Abstract:
An aortic punch including a handle mechanism and punch cartridge for interchangeability of a variety of cartridges with a common handle.

Description:
FIELD OF THE INVENTION 
       [0001]    The present invention relates to aortic punches for removing tissue from the vascular system in surgical procedures. 
       BACKGROUND OF THE INVENTION 
       [0002]    In cardiac surgery blood vessel walls are opened by a vascular or aortic punch to provide an opening of suitable configuration for attachment of arteries or veins as required in carrying out a cardiac surgical procedure. Initially, a blood vessel wall is slit with a scalpel creating a small incision through the wall for insertion of a punch head. An aortic punch removes a small disc, of tissue from a blood vessel wall by withdrawing the punch head and surrounding tissue through a cutting die. The disc so removed is retained by the punch head while a corresponding hole remains in the blood vessel defining a suitable opening for attachment of vein or artery in continuing with a cardiac procedure. 
         [0003]    A vascular punch of this kind is disclosed in my U.S. Pat. No. 5,192,294, which comprises a pistol-like housing for positioning and actuating a vascular punch in surgery. The &#39;294 vascular punch is an integrated device in which tissue removal components and their actuating components are permanently assembled in the pistol-like housing for the duration of the useful life of the punch, whether reused or disposed of as title of the &#39;294 patent suggests. 
         [0004]    It is desirable in surgical practice that different configurations of aortic punch be available to meet the variable operating site conditions encountered in practice. With prior art devices such as the &#39;294 patent, these desirable arrangements are meet only by keeping an inventory of integrated devices each with its own pistol grip and specific punch configuration. It is also desirable to meet the requirements of endoscopic surgery particularly constraints involved in using a trocar for passing instruments to a surgical site. 
         [0005]    There is need for an arrangement in which a common pistol grip or other handle configuration is suitable for a variety of punch configurations selected to meet specific operating site constraints of cardiac surgery. 
       SUMMARY OF THE INVENTION 
       [0006]    The present invention comprises an aortic punch comprising an operating handle and an aortic punch cartridge wherein a single handle accommodates a variety of punch cartridges individually configured according to operating site constraints. An operating handle providing linear reciprocating motion including scissors-type or pistol grip is used with the invention. A suitable operating handle is disclosed in my U.S. Pat. No. 6,869,435 entitled Repeating Multi-clip Applier. The &#39;435 operating handle housing accommodates a pistol grip set of handles to provide linear reciprocating motion by means of a spring biased translator slide. The operating handle housing includes a rotary finger wheel hub and rotatable drum subassembly which connect to a surgical clip applying cartridge and which link the cartridge to the translator slide. The operating handle defines a unique interface between handle and cartridge thereby permitting variation in cartridge design to meet constraints encountered in surgical practice. 
         [0007]    The present invention provides an aortic punch in the form of a cartridge suitable for use with a &#39;435 operating handle. 
         [0008]    The operating handle contains all components needed to impart linear reciprocating movement to an aortic punch cartridge including means for moving the punch components in a first linear direction, and for returning the punch to normal or starting position. Because of this arrangement, an aortic punch cartridge according to the invention is simplified to minimum components needed to achieve its function. 
         [0009]    In conjunction with the operating handle, an anti back-up mechanism prevents return of the handle, if released by a surgeon in mid-stroke, until full handle stroke is completed. The punch thereby retains excised tissue for removal from surgery site. 
         [0010]    An aortic punch cartridge according to the invention comprises a tubular outer housing, a blade drum defining a circular cutting edge fitted to an open of the housing, a punch mandrel fitted into the blade drum, and a connecting link between punch mandrel and operating handle. The dimensions and shape of the aortic punch cartridge are chosen as desired to meet constraints encountered during cardiac or vascular surgery. 
         [0011]    The invention simplifies logistic requirements for aortic punches in cardiac surgery in providing punch cartridges in a variety of sizes and configurations for interface with a common handle. 
       OBJECTS OF THE INVENTION 
       [0012]    An object of the invention is to provide a novel aortic punch with minimum complexity and with adaptability to a complete range of cardiac surgery procedures. 
         [0013]    Another object of the invention is to provide an aortic punch using a replaceable punch cartridge. 
         [0014]    Another object of the invention is to provide an aortic punch having an operating handle that contains operating components needed for linear reciprocating motion thereby simplifying punch cartridge components. 
         [0015]    Another object of the invention is to provide an aortic punch cartridge that can be used with various operating handle configurations including pistol grip, scissor type, surgical robot, as well as any actuating means for providing linear excursion. 
         [0016]    Other and further objects of the invention will become apparent with an understanding of the following detailed description of the invention or upon employment of the invention in practice. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWING 
         [0017]    A preferred embodiment of the invention has been chosen for detailed description to enable those having ordinary skill in the art to which the invention appertains to readily understand how to construct and use the invention and is shown in the accompanying drawing in which: 
           [0018]      FIG. 1  is a perspective view of a preferred embodiment of aortic punch according to the invention, indicating it&#39;s A-A′ axis. 
           [0019]      FIG. 2  is a side elevation view of the aortic punch of  FIG. 1  with the operating handle housing partially in section and with handle in release position. 
           [0020]      FIG. 3  is a perspective view of the handle components aligned on A-A′ axis comprising the handle side interface with punch cartridge. 
           [0021]      FIG. 4  is a plan view of aortic punch cartridge according to the invention. 
           [0022]      FIG. 5  is a plan section view of the aortic punch of  FIG. 4 . 
           [0023]      FIG. 6   a  is plan view of a punch mandrel of the aortic punch of  FIG. 5 . 
           [0024]      FIG. 6   b  is a side elevation of punch mandrel of  FIG. 6   a.    
           [0025]      FIG. 7  is a plan view of connecting link or pull bar of the aortic punch of  FIG. 5 . 
           [0026]      FIG. 8  is a plan view of a modified embodiment of aortic punch cartridge according to the invention. 
           [0027]      FIG. 9  is a sectional plan view showing internal components of the aortic punch cartridge of  FIG. 8 . 
           [0028]      FIG. 10  is a side elevation view of the aortic punch cartridge of  FIG. 8 . 
           [0029]      FIG. 11  is an end view of the aortic punch cartridge of  FIG. 10 . 
           [0030]      FIG. 12  is an exploded view showing layout of components of aortic punch cartridge of  FIG. 8 . 
           [0031]      FIG. 13  is another modified embodiment of the invention in exploded view showing layout of components of aortic punch cartridge. 
       
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT 
       [0032]    Referring to the drawing, a preferred embodiment of aortic punch  10  comprises operating handle  12  and aortic punch cartridge  14 . 
         [0033]    The operating handle  12  shown in  FIGS. 1 and 2  is fully described in my U.S. Pat. No. 6,869,435 and comprises a pistol grip  12   a  and trigger  12   b  that impart linear movement or linear excursion to internal components assembled within the housing. The internal components ( FIG. 2 ) include bar spring  16 , e.g., for biasing components forward within the housing, a linear translator  18  for true linear movement along the A-A′ axis, a rotary translator  20 , and a rotary drum  22  with finger wheel hub  23 . The rotary translator is fitted at one end  20   a  to the linear translator and at its other end  20   b  defines an interface for receiving the punch cartridge  14 . 
         [0034]    As best shown in  FIGS. 2 and 3 , the rotary translator  20  is assembled within the rotary drum  22  with both the drum and translator having keyhole openings  22   a ,  20   c  through their front faces for passing an end of connecting link or pull bar  24  of the punch cartridge. The rotary translator is further provided with a front-end cage  20   d  for receiving connecting link end  24   a , and for imparting linear movement to the link during operation of the aortic punch. 
         [0035]    The rotary drum subassembly within the operating handle housing is now ready to receive the removable aortic punch cartridge, to impart both reciprocating rectilinear movement to the cartridge and to accommodate rotary movement of the cartridge. The rotary drum and rotary translator serve as a receptacle for the T-shaped end of a cartridge connecting link described below. 
         [0036]    It is to be understood that the operating handle provides reciprocating liner motion of fixed length referred to herein as linear excursion. It is to be further understood that any suitable mechanism capable of providing reciprocating linear motion of fixed excursion including pistol grip and scissor type handles, surgical robot, as well as any actuating means for providing linear excursion may be used for operating the aortic punch cartridge. 
         [0037]    The aortic punch cartridge ( FIGS. 4-7 ) includes a housing  30  in the form of a tube along the A-A′ axis with punch end  30   a  and handle end  30   b . The punch end supports a blade drum or tissue cutting die  32  in the general form of a cylinder defining an interior passage  32   a . The blade drum includes outer surface  32   c  terminating in a circumferential shoulder  32   d  for nesting engagement within the tube punch end  30   c . The exposed end of the drum is conical  32   e  terminating in a circular cutting edge  32   f  against which a disc of tissue is cut from a vein or artery by a punch mandrel  34  during surgery. 
         [0038]    The punch mandrel  34  occupies interior passage  32   a  of the blade drum. The punch mandrel  34  comprises a cylindrical shaft  34   a  with recess  34   b  at one end to form a punch head  34   c . The punch mandrel is recessed at its other end  34   d  for assembly with connecting link  24 . The punch head includes a cylindrical base  34   e  defining a circular cutting edge  34   f  cooperating with the blade drum cutting edge  32   f  for severing arterial tissue. The punch head has a conical tip  34   g  for ease of passage of the punch head through an entry incision formed in an artery wall. 
         [0039]    The punch mandrel recess  34   d  has an integral block  34   h  for engagement with an aperture  24   b  in connecting link  24  for movement of the punch mandrel along the linear excursion of the handle. 
         [0040]    The connecting link  24  is an elongate strip preferably of stamped sheet metal with T-shaped flange  24   a  for connection to a handle, aperture  24   b  for connection to punch mandrel block, and spring engaging shoulders  24   c - d  cooperating with cartridge spring  35  described below. 
         [0041]    The aortic punch cartridge tube  30  at its handle end  30   b  has positioning pins  30   c  projecting radially from the tube, and an end slot  30   d  for passing the end of a connecting link or puller bar while maintaining radial alignment of the pins and puller bar. The connecting link or puller bar terminates in a T shape flange  24   a  for connection with the rotary translator forming part of the handle receptacle for the link. 
         [0042]    The assembly of housing  30  and puller bar  24  is shown in  FIG. 5  wherein the housing interior surface is recessed  30   e  to accommodate coil spring  35  encircling puller bar  24 . Coil spring is placed between interior surface shoulder  30   f  and puller bar shoulders  24   c - d  so that rearward movement of the puller bar compresses the coil spring which returns the bar to the position shown in  FIG. 5 . 
         [0043]    A modified form of aortic punch cartridge is shown in  FIGS. 8-12 . The modified punch includes a housing  40  in the form of a tube along the A-A′ axis with punch end  40   a  and handle end  40   b . The punch end supports a blade drum  32  and punch mandrel  34  which are the same as those in  FIGS. 4-7  to the extent indicated by common reference numerals, and vary as indicated by added numerals. 
         [0044]    The punch mandrel  34  is recessed by radial groove  34   m  to form a cyndrical connecting block  34   n  for assembly with connecting link  42  for movement of the punch mandrel along the linear excursion of the handle. Connecting link  42  comprises an elongate flat rod with forward slot  42   a  having a contour for coupling with punch mandrel block  34   n , a necked-down portion  42   b  defined by shoulder  42   c  a terminal T-shaped flange  42   d . A coil spring  44  occupies the necked-down portion of the connecting link engaging shoulder  42   c  to urge link and punch mandrel toward forward position. 
         [0045]    The aortic punch cartridge housing tube at its handle end has a closure sleeve  46  that slides onto handle end of the housing. The sleeve has positioning pins  46   a  projecting radially, and an end slot  46   b ( FIG. 11 ) for passing the T-shape end of the connecting link while maintaining radial alignment of the pins and puller bar. 
         [0046]    Another modified embodiment of aortic punch is shown in  FIG. 13  in which components are the same as those in the embodiments of  FIGS. 4-12  as indicated by common reference numerals. The aortic punch of  FIG. 13  includes a punch mandrel  48  having a front end as described for  FIGS. 4-12 . Mandrel  48  is elongate and terminates in a T-shape flange  48   a  for direct connection of the mandrel to a handle mechanism. Fixed collar  48   b  defines a shoulder for engagement with coil spring  44  in an assembled punch. In preferred form, mandrel  48  is cylindrical for the portion  48   c  extending forward of shoulder  48   b , and a flat strip  48   d  for that portion to the rear of the shoulder. This embodiment of aortic punch allows for a short-length aortic punch as is desirable in particular surgical procedures. 
         [0047]    Referring to  FIGS. 1-3  for assembly of aortic punch cartridge and operating handle: 
         [0048]    (a) the aortic punch cartridge is inserted through keyhole into the front end of the rotary drum with cartridge positioning pins entering interior drum slots; 
         [0049]    (b) the T flange projecting through cartridge end slot is in fixed radial orientation in relation to the positioning pins; 
         [0050]    (c) the T flange approaches end face of the rotary translator with the T flange in axial registry with the keyhole in the front face of cage flange ( FIG. 2 ); 
         [0051]    (d) the T flange passes through the keyhole into the rotary translator cage; 
         [0052]    (e) the cartridge is rotated (arrow  10   a ) on A-A′ axis with cartridge pins entering radial drum slots and the T flange coming to rest against the rotary translator interior cage shoulders. 
         [0053]    The slot spring engages one of the pins to hold the cartridge in assembled position with the handle. 
         [0054]    The cartridge and operating handle are taken apart by reversing the assembly sequence. 
         [0055]    It is to be understood that an aortic punch cartridge of this invention can be used with a scissor grip handle as well as with the pistol grip handle described above. For example, the scissor grip handle described in my. U.S. Pat. No. 6,423,079 modified to have a cartridge/handle interface as described above makes a suitable handle. It is within the purview of the invention for the cartridge to receive linear excursion from handles as described as well as from any mechanism whether manual or automatic capable of generating linear excursion and having a receptacle for interface with the cartridge puller bar T-flange. 
         [0056]    Various changes may be made to the structure embodying the principles of the invention. The foregoing embodiments are set forth in an illustrative and not in a limiting sense. The scope of the invention is defined by the claims appended hereto.