Single endoscopic vessel harvesting device with visual cues to identify cutting element orientation - Patents.com

Abstract

A resilient, single-piece endoscopic vessel harvesting device is disclosed. In some embodiments, such a device comprises an elongate body having a proximal end and a distal end, and a tip disposed at the distal end of the elongate body. The tip has a visual cue indicating the location of at least one cutting element extending from the elongate body.

Description

[Technical field]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS This application claims priority to and the benefit of co-pending U.S. Provisional Patent Application No. 62 / 841,413, filed May 1, 2019, for all subject matter common to both applications, the disclosure of which is incorporated herein by reference in its entirety.

[0002] FIELD OF THE DISCLOSURE Embodiments of the present disclosure relate to endoscopic cannulas and methods of use thereof. More particularly, the present invention relates to a single endoscopic vessel harvesting device that provides visual cues to identify the orientation of the cutting element. [Background technology]

[0003] Vessel harvesting is a surgical technique commonly used in conjunction with coronary artery bypass surgery. During bypass surgery, blood is rerouted around a blocked artery to restore and improve blood flow and oxygen to the heart. Blood is rerouted using a bypass graft, one end of which is attached to a blood source upstream of the blocked area and the other end is attached downstream of the blocked area, creating a "conduit" channel or new blood flow connection that bypasses the blocked area. In general, the surgery removes or "harvested" a healthy blood vessel from another part of the body to create the bypass graft. The success of coronary artery bypass graft surgery is influenced by the quality of the conduit and how the conduit is handled or processed during the vessel harvesting and preparation steps before implantation.

[0004] The vessel harvesting method involves selecting a vessel, traditionally the great saphenous vein in the leg or the radial artery in the arm, to be used as a bypass conduit to be sealed, severing smaller vessels that branch off from the main vascular conduit, and harvesting the main conduit from the body. This practice leaves the remaining vascular network unharmed, allowing it to heal and maintain adequate blood flow to the limb, and allowing the patient to return to normal function without noticeable repercussions.

[0005] A non-invasive technique for vessel harvesting is known as endoscopic vessel harvesting, a procedure that requires only a small incision. Although endoscopic vessel harvesting procedures are an improvement over traditional "open" procedures that required a single long incision from the groin to the ankle, endoscopic procedures are still cumbersome and difficult. In particular, current endoscopic harvesting systems require multiple tools, which not only increases the possibility of damage to the bypass conduit, but also extends the duration of the procedure. Thus, improvements in endoscopic vessel harvesting systems and methods are still required. Summary of the Invention

[0006] A single endoscopic vessel harvesting device is disclosed. In some embodiments, such device comprises an elongate body having a proximal end and a distal end, a tip with a visual cue designating the location of at least one cutting portion, the tip being disposed at the distal end of the elongate body, a cutting unit having a first cutting portion (i.e., a cutting blade or cutting member) and a second cutting portion, the first cutting portion and the second cutting portion being longitudinally movable relative to the elongate body to capture a vessel between the first cutting portion and the second cutting portion and rotatable relative to each other circumferentially about the tip to sever the captured vessel, and finally a biasing member engaging the cutting unit and biasing at least one cutting portion toward the other cutting portion.

[0007] In accordance with an exemplary embodiment of the present invention, a surgical device is provided that includes an elongate body terminating at a tip at a distal end of the body, and a cutting unit having a first cutting portion and a second cutting portion longitudinally movable relative to the elongate body toward the distal end, at least one cutting portion being rotatable relative to the other cutting portion in a circumferential direction about the tip. The device also includes a visual cue at the tip to designate a location of the at least one cutting portion when the cutting portion is moved longitudinally beyond the tip of the distal end of the elongate body.

[0008] In accordance with an aspect of the invention, the first cutting portion and the second cutting portion move longitudinally from a retracted position to an extended position beyond the tip. The visual cue is at least one of an indentation, a protrusion, and a mark. The visual cue is at least one of a vertical line, a horizontal line, an arrow, a dot, and a dashed line. The first cutting portion is rotatable as a blade and the second cutting portion is stationary as an anvil. The visual cue indicates where the anvil extends longitudinally from the elongated body. The visual cue is within the field of view of the surgeon and is visualized on an electronic display. The visual cue is located on one of an inner surface of the tip or an outer surface of the tip.

[0009] In accordance with an aspect of the present invention, the surgical device further includes a biasing member configured to move the cutting portions from an open position where the cutting portions are separated from one another to a closed position where the cutting portions contact one another. The surgical device further includes a rotation control collar disposed at a proximal end of the elongated body to move the cutting portions from the closed position to the open position, and the biasing member couples to the rotation control collar to return the cutting portions to the closed position. The first cutting portion and the second cutting portion are configured to be energized to seal, cut, or both, a blood vessel captured between the first cutting portion and the second cutting portion. The first cutting portion has a sharp end, and an end of the second cutting portion facing the sharp end of the first cutting portion is flat. The first cutting portion is stationary and the second cutting portion is rotatable about a tip away from the first cutting portion. The second cutting portion is rotatable bidirectionally about the tip. The tip includes a rigid transition element having a notch such that the cutting portion can extend through the notch.

[0010] According to an exemplary embodiment of the present invention, a method of blood vessel harvesting is provided. The method of the present invention includes the steps of advancing an elongate body having a cutting tip at a distal end along a main blood vessel to separate the main blood vessel and its branch vessels from surrounding tissue, and directing a visual cue at the cutting tip for visual confirmation of the positioning of the cutting tip. The method of the present invention also includes moving a first cutting portion and a second cutting portion toward the distal end while using the visual cue as a reference point to capture the blood vessel between the first and second cutting portions.

[0011] According to an aspect of the invention, the method further includes moving the first cutting portion and the second cutting portion in a distal direction relative to each other. In the moving step, the first and second cutting portions are in a closed position in contact with each other and are biased toward each other. The method further includes sealing the blood vessel with a first RF electrode supported by the first cutting portion and a second RF electrode supported by the second cutting portion. The method further includes capturing the blood vessel between the first cutting portion and the second cutting portion and rotating at least one of the first cutting portion and the second cutting portion. In the rotating step, the first cutting portion is stationary and the second cutting portion is bidirectionally rotatable about the tip. In the rotating step, the first cutting portion has a sharp end and the end of the second cutting portion facing the sharp end of the first cutting portion is flat.

[0012] Additional features and advantages will become more readily apparent from the following detailed description when taken in conjunction with the accompanying drawings.

[0013] Embodiments of the present disclosure will further be described with reference to the accompanying drawings, in which like structure is referenced by like numerals throughout the several views. The drawings illustrated are not necessarily to scale, with emphasis instead generally being placed upon illustrating the principles of embodiments of the present disclosure. [Brief description of the drawings]

[0014] [Figure 1A] 1 depicts a side view of an embodiment of an endoscopic cannula of the present disclosure; [Figure 1B-1C] 1 depicts an embodiment of the presently disclosed dissecting tip having a depression at its distal end. [Figure 2A] 1 depicts an open surgical procedure using an endoscopic cannula of the present disclosure. [Figure 2B] 1 depicts an open surgical procedure using an endoscopic cannula of the present disclosure. [Figure 2C] 1 depicts an open surgical procedure using an endoscopic cannula of the present disclosure. [Figure 3A]1 illustrates an embodiment of a cutting unit of an endoscopic cannula of the present disclosure. [Figure 3B] 1 illustrates an embodiment of a cutting unit of an endoscopic cannula of the present disclosure. [Figure 3C] 1 illustrates an embodiment of a cutting unit of an endoscopic cannula of the present disclosure. [Figure 4A] 1 illustrates an embodiment of a cutting unit of an endoscopic cannula of the present disclosure. [Figure 4B] 1 illustrates an embodiment of a cutting unit of an endoscopic cannula of the present disclosure. [Figure 4C] 1 illustrates an embodiment of a cutting unit of an endoscopic cannula of the present disclosure. [Figure 4D] 1 illustrates an embodiment of a cutting unit of an endoscopic cannula of the present disclosure. [Figure 5A-5B] 1 depicts an embodiment of a cutting tip of the present disclosure. [Figure 5C] 1 depicts an embodiment of a cutting tip of the present disclosure. [Fig. 5D-5E] 1 depicts an embodiment of a cutting tip of the present disclosure. [Figure 6A] 1 depicts an embodiment of a control handle suitable for use with an endoscopic cannula of the present disclosure. [Figure 6B-6G] 6 illustrates an embodiment of an endoscopic cannula of the present disclosure in operation controlled by the control handle of FIG. 5 . [Figure 7A] 1 illustrates an embodiment of a cutting unit of an endoscopic cannula of the present disclosure. [Figure 7B] 1 illustrates an embodiment of a cutting unit of an endoscopic cannula of the present disclosure. [Figure 7C-7F] 1 illustrates an embodiment of a cutting unit of an endoscopic cannula of the present disclosure. [Figure 8A-8B] 1 illustrates an embodiment of a cutting unit of an endoscopic cannula of the present disclosure. [Figure 9A-9B] 1 illustrates an embodiment of a cutting unit of an endoscopic cannula of the present disclosure. [Figure 9C] 1 illustrates an embodiment of a cutting unit of an endoscopic cannula of the present disclosure. [Figure 9D] 1 illustrates an embodiment of a cutting unit of an endoscopic cannula of the present disclosure. [Figure 9E] 1 illustrates an embodiment of a cutting unit of an endoscopic cannula of the present disclosure. [Fig. 9F-9G] 1 illustrates an embodiment of a cutting unit of an endoscopic cannula of the present disclosure. [Figure 10A-10B] 1 illustrates an embodiment of a cutting unit of an endoscopic cannula of the present disclosure. [Fig. 10C-10D] 1 illustrates an embodiment of a cutting unit of an endoscopic cannula of the present disclosure. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0015] While the above drawings set forth embodiments of the present disclosure, other embodiments are contemplated, as also set forth in the description. This disclosure shows exemplary embodiments for purposes of presentation and not limitation. Many other modifications and embodiments can be devised by those skilled in the art that fall within the scope and spirit of the principles of the embodiments of the present disclosure.

[0016] The following description provides exemplary embodiments only and is not intended to limit the scope, applicability, or configuration of the disclosure. Rather, the following description of exemplary embodiments will provide those skilled in the art with an effective description for implementing one or more exemplary embodiments. It will be understood that various changes can be made in the function and arrangement of elements without departing from the spirit and scope of the invention as set forth in the appended claims.

[0017] Specific details are given in the following description to provide a thorough understanding of the embodiments. However, it will be understood by those skilled in the art that the embodiments may be practiced without these specific details. For example, systems, processes, and other elements of the present invention may be shown as components in block diagram form in order to avoid obscuring the embodiments in unnecessary detail. In other instances, well-known processes, structures and techniques are shown without unnecessary detail in order to avoid obscuring the embodiments. Additionally, like numerals and designations in the various figures indicate like elements.

[0018] The present disclosure provides a single device for endoscopic vessel harvesting. Current systems for endoscopic vessel harvesting include multiple components. Typically, an endoscopic dissection device is used to separate the main vessel from the surrounding connective tissue by severing it from the surrounding connective tissue. The endoscopic cannula is then used to introduce yet another device, an endoscopic tributary sealing instrument, to seal and sever the side branch. Once the side branch is sealed, yet another device is used to harvest a portion of the main vessel to be used as a bypass graft. The single device of the present disclosure combines dissection function, tributary sealing and cutting function, and optionally main vessel sealing and cutting function, reducing vessel manipulation and improving ease of surgery. The device of the present disclosure is also used to extract the sealed and severed main vessel from the patient.

[0019] Reducing vascular manipulation reduces the likelihood of graft injury. Repeated vascular contact with multiple passes of the harvesting instrument increases potential vascular injury. A single device, such as the device of the present disclosure, cuts, i.e., separates the main vessel from the surrounding tissue as the device advances, and cauterizes and transects the tributaries and main vessel, and the vessel is harvested with a single pass of the device rather than multiple device insertions and withdrawals. Such devices with reduced diameters are used for dissection and tributary ligation, and graft trauma is reduced. The relatively small diameter of the device also facilitates harvesting of more tortuous vessels, such as the internal mammary arteries.

[0020] 1A, an endoscopic cannula 100 of the present disclosure includes an elongated body 102 having a proximal end 104 and a distal end 106, terminating in a cutting tip 120. The cannula 100 further includes a cutting unit 150 disposed about the distal end 106 for sealing and cutting a blood vessel, and a control handle 160 for controlling the cutting unit 150. The cutting unit 150 includes a resilient device that provides a resilient force during operation of the cutting unit 150. The resilient device may be internal or external to the endoscopic cannula 100.

[0021] In some embodiments, the elongate body 102 is configured to pass extravascularly through an entrance incision to a vascular harvest site. To aid in advancing the elongate body 102 to the harvest site, the elongate body 102 has sufficient axial stiffness along its length. To provide such properties to the elongate body 102, in embodiments, the elongate body 102 is made from a biocompatible material, such as, for example, a plastic material, an elastomeric material, a metallic material, a shape memory material, a composite material, or other material having desired properties. To the extent desired, the elongate body 102 has some flexibility to move radially or laterally from side to side depending on the application.

[0022] In some embodiments, the elongated body 102 of the cannula 100 is solid. In other embodiments, the endoscopic cannula 100 includes one or more lumens that accommodate the advancement of instruments or materials through the lumen. In some embodiments, the endoscopic cannula 100 includes an endoscope lumen 103 through which an endoscope 116 is advanced to visualize a procedure being performed with the cannula 100. The endoscopic cannula 100 includes an adapter 114 at the proximal end 104 for advancing the endoscope 116 into the endoscopic cannula 100. Additional lumens of the cannula 100 are described below.

[0023] In some embodiments, the endoscopic cannula or cannula 100 includes a cutting tip 120 disposed at or around the distal end 106 of the endoscopic cannula 100. The viewing tip of the endoscope is disposed inside the cutting tip 120. In some embodiments, the cutting tip 120 includes an internal cavity in fluid communication with the endoscope lumen 103, allowing the endoscope 116 to be advanced to the cutting tip 120. In some embodiments, a tip-on-tip type endoscope is integrated inside the cutting tip 120. The cutting tip 120 is also transparent to allow endoscopic viewing through the tip 120 while surgery is performed with the cannula 100. In some embodiments, the cutting tip 120 comprises any shape that facilitates endoscopic viewing therethrough and allows the necessary control during tissue cutting, i.e., separation. In some embodiments, the cutting tip is generally cone-shaped.

[0024] In some embodiments, the cutting tip 120 includes a generally flat shoulder 122 and a tapered portion 124 that terminates in a blunt end 126 for atraumatic separation of the harvested vessel segment from the surrounding tissue while minimizing or preventing tearing or perforating nearby vessels or tissue as the endoscopic cannula 100 advances along the vessel segment. Although depicted as blunt, it should be understood that, to the extent desired, the end 126 of the cutting tip 120 can be made relatively sharp to enhance the advancement of the cannula 100. Additionally, the generally flat shoulder 122 and the tapered portion 124 can be structurally configured differently to enhance the maneuverability of the cannula 100. For example, the generally flat shoulder 122 and the tapered portion 124 can be configured to include one or more other elements that aid in the operation and performance of the cutting unit 150.

[0025] 1B and 1C, in some embodiments, the cutting tip 120 is cone shaped and shaped at the distal end 129 in such a manner as to minimize the negative effects of visual distortion or blinding in the center of the endoscopic field of view when viewed through an endoscope inserted in the cannula 100 equipped with a light source (not shown) and a camera system (not shown). The inner surface 121 of the cutting tip 120 is tapered with a relatively constant slope towards the distal end 126 of the cutting tip 120, terminating at an inner apex 123, which is a sharp point as shown in FIG. 1C. The outer surface 125 of the cutting tip 120 is also tapered with a constant slope towards the distal end 126 of the cutting tip 120, but at the distal end 126, a relatively rounded blunt end is formed to minimize tissue damage during dissection.

[0026] As depicted, at the distal end 106, the outer surface 125 of the cutting tip 120 folds back on itself in the proximal direction and then terminates at an outer apex 127, maintaining a blunt outer surface and forming a depression at the distal end of the cutting tip 120. Both the inner apex 123 and the outer apex 127 are collinear with the central longitudinal axis of the cannula 100 and thus in some embodiments the endoscope 116. In other words, the centers of the inner apex 123 and the outer apex 127 are disposed on the central longitudinal axis of the cannula 100. By providing the apexes of the respective inner and outer surfaces 121 and 125 of the cutting tip 120 that are also collinear with the axis of the endoscope 116, those planes perpendicular to the optical path (parallel to the axis of the endoscope) are eliminated, thus eliminating optical refraction from perpendicular planes back to the camera, which then minimizes or eliminates visual distortion or blinding when viewing through an endoscope 116 equipped with a light source and camera system.

[0027] 1B and 1C, in order to reduce the possibility of trauma during the dissection process, in some embodiments, the dissection tip 120 is easily bendable, flexible, or deformable such that the dissection tip deflects slightly under the action of a force applied to the dissection tip 120. In some embodiments, the dissection tip 120 is easily compressible such that the walls of the dissection tip 120 deform under the action of a force perpendicular to the tip surface. To that end, the dissection tip 120 is formed from a thin-walled plastic material that allows the dissection tip to bend under load. Suitable materials include, but are not limited to, polycarbonate, polyethylene terephthalate glycol modified (PETG), polyethylene terephthalate (PET), and other materials that provide sufficient optical clarity while allowing the dissection tip to bend under load. At the same time, the dissection tip 120 provides sufficient column strength in the axial or longitudinal direction to allow dissection of the blood vessel from the surrounding connective tissue. Other properties of the cutting tip 120 are expected to include, for example, (1) axial strength greater than longitudinal strength, (2) longitudinal strength greater than axial strength, and (3) variable strength axial vs. longitudinal strength, where the axial strength is close to the longitudinal strength. Also, the cutting tip 120 may include two or more materials, where at least one of the materials has different material properties, such as elasticity, hardness, tensile strength, etc.

[0028] With reference to Figures 2A-2C, the blood vessels used in the bypass graft (such as the great saphenous vein or radial artery) lie in the subcutaneous space below the surface of the skin. The blood vessel 200 consists of a main trunk 210 and branch vessels 220 emerging from the trunk 210 as shown in Figure 2A. The blood vessel 200 and its branches 210 are encased in subcutaneous fatty connective tissue 230 and require cutting free of the surrounding fatty connective tissue 230 before the main blood vessel 200 can be harvested. The subcutaneous fat 230 is softer than skin, muscle, fascia or other connective tissue. Although it adheres to the blood vessel 200, the fatty connective tissue 230 forms a boundary 240 with the blood vessel 200 to be cut cleanly, i.e., there is a natural dissection plane between the outer layer (adventitia) of the blood vessel 200 and the surrounding subcutaneous fat 230.

[0029] 2B depicts the dissection of the main trunk 210 of the blood vessel 200 with the cutting tip 120 along a natural dissection plane, where the cutting tip 120 is advanced along the adventitial surface of the blood vessel 200. Typically, separation of the blood vessel 200 from the surrounding fatty connective tissue 230 along this surface does not require high dissection forces. In some embodiments, the cutting tip 120 has sufficient column strength to sever the blood vessel 200 from the surrounding tissue 230 along the natural dissection plane between the blood vessel and the surrounding tissue.

[0030] On the other hand, as depicted in FIG. 2C, when the cutting tip 120 approaches the branch vessel 220, the cutting tip 120 captures the branch vessel 220 at the junction 250 between the branch vessel 220 and the main vessel 200. Application of excessive force by the cutting tip 220 may tear the branch vessel 220, sever the branch vessel from the trunk vessel 210, or otherwise cause damage to the main vessel 200. To this end, in some embodiments, the cutting tip 120 is provided with sufficient column strength to sever the vessel 200 from the surrounding tissue 230 along the natural dissection plane between the vessel and the surrounding tissue, while being sufficiently pliable to deform or deflect away from the branch vessel 220 upon application of increased force, reducing the possibility of trauma to the graft vessel during dissection around the branch vessel. Of course, the stiffness of the cutting tip 120 may vary from completely soft to semi-rigid to rigid according to the surgical requirements. Cannula 100 further includes one or more end effectors for cauterizing or sealing and cutting the branch or main vessels.

[0031] 3A, in some embodiments, the cutting unit 150 of the cannula 100 includes a first cutting member 302 and a second cutting member 304, each having a cutting portion 310, 312 extending from its respective distal end. In some embodiments, the cutting portions 310, 312 are biased toward one another, as described in more detail below.

[0032] 3A-3C, FIG. 3A illustrates the cutting unit 150 in its retracted position during dissection. For example, the first cutting member 302 and the second cutting member 304 are longitudinally movable relative to the elongate body 102 of the cannula 100. In this manner, the cutting portions (i.e., cutting blades or cutting members) 310, 312 are moved from an initial retracted position during dissection as in FIG. 3A where the cutting portions 310, 312 are retracted substantially proximally of the dissection tip 120 and do not interfere with the dissection, to an operative or extended position in FIG. 3B for sealing and cutting where the cutting portions 310, 312 are advanced distally to provide a sufficient capture length for the vessel to allow the user to view the cut.

[0033] In some embodiments, the cutting portions 310, 312 extend at least partially beyond the cutting tip 120 to capture the blood vessel at the cutting portions 310, 312. Additionally, in some embodiments, the first cutting member 302 and the second cutting member 304 are rotatable relative to one another. In this manner, the cutting portions 310, 312 can be moved from an open position, in which the cutting portions 310, 312 are spaced apart from one another and capture the blood vessel therebetween, as shown in FIG. 3B, to a closed position, in which the cutting portions 310, 312 are brought toward one another around the cutting tip 120 to seal and cut the blood vessel, as shown in FIG. 3C.

[0034] In some embodiments, the first cutting member 302 and the second cutting member 304 are configured such that both cutting portions 310, 312 rotate circumferentially around the cutting tip 120 toward each other in both clockwise and counterclockwise directions depending on the location of the vessel captured between the cutting portions 310, 312. Such bidirectional circumferential motion of the cutting portions 310, 312 allows the user to manipulate the vessel on all sides of the cannula 100, saving time and reducing manipulation of the cannula during surgery, when the user does not need to be concerned about the orientation and position of the cannula 100 relative to the vessel. Furthermore, the cutting portions twist the side branches, thereby exerting traction on the vessel and therefore reducing the possibility of damaging the graft. The bidirectional motion is also more intuitive to the user, eliminating the need to remember which side is the active side for cauterization and cutting. In other embodiments, one of the cutting portions 310, 312 is stationary and the other rotates both clockwise and counterclockwise toward the stationary cutting portion for easier manipulation and visualization of the cutting portions 310, 312. Of course, the stationary cutting portion may also be moved to a desired orientation by moving the cannula 100.

[0035] 3A, 3B, and 3C, the cutting portions (i.e., cutting blades or cutting members) of the cutting members 302, 304 are generally blade-like with oval or rounded distal tips, although other shapes capable of cutting and sealing the vessel are used. To facilitate sealing of the vessel, one or both of the cutting portions 310, 312 are energized using various energy sources, including but not limited to resistive heating, ultrasonic heating, and bipolar or monopolar RF energy, when required. In some embodiments, the electrodes are controlled independently of one another. In some embodiments, the cutting portions 310, 312 are made from a material, such as a metal, that allows the cutting portions 310, 312 themselves to be energized. Additionally or alternatively, an energizing element, such as a metal wire, is disposed in the cutting portions 310, 312. When energized, the energizing element is brought into contact with the vessel by the cutting portions 310, 312 to seal the vessel. In some embodiments, one or both of the cutting members 310, 312 include prongs for use as spot cauterization. In some embodiments, one or both of the cutting members 310, 312 have sharp, thin ends for focused energy application to the vessel. Such focused energy application requires less energy to be applied to the side branch, thereby minimizing the spread of cauterization energy from the side branch to the main trunk of the vessel, thus eliminating potential trauma to the vessel.

[0036] 3A, 3B and 3C, in order to facilitate the cutting of the vessel after sealing of the vessel, in some embodiments, one of the opposing ends of the cutting portions 310, 312 where the cutting occurs has a flat surface, while the other is sharp, thin or pointed such that the tissue is not cut in a scissor-like action, but has a thin end against the flat surface. To this end, in some embodiments, both ends of the cutting member 310 are sharp ends, while both ends of the cutting portion 312 are flat, or vice versa. Instead, the cutting portions 310, 312 have one sharp end or blade end and one flat end, with the sharp end of one cutting portion facing the flat end of the other cutting portion. It should be noted that in some embodiments, the vessel is both sealed and cut using energy as described above. Of course, in some embodiments, the opposing ends of the cutting portions 310, 312 are both sharpened and the tissue is cut in a scissor-like manner.

[0037] 3B and 3C, in some embodiments, cutting members 302, 304 are substantially U-shaped and disposed in the same plane relative to cannula body 102. In some embodiments, cutting members 302, 304 include notches and fingers 314, 316, respectively, along their ends to allow circumferential movement of cutting members 302, 304 relative to one another, as shown in FIG.

[0038] With reference to Figures 4A and 4B, in some embodiments, the cutting members 302, 304 are substantially tubular and disposed in different planes of the cannula body 102. As shown in Figure 4A, in some embodiments, the cutting member 304 is disposed concentrically inside the cutting member 302. With reference to Figure 4B, in some embodiments, the elongated body 102 of the cannula 100 is composed of a series of coaxial tubes, both metal and plastic, that serve the functions of the structural main axis, the conductive and insulating pathways, and the end effector, i.e., the cutting portion (i.e., the cutting blade or cutting member). In some embodiments, there are three plastic sheaths that serve the functions of electrical insulators and mechanical support surfaces sandwiched between two metal conductive tubes over the entire length of the device. The innermost layer is the inner sheath 402 (plastic) that defines the inner lumen 403. The inner sheath 402 is followed on the outside by an inner electrode tube 404 (metal), a middle sheath 406 (plastic), an outer electrode tube 408 (metal) and an outer sheath 410 (plastic), and finally a shrink cover 412. In some embodiments, instead of three plastic sheaths, electrical insulation is provided using a non-conductive coating or similar method. For example, in some embodiments, the electrodes 404, 408 are coated with polyvinyldiene fluoride (PVDF), although other non-conductive coatings may be used.

[0039] The inner electrode tube 404 is used to form the first cutting member 302 and the outer electrode tube 408 is used to form the second cutting member 304, with the cutting segments 310, 312 formed at the distal ends of the inner electrode tube 404 and the outer electrode tube 408. The inner electrode tube 404 and the outer electrode tube 408 are longitudinally slidable relative to the cannula 100 and rotatable relative to one another so that the cutting segments 310, 312 can capture, seal and cut a blood vessel. Furthermore, because the cutting segments 310, 312 are formed from the inner electrode tube 404 and the outer electrode tube 408, the cutting segments 310, 312 are easily energized through the inner electrode 404 and the outer electrode 408. In some embodiments, the cut made from the inner electrode tube 404 (i.e., the inner cutting portion 411) bends out of the plane of the inner electrode 404 so that it can rotate along the same axis and be co-radial with the cut made in the outer electrode 408 (i.e., the outer cutting portion 413 in FIG. 4D). In some embodiments, FIG. 4D shows that the inner cutting portion 411 has flat surfaces 416 on either side of the inner cutting portion, while the outer cutting portion 413 has sharp or blade edges 418 on both sides, or vice versa. In other embodiments, as described above, each cutting portion 411, 413 has one sharp end and one flat end, with the flat end of one cutting portion facing the sharp end of the other cutting portion.

[0040] With reference to FIG. 4C, in some embodiments, the cutting tip 120 is connected to the inner sheath 402 to allow the advancement of the endoscope 116 through the inner lumen 403 to the cutting tip. The soft transition element 414 is used to protect tissue from damage during dissection by smoothing the contour between the cutting tip 120 and the cannula body 102. The distal end 414A of the transition element 414 is left unattached to the cutting tip 120 so that the cutting pieces 310, 312 are advanced distally through the transition element 414 as shown in FIG. 4D. In some embodiments, the transition element 414 is made of a flexible material so that during dissection, the transition element 414 conforms to the cutting tip creating a smooth transition and also a seal, preventing tissue or body fluids from entering the cannula 100. On the other hand, the flexible sleeve can deflect and stretch to allow the cutting pieces 310, 312 to be advanced distally out through the transition element 414. In some embodiments, the surface of the sleeve is coated with a lubricious substance to facilitate and smooth extension of the cutting portions 310, 312 through the transition element 414 by reducing friction between the cutting portions 310, 312 and the transition element 414. Figure 4C depicts that a thin wall shrink tube 412 is placed on the exterior surface of the cannula body for aesthetic purposes and to help secure the transition.

[0041] 5A and 5B, in some embodiments, the cutting tip 120 includes a transition element 514 made from a rigid material. The transition element 514 is configured with an opening or notch 512 through which the two cutting portions 310, 312 can extend out of the transition element 514 and cannula 100 (as shown in FIG. 5B) and retract into the primary cannula 100 (as shown in FIG. 5A). The transition element 514 is connected to the cannula 100 of the primary device and is on the cutting tip 120. The transition element 514 is coupled to the cannula 100 using any combination of methods. For example, the transition element 514 is coupled to the cannula 100 using a mechanical connection, adhesive, welding, or the like, or a combination thereof. In some embodiments, the cutting tip 120 and the transition element 514 are integral. In some embodiments, they are provided as separate pieces.

[0042] In some embodiments, the profile of the transition element 514 is molded to gradually decrease in diameter toward the distal end, creating a tapered shape. The transition element 514 is comprised of a single molded piece or a combination of pieces bonded together. In some embodiments, the transition element 514 is comprised of a strong, rigid material that maintains its shape through the incision and reduces incision loads. For example, due to its rigidity, the transition element 514 maintains its shape and supports the tissue sliding over the transition element 514 during surgery. Suitable materials for the transition element include, but are not limited to, medical grade metals and rigid plastics.

[0043] 5A and 5B, in some embodiments, the transition element 514 includes a notch 512 designed to allow the two cutting portions 310, 312 to extend from the transition element 514 (as shown in FIG. 5B). The notch 512 is positioned such that it allows passage of the two cutting portions 310, 312 from within the cannula 100 through the transition element 514. In some embodiments, the notch 512 is a curved notch that extends circumferentially with at least a portion of the transition element 514. For example, the notch 512 is shaped to mirror the arc, angle, shape, etc. of the distal end and / or tip 120 of the cannula 100. In some embodiments, the circumferential length of the notch 512 controls the range of rotation of the cutting portion relative to the cutting tip 120. In some embodiments, the allowable arc of rotation of the cutting portion is less than a full rotation depending on the opening of the notch 512. The cutting sections are positioned within the notches 512 and have a one-sided function, i.e., shape, where the conductive end 312 and the flat conductive end 310 (i.e., anvil) are located on the inner end of each cutting section and not on the outer end. This configuration allows one or both of the cutting elements 310, 312 to rotate within the notch 512 to achieve the desired effect (e.g., separating, cutting, etc.).

[0044] In operation, the two cutting portions 310, 312 (blade and anvil) when extended have an angular orientation in the operator's field of view when the operator looks at a screen showing the view from the endoscope 116 out of the cone of the cutting tip 120 of the device 100. In some embodiments, the anvil cutting portions 310 are "fixed" with respect to their angular orientation relative to the body of the device 100 as they extend from the cannula 100. When fixed, the anvil cutting portions 310 always extend according to what is considered the "top" of the device 100 or according to other user controls such as sliders and power buttons. For example, when the user rotates the entire device 100, the anvil cutting portions 310 rotate with the body since the anvil cutting portions are internally fixed to the body.

[0045] Conversely, the blade cutting portion 312 is not fixed to the body for angular rotation about the cutting tip 120. The blade cutting portion 312 is rotated about the central axis of the device 100 by rotating a "rotor" mechanism (e.g., rotor subassembly 901). The rotor is configured to rotate the blade cutting portion 312 internally while the anvil cutting portion 310 and subsequently the remainder of the body of the device 100 remain fixed. This allows the operator to separate the blade cutting portion 312 from the anvil cutting portion 310 while accessing the branch for cauterization. In some embodiments, the cutting portions 310, 312 are both rotatable about the cutting tip 120. In such cases, the inner surface 121 and / or the outer surface 125 of the cutting tip 120 are configured to be rotatable with the cutting portions 310, 312 and retain the visual cue 516 in accordance with the cutting portions 310, 312.

[0046] With the above operations in mind, while the cutting portions 310, 312 are being retracted, it is important that the operator knows the angular position of the cutting portions 310, 312 before extending them so that they can ensure that no damage is caused by inadvertently contacting something in front of them.

[0047] 5C-5E, in some embodiments, the cutting tip 120 includes a visual cue 516 thereon. The visual cue 516 is configured to designate a reference point where at least one location of the cutting portion is identified relative to the cutting tip 120 while the cutting portions 310, 312 are in a retracted state (e.g., below the transition element 514), as shown in FIG. 5A. Similarly, the visual cue 516 indicates where the cutting portions 310, 312 are positioned back into the cannula 100 during retraction. The visual cue 516 is designed to be visualized by the human eye, an imaging device, or a combination thereof.

[0048] In some embodiments, the visual cue 516 is located on the outer surface 125 of the cutting tip 120, as shown in Figure 5A, and / or on the inner surface 121 of the cutting tip 120, as shown in Figures 5C-5E, which is visualized through a transparent portion of the tip 120. The visual cue 516 is of any combination of length to provide a sufficient indicator to the user regarding the orientation of the device and / or the location of the cutting portion 310, 312. For example, the visual cue 516 extends over the entire length of the tip 120, as shown in Figure 5A, or over a portion of the tip, as shown in Figure 5C.

[0049] 5A-5E depict the visual cue 516 as a solid line, any combination of visual designations may be used without departing from the scope of the present invention. For example, the visual cue 516 may be a vertical line, a horizontal line, an arrow, a dot, a dashed line, a curved line, a plus sign, or the like, or a combination thereof. Similarly, the visual cue 516 may be any type of visual designation including a mark that is substantially flush with the surface of the cutting tip 102, an indentation in one of the surfaces of the cutting tip 102, a protrusion from one of the surfaces of the cutting tip 102, or a combination thereof. Similarly, the visual cue 516 may have any combination of orientations relative to the rest of the device. For example, the visual cue 516 may be a straight line that extends longitudinally on the tip 120. Similarly, the visual cue 516 may also be positioned to provide an indication of locating at least one of the cutting portions 310, 312.

[0050] In some embodiments, the visual cue 516 is sized, shaped, and colored to be sufficiently visualized, but small enough not to cause significant obstruction to the field of view. The visual cue 516 may be of any length without departing from the scope of the present invention, for example, the visual cue 516 extends the entire length of the cutting tip 120, as shown in FIG. 5A. Similarly, the transparency of the visual cue 516 may vary from barely visible to completely opaque. In some embodiments, depending on the location of the visual cue 516, the transparency of the cutting tip 120 and portions thereof may also vary. In particular, when the visual cue 516 is disposed on the inner surface 121 of the tip 120 (or within the tip 120 itself), then at least a portion of the outer surface 125 of the tip 120 and / or the tip 120 itself is sufficiently transparent to allow the visual cue 516 to be displayed. For example, the visual cue 516 is created during injection molding on the inner surface 121 of the cutting tip 120, which is transparent to create a slightly frosted visual cue 516 discernible as a small line, as shown in FIGS. 5C-5E. In some embodiments, the visual cue 516 is sized and shaped with a length and width such that it is visible but not obtrusive in the field of view. A short length and narrow width provide a balance of being unobtrusive and easily found on the fly. When the visual cue 516 does not extend the entire length of the tip 120, the visual cue 516 is placed at the distal end of the tip 120 where it is visually small and unobtrusive.

[0051] The visual cue 516 may be created using any combination of methods or systems known in the art. For example, the visual cue 516 may be created during injection molding of the surface of the cutting tip 120, where the visual cue 516 is a positive protrusion, a negative cavity, or a break in the surface finish to create a contrasting light deflection (e.g., ground glass, etc.). The visual cue 516 may also be etched into any combination of the exterior surface 125 and the interior surface 121. Other combinations of marks on any combination of the exterior surface 125 and the interior surface 121 may also be used. For example, marks may be painted, embossed, etc., on any combination of the exterior surface 125 and the interior surface 121. Any combination of methods may be combined to create the visual cue 516.

[0052] In some embodiments, the visual cues 516 are designed to be visualized on a digital display (e.g., a video screen) with data from the endoscope 116 and used to identify the angular position of the cutting segments 310, 312 while they are in a retracted position. By providing visualization of the visual cues 516 on a screen, it is easier for the user's brain to process the visual cues 516 in the field of view of the digital display, rather than the brain processing other cues that they do not see, such as tactile cues. In some embodiments, the visual cues 516 are designed for enhanced visualization based on the imaging system used. For example, the visual cues 516 have a contrast-based coating for viewing in a fluoroscopic system.

[0053] Regardless of the design, in some embodiments, the visual cue 516 designed to be displayed on the digital display is oriented in its simplest sense and positioned at the location of the anvil cutting portion 310. For example, the markings of the cutting tip 120 are viewed by the surgeon by an endoscope or other camera for projection on the digital display and identify exactly where the anvil cutting portion 310 is (longitudinally behind the visual cue 516 while the cutting portions 310, 312 are retracted). Thus, the user expects that when extending the cutting portions 310, 312, the anvil cutting portion 310 will exit the housing exactly where the visual cue 516 of the cutting tip 120 is positioned. Also, the user knows that the blade cutting portion 210 will always be positioned adjacent to the anvil cutting portion 310 in a clockwise or counterclockwise direction.

[0054] 5D and 5E, an exemplary view of the cutting portions 310, 312 extending from the housing of the device 100 is shown. As shown in FIG. 5D and 5E, the anvil cutting portion 310 is axially aligned with the visual cue 516 to provide an indication of the angular orientation of the anvil cutting portion 310. Thus, the visual cue 516 is relied upon to project where the anvil cutting portion 310 (and the blade cutting portion 312 based on its relationship to the anvil cutting portion 310) should extend from the housing, out of the notch 512 and onto the visual cue 516. Similarly, the user also knows that the blade is always positioned adjacent to the anvil in a clockwise direction. With this configuration, the user can accurately position the cutting portions 310, 312 without worrying about the cutting portions 310, 312 inadvertently striking an unintended portion of the body. In some embodiments, the tip 120 includes multiple visual cues 516. For example, tip 120 includes a separate visual cue 516 for cut 310 and a separate visual cue 516 for cut 312 .

[0055] In some embodiments, at least one of the cutting portions 310, 312 is constructed from a substantially transparent material to allow visualization of the visual cue 516 when the cutting portion 310, 312 is positioned over the visual cue 516. Similarly, at least one of the cutting portions 310, 312 includes a visual cue thereon (not shown) that mirrors the visual cue 516 on the tip 120. In some embodiments, the visual cue 516 is combined with other forms of feedback. In one example, a tactile response, such as a small protrusion felt by the operator, is combined with the visual cue 516 to provide two forms of confirmation. Tactile feedback includes any combination of methods. For example, there may be multiple protrusions, one attached to the rotor to indicate the angular position of the cutting portion 312 and another attached to the body of the device to indicate the angular position of the cutting portion 310. In this way, the operator does not need to defocus the video screen to view the device and position these features. While the surgeon looks at a screen, they simply feel the small protrusions with their hands.

[0056] 6A, a control handle 600 is provided at the proximal end of the cannula 100 for controlling the cutting member. In some embodiments, the control handle 600 includes a translation control 602 for advancing and retracting the cutting member. The control handle 600 further includes a rotation control collar 604 for rotating the cutting members relative to one another. The control handle 600 also includes an energy control 606 for supplying energy (e.g., bipolar radio frequency (RF) energy) to the cutting portions of the cutting members. In some embodiments, an adapter 114 is disposed at the proximal end 600A of the control handle 600 for advancing an endoscope into the cannula.

[0057] Operation of the device will be described with reference to Figures 6A-6G. In operation, an initial incision is made in a conventional manner to expose a target vessel (e.g., a saphenous vein). A cannula 601 (Figure 7B) is inserted into the incision and guided to the target vessel. In some embodiments, the cannula 601 includes a smooth tubular sheath around an elongated body to seal the cannula 601 within a port through which the cannula 601 is introduced into the patient. The cannula 100 is then advanced substantially along the target vessel, severing the target vessel from the surrounding tissue. In some embodiments, the cannula 601 is introduced through a sealable port that is used to seal the incision, allowing insufflation of the space created by the incision of the target vessel from the surrounding tissue.

[0058] As the cannula 100 is advanced, the cutting sections of the cutting elements are held in a retracted position proximal to the cutting tip so as not to interfere with the tissue incision until a branch vessel is encountered as shown in Figures 6B-6G. When a branch vessel is reached, the cutting sections 310, 312 are moved distally beyond the cutting tip 120 by advancing the translation or sliding control 602 of the handle 600 distally as shown in Figures 6D-6E. As described above, the cutting sections are urged toward each other and advanced together out into the endoscopic field of view of the cutting tip.

[0059] The cutting sections are then rotated away from each other to an open configuration using the rotation control 604 to seal and cut the branch vessel. The cutting sections are rotated about the cutting tips in an arc motion. The endoscope cannula is positioned to place the target branch vessel across one of the cutting sections regardless of the orientation of the branch vessel relative to the main vessel being harvested. The endoscope cannula is designed so that the user places the endoscope cannula and cutting section as far away from the target main vessel as possible to avoid damaging the main vessel. Then, when the branch vessel is positioned between the cutting sections 310, 312, the user can return the cutting section to the closed configuration, capturing the branch vessel between them. In some embodiments, the user manually brings the cutting sections together. Alternatively or additionally, the rotation control is spring loaded to urge the cutting sections towards each other. The energy control 608 button is then pressed to transfer energy to the branch vessel, sealing the vessel. In some embodiments, the cutting sections are energized before the cutting section contacts the branch vessel. After the seal is completed and the energy control button 608 is released, the user continues to advance the rotation control 604 until the cutter transects the branch vessel. Once the branch vessel has been severed, the user then retracts the cutter via the translation control 602 and advances the device to the next branch vessel until all tributaries have been successfully ligated and transected.

[0060] In some embodiments, to bias the cutting sections, the control handle 600 includes a biasing member 605 for spring loading the twisting motion of the control collar 604. In various embodiments, both cutting sections are rotatable, while in other embodiments, only one of the cutting sections is rotatable and the other one is stationary. For example, the cannula 100 is structured and arranged to externally spring load the twisting motion between the control handle 600 and the control collar 604 such that the cutting sections are held in a closed configuration. To place the cutting sections on the venous tributary, the control collar 604 is rotated to move one or both cutting sections away from each other to an open configuration. Upon release of the control collar 604, a predetermined amount of compressive force is applied to the tributary, and then bipolar RF energy is activated to cauterize the tributary. The compressive force on the tributary is achieved by spring force selection of the control collar 604 to optimize the process of tributary sealing. After application of bipolar cautery to seal the tributaries, the cannula 100 is rotated and / or axially displaced to sever the tributaries.

[0061] 7A and 7B, in some embodiments, the biasing member 605 includes a first control lever 610 attached to the exterior of the control collar 604 and a corresponding second control lever 620 attached to the exterior of the control handle 600 of the cannula 100. A resilient device or elastic band 615 is used to connect the control levers 610, 620 to place the two in compression and also to exert a compressive force between the cutting portions to hold the cutting portions in a closed configuration.

[0062] 7C and 7D, the elastic band 615 is in a relaxed, contracted configuration, holding the cutout in a closed configuration. With reference to Figures 7E and 7F, moving the rotational control 604 stretches the elastic band 615 and moves the cutout to an open configuration. Releasing the collar allows the elastic band to contract, returning the cutout to the closed configuration.

[0063] In some embodiments, the biasing members are disposed within the cavities of the control handle and control collar. In some embodiments, the biasing members 615 are used to uniform the compression force applied to the branch vessels during the cauterization and cutting process. In this manner, variations in manual compression force exerted by different clinicians / users during harvesting procedures are eliminated, increasing the likelihood of achieving hemostasis, thereby avoiding the possibility of hemorrhage or bleeding during the procedure. The external and internal biased cuts eliminate the need for the user to maintain his or her hands in opposing directions for the duration of the cauterization process, such that the user does not become substantially fatigued when performing multiple procedures.

[0064] In some embodiments, the cutting portions 310, 312 are also longitudinally movable relative to each other to enhance the cutting action achieved during severing of the branch vessels, as shown in Figures 8A and 8B. As shown in Figure 8A, the cutting portions 310, 312 extend distally together along the cutting tip 120. The user then continues to translate one of the cutting portions 310, 312 distally from the extended position to a "very extended" position, as shown in Figure 8B. In the very extended position, one of the cutting portions 310, 312 is advanced further distally than the other cutting portion. During the surgical process, the cutting portions are difficult to transect or cut large diameter venous tributaries after cauterization. Upon application of bipolar cauterization energy to the tributary, the tributary tissue is desiccated, transforming the tributary tissue into stiff fibrous strands rather than the soft tubular structure it assumes in its native state. The relative translational motion between the cutting parts creates a "slicing" action, helping to cut even tough blood vessels.

[0065] By way of non-limiting example, Figures 9A-9G depict exemplary assemblies that permit movement of the cutting sections longitudinally relative to one another. With reference to Figure 9A, a rotor assembly 901 is attached to the proximal end of an outer sheath 902. As shown in Figure 9B, an inner section 903 of the rotor assembly 901 includes two keys 905, 906 and a stopper 907, the purpose of which is described below. Figure 9C depicts an embodiment of an outer electrode subassembly 920, which is disposed at the proximal end of an outer electrode 908. The outer electrode subassembly 920 includes an inner adapter 922 that is connected to the outer electrode 908 by a compressible element 924. The inner electrode 904 extends through the outer electrode 908 into the inner adapter 922 and is secured to the inner adapter 922. Additionally, as shown in Figure 9D, an outer adapter 926 is disposed around the outer electrode 908. The outer adapter 926 is designed to allow the inner adapter 922 to rotate relative to the outer electrode 908, thereby rotating the inner electrode 904 relative to the outer electrode 908. As shown in FIG. 9E, the outer electrode subassembly 920 is inserted into the rotator assembly 901 and a handle 928 is placed around the outer electrode subassembly 920.

[0066] In operation, as shown in FIG. 9F, the outer electrode subassembly 920 is contracted to contract the cutting portion. To extend the cutting portion, the slider 602 is advanced distally, moving the outer electrode subassembly 920 in a distal direction. As shown in FIG. 9G, the outer electrode subassembly is advanced forward until the outer adapter 926 is pressed against the stopper 907 of the rotor subassembly 901. At this point, the cutting portions are advanced together to an extended position, as shown, for example, in FIG. 8A. The slider 902 is then moved further distally, moving the inner adapter 922 to compress the compressible element 924. Such movement of the inner adapter 922 also moves the inner electrode further distally, while the outer electrode 908 remains stationary. In this manner, the cutting portion of the inner electrode 904 is moved longitudinally relative to the cutting portion of the outer electrode 908 to a highly extended position, as shown in FIG. 8B.

[0067] With reference to Figures 10A and 10B, another embodiment for longitudinally moving the cutting portions relative to one another is depicted. Of course, it should be understood that the structures shown in Figures 9A-9G may be combined with the structures of Figures 10A-10B. With reference to Figure 10A, the cannula 100 includes a compressible element or compression spring 1035 disposed in a gap 1035A separating the control collar 1004 from the control handle 1000. One aspect of this configuration provides axial movement between the cutting portions. For example, at least one rotary cutting portion 1010 is actuated by a control collar 1004 and extended to approximately 3-5 mm, the control collar 1004 is moved forward of the control handle 1000, and the compressible element 1035 is positioned in the gap 1035A between the control collar 1004 and the control handle 1000, such that contraction of the control collar 1004 relative to the control handle 1000 results in an axial displacement of the rotary cutting portion 1010 of 3-5 mm relative to the stationary blade 1012.

[0068] 10C and 10D depict the use of axial motion between the two cutting sections 1010, 1012. For example, the control collar 1004 is rotated to close the long rotating section 1010 onto the stationary cutting section 1012 and bipolar electrocautery is applied to seal the tributaries (FIG. 10C). While maintaining the cutting sections 1010, 1012 in a closed, compressed configuration, the control collar 1004 is pulled back relative to the control handle 1000, contracting the long rotating cutting section 1010 relative to the stationary cutting section 1012 and providing relative longitudinal motion between the two cutting sections 1010, 1012 (FIG. 10D).

[0069] Although preferred types of energy for the various electrodes are presented in this disclosure, it should be noted that all electrodes can be energized using a variety of energy sources, including, but not limited to, resistive heating, ultrasonic heating, and bipolar or monopolar RF energy. In some embodiments, the electrodes are controlled independently of one another. It should also be noted that, if desired, the electrodes are insulated with an insulating coating or sheath.

[0070] All patents, patent applications, and published references cited herein are hereby incorporated by reference in their entirety. It should be emphasized that the above-described embodiments of the present disclosure are merely possible examples of implementations, and are set forth merely for a clear understanding of the principles of the present disclosure. Many variations and modifications may be made to the above-described embodiments without substantially departing from the spirit and principles of the present disclosure. It will be understood that some or alternatives of the present disclosure and other features and functions may be desirably combined into many other different systems or applications. All such modifications and variations are intended to be included herein within the scope of the present disclosure as defined by the appended claims.

[0071] As used herein, the terms "comprises" and "comprising" are intended to be interpreted as inclusive, not exclusive. As used herein, the terms "exemplary," "example," and "illustrative" are intended to mean "serving as an example, instance, or illustration," and should not be interpreted as indicating or not indicating a preferred or advantageous form compared to other forms. As used herein, the terms "about," "generally," and "approximately" are intended to include variations that exist at the upper and lower limits of a range of subjective or objective values, such as, for example, variations in characteristics, parameters, sizes, and dimensions. In one non-limiting example, the terms "about," "generally," and "approximately" mean plus or minus 10 percent or less. In one non-limiting example, the terms "about," "generally," and "approximately" mean close enough to be considered by one of ordinary skill in the relevant field involved. As used herein, the term "substantially" refers to the extent or degree of perfection or near perfection of an operation, feature, characteristic, state, structure, item, or result, as would be understood by one of ordinary skill in the art. For example, an object that is "substantially" circular would mean that the object is either a perfect circle or near a circle, the limits of which can be determined mathematically, as recognized or understood by one of ordinary skill in the art. The exact acceptable degree of deviation from absolute perfection may depend on the particular situation. Generally, however, the nearness of completion is such that the overall result is the same as if absolute and complete completion had been achieved or obtained. The use of "substantially" is equally applicable when utilized in a negative connotation to refer to a complete or near complete lack of an operation, feature, characteristic, state, structure, item, or result, as would be understood by one of ordinary skill in the art.

[0072] Numerous modifications and alternative embodiments of the present invention will be apparent to those skilled in the art in view of the foregoing description. Accordingly, this description is to be construed as illustrative only, and is for the purpose of teaching those skilled in the art the best mode of carrying out the invention. Details of construction may be varied substantially without departing from the spirit of the invention, and the exclusive use of all modifications that come within the scope of the appended claims is reserved. Although embodiments have been described herein in a manner that provides a clear and concise specification, it will be understood that the embodiments are intended to be variously combined or separated without departing from the invention. It is intended that the present invention be limited only to the extent required by the appended claims and applicable rules of law.

[0073] It is also to be understood that the following claims include all general and specific features of the invention described herein and, as a matter of language, all statements of the scope of the invention which are said to fall within their scope.

Claims

1. an elongated body terminating in a transparent tip at a distal end of the body; a cutting unit having a first cutting portion and a second cutting portion longitudinally movable from within the elongate body toward a distal end, at least one cutting portion being circumferentially movable about the tip relative to the other cutting portion to cut the tissue to be harvested; and a visual cue located at the distal end to function as a reference point for a user to define an exit point of the cutting unit from within the elongated body to (1) prevent the cutting unit from damaging tissue that is not to be harvested, and (2) facilitate rotational adjustment of the elongated body so that the cutting unit can approach tissue that is to be harvested for cutting.

2. The surgical device of claim 1 , wherein the first cutting portion and the second cutting portion move longitudinally from a retracted position to an extended position beyond the tip.

3. The surgical device of claim 1 , wherein the visual cue is at least one of an indentation, a protrusion, and a mark.

4. The surgical device of claim 1 , wherein the visual cue is at least one of a vertical line, a horizontal line, an arrow, a dot, and a dashed line.

5. The surgical device of claim 1 , wherein the first cutting portion is rotatable as a blade and the second cutting portion is stationary as an anvil.

6. The surgical apparatus of claim 5 , wherein the visual cue indicates where an anvil extends longitudinally from the elongate body.

7. The surgical device of claim 1 , wherein the visual cues are within the field of view of the surgeon and are visualized on an electronic display.

8. The surgical device of claim 1 , wherein the visual cue is located on one of an inner surface of the tip or an outer surface of the tip.

9. The surgical device of claim 1 , further comprising a biasing member configured to move the cutting portions from an open position in which the cutting portions are spaced apart to a closed position in which the cutting portions contact one another.

10. and a rotational control collar disposed at a proximal end of the elongate body for moving the cutting portion from the closed position to the open position. The surgical device of claim 9 , wherein the biasing member is coupled to the rotation control collar to return the cutting section to the closed position.

11. 10. The surgical device of claim 1, wherein the first cutting portion and the second cutting portion are configured to be energized to seal, cut, or both, a blood vessel trapped between the first cutting portion and the second cutting portion.

12. the first cutting portion has a sharp end; The surgical device of claim 1 , wherein an end of the second cutting portion facing a sharp end of the first cutting portion is flat.

13. The surgical device of claim 1 , wherein the first cutting portion is stationary and the second cutting portion is rotatable about the tip away from the first cutting portion.

14. The cutting device of claim 1 , wherein the second cutting portion is bidirectionally rotatable about the tip.

15. The surgical device of claim 1 , wherein the tip includes a rigid transition element having a notch such that the cutting portion can extend through the notch.

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