Abstract:
A biopsy device and method are provided for obtaining a tissue sample, such as a breast tissue biopsy sample. The biopsy device includes a disposable probe assembly with an outer cannula having a distal piercing tip, a cutter lumen, and a cutter tube that rotates and translates past a side aperture in the outer cannula to sever a tissue sample. The biopsy device also includes a reusable handpiece with an integral motor and power source to make a convenient, untethered control for use with ultrasonic imaging. The reusable handpiece incorporates a probe oscillation mode to assist when inserting the distal piercing tip into tissue. The motor also actuates a vacuum syringe in coordination with movement of the cutter tube to provide vacuum assistance in prolapsing tissue and retracting tissue samples.

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
     The present application is a reissue of U.S. Pat. No. 7,828,748, “VACUUM SYRINGE ASSISTED BIOPSY DEVICE” to Hibner, filed 17 Aug. 2006, which is a continuation-in-part of the co-pending and commonly-owned U.S. patent application Ser. No. 11/198,558, “BIOPSY DEVICE WITH REPLACEABLE PROBE AND INCORPORATING VIBRATION INSERTION ASSIST AND STATIC VACUUM SOURCE SAMPLE STACKING RETRIEVAL” to Hibner et al., filed 5 Aug. 2005, issued as U.S. Pat. No. 7,867,173, the disclosure disclosures of which is are hereby incorporated by reference in its their entirety. The present application is also related to U.S. patent application Ser. No. 13/672,037, filed 8 Aug. 2012, a reissue of U.S. Pat. No. 7,828,748, “VACUUM SYRINGE ASSISTED BIOPSY DEVICE” to Hibner, filed 17 Aug. 2006, now abandoned. 
    
    
     FIELD OF THE INVENTION 
     The present invention relates in general to biopsy devices, and more particularly to biopsy devices having a cutter for severing tissue, and even more particularly to biopsy devices for multiple sampling with a probe remaining inserted. 
     BACKGROUND OF THE INVENTION 
     When a suspicious tissue mass is discovered in a patient&#39;s breast through examination, ultrasound, MRI, X-ray imaging or the like, it is often necessary to perform a biopsy procedure to remove one or more samples of that tissue in order to determine whether the mass contains cancerous cells. A biopsy may be performed using an open or percutaneous method. 
     An open biopsy is performed by making a large incision in the breast and removing either the entire mass, called an excisional biopsy, or a substantial portion of it, known as an incisional biopsy. An open biopsy is a surgical procedure that is usually done as an outpatient procedure in a hospital or a surgical center, involving both high cost and a high level of trauma to the patient. Open biopsy carries a relatively higher risk of infection and bleeding than does percutaneous biopsy, and the disfigurement that sometimes results from an open biopsy may make it difficult to read future mammograms. Further, the aesthetic considerations of the patient make open biopsy even less appealing due to the risk of disfigurement. Given that a high percentage of biopsies show that the suspicious tissue mass is not cancerous, the downsides of the open biopsy procedure render this method inappropriate in many cases. 
     Percutaneous biopsy, to the contrary, is much less invasive than open biopsy. Percutaneous biopsy may be performed using fine needle aspiration (FNA) or core needle biopsy. In FNA, a very thin needle is used to withdraw fluid and cells from the suspicious tissue mass. This method has an advantage in that it is very low-pain, so low-pain that local anesthetic is not always used because the application of it may be more painful than the FNA itself. However, a shortcoming of FNA is that only a small number of cells are obtained through the procedure, rendering it relatively less useful in analyzing the suspicious tissue and making an assessment of the progression of the cancer less simple if the sample is found to be malignant. 
     During a core needle biopsy, a small tissue sample is removed allowing for a pathological assessment of the tissue, including an assessment of the progression of any cancerous cells that are found. The following patent documents disclose various core biopsy devices and are incorporated herein by reference in their entirety: U.S. Pat. No. 6,273,862 issued Aug. 14, 2001; U.S. Pat. No. 6,231,522 issued May 15, 2001; U.S. Pat. No. 6,228,055 issued May 8, 2001; U.S. Pat. No. 6,120,462 issued Sep. 19, 2000; U.S. Pat. No. 6,086,544 issued Jul. 11, 2000; U.S. Pat. No. 6,077,230 issued Jun. 20, 2000; U.S. Pat. No. 6,017,316 issued Jan. 25, 2000; U.S. Pat. No. 6,007,497 issued Dec. 28, 1999; U.S. Pat. No. 5,980,469 issued Nov. 9, 1999; U.S. Pat. No. 5,964,716 issued Oct. 12, 1999; U.S. Pat. No. 5,928,164 issued Jul. 27, 1999; U.S. Pat. No. 5,775,333 issued Jul. 7, 1998; U.S. Pat. No. 5,769,086 issued Jun. 23, 1998; U.S. Pat. No. 5,649,547 issued Jul. 22, 1997; U.S. Pat. No. 5,526,822 issued Jun. 18, 1996; and US Patent Application 2003/0199753 published Oct. 23, 2003 to Hibner et al. 
     At present, a biopsy instrument marketed under the trade name MAMMOTOME is commercially available from ETHICON ENDO-SURGERY, INC. for use in obtaining breast biopsy samples. This device generally retrieves multiple core biopsy samples from one insertion into breast tissue with vacuum assistance. In particular, a cutter tube is extended into a probe to cut tissue prolapsed into a side aperture under vacuum assistance and then the cutter tube is fully retracted between cuts to extract the sample. 
     With a long probe, the rate of sample taking is limited not only by the time required to rotate or reposition the probe but also by the time needed to translate the cutter. As an alternative to this “long stroke” biopsy device, a “short stroke” biopsy device is described in the following commonly assigned patent applications: U.S. patent application Ser. No. 10/676,944, “Biopsy Instrument with Internal Specimen Collection Mechanism” filed Sep. 30, 2003 in the name of Hibner et al.; and U.S. patent application Ser. No. 10/732,843, “Biopsy Device with Sample Tube” filed Dec. 10, 2003 in the name of Cicenas et al. The cutter is cycled across the side aperture, reducing the sample time. Several alternative specimen collection mechanisms are described that draw samples through the cutter tube, all of which allow for taking multiple samples without removing the probe from the breast. 
     The vacuum assistance presented at the side aperture provides a further benefit of reducing the accumulation of bodily fluids around the probe that may tend to interfere with taking a diagnostic image, may impede subsequent insufflation and marker deployment, leave an undesirable hematoma at the biopsy site, and/or result in external bleeding that is a biohazard and may increase the patient&#39;s discomfort. 
     While the vacuum assistance has a number of benefits, some practitioners prefer to perform core biopsy procedures with simpler devices that do not include a control module with graphical user interface, electronic control, vacuum generation and control, and other features. In addition to the desire to reduce capital costs, it is also generally desirable to reduce the need to tether a hand-held biopsy device to sources of mechanical motion, vacuum supply, electrical power and control. Such tethers may tend to impede positioning of the biopsy device, introduce tripping hazards, and increase set up time. 
     Therefore, while these multiple sample core biopsy instruments have numerous advantages, it is believed that the diagnostic and therapeutic advantages of the core biopsy procedures would be seen as more desirable if vacuum assistance could be incorporated in a more convenient manner. 
     SUMMARY OF THE INVENTION 
     The present invention addresses these and other problems of the prior art by providing a biopsy device that has a probe cannula that is inserted into tissue to obtain a core biopsy sample by translating a cutter with the probe cannula. Vacuum assistance to prolapse tissue for sampling is advantageously provided by an integral vacuum container whose internal pressure is reduced from atmospheric pressure by actuation of a single motor that also translates the cutter to sever biopsy samples. 
     In one aspect of the invention, a biopsy device handpiece has a motorized translation drive mechanism that engages and operates a disposable probe assembly that also translates a vacuum plunger of a vacuum syringe. A cutter tube translating within a cutter lumen severs tissue that is prolapsed therein under the urging from vacuum supplied by the vacuum syringe. 
     These and other objects and advantages of the present invention shall be made apparent from the accompanying drawings and the description thereof. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       While the specification concludes with claims particularly pointing out and distinctly claiming the present invention, it is believed the same will be better understood by reference to the following description, taken in conjunction with the accompanying drawings in which: 
         FIG. 1  is an isometric view of a biopsy device with attached vacuum syringe assembly consistent with the present invention. 
         FIG. 2  is an isometric view of the biopsy device of  FIG. 1  with a disposable probe assembly that includes the vacuum syringe assembly disengaged from a reusable handpiece that has a lower tray removed to expose a carriage frame assembly and a motor drive assembly. 
         FIG. 3  is an isometric view of the reusable handpiece of  FIG. 1  with a top cover detached with a left half cut away and with the lower handle tray detached to expose the motor drive assembly operatively engaged to the carriage frame assembly. 
         FIG. 4  is an isometric view of the motor drive assembly removed from the carriage frame assembly of  FIG. 3 . 
         FIG. 5  is a bottom isometric view of the top cover of the reusable handpiece of  FIG. 2 . 
         FIG. 6  is a top, left and aft isometric view of the carriage frame assembly of  FIG. 4 . 
         FIG. 7  is a top, left and forward view of the carriage frame assembly of  FIG. 4  with an upper frame disassembled. 
         FIG. 8  is a top, left and front isometric view of the carriage frame assembly of  FIG. 4  with the upper frame removed. 
         FIG. 9  is a bottom isometric view of the carriage frame assembly of  FIG. 8  with the upper frame removed. 
         FIG. 10  is a top, left and front isometric exploded view of the carriage frame assembly of  FIG. 4 . 
         FIG. 11  is a right front view of a transmission section of the motor drive assembly of  FIG. 4  with a distal bulkhead removed. 
         FIG. 12  is a front left exploded view of the transmission section of the motor drive assembly of  FIG. 4 . 
         FIG. 13  is a front left isometric view of the disposable probe assembly of  FIG. 1  with a bottom cover, vacuum conduits and vacuum syringe assembly disassembled. 
         FIG. 14  is a top detail view of a cutter gear and surrounding components of the disposable probe assembly of  FIG. 1 . 
         FIG. 15  is a left front exploded view of a distal portion of the disposable probe assembly of  FIG. 1 . 
         FIG. 16  is a left front exploded view of a proximal portion (vacuum syringe assembly) of the disposable probe assembly of  FIG. 1 . 
         FIG. 17  is a bottom left isometric view of the distal internal portion of the disposable probe assembly of  FIG. 1  with the bottom cover removed. 
         FIG. 18  is a left side section view of the disposable probe assembly of  FIG. 1  taken generally through a longitudinal axis and omitting a probe cannula. 
         FIG. 19  is a left side diagrammatic view of an initial state of the biopsy device of  FIG. 1  with the vacuum syringe assembly omitted and with both carriages distally positioned and engaged to the disposable probe assembly. 
         FIG. 20  is a left side diagrammatic view of the biopsy device of  FIG. 1  with the vacuum syringe assembly omitted, depicted after insertion of the probe cannula into tissue and the retraction of an aft (straw) carriage that withdraws a straw from the cutter tube. 
         FIG. 21  is a left side diagrammatic view of the biopsy device of  FIG. 1  with the vacuum syringe assembly omitted, depicted after retraction of a front (cutter) carriage that positions a valve and retracts a vacuum plunger to perform vacuum assistance within the probe cannula. 
         FIG. 22  is a left side diagrammatic view of the biopsy device of  FIG. 1  with the vacuum syringe assembly omitted, depicted after distal advancement of the front (cutter carriage) as the aft (straw) carriage begins to distally translate to insert the straw over a severed tissue sample and to reset the vacuum syringe assembly. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     Turning to the Drawings, wherein like numerals denote like components throughout the several views, in  FIGS. 1-3 , a biopsy device  10  includes a reusable handpiece  12 , and a disposable probe assembly  14 . A lower handle tray  16  is disassembled from upper portions of the reusable handpiece  12  to expose portions that operably engage the disposable probe assembly  14 . A vacuum syringe assembly  18  is a proximal portion of the disposable probe assembly  14  that is also actuated by the reusable handpiece  12 . With the close proximity of the source of vacuum, the amount of vacuum line that needs to be evacuated is minimized, enabling a modestly sized vacuum syringe assembly  18  to effect vacuum assistance to prolapse tissue into a side aperture  20  of a probe cannula  22  of the disposable probe assembly  14 . In  FIG. 3 , further economy is realized by employing one DC motor  24  in the reusable handpiece  12  to accomplish the severing of tissue samples as well as actuating the vacuum syringe assembly  18 . 
     With particular reference to  FIG. 1 , insertion of the probe cannula  22  into tissue is integrally supported by a piercing tip  26  attached at a distal end as well as a longitudinal jack hammer motion to the probe cannula  22  selected by positioning a slide button  28  distally and depressing a forward motor button  30 . In response, the DC motor  24  drives a. transmission section  31  grounded to a top cover  34  of the reusable handpiece  12  to longitudinally reciprocate an internal carriage frame assembly  32  that is engaged for movement with the probe cannula  22  ( FIG. 3 ). With the slide button  28  proximally positioned, depression of the forward motor button  30  causes the DC motor  24  to advance and rotate a cutter tube  36 , depicted in  FIG. 1  as having been fully distally translated, closing the side aperture  20 . Depression of a reverse motor button  38  causes the cutter tube  36  to retract. Depression of a mode button  40  may cause other functions to be performed. For example, fluid may be applied to or removed from the biopsy device  10  via a valve (not shown), activated by mode button  40 , inserted along distal vacuum conduit  330  ( FIG. 13 ). An external conduit  42  extends from the disposable probe assembly  14 , terminated by a filter/tube fitting  43 . Vacuum assistance passes through a lateral lumen  44  of the probe cannula  22  and distally enters a cutter lumen  46  that encompasses the cutter tube  36  and includes the side aperture  20 . It should be appreciated that the biopsy device  10  includes a minimum of “tethers” that would impede use, pose a tripping hazard, or extend set-up time. 
     Alternatively, instead of “hard-walled” lateral lumen  44  separated from the cutter lumen  46  along its length, applications consistent with the present invention may have a cylindrical probe cannula (not shown) wherein the cutter tube  36  is positioned off-center to translate across a side aperture. A “soft-walled” lateral lumen may then be defined as a space between an outer diameter of the cutter tube and an inner diameter of the cylindrical probe cannula. 
     In  FIG. 2 , the disposable probe assembly  14  has a bottom cover  48  with a distal probe mount cover  50  that assists in supporting the probe cannula  22  while allowing the longitudinal jack hammer motion. A plurality of locking tabs  52  with locking edges  54  extend upwardly through pass through slots  56  formed in the periphery of the lower handle tray  16  to resiliently extend outwardly into engaging contact with the slots  56 . Relieved areas  58  formed behind each locking tab  52  in a top extension member  59  that surrounds a probe support body  60 , the combination covering a cavity defined by the bottom cover  48 , allow depression of the locking tabs  52  to unlock the disposable probe assembly  14  to install another identical or similar assembly. 
     A proximal end of the cutter tube  36  receives a cutter gear  62  having distal and proximal reduced diameter bearing surfaces  64 ,  66  on each longitudinal side of a rotation spur gear section  68 , which engage the reusable handpiece  12  for rotation and for longitudinal translation through a distally open longitudinal aperture  70  formed in the lower handle tray  16 . A straw assembly  72  is also engaged by the reusable handpiece  12  through the longitudinal aperture  70  to reciprocate longitudinally into a proximal opening of the cutter tube  36  and cutter gear  62  to encompass and retract tissue samples. A vacuum source conduit  74  communicates between the vacuum syringe assembly  18  and the bottom cover  48  of the disposable probe assembly  14 . 
     In  FIG. 3-13 , the reusable handpiece  12  is depicted in various states of disassembly to illustrate its operation. The transmission section  31  is part of a rigidly mounted motor drive assembly  76  that includes the motor  24  in between a planetary gearbox  78  and an encoder  80 . Battery or other power sources and control circuitry are omitted in the depictions. The motor drive assembly also includes a right guide pin  82  and a left guide pin  84 . The motor drive assembly  76  is shown operably engaged to the longitudinally reciprocating carriage frame assembly  32  in  FIG. 3  and disassembled from the longitudinally reciprocating carriage frame assembly in  FIG. 4 . In  FIG. 4 , the right guide pin  82  is inserted proximally through a right front pin guide  86  and then through a right rear pin guide  88  both part of an upper frame  90  of the carriage frame assembly  32 . A proximal end of the right guide pin  82  resides within a distally projecting right pin receptacle  92  ( FIG. 12 ) formed as part of a distal bulkhead  94  of the transmission section  31 . A distal end of the right guide pin  82  is received by a right pin recess  96  ( FIG. 5 ) formed in the top cover  34 . Similarly, the left guide pin  84  is inserted proximally through a left front pin guide  98  and then through a left rear pin guide  100 , both part of the upper frame  90  of the carriage frame assembly  32 . A proximal end of the left guide pin  84  resides within a distally projecting left pin receptacle  102  respectively formed as part of the distal bulkhead  94  of the transmission section  31 . A distal end of the left guide pin  84  is received by a left pin recess  104  ( FIG. 5 ) formed in the top cover  34 . 
     With particular reference to  FIGS. 3, 4, 6, 7 and 12 , a right front ring bearing  106  is inserted over a distal portion of the right guide pin  82  and is received within a cylindrical recess  108  formed on a distal side of the right front pin guide  86 . A right aft ring bearing  109  is inserted over a proximal portion of the right guide pin  82  and is received within a cylindrical recess  111  ( FIG. 6 ) formed on a proximal side of the right aft pin guide  88 . A left front ring bearing  110  is inserted over a distal portion of the left guide pin  84  and is received within a cylindrical recess  112  formed on a distal side of the left front pin guide  98 . A left aft ring bearing  113  ( FIG. 9 ) is inserted over a proximal portion of the left guide pin  84  and is received within a cylindrical recess  115  ( FIG. 6 ) formed on a proximal side of the left aft pin guide  100 . A right compression spring  114  is proximally received over the right guide pin  82  between the right front and rear pin guides  86 ,  88 . More particularly, the right compression spring  114  is distally positioned against the right front pin guide  86  and at its proximal end by a right downwardly projecting structure  116  ( FIG. 5 ) formed on an interior of the top cover  34  that closely encompasses a top portion of the right guide pin  82  without contacting other portions of the carriage frame assembly  32 . A left compression spring  118  is proximally received over the left guide pin  84  between the left front and rear pin guides  98 ,  100 . More particularly, the left compression spring  118  is distally positioned against the left front pin guide  98  at its distal end by a left downwardly projecting structure  120  ( FIG. 5 ) formed on the interior of the top cover  34  that closely encompasses a top portion of the left guide pin  84  without contacting other portions of the carriage frame assembly  32 . Thereby, the carriage frame assembly  32  is biased to a distal position relative to the top cover  34  and lower handle tray  16 . 
     In  FIGS. 3-5 , a forward projecting cylindrical resilient member  122  fastened to the upper frame  90  reduces noise by contacting the front interior of the top cover  34  slowing distal movement of the carriage frame assembly  32  prior to reaching full travel. The distal bulkhead  94  is restrained by being proximal to a top ridge  123 , a right ridge  125 , and a left ridge  127  ( FIG. 5 ) formed in the interior of the top cover  34  and to a bottom ridge  129  formed on an upper surface of the lower handle tray  16 . 
     Returning to  FIGS. 3-4 and 7 , the upper frame  90  has right and left front shaft apertures  124 ,  126  that respectfully receive for rotation a distal end of a rotation shaft  128  and a translation shaft  130 . The right front shaft aperture  124  is closed by the front portion of a right lower frame  131  of the carriage frame assembly  32 . The left front shaft aperture  126  is closed by the front portion of a left lower frame  132  of the carriage frame assembly  32 . A front (cutter) carriage  134  and an aft (straw) carriage  136  are received on the translation shaft  130  and are encompassed by the upper and lower frames  90 ,  132 . In  FIG. 6 , a proximal beveled and slotted end  138  of the rotation shaft  128  extends out of right aft shaft aperture  140  formed in the upper frame  90  for engagement to the transmission section  31  and is closed by an aft portion of the lower frame  131 . A proximal slotted end  142  of the translation shaft  130  extends out of a left aft aperture  144  formed in the upper frame  90  for engagement to the transmission section  31  and closed by the lower frame  132 . A threaded receptacle  146  on the aft end of the upper frame  90  receives a proximally projecting bolt  148  having an upwardly directed strike pin  148  at its proximal end. 
     In  FIGS. 7-10 , the carriage frame assembly  32  sequences translation of the front and aft carriages  134 ,  136 . With particular reference to  FIG. 10 , the front and aft carriages  134 ,  136  respectively include lower longitudinal grooves  152 ,  154  that slide upon a lower rail  156  upwardly presented on the left lower frame  132 . The front and aft carriages  134 ,  136  respectively include an upper longitudinal groove  158 ,  160  that slides upon a rail (not shown) downwardly presented on the upper frame  90 . The translation shaft  130  has a distal overrun portion  162  and a center overrun portion  164  separated by a front threaded portion  166  that a threaded bore  168  of a front main body portion  169  of the front carriage  134  traverses in response to rotation of the translation shaft  130 . A front translation compression spring  170  on the translation shaft  130  distal to the front carriage  134  compresses to allow the front carriage  134  to free wheel when being distally advanced and then biases the front carriage  134  aft to engage the front threaded portion  166  for being retracted upon reversal of rotation of the translation shaft  130 . 
     With particular reference to  FIGS. 8 and 10 , proximal to the center overrun portion  164  is an aft threaded portion  172  and then a proximal overrun portion  174  that a threaded bore  176  of a back main body portion  177  of the aft carriage  136  traverses in response to rotation of the translation shaft  130  as well as in response to a connection to the front carriage  134 . In particular, a front bracket  178  mounted on a right side of the front carriage  134  has a rightward front pin guide  180  that receives a distal end of a longitudinally aligned carriage limiting rod  182 . A distal threaded end  184  of the carriage limiting rod  182  extends distally out of the rightward front pin guide  180  and is prevented from backing out by a front nut  186 . A long compression spring  188  is received over a shaft  190  of the carriage limiting rod  182  proximal to the rightward front pin guide  180 . An aft bracket  192  is attached to a right side of the back main body portion  177  of the aft carriage  136  to extend a rightward aft pin guide  194  that receives the carriage limiting rod  182 , which extends a proximal threaded end  196  proximally out of the rightward aft pin guide  194  to receive an aft nut  198  that limits forward movement. The long compression spring  188  biases the aft carriage  136  away from the front carriage  134 , delaying retraction of a tissue sample until cutting is complete when full distal translation of the front carriage  134  pulls the aft carriage  136  onto the aft threaded portion  172 . 
     With particular reference to  FIG. 9 , a lengthwise engagement aperture  200  defined between the right and left lower frames  131 ,  132  presents engaging structures that actuate the disposable probe assembly  14  and the vacuum syringe assembly  18 . The rotation (spur) gear  128  exposes its left side to the lengthwise engagement aperture  200  for engagement with the rotation spur gear section  68  of the cutter gear  62  to impart a rotation. The front bracket  178  has a downward distal half cylinder recess  202  sized to grip the distal reduced diameter bearing surface  64  of the cutter gear  62  ( FIG. 2 ). The front bracket  178  further has a downward proximal half cylinder recess  204  proximally spaced and sized to grip the proximal reduced diameter bearing surface  66  of the cutter gear  62  ( FIG. 2 ) as well as a downwardly projecting front actuation finger  206  to the left side and below of the cutter gear  62  for selecting vacuum from the vacuum syringe assembly  18 . Similarly, the aft bracket  192  has a downward distal half cylinder recess  208  and a downward proximal half cylinder recess  210  proximally spaced and sized to grip portions of the straw assembly  72  as applicable to effect retraction of tissue samples, as well as a downwardly projecting aft actuation finger  212  to the left side of the straw assembly  72 . 
     In  FIGS. 2-3 and 11-12 , the motor drive assembly  76  rotates rotation and translation shafts  128 ,  130  at a fixed ratio to optimize cutting performance of the cutter tube  36  when the slide button  28  is back. Alternatively, the motor drive assembly  76  imparts a jackhammer vibration to the carriage frame assembly  32  when the slide button  28  is forward. With particular reference to  FIGS. 11-12 , the planetary gearbox  78  extends proximally a keyed motor drive shaft  214  ( FIG. 12 ) through a drive shaft hole  216  formed in the distal bulkhead  94 . A slide spur gear  218  is received upon the keyed motor drive shaft  214  remaining engaged for rotation between a first distal (jack hammer) position and a second proximal (translation) position in accordance with a position of the slide button  28  whose distal and proximal feet  220 ,  222  straddle the slide spur gear  218 . In  FIG. 11 , the slide spur gear  218  is close to a proximal bulkhead  224  of the transmission section  31 , engaging a small spur  226  of a multiplier gear assembly  228 . The multiplier gear assembly  228  includes a longitudinal shaft  230  centrally attached to the small spur gear  226 . Proximal thereto, a cylindrical hub  232  is pinned to the longitudinal shaft  230  and in turn is encompassed by and pinned to a large spur gear  234  that rotates within a correspondingly sized, distally open recess  236  formed in proximally projecting container  237  integral to the proximal bulkhead  224 . A front cylinder bearing  238  received on a distal portion of the longitudinal shaft  230  is received by the proximal surface of the distal bulkhead  94 . 
     A first output drive shaft  240  distally presents a right angle prismatic end  242  shaped to engage the beveled and slotted end  138  of the rotation shaft  128  that passes through a lower right hole  244  in the distal bulkhead  94 . A cylindrical spacer  246  is received over a distal cylindrical portion  248  of the first output shaft  240 , taking up the space between the rotation shaft  128  and the proximal bulkhead  224 . A distally open recess  250 , formed as part of the container  237  that communicates from below with the recess  236 , is shaped to receive a proximal cylindrical end  252  of the first output drive shaft  240  and encompasses cylindrical bearing  254  as well as a small spur gear segment  256 , which is distal thereto and engages the large spur gear  234  of the multiplier gear assembly  228 . 
     A second output drive shaft  258  distally presents a right angle prismatic end  260  to engage the proximal slotted end  142  of the translation shaft  130  that extends through a low left hole  262  in the distal bulkhead  94 . A cylindrical spacer  264  is received over a distal cylindrical portion  266  of the second output drive shaft  258  proximal to the right angle prismatic end  260  and distal to a wider diameter hub segment  268  that is encompassed by and pinned to a large spur gear  270  that engages the small spur gear  226  of the multiplier gear assembly  228 . Proximal to the hub segment  268  is a wide spacer segment  272  and then a narrow cylindrical end  274  that receives a cylindrical bearing  276  that resides within a correspondingly-sized, distally open recess  278  that communicates from the left with the recess  236  and is formed as part of the same container  237 . 
     The distal and proximal bulkheads  94 ,  224  are structurally attached to one another in parallel alignment traverse to the longitudinal axis of the biopsy device  10  by cylindrical legs  280  molded to and proximally projecting from rectangular comers of the distal bulkhead  94  and fastened to the proximal bulkhead  224 . In addition, a pin  282  passes through holes  281 ,  283  longitudinally aligned in the distal and proximal bulkheads,  94 ,  224  respectively along a top surface. 
     When the slide button  28  is moved distally to the jackhammer position, the sliding spur gear  218  disengages from the small spur gear  226  and engages a large spur gear  284  of a rotary camming gear assembly  286 . A camming shaft  286  from distal to proximal includes a distal cylindrical end  288 , a cam wheel  290 , a mid-shaft portion  292  that receives the upwardly directed strike pin  150  of the proximally projecting bolt  148 , a wide diameter hub  294  that is encompassed by and pinned to the large spur gear  284 , and a proximal cylindrical end  296 . A distal cylindrical bearing  298  is received within a proximally open container  300  projecting distally from the distal bulkhead  94  and in turn receives the distal cylindrical end  288  of the camming shaft  286 . A proximal cylindrical bearing  302  is received within a distally projecting and open cylinder  304  formed on the proximal bulkhead  224  and in turn receives the proximal cylindrical end  296  of the camming shaft  286 . 
     As the camming shaft  286  rotates clockwise as viewed from behind, the cam wheel  290  presents a proximal surface to the distal edge of the strike pin  150  that is more proximal until the interrupted portion of the camming wheel  290  is presented, allowing the strike pin  150  to return to a distal position under the urging of the distal biasing of the right and left compression springs  114 ,  118 . 
     In  FIGS. 13-22 , the disposable probe assembly  14  has movable components that respond to the actuating motions of the reusable handpiece  12 . With particular reference to  FIGS. 13-17 , the probe support body  60  includes a distal probe mount  306  that is received within the distal probe mount cover  50  of the bottom cover  48 . Proximal to and underlying a longitudinal axis of the disposable probe assembly  14  defined by a probe guide hole  308  passing through the distal probe mount  306 , an upwardly open longitudinal trough  310  is formed into a necked portion  312  of the probe support body  60 . At a proximal end of the longitudinal trough  310 , an upper rod passage  314  longitudinally passes through an upper portion of a proximal block portion  316  of the probe support body  60 . A distal vacuum pump rod  317  is received for longitudinal movement in the upper rod passage  314 . 
     With particular reference to  FIGS. 15, 18 , a distal portion of the upwardly open longitudinal trough  310  is also downwardly open. A distally and proximally open, longitudinally aligned valve bore  318  is formed in a lower portion of the proximal block portion  316 . A proximal 90 degree fitting  319  seals a proximal opening of the valve bore  318  to an upper end of the external conduit  42 . Central and proximal ports  320 ,  321  communicate with the valve bore  318  laterally from a left side of the proximal block portion  316  and a distal port  322  communicates laterally from a left side of the proximal block portion  316 . A right distal 90-degree fitting  337  communicates between the distal port  322  and an intake filter  323  within an outer hose fitting  324 . 
     A valve control rod  325  has a distal actuating portion  326  extending distally out of the valve bore  318  with a distal end positionable under the downwardly open portion of the longitudinal trough  310 . The valve control rod  325  also has a valve spool portion  327  that longitudinally translates within the valve bore  318  to selectively position between a first position and a second position. A proximal O-ring  328  near a proximal end of the valve spool portion  327  and a distal O-ring  329  are spaced such that the first position entails the O-rings  328 ,  329  bracketing the central and distal ports  320 ,  322  and the second position entails the O-rings  328 ,  329  bracketing the proximal and central ports  321 ,  320 , respectively. 
     In  FIGS. 17-18 , the distal vacuum conduit  330  has one end attached to a center ninety-degree fitting  331  attached to the central port  320  and the other end attached to a probe union ninety-degree fitting  332  that communicates with the lateral lumen  44 . The vacuum source conduit  74  has one end attached to a canister ninety degree fitting  334  and the other attached to a proximal ninety degree fitting  335  attached to the proximal port  321 . 
     In  FIGS. 15, 18 , the front actuation finger  206  of the front carriage  134  ( FIG. 9 ) is received within an upwardly open socket  336  formed on a left side of a vacuum control shuttle  338  having a lateral concave recessed band  340  shaped to encompass with a clearance a lower portion of the rotation spur gear section  68  of the cutter gear  62 . The vacuum control shuttle  338  is laterally sized to bridge the longitudinally open trough  310  with an L-shaped connector  341  attached to an undersurface of the vacuum control shuttle  338  sized to reside within the longitudinal trough  310  and to extend its vertical and proximal portion below the longitudinal trough  310  to attach to the distal end of the vacuum actuating portion  326  of the valve control rod  325 . 
     A straw holder  342  of the straw assembly  72  includes a distal sleeve  344  with a leftward projection  346  near its distal end and attached at its proximal left edge to an elongate splint member  348  having a midpoint indented feature  350  and attached along its proximal rightward surface to a proximal sleeve  352 . A straw  354  is received through the proximal sleeve  352 , to the right of the elongate splint member  348 , through the distal sleeve  344 , and on through a rear dynamic seal  356  attached to a proximal end of the cutter gear  62 , and into the cutter tube  36 . A support plate  358  traversely fastened to an aft surface of the probe support body  60  has a downwardly open notch  360  that allows connection of the proximal 90 degree fitting  319  and passage of the distal vacuum pump rod  317 . An upper guide hole  362  receives the proximal sleeve  352  of the straw holder  342 . 
     A straw hook wire  364  keeps the straw assembly  72  in place upon the probe support body  60  prior to engagement with the reusable handpiece  12 . A curled lower right end passes into leftwardly opening  365  along the top right surface of the proximal block portion  316  of the probe support body  60  into a small mounting block  366  extending upwardly from a right side with a downwardly inserted pin  368  passing through the curled lower right end to hold the straw hook wire  364  in place. The straw hook wire  364  has a horizontal portion attached to the curled end that passes under the straw  354  and elongate splint member  348 , bending upward within the midpoint indented feature  350  and then bending leftward and horizontally again through a lateral slot  370  in a vertical wire support member  372  formed onto a left side of the top surface of the proximal block. portion  316 . It should be appreciated that engagement of the reusable handpiece  12  forces the left portions of the straw hook wire  364  out of engagement with the midpoint indented feature  350  as a rib feature  373  ( FIG. 9 ) deflects the left portion of the straw hook wire  364 . Thus, translation of the aft carriage  136  may cause translation of the straw assembly  72 . 
     With further reference to  FIG. 15 , proximal to the vacuum as control shuttle  338 , a vacuum pump shuttle  374  is also laterally sized to bridge the longitudinal trough  310  with an integral lower central portion sized to reside within the longitudinal trough  310  and to attach to a distal end of the vacuum pump rod  317 . A backward projecting locking arm  376  attached to a left side of the vacuum pump shuttle  374  has an inward proximal hook  378  that is resiliently inwardly biased. The top extension member  59  has an aft horizontal surface  382  sized to overlay a distal canister support structure  384  ( FIG. 16 ) attached to an upper canister portion  386  ( FIG. 16 ) of the vacuum syringe assembly  18 . The top extension member  59  also has a right horizontal surface  386  and a left horizontal surface  388  extending forward from the distal corners of the aft horizontal surface  382  that surround the top surface of the probe support body  60  covering the gap to the top edges of the bottom cover  48 . Right and left legs  390 ,  392  extend downward with inwardly curled edges at the juncture respectively between the right horizontal surface  386  and aft horizontal surface  382  and the juncture between the left horizontal surface  388  and the aft horizontal surface  382 . Along an inner surface of the left horizontal surface  388 , a kick-out ridge  394  extends upwardly, longitudinally positioned to coincide with full distal travel of the vacuum pump shuttle  374 , which coincides with an initial condition of the disposable probe assembly  14  with the straw assembly  72  locked forward by the straw hook wire  364  and the side aperture  20  of the probe cannula  22  closed by the cutter tube  36 . 
     With particular reference to  FIG. 16 , the vacuum syringe assembly  18  is configured to respond to longitudinal translation of the distal vacuum pump rod  317 . In particular, the canister support structure  384  includes a right rail bracket  396  and a left rail bracket  398 , joined at their proximal ends to one another and to an upper portion of a distal circular face  400  of the upper canister portion  386  with a distally and vertically open longitudinal guide slot  402  defined between the rail brackets  396 ,  398 . A connection block  404  with a transverse cross section similar to a cloverleaf with a narrowed upper lobe translates between the distal circular face  400  and right and left down-turned mounting surfaces  406 ,  408  of the right and left rail brackets  396 ,  398  respectively that are attached to the aft surface of the probe support body  60 . 
     An upper narrowed projection  410  of the connection block  404  is fastened to a proximal end of the distal vacuum pump rod  317  ( FIG. 18 ) and shaped to slide within the guide slot  402 . A hole  412  centered on the distal circular face  400  is aligned with a small lower protuberance  414  of the connection block  404 . A proximal vacuum pump rod  416  is attached to a proximal side of the small lower protuberance  414  and passes through the hole  412  and on through a dynamic O-ring seal  418  within a neck  420  of a seal cup  422  that is fastened to the proximal side of the distal circular face  400  of the upper canister portion  386 . The proximal end of the proximal vacuum pump rod  416  passes on through a vacuum pump cylinder  424  whose bottle neck  426  and distal portion fits within the seal cup  422 . Lateral sides of the vacuum pump cylinder  424  are closely encompassed by fastening together the upper container portion  386  to a lower canister portion  428  with a proximal circular opening closed by a canister end cap.  430  ( FIG. 2 ). 
     With particular reference to  FIGS. 16 and 18 , a proximal end of the proximal vacuum pump rod  416  passes through a central hole  431  in a tension plunger seal  432 , partially through an enlarged distal central hole  433  in a tension plunger body  434  that proximally communicates with a smaller proximal central hole  435  too small for the proximal vacuum pump rod  416 . A washer  436 , centered on a proximal face of the tension plunger body  434 , is held on by a small bolt  438  that passes distally into the smaller proximal central hole  435  and is threaded into the proximal vacuum pump rod  416 . The canister ninety-degree fitting  334  passes through a bottom hole  440  in the lower canister portion  428 . With particular reference to  FIG. 18 , an O-ring  442  between the lower canister portion  428  and the vacuum pump cylinder  424  form a static seal between the bottom hole  440  and an aligned distal bottom hole  446  to communicate with a variable volume vacuum cavity  448  whose volume is dictated by the longitudinal position of a syringe plunger assembly  450  formed by the combination of the tension plunger seal and body  432 ,  434 . 
     In use, in  FIG. 18 , the disposable biopsy assembly  14  is in an initial condition with the cutter gear  62  distally positioned, which closes the side aperture  20  in the probe cannula  22  for insertion ( FIG. 19 ). In addition, the underlying vacuum control shuttle  338  is at its distal position, moving the valve control rod  325  distally to the first position with the atmospheric air made available through the distal port  322  to the central port  320  to the lateral lumen  44  of the probe cannula  22 . The vacuum pump shuttle  374  is distally positioned behind the vacuum control shuttle  338  in its most distal position drawing distally the distal vacuum pump rod  317 , connection block  404 , proximal vacuum pump rod  416 , and finally the vacuum syringe plunger  450  to an unactuated state. In addition, the straw assembly  72  is also distally advanced with the straw  354  inserted through the cutter tube  36 . 
     In  FIG. 19 , the reusable handpiece  12  is mounted onto the disposable probe assembly  14  in the same state as  FIG. 18 . The front (cutter) carriage  134  of the reusable handpiece  12  engages the cutter gear  62  for longitudinal movement, as well as extending downwardly projecting front actuation finger  206  into engagement with the upwardly open socket  336  of the vacuum control shuttle  338 . The aft (straw) carriage  136  of the reusable handpiece  12  engages the straw assembly  72  for longitudinal movement, as presenting the downwardly projecting aft actuation finger  212  to leftward projection  346  of the straw assembly  72 . With the biopsy device  10  thus prepared, the piercing tip  26  is inserted into tissue with the side aperture  20  placed beside a suspicious lesion  452 . 
     In  FIG. 20 , the reusable handpiece  12  prepares the disposable probe assembly  14  by rotating the translation shaft  130  in the direction that retracts the aft carriage  136  whose threaded bore  176  is engaged to the aft threaded portion  172  while the front carriage  134  free wheels on the distal overrun portion  162 , which causes the straw  354  to retract within the cutter tube  36 . As the aft carriage  136  approaches its proximal most position, the aft carriage  136  reaches the full travel of the carriage limiting rod  182 , which thus pulls the threaded bore  168  of the front carriage  134  onto the front threaded portion  166 , overcoming the bias of the long compression spring  188  on the carriage limiting rod  182 . 
     In  FIG. 21 , continued rotation of the translation shaft  130  with the aft carriage  136  free wheeling on the proximal overrun portion  174  causes the front carriage  134  to retract to the center overrun portion  164  and freewheel, while proximally moving the vacuum control shuttle  338  and thus moving the vacuum control rod  325  proximally to the second position with the lateral lumen  44  communicating through the central port  320  to the proximal port  321  to the variable volume vacuum cavity  448  of the vacuum syringe assembly  18  which increases in volume as the vacuum pump shuttle  374  is driven aft by the vacuum control shuttle  338 . A sample indicator (not shown) located within the straw assembly  72  closes the lumen within the straw  354 , resulting in a low pressure (“vacuum”) as compared to atmospheric pressure within the lateral lumen  44 . This low pressure is presented to the side aperture  20  as the cutter tube  36  retracts, passing through internal holes  453  passing between the lateral and cutter lumens  44 ,  46  beneath the side aperture  20 , prolapsing a portion of the suspicious lesion  452  into the cutter lumen  46 . The backward projecting locking arm  376  of the vacuum pump shuttle  374  engages the downwardly projecting aft actuation finger  212  of the aft carriage  136 . 
     In  FIG. 22 , with the vacuum pump shuttle  374  thus held to keep vacuum assistance available, the front carriage  134  is distally translated by rotation of the translation shaft  130  in the opposite direction. In particular, the long compression spring  188  on the carriage limiting rod  182  urges the threaded bore  168  of the front carriage  134  into engagement with the front threaded portion  166  while the bias from the long compression spring  188  also biases the aft carriage  136  to remain free wheeling on the proximal overrun portion  174 . Although not shown in  FIG. 22 , it should be appreciated that the rotation shaft  128  is rotating the cutter gear  62  and thus the cutter tube  36  in a ratio related to the rate of translation. When the front carriage  134  reaches full distal travel, the vacuum control shuttle  338  switches the vacuum control rod  325  to the first position that vents the lateral lumen  44  to the atmosphere while the straw assembly  72  maintains a residual vacuum behind a severed tissue sample  454  in the cutter lumen  46 . The differential pressure on the sample  454  assists in retracting the sample  454 . In particular, as the carriage limiting rod  182  reaches full separation between the carriages  134 ,  136 , the aft carriage  136  is drawn onto the aft threaded portion  172  to distally translate both the vacuum pump shuttle  374  and the straw assembly  72  so that the straw  354  encompasses the severed tissue sample  454  with the biopsy device  10  returned to the position of  FIG. 19 . Operation as described for  FIG. 20  retracts the sample  454  preparing the device for repositioning as desired and the taking of another core biopsy sample. 
     It should be appreciated that any patent, publication, or other disclosure material, in whole or in part, that is said to be incorporated by reference herein is incorporated herein only to the extent that the incorporated material does not conflict with existing definitions, statements, or other disclosure material set forth in this disclosure. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein, will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material. 
     While preferred embodiments of the present invention have been shown and described herein, it will be obvious to those skilled in the art, given the benefit of the present disclosure, that such embodiments are provided by way of example only. Numerous variations, changes, and substitutions will now occur to those skilled in the art without departing from the spirit and scope of the appended claims. 
     While advantageous sequencing allows vacuum to be stored and used in relation to two carriages, applications consistent with the present invention may include other operable coupling of a motor contained in a hand-held proximal portion of a biopsy device, such as coupling the motor to turn a vacuum pump that evacuates a fixed volume vacuum accumulator. As another example, the motor may wind up a reel that positions a plunger of a vacuum syringe. 
     As another example, for imaging modalities such as magnetic resonance imaging (MRI), the power supplies, control circuitry and motor may be selected from technologies that are inherently immune to a strong magnetic field and/or shielded to avoid transmission of radio frequency (RF) interference that may create artifacts in the diagnostic images. Alternatively or in addition, certain components may be remote to the hand-held device such as the DC motor connected by a mechanical drive cable. 
     As yet another example, instead of segregating the vacuum syringe assembly to the disposable probe assembly, a vacuum container that is evacuated or otherwise causes to contain a low pressure by a motor-driven mechanism may be part of a reusable handpiece pneumatic conduits that communicate to a probe assembly.