Abstract:
A polypectomy instrument for the resection and withdrawal of a polyp tissue from a body lumen. The instrument comprises a dual handle arrangement on a first proximal end of the polypectomy instrument and a plurality of working channels on a distal end of the dual handle arrangement. Each of the working channels are arranged to carry a polyp engaging device. The dual handle arrangement is arranged to permit the easy manipulation and distally advancement and proximal retraction of the polyp engaging devices simultaneously.

Description:
BACKGROUND OF THE INVENTION  
       [0001]     1. Field of the Invention  
         [0002]     This invention relates to medical devices and more particularly to a polyp resecting arrangement for the grasping and resecting of a polyp within the colon of a body.  
         [0003]     2. Prior Art  
         [0004]     A growth of a tissue mass protruding from a mucous membrane is called a polyp. Such mucus membrane may be found in the nose, the ears, the mouth, the lung, heart, stomach, intestines and the uterus and cervix. Typically, polyps are benign and eventually cease any growth. However, some polyps do keep growing, and may mutate to form a cancerous tumor. As such cancerous tumors grow, they burrow deeper into the tissue supporting that polyp. The cancer, in its final stages, invades the blood and lymph systems wherein any malignant cells of the tumor spread to other organs. Such a malignancy is severe in the colon. Such colon tumors however, may be readily treated.  
         [0005]     Polyps grow from the mucus membrane with either a thin stalk or a broad base. A thin stalk holding a polyp is called a pedunculated polyp. A broad base which secures a polyp to the membrane, is called a sessile polyp.  
         [0006]     U.S. Pat. No. 6,015,415 to Avellanet shows a polypectomy snare instrument which used as a snare loop connected to a power source to supply cautery current. The snare loop captures the polyp. A current is then supplied to the snare loop to cauterize the polyp as the snare is closed tighter around that polyp stalk. A pair of graspers would then be introduced through the sheath after the snare has been removed therefrom. The graspers would seize upon the polyp and remove it from the colon by withdrawal into the distal end of the tubular sheath carrying their instrument. Such instrument would then be removed. Such a procedure unfortunately requires the insertion and removal of multiple instruments through multiple sheaths. Each one consuming time and raising the problems of injury to the patient.  
         [0007]     U.S. Pat. No. 5,746,747 to McKeating shows a polypectomy instrument with a pair of parallel sheaths slidable adjacent one another to reach the site of a polyp. The snare rides down the outer circumference of the sheath of its adjacent grasper. Such an arrangement is very complicated and may likely become entangled with one another at their distalmost ends during the grasping and snaring process. U.S. Pat. No. 6,616,659 to de la Torre et al. shows a polypectomy device having a pair of reciprocably advanceable jaws. The jaws have on its distalmost end, a wire snare extending thereacross. Such a device permits the snaring and grasping of a polyp but minimizes the manipulability of the distalmost end of the instrument when both the snare and the jaws are fixed together.  
         [0008]     It is an object of the present invention to overcome the disadvantages of the prior art.  
         [0009]     It is a further object of the present invention to provide a polypectomy device which permits multiple arrangements to be utilized either sequentially or simultaneously with a common handle, providing minimum intrusion within the patient.  
         [0010]     It is still yet a further object of the present invention to provide a polypectomy device which minimizes the time and maximizes the device manipulability and the safety for the patient being operated upon.  
       BRIEF SUMMARY OF THE INVENTION  
       [0011]     The present invention comprises an endoscopic polypectomy instrument having a first or proximal end comprising a dual handle arrangement. The polypectomy instrument, in one preferred embodiment, has a second or distal end through which a biopsy forcep and a snare wire both simultaneously extend.  
         [0012]     The dual handle portion of the instrument comprises an elongated generally cylindrical housing having an open ring at its proximalmost end as a thumb opening. The dual handle has an intermediately disposed frame portion with a distal end having a shaped distal frame grip thereon. The frame portion of the dual handle has a first slide member thereon having a pair of spaced apart flanges on either side of the handle with openings therethrough for insertion of the physician&#39;s fingers. The slide member is arranged to slide in an elongated track arranged in the intermediate portion of the dual handle instrument. The slide member is attached to the proximal end of a pair of push/pull control wires which extend through a first sheath. A pair of openable and closable jaws are arranged at the distal end of the first sheath. Distal movement of the slide member distally moves the control wires so as to spread apart the gripping jaws at the distal end of the first sheath. Proximal motion of the slide member with respect to the dual handle instrument pulls upon the control wires to close the jaws pivotably disposed on the distal end of the first sheath.  
         [0013]     A snare wire slide control member is also arranged on the dual handle distal of the slide member at the distal end of the dual handle instrument. The snare wire slide control member is also movable both distally and proximally on the distal end of the dual handle instrument and between the slide member and the distal frame grip member arranged thereat. The snare wire control member is connected to a push/pull control wire having a distal end with a pre-shaped openable snare wire loop arranged thereat. The snare wire loop extends at the outer end of the second sheath. The snare wire is movable proximally so as to pull the snare wire loop tighter around a polyp if such a polyp has been located within a patient&#39;s colon.  
         [0014]     The first sheath and a second sheath supporting the jaws and the snare loop respectively, are each individually and collectively movable reciprocably, in an outer conduit which extends through a colonoscope. The conduit is preferably attached to the distalmost end of the dual handle instrument distal of the frame grip member.  
         [0015]     In one preferred embodiment of the present invention, the wire snare is electrified so that when it extends out of the distalmost end of the second sheath within the distal end of the conduit, the self-enlarging snare loop opens up and is positionable around a visualized colonic polyp, which then may be readily resected by closure of the snare wire loop about that polyp. Once the snare wire loop has resected the polyp, the jaws of the polypectomy instrument may be easily opened by distal movement of the slide member with respect to the dual handle instrument, so as to open the jaws and permit them to close and sieze upon the now resected polyp. Those closed jaws with the polyp tissue, may be withdrawn from colon with the colonoscope for subsequent pathological examination. The forceps jaws may be returned through the colonoscope, so as to retrieve any further polyp successively resected by the snare wire, if necessary.  
         [0016]     The slide member may preferably have a circuit component therewith which is in electrical communication with an actuatable power source. The snare wire and the forceps may be both electrified to provide for cautery and bleeding control of any colon tissue. The actuable power source may be regulatable so as to permit either the forceps and/or the end or the snare wire loop to be electrified for such cautery and for bleeding control.  
         [0017]     In yet a further preferred embodiment of the present invention, a retriever wire may be utilized with or instead of the biopsy forceps jaws so as to permit retracting a polyp with a three or four pronged finger arrangement.  
         [0018]     The invention thus comprises a polypectomy instrument for the resection and withdrawal of a polyp tissue from a body lumen, comprising: a dual handle arrangement on a first proximal end of the polypectomy instrument; a plurality of working channels on a distal end of the dual handle, each of the working channels arranged to carry a polyp engaging device; and wherein the dual handle is arranged to distally advance, manipulate and proximally retract the polyp engaging devices simultaneously. At least one of the polyp engaging devices may have an electrical circuit connected thereto, for resecting and cauterizing a polyp thereby.  
         [0019]     The dual handle arrangement preferably has a slide arranged therealong for permitting controlled motion of a forceps jaw arrangement therefrom. The dual handle also has a slide arranged therealong for permitting controlled motion of a wire snare loop arrangement therefrom. The dual handle may also have a slide arranged therealong for permitting controlled motion of a multi-pronged retriever wire arrangement therefrom.  
         [0020]     The invention may also comprise a method of resecting and retrieving a polyp tissue from the body lumen of a patient being examined, comprising one or more of the following steps of: inserting a colonoscope into said body lumen of the patient; introducing a multi-working-channel polypectomy instrument through a conduit and into the colonoscope to permit internal visualization of the patient&#39;s colon, the polypectomy instrument having a dual handle to permit co-manipulating at least two instruments simultaneously therethrough; placing a wire snare loop around a located polyp on the lumen of the patient; resecting the polyp; grasping the resected polyp by a forcep arrangement manipulably disposed adjacent the wire snare loop in the polypectomy instrument; withdrawing the resected polyp with the colonoscope by withdrawing the forceps arrangement with the colonoscope. The resecting and grasping of the polyp preferably occurs simultaneously. The forceps may alternatively comprise a multi-pronged retriever wire device.  
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0021]     The objects and advantages of the present invention will become more apparent when viewed in conjunction with the following drawings, in which:  
         [0022]      FIG. 1  is a side elevational view of an endoscopic polypectomy instrument constructed according to the principles of the present invention;  
         [0023]      FIG. 2  is a view taken along the lines of A-A of  FIG. 1 .  
         [0024]      FIG. 3  is a view taken along the lines of B-B of  FIG. 1 :  
         [0025]      FIG. 4  is a view of the distal end of the instrument which view is taken along the lines C-C of  FIG. 1 ;  
         [0026]      FIG. 5  is a perspective view of the distal end of the polypectomy instrument showing both jaws and the wire loop snare extending therefrom;  
         [0027]      FIG. 6  is a side elevational view of the first sheath of the polypectomy instrument showing the jaws in a closed orientation.  
         [0028]      FIG. 7  is a view similar to  FIG. 6  showing the jaws in an open configuration and,  
         [0029]      FIG. 8  is a side elevational view of the polypectomy instrument showing an arrangement of grasper wires arranged adjacent to a snare in a sheathed conduit.  
     
    
     DETAILED DESCRIPTION OF THE INVENTION  
       [0030]     Referring now to the drawings in detail, and particularly to  FIG. 1 , there is shown the present invention which comprises an endoscopic polypectomy instrument  10  having a first or proximal end  12  comprising a dual handle arrangement  14 . The polypectomy instrument  10 , in a first preferred embodiment, has a second or distal end  16  through which a biopsy forcep  18  and a snare wire loop  20  extend.  
         [0031]     The dual handle portion  14  of the instrument  10  comprises an elongated generally cylindrical housing having an open ring  22  at its proximalmost end  12  as a thumb opening. The dual handle  14  has an intermediately disposed frame portion  24  with a distal end having a shaped distal frame grip  26  rigidly arranged thereon. The frame portion  24  of the dual handle  14  has a first slide member  28  thereon, as best show in  FIGS. 2 and 3 , having a pair of spaced apart flanges  30  and  32  on either side of the handle  14  with openings  34  therethrough for insertion of the physicians fingers. The slide member  28  is arranged to slide in an elongated track  36  arranged in the intermediate portion  24  of the dual handle instrument  10 . The first slide member  28  is attached to the proximal end of a pair of push/pull control wires  40  which extend through a first sheath  42 , as may be seen in  FIGS. 5, 6  and  7 . A pair of openable and closable jaws  44  are arranged at the distal end of the first sheath  42 . Distal movement of the slide member  28  distally moves the control wires  40  so as to spread apart the gripping jaws  44  at the distal end of the first sheath  42 . Proximal motion of the slide member  28  with respect to the dual handle instrument  14  pulls upon the control wires  40  to close the jaws  44  pivotably disposed on the distal end of the first sheath  42 , as represented in  FIG. 6 .  
         [0032]     A snare wire slide control member  50  is arranged distal of the slide member adjacent the distal end  16  of the dual handle instrument  14 , as may be seen in  FIGS. 1, 2  and  3 . The snare wire slide control member  50  is also movable both distally and proximally on the distal end  16  of the dual handle instrument  14  and between the slide member  28  and the distal frame grip member  26  arranged thereat either simultaneously with or previous to the movement of the first slide  28  as commonly arranged in the dual handle  14  arrangement. The snare wire control member  50  is connected to a push/pull control wire  52 , as represented in  FIG. 1 , having a distal end with its pre-shaped openable snare wire loop  20  arranged thereat. The snare wire loop  20  extends at the outer end of a second sheath  56 . The snare control wire  52  is movable proximally so as to pull the snare wire loop  20  tighter around a polyp “P” if such a polyp has been located within a patient&#39;s colon “C”.  
         [0033]     The first sheath  42  and the second sheath  54  supporting the jaws  18  and the snare loop  20  respectively, are each individually and collectively movable reciprocably, in an outer conduit  57  arranged within a colonoscope  58 , having optic visualization means therein, not shown for clarity, which colonoscope  58  is positioned within the colon “C” of the patient being examined, as represented in  FIG. 2 . The conduit  57  and colonoscope  58  are preferably arranged to abuttingly engage the distalmost end of the dual handle instrument  10  distal of the frame grip member  26 , as represented in  FIG. 2 .  
         [0034]     In one preferred embodiment of the present invention, the wire snare loop  20  is electrified via a proper controlled electrical circuit  61  in hub  63  so that when it extends out of the distalmost end of the second sheath  54 , which is electrically insulated within the distal end of the conduit  57 , the snare loop  20  opens up and is positionable around a visualized colonic polyp “P”, which then may be readily resected by electrified or non-electrified closure of the snare wire loop  20  about that polyp “P”. Once the snare wire loop  20  has resected the polyp, the jaws  44  of the polypectomy instrument  10  may be opened by distal movement of the slide member  28  with respect to the dual handle instrument  10 , so as to open the jaws  44  and permit them to close and seize upon the now resected polyp “P”, or the jaws  44  may have already been opened and grasped the polyp “P” prior to and in anticipation of its resection. Those closed jaws  44  and polyp tissue “P” may be pulled out with the colonoscope  58  for pathological examination of the polyp “P”. The forceps jaws  44  may be returned distally through the conduit  57 , so as to retrieve a further any further polyp successively resected by the snare wire, if necessary.  
         [0035]     The snare wire slide member  50  may also preferably have its circuit component  61  therewith which is in electrical communication with an actuatable power source  62 , as represented in  FIG. 1 . The forceps  18  may alternatively both be electrified by a proper circuit  60 , through hub  65  to therefore provide for simultaneous and/or sequential double cautery and bleeding control of any colon tissue through the readily manipulable common dual handle arrangement  14 . The actuable power source  62  may be regulatable by a foot control member, not shown for clarity, by the attending physician, so as to permit either the forceps  18  and/or the end of the snare wire loop  20  to both be electrified for such cautery and bleeding control.  
         [0036]     In yet a further preferred embodiment of the present invention, a multi-pronged retriever wire  64  may be utilized, as represented in  FIG. 8 , instead of the biopsy forceps jaws so as to permit retracting a larger resected polyp “PI” with such a hooked distal-ended three or four pronged retriever wire  64  arrangement instead of jaws to permit more appropriate manipulation of the retriever  64 . Alternatively, a forcep arrangement and a wire retriever may be utilized side by side for any particularly problematical retrieval of a polyp.