US20100160818A1 - MRI Biopsy Device - Google Patents

Abstract

A magnetic resonance imaging (MRI) compatible core biopsy system uses a biopsy device having intuitive graphical displays and a detachable remote keypad that advantageously allows convenient control even within the close confines afforded by a localization fixture installed within a breast coil that localizes a patient's breast and guides a probe of the biopsy device relative to the localized breast. A control module for interactive control and power generation are remotely positioned and communicate and transmit rotational mechanical energy via sheathed cable.

Description

CROSS REFERENCE TO RELATED APPLICATIONS
• The present application is a continuation in part of U.S. patent application Ser. No. 11/103,959, “MRI BIOPSY DEVICE LOCALIZATION FIXTURE” to Hughes et al., filed on 12 Apr. 2005, the disclosure of which is hereby incorporated by reference in its entirety.
FIELD OF THE INVENTION
• The present invention relates, in general, to a method of imaging assisted tissue sampling and, more particularly, to an improved method for positioning a biopsy probe with respect to a magnetic resonance imaging (MRI) breast coil for acquiring subcutaneous biopsies and for removing lesions.
BACKGROUND OF THE INVENTION
• Core biopsy devices have been combined with imaging technology to better target a lesion in breast tissue. One such commercially available product is marketed under the trademark name MAMMOTOME™, by Ethicon Endo-Surgery, Inc. An embodiment of such a device is described in U.S. Pat. No. 5,526,822 issued to Burbank, et al., on Jun. 18, 1996, and is hereby incorporated herein by reference. Its handle receives mechanical and electrical power as well as vacuum assist from a remotely positioned control module that is spaced away from the high magnetic field of a Magnetic Resonance Imaging (MRI) machine
• As seen from that reference, the 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 the sampling of tissues of varying hardness. In addition, a side opening aperture is used, avoiding having to thrust into a lesion, which may tend to push the mass away, cause a track metastasis, or cause a hematoma that, with residual contrast agent circulating therein, may mimic enhancement in a suspicious lesion. The side aperture may be rotated about a longitudinal axis of the probe, thereby allowing multiple tissue samples without having to otherwise reposition the probe. These features allow for substantial sampling of large lesions and complete removal of small ones.
• Vacuum assisted core biopsy devices have been adapted to be safe and compatible with various imaging modalities, including Magnetic Resonance Imaging (MRI). In particular, portions of a biopsy system placed near the magnet core of an MRI machine need to be nonresponsive to the strong magnetic field to prevent becoming drawn toward the magnet core or to malfunction. Further, the MRI machine depends upon sensing extremely weak radio frequency (RF) signals emanated by tissue after being excited by a strong change in the magnetic field. Components placed in the RF shielded MRI suite need to avoid producing electromagnetic interference (EMI) and need to avoid having materials that would distort RF signals sufficient to create artifacts in the MRI scan data.
• A successful approach has been to segregate motive power generation, graphical user interface, vacuum assist, and closed loop control in a control module that has typically been placed about 6 feet away from the magnet core to mitigate detrimental interaction with its strong magnetic field and/or sensitive radio frequency (RF) signal detection antennas. An intuitive graphical user interface (GUI) provides a range of preprogrammed functionality incorporated into a control module to efficiently use time in an MRI suite to take tissue samples.
• As an example, in U.S. Pat. No. 6,752,768, the disclosure of which is hereby incorporated by reference in its entirety, a control button may be depressed to change a mode of operation of a core biopsy device with this mode displayed remotely on a display.
• While a full function GUI has numerous clinical benefits, the clinician may find the control module inconveniently remote during hands-on portions of the procedure. In addition, some MRI machines have such increased sensitivity and/or increased magnet field strength that it is desirable to increase the distance of the control monitor (e.g., 30 feet) from the MRI machine. Further, even if the control monitor is sufficiently close, some clinicians prefer a simplified user interface to simplify training familiarity.
• Consequently, a significant need exists for a biopsy system compatible for use in an MRI suite with biopsy controls with enhanced convenience and intuitiveness.
BRIEF SUMMARY OF THE INVENTION
• The invention overcomes the above-noted and other deficiencies of the prior art by providing a handpiece of a magnetic resonance imaging (MRI) compatible core biopsy system that includes a graphical user interface that facilitates user control even with vacuum, power generation, and control processing components remotely positioned away from the MRI magnet and sensitive radio frequency (RF) receiving components. Thereby, a clinician may have the full functionality of vacuum assisted core biopsy systems yet not be inconvenienced by the distance from a remotely positioned control module.
• These and other objects and advantages of the present invention shall be made apparent from the accompanying drawings and the description thereof.
BRIEF DESCRIPTION OF THE FIGURES
• The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the invention, and, together with the general description of the invention given above, and the detailed description of the embodiments given below, serve to explain the principles of the present invention.
• FIG. 1 is a perspective disassembled view of a Magnetic Resonance Imaging (MRI) biopsy system including a handpiece (“biopsy device”) having intuitive graphical controls consistent with aspects of the invention.
• FIG. 2 is an isometric view of a lateral fence and pedestal of a localization fixture of the MRI biopsy system ofFIG. 1.
• FIG. 3 is an isometric view of a guidance assembly mounted on a right primary targeting rail ofFIG. 2.
• FIG. 4 is an exploded isometric view of the guidance assembly ofFIG. 3 and the sleeve trocar and introducer obturator ofFIG. 1.
• FIG. 5 is an isometric view of the introducer obturator inserted into the sleeve trocar ofFIGS. 1 and 4.
• FIG. 6 is an aft right isometric view of the MRI biopsy device ofFIG. 1 with a disposable probe assembly and keypad control disengaged from a reusable holster portion.
• FIG. 7 is a fore left isometric view of the MRI biopsy device ofFIG. 1 with the disposable probe assembly and keypad control disengaged from the reusable holster portion.
• FIG. 8 is a fore left exploded isometric view of the reusable holster portion ofFIG. 7.
• FIG. 9 is a top view of the disposable probe assembly ofFIG. 7 with an upper cover removed to expose interior components of a carriage cavity.
• FIG. 10 is a fore left exploded isometric view of the disposable probe assembly ofFIG. 7.
• FIG. 11 is an aft left isometric view of the localization fixture and guidance assembly installed into a breast coil ofFIG. 1.
• FIG. 12 is an aft isometric view of the MRI biopsy device ofFIG. 7 into the guidance assembly ofFIG. 11.
• FIG. 13 is a top detail view of a display portion of the MRI biopsy device ofFIG. 7.
• FIG. 14 is an aft right isometric view of the MRI biopsy device, localization fixture and breast coil ofFIG. 12 with insertion of a marker deploying instrument through a probe of the disposable probe assembly.
DETAILED DESCRIPTION OF THE INVENTION
• An MRI biopsy device advantageously includes is partially disposable for sterility purposes with a reusable portion for economy. Inconvenience of mechanical, electrical, and pneumatical coupling to a remotely placed control portion, necessitated by a strong magnetic field and sensitive RF receiving components of an MRI machine, is mitigated. First, proximal detachable intuitive controls and displays on the MRI biopsy device give interactive control even after insertion into localizing and guiding structures. Second, binding of mechanical coupling to the MRI biopsy device is sensed prior to equipment damage or malfunction. Third, mechanical coupling is moved closer to engagement points between the MRI biopsy device and guiding structures to reduce torque loads, especially those transferred through its distal probe. Fourth, a single mechanical drive cable drives a fixed ratio transmission that translates and rotates a cutter of the distal probe to realize an effective fixed ratio translation/rotation sampling cut without the encumbrance of two mechanical drive cables.
• Turning to the Drawings, wherein like numerals denote like components throughout the several views, inFIGS. 1-3, a Magnetic Resonance Imaging (MRI)compatible biopsy system10 has acontrol module12 that typically is placed outside of a shielded room containing an MRI machine (not shown) or at least spaced away to mitigate detrimental interaction with its strong magnetic field and/or sensitive radio frequency (RF) signal detection antennas. As described in U.S. Pat. No. 6,752,768, which is hereby incorporated by reference in its entirety, a range of preprogrammed functionality is incorporated into thecontrol module12 to assist in taking these tissue samples. Thecontrol module12 controls and powers an MRI biopsy device (“handpiece”)14 that is positioned and guided by alocalization fixture16 attached to abreast coil18 that is placed upon a gantry (not shown) of the MRI machine.
• Acable management spool20 is placed upon a cablemanagement attachment saddle22 that projects from a side of thecontrol module12. Wound upon thecable management spool20 is a pairedelectrical cable24 andmechanical cable26 which are bundled into sheathedcable27 for communicating control signals and cutter rotation/advancement motions respectively. In particular, electrical andmechanical cables24,26 each have one end connected to respective electrical andmechanical ports28,30 in thecontrol module12 and another end connected to areusable holster portion32 of theMRI biopsy device14. AnMRI docking cup34, which may hold theholster portion32 when not in use, is hooked to thecontrol module12 by a dockingstation mounting bracket36.
• Aninterface lock box38 mounted to a wall provides atether40 to alockout port42 on thecontrol module12. Thetether40 is advantageously uniquely terminated and of short length to preclude inadvertent positioning of thecontrol module12 too close to the MRI machine. An in-line enclosure44 may advantageously register thetether40,electrical cable24 andmechanical cable26 to theirrespective ports42,28,30 on thecontrol module12.
• Vacuum assist is provided by afirst vacuum line46 that connects between thecontrol module12 and anoutlet port48 of avacuum canister50 that catches liquid and solid debris. Atubing kit52 completes the pneumatic communication between thecontrol module12 and theMRI biopsy device14. In particular, asecond vacuum line54 is connected to aninlet port56 of thevacuum canister50. Thesecond vacuum line54 divides into twovacuum lines58,60 that are attached to theMRI biopsy device14. With theMRI biopsy device14 installed in theholster portion32, thecontrol module12 performs a functional check. Saline is manually injected intobiopsy device14 to serve as a lubricant and to assist in achieving a vacuum seal. Thecontrol module12 actuates a cutter mechanism (not shown) in theMRI biopsy device14, monitoring full travel. Binding in themechanical cable26 or within thebiopsy device14 is monitored with reference to motor force exerted to turn themechanical cable26 and/or an amount of twist in themechanical cable26 sensed in comparing rotary speed or position at each end of themechanical cable26.
• Just proximal to adisplay area61 on thereusable holster portion32, aremote keypad62, which is detachable from thereusable holster portion32, communicates via theelectrical cable24 to thecontrol module12 to enhance clinician control of theMRI biopsy device14, especially when controls that would otherwise be on theMRI biopsy device14 itself are not readily accessible after insertion into thelocalization fixture16 and/or placement of thecontrol module12 is inconveniently remote (e.g., 30 feet away). Anaft end thumbwheel63 on thereusable holster portion32 is also readily accessible after insertion to rotate the side from which a tissue sample is to be taken.
• Left and right parallel upper guides64,66 of alocalization framework68 are laterally adjustably received respectively within left and right parallelupper tracks70,72 attached to an underside74 and to each side of a selectedbreast aperture76 formed in apatient support platform78 of thebreast coil18. Abase80 of thebreast coil18 is connected bycenterline pillars82 that are attached to thepatient support platform78 between thebreast apertures76. Also, a pair of outervertical support pillars84,86 on each side spaced about arespective breast aperture76 respectively define alateral recess88 within which thelocalization fixture16 resides.
• InFIGS. 1-2, a selected breast is compressed along an inner (medial) side by amedial plate90 downwardly received into a medial three-sided frame92 of thelocalization framework68. The breast is compressed from an outside (lateral) side of the breast by alateral fence94 downwardly received into a lateral three-sided frame96 of thelocalization framework68, defining an X-Y plane. The X-axis is vertical (sagittal) with respect to a standing patient and corresponds to a left to right axis as viewed by a clinician facing the externally exposed portion of thelocalization fixture16.
• Perpendicular to this X-Y plane extending toward the medial side of the breast is the Z-axis, which typically corresponds to the orientation and depth of insertion of aprobe98 of adisposable probe assembly100 of theMRI biopsy device14 or of asleeve trocar102 with insertedintroducer obturator104. For clarity, the term Z-axis may be used interchangeably with “axis of penetration”, although the latter may or may not be orthogonal to the spatial coordinates used to locate an insertion point on the patient. Versions of thelocalization fixture16 described herein allow a nonorthogonal axis of penetration to the X-Y axis to a lesion at a convenient or clinically beneficial angle. An origin of the spatial coordinates may be imaging the dents imparted to the tissue by thelateral fence94. Alternatively, a disposablefiducial pointer106 held by afiducial holder108 is filled with an MRI imagable material (e.g., KY jelly, saline, gadolinium) and sealed with acap110.
• Theprobe98,sleeve trocar102 andfiducial pointer106 are guided by thelocalization fixture16. With particular reference toFIG. 2, a lateral fence supportedpedestal120 spatially positions left and right primary targeting rails121,122 that in turn guide thefiducial pointer106, the sleeve/trocar102, or theprobe98 of the biopsy device14 (FIG. 1). The primary targeting rails121,122 each include anattachment axle124 that receives in either a left or right side axle hub125 of a (Y-axis)height yoke126 that is vertically adjustable upon a pedestalmain body128, that in turn is laterally adjustable upon thelateral fence94. Alternatively, a breast coil may enable mounting the pedestal main body on themedial plate90 for accessing medially. The pedestalmain body128 includes a proximal uprightrectangular column132 with athinner wall134 projecting from its distal side that flares laterally outward (defining left and right verticalrectangular slots136,138) as part of abracket140 with top andbottom hanger arms144,146 that slide laterally respectively on atop track148 and a proximally openlower track150 formed in thelateral fence94. A lateral (X-axis)adjustment lever151 may be raised to lift itsdistal end149 out of engagement with abottom track147 formed in thelateral fence94 as thelateral adjustment lever151 is repositioned to the left or right to a desired location with reference to alateral measurement guide145.
• Theheight yoke126 is a rectangular cuff interrupted in a mid-portion of a distal side to form locking left andright hands152 respectively which ride vertically in the left and right verticalrectangular slots136,138. The locking left andright hands152 have respective ridged proximal surfaces (not shown) that are selectively drawn proximally into locking engagement by aheight locking lever156 with aridged surface158 on a proximal side of each verticalrectangular slot136,138. Lifting theheight locking lever156 takes theheight yoke126 out of locking engagement to the pedestalmain body128 as theheight yoke126 is vertically repositioned. For height adjustment, the proximal top surface of theheight yoke126 serves as asight160 to read aheight measurement scale162 presented on a proximal surface of theheight locking lever156.
• Theattachment axle124 allows rotation so that an axis of penetration may include an upward or downward trajectory. In the illustrative version, proximal corners of theheight yoke126 include angle detents164 (e.g., −15°, 0°, +15°) that are selectable by anangle lock lever166. Theprimary targeting rail122 includes adistal detent167 that serves as a home reference for the fiducial holder108 (FIG. 1).
• InFIGS. 3-4, aguidance assembly200, that may be attached to the lateral fence supportedpedestal120 ofFIG. 2, includes acradle202 whose upperlateral side202aflares upwardly to engage abottom channel203 of the primary targetingrail122. A lowerlateral side202bflares horizontally to provide aholster guide track204 that underlies the axis of penetration. To provide additional guidance to the MRI biopsy device14 (FIG. 1), asecondary targeting rail206 includes alateral channel208 that is guided along alongitudinal guide tab210 of the primary targetingrail122. When fully engaged thereon, apawl212 pivoting under urging of apawl spring214 about avertical pawl pin216 in alateral window218 proximally positioned in the secondary targetingrail206 drops into aproximal detent220 proximally positioned on the primary targetingrail122. Thepawl spring214 may maintain thepawl212 in a neutral position that serves in both assembly and later removal of the secondary targetingrail206 or comprises a pair of opposing pawl springs (not shown) for that purpose.
• InFIGS. 4-5, thesleeve trocar102 includes a hollow shaft (or cannula)223 that is proximally attached to acylindrical hub224 and has alateral aperture226 proximate to an opendistal end228. Thecylindrical hub224 has an exteriorly presentedthumbwheel230 for rotating thelateral aperture226. Thecylindrical hub224 has aninterior recess232 that encompasses aduckbill seal234,wiper seal236 and aseal retainer238 to provide a fluid seal when theshaft223 is empty and for sealing to the insertedintroducer obturator104.
• Theintroducer obturator104 advantageously incorporates a number of components with corresponding features. Ahollow shaft242 includes afluid lumen244 that communicates between animagable side notch246 and aproximal port248. Thehollow shaft242 is longitudinally sized to extend when fully engaging a piercingtip249 out of thedistal end228 of thesleeve trocar102. An obturator handle250 encompasses theproximal port248 and includes alocking feature252, which includes avisible angle indicator254, that engages thesleeve thumbwheel230 to ensure that theimagable side notch246 is registered to thelateral aperture226 in thesleeve trocar102. Anobturator seal cap256 may be engaged proximally into the obturator handle250 to close thefluid lumen244. Theobturator seal cap256 includes a locking or locatingfeature258 that includes avisible angle indicator259 that corresponds with thevisible angle indicator254 on theobturator thumbwheel cap230. Theobturator seal cap256 may be fashioned from either a rigid, soft, or elastomeric material.
• Returning toFIGS. 3,4, thesleeve trocar102 is guided, during penetration of tissue, by asleeve mount260 having asleeve hub262 that receives thecylindrical hub224 of thesleeve trocar102. Thesleeve mount260 has a lateralsleeve hub channel264 that slides along top andbottom guide flanges266,268 of the secondary targetingrail206, each having an aligned and recess ridged, ratchetingsurface270 that interacts with a respective top andbottom ratcheting feature272,274 on respective top and bottom rail lock rocker latches276,278 that are engaged by respective top and bottom latch pins280,282 in respective sides of thesleeve mount260. The ratcheting features272,274 are proximally ramped such as to allow distal movement. Distal portions of each rail lock rocker latches276,278 are biased away from thesleeve mount260 by respective rail lock compression springs284,286 to bias the ratcheting features272,274 into contact with the ridges surfaces270 of theguide flanges266,268. Simultaneous depression of the rail lock rocker latches276,278 allow thesleeve mount260 to be drawn proximally, withdrawing anysleeve trocar102 supported therein, until thesleeve mount260 reaches a proximal end of the secondary targetingrail206, whereupon thesleeve mount260 rotates thepawl212 clockwise (as viewed from the top) and is thus engaged to the secondary targetingrail206 as the secondary targetingrail206 is unlocked from the primary targetingrail122, causing removal therefrom with continued proximal movement.
• Before mounting the secondary targetingrail206 onto the primary targetingrail122 in the first place, thesleeve mount260 is advantageously adjustably positioned on the secondary targetingrail206 to set a desired depth of penetration. In particular, a depth guide290 is formed by a crescent-shapeddepth indicator292 having alateral channel296 shaped to engage the top andbottom guide flanges266,268. Forward rampedsurfaces298 on the top and bottom of thelateral channel296 are positioned to engage the ridged ratcheting surfaces270 on the secondary targetingrail206, allowing assembly by inserting thedepth indicator292 from a distal end of the secondary targetingrail206. Frictional engagement thereafter resists further proximal movement and strongly opposes any distal movement, especially from adepth lead screw300 of the depth guide290, whosedistal end302 rotates within anoutboard hole304 in thedepth indicator292 and whose proximal end deflects laterally as adepth actuator lever305 is used to rotate and longitudinally position thedepth lead screw300 therein. A mid portion of thedepth lead screw300 is received in a longitudinal throughhole306 formed in thesleeve mount260 outboard of itslateral channel208. For coarse depth adjustment, outer lead threads307 on thedepth lead screw300 selectively engage thesleeve mount260 until top and bottom coarse adjustbuttons308,310 are inwardly depressed into thesleeve mount260, compressing respective top and bottom coarse adjust compression springs312,314. Each coarse adjustbutton308,310 includes a respective verticallyelongate aperture316,318 whose inward surface presents aworm gear segment320,322 to engage the outer lead threads307 on thedepth lead screw300 when urged into engagement by relaxed coarse adjustcompression screws312,314.
• Returning toFIG. 3, thethumbwheel230 is depicted as engaged to thesleeve hug262 of thesleeve mount260 with other portions of thesleeve trocar102 omitted. Application s consistent with the present invention may include a probe of an MRI biopsy device that includes a piercing tip or that otherwise is used without passing through a hollow shaft (cannula)223. As such, the thumbwheel with similar sealing members may be incorporated into thesleeve mount260.
• InFIGS. 6-7, theMRI biopsy device14 has thedisposable probe assembly100 depicted detached from thereusable holster portion32 and with theremote keypad62 released from thereusable holster portion32. The sheathedcable27 is joined to an underside of thereusable holster portion32 distal to theaft end thumbwheel63 to enhance balance and support of the reusable holster portion, which in turn may be engaged to the holster guide track204 (FIG. 4) by an I-beam shapedholster rail324 whoseupper surface326 is engaged within abottom channel328 of aholster base plate330. A ridgedmember331 upon theholster base plate330 guides thedisposable probe assembly100 during engagement. A narrowed upperdistal surface332 of theholster rail324 also engages downward grippingflanges334 extending downward just proximal to adistal thumbwheel336 of thedisposable probe assembly100. An underslung shell337 is fastened to the proximal undersurface portion of theholster base plate330.
• Thedisposable probe assembly100 also has an undersurface that backwardly slides into engagement with thereusable holster portion32. In particular, a narrowedproximal end338 is formed into anupper cover340 with adistal locking arm342 separated from theupper cover340 on each side except proximally to present an unlockingbutton344 on an exposedsurface346 of theupper cover340 that is depressed to disengage a locking surface348 (FIG. 6) from adistal lip350 of a distally open receivingaperture352 in thereusable holster portion32 of theholster plate330.
• A recesseddeck354 in an upper proximal surface of a proximaltop cover356 of thereusable holster portion32 is shaped to receive theremote keypad62. Alower shell358 mates to the proximaltop cover356. The proximaltop cover356 also defines the upper portion of the receivingaperture352. The recesseddeck354 has afront guide hole360 and aback locking aperture362 registered to respectively receive afront tooth363 and aflexing unlock tab364 at an aft end of theremote keypad62 to selectively engage and disengage thekeypad62 from thereusable holster portion32. Thekeypad62 also includes atranslation rocker button366 that has a distal advance, a default neutral, and an aft retract command position. Anaft button368 may be programmed for mode functions such as saline flush.
• With particular reference toFIG. 6, thedisposable probe assembly100 has a plurality of interconnections presented on anaft docking end370. A rightward cantedvacuum hose nib372 is positioned to receive a vacuum conduit (not shown) that would be gripped by afriction clip373 extending under and aft thereof to prevent inadvertent release. Aright side slot374 is distally open and formed between theholster base plate330 and proximaltop cover356 to receive such a vacuum conduit as thedisposable probe assembly100 is engaged to thereusable holster portion32. A center splineddriveshaft375 engages theaft end thumbwheel63 and communicates with thedistal thumbwheel336 to rotate aside aperture376 inprobe98 to a desired side, as visually confirmed by anarrow indicator378 on thedistal thumbwheel336. A rightsplined driveshaft380 effects cutter translation and a leftsplined driveshaft382 effects cutter rotation.
• Thedistal thumbwheel336 and probe98 are mounted to acylindrical hub384, which is a distal portion of thelower shell358 that extends beyond the mating with theupper cover340. A sample throughhole386 communicates through thecylindrical hub384 for receiving a rotating and translating cutter tube388 (FIG. 9) that enters theprobe98 and for receiving tissue samples (not shown) deposited by aretracting cutter tube388. As thecutter tube388 fully retracts into acarriage cavity390 formed between theupper cover340 and proximal portion of thelower shell358, a distally extendingtip392 from avacuum tube394 encompassed by thecutter tube388 dislodges the retracted tissue sample onto asample retrieval platform396, which is a relieved area between theupper cover340 and thecylindrical hub384.
• InFIG. 8, it should be appreciated that the sheathedcable27 connects to theholster base plate330 and communicates a single mechanical drive rotation to a fixedratio transmission398 mounted to theholster base plate330 and electrically communicates with anencoder400 coupled to the fixedratio transmission398 aft of the receivingaperture352. The sheathedcable27 also communicates electrically with thedisplay area61 via a wire bundle (not shown) and with thekeypad62 via acable assembly402, the latter including astrain relief bracket404 that grips akeypad cable406 and is fastened proximate to the sheathedcable27. The fixedratio transmission398 has a pass-throughport408 that receives a distal end the center splined driveshaft375 (FIG. 6) to rotatingly engage a proximally receivedbeveled shaft410 distally presented by theaft end thumbwheel63 and sealed by an O-ring412. Aright port414 distally presented by the fixedratio transmission398 engages for rotation the rightsplined driveshaft380 from thedisposable probe assembly100 for advancing and retracting (“translation”) thecutter tube388. Aleft port416 distally presented by the fixedratio transmission398 engages for rotation the leftsplined driveshaft382 from thedisposable probe assembly100 for rotating thecutter tube388 when a distal cutting edge of thecutter tube388 slides past theside aperture376 of theprobe98.
• InFIGS. 9-10, thecarriage cavity390 of thedisposable probe assembly100 includes acutter carriage418 having a threadedlongitudinal bore420 that encompasses anelongate translation shaft422 whose proximal termination is the rightsplined driveshaft380 supported by an aft rightcylindrical bearing424 received in anaft wall425 of thelower shell358. A race about the outer circumference of thecylindrical bearing424 receives an O-ring426. Adistal end428 of the threadedtranslation shaft422 rotates within a distal rightcylindrical bearing430 engaged to aforward wall432 of thelower shell358. A race about the outer circumference of thecylindrical bearing430 receives an O-ring434. A threadedcentral portion436 of theelongate translation shaft422 resides between an unthreadeddistal over-run portion438 and an unthreadedproximal over-run portion440, both sized to allow the threadedlongitudinal bore420 of thecutter carriage418 to disengage from the threadedcentral portion436.
• Adistal compression spring442 and aproximal compression spring444 respectively reside on the unthreaded distal and proximalover-run portions438,440 to urge the threadedlongitudinal bore420 of thecutter carriage418 back into engagement with the threadedcentral portion436 upon reversal of rotation of theelongate translation shaft422. In particular, thecutter carriage418 includes a toplongitudinal channel446 that slidingly engages an undersurface of the upper cover340 (not shown) and a bottomlongitudinal guide448 that engages alongitudinal track450 on a top surface of thelower shell358. Thus rotationally constrained, rotation of theelongate translation shaft422 causes corresponding longitudinal translation of thecutter carriage418 with distal and aft pairs ofgripping flanges452,454 maintained laterally to the left to engage respectively distal andproximal races456,458 formed on each side of atoothed portion460 of acutter spur gear462, which has a longitudinal bore for applying vacuum.
• To that end, thevacuum hose nib372 is attached to a mountingstructure464 that is gripped between theupper cover340 and thelower shell358 to present an orifice466 within thecarriage cavity390 that is aligned with the longitudinal bore of thecutter gear462 and that is in fluid communication with thevacuum hose nib372.
• With particular reference toFIG. 10, the proximal end of thevacuum tube394 is received in the orifice466. Arectangular guide467 supports thedistally extending tip392 of thevacuum tube394 and is engaged between theupper cover340 and thelower shell358. Thecutter tube388 encompasses and translates relative to thevacuum tube394. Aseal cap468 attached to a proximal end of thecutter gear462 dynamically seals to the outer circumference of thevacuum tube394 so that vacuum pressure supplied proximate to thedistally extending tip392 is not released within thecarriage cavity390. Thecutter tube388 is advanced around the open distal end of thevacuum tube394, across thesample retrieval platform396 to seal against aback seal470 that substantially closes aproximal opening472 into asleeve union474 that rotates within thecylindrical hub384. Thesleeve union474 has adistal end476 engaged for rotation with thedistal thumbwheel336. Distal and proximal O-rings478,480 reside respectively within distal andproximal races482,484 that straddle alateral passage486 of thesleeve union474 to provide a degree of frictional resistance against inadvertent rotation and advantageously seal thelateral passage486 for vacuum assistance to prolapse tissue and to retract samples. Anoncircular opening488 is centered in a distal face of thedistal thumbwheel336. A proximal end of aprobe tube490 of theprobe98 extends through thenoncircular opening488 to receive a distal end of thecutter tube388. Alateral tube492 attached along its length to theprobe tube490 communicates with thelateral passage486 of theunion sleeve474. Thelateral tube492 defines a lateral lumen that communicates with the a cutter lumen defined by theprobe tube490/cutter tube388 below theside aperture376 through lumen holes494 (FIG. 9).
• The center splineddriveshaft375 that is turned by theaft end thumbwheel63 rotates in turn ashaft496 whose keyeddistal end498 in turn is engaged to and rotates apinion gear500 that is in gear engagement to aproximal spur gear502 that forms an outer proximal circumference of thesleeve union474. A cylindricaldistal tip504 of the keyeddistal end498 rotates within an axle hole (not shown) in thelower shell358. Rotation of theaft end thumbwheel63 thus rotates theprobe98.
• A distal elbowpneumatic fitting506 is supported in thelower shell358 to have anupper end508 communicating with thelateral passage486 of thesleeve union474 and anaft end510 attached to a ventpneumatic conduit512 supported by thelower shell358. The other end of the ventpneumatic conduit512 is attached to adistal end514 of a proximal elbow pneumatic fitting516 whose lateral end518 is open to atmosphere. Sizing of various components that vent atmospheric pressure through the lumen holes494 from the lateral end518 are such that a tissue sample may be withdrawn through theprobe tube490. Yet a greater pneumatic draw of air through thevacuum hose nib372 prior to severing a tissue sample results in a sufficient low pressure at theside aperture376 to prolapse tissue for severing.
• Anelongate rotation shaft520 proximally terminates in the leftsplined driveshaft382 that is supported for rotation by a left aftcylindrical bearing522 having a race about an outer circumference that receives an O-ring524 and is received in theaft wall425 of thelower shell358. Adistal end526 of theelongate rotation shaft520 is received for rotation in a left distalcylindrical bearing528 having a race about an outer circumference that receives an O-ring530 and that is received within thefront wall425 of thelower shell358. As thecutter carriage418 advances to position thecutter tube388 to slide past theside aperture376, thecutter spur gear460 engages aspur gear portion532 of theelongate rotation shaft520. Rotating thecutter tube388 in proportion to an amount of rotation advantages secures an effective severing of tissue. Eliminating rotation when not severing advantageously enhances retraction of tissue sample retraction.
• In use, inFIG. 11, thelocalization fixture16 has been installed into thebreast coil18. Theguidance assembly200 has been preset for a desired insertion point, a desired axis of penetration, and a depth of penetration. After thesleeve trocar102/introducer obturator104 have been inserted and imaged to confirm placement, theintroducer obturator104 is removed and theprobe98 of thebiopsy device14 is inserted, as depicted inFIG. 12. The shape of thesleeve trocar102 aligns theprobe98, visually assisted by lining up thearrow indicator378 on thedistal thumbwheel336 with the visible angle indicator on thethumbwheel230 of thesleeve trocar102. The surgeon may effect operation of thebiopsy device14 by depressing thetranslation rocker button366 andaft button368 on thekeypad62 while referencing status information about thebiopsy device14 on thedisplay area61. InFIG. 13, thedisplay area61 advantageously includes a cutterposition bar graph534 having distal andproximal indications536,538 that may be compared with how manylight segments540 have been illuminated to indicate progress of thecutter tube388 relative to theside aperture376. Theaft button368 may be toggled to cycle thebiopsy device14 through three modes, indicated by aposition LED indicator542, asample LED indicator544, and aclear LED indicator546 with a corresponding label that graphically depicts operation of the biopsy device in that mode. In particular, aposition mode depiction548 illustrates that thecutter tube388 may be advanced and retracted, for instance, closing theside aperture376 prior to insertion of theprobe98 into thesleeve trocar102. In asample mode depiction550, vacuum assistance is implemented, drawing sufficient air through thecutter tube388 to prolapse tissue into theopen side aperture376 that is maintained while translating thecutter tube388. In aclear mode depiction552, vacuum is maintained while fully retracting thecutter tube388 to retract a tissue sample. InFIG. 14, amarker device548 is deployed through the sample throughhole386 in thecylindrical hub388.
• It should be appreciated that any patent, publication, or other disclosure material, in whole or in part, that is said to be incorporated by reference herein is incorporated herein only to the extent that the incorporated material does not conflict with existing definitions, statements, or other disclosure material set forth in this disclosure. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein, will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material.
• While the present invention has been illustrated by description of several embodiments and while the illustrative embodiments have been described in considerable detail, it is not the intention of the applicant to restrict or in any way limit the scope of the appended claims to such detail. Additional advantages and modifications may readily appear to those skilled in the art.
• For example, while closed loop feedback sensing of a component that is related to cutter tube position has various advantages, determination of cutter position may be achieved in other ways consistent with the present invention. For instance, loading on drive components may be sensed at either full advancement and/or full retraction which are used to calibrate an estimate cutter position based on duration of a translation command.
• As another example, rather than discrete LED indicators and labeled depictions, applications consistent with aspects of the invention may include a graphical display (e.g., organic liquid crystal display) that is capable of interactive presentations of intuitive instrument status information. Alternatively or in addition, a touch screen capability may be incorporated to allow instrument control input as well as display.
• For another example, applications consistent with aspects of the present invention may be used in conjunction with different diagnostic imaging modalities (e.g., ultrasonic, computed tomography (CT).

Claims (30)

1.-17. (canceled)

18. A surgical system comprising:

a surgical device comprising:

a housing including a distal end;

a cutting element extending from the housing at the distal end, wherein the cutting element may be selectively rotated and translated; and

an adapter configured to selectively and detachably receive the surgical device and secure the surgical device thereto.

19. The system ofclaim 18, further comprising a cradle top, wherein the cradle top receives a portion of the surgical device and cooperates with the adapter to secure the surgical device to the adapter.

20. The system ofclaim 19, wherein the adapter includes a base section that receives a bottom portion of the cradle top and a wall portion that extends upwardly from the base section.

21. The system ofclaim 20, wherein the cradle top further comprises a latch that cooperates with a latch member formed on a portion of the base section of the adapter to selectively and detachably secure the cradle top to the adapter.

22. The system ofclaim 18, wherein the adapter further includes at least one mounting feature formed therein for securing the adapter to a selectively movable stage.

23. The system ofclaim 18, further comprising an introducer assembly that comprises an introducer hub and an introducer cannula.

24. The system ofclaim 23, wherein the introducer assembly is removably secured to a portion of the adapter.

25. The system ofclaim 24, wherein the introducer assembly is secured to a wall portion of the adapter that extends upwardly from a base portion of the adapter.

26. The system ofclaim 23, wherein the introducer hub includes a normally closed seal that may be selectively opened by the introduction of a portion of cutting element of the surgical device.

27. The system ofclaim 18, further comprising a console that supplies power and vacuum to the surgical device.

28. The system of claim1, further comprising a rotator operatively connected to the surgical device, wherein the rotator is selectively rotatable to position the cutting element.

29. The system ofclaim 28, further comprising a cutting element position indicator that indicates the position of the cutting element.

30. The system ofclaim 18, further comprising a fluid line for delivering fluid to said cutting element.

31. The system ofclaim 18, further comprising a trocar holder and a trocar, wherein the trocar holder may be selectively and detachably engageable with the adapter to position the trocar.

32. The system ofclaim 18, wherein the trocar may be selectively disengaged with the trocar holder.

33. A surgical system comprising:

a surgical device comprising:

a housing including a distal end;

a cutting element extending from the housing at the distal end, wherein the cutting element is configured to selectively rotate and translate relative to a tissue biopsy area;

a cradle top, wherein the cradle top receives a portion of the surgical device;

an adapter having an elongated base section and an upwardly extending wall, wherein the base section of the adapter is configured to selectively and detachably receive the cradle top, wherein the upwardly extending wall is configured to selectively and detachably receive a second surgical device; and

wherein the cradle top is selectively secured directly to the adapter by a latching mechanism.

34. The system ofclaim 33, wherein the adapter base section receives a bottom portion of the cradle top and the wall portion that extends upwardly is at a right angle from the base section.

35. The system ofclaim 34, wherein the latching mechanism comprises a latch that is operatively connected to a latch lever, wherein the latching mechanism is mounted to the cradle top, wherein the latch lever is operable to selectively and detachably secure the cradle top to the adapter.

36. The system ofclaim 33, wherein the adapter further includes at least one mounting feature formed therein for securing the adapter to a selectively movable stage.

37. The system ofclaim 33, further comprising an introducer assembly that comprises an introducer hub and an introducer cannula.

38. The system ofclaim 37, wherein the introducer assembly is removably secured to a portion of the adapter.

39. The system ofclaim 38, wherein the introducer assembly is secured to a wall portion of the adapter that extends upwardly from a base portion of the adapter.

40. The system ofclaim 37, wherein the introducer hub includes a normally closed seal that may be selectively opened by the introduction of a portion of cutting element of the surgical device.

41. The system ofclaim 33, further comprising a console that supplies power and vacuum to the surgical device.

42. The system ofclaim 33, further comprising an external rotator operatively connected to the surgical device, wherein the rotator is selectively rotatable to position the cutting element.

43. The system ofclaim 42, further comprising a cutting element position indicator that indicates the position of the cutting element.

44. The system ofclaim 33, further comprising a fluid line for delivering fluid to said cutting element.

45. A surgical system comprising:

a surgical device comprising:

a housing including a distal end;

a cutting element extending from the housing at the distal end, wherein the cutting element is configured to selectively rotate and translate relative to a tissue biopsy area;

an external rotator operatively connected directly to the surgical device, wherein the rotator is configured for selectively rotating the cutting element to a desired position;

a cradle top, wherein the cradle top receives a portion of the surgical device;

an adapter having an elongated base section and an upwardly extending wall, wherein the base section of the adapter is configured to selectively and detachably receive the cradle top and wherein the upwardly extending wall is configured to selectively and detachably receive a second surgical device, wherein the cradle top is selectively secured directly to the adapter by a latching mechanism; and

a trocar holder, wherein the trocar holder is selectively and detachably engageable with the adapter to position a separate trocar.

46. The system ofclaim 45, wherein the trocar is selectively disengaged with the trocar holder.

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