Abstract:
A kit for removing an embedded wire from tissue includes a dissector instrument for dissecting tissue surrounding an embedded wire and a pulling instrument for pulling the embedded wire from the tissue. The dissector instrument includes a proximal portion with a first and second handle and a distal portion. The distal portion of the dissector instrument includes a tubular section for surrounding an embedded wire. The pulling instrument includes a proximal portion with a first and second handle and a distal portion. The distal portion of the pulling instrument includes an elongated clamp for coupling to the embedded wire for extraction. The dissector instrument and pulling instrument may be used together as a kit, or separately to extract embedded wire from tissue.

Description:
BACKGROUND OF THE INVENTION 
       [0001]    1. Field of the Invention 
         [0002]    The subject disclosure relates to methods and instruments for removing items from tissue, and more particularly to improved methods and instruments for removing wires, jewelry and like embedded objects with minimal surrounding tissue damage. 
         [0003]    2. Background of the Related Art 
         [0004]    Wires may be embedded in tissues for a variety of reasons. For example, embedded wires provide treatment for urinary and fecal incontinence. Transcutaneous electrical nerve stimulation (TENS) is another common treatment that can benefit from embedded wires in treating chronic pain. Pacemakers and various coronary devices include embedded wires. For example, see U.S. Pat. No. 7,467,017 issued on Dec. 16, 2008 and U.S. PG Pub. No. 2013/00030512 published on Jan. 31, 2013, which are incorporated herein by reference. In addition to wires, there are various tubes and other appliances, such as catheters, that are embedded. There are also the jewelry and ornamental piercings that have become so popular. 
       SUMMARY 
       [0005]    The prior art method of removing embedded wires from the body is to dissect the tissue around the wire. After dissection, a clamp is used to grasp the wire. However, the jaws of the clamp tend to crush the wire because the force is applied to a small area. Crushing causes relatively weak spots that can lead to breaking even when the wire is pulled lightly. The subject technology improves dissection and eliminates local crushing of the wire, thus reducing the risk of breakage and/or leaving foreign material in the tissue. 
         [0006]    In view of the temporary nature of placement of various wires and the like in tissue, a need exists for instruments and methods for easily and reliably removing the objects with minimal surrounding tissue damage. 
         [0007]    Featured, in one embodiment, is an instrument for dissecting tissue surrounding an embedded wire. The dissecting instrument includes a first lever arm having a first proximal handle portion and a first distal portion. The first distal portion includes a first tip coupled to a cylindrical shell having a first semi-circular portion. A second lever arm has a second proximal handle portion and a second distal portion. The second distal portion includes a second tip coupled to a second semi-circular portion. A pin pivotally connects the first and second lever arms so that when the lever arms are closed, the second semi-circular portion mates with the first semi-circular portion to complete the cylindrical shell. In one design, the cylindrical shell forms an arcuate shape. In another design, the first lower end of the semi-circular portion and a second lower end of the second semi-circular portion are beveled for insertion into the tissue. 
         [0008]    The subject technology is also directed to an instrument for dissecting tissue surrounding an embedded item having a first lever arm with a first distal tip coupled to a first shell having a first portion for sliding over the item. The first lever arm also has a second portion for contacting a portion of the item. A second lever arm hingedly connects to the first lever arm. The second lever arm has a second distal tip coupled to a second shell complimentary to the first shell so that when the lever arms are closed, an inner portion of the shells matches a profile of the item. 
         [0009]    Also featured in one embodiment is an instrument for pulling an embedded wire from tissue. The puller instrument includes a first lever arm having a first proximal handle portion and a first distal portion. The first distal portion includes a first tip coupled to a cylindrical shell having a first semi-circular portion. A second lever arm has a second proximal handle portion and a second distal portion. The second distal portion includes a second tip coupled to a second semi-circular portion. A pin pivotally connects the first and second lever arms so that when the lever arms are closed, the second semi-circular portion can capture the embedded wire against the first semi-circular portion for reliably pulling the wire. 
         [0010]    Also featured in one embodiment is a kit for removing a wire embedded in tissue comprising a dissector instrument for dissecting tissue surrounding an embedded wire and a pulling instrument for pulling the embedded wire from the tissue. The dissector instrument has a tubular section for surrounding the embedded wire during extraction. The pulling instrument has an elongated clamp for coupling to the embedded wire for extraction. In one design the dissector instrument includes a first lever arm having a first proximal handle portion and a first distal portion. The first distal portion forms a first tip coupled to a cylindrical shell having a first semi-circular portion, wherein the first semi-circular portion forms part of the tubular section. A second lever arm has a second proximal handle portion and a second distal portion. The second distal portion forms a second tip coupled to a second semi-circular portion, wherein the second semi-circular portion forms part of the tubular section. A pin pivotally connects the first and second lever arms so that when the lever arms are closed, the second semi-circular portion mates with the first semi-circular portion to complete the cylindrical shell. In one design, the pulling instrument includes a first lever arm having a first proximal handle portion and a first distal portion. The first distal portion forms a first tip coupled to a cylindrical shell having a first semi-circular portion and the first semi-circular portion forms part of the elongated clamp. A second lever arm has a second proximal handle portion and a second distal portion. The second distal portion forms a second tip coupled to a second semi-circular portion and the second semi-circular portion forms part of the elongated clamp. A pin pivotally connects the first and second lever arms so that when the lever arms are closed, the second semi-circular portion can capture the embedded wire against the first semi-circular portion for reliably pulling the wire. 
         [0011]    It should be appreciated that the subject technology can be implemented and utilized in numerous ways, including without limitation as a process, an apparatus, a system, a device, a method for applications now known and later developed. These and other unique features of the system disclosed herein will become more readily apparent from the following description and the accompanying drawings. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0012]    So that those having ordinary skill in the art to which the disclosed system appertains will more readily understand how to make and use the same, reference may be had to the following drawings. 
           [0013]      FIG. 1  is a perspective view of a dissector instrument being readied to remove a wire from tissue in accordance with the subject disclosure. 
           [0014]      FIG. 2  is a perspective view of a dissector instrument dissecting a wire from tissue in accordance with the subject disclosure. 
           [0015]      FIG. 3  is an enlarged detailed view of the area circled in  FIG. 2 . 
           [0016]      FIG. 4  is a cross-sectional view of the dissector instrument being inserted in tissue in the closed position in accordance with the subject disclosure. 
           [0017]      FIG. 5  is a cross-sectional view of the dissector instrument separating tissue from a wire in accordance with the subject disclosure. 
           [0018]      FIG. 6  is a cross-sectional view of the dissector instrument further separating tissue from a wire having tines for retaining the wire in place in accordance with the subject disclosure. 
           [0019]      FIG. 7  is a cross-sectional view of the dissector instrument covering the tines from a wire for removal in accordance with the subject disclosure. 
           [0020]      FIG. 8  is a perspective view of a puller instrument being readied to remove a wire from tissue in accordance with the subject disclosure. 
           [0021]      FIG. 9  is a perspective view of a puller instrument closed on wire for removal from tissue in accordance with the subject disclosure. 
           [0022]      FIG. 10  is a cross-sectional view along line  10 - 10  of  FIG. 9 . 
       
    
    
     DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS 
       [0023]    The subject technology improves upon the prior art associated with removing embedded objects from tissue. The advantages, and other features of the instruments and methods disclosed herein, will become more readily apparent to those having ordinary skill in the art from the following detailed description of certain preferred embodiments taken in conjunction with the drawings which set forth representative embodiments of the present invention. It is understood that references to the figures such as lower, upper, up, down, upward, downward, left, and right are with respect to the figures and not meant in a limiting sense. 
       The Dissector Instrument 
       [0024]    Referring now to  FIGS. 1 and 2 , perspective views of a dissector instrument  100  readied to remove a wire  50  from tissue  52  and dissecting tissue  52  from wire  50  in accordance with the subject disclosure are shown. The dissector instrument  100  includes a first lever arm  102  having a first proximal handle portion  104  and a first distal portion  106 . The first distal portion  106  forms a first tip  108  coupled to a cylindrical shell  110  having a first semi-circular portion  112 . The shell  110  may be any shape such as oval, triangular, rectangular and the like in order to match the profile of the embedded item. The shell  110  may extend transverse to the lever arm  102  as shown, parallel or at any angle in between depending upon the particular application for which the dissector instrument  100  is designed. 
         [0025]    A second lever arm  114  has a second proximal handle portion  116  and a second distal portion  118 . The first and second proximal handle portions  104 , 116  form openings  120 ,  122  for the fingers and thumb so that the dissector instrument  100  can be used with a single hand. A pin  124  pivotally connects the first and second lever arms  102 , 114  together. 
         [0026]    The second distal portion  118  also forms a second tip  126  coupled to a second semi-circular portion  128 . The second semi-circular portion  128  is complimentary to the first semi-circular portion  112  so that when the lever arms  102 ,  114  are closed, the second semi-circular portion  128  completes the first semi-circular portion  112 . In other words, when the tips  108 ,  126  are squeezed together, the distal portions roughly form a cylinder  130  with an upper end  132  and a lower end  134 . The inner diameter “d” of the cylinder  130  is approximately equal to the diameter of the wire  50  but slightly larger so that the cylinder  130  can be moved along the embedded wire  50  when closed. 
         [0027]    Still referring to  FIGS. 1 and 2 , in operation, the first distal portion  106  is slid onto the wire  50  and the lever arms  102 ,  114  are closed to complete the cylinder  130 . Because the inner diameter of the cylinder  130  is slightly larger than the wire  50 , the cylinder  130  easily moves along the wire  50 . The lower end  134  is adjacent the tissue  52  to contact the tissue  52  first as the cylinder  130  slides down the wire  50 . 
         [0028]    Referring now to  FIG. 3 , an enlarged detailed view of the area circled in  FIG. 2  is shown with the tissue  52  drawn in cross-section. The lower end  134  of the cylinder  130  is beveled (best shown in  FIG. 6 ) so that as the lower end  134  slides down the wire  50 , the lower end  134  comes between the wire  50  and the tissue  52 . The lower end  134  is worked into the tissue  52  by gentle pressure and/or rotation as shown in cross-sectional view in  FIGS. 4 and 5 . To additionally facilitate dissection of the tissue  52  from the wire  50 , once the lower end  134  is within the tissue  52 , the lever arms  102 ,  114  may be opened, closed and rotated to separate the tissue  52  from the wire  50  circumferentially. The surgeon continues the process of inserting, rotating and opening the lower end  134  until sufficient tissue is separated for removal of the wire  50 . 
         [0029]    Referring now to  FIGS. 6 and 7 , cross-sectional views of the dissector instrument  100  further separating tissue  52  from a wire  50  having tines  140  is shown. The tines  140  help retain the wire  50  in place. The dissection procedure is similar to the one described above. The lower end  134  is worked into the tissue until the lower  134  end reaches the tines  140 . At this point, the surgeon continues opening, closing, rotating and inserting the lower end  134  to separate the tissue  52  from the tines  140 . Eventually, the lower end  134  surrounds the tines  140  as shown in  FIG. 7 , which indicates that the tissue  52  has been separated from the wire  50  and tines  140  to be ready for removal. As such, the wire  50  can be extracted while the dissector  100  is in place. 
       The Puller Instrument 
       [0030]    Referring now to  FIGS. 8-10 , a puller instrument  200  for removing an embedded wire  50  after dissection is shown. The puller instrument  200  includes a first lever arm  202  having a first proximal handle portion  204  and a first distal portion  206 . The first distal portion  206  forms a first tip  208  coupled to a cylindrical shell  210 . The cylindrical shell  210  has a first central semi-circular portion  212  with fixed collars  214  on each end. It is envisioned that the lower end  216  is beveled for insertion into tissue  52  and may be any length needed to accomplish the function described herein. 
         [0031]    A second lever arm  218  has a second proximal handle portion  220  and a second distal portion  222 . The first and second proximal handle portions  204 ,  220  form openings  230 ,  232  for the fingers and thumb so that the puller instrument  200  can be used with a single hand. The second distal portion  222  forms a second tip  224  coupled to a second semi-circular portion  226 . A pin  230  pivotally connects the first and second lever arms  202 ,  218  so that when the lever arms  202 ,  218  are closed, the second semi-circular portion  226  can capture a wire  50  against the first semi-circular portion  212  for reliably pulling the wire  50 . To reliably capture wire  50  against first semi-circular portion  212 , second semi-circular portion  226  may form a smaller diameter than wire  50 , form a small arc, or the like. 
         [0032]    As would be appreciated by one of ordinary skill in the art based upon review of the subject disclosure, the dissector instrument  100  and the puller instrument  200  can be used consecutively to dissect tissue from an embedded wire, then remove the wire. In operation, the fixed collars  214  of the puller instrument  200  are threaded onto the wire  50  as shown in  FIG. 8 . The lower end  216  is worked into the dissected tissue and preferably covers the tines if present. Then, the puller instrument  200  is closed so that the second semi-circular portion  226  captures the wire  50  against the first semi-circular portion  212 . The wire  50  is shown as having electrodes  54 . For example, as shown in  FIG. 10 , the inner diameter of the cylindrical shell  210  is slightly less than the outer diameter of the wire  50 , creating axial gaps  228  and allowing wire  50  to be securely gripped with a minimal likelihood of damage. Once the wire  50  is securely gripped, the puller instrument  200  draws out the wire  50  as shown in  FIG. 9 . 
         [0033]    In another approach, the dissector instrument  100  and the puller instrument  200  are used simultaneously. The dissector instrument  100  is used to dissect the tissue and free up the wire. While holding the dissection instrument  100  closed in place around the wire, the puller instrument  200  is coupled to the wire and used for extraction. 
         [0034]    In another embodiment, the dissector instrument is adapted to perform dissection and removal. The semi-circular portions are sized to grip the wire. As such, the dissection is performed similarly to that described. The surgeon can work the dissector instrument along the wire into the tissue provided that the dissector instrument is not closed enough to grip the wire. Once the desired dissection and insertion depth are reached, the dissector instrument can be closed to grip and extract the wire. 
         [0035]    It will be appreciated by those of ordinary skill in the pertinent art that the functions of several elements may, in alternative embodiments, be carried out by fewer elements, or a single element. Similarly, in some embodiments, any functional element may perform fewer, or different, operations than those described with respect to the illustrated embodiment. Also, functional elements (e.g., tip, shells, handles and the like) shown as distinct for purposes of illustration may be incorporated within other functional elements in a particular implementation. Additionally, the size and shape of the instruments can not only be adapted to the size and shape of the wire, but can be modified for removal of any item (e.g., oddly shaped jewelry) from tissue. 
         [0036]    While the subject technology has been described with respect to preferred embodiments, those skilled in the art will readily appreciate that various changes and/or modifications can be made to the subject technology without departing from the spirit or scope of the subject technology as defined by the claims.