Patent Publication Number: US-2023146263-A1

Title: Apparatus for tissue removal

Description:
RELATED APPLICATION 
     This application is a continuation of U.S. application Ser. No. 16/337,288, filed Mar. 27, 2019, which is a national stage entry of PCT Application No. PCT/M2016/051063, filed Sep. 27, 2016, the entire contents of which are hereby incorporated by reference. 
    
    
     TECHNOLOGICAL FIELD 
     The present disclosure is in the field of medical devices, and relates in particular to surgical tools. 
     BACKGROUND 
     Tissue removal from the body is solicited in various scenarios including for diagnosis or treatment purposes. For example, in biopsy procedure, a sufficiently small tissue specimen is acquired in order to undergo examination outside the body. Usually, the shape of the specimen or the cavity left at the site of the removed tissue have low importance, the body heals from the injury leaving apparently no traces. In another example, cancer treatment may involve tissue removal. Here, it is important to remove as much cancerous tissue as possible. On-line examination is carried to ensure that the ill tissue has been removed. In yet another example, tissue is removed in order to create paths for drainage of excessive liquids such as in Glaucoma condition. In the latter case, full control over the shape and volume of the cavity inside the body is necessary. 
     In WO2013186779 and WO2015145444, both assigned to the assignee of the present invention and incorporated herein by reference, various embodiments of cutting tools for controllable creation of a channel in the eye wall are described. The cutting tools are directly mounted on a reusable grip unit which includes a rotor to cause rotation of the cutting tool about its longitudinal axis upon actuation of the rotor. 
     GENERAL DESCRIPTION 
     The present invention provides a novel full-fledged apparatus for use in controlled tissue removal procedures. The apparatus of the invention is especially useful to use in treating sensitive body organs, such as the eye where accuracy of surgery is a must. The apparatus can then be used to create a diameter-controlled channel in the eye wall to treat glaucoma. The apparatus is user-friendly for both the treating and treated persons. It is safe to use and includes carefully-considered safety measures. Additionally, it assures sterile conditions while keeping the costs reasonable. 
     The apparatus includes a hand-held disposable probe device which includes a cutting tool, and a separate rotating motor device (a rotor) mounted on the proximal end of the disposable probe. The user grasps the disposable hand-held probe, functioning as a grip unit as well as the cutting tool. By fully separating between the probe and the motor, several advantageous features are gained. First, the probe can be disposable, a one-use only device therefore sterile, made from cost-effective yet durable materials. The rotor can be a multi-use device made from durable materials for long-lasting operation. Second, both the volume and weight of each of the hand-held probe and the rotor are under control to thereby control the overall weight of the device, a crucial factor when it comes to carrying the device by hand in order to perform sensitive and accurate surgical procedures. For example, since the motor is the heavier part, then making it smaller/shorter, by including the necessary transmission assembly within the lighter and disposable probe, keeps the parasite moment forces acting on the whole apparatus (the probe and the motor) balanced, and helps the physician in operating the apparatus by minimizing fatigue. When the lighter disposable probe is longer, the motor rests between the thumb and index fingers, hence increasing the convenience and manageability of the apparatus, whether being used by a right or left hand user. 
     The connection of the disposable probe to the rotor can be reversible (two opposite orientations), or is possible in a plurality of pivotal orientations between them. This saves effort and time when attaching the rotor to the disposable part, while insures full functionality. 
     The hand-held probe can be optimized for interaction with the external anatomy (the treated surface) of the body organ, e.g. the eye; its construction has at the top (distal) end a sufficiently short head portion with a preferred inclination angle, relative to the longer handle used to hold the probe. This enables approaching every point in the body organ comfortably from outside. The short head is achieved by positioning the rotor at the back (proximal) end of the hand-held device and providing a suitable transmission assembly from the rotor, through the longitudinal handle, to the cutting tool at the top end. 
     The apparatus includes a plurality of user-friendly features to maximize its efficiency and ergonomics. The hand-held probe can be used with right and left hands alike. The apparatus includes a backrest for the index finger to enable better grip and control of the cutting tool&#39;s orientation. As mentioned above, the positioning of the rotor at the back end of the elongated handle, such that the back end of the handle or the rotor or the interface there between sits between the surgeon&#39;s thumb and index finger (on the first dorsal interosseous muscle) functions as a balancing feature (because of the relatively heavier weight of the rotor) and consequently gives the surgeon more accurate control on the three dimensional orientation of the device. 
     The transmission assembly which passes through the hand-held probe from the rotor to the cutting tool is made from disposable plastic or other low cost and durable material(s). The transmission assembly includes at least two consecutively arranged/coupled parts with at least an inlet part and an outlet part. The outlet part is installed within the hand-held probe&#39;s housing in such a way that an axial lash is maintained. Along its operation, the transmission assembly is constructed such that it pushes the cutting tool towards outside the device, i.e. forwardly towards the treated organ, thus enabling better attachment to the organ. 
     The apparatus applies first-class safety measures both on the mechanical and control aspects. First, it includes a cover that covers the cutting tool before being used. The cover does not open accidentally unless actively opened. It does not open fully unless it passes a certain threshold distance. it opens along a path which does not coincide with cutting tool. It is removable only when fully opened and by pulling it in a different direction than the cutting tool axis and apex. Second, the activation of the cutting tool is controlled and monitored by a dedicated, specifically programmed control unit. The control unit enables to choose predetermined chosen values of the different activation parameters, to suit the specific surgical procedure. In one example, one fixed pulse is generated in response to the activation action; i.e. the output is not direct and continuous, meaning no additional output is generated in response to additional activations during a predefined period of time. 
     As a flexible solution, the invention can be potentially integrated in treatment machines which are already available in the operating room. For example, a treatment machine provided with a connection to which the hand-held probe and motor devices can be connected, and which can have an upgradable control unit can be used with invention. In this way, the surgeon will be able to perform related treatments from the same machine, while saving treatment time and space in the room. 
     Thus, according to a first broad aspect of the invention, there is provided an apparatus for use in tissue removal from a body organ, the apparatus comprising a hand-held probe device, a rotating motor device and a connection assembly configured for removably interconnecting between said hand-held probe device and said rotating motor device; 
     said hand-held probe device being disposable and comprising a housing having proximal and distal ends, a rotatable cutting tool extending distally from said distal end of the housing and being configured for cutting and removing tissue during rotation, and a transmission assembly passing inside said housing between said proximal and distal ends and being configured for transmitting rotational power to said rotatable cutting tool; 
     said connection assembly being distributed between the proximal end of said hand-held probe device and a distal side of said rotating motor device and configured for engaging between said rotating motor device and said transmission assembly to thereby controllably rotate the cutting tool and remove tissue. 
     In some embodiments, the apparatus further comprises a control unit configured for connecting to said rotating motor device and being configured and operable to activate the rotating motor device in a controlled activation mechanism. 
     In some embodiments, the connection assembly is configured to enable connecting said rotating motor device to said hand-held probe device in at least two relative orientations. In yet some embodiments, the connection assembly comprises a reversible connector. 
     In some embodiments, said housing comprises an elongated body and a head body successively arranged from said proximal end to said distal end of the housing. Said elongated body and head body can be formed as an integral member. Said head body can be oriented with a predetermined angle with respect to the elongated body, said predetermined angle being selected in accordance with an orientation of a treatment surface of the body organ. Said elongated body can have a predetermined length selected to provide a stable holding position of the apparatus during operation. Said stable holding position can be such that said rotating motor device rests on first dorsal interosseous muscle of a user holding the apparatus. 
     In some embodiments, said hand-held probe comprises a holding portion enabling a user to control three-dimensional orientation of the rotatable cutting tool. Said holding portion can comprise a depression in which a user positions his index finger, to thereby control the three-dimensional orientation of the rotatable cutting tool. Additionally or alternatively, said holding portion can be configured for enabling left- or right-hand user to operate the apparatus. 
     In some embodiments, said transmission assembly exerts both rotational and forward forces on the cutting tool, thereby enhancing attachment of the cutting tool to the body organ during operation. 
     In some embodiments, said housing comprises a removable cover configured to safely cover the cutting tool when not in use. Said cover can be configured to move in a predefined spatial path between a closed state covering said cutting tool and an open state revealing said cutting tool, while still being attached to the housing. Said hand-held probe can comprise a safety opening mechanism configured to return said cover to its closed state if the cover does not pass a predetermined distance along said spatial path. Additionally or alternatively, said hand-held probe can comprise a safety locking mechanism configured to keep said cover in said closed state unless pushed by the user along said spatial path. Said cover can be configured to be removable from said housing only when in its open state. Said open state of said cover can be configured to enable removing the cover by pulling it in a direction different from the cutting tool&#39;s longitudinal axis. 
     In some embodiments, said control unit comprises a touch screen. 
     In some embodiments, said control unit is preprogrammed to activate said rotating motor by generating a single fixed activation signal of a known rotation speed and duration during a predetermined time interval. 
     In some embodiments, the apparatus further comprises a pedal for activating predetermined activation functions, to controllably rotate said cutting tool. 
     In some embodiments, said body organ is the eye, said cutting tool being configured to form a channel in the sclera. 
     According to another broad aspect of the invention, there is provided a control unit for controlling operation of a tissue removal apparatus for tissue removal from a body organ, the control unit comprising an activation mechanism for activating a cutting tool of the tissue removal apparatus, and a controller configured for operating said activation mechanism to generate a single fixed activation signal of a known intensity and duration during a predetermined time interval, thereby restricting operation of the cutting tool during said time interval to said single activation signal only. 
     According to yet another broad aspect of the invention, there is provided a hand-held probe device comprising a rotatable cutting tool and being configured for connecting said cutting tool to an external rotating motor device, thereby enabling said probe device with the cutting tool to be disposable; said hand-held probe device comprising: a hollow housing having proximal and distal ends and comprising an elongated body and a head body successively arranged with a predetermined angle therebetween from said proximal end to said distal end; and a transmission assembly passing inside said housing and being connected at one end to said cutting tool and at the other end to a connection assembly associated with said rotating motor device to thereby controllably transfer power from the rotating motor device to the cutting tool. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       In order to better understand the subject matter that is disclosed herein and to exemplify how it may be carried out in practice, embodiments will now be described, by way of non-limiting example only, with reference to the accompanying drawings, in which: 
         FIGS.  1 A- 1 D  illustrate a non-limiting example of an apparatus configured in accordance with the present invention; 
         FIGS.  2 A- 2 E  illustrate a non-limiting example of a connection assembly for connecting between a hand-held probe and a rotating motor configured in accordance with the present invention; 
         FIGS.  3 A- 3 F  exemplify a safety cover and variety of safety mechanisms included in the hand-held probe of the present invention; 
         FIGS.  4 A- 4 B  illustrate various functional features included in the hand-held probe of the present invention; and 
         FIG.  5    exemplifies various components of the control unit of the present invention. 
     
    
    
     DETAILED DESCRIPTION OF EMBODIMENTS 
     Reference is made to  FIGS.  1 A- 1 D  illustrating a non-limiting example of a medical apparatus  100  configured according to the present invention. The medical apparatus  100  is configured for use in procedures involving tissue removal from a body organ, e.g. removing tissue from an eye such as to create a channel in the sclera tissue of the eye to allow draining of extra fluid accumulating inside the eye, a symptom that causes various medical conditions and/or complications. As shown in  FIG.  1 A , the apparatus  100  includes a hand-held probe device  110  which includes a rotatable cutting/surgical tool that cuts and removes the tissue, and a rotating motor device  120  that causes rotational movement of the cutting tool to remove the tissue. the hand-held probe and the rotating motor device, being enclosed in separate housings, are interconnected by a connection assembly  140 , as briefly shown in  FIG.  1 B  and as will be described further in detail below with reference to  FIGS.  2 A- 2 E . The apparatus  100  can also include, as shown, a control unit  130  that controls the operation of the rotating motor device and the cutting tool. Also shown in the figures, an optional stand  124  configured to safely hold the hand-held probe device when not being in use, and an optional pedal  134  by which a user can activate the control unit and/or the rotating motor. 
     As shown in  FIG.  1 C , the hand-held probe  110  includes, on the outside, a housing  111  extending between a proximal end PE and a distal end DE, and a rotatable cutting tool  116  extending distally from the distal end of the housing. In this application the word “distal” indicates the patient side, while the word “proximal” indicates the operator/physician side. The rotatable cutting tool  116  is configured for cutting and removing tissue during rotation. The cutting tool  116  can be configured as described in WO2013186779 titled “Medical Device, Assembly and Method for Creating a Channel in Soft Tissue” and in WO2015145444 titled “Medical Device for Tissue Removal”, both assigned to the assignee of the present invention and are incorporated herein by reference. On the inside, the housing of the hand-held probe encloses therein a transmission assembly configured to transmit rotational power from the rotating motor device  120  to the cutting tool  116  to thereby cause its rotation. An example of a transmission assembly is described herein below with reference to  FIG.  1 D . 
     The housing of the hand-held probe device can be formed as an integral member having a unibody configuration or it can be formed from more than one part, e.g. two parts. In either case, the housing can have more than one longitudinal axis along its length, between the proximal and distal ends. Having a plurality of longitudinal axes can be useful in that it enhances flexibility and access of the rotatable cutting tool to the treated organ in the three dimensional space. By tilting the housing at at-least one point along its length or by including two or more successive parts inclined by predetermined angles there between, with respect to each other, the three dimensional orientation of the probe as well as the cutting tool with respect to a treatment surface, being the organ&#39;s surface faced by the cutting tool, can be controlled. In the described example, as shown in  FIG.  1 C , the housing includes an elongated body  112  at a proximal side (i.e. at the side of the user, far from the patient) and a head body  114 , on which the rotatable cutting tool  116  is mounted, at a distal side (at the side of the patient, far from the user). As can be seen, the head  114  is oriented with a predetermined angle α with respect to the elongated body  112 . The predetermined angle α can be defined in several ways. In the example shown, it is defined as the angle between the longitudinal axes of the elongated body  112  and the cutting tool  116 , where the angle&#39;s rays AB and BC are parallel to the longitudinal axis of the elongated body and to the longitudinal axis of the cutting tool, respectively. The predetermined angle α is chosen based on the specific medical application to enable effective and comfortable access to the tissue removal site, in other words it is chosen to provide better or optimal ergonomics for holding the device with respect to the tissue treatment site. Consequently, the predetermined angle is selected to enable access of the cutting tool  116  to every point on the body organ, taking into account the curviness of the organ/treatment surface, while the user holds the probe  110  with his hand. The predetermined angle α is determined based on several factors, including, inter alia, absolute lengths of the elongated body and the head, or the relative length between them; length of the cutting tool; anatomy of the treated organ and its surrounding. The value of a is typically equal to or larger than 90° up to a maximum of 180°. In the case of treating the eye, a is chosen to be close or equal to 135°. 
     The apparatus of the present invention increases the safety of the patient and minimizes any risk of infection. According to preferable embodiments, the whole hand-held probe  110  is disposable, such that it is used once and on one patient at a time. As such, the whole probe  110  is made from materials that enable its disposal, such as different medical grade polymers, e.g. biocompatible polymers, with the exception of the cutting tool being made from biocompatible metal, ceramic or the like. At the same time, as the probe is used for short time, it can be made from affordable yet durable materials. For example, the probe housing can be made from Polycarbonate (plastic parts), and the surgical tool from Corrosion Resistance Steel (CRES)  420 F. 
       FIG.  1 D  illustrates a non-limiting example of a transmission assembly  150  configured according to the invention. The transmission assembly which is accommodated inside the housing  111 , e.g. the elongated body  112  and the head body  114 , is made from light-weight and disposable, yet durable materials, such as polymers. The transmission assembly is designed and selected to withstand rotational speed of tens of thousands of rpm. In specific situations, as when removing soft tissue as the sclera in the eye, the speed is chosen to be around 8,000 rpm, which is sufficient but not oversized. Further, the transmission assembly enables effective transmission of the rotational power and includes minimum number of separate elements to achieve this. In the described example, the transmission assembly  150  includes three parts: a clutch  146 , an inlet shaft  152  coupled to the clutch and an outlet shaft  154  coupled to the inlet shaft. The distal portion of the inlet shaft  152  includes an inlet gear  156  which is coupled to an outlet gear  158  formed at the proximal portion of the outlet shaft. The transmission assembly exerts both rotational and forward forces on the cutting tool  116 , thus enhancing attachment of the head body, and the cutting tool, to the body organ during treatment. In the example shown, the outlet shaft  154  has certain axial lash, and the gear profile creates a force vector directed forwardly to the distal direction. After attaching the motor device to the probe device, the clutch and inlet shaft are fixedly attached as a single rigid element and turn together as one part during rotational movement. 
     The rotating motor  120  connects, by its distal side, to the proximal end (PE in  FIG.  1 C ) of the probe  110 , via the connection assembly  140  which is located at the proximal end of the probe and the distal end of the rotating motor, to thereby cause rotation of the cutting tool  116  via the transmission assembly passing inside the probe&#39;s housing. The rotating motor can include an integrated sensor such as a magnetic, optical or other kind of encoder. In the case of a magnetic encoder, the configuration may be such that the encoder has a magnet with numerous polarities connected to the rotor part of the motor. Reading of the magnet polarities change is done by dedicated sensors, e.g. HOLE sensors, which are static and assembled inside the housing of the rotating motor. The sensor can be responsible for motor speed detection, rotation direction detection and number of rounds calculation. The motor type can be a brush or brushless motor or any other suitable kind. 
     The control unit  130  controls the operation of the motor  120  via a connection  122 , which in the shown example is a wired connection. In some embodiments, the connection can be wireless. As will be further detailed below, the control unit  130  activates the motor  120  and causes the rotation of the cutting tool  116  in response to a function selection made by the user via a control panel  132  on the control unit  130 . In some embodiments, as will be further described below, the control panel  132  includes a touch screen to select activation functions and/or parameters. 
     In some embodiments, such as in the example shown, the apparatus  100  further includes a pedal  134  which the user presses down by his foot to activate the rotating motor, based on a function preselected on the control unit  130 . Similarly, the pedal is connected to the control unit via a connection  136 , which in this example is a wired connection, however a wireless connection can be equally used. The pedal can be positioned inside an enclosing housing EH that minimizes accidental foot-pressing. It is only when the user inserts his foot inside the enclosing housing that he can press the pedal. As a result, unintentional pressing and activation of the rotating cutting tool is avoided. In addition, the enclosing housing functions as a guide for the operator. When the operator is focused on the patient and microscope he is able to find the pedal enclosure and to navigate his foot directly inside without the help of others. 
     The apparatus of the invention enables independent and fully-functional usage by the physician alone. Using a pedal enhances this by allowing the physician to independently use the apparatus by holding the probe in one hand and keeping the other hand free which he can then use to hold the patient or to hold another accessory/device needed in the process. 
     Reference is made to  FIGS.  2 A- 2 E  illustrating a non-limiting example of a connection assembly  140  configured according to the present invention. according to the invention, the connection assembly allows connecting the rotating motor  120  to the probe  110  in at least two orientations, relative to each other. The connection assembly is typically distributed between the hand-held probe, at its proximal end, and the rotating motor, at its distal side. In the described example, the connection assembly  140  provides a reversible connection between the motor and the probe, i.e. it allows connection between both devices in two opposite (180°) orientations. As shown in  FIGS.  2 A and  2 B , the motor  120  has at its distal side, the side connecting to the probe, one of the two elements of the connection assembly, where a hollow rod  142  extends distally and in which a rotatable shaft  144  is installed. An exploded view is shown in  FIG.  2 B . The rotatable shaft  144  connects at its proximal end to the rotating motor  120  so as to transmit the rotational movement down the way to the cutting tool  116 . The probe  110  includes at its proximal side the clutch  146  forming the second element of the connection assembly  140 . As can be seen in  FIG.  2 C  the clutch  146  and the rotatable shaft  144  engage together in a male-female engagement mechanism, such that two protrusions  144 P on the shaft  144  engage with two corresponding depressions  146 D formed in the proximal end of the clutch  146 . The engagement between the protrusions and the depressions is further illustrated in  FIG.  2 D  which shows a longitudinal cross-sectional view of the clutch  146 . 
     As shown, the two protrusions  144 P, as well as the two depressions  146 D, are identical and formed in a 180° with respect to each other. As a result, the connection is reversible and the probe and the motor are connectable to each other even if one is turned with a 180° with respect to the other during the engagement process. It is noted that the protrusions and the corresponding depressions may be more than two, and in such a case they can be equally spaced from each other along the perimeter of the base of the clutch  146  and the shaft  144 . 
     According to one aspect, the connection assembly enables effortless and seamless attachment between the probe and the motor, such that the user does not need to turn either in order to align them or look at the end sides of the probe and motor when he/she attaches them. In some embodiments, the connection assembly includes axial or rotational movement of one of the two engaging elements with respect to the other. In the described example, as shown in  FIG.  2 E , the clutch  146  is freely movable with respect to the probe  110  both axially and azimuthally. This helps in the attachment process and makes it seamless and unsupervised, because even if the protrusions and depressions are not aligned, when the probe and motor are brought together, then when the user pushes the rotatable shaft against the clutch in the distal direction, a spring  148  pushes the clutch in the opposite proximal direction thus causing the clutch to rotate until the protrusions align with the depressions and the engagement is achieved. The engagement between the motor device and the hand-held probe device involves their internal rotating parts, i.e. the rotatable shaft  144  at the motor side and the inlet shaft  152  at the disposable probe side, which start to move together either in 1:1 transmission ratio or in other predefined ratio. The latter case is particularly useful in case the motor is designed to work in a constant speed while it allows different output speeds for the transmission assembly and the cutting tool. While the internal rotating parts engage as described, the outer housings of the motor device and the hand-held disposable device are not necessarily engaged. In one specific case, they are free to turn with respect to each other. This feature enhances the manageability of the probe by the user as it prevents or at least minimizes parasite moments which might be caused by the wired connection  122  when the probe and motor devices are moved by the user. 
     Reference is made to  FIGS.  3 A- 3 F  illustrating a non-limiting example of a cover used with the disposable probe to keep the cutting tool safely covered when not in use, so to prevent accidental injury. According to the invention, the cover is configured to move in a predefined spatial path between a closed state covering the cutting tool and an open state revealing the cutting tool while still being attached to the head body of the probe. The cover enhances the safety further as it needs to pass a threshold distance along the spatial path in order to finally stay open, otherwise it returns back autonomously to its closed state. Additional safety measure is guaranteed since the cover does not detach from the probe unless it is in its open state, therefore accidental encounter with the cutting tool is prevented or at least minimized, inter alia because the direction of detachment is different from the axis of cutting tool, such that even during an unsuccessful removal of the cover, the user&#39;s hand does not accidentally move towards the cutting tool or at least its sharp apex. Yet further, additional safety is guaranteed by a safety locking mechanism which keeps the closed cover in place as long as no force is applied on it in order to open it. 
     In the described example, as shown in  FIGS.  3 A and  3 B , the cover  160  moves in a curved path, e.g. circular or semi-circular, around a hinge point  162  formed by a dent in the probe&#39;s housing, e.g. in the head body, to reveal the cutting tool. The cover  160  moves upwards, and not downwards, to facilitate its removal by the user. When the cover&#39;s front reaches a certain position, it can be pulled off the probe. If the cover does not pass a predetermined distance towards its open state, it returns back to its closed state, such that it cannot be kept in a partially opened state in which the risk for accidental injury increases. The threshold safety mechanism can be implemented in different ways, such as by providing a spring that acts against the movement until it loses its elasticity, or until the cover is locked at its open state by a suitable protrusion that prevent its back movement. In the described example, the threshold safety is achieved by the special structure of the side bars which act like springs, pushing the cover  160  towards the front of the probe if the cover does not reach the open state and get locked therein. 
     In addition, the probe includes a locking safety mechanism which keeps the cover closed and prevents its accidental opening. Such a safety mechanism is achieved in the described example by providing a depression  166  in the probe&#39;s housing, such as a dent in the head body, which traps the side bars  164  and keeps them in a closed state, as shown in  FIGS.  3 E and  3 F . Opening the cover requires overcoming a protrusion  168  such that the side bars spread to climb over the protrusions  168  on both sides. 
     In addition to the above-mentioned safety mechanisms, the apparatus includes an electrical safety mechanism. The control unit activates the rotating cutting tool after receiving an input of a predetermined duration from the user. The input from the user can be provided via the control panel, e.g. by pressing an icon, or the provided pedal, for a predetermined duration. For example, when a pedal is provided, if the user presses the pedal for a period shorter than a predetermined period (e.g. half a second), the control unit does not activate the cutting tool. This helps in minimizing unintentional activation of the cutting tool. 
     The present invention enhances the ergonomics of the probe to enable convenient, effective and controlled usage. Such requirements are especially important when treating sensitive organs such as the eye, because precise orientation of the probe and control over the power exerted by the operator are important. Reference is made to  FIGS.  4 A- 4 B  illustrating non-limiting examples of ergonomics enhancing features. In some embodiments, as shown in  FIG.  4 A , the probe  110  includes an ergonomic holding portion  170  at its distal side, which is aimed at facilitating the probe&#39;s grasping. The holding portion includes dedicated depressions  172  and  174  for positioning the index finger and the thumb respectively. The holding portion also includes a protrusion  176 , in the vicinity of the depression  172 , which acts as a pointer when the user pushes his index finger against it. In addition, the probe of the invention, e.g. its holding portion, is configured to be ambidextrous, equally used by both right and left handed users.  FIG.  4 A  shows a right hand holding the probe and  FIG.  4 B  shows a left hand holding the probe. 
     Reference is made to  FIG.  5    illustrating non-limiting examples of the control unit of the apparatus with the included control panel which can be in the form of a touch screen configured to enable controlling the operation of the apparatus. The control unit is a computing device that controls the operational mode of the apparatus including treatment parameters or functions of the surgical process as well as a test process. In the figure, a schematic illustration of the components of the control unit  130  is shown. The control unit  130  includes the control panel  132  which is configured to enable the user to select a desired operational mode  190  saved in a memory  180 . A controller  138  configured to execute the chosen operational mode, including parameters or functions, is included in the control unit and connected to the memory  180 . 
     The operational modes  190  include a test mode  192  and a working mode  194 , the latter includes a surgery working mode  196  and a research working mode  198 . 
     The control unit  130 , utilizing the controller  138 , continuously monitors the operation of the apparatus parts to insure normal operation of the apparatus. For example, the following are monitored: connection between the different parts (the motor and probe, the motor and control unit, the control unit and foot switch (pedal)), the speed of the motor, the time of pressing the pedal by the user, number of motor activations as an indicator for motor life time (e.g. 250 cycles) which is limited due to sterilization load. The apparatus can include suitable sensors (not shown) which deliver information to the controller  138  about the operation of the apparatus and its different parts, including the monitored parameters described above. One example is the magnetic encoder described above with respect to the rotating motor device. In some examples, the controller sends signals (e.g. electrical) to the motor device and/or to the pedal device every certain predefined time interval (e.g. every 100 milliseconds) and based on the signal received a fault can be detected and a suitable alert output is generated. The controller  138  may include a programmable chip enabling to add or modify features of the controller. 
     The test mode  192  can be a self-test mode which runs automatically each time the apparatus is turned on or each time an operational fault is detected by the monitoring controller, such as a fault in the connection between the control unit and the motor. Additionally or alternatively, the test mode  192  can run upon user&#39;s request by selecting it via the control panel  132 . The controller  138  outputs a suitable alert according to the error found during the running of the self-test or according to the continuous monitoring applied during the working modes  194  as described above. In one example, the test mode examines the speed of the motor in order to detect failures or alert about end of life. In such case, the controller activates the motor for a predetermined time period and counts the number of rounds the motor performed and compares the result to a value saved in the memory  180 . If the result is out of a predefined range around the saved value, the controller generates a fault alert. The alert may, for example, indicate that the motor may have completed its life cycle and needs to be replaced, that the cable connector is not working as specified or that the sensor monitoring the motor is not working as specified. 
     Upon finishing the test mode, the controller  138  can be programmed to automatically move the apparatus to the working mode  194 . By default, the surgery working mode  196  is selected. This mode is a predefined mode which has the operational parameters of the apparatus fixed at predetermined recommended values that suit the specific surgical operation, the body organ specifications, the treated population/race or the treated species. The control unit can be programmed to include a plurality of surgery working modes, each with saved predefined operational parameters, which the operator can access by a mere press of a button on the control panel (e.g. an icon/tile on a touch screen). For example, when removing tissue from the sclera tissue in the eye, the motor speed is determined to be 8000 RPM and the time for each activation is determined to be 0.4 sec. However, when treating animals, e.g. horses or dogs who suffer from excessive pressure in their eyes, the values are different and specific to the treated species. The saved values of the operational parameters can be recommended values chosen based on experience and/or experiments. 
     If exploring a new surgical operation or a new body organ/tissue, the apparatus can be put into a research working mode, which enables the user to control and change the parameters values. To assure safe usage, accessing the research working mode can be protected with a pin or password. The parameters which can be controlled include, inter alia, the speed of rotation, the duration of rotation, the direction of rotation (clockwise, counter clockwise, or a combination thereof) and the transmission ratio between the motor and the cutting tool. The user can then save a new working mode including the values of the parameters that he used in the research to be easily accessed again in the future. 
     The control panel includes a friendly user-interface that allows the user to choose the operational mode of the device as well as the different operational parameters. 
     Thus, the present invention provides an apparatus that enables a comprehensive, powerful and safe solution for tissue removal from the body. In addition, as described above, the invention may be powerfully integrated within other treatment apparatuses, thereby saving place and complexity inside the operating rooms.