Patent Publication Number: US-2019183470-A1

Title: Surgical device and method facilitating removal of tissue specimens

Description:
BACKGROUND 
     Technical Field 
     The present disclosure relates to tissue specimen removal and, more particularly, to a surgical device and method facilitating removal of tissue specimens from an internal body cavity. 
     Background of Related Art 
     In minimally-invasive surgical procedures, operations are carried out within an internal body cavity through small entrance openings in the body. The entrance openings may be natural passageways of the body or may be surgically created, for example, by making a small incision into which a cannula is inserted. 
     Minimally-invasive surgical procedures may be used for partial or total removal of tissue from an internal body cavity. However, the restricted access provided by minimally-invasive openings (natural passageways and/or surgically created openings) presents challenges with respect to removal of large tissue specimens. As such, tissue specimens that are deemed too large for intact removal are manipulated and/or broken down to enable removal from the internal body cavity. 
     SUMMARY 
     As used herein, the term “distal” refers to the portion that is described which is further from a user, while the term “proximal” refers to the portion that is being described which is closer to a user. Further, any or all of the aspects described herein, to the extent consistent, may be used in conjunction with any or all of the other aspects described herein. 
     Provided in accordance with aspects of the present disclosure is a surgical device including a housing, a grasper assembly, a shaft, and a movable handle. The grasper assembly extends distally from the housing and includes first and second jaw members disposed at a distal end portion thereof. The first and second jaw members are movable relative to one another between an open position and a closed position. The shaft extends distally from the housing and is movable relative to the grasper assembly between a retracted position, wherein the first and second jaw members extend distally from the shaft, and an extended position, wherein the shaft at least partially surrounds the first and second jaw members. The movable handle is associated with the housing and operably coupled to the grasper assembly and the shaft such that movement of the movable handle relative to the housing from an un-actuated position to an actuated position moves the first and second jaw members from the open position to the closed position, and moves the shaft from the retracted position to the extended position. 
     In an aspect of the present disclosure, the surgical device further includes an electrode associated with the shaft and an activation button mounted on the housing and electrically coupled to the electrode. In such aspects, in the actuated position, the movable handle activates the activation button to supply energy to the electrode. 
     In another aspect of the present disclosure, the electrode is disposed at an open distal end portion of the shaft. The electrode may be a ring electrode disposed annularly about the open distal end portion of the shaft and/or may be a monopolar electrode. 
     In still another aspect of the present disclosure, a specimen bag depends from the housing and is disposed in communication with an interior of the shaft. 
     In yet another aspect of the present disclosure, a plurality of inwardly and proximally-extending barbs is disposed within the shaft. 
     In still yet another aspect of the present disclosure, a biasing member is configured to bias the movable handle towards the un-actuated position, thereby biasing the shaft towards the retracted position and the grasper assembly towards the open position. 
     Another surgical device provided in accordance with aspects of the present disclosure includes a housing, a shaft, a grasper assembly, an activation button, and a movable handle. The shaft extends distally from the housing and defines an open distal end portion, a proximal opening, and a lumen extending longitudinally therethrough. The shaft further includes an electrode disposed at the open distal end portion thereof. The grasper assembly includes first and second jaw members configured to grasp tissue therebetween. One of the shaft or the grasper assembly is movable relative to the other and the housing from a retracted position, wherein the shaft is disposed proximally of the first and second jaw members, and an extended position, wherein the shaft at least partially surrounds the first and second jaw members. The activation button is mounted on the housing and electrically coupled to the electrode. The movable handle is associated with the housing and operably coupled to the one of the shaft or the grasper assembly such that movement of the movable handle relative to the housing from an un-actuated position to an actuated position moves the one of the shaft or the grasper assembly from the retracted position to the extended position and activates the activation button to supply energy to the electrode. 
     In an aspect of the present disclosure, the shaft is movable relative to the housing and the grasper assembly between the retracted and extended positions. 
     In another aspect of the present disclosure, a first drive assembly is operably coupled between the handle and the shaft such that movement of the movable handle relative to the housing from the un-actuated position to the actuated position moves the shaft from the retracted position to the extended position. Alternatively or additionally, a second drive assembly is operably coupled between the handle and the grasper assembly such that movement of the movable handle relative to the housing from the un-actuated position to the actuated position moves the first and second jaw members relative to one another from an open position to a closed position to grasp tissue therebetween. 
     In still another aspect of the present disclosure, the electrode is a ring electrode disposed annularly about the open distal end portion of the shaft. Alternatively or additionally, the electrode is a monopolar electrode. 
     In yet another aspect of the present disclosure, a specimen bag depends from the housing and is disposed in communication with the lumen of the shaft. 
     In still yet another aspect of the present disclosure, a plurality of inwardly and proximally-extending barbs are disposed within the lumen of the shaft. 
     In another aspect of the present disclosure, a biasing member is configured to bias the movable handle towards the un-actuated position, thereby biasing the one of the shaft or the grasper assembly towards the retracted position. 
     A method of surgery provided in accordance with aspects of the present disclosure includes positioning a distal end portion of a surgical device adjacent a tissue specimen and actuating a handle of the surgical device through an actuation stroke. Actuation of the handle through the actuation stroke manipulates a grasper assembly at the distal end portion of the surgical device to grasp a portion of the tissue specimen, energizes a distal electrode of the shaft to at least partially resect the portion of the tissue specimen from a remainder of the tissue specimen, and advances a shaft of the surgical device about the grasper assembly to at least partially receive the resected portion of the tissue specimen within the shaft. 
     In an aspect of the present disclosure, the method further includes moving the resected portion of the tissue specimen proximally through the shaft and into a specimen bag operably coupled to the shaft. 
     In an aspect of the present disclosure, the method further includes engaging the resected portion of the tissue specimen with at least one barb disposed within the shaft to inhibit distal movement of the resected portion of the tissue specimen relative to the shaft. 
    
    
     
       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 wherein like reference numerals identify similar or identical elements and: 
         FIG. 1  is a side view of a surgical device provided in accordance with the present disclosure, configured to facilitate removal of tissue specimens from an internal body cavity; 
         FIG. 2  is a longitudinal, cross-sectional view of the surgical device of  FIG. 1 ; 
         FIG. 3A  is a longitudinal, cross-sectional view of a distal end portion of the surgical device of  FIG. 1  positioned adjacent a tissue specimen to be removed; 
         FIG. 3B  is a longitudinal, cross-sectional view of the distal end portion of the surgical device of  FIG. 1  grasping and drawing a portion of the tissue specimen into the interior thereof; and 
         FIG. 4  is a longitudinal, cross-sectional view of an intermediate portion of the surgical device of  FIG. 1  illustrating portions of tissue moving proximally through the surgical device and into a specimen bag thereof. 
     
    
    
     DETAILED DESCRIPTION 
     The present disclosure provides a surgical device and method facilitating removal of tissue specimens from an internal body cavity. 
     Turning to  FIGS. 1 and 2 , a surgical device  100  provided in accordance with the present disclosure is shown generally including a housing  110 , a shaft  120  extending distally from housing  110 , a handle assembly  130  operably coupled to housing  110 , an activation button  140  operably coupled to housing  110 , a grasper assembly  150  distally-spaced from housing  110 , a first drive assembly  160  disposed within housing  110  and operably coupling handle assembly  130  with shaft  120 , a second drive assembly  170  extending through housing  110  and shaft  120  and operably coupling grasper assembly  150  with handle assembly  130 , and a specimen bag  180  operably supported by housing  110 . Surgical device  100  further includes an electrosurgical cable “C” configured to connect surgical device  100  to a source of electrosurgical energy (not shown) to enable selectively delivery of energy to distal electrode  122  of shaft  120 , e.g., upon activation of activation button  140 , as detailed below. 
     Housing  110  includes a body portion  112  and a fixed handle  114  that depends from body portion  112  to define the fixed handle  114  of handle assembly  130 . Housing  110  houses the internal operating components of surgical device  100 , as detailed below. 
     Shaft  120  extends distally from housing  110  and is movably coupled thereto, as detailed below. Shaft  120 , as noted above, includes a distal electrode  122 . Distal electrode  122  is configured as a ring electrode disposed about the annular perimeter of shaft  120  at the distal end portion thereof, although other configurations are also contemplated. Distal electrode  122  may be configured to receive monopolar energy and serve as an active electrode for use with a remote return pad (not shown). Alternatively, distal electrode  122  may define one electrode in a bipolar configuration with an electrically-isolated component(s) of surgical device  100 , e.g., another portion of shaft  120 , one or both of jaw members  152 ,  154  of grasper assembly  150 , etc. Distal electrode  122  is coupled to the source of electrosurgical energy (not shown) and activation button  140  by way of lead wires  142 . 
     Shaft  120  further defines a longitudinally-extending lumen  124  therethrough and includes a plurality of spaced-apart barbs  126  extending from an interior surface of shaft  120  inwardly into lumen  124 . Barbs  126  may be arranged in longitudinally-extending rows spaced-apart about the annular interior of shaft  120 , or may be arranged in any other suitable manner. Further, barbs  126  may extend over only a portion or over the entire length of shaft  120 . Barbs  126  are angled proximally such that tissue may more readily pass proximally over barbs  126  but is inhibited from passing distally over barbs  126 . 
     Shaft  120  further defines a proximal opening  128  disposed towards the proximal end portion thereof. Proximal opening  128  may be defined longitudinally through an open proximal end of shaft  120 , or may be defined transversely through shaft  120  towards the proximal end thereof (as shown). Proximal opening  128  is configured to receive or otherwise communicate with an open end  182  of specimen bag  180 . More specifically, open end  182  of specimen bag  180  extends through proximal opening  128  of shaft  120  into lumen  124  of shaft  120  and is sealed therein such that tissue passing proximally through lumen  124  of shaft  120  is routed through open end  182  of specimen bag  180  and into interior  184  of specimen bag  180 . To this end, specimen bag  180  depends from housing  110  such that gravity facilitates passage of tissue from lumen  124  of shaft  120  into interior  184  of specimen bag  180 . 
     Continuing with reference to  FIGS. 1 and 2 , handle assembly  130  includes fixed handle  114  and a movable handle  132 . Movable handle  132 , more specifically, includes an intermediate portion  133   a  pivotably coupled to housing  110  within housing  110  via a pivot pin  134 . Movable handle  132  further includes a bifurcated flange portion  133   b  extending from intermediate portion  133   a  further into housing  110  and a grasping portion  133   c  extending from intermediate portion  133   a  in an opposite direction as compared to bifurcated flange portion  133   b . Grasping portion  133   c  extends externally from housing  110  and defines a finger loop  133   d  to facilitate grasping thereof. Intermediate portion  133   a  of movable handle  132  further defines a cam slot  133   e  therethrough on the grasping-portion side of pivot pin  134 . 
     Bifurcated flange portion  133   b  of movable handle  132  surrounds and is captured between annular rims  163   a ,  163   b  of mandrel  162  of first drive assembly  160 . Mandrel  162 , in turn, is secured to the proximal end portion of shaft  120  such that translation of mandrel  162  through housing  110  likewise translates shaft  120  relative to housing  110 . First drive assembly  160  further includes a biasing member  164  configured to bias mandrel  162  proximally, thereby biasing shaft  120  proximally and movable handle  132  towards an un-actuated position, wherein movable handle  132  is spaced-apart from fixed handle  114 . As an alternative to first drive assembly  160  coupling movable handle  132  with shaft  120  to enable movement of shaft  120  relative to housing  110  (and, thus, grasper assembly  150 ), first drive assembly  160  may couple movable handle  132  with outer shaft  174  of second drive assembly  170 , similarly as above, to enable movement of outer shaft  174  and, thus, grasper assembly  150  relative to housing  110  (and, thus, shaft  120 ). 
     Movable handle  132  is further operably coupled to grasper assembly  150  via cam slot  133   e  and second drive assembly  170 . Second drive assembly  170  includes an outer shaft  172  fixed relative to housing  110  and supporting grasper assembly  150  at a distal end portion thereof, and inner drive shaft  174  slidably disposed within outer shaft  174  and operably coupled to jaw members  152 ,  154  of grasper assembly  150  at a distal end portion thereof, and a linkage  176  operably coupled between cam slot  133   e  and a proximal end portion of inner drive shaft  174 . More specifically, a cam pin  178  extending transversely from the proximal end portion of linkage  176  is received within cam slot  133   e  such that, upon pivoting of movable handle  132  about pivot pin  134  and relative to fixed handle  114  from the un-actuated position towards the actuated position, linkage  176  is pulled proximally, thereby pulling inner drive shaft  174  proximally through and relative to outer shaft  172 . Inner drive shaft  174  is operably coupled to jaw members  152 ,  154  of grasper assembly  150 , e.g., via a cam-slot mechanism (not shown), such that proximal movement of inner drive shaft  174  through outer shaft  172  pivots jaw members  152 ,  154  relative to one another from an open positon towards a closed position to grasp tissue therebetween. 
     Movable handle  132  additionally includes a protrusion  138  extending proximally from grasping portion  133   c  thereof. Protrusion  138  is configured to align with activation button  140  to enable activation of activation button  140  via urging from protrusion  138  upon pivoting of movable handle  132  about pivot pin  134  and relative to fixed handle  114  from the un-actuated position to the actuated position, wherein movable handle  132  is approximated relative fixed handle  134 . Activation button  140 , in turn, is electrically coupled to the source of electrosurgical energy (not shown) and distal electrode  122  via lead wires  142  to enable selectively delivery of energy from the source of electrosurgical energy (not shown) to distal electrode  122  upon activation of activation button  140 . 
     Referring still to  FIGS. 1 and 2 , as a result of the above-detailed configuration, pivoting of movable handle  132  about pivot pin  134  and relative to fixed handle  114  from the un-actuated position to the actuated position: urges bifurcated flange portion  133   b  of movable handle  132  distally, thereby urging mandrel  162  and shaft  120  distally relative to housing  110  such that shaft  120  is moved from a retracted position ( FIG. 3A ), wherein grasper assembly  150  extends distally from shaft  120 , to an extended position ( FIG. 3B ), wherein shaft  120  is disposed at least partially about grasper assembly  150 ; pulls linkage  176  proximally, thereby pulling inner drive shaft  174  proximally to pivot jaw members  152 ,  154  relative to one another from an open positon towards a closed position to grasp tissue therebetween; and urges protrusion  138  into activation button  140  to activate activation button  140 , thereby initiating the supply of energy to distal electrode  122 . 
     Referring to  FIGS. 1-4 , the use and operation of surgical device  100  is described. Initially, movable handle  132  is disposed in the un-actuated position under the bias of biasing member  164  and, as such, shaft  120  is disposed in the retracted position ( FIG. 3A ), wherein grasper assembly  150  extends distally from shaft  120 . Further, in the un-actuated position of movable handle  132 , jaw members  152 ,  154  of grasper assembly  150  are disposed in the open position ( FIG. 3A ) and distal electrode  122  is un-energized. 
     With reference to  FIG. 3A , in conjunction with  FIG. 2 , with movable handle  132  disposed in the un-actuated position, surgical device  100  is manipulated into position adjacent a tissue specimen “S” to be removed such that jaw members  152 ,  154  of grasper assembly  150  are positioned adjacent the tissue specimen “S.” 
     With additional reference to  FIG. 3B , once jaw members  152 ,  154  of grasper assembly  150  are positioned adjacent the tissue specimen “S” as detailed above, movable handle  132  may be moved from the un-actuated position to the actuated position. Movement of movable handle  132  through an actuation stroke from the un-actuated position to the actuated position pivots jaw members  152 ,  154  of grasper assembly  150  relative to one another from the open positon towards the closed position to grasp the tissue specimen “S,” and also advances shaft  120  from the retracted position to the extended position. As such, shaft  120  is extended to at least partially surround grasper assembly  150  and the portion of the tissue specimen “S” grasped thereby. In addition, movement of movable handle  132  through the actuation stroke urges protrusion  138  into activation button  140  to activate activation button  140 , thereby initiating the supply of energy to distal electrode  122  such that, as shaft  120  is advanced about the portion of the tissue specimen “S” grasped by jaw members  152 ,  154  of grasper assembly  150 , the portion of tissue is electromechanically resected, partially or wholly, from the remainder of the tissue specimen “S.” More specifically, the portion of tissue may be resected fully from the tissue specimen “S” to form a tissue segment “T” (as shown), or may be only partially resected such that the portion of the tissue specimen “S” defines a tissue strip capable of passing through lumen  124  of shaft  120 . 
     Once the tissue segment “T” is resected and received within lumen  124  of shaft  120 , movable handle  132  may be returned towards the un-actuated position or released, allowing movable handle  132  to be returned under bias of biasing member  164 . Return of movable handle to the un-actuated position pivots jaw members  152 ,  154  of grasper assembly  150  relative to one another from the closed positon back towards the open position to release the grasped tissue segment “T,” and also retracts shaft  120  from the extended position back towards the retracted position. Although shaft  120  is retracted proximally, the tissue segment “T” is maintained within shaft  120  via engagement of the tissue segment “T” with barbs  126 . Thus, once the tissue segment “T” is disposed within shaft  120 , barbs  126  permit the tissue segment “T” to move proximally through shaft  120  but inhibit the tissue segment “T” from moving distally therethrough. 
     Referring also to  FIG. 4 , with moveable handle  132  returned to the un-actuated position, the above-detailed use may be repeated such that movable handle  132  is actuated through one or more additional actuation strokes to grasp, resect, and draw additional tissue segments “T” into lumen  124  of shaft  120 . As more tissue segments “T” are drawn into lumen  124  of shaft  120  (or, as more length of the tissue strip is drawn into lumen  124  of shaft  120 , in embodiments where tissue is not fully resected), the more-distal tissue segments “T” urge the more-proximal tissue segments “T” further proximally through lumen  124  of shaft  120 . Ultimately, as each tissue segment “T” reaches proximal opening  128  of shaft  120 , the tissue segment “T” falls, under gravity, through open end  182  of specimen bag  180  and into interior  184  thereof, thus collecting the tissue segments “T” for testing and/or safe disposal. 
     Referring generally to  FIGS. 1-4 , as an alternative to manual actuation via movable handle  132 , the above-detailed surgical device  100  may alternatively be configured for use with a robotic surgical system configured, in response to receipt of an actuation signal, to actuate first and second drive assemblies  160 ,  170  and activation button  140  such that, similarly as detailed above, each actuation pivots jaw members  152 ,  154  of grasper assembly  150  relative to one another from the open positon towards the closed position to grasp a tissue specimen “S,” advances shaft  120  distally to at least partially surround grasper assembly  150  and the portion of the tissue specimen “S” grasped thereby, and activates activation button  140  to supply energy to distal electrode  122  to resect the portion of the tissue specimen “S” grasped by jaw members  152 ,  154 . In addition, as also detailed above, a specimen bag  180  may be provided to collect the tissue segments “T” for testing and/or safe disposal. 
     The robotic surgical system may employ various robotic elements to assist the surgeon and allow remote operation (or partial remote operation). More specifically, various robotic arms, gears, cams, pulleys, electric and mechanical motors, etc. may be employed for this purpose and may be designed with the robotic surgical system to assist the surgeon during the course of an operation or treatment. The robotic surgical system may include remotely steerable systems, automatically flexible surgical systems, remotely flexible surgical systems, remotely articulating surgical systems, wireless surgical systems, modular or selectively configurable remotely operated surgical systems, etc. 
     The robotic surgical system may be employed with one or more consoles that are next to the operating theater or located in a remote location. In this instance, one team of surgeons or nurses may prep the patient for surgery and configure the robotic surgical system with the surgical device disclosed herein while another surgeon (or group of surgeons) remotely control the surgical device via the robotic surgical system. As can be appreciated, a highly skilled surgeon may perform multiple operations in multiple locations without leaving his/her remote console which can be both economically advantageous and a benefit to the patient or a series of patients. 
     The robotic arms of the robotic surgical system are typically coupled to a pair of master handles by a controller. The handles can be moved by the surgeon to produce a corresponding movement of the working ends of any type of surgical instrument (e.g., end effectors, graspers, knifes, scissors, etc.) which may complement the use of one or more of the embodiments described herein. The movement of the master handles may be scaled so that the working ends have a corresponding movement that is different, smaller or larger, than the movement performed by the operating hands of the surgeon. The scale factor or gearing ratio may be adjustable so that the operator can control the resolution of the working ends of the surgical instrument(s). 
     The master handles may include various sensors to provide feedback to the surgeon relating to various tissue parameters or conditions, e.g., tissue resistance due to manipulation, cutting or otherwise treating, pressure by the instrument onto the tissue, etc. As can be appreciated, such sensors provide the surgeon with enhanced tactile feedback simulating actual operating conditions. The master handles may also include a variety of different actuators for delicate tissue manipulation or treatment further enhancing the surgeon&#39;s ability to mimic actual operating conditions. 
     From the foregoing and with reference to the various drawings, those skilled in the art will appreciate that certain modifications can be made to the present disclosure without departing from the scope of the same. While several embodiments of the disclosure have been shown in the drawings, 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.