Endoscopic bipolar multiple sample bioptome

An endoscopic bipolar multiple sample bioptome includes a relatively long conductive flexible member having a lumen with an axially displaceable conductive wire extending therethrough and covered with an electrically insulating sheath. The proximal ends of the flexible member and wire are coupled to a manual actuation device for axially displacing one of the flexible member and wire relative to the other and the manual actuation device is provided with bipolar electrical couplings for electrically coupling one pole of a current source to the flexible member and the other pole of the current source to the wire. The distal end of the flexible member is mechanically and electrically coupled to a partially conductive cylinder having a distal edge and the distal end of the wire is mechanically and electrically coupled to the jaw assembly. The jaw assembly includes a pair of opposed toothed jaw cups each of which is coupled by a narrow resilient arm to a base member. The base member is mounted inside the cylinder and axial movement of the base member relative to the cylinder draws the necks of the jaws into the cylinder to bring the jaw cups together in a biting action. The cylinder is substantially non-conductive with portions of its exterior being conductive. Cautery current flows between the jaw assembly and the conductive portion(s) of the cylinder by way of tissue which is being cauterized.

This application is related to co-owned applications Ser. No. 08/189,937 
filed Feb. 1, 1994, now U.S. Pat. No. 5,542,432, Ser. No. 08/265,217 filed 
Jun. 24, 1994, now U.S. Pat. No. 5,482,054, Ser. Nos. 08/440,326 and 
08/440,327 both filed May 12, 1995, all of which are both hereby 
incorporated by reference herein in their entirety. 
BACKGROUND OF THE INVENTION 
1. Field of the Invention 
This invention relates to endoscopic surgical instruments. More 
particularly, this invention relates to an instrument for taking multiple 
biopsy tissue samples and which is provided with bipolar cautery 
capability. 
2. State of the Art 
Endoscopic biopsy procedures are typically performed with an endoscope and 
an endoscopic biopsy forceps device (bioptome). The endoscope is a long 
flexible tube carrying fiber optics and having a narrow lumen through 
which the bioptome is inserted. The bioptome typically includes a long 
flexible coil having a pair of opposed jaws at the distal end and manual 
actuation means at the proximal end. Manipulation of the actuation means 
opens and closes the jaws. During a biopsy tissue sampling operation, the 
surgeon guides the endoscope to the biopsy site while viewing the biopsy 
site through the fiber optics of the endoscope. The bioptome is inserted 
through the narrow lumen of the endoscope until the opposed jaws arrive at 
the biopsy site. While viewing the biopsy site through the fiber optics of 
the endoscope, the surgeon positions the jaws around a tissue to be 
sampled and manipulates the actuation means so that the jaws close around 
the tissue. A sample of the tissue is then cut and/or torn away from the 
biopsy site while it is trapped between the jaws of the bioptome. Keeping 
the jaws closed, the surgeon withdraws the bioptome from the endoscope and 
then opens the jaws to collect the biopsy tissue sample. 
A biopsy tissue sampling procedure often requires the taking of several 
tissue samples either from the same or from different biopsy sites. 
Unfortunately, most bioptomes are limited to taking a single tissue 
sample, after which the device must be withdrawn from the endoscope and 
the tissue collected before the device can be used again to take a second 
tissue sample. The single-sample limitation of most bioptomes is due to 
the limited space between the biopsy forceps jaws. Several attempts have 
been made to provide an instrument which will allow the taking of several 
tissue samples before the instrument must be withdrawn and the samples 
collected. Problems in providing such an instrument include the extremely 
small size required by the narrow lumen of the endoscope and the fact that 
the instrument must be flexible in order to be inserted through the lumen 
of the endoscope. 
Co-owned application Ser. No. 08/189,937, (now U.S. Pat. No. 5,542,432) 
discloses an endoscopic multiple sample bioptome which includes a 
relatively long flexible member having a lumen with an axially 
displaceable wire extending therethrough. The proximal ends of the 
flexible member and wire are coupled to a manual actuation means for 
axially displacing one of the flexible member and wire relative to the 
other. The distal end of the flexible member is coupled to either a 
cylinder preferably having a knife sharp distal edge, or a jaw assembly. 
The distal end of the wire is coupled to the other of the cylinder and the 
jaw assembly. The jaw assembly includes a pair of opposed toothed jaw cups 
each of which is coupled by a narrow arm to a base member. The narrow arm 
of each jaw is preferably formed from Nitinol as described in Ser. Nos. 
08/440,326 and 08/440,327 and is arranged to urge the jaws away from each 
other. The base member of the jaw assembly is mounted inside the cylinder 
and axial movement of one of the jaw assembly and cylinder relative to the 
other draws the necks of the jaws into the cylinder or moves the cylinder 
over the necks of the jaws to bring the jaw cups together in a biting 
action. 
Clearly, where traumatic procedures such as taking a biopsy are being 
conducted, the ability to conduct endoscopic cautery procedures is 
desirable in order to stem bleeding. While both monopolar and bipolar 
endoscopic cautery instruments are known (such as disclosed in U.S. Pat. 
No. 4,418,692 to Guay), increasingly, bipolar cautery is preferred because 
it is less traumatic to the patient. In bipolar cautery instruments, the 
electric current path is from one electrode, through the tissue to be 
cauterized, and then through to the other electrode and out of the 
instrument. Thus, cauterization is limited to only that tissue between the 
two electrodes. On the other hand, in monopolar instruments, the patient 
effectively becomes the second electrode, and the cautery current is 
dissipated through the patient. In the monopolar situation, control of the 
cautery location is not exact, and tissue surrounding the tissue to be 
cauterized is also subject to different degrees of cautery. 
In U.S. Pat. No. 4,763,660 to Jaeger, a bipolar endoscopic 
microelectrocautery device is shown. The Jaeger patent also discloses a 
device for obtaining biopsies. However, the device disclosed in Jaeger 
requires a number of different single function "instrument heads" only one 
of which may be attached at any time to the instrument for performing a 
specific function such as grasping, cutting, or cauterizing. Thus, the 
biopsy forceps "head", is incapable of cauterizing, while the cauterizing 
"head" is incapable of obtaining a biopsy. This arrangement does not 
permit the surgeon to cauterize at the biopsy site at the time of taking a 
biopsy. 
SUMMARY OF THE INVENTION 
It is therefore an object of the invention to provide an endoscopic 
multiple sample bioptome which has bipolar cautery capability. 
It is also an object of the invention to provide an endoscopic bipolar 
multiple sample bioptome which has all of the advantages of traditional 
biopsy forceps with the added abilities to collect multiple samples and to 
apply bipolar cautery. 
In accord with these objects which will be discussed in detail below, the 
endoscopic bipolar multiple sample bioptome of the present invention 
includes a relatively long conductive flexible member having a lumen with 
an axially displaceable conductive wire extending therethrough which is 
covered with an electrically insulating sheath. The proximal ends of the 
flexible member and wire are coupled to a manual actuation means for 
axially displacing one of the flexible member and wire relative to the 
other and the manual actuation means is provided with bipolar electrical 
coupling means for electrically coupling one pole of a current source to 
the flexible member and the other pole of the current source to the wire. 
The distal end of the flexible member is mechanically and electrically 
coupled to one of a partially conductive cylinder having a distal edge and 
a conductive jaw assembly. The distal end of the wire is mechanically and 
electrically coupled to the other of the cylinder and the jaw assembly. 
The jaw assembly includes a pair of opposed jaw cups each of which is 
coupled by a narrow arm to a base member. The narrow arm of each jaw is a 
resilient member which urges each jaw away from the other. The base member 
of the jaw assembly is mounted inside the cylinder and axial movement of 
one of the jaw assembly and cylinder relative to the other draws the necks 
of the jaws into the cylinder or moves the cylinder over the necks of the 
jaws to bring the jaw cups together in a biting action. The partially 
conductive cylinder has a substantially non-conductive interior and 
portions of its exterior surface are conductive. When a source of cautery 
current is coupled to the bipolar couplings in the manual actuation means, 
cautery current flows between the jaw assembly and the conductive 
portion(s) of the cylinder. Since the interior of the cylinder is 
non-conductive, there is no short circuit caused by the interior of the 
cylinder embracing the necks of the jaw assembly. 
Preferred aspects of the invention include: forming the flexible member as 
a coil; coupling the cylinder to the distal end of the coil; forming the 
jaw assembly from Nitinol; providing teeth on the jaw cups; coupling the 
jaw assembly to the axially displaceable wire; and providing both the wire 
and the coil with respective insulating sheaths along substantially their 
entire lengths. According to one embodiment of the invention, the cylinder 
is formed from a ceramic material and plated with electrically conductive 
traces which extend from its coupling with the coil to its distal edge. 
According to another embodiment, the cylinder is formed from anodized 
aluminum. A portion of the outer surface of the cylinder is masked before 
the cylinder is anodized to render the unmasked portions non-conductive. 
Additional objects and advantages of the invention will become apparent to 
those skilled in the art upon reference to the detailed description taken 
in conjunction with the provided figures.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
Referring now to FIGS. 1 through 5, the bipolar multiple sample bioptome 10 
includes a proximal handle 12 and a distal end effector 14. A long 
flexible electrically conductive coil 16 having an axially displaceable 
control wire 18 extending therethrough couples the handle 12 and the end 
effector 14. The coil 16 is preferably covered with a non-conductive PTFE, 
FEP or polyethylene sheath 15 along substantially all of its length except 
for its proximal end 16a and its distal end 16b. A strain relief sleeve 17 
preferably covers a portion of the coil 16 which extends from the handle 
12. The control wire 18 is preferably covered with an electrically 
non-conductive sheath 19 substantially all of its length except for its 
proximal end 18a and its distal end 18b. The proximal handle 12 includes a 
central shaft 20 and a displaceable spool 22. The proximal end of the 
shaft 20 is provided with a thumb ring 24 and a longitudinal bore 26 is 
provided at the distal end of the shaft 20. A longitudinal slot 28 extends 
from the proximal end of bore 26 to a point distal of the thumb ring 24. 
The proximal end 16a of the coil 16 is mounted in the bore 26 and a 
radially engaging electrical connector 27 contacts the uninsulated end 16a 
of the coil 16. The displaceable spool 22 is provided with a cross member 
30 which passes through the slot 28 in the central shaft 20. The cross 
member 30 is provided with a central through hole 32 and a radially 
engaging set screw 34 having an electrical connector 35. The uninsulated 
proximal end 18a of the control wire 18 is engaged by the set screw 34. 
From the foregoing, those skilled in the art will appreciate that relative 
movement of the shaft 20 and spool 22 results in movement of the control 
wire 18 relative to the coil 16. Such action results in actuation of the 
end effector 14 as described in detail below. 
Turning now to FIGS. 2 through 5, the end effector 14 includes a partially 
conductive cylindrical sleeve 40 having a (preferably sharp) distal edge 
42, and a conductive jaw assembly 44. The jaw assembly 44 includes a pair 
of opposed jaw cups 46a, 46b each preferably having a plurality of sharp 
teeth 48a, 48b. A resilient, preferably narrow, arm 50a, 50b extends 
proximally from each jaw cup 46a, 46b. A cylindrical base member 52 joins 
the proximal ends of the arms 50a, 50b. The narrow resilient arms 50a, 50b 
are biased apart from each other, thereby urging the jaw cups 46a, 46b 
apart. According to a preferred embodiment of the invention, the 
cylindrical base member 52 of the jaw assembly 44 is mechanically and 
electrically coupled to the uninsulated distal end 18b of the control wire 
18 by providing the base member 52 with a lateral hole 53 and providing 
the distal end 18b of the control wire with a substantially right angle 
bend. The distal end 18b of the control wire 18 is soldered or otherwise 
electrically and mechanically attached in the hole 53 in the base member 
52. The cylindrical sleeve 40 is coupled to the uninsulated distal end 16b 
of the coil 16 by crimping and/or soldering. According to this embodiment 
of the invention, the partially conductive sleeve 40 has a first 
conductive area in the form of a ring 41 near the distal edge 42 and a 
second conductive area in the form of a longitudinal stripe 43 which 
extends from the ring 41 to the proximal end of the sleeve 40. The 
proximal end 43a of the stripe 43 is electrically coupled to the distal 
end 16b of the coil 16, preferably by soldering. Optionally, a third 
conductive area 45 is provided on the proximal edge and interior of the 
proximal end of the sleeve 40 and makes electrical contact with the distal 
end 16b of the coil 16. It will be appreciated that the conductive ring 41 
is therefore electrically coupled to the coil 16 via the stripe 43, and 
optionally the third conductive area 45. 
From the foregoing description those skilled in the art will appreciate 
that when the spool 22 and the shaft 20 are axially displaced relative to 
each other, the cylindrical sleeve 40 and the jaw assembly 44 are 
similarly axially displaced relative to each other, from the positions 
shown in FIG. 2 to the positions shown in FIG. 3 and vice versa. It will 
also be appreciated that when the spool 22 and shaft 20 are in the 
approximate position shown in FIG. 1, the cylindrical sleeve 40 and the 
jaw assembly 44 will be in the approximate position shown in FIG. 2; i.e., 
with the jaws open. Thus, those skilled in the art will further appreciate 
that when the spool 22 is moved towards the thumb ring 24, or vice versa, 
the cylindrical sleeve 40 and the jaw assembly 44 will be brought into the 
approximate position shown in FIG. 3 by movement of the jaws into the 
sleeve, thereby closing the jaws. 
It will also be understood that one pole of a bipolar cautery source (not 
shown) which is coupled to the electrical connector 27 will be 
electrically coupled to the ring 41 on the sleeve 40 via the coil 16 and 
another pole of the bipolar cautery source which is coupled to the 
electrical connector 35 will be electrically coupled to the jaws 46a, 46b 
via the control wire 18. Since the jaw assembly 44 never comes in contact 
with the conductive portions 41, 43, 45 of the sleeve 40 (ring 41 being 
separated from the jaws by the non-conductive distal edge 42) and since 
the control wire 18 is insulated from the coil 16 by the sheath 19, short 
circuits are avoided during all phases of the biopsy procedure. When 
cautery current is supplied to the end effector assembly 14, if tissue is 
present at the edge 42, current passes between the conductive ring 41 and 
the arms 50a, 50b or the jaws 46a, 46b via the tissue (not shown) 
depending on the position of the jaw assembly 44 relative to the sleeve 
40. 
According to one embodiment of the invention, the sleeve 40 is made of a 
non-conductive ceramic material and the conductive areas 41, 43, and 
optionally 45 are applied by tracing with a conductive material. For 
example, the conductive material may be applied by vapor deposition, 
thermal spray, or other means of metalization onto a ceramic sleeve where 
the sleeve is first masked to cover areas which will remain 
non-conductive. 
According to another embodiment of the invention, sleeve 40 is made of 
aluminum which is then anodized. Prior to anodizing the sleeve, portions 
of the sleeve are masked so that they will remain conductive after the 
unmasked portions of the sleeve are anodized. 
Turning now to FIGS. 6-8, according to a second embodiment of the 
invention, an end effector assembly 114 is coupled to the distal ends of 
the coil 16 and control wire 18. The end effector assembly 114 is similar 
to the end effector assembly 14 described above in that it includes a 
cylindrical sleeve 140 and a jaw assembly 144. The jaw assembly 144 is 
substantially the same as the jaw assembly 44 described above, with 
similar reference numerals indicating similar parts. In this embodiment, 
however, the cylindrical base 152 of the jaw assembly 144 is mechanically 
and electrically coupled to the distal end 16b of the coil 16 by crimping 
and/or soldering. The cylindrical sheath 140 is also similar to the 
cylindrical sheath 40 described above having a (preferably sharp) distal 
edge 142, a conductive ring 141 near the distal edge 142, and a conductive 
stripe or portion 143 which extends proximally from the conductive ring 
141. In this embodiment, however, the sleeve 140 is electrically and 
mechanically coupled to the distal end 18b of the control wire 18. The 
coupling is effected by providing a lateral hole 147 in the sleeve 140 and 
a right angle bend in the distal end 18b of the control wire 18. The end 
of the control wire is inserted in the hole and is soldered or otherwise 
mechanically and electrically connected to the sleeve. As seen in FIGS. 
6-8 the conductive portions 141 and 143 of the sleeve 140 make electrical 
contact with the distal end of the control wire 18 via the hole 147. 
It should be appreciated that when the endoscopic instrument with the jaw 
assembly 114 is actuated, the sheath 140 will be moved by the control wire 
18 over the arms 150a, 150b and jaw cups 146a, 146b. Because the arms are 
narrow, there is sufficient room for the right angled bend in the 
insulated wire 18 to extend between the arms and out to the sheath 140 
without contact being made between the wire and the arms. In addition, if 
desired, the connection between the control wire and the sheath can be 
made more proximally along the sheath to avoid contact between the control 
wire and biopsy samples collected between the arms. 
There have been described and illustrated herein several embodiments of an 
endoscopic bipolar multiple sample bioptome. While particular embodiments 
of the invention have been described, it is not intended that the 
invention be limited thereto, as it is intended that the invention be as 
broad in scope as the art will allow and that the specification be read 
likewise. Thus, while particular configurations of the handle have been 
disclosed, it will be appreciated that other types of handles could be 
utilized. Also, while specific couplings of the ends of the coil and 
control wire have been shown, it will be recognized that other types of 
couplings could be used with similar results obtained. Moreover, while 
particular configurations have been disclosed in reference to the jaw 
assembly, it will be appreciated that other configurations could be used 
as well. For example, while it is preferred to provide jaws with teeth, it 
will be appreciated that in lieu of teeth, the jaws can be provided with 
sharp edges which, in conjunction with a sharp cylindrical sleeve, will 
provide a cutting ability. Furthermore, while the jaw assembly has been 
disclosed as being formed from Nitinol, it will be understood that 
different formations of the jaw assembly can achieve the same or similar 
function as disclosed herein. Further yet, it will be appreciated that 
while the apparatus of the invention was described as advantageously 
permitting the obtaining of multiple biopsies without removal from the 
surgical site, the apparatus of the invention, if desired, could still be 
used for obtaining single biopsies at a time. With regard to the partially 
conductive sleeve, it will be appreciated that the arrangement of the 
conductive portions may be varied considerably so long as the conductive 
portions of the sleeve do not contact the jaw assembly. It will therefore 
be appreciated by those skilled in the art that yet other modifications 
could be made to the provided invention without deviating from its spirit 
and scope as so claimed.