US 20060282012 A1
An endoluminal biopsy device is provided with a proximal actuation mechanism attached to a distal sampler by at least one elongate member. The distal sampler includes a distal inner portion defining a plurality of chambers, each configured to receive a tissue sample, and a distal outer portion defining a cutting mechanism opening having a cutting edge adjacent the cutting mechanism opening. The distal outer portion is configured so that, when the cutting mechanism opening aligns with one of the plurality of chambers, the distal outer portion covers the remaining chambers. A related method for the use of such an endoluminal biopsy device also is provided.
35. A method of obtaining a plurality of tissue samples, comprising:
inserting a distal sampler into a body, the distal sampler having a longitudinal axis and defining a first biopsy chamber and a second biopsy chamber,
positioning the distal sampler proximate tissue to be sampled;
aligning a cutting mechanism opening that faces a direction transverse to the longitudinal axis with the first biopsy chamber while the second biopsy chamber is covered, the cutting mechanism opening being axially and rotatably movable relative to the distal inner portion,
receiving a first tissue sample into the first biopsy chamber; and
moving the cutting mechanism opening at least one of axially and rotatably relative to the first biopsy chamber, thereby severing the first tissue sample.
36. The method of
aligning the cutting mechanism opening with the second biopsy chamber while the first biopsy chamber is covered;
receiving a second tissue sample into the second biopsy chamber; and
severing the second tissue sample.
37. The method of
38. The method of
39. The method of
40. The method of
1. Field of the Invention
The present invention relates to a biopsy device for use in endoluminal procedures. More particularly, the present invention relates to a biopsy device that is capable of taking multiple biopsies.
2. Description of the Related Art
An endoluminal procedure is a medical procedure that takes place in one of the many tubes, or lumens, within the human body. These endoluminal procedures may take place in vascular, gastrointestinal, or air exchange lumens and may involve disease diagnosis and/or treatment. Millions of endoluminal procedures are performed each year in hospitals around the world.
Endoluminal procedures are often performed utilizing a device known as an endoscope. An endoscope is a tube, either rigid or flexible, that is introduced through a lumen (opening) in the human body, such as the mouth or rectum. The endoscope may simply be used to hold open the lumen for examination, but it may also carry light(s), visioning system(s), or other tools to be used in the procedure. An open or “working” channel is usually present within the endoscope into which the endoscopist can insert and withdraw a myriad of endoluminal diagnostic or treatment devices.
In some endoscopic procedures, biopsies (tissue samples) are obtained. Tissue samples can be examined in a laboratory to determine the presence of a pathological disorder, such as a malignancy. Often, the sample may need to be obtained from deep within the body cavity using medical sampling instruments. It is usually best to sample at various locations where the disorder is suspected so that the presence and progress of the disease (if any) may be determined. The samples may need to be catalogued according to the location from which each sample is taken, and the integrity of the samples should be maintained for subsequent lab analysis.
Existing endoluminal devices are capable of taking multiple biopsies without removing the device, but there are disadvantages to the devices currently in use. Usually the device must be moved each time a biopsy is taken so that the location of the biopsy is not completely accurate. In addition, current biopsy devices often store the tissue samples in one long cylindrical chamber. These samples may not be separated in any way and contamination between samples often occurs.
In addition to these disadvantages, current biopsy devices often utilize a mechanical means to pull away and cut the sample. This may create a variation in the amount of tissue taken each time, and this can also cause either more tissue than necessary to be taken or possibly not enough tissue to perform the desired analysis.
The advantages and purposes of the invention will be set forth in part in the description which follows, and in part will be obvious from the description, or may be learned by practice of the invention. These advantages and purposes will be realized and attained by way of the elements and combinations particularly pointed out in the appended claims.
To attain the advantages and in accordance with the purpose of the invention, as embodied and broadly described herein, one aspect of the invention is directed to an endoluminal device for taking tissue samples. The endoluminal device for taking a plurality of tissue samples includes a proximal actuation mechanism attached to a distal sampler by at least one elongate member. The distal sampler includes a distal inner portion defining a plurality of chambers, each configured to receive a tissue sample, and a distal outer portion defining a cutting mechanism opening having a cutting edge adjacent the cutting mechanism opening. The distal outer portion is configured so that, when the cutting mechanism opening aligns with one of the plurality of chambers, the distal outer portion covers the remaining chambers.
According to another aspect, the distal sampler includes a chamber opening corresponding to each of the plurality of chambers through which the corresponding chamber can receive the tissue sample.
According to yet another aspect, the distal inner portion defines a vacuum inlet corresponding to each of the plurality of chambers, each vacuum inlet configured to permit a vacuum to be applied to the corresponding chamber.
In another aspect, each vacuum inlet is in fluid communication with a vacuum channel that is capable of communicating with a vacuum source.
In yet another aspect, each vacuum inlet is in fluid communication with a separate vacuum channel to provide the vacuum to the corresponding chamber.
According to another aspect, the proximal actuation mechanism includes a mechanism for alternately applying the vacuum source to each of the separate corresponding vacuum channels.
In another aspect, the cutting mechanism opening has a substantially similar shape as each chamber opening.
According to yet another aspect, the cutting edge is configured to sever the tissue sample as the distal outer portion moves to align with one of the remaining chambers.
In yet another aspect, the distal inner portion is configured to keep a tissue sample obtained within one of the plurality of chambers separate from tissue samples obtained within the remainder of the plurality of chambers.
According to another aspect, each of the chambers has approximately the same volume.
According to another aspect, one of the plurality of chambers has a volume different from another of the plurality of chambers.
In another aspect, the distal inner portion and the distal outer portion are substantially cylindrical and substantially coaxial.
In yet another aspect, the distal outer portion is rotatably movable relative to the distal inner portion.
According to another aspect, the plurality of sample chambers are located on a distal face of the distal inner portion and positioned radially about a central axis of the distal inner portion and the cutting mechanism opening is located on a distal end of the distal outer portion.
According to yet another aspect, the distal outer portion is substantially closed at a distal end of the distal sampler and substantially covers the distal face of the distal inner portion.
According to another aspect, the distal face of the distal inner portion is substantially perpendicular to a longitudinal axis of the distal inner portion.
In another aspect, the distal outer portion is axially movable relative to the distal inner portion.
In yet another aspect, the plurality of sample chambers are located about a periphery of the distal inner portion and the cutting mechanism opening is located about a periphery of the distal outer portion.
According to another aspect, the cutting edge is integral to the distal outer portion.
In a further aspect, the distal outer portion comprises a substantially rigid material.
In yet another aspect, the distal outer portion is material comprised of a rigid plastic or surgical stainless steel.
According to another aspect, the at least one elongate member comprises a first conduit and a second conduit and the proximal actuation mechanism comprises a proximal outer portion connected to the distal outer portion by the first conduit and a proximal inner portion connected to the distal inner portion by a second conduit.
In another aspect, the proximal outer portion includes one or more finger rings and the proximal inner portion includes a thumb ring.
In yet another aspect, the proximal outer portion includes a first actuator knob and the proximal inner portion includes a second actuator knob.
According to another aspect, the invention is directed to a method of obtaining a plurality of tissue samples. The method includes inserting into a body lumen a biopsy device with a distal sampler defining first and second biopsy chambers, positioning the distal sampler proximate tissue to be sampled, aligning a cutting mechanism opening with the first biopsy chamber to expose the first biopsy chamber to the tissue to be sampled while the second biopsy chamber is covered, receiving a first tissue sample into the first biopsy chamber, and severing the first tissue sample.
According to yet another aspect, the method also includes aligning the cutting mechanism opening with the second biopsy chamber to expose the second biopsy chamber to tissue to be sampled while the first biopsy chamber is covered, receiving a second tissue sample into the second biopsy chamber, and severing the second tissue sample.
In another aspect, the distal sampler remains in substantially the same position relative to the body lumen when each of the first and second tissue samples is severed.
In yet another aspect, the severing of the first and second tissue samples is performed by moving a single cutting mechanism relative to the first and second biopsy chambers respectively.
According to another aspect, the receiving of the first and second tissue samples into the first and second biopsy chambers respectively includes applying a vacuum to the first and second biopsy chamber respectively.
According to yet another aspect, the applying a vacuum to the first and second biopsy chambers includes applying the vacuum through first and second vacuum inlets that correspond to the first and second biopsy chambers respectively.
In a further aspect, the biopsy device remains in the body lumen between the severing of the first tissue sample and the severing of the second tissue sample.
In yet a further aspect, the vacuum source is applied selectively to the first and second biopsy chambers by actuation of a vacuum line selection mechanism located at a proximal end of the biopsy device.
In another aspect, the aligning comprises actuating a proximal actuation mechanism of the biopsy device to translate movement of the proximal actuation mechanism to a distal sampler of the biopsy device.
In yet another aspect, actuating the proximal actuation mechanism comprises moving a proximal outer portion relative to a proximal inner portion to cause rotational and axial movement of a distal outer portion with respect to a distal inner portion, and the distal outer portion defines a cutting mechanism for severing the tissue and the distal inner portion defines the first and second biopsy chambers.
The foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the invention as claimed.
The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate several embodiments of the invention and together with the description, serve to explain the principles of the invention.
Reference will now be made in detail to the present preferred and exemplary embodiments of the invention, examples of which are illustrated in the accompanying drawings. Wherever possible, the same reference numbers will be used throughout the drawings to refer to the same or like parts.
Actuation mechanism 101 further includes a thumb ring assembly 104 that includes thumb ring 105 and extends within finger ring assembly 102. Thumb ring assembly 104 translates longitudinally and rotates relative to finger ring assembly 102. Thumb ring assembly 104 is integral with an elongate conduit 111 a defining a vacuum lumen 111 b. Conduit 111 a may be made of polyethylene or another suitable material to provide a suction tube of sufficient strength so as not to collapse on itself when suction is applied. Vacuum lumen 111 b could also comprise a separate tube, also of sufficient strength so as not to collapse on itself when suction is applied, extending within conduit 111 b. Vacuum lumen 111 b runs from a vacuum port 106 through conduit 111 a and ultimately connects with a vacuum channel 122 located within an inner portion 123 of distal sampler 120. Vacuum port 106 is provided to allow for the sampling device to be connected to a vacuum source (not depicted).
Conduit 111 a ultimately connects with inner portion 123 of distal sampler 120. In one exemplary embodiment, conduit 111 a may be integral with portion 123, i.e. a unitary part. In the configuration shown, relative movement of finger ring assembly 102 and thumb ring assembly 104, is translated via conduits 110 and 111 a to outer portion (or sleeve) 121 and inner portion 123, respectively. Thus, as thumb ring 105 rotates with respect to finger rings 103, that rotational motion will cause inner portion 123 to rotate with respect to outer potion (or sleeve) 121. Axial motion may also translate from proximal actuation mechanism 101 to distal sampler 120 in a similar manner. As will be described below, this rotational and axial motion may be used to take biopsy samples with device 100.
Outer portion 121 includes a cutting mechanism opening 125 that includes a cutting mechanism 126 located along at least one edge of opening 125. Outer portion 121 may be made of surgical stainless steel, a rigid plastic or any other material suitable for medical devices. Cutting mechanism 126 may be a sharpened cutting edge of opening 125, for example, if portion 121 were made of stainless steel or any other material capable of having an edge honed to a cutting sharpness. Cutting mechanism 126 alternatively may be a pre-manufactured cutting edge that is affixed to an edge of opening 125, for example by mechanical fastening, welding, brazing or any other suitable manner for affixing.
As is depicted by the arrows in
Biopsy sampling device 100 having distal sampler 120 may be used in connection with an endoscope or other similar device. In operation, distal sampler 120 of biopsy sampling device 100 is inserted in a lumen of the endoscope that has been inserted in a patient, until distal sampler 120 reaches an area of tissue to be sampled. Distal sampler 120 may then be positioned so that one or more of chambers 124 are proximate the area of tissue to be sampled. The user may then actuate thumb ring 105 with respect to finger rings 103 so as to position cutting mechanism opening 125 of outer portion 121 over one of the plurality of sample chambers 124. Once cutting mechanism opening 125 is positioned over one of sample chambers 124, suction may be applied in the selected chamber to cause tissue to enter the chamber. Portion 121 may then be moved in an axial sliding motion relative to inner portion 123, again by actuating thumb ring 105 with respect to finger rings 103, so that cutting mechanism 126 cuts the tissue from the patient. As portion 121 moves to cut the tissue, it seals the chamber so that only the sample taken at that time is located in the chamber.
The user then may actuate portion 121 into a position so that opening 125 is positioned over a different chamber, by rotation, axial movement, or both, so that a subsequent tissue sample may be captured in a similar fashion as just described. This procedure may be repeated until all chambers have a tissue sample or until all necessary samples have been obtained. As illustrated by the Figures, each retrieved sample may be isolated within its chamber so as to reduce the possibility of contamination between that sample and any other samples.
While the device is shown utilizing suction to draw the tissue sample into the chamber, alternatives could be used to accomplish this task. For example, in the case of a hanging polyp or tumor, or any similarly protruding segment of tissue, the distal sampler could be positioned so that a chamber engulfs the tissue without the use of suction. With the tissue then inside the chamber, portion 121 could be moved to cut the tissue. A further alternative may include a mechanical grabbing device at the base of the chamber. The mechanical grabbing device may have a jaw assembly or other mechanism that may be actuated at the proximal end of the biopsy sampling device by the user. This grabbing device may grasp and pull the tissue to be sampled into the chamber so that the tissue may then be cut by the movement of the portion 121. The mechanical grabbing assembly may also be spear-like and/or have barbs or hooks for grasping tissue and holding onto the tissue as tissue is pulled into the chamber.
The biopsy sampling device may also include indicators, such as color-coding or other such identification means, on portions of the proximal operator end 101. For example, axial and radial tick marks could be placed on portions of thumb ring assembly 104 and/or finger ring assembly 102 to denote relative positions of assemblies 102, 104 that correspond to each of the plurality of chambers 124 located within distal sampler 120. Each indicator can correspond to color-coding or other identification means associated with each chamber at distal sampler 120. This identification could allow the operator to relate the specific chamber in use to that indicated at the proximal end when remotely viewing distal sampler 120 during the procedure. For example, the user in this way may determine that he or she is viewing and working with the proximal-most chamber, as determined from the matching identification between the operator handle and the chamber.
In addition, each of the chambers in the distal inner portion may be the same size and/or volume or different sizes and/or volumes to allow for different size samples to be taken. By using a vacuum to suck the tissue sample into a chamber that is of a known volume, a more precise volume of tissue may be taken each time. Having sample chambers of different volumes within the same distal sampler may allow the operator more flexibility during a given procedure by being able to take samples of various sizes without having to remove the device from the patient.
As shown in
The configuration shown in
Proximal actuator 301 also has two actuator rings or knobs 303 and 305. Knobs 303, 305 are affixed to outer portion 302 and inner portion 304, respectively. Outer and inner portions 302, 304 are, in turn, integral with and/or fixedly connected to outer and inner conduits that extend to the distal end of the device, much like conduits 110 and 111 a in
Vacuum selection device 315 is capable of rotational movement with respect to knob 305 so that vacuum port 306 may align and communicate separately with each of vacuum lines 311. In this manner, an operator may apply suction to each chamber independent of the other chambers. This configuration also allows for substantially complete isolation between the various chambers.
In order to facilitate the rotation of vacuum selection device 315 with respect to knob 305, proximal actuator 301 could include a feature to reversibly lock vacuum selection device 315 in place on knob 305. In order to achieve this rotation without affecting the positioning of distal end 120, vacuum selection device 315 could rotate to detent positions whereby an operator would have to grip both knob 305 and vacuum selection device 315 to select the various lines. Vacuum selection device 315 could also include a locking means that unlocks to allow for free rotation of vacuum selection device 315 with respect to knob 305 until a desired vacuum line is selected. The locking means could then lock vacuum selection device 315 in place over a selected vacuum line with respect to knob 305.
Other configurations for inner portion and outer portion may be used depending on the desired application. For example, the cutting mechanism opening may be used to take samples without using a cutting edge. In this procedure, the device could act as a head that would selectively open chambers to allow tissue to be sucked in. The sucking motion alone could be sufficient to pull the tissue sample away from the patient. Once the tissue sample is completely contained within the chamber, the distal outer portion would move, this time without cutting any tissue, to isolate the sample in the selected chamber and proceed to the next chamber.
Other embodiments of the invention will be apparent to those skilled in the art from consideration of the specification and practice of the invention disclosed herein. It is intended that the specification and examples be considered as exemplary only, with a true scope and spirit of the invention being indicated by the following claims.