US20220386858A1 - Cleaning system for imaging devices - Google Patents

Abstract

An apparatus includes a tubular structure having a proximal end, a distal end, and a body extending between the proximal and distal ends, wherein the body includes a lumen for housing at least a part of an imaging device, and a fluid delivery channel that is fixed in position relative to the body, and an opening that is in fluid communication with the fluid delivery channel, wherein the fluid delivery channel has a first portion, and a second portion that forms an angle with an axis of the first portion.

Description

FIELD
• This application relates to a surgical instrument, and more particularly, to a surgical instrument for use in a vessel harvesting procedure.
BACKGROUND
• A significant area of cardiovascular disease involves the build up of plaque inside arteries that feed blood to the muscles of the heart. These deposits can cause occlusions which reduce or interrupt blood flow through these arteries. Coronary artery bypass grafting is a surgical procedure that has been used to address occlusions by creating an alternative blood path that bypasses the occluded artery.
• Before a bypass surgery is performed, a vessel needs to be harvested from a patient's body for use as a conduit in the bypass surgery. In endoscopic vessel harvesting (EVH) surgical procedures, a long slender cannula with a working lumen may be inserted inside a patient, and advanced into a tunnel next to the saphenous vein in the patient's leg, the radial artery in the patient's arm, or any other targeted vessel for grafting. A surgical tool housed at least partially within the working lumen of the cannula may be placed along the saphenous vein to dissect the vessel away from adjacent tissue, and to sever side-branch vessels along the course of the vessel to be harvested. The surgical tool may be configured to grasp a vessel, and may include one or more operative elements for cutting and/or sealing the vessel. While the surgical tool is used to operate on tissue, an endoscope may be used to view the procedure.
• Applicant of the subject application discovers that sometimes during the EVH procedure, blood, fatty tissue, debris, or other bodily substance may stick onto the lens of the endoscope, and/or may smear the endoscope lens. Thus, applicant of the subject application determines that it may be desirable to have a cleaning system for cleaning the lens of the endoscope during the EVH procedure, or during any procedure which requires the use of an endoscope or other types of imaging device.
SUMMARY
• In accordance with some embodiments, an apparatus includes a tubular structure having a proximal end, a distal end, and a body extending between the proximal and distal ends, wherein the body includes a lumen for housing at least a part of an imaging device, and a fluid delivery channel that is fixed in position relative to the body, and an opening that is in fluid communication with the fluid delivery channel, wherein the fluid delivery channel has a first portion, and a second portion that forms an angle with an axis of the first portion.
• In accordance with other embodiments, an apparatus includes a tube having a proximal end, a distal end, and a body extending between the proximal and distal ends, a lumen located in the body, wherein the lumen has a first portion that is parallel to a longitudinal axis of the body, and a second portion that forms an angle with the first portion, and an opening at a surface of the body, wherein the opening is in fluid communication with the second portion of the lumen.
• In accordance with other embodiments, an apparatus includes a shaft having a proximal end, a distal end, and a body extending between the proximal and distal ends, a lumen in the body, a retractor attached to a rod, wherein at least a part of the rod is located within the lumen, and the retractor is slidable relative to the shaft, wherein the retractor comprises a first portion and a second portion, the first portion having a first tip, the second portion having a second tip, and wherein the first and second tips are separated from each other to define a space therebetween for allowing a vessel to enter therethrough, and wherein the first and second portions define a region having a first cross-sectional dimension that is larger than a second cross-sectional dimension perpendicular to the first cross-sectional dimension.
• Other and further aspects and features will be evident from reading the following detailed description of the embodiments, which are intended to illustrate, not limit, the invention.
BRIEF DESCRIPTION OF THE DRAWINGS
• The drawings illustrate the design and utility of embodiments, in which similar elements are referred to by common reference numerals. These drawings are not necessarily drawn to scale. In order to better appreciate how the above-recited and other advantages and objects are obtained, a more particular description of the embodiments will be rendered, which are illustrated in the accompanying drawings. These drawings depict only typical embodiments and are not therefore to be considered limiting of its scope.
• FIG.1 illustrates a surgical instrument having a handle in accordance with some embodiments;
• FIGS.2A-2D illustrate a tool for cauterizing and cutting tissue in accordance with some embodiments;
• FIG.2E illustrates a retractor for engaging a vessel in accordance with some embodiments;
• FIG.3 is a perspective view of another tool for welding and cutting tissue in accordance with other embodiments, showing the tool having a pair of jaws;
• FIG.4A is a perspective cross sectional view of the pair of jaws ofFIG.3 in accordance with some embodiments;
• FIG.4B is a cross sectional view of the pair of jaws ofFIG.4A, showing the jaws being used to cut a side branch vessel;
• FIG.5 is a partial exploded view of some components of a surgical instrument in accordance with some embodiments;
• FIG.6A illustrates components of the handle ofFIG.1 in accordance with some embodiments;
• FIGS.6B and6C illustrate the handle ofFIG.1, showing a control being operated in different configurations;
• FIG.7 illustrates some components of the handle ofFIG.1 in accordance with some embodiments;
• FIGS.8 and9 illustrate additional components of the handle ofFIG.1 in accordance with some embodiments;
• FIG.10 illustrates an actuator of the handle ofFIG.1 in accordance with some embodiments;
• FIG.11 illustrates some components of the actuator ofFIG.10 in accordance with some embodiments;
• FIG.12 illustrates a surgical instrument having another handle in accordance with other embodiments;
• FIG.13 illustrates a surgical instrument having another handle in accordance with other embodiments;
• FIG.14 illustrates some components of the handle ofFIG.13;
• FIG.15 illustrates a surgical instrument having another handle in accordance with other embodiments;
• FIGS.16A and16B illustrate a distal end of a surgical instrument having a washing system in accordance with some embodiments;
• FIG.17 illustrates a component of the washing system ofFIG.16 in accordance with some embodiments;
• FIG.18 illustrates a cross sectional side view of the washing system ofFIG.16;
• FIG.19 illustrates another washing system in accordance with other embodiments;
• FIG.20 illustrates another washing system in accordance with other embodiments;
• FIG.21 illustrates another washing system in accordance with other embodiments;
• FIG.22 illustrates a technique for forming a distal portion of a tube that includes a fluid delivery channel;
• FIGS.23 and24 illustrate a distal end of a surgical instrument having a washing system in accordance with other embodiments; and
• FIG.25 illustrates a distal end of a surgical instrument having a washing system in accordance with other embodiments.
DETAILED DESCRIPTION
• Various embodiments are described hereinafter with reference to the figures. It should be noted that the figures are not drawn to scale and that elements of similar structures or functions are represented by like reference numerals throughout the figures. It should also be noted that the figures are only intended to facilitate the description of the embodiments. They are not intended as an exhaustive description of the invention or as a limitation on the scope of the invention. In addition, an illustrated embodiment needs not have all the aspects or advantages shown. An aspect or an advantage described in conjunction with a particular embodiment is not necessarily limited to that embodiment and can be practiced in any other embodiments even if not so illustrated.
• FIG.1 illustrates a surgical instrument9 in accordance with some embodiments. The surgical instrument9 includes ahandle11, anelongated body13 having aproximal end10 and adistal end12, and asurgical device14 located at thedistal end12 of thebody13. As used in this specification, the term “surgical device” refers to any device or component that may be used to operate on tissue (e.g., to treat, manipulate, handle, hold, cut, heat, or energize, etc., tissue). The surgical instrument9 also includes anelongated tube20 having a lumen for housing at least a part of theelongated body13. In some embodiments, the lumen may also house at least a portion of thesurgical device14. As used in this specification, the term “tube” or similar terms (e.g., “tubular structure”) may refer to any device that has a tubular configuration, wherein the device may have a unity configuration (e.g., formed as a single structure), or may be an assembly formed from assembling different components together. Also, as used in this specification, the term “lumen” or similar terms (e.g., “bore,” “opening,” etc.) may refer to any space that is defined by any components. For example, a lumen of a tube may refer to any space that is defined at least partially by the tube, by a component of the tube, or a component/device that is located within the tube.
• Theelongated tube20 has aproximal end22 that is coupled to thehandle11. Theproximal end10 of theelongated body13 is coupled to thehandle11 such that the body13 (and therefore the surgical device14) is rotatable and translatable relative to thetube20. Theelongated body13 may be rigid, or alternatively, flexible. Thehandle11 includes amanual actuator15 that is coupled to the surgical device14 (a tool) through linkage (not shown) within a bore of thebody13 for manually controlling an operation of thesurgical device14. Thehandle11 and theactuator15 may be made from insulative material(s) such as plastic. The details of thehandle11 will be described below.
• The surgical instrument9 is configured to be coupled to anenergy source30 during use. Theenergy source30 is configured to deliver radiofrequency energy in some embodiments. In other embodiments, theenergy source30 is direct current (DC) source configured to deliver DC energy.
• FIG.2A illustrates thesurgical device14 at the distal end of the surgical instrument9 in accordance with some embodiments. Thesurgical device14 includes afirst electrode102, asecond electrode104, and acutter106. Theelectrodes102,104 are fixedly coupled to the distal end of thebody13, and thecutter106 is slidably mounted to thebody13. Thecutter106 is configured to slide in and out of a slot at the distal tip of thebody13. Thefirst electrode102 has a loop configuration that is formed by a wire. Similarly, thesecond electrode104 also has a loop configuration that is formed by another wire. In other embodiments, theelectrodes102,104 may have other configurations (e.g., shape, size, and form). The first andsecond electrodes102,104 function together as a pair of bi-polar electrodes during use. As shown in the figure, theelectrodes102,104 are spaced apart from each other, thereby defining aspace108 therebetween for accommodating and securing a vessel (e.g., a side-branch vessel). As shown in the figure, theelongated tube20 may optionally includes anendoscopic lumen24 for housing anendoscope150 during use. Thesurgical device14 may be translated and/or rotated relative to the tube20 (and hence, relative to the endoscope) by operating theactuator15 at thehandle11. In some embodiments, the surgical instrument9 may further include theendoscope150.
• The distal end of thetube20 may optionally further include aretractor130 that is slidable relative to theelongated tube20 and thebody13. Theretractor130 is attached to tworods116a,116b(FIG.2B). As shown in the figure, the rods116 have a curvilinear configuration such that when they are deployed out of the lumen of thetube20, they curve away from the surgical tool/device14. In other embodiments, the rods116 may have a rectilinear or other configuration. As shown in the figure, thetube20 has acleaning device160 for cleaning the lens of theendoscope150 during use. Alternatively, one of the two rods116 may have a fluid delivery lumen for delivering fluid (e.g., saline, water) towards theendoscope150 for cleaning the lens of the endoscope during use.
• Thehandle11 may further include another actuator that is mechanically coupled by linkage (e.g., which may be the rods116 themselves, or may be another component, e.g., a shaft, that couples to the two rods116) housed within thetube20 for moving theretractor130 relative to thetube20. Theretractor130 is configured to engage amain vessel111 during use (FIG.2B). As used in this specification, the term “retractor” may refer to any device or component that is configured to engage a vessel. Thus, the term “retractor” should not be limited to any particular device or component that retracts or moves in a certain way. In some embodiments, theretractor130 may be considered to be a part of the surgical device/tool14 at the distal end of the surgical instrument9. As shown inFIG.2E, theretractor130 includes afirst portion132 with afirst tip136, and asecond portion134 with asecond tip138. Thetips136,138 define aspace140 therebetween for allowing a vessel to enter therethrough. The first andsecond portions132,134 define aspace141 for accommodating the vessel once the vessel enters through theopening140. In the illustrated embodiments, thespace141 has adimension142 that is longer to another dimension144 perpendicular to thedimension142. Thespace141 has an elliptical shape. In other embodiments, thespace141 may have other shapes, such as a circular shape.
• As shown inFIG.2B, theelectrodes102,104 may be configured (e.g., size, shaped, spaced apart by a certain distance, etc.) to capture a vessel110 (e.g., a side branch vessel), while theretractor130 engages with themain branch vessel111. Thecutter106 is omitted inFIG.2B for clarity purpose. Theelectrode104 has aramp portion114 that allows thevessel110 to be easily captured at thespace108. When thevessel110 is captured between theelectrodes102,104, energy may be delivered from anenergy source30 to theelectrodes102,104, which function as bi-polar electrodes to deliver RF energy, thereby heating the vessel. The vessel may be heated to a temperature that welds/seals the vessel. When thevessel110 is sealed, theactuator15 at thehandle11 may be operated to slidably move thecutter106 relative to theelectrodes102,104 from a first position (FIG.2C) to a second position (in the direction shown) to thereby cut the sealed vessel110 (FIG.2D). Such may be accomplished by providing a mechanical linkage housed within thebody13, which couples theactuator15 to thecutter106. As shown in the figures, thebody13 may include a protrusion at the interior wall that functions as adeflector152 for causing thecutter106 to move downward when atop portion154 of thecutter106 engages with thedeflector152.
• It should be noted that the tool at the distal end of the surgical instrument9 is not limited to the example shown inFIG.2, and that the surgical instrument9 may include other tools having different configurations in other embodiments.FIG.3 illustrates anothersurgical device14 at the distal end of the surgical instrument9 in accordance with other embodiments. In the illustrated embodiments, thesurgical device14 is a jaw assembly that includes a pair ofjaws321,323 for clamping, cutting, and sealing a vessel. Thejaw321 includes an electricallyconductive material325 which faces towards the opposingjaw323. Alternatively, or additionally, thejaw323 may include an electrically conductive material which faces towardsjaw321. The electricallyconductive material325 is in a form of an electrode, and is configured to provide heat during use. As used in this specification, the term “electrode” refers to a component that is for delivering energy, such as heat energy, RF energy, etc., and thus, should not be limited to a component that delivers any particular form of energy. The electricallyconductive material325 may be Ni-chrome, stainless steel, or other metals or alloys in different embodiments. Thejaws321,323 are configured to close in response to actuation (e.g., pressing, pulling, or pushing, etc.) of theactuator15, thereby clamping a vessel during use. In the illustrated embodiments, theactuator15 may be further actuated (e.g., further pressed, further pulled, or further pushed, etc.) to cause the electricallyconductive material325 to provide heat, thereby cutting and sealing the clamped vessel. In particular, when theactuator15 is further actuated, the electricallyconductive material325 is electrically coupled to an energy source30 (e.g., a DC source), which provides a current to the electrically conductive material (electrode)325, thereby heating theelectrode325. After the vessel is cut and sealed, theactuator15 may be de-actuated to open thejaws321,323, thereby stopping the delivery of heat. The mechanical linkage for translating operation of theactuator15 into closing and opening of thejaws321,323 may be implemented using cables, shafts, gears, or any of other mechanical devices that are known in the art. In other embodiments, a separate actuator (either on thehandle11 or otherwise coupled to thesource30, such as a separate foot pedal, etc.), may be provided for directing energy from theenergy source30 to theelectrode325. In such cases, theactuator15 is for closing and opening the jaw assembly, and is not used to cause theenergy source30 to deliver energy to theelectrode325.
• The linkage that mechanically couples thejaws321,323 to theactuator15 may be electrically insulated, for example, by silicone rubber, ceramic or other suitable non-electrically conductive material. In some embodiments, energy is supplied from theenergy source30 via electric line housed by thebody13 to the electrically conductive material (electrode)325 at jaw321 (and/or electrode at jaw323). In other embodiments, thebody13 may not include an electric line for delivering energy to theelectrode325. Instead, the linkage that mechanically couples thejaws321,323 to theactuator15 may be electrically conductive, and is used to deliver energy to theelectrode325 at jaw321 (and/or electrode at jaw323).
• As shown in the figure, the electricallyconductive material325 forms a heating element (electrode)340 that is disposed on a surface of thejaw321. Theheater element340 includes twoouter portions350,352, and an inner (middle)portion348. Theouter portions350,352 have respectiveouter terminals344,346 at their ends, and themiddle portion348 has aninner terminal342 at its end. Thus, theportions348,350,352 form an electrical heater circuit between thecenter terminal342 andouter terminals344,346. In the illustrated embodiments, theouter portions350,352 and theinner portion348 function as an electrode that is configured to deliver heat during operation. In particular, during operation, theterminal342 of theelectrode340 is electrically coupled to a first terminal of theDC source30, andterminals344,346 of theelectrode340 are electrically coupled to a second terminal of theDC source30, thereby allowing theelectrode340 to receive DC energy (e.g., for cutting and/or welding tissue). Theheating element340 may be formed using a single, flat sheet of electrically conductive material (e.g., Ni-chrome alloy, such as stainless steel at an outer layer, and Ni-chrome at an inner layer). This has reliability, manufacturing and cost advantages. It also reduces the likelihood of tissue build up and entrapment during use by not creating crevices into which the tissue can migrate.
• As shown inFIG.3, the jaw-operating mechanism and linkage thereof may be supported in ametal housing368 that includesmetal sliding pin370 andattachment pin372, all covered with an insulating layer of flexible material such as silicone rubber, or the like, to restrict energy discharges and to isolate tissue from moving parts. Also, such insulating cover retains the sliding and attachment pins370,372 in place to obviate the need for more expensive fasteners and mechanisms.
• During use, current from theDC source30 is conducted through thecenter terminal342, and flows in themiddle portion348 of theheater element340 and in parallel through the dualouter portions350,352 of theheating element340 to thecommon terminals344,346. Thus, forheater portions348,350,352 of equal thicknesses and equal widths, current density in themiddle portion348 is twice as high as the current density in each of theouter portions350,352 in response to electrical heater signal applied betweenterminal342 and thecommon terminals344,346. Of course, current densities in the center andouter portions348,350,352 may be altered (for example, by altering the relative widths of the heater portions, by altering resistances through selection of different materials, by altering both the widths and resistances, etc.) to alter the operating temperatures thereof in response to applied electrical heater signals. In operation, theouter heater portions350,352 may operate at a temperature sufficient to weld a tissue structure (e.g., a blood vessel) grasped between thejaws321,323, and thecenter heater portion348 may operate at a higher temperature sufficient to sever the grasped tissue structure intermediate the welded segments.
• Referring now toFIG.4A, there is shown a partial cross sectional perspective view of thejaws321,323 that illustrates the placement ofheater portions348,350,352. Thejaw321 includes astructural support364, and thejaw323 includes astructural support366. Thesupports364,366 may be made from any materials, such as ceramic, polymers, stainless steel, or other metals or alloys. In some embodiments, thestructural supports364,366 may be made from electrically conductive material that allows thesupports364,366 to function as electrical lines (e.g., for transmitting current, RF signal, etc.). Thestructural supports364,366 are covered byrespective layers374,376 of electrically insulating material, such as rubber, polymers, silicone, polycarbonate, ceramic or other suitable insulating material. Thestructural supports364,366 may include opening(s)378,380 along the length of therespective supports364,366 (FIG.4B). This allows thelayers374,376 to be overmolded onto therespective supports364,366 without using any adhesive to secure thelayers374,376 relative to therespective supports364,366. In particular, as thelayers374,376 are molded over therespective supports364,366, the molding material will flow through theopenings378,380, thereby mechanically anchoring thelayers374,376 relative to therespective supports364,366. As shown in the figure, thejaw323 includes a surface elevation (protrusion)354 substantially in alignment with themiddle portion348 in order to increase the compression force applied to a tissue structure grasped by thejaws321,323 and in contact with themiddle portion348. This promotes more efficient tissue severance, whileadjacent regions356,358 of lower surface elevations onjaw323 in alignment with theouter portions350,352 of the heater element introduce less compression force suitable for welding grasped tissue.
• In the illustrated embodiments, the cross sections of therespective jaws321,323 are not symmetrical. Instead,jaw321 has aprotrusion360, andjaw323 has aprotrusion362. Each of theprotrusions360,362 has a length so that when theprotrusions360,362 abut against a main branch vessel MB, the cutting point of the side branch vessel SB is at a prescribed distance D that is spaced away from the main branch vessel MB (FIG.4B). In the illustrated embodiments, the distance D is at least 1 mm, and more preferably, at least 1.5 mm. In other embodiments, the distance D may have other values, such as that which is sufficient to prevent or minimize thermal spread fromelectrode340 to the main branch vessel MB being harvested. As illustrated in the embodiments, theprotrusions360,362 are advantageous in that they help reduce thermal spread resulting from the cutting and sealing of the side branch vessel SB, thereby preserving the integrity of the main branch vessel MB that is being harvested. Also, theprotrusions360,362 obviate the need for an operator to guess whether the cutting of the side branch vessel SB is sufficiently far (e.g., beyond a minimum prescribed spacing) from the main branch vessel MB. Instead, the operator merely abuts theprotrusions360,362 of the jaw assembly against the main branch vessel MB, and theprotrusions360,362 will automatically place the jaw assembly relative to the side branch vessel SB so that the side branch vessel SB is cut at a minimum prescribed distance D from the main branch vessel MB. In some cases, if the surgical instrument9 is used to cut other types of tissue, such as nerves, organs, tendons, etc., theprotrusions360,362 also provide the same benefits of preserving the integrity of tissue that is being cut, and obviating the need for a user to guess what is the appropriate margin. As shown in the figure, theprotrusions360,362 diverge away from part of the side branch vessel SB. Such configuration allows part of the side branch vessel SB that is immediately next to the main branch vessel MB not to be clamped by the jaws. As a result, the end of the side branch vessel SB will fall away once it is cut. In other embodiments, the surgical instrument9 does not need to include bothprotrusions360,362. Instead, the surgical instrument9 may include eitherprotrusion360 orprotrusion362. Such configuration allows the device at the distal end of the instrument9 to have a smaller profile, thereby allowing a user to effectively maneuver the distal device in tight tissue conditions.
• As shown in the figure, theheater portion352 may protrude laterally along an outer edge of theclosed jaws321,323. Such configuration may allow theheater portion352 to deliver energy from the side of the jaw assembly even when the jaw assembly is closed. This may allow theheater portion352 to heat tissue from a side of the jaw assembly during an operation, such as, for bleeding control. In other embodiments, the jaws may not include theprotrusions360,362.
• As shown inFIG.3, the jaw assembly has a concave side and a convex side. In one method of use, while the jaw assembly is used to cut a side branch vessel SB, the jaw assembly is oriented so that its concave side faces towards the main branch vessel MB. The endoscope or viewing device may be placed next to the jaw assembly with the endoscope or viewing device viewing the concave side of the jaw assembly. This allows the user to better visualize the tip of the jaw assembly. Such configuration also provides a safety feature by allowing the user to know where the tips are during the vessel cutting procedure. Also as shown inFIG.3, the exposedelectrode portion352 is on the convex side of the jaw assembly while theprotrusions360,362 are on the concave side of the jaw assembly. The concavity provides extra spacing to protect the main branch vessel MB by keeping the distance along the side branch vessel SB even greater when it is grasped. Furthermore, having the exposedelectrode352 on the convex side creates an apex point that makes it easier to contact the side wall of the tunnel to address bleeding. In other embodiments, theprotrusions360,362 may be on the convex side of the jaw assembly. In such cases, during use, the convex side of the jaw assembly would be oriented towards the main branch vessel MB, thereby ensuring that the tips of the jaw assembly are away from the main branch vessel MB to enhance protection (e.g., preventing the tip of the jaw assembly from touching or injuring the main branch vessel MB).
• Referring now toFIG.5, there is illustrated an exploded view showing some components of the surgical instrument9. Specifically, theheater elements348,350,352 (conductive material325) are attached tojaw321. Bothjaws321,323 are pivotally attached viapin377 to themetal housing368.Pin370 is disposed to slide within the alignedslots379, and within the mating angledslots381,383 in the frame-mounts of the associated jaws to effect scissor-like jaw movement between open and closed positions as theslide pin370 is moved relative to thepivot pin377.Actuator rod336 is linked to theslide pin370, for example, viayoke399. In the illustrated embodiments, the proximal end of therod336 is mechanically coupled to theactuator15 at thehandle11. Axial movement of therod336 in one direction will cause theslide pin370 to move towards thepin377, thereby opening thejaws321,323. Axial movement of therod336 in the opposite direction will cause theslide pin370 to move away from thepin377, thereby closing thejaws321,323. Anelectrical conductor389 connects to theinner terminal342 of theheating element348,350,352, and theouter terminals344,346 are electrically connected in common toconductor391. In some embodiments, eitherconductor389 or391 may be housed within the wall or the bore of theelongated body13. In other embodiments, if therod336 is electrically conductive, eitherconductor389 or391 may be coupled to therod336. In such cases, therod336 will be electrically coupled to one terminal of theDC source30 during use. During use, theconductors389,391 may be electrically coupled to terminals of theDC source30, which provides a current to thereby heat up theheater elements348,350,352. Thecenter heater element348 is configured to cut a vessel (e.g., a side branch vessel) while theouter heater elements350,352 are configured to weld (seal) the vessel. In some embodiments, parts of thesurgical device14 may be insulated via an outer insulating layer for isolating certain components from biologic tissue and fluids.
• In any of the embodiments described herein, the jaw assembly at the distal end of the surgical instrument9 does not need to include all of the features described herein. For example, in some embodiments, the jaw assembly does not includeouter electrode portions350,352. Instead, the jaw assembly includes one electrode strip (like themiddle electrode portion348 described above) for cutting or sealing tissue. Furthermore, in other embodiments, thejaw323 may not have the raisedportion354. Instead, thejaw323 may have a flat surface that is for contacting theelectrode portions348,350,352. In addition, in further embodiments, thejaws321,323 may not include therespective protrusions360,362. Instead, the cross section of thejaw321/23 may have a symmetrical configuration. In other embodiments, protrusion(s) may be provided on both sides of the jaw assembly (e.g., one or more protrusions at the concave side of the jaw assembly, and one or more protrusions at the convex side of the jaw assembly). Such configuration provides buffering on both sides of the jaw assembly, and allows for correct placement of the jaw assembly regardless of which side (the concave or convex side) of the jaw assembly is oriented towards the main branch vessel MB during use. In further embodiments, instead of the curved configuration, the jaws could be straight. Also, in any of the embodiments described herein, instead of, or in addition to, using the jaw assembly for cutting and/or welding of vessel tissue, the jaw assembly may be used for transection of other types of tissue, such as fatty and connective tissue encountered during a vessel harvesting procedure or other procedures.
• FIG.6A illustrates thehandle11 of the surgical instrument9 ofFIG.1 in accordance with some embodiments. Thehandle11 includes asupport portion400, acarriage402 slidably mounted to thesupport portion400, theactuator15, and acoupler404 for coupling theactuator15 to thecarriage402. As used in this specification, the term “support portion” may refer to any part of a handle, relative to which thecarriage402 or theactuator15 may move, and does not need to provide any particular form of support for the remaining components of the handle. Thus, the term “support portion” should not be limited to a base or any other parts of the handle. During use, theactuator15 may be moved by a finger (e.g., thumb, index finger, etc.) laterally as indicated by the arrow shown. Movement of theactuator15 moves thecoupler404 relative to thecarriage402, thereby rotating the body13 (and hence, the surgical device/tool14) relative to thetube20.
• For example, theactuator15 may be moved laterally towards the right side (FIG.6B), thereby rotating thecoupler404 about an axis that is parallel to the longitudinal axis of thehandle11. Rotation of thecoupler404 relative to thecarriage402 actuates a gear system at thecarriage402, thereby turning the body13 (and hence, the surgical device/tool14) relative to thetube20 in the same direction as the rotation of thecoupler404. During use, either theactuator15 or thecoupler404 may be operated by the user's finger to rotate thetube20.
• Similarly, theactuator15 may be moved laterally towards the left side (FIG.6C), thereby rotating thecoupler404 about an axis that is parallel to the longitudinal axis of thehandle11. Such rotation of thecoupler404 relative to thecarriage402 actuates a gear system at thecarriage402, thereby turning the body13 (and hence, the surgical device/tool14) relative to thetube20 in the same direction as the rotation of thecoupler404. During use, either theactuator15 or thecoupler404 may be operated by the user's finger to rotate thetube20.
• FIGS.7-11 illustrate some components of thehandle11. As shown inFIG.7, thehandle11 includes agear system410 having afirst gear412 and asecond gear414 mounted between afirst carriage portion420 and asecond carriage portion422, wherein the first andsecond carriage portions420,422 together form thecarriage402. Thefirst gear412 includes asmall gear423 and alarge gear424, and is rotatably mounted to thecarriage402. Thesmall gear423 and thelarge gear424 are fixedly secured to each other. Thesecond gear414 is also rotatably mounted to thecarriage402, and engages with thesmall gear423. Thecarriage402 includes an opening430 for allowing a part of thelarge gear424 to be accessed. As shown in the figure, agear440 is fixedly secured to theproximal end10 of thebody13. Theproximal end10 with thegear440 extends through anopening442 at thecarriage402, thereby allowing thegear440 to be engaged with thesecond gear414. Also, as shown in the figure, wires that are connected to theelectrodes102,104 (in the embodiments ofFIG.2) or to terminals at the electrode325 (in the embodiments ofFIG.3) may be housed in acable441, which extends out of thebody13 and through a central opening at thegear440. In some embodiments, the wires may be coupled to theenergy source30. In other embodiments, if thehandle11 is also used to deliver energy to the surgical device/tool14, then at least one of the wires may be connected to a switch located in thehandle11.
• As shown inFIGS.8 and9, thecoupler404 includes afirst coupler portion450 and asecond coupler portion452, which are secured to each other via twoscrews454,456. Thecoupler404 also includes aprotrusion458, which is configured (e.g., sized and shaped) to engage with aslot459 at thecarriage402. Theslot459 guides the motion of thecoupler404 so that thecoupler404 will move relative to thecarriage402 in a defined path (e.g., in a curvilinear path). Thecoupler404 also includes aring gear460, which is configured to engage with thelarge gear424 at the opening430 of thecarriage402. Although theactuator15 and thecoupler404 have been described as separate components, in other embodiments, thecoupler404, or any of its components, may be considered to be a part of theactuator15. Also, although thecarriage402 and thecoupler404 have been described as separate components, in other embodiments, thecoupler404, or any of its components, may be considered to be a part of thecarriage402.
• Also, as shown in the figures, theactuator15 includes asurface471 for allowing manipulation of theactuator15 by a finger, andprotrusions470,472 for preventing the finger from sliding off the edge of theactuator15 during use. During use, theactuator15 may be moved laterally towards the right side (such as that shown inFIG.6B) to push thecoupler404 to rotate relative to thecarriage402 in the direction of actuation. The rotation of thecoupler404 relative to thecarriage402 causes thering gear460 to move relative to thecarriage402, thereby turning thelarge gear424 at theopening130. Since thelarge gear424 is fixedly secured to thesmall gear423, rotation of thelarge gear424 will rotate thesmall gear423 in the same direction as that of thelarge gear424. Rotation of thesmall gear423 turns thesecond gear414, which in turn, rotates thegear440 at theproximal end10 of thebody13. Thus, thesecond gear414 is for causing thebody13 and thesurgical device14 to rotate in the same direction as that of theactuator15. Also, during use, theactuator15 may be moved laterally towards the left side (such as that shown inFIG.6C) to push thecoupler404 to rotate relative to thecarriage402 in the direction of actuation. This will result in thebody13 rotating in the same direction as the direction of actuation, as similarly discussed.
• In some embodiments, the gear system may be configured (e.g., by selecting a desired gear ratio, gear size, number of gears, etc.) such that a relatively small amount of movement by theactuator15 will result in a rotation of thebody13 and thesurgical device14 through a large angular range. For example, in some embodiments, a rotation of theactuator15 through an angular range of +/−40° or less will result in turning of thebody13 and thesurgical device14 by +/−180° or more of 40°. Thus, by moving the actuator15 from the left-most position to the right-most position (or vice versa), thebody13 and thesurgical device14 may be turned 360°. Such configuration is beneficial in that it achieves amplification of motion for thebody13, thereby allowing thebody13 and thesurgical device14 to be rotated relative to thehandle11 efficiently. In should be understood that during use of the surgical instrument9, thebody13 does not always need to be rotated 360°. For example, a user may want to rotate thebody13 and thesurgical device14 by an angle θ_tthat is less than 360°. In such cases, the user may rotate theactuator15 by an angle θ_cto a desired position as determined by the user, thereby rotating thebody13 and thesurgical device14 by a desired angular range θ_t. As discussed, θ_tis larger than θ_c. In some embodiments, the gear system may be configured such that a movement by theactuator15 will result in a relatively smaller rotation of thebody13 and of thesurgical device14, for finer control of angular position. In such cases, θ_tis less than θ_c. In some embodiments, θ_tand θ_cmay be governed by the relationship: θ_t=k θ_c, wherein k represents an amplification factor when k>1, and represents a reduction factor when k<1. In some cases, k is a constant that is based on the design of the gear system.
• In the illustrated embodiments, theactuator15 is slidably coupled to a base500 (FIG.10). Thebase500 hasprojections480,482 on either side of thebase500 for engagement withrespective slots484,486 at the coupler404 (seeFIGS.9-11). Theactuator15 is also rotatably coupled to anarm476 via theshaft490. In particular, theshaft490 is housed within a slot formed by afirst actuator portion502 and a second actuator portion504 (FIG.11). Theshaft490 allows thearm476 to be pivotable relative to theactuator15 in the direction shown inFIG.10. Such tilting motion allows theactuator15 to be moved laterally (as inFIG.6B or6C) along an arc-path with a center that is offset from a longitudinal axis of thebody13. In other embodiments, if the arc-path of the actuator's15 movement has a center that coincides with a longitudinal axis of thebody13, then the tilting of thearm476 relative to theactuator15 is not required. Theactuator portion504 has aslot506 for slidable engagement with a protrusion512 at thebase500. Similarly, theactuator portion502 has a slot (with the same configuration as that of slot506) for slidable engagement with aprotrusion510 at thebase500. Thearm476 has asocket478 at its end for mating with asphere448 at an end of arod446 that extends out of thebody13. In some embodiments, therod446 may be coupled to thecutter106 in the embodiment ofFIG.2 for actuating movement of thecutter106. In other embodiments, therod446 may be theshaft336 in the embodiment ofFIG.5 for actuating movement of the jaw assembly. Thesocket478 together with thesphere448 forms a ball joint that allows thearm476 to move in different degrees of freedom with respect to therod446. In any of the embodiments described herein thearm476 and/or the base500 may be considered to be a part of theactuator15. In other embodiments, thearm476 and/or the base500 may be considered to be a part of thecoupler404.
• When thesurface471 of theactuator15 is pressed down towards thebase500, the slidable engagement between theslot506 and the protrusion512 at the base500 will guide theactuator15 to move in a curvilinear path (defined by the shape of the slot506). In the illustrated embodiments, the pressing of thesurface471 of theactuator15 will cause theactuator15 to move proximally relative to thebase500. This in turn causes the bottom end of thearm476 to move proximally to pull the ball joint, thereby pulling therod446 backward. This in turn pulls thecutter106 at the distal end of the surgical instrument9 proximally. Alternatively, in the case of the embodiment ofFIG.5, this will in turn pull therod336 proximally to close the jaw assembly. After thesurface471 is pressed down, therear surface520 of theactuator15 will be moved to a higher elevation. The user may press therear surface520 downward against the base500 so that theactuator15 is slidably moved distally relative to thebase500, as governed by the slidable engagement between theslot506 and the protrusion512. This in turn causes the bottom end of thearm476 to move distally to push the ball joint, thereby pushing therod446 distally. This in turn pushes thecutter106 at the distal end of the surgical instrument9 distally. Alternatively, in the case of the embodiment ofFIG.5, this will in turn push therod336 distally to open the jaw assembly.
• Also, during use, the actuator15 (or the coupler404) may be pushed distally so that thecarriage402 together with thebody13 and thesurgical device14 is translated distally relative to thetube20. Alternatively, the actuator15 (or the coupler404) may be pulled proximally so that thecarriage402 together with thebody13 and thesurgical device14 is translated proximally relative to thetube20.
• In some embodiments, thehandle11 may further includes an electrical contact, such that when theactuator15 is further pulled proximally, the electrical contact will close a conductive path, thereby allowing a current to be delivered from theenergy source30 to theelectrodes102,104, or to theelectrode325 at the jaw assembly. For example, thecable441 may carry a first wire connected to a first terminal at theelectrode325, and a second wire connected to a second terminal at theelectrode325. At the proximal end, the first wire may be electrically connected to the electrical contact at theactuator15, and a receiving contact (not shown) in thehandle11 may be coupled to a first terminal at theenergy source30. Also, at the proximal end, the second wire may be coupled to a second terminal at theenergy source30. During use, theactuator15 may be pulled all the way to the back to engage the electrical contact at theactuator15 with the receiving contact, thereby closing a conductive path formed by theenergy source30, theelectrode325, and the first and second wires, and allowing energy to be delivered from theenergy source30 to theelectrode325. In other embodiments, theactuator15 is not configured to cause delivery of energy from theenergy source30 to theelectrodes102,104, or to theelectrode325.
• As illustrated in the above embodiments, thehandle11 is advantageous in that it allows rotation and/or translation of the body13 (and hence, the surgical device14) relative to thetube20, and movement of a component of thesurgical device14, to be accomplished by manipulation of asingle actuator15. In some embodiments, the control may be configured to be operated like a joystick so that it can be used to rotate the tool14 (e.g. by moving the control left or right) and translate the tool14 (e.g., by moving the control forward or backward), wherein the translation of thetool14 may be done simultaneously or separately from the rotation of thetool14. Such joystick like control may also allow actuation of a component (e.g., a cutting element, a jaw, an electrode, etc.) of the tool14 (e.g. by providing a pivotable or depressable control surface, such as a button). In some cases, theactuator15 also allows delivery of energy from theenergy source30 to thesurgical device14. Thehandle11 is also advantageous in that it rotates thesurgical device14 by a large angular amount in response to a relatively small movement of theactuator15, thereby providing amplification of movement of thesurgical device14.
• During use of the surgical instrument9 to harvest a vessel, thetube20 is inserted into the patient's body through an opening (e.g., an incision through the patient's skin). Theendoscope150 may be placed inside thetube20 for viewing at distal end while a surgical procedure is being performed by thesurgical device14. In some cases, theendoscope150 may optionally include a light source and/or fiber optics for illuminating the target site. The distal end of thetube20 is placed next to a vessel that is desired to be harvested, such that the longitudinal axis of the tube is approximately parallel to the vessel. Theretractor130 is then deployed to engage and capture the vessel. Thetube20 is then advanced distal along the length of the vessel. When a side branch vessel is encountered, the user may then operate thehandle11 to deploy thesurgical device14 for cutting and/or sealing the side branch vessel. In particular, various components (e.g., theactuator15 and/or the coupler404) of thehandle11 may be operated to translate thesurgical device14 proximally or distally relative to the tube20 (as described herein), and/or to rotate thesurgical device14 relative to the tube20 (as described herein), thereby placing thesurgical device14 at an operative position relative to the side branch vessel for operation on the side branch vessel.
• Thehandle14 may then be further used to cause thesurgical device14 to cut and/or seal the side branch vessel. For example, for the embodiments ofFIG.2, theactuator15, or another actuator on thehandle11, or a control at theenergy source30, may be operated to cause energy to be delivered to theelectrodes102,104, thereby heating the side branch vessel, and sealing it. Theactuator15 may then be operated (or further operated) to pull thecutter106 proximally to cut the sealed vessel, as described herein. For the embodiments ofFIG.3, theactuator15 may be operated to close thejaws321,323 to grasp and compress the side branch vessel. Power is then supplied using theDC source30 to the heater elements48,50,52 (which function as resistive element that heats up in response to the delivered direct current) to effect tissue welds at tissues that are in contact with outer segments50,52, and to effect tissue cutting at tissue that is in contact with segment48.
• FIG.12 illustrates anotherhandle11 in accordance with other embodiments. In the illustrated embodiments, thehandle11 is similar to the embodiments described previously, except that thecoupler404 is configured to move laterally to control a rotation of the surgical device/tool14 independent of theactuator15. In such cases, theactuator15 and/or thecoupler404 is for translating the surgical device/tool14 longitudinally relatively to thetube20. Theactuator15 may also be used for moving a component (such as thecutter106, the jaw members, etc.) of the surgical device/tool14, as similarly discussed. However, unlike the embodiments ofFIGS.6-11, theactuator15 cannot be used to rotate thesurgical device14 relative to thetube20. Instead, rotation of thesurgical device14 relative to thetube20 is performed by moving thecoupler404 in either direction shown in the figure. Thehandle11 ofFIG.12 has components that are the same as those in the previous embodiments, except that theactuator15 is not configured to move laterally with thecoupler404. Thus, in the illustrated embodiments, theactuator15 may be coupled to a base (e.g., base500) that is fixedly secured to thecarriage402.
• FIG.13 illustrates anotherhandle11 in accordance with other embodiments. Thehandle11 includes aring600 located distal to theactuator15 for rotating the body13 (and hence the surgical device/tool14). Thering600 is circumferentially disposed at thehandle11 so that it may be conveniently manipulated by one or more fingers of a user. In the illustrated embodiments, the operation of thering600 is independent from the operation of theactuator15. Thus, theactuator15 and/or thecoupler404 may be used to translate thebody13 distally or proximally relative to thetube20 without involving thering600. Theactuator15 may also be used to move a component (e.g., thecutter106, the jaws, etc.) of the surgical device/tool14 without involving thering600. Also, thering600 may be used to rotate thebody13 without involving theactuator15 and thecoupler404.
• FIG.14 illustrates some components of thehandle11 ofFIG.13 in accordance with some embodiments. In the illustrated embodiments, thehandle11 includes many components that are the same as those ofFIGS.6-11. However, unlike the previous embodiments, thehandle11 does not include thecarriage402, and thecoupler404 is not rotatably coupled to thecarriage402. Instead, thecoupler404 is slidably coupled to thesupport400. This allows thebody13 and thesurgical device14 to be translated relative to thebody20 by translational movement of the coupler404 (or the actuator15) relative to thesupport400. Thehandle11 also includes thegear system410 having thegears412,414. However, unlike the previous embodiments ofFIG.6, thegear system410 is not coupled to themoveable carriage402. Instead, thegear system410 is coupled to a portion of thehandle11 that is fixed relative to thesupport400. As shown in the figure, thering600 has aring gear602 located circumferentially at an interior surface of thering600. Thering gear602 is configured to engage with thegear412 during use. Thebody13 has a non-circular cross section (such as a square section) so that it can transmit rotation from the gear train to the tool, as well as allow sliding of the tool back and forth. In other embodiments, thebody13 can have other cross sectional shapes.
• In some embodiments, thegear system410 may be configured (e.g., by selecting a desired gear ratio, gear size, number of gears, etc.) such that a relatively small amount of movement by thering600 will result in a rotation of thebody13 through a large angular range. For example, in some embodiments, a rotation of thering600 through an angular range of +/−40° or less will result in turning of thebody13 by +/−180° or more. Thus, by turning thering600 over a small angular range, thebody13 may be turned 360°. Such configuration is beneficial in that it achieves amplification of motion for thebody13, thereby allowing thebody13 to be rotated relative to thehandle11 efficiently. In should be understood that during use of the surgical instrument9, thebody13 does not always need to be rotated 360°. For example, a user may want to rotate thebody13 by an angle θ_tthat is less than 360°. In such cases, the user may rotate thering600 by an angle θ_cto a desired position as determined by the user, thereby rotating thebody13 by a desired angular range θ_t. As discussed, θ_tis larger than θ_c. In some embodiments, the gear system may be configured such that a movement by theactuator15 will result in a relatively smaller rotation of thebody13 and of thesurgical device14, for finer control of angular position. In such cases, θ_tis less than θ_c. In some embodiments, θ_tand θ_cmay be governed by the relationship: θ_t=k θ_c, wherein k represents an amplification factor when k>1, and represents a reduction factor when k<1. In some cases, k may be a constant that is based on the design of the gear system.
• FIG.15 illustrates anotherhandle11 in accordance with other embodiments. Thehandle11 includes a plurality ofwheels700 located at a periphery of thehandle11. Thewheels700 are rotatably coupled to the carriage702 through thegear system410 that is housed inside the carriage702. In the illustrated embodiments, thehandle11 is similar to the embodiments ofFIG.6, except that it doesn't have thecoupler404, and rotation of thebody13 is not controlled by theactuator15. In such cases, theactuator15 and/or thewheels700 may be pushed distally or pulled proximally for translating the surgical device/tool14 longitudinally relatively to thetube20. Theactuator15 may also be used for moving a component (such as thecutter106, the jaw members, etc.) of the surgical device/tool14, as similarly discussed. However, unlike the embodiments ofFIGS.6-11, theactuator15 cannot be used to rotate thesurgical device14 relative to thetube20. Instead, rotation of thesurgical device14 relative to thetube20 is performed by turning any one of thewheels700. Thehandle11 ofFIG.15 has components that are the same as those in the previous embodiments, except that the handle does not include thecoupler404, and theactuator15 is not configured to move laterally. Thus, in the illustrated embodiments, theactuator15 may be coupled to a base (e.g., base500) that is fixedly secured to thecarriage402.
• In some embodiments, thegear system410 may be configured (e.g., by selecting a desired gear ratio, gear size, number of gears, etc.) such that a relatively small amount of movement by any one of thewheels700 will result in a rotation of thebody13 through a large angular range. For example, in some embodiments, a rotation of thewheel700 through an angular range of +/−40° or less will result in turning of thebody13 by +/−180° or more. Thus, by turning thewheel700 over a small angular range, thebody13 may be turned 360°. Such configuration is beneficial in that it achieves amplification of motion for thebody13, thereby allowing thebody13 to be rotated relative to thehandle11 efficiently. In should be understood that during use of the surgical instrument9, thebody13 does not always need to be rotated 360°. For example, a user may want to rotate thebody13 by an angle θ_tthat is less than 360°. In such cases, the user may rotate thewheel700 by an angle θ_cto a desired position as determined by the user, thereby rotating thebody13 by a desired angular range θ_t. As discussed, θ_tis larger than θ_c. In some embodiments, the gear system may be configured such that a movement by theactuator15 will result in a relatively smaller rotation of thebody13 and of thesurgical device14, for finer control of angular position. In such cases, θ_tis less than θ_c. In some embodiments, θ_tand θ_cmay be governed by the relationship: θ_t=k θ_c, wherein k represents an amplification factor when k>1, and represents a reduction factor when <1. In some cases, k is a constant that is based on the design of the gear system.
• It should be noted that thehandle11 should not be limited to the examples described previously, and that thehandle11 may have different configurations in different embodiments. For example, in other embodiments, thehandle11 may not include all of the features described previously. Also, in other embodiments, thehandle11 may have other shapes and forms. Furthermore, in any of the embodiments described herein, in addition to the control (e.g., theactuator15, thecoupler404, thering600, the wheel(s)700, or any combination of the foregoing) described, thehandle11 may further include additional control(s) for performing other functions. As used in this specification, the term “control” may refer to any of the components of thehandle11, or any combination of the components of thehandle11.
• Also, it should be noted that the surgical device/tool14 of the surgical instrument9 should not be limited to the examples described above, and that the surgical instrument9 may includeother tools14 in other embodiments. For example, although the above embodiments have been described with reference to thesurgical device14 being for clamping, cutting, and/or sealing vessel (e.g., saphenous vein, an artery, or any other vessel), in other embodiments, thesurgical device14 may be any have different configurations, and different functionalities. For example, in other embodiments, thesurgical device14 may be clip appliers or grasping jaws for grasping other types of tissues.
• Thecleaning system160 for cleaning the lens of theendoscope150 will now be described with reference toFIGS.16-21. For clarity purpose, thesurgical device14 and theretractor130 are omitted in these figures.
• FIGS.16A and16B illustrate thecleaning system160 that includes atubular structure800 in accordance with some embodiments. As shown inFIG.17, thetubular structure800 has adistal end801, aproximal end802, and abody803 extending between theends801,802. Thetubular structure800 also has afirst channel804 that extends along the length of thetubular structure800, and asecond channel806 that forms an angle with thefirst channel804. In the illustrated embodiments, the angle may be a value that is between 20° and 40°, such as 30°. In other embodiments, the angle may be other values, as long as the fluid can be delivered to the lens of theendoscope150. Thesecond channel806 is in fluid communication with thefirst channel804, and ends with anopening808 that is located at an exterior surface of thetubular structure800. Thetubular structure800 also includes aprotrusion810 that is configured to mate with a slot at the tube20 (FIG.16A). In other embodiments, theprotrusion810 is optional, and thetubular structure800 may not include theprotrusion810. Thetubular structure800 may be secured to thetube20 via an adhesive. In further embodiments, thestructure800 and the distal portion of thetube20 may be integrally formed by a molding process to have a unity configuration.
• As shown inFIG.16B, thecleaning system160 is located at a radial angle relative to the lens of theendoscope150 such that thecleaning system160 is not directly across from theendoscope150. Such configuration allows thetool14 to be directly across theendoscope150 without having thecleaning system160 interfering with thetool14. Also, such configuration allows theopening808 to be aimed at the lens of theendoscope150 such that the fluid injection path does not intercept thetool14 and thesupport structures116a,116bof theretractor130. In other embodiments, thecleaning system160 may be directly across from theendoscope150. In such cases, thetool14 may be located at a radial angle relative to theendoscope150 such that it is not directly across from theendoscope150. Thus, in other embodiments, thecleaning system160 may be located at any position relative to the endoscope150 (e.g., thecleaning system160 may be implemented at any location along the circumferential cross section of the tube20). Also, in other embodiments, thecleaning system160 may be configured so that theopening808 is pointed towards other directions (e.g., for providing cleaning function at other target sites).
• FIG.18 illustrates a partial side view of the distal end of thetube20 in accordance with some embodiments. As shown in the figure, theproximal end802 of thetubular structure800 is coupled to afluid delivery tube826. During use, the proximal end of thefluid delivery tube826 is connected to a fluid source, such as a syringe. If the user determines that the lens of theendoscope150 needs to be cleaned, the user may operate on the syringe to cause fluid (e.g., saline, water, etc.) to be delivered from the syringe to thetubular structure800 via thetube826. The fluid is delivered through thechannel804 and thechannel806, and out of theopening808. As shown in the figure, thesecond channel806 is oriented such that fluid exiting from theopening808 is directed proximally towards the lens of theendoscope150, thereby cleaning the lens of theendoscope150.
• It should be noted that thecleaning system160 should not be limited to the example described previously, and that thecleaning system160 may have other configurations in other embodiments. For example, in other embodiments, thecleaning system160 may include atubular structure800 that is in a form of a bent tube (FIG.19). In other embodiments, instead of having a tubular structure coupled to thefluid delivery tube826, thecleaning system160 may include just thefluid delivery tube826 having a bent distal end (FIG.20). Thefluid delivery tube826 may be secured to thetube20 using an adhesive or a mechanical coupler. In any of the embodiments described herein, thetube20 may include a distal section that is mechanically attached (e.g., via an adhesive or a mechanical coupler) to a remaining part of thetube20. In such cases, thecleaning system160 may be coupled to the distal section of thetube20.
• In further embodiments, thecleaning system160 may be implemented by providingfluid delivery channels840,842 within the wall of the tube20 (FIG.21). In such cases, the interior surface of the wall of thetube20 will include anopening844 for allowing fluid to be exiting therethrough. In some embodiments, thetube20 may include a distal section that is mechanically attached (e.g., via an adhesive or a mechanical coupler) to a remaining part of thetube20. In such cases, thecleaning system160 may be implemented at the distal section of thetube20.
• Also, as shown in the above embodiments, the distal end of thetube20 does not have any wall near the location where theendoscope150 is located. In particular, thetube20 has a cut-outsection888 at the distal end next to theendoscope150, which allows fluid from thecleaning system160 to escape without being trapped inside the tube20 (wherein trapped fluid may obstruct the view of the endoscope). Thetube20 with the cut-out section may be formed by removing a section of a tube that is used to construct thetube20. Alternatively, thetube20 with the cut-out section may be formed by molding thetube20 to have the configuration shown. In other embodiments, the distal end of thetube20 does not have the cut-out section.
• In some embodiments, the distal end of thetube20 may be a separate component that is separately formed from a remaining part of thetube20, and is then coupled to the remaining part of thetube20. For example, the distal end of thetube20 may be molded to have an unity configuration. In some cases, such distal end of thetube20 may be molded to have the cut-outsection888, and thefluid delivery channels840,842 (such as those shown inFIG.21). One technique for forming thechannel842 at thedistal component889 of thetube20 is to place apin890 relative to the material of thedistal component889 like that shown inFIG.22. Thepin890 may be longer and may have a bent configuration so that it can also be used to form thechannel840. Such technique may result in thedistal component889 having anopening892 through the wall of thecomponent889.Such opening892 may be used to drain fluid during use. For example, in some cases, cleaning fluid that is delivered from theopening844 may escape through the cut-outsection888 and through theopening892.
• Also, in any of the embodiments described herein, instead of using thecleaning system160 to clean the lens of the endoscope, thecleaning system160 may be used to clean other devices, such as another imaging device, a window of a component that is used to house an endoscope or another type of imaging device, or other surgical tools.
• It should be noted that thedistal end20/889 of the surgical instrument is not limited to the configurations described previously, and that thedistal end20/889 of the surgical instrument may have other configurations in other embodiments. For example, in other embodiments, instead of the configuration shown inFIGS.16-17, the distal end of thetube20/component889 may have the configuration shown inFIGS.23 and24. Also, in other embodiments, instead of the configuration shown inFIG.21, the distal end of thetube20/component889 may have the configuration shown inFIG.25.
• Although particular embodiments have been shown and described, it will be understood that they are not intended to limit the present inventions, and it will be obvious to those skilled in the art that various changes and modifications may be made without departing from the spirit and scope of the present inventions. The specification and drawings are, accordingly, to be regarded in an illustrative rather than restrictive sense. The present inventions are intended to cover alternatives, modifications, and equivalents, which may be included within the spirit and scope of the present inventions as defined by the claims.

Claims (21)

1. An apparatus, comprising:

a tubular structure having a proximal end, a distal end, and a body extending between the proximal and distal ends, wherein the body includes a lumen for housing at least a part of an imaging device; and

a fluid delivery channel that is fixed in position relative to the body; and

an opening that is in fluid communication with the fluid delivery channel;

wherein the fluid delivery channel has a first portion, and a second portion that forms an angle with an axis of the first portion.

2. The apparatus ofclaim 1, wherein at least a part of the fluid delivery channel is located within a wall of the body.

3. The apparatus ofclaim 1, wherein at least a part of the fluid delivery channel comprises a tube that is coupled to the tubular structure.

4. The apparatus ofclaim 3, wherein the tube has a length that is shorter than a length of the tubular structure.

5. The apparatus ofclaim 3, wherein the tube has a protrusion for mating with a slot at a wall of the tubular structure.

6. The apparatus ofclaim 3, wherein the tube has a lumen that forms a part of the fluid delivery channel, and wherein the opening is located at a wall of the tube.

7. The apparatus ofclaim 1, wherein the first portion of the fluid delivery channel is parallel to a longitudinal axis of the tubular structure.

8. The apparatus ofclaim 1, wherein at least a part of the fluid delivery channel comprises a tube having a bent configuration.

9. The apparatus ofclaim 8, wherein an angle of the bent is a value that is between 20° and 40°.

10. The apparatus ofclaim 1, further comprising a handle that is coupled to the proximal end of the tubular structure.

11. The apparatus ofclaim 1, further comprising:

an elongated shaft having a proximal end and a distal end; and

a handle coupled to the proximal end of the elongated shaft;

wherein the proximal end of the tubular structure is coupled to the distal end of the elongated shaft.

12. The apparatus ofclaim 11, wherein the tubular structure is transparent.

13. The apparatus ofclaim 1, further comprising a retractor that is slidable relative to the lumen.

14. The apparatus ofclaim 13, wherein the retractor is configured to engage with a vessel.

15. The apparatus ofclaim 13, wherein the retractor defines a space that has an elliptical shape.

16. The apparatus ofclaim 1, wherein the tubular structure is configured for attachment to a distal end of a shaft.

17. The apparatus ofclaim 16, wherein the shaft is a part of a vessel harvesting device.

18. The apparatus ofclaim 1, wherein the opening is for delivering fluid towards the lumen where the imaging device is or will be located.

19. The apparatus ofclaim 1, wherein the distal end of the tubular structure has a cut-out section.

20. The apparatus ofclaim 1, wherein the tubular structure is integrally formed to have the fluid delivery channel and the opening.

21.-37. (canceled)

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