Patent Publication Number: US-2021169514-A1

Title: Cutting Assembly Including A Grip For A Surgical Instrument

Description:
PRIORITY CLAIM 
     This is a continuation of copending U.S. application Ser. No. 16/087,743, filed Sep. 24, 2018, which is a United States national entry of International Patent Application No. PCT/IB2017/051723, filed on Mar. 24, 2017, which claims priority to and all the benefits of U.S. Provisional Patent Application No. 62/312,675, filed on Mar. 24, 2016. The entire contents of each of the above applications are hereby incorporated by reference. 
    
    
     TECHNICAL FIELD 
     The present invention relates generally to surgical instruments, and more particularly to a surgical instrument having a cutting assembly with a grip. 
     BACKGROUND 
     It is known that medical practitioners have found it useful to use surgical instruments to assist in the performance of surgical procedures. A surgical instrument is designed to be applied to a surgical site on the patient. The practitioner is able to position the surgical instrument at the site on the patient at which the instrument is to perform a medical or surgical procedure. Endoscopic surgical procedures are routinely performed in order to accomplish various surgical tasks. In endoscopic surgery the surgical site is may be accessed via small incisions called portals made in the patient, or through natural openings in the patient such as the nasal cavity in the case of sinus surgery. An endoscope, which is a device that allows medical personnel to view the surgical site, is inserted in one of the portals or nasal cavities. Surgical instruments used to perform specific surgical tasks are inserted together with the endoscope or though other portals. The surgeon views the surgical site through the endoscope to determine how to manipulate the surgical instruments in order to accomplish the surgical procedure. An advantage of performing endoscopic surgery is that it minimizes the amount of damage to surrounding tissues in order to access the surgical site and therefore the amount of the body that needs to heal after surgery. Moreover, during an endoscopic surgical procedure, only relatively small portions of the patient&#39;s internal organs and tissue are exposed to the open environment. This minimal opening of the patient&#39;s body lessens the extent to which a patient&#39;s organs and tissue are open to infection. 
     The ability to perform endoscopic surgery is enhanced by the development of powered surgical tools especially designed to perform endoscopic surgical procedures. One such tool, for example, is sold by the Applicant&#39;s Assignee under the trademark ESSx. This tool is in the form of a cylindrical handpiece designed to be held in the hand of the surgeon. Internal to the handpiece there is a motor. A front end of the handpiece is provided with a coupling assembly for releasably holding a cutting accessory. The types of cutting accessories that are attached to these handpieces include shavers and burs. Integral with the motor and coupling assembly is a mechanism for transmitting the rotary power developed by the motor to the cutting accessory. Often, handpieces are not comfortable to the user, and in many cases do not provide easy rotation of a cutting window of the cutting accessory. A surgical instrument designed to overcome one or more of the aforementioned disadvantages is desired. 
     SUMMARY 
     According to one exemplary embodiment of the present disclosure, a cutting assembly for a surgical instrument includes a drive assembly having a motor. The cutting assembly is configured to be removably coupled to the drive assembly of the surgical instrument. The cutting assembly comprises a tube assembly having a longitudinal axis defined between a distal end opposite a proximal end. A cutting window of the tube assembly is at the distal end and adapted to be applied to a surgical site of the patient. An inner tube of the tube assembly is adapted to be rotated by the drive assembly and comprises an inner tube aperture. The tube assembly further comprises an outer tube disposed over the inner tube and comprising an outer tube aperture. The inner tube and outer tube apertures define the cutting window of the tube assembly. The cutting assembly comprises a grip coupled to the tube assembly and configured to be engaged by a portion of a hand of a user. A manually movable member is coupled to the outer tube and adapted to be rotated by the user to rotate the outer tube aperture about the longitudinal axis. The manually movable member is adapted to be rotated with an index finger or a thumb of the hand while the grip is engaged by a web of the hand. 
     According to another exemplary embodiment of the present disclosure, a cutting assembly for a surgical instrument includes a drive assembly including a motor, and a housing coupled to the motor. The cutting assembly is configured to be removably coupled to the drive assembly of the surgical instrument. The cutting assembly comprises a tube assembly having an inner tube adapted to be rotated by the drive assembly, and an outer tube disposed over the inner tube. A grip is coupled to the tube assembly and configured to be engaged by a portion of a hand. The grip comprises a finger portion adapted to be engaged by an index finger or a secondary finger of the hand, and a web portion adapted to be engaged by the web of the hand without being engaged by the palm of the hand. 
     A method for gripping a cutting assembly with at least a portion of a hand of a user is provided. The cutting assembly includes a tube assembly having an inner tube rotatably disposed within an outer tube, a grip coupled to the tube assembly and comprising a finger portion and a web portion, and a manually movable member coupled to the outer tube of the tube assembly. The finger portion of the grip is engaged with a finger of the hand. The manually movable member is engaged with the finger, a thumb, or an index finger of the hand. The web portion of the grip is engaged with a web disposed between the thumb and the index finger of the hand. The manually movable member is moved with the thumb or the index finger to rotate the outer tube of the tube assembly while the web of the hand remains engaged with the web portion and the finger of the hand remains engaged with the finger portion. A drive assembly comprising a motor may be provided, and the drive assembly may be removably coupled to the cutting assembly. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is an elevational view of a surgical instrument according to an exemplary embodiment of the present disclosure. 
         FIG. 1A  is a perspective view of a surgical instrument according to another exemplary embodiment of the present disclosure. The drive assembly is shown in phantom. 
         FIG. 2  is a perspective view of the surgical instrument of  FIG. 1  with a drive assembly removed. 
         FIG. 3  is a right side elevational view of the surgical instrument of  FIGS. 1 and 2  with the drive assembly removed. 
         FIG. 4  is a bottom plan view of the surgical instrument of  FIG. 2 . 
         FIG. 5  is a left side elevational view of the surgical instrument of  FIG. 2 . 
         FIG. 6  is an elevational view the surgical instrument of  FIG. 2  viewed from the proximal end. 
         FIG. 7  is an elevational view of the surgical instrument of  FIG. 2  viewed from the distal end. 
         FIG. 8  is a top plan view of the surgical instrument of  FIG. 2 . 
         FIG. 9  is a sectional view taken along line  9 - 9  of  FIG. 8 . 
         FIG. 10  is a perspective view of a surgical instrument according to another exemplary embodiment of the present disclosure with a drive assembly removed, and a tracking element coupled to a cutting assembly of the surgical instrument. 
         FIG. 11  is a perspective view of the surgical instrument of  FIG. 10 . 
         FIG. 12  is an elevational view of a surgical instrument according to another exemplary embodiment of the present disclosure with a drive assembly removed. 
         FIG. 13  is a perspective view of the surgical instrument of  FIG. 1A  illustrated in operational relationship with a hand of a user. 
         FIG. 14  is an elevational view of the surgical instrument of  FIG. 1A  illustrated in operational relationship with a hand of a user. 
         FIG. 15  is a perspective view of the surgical instrument of  FIG. 1A . 
         FIG. 16  is a perspective view of the surgical instrument of  FIG. 1A  with the drive assembly disengaged from the cutting assembly. 
         FIG. 17  is a perspective view of the surgical instrument of  FIG. 1A , with a housing of the drive assembly is shown in phantom. 
         FIG. 18  is an elevational view of the surgical instrument of  FIG. 1A  with a sectional view of the drive assembly and a portion of the cutting assembly. 
         FIG. 19  is an enlarged view of a portion of  FIG. 18 . 
         FIG. 20  is a sectional perspective view of a portion of the cutting assembly of  FIG. 18 . 
         FIG. 21  is a perspective view of a connection hub of the cutting assembly. 
         FIG. 22  is a perspective view of the drive assembly. 
         FIG. 23  is an exploded view of the drive assembly of  FIG. 22 . 
         FIG. 24  is a top plan view of the drive assembly of  FIG. 22 . 
         FIG. 25  is a sectional view taken along line  25 - 25  of  FIG. 24 . 
         FIG. 26A  is a fragmentary perspective view of the drive assembly. 
         FIG. 26B  is a fragmentary perspective view of the portion of the drive assembly of  FIG. 26A . 
         FIG. 27  is a fragmentary sectional perspective view of the cutting assembly. 
         FIG. 28A  is a perspective view of the cutting assembly. 
         FIG. 28B  is a perspective view of a manually movable member of the cutting assembly of  FIG. 26 . 
         FIG. 29A  is an elevational sectional view of a cutting assembly according to another exemplary embodiment of the present disclosure with the cutting assembly having a tube assembly with straight tubes. 
         FIG. 29B  is an elevational sectional view of a cutting assembly according to another exemplary embodiment of the present disclosure with the cutting assembly having a rotatable end effector. 
         FIG. 30  is an exploded view of a portion of a cutting assembly according to another exemplary embodiment of the present disclosure with the cutting assembly having a tube assembly adapted to be manually rotated relative to a grip. 
         FIG. 31  is a sectional view of the tube assembly having inner and outer tubes. 
         FIG. 32  is a sectional view of the tube assembly having inner, outer, and covering tubes. 
         FIGS. 33A-E  are fragmentary views the surgical instrument of  FIG. 30  illustrating the repositioning of the tube assembly. 
         FIG. 34  is a perspective view of a cutting window of the surgical instrument. 
     
    
    
     DETAILED DESCRIPTION 
     Referring to  FIG. 1 , one embodiment of a surgical instrument  10 , according to the present invention, is shown for use in a medical procedure for a patient (not shown). As illustrated, the surgical instrument  10  includes a drive assembly, generally indicated at  12 , and a cutting assembly, generally indicated at  14 , removably coupled to the drive assembly  12 . The drive assembly  12  is used to rotate a portion of the cutting assembly  14  to remove tissue, bone, etc. from a surgical site of the patient. It should be appreciated that the surgical instrument  10  may be operated by a user (not shown) such as a surgeon. 
     As illustrated in  FIG. 1 , the drive assembly  12  includes a housing  15  extending axially. The housing  15  is generally cylindrical in shape. The drive assembly  12  also includes a motor  16  disposed in the housing  15  and having a rotatable drive element  18  ( FIG. 17 ) coupled to the cutting assembly  14 . The motor  16  may be of an electric or pneumatic type. In one embodiment, the drive element  18  is removably coupled to the cutting assembly  14  as illustrated in  FIG. 16 . 
     It should be appreciated that, in one embodiment, the cutting assembly  14  may be free of any motor. Thus, the cutting assembly  14  may be configured to be disposable after a single-use, or series of uses. It should also be appreciated that, because the cutting assembly  14  may not include any motors, the cost of the cutting assembly  14  may be reduced. 
     Referring to  FIGS. 1-9 , the cutting assembly  14  includes a plurality of tubes or tube assembly, generally indicated at  20 , extending axially with a window  22 , for example, a cutting window, at a distal end  23  adapted to be applied to a surgical site of a patient. The tube assembly  20  has a longitudinal axis  24  defined between the distal end  23  and a proximal end. In one embodiment, the tube assembly  20  includes a first, or outer, tube  26  and a second, or inner, tube  28 . The inner tube  28  is removably coupled to and adapted to be rotated by the drive assembly  12 , such as by the drive element  18 . Rotation of the inner tube  28  by the drive element  18  is relative to the outer tube  26 . 
     Each of the inner tube  28  and the outer tube  26  are generally hollow cylinders and have a generally circular cross-sectional shape. The outer tube  26  has a diameter greater than a diameter of the inner tube  28  such that the inner tube  28  is disposed within the outer tube  26 . In other words, the outer tube  26  is disposed over the inner tube  28 . The inner tube  28  and the outer tube  26  extend axially between a proximal end and a distal end. In one embodiment, the inner tube  28  may have an axial length longer than an axial length of the outer tube  26  such that the inner tube  28  extends past a proximal end of the outer tube  26  when the inner tube  28  is disposed within the outer tube  26 . In another embodiment, the outer tube  26  may have a bend  29  near the distal end  23  thereof as illustrated in  FIG. 12 . The bend  29  is disposed between the distal end  23  and the proximal end of the outer tube  26 . 
     In one embodiment, the tube assembly  20  may further include a non-rotatable sheath or covering tube  30  disposed about a portion of the outer tube  26 . The covering tube  30  has an axial length less than an axial length of the outer tube  26 . The covering tube  30  may be angled, straight, or malleable. It should be appreciated that the covering tube  30  is optional. In addition, it should be appreciated that the covering tube  30  may be coupled to the grip  40  such that the covering tube  30  isstationary relative to the grip  40 . Furthermore, it should be appreciated that any suitable tubing configuration may be utilized so long as the cutting assembly  14  defines a window and can be driven by the drive assembly  12 . 
     The inner tube  28  and/or outer tube  26  are made of a metal material such as stainless steel or a non-metallic material such as a composite depending on the application. The covering tube  30  may be made of a metal material or a non-metallic material such as a composite depending on the application. It should be appreciated that the wall thickness of the inner tube  28  and the outer tube  26  is relatively thin such as approximately 0.1 to approximately 0.5 millimeters (mm) to allow the tube assembly  20  to be of a relatively small diameter and also to be light-weight. It should also be appreciated that the diameters of the inner tube  28  and the outer tube  26  have a relatively small diameter such as approximately 2.0 mm to approximately 5.0 mm so as to work in a small opening of a nasal cavity or oral cavity of the patient and to prevent the user&#39;s view from being obstructed. It should further be appreciated that the inner tube  28  and the outer tube  26  may be scaled larger or smaller depending on the application. 
     As illustrated in  FIGS. 8, 9, and 34 , the outer tube  26  includes an outer opening or outer aperture  32 , and the inner tube  28  includes an inner opening or inner aperture  34 . The outer aperture  32  and the inner aperture  34  are generally positioned at or slightly proximal to the distal end  23  of the tube assembly  20 . The outer aperture  32  and the inner aperture  34  define the cutting window  22  such that the window  22  extends diametrically through a wall on one side of the tube assembly  20  near the distal end  23  thereof. The openings  32  and  34  are generally elongated in shape, but may be any suitable shape. The outer aperture  32  may include at least one serrated edge, knife edge, or resector edge  36 . The inner aperture  34  is axially aligned with the outer aperture  32  and configured to rotate about the longitudinal axis  24  as the drive assembly rotates the inner tube  28 . The inner aperture  34  may include at least one serrated edge, knife edge, or resector edge  38 . It should be appreciated that the serrated edges  36  and  38  allow cutting for the window  22 . 
     The cutting assembly  14  also includes a grip, generally indicated at  40 , adapted to be engaged by a least a portion of a hand of a user. As is well understood, and with reference to  FIG. 14 , the hand H of a user comprises a thumb TH, an index finger IF, secondary fingers SF, a palm P, and a web disposed between the thumb TH and the index finger IF. The secondary fingers SF are the middle, ring, and little fingers of the hand H. The web W may be characterized generally as the lateral surface and a relatively small portion of the palmar surface of the hand H between the thumb TH and the index finger IF. Alternatively, the web W may be characterized as area between the thumb TH and the index finger IF bounded medially by an imaginary line IL (approximated in  FIG. 14 ) extending proximally from between the index finger IF and middle finger of the hand H. In certain characterizations, the palm P of the hand H may be characterized as the level of the superficial palmar arch as commonly referred to in medical literature and approximated in  FIG. 14 . The web W is lateral of the superficial palmar arch between the thumb TH and the index finger IF. Regardless of characterization, it is to be understood that the palm P does not include the web W of the hand H, and the web W does not include the palm P of the hand H in certain embodiments. 
     The grip  40  may also support the tube assembly  20 . The grip  40  may include a hub or nose portion  42  having an aperture  43  extending axially therethrough to receive the tube assembly  20 . The grip  40  also includes a finger portion  44  extending from the nose portion  42  to support a finger of the hand different from the at least one finger. The finger portion  44  defines a front surface  46  and is sized such that the front surface  46  accommodates at least one finger of the hand of the user. In certain embodiments, the finger portion  44  is adapted to be engaged by the index finger IF and/or the secondary finger SF of the hand. It should be appreciated that, in another embodiment, the nose portion  42  may not be part of the grip  40  and be separate and distinct from the grip  40 . 
     In certain embodiments, the finger portion  44  extends from the nose portion  42  at an angle between at least perpendicular and an obtuse angle relative to the nose portion  42 . Thus, in those embodiments, it should be appreciated that the angle between the finger portion  44  and the nose portion  42  does not form an acute angle. It should also be appreciated that, in the embodiment illustrated in  FIG. 1A , the finger portion  44  is longer than the finger portion  44  of the embodiment of  FIG. 1 . 
     As used therein, the term “grip” is a portion that can be used for any type of cutting instrument such as burs, shavers, or any other device imaginable that couples to a handpiece including a motor. It should be appreciated that the term “grip” may provide for both pencil and pistol types. It should also be appreciated that the grip  40  may be a hybrid between a pencil grip and a pistol grip and combines the advantages of both by providing the hand-held like pencil and the web-like pistol features of the pencil grip and the pistol grip, respectively. 
     In certain embodiments illustrated in  FIGS. 1-9 , the grip  40  may include an intermediate portion  48  extending axially from the finger portion  44  towards the drive assembly  12 . As illustrated in  FIGS. 2 and 3 , the intermediate portion  48  forms an open area ledge  50  with the nose portion  42 . The open area ledge  50  may be contoured relative to a manually movable member, generally indicated at  56 , and a connecting hub, generally indicated at  86 , to be described. It should be appreciated that the dimensions of the intermediate portion  48  are not particularly limited, and may be customized to suit the dimensions of a user&#39;s hand. It should also be appreciated that the intermediate portion  48  is optional and a web portion  52  to be described may be directly coupled to the housing  15  of the drive assembly  12 . 
     The grip  40  also includes the web portion  52 . In  FIG. 5 , the web portion  52  extends from the intermediate portion  48  and apart from the finger portion  44  to engage the web W of the hand H as illustrated in  FIG. 13 . The web portion  52  is adapted to be engaged by the web W of the hand H without being engaged by the palm P of the hand H. The web portion  52  has a rear surface  54  to engage the web W of the hand. It should be appreciated that, in certain embodiments, the rear surface  54  may be substantially parallel to the front surface  46 . It should also be appreciated that the front surface  46  may be substantially perpendicular to a proximal portion of the tube assembly  20 . 
     In one embodiment, the nose portion  42 , finger portion  44 , intermediate portion  48 , and web portion  52  may be integral, unitary, and formed as one-piece. In certain embodiments, such as those illustrated in  FIGS. 1 and 1A , each of the finger portion  44  and the web portion  52  extend away from the intermediate portion  48  in a direction opposite the housing  15  or a movable member  56  to be described to define a generally U-shaped configuration of the grip  40 . It should be appreciated that, in one embodiment, the grip  40  may be separable from the inner tube  28  of the tube assembly  20 . 
     In another embodiment, a position of the web portion  52  is adjustable relative to a position of the finger portion  44 . In such an embodiment, the web portion  52  extends downwardly from the intermediate portion  48  of the grip  40 . The web portion  52  may be extendable or have a longer length to accommodate various hand sizes of users. 
     The web portion  52  and the finger portion  44  each have a length extending away from the tube assembly  20 . In one embodiment, the length of the finger portion  44  is greater or larger than the length of the web portion  52  as illustrated in  FIG. 10 . In other embodiments, the length of the finger portion  44  is substantially the same length as the length of the web portion  52  as illustrated in  FIG. 1 . 
     In certain embodiments, the grip  40  may have still other configurations that allow the user to grasp the grip  40  and operate the surgical instrument  10 . 
     As illustrated in  FIGS. 13 and 14 , the hand of the user is used to grasp or grip the grip  40 . The user places the web W of the hand on the web portion  52  and at least one finger of the hand H on the front surface  46  of the finger portion  44  of the grip  40 . When the hand H is engaged with the grip  40 , a palm P of the user&#39;s hand H does not engage the grip  40  as is done with conventional handles or pistol grips. Rather, in certain embodiments, the index finger IF or the secondary finger SF engaging the finger portion  44 , together with the web W of the hand H engaging the web portion  52 , provide opposing forces to the grip  40  so as to grasp the grip  40 . In effect, the grip  40  is squeezed between the index finger IF or secondary finger SF and the web W of the hand without the palm P of the hand H engaging the grip  40 . It should be appreciated that the features that allow the hand H to engage the grip  40  in the manner described above are based on the design of the grip  40 . 
     Referring to  FIGS. 1-14 , the cutting assembly  14  further includes a manually movable member, generally indicated at  56 , coupled to the tube assembly  20  and located axially along the grip  40 . More particularly, the manually movable member  56  is coupled to the outer tube  26  and adapted to be rotated by the user to rotate the outer tube aperture about the longitudinal axis  24 . The manually movable member  56  is positioned to be within reach of the thumb TH or at least one finger of the hand H of the user when the web W of the hand H is engaged with the grip  40  to allow the thumb TH or the at least one finger, such as the index finger IF, to rotate the window  22  of the tube assembly  20  relative to the longitudinal axis  24  of the tube assembly  20 . In certain embodiments, the manually movable member  56  is adapted to be rotated with both the index finger IF and the thumb B of the hand H while the finger portion  44  is engaged by the secondary finger SF of the hand and the web portion  52  is engaged by the web W of the hand. In one embodiment, the manually movable member  56  is located axially along the grip  40  and within at least twenty, thirty, forty, fifty, sixty, or seventy percent of an axial length from the distal end of the nose portion  42 . This positioning allows the user&#39;s thumb TH or index finger IF to actuate the manually movable member  56  while the web W of the user&#39;s hand H engages the web portion  52  of the grip  40 . It should be appreciated that the manually movable member  56  is part of the cutting assembly  14  and not part of the drive assembly  12 . 
     In the illustrated embodiment, the manually movable member  56  includes a rotatable wheel  58  coupled to the outer tube  26  to allow the at least one finger of the hand H of the user to rotate the outer tube  26  relative to the longitudinal axis  24 . The rotatable wheel  58  is generally circular in shape, but may be any suitable shape. The rotatable wheel  58  includes a plurality of gripping members  60  extending radially and axially and spaced circumferentially to allow the user to rotate the rotatable wheel  58 . The rotatable wheel  58  also includes an aperture  62  extending axially therethrough to allow the rotatable wheel  58  to be disposed over and about the outer tube  26  as illustrated in  FIG. 9 . The rotatable wheel  58  further includes a projection  70  extending axially. The rotatable wheel  58  is made of a non-metallic material. The rotatable wheel  58  is integral, unitary, and formed as one-piece. It should be appreciated that the rotatable wheel  58  is coupled to the outer tube  26  through a suitable mechanism, for example a knurled area of the aperture  43 , to form a friction fit, adhesive bond, or induction bond. 
     Referring to  FIGS. 13, 14, and 26 , the manually movable member  56  may include a locking assembly, generally indicated at  66 , cooperating with the grip  40  to lock the rotatable wheel  58  in place relative to the nose portion  42  of the grip  40 . The locking assembly  66  includes one or more movable locking members  68  having a pin  69  at one axial end to be disposed in one or more recesses  70  spaced circumferentially about the rotatable wheel  58  as illustrated in  FIG. 26 . In one embodiment, two movable locking members  68  are disposed on opposed sides of the nose portion  42  to allow a right-handed or left-handed user to operate one of the movable locking members  68 . More particularly, the movable locking members  68  are adapted to be engaged by the index finger IF or the thumb TH of the hand H while the grip  40  is engaged by the web W of the hand H. Thus, the user may lock the manually movable member  58  from rotating relative to the grip  40  without needing to use a secondary hand or significantly readjust one&#39;s grip on the cutting assembly  14 . It should be appreciated that the user slides the movable member  58  distally to disengage the pin  69  from one of the recesses  70 , rotates the rotatable wheel  58 , and slides the movable locking member  68  proximal to engage the pin  69  with another recess  70  to lock the rotatable wheel  58  in place. It should be appreciated that the number of recesses  70  are not particularly limited and may correspond to a number of predetermined positions, etc. 
     The cutting assembly  14  also includes a drive hub, generally indicated at  72 , disposed about a proximal end of the inner tube  28  to allow the inner tube  28  to be connected to the drive element  18  for rotation of the inner tube  28  about the longitudinal axis  24 . The drive hub  72  includes a hub member  74  disposed about the inner tube  28 . The hub member  74  extends axially and is generally cylindrical in shape. The hub member  74  has an aperture  76  extending axially therethrough to receive the inner tube  28  as illustrated in  FIG. 9 . The hub member  74  also includes a plurality of projections  78  extending radially and axially and spaced circumferentially thereabout. The hub member  74  further includes a reduced diameter portion  80  adjacent the projections  78 . The hub member  74  also includes a flange  81  extending radially at a distal end thereof. The hub member  74  is made of a non-metallic material. The hub member  74  is integral, unitary, and formed as one-piece. The drive hub  72  includes a spring  82  disposed about the hub member  74  in the reduced diameter portion  80 . It should be appreciated that the drive hub  72  allows for rotation of the inner tube  28  and may allow for the transfer of fluid through the inner tube  28 . It should also be appreciated that a variety of drive coupling configurations may be used with the cutting assembly  14 . 
     The cutting assembly  14  further includes a connecting hub, generally indicated at  86 , disposed about the inner tube  28  and a portion of the drive hub  72  to allow the drive assembly  12  to be coupled to the cutting assembly  14 . The connecting hub  86  includes a coupling member  88  disposed about the inner tube  28 . The coupling member  88  extends axially and is generally cylindrical in shape. The coupling member  88  has an aperture  90  extending axially therethrough to receive the inner tube  28 . The coupling member  88  includes a first or distal cavity  92  extending axially therein to receive the projection  70  of the rotatable wheel  58  and a second or proximal cavity  94  extending axially therein to receive a distal end of the fluid coupling. The proximal cavity  94  includes at least one raised portion  95  extending axially and radially from an axial end thereof to allow fluid flow between a bushing  138  to be described and the connecting hub  86 . The coupling member  88  also includes a plurality of recesses  96  extending circumferentially and radially and spaced circumferentially about the coupling member  88 . The coupling member  88  includes a plurality of recesses  98  extending radially and circumferentially therein. The coupling member  88  also includes a flange  100  extending radially and disposed axially therealong to act as a stop against the movable member  56 . The coupling member  88  includes one or more projections  101  extending radially from the flange  100  and spaced circumferentially from each other. The projections  101  are disposed in either corresponding apertures or a groove  101   a  ( FIG. 30 ) in the intermediate portion  48  of the grip  40  to prevent rotation of the coupling member  88 . The coupling member  88  is made of a non-metallic material. The coupling member  88  is integral, unitary, and formed as one-piece. It should be appreciated that the connecting hub  86  allows for the coupling of the drive assembly  12 . 
     In another embodiment illustrated in  FIGS. 10 and 11 , the surgical instrument  10  may include at least one tracking element  102  coupled to the grip  40 . In one embodiment, the tracking element  102  may cooperate with an integrated Pattern Recognition Optical Navigation system (as per PROFESS). In another embodiment, the tracking element  102  may be used with a computer-implemented technique for determining a coordinate transformation for surgical navigation such as disclosed in International Publication No. WO 2015/024600 to Stryker Leibinger GmbH &amp; Co. KG. It should be appreciated that the at least one tracking element  102  is optional. 
     Referring to  FIGS. 15-26 , the drive assembly  12  may be removably connected to the cutting assembly  14 . The drive assembly  12  includes the motor  16  having the rotatable drive element  18  and the housing  15  for enclosing the motor  16 . The housing  15  is a generally cylindrical, elongated housing. The distal end of the housing  15  is formed with a bore for receiving the proximal end of the cutting assembly  14 . (Throughout this document, “distal” is understood to be away from the face of the surgeon holding the drive assembly; “proximal” is understood to mean towards the face of the surgeon.) The drive assembly  12  includes a latch or coupling assembly, generally indicated at  104 , for removably coupling the housing  15  to the connecting hub  86  of the cutting assembly  14 . The coupling assembly  104  includes a plurality of latch channels  106  extending axially into the housing  15 . The coupling assembly  104  includes a generally ring shaped collet  108  that is secured to the housing  15 . The coupling assembly  104  also includes a locking ring  110  movably disposed in the collet  108 . The coupling assembly  104  includes a release button  112  integrally formed with the locking ring  110  to move the locking ring  110 . The coupling assembly  104  includes one or more projections or tabs  114  on the connecting hub  86  that cooperate with the locking ring  110  to be engaged and disengaged by the locking ring  110 . It should be appreciated that the release button  112  is spring loaded. It should also be appreciated that the coupling assembly  104  is similar to that disclosed in U.S. Pat. No. 7,237,990 to Deng, the entire disclosure of which is hereby incorporated by reference. 
     As part of the assembly of drive assembly  12 , the collet  108  is attached to the housing  15 . Prior to the attachment of the collet  108  to the housing  15 , a coil  116  is seated in the connecting hub  86 . The coil  116 , which may be a wire wrap or a conductive trace formed on a flexible substrate, is the coil used to facilitate inductive signal transfer to/from a radio frequency identification device (RFID) chip  118  disposed in the connecting hub  86  ( FIG. 20 ) between a coil seal  134  to be described and the connecting hub  86 . It should be appreciated that the coil  116  and chip  118  is similar that disclosed in U.S. Pat. No. 7,237,990 to Deng. 
     Referring to  FIGS. 22-28B , the drive assembly  12  includes an irrigation/suction connection assembly, generally indicated at  120 , on the housing  15  for connection to a fluid source (not shown). In the embodiment illustrated, the irrigation/suction connection assembly  120  includes a housing  122  and an irrigation fluid connection  124  extending axially from the housing  122 . The connection  124  is generally a hollow cylindrical member having a generally circular cross-sectional shape. The connection assembly  120  also includes a suction connection  126  extending axially from the housing  122  for connection to a suction source. 
     The drive assembly  12  includes a suction passage  128  extending axially through the housing  15  between the suction connection  126  and the drive hub  72  of the cutting assembly  14 . The cutting assembly  14  includes a radial seal  130  disposed about a proximal end of the drive hub  72  to prevent fluid from exiting between the drive hub  72  and the drive element  18  when the cutting assembly  14  is coupled to the drive assembly  12 . In one embodiment, the radial seal  130  may be an o-ring disposed in a groove of the drive hub  72 . It should be appreciated that the suction source is connected to the suction connection  126  to aspirate fluid and tissue from the window  22  through the inner tube  28 , connecting hub  86 , drive hub  72 , suction passage  128 , and suction connection  126  to the suction source. 
     The drive assembly  12  also includes an irrigation passage  132  extending axially through the housing  15  between the irrigation connection  124  and the cutting assembly  14 . The cutting assembly  14  includes a coil seal  134  disposed between the drive hub  72  and the connecting hub  86  to allow fluid flow between the coil seal  134  and the drive hub  72 . The coil seal  134  is generally cylindrical in shape and hollow. As illustrated in  FIG. 20 , the coil seal  134  includes at least one or more internal protrusions  136  extending radially inwardly to engage the flange  81  on the drive hub  72  to prevent accidental disassembly of the drive hub  72  from the cutting assembly  14 . In one embodiment, two opposed internal protrusions  136  extend circumferentially a predetermined distance. The coil seal  134  is formed from flexible sterilizable material. It should be appreciated that irrigation fluid flows from the irrigation passage  132  into a space between the housing  15  and the drive hub  72  and between the coil seal  134  and the drive hub  72  and into the proximal cavity  94  of the connecting hub  86 . 
     The cutting assembly  14  may include one or more bushings  138  disposed axially between the drive hub  72  and the connecting hub  86 . In one embodiment, the bushings  138  are generally planar and circular in shape. It should be appreciated that fluid flows axially past the bushings  138  and radially between the raised portions  95  in the proximal cavity  94  of the connecting hub  86 . It should also be appreciated that, in one embodiment, the bushings  138  may wear due to relative rotation between the drive hub  72  and the connecting hub  86 . 
     The cutting assembly  14  includes a radial seal  140  disposed between the manually movable member  56  and the connecting hub  86  to prevent fluid from exiting from the irrigation passage  132  between the manually movable member  56  and the connecting hub  86 . The irrigation fluid is routed through the connecting hub  86  and between the inner tube  28  and outer tube  26  of the tube assembly  20  to the window  22 . It should be appreciated that when the surgical instrument  10  of the present invention is employed to perform a surgical procedure, irrigating fluid is introduced into the surgical site through the irrigation connection  124  into the irrigation passage  132  and into a space between the housing  15  and the drive hub  72  and between the coil seal  134  and the drive hub  72  and into the connecting hub  86  past the bushings  138  and between the inner tube  28  and outer tube  26  of the tube assembly  20  to the window  22 . It should also be appreciated that irrigation fluid may be introduced through a separate cannula that opens into the surgical site. It should further be appreciated that suction is drawn from the suction source to aspirate irrigating fluid and material from the window  22  through the inner tube  28 , connecting hub  86 , drive hub  72 , suction passage  128 , and suction connection  126  to the suction source to remove irrigating fluid and the material entrained in the irrigating fluid. 
     Referring to  FIG. 29A , another embodiment, according to the present invention of the surgical instrument  10  is shown. In this embodiment, the cutting assembly  14  includes the tube assembly  20  having a two tube configuration of the inner tube  28  and the outer tube  26 . The inner tube  28  is rotatable and connected to the drive hub  72 . The outer tube  26  is also rotatable and connected to the manually movable member  56 . It should be appreciated that, in the embodiment illustrated, the tube assembly  20  has a straight two tube configuration, but may be used with an angled tube assembly  20  having a bend  29 . It should also be appreciated that the tube assembly  20  includes the cutting window  22  and the tube assembly  20  is connected to the grip  40  of the cutting assembly  14 , which may be the disposable portion of the surgical instrument  10 . It should also be appreciated that the covering tube is not included in the two tube configuration. 
     Referring to  FIG. 29B , yet another embodiment, according to the present invention of the surgical instrument  10  is shown. In this embodiment, the cutting assembly  14  includes the tube assembly  20  having a two tube configuration of the inner tube  28  and the outer tube  26 . The tube assembly  20  is connected to the grip  40  of the cutting assembly  14 , which may be the disposable portion of the surgical instrument  10 . The inner tube  28  is rotatable and connected to the drive hub  72 . The outer tube  26  is fixed and connected to the grip  40 . The cutting assembly  14  also includes a rotatable end effector, generally indicated at  142 , such as a bur. The rotatable end effector  142  includes a head  144  at a distal end thereof and a shaft  146  extending from the head  144  to a proximal end coupled to the inner tube  28 . The head  144  is generally spherical in shape, but may be any suitable shape. The head  144  may be fluted or coated with a diamond grit to enable cutting of bone. The shaft  146  is generally cylindrical and circular in shape, but may be any suitable shape. The tube assembly  20  includes a distal bearing  148  disposed in the distal end of the inner tube  28  and the shaft  146  is coupled to the distal bearing  148 . The shaft  146  may also include a notch extending radially and circumferentially for suction. It should be appreciated that other end effectors are contemplated other than rotatable end effectors such as any rotatable cutting element or tool. It should also be appreciated that the tube assembly  20  has a straight two tube configuration, but may be used with an angled tube assembly  20  having a bend  29 . It should further be appreciated that, in this embodiment, there is no rotatable wheel. 
     Referring to  FIGS. 30-32 , yet other embodiments, according to the present invention of the surgical instrument  10  is shown. These embodiments may also be used where there is no bend and no rotatable wheel to simply reorient the cutting window  22 . In these embodiments, the cutting assembly  14  includes the tube assembly  20  having bent tube configuration. In the embodiment illustrated in  FIG. 31 , the tube assembly  20  has a two tube configuration of the inner tube  28  and the outer tube  26 . The outer tube  26  has the bend  29  therein between the proximal end and distal end. The inner tube  28  is rotatable and connected to the drive hub  72  (not shown in this figure). The outer tube  26  is connected to the nose portion  42  of the grip  40 . The cutting assembly  14  includes a relocation assembly, generally indicated at  150 , that allows the surgeon to relocate the bend  29  in a plurality of orientations. In one embodiment, the bend  29  is relocated to four different orientations at ninety degrees to each other, e.g., 12 o&#39;clock ( FIG. 33C ), 3 o&#39;clock ( FIGS. 33A and 33B ), 6 o&#39;clock (opposite  FIG. 33C ), or 9 o&#39;clock ( FIGS. 33D and 33E ). 
     In the embodiment illustrated in  FIG. 32 , the tube assembly  20  has a three tube configuration of the inner tube  28 , the outer tube  26 , and the covering tube  30 . The covering tube  30  has the bend  29  therein between the proximal end and distal end. The inner tube  28  is rotatable and connected to the drive hub  72  (not shown in this figure). The outer tube  26  is also rotatable and connected to the manually movable member  56 . The covering tube  30  is connected to the nose portion  42  of the grip  40 . The cutting assembly  14  includes the relocation assembly  150  that allows the surgeon to relocate the bend  29  in a plurality of orientations. In one embodiment, the bend  29  is relocated to four different orientations at ninety degrees to each other, e.g., 12, 3, 6, or 9 o&#39;clock. It should be appreciated that, in one embodiment of a two tube configuration, the inner tube  28  has a flexible region corresponding to the bend  29  in the outer tube  26 . It should also be appreciated that, in another embodiment of a three tube configuration, both the inner tube  28  and outer tube  26  have a flexible region corresponding to the bend  29  in the covering tube  30 . 
     Referring to  FIGS. 30-33E , the relocation assembly  150  includes a cavity  152  in the nose portion  42  of the grip  40  distal to the aperture  43 . The relocation assembly  150  includes a plurality of projections  154  extending axially and radially and disposed circumferentially about the aperture  43 . In one embodiment, the projections  154  are spaced ninety degrees to each other about the aperture  43 . 
     The relocation assembly  150  also includes the outer most tube, either the outer tube  28  ( FIG. 31 ) or the covering tube  30  ( FIG. 32 ) to have a plurality of recesses  156  extending axially into the distal end and disposed circumferentially thereabout. Because the grip  40  is fixed to the cutting assembly  14 , the recesses  156  allow the outer most tube to be re-orientated relative to different orientations of the hand of the user. In one embodiment, the recesses  156  are generally pentagonal in shape and are spaced ninety degrees to each other. The relocation assembly  150  includes a flange or ring  158  on the outer tube  28  or the covering tube  30 . The relocation assembly  150  also includes a biasing assembly having a floating washer  160  disposed in the cavity  152  of the nose portion  42  and about the outer tube  28  or the covering tube  30 . The biasing assembly also includes a spring  162  disposed in the cavity  152  of the nose portion  42  and about the outer tube  28  or the covering tube  30  between the ring  158  and floating washer  160 . It should be appreciated that the projections  154  and recesses  156  are shaped to allow easy sitting and self-guiding. It should also be appreciated that the nose portion  42  may be molded such that it is a two-piece assembly with the finger portion  44 , intermediate portion  48 , web portion  52 , and half the nose portion  42  as one molded piece and a top cap of the nose portion  42  (may include tracking element  102 ) as another molded piece to allow the relocation assembly  150  to be assembled. 
     Referring to  FIGS. 33A-33E , in operation of the relocation assembly  150 , the operator grips the outer tube  28  ( FIG. 31 ) or the covering tube  30  ( FIG. 32 ) close to the nose portion  42  of the grip  40  and pulls axially. The ring  158  moves axially and compresses the spring  162 . The recesses  156  disengage the projections  154 . The operator then rotates the outer tube  28  ( FIG. 31 ) or the covering tube  30  ( FIG. 32 ) ninety degrees. The operator releases the outer tube  28  ( FIG. 31 ) or the covering tube  30  ( FIG. 32 ) and the spring  162  expands and forces the recesses  156  to engage the projections  154  to lock back in position. It should be appreciated that  FIGS. 33A-33E  illustrate the reorientation. 
     The present disclosure further provides methods for gripping a cutting assembly  14  with at least a portion of a hand H of a user. In one exemplary method, the cutting assembly  14  includes a tube assembly  20  having an inner tube  28  rotatably disposed within an outer tube  26 , a grip  40  coupled to the tube assembly  20  and comprising a finger portion  44  and a web portion  52 , and a manually movable member  56  coupled to the outer tube  26  of the tube assembly  20 . The finger portion  44  of the grip  40  is engaged with a finger of the hand. The manually movable member  56  is engaged with the finger, a thumb TH, or an index finger IF of the hand. The web portion  52  of the grip  40  is engaged with a web W disposed between the thumb TH and the index finger IF of the hand. The manually movable member  56  is moved with the thumb TH or the index finger IF to rotate the outer tube  26  of the tube assembly  20  while the web W of the hand H remains engaged with the web portion  52  and the finger of the hand H remains engaged with the finger portion  44 . A drive assembly  12  comprising a motor  16  may be provided, and the drive assembly  12  may be removably coupled to the cutting assembly  14 . 
     According to another exemplary method, for gripping a cutting assembly  14  including an inner tube  28  and an outer tube  26  with a window  22  at a distal end adapted to be applied to a surgical site of a patient, a grip  40  adapted to be engaged by a least a portion of a hand of a user and supporting the inner tube  28  and the outer tube  26 , wherein the grip  40  includes a nose portion  42  having an aperture  43  extending axially therethrough to allow the inner tube  28  and the outer tube  26  to extend axially therethrough and a finger portion  44  extending from the nose portion  42  to support a finger of the hand H, and a manually movable member  56  coupled to the outer tube  26  and located axially along the grip  40  within reach of at least one finger or thumb of the user when the hand H is engaged with the grip  40 . The method includes the steps of placing a finger of the hand H on the finger portion  44 , placing a thumb or at least another finger of the hand H different from the finger accommodated by the finger portion  44  on the manually movable member  56 , and placing a web of the hand H disposed between the thumb and index finger of the hand H on the web portion  52 . The method also includes the steps of moving the manually movable member  56  with the thumb or the at least another finger to rotate the window  22  of the outer tube  26  relative to a longitudinal axis of the outer tube  26  when the hand H is engaged with the grip  40 . It should be appreciated that, in one embodiment of a shaver, the inner tube  28  rotates clockwise then counterclockwise in an oscillating manner when resecting tissue. 
     Accordingly, the surgical instrument  10 , in certain embodiments, provides a more comfortable grip and easy window rotation mechanism for reorientating a tube window  22  on the fly to perform a surgical task. The surgical instrument  10  of the present invention includes a manually movable member  56  connected to a grip  40  that may be disposed on a disposable portion of the surgical instrument  10 . The surgical instrument  10  may cut and aspirate tissue as per current shaver systems, utilizing suction, irrigation, and motor rotation and the cutting window  22  is turned to re-orientate the window  22 . It should be appreciated that, in another embodiment, the surgical instrument  10  may be used with the surgical tools or be a dedicated tool or instrument. 
     It will be further appreciated that the terms “include,” “includes,” and “including” have the same meaning as the terms “comprise,” “comprises,” and “comprising.” 
     The present invention has been described in an illustrative manner. It is to be understood that the terminology, which has been used, is intended to be in the nature of words of description rather than of limitation. Many modifications and variations of the present invention are possible in light of the above teachings. Therefore, the present invention may be practiced other than as specifically described. 
     Embodiments of the disclosure may be described with reference to the following exemplary clauses: 
     Clause 1—A surgical instrument for use on a patient, the surgical instrument comprising: a drive assembly including a motor having a rotatable drive element; a cutting assembly configured to be removably coupled to the drive element, the cutting assembly including a plurality of tubes extending axially with a window at a distal end of at least two of the tubes adapted to be applied to a surgical site of a patient, one of the tubes being stationary and another of the tubes being rotatable relative to the one of the tubes, a grip adapted to be engaged by a least a portion of a palm of a hand of a user and supporting the one of the tubes, and a manually movable member coupled to the one of the tubes and located axially along the grip within reach of a thumb or at least one finger of the hand of the user when the hand is engaged with the grip to allow the at least one finger to rotate the window of the one of the tubes relative to a longitudinal axis of the tubes. 
     Clause 2—A surgical instrument as set forth in clause 1 wherein the grip comprises a nose portion having an aperture extending axially therethrough to allow the at least one of the tubes to extend axially therethrough. 
     Clause 3—A surgical instrument as set forth in clause 2 wherein the grip further comprises a finger portion extending from the nose portion to support a finger of the hand different from the at least one finger. 
     Clause 4—A surgical instrument as set forth in clause 3 wherein the finger portion extends from the nose portion at an angle between at least perpendicular and an obtuse angle relative to the nose portion. 
     Clause 5—A surgical instrument as set forth in clause 3 wherein the grip further comprises an intermediate portion extending axially from the finger portion towards the drive assembly. 
     Clause 6—A surgical instrument as set forth in clause 5 wherein the grip includes a web portion extending from the intermediate portion and apart from the finger portion to engage a web disposed between a thumb and an index finger of the hand. 
     Clause 7—A surgical instrument as set forth in clause 6 wherein a position of the web portion is adjustable relative to a position of the finger portion. 
     Clause 8—A surgical instrument as set forth in clause 1 wherein the tubes comprise an outer tube coupled to the manually movable member and an inner tube coupled to the drive element and being rotatable by the drive element relative to the outer tube. 
     Clause 9—A surgical instrument as set forth in clause 8 wherein the outer tube comprises an outer opening forming the window. 
     Clause 10—A surgical instrument as set forth in clause 9 wherein the inner tube has an inner opening aligned with the outer opening. 
     Clause 11—A surgical instrument as set forth in clause 8 wherein the manually movable member comprises a rotatable wheel coupled to the outer tube to allow the at least one finger of the hand of the user to rotate the outer tube relative to the longitudinal axis. 
     Clause 12—A surgical instrument as set forth in clause 11 wherein the rotatable wheel is disposed about and attached to the outer tube, wherein the rotatable wheel includes a projection extending axially. 
     Clause 13—A surgical instrument as set forth in clause 12 further comprising a drive hub disposed about a proximal end of the inner tube to allow the inner tube to be connected to the drive element for rotation of the inner tube about the longitudinal axis. 
     Clause 14—A surgical instrument as set forth in clause 13 further comprising a connecting hub disposed about the inner tube and the drive hub for connection to the drive assembly. 
     Clause 15—A surgical instrument as set forth in clause 14 wherein the connecting hub includes a distal cavity extending axially therein to receive the projection. 
     Clause 16—A surgical instrument as set forth in clause 6 wherein the web portion and the finger portion each comprise a length extending away from the tubes, wherein the length of the finger portion is greater than the length of the web portion. 
     Clause 17—A surgical instrument as set forth in clause 8 wherein the tubes include a covering tube disposed about the outer tube and being coupled to the grip to be stationary relative to the grip. 
     Clause 18—A surgical instrument as set forth in clause 17 wherein the covering tube has a bend disposed between the grip and a distal end thereof. 
     Clause 19—A surgical instrument as set forth in clause 1 wherein the grip is separable from at least one of the tubes. 
     Clause 20—A surgical instrument as set forth in clause 16 wherein the drive assembly includes a housing for enclosing the motor and a latch assembly for removably coupling the housing to the connecting hub of the cutting assembly. 
     Clause 21—A surgical instrument as set forth in clause 20 wherein the drive assembly includes an irrigation connection on the housing for connection to a fluid source. 
     Clause 22—A surgical instrument as set forth in clause 21 wherein the drive assembly includes an irrigation passage extending through the housing between the irrigation connection and the cutting assembly. 
     Clause 23—A surgical instrument as set forth in clause 22 wherein the cutting assembly includes a coil seal disposed between the drive hub and the connecting hub to allow fluid flow between the coil seal and the drive hub. 
     Clause 24—A surgical instrument as set forth in clause 23 wherein the coil seal includes at least one internal protrusion to engage the drive hub to prevent accidental disassembly of the drive hub from the cutting assembly. 
     Clause 25—A surgical instrument as set forth in clause 24 wherein the cutting assembly includes a first radial seal disposed between the manually movable member and the connecting hub to prevent fluid from exiting from the irrigation passage between the manually movable member and the connecting hub. 
     Clause 26—A surgical instrument as set forth in clause 24 wherein the irrigation passage is routed past the coil seal and through the connecting hub between the connecting hub and the tubes. 
     Clause 27—A surgical instrument as set forth in clause 25 wherein the cutting assembly includes a second radial seal disposed about a proximal end of the drive hub to prevent fluid from exiting between the drive hub and the drive element when the cutting assembly is coupled to the drive assembly. 
     Clause 28—A surgical instrument as set forth in clause 27 wherein the cutting assembly includes at least one bushing disposed axially between the drive hub and the connecting hub. 
     Clause 29—A surgical instrument as set forth in clause 27 wherein the connecting hub includes at least one aperture extending radially through a proximal end thereof to engage the coil seal. 
     Clause 30—A surgical instrument as set forth in clause 28 wherein the connecting hub includes a proximal cavity extending axially therein and at least one raised area extending axially and radially from an axial end of the proximal cavity to allow fluid flow from the at least one aperture into the proximal cavity and between the bushing and the connecting hub. 
     Clause 31—A surgical instrument as set forth in clause 30 wherein the drive assembly includes a suction connection on the housing for connection to a suction source. 
     Clause 32—A surgical instrument as set forth in clause 31 wherein the drive assembly includes a suction passage extending through the housing between the suction connection and the cutting assembly. 
     Clause 33—A surgical instrument as set forth in clause 20 wherein the latch assembly comprises a plurality of latch channels extending axially into the housing. 
     Clause 34—A surgical instrument as set forth in clause 23 including a radio frequency identification (RFID) disposed between the coil seal and the connecting hub. 
     Clause 35—A surgical instrument as set forth in clause 23 including a cutter drive spring disposed about the drive hub. 
     Clause 36—A surgical instrument as set forth in clause 18 including a relocation assembly to allow the user to relocate a bend in one of the tubes to one or more different orientations. 
     Clause 37—A surgical instrument as set forth in clause 36 wherein the relocation assembly includes a plurality of recesses in a distal end of the one of the tubes and a plurality of projections in the aperture of the nose portion, the recesses and the projections matingly engaging and disengaging each other. 
     Clause 38—A surgical instrument as set forth in clause 37 wherein the relocation assembly includes a cavity in the nose portion, a ring disposed about and fixed to the one of the tubes and disposed in the cavity, a floating washer disposed about the one of the tubes and spaced axially from the ring and disposed in the cavity, and a spring disposed about the one of the tubes and spaced axially between the floating washer and the ring and disposed in the cavity. 
     Clause 40—A surgical instrument as set forth in clause 11 including a locking assembly cooperating with the grip to lock the rotatable wheel in place relative to the grip. 
     Clause 41—A surgical instrument as set forth in clause 40 wherein the locking assembly comprises one or more movable members having a pin at one axial end and one or more recesses disposed circumferentially about the rotatable wheel to receive the pin. 
     Clause 42—A cutting assembly for a surgical instrument for use on a patient, the cutting assembly being configured to be coupled to a drive assembly including a motor having a rotatable drive element enclosed in a housing and, the cutting assembly comprising: a plurality of tubes, one of the tubes being a rotatable inner tube adapted to be rotated by the drive element and another of the tubes being a rotatable outer tube disposed over the inner tube with a window at a distal end adapted to be applied to a surgical site of a patient; a grip supporting the outer tube, the grip configured to be engaged by a least a portion of a palm of a hand of a user; and a manually movable member coupled to the outer tube and located axially along the grip within reach of at least one finger of the hand of the user when the portion of the hand is engaged with the grip to allow the at least one finger to rotate the window of the outer tube relative to a longitudinal axis of the outer tube. 
     Clause 43—A cutting assembly as set forth in clause 42 wherein the grip comprise a nose portion having an aperture extending axially therethrough to allow the outer tube to extend axially therefrom, and a finger portion extending from the nose portion to support a finger of the hand different from the at least one finger. 
     Clause 44—A cutting assembly as set forth in clause 43 wherein the finger portion extends from the nose portion at an angle between at least perpendicular and an obtuse angle relative to the nose portion. 
     Clause 45—A cutting assembly as set forth in clause 43 wherein the grip further comprises an intermediate portion extending axially from the finger portion, and a web portion extending from the intermediate portion and spaced part from the finger portion to support a web disposed between a thumb and an index finger of the hand. 
     Clause 46—A cutting assembly as set forth in clause 43 wherein the tubes include a covering tube disposed about the outer tube and being coupled to the grip to be stationary relative to the grip. 
     Clause 47—A cutting assembly as set forth in clause 46 wherein one of the covering tube and the outer tube has a bend disposed between the grip and a distal end thereof. 
     Clause 48—A cutting assembly as set forth in clause 45 wherein the manually movable member is within reach of an index finger or thumb of the hand when the web and a finger of the hand different from the index finger are engaged with the web portion and the finger portion, respectively. 
     Clause 49—A cutting assembly as set forth in clause 45 wherein the web portion and the finger portion each comprise a length extending away from the outer tube, wherein the length of the finger portion is larger than the length of the web portion. 
     Clause 50—A cutting assembly as set forth in clause 42 wherein the finger portion defines a front surface and sized such that the front surface accommodates at least one finger of the hand of the user. 
     Clause 51—A cutting assembly as set forth in clause 42 wherein the cutting assembly is free of a motor. 
     Clause 52—A cutting assembly as set forth in clause 42 further comprising at least one tracking element coupled to the grip. 
     Clause 53—A cutting assembly as set forth in clause 42 wherein the manually movable member is located axially along the grip and within at least forty percent of a length from the finger portion. 
     Clause 54—A cutting assembly as set forth in clause 47 including a relocation assembly to allow the user to relocate a bend in one of the tubes to one or more different orientations. 
     Clause 55—A cutting assembly as set forth in clause 48 wherein the relocation assembly includes a plurality of recesses in a distal end of the one of the tubes and a plurality of projections in the aperture of the nose portion, the recesses and the projections matingly engaging and disengaging each other. 
     Clause 56—A cutting assembly as set forth in clause 55 wherein the relocation assembly includes a cavity in the nose portion, a ring disposed about and fixed to the one of the tubes and disposed in the cavity, a floating washer disposed about the one of the tubes and spaced axially from the ring and disposed in the cavity, and a spring disposed about the one of the tubes and spaced axially between the floating washer and the ring and disposed in the cavity. 
     Clause 57—A cutting assembly as set forth in clause 42 including a locking assembly cooperating with the grip to lock the manually movable member in place relative to the grip. 
     Clause 58—A cutting assembly as set forth in clause 51 wherein the locking assembly comprises one or more movable members having a pin at one axial end and one or more recesses disposed circumferentially about the manually movable member to receive the pin. 
     Clause 59—A surgical instrument for use on a patient comprising a cutting assembly and a drive assembly, the drive assembly being configured to be coupled to the cutting assembly, the drive assembly comprising: a motor having a rotatable drive element; a housing for enclosing the motor; a latch assembly cooperating with the housing for removably coupling the housing to the cutting assembly; an irrigation connection on the housing for connection to a fluid source; an irrigation passage extending through the housing between the irrigation connection and the cutting assembly; a suction connection on the housing for connection to a suction source; and a suction passage extending through the housing between the suction connection and the cutting assembly. 
     Clause 60—A surgical instrument as set forth in clause 59 including a coil seal adapted to be disposed between a drive hub and a connecting hub of the cutting assembly to allow fluid flow between the coil seal and the drive hub. 
     Clause 61—A surgical instrument as set forth in clause 60 wherein the coil seal includes at least one internal protrusion adapted to engage the drive hub to prevent accidental disassembly of the drive hub from the cutting assembly. 
     Clause 62—A surgical instrument as set forth in clause 60 including a radial seal adapted to be disposed between a manually movable member of the cutting assembly and the connecting hub to prevent fluid from exiting the irrigation passage between the manually movable member and the connecting hub. 
     Clause 63—A surgical instrument as set forth in clause 60 wherein the irrigation passage is routed past the coil seal and through the connecting hub between the connecting hub and at least one tube of the cutting assembly. 
     Clause 64—A surgical instrument as set forth in clause 63 including a radial seal adapted to be disposed about a proximal end of the drive hub to prevent fluid from exiting between the drive hub and the drive element when the cutting assembly is coupled to the drive assembly. 
     Clause 65—A surgical instrument as set forth in clause 63 including a bushing adapted to be disposed axially between the drive hub and the connecting hub to prevent fluid in the irrigation passage from exiting radially between the drive hub and the connecting hub. 
     Clause 66—A surgical instrument comprising: a cutting assembly including a plurality of tubes extending axially with a window at a distal end adapted to be applied to a surgical site of a patient, a grip adapted to be engaged by a least a portion of a palm of a hand of a user and supporting the tubes, and a manually movable member coupled to at least one of the tubes and located axially along the grip within reach of a thumb or at least one finger of the hand of the user when the hand is engaged with the grip to allow the at least one finger to rotate the window of the at least one of the tubes relative to a longitudinal axis of the tubes; and a drive assembly including a motor having a rotatable drive element, a housing for enclosing the motor, a latch assembly cooperating with the housing for removably coupling the housing to the cutting assembly, an irrigation connection on the housing for connection to a fluid source, an irrigation passage extending through the housing between the irrigation connection and the at least one tube to the distal end thereof, a suction connection on the housing for connection to a suction source, and a suction passage extending from the window through the tubes and through the housing to the suction connection. 
     Clause 67—A cutting assembly for a surgical instrument for use on a patient, the cutting assembly being configured to be coupled to a drive assembly including a motor having a rotatable drive element enclosed in a housing and, the cutting assembly comprising: a rotatable inner member adapted to be rotated by the drive element and an outer tube disposed over the inner member; and a grip supporting the outer tube, the grip configured to be engaged by a least a portion of a palm of a hand of a user and a finger of the hand, wherein the grip comprises a nose portion having an aperture extending axially therethrough to allow the inner member to extend axially therethrough, wherein the grip further comprises a finger portion extending from the nose portion to support a finger of the hand. 
     Clause 68—A cutting assembly as set forth in clause 67 wherein the finger portion extends from the nose portion at an angle between at least perpendicular and an obtuse angle relative to the nose portion. 
     Clause 69—A cutting assembly as set forth in clause 67 wherein the grip further comprises an intermediate portion extending axially from the finger portion. 
     Clause 70—A cutting assembly as set forth in clause 69 wherein the grip includes a web portion extending from the intermediate portion and apart from the finger portion to engage a web disposed between a thumb and an index finger of the hand. 
     Clause 71—A cutting assembly as set forth in clause 70 wherein a position of the web portion is adjustable relative to a position of the finger portion. 
     Clause 72—A cutting assembly as set forth in clause 67 wherein the outer tube includes a cutting window at a distal end adapted to be applied to a surgical site of a patient. 
     Clause 73—A cutting assembly as set forth in clause 67 including a bur coupled to a distal end of the inner member. 
     Clause 74—A method for gripping a cutting assembly including an inner tube and an outer tube with a window at a distal end adapted to be applied to a surgical site of a patient, a grip adapted to be engaged by a least a portion of a hand of a user and supporting the inner tube and the outer tube, wherein the grip includes a nose portion having an aperture extending axially therethrough to allow the inner tube and outer tube to extend axially therethrough and a finger portion extending from the nose portion to support a finger of the hand, and a manually movable member coupled to the outer tube and located axially along the grip within reach of at least one finger or thumb of the hand of the user when the hand is engaged with the grip, the method comprising the steps of: placing a finger of the hand on the finger portion; placing a thumb or at least another finger of the hand different from the finger accommodated by the finger portion on the manually movable member; placing a web of the hand disposed between the thumb and index finger of the hand on the web portion; and moving the manually movable member with the thumb or the at least another finger to rotate the window of the outer tube relative to a longitudinal axis of the outer tube when the hand is engaged with the grip. 
     Clause 75—A surgical instrument comprising: a drive assembly comprising a motor having a rotatable drive element, and a housing coupled to the motor; a cutting assembly comprising an inner tube adapted to be rotated by the drive assembly, an outer tube disposed over the inner tube, a drive hub for coupling the inner tube to the rotatable drive element, a connecting hub for coupling the cutting assembly to the drive assembly, and a manually movable member coupled to the cutting assembly and adapted to be rotated by the user to rotate the outer tube; an irrigation connection disposed on the housing for connection to a fluid source; an irrigation passage extending through the housing between the irrigation connection and the cutting assembly; a suction connection disposed on the housing for connection to a suction source; a suction passage extending through the housing between the suction connection and the cutting assembly; a coil seal disposed between the drive hub and the connecting hub of the cutting assembly to allow fluid flow between the coil seal and the drive hub; and a radial seal disposed between the manually movable member and the connecting hub to prevent fluid from exiting the irrigation passage between the manually movable member and the connecting hub.