Multi-instrument surgical device

Abstract

A device for surgery that accommodates multiple different instruments, which may be interchanged or changed during the course of surgery in a manner that does not require disengagement of the device from the surgical site, thereby minimizing the need for reinsertion of the device into the patient and other hazards associated with multiple trips to the surgical site. In one embodiment, the device includes a cannula architecture to avoid the use of another cannula at the surgical site.

Description

[Background technology]

[0001] Over the years, many dramatic advances have been made in the field of minimally invasive surgical procedures. Accordingly, the natural damage and healing time of patients has been dramatically reduced. For example, in the field of ophthalmic surgery, damaged or deteriorated tissues that were previously difficult to access can now be repaired or directly treated by minimally invasive procedures. For example, vitrectomy is the removal of some or all of the vitreous humor from a patient's eye. In some cases, where surgery is limited to removing the cloudy vitreous humor, vitrectomy may constitute the majority of the procedure. However, vitrectomy may be accompanied by cataract surgery, retinal repair surgery, surgery to address epiretinal membranes, or many other issues.

[0002] Looking at the example of ophthalmic surgery and vitrectomy, the vitreous humor itself is a clear gel that can be removed by an elongated needle inserted through a cannula previously placed in the eye. More specifically, a vitrectomy probe is a surgical tool held in a gripping position by the surgeon with the needle emerging from the tool. The needle comprises a central channel for removing the vitreous humor. Furthermore, the cannula provides a conduit for structural support strategically placed at an offset location in the front of the eye, such as the pars plana. In this way, the probe needle can be inserted into the eye via a guide to avoid damage to the patient's lens or cornea.

[0003] The needle is generally guided and supported by a cannula and trocar assembly that is pre-positioned at the location of the incision through the pars plana as described above, thereby allowing the needle to be passed securely into the interior of the eye to perform the surgical procedure. Of course, as well as a probe needle for vitrectomy, a variety of other surgical instruments for a variety of different surgical purposes can be passed through the cannula and trocar assembly as well, including forceps, scissors, lights, and other instruments.

[0004] It is common that two or more different types of manipulation instruments may be required during the course of a given surgery. For example, a light may be placed and left in place to support the surgery, while a more interventional or "manipulation" instrument, such as a vitrectomy probe, is used, removed, and replaced with another. Consider the example where a vitrectomy has been performed for a period of time, and then forceps or scissors are used to address bleeding or other issues that were not adequately addressed by the vitrectomy probe. This involves multiple round trips into the eye with a fairly sharp probe or needle. For example, a vitrectomy probe is inserted into the eye and removed, followed by another insertion and removal of the forceps, and possibly a further insertion and removal of the vitrectomy probe.

[0005] Naturally, the risk of inserting an instrument into a patient's eye increases with each in and out of the eye. Each insertion exposes the instrument to the risk of leakage, and the surgeon must adjust and re-adjust the proper positioning of the tool with his or her own eye to avoid injury. The surgeon must repeatedly and steadily carry the instrument. This difficulty can be magnified given that the instrument continues to get smaller in size. For example, a needle that may traditionally be about 23 gauge may be about 25 or 27 gauge. This means that the needle diameter decreases from a size just below about 0.5 mm (millimeter) to a size less than about 0.4 mm. Considering that a vitrectomy probe needle may be several millimeters in length and hollow, this increasingly thinner gauge instrument may be somewhat flexible. Other instruments sized to operate in the eye are similarly somewhat flexible at smaller gauge sizes.

[0006] The potential for injury due to the extra trips into the eye is further increased by the fact that another surgeon, nurse, or other person may also be involved in the shuttle of an instrument, for example, to help remove an instrument for extraction or to select and hand over an instrument for insertion, meaning that such other person must also take care with each trip, for example, to hand over the proper instrument or to avoid unstable contact with the surgeon. Summary of the Invention [Means for solving the problem]

[0007] A tool for surgery (e.g., ophthalmic surgery) is provided that can be supported by a cannula at a surgical site on a patient. Although the examples provided herein may relate to ophthalmic surgery, it should be understood that the tool can also be used for other types of surgery (e.g., in other locations such as the abdomen). The tool includes a tubular guide for coupling with the cannula. A first retractable instrument is provided that can extend from the body of the tool through the cannula to facilitate a first application on the eye during surgery. A second retractable instrument is also provided that can extend from the tool body through the cannula to facilitate a second application on the eye during surgery. Furthermore, the first retractable instrument is retractable through the tubular guide upon extension of the second retractable instrument. [Brief description of the drawings]

[0008] [Figure 1] FIG. 1 illustrates a side perspective view of one embodiment of a multi-instrument ophthalmic surgical device. [Diagram 2] 2 is an exploded view of selected internal architectures of the multi-instrument ophthalmic surgical device of FIG. 1. [Diagram 3] 3 is a side cross-sectional view of the selected internal architecture of FIG. 2 within the body of the multi-instrument ophthalmic surgical device of FIG. 1. [Figure 4] 1 is a top schematic view of a multi-instrument ophthalmic surgical device from the perspective of a surgeon presented with the multi-instrument option. [Figure 5A]2 is a perspective cross-sectional view of a surgical procedure performed by a first instrument of the multi-instrument ophthalmic surgical device of FIG. 1. [Figure 5B] 5B is a perspective cross-sectional view of the surgical procedure of FIG. 5A performed by a second instrument of the multi-instrument ophthalmic surgical device of FIG. 1. [Figure 6] 1 is a flow chart summarizing one embodiment of performing minimally invasive eye surgery using a multi-instrument eye surgery device. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0009] In the following description, numerous details are set forth to provide an understanding of the present disclosure. However, it will be understood by those skilled in the art that the described embodiments may be practiced without these specific details. Moreover, numerous variations or modifications may be employed that are still contemplated in the specifically described embodiments.

[0010] The embodiments are described with reference to certain types of surgical instrument procedures. In particular, vitrectomy probes and various forceps are featured in the various figures. However, the tools and techniques detailed herein may include the use of a wide variety of different surgical instruments to further advance ophthalmic surgery, whether or not such instruments are specifically mentioned herein. That is, the embodiments herein are not meant to be limited to these instruments or other described instruments such as backflushes, soft-tip cannulas, scissors, lasers, scrapers, lights, or diathermy machines.

[0011] Additionally, although vitrectomy and forceps procedures are primarily discussed herein, the multi-instrument probe or device embodiments detailed herein may be used to address retinal detachment, epiretinal membranes, macular holes, floaters, diabetic retinopathy, or a variety of other ocular conditions. Indeed, to the extent that surgical devices are available that support multiple instrument types to minimize the number of trips into a patient's eye during a surgical procedure, appreciable advantages may be realized.

[0012] 1, a side perspective view of one embodiment of a multi-instrument ophthalmic surgical device 100 is shown. Specifically, the device 100 is shown being hand-held in a surgeon's gloved hand 175, as is common in the application of several different ophthalmic surgical devices. What distinguishes the illustrated embodiment is that a single device 100 can support a wide variety of different applications. This minimizes the need to remove the device 100 for another device during the course of an ophthalmic surgery procedure, which also minimizes the number of new trips into the eye 550 (see FIGS. 5A and 5B) with very sharp, thin instruments.

[0013] As shown, the surgeon's thumb is placed on the depressor 155 of a given actuator 150. This allows the surgeon to select a given instrument (e.g., 310) for a procedure as part of an ophthalmic procedure, with further reference to Figure 3. In the illustrated embodiment, the device 100 includes a body 125 from which emerges a tubular guide 110 for receiving the selected instrument 310.

[0014] 5A and 5B, the tubular guide 110 may remain engaged with the cannula 530 throughout the ophthalmic surgery, or at least during certain instrument exchanges (e.g., 500 and 310). Thus, as used herein, terms such as "minimizing the number of trips into the eye" do not mean that an instrument is not withdrawn and replaced with another instrument advanced into the eye 550. Rather, the term emphasizes the fact that this instrument exchange occurs while the tubular guide 110 remains engaged with the cannula 530. Thus, from the perspective of the eye 550, there is no need for a new engagement. Thus, from the perspective of the eye 550, an instrument exchange may not be a "new trip" in the traditional sense, assuming the guide 110 remains in place throughout.

[0015] Continuing to refer to FIG. 1, the illustrated embodiment of device 100 accommodates six different actuators 150 for six different instruments. This is best illustrated in FIG. 4, which better illustrates the device 100 and surgical options from a surgeon's perspective. Additionally, in the illustrated embodiment, a backflush tube 160 is shown, which may support the use of a backflush fluid that may be delivered through a dedicated backflush instrument, or even through the guide 110 supporting another surgical application. Thus, in the latter case, device 100 effectively supports seven different surgical applications. Additionally, it should be noted that tube 160 may support vitrectomy, as described in further detail herein.

[0016] Of course, the number of different applications or instrument types that can be accommodated by device 100 is not set to any particular number. The number can range from 2 to 8 or more. Over the years, the effort to make the instrument size as small as possible has made the illustrated six instrument plus backflush embodiment a possible embodiment. In some embodiments, device 100 may be intentionally limited to only a few instrument options in order to make body 125 thin enough for the surgeon. For example, when preparing a surgical plan based on vitrectomy, the device 100 selected may include the vitrectomy probe instrument plus one or two (or other number) of other instrument types that are most likely to be required according to the surgical plan.

[0017] It should be noted that utilizing a device 100 with multiple instrument options not only reduces the number of trips into the eye to potentially just one, but also provides other benefits of singularity. For example, a single device 100 means a single manufacturing, packaging, sterilization, and storage for multiple different instruments. This reduces waste and increases efficiency in a variety of areas.

[0018] 2, an exploded perspective view of select internal architecture of the multi-instrument ophthalmic surgery device 100 of FIG. 1 is shown. Specifically, two instrument actuators 150 are shown along with the pusher 155 described above. The actuators 150 are visibly guided along the exterior of the device body 125. In one embodiment, the external visibility of the pusher 155 and actuators 150 is utilized with color coding to indicate the type of instrument. For example, a yellow actuator 150 can indicate association with a vitrectomy probe instrument, while a blue actuator 150 can indicate association with a forceps instrument.

[0019] Not visible in FIG. 1 are drive mandrels 230 coupled to each actuator 150 to advance the selected instrument. With further reference to the cross-sectional view of FIG. 3, the drive mandrels 230 can be considered an extension of any instrument. For example, a forceps 310 is shown as an instrument that is selected in FIG. 3 by depressing the associated actuator 150, which in turn depresses the drive mandrel 230 (as also shown in FIG. 2). A surgeon may be able to actuate this actuation appropriately unassisted, using only one finger. In the view of FIG. 3, it can be seen that a forceps instrument is made up of a forceps 310 and an associated drive mandrel 230.

[0020] 2 and 3, the drive mandrel 230 is guided through the center cap 200. The center cap 200 plays a mechanical role in controlling the advancement of one instrument and the coordinated retraction of another. Additionally, an internal tube 210 coupled to the backflush tube 160 is arranged to supply fluid through the cap 200 for application through the guide 110 for the surgical procedure at the surgeon's request. Of course, if the application is a vitrectomy, the tubes 160, 210 may facilitate the intake of vitreous. Furthermore, the internal architecture of the device 100 may be substantially more capable of driving the reciprocating motion of the cutter (e.g., via an internal electric drive or pneumatic drive that may use additional tubes (e.g., air supply tubes) / supply lines (e.g., electrical supply lines) to the device 100 for the operation of the drive).

[0021] With specific reference to FIG. 3, the selected instrument 310 is a particular forceps emerging from within the center cap 200. It should be noted that the center cap 200 is of a profile with sufficient volume to accommodate several instruments simultaneously as shown in FIG. 4. Modern ophthalmic surgical instruments, particularly the mandrel portion 230, may be 25 or 27 gauge (or other gauge) and are suitable for such arrangement. However, at the same time, the cap 200 is also tapered at the bottom end in some embodiments to such an extent that multiple instruments do not occupy the outlet of the cap 200 at the same time. Along these lines, when the surgeon selects an instrument in the pusher 155, an automatic release may be triggered to withdraw an instrument that may already be in the tubular guide 110. Thus, the previously extended instrument may retract into the cap 200 before the newly selected instrument reaches the guide 110. In this way, it is possible to avoid multiple instruments becoming stuck in the guide 110. Furthermore, when the newly selected instrument is extended, a conventional automatic lock may be triggered in the cap 200 to stabilize the instrument for the surgical procedure. As suggested, this lock may be maintained until the surgeon makes a different selection with the pusher 155.

[0022] 4, a schematic top view of the multi-instrument ophthalmic surgical device 100 is shown from the perspective of a surgeon utilizing the device 100. For example, by simply looking at the top of the device 100, the surgeon may be presented with many different instrument options. In the figure, six different instruments are shown exploded (e.g., 310). However, as indicated above, the surgeon may actually be presented with a distinguishable indication of the instrument options by color coding of the different sliders or actuators 150. The surgeon may select the depressor 155 accordingly. Of course, color coding is not required. The functions of the actuators 150 or other adjacent devices may be labeled or some other form of indicator may be utilized.

[0023] With continued reference to Figure 4, recall that the particular multi-instrument device 100 illustrated also includes additional application support by way of a backflush tube 160 that may support application of a backflush that flows centrally through the device 100 from the guide 110 (see Figure 3). Additionally, in the illustrated embodiment, the instruments are different sized jaw or forceps tools 310. However, in addition to the forceps 310 and backflush tube 160, instrument options may include scissors, lasers, scrapers, lights, soft-tip cannulas, diathermy machines, or even a vitrectomy probe 500 (see Figure 5A).

[0024] 5A, there is shown a perspective cross-sectional view of a surgical procedure performed by a first instrument 500 of the multi-instrument ophthalmic surgical device 100 of FIG. 1. In this embodiment, the surgeon's one hand 175 of FIG. 1 manually selects the actuator 150 associated with the vitrectomy probe 500. A pre-placed cannula 530 is placed offset at the sclera 570. In this manner, the more delicate cornea 590 and lens 580 may be avoided.

[0025] In a vitrectomy, the probe instrument 500 is advanced through the pre-placed guide 110 through the cannula 530. In the illustrated embodiment, the guide passes completely through the cannula 530 to the interior of the eye 550. However, in other embodiments, the guide 110 may serve to provide structural support for the instrument and to stably couple to the cannula 530, avoiding traversal into the eye 550. In the illustrated embodiment, the vitrectomy probe instrument 500 is directed near the area 575 from which vitreous is to be removed, illuminated by the illuminator 525. Specifically, suction is applied via the backflush tube 160 and the inner tube 210, and a port 577 is used for collection of vitreous or other material (see also FIG. 2).

[0026] For ease of explanation, Figures 5A and 5B illustrate situations in which a surgeon may wish to switch instruments used. For example, in the procedure shown, bleeding or other damaged tissue may be present, in which case the surgeon may prefer to use the forceps instrument 310 for a period of time prior to further capture with the probe 500. Thus, with specific reference to Figure 5B, to switch the vitrectomy probe 500 to the forceps 310, the surgeon simply depresses the appropriate actuator 150 to select a different instrument (see also Figure 1).

[0027] It should be noted that the above switching of instruments does not require any repositioning of the device 100. In fact, the second instrument 310 is also directed to the same area 575 as the first instrument 500, as is generally the case. That is, the surgeon simply decides to address a given problem with a different instrument. There is no need to reinsert the device 100 through the cannula 530. Thus, even after briefly looking at the back of the device 100 to select a new instrument 310, it is easy for the surgeon to look at the area 575 again, since the device 100 is already pointing to the area 575. Avoiding extra trips into the eye 550 is also avoided when the surgeon decides to resume the vitrectomy application for incorporation of the vitreous and tissue that was broken or otherwise addressed by the forceps 310.

[0028] 5A and 5B, the guide 110 is shown through the cannula 530. As mentioned above, the guide 110 can instead serve to provide structural support and rest stably when coupled with the cannula 530 to support the procedure. However, in yet another embodiment, the tip of the guide 110 can include a knife and have the architecture of a cannula. Thus, the separate use of the cannula 530 can be avoided by having the guide 110 act as a combined support and cannula device supporting the delivery of any number of instruments, as detailed herein.

[0029] Referring now to FIG. 6, a flow chart is shown summarizing one embodiment of performing minimally invasive eye surgery using a multi-instrument eye surgery device. As shown at 615 and 630, a cannula may or may not be pre-positioned at the surface location of the eye to help accommodate the tubular guide of the device. Furthermore, as shown at 645 and 660, the tubular guide may traverse to the interior region of the eye or act more as a structural support. In either case, the device helps to further advance the surgical instruments through the guide to the interior region for the surgical procedure (see 675). Furthermore, as shown at 690, the first instrument may be changed for a second instrument while the guide remains in place. In fact, this type of exchange may be repeated with the same device and many different instruments without the need to remove the guide from the eye. Thus, the risk of re-engaging the device every time a new round trip with a new instrument is performed may be avoided.

[0030] The foregoing description has been presented with reference to the presently preferred embodiment. However, other embodiments and / or features of embodiments disclosed but not detailed above may be employed. Moreover, those skilled in the art and technology to which these embodiments pertain will appreciate that still other modifications and variations in the described structure and method of operation may be made without significantly departing from the principles and scope of these embodiments. In addition, the foregoing description should not be read as relating solely to the exact structure described and shown in the accompanying drawings, but rather as consistent with and in support of the following claims, which shall have their fullest and most reasonable scope.

Claims

1. 1. A multi-instrument device for surgery at a surgical site on a patient, said device comprising: A tubular guide; a first retractable instrument extending from a body of the device through the tubular guide to facilitate a first application during the procedure; a second retractable instrument extending from the body through the tubular guide to facilitate a second use during the procedure, the first retractable instrument being retracted through the tubular guide upon the extension of the second retractable instrument; A multi-instrument device comprising:

2. 10. The multi-instrument device of claim 1, wherein the retractable instruments are selected from the group consisting of a vitrectomy probe, forceps, a backflush device, scissors, a soft-tip cannula, a laser tool, a scraper, a light instrument, and a diathermy machine.

3. 10. The multi-instrument device of claim 1, further comprising one of a backflush, a soft-tip cannula, and a vitrectomy tube coupled to the body at an end opposite the end from which the instruments extend.

4. The multi-instrument device of claim 1 , wherein the tubular guide is configured to couple with a cannula at the surgical site.

5. 10. The multi-instrument device of claim 1, further comprising a first actuator to facilitate the extension of the first instrument and a second actuator to facilitate the extension of the second instrument.

6. The multi-instrument device of claim 5 , wherein the actuators are provided with visually distinguishable indicators for a surgeon to distinguish between the instruments.

7. The multi-instrument device of claim 6 , wherein the visually distinct indicators are of different colors.

8. 1. A multi-instrument device for surgery, comprising: A tubular guide; a first retractable instrument extending from a body of the device through the tubular guide to facilitate a first application during the procedure; a second retractable instrument extending from the body of the device through the tubular guide to facilitate a second use during the procedure, the first retractable instrument being retracted through the tubular guide upon the extension of the second retractable instrument; A multi-instrument device comprising:

9. 9. The multi-instrument device of claim 8, wherein the retractable instruments are selected from the group consisting of a vitrectomy probe, forceps, a backflush device, a soft-tip cannula, scissors, a laser tool, a scraper, a light instrument, and a diathermy machine.

10. 10. The multi-instrument device of claim 8, further comprising one of a soft-tip cannula, a backflush, and a vitrectomy tube coupled to the body at an end opposite the end from which the instruments extend.

11. 1. A method of performing surgery on a patient, the method comprising: engaging a tubular guide extending from a body of the multi-instrument surgical device at the surgical location; advancing a first instrument of the surgical device through the tubular guide to an interior region of the surgical location for a first application; changing the first instrument of the surgical device for a second instrument while keeping the guide engaged at the surgical site; A method comprising:

12. The method of claim 11 , further comprising pre-positioning a cannula at the surgical site to support the engagement of the guide to the surgical site.

13. The method of claim 12 , further comprising one of: employing the guide as a structural support during said application; and advancing the guide into the interior region during said application.

14. The method of claim 11 , further comprising employing a knife of the guide for the engagement of the surgical site, the guide comprising a cannula architecture.

15. 12. The method of claim 11, wherein the multi-instrument device comprises a tube extending from an opposite side of the body relative to the tubular guide, the method further comprising employing the tube to facilitate one of a soft-tip cannula application, a backflush application, and a vitrectomy application.

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