Patent Publication Number: US-2010121136-A1

Title: Methods and apparatus for capturing and manipulating body parts

Description:
PRIORITY CLAIM 
     This application claims priority to U.S. Provisional Patent Application Ser. No. 61/059,806, filed Jun. 8, 2008, the disclosure of which is incorporated by reference in its entirety for all purposes. 
    
    
     FIELD OF THE INVENTION 
     The present invention relates to devices and methods for retrieving and manipulating body parts, and more particularly to devices and methods for retrieving and manipulating tendons or similar body parts. 
     BACKGROUND 
     A person&#39;s hand has tendons that extend along the length of each finger and assist in moving the fingers. When properly positioned in the finger, each tendon passes through three separate pulleys, which medical practitioners skilled in surgery understand are collar-like structures in the finger. One or more of these tendons can be accidentally severed and, if so, tension in the tendon causes the severed end of the tendon to be pulled away from the finger tip and back through one or more of the pulleys. To reattach the tendon the hand must be opened surgically, the end of the tendon retrieved, pulled back into position through each relevant pulley towards the fingertip, and sutured into place. 
     The difficulty in retrieving severed tendons lies largely in the problem of pulling a severed tendon back through each of the pulleys because the available space is small and current devices will not easily fit (if they fit at all) in the available space. Furthermore, many current devices are rigid and do not bend along the contour of the finger. 
     Therefore, a device is needed that fits through the pulleys and that can follow the contour of a finger to assist with directing tendons back through applicable pulleys. It would also be advantageous if such a device could grasp and retrieve more than one tendon at a time in order to reduce the time of a surgery. 
     DEFINITIONS 
     “Body part” means one or more body parts, such as one or more tendons. 
     “Catheter” means any elongated device that may be used to extend into any part or portion of the body and used in the practice of the invention. 
     “Grasping portion: means any structure or device that can grasp a body part with sufficient force to move the body part into the position desired by the user. 
     “User” means a person using the catheter. The user may be a physician such as a surgeon. 
     “Wire mesh” means any structure comprised of wires or struts. 
     “Retriever” means to grasp a body part with enough force to move it to another position desired by a user of the device. 
     SUMMARY OF THE INVENTION 
     Aspects of the present invention comprise a catheter with a proximal end that is juxtaposed an operator when in use and a distal end that has a grasping portion that is preferably at or near the distal end. The grasping portion is preferably comprised of a wire mesh with a first end affixed to the distal end of the catheter and a second end that has an open position wherein it does not grasp a body part and a closed position wherein it can grasp a body part with sufficient force for the user to move the body part to a desired location. The invention may be used to retrieve one or more severed tendons in the hand or used to retrieve other body parts. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  illustrates an embodiment of the present invention. 
         FIG. 2  shows the device of  FIG. 1  with a known part attached for introducing a catheter into a body structure such as a blood vessel. 
         FIG. 3  shows the device of  FIG. 2  with its three tubular sections separated. 
         FIG. 4  shows the device of  FIG. 2  with the inner tube partially removed from the catheter. 
         FIG. 5  shows the device of  FIG. 2  with the inner tube removed and the grasping portion in its open position. 
         FIG. 6  is close-up view of the grasping portion as shown in  FIG. 5 . 
         FIG. 7  shows the device of  FIG. 5  in which the outer sheath is being moved over the grasping portion to close it. 
         FIG. 8  is a close-up view of the grasping portion of  FIG. 7 . 
         FIG. 9  shows the device of  FIG. 5  with the outer tube/sheath covering and closing the grasping portion. 
         FIG. 10  is a close-up view of the grasping portion and inner tube of  FIG. 4 . 
         FIG. 11  shows the device of  FIG. 1  with the stylus slightly removed. 
         FIG. 12  is a close-up view of a stylus and catheter tip. 
         FIG. 13  shows an alternate embodiment of the invention. 
         FIG. 14  shows a close-up view of the grasping portion of the device of  FIG. 13  with the grasping portion in a partially open position. 
         FIG. 15  shows a close-up view of the grasping portion of the device of  FIG. 13  in a fully open position. 
         FIG. 16  shows the device of  FIG. 13  with the grasping portion in a closed position. 
     
    
    
     DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS 
     Turning now to the Figures, wherein the purpose is to describe preferred embodiments of the invention and not to limit same,  FIGS. 1-12  illustrate one preferred embodiment of the invention. Device  10  comprises a catheter  12  having a proximal end  13 , a distal end  14 , a tip  16  (that is preferably removable), a stylus  16 A attached to or formed integrally with tip  16 , an inner tube  18  and an outer tube  20 . A connector port  21  is preferably attached to or near proximal end  13  and is known in the art and could be any suitable type now known or designed in the future. A catheter according to the invention may have any desired diameter, but preferably has an outer diameter of between 10 mm and 25 mm. 
     Inner tube  18  has a proximal end  18 A and a distal end  18 B and a grasping section  22  is attached to (preferred) or integrally formed with end  18 B. Inner tube  18  is preferably formed of biocompatible plastic and is preferably of a standard width and manufactured of standard material used to manufacture catheters. 
     Grasping section  22  has a proximal end  22 C attached or integrally formed with end  18 B, a body part  22 A, a distal end  22 B and a cavity  22 D that is located within and defined by body part  22 A when grasping section  22  is in its open position. Grasping section  22  is preferably made of wire mesh that is preferably nitinol wire mesh or stainless steel mesh, but any suitable material or device may be used for grasping section  22 . Alternatively, grasping section  22  may comprise struts that are substantially parallel to one another. Grasping section  22  has an open position (as shown, for example, in  FIG. 5 , wherein a body part can be received in cavity  22 D, and a closed position (as shown, for example, in  FIG. 9 ) wherein grasping section  22  grasps a body part or is closed for deployment through tissue. The grasping section  22  may be provided with additional aspects that improve gripping ability, such as an inward-facing edge whether smooth or discontinuous (e.g. to have a jagged edge to improve grip), or inward-facing hooks. 
     When the device  10  is assembled (see, e.g.,  FIG. 2 ), outer tube  20  surrounds inner tube  18  and may be moved over the inner tube  18  in either the proximal  13  or distal  14  directions by sliding. When the outer tube  20  is deployed in the distal direction (see, e.g.  FIG. 2 ), the outer tube compresses the grasping section  22  and substantially reduces its effective outside diameter to a sufficient size to pass through human tissues. With the outer tube  20  in this position, the grasping section  22  is in its closed position. For example,  FIGS. 7 and 8  show the outer tube  20  compressingly engaging the grasping section  22 , and in  FIG. 9 , the outer tube  20  has completely compressed the grasping section  22  which is now nested within the outer tube Likewise, moving the outer tube  20  towards the proximal end  13  of the catheter allows the grasping section  22  to open by spring forces in the material comprising the grasping section  22  (see, e.g.  FIG. 5 ). 
     As shown, the catheter may include a tip  16  and stylus  16 A that is insertable into the inner tube  18  of the catheter. A purpose of tip  16  is to create a solid, rounded section that can easily be moved through certain body structures, such as pulleys in the finger or hand, and any suitable design may be used. Stylus  16 A is preferably long enough to make the combined structure including stylus  16 A and tip  16  easy to find and use when performing multiple procedures (for example, when retrieving the tendons on multiple fingers). 
     In one method of the present invention using the catheter of  FIGS. 1-12 , the device  10  is assembled with the tip  16  and stylus  16 A is inserted into distal end  14  of the catheter, and the outer tube  20  is slid toward the distal end  14  of the catheter to compress the grasping section  22 . The distal end  14  is then juxtaposed a body part to be operated upon. In one embodiment, the tip  16  of the device  10  is inserted through at least one pulley in the hand, and may be threaded through as many pulleys as needed until the tip  16  comes within the vicinity of the severed end of a tendon. Typically, the direction of insertion is from the distal end of the finger towards the patient&#39;s body, but other directions may be used depending on the body part needing to be grasped and manipulated. Once the device  10  has been inserted to a desired location, tip  16  and stylus  16 A are removed. Alternatively, device  10  may not include a tip  16  or stylus  16 A, or may include another type of suitable tip. Once any tip is removed, the outer tube  20  is slid toward the proximate end  13  of the device  10  to allow the grasping section  22  to open. The tendon or other tissue part is then received in the cavity  22 D in the opened grasping section  22 , and then the outer tube is slid toward the distal end  14  of the catheter, at least partially compressing the grasping section  22 , which in turn applies a gripping force to the surface of the tendon or body part to be moved. The device  10  is then pulled from the proximate end  13  to pull the tendon or other body part, and in one embodiment, a tendon is pulled through one or more pulleys of the hand. The grasping section may then release the tissue or tendon by sliding the outer tube  20  toward the proximate end  13  of the catheter, and the physician may then take additional actions such as removing the device  10  and attaching the tendon or tissue to a desired location such as by suturing. 
       FIGS. 13-16  show an alternate embodiment of the invention. Device  10 ′ comprises a catheter  12 ′ having a proximal end  13 ′ and a distal end  14 ′. The grasping section  22 ′ of device  10 ′ is not located at distal end  14 ′, but is juxtaposed the distal end  14 ′. The catheter  12 ′ has an inner tube  18 ′ with a grasping section  22 ′, the grasping section  22 ′ having a proximate grasping end  22 C′ and a distal grasping end  22 B′. The proximate grasping end  22 C′ is at least partially formed on or attached to the inner tube, and may in some embodiments be attached to the interior lumen of the inner tube  18 ′. The distal grasping end  22 B′ of the grasping section  22 ′ is attached to an innermost tube  23 ′ that is slidably disposed within the inner tube  18 ′ and extends beyond the distal end of the inner tube  18 ′. The distal grasping end  22 B′ may be attached to the inner most tube  23 ′ by any appropriate means, such as by molding, integrally forming, adhering, or coupling, and may be attached to a lumen of the innermost tube  23 ′. 
     Grasping section  22 ′ is preferably made of wire mesh that is preferably nitinol wire mesh or stainless steel mesh, but any suitable material or device may be used for grasping section  22 ′. Grasping section  22 ′ has an open position (as shown, for example, in  FIG. 15 , wherein a body part can be received through an opening  220 , and a closed position (as shown, for example, in  FIG. 16 ) wherein grasping section  22  grasps and can retrieve a body part. 
     The innermost tube  23 ′ has a first position and a second position relative to the inner tube  18 ′, the grasping section  22 ′ being in its open position when the innermost tube  23 ′ is in its first position (see, e.g.,  FIG. 15 , where the distal end of the innermost tube has been moved toward the proximate end of the inner tube) and being in its closed position when the innermost tube is in its second position (see, e.g.,  FIG. 16 , where the distal end of the innermost tube has been moved away from the proximate end of the inner tube). Put another way, sliding the innermost tube  23 ′ through the inner tube  18 ′ to move the distal ends of the inner tube  18 ′ and innermost tube  23 ′ away from each other  26 ′ flattens and compresses the grasping section  22 ′ to grasp tissue or otherwise reduces diameter of the grasping section  22 ′ to assist with deployment through tissue Likewise, sliding the innermost tube  23 ′ through the inner tube  18 ′ to move the distal ends of the inner tube  18 ′ and innermost tube  23 ′ toward each other  25 ′ opens the grasping section  22 ′ to create an opening  220  which may receive tissue to be grasped. In other embodiments, the inner sheath  18 ′ may be surrounded by a slidable outer sheath (not shown) to cover the gripping section  22 ′ to assist with transport through tissue, or to improve the gripping strength of the gripping section  22 ′ when deployed toward the distal end  14 ′ of the catheter  12 ′. 
     A solid or flexible distal tip  16 ′ may also be provided that may be unremovably or removably attached to the distal end  14 ′ of the catheter  12 ′. The tip  16 ′ is provided to assist with threading the device  10 ′ through tissues to the vicinity of a tendon or other tissue that needs to be grasped and pulled.