Tissue severing devices with sliding support and methods

Abstract

Tissue severing devices and methods are provided operable to be inserted through small surgical openings and advanced to tissue to be severed. The tissue severing device includes a cutting element that extends from a tube member during use. A slidable support ribbon is operable to support the cutting element at an angle to an axis of the tube member.

1 - 27 . (canceled) 
     
     
         28 . A tissue severing device comprising:
 a handle;   a tube member including an elongated tube having a tube member proximal end extending into the handle and a tube member distal end opposite the tube member proximal end, the tube member defining a tube member lumen that extends through the tube member proximal end to the tube member distal end and defining a tube member axis;   an inner member including an elongated body having an inner member proximal end extending through the tube member lumen and into the handle and an inner member distal end opposite the inner member proximal end, the inner member being operable to be received within the tube member lumen;   a cutting element including a cutting element proximal end and a cutting element distal end opposite the cutting element proximal end, the cutting element proximal end extending into the inner member distal end, the cutting element distal end extending from the inner member distal end,   the tube member distal end being operable to move distally over and receive the inner member distal end and the inner member distal end therein, and the tube member distal end being operable to move in a proximal direction to expose the cutting element distal end; and   a slidable support ribbon operable for supporting the inner member distal end in a curved position when the inner member distal end is at least partially exposed by the withdrawal of the tube member distal end, the slidable support ribbon comprising an elongated body including a slidable support ribbon proximal end and a slidable support ribbon distal end opposite the slidable support ribbon proximal end, the slidable support ribbon proximal end extending through the tube member lumen from about the tube member proximal end to about the tube member distal end and adjacent the inner member, the slidable support ribbon distal end positioned adjacent the inner member distal end and the cutting element distal end.   
     
     
         29 . The tissue severing device of  claim 28 , wherein the slidable support ribbon proximal end is positioned generally adjacent the handle and may be operably engaged by a user. 
     
     
         30 . The tissue severing device of  claim 28 , wherein the slidable support ribbon distal end is operable to support the inner member distal end into a curved shape when the tube member distal end is withdrawn therefrom, the slidable support ribbon being operable to substantially prevent the inner member distal end from extending toward the tube member axis when the cutting element distal end is pulled through tissue to be severed. 
     
     
         31 - 35 . (canceled) 
     
     
         36 . The tissue severing device of  claim 30 , wherein the slidable support ribbon distal end is operably coupled to the tube member so as to begin withdrawing proximally from being adjacent the cutting element distal end as the cutting element distal end begins to be exposed by the withdrawing tube member distal end, the slidable support ribbon distal end operable to be exposed substantially concurrently with the exposure of the inner member distal end by the tube member distal end. 
     
     
         37 . (canceled) 
     
     
         38 . The tissue severing device of  claim 30 , wherein the tube member distal end is operable to be withdrawn so as to expose a portion of the inner member distal end, the slidable support ribbon distal end is operable to be withdrawn from adjacent the cutting element distal end and operably engage the inner member distal end so as to support the inner member distal end into an angle to the tube member axis. 
     
     
         39 . The tissue severing device of  claim 30 , wherein the slidable support ribbon distal end is slidingly coupled to the inner member distal end, wherein when the inner member distal end is exposed by withdrawing the tube member distal end, a user may pull the slidable support ribbon proximal end in the proximal direction so as to withdraw the slidable support ribbon distal end from adjacent the cutting element distal end and flex the inner member distal end into a desired angle to the tube member axis. 
     
     
         40 . The tissue severing device of  claim 30 , further comprising an engagement ring coupled to the inner member distal end, the slidable support ribbon distal end and the inner member distal end are slidingly coupled by cooperative engagement of the inner member distal end and the engagement ring, the slidable support ribbon distal end comprising a substantially uniform width body portion and a flared portion at about the inner member distal end, wherein the flared portion has a width that is larger than the body portion, the engagement ring comprising a shape of a partial loop coupled to the inner member distal end transverse to an inner member axis, the engagement ring being operable to slidingly receive the body portion of the slidable support ribbon distal end and is undersized so as to not be able to receive the flared portion therethrough, the flared portion operable as a catch such that there is no further axial movement of the slidable support ribbon distal end relative to the engagement ring when the flared portion engages the engagement ring, wherein the engagement of the flare portion with the engagement ring is operable to provide a means for pulling the inner member distal end proximally and thus flex the inner member distal end to present the cutting element distal end to an angle to the tube member axis, wherein the engagement ring being operable to be slidingly received within the tube member lumen. 
     
     
         41 - 42 . (canceled) 
     
     
         43 . The tissue severing device of  claim 40 , wherein the slidable support ribbon distal end further comprises a cutting element engagement element operable to engage the cutting element distal end about the inner member distal end, operable to open and stabilize the cutting element distal end when the cutting element engagement element engages the cutting element distal end about the about the inner member distal end. 
     
     
         44 - 46 . (canceled) 
     
     
         47 . The tissue severing device of  claim 28 , wherein the slidable support ribbon proximal end is cooperatively engaged with the tube member proximal end such that when the tube member proximal end is moved axially, the slidable support ribbon is operable to be moved axially as well. 
     
     
         48 . The tissue severing device of  claim 28 , wherein the slidable support ribbon proximal end further comprising a snare extending at an angle from the slidable support ribbon proximal end operable to engage the tube member proximal end such that when the tube member proximal end is moved axially, the slidable support ribbon is operable to be moved axially. 
     
     
         49 . The tissue severing device of  claim 43 , wherein the cutting element engagement element is a flange extending at an acute angle from the slidable support ribbon distal end and extending into the loop formed by the cutting element distal end when adjacent thereto. 
     
     
         50 . (canceled) 
     
     
         51 . The tissue severing device of  claim 28 , wherein the cutting element comprises a cutting element proximal end and a cutting element distal end opposite the cutting element proximal end, the cutting element proximal end and the inner member distal end removably coupled therebetween, the cutting element distal end including at least a portion operable to cut and sever tissue. 
     
     
         52 . (canceled) 
     
     
         53 . The tissue severing device of  claim 28 , wherein the cutting element distal end defines a loop, at least a portion of the cutting element distal end including one or more sharp portions that are suitable for severing tissue. 
     
     
         54 . The tissue severing device of  claim 53 , wherein the loop is operable to be biased to expand when the tube member distal end is withdrawn therefrom, and wherein the cutting element distal end being elastically deformed under the impinging force of the tube member distal end so as to enter and be contained by the tube member lumen when the tube member is advanced over the cutting element distal end. 
     
     
         55 . (canceled) 
     
     
         56 . The tissue severing device of  claim 28 , wherein the inner member further comprises at least one inner member lumen extending through the inner member proximal end and the inner member distal end, the cutting element proximal end extending through the inner member lumen and coupled within the handle. 
     
     
         57 . The tissue severing device of  claim 56 , wherein the cutting element comprises a ribbon defining a flat-sided elongated member that defines a loop at the cutting element distal end and two ends forming the cutting element proximal end, the cutting element proximal end received within the inner member lumen and extending from the inner member proximal end. 
     
     
         58 . The tissue severing device of  claim 28 , wherein the cutting element distal end has a bias to form an angle to the tube member axis. 
     
     
         59 . The tissue severing device of  claim 28 , further comprising an energy source coupled to the cutting element and operable to assist the cutting element proximal end in cutting and severing tissue. 
     
     
         60 - 63 . (canceled) 
     
     
         64 . The tissue severing device of  claim 59 , wherein the energy source is a mechanical oscillator that is operable to rapidly and alternatively pull on the two ends of the cutting element proximal end so as to impart a sawing motion to the cutting element distal end. 
     
     
         65 - 66 . (canceled) 
     
     
         67 . The tissue severing device of  claim 28 , wherein the inner member proximal end is coupled to a mechanical oscillator that is operable to rapidly push-pull on the inner member proximal end so as to impart motion to the cutting element distal end. 
     
     
         68 - 118 . (canceled)