Surgical cutting instrument and method of use

Abstract

A surgical cutting instrument adapted for percutaneous insertion into a body cavity to facilitate a minimally invasive surgical procedure. The surgical cutting instrument includes a shaft having a proximal end, an open distal end, and an axial lumen therebetween. An inlet opening may be fluidly coupled to the lumen at a proximal end of the shaft, for connection to a vacuum source for creating a suction force sufficient to retain the distal end of the shaft adjacent to a surface of a body structure within the body cavity. A cutting element is disposed within the lumen of the shaft near the distal end of the shaft, and is operable to cut the body structure without removing any substantial portion of the body structure when the shaft is held adjacent to the surface of the body structure.

1 . A surgical cutting instrument comprising: 
 an elongate shaft having a proximal end, a distal end adapted for percutaneous insertion into a body cavity within a patient, and an axial lumen therebetween;    a stabilizing element associated with said distal end of said shaft; and    a cutting element disposed within said lumen of said shaft near said distal end;    wherein said cutting element and said shaft are relatively moveable between a first position and a second cutting position, said cutting element being adapted to cut a body structure within the body cavity when said cutting element and said shaft are in said second cutting position; and    wherein said stabilizing element, upon actuation, is adapted to maintain the body structure in a stable position adjacent said distal end.    
     
     
         2 . The surgical cutting instrument of  claim 1 , wherein said instrument is adapted to cut the body structure without removing a substantial portion of the body structure.  
     
     
         3 . The surgical cutting instrument of  claim 1 , wherein said distal end has an outside diameter of less than about 5 mm.  
     
     
         4 . The surgical cutting instrument of  claim 1 , wherein said cutting element comprises at least one blade which has a substantially straight cutting edge.  
     
     
         5 . The surgical instrument of  claim 4 , wherein said cutting edge is displaced at an angle of between about 15 to 30 degrees relative to a vertical axis through the blade.  
     
     
         6 . The surgical cutting instrument of  claim 1 , wherein said cutting element is movably disposed within said lumen of said shaft.  
     
     
         7 . The surgical cutting instrument of  claim 6 , wherein said cutting element comprises at least one blade fixed to a distal end of an actuator push rod located within said lumen of said shaft.  
     
     
         8 . The surgical cutting instrument of  claim 7 , further comprising an actuator button coupled to said actuator push rod at a proximal end of said rod which is operable to move said rod with respect to said shaft to position said cutting element between said first position and said second cutting position.  
     
     
         9 . The surgical cutting instrument of  claim 1 , wherein said cutting element comprises at least one blade which is operably coupled to a source of ultrasonic energy.  
     
     
         10 . The surgical instrument of  claim 1 , wherein said stabilizing element comprises a vacuum line fluidly coupled to said lumen of said shaft and adapted to connect to a vacuum to effect a suction force at said distal end.  
     
     
         11 . The surgical cutting instrument of  claim 1 , wherein said body structure is selected from the group consisting of a heart, a coronary artery, a coronary vein, an aorta, and a peripheral vessel.  
     
     
         12 . The surgical cutting instrument of  claim 11 , wherein said peripheral vessel is selected from the group consisting of a saphenous vein, a radial artery, a brachial artery, a gastroepiploic artery, and a subclavian artery.  
     
     
         13 . The surgical cutting instrument of  claim 1 , wherein the body cavity comprises a thoracic cavity.  
     
     
         14 . The surgical cutting instrument of  claim 1 , further comprising at least one electrode disposed near said distal end of said shaft.  
     
     
         15 . The surgical cutting instrument of  claim 14 , further comprising a connector associated with said proximal end of said shaft for electrically coupling said electrode to an electrosurgical power supply.  
     
     
         16 . The surgical cutting instrument of  claim 1 , wherein said stabilizing element comprises a gripper assembly associated with said distal end of said shaft and configured to grip a portion of the body structure.  
     
     
         17 . The surgical cutting instrument of  claim 1 , further comprising a handle connected to said proximal end of said shaft and adapted to be held by at least one hand of a user.  
     
     
         18 . The surgical cutting instrument of  claim 1 , further comprising an irrigation port fluidly coupled to said lumen near said proximal end of said shaft, said irrigation port being connectable to a source of irrigation fluid for clearing debris away from the body structure.  
     
     
         19 . The surgical cutting instrument of  claim 8 , further comprising a biasing element engaging said actuator button.  
     
     
         20 . The surgical cutting instrument of  claim 19 , wherein said biasing element comprises a spring.  
     
     
         21 . The surgical cutting instrument of  claim 1 , wherein said shaft is movably disposed with respect to said cutting element.  
     
     
         22 . The surgical cutting instrument of  claim 21 , further comprising a handle disposed at said proximal end of said shaft, said shaft being slidably mounted to said handle.  
     
     
         23 . The surgical cutting instrument of  claim 22 , further comprising an anchor fixedly connecting said cutting element to said handle.  
     
     
         24 . The surgical cutting instrument of  claim 23 , wherein said anchor comprises a rod coaxially disposed within said shaft.  
     
     
         25 . The surgical cutting instrument of  claim 21 , further comprising an actuator member mounted to said shaft.  
     
     
         26 . The surgical cutting instrument of  claim 25 , wherein said actuator member is mounted near said proximal end of said shaft.  
     
     
         27 . The surgical cutting instrument of  claim 25 , further comprising a biasing element engaging said actuator member.  
     
     
         28 . The surgical cutting instrument of  claim 27 , wherein said biasing element comprises a spring interposed between said actuator member and said handle, wherein said spring biases said shaft to said first position.  
     
     
         29 . The surgical instrument of  claim 1 , further comprising an electrode operatively coupled to said cutting element.  
     
     
         30 . The surgical instrument of  claim 5 , further comprising an electrode substantially colinearly coupled to said cutting edge.  
     
     
         31 . The surgical instrument of  claim 10 , further comprising a control mechanism positionable to block flow between said vacuum source and said lumen.  
     
     
         32 . The surgical instrument of  claim 31 , wherein said control mechanism comprises a slide valve.  
     
     
         33 . The surgical instrument of  claim 31 , wherein said control mechanism comprises an on/off button.  
     
     
         34 . The surgical cutting instrument of  claim 21 , further comprising a handle disposed at said proximal end of said shaft, said proximal end of said shaft being slidably mounted within said handle.  
     
     
         35 . The surgical cutting instrument of  claim 34 , further comprising an anchor fixedly connecting said cutting element to said handle.  
     
     
         36 . The surgical cutting instrument of  claim 35 , wherein said anchor comprises a rod coaxially disposed within said shaft.  
     
     
         37 . The surgical cutting instrument of  claim 25 , further comprising a lever mounted to said handle and movable to engage said actuator member to move said shaft between said first position and said second cutting position.  
     
     
         38 . A surgical cutting instrument adapted for percutaneous insertion into a body cavity within a patient comprising: 
 an elongate shaft having a proximal end, a distal end, and an axial lumen therebetween;    means for retaining the distal end of the shaft adjacent to or near a surface of a body structure within said body cavity;    a cutting element disposed within said lumen of said shaft near the distal end of the shaft; and    an actuator member disposed near the proximal end of the shaft which is operable to position the cutting element in contact with said body structure for cutting said body structure without substantially removing any portion of said body structure when said retaining means holds said shaft adjacent to or near said body structure.    
     
     
         39 . The surgical cutting instrument of  claim 38  wherein said shaft is moveable between a first position and a second position and is adapted to substantially cover the cutting element when in said first position and to expose at least a portion of the cutting element when in said second position.  
     
     
         40 . The surgical cutting instrument of  claim 38  wherein said cutting element is moveable between a first position and a second position, said shaft substantially covering said cutting element in said first position, and at least a portion of said cutting element extending from said distal end of said shaft in said second position.  
     
     
         41 . The surgical cutting instrument of  claim 39 , wherein said actuator member includes an actuator body fixed to said shaft near said proximal end of said shaft and operable to move said shaft between said first position and said second position.  
     
     
         42 . The surgical cutting instrument of  claim 41  further including a spring coupled to said actuator body for biasing said shaft into said first position.  
     
     
         43 . The surgical cutting instrument of  claim 38 , wherein said retaining means comprises a vacuum source fluidly coupled to said lumen of said shaft and operable to produce a suction force at the distal end of the shaft which is sufficient to retain the distal end of the shaft adjacent to or near the surface of the body structure.  
     
     
         44 . The surgical cutting instrument of  claim 38 , wherein said retaining means includes a gripper assembly at said distal end of said shaft which is configured to grip a portion of the body structure to retain the body structure adjacent to said distal end.  
     
     
         45 . The surgical cutting instrument of  claim 38 , further comprising an irrigation port fluidly coupled to said lumen near said proximal end of said shaft.  
     
     
         46 . A surgical cutting instrument comprising: 
 a shaft having a proximal end, an open distal end, and an axial lumen therebetween;    an inlet opening, fluidly coupled to said lumen at said proximal end of said shaft, connectable to a vacuum source for creating a suction force sufficient to retain said distal end of said shaft adjacent a surface of a body structure within the body cavity; and    a cutting element disposed within said lumen near said distal end;    wherein said shaft is movable between a first position, in which said shaft substantially covers said cutting element, and a second position, in which at least a portion of said cutting element is exposed beyond said open distal end of said shaft.    
     
     
         47 . A surgical cutting instrument comprising: 
 a shaft configured for percutaneous insertion into a body cavity of a patient having a proximal end and a distal end;    a cutting element disposed near the distal end of the shaft;    a retention mechanism coupled to the shaft which is configured to retain the distal end of the shaft adjacent to or near a surface of a body structure within the body cavity; and    actuating means disposed near the proximal end of the shaft for positioning the cutting element in contact with a body structure within said body cavity for cutting said body structure when said shaft is held adjacent to or near the body structure.    
     
     
         48 . A method for cutting a body structure within a body cavity without removing any substantial portion of the body structure, the method comprising: 
 introducing a distal end of a surgical cutting instrument through a percutaneous opening in the body cavity;    retaining said distal end of said shaft relatively immobile with respect to a surface of the body structure; and    manipulating the surgical instrument from outside the body cavity to position a cutting element of said surgical cutting instrument in contact with the body structure to cut the body structure.    
     
     
         49 . The method of  claim 48 , wherein said retaining comprises retaining said distal end in abutting engagement with the surface of the body structure.  
     
     
         50 . The method of  claim 49  wherein said retaining comprises applying a suction force to the surface of the body structure.  
     
     
         51 . The method of  claim 50 , wherein said retaining comprises applying a suction force through said distal end.  
     
     
         52 . The method of  claim 48  wherein said manipulating comprises actuating an actuator body, externally of said percutaneous opening, to move a cutting element disposed near a distal end of the shaft from a first position to a second, cutting position.  
     
     
         53 . The method of  claim 48  wherein said manipulating comprises actuating said shaft to move from a first position, in which said shaft substantially covers said cutting element, to a second position in which at least a portion of said cutting element is exposed for cutting the body structure.  
     
     
         54 . The method of  claim 48  further comprising applying radiofrequency energy to the body structure to facilitate making a cut in the body structure.  
     
     
         55 . The method of  claim 54  wherein said applying radiofrequency energy includes applying energy to an electrode disposed at or near a distal end of the surgical cutting instrument.  
     
     
         56 . The method of  claim 48  further comprising applying ultrasonic energy to said cutting element to effect or enhance cutting.  
     
     
         57 . A method for endoscopically cutting a body structure within a body cavity, the method comprising: 
 introducing a distal end of a surgical cutting instrument through a percutaneous opening in the body cavity;    applying a suction force to a surface of the body structure to retain the surface of the body structure adjacent to a distal end of the surgical cutting instrument; and    positioning a cutting element disposed near the distal end of the surgical cutting instrument in contact with the body structure to cut the body structure.    
     
     
         58 . The method of  claim 57 , wherein said positioning comprises actuating an actuator body externally of said percutaneous opening, to move said cutting element from a first position to a second, cutting position.  
     
     
         59 . The method of  claim 57 , wherein said positioning comprises moving a shaft included as a portion of said surgical cutting instrument, from a first position in which said shaft substantially covers said cutting element, to a second position in which at least a portion of said cutting element is exposed for cutting the body structure.  
     
     
         60 . The method of  claim 57 , further comprising applying radiofrequency energy to the body structure to facilitate making a cut in the body structure.  
     
     
         61 . The method of claim  60 , wherein said applying radiofrequency energy includes applying radiofrequency energy to an electrode disposed at or near said distal end of said surgical cutting instrument.  
     
     
         62 . The method of  claim 57 , further comprising applying ultrasonic energy to said cutting element.