Apparatus for and method of removal of material using ultrasonic vibraton

A hand-held surgical instrument for fragmentation and removal of animal tissue such as a cataract has a working tip which in addition to being longitudinally vibrated is laterally oscillated to enhance the operation thereof. Also, the method of laterally oscillating the working tip in the range of about 5 degrees to about 60 degrees, longitudinally vibrating the tip ultrasonically, supplying treatment fluid to the region adjacent to the working tip and withdrawing the suspended particles of the cataract in the fluid.

This invention relates to material-removal apparatus and methods, and, more 
particularly, to an instrument having an operative working tip vibrating 
at high frequency and at small amplitudes for breaking apart and removing 
material from relatively inaccessible places and methods for its use. The 
present apparatus is particularly advantageous when employed as a surgical 
instrument for breaking apart and the removal of unwanted tissue, for 
example, a cataract from a human eye. 
Apparatus of this type is described and claimed in my U.S. Pat. No. 
3,589,363 issued June 29, 1971. Improved apparatus of this type is 
described in my publication "PHACO-EMULSIFICATION and ASPIRATION," 
published in the American Journal of Ophthalmology, Vol. 67, No. 4, April, 
1969. 
While the previously described apparatus is satisfactory, I have found that 
the speed with which the cataract can be fragmented and removed can be 
considerably increased in accordance with the present invention. 
It is an object of the present invention, therefore, to avoid one or more 
of the limitations of such prior apparatus and methods. 
It is another object of the invention to provide a new and improved 
apparatus for and method of breaking apart and removal of animal tissue 
and the like which accomplishes such fragmentation and removal in a 
shorter period of time than was heretofore possible. 
It is another object of the invention to provide a new and improved 
apparatus for and method of breaking apart and removal of a cataract from 
an eye which accomplishes such fragmentation and removal in a shorter 
period of time than was heretofore possible. 
In accordance with the invention, apparatus for the breaking apart and 
removal of animal tissue and the like from an enclosed area comprises an 
elongated working tip adapted to have one end placed directly against the 
tissue and capable of supporting ultrasonic vibrations. The apparatus 
includes means for applying longitudinal ultrasonic vibrations to the 
working tip, means for supporting the working tip for lateral rotation, 
and means for laterally rotating the working tip. The apparatus also 
includes means for supplying a treatment fluid to bathe the tissue in the 
region adjacent the working tip and means adjacent the working tip for 
withdrawing the suspension of particles of the tissue in the fluid 
resulting from ultrasonic vibration of the working tip. 
Also in accordance with the invention, a method for the breaking apart and 
removal of animal tissue and the like from an enclosed area, employing an 
elongated working tip comprises the simultaneous steps of applying 
ultrasonic vibrations to the working tip in contact with the tissue, 
supplying a treatment fluid to bathe the tissue in the region adjacent the 
working tip, withdrawing the suspension of particles of the tissue in the 
fluid so that the pressure within the enclosed area is controlled, and 
laterally rotating the working tip. 
For a better understanding of the present invention, together with other 
and further objects thereof, reference is made to the following 
description, taken in connection with the accompanying drawings, and its 
scope will be pointed out in the appended claims.

Referring now more particularly to FIG. 1 of the drawings, apparatus for 
the breaking apart and removal of animal tissue and the like from an 
enclosed area and, more particularly, a surgical instrument adapted to be 
held in the hand and moved freely during operative use, comprises a casing 
10 of, for example, stainless steel. The instrument also comprises 
transducer means 11 supported within the casing 10 for generating high 
frequency mechanical vibrations upon excitation with a high frequency 
alternating-current electrical signal. The transducer 11 preferably is a 
magnetostrictive transducer with an electrical coil 12 wound about each 
leg in such a manner as to develop in-phase longitudinal mechanical 
vibrations in both legs. The instrument includes a connecting body 13 of, 
for example, titanium, attached to another connecting body 16 and which 
form an acoustic impedance transformer for increasing the amplitude of the 
longitudinal vibrations of the transducer 11 for application to the 
operative tool or working tip 14 of the instrument. 
The working tip 14 is at least partially external of the casing 10 and is 
supported thereby and is coupled to the transducer means 11 to be 
longitudinally vibrated thereby. The working tip 14 preferably is an 
elongated, hollow tip capable of supporting ultrasonic vibrations and 
having a beveled end adapted to be placed against the tissue to be 
removed. The working tip 14 preferably is an interchangeable cutting tip 
of titanium having a base portion 15 in threaded engagement with one end 
of the connecting body 16. 
The tip 14 preferably is surrounded by a silicon sleeve 17 supported on a 
reduction housing 18 in threaded engagement with the casing 10. 
The connecting body 16 has disposed thereon two elastomeric O-rings 19, 20 
which provide fluid-tight seals between the connecting body 16 and the 
casing 10. A plurality of screws 51 are disposed around the axis of the 
casing 10 for preventing longitudinal displacement (other than 
vibrational) or rotational movement of the vibratory structure within the 
casing and also for radially centering the vibratory structure within the 
casing. 
Means including the sleeve 17 around the tip 14 forms a first fluid passage 
21 between the tip 14 and a point remote therefrom. Means for supplying 
fluid to the passage 21 comprises an inlet 22 to which a treatment fluid 
supply (not shown) may be coupled. 
means comprising the connecting body 16 is coupled to the tip 14 for 
providing a second fluid passage 23 between the hollow interior of the tip 
14 and a point remote therefrom. Means for applying a suction force to the 
passage 23 comprises an outlet 24 to which a suction pump (not shown) may 
be coupled. 
The apparatus also includes means for supporting the working tip 14 for 
lateral rotation. The supporting means includes the casing 10 surrounded 
by ball bearings 30 and an outer sleeve 31, which may be hand-held. 
There is mounted on the sleeve 31 a motor 32 for laterally rotating the 
casing 10 and the working tip 14 and preferably for oscillating the 
working tip within the range from about 5 degrees to about 60 degrees at a 
frequency in the range of approximately 1 cycle per second to 
approximately 10 cycles per second. 
Referring now more particularly to FIG. 2, the output shaft 33 of the motor 
32 is fixedly connected to a short rotatable arm 34 having a rotatable 
connection 35 to a longer arm 36 which, in turn, is pivotally connected to 
a leg 37 extending from the end of the casing 10. 
The apparatus also includes electrical input terminals 40, 41 for applying 
a suitable electrical signal to the magnetostrictive transducer 11. A 
cooling water inlet 42 and a cooling water outlet 43 for circulating 
cooling water inside the casing 10 in the region around the 
magnetostrictive transducer 11 and connecting body 13 are provided and are 
sealed by the "O-ring" 19 and by a fluid-tight grommet 50. 
Suitable apparatus (not shown) including a suction pump, a treatment fluid 
supply, an oscillator for applying an electrical signal to the vibratory 
structure and control apparatus therefor may be of conventional 
construction, for example, as described in U.S. Pat. No. 3,589,363. 
Additionally, a conventional 60 cycle, alternating-current supply circuit 
may be utilized to energize the motor 32. 
Considering now the operation of the instrument, when an electrical signal 
having a frequency of, for example, 40,000 cycles is applied to the coil 
12 around the magnetostrictive transducer 11, the transducer 11 vibrates 
longitudinally at 40,000 cycles per second, thereby vibrating the 
connecting bodies 13, 16 and the working tip 14. Treatment fluid is 
supplied through inlet 22 and fluid passage 21 to bathe the tissue in the 
region around the working tip 14. Suction is applied through inlet 24 and 
passage 23 to the working tip 14 to withdraw the fragmented tissue. 
At the same time the output shaft of the motor 32 rotates at, for example, 
60 revolutions per minute. In order to accomplish this, the motor may 
include suitable gearing and/or electronic circuitry. 
Rotation of the shaft 33, causes rotation of the arm 34. The arm 36 pivots 
at connection 35 and causes the leg 37 to oscillate laterally at a 
frequency in the range of approximately 1 cycle per second to 
approximately 10 cycles per second supported by the ball bearings 30 
within sleeve 31 which is held by the surgeon's hand. This causes lateral 
oscillation of the working tip 14 while the latter is vibrating 
longitudinally. The relatively low frequency lateral oscillating motion of 
the working tip, superimposed on the relatively high frequency 
longitudinal vibrational movement thereof results in fragmentation and 
removal of tissue, such as a cataract in an eye, in a shorter period of 
time than was heretofore possible. 
While there has been described what is at present considered to be the 
preferred embodiment of this invention, it will be obvious to those 
skilled in the art that various changes and modifications may be made 
therein without departing from the invention, and it is, therefore, aimed 
to cover all such changes and modifications as fall within the true spirit 
and scope of the invention.