Patent Publication Number: US-2019167307-A1

Title: Surgical instruments for engaging tissue to stabilize tissue and facilitate tissue manipulation

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation application of U.S. patent application Ser. No. 15/666,784, filed on Aug. 2, 2017, the entire contents of which are hereby incorporated herein by reference. 
    
    
     TECHNICAL FIELD 
     The present disclosure generally relates to surgical instruments, and more particularly, to surgical instruments for engaging tissue, such as, for example, uterine tissue, to stabilize tissue and facilitate manipulation of the tissue. 
     BACKGROUND 
     Certain surgical procedures are performed to remove uterine tissue, such as hysterectomies, fibroidectomies, myomectomies, and the like. One or more of these procedures can be performed laparoscopically by passing surgical instrument(s) down a cannula so that a distal working end of the surgical instrument(s) can be positioned within an internal surgical site, while operated from a proximal manipulator of the surgical instrument(s). In these instances, a surgical instrument inserted through an abdominal cannula may be utilized to engage a uterus, uterine fibroids (known as leiomyomas), or other tissue to enable manipulation of the tissue relative to a moving cutting tool, such as a morcellator, operating within the internal surgical site. 
     To stabilize the uterus or other tissue during a procedure, for example, the clinician may employ mechanical graspers or a screw. However, due to the slippery nature of uterine tissue and its size and bulky shape, the clinician may be required to make several attempts to reposition the mechanical graspers and/or screw in order to secure the uterus or other tissue in position. Thus, although mechanical graspers and screws are effective, they may be improved. 
     SUMMARY 
     As used herein, the term “distal” refers to the portion that is being described that is further from a user, while the term “proximal” refers to the portion that is being described that is closer to a user. Further, to the extent consistent, any of the aspects described herein may be used in conjunction with any of the other aspects described herein. 
     A surgical instrument provided in accordance with aspects of the present disclosure includes a shaft assembly, a surgical tool, and a cup. The shaft assembly includes a stationary shaft and a movable shaft slidably disposed within the stationary shaft. The stationary shaft defines a conduit extending therethrough. The surgical tool extends distally from a distal end portion of the movable shaft. The cup extends distally from a distal end portion of the stationary shaft. The cup includes a body, an annular rim, and a cap. The body includes a proximal end portion and a distal end portion and defines one or more channels extending from the proximal end portion to the distal end portion thereof. The annular rim is disposed at the distal end portion of the body and defines a plurality of apertures therethrough, each of which is disposed in fluid communication with one of the channels. The cap is disposed at the proximal end portion of the body and defines a lumen fluidly coupling the channels with the conduit and a central aperture configured to slidably receive the surgical tool and/or the movable shaft. The movable shaft is slidable relative to the stationary shaft from a retracted position, wherein the surgical tool is disposed proximally of the distal end portion of the cup, and an extended position, wherein the surgical tool extends through and distally from the cup. 
     In an aspect of the present disclosure, the surgical tool is a tissue-engaging implement. The tissue-engaging implement may be a screw and, more specifically, may be a screw defining a corkscrew-shaped configuration. 
     In another aspect of the present disclosure, the plurality of apertures is equally-spaced about a circumference of the annular rim of the cup. 
     In still another aspect of the present disclosure, a compliant annular ring is disposed about the annular rim of the cup. In such aspects, the plurality of apertures extends through the compliant annular rim. 
     In yet another aspect of the present disclosure, the movable shaft is rotatable relative to the stationary shaft to rotate the surgical tool relative to the cup. 
     In still yet another aspect of the present disclosure, the stationary shaft defines an inlet opening at a proximal end portion thereof. The inlet opening is disposed in fluid communication with the conduit and adapted to connect to a pump. 
     A surgical system provided in accordance with aspects of the present disclosure includes a pump and a surgical instrument. The surgical instrument includes a shaft assembly, a surgical tool, and a cup. The shaft assembly includes a stationary shaft and a movable shaft slidably disposed within the stationary shaft. The stationary shaft defines a conduit extending therethrough having a proximal end portion fluidly coupled to the pump. The surgical tool extends distally from a distal end portion of the movable shaft. The cup extends distally from a distal end portion of the stationary shaft. The cup includes a body, an annular rim, and a cap. The body includes a proximal end portion and a distal end portion and defines one or more channels extending from the proximal end portion to the distal end portion thereof. The annular rim is disposed at the distal end portion of the body and defines a plurality of apertures therethrough, each of which is disposed in fluid communication with one of the channels. The cap is disposed at the proximal end portion of the body and defines a lumen fluidly coupling the channels with the conduit and a central aperture configured to slidably receive the surgical tool and/or the movable shaft. Upon activation of the pump, suction is established through the conduit, the lumen, the one or more channels, and the apertures. 
     In an aspect of the present disclosure, the movable shaft is slidable relative to the stationary shaft from a retracted position, wherein the surgical tool is disposed proximally of the distal end portion of the cup, and an extended position, wherein the surgical tool extends through and distally from the cup. 
     In another aspect of the present disclosure, the surgical tool is a tissue-engaging implement. The tissue-engaging implement may be a screw and, more specifically, may be a screw defining a corkscrew-shaped configuration. 
     In yet another aspect of the present disclosure, the system further includes a connector fluidly coupling the pump with the proximal end portion of the conduit. 
     In still another aspect of the present disclosure, a compliant annular ring is disposed about the annular rim of the cup including the plurality of apertures extending therethrough. 
     In still yet another aspect of the present disclosure, the movable shaft is rotatable relative to the stationary shaft to rotate the surgical tool relative to the cup. 
     A method provided in accordance with aspects of the present disclosure includes positioning a cup against a target area of the tissue, applying suction to the cup to suction the target area of tissue against the cup, thereby stabilizing the target area of tissue, and advancing a surgical tool through an interior of the cup and into engagement with the target area of tissue. 
     In an aspect of the present disclosure, the surgical tool is advanced and rotated into engagement with the target area of tissue. 
     In another aspect of the present disclosure, the method further includes maneuvering the surgical tool to manipulate the target area of tissue. 
     In another aspect of the present disclosure, the method further includes cutting the target area of tissue. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The above and other aspects and features of the present disclosure will become more apparent in light of the following detailed description when taken in conjunction with the accompanying drawings, in which: 
         FIG. 1  is a front, perspective view of a surgical instrument provided in accordance with aspects of the present disclosure; 
         FIG. 2  is an enlarged, front, perspective view of a cup of the surgical instrument of  FIG. 1 ; 
         FIG. 3  is an end view of the cup of  FIG. 2  with the annular ring removed therefrom; 
         FIG. 4  is a longitudinal, cross-sectional view of the surgical instrument of  FIG. 1 , shown operably coupled to a pump; 
         FIG. 5  is a rear, perspective view of the surgical instrument of  FIG. 1 , shown operably coupled to a pump; and 
         FIGS. 6 and 7  are perspective views of the surgical instrument of  FIG. 1  in use engaging tissue to stabilize tissue and facilitate manipulation of tissue. 
     
    
    
     DETAILED DESCRIPTION 
     Surgical instruments configured to engage tissue to stabilize tissue and facilitate manipulation of tissue are provided, each generally including a shaft assembly having a movable member with a distal end portion including a screw extending distally therefrom and a stationary member defining a vacuum conduit, and a cup having a cap through which the movable member is slidably disposed and to which the stationary member is coupled. A vacuum pump may be coupled to the stationary member to provide suction to the cup via the vacuum conduit. In use, the surgical instrument is maneuvered such that the cup is disposed about a target area of tissue. The vacuum pump is then turned on to suction the target area to the cup, thereby stabilizing the target area to enable advancement of the movable member distally towards the target area to engage the target area with the screw. In embodiments, the movable member may be simultaneously advanced and rotate to thereby rotate the screw into engagement with the target area. Fluid, debris, and/or other biological matter may be collected within the cup and carried away via the suction. These and other aspects and features of the present disclosure are detailed below. 
     With reference now to  FIGS. 1-4 , a surgical instrument provided in accordance with the present disclosure and configured to engage tissue to stabilize tissue and facilitate manipulation of tissue is shown generally identified by reference numeral  100 . Surgical instrument  100  includes a shaft assembly  102 , a screw  104  extending distally from the shaft assembly  102 , and a cup  106  having a central opening  108  through which the shaft assembly  102  extends. To permit the cup  106  to be suctioned against a surface of tissue, a rim portion  110  of the cup  106  includes one or more suction holes  112  communicating with radial apertures  116  in a cap  118  covering the central opening  108  of the cup  106  and the radial apertures  116  communicate, via channel(s)  121  and annular lumen  142 , with a vacuum lumen  120  that extends through at least a portion of the shaft assembly  102  to a proximal end portion  122  of shaft assembly  102  that is configured to couple to a vacuum pump  114  via a pump connection  180  (see  FIG. 4 ). 
     The cup  106  is generally dome-shaped with the central opening  108  formed in the apex of the dome. In embodiments, the cup  106  is made of a durable, biocompatible plastic or polymer and may be transparent or semi-transparent. Other suitable materials configured to maintain structural integrity the cup  106  when pressurized are also contemplated. 
     The cup  106  is made up of a body  109  having an outer surface  126  and an inner surface  128  that defines an interior cavity  130 . The body  109  includes one or more channels  121  formed between the outer and inner surfaces  126 ,  128 , which extend from the rim portion  110  of the cup  106  to the central opening  108  of the cup  106 . The one or more channels  121  terminate at the rim portion  110  at corresponding suction holes  112 . Although the outer and inner surfaces  126 ,  128  are illustrated as being smooth such that the presence of the channel(s)  121  is not immediately visibly detectable, it will be appreciated that the outer surface  126  and/or inner surface  128  of the cup  106  may alternatively include ridges beneath which the channel(s)  121  are located. Further, although suction holes  112  are illustrated as generally circular, other suitable configurations, e.g., slotted, elongated, rectangular, etc., are also contemplated. Additionally, although distinct channels  121  are illustrated, it is also contemplated that one or more channels  121  be formed via a hollow or partially hollow (with or without partitions) body  109  of the cup  106 . 
     In embodiments, an annular ring  138  is disposed over the rim portion  110  of the cup  106  to cover the distally-facing surface and inner and outer edges of the rim portion  110  of the cup  106 . The annular ring  138  may define apertures that communicate with apertures or other openings defined within the rim portion  110  to define suction holes  112  therethrough. The annular ring  138  may be formed of a compliant material, such as rubber, a foam, a polymeric material, or the like, and may be adhered with an adhesive or molded over the rim portion  110  of the cup  106 . 
     Continuing with reference to  FIGS. 1-4 , as noted above, the plurality of channels  121  extending through the body  109  of the cup  106  terminate at the central opening  108 . The cap  118  is disposed about the outer surface  126  of the cup  106  at the apex thereof and, more particularly, over the central opening  108 . The cap  118  defines radial apertures  116  that align with corresponding outlets of the one or more channels  121 . The radial apertures  116  provide communication with an annular lumen  142  formed in the cap  118 , and the annular lumen  142  communicates with the vacuum lumen  120  that extends through at least a portion of the shaft assembly  102 , as described in detail below. The cap  118  further includes a central aperture  144  within which a portion of the shaft assembly  102  is slidably disposed. Although not specifically depicted, in other embodiments, the cap  118  is disposed on the inner surface  128  of the cup  106  within the interior cavity  130  defined by the body  109  of the cup  106 . 
     The shaft assembly  102  includes a movable member  150  and a stationary member  152 . The movable member  150  extends through a main lumen  154  formed through the stationary member  152  and has a length that is greater than that of the stationary member  152 . In particular, the movable member  150  is configured to have a middle portion that is the length of the stationary member, a distal end portion  156  that extends distally from the stationary member  152  and through the central opening  108  of the cup  106  at least partially through the interior cavity  130  of the cup  106 , and a proximal end portion  158  that extends from the stationary member  152  in a proximal direction a length that is sufficient to enable manipulation of the movable member  150  relative to the stationary member  152  to advance the distal end portion  156  of the movable member  150  into tissue a desired distance. 
     In embodiments, the distal end portion  156  of the movable member  150  includes the screw  104 . The screw  104  is made of stainless steel or another biocompatible material capable of maintaining structural integrity when inserted into tissue and is spiral or corkscrew shaped. The screw is engaged to the distal end portion  156  of the movable member  150  and extends distally therefrom. The screw  104  has a tip  160  that is sharp in order to more easily puncture tissue when the screw  104  is rotated in a particular direction. In other embodiments, the tip  160  is blunt. 
     The proximal end portion  158  of the movable member  150  extends proximally out of the main lumen  154  of the stationary member  152 , as noted above, so as to provide a handle portion  162  for manipulation, e.g., translation and/or rotation, by a user. The handle portion  162  may include a textured surface, knob, or other mechanical feature to improve the user&#39;s grasp of the movable member  150 . In embodiments, the movable member  150  slidably contacts the interior surface of the stationary member  152  that defines the main lumen  154 . In other embodiments, a small annular gap is maintained between the movable member  150  and the surface of the stationary member  152  in any suitable fashion, e.g., via washers, bearings, etc. 
     The stationary member  152  is configured to maintain its stiffness throughout the entirety of a surgical procedure. As illustrated in  FIG. 4 , a distal end portion  164  of the stationary member  152  extends through the central aperture  144  of the cap  118 . The stationary member  152  may be either temporarily or permanently coupled to the cap  118 . An annular opening  166  is formed in the distal end portion  164  of the stationary member  152  and is aligned with the annular lumen  142  of the cap  118 . In other embodiments, a plurality of annular openings is included in the distal end portion  164 , each annular opening being aligned with the annular lumen  142 . The vacuum lumen  120  extends from the radial annular opening  166  to one or more vacuum pump inlet openings  172  formed at the proximal end portion  122  of the stationary member  152 . In embodiments, with additional reference to  FIG. 5 , a pump connection  180  is coupled to the one or more inlet openings  172 . In other embodiment, two pump connections  180 ,  180   a  (shown in phantom) are coupled to corresponding ones of the inlet openings  172 . 
     With reference to  FIGS. 6 and 7 , in conjunction with  FIGS. 1-4 , during a surgical procedure, the surgical instrument  100  is navigated to a target area of tissue with the movable member  150  of the shaft assembly  102  disposed in a retracted position, wherein the screw  104  is disposed within the main lumen  154  of the stationary member  152  or protruding minimally therefrom into (but not beyond) the internal cavity  130  of the cup  106 . 
     Once disposed in a desired position, the annular ring  138  disposed on the rim portion  110  of the cup  106  is urged against the surface of the target area of tissue  600 , and the vacuum pump  114  is activated to a powered on condition. As a result, suction is created through the vacuum lumen  120  of the stationary member  152  of the shaft assembly  104 , the annular lumen  142  of the cap  118 , the channels  121  of the cup  106 , and the suction holes  112  defined through rim portion  110  of the cup  106  and the annular ring  138  to cause the cup  106  to be suctioned to the target area of tissue  600 . In this manner, the cup  106  stabilizes the target area of tissue  600 . 
     With the surgical instrument  100  suctioned to the target area of tissue  600 , the proximal end portion  158  of the movable member  150  is urged distally relative to the stationary member  152  to advance the distal end portion  156  of the movable member  150  and, thus, screw  104  into the target area of tissue  600 . In embodiments, the proximal end portion  158  of the movable member  150  is rotated relative to the stationary member  152  in a direction corresponding to the corkscrew shape of the screw  104  during the distal advancement of the movable member  150  to permit the screw  104  to engage and embed within the target area of tissue  600 . By using the suction provided by cup  106 , engagement of the screw  104  within the target area of tissue  600  is more easily, accurately, and securely achieved. 
     The suction provided by cup  106  also enables fluid, debris, and/or other biological matter to be suctioned into the cup  106  and carried away via the suction path detailed above. This may be accomplished before suctioning the cup  106  to the target area of tissue  600 , after suctioning the cup  106  to the target area of tissue  600 , and/or while the cup  106  is suctioned to the target area of tissue  600 . Additional apertures communicated with the suction path may be provided on the interior surface  128  of the body  109  of the cup  106 , the exterior surface  126  of the body  109  of the cup  106 , and/or on another portion of the cup  106  for these purposes. 
     Once screw  104  is engaged within the target area of tissue  600 , shaft assembly  102  may be maneuvered to manipulate the target area of tissue  600  to a desired orientation and/or position such as, for example, to facilitate cutting, e.g., morcellating, the target area of tissue  600 . Alternatively, stationary member  152  and cup  106  may be withdrawn proximally about movable member  150  such that movable member  150  may be maneuvered to manipulate the target area of tissue  600  to a desired orientation and/or position. 
     The embodiments disclosed herein are examples of the disclosure and may be embodied in various forms. For instance, although certain embodiments herein are described as separate embodiments, each of the embodiments herein may be combined with one or more of the other embodiments herein. Specific structural and functional details disclosed herein are not to be interpreted as limiting, but as a basis for the claims and as a representative basis for teaching one skilled in the art to variously employ the present disclosure in virtually any appropriately detailed structure Like reference numerals may refer to similar or identical elements throughout the description of the figures. 
     It should be understood that the foregoing description is only illustrative of the present disclosure. Various alternatives and modifications can be devised by those skilled in the art without departing from the disclosure. Accordingly, the present disclosure is intended to embrace all such alternatives, modifications and variances. The embodiments described with reference to the attached drawing figures are presented only to demonstrate certain examples of the disclosure. Other elements, steps, methods, and techniques that are insubstantially different from those described above and/or in the appended claims are also intended to be within the scope of the disclosure.