BIOPSY APPARATUS AND METHOD

Abstract: A surgical biopsy apparatus (10) is provided which includes a housing (14), a first elongated tubular member (32) removably mounted in the housing (14), and defining a fluid passageway therein, the first elongated tubular member including a tapered closed distal end portion adapted to penetrate tissue; a laterally disposed tissue receiving opening (34) formed near the tapered distal end which includes a tissue support surface defining a plurality of holes (32) in fluid communication with the fluid passageway; a second elongated tubular member rotatable, reciprocating disposed coaxially about the first elongated tubular member, the second elongated tubular member having a cutting edge (42) formed at an open distal end thereof, and a lateral tissue discharge port formed proximally of the cutting edge (42).

Description: BIOPSY APPARATUS AND METHOD CROSS REFERENCE TO RELATED APPLICATIONS: This application claims priority to U.S. Provisional Application Serial No. 60/059,548 filed September 19, 1997 by Farascioni et al., and to U.S. Provisional Application Serial No. 60/059,545 filed September 19, 1997 by Matula, the entire contents of each of these applications are hereby incorporated by reference. 1. Technical Field This disclosure relates to an apparatus and method for the biopsy of tissue specimens and, more particularly, to a single insertion, multiple sample percutaneous biopsy apparatus and method. 2. Background of Related Art It is often necessary to sample tissue in.order to diagnose and treat patients suspected of having cancerous tumors, pre-malignant conditions and other diseases or disorders. Typically, in the case of suspected cancerous tissue, when the physician establishes by means of procedures such as palpation, x-ray or ultrasound imaging that suspicious conditions exist, a biopsy is performed to determine whether the cells are cancerous. Biopsy may be done by an open or percutaneous technique. Open biopsy removes the entire mass (excisional biopsy) or a part of the mass (incisional biopsy). Percutaneous biopsy on the other hand is usually done with a needle-like instrument and may be either a fine needle aspiration (FNA) or a core biopsy. In FNA biopsy, individual cells or clusters of cells are obtained for cytologic examination and may be prepared such as in a Papanicolaou smear. In core biopsy, as the term suggests, a core or fragment tissue is obtained for histologic examination which may be done via frozen section or paraffin section. In more recent developments percutaneous techniques have been used to remove the entire mass during the initial procedure. The type of biopsy utilized depends in large part on the circumstances present with respect to the patient and no single procedure is ideal for all cases. Core biopsy, however, is extremely useful in a number of conditions and is being used more frequently. Intact tissue from the organ or lesion is preferred by medical personnel in order to arrive at a definitive diagnosis regarding the patient's condition. In most cases only part of the organ or lesion need be sampled. The portions of tissue extracted must be indicative of the organ or lesion as a whole. In the past, to obtain adequate tissue from organs or lesions within the body, surgery was performed so as to reliably locate, identify and remove the tissue. With present technology, medical imaging equipment such as stereotactic x-ray, fluoroscopy, computer tomography, ultrasound, nuclear medicine and magnetic resonance imaging, may be used. These technologies make it possible to identify small abnormalities even deep within the body. However, definitive tissue characterization still requires obtaining adequate tissue samples to characterize the histology of the organ or lesion. Mammography can identify non-palpable (not perceptible by touch) breast abnormalities earlier than they can be diagnosed by physical examination. Most non- palpable breast abnormalities are benign but some are malignant. When breast cancer is diagnosed before it becomes palpable, breast cancer mortality can be reduced. It is still difficult to determine if pre-palpable breast abnormalities are malignant, as some benign lesions have mammographic features which mimic malignant lesions and some malignant lesions have mammographic features which mimic benign lesions. Thus, mammography has its limitations. To reach a definitive diagnosis, tissue from within the breast must be removed and examined under a microscope. The introduction of stereotactic guided percutaneous breast biopsies offered alternatives to open surgical breast biopsy. With time, these guidance systems have become more accurate and easier to use. Biopsy guns were introduced for use in conjunction with these guidance systems. Accurate placement of the biopsy guns was important to obtain useful biopsy information because only one small core could be obtained per insertion at any one location. To sample the lesion thoroughly, many separate insertions of the instrument had to be made. Biopsy procedures may benefit from larger tissue samples being taken, for example, tissue samples as large as 10 mm across. Many of the prior art devices required multiple punctures into the breast or organ in order to obtain the necessary samples. This practice is both tedious and time consuming. One further solution to obtain a larger tissue sample is to utilize a device capable of taking multiple tissue samples with a single insertion of an instrument. An example of such a device is found in U.S. Patent No. 5,195,533 to Chin et al. which describes a technique for extracting multiple samples with a single insertion of the biopsy device. Generally, such biopsy instruments extract a sample of tissue from a tissue mass by either drawing a tissue sample into a hollow needle via an external vacuum source or by severing and containing a tissue sample witiiin a notch formed on a stylet. Typical of such devices utilizing an external vacuum source are U.S. Patent No. 5,246,011 issued to Cailouette and U.S. Patent No. 5,183,052 issued to Terwiliger. Such devices generally contemplate advancing a hollow needle into a tissue mass and applying a vacuum force to draw a sample into the needle and hold the same therein while the tissue is extracted. When extracting multiple samples with - single insertion of the biopsy device using suction to either draw in tissue or remove the tissue from the body, it is important that the vacuum path remain unclogged. If the vacuum path clogs, the sample removal will become difficult or impossible. This may necessitate multiple insertions of the device or reduce the sample mass per extraction. Therefore, a continuing need exists for percutaneous biopsy apparatus and methods which can reliably extract adequate biopsy sample(s) wi a single insertion of the biopsy instrument. SUMMARY One particular embodiment of die present disclosure provides a surgical biopsy apparatus which includes a housing; a first elongated tubular member removably mounted in the housing and defining a fluid passageway therein, the first elongated tubular member including: a tapered closed distal end portion adapted to penetrate tissue; a laterally disposed tissue receiving opening formed near die tapered distal end which includes a tissue support surface defining a plurality of holes in fluid communication with the fluid passageway; and a second elongated tubular member rotatably and reciprocatingly disposed coaxially about the first elongated tubular member, the second elongated tubular member having a cutting edge formed at an open distal end Λereof and a lateral tissue discharge port formed proximally of the cutting edge. A third elongated tubular member is also provided which is removably supported by the housing and coaxially disposed about the first and second elongated tubular members, the third elongated member being movable from a retracted position to an extended position wherein a distal end portion is disposed laterally adjacent a distal-most position of the tissue receiving opening of the first elongated tubular member. The third elongated member may be radiolucent to permit the passage of x-rays therethrough and may also include a radiopaque marking formed on a portion of the third elongated member such mat when the third elongated tubular member is in the deployed position die radiopaque marking is laterally adjacent the distal-most position of me tissue receiving opening of the first elongated tubular member. In one aspect of die biopsy apparatus a tissue stripping member is disposed adjacent me lateral tissue discharge port, die tissue stripping member including a flexible extended portion configured and dimensioned to enter me tissue receiving opening of die first elongated tubular member upon alignment of the tissue receiving opening with die lateral tissue discharge port. -The tissue stripping member may include a friction reducing coating formed ereon to reduce friction with body tissue coming in contact with the tissue stripping member. In another aspect of the presently disclosed biopsy apparatus, the tissue support surface of the laterally disposed tissue receiving opening has an arcuate cross-section. In another embodiment, me present disclosure provides a surgical biopsy apparatus which includes a housing; a first elongated tubular member removably mounted in the housing and defining a fluid passageway dierein, die first elongated tubular member including: a tapered closed distal end portion adapted to penetrate tissue; a laterally disposed tissue receiving opening formed near die tapered distal end; a second elongated tubular member rotatably and reciprocatingly disposed coaxially about die first elongated tubular member, me second elongated tubular member having a cutting edge formed at an open distal end Λereof and a lateral tissue discharge port formed proximally of die cutting edge; and a tissue marking member removably insertable through die second elongated tubular member, die tissue marking member including: an elongated shaft; a clamp disposed at a distal end of die elongated shaft, die clamp being operable from a first orientation configured and dimensioned to retain a tissue marker therein and a second orientation to deform a tissue marker retained by die clamp thereby attaching the tissue marker to body tissue of a patient. In another embodiment, me present disclosure provides a mediod of performing a surgical biopsy which includes die steps of: a) inserting a biopsy apparatus into the tissue of a patient, die biopsy apparatus including an inner mbular member having a tapered penetrating end formed on die distal end and an outer mbular member held longitudinally fixed relative to die inner mbular member during d e insertion step; b) retracting the outer mbular member relative to the inner mbular member to expose a laterally disposed tissue receiving area formed on ie inner mbular member; c) applying suction to a series of openings formed along an inner surface of die tissue receiving area to pull tissue into die tissue receiving area; c) severing tissue disposed widiin the tissue receiving area by advancing die outer mbular member over the inner mbular member such mat a cutting surface formed on the distal end of the outer mbular member rotates as it passes over the tissue receiving area; and d) removing the severed tissue sample from the tissue sampling site by retracting the inner mbular member from the outer mbular member until the tissue receiving area is aligned widi a lateral opening formed in the outer mbular member wherein a tissue stripping plate urges the tissue sample out of ie tissue receiving area. BRIEF DESCRIPTION OF THE DRAWINGS Various embodiments are described herein widi reference to die drawings, wherein: FIG. 1 is a perspective view of one embodiment of a percutaneous biopsy apparatus constructed in accordance widi die present disclosure; FIG. 2 is an exploded perspective view of die biopsy apparams embodiment of FIG. 1; FIG. 3 is an enlarged perspective view f a tip portion of die biopsy apparams embodiment of FIG. 1; FIG. 4 is an exploded perspective view of a vacuum assembly of the biopsy apparams embodiment of FIG. 1; FIG. 5 is a cross-sectional view taken along section line 5-5 of FIG. 4; FIG. 6 is a cross-sectional view taken along section line 6-6 of FIG. 4; FIG. 7 is a cross-sectional view taken along section line 7-7 as shown in FIG. 1; FIG. 8 is an enlarged cross-sectional view of die area of detail indicated in FIG. 7; FIG. 9 is an enlarged cross-sectional view of me area of detail indicated in FIG. 7; FIG. 10 is an enlarged cross-sectional view of die area of detail indicated in FIG. 7; FIG. 11 is a cross-sectional view of die biopsy apparams taken along section line 11-11 of FIG. 1; FIG. 12 is an enlarged cross sectional view of die indicated area of detail as shown in FIG. 11; FIG. 13 is a perspective view of die biopsy apparams mounted to a guidance and driver platform; FIG. 14 is a side view of die biopsy apparams showing a clamped breast prior to insertion of a penetrating tip; FIG. 15 is a side view of die biopsy apparams showing a clamped breast after insertion of a penetrating tip into a target tissue mass; FIG. 16 is an enlarged cross-sectional view of a distal portion of the biopsy apparams disposed wid in a target tissue mass with a knife mbe fully advanced; FIG. 17 is an enlarged cross-sectional view of a housing portion of the biopsy apparams showing a gear and gear shaft being moved proximally; FIG. 18 is a cross-sectional view of die biopsy apparams showing a gear and a gear shaft fully retracted; FIG. 19 is a perspective view of die biopsy apparams showing the bottom of the apparams; FIG. 20 is an enlarged perspective view of me tip of the biopsy apparams showing the indicated area of detail of FIG. 19; FIG. 21 is an enlarged cross-sectional view of die indicated area of detail of FIG. 18 showing suction lines and tissue mass .being drawn into a lateral opening formed in the biopsy apparams; FIG. 22 is an enlarged cross-sectional view of me indicated area of detail of FIG. 18 showing a knife mbe being rotated and advanced distally to sever a tissue mass into the lateral opening in the biopsy apparams; FIG. 23 is a perspective view of a proximal portion of the biopsy apparams mounted on ie guidance and driving platform showing a vacuum knob detaching from an attachment port in order to retract a vacuum mbe and tip portion; FIG. 24 is a cross-sectional view of a distal portion of die biopsy apparams showing the vacuum knob detached from the attachment port in order to retract vacuum mbe and tip portion; FIG. 25 is a cross-sectional view of ie biopsy apparams tip portion showing a stripper plate and a tissue sample prior to removal of the tissue from me apparams; FIG. 26 is a cross-sectional view of the biopsy apparams tip portion showing the stripper and the tissue sample during removal of the tissue from the apparams; FIG. 27 is an enlarged perspective view of die biopsy apparams tip portion showing the stripper plate and tissue sample during removal of the tissue from the apparams; FIG. 28 is a perspective view of the biopsy apparams showing the vacuum knob in a first position; FIG. 29 is a perspective view of die biopsy apparams showing the vacuum knob in a second position rotated from the first position of FIG. 29 and also showing the lateral opening rotated; FIG. 30 is a perspective view of a portion of die biopsy apparams showing the attachment port detached and being retracted; FIG. 31 is a perspective view of die tissue sample being removed from the biopsy apparams; FIG. 32 is perspective view of a breast having a support mbe retained tiierein; FIG. 33 is a colored diree dimensional image of a biopsy apparams mounted on a platform having a tissue tray at a distal end; FIG. 34 is a perspective view of die biopsy apparams of FIG. 33 having a knife mbe retracted; FIG. 35 is a perspective view of a biopsy apparams having a tissue tray at a distal end; FIG. 36 is a side view of die biopsy apparams of FIG. 33; . FIG. 37 is a cross-sectional view taken along section line 37-37 of FIG. 36; FIG. 38 is a perspective view of an alternate embodiment of a percutaneous biopsy apparams constructed in accordance widi die present disclosure; FIG. 38A is a partial perspective view which shows detachably mounting a biopsy apparams on a drive unit; FIG. 39 is a perspective view of a disposable loading unit portion of the percutaneous biopsy apparams of FIG. 38; FIG. 40 is a perspective view widi parts separated showing the component parts of the disposable loading unit of FIG. 39; FIG. 41 is an enlarged perspective view of a distal end portion of the disposable loading unit illustrating a tissue receiving basket of the biopsy apparams; FIG. 42 is a cross-sectional view taken along section lines 42-42 of FIG. 39; FIG. 43 is an enlarged view of die area of detail as indicated in FIG. 42; FIG. 44 is an enlarged view of die area of detail as indicated in FIG. 42; FIG. 45 is an enlarged view of die area of indicated detail as indicated in FIG. 42; FIG. 46 is a cross-sectional view taken along section line 47-47 of FIG. 39; FIG. 47 is an enlarged view of die indicated area of detail of FIG. 46; FIG. 48 is a side view illustrating the relative alignment of the biopsy apparams widi a target tissue means in a clamped breast prior to insertion of a penetrating tip; FIG. 49 is a view similar to FIG. 48 showing the penetration of the target tissue by d e biopsy apparams embodiment of FIG. 39; FIG. 50 is an enlarged view of die distal end portion of die biopsy apparams disposed within a target tissue mass with a knife mbe fully advanced; FIG. 51 is a side cross-sectional view showing the biopsy apparams with die knife mbe retracted; FIG. 52 is an enlarged cross-sectional view of die distal portion of the biopsy apparams disposed widiin a target tissue mass with a knife mbe fully retracted and a vacuum source supplying suction to a tissue basket of me biopsy apparams; FIG. 53 is a view similar to FIG. 52, which shows die knife mbe rotating and advancing distally diereby severing the tissue enclosed widiin a tissue basket of the biopsy apparams; FIG. 53A is a cross-sectional view of a tissue basket taken along section line 53A-53A of FIG. 53; FIG. 54 is a section view looking distally taken along section line 54-54 of FIG. 42; FIG. 55 is a view similar to FIG. 54, which shows die release of a vacuum mbe locking mechanism; FIG. 56 is a broken perspective view of the biopsy apparams showing rotation of the tissue basket and vacuum mbe which corresponds to the movement indicated in FIG. 55; FIG. 57 is a cross-sectional view of die biopsy apparams showing withdrawal of die vacuum mbe from the disposable loading unit; FIG. 58 is an enlarged view of die indicated area of detail of FIG. 57, which shows stripping of a severed tissue sample from widiin a tissue basket of the biopsy apparams; FIG. 59 is a sectional view taken along section line 59-59 of FIG. 39, which shows die removal of an outer mbe from the disposable loading unit of the biopsy apparams; FIG. 60 is a perspective view of an outer mbe of the biopsy apparams; FIG. 61 is a side cross-sectional view showing the outer mbe of FIG. 60 retained in a patient's breast after removal of die biopsy apparams; FIG. 62 is a perspective view of a tissue marking apparams constructed in accordance witfi the present disclosure; FIG. 63 is an enlarged view of die indicated area of detail shown in FIG. 62; FIG. 64 is an enlarged partial perspective view of die distal end portion of the tissue marking apparams of FIG. 62; FIG. 65 is a perspective view witia parts separated showing the components of e tissue marking apparams of FIG. 62; FIG. 66 is a perspective view of the tissue marking apparams of FIG. 62 inserted dirough a knife mbe of the biopsy apparams; FIG. 67 is an enlarged view of d e indicated area of detail shown in FIG. 66; FIG. 68 is an enlarged view of die indicated area of detail shown in FIG. 66; FIG. 69 is a cross-sectional view of the tissue marking apparams inserted widiin die biopsy apparams and into breast tissue of a patient; FIG. 70 is an enlarged view of die indicated area of detail shown in FIG. 69; FIG. 71 is a cross-sectional view of the. distal end portion of die tissue marking apparams with a clip being disposed around tissue at ie tissue sampling site; FIG. 72 is a cross-sectional view of the proximal end portion of die tissue marking apparams; and FIG. 73 is a view similar to FIG. 71, which shows deployment and formation of the clip at the tissue sampling site. DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS The present disclosure is directed to an apparams and method for die biopsy of tissue specimens and, more particularly, to a single insertion multiple sample percutaneous biopsy apparams and method. In general, die apparams includes a series of concentric members, the inner most of which includes a tip portion which has a lateral opening that is introduced into a target tissue mass in a patient's breast. Suction is applied which is communicated to an area adjacent die lateral opening through a vacuum plate to draw at least a portion of the target tissue mass into the lateral opening. A knife mbe is advanced distally around die outside of die vacuum mbe while rotating, in order to sever die target tissue portion from the surrounding tissue mass. Once me target tissue portion is severed, die vacuum mbe with me tip portion is retracted dirough the knife mbe in order to remove the sample. In particular, upon refraction, die lateral opening is exposed adjacent to a tissue receptacle location. Retraction of the vacuum mbe to the tissue receptacle location brings a stripper plate into contact widi die target tissue portion, removing it from the vacuum plate and preferably causing it to fall into a receptacle. Referring now in specific detail to die drawings in which like reference numerals identify similar or identical elements diroughout the several views, and initially to FIG. 1, one embodiment of a percutaneous biopsy apparams is shown generally as apparams 10. Apparams 10 is preferably in the form of disposable loading unit which is adapted for attachment to a reusable driver housing. Apparams 10 includes an insertion end portion 12 configured and dimensioned for percutaneous introduction into a patient. Insertion end portion 12 extends from a distal end 16 of a housing 14. A vacuum hub 18 is removably connected to a proximal end 20 of housing 14. Further details of die components and meύ od are detailed herein. Referring to FIG. 2, housing 14 defines a first bore 24 at a proximal end portion 26. First bore 24 removably receives vacuum hub 18 therein. A vacuum knob 28 is removably received in the proximal end opening of vacuum hub 18. Vacuum knob 28 has a bore formed longimdinally Λeredirough for communicating suction to an elongated vacuum mbe 32. Housing 14 further defines a second bore 34. First bore 24 and second bore 34 are axially aligned widi each odier. Distal end portion 36 and proximal end portion 26 are rigidly connected by a tissue receiving bay 38. Vacuum mbe 32, when inserted, extends dirough first bore 24 and second bore 34 of housing 14. Vacuum mbe 32 is mounted in fluid communication widi bore 30 of vacuum knob 28 and is connected diereto at a proximal end 40. Vacuum mbe 32 has a distal end portion 42 which includes penetrating insertion tip portion 44. A hollow gear shaft 46 having a gear 48 disposed diereon is attached to a hollow knife mbe 50. Gear shaft 46 has a flanged end 52 on a distal end portion 54. A proximal end 56 of knife mbe 50 is received in flanged end 52 of gear shaft 46. A proximal end portion 58 of gear shaft 46 is rotatably disposed in second bore 34 of housing 14. When assembled, vacuum mbe 32 is disposed widiin gear shaft 46 and knife mbe 50. A support slide 60 is slidably mounted on housing 14 in a slot 62 formed adjacent distal end portion 16. Slot 62 includes tracks 64 formed for receiving tabs 66 formed at a proximal end portion 68 of support slide 60. A distal end portion 70 of support slide defines a stepped bore 72 formed merein. A hollow and preferably radiolucent support mbe 76 is securely disposed in bore 72 (as best shown in FIG. 18). Thus, bore 72 is dimensioned to allow vacuum mbe 32 and tip portion 44 to pass theredirough while engaging a proximal end 78 of support mbe 76. When assembled, knife mbe 50 is disposed widiin support mbe 76. Referring to FIG. 3, a magnified view of die distal end portion of insertion tip portion 44 is shown. A spring 80 is disposed on vacuum mbe 32 and is captured between a proximal end 82 of a tissue basket 84 and a retaining ring portion 86 of a stripper plate 88. Tissue basket 84 has a distal end 90 forming a penetrating tip 92 thereon. Insertion tip portion 44 is dimensioned to fit within knife mbe 50 to permit relative longitudinal movement of the two elements. Referring to FIG. 4, a vacuum assembly 9-assembly 18 (FIG. 1). Vacuum hub subassembly 18 includes attachment port 22 and vacuum knob 28. Proximal end 40 of vacuum mbe 32 is received in a bore 100 defined at a distal end portion 98 of vacuum knob 28. Distal end portion 98 defines a groove 102 for securing an o-ring 104 which facilitates engagement with attachment port 22 and permits rotation therein. A pair of tabs 106 are oppositely disposed on vacuum knob 28. Tabs 106 have corresponding acmator buttons 108 attached diereto for deflecting tabs 106 for engagement to attachment port 22. Tabs 106 are cantilevered to allow relatively high degree of deflection on end portions 110 of tabs 106. Vacuum knob 28 has a proximal end portion 112 for connecting to a vacuum source (not shown). Attachment port 22 defines a plurality of circularly arrayed openings 114 therein for receiving tabs 106 of vacuum knob 28. Attachment port 22 has tabs 116 oppositely disposed diereabout. Tabs 116 have corresponding actuator buttons 118 attached diereto for deflecting tabs 116 for engagement to mounting base 14 (FIG. 2). An extension mbe 120 on attachment port 22 defines a bore 122 dieredirough dimensioned to allow sliding contact with vacuum mbe 32 during operation. Extension mbe 120 has a key 124 longimdinally disposed diereon. A key way 126 is formed in first bore 24 of housing 14 (FIG. 2) such tibat when extension mbe 120 is attached to housing 14, key 124 fits into keyway 126 thereby indexing attachment port 22 to housing 14. Tissue basket 84 defines a lateral opening 128 formed therein. Lateral opening 128 is in fluid communication with vacuum mbe 32 during operation and extends substantially die length of tissue basket 84. Lateral opening 128 supports a vacuum plate 130 which has a plurality of holes 132 formed dieredirough. During operation, each of holes 132 fluidly communicates with vacuum mbe 32 and aids in preventing tissue from entering vacuum mbe 32. Lateral opening 128 also supports a tissue-stripping end portion 134 of stripper plate 88. Stripping end portion 134 slidably contacts the upper surface of vacuum plate 130, thereby aiding in die removal of tissue samples as described hereinafter. Spring 80 is mounted on distal end 42 of vacuum mbe 32. Distal end 42 of vacuum mbe 32 is attached to proximal end 82 of tissue basket 84. Tissue-stripping end portion 134 of stripper plate 88 has a tissue engagement end 136 which includes lateral tabs 138 extending therefrom. Stripping end portion 134 defines recesses 140 disposed proximally to lateral tabs 138 and defines an opening 142 in fluid communication witii vacuum mbe 32. Stripping end portion 134 is curved with respect to a middle portion 144 of stripper 88. Middle portion 144 of stripper 88 and tissue engagement end 136 are axially offset but remain substantially parallel. Middle portion 144 slidably engages a flat upper proximal surface 146 formed on proximal end portion 82 of tissue basket 84. During operation, knife mbe 50 prevents middle portion 144 of die stripper 88 from being separated from flat surface 146 (FIG. 2). Ring portion 86 of stripper 88 is shown in FIG. 4 in an open position. When assembled, lateral extensions 148 are deformed into the shape of a ring such that spring 80 is captured between tissue bracket 84 and die ring 86 which is closed about vacuum mbe 32, thereby slidably attaching ring 86 thereto. Referring to FIGS. 4, 5 and 6, vacuum plate 130 is dimensioned to fit widiin lateral opening 128 and fits within a recess 150. When assembled, vacuum plate 130 is secured by stripping end portion 134 of stripper 88 and a slot 152 cut into tip 92. Lateral tabs 138 are slidably engaged widiin slots 154 maintaining vacuum plate 130 in place and ensuring engagement with vacuum plate 130 during stripping of tissue samples. Edges 156 are chamfered to aid in assembly and to allow tissue to more easily move against vacuum plate 130 during operation. A slot 158 extends along lateral opening to allow fluid communication with vacuum mbe 32. Referring to FIGS. 7-10, vacuum knob 28 is connected to attachment port 22 and secured diereto by tabs 106 and die engagement of o-ring 104. Extension mbe 120 of attachment port 22 is disposed widiin first bore 24 of mounting base 14. Extension mbe 120 is able to slide and rotate relative to first bore 24. Gear shaft 46 is disposed within second bore 34 of housing 14. Gear shaft 46 is able to slide and rotate within second bore 34. Housing 14 supports gear shaft 46 and gear 48 widiin a housing portion 160, as shown in FIG. 9. Housing portion 160 defines an opening 162 for a portion of gear 48 to be presented for manipulation of gear 48 and gear shaft 46 during operation. Gear 48 is preferably driven by a motor contained widiin driver and guidance platform 180 (FIG. 13). Knife mbe 50 is attached widiin gear shaft 46. Knife mbe 50 extends past mounting base 14 and engages a proximal end portion 164 of penetration tip 92 when knife mbe 50 is fully advanced distally. Knife mbe 50 extends dirough support slide 60. Gear shaft 46 engages support slide 60 such tiiat when gear shaft 46 is advanced or retracted, support slide 60 tracks die motion of gear shaft 46 by sliding along tracks 64. The range of motion of gear shaft 46 is controlled by die placement of gear 48. In a fully advanced position 48 gear engages a stop 166 mounted on an interior surface 168 of housing portion 160. In a fully retracted position gear 48 engages an interior wall 170 of housing portion 160. As shown in FIG. 7, support mbe 76 extends from support slide 60. Knife mbe 50 is disposed in support mbe 76, and vacuum mbe 32 and tip portion 44 are disposed in knife mbe 50. Referring to FIG. 8, knife mbe 50 is shown fully advanced and contacting proximal end portion 164 of penetration tip 92. Lateral opening 128 is closed off when knife mbe 50 is advanced. Stripper plate 88 is initially positioned in a retracted position. Spring 80 maintains a slight force on ring portion 86 and proximal end 82 of tissue bracket 84 to maintain stripper plate 88 in the initially retracted position. Stripper plate 88 engages vacuum plate 130 and is disposed in slot 154. Distal end 42 of vacuum mbe 32 is attached to proximal end 82 of trocar 84. Support mbe 76 is also disposed about knife mbe 50. Referring to FIG. 9, housing portion 160 defines an opening 162 for a portion of gear 48 to be presented for manipulation of gear 48 and gear shaft 46 during operation. The range of motion of gear shaft 46 is controlled by die placement of gear 48. In a fully advanced position 48 gear engages a stop 166 mounted on an interior surface 168 of housing portion 160. In a fully retracted position gear 48 engages an interior wall 170 of housing portion 160. Referring to FIG. 10, vacuum knob 28 is connected to attachment port 22 and secured diereto by tabs 106 and die engagement of o-ring 104. Extension mbe 120 of attachment port 22 is disposed widiin first bore 24 of mounting base 14. Extension mbe 120 is able to slide and rotate relative to first bore 24. Bore 122 of extension mbe 120 is dimensioned to receive ring portion 86 and spring 80 (FIG. 3). Edges 172 are chamfered to aid in receiving ring portion 86 and spring 80 therein during the collection of tissue samples. Referring to FIG. 11, distal end portion 16 of housing 14 has slot 62 formed dierein. Slot 62 receives flanged end 52 of gear shaft 46. Referring to FIG. 12, housing 14 has extension portions 174 oppositely disposed about proximal end portion 20. Extension portions 174 have a lip 176 disposed diereon. Tabs 116 of attachment port 22 engage lip 176 and secure attachment port 22 to housing 14. Referring to FIG. 13, housing 14 is mounted on a driver guidance platform 180 in order to perform the biopsy procedure. Platform 180 is configured and dimensioned for attachment to an instrument positioning stage of a stereotactic imaging apparams. Examples of such apparams are available from LORAD Corporation of Danbury, Connecticut or from Fischer Imaging Corporation of Denver, Colorado. Alternatively, apparams 10 may be adapted to fit on any odier suitable imaging apparams such as, for example, ultrasound. A vacuum source (not shown) is connected by a vacuum hose 182 to proximal end portion 112 of vacuum knob 28. Platform 180 is used to stabilize apparams 10 and provide power and support diereto during the biopsy procedure. Platform 180 includes a partially enclosed area 184 at a distal end portion 186. Partially enclosed area 184 provides structure for maintaining housing 14 in a secured position relative to platform 180. Distal end portion 186 of platform 180 defines an opening 188 to allow support mbe 76 to extend dierefrom. Housing 14 is further stabilized by a block 190 which is attached to platform 180. Platform 180 also includes a motor which drives a gear d at engages gear 48 and further includes a compression spring released by a trigger which serves to shoot apparams 10 die final distance, approximately 3/4 of an inch, into the tissue. One or more control knobs such as control knob 193 may be provided to control die advancement and retraction of knife mbe 50 and vacuum mbe 32. In operation, referring to FIGS. 14 and 15, a patient's breast 192 is disposed between a movable clamp 194 and a stationary clamp 196. Movable clamp 192 is moved toward stationary clamp 194 capturing breast 192 dierebetween. Upon securing breast 192 in position an image is taken of a target tissue mass 198 within breast 192. Apparams 10 is aimed at target tissue mass 198 utilizing ie positioning capabilities of the imaging and guidance system such mat insertion end portion 12 is aligned widi tissue mass 198. Stationary clamp 196 defines an opening 200 therethrough to allow insertion portion 12 to enter breast 192. Before insertion into breast 192, gear shaft 48 and, Λerefore, knife mbe 50 are fully advanced distally to enclose lateral opening 128 in trocar 84 (FIG. 8). The surgeon may manually place a nick utilizing a scalpel at e point of insertion of tip 92 to facilitate easy entry into breast 192. Penetrator tip 92 is approximated adjacent me location of the nick into breast. Preferably, diis is accomplished by the positioning capability of the imaging and guidance system. Insertion portion 12 is advanced distally into breast 192 by release of the stored energy of the compression spring in platform 180, e.g., by activating a trigger release mechanism, so that insertion tip portion 44 is located adjacent to or widiin target tissue mass 198, as required. Referring to FIG. 16, insertion portion 12 is advanced into target tissue mass 198. The guidance system (not shown) can be used to monitor the location of insertion portion 12 to confirm target tissue mass 198 is positioned adjacent to lateral opening 128. As mentioned above, knife mbe 50 is initially fully advanced distally and engages proximal end portion 164 of tip 92. Stripper plate 88 is disposed in a normally retracted position witihi spring 80 in a minimally compressed position applying a small force between tissue bracket 84 and ring portion 86. Referring to FIG. 17, knife mbe 50 is retracted proximally by retracting gear shaft 46 and gear 48. In one illustrative embodiment, gear 48 is coupled to support members 202. Support members 202 may support a drive gear 204 which may be driven by a driving mechanism (not shown). Driving mechanism rotates gear 48 by turning drive gear 204. Proximal and distal movement of gear 48 is accomplished by moving support members 202. Gear 48 is captured between stop 166 and a protrusion 206 extending from interior surface 168 of housing portion 160 when fully distally advanced. As previously described, diis position corresponds to knife mbe 50 engaging proximal end portion 164 of tip 92 diereby closing off lateral opening 128. Protrusion 206 is attached to a cantilever member 208 which allows deflection of protrusion 206 to enable gear 48 to be released dierefrom and moved proximally. As gear is moved past protrusion 206 cantilever member 208 rebounds to its initial position. Referring to FIG. 18, gear 48 is fully retracted proximally by support members 202 and drive gear 204 to a position abutting interior wall 170. Knife mbe 50 is thereby retracted proximally exposing lateral opening 128 to target tissue mass 198. Suction is applied to vacuum mbe 32 through vacuum knob 28 from the vacuum source (not shown) via vacuum hose 182. Referring to FIGS. 19 and 20, a perspective view of apparams 10 shows gear shaft 46 and gear 48 disposed in a proximal-most position within housing portion 160 of housing base 14. Knife mbe 50 is retracted exposing tissue basket 84. Stripper plate 88 and vacuum plate 130 are shown within lateral opening 128, and stripping end portion 134 extends into slots 154. Referring to FIG. 21, applied suction draws a portion of target tissue mass 198 into lateral opening 128. Suction flow arrows 210 show the direction and location of die force exerted on target tissue mass 198. The suction force passes through die plurality of holes 132 in vacuum plate 130 and dirough opening 140 in stripper 88. Referring to FIG. 22, suction is maintained for a predetermined amount of time to allow lateral opening 128 to gamer a desired amount of target tissue mass 198 therein. Knife mbe 50 is simultaneously rotated and advanced to sever a tissue sample 212 from target tissue mass 198 using an annular knife edge 94 formed at die distal end of knife mbe 50. Knife mbe 50 is rotated and advanced distally by drive gear 204 and support members 202, respectively, in the same manner as mentioned widi reference to FIG.17. When tissue sample 212 is enclosed by knife mbe 50 suction is no longer needed and may be removed. Referring to FIGS. 23 and 24, vacuum knob 28 is detached from attachment port 22 by depressing buttons 108 to release tabs 106 from holes 114. Vacuum knob 28 is translated proximally to retract vacuum mbe 32. Proximal translation of vacuum mbe 32 removes tip portion 44 from knife mbe 50 exposing tissue sample 212 at tissue bay 38. If desired, suction may be continued during die translation of vacuum mbe 32 to maintain tissue sample 212 against vacuum plate 130 within tissue basket 84. Vacuum mbe 32 is retracted until ring portion 86 and spring 80 are disposed widiin bore 124 of extension mbe 120. Edges 172 are chamfered to aid in receiving ring portion 86 and spring 80 dierein. As tissue basket 84 begins to exit second bore 34 of housing 14, tissue sample 212 is held over tissue receptacle portion 38 of housing 14. Vacuum mbe 32 may be rotated to ensure diat tissue basket 84 is facing downwardly towards tissue .receptacle portion 38 of housing 14. Referring to FIGS. 25, 26 and 27, ring-portion 86 engages a stepped portion 214 widiin extension mbe 120. As proximal translation of vacuum mbe 32 continues spring 80 begins to become compressed between tissue basket 84 and ring portion 86. As spring 80 compresses, stripper plate 88 is advanced distally having stripping end portion 134 running in slots 154 and in engagement with vacuum plate 130. As stripper plate 88 advances, tissue sample 212 is stripped away from vacuum plate 130 and falls out of tissue basket 84. Tissue sample 212 can now be collected for examination. Referring to FIGS. 28 and 29, a preferred embodiment of apparams 10 is shown. FIG. 28 shows a first position for vacuum knob 28. Vacuum knob 28 is secured to attachment port 22 by placing tabs 106 widiin holes 114 as described above and illustrated in FIG. 3. Vacuum knob 28 is attached to vacuum mbe 32 during die collection of tissue sample 212 by the memod described widi reference to FIGS. 14-27 above. During the collection of tissue sample 212, support mbe 76 and knife mbe 50 can be left within breast 192 (FIGS. 14 and 15) while vacuum mbe 32 is extracted. After the collection of tissue sample 212, vacuum mbe 32 may be reinserted through support mbe 12 and knife mbe 50 into breast 192 (FIGS. 14 and 15). An additional tissue sample or samples may be extracted from the same location. FIG. 29 shows vacuum knob 28 rotated to angularly displace the orientation of lateral opening 128. When vacuum knob 22 is rotated, vacuum mbe 32 is also rotated causing lateral opening 128 to be angularly displaced. When inserted in breast 192 (FIGS. 14 and 15), lateral opening 128 may be rotated from a first position so diat a different portion of target tissue mass 198 (FIGS. 14 and 15) may be extracted through a single insertion of apparams 10. Vacuum knob 28 can be resecured to attachment port 22 by tabs 106 in holes 114. Holes 114 are disposed about attachment port 22 to allow vacuum knob 28 to be secured in a plurality of different rotated positions. For example, attachment port 22 can have ten securable positions by providing ten holes or five pairs of oppositely disposed holes. Each of die securable positions corresponds, for example, to an angular displacement of tissue basket 84 equal to about 36 degrees from an adjacent securable position. Referring to FIGS. 30 and 31, attachment port 28 is removable from housing 14. It may be desirable to remove a tissue sample 216 at a location different from tissue receiving portion 38 of housing 14. Attachment port 22 and vacuum knob 28 may be removed while being secured to each otiier. Buttons 118 may be depressed to release tabs 116 from extensions portions 174 of housing 14. Vacuum mbe 32 is drawn proximally dirough housing 14 widi tissue sample 216 disposed in tissue basket 84. Tissue basket 84 widi tissue sample 216 may be positioned over a remotely located receptacle (not shown) for receiving tissue sample 216. Vacuum knob 28 is detached by deflecting tabs 106 as previously described above and moved apart from attachment port 22. Vacuum mbe 32 is drawn dirough attachment port 22. Tissue sample 216 is then stripped from tissue basket 84 as described previously widi reference to FIGS. 25 and 26. Referring to FIG. 32, it may be necessary to maintain access to breast 192 during or after d e biopsy procedure. Support slide 60 is removable from housing 14 for this purpose. Support mbe 76 is attached to support slide 60. Support mbe 76 provides access to breast 192 for reinsertion of tissue bracket 84 and knife mbe 50 to prevent having to make an additional insertion to reaccess breast 192. Referring to FIGS. 33-37, an alternate embodiment of a biopsy apparams 310 is mounted on driver guidance platform 180 in order to perform the biopsy procedure. Platform 180 is configured and dimensioned for attachment to an instrument positioning stage of a stereotactic imaging apparams, such apparams are available from LORAD Corporation of Danbury, Connecticut or from Fischer Imaging Corporation of Denver, Colorado. Alternatively, apparams 310 may be adapted to fit on any odier suitable imaging apparams such as, for example, ultrasound. Apparams 310 is reconfigured such diat a tissue bay 312 is mounted at a distal end portion 314. A tissue sample (not shown) is severed and retrieved essentially as mentioned hereinabove. FIG. 33 shows a knife mbe 316 in a fully advanced position, while FIG. 34 shows knife mbe 316 retracted. Referring to FIG. 35, apparams 310 is shown. Knife mbe 316 defines an opening 318 therein for accessing tissue sample when they are obtained during die biopsy procedure. Referring to FIGS. 38 and 38 A, a further alternate embodiment of a percutaneous biopsy apparams 410 is shown in FIGs. 38 and 38A mounted on a drive unit 411 which is configured and dimensioned for attachment to an instrument positioning stage of a stereotactic imaging apparams (not shown). An example of a drive unit is disclosed in commonly assigned provisional application Serial No. , entitled "Biopsy Instrument Driver Apparams" filed on February 20, 1998, the entire contents of which are hereby incorporated by reference. Examples of stereotactic imaging apparams which are used to perform biopsy procedures are commercially available from LORAD Corporation of Danbury, Connecticut or from Fischer Imaging Corporation of Denver, Colorado. Alternatively, apparams 410 may be adapted to fit on or interact with other suitable imaging apparams such as, for example, ultrasound imaging devices such as are available from Neovision of Seattle, Washington. Biopsy apparams 410 is structurally and operationally similar to biopsy apparams embodiments 10 and 310 previously described herein. Accordingly, die following description of biopsy apparams 410 will focus mainly on the features which are different on apparams 410. Referring now to FIGs. 40-47, biopsy apparams 410 includes a housing 412 which supports a series of concentrically disposed mbular members. The first such mbular member is a knife mbe 414 which has a beveled annular cutting surface 416 formed at die distal end thereof and a laterally facing tissue discharge port 418 disposed proximally of annular cutting surface 416. A series of vent holes 420 are formed dirough die side walls of knife mbe 414 at points distal of tissue discharge port 418 to facilitate venting of fluids and die like which may travel up knife mbe during operation of die insttument. To assist in the removal of fluids or die like, a laterally oriented vacuum port 421 is found adjacent ie distal end of housing 412 and is preferably connected to a vacuum source (not shown) which may be actuated by the user. A gear shaft 422 is secured over die proximal end of knife mbe 414 and has a gear 424 securely mounted about bosses 426 which are disposed on gear shaft 422. The assembled knife mbe 414 is fitted into an axial passageway 428 formed longimdinally through housing 412. Knife mbe 414 is disposed in axial passageway 428 such diat simultaneous rotational and longitudinal translational movement thereof is facilitated. A vacuum mbe 430 is concentrically disposed within knife mbe 414 such mat a penetrating tip 432 extends out die distal end of knife mbe 414 beyond annular cutting surface 416. In tiiis manner, penetrating tip 432 and knife mbe 414 form a substantially continuous penetrating assembly for insertion into a patient's tissue, for example, a compressed breast. As best shown in FIGs. 41-43, a tissue basket 434 is formed adjacent die distal end of vacuum mbe 430. Tissue basket 434 faces laterally and is defined by a tissue support plate 436 which is provided with a series of vacuum holes 438 formed longimdinally merealong and a proximal-most vacuum hole 440 which is formed a distance away from the series of holes 438. Vacuum hole 440 is provided to assist in sealing off the distal end of knife mbe 414 (FIG. 52) to prevent too great a loss of vacuum force through apparams 410 so that die remaining vacuum holes 438 can efficaciously pull die target tissue into tissue basket 434. Tissue plate 436 is preferably arcuately shaped in cross section (FIG. 53A) and secured to vacuum mbe 430 by welding or die like so that a substantially continuous surface depression is formed near d e distal end of vacuum mbe 430. This arcuate or sinusoidal shape of tissue plate 436 in combination widi die fact that knife mbe 414 represents die outer most diameter of apparams 410 at the point of insertion facilitates taking larger tissue samples than with other existing tissue sampling apparams geometries. Referring now to FIG. 40 in conjunction wi FIG. 45, a locking wheel and indexer 442 having a longitudinal bore 444 formed dieredirough is secured adjacent d e distal end of vacuum mbe 430. Locking wheel 442 includes a tab member 446 which, when locking wheel 442 is mounted to vacuum mbe 430, is radially aligned widi tissue basket 434. In die locked orientation, tab 446 is simated behind a lip 448 formed on housing 412. This configuration prevents proximal movement of vacuum mbe 430 and, ti erefore, penetrating tip 432 upon insertion of apparams 410 into the patient. Additionally, a small notch 448 is formed on locking wheel 442 which is also aligned widi tab 446 so as to provide the user widi a visual indication of die relative orientation of tissue basket 434. A vacuum port adapter 450 is securely mounted to die distal end of vacuum mbe 430 adjacent to locking wheel and indexer 442. Vacuum port adapter 450 facilitates die attachment of a vacuum hose which is connected to a vacuum source (not shown) to provide a vacuum supply to vacuum mbe 430. Extraction of the tissue sample from within tissue basket 434 is facilitated by a tissue stripping clip 452 which is in the form of a modified leaf spring having an open-sided collar portion 454 configured and dimensioned to clip onto knife mbe 414 as shown in FIGS. 46 and 47, in alignment with tissue discharge opening 418. Tissue stripping clip 452 includes an inwardly deflected distal end portion 456 which is held biased against the outer surface of vacuum mbe 430 to facilitate stripping of die sample tissue upon retraction of vacuum mbe 430 within knife mbe 414 (FIG. 57 and FIG 58). Tissue stripping clip 452 may additionally be provided widi a coating of material or lubricant to reduce die friction forces along die surface of tissue stripping clip 452 which come into contact widi die sample tissue being extracted. In tiiis manner, the tissue will be more readily removed from tissue basket 434 widi less likelihood of adherence to tissue stripping clip 452. Any suitable known friction-reducing coatings may be applied to tissue stripping clip 452 and/or tissue plate 436. Referring again to FIGS. 39 and 40, a radiolucent outer mbe 458 is attached to a sliding clip 460 which provides removable attachment to housing 412 at e distal end tiiereof. Outer mbe 458 is radiolucent so mat it may be left at the tissue sampling site for imaging of the suspect tissue witiiout the presence of die radiopaque stainless steel knife mbe 414 and vacuum mbe 430. Outer mbe 458 is preferably provided widi radiopaque lines formed to indicate die longimdinal spacing of tissue basket 434 in order to provide die user widi an indication of die tissue sampling area. Referring temporarily to FIGS. 59-61, and initially to FIG. 59, the mounting of sliding clip 460 to housing 412 is shown. In particular, sliding clip 460 is provided widi a pair of deflectable legs 462 which fit widiin parallel receiving slots 464 formed on die underside of housing 412. A pair of diamond-shaped camming surfaces 466 are formed along wall portion 468 which separates parallel slots 464. Camming surfaces 466 act as temporary stops which resist longimdinal movement of sliding clip 460. To facilitate this resistance, a pair of laterally facing tabs 470 are formed on die outer facing portions of each of flexible legs 462 and provide a bearing surface to flexible legs 462 against the inner wall of parallel slots 464. In this manner, proximal portions 474 of flexible legs 462 are cantilevered outwardly as tiiey pass over camming surfaces 466. Upon complete distal movement of sliding clip 460 over camming surfaces 466, the distal- end of outer mbe 458 is substantially aligned widi d e distal end portion of die location of tissue basket 434 at insertion in the target tissue mass thus providing a marker for the location of die tissue sampling site upon removal of apparams 412 from e suspect tissue region. Referring to FIGS. 48-61, the operation of biopsy apparams 410 will now be described for use in connection widi a biopsy procedure performed on a breast of a patient. It is to be understood, however, diat die procedures described herein may also be utilized in connection with d e biopsy of tissue in other regions of die body as well. Much of die operational procedures are d e same as or similar to those described above in connection with d e otiier embodiments of the present disclosure. Accordingly, the following description will focus mainly on the features of biopsy apparams 410. Some of the procedures previously described for other embodiments will, however, be described again at this point for the convenience of die reader. As shown in FIG. 48, biopsy apparams 410 which is mounted to a driver unit 411, which in turn is mounted to die instrument stage of a stereotactic imaging table, are positioned in alignment with a suspect tissue mass 476, the exact position of which has been previously identified by me use of me stereotactic imaging apparams. Utilizing e positioning capabilities of the stereotactic imaging apparams, biopsy apparams 410 is positioned such diat penetrating tip 432 is aligned widi die center of die targeted tissue mass 476. Biopsy apparams 410 may be either manually advanced dirough die tissue mass targeted such diat tissue basket 434 spans die entire longimdinal distance of tissue mass 476 relative to tissue basket 434. In procedures where the targeted tissue mass exceeds die lengtii of tissue basket 434, die instrument may first be inserted all the way to one end of die tissue mass wherein that end of die tissue may be removed dirough die procedure described herein and tiien die biopsy apparams 410 moved such diat die tissue basket aligns witii die remaining tissue sample to be removed and die procedure repeated until all of the targeted tissue sample has been removed. Referring to FIG. 50, when biopsy apparams 410 is inserted dirough tissue sample 476, knife tube 414 is positioned over tissue basket 434 so as to prevent any tissue from prematurely entering the tissue basket prior to positioning of die tissue basket adjacent the desired suspect tissue mass 476. As shown in FIG. 51, once tissue basket 434 is positioned properly adjacent die suspect tissue mass 476, knife mbe 414 is proximally retracted by releasing gear 424 from locking tab 478 disposed on housing 412 (FIG. 44). In this manner, tissue basket 434 is exposed and die vacuum source may be turned on so as to create a vacuum within tissue basket 434 diereby pulling in the portion of suspect tissue mass 476 adjacent tissue basket 434. Widi the suction continually applied, knife mbe 414 is rotated and translated distally so as to sever die tissue included in tissue basket 434 by annular cutting surface 416. Knife mbe 414 is preferably rotated and advanced distally by a motor provided in driver unit 412 which is connected by gearing to gear 424. Once knife mbe is fully distally advanced, locking wheel and indexer 442 is rotated until tab 446 clears the upper structure of housing 412 diereby releasing vacuum mbe 430 and permitting witiidrawal of the vacuum mbe and, tiierefore, tissue basket 434 from within knife mbe 414. The user can confirm that vacuum tube 430 is free to be withdrawn by die visual indication provided by notch 448 which is aligned widi tab 446. Once vacuum mbe 430 is witiidrawn such diat tissue basket 434 is adjacent to discharge opening 418 in knife mbe 414, tissue stripping clip 452 will enter into tissue basket 434 such that inwardly deflected portion 456 contacts the proximal end of severed tissue sample 476A diereby urging die tissue sample out of the tissue basket 434 as shown in FIG. 58. Upon completion of the desired amount of sampling, outer mbe 458 is moved distally to position die radiopaque markers formed on outer mbe 458 in relative alignment with the location of die site and lengtii of d e location where tissue basket 434 was previously aligned. Outer mbe 458 may then be detached from biopsy apparams 410 and die apparams translated away from the tissue of me patient so mat the tissue may be imaged without interference from the radiopaque nature of the remaining compounds of biopsy apparams 410. Upon completion of the imaging, if it is determined diat further sampling is desired or necessary, biopsy apparams 410 may be re-inserted dirough outer mbe 458 and 458 re-connected widi housing 412 and additional sampling may be made as previously described herein. Referring now to FIGS. 62-65, a tissue marking apparams used in conjunction with die previously described biopsy apparams 410 will now be described in detail. Tissue marking apparams 500 includes an acmator housing 502 having an elongated flexible mbular sheatii 504 extending from a distal end tiiereof with a camming mbe 506 secured to a distal end of the flexible mbular sheath 504. A clip forming clamp member 508 is attached to die distal end of an acmator cable 510 which is tensionably mounted to acmator member 512. Cable 510 is mounted to acmator 512 by way of ferrule 514 which has a stepped shoulder portion 516 diat seats widiin a stepped bore formed in acmator member 512. A pair of coil springs 518 and 520 are provided on eitiier side of actuator member 512 widiin die housing and have relative spring forces to position acmator 512 in an initial orientation corresponding to an expanded state for clamp 508, as shown in FIG. 64. Housing 502 is formed as a split housing including housing components 522 and 524 which are snap-fitted togetiier to house the actuation components. When assembled, housing portions 522 and 524 form a thumb rest 526 to provide a bearing surface for die user's tiiumb when actuating tissue marking apparams 500. Acmator 512 includes radially extending opposed finger bearing surfaces 528 and 530 which die user may grip in a syringe-like fashion to deploy and secure a clip 532 at die site of die biopsy widiin die patient. Tissue marking apparams 500 further includes a pair of marking bands 534 and 536 which assist in orienting tissue marking apparams relative to biopsy apparams 410. Referring now to FIGS. 66-73, in use tissue marking apparams 500 is inserted widiin tissue discharge opening 418 of knife mbe 414 so that die distal end portion of tissue marker apparams 500 extends from the distal end portion of knife mbe 414 beyond annular cutting surface 416, as shown in FIG. 68. Advantageously, die distal end portion of tissue marker apparams 500 extends centrally dirough and exits centrally from knife mbe 414 for clip placement in alignment with die longimdinal axis of biopsy apparams 410. The user is provided widi a visual indication of such alignment when tissue marking bands 536 and 534 straddle die distal end of tissue discharge opening 418 as shown in FIG. 67. With tissue marking apparams 500 inserted in biopsy apparams 410, the user grasps tissue marking apparams much in the same manner as for grasping the plunger of a syringe and pulls back on tissue finger biasing surfaces 528 and 530 of acmator 512. This action pulls cable 510 proximally thereby drawing clip forming clamp 508 within camming mbe 506 to attach clip 532 at die site of die sampled tissue. In tiϋs manner, the biopsy apparams 410 as well as outer mbe 458 may be completely removed from the patient diereby marking the biopsy site to provide an indication of die exact location of die biopsy for future reference, for example, in further imaging of the site or should die need arise in further biopsy ing of die site. It will be understood diat various modifications may be made to die embodiments disclosed herein. Therefore, the above description should not be construed as limiting, but merely as exemplifications of preferred embodiments. Those skilled in die art will envision other modifications widiin die scope and spirit of the claims appended hereto.

Claims: WHAT IS CLAIME IS: 1. A surgical biopsy apparams which comprises: a housing; a first elongated mbular member removably mounted in the housing and defining a fluid passageway dierein, the first elongated mbular member including: a tapered closed distal end portion adapted to penetrate tissue; a laterally disposed tissue receiving opening formed near die tapered distal end which includes a tissue support surface defining a plurality of holes in fluid communication widi die fluid passageway; and a second elongated mbular member rotatably and reciprocatingly disposed coaxially about die first elongated mbular member, the second elongated mbular member having a cutting edge formed at an open distal end tiiereof and a lateral tissue discharge port formed proximally of the cutting edge. 2. A surgical biopsy apparams according to claim 1, which further comprises a third elongated mbular member removably supported by die housing and coaxially disposed about die first and second elongated mbular members, the third elongated member being movable from a .retracted position to an extended position wherein a distal end portion is disposed laterally adjacent a distal-most position of the tissue receiving opening of the first elongated mbular member. 3. A surgical biopsy apparams according to claim 2, wherein the diird elongated member is radiolucent to permit the passage of x-rays dieredirough. 4. A surgical biopsy apparams according to claim 3, wherein the tiiird elongated member includes a radiopaque marking formed on a portion of die tiiird elongated member such mat when the tiiird elongated mbular member is in the deployed position die radiopaque marking is laterally adjacent die distal-most position of the tissue receiving opening of the first elongated mbular member. 5. A surgical biopsy apparams according to claim 1 which further comprises a tissue stripping member disposed adjacent die lateral tissue discharge port, die tissue stripping member including a flexible extended portion configured and dimensioned to enter the tissue receiving opening of the first elongated mbular member upon alignment of the tissue receiving opening with die lateral tissue discharge port. 6. A surgical biopsy apparams according to claim 5 wherein the tissue stripping member includes a friction reducing coating formed diereon to reduce friction widi body tissue coming in contact with die tissue stripping member. 7. A surgical biopsy apparams according to claim 1 wherein die tissue support surface of die laterally disposed tissue receiving opening has an arcuate cross-section. 8. A surgical biopsy apparams which comprises: a housing; a first elongated mbular member removably mounted in the housing and defining a fluid passageway dierein, the first elongated mbular member including: a tapered closed distal end portion adapted to penetrate tissue; a laterally disposed tissue receiving opening formed near the tapered distal end; a second elongated mbular member rotatably and reciprocatingly disposed coaxially about die first elongated mbular member, die second elongated mbular member having a cutting edge formed at an open distal end tiiereof and a lateral tissue discharge port formed proximally of the cutting edge; and a tissue marking member removably insertable dirough die second elongated mbular member, the tissue marking member including: an elongated shaft; a clamp disposed at a distal end of die elongated shaft, die clamp being operable from a first orientation configured and dimensioned to retain a tissue marker therein and a second orientation to deform a tissue marker retained by die clamp thereby attaching me tissue marker to body tissue of a patient. 9. A surgical biopsy apparams according to claim 8, which further comprises a third elongated mbular member removably supported by die housing and coaxially disposed about die first and second elongated mbular members, the tiiird elongated member being movable from a retracted position to an extended position wherein a distal end portion is disposed laterally adjacent a distal-most position of the tissue receiving opening of die first elongated mbular member. 10. A surgical biopsy apparams according to claim 9, wherein the tiiird elongated member is radiolucent to permit the passage of x-rays dieredirough. 11. A surgical biopsy apparams according to claim 10, wherein die tiiird elongated member includes a radiopaque marking formed on a portion of die tiiird elongated member such mat when the tiiird elongated mbular member is in e deployed position die radiopaque marking is laterally adjacent die distal-most position of the tissue receiving opening of the first elongated mbular member. 12. A surgical biopsy apparams according to claim 8 which further comprises a tissue stripping member disposed adjacent die lateral tissue discharge port, die tissue stripping member including a flexible extended portion configured and dimensioned to enter die tissue receiving opening of the first elongated mbular member upon alignment of me tissue receiving opening with the lateral tissue discharge port. 13. A surgical biopsy apparams according to claim 12 wherein the tissue stripping member includes a friction reducing coating formed diereon to reduce friction with body tissue coming in contact widi die tissue stripping member. 14. A surgical biopsy apparams according to claim 8 wherein die laterally disposed tissue receiving opening defines a tissue support surface having an arcuate cross-section. 15. A method of performing a surgical biopsy comprising the steps of: inserting a biopsy apparams into the tissue of a patient, die biopsy apparams including an inner mbular member having a tapered penetrating end formed on die distal end and an outer mbular member held longimdinally fixed relative to die inner mbular member during die insertion step; retracting the outer mbular member relative to the inner mbular member to expose a laterally disposed tissue receiving area formed on die inner mbular member; applying suction to a series of openings, formed along an inner surface of die tissue receiving area to pull tissue into the tissue receiving area; severing tissue disposed widiin the tissue receiving area by advancing die outer mbular member over the inner mbular member such that a cutting surface formed on d e distal end of d e outer mbular member rotates as it passes over the tissue receiving area; and removing the severed tissue sample from the tissue sampling site by retracting the inner mbular member from the outer mbular member until die tissue receiving area is aligned widi a lateral opening formed in the outer mbular member wherein a tissue stripping plate urges the tissue sample out of the tissue receiving area.

Inventors: CHELEDNIK GEORGE M, FARASCIONI DAVID, KLECHER CHRISTOPHER F, MATULA PAUL A, CHELEDNIK, GEORGE, M., FARASCIONI, DAVID, KLECHER, CHRISTOPHER, F., MATULA, PAUL, A.
Applicants: UNITED STATES SURGICAL CORP, UNITED STATES SURGICAL CORPORATION
Application year: 1998
Main classification: A61B10
IPC codes: A61B10