Abstract:
A surgical instrument includes a single articulating tip to apply energy to tissue within a body. The articulating tip travels in a semi-arc around an insulated hinge in such a way that the tip can articulate up or down less than 90 degrees from a central axis. In particular, the articulating range is between 70 degrees upward to about 20 degrees downward for a total range of movement of about 90 degrees. Other ranges of angles such as +60 degrees to −30 degrees are contemplated as well.

Description:
BACKGROUND OF THE INVENTION 
       [0001]    1. Field of the Invention 
         [0002]    The present invention relates to medical instruments and, more particularly, to medical instruments having an articulating tip. 
         [0003]    2. Description of Related Art 
         [0004]    General surgical instruments are known that are inserted into a body, such as a human body, to manipulate in some way tissue within the body. These instruments have included scissors having two blades the pivot relative to one another to cut tissue and graspers that have two tips that close together in order to grasp tissue. 
         [0005]    Endoscopic surgical instruments have been developed with varying degrees of complexity. In general endoscopic instruments are useful when they articulate up and down as well as left and right. However, to enable such complex articulation often requires complex mechanisms that are expensive and difficult to manufacture. Furthermore, endoscopic instruments are typically used by being inserted through an existing body orifice rather that a specific incision that places the instrument at a desired starting position. 
         [0006]    There are also a number of ablation and fulgurator instruments that have been developed for specific purposes. Typically, these devices have two articulating tips that open or close but do not do so independent of one another. In other words, the top tip moves a certain distance away from a neutral position while at the same time the bottom tip moves the same distance but in an opposite direct from the neutral position. Such instruments are useful for many purposes and can be even be somewhat useful for unintended uses such a treating laparoscopic endometriosis. However, the two tips make such an instrument more prone to unintended contact with healthy tissue while being used. 
         [0007]    In view of the surgical and medical instruments available today there still remains the need for a fulgurator having a single articulating tip that can be easily controlled and having an inexpensive and relatively simple articulating mechanism. 
       BRIEF SUMMARY OF THE INVENTION 
       [0008]    Embodiments of the present invention relate to a surgical instrument that includes a single articulating tip to apply energy to tissue within a body. The articulating tip travels in a semi-arc around a hinge in such a way that the tip can articulate up or down in an angle of about 90 degrees relative to a central axis of the instrument. In particular, the articulating range can be between about 70 degrees upward to about 20 degrees downward for a total range of movement of about 90 degrees. Other ranges of angles such as +60 degrees to −30 degrees are contemplated as well 
         [0009]    It is understood that other embodiments of the present invention will become readily apparent to those skilled in the art from the following detailed description, wherein it is shown and described only various embodiments of the invention by way of illustration. As will be realized, the invention is capable of other and different embodiments and its several details are capable of modification in various other respects, all without departing from the spirit and scope of the present invention. Accordingly, the drawings and detailed description are to be regarded as illustrative in nature and not as restrictive. 
     
    
     
       BRIEF DESCRIPTION OF DRAWINGS 
         [0010]      FIG. 1  illustrates a block diagram of aspects of the present invention. 
           [0011]      FIG. 2  illustrates a side view of a surgical instrument in accordance with the principles of the present invention. 
           [0012]      FIG. 3  illustrates a side view of the instrument of  FIG. 1  in which the trigger is moved to articulate the tip downwards. 
           [0013]      FIG. 4  illustrates a side view of the instrument of  FIG. 1  in which the trigger is moved to articulate the tip upwards. 
           [0014]      FIG. 5A-FIG .  5 D illustrate details of an articulating tip in accordance with the principles of the present invention. 
           [0015]      FIG. 6  illustrates a flowchart of an exemplary method of using the articulating tip instrument in accordance with the principles of the present invention. 
       
    
    
     DETAILED DESCRIPTION OF INVENTION 
       [0016]    The detailed description set forth below in connection with the appended drawings is intended as a description of various embodiments of the invention and is not intended to represent the only embodiments in which the invention may be practiced. The detailed description includes specific details for the purpose of providing a thorough understanding of the invention. However, it will be apparent to those skilled in the art that the invention may be practiced without these specific details. In some instances, well known structures and components are shown in block diagram form in order to avoid obscuring the concepts of the invention. 
         [0017]    In the description provided herein, the phrase “upward” and “downward” are used to aid the reader in understanding how portions of the instrument move relative to one another. These terms, however, depend on the orientation of the instrument relative to an arbitrary set of three-dimensional axes. Thus, if the instrument were rotated along one or more of these axes, then the relative movement of the instrument portions to one another remain the same but “upwards” is no longer the same relative to the arbitrary axes. Accordingly, the terms “upwards” and “downwards” are not meant to limit the operating parameters of the present invention but are merely provided so that, with the aid of the drawings and their fixed perspective, a reader can more easily understand how portions of the articulating instrument move relative to one another. Thus, the terms “upwards” and “downwards” are merely convenient terms to describe how, within its plane of rotation, the articulating tip can deflect in one direction from a neutral position and can also deflect in an opposite direction. Similarly, the instrument will often times be referred to as a fulgurator, however, one of ordinary skill will recognize that this term does not encompass all the functionality that can be performed such as sealing tissue, coagulating tissue, dissecting tissue, freezing tissue, etc. Thus, the term “fulgurator” also is not intended to limit embodiments of the present invention to only destruction of living tissue by electric sparks generated by a high-frequency current. 
         [0018]      FIG. 1  illustrates a block diagram of aspects of the present invention. The instrument  102  is shaped and sized for insertion into an incision made in the human body, typically with the help of a trocar. Not shown in  FIG. 1  are one or more cameras that may also be used in conjunctions with the instrument  102  to aid the user in positioning the instrument  102  as desired. The purpose of inserting the instrument  102  into an incision is so that part of the instrument  102  can be positioned within an internal cavity of the body such as the abdominal cavity. Once in the cavity, the instrument  102  can be used to manipulate tissue such as, for example, endometrial cells outside the uterus. 
         [0019]    A portion of the instrument  102  is located outside of the body cavity, such as in a surgeon&#39;s hand, and this portion includes a tip control mechanism  108  that allows the surgeon to move the tip as desired. Thus, gross-level positioning of the instrument  102  can position it close to a desired location while fine-level tip positioning can be used to place the articulating tip  110  at a precise location. 
         [0020]    Once the articulating tip is in its desired location, then a switch  106  can be triggered that will cause energy from an energy source  104  to be communicated with the articulating tip  110  so that the energy is delivered to the body tissue where the articulating tip  110  is located. One typical type of energy that is used for fulguration is high frequency electrical current (e.g., from about 9 kHz to 1000 GHz). This electrical current can be delivered using a bi-polar tip or a unipolar tip. As is known, the unipolar tip (and energy source) completes the electrical circuit through another portion of the patient&#39;s body, while a bi-polar tip (and energy source) provides both the positive and ground paths for the electrical current to travel. In addition to electrical signals, other ways of cutting, coagulating, ablating and fulgurating tissue are known such as through a vibrating ceramic that uses friction to affect the tissue that it touches. There are also known frequencies and waveforms that have different effects such that a desired duration and type of energy can be delivered by controlling the energy source  104  accordingly. Embodiments of the present invention do not require any particular energy source  104  or switch  106  to operate according to its inventive principles. Thus, one of ordinary skill will recognize that the instrument  102  described herein can be utilized with a variety of different energy source without departing from the scope of the present invention. For example, an instrument having an articulating tip operating in accordance with the principles of the present invention may be used to perform cryotherapy as well wherein the tip delivers cryogenic freezing temperatures to tissue within a body cavity. 
         [0021]    Because the instrument  102  and articulating tip  110  are intended to be inserted within the human body, they are constructed of materials selected to withstand that environment and to be safely used within that environment. While various recipes of stainless steel are useful for some portions of the instrument  102  and tip  110 , insulative plastic and polymer materials may also be used as appropriate and further described herein. It is envisioned that a wide range of materials can be selected based on their known properties such that the portion of the instrument  102  within the body is of an inert material that has minimal unintended effect on bodily tissue and that the tip can deliver energy at a desired location but, also not impact any unintended areas. 
         [0022]      FIG. 2  illustrates a side view of a surgical instrument in accordance with the principles of the present invention. There is a handle portion  200  that includes a trigger  206  that controls movement of the articulating tip  210 . The handle portion also includes a port  212  that accepts a signal from an energy source (not shown) and a switch  204  that activates or deactivates delivery of the energy source signal to the tip  210 . The switch  204  is shown on the handle portion  200  in  FIG. 2  but the switch  204  can also be a floor-mounted switch or mounted to some other surface as well. 
         [0023]    The handle portion  200  is connected to a proximal end of a shaft  202  and at the distal end of the shaft  202  is an articulating mechanism  208 , such as for example, a hinge and a tip  210 . The trigger  206  is used to control movement of the articulating mechanism  208  such that the tip  210  can move upwards or downwards. In a particular embodiment, the tip  210  is rigid such that it does not bend but, instead rotates as a rigid shaft about a hinge  208 . 
         [0024]    The trigger  206  and articulating mechanism  208  can be connected in a variety of different ways to effect mechanical movement of the tip  210  in a desired manner. For example, electromagnetic motors could be used at the trigger  206 , the articulating mechanism  208 , or both to effect movement of the tip  210 . A variety of mechanical movements such a screw gears, planetary gears and other interlocking geared shafts could also be used to affect the desired movement of the tip  210 . While such complex approaches may be useful in certain environments, a simple mechanical linkage from the trigger  206  to the articulating mechanism  208  is a beneficial approach that simplifies the design of the instrument shown in  FIG. 2 . Similarly, the articulating mechanism  208  can be any of a wide variety of designs such that the tip  210  can pivot relative to the shaft  202 . However, a simple hinge having a fixed portion and a rotating portion either encircling the fixed portion or encompassed within the fixed portion also simplifies the design of the instrument shown in  FIG. 2 . 
         [0025]    Although shown as a trigger  206 , this mechanism that the surgeon manipulates to control the degree of articulation of the tip  210  can be constructed in other ways as well. For example, a thumbwheel can be used that the surgeon rotates back a forth. Also, a sliding switch can be used that slides back and forth to effect motion of the tip  210 . In some instances, a trackball or joystick mechanism could also be used wherein the movement of the manipulated mechanism is transformed into appropriate movement of the articulating tip  210  such that the tip is positioned at a desired angle and location. 
         [0026]    As for size, the tip  210  can be selected for different purposes and can range from about 2 cm to 4 cm in length. The shaft  202  can vary in size as well but a length of about 40 cm and a diameter which can be of different sizes will allow a variety of uses. Thus, a wide variety of shaft diameters is beneficial. The shaft of the instrument is typically inserted through a plastic tube placed through an incision in the skin. These tubes, known as trocars, come in sizes ranging from 5 to 15 mm. Thus, the diameter of the shaft  202  can vary along that same range of sizes as well. The handle portion  200  can be any of a variety of different designs that allow it to be held by a single hand in a steady manner that provides easy and intuitive access to the trigger  206 . 
         [0027]    The trigger  206  may be configured such that constant pressure by a finger is needed to hold the trigger  206  in a desired position. Thus, a spring can be attached to the trigger  206  biased in such a way as to return the trigger  206  to a neutral position so that pressure by a finger is required to hold the trigger  206  in a forwards or backwards position and thus to hold the articulating tip  110  in a desired angle. Alternatively, a ratcheting mechanism can be employed so that movement forward of the trigger ratchets the mechanical linkage in one direction and movement backwards of the trigger  206  ratchets the mechanical linkage in an opposite direction. In this way, the articulating tip is positioned at a desired angle and remains there even if the trigger  206  is released. 
         [0028]      FIG. 3  illustrates a side view of the instrument of  FIG. 1  in which the trigger is moved to articulate the tip downwards. In  FIG. 2 , the trigger  206  was in a position that placed the tip  210  in a neutral position. In this position the tip  210  has its major axis substantially aligned with the major axis of the shaft  202 . In  FIG. 3 , however, the trigger  206  is moved so that the tip  210  articulates downwards an angle θ. The articulating mechanism  208  and the tip  110  are constructed such that the maximum angle downwards that the tip  210  can move is about 20 degrees. This limited movement can be accomplished using a variety of methods. For example, the length, and thus allowed movements, of the mechanical linkages between the trigger  206  and the tip  210  can be selected so that maximum mechanical travel of the trigger  206  forward would result in tip articulation downward of only 20 degrees. Thus moving the trigger from a neutral position to its maximum forward position would articulate the tip  210  downwards from zero degrees to 20 degrees. Alternatively, or in addition to, mechanical stops can be present which stop the movement of the articulating tip  210  at a desired maximum downward angle. 
         [0029]      FIG. 4  illustrates a side view of the instrument of  FIG. 1  in which the trigger is moved to articulate the tip upwards. In  FIG. 3 , the trigger  206  was in a position that placed the tip  210  in a downward position. In this position the tip  210  has its major axis tilted, or deflected, downward with respect to the major axis of the shaft  202 . In  FIG. 4 , however, the trigger  206  is moved so that the tip  210  articulates upwards an angle θ. In this position the tip  210  has its major axis tilted, or deflected, upward with respect to the major axis of the shaft  202 . The articulating mechanism  208  and the tip  110  are constructed such that the maximum angle upwards that the tip  210  can deflect is about 70 degrees. This limited movement can be accomplished using a variety of methods. For example, the length, and thus allowed movements, of the mechanical linkages between the trigger  206  and the tip  210  can be selected so that maximum mechanical travel of the trigger  206  backward would result in tip articulation upward of only 70 degrees. Thus moving the trigger from a neutral position to its maximum backward position would articulate the tip  210  upwards from zero degrees to 70 degrees. Alternatively, or in addition to, mechanical stops can be present which stop the movement of the articulating tip  210  at a desired maximum upwards angle. 
         [0030]    Thus, the instrument of  FIG. 2-4  includes only one articulating tip that has a limited range of articulation angles. In particular the articulating tip can rotate downwards to about −20 degrees and upwards to about 70 degrees. These specific angles provide what is believed to be a beneficial range of articulation; however other ranges are contemplated as well. Because a surgeon can rotate the instrument and, thereby “change” the plane of reference as needed to reach any particular tissue within the body cavity, the total beneficial range of articulation for the single tip instrument to be achieved is about 90 degrees. In the specific embodiment described above, the range of 90 degrees was accomplished with a possible 70 degree movement in one direction from a neutral position and a possible 20 degree movement in the opposite direction. However, a range of articulation from about +60 degrees to −30 degrees will also provide the desired total range of 90 degrees. While +45 degrees to −45 degrees would also provide the desired total range of articulation, it is beneficial to have articulation in one direction to be closer to 90 degrees as this allows the tip to more easily reach tissue that are oriented somewhat orthogonally to the major axis of the shaft  202 . 
         [0031]      FIG. 5A-FIG .  5 D illustrate details of an articulating tip in accordance with the principles of the present invention. In  FIG. 5A-5C  the articulating mechanism  208  is shown to be enclosed in an insulating cap  508 . In particular, the tip  210  includes a shaft  506  and a distal end  504  that are conductive for the energy being delivered from the energy source  104  (See  FIG. 1 ). Thus, there is a portion of the articulating mechanism  208  around the region  507  that would be exposed if not for the insulating cap  508 . Without the insulating cap  508 , there would be a greater risk that unintended tissue could be contacted by portions of the tip  210  that deliver energy to the body tissue. Thus, a substantial portion of the articulating mechanism may be covered by the electrically insulating cap  508 . By “substantial portion” it is meant that as much of the articulating mechanism can be covered without interfering with the operation of the articulating mechanism and the articulating tip. The top view from  FIG. 5C  shows an opening, or slot,  502  in the cap  508  that allows the tip  210  to move but also prevents the majority of the articulating mechanism  208  from being exposed. As mentioned briefly above, the slot  502  can be sized so that it provides a lower hard mechanical stop and an upper hard mechanical stop that prevent the tip  210  from articulating outside of the desired range of articulation. 
         [0032]      FIG. 5D  shows a cutaway view inside the instrument of  FIG. 2 . From this view it can be seen that the energy source  104  is connected through a conductive path  554  and the switch  204  to the articulating tip  210 . Additionally, a trigger  206  is also coupled through mechanical linkages  552  to the articulating mechanism  208 . An insulating cap  508  helps minimize the amount of the articulating tip  210  and articulating mechanism  208  that are exposed. In this way, unintended damage to tissue may be reduced. The end of the tip  210  may be either a unipolar end or a bi-polar end depending on the energy source  104  selected. The difference being that a bi-polar tip includes both the positive and negative electrodes in close proximity to one another. Other types of tips can be used as well if other energy sources are selected such as, for example, tips used with harmonic energy sources. 
         [0033]      FIG. 6  illustrates a flowchart of an exemplary method of using the articulating tip instrument in accordance with the principles of the present invention. Because of the position of the patient&#39;s body during endometriosis fulguration as well as the structure of the abdominal cavity, there are regions that are more easily seen and reached with a non-articulating fulgurator. For some regions, however, a direct or straight approach is difficult and damage to surrounding tissue can occur or complete fulguration may be difficult. Thus, an articulating tip fulgurator as described above is useful in many instances. However, using dual-tipped instruments as a makeshift fulgurator is difficult in many instances because the risk of unintentionally damaging nearby tissue increases. Accordingly, a method is described with reference to  FIG. 6  that uses the single articulating tip device described above to perform fulguration of tissue such as endometrial cells within the abdominal cavity. One of ordinary skill will recognize that the method and instrument can be used for other tissue-related surgical procedures as well without departing from the scope of the present invention. 
         [0034]    Step  602  assumes that an incision has previously been made through which to insert the distal tip of a surgical instrument in accordance with the principles of the present invention. Also, it is assumed that there are one or more cameras present that image the area within the body where the distal tip may be moved around in order to fulgurate desired tissue. Although such a camera is assumed to be separate from the device illustrated in  FIGS. 2-5D , the camera could be located near the articulating tip  210  such that the image signal is acquired by a camera connected to the surgical instrument with the image signal being sent through a cable within the shaft  202  or possibly by a wireless transmitter to a viewing screen outside the body. In step  602 , the distal, articulating end of the surgical instrument is inserted into the incision and thus into the abdominal cavity of a person (or animal). 
         [0035]    In step  604 , the instrument is moved in such a way that the distal end is positioned near tissue that is to be fulgurated. Once in the general desired location, the articulating tip at the distal end of the instrument can be articulated, in step  606 , to the desired angle such that a significant portion of the tip surface is in contact with the tissue to be fulgurated. Depending on the orientation of the person and the tissue within the abdominal cavity, the tip is articulated to an angle within −20 degrees to +70 degrees from a neutral position that best locates the tip to perform fulguration without unintentionally damaging nearby tissue. Once in place, the surgeon, in step  608 , delivers energy through the instrument to the tissue such that the tissue is fulgurated. 
         [0036]    The previous description is provided to enable any person skilled in the art to practice the various embodiments described herein. Various modifications to these embodiments will be readily apparent to those skilled in the art, and the generic principles defined herein may be applied to other embodiments. Thus, the claims are not intended to be limited to the embodiments shown herein, but are to be accorded the full scope consistent with each claim&#39;s language, wherein reference to an element in the singular is not intended to mean “one and only one” unless specifically so stated, but rather “one or more.” All structural and functional equivalents to the elements of the various embodiments described throughout this disclosure that are known or later come to be known to those of ordinary skill in the art are expressly incorporated herein by reference and are intended to be encompassed by the claims. Moreover, nothing disclosed herein is intended to be dedicated to the public regardless of whether such disclosure is explicitly recited in the claims. No claim element is to be construed under the provisions of 35 U.S.C. §112, sixth paragraph, unless the element is expressly recited using the phrase “means for” or, in the case of a method claim, the element is recited using the phrase “step for.”