be removed,motor500 may be disengaged, andelongate member102 may be withdrawn proximally through the target site. In the case of a curved elongate member, as shown inFIG. 2,elongate member102 may be repositioned by rotatingelongate member102 about its longitudinal axis, without requiring removal and re-insertion ofelongate member102 into the patient's body.Motor500 may then be re-engaged, andelongate member102 may be advanced into a second region of the target site. The activation step of the tissue removal procedure may be repeated until the desired volume of tissue has been removed. At this point,apparatus100 may be removed from the body, as discussed further below. It should be noted that, in some embodiments, only one pass ofelongate member102 may be required in order to remove the desired amount of tissue.
• Without being restricted to a specific theory of operation, a proposed mechanism of action ofapparatus100, in one embodiment of the present invention, will be presently described. In operation,tissue removal member116 remains substantially static or stationary with respect to the longitudinal axis ofelongate member102. In other words,tissue removal member116 does not move ‘in and out’ with respect to elongatemember102.Apparatus100 is advanced through the target site to core the material to be removed. Asapparatus100 is advanced, material enterselongate member102 throughaperture112 and is forced proximally intoelongate member102 by the advancement ofapparatus100. In other words, material is substantially gathered into the lumen ofelongate member102. As used herein, the term “substantially gathered” may refer to a sample or portion of tissue that is still connected with tissue outside of the lumen ofelongate member102, or may alternatively refer to tissue that has been detached from tissue outside of the lumen. At a certain location withinelongate member102, the material contactstissue removal member116, which functions to convey the material proximally fromdistal portion108 ofelongate member102, to, for example, the exterior of the patient's body.Tissue removal member116 may function by a variety of mechanisms. In one embodiment,tissue removal member116 is coupled tomotor500. Upon engagement ofmotor500,tissue removal member116 rotates about its longitudinal axis. Outwardly extendingprojections126, described hereinabove, will engage the tissue withinelongate member102, and convey the tissue toward proximal end120 oftissue removal member116. In one specific embodiment,proximal portion118 oftissue removal member116 is operatively connected tocollection chamber138 as described hereinabove. In this embodiment, the tissue may be conveyed fromdistal portion108 ofelongate member102 and be deposited withinchamber138. As described hereinabove,tissue removal member116 is recessed fromdistal tip110 ofelongate member102; therefore the material does not contacttissue removal member116 until after the material has entered the lumen ofelongate member102. This functions to protect any non-target tissue fromtissue removal member116. For example, in the case of an intervertebral disc, as shown inFIGS. 8I to8L,apparatus100 is advanced through the soft tissue ofnucleus pulposus806 to effect removal of the tissue as described above. Asapparatus100 is advanced, it may eventually contactannulus fibrosis804, the integrity of which is essential to the health of the disc. Due to the more rigid structure of the annulus fibrosis, it may be prevented from being cored intoelongate member102, and therefore, due to the fact thattissue removal member116 is recessed fromdistal tip110, the annulus fibrosis will not contacttissue removal member116. Thus, the annulus fibrosis may be protected from the high speed motion and projections oftissue removal member116.
• In some embodiments, for example as shown inFIGS. 8G to8L, aclip802, sliding depth marker, or other marking mechanism may be used to indicate the location ofdistal end110 ofelongate member102 within the patient's body. For example, in the case of an intervertebral disc, the user may positiondistal end110 ofelongate member102 at the boundary ofannulus fibrosis804 andnucleus pulposus806, as described above with respect to the positioning step. As shown inFIGS. 8G and 8H, the user may then advanceelongate member102 distally throughnucleus pulposus806, without activatingtissue removal member116, untildistal end110 ofelongate member102contacts annulus fibrosis804 on the anterior side or portion of the disc. This point of contact may be referred to the as the “anterior annulus inner wall” of the intervertebral disc. The boundary between nucleus pulposus806 andannulus fibrosis804 may be located by tactile sensation, as theannulus fibrosis804 is generally stiffer than thenucleus pulposus806, or by using a contrast solution and performing the method under fluoroscopy, as described hereinabove. The user may place marker or clip802 on the distalmost portion ofelongate member102 that is proximal to the proximal end ofcannula700, as shown inFIG. 8G. Referring now toFIGS. 8I and 8J, the user may then retractdistal end110 ofelongate member102 proximally todistal end702 ofcannula700. In one embodiment,proximal portion104 ofelongate member102 may comprise a marking812 located such that when the marking is aligned with the proximal end ofcannula700, it indicates that the distal ends ofcannula700 andelongate member102 are aligned. Thus, whenelongate member102 is withdrawn proximally through the disc, the user will know to stop retractingelongate member102 when marking812 is aligned with the proximal end ofcannula700. The user may then engagetissue removal member116, and begin the coring and conveyance procedure. As shown inFIGS. 8K and 8L, the user may stop advancingapparatus100 through the disc as marker or clip802 approaches the proximal end ofcannula700. The user may then withdrawapparatus100 by realigning the marking with the proximal end ofcannula700, and repeat the coring and conveying step. The use of marker orclip802 may help to ensure thatdistal end110 ofelongate member102 does not contactannulus fibrosis804. This may be especially advantageous in the case of a severely damaged disc that may be severely affected by damage toannulus fibrosis804.
• Termination of the procedure may be decided by a user, which decision may be facilitated in one or more ways by the apparatus being used. For example, the procedure may be terminated once a sufficient amount of tissue has been removed. In the case of an intervertebral disc, the amount of tissue to be removed may be up to 3.0 grams, more specifically, between 0.05 and 1.5 grams. Several methods may be used to determine when the appropriate amount of tissue has been removed from the body. In one embodiment,collection chamber138 is at least partially pervious to light and comprises volume markings for determining the amount of tissue held withinchamber138. By visualizing the markings and/or the contents ofcollection chamber138, the user may decide when the desired amount of tissue has been removed. Alternatively,collection chamber138 may comprise a sensing means for automatically indicating when a desired amount of tissue has been removed. For example,collection chamber138 may be fitted with a sensor, including but not limited to a pressure, optical or chemical sensor, such that the sensor may provide an indication to the user once a desired amount of tissue has been collected. The sensor may be movable so that the user can adjust for the desired amount of tissue for a given procedure. In one embodiment, tissue may be collected and, once the amount of tissue collected is such that the tissue contacts the sensor, the sensor may provide an indication, for example, a visible or audible indication, that the desired amount of tissue has been removed.
• In another embodiment, a pressure monitoring device may be coupled toapparatus100. By monitoring the change in pressure at the target site, the user may determine when the desired amount of tissue has been removed. Alternatively, the pressure monitoring device may be operable to provide an indication to the user when the pressure has changed by a pre-determined amount. The indication may take the form of, for example, a visible or audible indication and may indicate to the user that the desired amount of tissue has been removed. These embodiments are meant to be exemplary only, and are not intended to limit the methods for determining when the appropriate amount of tissue has been removed.
• Once the procedure has been terminated, the tissue removal member, as well as other components of the apparatus being used, may be removed from the patient's body. The step of removing these components may include, in some embodiments, removingelongate member102 fromcannula700, injecting a substance throughcannula700 and removingcannula700 from the patient's body. For example, it may be beneficial to inject a fluid, including but not limited to an antibiotic fluid, into the target site to prevent the possibility of infection.
• In some embodiments,apparatus100 may be maneuvered by the user during, for example, the positioning, advancing, and removing steps, by graspinghandpiece140 in one or more of a variety of grips, as described hereinabove, and manipulatinghandpiece140 to control the position ofelongate member102 andtissue removal member116 at the target site.
• The entire treatment procedure described herein may be repeated at a different site, if necessary. Following completion of all such procedures, the patient should be allowed to recover. In addition, the user may collect material removed from the patient during the procedure in order to allow for further analysis. Collecting material from the tissue removal member may be accomplished in several ways. For example, material may be removed fromtissue removal member116 manually by scraping, tweezing or otherwise grasping and removing the material. Alternatively, if material has been collected withincollection chamber138, thenchamber138 may be removed fromapparatus100, sealed and/or capped and sent for analysis. In addition, as described further below,motor500 may be run at high speeds in order to convey material up tocollection chamber138 prior to removal ofchamber138. Furthermore,motor500 may be operable to run in reverse, such that material may be conveyed todistal portion122 oftissue removal member116 which may allow for easier removal of material fromapparatus100, for example.
• In another embodiment,apparatus100 may be used to introduce material into a patient's body. For example, in the case of an intervertebral disc, it may be desired to add artificial (for example, synthetic) or natural (for example, xenobiotic) material or tissue, such as collagen or cement, into the intervertebral disc. In this embodiment, the material may be housed inreceptacle138, andmotor500 may be run in the reverse direction from that used in the tissue removal process. In this embodiment,tissue removal member116 may be referred to as a motorized device. The motorized device may engage the material housed in the receptacle, and convey it distally through the lumen ofelongate element102 and deposit it in the body. In one specific embodiment, tissue may be removed from the patient's body, and then material may be introduced into the patient's body. In this embodiment, after the tissue has been removed from the body as described above,apparatus100 may be removed from the body and introducer apparatus, and the receptacle housing the tissue may be replaced with a receptacle housing the material to be introduced.Device100 may then be re-introduced into the patient's body, as described hereinabove, and the motor may be run in reverse to convey the material into the body.Device100 may be advanced and withdrawn within the target tissue in order to disperse the material. In another embodiment, material may be introduced to the target site prior to removal of tissue from the patient's body. In yet another embodiment, material other than tissue, referred to herein as a “second material”, such as previously introduced cements or pharmaceutical compounds, may be removed from the target site. This may be done either before or after the introduction of material, and before or after a step of removing tissue.
• Some embodiments of the method aspect of the present invention may comprise one or more further steps. For example, in one embodiment, the method may comprise a step of delivering energy to the target site before, during, or after removal of material. In this embodiment,apparatus100 may include a probe or other device capable of delivering energy, as described hereinabove. The method may thus include placement of the probe at the target site, and activation of the probe to deliver energy. The user may advance or otherwise move the probe within the tissue, or may keep the probe stationary. Further details regarding such an embodiment may be found in co-pending U.S. patent application No. 20050234445 (published on 20 Oct. 05), incorporated herein by reference.
• In another embodiment, a second device may be separately introduced into the patient's body. This device may be used to aid in the collection of material. For example, aselongate member102 andtissue removal member116 are being operated at the target site, the secondary device may be used to push tissue towardselongate member102.
• In yet another embodiment, the method further comprises a step of disposing ofapparatus100 after use. This may be beneficial as single-use devices avoid several problems associated with reusable devices, including those associated with bacterial infections, viruses, and prions.
• In some embodiments, the method may comprise one or more steps of variably adjusting the speed (i.e. rotations per minute—RPM) ofmotor500. In such embodiments,motor500 is capable of rotating at various speeds, and the speed ofmotor500 may be adjusted by the user. For example, the user may adjust the speed by using a control element such as a dial, lever, knob, or any other control element coupled tomotor500. In one such embodiment, a user may adjust the motor to run at a high speed as the user begins the tissue removal procedure, wherein a high speed may be desirable to assist in rapidly removing material. Towards the end of the procedure, however, the user may reduce the speed to ensure that an excess of tissue is not removed. Furthermore, when the procedure is completed andapparatus100 has been removed from the patient's body, the user may desire to rotatetissue removal member116 at a high speed to remove any tissue remaining inelongate member102 or ontissue removal member116.
• In another embodiment, the longitudinal motion ofapparatus100 may be automated. In such an embodiment, the advancement ofapparatus100 into and through the target site would be automatic, rather than as a result of force applied by the user.
• As mentioned above, this embodiment of the method of the present invention is not intended to be limited to use within an intervertebral disc. Other tissues and/or materials may be removed from a patient=3 s body using the steps described above. Embodiments of the present invention thus provide for a minimally invasive apparatus that may be used to remove material, for example tissue from a patient's body, while minimizing blood loss and trauma to the patient.
• The embodiments of the invention described above are intended to be exemplary only. The scope of the invention is therefore intended to be limited solely by the scope of the appended claims.
• It is appreciated that certain features of the invention, which are, for clarity, described in the context of separate embodiments, may also be provided in combination in a single embodiment. Conversely, various features of the invention, which are, for brevity, described in the context of a single embodiment, may also be provided separately or in any suitable sub-combination.
• Although the invention has been described in conjunction with specific embodiments thereof, it is evident that many alternatives, modifications and variations will be apparent to those skilled in the art. Accordingly, it is intended to embrace all such alternatives, modifications and variations that fall within the spirit and broad scope of the appended claims. All publications, patents and patent applications mentioned in this specification are herein incorporated in their entirety by reference into the specification, to the same extent as if each individual publication, patent or patent application was specifically and individually indicated to be incorporated herein by reference. In addition, citation or identification of any reference in this application shall not be construed as an admission that such reference is available as prior art to the present invention.

Claims (21)

1. A method for removing material from a patient's body, comprising the steps of:

providing an apparatus comprising an elongate member for receiving said material, said elongate member defining a lumen and comprising a distal end defining an aperture and a proximal end, the apparatus further comprising an elongate tissue removal member for conveying material through said lumen, said tissue removal member being rotatably disposed within said lumen, said tissue removal member having a proximal end and a distal end, the distal end of the tissue removal member being recessed proximally relative to said aperture when said tissue removal member is fully disposed within said lumen;

gathering a sample of said material into said lumen; and

conveying with said tissue removal member at least a portion of the material sample proximally along said lumen.

2. The method ofclaim 1, wherein the step of gathering a sample of said material comprises the step of advancing the elongate member through a region of the body comprising material to be removed.

3. The method ofclaim 1, further comprising a step of positioning said elongate member at said region of said body.

4. The method ofclaim 2, wherein said step of positioning said elongate member is facilitated by fluoroscopic visualization.

5. The method ofclaim 2, wherein said step of positioning said elongate member further comprises the steps of:

providing an introducer apparatus comprising a cannula defining a cannula lumen and an obturator disposed within said cannula lumen;

inserting said introducer apparatus into said patient's body such that a distal end of said cannula is positioned at said region of said body;

withdrawing said obturator from said cannula lumen; and

inserting said elongate member into said cannula lumen.

6. The method ofclaim 4, wherein said step of inserting said introducer apparatus is facilitated by fluoroscopic visualization.

7. The method ofclaim 4, further comprising a step of injecting a fluid through said cannula lumen.

8. The method ofclaim 6, wherein said fluid is selected from the group consisting of an anesthetic, an antibiotic and a dye.

9. The method ofclaim 1, wherein at least one of said elongate member and said tissue removal member are operatively connected to a handpiece and wherein a motor is housed within said handpiece and is operatively connected to said tissue removal device.

10. The method ofclaim 9, wherein a portable source of energy is housed within said handpiece.

11. The method ofclaim 1, wherein said tissue removal member comprises a shaft having at least one helical projection.

12. The method ofclaim 1, wherein said tissue removal member comprises an auger.

13. The method ofclaim 1, wherein a distal portion of said elongate member defines at least one slot extending proximally from a distal end of said elongate member.

14. The method ofclaim 1, wherein a proximal end of said elongate member is operatively coupled to a receptacle structured to collect material removed by said tissue removal member, said elongate member defining at least one opening for transferring material from said elongate member to said receptacle.

15. The method ofclaim 14, wherein said receptacle is at least partially pervious to light.

16. The method ofclaim 14, wherein said receptacle comprises means for measuring the volume of material disposed within said receptacle.

17. A method for removing material from a patient's body, the method comprising the steps of:

providing an introducer apparatus comprising a cannula defining a cannula lumen and an obturator disposed within said cannula lumen;

inserting said introducer apparatus into a patient's body such that a distal end of said cannula is positioned at a region of the patient's body comprising material to be removed;

withdrawing said obturator from said cannula lumen;

providing a tissue removal apparatus comprising an elongate member for receiving said material, said elongate member defining a lumen and comprising a distal end defining an aperture and a proximal end, the apparatus further comprising an elongate tissue removal member for conveying material through said lumen, said tissue removal member being rotatably disposed within said lumen, said tissue removal member having a proximal end and a distal end;

inserting the elongate member into said cannula lumen; and

engaging the tissue removal member in order to convey the material through the lumen of the elongate member.

18. The method ofclaim 17, further comprising the step of advancing said elongate member through said region of a patient's body, such that material is substantially gathered into said lumen.

19. The method ofclaim 18, further comprising the step of engaging the tissue removal member with a motor during said step of advancing said elongate member.

20. A method for removing material from a patient's body, comprising the steps of:

providing a tissue removal apparatus comprising an elongate member for receiving said material, said elongate member defining a lumen and comprising a distal end defining an aperture and a proximal end, the apparatus further comprising an elongate tissue removal member for conveying material through said lumen, said tissue removal member being rotatably disposed within said lumen, said tissue removal member having a proximal end and a distal end;

advancing the elongate member through a region of a patient's body comprising material to be removed, so that material is at least substantially gathered into said lumen; and

conveying at least a portion of the material at least substantially gathered into said lumen away from said region.

21. The method ofclaim 20, wherein said material is selected from the group consisting of cartilage, adipose tissue, and cyst tissue.

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