Abstract:
Systems, devices and methods for use in liposuction and infusion medical procedures including handheld devices, micro-cannulas, curved cannulas vacuum pressure changing features.

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application claims priority to U.S. Provisional Application No. 62/300,395, filed Feb. 26, 2016, and claims priority to U.S. Provisional Application No. 62/301,328, filed Feb. 29, 2016, the entire contents and disclosures of which are hereby incorporated by reference. 
     
    
     FIELD OF THE INVENTION 
       [0002]    The subject matter described herein relates generally to systems, methods and related apparatuses for fat and other tissue aspiration and fat and other synthetic filler injections using cordless, handheld, pulsatile and non-pulsatile devices. 
       BACKGROUND OF THE INVENTION 
       [0003]    Liposuction is one of the most popular procedures in aesthetic surgery that is practiced around the world. Liposuction procedures generally include the removal of undesirable fat cells from the face and body, including thighs, breasts buttocks and other areas to improve contours by reshaping, slimming or achieving another desired effect. In some cases, this fat can then be inserted back into the patient&#39;s body in a different location in an effort to achieve a specific aesthetic effect. 
         [0004]    A cannula is a hollow metal tube with a bullet shaped tip that may have various different types of hole configurations near the tip. During a liposuction procedure, a cannula is placed through the skin and into the fatty layer that the surgeon plans to reduce by removing fat cells. Once the cannula is placed under the skin, a vacuum pump generates negative pressure up to a maximum pressure level and maintains the pressure level at a relatively constant level. Most liposuction machines used today include a vacuum pump that generates a maximum of about 30 inHg of negative pressure, where 14.74 PSI=762 torr=1 atm. Tubing attaches the large suction machine from a typical location on the floor of the operating room to a sterile cannula on the operative field. Fat is aspirated or drawn by the negative pressure created by the vacuum through the holes in the cannula and into the body of the cannula before being deposited in a reservoir. 
         [0005]    One example of a current hand-held micro-liposuction adipose harvester, processor and cell concentrator is disclosed in U.S. patent application Ser. No. 13/844,548 including devices and methods for aspirating adipose tissue with a portable device. This device includes a processing chamber, a cannula, a vacuum source, a filter or screen for separating connective tissue strands from adipose tissue, a digestion area and a product cell concentration chamber. 
         [0006]    There many different liposuction machines in use currently, including ultrasonic assisted, laser assisted, power assisted and radiofrequency assisted liposuction machines, all of which use some form of vacuuming suction. However, there are currently no liposuction machines that utilize pulsatile vacuum. It would be desirable to have pulsating components, features and liposuction devices in order to achieve beneficial effects. For example, it would be desirable to agitate and loosen the fat cells targeted for removal to increase the speed, efficiency and effectiveness of liposuction procedures, in addition to aspiration of other tissues for biopsy. 
         [0007]    Further, there are currently no handheld motorized liposuction devices that are able to remove or harvest fat while remaining sterile, that can then rapidly or immediately re-inject this harvested fat into other areas of the face or body. At present, modification or improvement of facial contours and wrinkles is achieved using syringes containing synthetic fillers or autologous fat in an office setting. However, there no similarly simple handheld device exists that is also easily remove undesirable fatty bulges, for example in the neck, jowls and lateral to the nasolabial folds. 
         [0008]    An additional issue existing in the reinjection art occurs as a result of suctioned fat being frequently accompanied by thicker clumps of fascia and fat. This can cause an obstruction of an operative cannula that can hinder and reduce the effectiveness of reinjection procedures. In these situations, manual thumb pressure of the syringe plunger by a user can result in over-pressurization until a sudden release of an undesirable fat bolus occurs. This can cause numerous aesthetic problems, especially when the reinjection site is meant to fill or affect a small, localized area. A motorized method of reinjection can provide a calibrated, smooth and reliable injection or reinjection for biological and synthetic fillers of different consistencies, especially relatively thick or dense ones. 
         [0009]    All suction cannulas currently used are straight and no suction cannulas are produced that include any curvature. One reason suction cannulas are straight is because some of the technology in use that is incorporated into current suction cannulas requires the cannulas to be straight. However, as described herein, there are numerous benefits that can be provided by using cannulas that are curved to follow the curved planes of the body 
         [0010]    It is therefore desirable to have a pulsating vacuum device or pulsating components associated with a vacuum device in order to achieve this agitation and loosening of the fat cells while remaining sterile. These devices and components also have applicability in other procedures and can aid in the agitation and loosening of other cells and tissue, such as fine needle aspiration (FNA) biopsy and micro-tissue harvesting. 
       SUMMARY OF THE INVENTION 
       [0011]    Disclosed are systems, devices and methods for use in liposuction and other medical procedures. These include devices and components that include fixed and variable pulsatile vacuums. For variable pulsatile vacuum devices and components, frequency and amplitude of pulse oscillations can be adjusted before or during a procedure to achieve specific effects. As such, various pulsating component mechanisms can be applied to different liposuction techniques and volumes of cells and tissues to be removed. 
         [0012]    Additionally disclosed are systems, methods and handheld micro-cannular suction devices that can be cordless, battery-operated and motorized and that can be used to remove small volumes of fat cells. One example of a use for such devices is in facial and neck-related liposuction procedures. In some embodiments, patients can even remain awake during procedures. In some embodiments, these handheld, mechanized devices can have operability for both suction and injection procedures that allow a surgeon to easily harvest fat and then quickly reinject it into desired areas that are selected to benefit from augmentation 
         [0013]    Also disclosed herein are curved cannulas and methods of use for liposuction procedures. These cannulas provide numerous benefits, including the ability to stay in one or more optimal tissue planes of the endlessly curved body. As such, curved cannulas can assist a surgeon in maintaining the tip of the cannula in the correct planes between the skin and underlying structures during medical procedures, thereby greatly minimizes the risk of contour irregularity. Curved cannulas also allow the surgeon to greatly minimize the number of incisions needed to sculpt the entire body as the curved cannula can spiral around the sides of the body from the anterior or posterior aspects. Since curved cannulas allow surgeons to follow bodily curves and spirals, they can provide reduced time for healing, more effective healing and increased ease and effectiveness during procedures. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWING(S) 
         [0014]    The details of the subject matter set forth herein, both as to its structure and operation, may be apparent by study of the accompanying figures, in which like reference numerals refer to like parts. The components in the figures are not necessarily to scale, emphasis instead being placed upon illustrating the principles of the subject matter. Moreover, all illustrations are intended to convey concepts, where relative sizes, shapes and other detailed attributes may be illustrated schematically rather than literally or precisely. Illustrated in the accompanying drawing(s) is at least one of the best mode embodiments of the present invention. 
           [0015]      FIG. 1  shows an example embodiment diagram of a liposuction system. 
           [0016]      FIG. 2  shows an example embodiment internal component diagram of a peristaltic pulsator. 
           [0017]      FIG. 3  shows an example embodiment of a liposuction system. 
           [0018]      FIG. 4  shows an example embodiment diagram of a piston head, piston plunger arm and eccentric gear. 
           [0019]      FIG. 5  shows an example embodiment diagram of a handheld micro-cannular suction device. 
           [0020]      FIG. 6  shows an example embodiment of a handheld micro-cannular suction device coupled with a syringe. 
           [0021]      FIG. 7  shows an example embodiment of a volume aspirated versus mmHg graph. 
           [0022]      FIG. 8  shows an example embodiment diagram of a plurality of curved cannulas with varying lengths and curvatures. 
           [0023]      FIG. 9  shows an example embodiment of a human body frontal diagram  900  and human body backside diagram showing various curved liposuction pathways for curved cannula. 
           [0024]      FIG. 10  shows an example embodiment diagram of two cannulas. 
           [0025]      FIG. 11  shows an example embodiment of a controller architecture diagram for use with a handheld micro-cannular suction device. 
           [0026]      FIG. 12  shows an example embodiment of a component diagram for coupling a syringe plunger with a screw drive. 
           [0027]      FIG. 13  shows an example embodiment diagram of a plunger and rubber tip. 
           [0028]      FIG. 14  shows an example embodiment diagram of a rubber tip and screw. 
           [0029]      FIG. 15  shows an example embodiment diagram of a handheld micro-cannular suction device. 
           [0030]      FIG. 16  shows an example embodiment of a drive motor. 
       
    
    
     DETAILED DESCRIPTION 
       [0031]    Before the present subject matter is described in detail, it is to be understood that this disclosure is not limited to the particular embodiments described, as such may vary. It should also be understood that the terminology used herein is for the purpose of describing particular embodiments only, and is not intended to be limiting, since the scope of the present disclosure will be limited only by the appended claims. 
         [0032]    As described herein, a pulsating vacuum with adjustable or otherwise variable pulse frequencies and amplitudes can help agitate fat cells and ease in their removal. This technology can be applied to many of current and later developed liposuction techniques and procedures. The components, devices and features described herein can also be applied to fine needle aspiration (FNA) biopsy procedures in order to improve specimen loads. 
         [0033]      FIG. 1  shows an example embodiment diagram of a liposuction system  100 . As shown in the example embodiment, liposuction system  100  can generally include a vacuum pump  102 , a pulsator  104 , tubing  106  and a cannula  108 . 
         [0034]    As shown in the example embodiment, cannula  108  can include one or more holes  110  at a cannula distal end  112  and can be removably or permanently coupled with a distal end  116  of tubing  106  at cannula proximal end  114 . One or more components  118  can be used to assist in coupling tubing  106  and a cannula  108 , such as screwing mechanisms, clamps, latches or others. In various embodiments, components can be sized such that cannula proximal end  114  can be inserted into distal tubing end  116 , distal tubing end  116  can be inserted into cannula proximal end  114  or they can be coupled without inserting one into the other. Cannula  108  can have a larger section. 
         [0035]    Tubing  106  can be one or more pliable tube that is hollow, has an open distal end  116  and an open proximal end  120 . As shown in the example embodiment, open proximal end  120  can be removably coupled over a nozzle  122  of vacuum pump  102 . In other embodiments, open proximal end may be inserted into a hole in vacuum pump  102 . Material for tubing  106  can be a single uniform material or can be multiple materials. As such, tubing  106  can have different qualities and features in different locations. For example, more rigid sections can be interspersed with more pliable sections. Tubing  106  can have a circular cross-section in some embodiments that may be uniform or may be different at different locations. One example is a section that has accordion-like features. 
         [0036]    As shown in the example embodiment, vacuum pump  102  can be coupled with tubing  106  and tubing  106  coupled with cannula  108  can create a sealed environment in which air, fluids and bodily materials can be drawn through hole  110  of cannula  108 , into tubing  106  and into vacuum pump  102 . In the example embodiment, a Luer-lok type tip can be used to securely couple tubing  106  to vacuum pump  102 . In some embodiments, material for tubing  106  with less elastic wall properties or walls that have more rigid properties can improve the propagation of pressure fluctuations from a vacuum pump device  102  to the distal tip  112  of cannula  108 . 
         [0037]    In various embodiments, vacuum pump  102  can be located on a floor, table, stool, box or in another location. When connected to electricity and turned on, a motor in vacuum pump  102  creates a negative pressure at a directed source, here nozzle  122 . In some embodiments, vacuum pumps can be manually controlled. In some embodiments, they can be semi-automatically or automatically controlled using computer processor and instructions stored in memory. User interface displays may allow users to change settings and modify vacuum pump conditions. Vacuum pumps are generally known to create movement, flux or changes in location in a fluid. 
         [0038]    Regarding pulsations, pulses or other fluctuations in suction pressure generated by vacuum pump  102 , these can be achieved using a variety of mechanisms, such as peristaltic pumps, piston pumps, motorized reciprocating screw drives or others. As shown in  FIG. 1 , constant negative pressure created in tubing  106  by liposuction vacuum pump  102  can be manipulated or otherwise fluctuated by inserting a portion of tubing in a channel  124  within a portion of or otherwise associated with pulsator  104 . The example embodiment shows pulsator  104  as a peristaltic pulsator but it can be a different pulsator in different embodiments. 
         [0039]    Generated fluctuations in pressure within tubing  106  can be accentuated in various embodiments by including a relief valve  126  that is coupled with an opening  128  in a side of tube  106 . Relief valve  126  can have a reduced diameter compared with opening  128  and in the example embodiment it is shown as in a location on tubing  106  that is distal to the location of peristaltic pulsator  104 , such that it is positioned between pulsator  104  and the patient. Timing for affecting an opening or closing of air valve  126  such that it is synchronized, desynchronized or offset from operations performed by peristaltic pump  104  can further accentuate the pressure fluctuations. 
         [0040]    Also shown in  FIG. 1  is a pressure gauge  130  that is coupled with tubing  106 . Pressure gauge  130  can include a digital or analog mechanism for displaying an internal pressure of tubing  106  such that a surgeon, nurse or other party can monitor operating conditions. 
         [0041]      FIG. 2  shows an example embodiment internal component diagram of a peristaltic pulsator  200 . As shown in the example embodiment, a pulsator body  202  can be constructed of one or more materials including plastic, metal or others as appropriate. A channel  204  in body  202  can be defined by one or more walls and can have various cross sections including circular, semicircular, square, rectangular, triangular or others. In the example embodiment, channel  204  has an overall semicircular shape. 
         [0042]    A first tube interface  206  includes a hollow interior tunnel defined by at least one wall having a length and ending in a fluid inlet  208  and fluid outlet  210 . Similarly, a second tube interface  212  includes a hollow interior tunnel defined by at least one wall having a length and ending in a fluid inlet  214  that is opposite a fluid outlet  216 . 
         [0043]    As shown in the example embodiment, pulsator internal tube  218  can be pliable and can be coupled at each end with fluid inlet  214  and fluid outlet  210  respectively. Internal tube  218  can be placed in channel  204  and partially wrapped around rotor  220 . 
         [0044]    Rotor  220  can be a mechanical or electro-mechanical rotating mechanism that is driven by a motor (not shown) and rotates about a central axis  220 . As shown one or more arms or projections  222   a,    222   b  can extend away out from central axis  220  and extend at least partially into channel  204 . In operation, projections  222   a,    222   b  contact internal hose  218  and can pinch or otherwise influence pressure within internal tube  218 . 
         [0045]    When a vacuum is operating, for example according to the principles and techniques described with respect to  FIG. 1 , fluid is drawn by a vacuum through fluid inlet  208 , fluid outlet  210 , tube  218 , fluid inlet  214  and fluid outlet  216 . Rotator  220  can then influence the flow regularly or irregularly based on the speed it is operated at. 
         [0046]    It should be understood that tubing can be coupled with fluid outlet  216  and fluid inlet  208 . Additionally, tubing  218  can be part of a larger single tube that is looped into first tube interface  206  and second tube interface  212 . 
         [0047]      FIG. 3  shows an example embodiment of a liposuction system  300 . As shown in the example embodiment, liposuction system  300  can generally include a vacuum pump  302 , a pulsator  304 , tubing  306  and a cannula  308 . The setup and interfaces can be similar to those described with respect to  FIG. 1 , with the exception of pulsator  304 . As mentioned herein, a pulsator  304  can be a mechanism that has a piston design. 
         [0048]    As shown in the example embodiment, pulsator  304  can be an air sealed piston having a head  310  and plunger  312  within a chamber  314 . Chamber  314  can be cylindrical and can be located within an airtight cylinder body  316  coupled in a T-connector fashion with tubing  306 . The piston plunger  312  can be connected in an eccentric fashion to a toothed gear that can be round. The gear can be connected to a mechanical or electromechanical motor that, when powered drives the gear to rotate. When the motor rotates the gear, the piston head  310  and plunger  312  forward and backward and creates fluctuations and other pulses in tubing  306 . 
         [0049]      FIG. 4  shows an example embodiment diagram of a piston head  400 , piston plunger arm  402  and eccentric gear  404 . As shown in the example embodiment, a piston plunger arm  402  can include a distal end  406 , a body  408  and proximal receiver end  410 . Piston head  412  can be generally cylindrical and sized to be airtight within a piston chamber. Piston head  412  can be coupled with distal end  406  of plunger arm  402 . Proximal receiver end  410  of piston arm  402  can be rotatably coupled with an exterior surface of driving cylinder  412  eccentric gear  404 . A central hole  414  can maintain a standard position when rotatably coupled with a pin or other appropriate component. Ridges  416  can be engaged with ridges of another component or motor in order to cause eccentric gear  404  to rotate. 
         [0050]      FIG. 5  shows an example embodiment diagram of a handheld micro-cannular suction device  500 . As shown in the example embodiment, device  500  can generally include a platform body  504 , movable platform  502 , screw drive  506 , motor  508 , smart controller  510  and power source  512 . In some embodiments, device  500  can also be used for infusion. In some embodiments device  500  can be used exclusively for infusion. 
         [0051]    As shown in the example embodiment, moving platform  502  can be slidably coupled with platform body  504  such that moving platform can move laterally across at least a portion of a face of platform body  504  through an opening or channel in the face. In the example embodiment moving platform is removably or permanently coupled with a feature (not shown) that is operable to be moved in one direction and a second direction using screw drive  506  when powered by motor  508 . This feature can be a threaded cylindrical shape in some embodiments, with threads corresponding to those of screw drive  506 . As screw drive is cylindrical and coupled with a rotating component of motor  508 , it can turn or rotate on a central axis in both directions, depending on the direction motor  508  causes it to turn or rotate. Motor  508  can be electrically and communicatively coupled with smart controller  510  that includes instructions, stored in non-transitory memory, that operate motor  508  according to a program. Smart controller  510  can also include at least one processor that executes the instructions. Motor  508  and smart controller  510  can be electrically coupled with and powered by a removable or rechargeable battery  512 . 
         [0052]    Additional features can also be provided in various embodiments, including a housing; power and operation buttons; potentiometers and other sensors; user interface displays showing tension level readouts, pressure level readouts, timers and other pertinent information; LED or other indicator lighting and others as would be appropriate in order to assist the user or operator during a procedure. 
         [0053]      FIG. 6  shows an example embodiment of a handheld micro-cannular suction device  600  coupled with a syringe  616 . As shown in the example embodiment, device  600  can generally include a platform body  604 , movable platform  602 , screw drive  606 , motor  608 , smart controller  610  and power source (not shown) with couplings and operation similar to the description of  FIG. 5 . Although not shown, a housing for devices  500  and  600  can be provided that protects the interior components and allows for operation as described herein without impediment. 
         [0054]    In some embodiments, motor  608  can be a step motor that is coupled with screw drive  606 . In some embodiments motor  608  can be a brushless motor. This can power movement of moving platform  602 , which can be removably coupled to a plunger  614  of syringe  616 . As shown, a lip  618  (or other appropriate location) of syringe  616  can be removably coupled with a distal end  620  of device  600  in order to maintain it in a stationary position with respect to plunger  614  in operation, such that plunger  614  can expel, dispense or otherwise push out the contents within syringe  616 . Similarly, in reverse operation, plunger  614  of syringe  616  can draw in external fluid or matter into syringe  616  when motor  608  is run in a reverse direction that causes moving platform  602  to move along screw drive  606  proximally with respect to body  604 . In some embodiments, the syringe is about 1-20 cc, while in some embodiments it is 10-12 cc or others. 
         [0055]    As described previously, syringe plunger  614  can be coupled with moving platform  602  and controlled by the motor-coupled screw drive  606 . In some embodiments, step motors or brushless motors are coupled with screw drives that are in turn coupled to a plunger of a syringe of about 1 cc to about 30 cc or more. In some embodiments screw drive  606  can be coupled with a center of the plunger  614  itself. This can be achieved by coupling the screw drive  606  to the plunger  614  or by having a sterile adaptor (not shown) in between plunger  614  and screw drive  606 . This can also be accomplished by coupling screw drive  606  to a handle at the proximal end  622  of plunger  614 . Syringe  616  and its various components can be rubber or other appropriate materials in various embodiments and can be disposable and sterile. 
         [0056]    In various embodiments, a disposable sterile needle or cannula can be coupled with the distal end  624  of syringe  616  and screw drive  606  can be coupled to plunger  614 . One or more operation buttons (not shown) on a side of device  600  can operate motor  608  in order to cause reverse or forward spin of screw drive  606  at one or more speeds. In some embodiments, buttons can be pressure sensitive and can allow for the reverse or forward spin of the screw at variable speeds dependent upon the pressure of a user&#39;s push. This can create negative pressure or positive pressure within syringe  616 . In some embodiments, negative pressure can reach a maximum of about 635 mmHg, 25 inHg or 12.3 PSI, where 1 mmHg=1 Torr. An additional, separate button (not shown) can be used to control pulsatile or constant suction modes. It should be understood that buttons can be provided on the housing (not shown) or in another appropriate location. 
         [0057]    Motor  608  can be modulated or otherwise controlled by controller module  610  that it is coupled with by a potentiometer (not shown). This can allow for customized manual control by an operator, or operation according to stored programs automatically, as initiated and terminated by a user. Controller module  610  can allow for pulsatile action of plunger  614  via backward and forward motion of screw drive  602  at different speeds. In some embodiments, these speeds can be faster than would generally be possible by manual manipulation without using the device. The pulsatile motion causing pressure changes in syringe  616  including vacuum pressure can loosen the desired, targeted fat cells from nearby tissues that they are coupled to, as has been proven with pump technology of other mediums and arts. In some embodiments, an electrical, mechanical or electromechanical shutoff can ensure that physical limitations of syringe  624  are not overreached. Once the desired, targeted quantity of fat cells are removed, the syringe is full or both, the user or operator can then transfer the removed fat cells in the body of the syringe to a different area or depression of the patient by moving the syringe and any coupled cannula to the new, desired location and pressing a forward injection button to operate the motor accordingly. In some embodiments, handheld micro-cannular suction devices may include pulsing operability while in others they may not. 
         [0058]    In various embodiments, handheld micro-cannular suction devices can be custom sized for each differently sized syringe. Alternately, devices can be designed to accommodate a plurality of different sized syringes. In some embodiments, an ideally sized device housing can accommodate a syringe of about 10cc that is able to achieve maximal negative pressure of about −559 mmHG, −22 inHg, or 10.8 PSI with a plunger pulled to 10-11 cc. After 10-12 cc of negative pressure, any further pull in larger syringes produces a slower increase in negative pressure and generally negative pressure reaches a plateau at about 30 cc of retraction, corresponding to −650 mmHg, −25.6 inHg or 12.6 PSI. Alternatively, although 12 cc syringes are less commonly found, a device can be sized to accommodate them. 
         [0059]      FIG. 7  shows an example embodiment of a volume aspirated versus mmHg graph  700 . Graph  700  shows the plateauing of negative pressure for differently sized syringes. Graph  700  was displayed in “Quantification of Negative Pressures Generated by Syringes of Different Calibers Used for Liposuction”, Rodriguez R L, Conde-Green A, ASPS, Vol 130, #2, pp 383e-384e. This paper, which is incorporated herein by reference in its entirety, describes the principle that each 1 cc of retraction on a syringe plunger creates the same amount of negative pressure regardless of whether a 1 cc, 3 cc, 10 cc, 20 cc or 60 cc syringe is used. 
         [0060]    The concept of micro-liposuction has been theorized in the past but has essentially been defined as cannulas with outside diameters between 1-3 mm. In various embodiments described herein, microsuction cannulas can have an outside diameter less than 1.4 mm, which is equivalent to about a 17 gauge and which does not currently commonly exist. Infusion cannulas smaller in diameter than 19 gauge with only one hole do exist but are not used in suction procedures as fat cannot be removed through the small holes provided. As with other liposuction cannulas, the hole or holes at the tips of suction microcannulas can have one or an array of openings with a different number of holes, shapes, locations and sizes in various embodiments. 
         [0061]      FIG. 8  shows an example embodiment diagram  800  of a plurality of curved cannulas with varying lengths and curvatures. As shown in the example embodiment, cannulas generally can have a cylindrical shape creating a hollow tube interior. This hollow tube is defined by an opening in a distal end  802 , a cylindrical wall along a body section having a length and one or more curved areas having an arc length and curvature, and one or more holes or openings  808  near a distal end  804 . A body section  810  can be shaped with edges or other grip related features and can have one or more coupling features  812  that are operable to removably engage with a syringe body, tubing, or other appropriate component. Coupling features  812  can be interior, exterior or both and can include threaded ridges, notches or others as appropriate to secure to the component to be coupled to. 
         [0062]    Cannulas used in liposuction procedures can be metal, plastic or other appropriate materials or combinations of materials. In some embodiments, cannulas can provide ultrasonic capabilities, laser attributes or reciprocating movements. In some embodiments, a programmed microcontroller can cause one or more coupled step or brushless micro-motors that included or are coupled with screw drives or driveshafts to move back and forth or forward and backward in a manner, aligned and contiguous with the shaft of the syringe. This can therefore create pulsatile negative and positive pressures within a syringe. 
         [0063]      FIG. 9  shows an example embodiment of a human body frontal diagram  900  and human body backside diagram  902  showing various curved liposuction pathways for curved cannula. As described herein, the use of curved cannulas in liposuction procedures also allows a surgeon to reduce the number of incisions required in a procedure or use very few incisions, since the curved cannulas can spiral around certain bodily features. To elaborate, curved suction cannulas of different diameters and lengths can allow a surgeon to perform liposuction on areas around a patient&#39;s entire body from the chest to below the knees using a minimal number of incisions. As shown in the example embodiment, this can be as few as four incisions or less. In the frontal diagram  900 , an incision  904  in the lower torso can allow for liposuction upward toward the chest, outward toward the hips and downward across the thighs and front of the legs on the outside and inside, even as far as below the inner knees. As shown in backside diagram, an incision  906  in the lower back can allow for liposuction upward across much of the back toward the shoulder blades. An incision  908  or  910  below the buttocks can allow for liposuction downward, inward and outward across much of the rear upper legs and upward around the buttocks. 
         [0064]      FIG. 10  shows an example embodiment diagram  1000  of two cannulas  1001 ,  1003 . As shown in the example embodiment, each cannula  1001 ,  1003  can have a proximal end  1002  and distal end  1004 . A gram liposuction cannula  1003  can be substantially similar to the cannulas described herein with respect to  FIG. 8 . A disposable cannula  1001  can be removably coupled with a reusable handle  1010   a  that has gripping features on its exterior surface. 
         [0065]      FIG. 11  shows an example embodiment of a controller architecture diagram  1100  for use with a handheld micro-cannular suction device, such as that described and shown in  FIGS. 5-6 . As shown in the example embodiment, non-transitory computer readable memory can store programs featuring instructions and also data regarding operations of the device. Non-transitory memory  1102  is coupled with a processor  1104  that can execute instructions stored in memory, process information, compute and perform other controller related functions. Processor receives power from power block  1106  that can be coupled with a battery in some embodiments. In some embodiments, it can be coupled with a wall plug or other fixed power source. Processor  1102  can receive orders or instructions from a user via input block  1112  in the form of button pushes or others, as appropriate. Processor  1104  can cause the controller to perform actions based on the instructions in the form of output block  1114 , which can cause an electrically coupled motor to start, stop or otherwise change state based on the instructions received at input block  1112 . In some embodiments, processor  1104  can be coupled with communication block  1108  that can communicate via a link with a computer or other device, such as a smart phone. This can be wired or wireless via computer networking protocols as known in the art or later developed such as Wi-Fi or Bluetooth. Communication block  1108  allows the handheld wireless micro-cannular suction device to be updated with new programs or instructions in some embodiments and for users to retrieve locally stored data regarding procedures from memory block  1102 . Although not shown, it should be understood that other functional architectural blocks can be included in various embodiments, such as user interfaces including indicator lights, display screens, interactive touch screens and others that are coupled with processor block  1104  in an operative fashion to provide information to users. 
         [0066]    It should be understood that controller architecture diagram  1100  is similar to one that could be provided for a controller for a peristaltic pulsator or piston driving generator, as described in  FIGS. 1-4 . As such, motors in the embodiments described with respect to those figures could be operated similarly via similar controllers when appropriately and operatively coupled via communication and electronic couplings. Additionally, it should be understood that operating buttons and other user interaction controls, though not specifically shown in the figures herein are contemplated and would be operatively and communicatively coupled to various components to provide the features and effects described herein. 
         [0067]    Another example embodiment of creating or augmenting pulsatile vacuum principles described herein is by using a new type of syringe with an incorporated side channel or hollow tube that is open at one end to the syringe&#39;s interior chamber near a plunger at a proximal end of the chamber and open near the distal tip of the syringe in the chamber. This will be described with respect to  FIGS. 12-15 . 
         [0068]      FIG. 12  shows an example embodiment of a component diagram  1200  for coupling a syringe plunger  1212  with a screw drive  1202 . As shown in the example embodiment, an adaptor clip  1208  can be removably coupled with a thumb rest  1210  of a plunger  1212  that is located at a proximal end of plunger  1212 , opposite a distal end tip  1216 . Adaptor clip  1208  can slide in a space in adaptor clip  1208  such that it is held securely. Clip  1208  can have straight edges that engage cross supports  1210  and thus prevent plunger  1212  from turning in adaptor clip  1208 . 
         [0069]    Opposite a plunger holding side of adaptor clip  1208  can be a removable or permanent tip holder  1206  for a tip  1204  of a screw drive  1202 . As such, a distally located tip  1204  of screw drive  1202  can operate movement of adaptor clip  1208 . In the example embodiment tip  1204  is a ball or sphere shape. As such, in the example embodiment the tip holder  1204  has a complementary and corresponding shape. The screw side of the clip would be attached to the screw via a rotating interface comprised of ball bearings or a simple spherical tip that rotates in a complementary housing of the clip. 
         [0070]      FIG. 13  shows an example embodiment diagram  1300  of a plunger  1302  and rubber tip  1306 . In the example embodiment, plunger  1302  includes a plunger shaft tip  1304  at its distal end. Rubber tip  1306  can be shaped such that it points distally and can receive and couple to tip  1304  in a space on its proximal side. In some embodiments rubber tip can have a solid body  1308  that is bullet shaped, while in others body  1308  can be a series of arms separated from each other. One or more distally pointing protrusions  1310  can hold rubber tip substantially in place with tip  1304  when engaged such that any movement of rubber tip  1306  and plunger  1302  is done in unison. 
         [0071]    Rotation of rubber tip  1306  can be mitigated, prevented or eliminated by allowing the plunger tip  1304  to rotate in rubber tip  1306 . Coupling of rubber tip  1306  can be accomplished by clipping it onto plunger tip  1304  in such a way that any supporting internal syringe casing configurations needed to hold the rubber tip exterior walls to the syringe casing do not impede the rotation of the tip  1304  in the rubber tip  1306 . 
         [0072]      FIG. 14  shows an example embodiment diagram  1400  of a rubber tip  1406  and screw drive  1402 . As shown in the example embodiment, rubber tip  1406  can be similar to one used with syringe plungers, as depicted and described with respect to  FIG. 13 . As such,  1306 ,  1308  and  1310  correspond similarly with numbers  1406 ,  1408  and  1410 . In the example embodiment, rubber tip  1406  can be coupled with tip adaptor  1404 . Tip adaptor  1404  allows rubber tip  1406  to be coupled with a screw drive  1402 . At a proximal end of tip adaptor  1404  can be a removable or permanent tip holder  1412  for a tip  1414  of screw drive  1402 . As such, a distally located tip  1414  of screw drive  1402  can operate movement of tip adaptor  1404  and rubber tip  1406 . In the example embodiment, tip  1414  is a ball or sphere shape. As such, in the example embodiment the tip holder  1412  has a complementary and corresponding shape. As rubber tip  1406  is gripped firmly by a syringe casing&#39;s internal walls (not shown) in order to create a tight seal that prevents fluid escape, rubber tip  1406  is unlikely to or will not rotate as a coupled driveshaft (not shown) rotates. Mechanisms described in  FIGS. 12-14  can eliminate rotation of a plunger rubber tip in various embodiments and can be used in unison in some embodiments. 
         [0073]      FIG. 15  shows an example embodiment diagram of a handheld micro-cannular suction device  1500 . As shown in the example embodiment, device  1500  can include a battery  1502  that is coupled with and powers a controller module  1504 , motor  1506  or both. Controller module  1504  can be a controller as described elsewhere herein with logic used to operate motor  1506 . 
         [0074]    Motor  1506  can include a first driveshaft  1508  the rotates in two directions when powered by motor  1506 . A second driveshaft  1510  can be included in some embodiments that is coupled with first driveshaft  1508 . As shown in the example embodiment, first driveshaft  1508  can be a device driveshaft, while second driveshaft  1510  can be a syringe pushing driveshaft. These can be coupled with a slot connection, D-ten clip or clip like securing mechanism. 
         [0075]    A driveshaft tip  1512  can be coupled with a tip adaptor  1516  using a mechanism  1514  that receives and securely couples with driveshaft tip  1512 . A rubber tip  1514  can be coupled with tip adaptor  1514  as described with respect to  FIG. 14 . 
         [0076]    In operation, driveshaft tip  1512  can be propelled forward and backward within a hollow central cylinder  1534 . Threading features within a central cylindrical chamber inside motor  1506  that is rotatably coupled with threading features can cause threading on complementary surfaces of first driveshaft  1508  to impel it proximally and distally. 
         [0077]    An external housing  1520  can house one or more of the components and modules mentioned above with respect to  FIG. 15 . A syringe holding clip  1522  of syringe housing  1520  can hold one or more flanges  1524  or finger wings of a casing  1526  that are located opposite a distal end  1530  of a syringe  1528  where fluid or material is drawn in or pushed out. Here, custom or general purpose syringes  1528  can be inserted into clips  1524  via a door or opening (not shown) in a side of external housing  1520 . When inserted from the side, the syringe holding clips  1522  accept the finger phalanges  1524  of the syringe. In general, flanges  1524  or finger wings of a casing  1526  of syringe  1528  can be inserted into a non-moving or stationary end of adapted handheld mechanical device  1500  such as those shown in  FIGS. 5-6 . It should be understood that external housings can be plastic, metal, combinations or other materials as appropriate. 
         [0078]    Custom syringes  1528  can be manufactured with a screw plunger that is stabilized within the syringe casing with an internal screw stabilizer mechanism  1532 . The driveshaft  1510  would thus be stabilized. When syringe  1528  is inserted into housing  1520 , the slatted tip of the syringe screw  1510  would insert into a corresponding slit in the end of a screw driveshaft  1508  that is designed so that the threads line up perfectly. Some embodiments of these manufactured custom syringes can be designed to have standardized ergonomic casing diameters with standardized phalanges. They can also include different syringe casing lengths to adjust for different amounts of material to be aspirated, injected or both. Different external housing  1500  dimension sizes can also be manufactured to accommodate different sized syringes. 
         [0079]    Alternatively, a side channel or hollow tube can be open at one end of a syringe casing&#39;s interior chamber near a plunger at a proximal end of the chamber and open to a location at or near a hub of an attachable cannula or needle. These types of features do not require major changes or modifications to standard syringes that are currently in use. Another end can have an airtight piston and plunger coupled to and driven by a powered motor. The piston and plunger can move forward and backward to increase and decrease negative or positive pressure in the syringe chamber according to the motor and any coupled gears. The piston and plunger action can also be driven by a round gear or eccentric gear that is operably coupled with a screw drive (as in  FIGS. 5 and 6 ) that creates vacuum pressure. The piston and plunger action and forward and backward pulsations caused by the motor and screw drive can be timed to augment each other. 
         [0080]    Also shown in  FIG. 15  are forward button  1536 , reverse button  1538  and pulsatile engaging button  1540 . In some embodiments, when pulsatile engaging button or other buttons are selected, a light can be turned on or off to indicate the condition. Additionally shown is a potentiometer  1542 , operable as described elsewhere herein. 
         [0081]      FIG. 16  shows an example embodiment of a drive motor  1600 . As shown in the example embodiment, a motor body  1602  can include internal gears operable, when powered, to rotate a central section  1606  such that a driveshaft  1604  within rotates and moves along complementary threaded ridges. 
         [0082]    It should be understood that couplings and seals as described herein can be removable or permanent as appropriate in various embodiments. Further, they can generally be accomplished through various means in various embodiments including mechanical couplings, adhesive couplings and various others. 
         [0083]    As used herein and in the appended claims, the singular forms “a”, “an”, and “the” include plural referents unless the context clearly dictates otherwise. 
         [0084]    The publications discussed herein are provided solely for their disclosure prior to the filing date of the present application. Nothing herein is to be construed as an admission that the present disclosure is not entitled to antedate such publication by virtue of prior disclosure. Further, the dates of publication provided may be different from the actual publication dates which may need to be independently confirmed. 
         [0085]    It should be noted that all features, elements, components, functions, and steps described with respect to any embodiment provided herein are intended to be freely combinable and substitutable with those from any other embodiment. If a certain feature, element, component, function, or step is described with respect to only one embodiment, then it should be understood that that feature, element, component, function, or step can be used with every other embodiment described herein unless explicitly stated otherwise. This paragraph therefore serves as antecedent basis and written support for the introduction of claims, at any time, that combine features, elements, components, functions, and steps from different embodiments, or that substitute features, elements, components, functions, and steps from one embodiment with those of another, even if the following description does not explicitly state, in a particular instance, that such combinations or substitutions are possible. It is explicitly acknowledged that express recitation of every possible combination and substitution is overly burdensome, especially given that the permissibility of each and every such combination and substitution will be readily recognized by those of ordinary skill in the art. 
         [0086]    In many instances entities are described herein as being coupled to other entities. It should be understood that the terms “coupled” and “connected” (or any of their forms) are used interchangeably herein and, in both cases, are generic to the direct coupling of two entities (without any non-negligible (e.g., parasitic) intervening entities) and the indirect coupling of two entities (with one or more non-negligible intervening entities). Where entities are shown as being directly coupled together, or described as coupled together without description of any intervening entity, it should be understood that those entities can be indirectly coupled together as well unless the context clearly dictates otherwise. 
         [0087]    While the embodiments are susceptible to various modifications and alternative forms, specific examples thereof have been shown in the drawings and are herein described in detail. It should be understood, however, that these embodiments are not to be limited to the particular form disclosed, but to the contrary, these embodiments are to cover all modifications, equivalents, and alternatives falling within the spirit of the disclosure. Furthermore, any features, functions, steps, or elements of the embodiments may be recited in or added to the claims, as well as negative limitations that define the inventive scope of the claims by features, functions, steps, or elements that are not within that scope.