US20080146965A1 - Surgical Device for The Collection of Soft Tissue - Google Patents

Abstract

A handheld biopsy device is provided for the collection of soft tissue samples from a surgical patient. In a preferred embodiment, the biopsy device comprises a handpiece, a fluid collection system, and a power transmission source. The handpiece is configured for grasping by a single hand, and being independently manipulatable by hand for movement of the instrument toward and away from the patient. An elongated piercer extends from the distal end of the handpiece. The piercer has a sharpened distal end for entering the tissue and a port located proximal to the sharpened distal end for receiving a portion of tissue mass. An elongated cutter is disposed coaxially relative to a piercer lumen of the piercer. A distal blade of the cutter slides distally past the port of the piercer to severe the tissue portion drawn into the port by vacuum. The cutter is retracted to a most proximal position for removal of the tissue portion from a cutter lumen of the cutter. The handpiece further comprises a holster for detachably connecting a cutter rotation transmission and a cutter axial transmission to the power transmission source.

Description

RELATED PATENTS AND PATENT APPLICATIONS
• This application claims priority to U.S. patent application Ser. No. 10/638,519 Filed Aug. 11, 2003, which claims priority to U.S. Ser. No. 09/895,732 filed Jun. 29, 2001; which claims priority to Ser. No. 09/543,122 filed Apr. 5, 2000; which claims priority Ser. No. 09/178,075 filed Oct. 23, 1998.
• This application is related to the following co-pending U.S. patent applications: Ser. No. 08/825,899 filed on Apr. 2, 1997; Ser. No. 09/107,845 filed on Jun. 30, 1998. This application is farther related to the following co-pending U.S. patent application Ser. No. ______, filed (Attorney Docket No. END 562); Ser. No. ______, filed (Attorney Docket No. END 563).
FIELD OF THE INVENTION
• The present invention relates, in general, to devices for tissue sampling and, more particularly, to improved biopsy probes for acquiring subcutaneous biopsies and for removing lesions.
BACKGROUND OF THE INVENTION
• The diagnosis and treatment of patients with cancerous tumors, pre-malignant conditions, and other disorders has long been an area of intense investigation. Non-invasive methods for examining tissue include palpation, X-ray, MRI, CT, and ultrasound imaging. When the physician suspects that a tissue may contain cancerous cells, a biopsy may be done using either an open procedure or a percutaneous procedure. For an open procedure, a scalpel is used by the surgeon to create a large incision in the tissue in order to provide direct viewing and access to the tissue mass of interest. The entire mass (excisional biopsy) or a part of the mass (incisional biopsy) may then be removed. For a percutaneous biopsy, a needle-like instrument is used through a very small incision to access the tissue mass of interest and to obtain a tissue sample for later examination and analysis. The advantages of the percutaneous method as compared to the open method may be significant and may include: less recovery time for the patient, less pain, less surgical time, lower cost, and less disfigurement of the patient's anatomy. Use of the percutaneous method in combination with imaging devices such as X-ray and ultrasound has resulted in highly reliable diagnoses and treatments.
• Generally there are two ways to obtain percutaneously a portion of tissue from within the body, by aspiration or by core sampling. Aspiration of the tissue through a fine needle requires the tissue to be fragmented into pieces small enough to be withdrawn in a fluid medium. The method is less intrusive than other known sampling techniques, but one can only examine cells in the liquid (cytology) and not the cells and the structure (pathology). In core biopsy, a core or fragment of tissue is obtained for histologic examination which may be done via a frozen or paraffin section.
• The type of biopsy used depends mainly on various factors present in the patient, and no single procedure is ideal for all cases. Core biopsy, however, is very useful in a number of conditions and is widely used by physicians.
• A number of biopsy devices have been designed and commercialized for use in combination with imaging devices. One such biopsy instrument is the BIOPTY gun, available from C.R. Bard, Inc. and described in U.S. Pat. Nos. 4,699,154 and 4,944,308 as well as in U.S. Reissued Pat. No. Re. 34,056. The BIOPTY gun is a core sampling biopsy device in which the biopsy needle is spring-powered. However, when using the BIOPTY gun, the breast or organ must be punctured and the device is re-inserted each time a sample is taken. Another core biopsy device is the TRUE CUT needle manufactured by Travenol Laboratories. This TRUECUT needle collects a single core of tissue using a pointed element with a side-facing notch to receive tissue and an outer, sharpened sliding cannula to cut the core sample from the surrounding tissue.
• Aspiration biopsy devices for obtaining biopsy samples from the body are described in the following: U.S. Pat. No. 5,492,130; U.S. Pat. No. 5,526,821; U.S. Pat. No. 5,429,138; and U.S. Pat. No. 5,027,827. These patents describe devices which use the aspiration method of liquid suspended tissue extraction rather than core sampling to extract tissue.
• To overcome operator error associated with such devices, and to enable multiple sampling of the tissue without having to reenter the tissue for each sample, a biopsy instrument now marketed under the tradenamne MAMMOTOME was developed. Embodiments of the invention are described in U.S. Pat. No. 5,526,822. The MAMMOTOME instrument is a type of image-guided, percutaneous, coring, breast biopsy instrument. It is vacuum-assisted and some of the steps for retrieving the tissue samples have been automated. The physician uses this device to capture “actively” (using the vacuum) the tissue prior to severing it from the body. This allows for sampling tissues of varying hardness. In the MAMMOTOME biopsy instrument, the cutter is rotated using a motor drive mounted in the instrument while the surgeon manually moves the cutter back and forth by a knob on the outside of the instrument. Thus, the surgeon is able, through tactile feedback, to determine whether the blade is effectively cutting tissue or if there is a problem, such as binding or stalling. The surgeon may then adjust the speed at which the blade is moved through the tissue, stop the blade, or back the blade away from the tissue. The device can also be used to collect multiple samples in numerous positions about its longitudinal axis, without removing the biopsy needle from the body. These features allow for substantial sampling of large lesions and complete removal of small ones. In the MAMMOTOME, a vacuum chamber is attached alongside and fluidly connected to an elongated, hollow piercer. The vacuum supplied through the vacuum chamber pulls tissue into the lateral receiving port of the hollow piercer.
• For breast biopsies, the devices described so far are most commonly used in combination with either X-ray or ultrasound imaging to locate suspicious tissue, although other imaging modalities such as magnetic resonance imaging are also available. When using, for example, the MAMMOTOME biopsy device with an X-ray stereotactic table, the biopsy device is attached to a movable, mechanical mounting arm. The patient lies face down on the table and the patient's breast is guided through an opening in the stereotactic table. Several X-ray images of the breast are taken from different angles to determine the location of the calcifications, lesions, etc. which are to be removed from the breast. Next the mounting arm is manually repositioned so that the biopsy device is properly aligned with the breast. Then the mounting arm is manipulated to push piercer of the biopsy device into the breast until the tip of the piercer is positioned alongside the tissue to be sampled. Additional X-ray images are then made to confirm that the port on the distal end of the piercer is in the proper position to collect the desired tissue portions. The biopsy device is then used to retrieve one or more core samples of tissue. Additional X-ray images are taken to confirm the removal of the suspect tissue. Sometimes the biopsy device and mounting arm must be repositioned during the procedure so that the tip of the piercing element is in a new location in order to retrieve more tissue samples. As this brief description illustrates, there are many time consuming steps in getting the biopsy device properly positioned to retrieve the desired tissue. In addition, the accessibility of certain parts of the breast may be hindered by the degrees of freedom of the movement of the mounting arm. Also, the size of the stereotactic table and associated equipment precludes portability of the system. It is not possible, for example, to have a number of patients being prepared for the procedure in separate rooms of a clinic, if there is only one room set-up for doing the procedure. Having a portable system would allow the surgeon to go from room-to-room and perform the procedure, and thus allow more patients to be treated in a given time period at the clinic.
• Biopsy devices are also used with other kinds of X-ray imaging systems such as those for which the patient is upright rather than lying down. The numerous steps described above for locating, confirming, and reconfirming using X-ray stereo “snapshots” are also necessary for the upright versions.
• The MAMMOTOME biopsy instrument may also be used with real time handheld imaging devices such as ultrasound imaging devices. When using a biopsy instrument such as the MAMMOTOME with a handheld ultrasound imaging device, the surgeon gains the advantage of having real time imaging of the tissue of interest. Typically the ultrasound imaging device is held in one hand and pointed at the tissue being penetrated by the piercer. In order to facilitate positioning and manipulation of both the biopsy instrument and the imaging device, it is normally necessary to attach the biopsy instrument to a mechanical, articulating arm which is designed to support the weight of the biopsy instrument. In addition, since axial movement of the cutter on the MAMMOTOME is actuated by hand, the biopsy device must be rigidly supported to allow the surgeon to actuate the cutter without moving the tip. Alternatively, an assistant may be used to help operate the controls for the biopsy device. It would, therefore, be advantageous to design a handheld core sampling biopsy instrument wherein the cutter of the instrument was moved using a motor drive which could be actuated by the touch of a switch. Further, since some of the electrical and vacuum controls are not on the MAMMOTOME biopsy instrument itself, the biopsy instrument must be rigidly supported or the surgeon must have an assistant to actuate the controls. It would, therefore, be further advantageous if the electrical and vacuum controls for the biopsy device were positioned in relatively close proximity either on the instrument or, for example, on an associated generator. Automating axial movement of the cutter will, to some extent, eliminate the tactile feedback that the surgeon gets from moving the cutter blade manually. It would, therefore, be advantageous to provide a method of automatically measuring and controlling the axial movement of the cutter which could be utilized to, for example, prevent the cutter from advancing when the port is blocked.
• In recent years several patents have issued describing handheld, motorized devices for the extraction of tissue from the body. Many of these devices are for arthroscopic surgery and are not intended for retrieving biopsy core samples of tissue for pathological analysis. The motors are for rotationally driving the cutting/milling end effectors, but not for advancing the end effectors into the tissue. Examples of arthroscopic, handheld, motorized devices include the following U.S. Pat. Nos. 4,995,877; 4,705,038; 5,192,292; 5,112,299; 5,437,630; 5,690,660; and 5,320,635.
• In U.S. Pat. No. 4,940,061 issued to Terwilliger, et al, on Jul. 10, 1990, a core sampling, handheld biopsy device incorporating a battery powered motor for driving a means to penetrate and sever tissue is described. The motor axially drives a cutter to advance the cutter into tissue, thus eliminating the noise and jerking associated with mechanical stops of the spring-actuated devices. This significantly adds to the comfort of both the patient and the surgeon. However, the device does not incorporate a vacuum source for obtaining the tissue portion. As described in Burbank, et al, '822 and '333, the vacuum greatly facilitates the capturing of a complete tissue portion within the distal end port on the piercing element. Capturing more tissue with each sample reduces the number of samples required, and increases the likelihood of obtaining the diseased tissue. The Terwilliger device in '061 also does not address how to minimize leakage and spilling of the high volume of fluids present in biopsy procedures.
• The surgeon may prefer to use an X-ray imaging system for some patients, and an ultrasound imager for others. In such situations, it would be desirable to use a biopsy instrument which is adaptable to both kinds of imaging systems.
• Such an instrument could be used as a handheld instrument or also as an instrument mounted onto the arm of an X-ray stereotactic table, depending on the situation.
• It is therefore desirable to provide a more versatile and “patient friendly” biopsy device than what is currently available. The device should be particularly adapted for use without mounting to an X-ray stereotactic table. It should be a lightweight, maneuverable, handheld device, so that the surgeon may have the option to perform the biopsy procedure in combination with an ultrasound imaging device. It is desirable that the device be easily transported from room-to-room so that several patients may be prepared for the surgical procedure concurrently, thus allowing more patients to be treated in a given time period, and potentially reducing the overall cost of the surgical procedure. In addition, it is desirable to perform a biopsy with fewer steps in order to decrease the overall time of the procedure. This would be achievable by eliminating the need to set-up and operate the X-ray stereotactic table. The combination of these factors could allow the surgical procedure to be more widely available to patients than it is currently.
• It is also desirable to provide a handheld biopsy device which may be held parallel to the chest wall of the patient, so that suspect tissue masses close to the chest wall can be easily sampled. It is desirable that the surgeon be able to easily steer the penetrating tip of the handheld device towards the desired tissue to be sampled. It is further desired that the surgeon have tactile feedback as the tissue is probed by the penetrating tip of the device, to provide the surgeon with clues regarding the disease state of the tissue encountered. It is also desirable that the biopsy device be “patient friendly” by not having noisy or jerky mechanical actuations during the procedure, and by not having to be used with large machines such as an X-ray stereotactic table.
SUMMARY OF THE INVENTION
• The present invention overcomes problems associated with using a biopsy instrument which may be used only when mounted to an X-ray stereotactic system.
• In the preferred embodiment, the present invention is a handheld biopsy device which may be used in combination with another handheld imaging device such as an ultrasound imaging device. The biopsy instrument is for the collection of at least one soft tissue sample from a surgical patient. The biopsy instrument has a handpiece which is independently manipulatable by hand movement of the instrument toward and away from the patient. The biopsy instrument has an elongated piercer extending from the distal end of the handpiece. The piercer has a piercer lumen through it and a sharpened distal end for entering tissue when the handpiece is moved independently by hand toward the surgical patient so as to cause the sharpened distal end to penetrate tissue
• The piercer also has a port located proximal to the sharpened distal end for receiving a portion of a tissue mass when the handpiece is further manipulated independently by hand so as to position the tissue mass adjacent to the port. The piercer lumen is in fluid communication with this port.
• The present invention also has an elongated cutter with a lumen through it. This cutter is disposed coaxially and slidably relative to the piercer. The cutter has a cutting blade on the distal end for cutting the portion of tissue protruding into the port of the piercer when the cutter slides distally past the port. A portion of the cut tissue is then deposited within the cutter lumen proximal to the cutting blade.
• The present invention includes a cutter rotational transmission contained within the handpiece and operationally connected to the elongated cutter. When the cutter rotational transmission is actuated, the cutter is rotated about its longitudinal axis.
• The present invention further includes a cutter axial transmission contained within the handpiece and operationally connected to the elongated cutter. When the cutter axial transmission is actuated, the cutter is slid in an axial direction relative to the piercer. It is slid in the distal axial direction to cut a portion of tissue protruding into the port. It is slid in the proximal axial direction to retrieve the cut portion of tissue from the biopsy instrument.
• The biopsy device also has a power transmission source which is operationally engageable with the cutter rotational transmission for rotation of the cutter. In the preferred embodiment, the power transmission source is also operationally engageable with the cutter axial transmission for the longitudinal movement of the cutter. A first electric motor is operationally engaged to the cutter rotational transmission by a first flexible, rotatable shaft. A second electric motor is operationally engaged to the cutter axial transmission by a second flexible, rotatable shaft. The handpiece also includes a holster. The distal ends of the first and second rotatable shafts are rotatably mounted in the holster so that the first and second shafts are operationally engaged, respectively, to the cutter rotational transmission and the cutter axial transmission inside the handpiece.
• In the preferred embodiment of the present invention, a tubular tissue remover is disposed in the cutter lumen of the cutter. The tissue remover pushes the tissue portion out of the distal end of the cutter lumen and onto a tissue sampling surface of the handle when the cutter is retracted in the proximal direction. The proximal end of the tissue remover is connected to a first vacuum tube which is connected by a first connector to a fluid collection system. The fluidic contents of the cutter lumen are transported to the fluid collection system when the vacuum is actuated. A strainer on the distal end of the remover is provided to block the tissue portion from entering the remover.
• Also in the preferred embodiment, the proximal end of the piercer lumen is connected by a second vacuum tube which is connected by a second connector to the fluid collection system. The fluidic contents of the piercer lumen also are transported to the fluid collection system when the vacuum of the system is actuated.
BRIEF DESCRIPTION OF THE DRAWINGS
• The novel features of the invention are set forth with particularity in the appended claims. The invention itself, however, both as to organization and methods of operation, together with further objects and advantages thereof, may best be understood by reference to the following description, taken in conjunction with the accompanying drawings in which:
• FIG. 1 is an isometric view of the present invention, a biopsy instrument which includes a handpiece for the collection of soft tissue;
• FIG. 2 is an isometric view of the handpiece showing a probe assembly prior to attachment to a holster;
• FIG. 3 is an exploded isometric view of the probe assembly;
• FIG. 4 is an isometric view of the probe assembly ofFIG. 2 with the left handle shell removed to reveal the internal Components;
• FIG. 5 is an exploded isometric view of the holster;
• FIG. 6A is a top view in section of the probe assembly and a distal portion of the holster, revealing a cutter in the a first, fully retracted position;
• FIG. 6B is a top view in partial section of the distal end of the probe assembly for when the cutter is in the first position and a port on the distal end of a piercer is open;
• FIG. 7A is a top view in section of the probe assembly and a distal portion of the holster, revealing the cutter in a third, intermediate position;
• FIG. 7B is a top view in partial section of the distal end of the probe assembly and the port on the distal end of the piercer is open in order to receive the tissue portion to be removed from the patient, and a distal blade (shown with hidden lines) of the cutter is immediately proximal to the port, corresponding to the third position of the cutter shown inFIG. 7A;
• FIG. 8A is a top view in section of the probe assembly and a distal portion of the holster revealing the cutter in a fourth, fully deployed position;
• FIG. 8B is a top view in partial section of the distal end of the probe assembly and the distal blade (shown with hidden lines) of the cutter is shown distal to the port on the distal end of the piercer, corresponding with the fourth position of the cutter tube shown inFIG. 8A;
• FIG. 9 is an isometric view of the probe assembly with the left handle shell removed, showing the cutter in the first position, and a tissue portion is shown deposited onto a tissue sampling surface of the handle after the tissue portion was removed from the distal end of the cutter;
• FIG. 10 is a partial top view of a second embodiment of the present invention, wherein a holster upper shell and a probe assembly upper shell have been removed to reveal the internal components;
• FIG. 11 is an isometric view of a holster lower shell and part of a probe assembly lower shell of the biopsy instrument shown inFIG. 10 revealing a latch and a holster slot;
• FIG. 12 is a longitudinal section of the assembled components ofFIG. 11;
• FIG. 13 is an exploded isometric view of a holster of a third embodiment of the present invention, showing a switch board and a rotation sensor;
• FIG. 14 is a schematic diagram of a control unit and its relationship to the other components of the present invention; and
• FIG. 15 is an enlarged diagram of the display illustrated inFIG. 14.
DETAILED DESCRIPTION OF THE INVENTION
• FIG. 1 shows a first embodiment of a biopsy instrument comprising aprobe assembly40, aholster140, afluid collection system22, acontrol unit342, and apower transmission source24. Theprobe assembly40 is detachably connected to theholster140. Together they constitute a lightweight, ergonomically shaped, hand manipulatable portion referred to as ahandpiece20. Theprobe assembly40 includes apiercer70 extending distally from ahollow handle43. Theprobe assembly40 is fluidly connected to thefluid collection system22 by afirst vacuum tube94 and asecond vacuum tube136. The first and second vacuum tubes are detachably connected to thefluid collection system22 by afirst connector27 and asecond connector25, respectively. The first connector has amale portion32 and afemale portion28 attached to thefirst vacuum tube94. Thesecond connector25 has afemale portion30 and amale portion26 attached to thesecond vacuum tube136. The connector portions,26,28,30, and32, are attached in this manner to prevent the accidental switching of the first and second tubes,136 and94, to thefluid collection system22. Theholster140 includes a firstrotatable shaft34, a secondrotatable shaft36, and acontrol cord38. The first and second rotatable shafts,34 and36, are preferably flexible so that the operator may easily manipulate thehandpiece20 with one hand. Thecontrol cord38 operatively connects thehandpiece20 to thepower transmission source24 andcontrol unit342.
• Since thehandpiece20 is manipulated by the operator's hand rather than by an electro-mechanical arm, the operator may steer the tip of thehandpiece20 with great freedom towards the tissue mass of interest. The surgeon has tactile feedback while doing so and can thus ascertain, to a significant degree, the density and hardness of the tissue being encountered. In addition, thehandpiece20 may be held approximately parallel to the chest wall of the patient for obtaining tissue portions closer to the chest wall then may be obtained when using a instrument mounted to an electro-mechanical arm. As can be seen inFIG. 1, thepiercer70 extends from the distal end of thehandpiece40 and is longitudinally offset with respect to thehandpiece40. This offset also facilitates the insertion of thepiercer70 into the tissue while the axis of thepiercer70 is approximately parallel to the plane of the patient's chest wall. As a result, it is possible to extract tissue portions which are located close to the chest wall of the patient.
• Those skilled in the art may appreciate that a mount or “nest” could be provided to hold thehandpiece20 securely to the movable arm of an X-ray stereotactic table or other kind of imaging device which incorporates a movable arm for holding a biopsy instrument. This would provide the operator with the option to use thehandpiece20 to access the tissue mass within the surgical patient in much the same manner as was described earlier for using the MAMMOTOME instrument. This versatility may be advantageous to the operator, for example, in a situation where the handheld imaging device was temporarily not available for use, and it would be necessary to use the X-ray stereotactic table.
• FIG. 2 shows theholster140 and theprobe assembly40 separated. A pair oftabs144 project laterally from each side of a holsterupper shell142, and insert into right and left undercut ledges,138 and139 respectively, of thehollow handle43 of theprobe assembly40. A plurality ofindentations66 are provided on thehandle43 to improve the operator's grip on the instrument. Atube slot162 in thelower shell156 of the holster L40 provides clearance for first and second vacuum tubes,94 and136. Afirst switch146, asecond switch148, and athird switch150 are mounted in the distal portion of theholster140 so that the physician can operate thehandpiece20 with a single hand while having the other hand free to operate an ultrasonic imaging device or the like. Theswitches146,148, and150 are provided to operate thepower transmission source24 and thefluid collection system22 in conjunction with thecontrol unit342. Aridge152 on the distal end of theholster140 is provided to assist the operator in grasping thehandpiece20 and in operating theswitches146,148, and150. Theridge152 further provides the operator with a tactile reference as to where to properly grasp thehandpiece20.
• Still inFIG. 2, theprobe assembly40 includes awindow58 so that a portion of thefirst vacuum tube94 may be viewed. The first and second vacuum tubes,94 and136, are made from a flexible, transparent or translucent material, such as silicone tubing. This enables visualization of the material flowing through the tubes. By having thewindow58 in theprobe assembly40, the operator can see the flow in thefirst vacuum tube94 without needing to look away from the tissue into which thepiercer70 is inserted. Atransverse opening68 is provided in the distal end of thehollow handle43 which allows access from either side to atissue sampling surface64. The tissue extracted from the surgical patient is retrieved by the operator or an assistant from thetissue sampling surface64.
• FIG. 3 is an exploded isometric view of theprobe assembly40. Thehandle43 is formed from aright handle shell42 and aleft handle shell44, each injection molded from a rigid, biocompatible plastic such as polycarbonate. Upon final assembly of theprobe assembly40, the left and right handle shells are joined together by ultrasonic welding along a joiningedge62, or joined by any of several other methods well known in the art. Theprobe assembly40 comprises thepiercer70 which includes an elongated,metallic piercer tube74 having apiercer lumen80. On the side of the distal end of the piercer tube is aport78 for receiving the tissue to be extracted from the surgical patient. Joined alongside thepiercer tube74 is an elongated, tubular, metallicvacuum chamber tube76 having avacuum lumen82.Piercer lumen80 is in fluid communication withvacuum lumen82 via a plurality of vacuum holes77 (seeFIG. 6B) located in the bottom of the “bowl” defined by theport78. These holes are small enough to remove the fluids but not large enough to allow excised tissue portions to be removed through thefirst vacuum tube94 which is fluidly connected to thevacuum chamber76. A sharpened, metallicdistal end72 is attached to the distal end of thepiercer70. It is designed to penetrate soft tissue such as the breast. In this embodiment, the sharpeneddistal end72 is a three-sided, pyramidal-shaped point, although the tip configuration may also have other shapes.
• Still referring toFIG. 3, the proximal end of thepiercer70 is attached to aunion sleeve90 having alongitudinal bore84 through it, a widenedcenter portion86, and atransverse opening88 through the widenedcenter portion86. Theunion sleeve90 is mounted between the left and right handle shells,44 and42 respectively, on a pair ofunion sleeve ribs50 projecting from each handle shell. An elongated, metallic,tubular cutter96 is axially aligned within thelongitudinal bore84 of theunion sleeve90 and thepiercer lumen80 of thepiercer70 so that thecutter96 may slide easily in both the distal and proximal directions. A pair of cutter guides46 are integrally molded into each of the handle halves,42 and44, to slidably retain thecutter96 in an coaxially aligned position with the proximal end of thepiercer tube74.Cutter96 has a cutter lumen95 through the entire length of thecutter96. The distal end of thecutter96 is sharpened to form acutter blade97 for cutting tissue held against thecutter blade97 as thecutter96 is rotated. The proximal end of thecutter96 is attached to the inside of a cutter gear bore102 of acutter gear98. Thecutter gear98 may be metallic or polymeric, and has a plurality ofcutter gear teeth100, each tooth having a typical spur gear tooth configuration as is well known in the art.
• Still inFIG. 3, thecutter gear98 is driven by anelongated drive gear104 having a plurality ofdrive gear teeth106 designed to mesh with thecutter gear teeth100. The function of thedrive gear104 is to rotate thecutter gear98 and thecutter96 as they translate in both longitudinal directions. Thedrive gear104 is preferably made from a metal such as stainless steel. Adistal drive axle108 projects from the distal end of thedrive gear104 and mounts into an axle support rib molded on the inside of theleft handle shell44. Agear shaft110 projects from the proximal end of thedrive gear104 and is supported by a gear shaft support rib also molded on the inside of theleft handle shell44. Aleft cross pin112 is attached to the proximal end of thegear shaft110 as a means for rotationally engaging thedrive gear104.
• Still referring toFIG. 3, acarriage124 is provided to hold thecutter gear98 and to carry thecutter gear98 as it is rotated in the distal and proximal directions. Thecarriage124 is preferably molded from a rigid polymer and is cylindrically shaped with a threaded bore126 through it and with acarriage foot130 extending from its side. Thefoot130 has arecess128 formed into it for rotatably holding thecutter gear98 in the proper orientation for thecutter gear teeth100 to mesh properly with thedrive gear teeth106. Thecarriage124 is attached via the threaded bore126 to anelongated screw114 which is parallel to thedrive gear104. Thescrew114 has a plurality of conventionallead screw threads116 and is preferably made from a stainless steel. The rotation of thescrew114 in one direction causes thecarriage124 to move distally, while the reverse rotation of thescrew114 causes thecarriage124 to move proximally. In turn, thecutter gear98 moves distally and proximally according to the direction of the screw rotation, and thecutter96 is advanced or retracted. In this embodiment, thescrew114 is shown with a right hand thread so that clockwise rotation (looking from the proximal to distal direction) causes thecarriage124 to translate in the distal direction. It is also possible to use a left hand thread for thescrew114 as long as provisions are made to do so in thecontrol unit342. Adistal screw axle118 and aproximal screw shaft120 project from the distal and proximal ends, respectively, of thescrew114. The distal screw axle mounts rotatably in adistal screw support48 of theright handle shell42 while theproximal screw shaft120 mounts rotatably in a proximal screw support54, also in theright handle shell42. Aright cross pin122 is attached to the proximal end of thescrew shaft120 as a rotational engagement means.
• FIG. 3 also shows the first and second vacuum tubes,94 and136 respectively, referred to earlier. The distal end of thefirst vacuum tube94 is attached to a polymeric vacuum fitting92 which inserts tightly into thetransverse opening88 of theunion sleeve90. This allows the communication of fluids in thepiercer lumen80 to thefluid collection system22. Thefirst vacuum tube94 is contained within thehollow handle43 in an open space above thescrew114 and drivegear104, and exits the distal end of the hollow handle through anopening57. Thesecond vacuum tube136 is fluidly attached to the proximal end of an elongated, metallic,tubular tissue remover132. Thesecond vacuum tube136 exits thehollow handle43 alongside thefirst vacuum tube94 out theopening57. Astrainer134 is attached to the distal end of thetissue remover132 to prevent the passage of fragmented tissue portions through it and into thefluid collection system22. Thetissue remover132 inserts slideably into thetubular cutter96. During operation of the biopsy instrument, thetissue remover132 is always stationary and is mounted between a pair ofproximal supports52 on the inside of the right and left handle shells,42 and44 respectively. When thecutter96 is fully retracted to the first position, the distal end of thetissue remover132 is approximately even with the distal end of thecutter96. The distal end of thecutter96 when at its first, fully retracted position, is slightly distal to avertical wall69 which is proximal and perpendicular to thetissue sampling surface64.
• InFIG. 3, a right access hole56 is shown in the proximal end of theright handle shell43. The right access hole56 provides access to the proximal end of thescrew114 for operational engagement to thepower transmission source24. Similarly, a left access hole is provided in theleft handle shell44 to provide access to the proximal end of thedrive gear104 for operational engagement with thepower transmission source24.
• Thetissue remover132 has two functions. First, it helps to evacuate fluids contained in thepiercer lumen80. This is accomplished by the attachment of thesecond vacuum tube136 to the proximal end of thetissue remover132. Since the distal end of thetissue remover132 is inserted into thepiercer lumen80, thepiercer lumen80 is fluidly connected to thefluid collection system22. Second, thetissue remover132 removes tissue from thecutter96 as follows. When a tissue sample is taken, thecutter96 advances to the fourth position just distal to theport78, and asevered tissue portion200 is captured within the cutter lumen95 in the distal end of thecutter96. Then thecutter96 translates to the first position so that thecutter blade97 is just distal to thetissue sampling surface64. At this position of thecutter96, the distal end of the tissue remover132 (which is always stationary) is approximately even with the distal end of thecutter96. Therefore, any tissue portion of significant size contained within the cutter lumen95 is pushed out of the cutter lumen95 and onto thetissue sampling surface64, as is shown inFIG. 9. Thetissue portion200 may then be retrieved by the operator or an assistant.
• Now turning toFIG. 4, an isometric view of theprobe assembly40 with theleft handle shell44 removed reveals the placement of the components described forFIG. 3. Part of thefirst vacuum tube94 has also been removed for clarity. Thecarriage124 is shown in the fully retracted position so that thecutter96 is also at the fully retracted, or first position. Thecutter blade97 is slightly distal to thevertical wall69 on thehandle43. Thefoot130 of thecarnage124 is adapted to slide along acarriage guide surface60 on the inside bottom of thehollow handle43.
• As shown inFIG. 4, a cutteraxial transmission121 includes thecarriage124, thescrew114, and thescrew shaft120. A cutterrotational transmission109 includes thedrive gear104, thecutter gear98, and thegear shaft110.
• FIG. 5 is an exploded isometric view of theholster140 of the first embodiment of the present invention. A holsterupper shell142 and a holsterlower shell156 are each injection molded from a rigid, biocompatible plastic such as polycarbonate. Upon final assembly, the shells are joined together by screws (not shown) or other types of fasteners well known in the art, into a plurality of alignment holes164. Agear drive shaft180 and ascrew drive shaft182 are contained within the proximal, enclosed portion of theholster140. These shafts extend from agrommet176 which has agroove172 for retainably mounting ontoshell edge170 of both holster upper and lower shells,142 and156, respectively. Thegrommet176 rotatably attaches the firstrotatable shaft34 to thescrew drive shaft182 and the secondrotatable shaft36 to thegear drive shaft180. The firstrotatable shaft34 rotatably inserts into aleft bore172 of thegrommet176. The secondrotatable shaft36 rotatably inserts into aright bore178. Thegrommet176 also provides a strain-relieved attachment of thecontrol cord38 to theholster140.
• Still referring toFIG. 5, thegear drive shaft180 is supported rotatably upon a pair of gear drive mounts160 formed into afirst wall166 and asecond wall168 of the inside of the holster shells,142 and156. Thescrew drive shaft182 is likewise supported rotatably on screw drive mounts158. Aleft coupler184 is attached to the distal end of thedrive gear shaft180 and has aleft coupler mouth192 for rotational engagement with theleft cross pin112 attached to thegear shaft110. When theprobe assembly40 shown inFIG. 4 is attached to theholster140, thegear shaft110 becomes rotatably engaged to thegear drive shaft180. This may be seen more clearly inFIG. 6A. Similarly, thescrew drive shaft182 has aright coupler186 with amouth194 which rotatably engages with thecross pin122 of thescrew shaft120. Each of the left and right couplers,184 and186, have a coupler flange,188 and190, which rotatably insert intothrust slots159 formed into the corresponding portions of the drive mounts158 and160. These coupler flanges,188 and190, bear the axial loading of the drive shafts,180 and182.
• Still referring toFIG. 5, theholster140 further includes ascrew rotation sensor198, available from Hewlett-Packard as part number HEDR-810102P, for providing an electronic signal to thecontrol unit342 to be described in more detail later. In this first embodiment, therotation sensor198 is mounted within the inside of the holsterupper shell142 and in a position directly above thescrew drive shaft182. A fluted wheel199 is attached to thescrew drive shaft182 and extends in front of a light emitting diode contained within therotation sensor198. As thefluted wheel192 rotates, the interrupted light beams are electronically detected and transmitted back to thecontrol unit342 to provide information about the rotational speed of the screw drive shaft (cutter tube axial advancement or retraction speed), and the number of screw rotations from the beginning of operation (instantaneous axial position of the cutter96). The rotation sensor leads196 pass through thegrommet176 and are part of the bundle of conductors within thecontrol cord38.
• Theholster140 of the first embodiment of the present invention has the switches,146,148, and150, mounted on the inside of the holsterupper shell142. The switches,146,148, and150, are electronically connected to a plurality ofconductors193 contained in thecontrol cord38. In one embodiment, thethird switch150 operates the fluid communication between thehandpiece20 and thefluid collection system22 and also sets thecontrol unit342 to respond to various commands; thesecond switch148 operates the movement of thecutter96 in the proximal direction and sets thecontrol unit342 to respond to various commands; thefirst switch146 operates the movement of thecutter96 in the distal direction and sets thecontrol unit342 to respond to various commands. The functions of the switches,146,148, and150, are not restricted to what has been described for the first embodiment. Also, the physical locations of the switches,146,148, and150, on thehandpiece20 are not restricted to the locations depicted inFIG. 2. Other embodiments of thehandpiece20 of the present invention may incorporate certain ergonomic or other considerations, and the switches,146,148, and150, may be located elsewhere.
• FIGS. 6A through 8A depict three of the four positions of thecutter96 during the operation of the present invention as embodied in the priorFIGS. 1-5. The three positions are most easily distinguished by observing the relative positions of thecarriage124 and thecutter blade97 of thecutter96.
• InFIGS. 6A and 6B, the retracted, first position is depicted with thecarriage124 located on the proximal ends of thedrive gear104 and thescrew114. Thecutter blade97 is shown to be immediately proximal to thetissue sampling surface64. In this first position, thetissue portion200 may be retrieved from thetissue sampling surface64 as depicted inFIG. 9.
• The second position of thecutter96 is not shown in the Figures. At the second cutter position, the distal end of thecutter96 is just distal to thetissue sampling surface64 and inside thepiercer lumen80 near the proximal end of thepiercer tube74. During operation thecutter96 is moved from the first position to the second position at a slower axial speed than from the second position to the third position in order to facilitate the insertion of thecutter96 into the proximal end of thepiercer lumen80.
• InFIGS. 7A and 7B, thecutter96 is shown in the third position. Thecarriage124 is shown to have moved axially to the intermediate position which is a short distance from the distal ends of thescrew114 and thedrive gear104. Thecutter blade97 is shown by hidden lines to be located just proximal to theport78. The vacuum holes77 are open to theport78 so that soft tissue adjacent to theport78 prolapses into theport78 when thefirst vacuum tube94 is fluidly connected to the vacuum of thefluid collection system22.
• FIGS. 8A and 8B shows thecutter96 at the fourth position, and thecarriage124 is located near the distal ends of thescrew114 and thedrive gear104. Thecutter blade97 is shown now (by hidden lines) to be distal to theport78 and to be covering the vacuum holes77. The tissue pulled into theport78 will have been severed by the rotating, advancingcutter blade97 and stored inside the cutter lumen95 of the distal end of thecutter96. When thecutter96 retracts back to the first position as shown inFIGS. 6A and 6B, thetissue portion200 may be retrieved as shown inFIG. 9.
• FIG. 10 shows a second embodiment of the present invention. The main difference from the first embodiment is that in the second embodiment a first and a second brushless, electric motor,234 and236 respectively, are mounted inside aholster221. First and second motors,234 and236, are available from Harowe Servo Controllers, Inc., part number B0508-050. In this second embodiment, therotatable shafts34 and36 have been eliminated so that only a control/electrical power cord232 is required to electrically connect theholster221 to thepower transmission source24 and the control unit342 (seeFIG. 1). A holsterlower shell222 has afirst wall242 and a second wall,244, which are spaced apart and adapted to support the pair of electric motors,234 and236 in a side-by-side arrangement. The use of the brushless electric motors,234 and236, eliminates the need for a separate rotation sensor to be mounted in the drive train of one or both of ascrew206 and adrive gear204 as was described for the first holster embodiment shown inFIG. 5. As in the first embodiment, when aprobe assembly202 is attached to theholster221, a right coupler238 rotationally engages aright cross pin214 of ascrew shaft210. A left coupler240 rotationally engages aleft cross pin216 of agear shaft212. Agrommet230 having agrommet groove231 is retained by anattachment slot233 in theholster shell222. Fastener holes228 are provided to fasten the holsterlower shell222 to a holster upper shell using screws or other types of fasteners well known in the art.
• Still referring toFIG. 10, another difference of the second embodiment compared to the first is that theprobe assembly202 comprises alower shell208 and an upper shell (removed for clarity) whereas thehollow handle43 of the first embodiment shown inFIGS. 1-4 was divided vertically into left and right shells,44 and42 respectively. This embodiment facilitates the addition of aprobe latch220 and other features shown inFIG. 11.
• Using conventional techniques well known in the art, it is possible to use only one electrically driven motor in place of the two motors described for both the first and second embodiments of the present invention. That is, a single motor may be used to both rotate and advance thecutter96. The motor may be incorporated into the instrument so that the cutter rotation and cutter advancement (axial movement) may occur either simultaneously or separately. The motor may be located within the adaptedhandpiece40 and be electrically connected to thepower source24 and thecontrol unit342. The motor may also be outside thehandpiece40, still electrically connected to thepower source24 and thecontrol unit342, and mechanically engaged to thehandpiece40 by a single flexible shaft.
• FIG. 11 shows an isometric view of the probelower shell208 and the holsterlower shell222 of thebiopsy instrument201 of the second embodiment of the present invention. The view is shown with the bottom side up in order to clearly present aprobe latch220 which is molded as a cantilever into the probelower shell208, and can be deflected downwards by a force applied to alatch ramp surface223. Thelatch220 further comprises alatch projection219 for insertion into aholster slot224 as the probe assembly is inserted into theholster221. Theramp surface220 is deflected downwards by interaction with aninside surface225 of theholster shell222 and retainably snaps into aslot key226 when the probe assembly is fully inserted into the holster, thus rotationally engaging the left and right couplers,240 and238, to thedrive shaft212 and thegear shaft210, respectively, as shown inFIG. 10. To remove the probe assembly from the holster, one must press on theprojection219 while pulling them apart.FIG. 12 shows a longitudinal section through the center axis of the probelower shell208 and the holsterlower shell222 ofFIG. 11 for when they are fully attached together.
• FIG. 13 is an exploded isometric view of aholster251 of a third embodiment of the present invention. It may be used with theprobe assembly40 of the first embodiment shown inFIG. 14. A first and a second rotatable shafts,264 and266, are attached by agrommet262 to adrive shaft258 and ascrew shaft260, respectively. Rotatable shafts,264 and266, are preferably flexible too, in order for theholster251 combined with the probe assembly40 (seeFIG. 2) to be easily manipulatable with one hand. A fullyintegral rotation sensor268 is shown mounted on ascrew shaft260. Thisrotation sensor268 is a miniature optical encoder which is commercially available as Model Number SEH17 from CUI Stack, Inc. It is electrically connected to aswitch board274 which mounts to the inside of the holsterupper shell252. Theswitch board274 also has aribbon cable270 containing a plurality of conductors for conveying electronic information to and from thecontrol unit342,power transmission source24, and thefluid collection system22, via acontrol cable265. Theswitch board274 has mounted on its distal end, three switches,276,278, and280, for operation of the present invention in the same manner as described in the first embodiment: athird switch280 for fluidic connection to the vacuum of the fluid collection system; a first switch246 for the forward movement of thecutter96; and a second switch248 for the reverse movement of thecutter96. The specific functions of the switches,276,278, and280, are not restricted, in other possible embodiments of the present invention, to the functions described, nor to the physical locations shown. The switches,276,278, and280, project throughswitch openings254 of the holsterupper shell252. A holsterlower shell256 attaches to theupper shell252 as in the other embodiments to enclose the components of the proximal portion of theholster251.
• Those skilled in the art could easily appreciate that theswitch board274 and the three switches,276,278, and280, may instead be incorporated into a foot operable device rather than in the handoperable holster251 shown inFIG. 13. The operator would still be able to manipulate the instrument with a single hand while actuating the switches,276,278, and280, by foot, thus freeing the other hand for holding the ultrasound imaging device, or for performing other steps in the surgical procedure.
• FIG. 14 shows the relationship of the electro-mechanical components of the present invention to thecontrol unit342. The third embodiment of the present invention is depicted and includes theholster251 ofFIG. 13. A first motor/tachometer combination338 (sometimes referred to as a first motor/tach) and a second motor/tachometer combination340 (sometimes referred to as a second motor/tach) are depicted as part of thepower transmission source24, and transmit rotational power to theholster251 via the first and second rotatable shafts,264 and266, respectively. The motor/tach combinations,340 and348, are comniercially available as DC MicroMotors Series 3863, MicroMo Electronics, Inc. Thecontrol cord265 is electrically connected to aserial controller380 available as Part No. MCF5206eFT40 from Motorola, Inc. Aserial controller380 is electronically connected to theswitchboard274 byribbon cable270 andcontrol cord265. Theserial controller380 coordinates information exchange across the serial communication link between theswitchboard274 and themicroprocessor408. An advantage provided by the use of theserial controller380 is that the required number ofconductors193 may be reduced.
• FIG. 14 depicts the interconnection of the electro-mechanical components of thefluid collection system22 andpower transmission source24 withcontrol unit342. Thefirst vacuum tube94 coming from the probe assembly40 (seeFIG. 2) is attached to a first vacuum Y-connector302 fluidly connected a firstupper line306 and a firstlower line308. The two lines,306 and308, pass through afirst pinch valve314. A suitable, commercially available, three-way pinch valve for this application isModel Number 373 12-7 15 available from Angar Scientific Company, Inc. Thepinch valve314 closes either theupper line306 or thelower line308, but never both lines simultaneously. Thelower line308 provides a vent to atmospheric pressure. Theupper line306 attaches to afluid collection canister318. Similarly, thesecond vacuum line136 from theprobe assembly40 attaches to a second Y-connector304 which fluidly is connected to a secondupper line310 and a secondlower line312. The first and second vacuum Y-connectors,302 and304, are molded from a rigid polymer such as polycarbonate The secondupper line310 passes through asecond pinch valve316, which is identical to the first, and to thecanister318. The secondlower line312 passes through thesecond pinch valve316 and vents to atmosphere. Again, only one or the other of the two lines may be pinched closed at any time.
• Still referring to the fluid collection system ofFIG. 14, amain vacuum line320 attaches thecanister318 to an electricallypowered vacuum pump330. A suitable vacuum pump for this application is available by the trademark name WOB-L PISTON Series 2639, from Thomas Compressors and Vacuum Pumps. Themain vacuum line320 passes through aregulator valve322 to electronically adjust the vacuum pressure supplied to thecanister318. A commercially available regulator valve for this application is model number VSONC 6 S11 V H Q 8 from Parker Hannifin Corp., Pneutronics Division. Apressure sensor328 is fluidly attached to themain vacuum line320 at asensor connection324. The signal from thepressure sensor328 is sent to an A/D converter396 of thecontrol unit342. A commercially available, compensated pressure sensor for this application is model number SDX15 from SenSym, Inc.
• At the heart of thecontrol unit342 is a 40 MHz, 32bit microprocessor408, available from Motorola, Inc. as Part No. MCF5206EFT40, which is designed to perform logic operations that eventually translate into simple electromechanical actions.
• Still referring toFIG. 14, thecontrol unit342 includes a 640.times.480 color TFT-LCD display334 available from Sharp as part number LQ64D343.Display334 is covered by aresistive touchscreen336 for the user interface. Thetouch screen336 is available from Dynapro as part number 95638, and is electronically connected to atouch screen controller402 in thecontrol unit342. Thetouchscreen controller402 interfaces with themicroprocessor408 and comprises the following: a microcontroller, part number PIC16C58A, available form Microchip; an EEPROM, part number 93AA466SN, available from Microchip; an A-D converter, part number TLVI543CDW, available from Texas Instruments; and a multiplexer-demultiplexer, part number MC74HC4052D, available from Motorola. The touch screen controller allows thecontrol unit342 to respond to the user's touch by interpreting touch inputs. Similarly, anLCD controller404 is an interface between themicroprocessor408 and theLCD display334. TheLCD controller404 reduces the burden of themicroprocessor408 by efficiently controlling display parameters such as color, shading, screen update rates, and it typically accesses the memory chips of themicroprocessor408 directly. TheLCD controller404 comprises the following: a LCD controller, part number SED1354FOA, available from Epson; a display buffer DRAM, part number MT4LCIM16E5TG-6, available from Micron; and a line driver, part number 74ACTQ16244SSCX, available from National.
• Aminiature annunciator332 is provided with thecontrol unit342 in order to provide the user with audible, feedback “beeps” upon each activation of an icon control on theLCD display334. A suitable annunciator for this application is model number EAS-45P104S from Panasonic (Matshusita Electric Corp. of America). Theannunciator332 interfaces with themicroprocessor408 by anoscillator400 which converts the digital input signal from themicroprocessor408 to an analog, periodic output signal, thus controlling the audio frequency of the speaker. The volume of the sound coming from theannunciator332 is controlled by a programmable attenuator. Theoscillator400 comprises the following: a 8 MHz oscillator, part number ASL-8.0000000-PCSA, available from AMD; and a PLD, part number EPM7256ATC144-7, from Altera.
• Still referring to the schematic diagram ofFIG. 14, a first motor controller anddriver390 interfaces the second electric motor/tach340 with themicroprocessor408. The first motor controller anddriver390 comprises the following: an H-bridge, part number LMDI 8200T, available from National; a motion controller, part number LM629M-8, available from National; and a PLD, part number EPM7256ATC144-7, available from Altera. The second motor/tach340 is operationally connected to the secondflexible shaft266 for the actuation of the cutter axial transmission121 (seeFIG. 4). The controller anddriver390 converts digital input signals from themicroprocessor408 into analog motor input signals for controlling motor rotational direction and speed. A closed loop digital speed control of the motor is also achieved within the controller anddriver390 using feedback signals from therotation sensor268 available from CUI Stack, Inc., as part number SEH17 (seeFIG. 13). The first electric motor/tach338 drives the cutter rotational transmission109 (seeFIG. 4) via the firstrotatable shaft264. The first electric motor/tach338 interfaces with the microprocessor through the second controller and driver406.
• Anoptional card reader382 may be provided in thecontrol unit342 for reading data from memory card in order to facilitate future software upgrades and servicing.
• Aserial port384 is provided for the bidirectional data exchange in a serial transmission mode, again to facilitate future software upgrades and servicing. Theserial port384 comprises the following: a UART, part number ST16C2552CJ44, available from EXAR; and a line driver-receiver, part number DS14C335MSA, available from National.
• A first PWM (pulse width modulation)driver386 interfaces thefirst pinch valve314 with themicroprocessor408. Thefirst PWM driver386 converts a digital input signal from themicroprocessor408 to an analog output signal having a wave of fixed frequency and amplitude, but varying duty cycle. To drive the solenoid in thepinch valve314, thePWM driver386 is used when the duty cycle is high to initially move the solenoid. Once thepinch valve314 is actuated, the duty cycle is reduced to a level which maintains valve position, thus minimizing power requirements. Asecond PWM driver388 similarly interfaces asecond pinch valve316 with themicroprocessor408. Athird PWM driver394 interfaces with theregulator valve322. The PWM drivers,394,388, and386 each comprise the following: a PLD, part number EPM7256ATC144-7, available from Altera; and a FET transistor, part number NDS9945, available from Fairchild.
• ARAM memory device392 available from Micron as DRAM part number MT4LC1M16E5TG-6, is provided with themicroprocessor408, and inherently loses stored data when power is removed. Aflash memory device398, on the other hand, is provided with themicroprocessor408 to store data even without continuous power, but it has slower access time than theRAM device392. Theflash memory device398 is part number Am29LV800BT-70REC from AMD.
• An A/D converter396 converts voltage signals from thepressure sensor328 into digital signals to themicroprocessor408, for maintaining the desired vacuum pressure in thefluid collection system22. The A/D converter396 is part number PCF8591AT, available from Philips.
• Still referring toFIG. 14, the first (axial) controller anddriver390 and the second (rotational) controller and driver406 continually calculate and update the axial and rotational position of thecutter96 within thehandpiece20. They also calculate the speed and acceleration of thecutter96 axial and rotational movement from the positional information. Themicroprocessor408 monitors both the axial position and speed of thecutter96 and the rotational position and speed via the first controller anddriver390 and the second controller and driver406.
• While in the sampling mode and with thecutter96 advancing toward the third position (proximal to port78), when thecutter96 reaches a predetermined axial position, themicroprocessor408 sends a signal to the second controller and driver406 to initiate cutter rotation. The rotational speed of thecutter96 follows a predefined speed profile which insures that the cutter rotational speed is at Z revolutions per minute (rpm) when thecutter96 reaches the third position. When thecutter96 reaches the third position, themicroprocessor408 sends a signal to the first controller anddriver390 to advance thecutter96 at speed Y. Thecutter96 then progresses through theport78 at advancement speed Y while rotating at velocity Z. While advancing through theport78, the cutter rotational speed is monitored by the second controller and driver406. If the rotational speed is greater than Z rpm, electrical current to the first (cutter rotation) motor/tach338 is decreased. If the cutter rotational speed is less than Z rpm, electrical current to the first motor/tach338 is increased. One method of performing the speed control on both the first and second motor/tach's,338 and340, is to generate an error signal based on the difference between the desired speed and the actual speed. The error signal is then input into a proportional, differential, and derivative (PID) digital filter which is part of the respective controller and driver, either390 or406. The sum of these three terms is used to generate the pulse width modulation (PWM) signal. The generation of the error signal and the PWM signal is accomplished by the first and second controllers and drivers,390 and406. A PWM signal is input to the first controller anddriver390 to generate an analog output signal to drive the first motor/tach338. Similarly, a PWM signal is input to the second controller and driver406 to generate an analog output signal to drive the second motor/tach340.
• Themicroprocessor408 also monitors the output value of the second controller and driver406 PID filter such that if it exceeds a predefined maximum value, it will reduce the axial speed of the cutter96 a set amount by sending an updated speed command to the first controller anddriver390. This closed-loop algorithm is intended to insure that the target rotational speed is attained by decreasing the axial speed of thecutter96 under maximum loading conditions. The control logic then repeats from the beginning.
• FIG. 15 is an enlarged view of theLCD display334 and thetouch screen336, shown as part of thecontrol unit342 ofFIG. 14. In one embodiment of the present invention, twelve separate operating modes are available to a user. A control switch for each operating mode is displayed graphically onLCD display334 in the form of icons,346,348,350,352,354,356,358,360,362,364,366, and368. The user may initiate a particular operation by pressing the touch screen in the region of the appropriate icon using at the appropriate time during the surgical procedure to electronically control the operation of the biopsy device. The present invention is not restricted to use with the particular combination of modes of operation shown inFIG. 15.
• For the following description of the modes of operation, it will be assumed for discussion purposes that the first embodiment of the present invention is being described, and that thefirst switch146 primarily controls the forward (distal direction) axial movement of thecutter96, thesecond switch148 primarily controls the reverse (proximal direction) axial movement of thecutter96, and that thethird switch150 primarily controls the fluidic connection of thehandpiece20 to thefluid collection system22. The switches,146,148, and150, also have secondary functions such as setting thecontrol unit342 for particular steps during the operation of the instrument, and these secondary functions are described later. The modes of operation are also applicable to the second embodiment of the present invention which includesfirst switch276,second switch278, andthird switch280.
• Each mode of operation is utilized for a particular portion of the general biopsy procedure. The “Prime” mode of operation is selected when the operator is preparing the instrument for use. When an operator activates the “Prime” mode of operation by, for example, touching theLCD display344 in the region oficon346, thedisplay334 indicates the status as being “Prime Mode”. Thecutter96 then translates to the third position just proximal to theport78. Once the cutter is in the third position, the display instructs the operator to apply saline to theport78 and to depress thevacuum switch150 as needed to draw saline intopiercer70 and through theprobe assembly40. The operator may observe the flow of saline through thewindow58. Finally, thefirst pinch valve314 andsecond pinch valve316 are both set to respond to thevacuum switch150.
• The “Insert” mode of operation is next selected when the operator is preparing the instrument for insertion into the tissue of the surgical patient. When an operator activates the “Insert” mode of operation by, for example, touching theLCD display344 in the region ofIcon348, thedisplay344 indicates the status as being “Insert Mode”. Thecutter96 then translates to the fourth position, just distal to theport78. Once thecutter96 translates to the fourth position, the display indicates that the instrument is ready to insert.
• The “Verify” mode of operation is selected when the operator wants to verify that the position of theport78 is adjacent to the tissue to be extracted. In order to more easily visualize theport78 of the insertedpiercer70 on the imaging device, it has been found that thecutter96 should be retracted to a position proximal to theport78, that is, theport78 should be “open.” If theport78 is not adjacent to the tissue to be extracted, then the operator should “close” theport78 by moving thecutter96 to the fourth position, so that thepiercer70 may be hand-manipulated towards the tissue to be extracted. Then theport78 should be opened again to verify that theport78 is adjacent to the tissue to be extracted. These steps are repeated until theport78 is adjacent the tissue to be extracted. When an operator activates the “Verify” mode of operation by, for example, touching theLCD display344 in the region ofIcon350, thedisplay344 indicates the status as being “Verify Mode”. If thecutter96 is not at the fourth position (theport78 is “open”), thesecond motor340 is set to respond to the handpiece first (forward)switch146. Then thedisplay344 instructs the operator to close theport78 by pressing the first (forward) switch146 on thehandpiece20. When the operator presses the first (forward)switch146, thecutter96 translates to the fourth position. Thesecond motor340 is then set to respond to the handpiece second (reverse)switch148. If thecutter96 is already at the fourth position when the “Verify” mode is selected, then thesecond motor340 is set to respond to the second (reverse)switch148. Then thedisplay344 instructs the operator to open theport78 by pressing the second (reverse)switch148 on the handpiece. When the operator presses the second (reverse)switch148, thecutter96 translates to the third position just proximal to theport78. Then thesecond motor340 is set to respond to the first (forward)switch146.
• The “Sample” mode of operation is selected when the operator desires to extract a portion of tissue from the surgical patient. When the operator activates the “Sample” mode of operation by, for example, touching theLCD display344 in the region oficon352, thedisplay344 indicates the status as being “Sample Mode”. Thecutter96 then translates to the third position which is just proximal to theport78. Then thesecond motor340 is set to respond to the first (forward)switch146. Once thecutter96 is in the third position, thedisplay344 instructs the operator to take a tissue sample by pressing the first (forward) switch146 on the handpiece. When the first (forward)switch146 is pressed, thefirst pinch valve314 andsecond pinch valve316 are opened, and thefirst motor338 is activated to rotate thecutter96 at the appropriate speed. Then thecutter96 translates to the fourth position, severing the tissue portion prolapsed into theport78 as thecutter96 moves distally. Once thecutter96 reaches the fourth position, thefirst motor338 is deactivated and thecutter96 stops rotating. Then thefirst pinch valve314 is activated to close. Next thedisplay344 instructs an operator to retrieve a tissue sample by pressing the second (reverse)switch148 on thehandpiece20. The second motor is set to respond to the second (reverse)switch148 on thehandpiece20. When the operator presses the second (reverse)switch148, thecutter96 translates to the first, fully retracted position, just distal to thesampling surface64. Then thesecond pinch valve316 is activated to close the vacuum for thetissue remover132. A “smart-vacuum” is also activated and a plurality of vacuum pulses (0.5 seconds on and 0.5 seconds off) are supplied to thesecond vacuum tube136. A detailed description of the “smart vacuum” is provided in U.S. patent application Ser. No. 08/878,468 filed by the same assignee as for the present application and which is incorporated herein for reference. Thedisplay344 instructs the operator to remove the tissue sample. If there was no sample extracted, that is, the severed tissue portion remained at the distal end of thepiercer70 rather than be deposited onto thetissue sample surface64, the operator is instructed to select “Dry Tap”. The operator is also instructed to select “Remove Air/Blood” if required to remove excessive fluids in the patient and probe assemble40. The operator is sally instructed to press the first (forward) switch146 on thehandpiece20 to extract the next sample. Next, thesecond motor340 is set to respond to the first (forward) switch146 on thehandpiece20. When the first (forward)switch146 is pressed by the operator, the “smart-vacuum” is stopped and the first and second pinch valves,314 and316, are activated to open, and thecutter96 translates in the distal direction. As thecutter96 approaches the third position just proximal to theport78, thefirst motor338 is activated to rotate thecutter96 which then translates to the fourth, fully distal position. Then thecutter96 rotation is stopped and thefirst pinch valve314 is closed to stop the vacuum to the vacuumpressure chamber tube76 supplied by thefirst vacuum tube94.
• The “Mark” mode of operation is selected when the operator desires to implant a metallic marker within the surgical patient at the location from which the tissue was extracted. When the operator activates the “Mark” mode of operation by, for example, touching thedisplay344 in the region oficon354, thedisplay344 indicates the status as being “Marker Mode” and also prompts the operator to select “Dry Tap” if required. Then the operator is instructed to press the third (vacuum)switch150 on thehandpiece20 to activate the “Mark” mode. A marking instrument which may be used in combination with the present invention for marking tissue is commercially available under the tradename MICROMARK from Ethicon Endo-Surgery, Inc., Cincinnati, Ohio. A complete description of the MICROMARK applier and clip, and the method of its use, is included in U.S. patent application Ser. No. 09/105,757 and Ser. No. 09/105,570, both filed on Jun. 26, 1998, and which are incorporated herein for reference. When the operator presses the third (vacuum)switch150, thecutter96 translates to the first position just proximal to thetissue sampling surface64. Thedisplay344 then instructs the operator to insert the MICROMARK instrument, to press the third (vacuum)switch150 on handpiece when ready to deploy, and to deploy the marker. Then when the third (vacuum)switch150 is pressed, thefirst pinch valve314 is activated to the open position for five seconds to supply vacuum to theport78 through thevacuum chamber76. Next thedisplay344 instructs the operator to reposition the MICROMARK instrument if marker deployment was not complete, to press the third (vacuum)switch150 on the handpiece when ready to deploy the marker, to deploy the marker, and if the marker deployment is complete, to remove the MICROMARK instrument.
• The “Remove” mode of operation is selected when the operator is ready to remove thepiercer70 from within the tissue of the surgical patient. When the operator activates the “Remove” mode of operation by, for example, touching thedisplay344 in the region oficon356, thedisplay344 indicates the status as being “Remove Mode”. Thecutter96 translates to the fourth, fully distal position and closes theport78. Thedisplay344 instructs the operator that the instrument is ready to remove.
• The “Remove Air/Blood” mode of operation is selected when the operator desires to remove any fluids present near the distal end of thepiercer78 and within theprobe assembly40. When the operator activates the “Remove Air/Blood” mode of operation by, for example, pressing thedisplay344 in the region oficon360, thedisplay344 indicates the status as being “Remove Air/Blood Mode”. Thecutter96 then translates to the third position just proximal to theport78. Thefirst pinch valve314 and thesecond pinch valve316 are both set to respond to the third (vacuum)switch150 on thehandpiece20. The display then instructs the operator to remove the air/blood by pressing the third (vacuum)switch150 on thehandpiece20. When the third (vacuum) switch ISO is pressed, thefirst pinch valve314 and thesecond pinch valve316 are activated to open for five seconds. When they are closed, thecutter96 then translates to the first, fully retracted position just proximal to thetissue sampling surface64. Then the “Remove Air/Blood” mode is automatically exited and the previous mode selected is automatically reset.
• The “Dry Tap” mode of operation is selected when the operator had attempted to extract a tissue portion from the surgical patient using the “Sample” mode of operation, but a tissue portion was not deposited onto thetissue sample surface64. This may occur when the tissue portion is properly severed from the surgical patient, but remained in the distal end of thepiercer78. When the operator activates the “Dry Tap” mode of operation by, for example, touching thedisplay344 in the region oficon358, thedisplay344 indicates the status as being “Dry Tap Mode”. Thecutter96 then translates to the third position just proximal to theport78. Then thesecond pinch valve316 is activated to open for 0.5 seconds and to close for 0.5 seconds three times in order to pulse the vacuum supplied to thetissue remover132 through thesecond vacuum tube136. Thecutter96 then translates to the first, fully retracted position just proximal to thetissue sampling surface64. The “Dry Tap” mode of operation is then exited and the previously selected mode of operation is automatically selected.
• The “Flush” mode of operation is selected when the operator desires to clear any obstructions (tissue fragments, etc.) on the distal end of thetissue remover132 to enable the passage of fluids through it. When an operator activates the “Flush” mode of operation by, for example, touching thedisplay344 in the region oficon362, thedisplay344 indicates the status as being “Flush Mode”. Thecutter96 then translates to the first, fully retracted position, thus exposing the distal end of thetissue remover132. Then thecontrol unit342 is set to respond to thevacuum switch150, which when pressed by the operator, causes the “Flush” mode of operation to be exited and the previously selected mode of operation to be automatically reset. Before pressing thevacuum switch150, however, the operator may temporarily disconnect thesecond connector304, inject fluid such as saline into thesecond vacuum tube136 using a syringe, and reconnect thesecond connector304.
• The “Inject” mode of operation is selected when the operator desires to inject a fluid, such as a local anesthetic, into the tissue surrounding the distal end of thepiercer78. When the operator activates the “Inject” mode of operation by, for example, touching thedisplay344 in the region oficon364, thedisplay344 indicates the status as being “Inject Mode”. Thecutter96 then translates to the third position just proximal to theport78. Then thecontrol unit342 is set to respond to the third (vacuum)switch150 on thehandpiece20. Next the display instructs the operator to inject the fluid into thesecond vacuum tube136, and to press the third (vacuum)switch150 again once the injection is complete. When the operator has completed the injection into thesecond vacuum tube136, reconnected it to thefluid collection system22, and pressed the third (vacuum)switch150, thecutter96 translates to the first, fully retracted position. At that point, the “Inject” mode of operation is exited, and the previously selected mode of operation is automatically reset.
• Each time one of the available operating modes is selected, adisplay area344 provides written and graphic information to prompt the user as to the correct usage of the instrument and the next operational steps. Amode indicator display370 includes a representation of the probe assembly showing the instantaneous position of the cutter tube, referred to as acutter position indicator373, activation of the front vacuum indicator372 (corresponding with the first vacuum tube94), and activation of the rear vacuum indicator371 (corresponding with the second vacuum tube136).
• The present invention, as described, is transportable from room to room of a physician's office, primarily because the handpiece need not be mounted to an X-ray stereotactic table. The remaining portions of the instrument, including the fluid collection system, the power transmission source, and the control unit, may be packaged into a portable, wheeled unit. In one scenario, the physician would have a number of patients, each in a separate room, being prepared for treatment while the surgical procedure is being performed on another patient. The biopsy instrument could then be moved to the patient, rather than vice versa, thus helping the patient to feel relaxed and prepared for the procedure. A different, sterile probe assembly would be provided for each patient, while the holster portion of the handpiece would be reused.
• While preferred embodiments of the present invention have been shown and described herein, it will be obvious to those skilled in the art that such embodiments are provided by way of example only. Numerous variations, changes, and substitutions will now occur to those skilled in the art without departing from the invention. Accordingly, it is intended that the invention be limited only by the spirit and scope of the appended claims.

Claims (7)

1-12. (canceled)

13. A biopsy device comprising:

a handpiece configured for grasping by a single hand, the handpiece having a distal end and a proximal end, the handpiece being independently manipulatable by the single hand without an external support for movement of the biopsy device toward and away from the patient;

an elongate outer piercing needle extending from the distal end of the handpiece, the outer piercing needle having a longitudinal axis, a closed distal end, and a lateral opening located proximal to the closed distal end for receiving tissue;

an elongate hollow cutter having a longitudinal axis and the cutter being translatable and rotatable with respect to the lateral opening in the needle, and the cutter having a sharpened distal end for cutting tissue received in the lateral opening of the outer piercing needle;

a linear actuator disposed within the handpiece for providing translation of the cutter, wherein the linear actuator is offset from the longitudinal axis of the cutter.

14. The biopsy device ofclaim 13 wherein the linear actuator comprises a motor offset from the longitudinal axis of the cutter.

15. A biopsy device comprising:

a handpiece configured for grasping by a single hand, the handpiece having a distal end and a proximal end, the handpiece being independently manipulatable by the single hand without an external support for movement of the biopsy device toward and away from the patient;

an elongate outer piercing needle extending from the distal end of the handpiece, the outer piercing needle having a longitudinal axis, a closed distal end, and a lateral opening located proximal to the closed distal end for receiving tissue;

an elongate hollow cutter having a longitudinal axis and the cutter being translatable and rotatable with respect to the lateral opening in the needle, and the cutter having a sharpened distal end for cutting tissue received in the lateral opening of the outer piercing needle;

a rotary actuator disposed within the handpiece for providing rotation of the cutter, wherein the rotary actuator is offset from the longitudinal axis of the cutter.

16. The biopsy device ofclaim 15 wherein the rotary actuator comprises a motor offset from the longitudinal axis of the cutter.

17. A biopsy device comprising:

a handpiece configured for grasping by a single hand, the handpiece having a distal end and a proximal end, the handpiece being independently manipulatable by the single hand without an external support for movement of the biopsy device toward and away from the patient, the handpiece having an outer surface adapted to be grasped by the user;

an elongate outer piercing needle extending from the distal end of the handpiece, the outer piercing needle having a longitudinal axis, a closed distal end, and a lateral opening located proximal to the closed distal end for receiving tissue, the elongate outer piercing needle being offset with respect to the handpiece;

an elongate hollow cutter having a longitudinal axis and the cutter being translatable and rotatable with respect to the lateral opening in the needle, and the cutter having a sharpened distal end for cutting tissue received in the lateral opening of the outer piercing needle.

18. A biopsy device comprising:

a handpiece configured for grasping by a single hand, the handpiece having a distal end and a proximal end, the handpiece being independently manipulatable by the single hand without an external support for movement of the biopsy device toward and away from the patient, the handpiece having a portion disposed between the proximal end and the distal end of the handpiece, the portion having an outer surface adapted to be grasped by the user;

an elongate outer piercing needle extending from the distal end of the handpiece, the outer piercing needle having a longitudinal axis, a closed distal end, and a lateral opening located proximal to the closed distal end for receiving tissue, wherein the longitudinal axis of the elongate outer piercing needle is offset from the center of the portion of the handpiece having the outer surface adapted to be grasped by a user;

an elongate hollow cutter having a longitudinal axis and the cutter being translatable and rotatable with respect to the lateral opening in the needle, and the cutter having a sharpened distal end for cutting tissue received in the lateral opening of the outer piercing needle.

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