Abstract:
An elongate flexible endoscopic surgical scissor instrument includes an actuating means at the proximal end and a blade assembly that includes pair of pivotable scissor blades at the distal end. The actuating means is adapted to place the scissor blades in an opened or closed configuration. The scissors include a torque-transmitting shaft assembly that couples the proximal end of instrument to the blade assembly positioned at the distal end. Rotation of the torque transmitting shaft assembly at the proximal end causes the distally-located blade assembly to similarly rotate in both the open and closed configurations, which can provide precise targeting.

Description:
INCORPORATION BY REFERENCE TO ANY PRIORITY APPLICATIONS 
       [0001]    This application claims priority benefit under 35 U.S.C. §119(e) of U.S. Provisional Patent Application No. 61/814,201, filed Apr. 20, 2013, titled “FLEXIBLE ENDOSCOPIC TORQUEABLE DEVICES,” which is hereby incorporated by reference in its entirety. 
     
    
     BACKGROUND 
       [0002]    1. Field 
         [0003]    The present disclosure relates generally to endoscopic surgical instruments. In particular, the present disclosure relates to endoscopic instruments suitable for passage through the working channel of an endoscope and, more particularly, to means for increasing the transmission torque applied to an end effector positioned at the distal end of an endoscopic instrument such as a pair of scissor blades. 
         [0004]    2. Description of the Related Art 
         [0005]    Endoscopic surgical scissor instruments are primarily used in laparoscopic surgical procedures for cutting tissue, suture and other prosthetic materials. There exists many different varieties of endoscopic scissor instruments for laparoscopic use that incorporate novel blade technology, cautery capability (both mono-polar and bi-polar), articulating ends and numerous other modifications. 
         [0006]    Generally, these instruments have an elongate rigid tubular shaft, typically 30 cm to 60 cm in length, with a handle positioned at the proximal end of the shaft and a pair of actuatable scissor blades positioned at the distal end of the shaft. Actuation means, typically a pull wire, generally couple the handle to the scissor blades and is positioned with the rigid shaft to cause the scissor blades to open and close when the handle is manipulated. With the general rigid construction of these surgical scissor instruments, the physician has the ability to precisely orient the scissor blades relative to the intended target and cut with ease. 
       BRIEF SUMMARY 
       [0007]    The present disclosure is directed towards a flexible endoscopic scissor instrument for use through the working channel of a flexible endoscope that has proximally located handle assembly coupled to an elongate flexible hollow torque transmitting shaft member and a scissor blade assembly fixedly positioned at the shaft distal end. An elongate actuation member having proximal and distal ends is slidably positioned within the lumen of the torque transmitting shaft member. The proximal end of the actuation member is coupled to the handle assembly whereas the distal end is coupled to the scissor blade assembly such that when the handle member is operated, the actuation member is moved longitudinally relative to the torque transmitting shaft member thereby causing the scissor blades to move between open and closed configurations. The scissor blade assembly is preferably welded to the torque transmitting shaft member in a fixed relationship such that rotation of the proximal end of the shaft member causes the distal end of the shaft member to rotate accordingly, which can provide precise orientation control of the scissors blades relative to an intended target. 
         [0008]    In accordance with an embodiment of the present disclosure, there is provided an elongate hollow torque transmitting shaft that takes the form of an elongate hollow multi-wire stranded cable having proximal and distal ends. The hollow cable includes a helically wound coil having proximal and distal ends which is coaxially disposed within the cable lumen. The hollow cable and the helical coil have lengths that are generally equivalent and make up essentially the entire length of the shaft. The shaft lengths may generally range from about 100 cm to about 350 cm. The hollow cable is secured to the coil in at least two locations along the length of the shaft, preferably at the proximal and distal ends and preferably by laser welding. Other means for securing the cable to the coil may be suitable such as resistance welding, soldering, crimping and adhesives or glues. 
         [0009]    In accordance with another embodiment of the present disclosure, there is provided an elongate hollow torque transmitting shaft having proximal and distal ends including a helical coil generally extending the entire length of the shaft and a hollow multi-wire cable coaxially disposed about the helical coil and generally extending from the proximal end of the shaft to a position proximal to the distal end of the shaft. Preferably the distance from the distal end of the shaft to the distal end of the hollow cable is not more than about 60 cm and more preferably not more than about 45 cm. The proximal and distal end of the hollow cable is secured to the coil preferably through welding. Additionally, intermediate locations between the proximal and distal ends of the cable may also be secured to the coil. 
         [0010]    Certain aspects of the disclosure are directed toward a flexible endoscopic surgical instrument. The surgical instrument can include an elongate, flexible shaft member having a proximal portion, a distal portion, and a lumen extending therethrough. The shaft member can be configured for delivery through a working channel of an endoscope. The shaft member can include an elongate cable member having a proximal portion and a distal portion, and an elongate coil member having a proximal portion and a distal portion. The cable member and the coil member can be in coaxial arrangement. The surgical instrument can include an elongate actuation member having a proximal portion and a distal portion. The actuation member can be slidably positioned in the shaft member. The surgical instrument can include a handle member having a body portion and a slidable portion. The body portion can be coupled to the proximal portion of the shaft member in a longitudinally fixed configuration. The slidable portion can be coupled to the proximal portion of the actuation member. An end effector can be coupled to the distal portion of the actuation member such that longitudinal movement of the actuation member actuates the end effector. Rotation of the proximal portion of the shaft member can be configured to rotate the end effector. 
         [0011]    In any of the above-mentioned embodiments, a diameter of the shaft member can be less than or equal to about 3.2 mm. 
         [0012]    In any of the above-mentioned embodiments, the cable member can be secured to the coil member by a number of welds. In certain embodiments, the number of welds is two welds. The welds can be longitudinally spaced apart along a length of the shaft (e.g., a first weld at a distal portion of the shaft and a second weld at a proximal portion of the shaft). In certain embodiments, the welds can be circumferential welds. 
         [0013]    In any of the above-mentioned embodiments, the distal portion of the coil member can extend distal to the distal end of the cable member. 
         [0014]    In any of the above-mentioned embodiments, the elongate coil member can be positioned in the elongate cable member. 
         [0015]    In any of the above-mentioned embodiments, there can be an actuation member that takes the form of an elongate resilient wire. Suitable materials for the wire include stainless steels, nitinol and other generally biocompatible metals, alloys and materials including plastics and composites with low percentages of elongation. 
         [0016]    In accordance with still yet another aspect of the present disclosure, there is provided an actuation member that takes the form of an elongate resilient multifilament cable. Suitable materials for the cable include stainless steels, nitinol and other generally biocompatible metals, alloys and materials including plastics and composites with low percentages of elongation. 
         [0017]    Certain aspects of the disclosure are directed toward a method of manufacturing a flexible endoscopic surgical instrument having any of the features described herein. The method can include coaxially positioning an elongate coil member and a cable member to form a shaft member. The method can include welding the elongate coil member to the cable member. In certain aspects, the welding step can include forming two longitudinally spaced apart welds (e.g., a first weld at a distal portion of the shaft member and a second weld at a proximal portion of the shaft member). In certain aspects, the welding step can include forming at least one circumferential weld (e.g., two welds, three welds, or more). The method can include slidably positioning an actuation member within the shaft member. The method can include connecting an end effector to a distal portion of the actuation member such that longitudinal movement of the actuation member actuates the end effector. In certain aspects, rotation of the proximal portion of the shaft member can be configured to rotate the end effector. The method can include securing a body portion of a handle member to a proximal portion of the shaft member and securing a slidable portion of the handle member to a proximal portion of the actuation member. 
         [0018]    Certain aspects of the disclosure are directed toward a method of using a flexible endoscopic surgical instrument including any of the features described herein. For example, the surgical instrument can include an elongate, flexible shaft member having a proximal portion, a distal portion, and a lumen extending through the shaft member. The shaft member can include an elongate cable member having a proximal portion and a distal portion, and an elongate coil member having a proximal portion and a distal portion. The cable member and the coil member can be in coaxial arrangement. The surgical instrument can include an elongate actuation member slidably positioned within the shaft member. The method can include inserting the surgical instrument through a working channel of an endoscope. In certain aspects, the method can include longitudinally moving the actuation member to actuate an end effector. In certain aspects, the method can include rotating a proximal portion of the shaft member to rotate the end effector. 
         [0019]    These aspects of the disclosure and the advantages thereof will be more clearly understood from the following description and drawings of embodiments of the present disclosure. 
         [0020]    Any feature, structure, or step disclosed herein can be replaced with or combined with any other feature, structure, or step disclosed herein, or omitted. Further, for purposes of summarizing the disclosure, certain aspects, advantages, and features of the inventions have been described herein. It is to be understood that not necessarily any or all such advantages are achieved in accordance with any particular embodiment of the inventions disclosed herein. No individual aspects of this disclosure are essential or indispensable. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0021]    Various embodiments are depicted in the accompanying drawings for illustrative purposes, and should in no way be interpreted as limiting the scope of the embodiments. Furthermore, various features of different disclosed embodiments can be combined to form additional embodiments, which are part of this disclosure. 
           [0022]      FIG. 1  is a view of a flexible endoscopic scissor instrument with the scissor blades in an open configuration according to an embodiment of the present disclosure. 
           [0023]      FIG. 2  is a partially sectioned view of the flexible endoscopic scissor instrument shown in  FIG. 1 . 
           [0024]      FIG. 3A  is an enlarged partial view of the distal end of the flexible endoscopic scissor instrument shown in  FIG. 1 . 
           [0025]      FIG. 3B  is a partially sectioned view of the distal end of the flexible endoscopic scissor instrument shown in  FIG. 3A . 
           [0026]      FIG. 4A  is an enlarged partial top view of the distal end of the flexible endoscopic scissor instrument shown in  FIG. 1 . 
           [0027]      FIG. 4B  is a partially sectioned view of the distal end of the flexible endoscopic scissor instrument shown in  FIG. 4A . 
           [0028]      FIG. 5  is a view of a flexible endoscopic scissor instrument with the scissor blades in a closed configuration according to an embodiment of the present disclosure. 
           [0029]      FIG. 6  is a partially sectioned view of the flexible endoscopic scissor instrument shown in  FIG. 5 . 
           [0030]      FIG. 7  is an enlarged partially sectioned view of the distal end of the flexible endoscopic scissor instrument shown in  FIG. 5 . 
           [0031]      FIG. 8  is a view of a flexible endoscopic scissor instrument with the scissor blades in an open configuration according to another embodiment of the present disclosure. 
           [0032]      FIG. 9  is a partially sectioned view of the flexible endoscopic scissor instrument shown in  FIG. 8   
           [0033]      FIG. 10  is an enlarged partially sectioned view of the distal end of the flexible endoscopic scissor instrument shown in  FIG. 8 . 
           [0034]      FIG. 11  is an enlarged partially sectioned view of the distal end of the flexible endoscopic scissor instrument of  FIG. 8  shown in closed configuration. 
       
    
    
     DETAILED DESCRIPTION 
       [0035]    As the physician community moves to perform more minimally invasive procedures by using flexible endoscopes positioned through a natural orifice, there is a need to have flexible endoscopic surgical instruments that perform comparably to their laparoscopic brethren. In the case of endoscopic scissors, applying the aforementioned simple construction configurations of rigid endoscopic scissors to a flexible platform, having lengths of over 300 cm, generally yields instruments with poor performance characteristics. 
         [0036]    Referring now to  FIG. 1 , there is shown a flexible endoscopic scissor instrument  10  for use in endoscopic surgical procedures and particularly suited for use through the working channel of a flexible endoscope positioned within the body though a natural orifice. Since the flexible endoscopic scissor instrument is suited for delivery through the working channel of a flexible endoscope it also suited for use with other flexible cannulas or passageways and as such, the term “endoscopic” should be construed to include arthroscopic, laparoscopic, robotic, etc. In some scenarios, the working channel can have a diameter of less than or equal to about 3.2 mm. Depending upon the length of the instrument, it will be adaptable to a variety of endoscopic procedures and will also be suitable for open surgical procedures. 
         [0037]    As illustrated in  FIG. 1 , scissor instrument  10  includes a handle assembly  12  at the proximal end of the instrument coupled to an elongate flexible torque transmitting shaft  14  having a proximal end  16  with proximal and intermediate weld  17  and  18  respectively located proximal to distal end  19  and fixedly coupled scissor blade assembly  20 . Handle assembly  12  is of a general type that includes a handle body  22  having a proximal end  24  and a distal end  26 . Handle body  22  includes first and second projections  28  and  30  that are spaced apart and extend from the proximal end  24  to the distal end  26 . Located at the proximal end  24  of handle body  22  there is an integrally formed thumb ring  32 . Positioned on handle body  22  between proximal end  24  and distal end  26  is handle slide  34 . Handle slide  34  is configured to surround projections  28  and  30  and partially extend between the projections such that slide  34  is slidable in a longitudinal direction distally and proximally on the projections. Extending from opposite sides of slide  34  are integrally formed finger rings  36  and  38 . Centrally located on slide  34  is securing member  40  which typically takes the form of a set screw. Cap member  42  is positioned at the distal end of handle body  22  and couples the proximal end  16  of shaft  14  to handle assembly  12 . Actuation member  50  is shown in  FIG. 2  positioned within the lumen of shaft  14  extending from proximal end  16  to distal end  19 . The proximal end  52  of actuation member  50  is coupled to slide  34  via securing member  40  while the distal end  54  is coupled to blade assembly  20 . 
         [0038]    Turning now to  FIGS. 3A ,  3 B,  4 A and  4 B which illustrate an enlarged view of the distal portion of scissor instrument  10 , blade assembly  20  is shown in more detail. Blade assembly  20  includes a tubular clevis  60  which is fixedly coupled to shaft distal end  19  at weld  61  located at the clevis proximal end  62 . Clevis  60  has a distal end  64  and spaced apart clevis arms  66  and  68 . Disposed between clevis arms  66  and  68  is a first scissor blade  70  having a distal end  72 , a proximal end  74  and an elongate slot  76  adjacent proximal end  74 . A second scissor blade  80  having a distal end  82 , a proximal end  84  and an elongate slot  86  adjacent proximal end  84  is also disposed between clevis arms  66  and  68 . First and second scissor blades  70  and  80  are pivotally coupled to clevis  60  at distal end  64  through pivot rivet  88 . 
         [0039]    The partially sectioned view of  FIGS. 3B and 4B  reveal an internal clevis  90  which is fixedly coupled to distal end  54  of actuation member  50 . Clevis pin  92  extends through slots  76  and  86  of scissor blades  70  and  80  to couple the blades to actuation member  50 . While scissor blades  70  and  80  are shown in an open configuration and have a generally curved shape, other shapes are contemplated. In the open configuration, the internal clevis pin  92  is positioned at the most distal position possible relative to slots  76  and  86 . Hollow torque transmitting shaft  14  is shown in cross section depicting the arrangement of hollow cable  94  and inner coil  96  which are secured together at weld  61 . 
         [0040]    The hollow cable  94  and the inner coil  96  can be coaxially arranged. Although  FIG. 3B  depicts the inner coil  96  being positioned in the hollow cable  94 , in some embodiments, the hollow cable  94  can be positioned in the coil  96 . 
         [0041]    The hollow cable  94  can be secured to the inner coil  96  by one or more welds  17 ,  18 ,  61 , e.g., one weld, two welds, three welds, or more. If the cable  94  is formed from multiple cables, the one or more welds can prevent the cable  94  from unraveling. It may be desirable to include less than or equal to three welds to maximize the flexibility of the shaft  14 . In certain aspects, the hollow cable  94  and the inner coil  96  can be secured together by longitudinally spaced apart welds. The one or more welds can be circumferential welds around the shaft  14 . 
         [0042]    As shown in  FIG. 1 , the hollow cable  94  can be secured to the inner coil  96  by a first weld  16  positioned at a proximal portion of the shaft  14 . In certain aspects, the hollow cable  94  can be secured to the inner coil  96  by a second weld  61  positioned at a distal portion of the shaft  14 . The first and second welds  16 ,  61  can be spaced apart by at least a majority of a length of the shaft  14 , or substantially the entire length of the shaft. In certain aspects, the hollow cable  94  can be secured to the inner coil  96  by a third weld  17  positioned closer to the first weld  16  than the second weld  61 . 
         [0043]    When scissor blades  70  and  80  are in the open configuration, instrument  10  may be operated to close the scissor blades by moving slide  34  of handle assembly  12  in a proximal direction relative to handle body  22 . During this motion, slide  34  which is coupled to actuation member  50  causes the actuation member move proximally relative to shaft member  14 . Within scissor blade assembly  20 , internal clevis pin  92  is moved proximally along slots  76  and  86  such that scissor blades  70  and  80  pivot about pivot pin  88  to thereby move to the closed configuration as shown in  FIGS. 5 ,  6  and  7 . Conversely, to open the scissor blades from the closed configuration, instrument  10  may be operated by moving slide  34  distally to subsequently cause scissor blades  70  and  80  to pivot to the open configuration. 
         [0044]    With reference to  FIGS. 8-11 , another illustrative embodiment of a surgical tool is shown. The scissor instrument  110  resembles or is identical to the scissor instrument  10  discussed above in many respects. Accordingly, numerals used to identify features of the scissor instrument  10  are incremented by a factor of one hundred (100) to identify like features of the scissor instrument  110 . This numbering convention generally applies to the remainder of the figures. Any component or step disclosed in any embodiment in this specification can be used in other embodiments. 
         [0045]    As illustrated in  FIG. 8 , scissor instrument  110  includes a handle assembly  112  at the proximal end of the instrument coupled to an elongate flexible torque transmitting shaft  114  having a proximal end  116  with proximal and intermediate weld  117  and  118  respectively located proximal to distal end  119  and fixedly coupled scissor blade assembly  120 . Handle assembly  112  is of a general type that includes a handle body  122  having a proximal end  124  and a distal end  126 . Handle body  122  includes first and second projections  128  and  130  that are spaced apart and extend from the proximal end  124  to the distal end  126 . Located at the proximal end  124  of handle body  122  there is an integrally formed thumb ring  132 . Positioned on handle body  122  between proximal end  124  and distal end  126  is handle slide  134 . Handle slide  134  is configured to surround projections  128  and  130  and partially extend between the projections such that slide  134  is slidable in a longitudinal direction distally and proximally on the projections. Extending from opposite sides of slide  134  are integrally formed finger rings  136  and  138 . Centrally located on slide  134  is securing member  140  which typically takes the form of a set screw. Cap member  142  is positioned at the distal end of handle body  122  and couples the proximal end  116  of shaft  114  to handle assembly  112 . Actuation member  150  is shown in  FIG. 9  positioned within the lumen of shaft  114  extending from proximal end  116  to distal end  119 . The proximal end  152  of actuation member  150  is coupled to slide  134  via securing member  140  while the distal end  154  is coupled to blade assembly  120 . 
         [0046]    Turning now to  FIGS. 10 and 11  which illustrate an enlarged view of the distal portion of scissor instrument  110 , blade assembly  120  is shown in more detail. Blade assembly  120  includes a tubular clevis  160  which is fixedly coupled to shaft distal end  119  at weld  161  located at the clevis proximal end  162 . Clevis  160  has a distal end  164  and spaced apart clevis arms  166  and  168 . Disposed between clevis arms  166  and  168  is a first scissor blade  170  having a distal end  172 , a proximal end  174  and an elongate slot  176  adjacent proximal end  174 . A second scissor blade  180  having a distal end  182 , a proximal end  184  and an elongate slot  186  adjacent proximal end  184  is also disposed between clevis arms  166  and  168 . First and second scissor blades  170  and  180  are pivotally coupled to clevis  160  at distal end  164  through pivot rivet  188 . 
         [0047]    The partially sectioned view of  FIGS. 10 and 11  reveal an internal clevis  190  which is fixedly coupled to distal end  154  of actuation member  150 . Clevis pin  192  extends through slots  176  and  186  of scissor blades  170  and  180  to couple the blades to actuation member  150 . While scissor blades  170  and  180  are shown in an open configuration and have a generally curved shape, other shapes are contemplated. In the open configuration, the internal clevis pin  192  is positioned at the most distal position possible relative to slots  176  and  186 . Hollow torque transmitting shaft  114  is shown in cross section depicting the arrangement of hollow cable  194  and inner coil  196  which are secured together at weld  118 . 
         [0048]    As shown in  FIG. 10 , the distal portion  198  of the inner coil  196  can extend beyond the distal end of the hollow cable  194 . This arrangement provides greater flexibility at a distal portion of the shaft  114 . 
         [0049]    Although certain embodiments have been described herein with respect to scissors, the surgical tools described herein can be graspers, dissectors, needle drivers, suction tools, electrocautery tools, or otherwise. 
         [0050]    As used herein, the relative terms “proximal” and “distal” shall be defined from the perspective of the surgical tool. Thus, proximal refers to the direction of the handle and distal refers to the direction of the end effector. 
         [0051]    Conditional language, such as “can,” “could,” “might,” or “may,” unless specifically stated otherwise, or otherwise understood within the context as used, is generally intended to convey that certain embodiments include, while other embodiments do not include, certain features, elements, and/or steps. Thus, such conditional language is not generally intended to imply that features, elements, and/or steps are in any way required for one or more embodiments. 
         [0052]    Although certain embodiments and examples have been described herein, it will be understood by those skilled in the art that many aspects of the surgical instruments shown and described in the present disclosure may be differently combined and/or modified to form still further embodiments or acceptable examples. A wide variety of designs and approaches are possible. No feature, structure, or step disclosed herein is essential or indispensable. It will be understood by those skilled in the art that numerous modifications and improvements may be made to the embodiments of the disclosure described herein without departing from the spirit and scope thereof. 
         [0053]    For purposes of this disclosure, certain aspects, advantages, and novel features are described herein. It is to be understood that not necessarily all such advantages may be achieved in accordance with any particular embodiment. Thus, for example, those skilled in the art will recognize that the disclosure may be embodied or carried out in a manner that achieves one advantage or a group of advantages as taught herein without necessarily achieving other advantages as may be taught or suggested herein. 
         [0054]    Moreover, while illustrative embodiments have been described herein, the scope of any and all embodiments having equivalent elements, modifications, omissions, combinations (e.g., of aspects across various embodiments), adaptations and/or alterations as would be appreciated by those in the art based on the present disclosure. The limitations in the claims are to be interpreted broadly based on the language employed in the claims and not limited to the examples described in the present specification or during the prosecution of the application, which examples are to be construed as non-exclusive. It is intended, therefore, that the specification and examples be considered as illustrative only, with a true scope and spirit being indicated by the claims and their full scope of equivalents. 
         [0055]    Any methods disclosed herein need not be performed in the order recited. The methods disclosed herein include certain actions taken by a practitioner; however, they can also include any third-party instruction of those actions, either expressly or by implication. For example, actions such as “rotating a proximal end of the shaft member to rotate the end effector” include “instructing rotation of a proximal end of the shaft member to rotate the end effector.” 
         [0056]    The ranges disclosed herein also encompass any and all overlap, sub-ranges, and combinations thereof. Language such as “up to,” “at least,” “greater than,” “less than,” “between” and the like includes the number recited. Numbers preceded by a term such as “about” or “approximately” include the recited numbers. For example, “about 3 mm” includes “3 mm.”