Abstract:
Apparatus configured for the removal of polyps are provided and include a first jaw member including first and second elongated members, the first and second elongated members having proximal and distal ends and defining a channel therebetween; and a second jaw member having proximal and distal ends and defining a tissue contacting surface, the proximal end of the second jaw member being pivotably coupled between the proximal ends of the first and second elongated members, wherein the distal end of the second jaw member is in a spaced apart relationship with the first jaw member when in a first position, and the distal end of the second jaw member extends into the channel defined between the distal ends of first and second elongated members when in a second position.

Description:
BACKGROUND 
       [0001]    1. Technical Field 
         [0002]    The present disclosure relates to an apparatus and method for the removal of internal tissue, and more particularly, to jaw members configured for the removal of polyps and the like. 
         [0003]    2. Background of Related Art 
         [0004]    A polyp is an abnormal growth of tissue projecting from a mucous membrane. A polyp that is attached to the surface of the mucous membrane by a narrow elongated stalk is said to be pedunculated. If no stalk is present, the polyp is said to be sessile. Polyps are commonly found in the colon, stomach, nose, urinary bladder and uterus. Polyps may also occur elsewhere in the body where mucous membranes exist like the cervix and small intestine. 
         [0005]    The surgical procedure for removing a polyp is generally referred to as a “polypectomy”. Polypectomys are generally endoscopic or laparoscopic procedures performed through the oral or anal cavities. When the location of the polyp permits, the polypectomy may be performed as an open procedure. Conventional polypectomys are completed using various apparatus and techniques known in the art. 
         [0006]    As noted above, there are two forms of polyps, sessile and pedunculated. The stalkless or sessile polyps are generally removed using electrical forceps. The excess tissue projecting from the mucous membrane is cauterized, sealed, or the like, and torn from the tissue wall. Large sessile polyps or pedunculated polyps (e.g., polyps having stalks) tend to be relatively larger with a greater blood supply. The size and shape of large sessile polyps or pedunculated polyps typically do not lend themselves to being removed using traditional forceps. Unlike sessile polyps, large sessile polys or pedunculated polyps cannot simply be grasped in the jaw members of an electric forceps and torn from the tissue wall. Instead, the polypectomy is performed using a surgical snare device. The snare device is configured with a snare for looping over the hanging polyp and fitting securely over the polyp and/or poly stalk. By constricting the snare, and selectively applying energy, the device may cauterize or seal the polyp along the stalk as the polyp is severed from the tissue wall. 
         [0007]    Polyp removal using a surgical snare device requires an operator to loop the snare over the end of the polyp in order to properly position the polyp about the stalk. In many circumstances access to the stalk of the polyp, much less the entire polyp is limited. Without complete access to the polyp the surgical snare device is useless for removal of the polyp. 
         [0008]    It would therefore be beneficial to have a polyp removal device that does not incorporate a snare that must be placed looped over a polyp. 
       SUMMARY 
       [0009]    The present disclosure relates to apparatus and methods for the removal of polyps and the like. 
         [0010]    According to an aspect of the present disclosure, an apparatus for the removal of tissue comprises a first jaw member including first and second elongated members, the first and second elongated members having proximal and distal ends and defining a channel therebetween; and a second jaw member having proximal and distal ends and defining a tissue contacting surface, the proximal end of the second jaw member being pivotably coupled between the proximal ends of the first and second elongated members, wherein the distal end of the second jaw member is in a spaced apart relationship with the first jaw member when in a first position, and the distal end of the second jaw member extends into the channel defined between the distal ends of first and second elongated members when in a second position. 
         [0011]    The distal end of the second jaw member may be configured to extend beyond the distal end of first and second elongated members of the first jaw member when the jaws are in the second position. The second jaw member may be configured to deliver electrosurgical energy to the tissue. 
         [0012]    The first and second elongated members may include a shelf extending at least partially therebetween. An electrode may be supported on the shelf. The shelf may be configured to extend distally between the first and second elongated members to form a stop for engaging a distal end of the second jaw member when the jaws are in the second position. An electrode may be operably disposed between the first and second elongated members. 
         [0013]    The first and second jaw members may be resilient. At least one of the first jaw member and the second jaw member may include a semi-arcuate shape. Proximal ends of the first and second jaw members may be configured to be operably engaged with an endoscopic device. 
         [0014]    The first and second jaw members may be configured for bipolar sealing of tissue. The first jaw may be at least partially electrically conductive, and wherein the second jaw may be electrically non-conductive and includes at least one electrode disposed between the first and second elongated members thereof. 
         [0015]    According to another aspect of the present disclosure, an apparatus for the removal of tissue is provided and includes a first jaw member having first and second elongated space apart members and a shelf disposed therebetween; and a second jaw member pivotably connected between the first and second elongated members of the first jaw member, wherein the second jaw member is configured to operably engage the shelf when the first and second jaw members are in a closed position. 
         [0016]    A gap may be formed between the first and second jaw members when the first and second jaw members are in a closed position. The first and second jaw members may be configured for a bipolar electrosurgical procedure. At least one of the first jaw member and the second jaw member may be configured for a monopolar electrosurgical procedure. 
         [0017]    The first and second jaw members may be formed from a resilient material. 
         [0018]    The apparatus may further include a housing for receiving the first and second jaw members therein. The first and second jaw members may be flexed for receipt within the housing. 
         [0019]    According to yet another aspect of the present disclosure, a system for the removal of tissue is provided. The system comprises an apparatus having first and second jaw members configured to selectively receive tissue therebetween. The first jaw member includes first and second elongated members, the first and second elongated members having proximal and distal ends and defining a channel therebetween; and the second jaw member includes proximal and distal ends and defines a tissue contacting surface, the proximal end of the second jaw member being pivotably coupled between the proximal ends of the first and second elongated members, wherein the distal end of the second jaw member is in a spaced apart relationship with the first jaw member when in a first position, and the distal end of the second jaw member extends into the channel defined between the distal ends of first and second elongated members when in a second position. The system further includes a source of electrosurgical energy operably connected to at least one of the jaw members to deliver electrosurgical energy to the tissue. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0020]    The foregoing summary, as well as the following detailed description will be better understood when read in conjunction with the appended figures. For the purpose of illustrating the present disclosure, a preferred embodiment is shown. It is understood, that the present disclosure is not limited to the precise arrangement and instrumentalities shown. 
           [0021]      FIG. 1  is a perspective view of polyp removal jaws according to an embodiment of the present disclosure, in a first or open position; 
           [0022]      FIG. 2  is a perspective view of the polyp removal jaws of  FIG. 1 , shown in a second or closed position; 
           [0023]      FIG. 3  is partial, cross-sectional, side view of the polyp removal jaws of  FIGS. 1 and 2 , shown in a closed position, and shown operably connected to an endoscopic device; 
           [0024]      FIG. 4  is a partial, cross-sectional, side view of the polyp removal jaws of  FIGS. 1-3 , shown in an open position, operably connected to an endoscopic device; 
           [0025]      FIG. 5A  is a cross-sectional, side view of the polyp removal jaws of  FIGS. 1-4 , shown in a closed position; 
           [0026]      FIGS. 5B-5F  are transverse, cross-sectional views of the polyp removal jaw of  FIGS. 1-5A  taken along lines  5 B- 5 B,  5 C-C,  5 D- 5 D,  5 E- 5 E and  5 F- 5 F, respectively, of  FIG. 5A ; 
           [0027]      FIG. 6  is a perspective view of polyp removal jaws according to an alternate embodiment of the present disclosure, shown in a first or open position; 
           [0028]      FIG. 7  is a perspective view of the polyp removal jaws of  FIG. 6 , shown in a second or closed position; 
           [0029]      FIG. 8  is a perspective view of polyp removal jaws according to another embodiment of the present disclosure, shown in first or open position; 
           [0030]      FIG. 9  is a perspective view of the polyp removal jaws of  FIG. 8 , shown in a second or closed position; 
           [0031]      FIG. 10A  is a cross-sectional, side view of the polyp removal jaws of  FIGS. 8-9 , shown in a closed position; 
           [0032]      FIGS. 10B-10E  are transverse, cross-sectional views of the polyp removal jaws of  FIGS. 8-10A  taken along line  10 B- 10 B,  10 C- 10 C,  10 D- 10 D and  10 E- 10 E, respectively, of  FIG. 10A ; 
           [0033]      FIGS. 11A-11D  are partial, cross-sectional, side views of polyp removal jaws shown at various stages of insertion into a tubular housing; and 
           [0034]      FIG. 12  is a schematic illustration of an electrosurgical system including any of the jaws shown in  FIGS. 1-11D . 
       
    
    
     DETAILED DESCRIPTION OF EMBODIMENTS 
       [0035]    The foregoing summary, as well as the following detailed description will be better understood when read in conjunction with the appended figures. For the purpose of illustrating the present disclosure, various embodiments are shown. It is understood, however, that the present disclosure is not limited to the precise arrangement and instrumentalities shown. As shown in the drawings and described throughout the following description, as is traditional when referring to relative positioning on an object, the term “proximal” refers to the end of the apparatus which is closer to the user and the term “distal” refers to the end of the apparatus which is further from the user. 
         [0036]    Referring to  FIGS. 1-5F , an illustrative embodiment of the presently disclosed polyp removal jaws is shown therein and generally designated as jaws  100 . Jaws  100  comprise a first jaw member  110  and a second jaw member  120 . First and second jaw members  110 ,  120  are pivotably connected to one another by a pivot pin  115 . Jaw members  110 ,  120  are configured to retain, seal, cauterize, and/or sever tissue grasped therebetween. Jaw members  110 ,  120  are configured to engage tissue to be excised, such as stems of pedunculated polyps. 
         [0037]    Jaws  100  may be incorporated into a hand-held instrument for use in open surgical procedures or may be configured, as shown in  FIGS. 3 and 4 , for incorporation into endoscopic instruments for use in closed surgical procedures. First and second jaw members  110 ,  120  may be composed of plastics, polymers, metals, alloys or the like or any combination thereof. First and second jaw members  110 ,  120  may be fabricated from any suitable dielectric material. Jaws  100  may be configured for monopolar and/or bipolar operation, as will be discussed below. 
         [0038]    First jaw member  110  forms a semi-arcuate base including a first elongated section  112  and a second elongated section  114  spaced apart from substantially parallel to first elongate section  112 . A connector or shelf member  113  ( FIGS. 5A-5E ) extends at least partially between first and second elongated sections  112 ,  114  to one another. First and second elongated sections  112 ,  114  include proximal ends  112   a ,  114   a  and distal ends  112   b ,  114   b , respectively. 
         [0039]    Proximal ends  112   a ,  114   a  of first and second elongated sections  112 ,  114  define a first channel  116  therebetween. First channel  116  is configured for selectively receiving a proximal end  120   a  of second jaw member  120  therein, as will be described in greater detail below. Distal ends  112   b ,  114   b  of elongated sections  112 ,  114 , define a second channel  118  therebetween. Second channel  118  is configured for selectively receiving a distal end  120   b  of second jaw member  120  therethrough. Proximal ends  112   a ,  114   a  of first and second elongated sections  112 ,  114 , respectively, define an opening  110   c  for receiving a pivot pin  115 . 
         [0040]    With continued reference to  FIGS. 1-5F , second jaw member  120  forms a single semi-arcuate member having proximal and distal ends  120   a ,  120   b , respectively. Proximal end  120   a  of second jaw member  120  is configured to be received within first channel  116  formed between proximal ends  112   a ,  114   a  of respective first and second elongated sections  112 ,  114 , respectively. Proximal end  120   a  of second jaw member  120  defines opening  120   c  corresponding to openings  110   c  formed in first and second elongated section  112 ,  114 . Opening  120   c  is configured for receiving pivot pin  115 . Distal end  120  of second jaw member  120  is configured to be selectively received within and through second channel  118  formed between distal ends  112   b ,  114   b  of respective first and second elongated sections  112 ,  114 . 
         [0041]    Second jaw member  120  may comprise an electrically conductive material or may be fabricated substantially of an electrically conductive material. In an alternate embodiment, second jaw member  120  may include one or more electrodes (not shown), supported thereon, for effecting monopolar and/or bipolar cutting and/or sealing of tissue. Second jaw member  120  may include an insulative layer (not shown) to prevent a short circuit with first jaw member  110  and/or the one or more electrodes mounted thereon. The insulative layer may also prevent damage to tissue resulting from incidental contact during a surgical procedure. 
         [0042]    Referring now to  FIGS. 3-4  and  5 A- 5 F, second jaw member  120  includes a tissue contacting surface  122   a . Tissue contacting surface  122   a  may comprise at least a portion of a length of second jaw member  120 . As will be discussed in more detail below, as first and second jaw members  110 ,  120  are closed about stem  12  of polyp  10  ( FIG. 3 ), tissue contacting surface  122   a  of second jaw member  120  engages and guides stem  12  against first and second jaw members  110 ,  120 . Tissue contacting surface  122   a  may have a rounded, sharpened, flattened or other suitable transverse cross-sectional profile. 
         [0043]    Proximal ends  112   a ,  114   a  of first and second elongated sections  112 ,  114 , respectively, and proximal end  120   a  of second jaw member  120 , may further be configured for incorporation into a conventional hand-held forceps or for operable engagement with the distal end of an endoscopic device. With particular reference to  FIGS. 3 and 4 , proximal ends  112   a ,  114   a  of first and second elongated sections  112 ,  114  define openings  112   c ,  114   c  ( FIGS. 1 and 2 ) therein, configured for operable engagement with actuation cables  45 ,  46  extending from a distal end  52   b  of an endoscopic device  50 . As will be described in more detail below, first and second actuation cables  45 ,  46  are configured to move first and second jaw members  110 ,  120 . First and second actuation cables  45 ,  46  may operate in unison or independently of each other to pivot first and/or second jaw members  110 ,  120  relative to one another. Actuation cables  45 ,  46  may also be configured to supply electrosurgical energy to first and/or second jaw members  110 ,  120 , respectively, and/or alternatively, to electrodes (not shown) mounted thereon. 
         [0044]    Referring now, to  FIGS. 5A-5F , shelf member  113  is disposed between first and second elongated section  112 ,  114 . Shelf member  113  includes a proximal end  113   a , a distal end  113   b  and a middle portion  113   c  therebetween. Proximal and distal ends  113   a ,  113   b  are configured to act as stops when first and second jaw members  110 ,  120  are in a closed and fully engaged position with one another. Proximal end  113   a  of shelf member  113  is configured to engage second jaw member  120  in a region proximal of tissue contacting surface  122   a  ( FIGS. 5A and 5B ). Distal end  113   b  of shelf member  113  is configured to engage second jaw member  120  in a region distal of tissue contacting surface  122   a  ( FIGS. 5A and 5E ). In this manner, a gap or opening  117  is formed between tissue contacting surface  122   a  of second jaw member  120  and an upper surface  113   d  of shelf member  113  of first jaw member  110  ( FIGS. 5C and 5D ). By varying the curvature of first and/or second jaw members  110 ,  120  and/or altering the configuration of proximal and/or distal ends  113   a ,  113   b  of shelf member  113 , the height or dimensions of opening  117  may be adjusted. Proximal and distal ends  113   a ,  113   b  of shelf member  113  may include a layer of insulation to prevent a short circuit between first and second jaw members  110 ,  120 . 
         [0045]    Middle portion  113   c  of shelf member  113  may be recessed with, flush to or extend past an upper surface of first and second elongated sections  112 ,  114 . Middle portion  113   c  may be flat, curved inwardly, curved outwardly, or may include a texture for more securely engaging tissue. Depending on the electrical configuration of jaw  100 , middle portion  113   c  of shelf member  113  may include one or more electrodes  119  mounted thereon. Electrode  119  may be sized and dimensioned to be maintained on middle portion  113   c  of shelf member  113 . Electrode  119  may be recessed within channels  116 ,  118  formed between first and second elongated sections  112 ,  114 . Alternately, electrode  119  may be maintained flush with the top surface of elongated sections  112 ,  114  or may extend beyond the top surface of elongated sections  112 ,  114 . Electrode  119  may have a flat, curved or textured tissue contacting surface  119   a.    
         [0046]    Referring back to  FIG. 1 and 4 , polyp removal jaw  100  is shown in a first or open position. In the open position, distal end  120   b  of second jaw member  120  is pivoted out from within channel  118  formed between distal ends  112   b ,  114   b  of first and second elongated sections  112 ,  114  to define an opening  125  between first and second jaw members  110 ,  120 . Opening  125  is configured for facilitating the placement of jaws  100  about a portion of tissue, such as, for example the stem of a pedunculated polyp. Depending on the configuration of the actuation mechanism, and whether it is for open or closed procedures, first jaw member  110  may be held stationary relative to the actuation assembly (not shown) while second jaw member  120  is pivoted about pivot pin  115  relative to first jaw member  110 . In an alternate embodiment, both first and second jaw members may be pivoted relative to each, while in yet another embodiment, second jaw member  120  may be held stationary relative to the actuation assembly while first jaw member  110  is pivoted about pivot pin  115  relative to second jaw member  120 . First and second jaw member  110 ,  120  may be articulated up to and beyond ninety degrees (90°) relative to one another. The range of articulation of second jaw member  120  relative to first jaw member is limited only by range of motion of the actuation assembly connected thereto. 
         [0047]    Turning now to  FIGS. 2-3  and  5 A-F, polyp removal jaw  100  is shown in a second or closed position. In the closed position, proximal and distal ends  110   a ,  110   b  of second jaw member  110  extend through or positioned in channels  116 ,  118 , respectively, formed between elongated sections  112 ,  114 . As described above, shelf member  113  includes proximal and distal ends  113   a ,  113   b  for engaging second jaw member  120 . Gap  119  formed between first and second jaw members  110 ,  120  is configured for operably retaining stem  12  of a polyp  10  ( FIG. 3 ). Whether of a monopolar or bipolar design, electrosurgical energy may be applied to either first or second jaw members  110 ,  120  or one or more electrodes  119  mounted thereon, at any time during the polyp removal procedure. For larger polyps it may be necessary to activate the tissue sealing mechanism prior to the complete closure of first and second jaw members  110 ,  120 . 
         [0048]    Referring now to  FIGS. 6 and 7 , polyp removal jaws according to an alternate embodiment of the present disclosure are shown as  200 . Polyp removal jaws  200  are substantially similar to polyp removal jaws  100  and will only be described to the extent necessary to disclose the difference in construction and operation between the two. Polyp removal jaws  200  include first and second jaw members  210 ,  220 . Second jaw member  220  includes a distal end  220   b  configured for supplying electrosurgical energy by way of an electrode tip  222 . When jaws  200  are in a closed position, as shown in  FIG. 7 , distal end  220   b  of second jaw member  220  extends through channel  218  of first jaw member  210  and defines an operational end  221  that acts as a monopolar pencil. Operational end  221  may be an extension of electrically conductive second jaw member  220 . Alternatively, operational end  221  may include an electrode or electrode tip  222 . Electrode tip  222  may be selectively energized to permit a user to spot cauterize tissue without having to introduce a second instrument into the surgical field. 
         [0049]    Referring now to  FIGS. 8-10E , a second embodiment of the polyp removal jaw  300  is illustrated. Polyp removal jaws  300  are substantially similar to polyp removal jaws  100 ,  200  and will only be described with respect to the difference in construction and operation therebetween. Polyp removal jaw  300  includes a first and second jaw member  310 ,  320 . First jaw member  310  forms a level, or planar, or linear base including a first and second elongated section  312 ,  314  and a shelf  313  therebetween. In the present embodiment, shelf  313  extends distally between first and second elongated members  312 ,  314 , substantially along an entire length of elongated members  312 ,  314 , thereby preventing distal end  320   b  of second jaw member  320  from extending through elongated members  312 ,  314 . 
         [0050]    Turning now to  FIGS. 10A-10E  in particular, shelf member  313  is disposed between first and second elongated section  312 ,  314 . Shelf member  313  extends distally the length of first and second elongated section  312 ,  314 . Shelf member  313  defines a closure surface  313   c  configured to engage a distal end  320   b  of second jaw member  320  ( FIGS. 10A and 10E ) when jaws  300  are in a closed position. Proximal end  313   a  of shelf member  313  may be configured to engage a portion of second jaw member  320 , or as shown ( FIGS. 10A and 10B ), proximal end  313   a  does not engage any portion of second jaw member  320 . Shelf member  313  may include an electrode  319  mounted thereon (FIGS.  10 A and  10 C-D). Electrode  319  may be configured similar to electrode  119 , as detailed above. A gap  317  is formed between first and second jaw members  310 ,  320 . The height or dimension of gap  317  may vary depending on the configuration, i.e. arc, length, of first and second jaw members  310 ,  320 . 
         [0051]    In an alternate embodiment, closure surface  313   c  of shelf  313  may be configured to securely engage distal end  320   b  of second jaw member  320 . Alternatively, closure surface  313   c  may be configured to complete a circuit upon contact with distal end  320   b  of second jaw member  320 . In yet another embodiment, second jaw member  320  may be configured to deform as distal end  320   b  engages closure surface  313   c  of shelf  313 . In this manner, the height of gap  317  between first and second jaw member  310 ,  320  will be reduced as first and second jaw members  310 ,  320  are squeezed together. As with prior embodiments, polyp removal jaw  300  may be monopolar, bipolar or a combination of the two. 
         [0052]    Referring now to  FIGS. 11A-11D , polyp removal jaws  100 ,  200 ,  300  herein described may be configured to be received with a housing  60  of an endoscopic device  50 , even when on opening  62  in housing  60  is less then the height of the jaws in a first or closed state. Polyp removal jaws  400  may be configured from elastomeric material, shape memory metals, plastics or the like. Referring initially to  FIG. 11A , polyp removal jaws  400  include first and second jaw member  410 ,  420 . When jaws  400  are exposed or deployed from housing  60 , the height of polyp removal jaw  400  is greater than the dimension of opening  62  of housing  60  from which it is to be received. A polyp removal jaw  400  is retracted into housing  50 , first and second jaw members  410 ,  420  are cammed against a front edge of housing  60  so as to be extended and compressed towards one another ( 10 B- 10 C) until polyp removal jaws  400  are dimensioned to be completely received within housing  60 . Polyp removal jaws  400  are configured to return to their initial shape upon ejection or deployment from housing  60 . Polyp removal jaws  400  may be configured in any manner herein described. 
         [0053]    As seen in  FIG. 12 , any of the polyp removal jaws disclosed herein, such as, for example, polyp removal jaws  100  (as exemplarily shown in  FIG. 12 ) may form a part of an electrosurgical system  1000 . Electrosurgical system  100  may include at least an electrosurgical generator “G”, and polyp removal jaws  100  electrically connected/connectable to electrosurgical generator “G” or the like via electrical conduits  1010 ,  1020 . In particular, as seen in  FIG. 12 , a first electrical conduit  1010  is electrically connected to electrode  119  of first jaw  110  of polyp removal jaws  100 , and a second electrical conduit  1020  is electrically connected to second jaw  120  of polyp removal jaws  100 . 
         [0054]    Thus, it should be understood that various changes in form, detail and operation of the polyp removal jaws of the present disclosure may be made without departing from the spirit and scope of the present disclosure.