Abstract:
A method for performing a surgical procedure within lungs of a patient. The method comprising the steps of providing a plurality of surgical instruments and providing a housing. Attaching a flexible, elongated shaft with distal and proximal ends to the housing. Engaging at least one working end to the distal end of the housing, the working end including a plurality of tubes disposed therein that define a corresponding plurality of working channels for housing a corresponding plurality of surgical instruments. Controlling an actuator to engage at least one of the corresponding plurality of surgical instruments, wherein rotation of the working end with respect to a longitudinal axis of the elongated shaft engages at least one of the plurality of surgical instrument with the actuator to deploy the at least one surgical instrument to the lung as needed during a surgical procedure.

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
       [0001]    This application is a continuation of U.S. patent application Ser. No. 15/194,831, filed on Jun. 28, 2016, now U.S. Pat. No. 9,549,757, which is a divisional application of U.S. patent application Ser. No. 14/066,868 filed on Oct. 30, 2013, now U.S. Pat. No. 9,375,283, which is a continuation application of U.S. patent application Ser. No. 13/670, 253, filed on Nov. 6, 2012, now U.S. Pat. No. 8,597,291, which is a continuation application of U.S. patent application Ser. No. 12/202,546, filed on Sep. 2, 2008, now U.S. Pat. No. 8,303,581 the entire contents of all of which are incorporated by reference herein. 
     
    
     TECHNICAL FIELD 
       [0002]    The present disclosure relates to devices for use with catheters, endoscopes and other electrosurgical instruments for coagulating tissue. More particularly, the present disclosure relates to a catheter having a series of channels disposed therein for housing a variety of selectively extendible and deployable surgical instruments. 
       BACKGROUND OF RELATED ART 
       [0003]    This present disclosure relates to instruments and methods for performing minimally invasive, laparoscopic or endoscopic surgical procedures. More particularly, the present disclosure relates to instruments and methods that are especially suitable for procedures that require or benefit from minimally invasive access to anatomical conduits, vessels or tissue for treating the same. 
         [0004]    Over the last several years, minimally invasive or endoscopic surgical tools and methods have been developed for treating vessels and tissue that are less intrusive and less traumatic. For example, with one known technique, the surgeon makes a few small incisions in the abdomen and inserts one or more elongated surgical instruments, e.g., forceps, scissors, clip appliers, staplers, etc., into the incision and carefully manipulates the instruments while viewing the operating area through an endoscope or laparoscope. These techniques are often referred to as endoscopic, laparoscopic, minimally invasive, or video-assisted surgery. References to endoscopic surgery and endoscopes below is intended to encompass all these fields, and the exemplary operations described below with reference to endoscopes can also be accomplished with laparoscopes, gastroscopes, and any other imaging devices which may be conveniently used. 
         [0005]    Typically, many of the above-described techniques require the surgeon to insert different instruments through the working lumen of the catheter to treat tissue, separate vessels or perform other surgical procedures. As can be appreciated, this simply adds to the overall complexity of the operation since it requires the repeated exchange of surgical instruments through the working lumen to perform the different tasks associated with a given surgical procedure. 
       SUMMARY 
       [0006]    The present disclosure relates to an electrosurgical apparatus for performing a surgical procedure including a housing having an elongated shaft with proximal and distal ends. The shaft includes a plurality of tubes disposed therein that define a corresponding plurality of working channels configured to house a corresponding plurality of surgical instruments. An actuator is included and dimensioned for selective reciprocation within the shaft and configured to operably engage one or more of the corresponding plurality of surgical instruments and deploy the surgical instrument to an operating cavity as needed during a surgical procedure. The actuator is configured to allow remote operation of the surgical instrument within the operating cavity. 
         [0007]    In one embodiment, the plurality of surgical instruments are arranged in an array-like manner within the working channels of the shaft. In another embodiment, the plurality of surgical instruments is selected from a group consisting of: vessel sealers, coagulators, biopsy instruments, needles, probes, sensors, graspers, forceps, knives, scissors, sutures, balloon dissectors, stents, irrigators, suction devices, stabilizers, blunt dissectors, lasers, optical devices, implants and anchors. 
         [0008]    In yet another embodiment, the actuator includes an actuating cable and/or an electrical cable operably connected thereto. One or more of the cables are utilized to engage, deploy and/or operate one or more of the plurality of surgical instruments. 
         [0009]    The housing is adapted to connect to an electrosurgical generator, an irrigation source, a suction source and/or accessory equipment configured to operably connect to at least one of the plurality of surgical instruments. The electrosurgical generator, irrigation source, suction source and/or accessory equipment may be configured to include a controller disposed thereon for remotely controlling the actuator and/or a sensor disposed thereon for indexing the plurality of surgical instruments attached to the flexible shaft. 
         [0010]    The present disclosure also relates to an electrosurgical apparatus for performing a surgical procedure having a housing with an elongated flexible shaft attached thereto with proximal and distal ends and a working end including a plurality of tubes disposed therein that define a corresponding plurality of working channels configured to house a corresponding plurality of surgical instruments. The working end is selectively engageable with the distal end of the elongated shaft. An actuator is included that is dimensioned for selective reciprocation within the shaft and configured to operably engage the corresponding plurality of surgical instruments and deploy one or more of the corresponding plurality of surgical instruments to an operating cavity as needed during a surgical procedure. A sensor may be disposed on the housing for indexing (from each of the working ends) the plurality of surgical instruments attached to the flexible shaft. 
         [0011]    The present disclosure also relates to a method for performing a surgical procedure and includes the steps of: providing a housing and attaching a flexible, elongated shaft with distal and proximal ends to the housing; engaging one or more working ends (in series) to the distal end of the housing, the working end including a plurality of tubes disposed therein that define a corresponding plurality of working channels for housing a corresponding plurality of surgical instruments; and controlling an actuator to engage one or more of the corresponding plurality of surgical instruments and deploy the corresponding surgical instrument(s) to an operating cavity as needed for use during a surgical procedure. 
         [0012]    The method may also include the steps of indexing the plurality of surgical instruments disposed in the working end(s); and providing feedback to the surgeon relating to the status and/or location (“stored”, “deployed”, “in use”, “disposed” and/or “malfunction”) of each of the plurality of surgical instruments. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0013]      FIG. 1  is a front, perspective view of electrosurgical instruments shown extending through working channels of a flexible shaft of a catheter in accordance with one embodiment of the present disclosure; 
           [0014]      FIG. 2  is a schematically-illustrated, enlarged, side perspective view of one embodiment of the present disclosure showing a working end for use with the elongated shaft having selectively extendable instruments disposed therein; 
           [0015]      FIG. 3  is a schematically-illustrated, internal view of the present disclosure showing various selectively extendible instruments disposed therein and a deployment tool; 
           [0016]      FIGS. 4A-4C  are schematically-illustrated, greatly enlarged, sequential views of a biopsy tool for use with the catheter of  FIG. 1 ; 
           [0017]      FIG. 5  is a schematically-illustrated, enlarged view showing an exchangeable instrument magazine for use with the catheter of  FIG. 1 ; and 
           [0018]      FIG. 6  is a schematically-illustrated, enlarged view showing a series of exchangeable magazines for use with the catheter of  FIG. 1 . 
       
    
    
     DETAILED DESCRIPTION 
       [0019]    Referring now to  FIG. 1 , a multi-port catheter, generally identified by reference numeral  10  is shown. Catheter  10  includes a proximal end  13 , a distal end  15  and an elongated shaft  12  disposed therebetween. In the drawings and in the description that follows, the term “proximal”, as is traditional, will refer to the end of the forceps that is closer to the user, while the term “distal” will refer to the end of the forceps that is further from the user. 
         [0020]    The proximal end  13  of catheter is operably engaged to a housing  16  that, in turn, operably connects to an electrosurgical generator  50  and accessory equipment  60  via cables  55  and  65 , respectively. Accessory equipment  60  is configured to support one or more of the various features associated with the surgical instruments attached to catheter  10  as explained in more detail below, e.g., suction, irrigation, gas supply, optical equipment, steering and actuating handles and/or act as an alternate energy source for supporting instruments with alternate energy capabilities, e.g., microwave, ultrasound laser, etc. 
         [0021]    As shown in  FIGS. 1-3 , shaft  12  is generally elongated and flexible to facilitate negotiating various cavities and other internal structures of an operating cavity and includes a plurality of working channels  14   a - 14   d  defined in a general, array-like manner therein and that extend therethrough. The shaft  12  may be rigid in an alternative embodiment. Housing  16  may include a similar plurality of channels  16   a  and  16   b  defined therein that align in registration with one or more respective channels  14   a - 14   d  defined in shaft  12  to facilitate remotely controlling one or more surgical instruments. Alternatively, one or more deployment actuators or tools  320  may be utilized to control the various surgical instruments, as explained in detail below. Housing  16  may also include one or more instrument controllers  20  disposed thereon that are actuatable to control (activate, rotate, extend, operate, articulate, etc.) one or more surgical instruments or the deployment tool  320 . 
         [0022]    Turning now to  FIG. 2  which shows one embodiment of the catheter  10  having four tubes  110   a - 110   d  disposed therein that define four channels  107   a - 107   d  for housing a corresponding number of surgical instruments, e.g., instruments  125  and  135 . More particularly, the distal end  15  of shaft  12  is configured to operatively engage one or more working ends  205  and  105  that are, in turn, configured to house one or more surgical instruments, e.g., surgical instruments  125  and  135 , therein. As shown, working end  205  is configured to removeably engage distal end  15  or may be configured to be integrally associated therewith. Working end  205 , in turn, includes a plurality of mechanical interfaces  203 ,  204 ,  206   a  and  206   b  that are dimensioned to operably engage a corresponding plurality of interfaces  103 ,  104 ,  106   a  and  106   b  disposed working end  105 . 
         [0023]    The mechanically engaging interfaces, namely, interfaces,  203 ,  204 ,  206   a  and  206   b  on end  205  and the mechanically engaging interfaces,  103 ,  104 ,  106   a  and  106   b  on end  105  are configured to assure accurate and consistent alignment of the internal working channels  110   a - 110   d,  mechanical actuators  115   a,    115   b  and internal electrical connections  117 . As such, the various electrical and mechanical connections of working end  105  are universal and allow selective replacement (or interchangeability) of different working ends onto working end  205  as needed. A surgeon can select a working end  105  containing specific surgical tools needed for a particular surgical procedure and engage the working end  105  onto end  205 , thereby reducing the need to feed a new surgical instrument down the channel of the catheter  10  for each use. Alternatively, a surgeon may manually load working end  105  with specific instruments needed for a particular surgical procedure or order a custom set of instruments that is loaded by a manufacturer. 
         [0024]    As explained in more detail below with respect to the operation of the catheter  10 , the surgeon has the ability to rotate the working end  105  independently (or with shaft  12 ) to orient a new surgical instrument, e.g., instrument  125 , for use inside a operating cavity as needed without compromising the integrity of the operating cavity and without having to replace instruments during a surgical procedure due to sterilization or mechanical issues. Moreover, each instrument, e.g., instrument  125 , may be rotated into place and deployed (via controllers  20  and actuators  115   a  and  115   b ) either separately or in tandem as needed. Certain channels, e.g., channels  107   b  and  107   d,  may be left available in case a new or unanticipated instrument is needed during a given procedure. 
         [0025]    For example, the working end  105  may include a vessel sealing device  125  and an electrosurgical pencil  135 , which are each independently deployable, activatable and controllable via one or more controllers  20  disposed on the housing  16  or as part of the accessory equipment  60 . Vessel sealer  125  is configured to allow a surgeon to selectively and remotely grasp, dissect, manipulate, seal and/or cut vessels and tissue. Electrosurgical pencil  135  allows a surgeon to remotely coagulate and cut vessels and tissue. When not in use, each instrument, e.g., sealer  125 , is housed within a corresponding channel or pocket  110   a  disposed in working end  105 . A remote actuator, e.g., actuator  115   a,  is activated to deploy the vessel sealer  125  from the distal end  103  of the working end  105 . 
         [0026]    Actuator  115   a  may be multifunctional and include one or more cables or other electrical connections that enable the surgeon to deploy, rotate, articulate, extend and otherwise operate the surgical instrument during use thereof. Similarly, electrical connections  117  may be multifunctional as well and allow the surgeon to activate various electrical components of the surgical instrument as well as actuate various electrically-controlled operating components (motors, solenoids, gears, etc.). 
         [0027]    Other instruments may be selected as part of a given working end  105  that perform different functions depending upon the particular surgery involved. Examples of instruments that may be utilized within the various working channels include vessel sealing instruments e.g., as described in commonly-owned U.S. Pat. No. 7,771,425, electrosurgical pencils, e.g., as described in commonly-owned U.S. Pat. No. 7,879,033 and ablation instruments, e.g., as described in commonly-owned U.S. Pat. No. 7,879,031. Other instruments and devices that may be utilized include: biopsy instruments, needles, probes, sensors, graspers, forceps, knives, scissors, sutures, stents, irrigators, balloon dissectors, suction devices, stabilizers, blunt dissectors, lasers, optical devices, implants, anchors, tissue ablators, etc. These instruments may be housed within the articulating members of the end of the shaft  12 . 
         [0028]      FIG. 3  shows another embodiment of a working end  305  for use with catheter  10  that includes two internally disposed channels  307   a  and  307   b  defined therein for use in deploying various surgical instruments  335   a - 335   d.  Channels  307   a  and  307   b  are generally offset relative to one another and extend through the distal end  303  of working end  305 , thereby allowing independent and/or simultaneous deployment of surgical instruments  335   a - 335   d  to the operating cavity. Working end  305  also includes a plurality of elongated cavities  310   a - 310   d  disposed around the internal peripheral surface thereof that are dimensioned to house one or more instruments therein. Similar to the working ends  105  and  205  above, working end  305  may be configured to house various surgical instruments needed for a particular surgical procedure, thereby reducing the need to feed a new surgical instrument down the channels  307   a,    307   b  of the catheter  10  for each use. 
         [0029]    Working end  305  also includes a deployment tool  320  that operably connects to one or more controllers on the housing  16  that is configured to allow selective deployment and control of a particular surgical instrument into a respective working channel, e.g.,  307   a,  and into the operating cavity. More particularly, deployment tool  320  includes a shaft  318  that is selectively reciprocateable within the catheter  10  to allow a surgeon the ability to selectively engage a desired surgical instrument, e.g., instrument  335   c,  from the surgical instrument&#39;s respective cavity  310   c  and deploy the instrument  335   c  into the operating cavity via a working channel  307   a  or  307   b.  The deployment tool  320  may include a universal coupling  315  disposed at a distal end thereof that is configured to engage a corresponding coupling  322   a,    322   c  disposed on the surgical instrument  335   a,    335   c,  respectively. The universal coupling  315  may be multifunctional and include one or more actuators, cables or electrical connections that enable the surgeon to engage, deploy, rotate, articulate, extend and otherwise operate the surgical instrument (or components thereof, e.g., various electrically-controlled operating components (motors, solenoids, gears, etc.)) during use. 
         [0030]    In the particular embodiment shown in  FIG. 3 , the various tools include an electrosurgical pencil  335   a,  a needle electrode  335   b,  a biopsy tool  335   c  and a deployable stent  335   d.  Again, other instruments may also be housed within the various cavities of working end  305  including: probes, sensors, graspers, forceps, knives, scissors, sutures, irrigators, suction devices, stabilizers, dissectors, lasers, optical devices, implants, anchors, tissue ablators, etc. 
         [0031]    The remote proximal end  13  of the catheter shaft  12 , the housing  16  or the accessory equipment  60  may include one or more sensors or indexing devices  17  that are configured to locate, orient or “index” the various surgical instruments disposed within working end  305  and, e.g., the cavity location and/or particular function of each instrument. For example, the housing  16  (or equipment  60 ) may include a sensor or an indexing tool (or other visual indicator)  17  that corresponds to both instrument type and instrument location within the working end  305 . The surgeon may then manually engage a desired surgical instrument (or activate an automatic instrument engagement protocol) based on the indexing information displayed on the housing  16  (or equipment  60 ). Moreover, it is contemplated that a second set of cavities (not shown) may be defined within the working end  305  for “used” instruments, sample specimens or additional working components (e.g., additional stents). 
         [0032]    Sensors  17  may also be used to confirm engagement/disengagement of the proper instrument, mechanical failure, or various operating characteristics of the surgical instruments as needed during use, impedance matching, temperature monitoring, etc. Various tissue parameters may also be determined by the sensor(s)  17 , e.g., tissue impedance, tissue temperature, tissue moisture, etc. 
         [0033]      FIGS. 4A-4C  shows an example of a surgical instrument or tool  435  that may be selectively deployable from one or more of the hereindescribed working ends for use with catheter  10 . More particularly, and similar to the instruments described above, instrument  435  is a biopsy tool configured to fit within working channel  407  defined in tube  402 . A tool actuator  415  is reciprocateable within the working channel  407  and allows a surgeon to remotely operate the biopsy tool  435  as needed. For example, the biopsy instrument  435  is initially deployed by moving the actuator  415  distally past the end of working channel  407  which opens a pair of cup-like opposing jaws  436   a  and  436   b  of the biopsy tool  435  about a pivot  438  via a spring bias  427  disposed at the proximal end of the tool  435 . Once the opposing jaws  436   a  and  436   b  are opened, the biopsy tool  435  may be moved into position to engage specimen tissue  1000  as shown in  FIG. 4A . 
         [0034]    Once positioned, the surgeon pulls the actuating tool proximally (while maintaining shaft  12  in place), which forces the opposing jaws  436   a  and  436   b  to close about the tissue specimen  1000  as shown in  FIG. 4B . The edges of the opposing jaw members  436   a  and  436   b  include sharpened edges that allow the jaw members  436   a  and  436   b  to cut and capture the tissue specimen  1000  between the jaw members  436   a  and  436   b.  Once the tissue  1000  is cut, the surgeon continues to pull the tool  435  proximally so that the tissue specimen  1000 ′ may be safely stored between the opposing jaw members  436   a  and  436   b  within working channel  507  (See  FIG. 4C ). 
         [0035]      FIG. 5  shows another embodiment of a working end  505  for use with catheter  10  that includes one or more internally disposed tubes  502   a  and  502   b  having channels  507   a  and  508   a  defined therein for use in deploying various surgical instruments, e.g., instrument  535  within channel  507   a.  More particularly, working end  505  is selectively engageable with end  205  of catheter  10  in a similar manner described above with respect to  FIG. 2 . In the instance wherein the actuating and electrical cables need to be properly aligned to operate a particular surgical instrument, it is necessary to ensure proper alignment of the working channels  507   a  and  210   a  of ends  505  and  205 , respectively. 
         [0036]    For example, in order to ensure actuating cables  515  and  215  align for proper operation of instrument  535 , the proximal end  525   a  of tube  502   a  may be configured to align with the distal end  225   a  of tube  202   a.  One or more alignment interfaces  532  and  232  may be employed on ends  525   a  and  225   a,  respectively. The alignment interfaces  532  and  232  may also be employed to register the electrical cables  517  and  217  on each end  525   a  and  225   a.  Ideally, the mechanical interfaces  532   a  and  232   a  are universal connections or interfaces, thereby allowing interchangeability of various working ends of surgical instrumentation with differently configured or “loaded” configurations of surgical tools. The mechanical interfaces  532   a  and  232   a  may be threaded, snap-fit, tongue and groove or any other suitable type of mating connectable interfaces. 
         [0037]      FIG. 6  shows another embodiment of a catheter  10  that includes a series of interchangeable working ends  605   a - 605   c  that may be selectively engaged to end  205  of catheter  10 . Each interchangeable working end  605   a - 605   c  includes a plurality of cavities  610   a - 610   d,    610   a ′- 610   d ′ and  610   a ″- 610   d ″ defined therein for housing various surgical instruments. One or more mechanical interfaces (similar to the mechanical interfaces  532  and  232  described above) may be employed to align and/or secure the plurality of working ends  605   a - 605   c  to one another and/or to end  205 . A deployment tool  615  may be utilized to remotely engage, deploy and/or operate any one of the instruments, e.g., instruments  635   a,    635   b,  within the operating cavity as needed. For example, in the particular arrangement shown in  FIG. 6 , as many as twelve instruments may be used within a surgical cavity without having to remove and insert instrumentation in a conventional manner. One or more actuating cables  615  and electrical connections  617  may be employed to permit remote engagement, deployment and operation of the various surgical instrumentation as needed. 
         [0038]    The present disclosure also relates to a method for performing a surgical procedure and includes the steps of: providing a housing and attaching a flexible, elongated shaft with distal and proximal ends to the housing. The method also includes the additional steps of: engaging one or more working ends (in series) to the distal end of the housing, the working end including a plurality of tubes disposed therein that define a corresponding plurality of working channels for housing a corresponding plurality of surgical instruments, and controlling an actuator to engage one or more of the corresponding plurality of surgical instruments and deploy the corresponding surgical instrument to an operating cavity as needed for use during a surgical procedure. 
         [0039]    The method may also include the steps of indexing the plurality of surgical instruments disposed in the working end(s), and providing feedback to the surgeon relating to the status and/or location of each of the plurality of surgical instruments. The feedback relating to the status and/or location of each of the plurality of surgical instruments may include indicia displayed on the housing such as: “stored”, “deployed”, “in use”, “disposed” and/or “malfunction”. 
         [0040]    From the foregoing and with reference to the various figure drawings, those skilled in the art will appreciate that certain modifications can also be made to the present disclosure without departing from the scope of the present disclosure. For example and as mentioned above, the housing, generator, suction/irrigation equipment and/or the accessory equipment may include a sensor or indexing mechanism or tool which orients and “indexes” the various surgical instruments, before, during or after use. The indexing tool may be configured to provide real-time feedback to the surgeon as to the status and location of each instrument. As a new instrument or magazine of instruments is added or interchanged, the indexing tool automatically (or manually) updates the display or index on the appropriate system component (e.g., housing, generator, suction/irrigation equipment and/or the accessory equipment) thereby providing accurate information to the surgeon. 
         [0041]    Moreover, there have been described and illustrated herein several embodiments of a catheter with various working ends for treating tissue and performing other surgical procedures. While particular embodiments of the disclosure have been described, it is not intended that the disclosure be limited thereto, as it is intended that the disclosure be as broad in scope as the art will allow and that the specification be read likewise. Therefore, the above description should not be construed as limiting, but merely as exemplifications of particular embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.