Rotating tissue cutting device

Abstract

The present invention is entitled a rotary tissue cutting device. The device for cutting an opening in a tissue wall includes an inner cutting member having a first cylindrical body, the first cylindrical body supporting at least one first cutting surface at a distal end. The first cutting surface faces a first rotational direction relative to the axis of the first cylindrical body and has a first cutting edge at the outer periphery of the first cylindrical body. Also included is an outer cutting member having a second cylindrical body, the second cylindrical body being concentrically arranged around the first cylindrical body and supporting at least one second cutting surface at the distal end. The second cutting surface faces a second rotational direction relative to the axis and has a second cutting edge at the inner periphery of the second cylindrical body. In response to application against the distal end of the tissue device and causing the inner cutting member and the outer cutting member to rotate in opposite directions, tissue can be rotatably sheared between the first cutting edge of the inner cutting member and the second cutting edge of the outer cutting member.

Description

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS

[0002] This application is related to co-pending application with attorney docket number ORA0107US1 filed herewith for "ROTATIONAL TISSUE CUTTING CONTROL DEVICE," the entire contents of which are incorporated by reference. Technical Field

[0003] The present disclosure relates to devices, systems, and methods for cutting openings in tissue walls. Background Art

[0004] The statements in this section merely provide background information related to the present disclosure and may not constitute prior art.

[0005] The ability to access tissue within a patient's body without invasive surgery allows for ever-improving types of analysis, diagnosis, and treatment while reducing pain, reducing recovery time, and reducing the risk of complications. By way of two examples, endoscopic imaging and catheterization therapy enable the evaluation and treatment of many internal lesions without invasive surgery.

[0006] In some cases, it may be desirable to insert a thin probe-like device to remotely cut tissue within a patient's body. For example, to provide relief to a patient when a bile duct is blocked, it may be desirable to insert a probe into the gastrointestinal tract to cut an opening so that the gallbladder can discharge bile into the duodenum to relieve the pain of gallbladder swelling. However, although the probe can be inserted to reach the desired location, making small cuts remotely can prove to be very difficult. When there is no structure behind the tissue to press against to make the cut, the tissue may be too flexible to perforate or cut through. Summary of the invention

[0007] The disclosed embodiments include devices, systems, and methods for cutting openings in tissue walls.

[0008] In an exemplary embodiment, the device includes an inner cutting member having a first cylindrical body that supports at least one first cutting surface at a distal end. The first cutting surface faces a first rotational direction relative to the axis of the first cylindrical body and has a first cutting edge at the outer periphery of the first cylindrical body. The device also includes an outer cutting member having a second cylindrical body that is concentrically arranged around the first cylindrical body and supports at least one second cutting surface at the distal end. The second cutting surface faces a second rotational direction relative to the axis and has a second cutting edge at the inner periphery of the second cylindrical body. In response to the application of the distal end of the tissue device against the inner cutting member and the outer cutting member counter-rotating, the tissue can be rotatably sheared between the first cutting edge of the inner cutting member and the second cutting edge of the outer cutting member.

[0009] In another exemplary embodiment, the device includes an inner cutting member having a first cylindrical body that supports two or more first cutting surfaces at the distal end of the device. The first cutting surface faces a first rotational direction relative to the axis of the first cylindrical body. The first cutting surface includes a first cutting edge at the outer periphery of the first cylindrical body and inclined relative to the axis of the inner cutting member. The first cutting surface also includes an anchor tip that extends outward beyond the distal end and is configured to puncture tissue. The device also includes an outer cutting member having a second cylindrical body that is concentrically arranged around the first cylindrical body and supports at least one second cutting surface at the distal end of the device. The second cutting surface faces a second rotational direction relative to the axis and has a second cutting edge at the inner periphery of the second cylindrical body. In response to the application of the distal end of the tissue device against the inner cutting member and the inner cutting member and the outer cutting member rotating inversely, the tissue can be punctured by the anchor tip and can be rotatably sheared between the first cutting edge of the inner cutting member and the second cutting edge of the outer cutting member.

[0010] In another exemplary embodiment, the method includes extending a cylindrical cutting device against tissue, the cylindrical cutting device having an inner cutting member and a concentric outer cutting member. The inner cutting member and the concentric outer cutting member have opposing cutting surfaces that are configured to radially cut tissue orthogonally to the axes of the inner cutting member and the concentric outer cutting member. The inner cutting member is moved to cause the tip of the anchor at the distal end of the inner cutting member to pierce the tissue. The inner cutting member and the concentric outer cutting member are rotated relative to each other to radially cut the tissue.

[0011] In another exemplary embodiment, an apparatus for controlling a cutting device capable of counter-rotation includes a first radial actuator configured to engage a first drive shaft. A second radial actuator configured to engage a second drive shaft disposed coaxially with the first drive shaft. A housing supports the first radial actuator and the second radial actuator and allows the first drive shaft and the second drive shaft to extend therethrough, the first drive shaft and the second drive shaft being capable of relatively counter-rotation in response to rotation of at least one of the first radial actuator and the second radial actuator.

[0012] In another exemplary embodiment, the device for controlling a cutting device capable of reverse rotation includes a first radial actuator, which is configured to engage a first drive shaft. The second radial actuator is configured to engage a second drive shaft, which is coaxially arranged with the first drive shaft. A reverse rotation mechanism mechanically couples the first radial actuator and the second radial actuator, and the reverse rotation mechanism is configured to cause the second radial actuator to rotate in a second direction when the first radial actuator rotates in a first direction. The housing supports the first radial actuator and the second radial actuator, and allows the first drive shaft and the second drive shaft to extend through it. The rotation controller is mechanically coupled to the first radial actuator to allow rotation of the first radial actuator, and the first drive shaft and the second drive shaft can simultaneously reversely rotate in response to the rotation of the first rotation controller.

[0013] In yet another exemplary embodiment, a system for cutting an opening in a tissue wall includes a drive shaft assembly including a first drive shaft; a second drive shaft coaxially disposed about the first drive shaft and configured to rotate independently of the first drive shaft; and a sheath containing the first drive shaft and the second drive shaft. A first radial actuator is configured to engage the first drive shaft. A second radial actuator is configured to engage the second drive shaft. A housing supports the first radial actuator and the second radial actuator and allows the sheath containing the first drive shaft and the second drive shaft to extend therethrough. A rotation controller is mechanically coupled to the first radial actuator to allow the first radial actuator to rotate relative to the second radial actuator. A cutting device includes an inner cutting member having a first cylindrical body supporting at least one first cutting surface at a distal end of the cutter and mechanically coupled to the first drive shaft, wherein the first cutting surface faces a first rotational direction relative to an axis of the first cylindrical body and has a first cutting edge at an outer periphery of the first cylindrical body. An outer cutting member having a second cylindrical body is concentrically disposed around the first cylindrical body and mechanically coupled to the second drive shaft, wherein the outer cutting member supports at least one second cutting surface at the distal end of the device, and the second cutting surface faces in a second rotational direction relative to the axis, and has a second cutting edge at the inner periphery of the second cylindrical body. In response to application of the distal end of the device and rotation of the rotation controller, tissue can be rotatably sheared between the first cutting edge of the inner cutting member and the second cutting edge of the outer cutting member.

[0014] Other features, advantages, and scope of applicability will become apparent from the description provided herein.It should be understood that the detailed description and specific examples are for illustrative purposes only and are not intended to limit the scope of the present disclosure. BRIEF DESCRIPTION OF THE DRAWINGS

[0015] The drawings described herein are for illustrative purposes only and are not intended to limit the scope of the present disclosure in any way. The components in the drawings are not necessarily drawn to scale, but emphasis is placed on illustrating the principles of the disclosed embodiments. In the drawings:

[0016] Figure 1 is a side plan view of a system for cutting tissue according to the present disclosure;

[0017] Figure 2 yes Figure 1 A side plan view of a cutting device of the system;

[0018] FIG. 3A to FIG. 3C yes Figure 2 Perspective and side views of the inner cutting member of the cutting device;

[0019] FIG. 4A to FIG. 4C yes Figure 2 Perspective and side views of one embodiment of an outer cutting member of a cutting device;

[0020] FIG. 5A to FIG. 5C yes Figure 2 A perspective and side view of another embodiment of an inner cutting member of a cutting device;

[0021] Figure 6 yes Figure 2 An enlarged side plan view of a cutting device;

[0022] Figure 7 It is used to control Figure 1 An exploded view of an embodiment of a device of a system of a cutting device capable of counter-rotation;

[0023] Figure 8 It is used to control Figure 1 A side plan view of a section of a device of a system capable of counter-rotating cutting devices;

[0024] Fig. 9 It can be used for Figure 8 A perspective view of another embodiment of a counter-rotation mechanism in an apparatus;

[0025] Fig.10 It is used to control Figure 1 A side plan view of another embodiment of a device of a system capable of counter-rotating cutting devices;

[0026] Fig.11 yes Figure 1 a cross-sectional view of a drive shaft assembly of the system; and

[0027] Fig.12 is a flow chart of an exemplary method of cutting tissue according to the present disclosure. DETAILED DESCRIPTION

[0028] The following description is merely exemplary in nature and is not intended to limit the present disclosure, application or uses. It should be noted that the first digit of a three-digit reference numeral and the first two digits of a four-digit reference numeral correspond to the first digit of a one-digit reference numeral and the first two digits of the reference numeral where the element first appears, respectively.

[0029] The following description explains various embodiments of the device, system and method for cutting tissue by way of illustration only and not limitation.As will be described in detail below, the cutting device has a rotating element capable of counter-rotation, which extends to the tissue and causes them to rotate relative to each other to puncture and shear the tissue.

[0030] See also Figure 1An exemplary system 100 is provided for cutting an opening in a tissue wall in an anatomical region of a patient (in Figure 1 In various embodiments, generally speaking, the system 100 includes a cutting device 111, a control device 150 for controlling the cutting device 111, and a drive shaft assembly 140 that couples the cutting device 111 to the control device 150. As will be described in detail below, the cutting device 111 is a counter-rotatable cutting device having a cutting member that is configured to rotate about the axis 101 in directions 103 or 105, as described below with reference to Figure 2 , FIG. 3A to FIG. 3C , FIG. 4A to FIG. 4C , FIG. 5A to FIG. 5C and Figure 6 The drive shaft assembly 140 includes a first drive shaft and a second drive shaft, which in some embodiments includes a hollow shaft coaxially disposed around the first drive shaft. The first drive shaft and the second drive shaft are capable of being coupled to components of the cutting device 111 and are contained in a sheath, as described below with reference to Fig.11 Further described. In some embodiments, the first drive shaft and the second drive shaft include flexible cables capable of counter-rotation. The control device 150 includes a housing 160 that supports a position adjustment device 170 and at least one rotating handle 180, each of which is referred to below Figure 7 , Figure 8 and / or Fig. 9 Further description.

[0031] See also Figure 2 The cutting device 111 includes two counter-rotatable members, the counter-rotatable members including an inner cutting member 211 and an outer cutting member 251. FIG. 3A to FIG. 3C and FIG. 5A to FIG. 5C Further describing, the inner cutting member 211 is configured to puncture tissue and / or secure tissue at the distal end 290 at the cutting device 211, and then pull the tissue into a cutting region 292 between opposing cutting surfaces, including the inner cutting surface 241 on the inner cutting member 211 and the outer cutting surface 271 on the outer cutting member 251. Thus, counter-rotation of the inner cutting member 211 and the outer cutting member 251 shears the tissue to form an opening in the tissue.

[0032] See also FIG. 3A to FIG. 3C The inner cutting member 211 includes a body 315 having a proximal end 349 that engages the drive shaft assembly 140 ( Figure 1 ,exist FIG. 3A to FIG. 3C ), which is referred to below Fig.11Further described. The inner cutting member 211 includes one or more anchor tips 321 that extend longitudinally toward the distal end 290 and are radially curved about the axis 101 in the direction 103. The anchor tips 321 are angled so as to extend toward the distal end 290 in front of the one or more inner cutting surfaces 241. The anchor tips 321 have a piercing end 323 that is configured to pierce a tissue wall (at the distal end 290) presented at the distal end 290 of the inner cutting member 211. FIG. 3A to FIG. 3C In some embodiments and as Figure 2 , FIG. 3A to FIG. 3C and Figure 6 As shown, the anchor tip 321 describes a helical shape. In some other embodiments, the anchor tip 321 can also include a flat anchoring surface 325 that faces away from the distal end 290.

[0033] The inner cutting member 211 also includes one or more inner cutting surfaces 241. The inner cutting surface 241 is inclined from the front cutting edge 343 to the rear cutting edge 345. In some embodiments, the front cutting edge 343 of the inner cutting surface 241 is at the outer edge of the inner cutting member, wherein the front cutting edge will engage the front edge of the outer cutting surface 271 of the outer cutting member 251, as further described below. In some embodiments, the one or more inner cutting surfaces 241 are inclined at an acute angle relative to the axis 101. The one or more inner cutting surfaces 241 are angled so that in the cutting area 292 ( Figure 2 ), the one or more inner cutting surfaces 241 of the inner cutting member and the one or more inner cutting surfaces 271 of the outer cutting member 251 are brought together at an acute angle facing the distal end 290 like the opposing blades of a pair of scissors, thereby promoting the shearing of tissue. The inner cutting surface 241 of the inner cutting member 211 is parabolic in shape, terminating at the lower end 347 to help form a scissor shape between the inner cutting surface 241 and the outer cutting surface 271.

[0034] Continue to see FIG. 3A to FIG. 3C , presenting the anchor tip 321 against the tissue wall and rotating the inner cutting member 211 about the axis 101 in the direction 103 will cause the piercing end 323 of the anchor tip 321 to pierce the tissue. Continued rotation about the axis 101 in the direction 103 can then cause the flat anchor surface 325 to pull the tissue wall away from the distal end 290 and into the cutting region 292. In the cutting region, the inner cutting surface 241 will abut against the outer cutting surface 271 ( Figure 2 ) shear tissue, as previously described and as referenced below Figure 6 Further description.

[0035] See also FIG. 4A to FIG. 4C, the outer cutting member 251 includes a body 455 having a proximal end 499 that engages the drive shaft assembly 140 ( Figure 1 ,exist FIG. 4A to FIG. 4C ), which is referred to below Fig.11 The outer cutting member 251 includes a front end portion 461, which in some embodiments includes a tip portion 463 extending longitudinally toward the distal end 290. In some embodiments, the front end portion 461 is angled away from the tip portion 463 at the distal end 290 to facilitate penetration into the tissue wall, as shown in reference Figure 6 The outer cutting member 251 also includes one or more outer cutting surfaces 271. The outer cutting surface 271 slopes from the front cutting edge 473 to the rear cutting edge 475. In some embodiments, the front cutting edge 473 of the outer cutting surface 271 is at the inner edge of the outer cutting member 251, wherein the front cutting edge will engage the front edge 343 of the inner cutting surface 241 of the inner cutting member 221, as described below with reference to Figure 6 Further description.

[0036] In some embodiments, the outer cutting surface 271 of the outer cutting member 251 is generally U-shaped, terminating at a lower end 477. FIG. 4A to FIG. 4C As shown, in some embodiments, the outer cutting surface 271 is substantially parallel to the axis 101. The outer cutting member 251 is presented against the tissue wall together with the inner cutting member ( Figure 2 and FIG. 3A to FIG. 3C ) and counter-rotating the outer cutting member 251 about the axis 101 in the second direction 105 against the inner cutting member 211 will shear the tissue between the outer cutting surface 271 of the outer cutting member 251 and the inner cutting surface 241 of the inner cutting member 211, as will be described below with reference to Figure 6 Further description.

[0037] In some embodiments and as FIG. 3A to FIG. 3C and FIG. 4A to FIG. 4C As shown, the inner cutting surface 241 is at an acute angle relative to the axis 101 and the outer cutting surface 271 is substantially parallel to the axis 101 to present opposing cutting surfaces that intersect at an acute angle to facilitate shearing of tissue. However, it should be understood that the same acute cutting angle between the opposing cutting surfaces can be formed by arranging the inner cutting surface 241 of the inner cutting member 211 to be substantially parallel to the axis 101, while making the outer cutting surface 271 at an acute angle relative to the axis 101 to form an acute cutting angle between the cutting surfaces 241 and 271. In addition, in some other embodiments, the inner cutting surface 214 of the inner cutting member 211 and the outer cutting surface 271 of the outer cutting member 251 can be angled with the axis 101 in relative directions to form an acute cutting angle between the opposing cutting surfaces 241 and 271. In addition, as previously described with reference to FIG. 3A to FIG. 3C as well as FIG. 4A to FIG. 4C It is described that the leading edge 343 of the inner cutting surface 241 of the inner cutting member 221 is at the outer surface of the inner cutting member 221, and the leading edge 473 of the outer cutting surface 471 of the outer cutting member 251 is at the inner surface of the outer cutting member 251, so that the leading edges 343 and 473 will be gathered together like the leading edges of scissors blades to facilitate cutting of tissue therebetween.

[0038] See also FIG. 5A to FIG. 5C In some other embodiments, the inner cutting member 511 includes a body 515 having a proximal end 549 that engages the drive shaft assembly 140 ( Figure 1 ,exist FIG. 3A to FIG. 3C ), which is referred to below Fig.10 Further description. Instead of the angled anchor tip 321 of the inner cutting member 211, as Figure 2 and FIG. 3A to FIG. 3C As shown, the inner cutting member 511 includes a concave anchor tip 521 having a pair of piercing ends 523 at either end. The piercing ends 523 are configured to pierce the tissue wall present at the distal end 290 of the inner cutting member 511 (at FIG. 5A to FIG. 5C 541, including the leading edge 543, the trailing edge 545, and the generally parabolic shape terminating at the lower end 547, are the same as the corresponding leading edge 343, the trailing edge 345, and the generally parabolic shape terminating at the lower end 347 of the inner cutting member 211, as shown in FIG. Figure 2 and FIG. 3A to FIG. 3C However, it should be noted that the inner cutting surface 541 may be angled differently relative to the axis 101 to correspond to the above reference. FIG. 4A to FIG. 4C The outer cutting surface 271 is depicted as being angled to form a scissor-type shape between the inner cutting surface 541 and the outer cutting surface 271 .

[0039] In various embodiments and see Figure 6, the cutting device 111 including the inner cutting member 211 and the outer cutting member 251 is positioned and operated to puncture and shear tissue. The cutting device 111 is positioned at the tissue wall 601 represented by the dotted line. The inner cutting member 211 and the outer cutting member 251 are relatively counter-rotated, wherein the inner cutting member 211 is relatively counter-rotated in a first direction 103 about the axis 101, and the outer cutting member 251 is relatively counter-rotated in a second direction 105 about the axis 101. The rotation of the inner cutting member 321 in the first direction 103 causes the piercing end 323 of the anchor tip 321 to puncture the tissue wall 601. In addition, the relatively counter-rotating of the inner cutting member 211 causes the flat anchor surface 325 to face away from the distal end 290 of the cutting device 111 to pull the tissue at the tissue wall 601 into the cutting area 292 along the direction 607.

[0040] As the cutting members 211 and 251 of the cutting device 111 move relative to each other, the tissue wall 601 is pulled between the inner cutting surface 241 of the inner cutting member 211 and the outer cutting surface 271 of the outer cutting member 251. As the inner cutting member 211 and the outer cutting member 251 relatively counter-rotate about the axis 101, the inner cutting surface 241 and the outer cutting surface 271 shear the tissue 601 around the periphery of the cutting device 111 to form an opening in the tissue wall 601.

[0041] wherein the inner cutting member comprises a cutting device 111 (such as FIG. 5A to FIG. 5C In some other embodiments of the inner cutting member 511 shown, the anchor tip 521 of the inner cutting member 511 may not be configured to pull tissue into the cutting region between the cutting surfaces, as the anchor tip 221 of the inner cutting member 211 ( Figure 2 , FIG. 3A to FIG. 3C and Figure 6 ). However, pressure applied by the cutting device 111 against the tissue wall 601 toward the distal end 290 of the cutting device 111 can cause the cutting device 111 to be punctured into the tissue wall 601 and the cutting device 111 to move into the tissue wall to bring the tissue into the cutting range 292 between the inner cutting surface 541 of the inner cutting member 511 and the outer cutting surface 271 of the outer cutting member 251.

[0042] See also Figure 7 In various embodiments, the control device 150 includes components that can be used to position and relatively counter-rotate the cutting device 111 (in Figure 7 The position adjustment device 170 includes a sleeve 772 that is fixedly connected to the sheath of the drive shaft assembly 140 (not shown). Figure 7111 is to be deployed). The sleeve 772 is slidably received in the first end 774 of the housing 160 of the control device 150. The sleeve 772 includes a locking groove 777 that receives a sheath lock 776, which in turn is received in the housing 160 through a sheath locking port 778.

[0043] like Figure 7 As shown, in some embodiments, the sheath lock 776 is in the form of a knurled locking screw that mechanically and selectively engages a locking groove 777 in the sleeve 772. The sheath lock 776 can be rotated to release the sheath lock 776 from the locking groove 777 to enable the sleeve 772 and, therefore, the drive shaft assembly 140 to move. The sleeve 772 is manipulated by sliding the sleeve 772 relative to the housing 160. Then, once the cutting device 111 has been positioned at the desired position, the sheath lock 776 can be rotated to cause the sheath lock 776 to engage the locking groove 777 in the sleeve 772 to lock the drive shaft assembly 140, and, therefore, the cutting device 111 coupled to the drive shaft assembly 140 at the desired position (at the desired position). Figure 7 772). It should be understood that other forms of position adjustment devices 170 may be used, including, for example, levers or latches to lock the sleeve 772 in place. It should also be understood that other forms of position adjustment devices 170 may be fixedly coupled to the housing of the bronchoscope or other device for guiding the cutting device 111, so that moving the housing causes moving the drive shaft assembly 140. The embodiments of the present disclosure are not limited to the use of any particular form of position adjustment device 170.

[0044] Still see Figure 7 In some embodiments, the rotating grip 180 may include a user grip 781, such as a knurled grip, and an interface 782 for engaging a rotating mechanism, such as described below with reference to Figure 8 describe.

[0045] See also Figure 8 In some embodiments, the control device 150 includes a reverse rotation mechanism 802. The reverse rotation mechanism 802 includes a first radial actuator 812 configured to engage a first drive shaft of the drive shaft assembly 140 (at Figure 8 ), which in turn may be coupled to the inner cutting member 211 of the cutting device 111 (neither of which is shown in Figure 8 The reverse rotation mechanism 802 includes a second radial actuator 852 configured to engage a second drive shaft (in Figure 8The second drive shaft can then be coupled to the outer cutting member 251 of the cutting device 111. The configuration of the drive shaft assembly 140 is described below with reference to Fig.11 Further description.

[0046] To cause the drive shaft of the drive shaft assembly 140 to rotate in opposite directions, the first radial actuator 812 and the second radial actuator 852 are mechanically connected to cause the radial actuators 812 and 852 to rotate in opposite directions when one or the other is rotated. Figure 8 In the reverse rotation mechanism 802 shown, the first radial actuator 812 includes a first bevel gear 814 facing the first end 801 of the housing 160, and the second radial actuator 852 includes a second bevel gear 854 facing the first end 801 away from the housing 160. Mechanically coupled to each of the first bevel gear 814 and the second bevel gear 854 is a drive gear 892 including a differential bevel gear 894. Rotation of the first bevel gear 814 applies rotation to the differential bevel gear 894, which causes relative rotation with the second bevel gear 854. The reverse rotation mechanism 802 may also include a base 896 to support the differential actuators 812 and 854 and the drive gear 892. Figure 8 As shown, the first differential actuator 812 is received on the interface 782 on the rotating handle 180, so that when the rotating handle 180 is rotated in one direction, the first differential actuator 812 rotates in the same direction and the second differential actuator 852 rotates in the opposite direction. Therefore, the drive shafts of the drive shaft assembly 140 rotate in opposite directions, causing the cutting members 211 and 251 of the cutting device 111 to rotate in opposite directions.

[0047] See also Fig. 9 , so that the drive shaft of the drive shaft assembly 140 and the cutting device 111 (both of which are not in Fig. 9 Another embodiment of the reverse rotation mechanism 902 of the reverse rotation shown in FIG. 1 uses spur gears instead of Figure 8 The bevel gear used in the reverse rotation mechanism 802. The reverse rotation mechanism 902 includes a base gear 914, which is connected to the first radial actuator 812 (in Fig. 9 ) is connected to the first radial actuator 812 as shown in the reference Figure 8 When describing rotation, rotation is applied to base gear 914. Base gear 914 is an inwardly facing spur gear that is configured to rotate about axis 101. Base gear 914 engages axle 992. Axle 992 includes a first transmission gear 915, which may include an outwardly facing spur gear. Base gear 914 engages first transmission gear 915 so as to rotate in the same direction as the rotation of base gear 914, such as in the direction of rotation of the base gear 914. Fig. 9The direction 103 shown applies rotation to the first transmission gear 915. The first radial actuator 812, the base gear 914, or the axle 992 may be coupled to the first drive shaft or the second drive shaft (in Fig. 9 (not shown) to apply rotation to the first drive shaft.

[0048] The axle 992 may also include a first shaft 907 extending to a second transmission gear 919, which may also include an outwardly facing spur gear. Fig. 9 The other components in the bracket can be rotatably mounted on the bracket (in Fig. 9 The first axle 907 and the second transmission gear 919 both rotate in the same direction as the first transmission gear 915. The second transmission gear 919 engages a counter-rotating gear 954, which can also be rotatably mounted on the bracket ( Fig. 9 914). The engagement of the second transmission gear 919 with the reverse rotating gear 954 causes the reverse rotating gear 954 to rotate in a direction opposite to the second transmission gear 919 of the axle 992. Thus, for example, if the base gear 914 rotates in direction 103, the reverse rotating gear 954 will rotate in direction 105. The reverse rotating gear 954 may be coupled to a second shaft 957, which may be coupled to the second drive shaft (if the first drive shaft is coupled to the first radial actuator 812 or the base gear 914) or the first drive shaft (if the second drive shaft is coupled to the first radial actuator 812 or the base gear 914). In either case, rotation of the first radial actuator 812 and the base gear 914 in the first direction will cause the reverse rotating gear 954 to rotate in a relative direction to apply reverse rotation to the cutting member of the cutting device (in Fig. 9 ).

[0049] It should also be understood that the reverse rotation mechanism 902 may include a gear differential that enables the base gear 914 to rotate at a different angular velocity than the reverse rotating gear 954. For example, the radius of the first drive gear 915 and the plurality of spurs extending therefrom relative to the base gear 914 changes the rotational speed of the axle 992 relative to the base gear 914. Alternatively or in addition, the radius of the second drive gear 919 and the plurality of spurs extending therefrom relative to the reverse rotating gear 954 changes the reverse rotational speed of the reverse rotating gear 954 relative to the second drive gear 919. Thus, the drive shaft (at Fig. 9 (not shown) can rotate in opposite directions at different speeds, causing the cutting member of the cutting device (in Fig. 9 (not shown) rotates in the opposite direction at different speeds. In addition, it should be understood that although Fig. 9The spurs are shown extending only partially around the circumference of the spur gear to highlight the interengagement of the spurs and the associated spur gear, but it will be appreciated that the spurs may extend completely around the circumference of the spur gear.

[0050] See also Fig.10 In some other embodiments, the control mechanism 950 includes a housing 160 and a position adjustment device 170, such as Figure 7 and Figure 8 However, unlike control device 150, control device 1050 includes two rotating grips 1082 and 1084. Each of the rotating grips can be individually coupled to the drive shaft of drive shaft assembly 140 to achieve individual rotation of associated cutting members 211 and 251 of cutting device 111 (in Fig.10 1084). Each of the rotating grips 1082 and 1084 can be individually rotated, for example by rotating the first rotating grip 1082 in a first direction 1083 and by rotating the second rotating grip 1084 in a second direction 1085, to selectively allow individual rotation of the drive shaft of the drive shaft assembly 140 and the associated cutting members 211 and 251 of the cutting device 111, or simultaneous counter-rotation of the associated cutting members 211 and 251 of the cutting device 111.

[0051] See also Fig.11 In various embodiments, the drive shaft assembly 140 includes a first drive shaft 1142 that is capable of engaging with the inner cutting member 211 (in Fig.10 The drive shaft assembly 140 also includes a second drive shaft 1144 that can be coupled to the outer cutting member 251 of the cutting device 111. The first drive shaft 1142 can be solid or hollow, and the second drive shaft 1144 is a hollow member coaxially arranged around the first drive shaft 1142. The first drive shaft 1142 and the second drive shaft 1144 are arranged in a sheath 1146, which can be connected to the sleeve 772 ( Figure 7 and Figure 8 ) are fixedly coupled to allow extension and retraction of the drive shaft assembly 140. The first drive shaft 1142 can be separated from the second drive shaft 1144 by a gap 1148 so as not to hinder the rotation of the first drive shaft 1142. Similarly, the second drive shaft 1144 can be separated from the sheath 1146 by a gap 1148 so as not to hinder the sheath 1146 from rotating the second drive shaft 1144.

[0052] See also Fig.12, an exemplary method 1200 for cutting tissue is provided. The method 1200 begins at box 1205. At box 1210, a cylindrical cutting device having an inner cutting member and a concentric outer cutting member is extended against tissue. The inner cutting member and the concentric outer cutting member have opposing cutting surfaces that are configured to radially cut tissue orthogonal to the axes of the inner cutting member and the concentric outer cutting member. The configuration of the cutting member and its positioning are described previously with reference to Figure 2 , FIG. 3A to FIG. 3C , FIG. 4A to FIG. 4C , FIG. 5A to FIG. 5C and Figure 6 describe.

[0053] At block 1220, the inner cutting member is moved to cause the tip of the anchor at the distal end of the inner cutting member to pierce the tissue, as previously described with reference to FIG. FIG. 3A to FIG. 3C , FIG. 5A to FIG. 5C and Figure 6 At block 1230, the inner cutting member and the concentric outer cutting member are rotated relative to each other to radially cut tissue, as previously described with reference to Figure 6 Detailed description. Method 1200 ends at block 1235.

[0054] It should be understood that the present description of the cutting device and control device and the systems and methods described herein for cutting holes in tissue walls can be used to cut tissue in different parts of the body and can be guided by an endoscope, bronchoscope, laparoscope or other device.

[0055] It should also be understood that the detailed description set forth above is merely exemplary in nature, and variations that do not depart from the gist and / or spirit of the subject matter protected by the claims are intended to be within the scope of the claims. Such variations should not be considered as departing from the spirit and scope of the subject matter protected by the claims.

Claims

1. A device for cutting an opening in a tissue wall, the device comprising: an inner cutting member having a first cylindrical body defining a distal end opening at a distal end and supporting at least one first cutting surface at the distal end, wherein the first cutting surface faces in a first rotational direction relative to an axis of the first cylindrical body and has a first cutting edge extending along an edge of the distal end opening of the first cylindrical body, wherein the inner cutting member further comprises an anchor tip extending outwardly beyond the distal end and configured to puncture tissue; as well as An outer cutting member, the outer cutting member having a second cylindrical body, the second cylindrical body being concentrically arranged around the first cylindrical body and supporting at least one second cutting surface at the distal end, wherein the second cutting surface faces a second rotational direction relative to the axis and has a second cutting edge at the inner periphery of the second cylindrical body, in response to application of the distal end of the device against tissue and causing the inner cutting member and the outer cutting member to rotate in opposite directions, tissue can be rotatably sheared between the first cutting edge of the inner cutting member and the second cutting edge of the outer cutting member.

2. The apparatus of claim 1, wherein the inner cutting member supports two or more first cutting surfaces and the outer cutting member supports two or more second cutting surfaces.

3. The apparatus of claim 2, wherein at least one of the first cutting surface and the second cutting surface is inclined relative to the axis of the inner cutting member and the outer cutting member.

4. The apparatus of claim 3, wherein the first cutting surface is inclined at an acute angle relative to the axis and the second cutting surface is substantially parallel to the axis.

5. The apparatus of claim 1, wherein the anchor tip comprises an angled member extending in the first rotational direction in front of the first cutting surface and configured to draw the tissue toward the first cutting surface.

6. The apparatus of claim 5, wherein the angled member comprises a flat anchoring surface facing inward from the distal end.

7. The apparatus of claim 5, wherein the angled member has a generally helical shape.

8. The device of claim 1, wherein the anchor tip comprises a concave cutting surface facing the distal end and terminating in a sharp piercing tip.

9. The apparatus of claim 1, wherein the first proximal end of the inner cutting member and the second proximal end of the outer cutting member are each configured to be coupled to a counter-rotational drive mechanism.

10. An apparatus for cutting an opening in a tissue wall, the apparatus comprising: an inner cutting member having a first cylindrical body defining a distal end opening at a distal end and supporting two or more first cutting surfaces at the distal end of the device, wherein the first cutting surfaces face in a first rotational direction relative to an axis of the first cylindrical body, the first cutting surfaces comprising: a first cutting edge extending along an edge of a distal end opening of the first cylindrical body and inclined relative to the axis of the inner cutting member; and an anchor tip extending outwardly beyond the distal end and configured to penetrate tissue; and An outer cutting member, the outer cutting member having a second cylindrical body, the second cylindrical body being concentrically arranged around the first cylindrical body and supporting at least one second cutting surface at the distal end of the device, wherein the second cutting surface faces a second rotational direction relative to the axis and has a second cutting edge at the inner periphery of the second cylindrical body, in response to application of the distal end of the device against tissue and causing the inner cutting member and the outer cutting member to rotate in opposite directions, the tissue can be punctured by the anchor tip and can be rotationally sheared between the first cutting edge of the inner cutting member and the second cutting edge of the outer cutting member.

11. The apparatus of claim 10, wherein the first cutting surface is inclined at an acute angle relative to the axis and the second cutting surface is substantially parallel to the axis.

12. The apparatus of claim 10, wherein the anchor tip comprises an angled member extending in the first rotational direction in front of the first cutting surface and configured to draw the tissue toward the first cutting surface.

13. The apparatus of claim 12, wherein the angled member comprises a flat anchoring surface facing inward from the distal end.

14. The apparatus of claim 12, wherein the angled member has a generally helical shape.

15. The device of claim 10, wherein the anchor tip comprises a concave cutting surface facing the distal end and terminating in a sharp piercing tip.

16. The apparatus of claim 10, wherein the first proximal end of the inner cutting member and the second proximal end of the outer cutting member are each configured to be coupled to a counter-rotational drive mechanism.

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