Surgical cutting instrument

Abstract: A surgical cutting instrument (10) such as for use in intraocular surgery having a handpiece (12) with an elongate probe extending forward from it. The probe has an elongate stationary outer cutter (44) with a port (46) at its tip and an elongate inner cutter (42) with a cutting surface (47) coaxially disposed therein. The interior of the inner cutter (42) communicates with a vacuum source (16). A spring (48) and diaphragm assembly (40) in the handpiece (12) and powered by a low pressure pump (18) causes the inner cutter (42) to rapidly reciprocate axially in the outer cutter (44), and body material, such as vitreous material, drawn in through the port (46) by the vacuum source (16) is thereby chopped by the cutting surface (47) and aspirated out of the patient's body through the handpiece (12). A large adjustment nut (76) on the handpiece (12) allows the size of the port (46) to be easily adjusted. Irrigation fluid can be provided at the surgical site through an infusion cap (28) which is adjustable both longitudinally and rotatably on the handpiece (12).

Description: Background of the Invention The present invention relates to surgical cutting instruments and more particularly to surgical cutting instruments used in ophthalmic surgery. It further relates to surgical cutting instruments for use in cutting and evacuating material from parts and organs of animal and human bodies. It also pertains to vitrectomy handpieces for providing irrigating and aspirating and cutting functions for cutting and removing vitreous, blood clots, and other material from the eye during intraocular surgery, and to such handpieces which more particularly incorporate reciprocating cutters. Many surgical instruments have been designed in the recent past to aid ophthalmic surgeons in removing vitreous, blood clots, cataracts, lenses and other matter from the eye. These instruments typically have an elongated probe defining a cutter at the distal end thereof, which is inserted into the body, for example into the eye through an incision in the cornea or sclera. The probe thereof is typically formed by coaxial inner and outer tubes wherein a port is provided in the outer tube adjacent the end and the inner tube moves relative thereto, and the inner and outer tubes cut the material as it is drawn in through the port. The excised tissue is aspirated by suction from the interior of the body part, such as the eye, possibly together with fluid, through the central lumen of the hollow inner tube, and is collected in a collection vessel. It has been found that when the inner tube motion is rotational relative to the outer tube that the vitreous and other materials are pulled or sheared while being cut. Thus, the current practice is to provide for the inner tube to reciprocate longitudinally relative to the outer tube and thereby provide a chopping or guillotine type of action to cleanly cut the vitreous body. Many methods are known for effecting this reciprocating movement of the inner cylinder including utilizing an electric motor or a pneumatic actuator positioned in the handpiece, and these include the devices disclosed in US Patent 4 246 902 to Martinez, and US Patent 4 674 502. It is also known to use a bellows positioned in the handpiece with the inner cutting tube being secured to the bellows, and a means for alternately supplying compressed air and vacuum to the bellows. This arrangement is shown for example in US Patent 3 884 238, whose entire contents are also hereby incorporated by reference. It is further known to include on the surgical cutting tool an infusion sleeve or similar means for providing irrigation either during or separately from the cutting procedure. This irrigation means can bathe the surgical site in a physiological fluid and for ophthalmic surgery can maintain the intraocular pressure to prevent the collapse of the eyeball. US 4 696 298 describes a vitrectomy cutting instrument comprising a housing bearing a suction outlet port, a fluid inlet port and a probe needle. The housing is also provided with air vents, a nose and a cap. The nose carries the probe needle with a port, the needle has an inner tubular member which extends into the finger grip of the housing. The tubular member is provided with an outer cutting blade which may be slid across the port. The blade tubular member and suction outlet are resiliently biased to an open position by a compression spring. The spring is contained within the housing and acts upon a flanged collar retainer through which the inner tubular member and section outlet have been inserted. The housing comprising a spring chamber and a fluid chamber separated from one another by a diaphragm. The cap interlocks with the housing and carries the outer tubular member which is sealed in the cap by an O-ring. The inner tubular member and suction outlet reciprocable by injection pressurised fluid pulses through the fluid inlet port into the fluid chamber. The pulses cause the diaphragm to push against a retainer connected to the suction outlet. These known cutting instruments though suffer from many disadvantages, including the difficulty in assembling them, excessive vibrations created by the handpiece, inability to attain cutting speeds greater than 600 cuts per minute, lack of suitable means for adjusting the size of the cutting and aspirating port, and the presence of outside moving parts on the handpiece. Thus, a need has arisen for an improved design for such surgical cutting instruments. Accordingly, it is a principal object of the present invention to provide an improved design for a surgical cutting instrument. At least some embodiments of the present invention provide an improved surgical cutting instrument construction which can be easily assembled and is designed to be economically disposable after a single use. At least some embodiments of the present invention provide an improved construction of a surgical cutting instrument having an infusion component which can be easily adjusted. At least some embodiments of the present invention provide an improved surgical cutting instrument design which reduces the vibrations created by the handpiece thereof. At least some embodiments of the present invention provide an improved vitrectomy handpiece having no moving parts outside of the body of the handpiece. At least some embodiments of the invention provide an improved surgical cutting instrument having greater cutting speeds for increased efficiency and safety. Other objects and advantages of the present invention will become apparent to those persons of ordinary skill in the art from the foregoing description taken in conjunction with the accompanying drawings. As is known there is provided a surgical cutting instrument comprising: a diaphragm assembly contained within a housing and connectable to a source of pressure, an inner cutter operatively connected to said diaphragm assembly and connectable to a source of vacuum, and defining a cutting surface, an outer cutter positioned outside of said inner cutter and defining a suction port, spring biasing means for urging said inner cutter against the bias caused by the force of the source of pressure on said inner cutter via said diaphragm assembly, and said spring biasing means and the operation of the source of pressure causing said cutting surface to reciprocate relative to said port and to thereby cut the matter drawn into said port by the operation of the source of vacuum, said diaphragm assembly including a diaphragm portion arranged to transmit force from said pressure source to the proximal end of said cutter. In contrast to US-A-4696298 and in accordance with the invention, the diaphragm 40 also includes a bellows portion connected to and movable with a proximal end portion of said inner cutter, which is expandable and contractible generally along a longitudinal axis of said inner cutter in response to the reciprocation of said inner cutter, the flexible means constituting the only fluid passage between the proximal end portion of said inner cutter and the housing. Brief Description of the Drawings Figure 1 is a perspective view of a surgical cutting instrument of the present invention with the handpiece thereof shown enlarged for the sake of clarity. Figure 2 is a cross-sectional view of the handpiece of the surgical cutting instrument of Figure 1 taken along line 2-2 and illustrated in isolation. Figure 3 is a view similar to Figure 2 illustrating the components of the handpiece in their extended position. Figure 4 is a fragmentary, cross-sectional view of the proximal end of the handpiece illustrating the proximal end of the diaphragm after being threaded through the end cap. Figure 5 is an elevational view of the handpiece of the surgical cutting instrument of Figure 1. Figure 6 is an elevational view of a posterior vitrectomy handpiece variant of the surgical cutting instrument of Figure 1. Figure 7 is a perspective view of the posterior vitrectomy handpiece of Figure 6. Figure 8 is an exploded cross-sectional view of the posterior vitrectomy handpiece of Figure 6 illustrating the major components thereof. Detailed Description of the Preferred Embodiments Referring to the drawings a preferred surgical cutting instrument of the present invention is illustrated generally at 10. Instrument 10 is shown in Figure 1 to comprise a vitrectomy handpiece illustrated generally at 12 connected to a low pressure 1·3-2 bar (twenty to thirty psi) pump illustrated schematically at 14 providing a vacuum source 16 and a pressure source 18, and an irrigation source 20, such as a BSS bottle located at a predetermined height above the surgical site, providing a source of irrigation fluid. The bottle 20 is connected by a silicone or PVC tubing 22 to the infusion fitting 24 on the infusion sleeve 26 portion of the infusion cap 28. A logo pad 29 to display the manufacturer's or distributor's logo is provided on and along the infusion cap 28. A silicone tubing vacuum line 30 is provided from the vacuum source 16 to the vacuum fitting 32 of the handpiece 12, and a silicone tubing pressure line 34 connects to a pressure line fitting 36. The vacuum fitting 32 and the pressure fitting or opening 36 are both attached generally at separate locations to the distal end of the end cap 38 of the handpiece 12. The end cap 38 which is formed of a medical grade plastic houses a diaphragm assembly shown generally at 40 (Figure 2), and the diaphragm assembly 40 is secured to the inner cutting tube 42 which is adapted to reciprocate within the outer cutting tube 44. The outer cutting tube 44 has a side port 46 adjacent its forward tip and has a cutting surface, and the inner cutting tube 42 has a cutting surface 47 at its distal tip which slides reciprocally relative to the port 46. Inner cutting tube 42 is hollow so that when suction is applied to it through the fitting 32, vitreous and other matter is drawn into the port 46 and the reciprocating inner cutting tube 42 chops the matter drawn into the port 46 in a guillotine fashion, and then aspirated out the inner cutting tube 42 through the vacuum line 30, as illustrated for example in U.S. Patent No. 3,776,238, Simply explained, the diaphragm assembly 40 is caused to reciprocate back and forth by the action of pressurized air through the pressure line 34 against the diaphragm assembly 40 in a forward direction, and the bias to the diaphragm assembly 40 in the opposite rearward direction is caused by the compressed bias spring 48 disposed in the chamber 50 of the assembly tip and body member 52 and also by the vacuum effect thereon from the vacuum source 16. The assembly tip and body member 52 can be also made from a medical grade plastic. The diaphragm assembly 40 in its retracted position is best illustrated in Figure 2 and in its extended position in Figure 3. It is seen from those figures that the diaphragm assembly 40 which is formed of silicone has a proximal expandable and contractable bellows portion 54, a diaphragm 56a, an integral diaphragm flange 56, and a separate diaphragm hub 58 disposed forward of the diaphragm flange 56 and in which the inner cutting tube 42 is secured by tube proximal outwardly-flaring flange 60. The bias spring 48 has its rearward end seated in the seat 62 formed by the diaphragm hub 64 and its forward end positioned against gasket 66. Gasket 66 in turn is sandwiched between the bottom of the major hole 68 in the body member 52 and the bias spring 48, and is provided to prevent air bubbles from forming in the vacuum line 30 by blocking air from passing between the inner and outer cutting tubes 42, 44. The diaphragm assembly 40 has a diaphragm passageway 70 passing longitudinally therethrough as does the diaphragm hub 58 with its hub passageway 72, both of which define a passageway communicating the interior of the inner cutting tube 42 with the vacuum line 32 and through which a vacuum pressure is applied and out through which the cut vitreous materials are aspirated. Thus, during the reciprocating cycle when the pressure in the pressure line 34 is not at its peak the spring 48 and the alternating sucking force in the pressure line 34 cause the diaphragm assembly 40, and thus the inner cutting tube 42 secured thereto and the spring, to be positioned in their rearward position, as best illustrated in Figure 2. In this position the port 46 is open so that vitreous material can be sucked therethrough and into the tip of the inner cutting tube 42. Then when the pressure in the pressure line 34 is increased the pressurized air acts against the diaphragm 56a and causes the diaphragm bellows portion 54 to expand and the diaphragm hub 58 to be pushed forward against the bias of the spring 48. The inner cutting tube 42 secured to the hub 58 is thereby caused to move forward so that its cutting surface 47 passes in front of the port 46 and chops the drawn-in vitreous material. This forward position is best illustrated in Figure 3. As the diaphragm 56a moves forward, the air in the chamber 50 is expelled out of the body member 52 through relief holes 74, and sucked in through them when the diaphragm 56a moves backward. The relief holes 74 are positioned so that they cannot be closed off as by the user's fingers or by other means. Adjustments to the size of the port 46 can be made by holding the end cap 38 against rotation and turning clockwise or counterclockwise relative to the body member 52 the adjustment nut 76, which is threaded on the aft portion of the body member 52 and formed of a medical grade plastic. An annular adapter 78 also formed of a medical grade plastic is snap fitted tightly to the end cap 38, and thus, as the adjustment nut 76 is turned, the adapter 78, the end cap 38 and the diaphragm hub 58 are all moved forward or backward depending on the direction in which the adjustment nut 76 is turned. As the diaphragm hub 58 is moved relative to the body member 52, the longitudinal normal position of the inner cutting tube 42 relative to the outer cutting tube 44 is also adjusted. Due to this design the forward and backward movements of the diaphragm assembly 40 can be repeated up to eight hundred times a minute, which is considerably greater than the six hundred times per minute rate possible with most commercially-available surgical cutting instruments. The rotary movement of the adapter 78, diaphragm hub 58, and end cap 38 is prevented by built-in orientation means. The body member 52 has two round dimples 79a, spaced one hundred and eighty degrees apart. The adjustment nut 76 has twelve longitudinal lips 79b equally spaced on the internal surface between the threads and the distal end. The radial distance between two opposite lips is slightly smaller than the distance between the dimples. A click can be heard each time the adjustment nut 76 is turned thirty degrees in either the clockwise or the counterclockwise direction as the lips 79b of adjustment nut 76 are forced over the dimples 79a of body member 52. The construction of the diaphragm assembly 40 is thus unique in that it provides a diaphragm, bellows, sealing and free passageway functions all in one unit. It expands and contracts in its bellows portion 54 thereby providing flexibility and eliminating the need for any (stainless steel) aspiration tubes sticking outside of the end cap 38 as found on many prior devices, and in fact no moving parts outside of the body member 52 of the vitrectomy handpiece 12 are needed. Also, the very end 80 of the diaphragm assembly 40 outside of the body member 52, as shown in Figure 4, comprises an assembly aid to easily thread the end portion 80 of the diaphragm assembly 40 through the hole in the back of the end cap 38, and to be cut off as at location 81 after threading the end portion 80 of the diaphragm assembly 40 through that hole. The diaphragm flange 56 is sandwiched between the end cap 38 and the adapter 78 to provide a good seal therebetween. It has been found that the diaphragm assembly 40 also creates less vibration during its operation than experienced with other similar handpieces. The infusion cap 28 which is made of a medical grade plastic is adjustable in both longitudinal and circular directions relative to the body member 52, as indicated by the arrows in Figure 1. An O-ring 82 provides a seal against the infusion fluid that comes in through the infusion fitting 24 and allows firm yet adjustable movements of the infusion cap 28 relative to the body member 52. The infusion or irrigation fluid then passes out the infusion sleeve 26 and out the two coaxial openings 88 at the end of the sleeve adjacent the port 46. Since no O-rings are needed in the reciprocating drive aspect of this instrument 10, reduced drag results, the instrument is easier to operate, a lower air pressure of only 1·3 to 2 bar (twenty to thirty psi) of pump 14 is needed, and no silicone oil is needed. Also because the body parts are snap-fitted together, assembly of handpiece 12 is easy and reliable and no adhesives or the like are required. Although the primary use of the subject surgical cutting instrument 10 is for ophthalmic surgery, namely irrigation and aspiration, anterior vitrectomy and posterior vitrectomy, surgical uses on or in other parts of the body are possible, including liposuction, back surgery, kidney stone surgery, gall bladder surgery, orthopedic surgery and reconstructive plastic surgeries. An example of a posterior vitrectomy handpiece of the present invention is shown in Figures 6-8 generally at 90. Handpiece 90 corresponds generally to handpiece 12 except that it lacks an irrigation infusion capability and thus has a body sleeve construction as shown generally at 92 in place of the infusion cap 28. From the foregoing detailed description it will be evident that there are a number of changes, adaptations and modifications of the present invention which come within the province of those persons having ordinary skill in the art to which the aforementioned invention pertains.

Claims: A surgical cutting instrument comprising: a diaphragm assembly (40) contained within a housing and connectable to a source of pressure (18), an inner cutter (42) operatively connected to said diaphragm assembly (40) and connectable to a source of vacuum (16), and defining a cutting surface (47), an outer cutter (44) positioned outside of said inner cutter (42) and defining a suction port (46), spring biasing means (48) for urging said inner cutter (42) against the bias caused by the force of the source of pressure (18) on said inner cutter (42) via said diaphragm assembly (40), and said spring biasing means (48) and the operation of the source of pressure (18) causing said cutting surface to reciprocate relative to said port (46) and to thereby cut the matter drawn into said port (46) by the operation of the source of vacuum (16), said diaphragm assembly (40) including a diaphragm (56a) arranged to transmit force from said pressure source (18) to the proximal end of said cutter (42) characterised in that the diaphragm assembly (40) also includes a bellows portion (54) connected to and movable with a proximal end portion of said inner cutter (42) which is expandable and contractible generally along a longitudinal axis of said inner cutter (42) in response to the reciprocation of said inner cutter (42), the bellows portion constituting the only fluid passage (70) between the proximal end portion of said inner cutter (42) and the housing (28,38,52,76). An instrument according to claim 1 wherein said diaphragm assembly (40) further comprises a diaphragm hub (58) which abuts said diaphragm (56a) and is positioned generally forward thereof. An instrument according to claim 2 wherein said inner cutter (42) is secured in said diaphragm hub (58). An instrument according to claim 2 or claim 3 wherein said hub (58) is positioned directly between and adjacent said spring biasing means (48) and said diaphragm (56a). An instrument according to any one of the preceding claims further comprising a body member (52) secured to said outer cutter (44), an adjustment nut (76) threadably received on said body member (52), an end cap (38), and an adapter (78) disposed between said adjustment nut(76) and said end cap (38), and said adapter (78) being operatively connected to said diaphragm assembly (40) such that, when said adjustment nut (76) is turned on said body member (52), said inner cutter (42) is moved relative to said body member (52) to thereby adjust the position of said cutting surface relative to said port. An instrument according to claim 1 further comprising an adjustment means (76) connected to said inner cutter (42) for adjusting the normal position of said cutting surface relative to said port. An instrument according to claim 5 including an interference fit between said adjustment nut (76) and said body member (52) providing a click noise when said adjustment nut (76) is turned a predetermined amount on said body member (52). An instrument according to any one of the preceding claims further comprising an infusion means connectable to a source of irrigation fluid (20) for conducting irrigation fluid from the source of irrigation fluid (20) to a site adjacent said port. An instrument according to claim 8 wherein said infusion means comprises an infusion cap (28) which includes an infusion sleeve (26) surrounding said outer cutter, and an infusion fitting (24) communicating the source of irrigation fluid with said infusion sleeve (26). An instrument according to claim 9 when dependent on claim 5 said infusion cap (28) being fitted onto the distal end of said body member (52). An instrument according to claim 9 or 10 wherein said infusion sleeve (26) defines at the distal end thereof at least one fluid opening (88) around said outer cutter (44) and out through which the irrigation fluid can flow. An instrument according to any one of the preceding claims further comprising a gasket means (66) at the proximal end of said outer cutter (44) for preventing the flow of air between said inner and outer cutters (42,44). An instrument according to claim 5 wherein the body member (52) is connected to said outer cutter (44) and defining at least one relief opening (74) through which air can pass between the interior and exterior of said body member (52) as said diaphragm assembly is moved relative thereto and therein. An instrument according to any one of claims 11 to 13 other than when dependent on claim 5 wherein said diaphragm assembly includes an diaphragm flange portion (56) and further comprising an end cap (38) surrounding a portion of said diaphragm assembly (40), and an annular adapter (78) sandwiched between said end cap (38) and said diaphragm flange portion (56) and defining a seal therebetween. An instrument according to claim 14 wherein said end cap (38) defines an opening (36) therethrough through which pressurized air from the source of pressure can flow adjacent to the diaphragm (56a) so that the pressurized air directly impacts the diaphragm (56a). An instrument according to claim 5 wherein said spring biasing means (48) comprises a spring (48) operatively positioned between said diaphragm assembly (40) and said body member. An instrument according to claim 1 further comprising an end cap (38) to which a distal end of said diaphragm assembly (40) is secured, and said end cap defining an end cap opening through which the source of vacuum can communicate with said port. An instrument according to claim 17 wherein said diaphragm assembly includes a proximal portion (54a) thereof extending out through said end cap (38) opening. An instrument according to claim 17 wherein said bellows portion (54) is positioned entirely within said end cap (38). An instrument according to any one of the preceding claims wherein said outer cutter defines a cutting surface at said port. An instrument according to any one of the preceding claims further comprising a body sleeve surrounding at least a portion of said outer cutter and whereby said instrument defines a posterior vitrectomy handpiece.

Inventors: AKKAS TAMER, CARLSON TED, AKKAS, TAMER, CARLSON, TED
Applicants: NESTLE SA
Application year: 1988
Main classification: A61B17
IPC codes: A61F9, A61B17