US3844272A - Surgical instruments - Google Patents

Abstract

Surgical instrument for taking tissue specimens in which a pair of coaxial tubular members are provided which are formed to have a tissue specimen receiving or flow compartment or provisions for holding the tissue. Each of the tubular members has a cutting or a holding edge and suction is provided through the instrument for drawing the specimen into the tissue receiving or tissue flow compartment. Movement of one of the tubular members relative to the other causes the tissue specimen to be cut and placed in the compartment or to be just cut and held in place.

Description

United StatesPatent 11 1 anko Oct. 29, 1974 SURGICAL INSTRUMENTS 3,526,219 9/1970 13111611111111 1211/2 3,606,878 9/1971 Kellogg 1211/2 B [76] lnvemor- Bank, 1496 Mayflower 3,614,953 10 1971 Moss 1211 3105 Ave., Bronx, NY. 10461 [22] Filed: Apr. 4, 1972 Primary Examiner-Lawrence W. T rapp [211 pp No 241 019 Attorney, Agent, or Firm-Darby & Darby US. Cl. 128/2 B, 128/305, 128/276 Int.Cl A6lb 5/00 Field ofSearch 128/2 R, 2 B, 305, 276,

References Cited UNITED STATES PATENTS 3/1965 Guillant 128/2 B [57] ABSTRACT Surgical instrument for taking tissue specimens in which a pair of coaxial tubular members are provided which are formed to have a tissue specimen receiving or flow compartment or provisions for holding the tissue. Each of the tubular members has a cutting or a holding edge and suction is provided through the instrument for drawing the specimen into the tissue receiving or tissue flow compartment. Movement of one of the tubular members relative to the other causes the tissue specimen to be cut and placed in the compartment or to be just cut and held in place.

21 Claims, 33 Drawing Figures PATENIEUUEIZQIQI m'uw FIG. 20B FIG. 20C

FIG. 22 FIG. 22c

1 SURGICAL INSTRUMENTS CROSS-REFERENCE TO RELATED APPLICATION This application is a continuation-in-part of applicants copending application Ser. No. 799,476, filed Feb. 14, 1969 and now U.S. Pat. No. 3,732,858, which is in turn a continuation-in-part of the then copending application Ser. No. 762,286, filed Sept. 16, 1968 and now U.S. Pat. No. 3,528,425. All of said applications are assigned to the assignee of the subject application.

In the foregoing patent applications various forms of instruments are disclosed and claimed which are adapted for the cutting, holding and removal of tissue from the body. The present invention also relates to instruments of the same general type. More specifically, the subject application includes instruments adopted for cutting tissue members as bands and membranes in the eye and instruments which are adopted for holding and working tissue members, in the manner of forceps. In addition the invention also relates to instruments of the type wherein a tissue sample of a portion of the body of an animal or a human being may readily be taken.

The preferred embodiments of the instruments of the present invention are provided with a suction arrangement wherein the tissue is drawn into the active portion of the instrument for cutting, holding or removing the tissue material. Further these instruments are constructed so that the relative displacement of the holding or cutting surfaces with respect to each other may be easily controlled so that a predetermined amount of tissue can be held, cut or removed at any one time.

In accordance with the invention, surgical type instruments are provided having first and second tubular coaxial members. Each of the members has a holding or cutting edge which cooperates with the holding or cutting edge of the other member. In the preferred embodiment of the invention for removal of a tissue specimen, the two members have an opening adjacent the respective cutting edges and the openings can be aligned to provide access to a tissue receiving compartment, all or a portion of which is formed in one of the members. The instrument is also provided with a manually or mechanically operated suction system which communicates with the tissue receiving compartment of one of the members so that the tissue specimen can be drawn into the compartment. Once the desired quantity of tissue is present in the compartment, the two members are rotated relative to each other so that the respective cutting edges thereon coact to cut off the specimen and place it into the compartment. In another embodiment of the invention, one of the members has an opening into a tissue receiving compartment which is surrounded by a cutting edge. The other members is axially slidable and has a cutting edge which cuts off the specimen to be taken.

Embodiments of the instruments of the present invention are also preferably provided with an arrangement to limit the relative rotation of the two tubular members so that the user can readily tell when the tissue receiving compartment of the instrument is open, to receive a tissue specimen, and closed with the specimen cut off and held in the compartment.

The instruments of the present invention also have the capability of moving one of the tubular members longitudinally, relative to the other member, to control the size of the opening into the tissue receiving compartment and thereby the size of the specimen to be cut. Further, various types of instruments are disclosed which have the capability of providing suction as well as irrigation into the area being worked upon. An arrangement for ejecting the severed tissue is also provided.

It is therefore an object of the present invention to provide instruments for taking tissue specimens.

A further object is to provide an instrument for taking tissue specimens in which suction can be provided via the instrument to draw the specimen to be taken into a tissue receiving compartment.

Another object is to provide surgical instruments for taking tissue specimens which can provide both suction and irrigation to the area of the tissue being operated upon.

Still a further object is to provide surgical instruments for taking tissue specimens in which a stop arrangement is provided for two members which are movable relative to each other so that the user can readily tell when the instrument is in a position to receive a specimen and when it is closed with the specimen trapped therein.

Other objects and advantages of the present invention will become more apparent upon reference to the following specification and annexed drawings, in which:

FIG. 1 is a perspective view of a preferred embodiment of the invention for removing a tissue sample;

FIG. 2 is a plan view of the instrument of FIG. 1 shown partly broken away and partly in cross-section;

FIG. 3 is a cross-sectional view of the instrument of FIGS. 1 and 2 taken along lines 33 of FIG. 2;

FIG. 4 is an enlarged fragmentary view of the tip of the instrument in cross section of the instrument of FIG. 1;

FIG. 5 is a cross-sectional view taken along 55 of FIG. 4;

FIG. 6 is a view similar to FIG. 4 showing the operative end of the instrument in the closed position;

FIG. 7 is a cross-sectional view of FIG. 6 taken along lines 77;

FIG. 8 is a fragmentary view of a portion of the instrument of FIGS. 1 and 2 showing an alternative type of arrangement for providing axial motion of a portion of the instrument;

FIG. 9 is a plan view, partly broken away and party in cross-section, of another embodiment of the subject invention;

FIGS. 10 and 11 are cross-sectional views of the instrument of FIG. 9 taken respectively along lines 10-l0 and ll1l;

FIG. 12 is a fragmentary view of the front portion of another embodiment of the invention taken in crosssection;

FIGS. 13 and 14 are fragmentary views of the front portion of still a further embodiment of the invention, shown in cross-section, and showing respectively the open and closed positions of the instrument;

FIGS. 12A and l3A are views corresponding to FIGS. 12 and 13 showing further embodiments of the invention;

FIGS. 15 and 16 are fragmentary views of the front portion of yet a further embodiment of the invention,

showing respectively the open and closed positions of the instrument, in cross-section;

FIGS. 17A and 178 show a plan view and an enlarged fragmentary view, both partly in section, of another instrument and its front portion, respectively;

FIGS. 18A and 18B are side and cross-sectional views of the front portion of another embodiment of instrument;

FIG. 19 is a plan view, partially in section, of the front portions of another form of instrument;

FIGS. MIA-E are various views of a type to instrument constructed as a scissors;

FIGS. 21A and 21B are a plan view, in cross-section, and a front view of a type of instrument constructed as a forceps;

FIGS. 2llA-21C are various views of a type of instrument constructed as a knife.

FIGS. 1-8 show a preferred embodiment of the instrument of the present invention for taking a tissue sample from the body of an animal or a human being. Theinstrument 10 includes a firsttubular member 12 which extends substantially the entire length of the instrument and whose terminal (distal)operative end 12a is coaxial with a secondtubular member 19.Member 12 has an internalfluid flow passage 13. Aconduit 14 is shown attached to the proximal end of thetubular member 12 in communication with theflow passage 13. Theconduit 14 is in turn connected to a suitable apparatus (not shown) for applying suction.

An intermediate portion of the firsttubular member 12 passes through ahollow housing 16 of generally cylindrical shape which has a tapered downfront section 17. An intermediate distal portion of firsttubular member 12 undergoes a reduction in diameter withinhousing 16 to form theoperative portion 12a. Similarly, the secondtubular member 19 is a reduced diameter extension ofhousing 16.

The open end ofhousing 16 remote from secondtubular member 19 hasscrew threads 21 thereon to accept acap 23 which seals off the housing. An O-ring 24 is held against the end wall of thecap 23 and acollet 27 which is fastened to thetubular member 12. This seals theopening 28 in the cap end wall. Astop pin 31 projects axially from thecollet 27 toward the front of the instrument within thehousing 16 to engage anupstandin stop lug 35 mounted on the internal wall of housing upstanding A knob having a central bore through which firsttubular member 12 passes is held to themember 12 by aset screw 42. The knob may have a knurled outer surface to provide better gripping action. Rotation of theknob 40 turns thetubular member 12 and itsextension 12a relative to themember 19. The rotation oftubular member 12 is limited by thestop pin 31 engaging thestop lug 35.

As shown best in FIGS. 4 and 6, theflow passage 13 in firsttubular member 12 terminates at asolid end wall 46. Ahead of the wall, the distal end ofmember 12 is formed with a generallycupshaped member 48 which forms a portion of a tissue specimen receiving compartment. The upper edge of thecup 48 is formed with acutting edge 49 completely thcrearound. This edge is sharp all aroundcompartment 48 with the exception of the rear portion adjacent thetubular mem ber 120. As seen in FIGS. 5 and 7, thecup 48 has an interior surface which is substantially semi-cylindrical in shape. Theleading end wall 48a is tapered outwardly somewhat while the trailing end wall 4% is tapered inwardly somewhat. The lower portion of the wall ofcup 48 is and an is formed with one ormore flow passages 51. The two interior side walls of the compartments are straight and tangent to the curved bottom wall. This facilitates the removal of tissue from the compartment.

The front end of secondtubular member 19 is solid and is tapered to have aneedle point 55. This permits the active end of the instrument to be inserted directly into the body from which the specimen is being taken. To the rear of the needle point 55 a hollowtubular pocket portion 19a (see FIG. 6) ofmember 19 is of generally semi-cylindrical shape which is complementary overall to the outer surface ofcup 48 of thetubular member 12. This permitscup 48 to be rotated within thepocket 19a.

The upper edge ofportion 19a (FIG. 7) of secondtubular member 19 is also sharpened to provide acutting edge 59, as shown in FIGS. 5 and 7. Cuttingedge 49 is on the outside ofcup 48 whileedge 59 is on the inside ofpocket 19a. Consequently, when the two edges oppose each other, a cutting action can take place. The upper cutting edges 49 and 50 ofcup 48 and themember 19a can be substantially flush when themember 12 is rotated to havecup 48 in the open position shown in FIG. 4.

Aspace 62 is provided between the lower wall of thecup 48, which contains thepassages 51, and the lower wall ofsection 19a ofmember 19. It should be understood that only oneopening 51 can be used. Thespace 62 extends the length ofcup 48 to apocket 51 close to the front end ofsection 190, adjacent the inner end ofneedle 55. Aflow passage 15 is formed in the wall oftubular member 12a to the rear of thesolid end 46.Passage 15 communicates with the throughflow passage 13 ofmember 12 and thespace 62 betweencup 48 andsection 19a oftubular member 19. As can be seen, a complete flow passage is provided from the suction orpressure line 14 through thepassage 13 oftubular member 12, theopening 15, theelongated passage 62 and then through theopenings 51 into thecup 48.

In operation of the instrument of FIGS. 1-8, theneedle end 55 is inserted through the skin of the subject into the appropriate tissue from which the sample is to be taken. The instrument is inserted in its closed position. This prevents tissue particles from collecting incompartment 48 during penetration. When in place,member 12 is rotated to the open position shown in FIGS. 4 and 5. Suction is then applied through theconduit 14 which aids in drawing the tissue to be sampled into thecup 48 through theflow passage 62 previously described. Any blood or other liquid in the area from which tissue is being sampled is aspirated through thepassages 51 and out of the instrument through thepath 62, 15, 13 and 14. Once the tissue is in the cup the operator rotates thetubular member 12 by turning theknob 40. The leadingcutting edge 49 ofcup 48, depending upon the direction of rotation ofmember 12, cooperates with thecutting edge 59 onsection 19a and cuts off the tissue sample as the member is rotated. Completion of the rotation ofmember 12 to the position shown in FIGS. 6 and 7 causes the tissue specimen to be cut off completely and separated from the rest of the anatomy.

As shown in FIGS. 6 and 7, with the instrument in the closed position a compartment is formed between thecup 48 andsection 19a of themember 19. The tissue sample is completely contained within the compartment. At this time, the needle in its closed position is withdrawn from the subject. The tissue specimen is removed from the instrument by first rotatingmember 12 to open the compartment. Gas or liquid under pressure is then applied through theconduit 14. This can be from any source, for example, by attaching a filled syringe to the fine end ofconduit 14. After the fluid from the syringe is ejected to move the tissue out of the compartment, the syringe can be disconnected from the conduit so that the instrument can again be used to collect a tissue specimen. The syringe also can apply suction pressure.

Thestop pin 31 is preferably located with respect to stoplug 35 so that the compartment will be fully opened whenmember 12 is rotated up against a stop in one direction and fully closed when rotated up against the stop in the other direction.

The instrument shown in FIGS. 1-7 is shown as having only rotating motion, the amount of rotation being limited by the position of stops 31a and 31b. In FIG. 8, an arrangement is shown for providing axial reciprocating motion for theinner tubular member 12. Here, thecollet 27 onmember 12 is movedfurther info housing 16 and acoil spring 25 is located between the end of the collect to contact a washer 25a adjacent the O-ring 24. As should be apparent,tubular member 12 can be moved backwards toward thehousing cap 23 against the force ofspring 25. As this takes place thecup 48 moves further into theouter tube 19, thereby reducing the area available or tissue to be drawn into the cup and be cut off. By using this arrangement, the size of the tissue sample can be readily controlled. Upon release of theinner tubular member 12 against the force of the spring 65, it is moved back to its full open position shown in FIG. 4. The two members are rotated relative to one another to cut off the tissue specimen after the size of compartment has been established. As should be apparent, a solenoid (electrically operated) arrangement can be substituted forspring 25.

FIGS. 9 through 16 show further embodiments of the invention for taking tissue samples and/or for performing tissue removal. Referring first to FIGS. 9-14, an innertubular member 112 passes through ahollow housing 114 whose end has acap 116 thereon.Member 112 is hollow so that suction can be applied from a suitable source (not shown). Aknob 117 is attached byspokes 118 to innertubular member 112. Thespokes 118 serve as a stop for rotation ofmember 112 againstconduit 128 which passes throughknob 117 and provides irrigation fluid to the instrument. If desired, an arrangement such as shown in FIG. 8, and in FIGS. and 16 to be described below, can be provided inhousing 114 so that the innertubular member 112 can be reciprocated forward and backward.

The distal end of innertubular member 112 has a reduceddiameter end portion 112a which is coaxial with an passes through a concentriccentral tube 120 which is attached to the end of the housing.Tube 120 serves as an alignment and bearing surface for theinner tubular member 112a.

Anouter tube 122 surrounds thecentral tube 120 and is concentric therewith.Outer tube 122 is attached to the left end ofhousing 114 in flow communication with an annularfluid flow chamber 126 formed in the housing. Afluid flow passage 124 is provided between the central tube and theouter tube 122 which is in communication withannular flow passage 126 formed inhousing 114.'Conduit 128 for the irrigation fluid passes throughknob 117 and thehousing 114. The end ofconduit 128 is at theflow chamber 126 at the front end ofhousing 114.

The fluid fromconduit 128 goes from theflow chamher 126 in the housing to thepassage 124. Two different arrangements for the exit of the irrigation fluid are shown respectively in FIGS. 12-12A and FIGS. 13, 13A, 14.

In both the embodiments of FIG. 12 and FIGS. 13-14, the centraltubular member 112 has anarcuate opening 113. The edges surrounding theopening 113 are sharpened to provide a cutting surface. Similarly, thecentral tube 120 has anopening 121 of a shape complementary to that ofopening 113. Theedge surrounding opening 121 is also sharpened to provide a cutting surface.

The embodiments of FIGS. 12A and 13A correspond, respectively, to those of FIGS. 12 and 13. Here, however, opening 113a is straight. This configuration provides a flat area which can be rested against a desired part of the work area to seal it off. Maximum suction can therefore be applied. The embodiments of FIGS. 12, 13 and 14, due to the use of thecurved surface 113 would have some leakage in the area of the curve.

In each of the embodiments of FIGS. 12, 12A, 13, 13A, and 14, thedistal end 120a of the centraltubular member 120 is shown rounded. Therefore, the instruments of these embodiments are not self-penetrating, as is the instrument of FIGS. 1-8, and a preliminary incision has to be made. The inner wall of thedistal end 120a has an obtuse angle atpoint 12% with the wall of thetubular member 120. The front end of theinner tubular member 112a is of a complementary shape. The leading edge ofopening 113 and 113a of each of these instruments preferably starts above the center line (longitudinal central axis of theinner member 112.)

Considering now the arrangements for providing the fluid flow, and referring first to FIGS. 12 and 12A the distal end of the outertubular member 122 is fastened at 123 to the centraltubular member 120 to close off theflow passage 124 for the irrigation fluid at the end of the instrument. One or more openings are provided in the outertubular member 122 through which the irrigation fluid can exit frompassage 124 into the area being worked upon.

As in the case of the embodiment of FIGS. 1-8, suction applied to theinner tube 112 through theopening 113 draws the tissue specimen into the opening. Rotation of theinner tube 112 relative to thecenter tube 120 causes the two cutting edges of inner andcentral members 112 and 120 to mate and cut the specimen. It is then drawn intotubular member 112. After themember 112 is rotated to cut the specimen, the suction force can be turned off and the cut specimen held in the hollow portion ofinner member 112. The instrument can then be withdrawn from the incision. As an alternative to this, the suction force can be left on and the cut tissue specimen drawn through the suction line. A trap (not shown) can be placed in the suction line to accept and hold the specimen as it comes fromtubular member 112 through the suction conduit. Where continuous removal of a portion of tissue is to take place, innertubular member 112 can alternately be rotated between its open and closed positions. In this case, the suction force is left on to provide for continuous removal of the cut tissue from theopening 113 ofmember 112.

FIGS. 13, 13A and 14 show another type of flow arrangement in which a passage, or passages, 140 for the irrigation fluid has been shifted from theouter tube 122 to thecentral tube 120. These passages are located to direct the fluid into theopening 113 or 113a. In the open position of the instrument, shown in FIG. 13, the irrigation fluid has no exit sincepassage 140 is closed by the bottom of the innertubular member 112. As in the case of the instrument of FIG. 12, the tissue is drawn into theinner tube 112 throughopening 113 or 113a by the suction force. Theinner tube 112 is then rotated to the closed position to cut off the specimen. As shown in FIG. 14, at this time the irrigation fluid can exit throughpassage 140 into the innertubular member 112 to aid in washing the tissue specimen back up through the suction conduit provided by thetube 112.

FIGS. 15 and 16 show a further embodiment of the invention which is in some respects similar to that of FIG. 12. Here, theirrigation passage 130 is formed in theouter tube 122 and the outer tube is permanently attached at 123 to the end of thecentral tube 120. In this case, theend 120a of thetube 120 is curved upwardly at 12% to form acutting edge 1200 at the front end of the opening 121a. The shape of the openings of the embodiment of FIGS. 15-16 are suitable for a side cutting operation while those of FIGS. 12-14 are more suitable for front cutting. This is so because thefront portion 120a of the central tubular member is FIGS. 12-14 has a part removed to provide entrance from the front of the instrument intoopening 113. In FIGS. 15-16, the front 1200 is left substantially intact. In FIGS. 15 and 16, theexit passage 130 for the irrigation fluid is in theouter member 122 opposite the cutting surfaces. It is formed as close to the end of the tip as possible.

In FIGS. 15-16, the front end of theinner tube 112 is provided with a cuttingend 112b. Thetube 112 can be reciprocated forward and backward for example, in the manner shown for example in the embodiment of FIG. 8. As should be apparent, as theinner tube 112 is slid forward the cuttingedge 11% cuts the tissue specimen. The cut is completed by a shearing action with an inwardly facing cutting edge 1206 on the front 120a of centraltubular member 120a. This is shown in FIG. 16. The instrument can be withdrawn from the body with thecentral member 112 in the position shown in FIG. 16. The cut specimen can be removed fromcentral member 112 when the instrument is outside of the body. As an alternative to this, the suction force can be left on to withdraw the specimen. As'in the case with the embodiments of FIGS. 12-14, this can provide repeated removal of tissue. A solenoid can be used to provide the reciprocating action to achieve the cutting.

FIGS. 17A and 178 show a modified form of the instrument of FIGS. 1-8. The instrument includes anouter tube 200 having apointed end 201.Tube 200 has its end remote frompoint 201 fastened into a forwardouter housing section 203a. Aninner tube 204 is rotatable within theouter tube 200.Inner tube 204 includes apassage 205 which extends for its length and terminates in a restrictedoutlet end 207 which opens into the interior of a pocket orcup 208 formed at the end of the inner tube.Pocket 208 is of the same general shape aspocket 48 of FIG. 4 and has acutting edge 210 formed on its upper edge in the same general manner as thecutting edge 49 of FIGS. 1-8. The end portion ofouter tube 200 is formed of a complementary shape to pocket 208 oftube 204 which has a cutting edge (not shown) formed therearound in a manner similar to thecutting edge 59 of FIGS. 1-8. Thus, upon rotation of theinner tube 204 relative toouter tube 200, a tissue specimen may be cut off and placed in thepocket 208. The suction pressure or irrigation fluid is supplied directly from theend 207 ofpassage 205 intopocket 208 in a direction along the longitudinal axis of the instrument.

Theinner tube 204 passes through the forwardouter housing section 203a and a forward inner housing section 211a whose forward end is threaded to section 2030. An O-ring 203C seals off the two members. The end oftube 204 opposite thepocket 208 terminates in anenlarged fixture 214 with a threadedouter surface 215.Fixture 214 is designed to accept and hold an end of ahypodermic type syringe 220 which has the usualouter cylinder 221 andinner piston 223 withthumb actuator 224 at its near end. The forward end of the syringe has a reduceddiameter opening 225 which is internally thread to mate withthreads 215 offixture 214 to hold the syringe to the instrument.

The forwardinner housing section 2110 has a rear collar section 211b coupled to it by a threaded engagement. The rear section 2l1b has a central opening into which the forward end offixture 214 extends. A rearouter housing section 203b, which forms a cup, has a set screw 217 passing radially therethrough to engage and hold thefixture 214 of theinner tube 204. Awasher 218 is attached toinner tube 204 and a spring 218a is located between the washer and the forward shoulder of inner housing section 211b. This arrangement stabilizestube 204.

The rearouter housing section 203b is rotatable relative to theinner housing sections 2110, 2111). Thus. when it is turned, the engagement between set screw 217 andfixture 214 causes theinner tube 204 to rotate relative toouter tube 200 and produce the cutting action ofpocket 208. A stop (not shown) in the form of contacting lugs on the rear inner and outer housing sections 2llb and 203b can be used to limit the rotation.

Piston 223 has anoperative end 227 of rubber or like material which forms a seal with the inner surface ofcylinder 221 to eject fluid out ofsyringe 220 into thepassage 204 ofinner tube 204. Alternatively, movingpiston 220 out of the cylinder creates a suction pressure inpassage 205. Thesyringe 220 can be filled with fluid by unscrewing from the remainder of the assembly. If desired, a flexible tube can be interposed between the flxture 214 and thesyringe end 225 so that thef syringe can be located remote from the needle itsel FIGS. 18A and 188 show a further embodiment of the invention which in some respects is similar to the embodiments shown in FIGS. 9-16. Here, atube 250 is formed with inner and outer section to define an intermediatehollow passage 251.Passage 251 terminates in anexit port 254 through which irrigation fluid can be ejected into the area being worked upon. Theend section 250a of theouter tube 250 forward ofport 254 tapers inwardly to ablunt end 257.

Outer tube 250 has anopening 255 formed inwall section 250a. This opening can be for example, of circular, elliptical, or elongated, shape. The lower edge surrounding the periphery of the opening is preferably sharpened to provide a cutting surface.

Aninner tube 260 of generally complementary shape to theouter tube 250 is provided which is rotatable relative to the outer tube, for example, by an arrangement such as is shown in FIG. 9.Inner tube 260 defines aninterior suction passage 261 and has anopening 262 in itsforward wall section 260a which is of the same shape asopening 255. Theopening 255 preferably has a cutting edge (not shown) around the periphery of its upper surface. The front end of theinner tube 260 can be left open sincepassage 261 has a dead end against theend 257 of the outer tube. The taper of the forward ends of bothtubes 250 and 260 provide a tight fit for the two tubes for cutting purposes and a self-sharpening action as the two tubes are rotated relative to each other. The preferred minimum angle of taper is about total included angle.

In operation of the instrument of FIG. 18, irrigation fluid is supplied to thepassage 251 in theouter wall 250 and exits throughport 254. Suction pressure is applied throughinner tube passage 261.

With the twotubes 250 and 260 rotated to a position whereby theopening 255 is closed by the bottom portion of theinner tube 260, the irrigation fluid fromport 254 is supplied to the working area. When the tissue is to be cut, the flow of irrigation fluid can, if desired, be stopped or left on. To make the cut, theinner tube 260 is rotated relative to theouter tube 250 so that theopenings 255 and 262 are aligned. The suction inpassage 261 draws the tissue through the twoopenings 255, 262 into thepassage 261. Upon rotation ofinner tube 260 to close theopening 255, the tissue in the opening will be cut by the sharpened cutting surfaces surrounding the two openings. The tissue cut off can be removed through thepassage 261.

FIG. 19 shows a modification of the instrument FIG. 19. The same reference numbers are used for the same parts. In FIG. 19, instead of using aninner tube 250 with an opening aligning with theopening 255 in theouter tube 250, adrill 270 is provided having ahead end 272 of a shape complementary to the taperedouter tube section 250a.Drill 272 has acutting edge 273 which upon rotation of the drill mates with the cutting edge on the lower surface of theopening 255.

Upon application of suction through apassage 275 defined by the interior wall ofouter tube 250, suction is applied to the working area through theopening 255. The sample is sucked intoopening 255 and is continuously cut off as thedrill 270 rotates. The cut off tissue is removed from the instrument throughpassage 275. As should be apparent, the instrument of FIG. 19 has advantages in that it provides for a continuous cutting of the sample.

In the embodiments shown in FIGS. ISA-18B and 19, theinner tube 260 of FIGS. 18A-18B and thedrill 270 of FIG. 19 can be rotated either manually or by an automatic device, for example, a motor (not shown).

FIGS. 20A-20E show a scissors type of instrument for cutting tissue. An elongatedouter tube 280 is provided as a support for the remainder of the instrument.

An innertubular member 285 extends through the length ofhousing 280 and is adapted at oneend 286 to receive suction pressure. The other end oftube 285 is supported within an outertubular guide 290 which is fastened to anend wall 281 of thehousing 280. Aconduit 292 which extends throughhousing 280 has adischarge end 293 in thehousing end wall 281. Thedischarge end 293 communicates with the space between the outer surface of theinner tube 285 and the inner surface ofguide tube 290 to define apassage 294 so that fluid applied throughconduit 292 can exit through aport 296 adjacent the end of the guide tube into the work area. FIGS. 20A-20E show the end of theinner tube 285 supported by the interior wall ofguide 290 and thepassage 294 withexit port 296.

Theend 286 ofinner tube 285 has aknob 298 fastened thereon which backs up against aspring 302 located between the knob and the end wall ofhousing 280. The knob permits theinner tube 285 to be rotated relative to theguide tube 290.Spring 302 insures that if there is a slight reciprocation ofmembers 285 and 290 relative to each other, that the two will be aligned whenknob 298 is released.

The cutting end of the instrument includes a firstcurved cutting member 310 which is formed partially around the end oftube 285. The twocurved cutting members 310 and 320 have respectiveinclined edges 311 and 321 on each side thereof. When viewed from the side, such as in FIGS. 20B and 20C, the edges form a negative angle with respect to each other, that is, the opening between the opposing edges of the cuttingmembers 310 and 320 increases from the front to the rear of the instrument. The negative angle is used so that the tissue being cut will not squeeze out as the twomembers 285 and 290 are rotated relative to each other. As shown in FIGS. 20D and 20E, the radius of the circle on which thecutting edge 311 is located is smaller than the one on which thecutting edge 321 is located and are such that thecutting edge 321 can move within theedge 311 to provide a scissors type shearing action. FIGS. 20D and 20E show front views of slightly different forms of cutting surfaces.

FIGS. 21A and 218 show an instrument similar to that of FIGS. 20A-20E. The housing and the irrigation and suction arrangements are the same as are the other portions of the instrument. The only difference between the instruments of FIG. 20 and FIG. 21 is that the operative ends of the twomembers 285 and 290 are not formed with cutting members. Instead,inner tube 285 has an arcuately shaped grippingmember 335 formed thereon withflat surface 336 on each side thereof. Similarly guide 290 has an arcuate grippingmember 340 with aflat surface 341 on each side thereof.

The opposingsurfaces 336 and 341 ofmembers 335 and 340 define the same type of negative angle as in FIG. 20. However, the radii of themembers 335 and 340 are the same so that when themembers 280 and 285 are rotated relative to each other, the tissue, or other material, is held between the twosurfaces 336 and 341. As should be apparent, the application of suction through theinner tube 285 aids in having the tissue held between the twogripping members 335 and 340.

FIGS. 22A-22C show a type of knife with provisions for providing both irrigation fluid and suction pressure. Ahousing 360 has a rear end on which arotatable cap 362 is held by aset screw 364 which rides in agroove 365. A threadedbushing 366 is fastened to an innertubular member 370. Aconduit 372 for applying suction pressure to thecentral passage 371 oftube 370 is attached to an end oftube 370 outside ofhousing 360.Cap 362 hasthreads 366a which rotate on the threads ofbushing 366. Apin 374 is fastened to thetube 370 and extends through aslot 375 in the wall ofhousing 360. The end 361 ofhousing 360 remote fromcap 362 has aguide tube 380 attached thereto. The guide tube is formed of two conctcutivetubular members 3800 and 380b to define a hollow interior to provide apassage 381 for irrigation fluid which exits through aport 383 near the end oftube 380.Tube 380 is closed off by anipple 385. The irrigation fluid is supplied via aconduit 387 which passes through end 361 ofhousing 360 to communicate withpassage 381.

The end ofinner tube 370 which is remote fromconduit 372 passes through and is guided by the interior walls of the innermosttubular section 380b of theguide tube 380. Aknife blade 390 of any desired shape and having acutting edge 392 is mounted on the end oftube 370 leaving the front of the tube partially open for suction pressure to be available through thepassage 371.

In the operation of the instrument of FIGS. 22A-22B the irrigation fluid flowing through port 283 clears the work area. The suction frompassage 371 draws the member to be cut into the active area of the knife. The knife is moved with a to-and-fro motion by turningcap 362 which rotates around fixedbushing 366 causing the knife to move.Pin 374 provides a stop in each direction. Pieces of the material cut are removed through thepassage 371 by the suction pressure.

What is claimed is:

l. A surgical instrument comprising a first tubular member having a first active cutting means thereon, a second tubular member having a second active cutting means thereon, said first and second tubular members being concentric with each other, means for rotating said first and second members relative to each other to bring said first and second active means into an active relationship to cut an object, said second active means including a pocket formed at the end of said second active means having a cutting edge formed around at least a portion thereof, said first member having a portion of its first active means formed of a shape complementary to the pocket formed on said second member and including a cutting edge formed around at least a portion thereof, and means for applying suction including a first passage formed in said second member adapted to receive suction from a source, at least one opening in said second member through a wall thereof into its pocket, and a second passage between said first and second members to provide communication between said first passage and said opening.

2. An instrument as in claim 1 further comprising means for supplying irrigation fluid to exit from said instrument at a location adjacent said first and second active means.

3. An instrument as in claim 1 further comprising means for limiting the rotation of said first and second members relative to each other.

4. An instrument as in claim 1 wherein the leading end of said first member is pointed.

5. A surgical instrument comprising a first tubular member having a first active cutting means thereon, a

second tubular member having a second active cutting means thereon, said first and second tubular members being concentric with each other, means for rotating said first and second members relative to each other to bring said first and second active means into an active relationship to cut an object, said second active means including a pocket formed at the end of said second means having a cutting edge formed around at least a portion thereof, said first member having a portion of its first active means formed of a shape complementary to the pocket formed on said second member and including a cutting edge formed around at least a portion thereof, and means for applying suction including a first passage formed in said second member adapted to receive suction from a source, said first passage having an exit directly into its said pocket.

6. An instrument as inclaim 5 wherein said second member includes means at an end thereof for attaching a syringe to said second member.

7. An instrument as in claim 6 further comprising means for limiting the rotation of said first and second members relative to each other.

8. A surgical instrument comprising a first tubular member having a first active cutting means thereon, a second tubular member having a second active cutting means thereon which is located within said first member and movable relative thereto to bring said first and second active means into an active cutting relationship, means for applying suction pressure through said second member to said instrument to draw material into the area occupied by said second active member when in said active relationship, and means for supplying irrigation fluid to exit from said instrument at a location adjacent said first and second active means, said supplying means including a third tubular member concentric with said first member and defining a passage through which the irrigation fluid is supplied.

9. An instrument as inclaim 8 wherein said third tubular member is formed with an exit passage through which the irrigation fluid leaves the instrument.

10. An instrument as inclaim 8 wherein said second tubular member is formed with a second opening at the end thereof adjacent which said second active cutting means are located, and first opening formed in the wall of said first member to direct the irrigation fluid into said second member when the same is moved to a position where its second opening is aligned in fluid flow communication with the first opening in said first member.

11. An instrument as inclaim 8 wherein said first and second tubular members each have their respective ends formed with openings having arcuate shaped cutting surfaces, said first and second tubular members being rotatable relative to each other.

12. An instrument as inclaim 8 wherein said first and second tubular members each have their respective ends formed with openings having flat shaped cutting surfaces, said first and second members being rotatable relative to each other.

13. An instrument as inclaim 11 wherein said third tubular member is formed with an exit passage through which the irrigation fluid leaves the instrument.

14. An instrument as inclaim 12 wherein said third tubular member is formed with an exit passage through which the irrigation fluid leaves the instrument.

15. An instrument as inclaim 11 wherein said second member is formed with a second opening at the end thereof adjacent which said second active means are located, and first opening formed in the wall of said first member to direct the irrigation fluid into said second member when the same is moved to a position where its second opening is aligned in fluid flow communication with the first opening in said first member.

16. An instrument as inclaim 12 wherein said second member is formed with a second opening at the end thereof adjacent which said second active means are located, and first opening formed in the wall of said first member to direct the irrigation fluid into said second member when the same is moved to a position where its second opening is aligned in fluid flow communication with the first opening in said first member.

17. An instrument comprising first and second tubular members, said second member being located within said first member and being movable relative thereto, at least one means at an end of said second member to perform an operative function, and means for applying suction pressure through said second tubular member to exit through said second member at a location adjacent said one means to perform an operative function.

18. An instrument as inclaim 17 wherein said first and second members are formed with a passage therebetween through which irrigation fluid can be supplied,

' and an exit port for said irrigation fluid in said first member.

19. An instrument as inclaim 8 wherein said first and second tubular members each have an opening therein, the suction pressure exiting the instrument when said two openings are aligned, and an opening in said third tubular member through which the irrigation fluid exits.

20. An instrument as inclaim 19 wherein said openings of said first and second members have cutting surfaces which are said first and second active means respectively, said first and second members being rotatable relative to each other.

21. An instrument as in claim 20 wherein said openings of said first and second members are located spaced away from the front end of the instrument.

Claims (21)

1. A surgical instrument comprising a first tubular member having a first active cutting means thereon, a second tubular member having a second active cutting means thereon, said first and second tubular members being concentric with each other, means for rotating said first and second members relative to each other to bring said first and second active means into an active relationship to cut an object, said second active means including a pocket formed at the end of said second active means having a cutting edge formed around at least a portion thereof, said first member having a portion of its first active means formed of a shape complementary to the pocket formed on said second member and including a cutting edge formed around at least a portion thereof, and means for applying suction including a first passage formed in said second member adapted to receive suction from a source, at least one opening in said second member through a wall thereof into its pocket, and a second passage between said first and second members to provide communication between said first passage and said opening.

2. An instrument as in claim 1 further comprising means for supplying irrigation fluid to exit from said instrument at a location adjacent said first and second active means.

3. An instrument as in claim 1 further comprising means for limiting the rotation of said first and second members relative to each other.

4. An instrument as in claim 1 wherein the leading end of said first member is pointed.

5. A surgical instrument comprising a first tubular member having a first active cutting means thereon, a second tubular member having a second active cutting means thereon, said first and second tubular members being concentric with each other, means for rotating said first and second members relative to each other to bring said first and second active means into an active relationship to cut an object, said second active means including a pocket formed at the end of said second means having a cutting edge formed around at least a portion thereof, said first member having a portion of its first active means formed of a shape complementary to the pocket formed on said second member and including a cutting edge formed around at least a portion thereof, and means for applying suction including a first passage formed in said second member adapted to receive suction from a source, said first passage having an exit directly into its said pocket.

6. An instrument as in claim 5 wherein said second member includes means at an end thereof for attaching a syringe to said second member.

7. An instrument as in claim 6 further comprising means for limiting the rotation of said first and second members relative to each other.

8. A surgical instrument comprising a first tubular member having a first actiVe cutting means thereon, a second tubular member having a second active cutting means thereon which is located within said first member and movable relative thereto to bring said first and second active means into an active cutting relationship, means for applying suction pressure through said second member to said instrument to draw material into the area occupied by said second active member when in said active relationship, and means for supplying irrigation fluid to exit from said instrument at a location adjacent said first and second active means, said supplying means including a third tubular member concentric with said first member and defining a passage through which the irrigation fluid is supplied.

9. An instrument as in claim 8 wherein said third tubular member is formed with an exit passage through which the irrigation fluid leaves the instrument.

10. An instrument as in claim 8 wherein said second tubular member is formed with a second opening at the end thereof adjacent which said second active cutting means are located, and first opening formed in the wall of said first member to direct the irrigation fluid into said second member when the same is moved to a position where its second opening is aligned in fluid flow communication with the first opening in said first member.

11. An instrument as in claim 8 wherein said first and second tubular members each have their respective ends formed with openings having arcuate shaped cutting surfaces, said first and second tubular members being rotatable relative to each other.

12. An instrument as in claim 8 wherein said first and second tubular members each have their respective ends formed with openings having flat shaped cutting surfaces, said first and second members being rotatable relative to each other.

13. An instrument as in claim 11 wherein said third tubular member is formed with an exit passage through which the irrigation fluid leaves the instrument.

14. An instrument as in claim 12 wherein said third tubular member is formed with an exit passage through which the irrigation fluid leaves the instrument.

15. An instrument as in claim 11 wherein said second member is formed with a second opening at the end thereof adjacent which said second active means are located, and first opening formed in the wall of said first member to direct the irrigation fluid into said second member when the same is moved to a position where its second opening is aligned in fluid flow communication with the first opening in said first member.

16. An instrument as in claim 12 wherein said second member is formed with a second opening at the end thereof adjacent which said second active means are located, and first opening formed in the wall of said first member to direct the irrigation fluid into said second member when the same is moved to a position where its second opening is aligned in fluid flow communication with the first opening in said first member.

17. An instrument comprising first and second tubular members, said second member being located within said first member and being movable relative thereto, at least one means at an end of said second member to perform an operative function, and means for applying suction pressure through said second tubular member to exit through said second member at a location adjacent said one means to perform an operative function.

18. An instrument as in claim 17 wherein said first and second members are formed with a passage therebetween through which irrigation fluid can be supplied, and an exit port for said irrigation fluid in said first member.

19. An instrument as in claim 8 wherein said first and second tubular members each have an opening therein, the suction pressure exiting the instrument when said two openings are aligned, and an opening in said third tubular member through which the irrigation fluid exits.

20. An instrument as in claim 19 wherein said openings of said first and second members have cutting surfaces which are said firSt and second active means respectively, said first and second members being rotatable relative to each other.

21. An instrument as in claim 20 wherein said openings of said first and second members are located spaced away from the front end of the instrument.

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