[go: up one dir, main page]

WO2022130368A1 - Dispositifs pneumatiques de réduction tumorale des tissus - Google Patents

Dispositifs pneumatiques de réduction tumorale des tissus Download PDF

Info

Publication number
WO2022130368A1
WO2022130368A1 PCT/IL2021/051422 IL2021051422W WO2022130368A1 WO 2022130368 A1 WO2022130368 A1 WO 2022130368A1 IL 2021051422 W IL2021051422 W IL 2021051422W WO 2022130368 A1 WO2022130368 A1 WO 2022130368A1
Authority
WO
WIPO (PCT)
Prior art keywords
piston
distal
surgical tool
chamber
headpiece
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/IL2021/051422
Other languages
English (en)
Inventor
Eran Miller
Yoseph Weitzman
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Carevature Medical Ltd
Original Assignee
Carevature Medical Ltd
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Carevature Medical Ltd filed Critical Carevature Medical Ltd
Publication of WO2022130368A1 publication Critical patent/WO2022130368A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/16—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans
    • A61B17/1604—Chisels; Rongeurs; Punches; Stamps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/16—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans
    • A61B17/1662—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans for particular parts of the body
    • A61B17/1671—Instruments for performing osteoclasis; Drills or chisels for bones; Trepans for particular parts of the body for the spine
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
    • A61B17/92—Impactors or extractors, e.g. for removing intramedullary devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00535—Surgical instruments, devices or methods pneumatically or hydraulically operated
    • A61B2017/00544—Surgical instruments, devices or methods pneumatically or hydraulically operated pneumatically

Definitions

  • the present disclosure relates generally to surgical tools for tissue removal.
  • spinal stenosis narrowing (stenosis) of the spinal canal, due to excess bone tissue pressing on the spinal cord, which results in a neurological deficit.
  • Other such common conditions include bulging or herniated discs, which are associated with osteophyte formation in the spinal canal.
  • Standard treatments for spinal stenosis include corpectomy, laminectomy, and osteotomy. These treatments involve removal from a vertebra of bone spurs pressing on the spinal cord, thereby decompressing the spinal cord and nerves and alleviating the neurological deficit.
  • Treatments of a herniated disc typically involve discectomy: a surgical procedure during which herniated disc material that presses against the nerve root or spinal cord is removed.
  • target tissue which is often difficult to reach - while avoiding damage to surrounding tissue. This task is made doubly difficult when, in addition, the target tissue is hard tissue, such as excess bone growth on a vertebra.
  • aspects of the disclosure relate to pneumaticbased surgical tools, and related methods, for tissue removal. More specifically, but not exclusively, aspects of the disclosure, according to some embodiments thereof, relate to pneumatic-based surgical tools configured for breaking up hard/hardened tissue by hammering/pounding/grounding the tissue.
  • the surgical tools and methods of the present disclosure allow for selective removal of tissue in difficult-to-reach anatomical sites while minimizing damage to surrounding tissue.
  • the surgical tools and methods of the present disclosure make use of the mechanical properties of the tissue, that is to be removed, in order to prevent, or at least mitigate, damage to surrounding tissue.
  • the surgical tools and methods of the present disclosure are configured for hammering tissue, and, as such, are adapted to debulk hard tissue (such as bone), which is breakable/brittle, while avoiding, or at least mitigating, damage to soft tissue (around the bone), which is elastic. More specifically, due to its rigidity, bone poses resistance to hammering by a hard tool, and, as such, is debulked thereby.
  • soft tissue is not harmed, or substantially not harmed, when hammered by a hard and blunt tool, since the soft tissue moves back and forth with the tool.
  • the inherent safety exhibited by the surgical tools and methods of the present disclosure with respect to soft tissue may allow shortening the duration of hard tissue removal procedures, which are performed in close vicinity to neural matter.
  • a surgical tool for debulking tissue includes:
  • a handle including a fluid inlet.
  • a first lumen extending distally from the fluid inlet to the chamber.
  • a piston assembly housed within the chamber and including a first piston and a first return mechanism.
  • the first piston is configured for axial, reciprocating motion within the chamber.
  • a headpiece positioned distally to the chamber and motionally associated with the first piston.
  • the first return mechanism is configured to exert a proximally acting force on the first piston, which increases as a distal displacement of the first piston is increased, at least beyond a first threshold displacement.
  • the chamber is configured to receive pressurized fluid, injected via the fluid-inlet.
  • the fluid is configured to distally push the first piston and the headpiece until the motions thereof are reversed by the first return mechanism, such as to effect an axial, reciprocating motion of the headpiece.
  • the headpiece is configured to debulk tissue by striking thereof, when effecting axial, reciprocating motion.
  • the elongated member includes a distally located bent section. At least a part of the chamber is positioned distally to the bent section.
  • the headpiece is configured to debulk hard tissue by hammering thereof while simultaneously minimizing damage to soft tissue if struck.
  • the headpiece is sharp and is configured to debulk soft tissue.
  • elongated member includes a main section positioned proximally to the bent section, and a distal section positioned distally to the bent section.
  • An angle between the distal section and the main section is smaller than 179°, smaller than 175°, smaller than 150°, and/or is adjustable.
  • the angle between the distal section and the main section may be in the range of 175°-100°, or in the range of 170°-105° and/or is adjustable.
  • Each possibility is a separate embodiment.
  • the distal section includes the chamber.
  • a proximal wall of the chamber includes a proximal opening which fluidly couples the chamber to the first lumen.
  • the surgical tool is configured to allow the headpiece to strike hard tissue at rate of at least about 1000, at least about 5000, or at least about 10,000 strikes per minute (SPM).
  • the headpiece distally projects outside a distal edge of the elongated member.
  • the piston assembly includes a mounting portion distally projecting or projectable through a distal opening in a distal wall of the chamber.
  • the mounting portion is mechanically associated with the first piston and has installed thereon the headpiece.
  • the chamber includes a proximal compartment and a first distal compartment. Volumes of the proximal compartment and the first distal compartment are defined at least by the displacement of the first piston within the chamber.
  • the first return mechanism is, at least in part, springbased. Additionally, or alternatively, according to some embodiments, the first return mechanism may be at least in part pneumatic-based.
  • the first return mechanism includes at least one spring housed in the first distal compartment and connected on a distal end thereof to the distal wall of the chamber and on a proximal end thereof to the first piston. Additionally, or alternatively, the first return mechanism may include at least one spring housed in the proximal compartment and connected on a distal end thereof to the first piston and on a proximal end thereof to the proximal wall of the chamber.
  • the surgical tool further includes a second lumen.
  • the handle includes a fluid outlet fluidly coupled to the second lumen.
  • the second lumen is fluidly decoupled from the proximal compartment.
  • the first piston is distally positioned relative to a position thereof in the first configuration and the second lumen is fluidly coupled to the proximal compartment.
  • the second lumen in both the first configuration and the second configuration, is fluidly coupled to the first distal compartment.
  • the fluid-coupling of the chamber to the second lumen is effected via one or more apertures, and/or one-way valves, in a sidewall of the chamber.
  • the distal tip of the headpiece includes an eroding surface, which includes one or more protrusions, such as to facilitate debulking hard tissue by hammering thereof.
  • a circumferential surface of the headpiece is eroding. The surgical tool being thereby further configured for debulking hard tissue by grating.
  • the headpiece is detachably installed on the mounting portion.
  • the hard tissue is bone tissue.
  • the fluid forced into the chamber is a pressurized gas (i.e. gas at a pressure greater than atmospheric pressure and, in particular, sufficiently high to push the first piston).
  • a pressurized gas i.e. gas at a pressure greater than atmospheric pressure and, in particular, sufficiently high to push the first piston.
  • the fluid forced into the chamber is pressurized air and/or pressurized nitrogen.
  • the headpiece is positioned excentrically to a central axis the of elongated member.
  • the elongated member includes an operational input and an additional lumen extending from the operational input to a lumen distal end.
  • the lumen distal end is open or may be opened.
  • a circumferential sidewall of the elongated member is double-walled, including an inner sidewall and an outer sidewall.
  • the outer sidewall is disposed about the inner wall, such as to define there between the additional lumen.
  • the surgical tool further includes one or more electrodes positioned on the distal edge of the elongated member, such as to render the surgical tool configured for electrophysiological monitoring and/or neurostimulation.
  • the surgical tool further includes one or more electrical wires embedded within a wall of the elongated member such that respective distal ends of the one or more wires are connected to the one or more electrodes, respectively.
  • At least part of the elongated member is made of an electrically conducting material(s) extending along a length of the elongated member until the distal edge of the distal elongated member.
  • the distal edge of the elongated member constitutes the one or more electrodes and is configured to function as a single electrode.
  • the elongated member being thereby configured to allow establishing a voltage between the one or more electrodes and an external electrode placed on/in a body of a subject during a hard tissue debulking procedure.
  • At least part of the elongated member is made of an electrically conducting material(s) extending along a length of the elongated member until the distal edge of the elongated member.
  • the one or more electrodes include at least two electrodes.
  • the distal edge of the elongated member constitutes the at least two electrodes and is configured to function as an electrode pair (i.e. an anode and a cathode).
  • the elongated member being thereby configured to allow establishing a voltage between the at least two electrodes.
  • the mounting portion is housed within the first distal compartment.
  • the at least one spring includes a spring disposed around the mounting portion.
  • the at least one spring includes one or more of a coil spring, a wave spring, and a disc spring.
  • the chamber includes a bearing mechanism configured to translate axially acting forces on the first piston into both axial, reciprocating motion and rotary motion of the first piston and thereby the headpiece.
  • the first piston is tubular and includes a hole on a distal end thereof and a proximally positioned flange, which partitions the chamber into the proximal compartment and the first distal compartment.
  • the first piston distally projects, or is projectable, through the distal opening in the distal wall of the chamber.
  • the piston assembly includes a second piston positioned within the first piston such as to be configured for axial, reciprocating motion within the first piston.
  • the second piston defines a second distal compartment within the first piston.
  • the second piston includes the mounting portion, which distally projects, or is projectable, through the hole on the distal end of the first piston.
  • the piston assembly further includes a second return mechanism, which is configured to exert a proximally acting force on the second piston, which increases as a distal displacement of the second piston within the first piston is increased, at least beyond a second threshold displacement.
  • the second return mechanism is, at least in part, springbased. Additionally, or alternatively, according to some embodiments, the second return mechanism may be at least in part pneumatic-based.
  • the second return mechanism includes a spring housed within the second distal compartment and connected on a distal end thereof to the distal end of the first piston and on a proximal end thereof to the second piston.
  • the spring of the second return mechanism is disposed about the mounting portion.
  • the at least one spring of the first return mechanism includes a spring housed within the first distal compartment and disposed about the first piston.
  • the first piston is tubular, includes a hole on a distal end thereof, and distally projects, or is projectable, through the distal opening in the distal wall of the chamber.
  • the piston assembly includes a second piston positioned within the first piston such as to be configured for axial, reciprocating motion within the first piston.
  • the second piston includes a mounting portion, which distally projects, or is projectable, through the hole on the distal end of the first piston.
  • the piston assembly further includes a second return mechanism, which is configured to exert a proximally acting force on the second piston, which increases as a distal displacement of the second piston within the first piston is increased, at least beyond a second threshold displacement.
  • the first return mechanism includes at least one spring housed in the proximal compartment and connected on a distal end thereof to the first piston and on a proximal end thereof to the proximal wall of the chamber.
  • the second piston defines a distal compartment within the first piston.
  • the second return mechanism includes a spring housed within the distal compartment and connected on a distal end thereof to the distal end of the first piston and on a proximal end thereof to the second piston.
  • the first piston includes a bearing mechanism configured to translate axially acting forces on the second piston into both axial, reciprocating motion and rotary motion of the second piston and thereby the headpiece.
  • a method for debulking tissue includes:
  • the issue is hard tissue and the headpiece is configured to debulk hard tissue by hammering thereof while simultaneously minimizing damage to soft tissue if struck.
  • Certain embodiments of the present disclosure may include some, all, or none of the above advantages.
  • One or more other technical advantages may be readily apparent to those skilled in the art from the figures, descriptions, and claims included herein.
  • specific advantages have been enumerated above, various embodiments may include all, some, or none of the enumerated advantages.
  • Figure 1A is a schematic, cross-sectional view of a pneumatic-based surgical tool for hard tissue removal, according to some embodiments
  • Figure IB is a schematic, cross-sectional view of a distal section of the surgical tool of Fig. 1A, according to some embodiments;
  • Figure 2 is a schematic, cross-sectional view of a pneumatic-based surgical tool for hard tissue removal, which is a specific embodiment of the surgical tool of Fig. 1A;
  • Figure 3 is a schematic, cross-sectional view of a distal section of a pneumatic-based surgical tool for hard tissue removal, according to some embodiments.
  • the words “include” and “have”, and forms thereof, are not limited to members in a list with which the words may be associated.
  • the term “about” may be used to specify a value of a quantity or parameter (e.g. the length of an element) to within a continuous range of values in the neighborhood of (and including) a given (stated) value.
  • “about” may specify the value of a parameter to be between 80 % and 120 % of the given value.
  • the statement “the length of the element is equal to about 1 m” is equivalent to the statement “the length of the element is between 0.8 m and 1.2 m”.
  • “about” may specify the value of a parameter to be between 90 % and 110 % of the given value. According to some embodiments, “about” may specify the value of a parameter to be between 95 % and 105 % of the given value.
  • the terms “substantially” and “about” may be interchangeable.
  • a three-dimensional cartesian coordinate system (with orthogonal axes x, y, and z) is introduced. It is noted that the orientation of the coordinate system relative to a depicted object may vary from one figure to another. Further, the symbol ® may be used to represent an axis pointing “out of the page”, while the symbol ® may be used to represent an axis pointing “into the page”.
  • a pneumatic-based surgical tool for hard tissue removal there is provided a pneumatic-based surgical tool for hard tissue removal.
  • Fig. 1A is a schematic, cross-sectional view of such a pneumatic-based surgical tool, a surgical tool 100, according to some embodiments.
  • Surgical tool 100 includes an elongated member 102, a headpiece 104, a piston assembly (components thereof are enumerated below), and a handle 110.
  • Elongated member 102, or at least a part thereof, distally extends from handle 110.
  • Elongated member 102 includes a main section 112 and a distal section 114, which is distally positioned relative to main section 112. According to some embodiments, and as depicted in Fig.
  • distal section 114 may be set at an angle relative to main section 112. That is, distal section 114 may be positioned, or positionable, at an angle a ⁇ 180° relative to main section 112.
  • elongated member 102 may be articulated such as to allow controllably changing the angle a.
  • elongated member 102 may be flexible or malleable.
  • Handle 110 is configured to facilitate operation and control of surgical tool 100 (e.g. by a surgeon).
  • Fig. IB is a schematic, cross-sectional view of distal section 114, according to some embodiments.
  • Surgical tool 100 includes a (first) lumen 116.
  • Lumen 116 extends in the proximal direction from distal section 114 - and through elongated member 102, onto a fluid inlet 118 on handle 110.
  • Distal section 114 is hollow such as to define a chamber 124 therein (i.e. in distal section 114).
  • Chamber 124 distally extends within distal section 114 until a chamber distal wall 126, which is defined by a distal edge 128 of elongated member 102.
  • Chamber 124 is bounded in the proximal direction by a chamber proximal wall 132.
  • Chamber proximal wall 132 includes a proximal opening 134, which fluidly couples chamber 124 to lumen 116, and thereby to fluid inlet 118.
  • Distal edge 128 (and therefore chamber distal wall 126) includes a distal opening 136.
  • the piston assembly includes a piston 140 and a piston return mechanism.
  • Piston 140 is housed in chamber 124.
  • Piston 140 is configured for axial, reciprocating motion within chamber 124.
  • piston 140 may include a base portion 142 and a mounting portion 154 (the function of which is described below).
  • Mounting portion 154 projects distally from a central part of base portion 142, such that base portion 142 defines a flange 144 around mounting portion 154.
  • Flange 144 extends radially until the (circumferential) sidewall of chamber 124.
  • Base portion 142 partitions chamber 124 into a distal compartment 146 and a proximal compartment 148 (at least when piston 140 is not adjacent to one of the transverse walls of chamber 124).
  • Piston 140 is configured for axial, reciprocating motion within chamber 124, such as to alternately decrease and increase the volume of distal compartment 146 (and, at the same time, alternately increase and decrease the volume of proximal compartment 148). It is noted that in embodiments wherein piston 140 range of motion allows for piston 140 to arrive at a position adjacent, or nearly adjacent, to chamber proximal wall 132, the volume of proximal compartment 148 vanishes, or nearly vanishes, with the volume of distal compartment 146 equaling, or nearly equaling, the volume of chamber 124.
  • the piston return mechanism is configured to exert a proximally acting force on piston 140, which may increase in an inverse relation to the volume of distal compartment 146 (at least when the volume of distal compartment 146 is smaller than a respective threshold volume). That is, the force increases with an increase in the volume of proximal compartment 148 (at least when the volume of proximal compartment 148 is greater than a respective threshold volume).
  • the piston return mechanism includes a spring 150 housed in distal compartment 146.
  • Spring 150 may be disposed about base portion 142.
  • spring 150 may be housed in distal compartment 146 and connected on a distal end thereof to chamber distal wall 126 (i.e. on the inner surface of distal edge 128) and on a proximal end thereof to piston 140.
  • when spring 150 is relaxed i.e.
  • piston 140 may be positioned in proximity to chamber proximal wall 132 (so that the volume of distal compartment 146 is greater than that of proximal compartment 148), or even adjacently to chamber proximal wall 132.
  • the relaxation length of spring 150 may be greater than the height of chamber 124 (i.e. the distance between chamber proximal wall 132 and chamber distal wall 126), so that spring 150 is always compressed and always exerts a proximally acting force on piston 140.
  • the piston return mechanism may include a plurality of springs, for example, two oppositely positioned springs, such that a first spring is positioned to the left of base portion 142 and the second spring is positioned to the right of base portion 142.
  • one or more springs may be housed in proximal compartment 148 and connected on distal ends thereof to piston 140 and on proximal ends thereof to chamber proximal wall 132.
  • the one or more springs housed in proximal compartment 148 may be configured to proximally pull piston 140 when piston 140 distal displacement is beyond the relaxation length of the springs.
  • the relaxation length of the springs may be such that, when relaxed, piston 140 is positioned proximately to the chamber proximal wall 132.
  • Mounting portion 154 may be elongated such as to allow the extension thereof into distal opening 136.
  • mounting portion 154 extends into distal opening 136 even when piston 140 is positioned adjacently, or substantially adjacently to chamber proximal wall 132.
  • Headpiece 104 is installed on mounting portion 154 (e.g. on a distal tip of mounting portion 154).
  • headpiece 104 may be detachably mountable on mounting portion 154.
  • the distal tip of mounting portion 154 may define a threaded socket and the proximal portion of headpiece 104 may be correspondingly threaded.
  • headpiece 104 and mounting portion 154 may be configured for snap-engagement.
  • headpiece 104 and mounting portion 154 may include an interlock mechanism, whereby headpiece 104 may be mounted on mounting portion 154 only at a specific azimuth angle there between.
  • headpiece 104 and mounting portion 154 are concentrically disposed about an axis parallel to the z- axis. The azimuth angle equals the difference of the respective angular positions thereof as measured on the y-plane relative to the x-axis).
  • headpiece 104 may include a radially extending pin and mounting portion 154 may include a matching groove.
  • headpiece 104 may be magnetically attached to mounting portion 154.
  • the distal tip of mounting portion 154 may include a magnet (and headpiece 104 may be metallic or include a metal).
  • surgical tool 100 may include electrical infrastructure, such that the distal tip of mounting portion 154 may be controllably magnetized, thereby allowing to easily detach headpiece 104.
  • headpiece 104 may be permanently affixed onto mounting portion 154.
  • Headpiece 104 is configured for debulking hard tissue.
  • headpiece 104 may be configured for hammering/grinding and/or grating/polishing hard tissue when effecting axial, reciprocating motion.
  • a headpiece distal tip 156 i.e.
  • a distal surface 158 of headpiece distal tip 156 may be blunt, e.g. flat.
  • distal surface 158 may be oriented perpendicularly to a central axis A of distal section 114.
  • distal surface 158 may be convex or even concave.
  • distal surface 158 may include protrusions (not shown) configured to facilitate breaking up hard tissue. The protrusions may be formed, for example, by diamonds embedded in distal surface 158.
  • a circumferential surface 160 of headpiece 104 may be abrasive (erosive), so that surgical tool 100 may be configured/further configured for debulking hard tissue by polishing and/or grating thereof. More specifically, in such embodiments, by bringing surgical tool 100 against a hard tissue surface such that circumferential surface 160 is adjacent to the tissue surface and is in contact therewith, due to headpiece 104 axial, reciprocating motion, circumferential surface 160 grates the tissue surface (by moving back and forth in the axial direction), leading to fragmentation of the tissue.
  • headpiece 104 may additionally effect rotary motion (i.e. rotating about the central axis A) while effecting the axial, reciprocating motion.
  • circumferential surface 160 may be abrasive, thereby allowing to fragment hard tissue by simultaneously hammering and polishing thereof.
  • chamber 124 may include a bearing mechanism configured to translate the axially acting force on mounting portion 154 into both axial, reciprocating motion and rotary motion of mounting portion 154 (and consequently into both axial, reciprocating motion and rotary motion of headpiece 104).
  • the bearing mechanism may be a threaded bearing (e.g. a “screw bearing”) having a thread angle sufficient to overcome friction.
  • headpiece 104 may be excentric. That is, radially displaced with respect to the central axis A.
  • Fluid inlet 118 is configured to be fluidly coupled to a fluid source (e.g. a compressed gas source or even a liquid (e.g. water) source; not shown).
  • a pump (not shown) may be used to facilitate injecting pressurized fluid (e.g. compressed air and/or nitrogen) into lumen 116 (via fluid inlet 118).
  • surgical tool 100 may further include a second lumen 162 and a fluid outlet 164 fluidly coupled/connected to second lumen 162.
  • Second lumen 162 may extend from distal section 114 in the proximal direction along main section 112 (e.g. in parallel to first lumen 116).
  • fluid outlet 164 may be positioned on handle 110.
  • chamber 124 includes a (first) aperture 166 (shown in Fig. IB) positioned on a side-surface 168 of chamber 124.
  • Aperture 166 may be fluidly coupled to second lumen 162, e.g.
  • Piston 140 may be switchable between at least two configurations: In a first configuration, piston 140 is positioned proximally relative to aperture 166, so that proximal compartment 148 is fluidly decoupled from channel 170. In a second configuration, piston 140 is positioned distally relative to aperture 166, so that proximal compartment 148 is fluidly coupled to channel 170.
  • second lumen 162 may be disposed about first lumen 116, or at least a distal part thereof. According to some such embodiments, second lumen 162 and first lumen 116 may be concentrically disposed.
  • piston 140 In operation, piston 140, and hence headpiece 104, effect axial, reciprocating motion.
  • piston 140 may be positioned in proximity to, or adjacently to, chamber proximal wall 132, so that piston 140 is in the first configuration, and, according to some embodiments, spring 150 may be relaxed.
  • Pressurized fluid is injected into first lumen 116.
  • the injected fluid spreads along first lumen 116 and therefrom into proximal compartment 148 (via proximal opening 134). Consequently, piston 140 is pushed in the distal direction and spring 150 is compressed (or further compressed).
  • piston 140 As more of the fluid is forced into first lumen 116 (and into proximal compartment 148), piston 140 is further pushed in the distal direction, thereby switching from the first configuration to the second configuration. That is, proximal compartment 148 grows to include aperture 166 and fluidly couples to channel 170.
  • the pressure of the fluid within proximal compartment 148 consequently starts dropping, as some of the fluid escapes into second lumen 162 (via aperture 166), wherefrom the escaped fluid may be released from surgical tool 100 to the surroundings.
  • the magnitude of the proximally acting force, exerted by spring 150 on piston 140 exceeds the magnitude of the distally acting force, exerted by the fluid on piston 140, and, soon after, the motion of piston 140 is reversed.
  • Piston 140 is switched back from the second configuration to the first configuration.
  • the motion of piston 140 is reversed again - as the pressure of the fluid builds up again within proximal compartment 148 - a new cycle (of axial, reciprocating motion) begins.
  • surgical tool 100 is configured to allow piston 140 to affect as many as 1000, 5000, or 10,000 cycles per minute, so that headpiece 104 may strike hard tissue at a rate of at least about 1000, 5000, or 10,000 strikes per minute (SPM).
  • SPM strikes per minute
  • chamber 124 includes a second aperture 172 (shown in Fig. IB) positioned on side-surface 168 distally relative to first aperture 166.
  • Second aperture 172 may be fluidly coupled to second lumen 162 via channel 170.
  • Second aperture 172 may differ from first aperture 166 in being positioned in distal compartment 146 not only in the second configuration (of piston 140) but also in the first configuration (of piston 140). That is, second aperture 172 fluidly couples distal compartment 146 to channel 170 both in the first configuration and in the second configuration.
  • second aperture 172 functions to regulate the pressure within distal compartment 146, such as to keep the pressure within distal compartment 146 (during surgical tool 100 operation, i.e. when piston 140 effects reciprocating motion) at atmospheric pressure or slightly there above.
  • main section 112 may be flexible such as to conform to a range of angles or curvatures before and/or during the surgery, thereby allowing guiding headpiece 104 onto difficult-to-reach target sites within the body.
  • distal opening 136 may include a seal/gasket configured to prevent escape of fluid from distal compartment 146 via distal opening 136.
  • headpiece 104 may be replaced with other headpieces, which may differ in size, dimensions, as well as in the hard tissue breaking properties thereof.
  • headpiece 104 may be (temporarily) replaced with a headpiece configured to allow cutting soft-tissue.
  • surgical tool 100 may be provided as part of a kit including, in addition to surgical tool 100, one or more additional headpieces as described above.
  • distal section 114 may include one or more electrodes (not shown) exposed thereon, for example, on distal edge 128, such as to allow for in vivo neuro-stimulation (and neuro-monitoring) during a surgical procedure wherein bone tissue is removed from a site including one or more nerves.
  • distal edge 128 may include or form an electrode.
  • an electrical wire (not shown) may be embedded within circumferential sidewall 138, such that a distal end of the wire is connected to the electrode and a proximal end of the wire is connected to an electrical port (not shown) on handle 110.
  • the electrode may be used in conjunction with a second electrode placed on the body of a subject (during a surgical procedure wherein surgical tool 100 is inserted into the body of the subject) to provide neuro-stimulation at or near a target tissue site.
  • at least a part of elongated member 102 is made of an electrically conducting material (e.g. stainless steel)
  • elongated member 102 may be used to establish a voltage between the electrode and the second electrode (thereby obviating the necessity of using an electrical wire, at least along elongated member 102).
  • distal edge 128 may include or form two electrodes.
  • electrical wires (not shown) may be embedded within circumferential sidewall 138, such that the distal end of each wire is connected to a respective electrode, and the proximal ends of the wire is connected to an electrical port (not shown) on handle 110.
  • the electrodes may be used for localized neuro-stimulation within the body of a subject (during a surgical procedure), at or near a treatment site, by establishing a voltage between the electrodes.
  • circumferential sidewall 138 may be used (instead of electrical wires) to establish a voltage between the two electrodes.
  • the piston return mechanism may be pneumatic-based. More specifically, in such embodiments, distal compartment 146 may include a gas and may be fluidly-sealed (so that chamber 124 does not include a second aperture 172). Further, in such embodiments, in the first configuration (as well as in the second configuration) distal compartment 146 is decoupled from first aperture 166. This may be achieved, for example, by means of a pressure-actuated one-way valve installed in first aperture 166, which opens when above a threshold pressure, which can only be attained in proximal compartment 148 but not in distal compartment 146.
  • a pressurized (first) fluid is injected into first lumen 116.
  • the first fluid spreads along first lumen 116 and therefrom into proximal compartment 148. Consequently, piston 140 is pushed in the distal direction and the pressure of the second fluid in distal compartment 146 increases. As more of the first fluid is forced into first lumen 116 (and into proximal compartment 148), piston 140 is further pushed in the distal direction, thereby switching from the first configuration to the second configuration. That is, proximal compartment 148 grows to include aperture 166 and fluidly couples to channel 170.
  • the pressure of the first fluid within proximal compartment 148 consequently starts dropping, as some of the fluid escapes into second lumen 162 (via aperture 166).
  • the magnitude of the proximally acting force, exerted by the gas on piston 140 exceeds the magnitude of the distally acting force, exerted by the first fluid on piston 140, and, soon after, the motion of piston 140 is reversed.
  • Piston 140 is switched back from the second configuration to the first configuration.
  • the motion of piston 140 is reversed again - as the pressure of the first fluid builds up again within proximal compartment 148 - a new cycle (of axial, reciprocating motion) begins.
  • the piston return mechanism may be both spring-based and pneumatic-based. That is, chamber 124 may include a spring configured to exert a proximally acting force on piston 140 (at least when piston 140 has been distally displaced beyond a threshold displacement) and distal compartment 146 may include a gas as described above.
  • Fig. 2 is a cross-sectional view of a pneumatic-based surgical tool 200 for hard tissue removal, according to some embodiments.
  • Surgical tool 200 is a specific embodiment of surgical tool 100 further characterized by the inclusion of an operational input 274 and an additional lumen 276 fluidly associated with operational input 274, as described below.
  • surgical tool 200 includes an elongated member 202, a headpiece 204, a piston assembly (components thereof are enumerated below), and a handle 210, which are specific embodiments of elongated member 102, headpiece 104, the piston assembly of surgical tool 100, and handle 110, respectively.
  • first lumen 216 a first lumen 216, a fluid inlet 218, a bent section 220, a chamber 224, a piston 240, a second lumen 262, and a fluid outlet 264, which are specific embodiments of first lumen 116, fluid inlet 118, bent section 120, chamber 124, piston 140, second lumen 162, and fluid outlet 164, respectively, of surgical tool 100.
  • Elongated member 202 includes a main section 212, a distal section 214, and a circumferential side wall 238, which are specific embodiments of main section 112, distal section 114, and circumferential sidewall 138, respectively.
  • distal section 214 may be positioned, or positionable, at an angle
  • Operational input 274 may be positioned on handle 210.
  • An additional channel 278 may extend from operational input 274 to additional lumen 276 fluidly coupling operational input 274 to additional lumen 276. Additional lumen 276 may extend along a length of elongated member 202 from additional channel 278 onto an additional opening 280 on distal edge 228 of elongated member 202.
  • circumferential sidewall 238 is double-walled including an outer sidewall 286 and an inner sidewall 288.
  • Outer sidewall 286 may be disposed about inner sidewall 288, such as to define additional lumen 276 there between. More specifically, outer sidewall 286 and inner sidewall 288 may define an empty volume there between in the form of a cylindrical shell of non-vanishing width, so that additional opening 280 is ring-shaped.
  • additional lumen 276 may be disposed about second lumen 262 or at least a distal part thereof. (Second lumen 262 may be disposed about first lumen 216 or at least a distal part thereof.) According to some such embodiments, additional lumen 276, second lumen 262, and first lumen 216 may be concentrically disposed.
  • operational input 274 may function as a port for introducing/withdrawing/suction of fluids into additional lumen 276.
  • operational input 274 may be configured to be coupled to a vacuum pump (e.g. by having inserted thereinto a suction tip). More specifically, operational input 274 may be employed to irrigate a target tissue site in order to cool or wash the target tissue site during a tissue-debulking procedure. Additionally, or alternatively, operational input 274 may be employed to remove debris from a target tissue, during a tissue debulking procedure, by applying suction at operational input 274.
  • operational input 274 and additional lumen 276 may be configured to allow introduction therethrough of additional surgical instruments (e.g. a tissue dissector, a spatula, an electrophysiological monitoring device/neuro- stimulation device, sensors/cameras, and/or the like) to the vicinity of a target tissue site during a tissue-debulking procedure.
  • additional surgical instruments e.g. a tissue dissector, a spatula, an electrophysiological monitoring device/neuro- stimulation device, sensors/cameras, and/or the like
  • a distal edge of outer sidewall 286 includes at least one first electrode, for example, a ring-shaped first electrode.
  • a distal edge of inner sidewall 288 may include at least one second electrode, for example, a ring-shaped second electrode.
  • the first electrode and second electrode may each be connected to an electrical port (not shown) on handle 210 via electrical wires in outer sidewall 286 and inner sidewall 288, respectively.
  • each of outer sidewall 286 and inner sidewall 288 may be made of an electrically conducting material (e.g. stainless steel).
  • outer sidewall 286 and inner sidewall 288 may be employed - instead of electrical wires - in establishing a voltage between the first electrode and the second electrode.
  • Fig. 3 is a cross-sectional view of a pneumatic-based surgical tool 300 (shown in part) for tissue removal, according to some embodiments. More specifically, Fig. 3 is a cross- sectional view of a distal section 314 and a headpiece 304 of an elongated member (not shown) of surgical tool 300, according to some embodiments.
  • Surgical tool 300 differs from surgical tool 100 at least in that the piston assembly thereof is “telescopic”, including a plurality of pistons (two, for example, in Fig. 3), as described below.
  • Distal section 314 includes a chamber 324.
  • a chamber distal wall 326 (i.e. a distal wall of chamber 324) includes a distal opening 336.
  • the piston assembly includes a first piston 340, a second piston 305, a first piston return mechanism (described below), associated with first piston 340, and a second piston return mechanism (described below), associated with second piston 305.
  • First piston 340 may include a piston body 311 and a flange 313.
  • Piston body 311 may be shaped as an axially extending hollow tube.
  • Flange 313 may radially extend from a proximal portion of piston body 311, for example, from a piston body proximal end 321 (i.e. a proximal end of piston body 311).
  • Piston body proximal end 321 may be fully open, while a piston body distal end 323 may be partially open, including a distal hole 327, which is of smaller diameter than the diameter of piston body 311.
  • First piston 340 is configured for axial, reciprocating motion along chamber 324, such that at least during part of the motion, piston body distal end 323 projects through distal opening 336. (In contrast, flange 313 remains within chamber 324 throughout the motion). The extent of the projection changes with the axial displacement of piston 340 in chamber 324 (e.g. the distance between flange 313 and a chamber proximal wall 332). Second piston 305 is positioned within first piston 340 and is configured for axial, reciprocating motion along first piston 340, as described below. Second piston 305 may be shaped similarly to piston 140 of surgical tool 100. More specifically, second piston 305 may include a base portion 331 and an elongated mounting portion 333.
  • Mounting portion 333 may project distally from a central part of base portion 331, with base portion 331 defining a flange 335 around mounting portion 333.
  • Flange 335 extends radially until the (circumferential) side wall of piston body 311.
  • proximal opening 334 on chamber proximal wall 332.
  • Proximal opening 334 couples chamber 324 to a first lumen (not shown), which may be similar to first lumen 116 of surgical tool 100, and which is configured to convey pressurized fluid into chamber 324.
  • the first piston return mechanism includes a first spring 350 disposed about first piston 340
  • the second piston return mechanism includes a second spring 341 disposed about mounting portion 333.
  • First spring 350 may be connected on a distal end thereof to chamber distal wall 326 and on a proximal end thereof to flange 313.
  • Second spring 341 may be connected on a distal end thereof to piston body distal end 323 and on a proximal end thereof to flange 335.
  • Headpiece 304 is mounted/installed on mounting portion 333 (e.g. on a distal tip of mounting portion 333). Headpiece 304 may be configured for debulking hard tissue. According to some embodiments, headpiece 304 may be configured for hammering hard tissue when effecting axial, reciprocating motion, essentially as described above with respect to headpiece 104 of surgical tool 100. In particular, according to some embodiments, headpiece 304 may be similar to, or even identical to, headpiece 104.
  • First piston 340 and second piston 305 partition chamber 324 into three compartments: a proximal compartment 348 and two distal compartments: a circumferential (or first) distal compartment 351 and a central (or second) distal compartment 355.
  • the volume of circumferential distal compartment 351 is determined by the displacement of first piston 340 within chamber 324. In particular, the volume of circumferential distal compartment 351 decreases as the distal displacement of first piston 340 is increased.
  • the volume of central distal compartment 355 is determined by the displacement of second piston 305 within first piston 340. In particular, the volume of central distal compartment 355 decreases as the distal displacement of second piston 305 is increased.
  • Mounting portion 333 is housed within central distal compartment 355.
  • chamber 324 includes a (first) aperture 366 positioned on a side-surface 368 of chamber 324.
  • Aperture 366 may be fluidly coupled to a second lumen (not shown), e.g. via a channel 370 longitudinally extending within a circumferential sidewall 338 of surgical tool 300 along a length of distal section 314.
  • the second lumen may be essentially similar to second lumen 162 of surgical tool 100 and, according to some embodiments, may be disposed about the first lumen.
  • First piston 340 is switchable between at least two configurations: In a first configuration, first piston 340 is positioned proximally relative to aperture 366, so that proximal compartment 348 is fluidly decoupled from channel 370. In a second configuration, first piston 340 is positioned distally relative to aperture 366, so that proximal compartment 348 is fluidly coupled to channel 370.
  • first piston 340 and second piston 305 effect axially, reciprocating motions. Consequently, headpiece 304 also effects axially, reciprocating motion.
  • first piston 340 is positioned in proximity to, or adjacently to, chamber proximal wall 332 and, according to some embodiments, first spring 350 may be relaxed or nearly relaxed. Fluid forced into proximal compartment 348, pushes each of first piston 340 and second piston 305 in the distal direction, so that first spring 350 is compressed (or further compressed) and second spring 341 is compressed. As more of the fluid is forced into first lumen 316 (and into proximal compartment 348), first piston 340 is further pushed in the distal direction, thereby switching from the first configuration to the second configuration. That is, proximal compartment 348 grows to include aperture 366 and fluidly couples to channel 370.
  • the pressure of the fluid within proximal compartment 348 consequently starts dropping as some of the fluid escapes into the second lumen (via aperture 366), wherefrom the escaped fluid may be released from surgical tool 300 to the surroundings.
  • the magnitude of the proximally acting force, exerted by first spring 350 on first piston 340 exceeds the magnitude of the distally acting force, exerted by the fluid on first piston 340, and, soon after, the motion of first piston 340 is reversed.
  • First piston 340 is switched back from the second configuration to the first configuration.
  • surgical tool 300 is configured such as to allow headpiece 304 to strike hard tissue at a rate of at least about 1000, 5000, or 10,000 strikes per minute (SPM). Each possibility is a separate embodiment.
  • chamber 324 includes a second aperture 372 positioned on side-surface 368 distally relative to first aperture 366.
  • Second aperture 372 may be fluidly connected to channel 370.
  • Second aperture 372 may differ from first aperture 366 in being positioned in circumferential distal compartment 351 not only in the second configuration (of first piston 340) but also in the first configuration thereof. That is, second aperture 372 fluidly couples circumferential distal compartment 351 to channel 370 both in the first and second configurations.
  • second aperture 372 functions to regulate the pressure within circumferential distal compartment 351, such as to keep the pressure within circumferential distal compartment 351 (during surgical tool 300 operation) at atmospheric pressure or slightly there above.
  • piston body 311 may include a third aperture (not shown) positioned on a distal portion thereof.
  • the third aperture may allow for release of fluid from central distal compartment 355 into the surroundings (at least when first piston 340 is sufficiently distally displaced), thereby functioning to regulate the pressure within central distal compartment 355.
  • headpiece 304 is permanently affixed onto mounting portion 333.
  • headpiece 304 may be detachably installed on mounting portion 333, such as to allow switching between different headpieces, which may differ in size, dimensions, as well as in the hard-tissue breaking properties thereof, essentially as described with respect to headpiece 104.
  • surgical tool 300 may be provided as part of a kit including in addition to surgical tool 300 one or more headpieces as described above.
  • elongated member 302 may be flexible such as to conform to a range of angles or curvatures before and/or during the surgery, thereby allowing guiding headpiece 304 onto difficult-to-reach target sites within the body.
  • distal section 314 may be positioned, or positionable, at an angle (e.g. at an obtuse angle) relative to a main section (not shown) of elongated member 302.
  • headpiece distal tip 356 of headpiece 304 and a distal surface 358 of headpiece distal tip 356, which may be similar to headpiece distal tip 156 and distal surface 158, respectively, of surgical tool 100.
  • a circumferential surface 360 of headpiece 304 may be abrasive (erosive), so that surgical tool 300 may be configured/further configured for debulking hard tissue by polishing and/or grating thereof, essentially as described above with respect to surgical tool 100.
  • headpiece 304 is excentric in the sense of being laterally offset (laterally displaced) relative to a central axis C of elongated member 302.
  • surgical tool 300 may include an operational input and an additional lumen, which may be similar to operational input 274 and additional lumen 276 of surgical tool 200.
  • a surgical tool (not shown), which is similar to surgical tool 300, but differs therefrom in not including a circumferential distal compartment.
  • a first spring of the surgical tool may be connected, on a distal end thereof, to a first piston of the surgical tool, and, on a proximal end thereof to a proximal wall of a chamber (housing the first piston) of the surgical tool.
  • the first piston of the surgical tool may be configured for axial, reciprocating motion within a chamber of the surgical tool, such that walls of the first piston slide along inner walls of the chamber.
  • the first spring may be configured to proximally pull the first piston when the distal displacement of the piston is beyond the relaxation length of the first spring.
  • the relaxation length of the first spring may be such that, when relaxed, the first piston is positioned proximately to the proximal wall of the chamber.
  • a surgical tool (not shown), which is similar to the fully pneumatic (i.e. springless) surgical tool described above, but differs therefrom at least in that a distal compartment thereof is at least part of the time open during operation.
  • fluid is alternately pumped into each of a proximal compartment and the distal compartment:
  • fluid is ejected from the distal compartment as the build-up of pressure in the proximal compartment distally pushes a piston, thereby decreasing the size of the distal compartment and forcing out fluid therefrom.
  • fluid When fluid is pumped into the distal compartment, fluid is ejected from the proximal compartment as the build-up of pressure in the distal compartment proximally pushes the piston, thereby decreasing the size of the proximal compartment and forcing out fluid therefrom.
  • a main lumen may be connected to a fluid-inlet and may be used to provide pressurized fluid to each of the proximal and distal compartments. More specifically, the main lumen may diverge into two lumens: a first lumen which may be fluidly connected to the proximal compartment, and a second lumen which may be fluidly connected to the distal compartment.
  • a controllable valve may be positioned at the point of divergence, thereby allowing to alternately pump pressurized fluid into the proximal compartment and the distal compartment, respectively.
  • each of the proximal compartment and the distal compartment may be connected to a respective fluid source.
  • each of the proximal and distal compartments may be also be used to eject fluid.
  • each of the proximal and distal compartments may respectively include a dedicated outlet for ejecting fluid.
  • Each of the dedicated outlets may include a valve, e.g. a one-way valve, which opens when the pressure within the respective compartment increases beyond a threshold pressure.
  • the surgical tools are adapted for debulking tissue.
  • the surgical tools are adapted for debulking hard tissue while leaving intact soft (elastic) tissue.
  • the mechanical properties of the headpiece and the amplitude and frequency of the reciprocating motion are such that when the headpiece effects axial, reciprocating motion against hard tissue (e.g. a bone), it may fragment the hard tissue, but when the headpiece effects reciprocating motion against soft tissue, it will not damage the soft tissue.
  • the headpiece may be configured for debulking soft tissue.
  • a surgical tool such as surgical tool 100, surgical tool 200, surgical tool 300, or a surgical tool similar thereto, for debulking hard tissue.
  • the surgical tool includes an elongated member, a headpiece, a piston assembly, and a handle.
  • the elongated member extends in the distal direction from the handle.
  • the elongated member includes a main section and a distal section, which, according to some embodiments, is positioned, or may be positioned, at an angle relative to the main section.
  • the piston assembly includes a (first) piston and a return mechanism associated with the piston.
  • a first lumen distally extends from a fluid inlet, positioned on the handle, to the distal section (through the main section).
  • the distal section is hollow defining a chamber therein.
  • the chamber is distally bounded by a chamber distal wall, which may also constitute the distal edge of the elongated member.
  • the chamber distal wall includes a distal opening.
  • the piston is housed in the chamber and partitions the chamber into a proximal compartment, which is fluidly coupled to the first lumen, and a (first) distal compartment.
  • the piston is configured for axial, reciprocating motion within the chamber.
  • the piston assembly further includes a mounting portion, which is mechanically associated with the (first) piston, and which distally projects, or which is projectable, into the distal opening.
  • the return mechanism is configured to exert a proximally acting force on the piston, such that the force increases together with an increase in a distal displacement of the piston, at least when the piston is distally displaced beyond a first threshold displacement.
  • the headpiece is installed on the mounting portion, and being mechanically associated therewith, is thereby configured to move together with the piston.
  • the surgical tool is configured such that, in operation, pressurized fluid, injected into the first lumen, distally pushes the piston until the return mechanism pushes the piston back, thereby effecting the axial, reciprocating motion of the piston.
  • the handle may be configured to facilitate operation, manipulation, and control of the surgical tool by an operator (e.g. a surgeon).
  • the angle between the distal section and the main section may be controllably changed.
  • the return mechanism is spring-based. According to some such embodiments, the return mechanism includes at least one spring housed in the (first) distal compartment and connected on a first end thereof to the chamber distal wall and on a second end thereof to the (first) piston.
  • a second lumen distally extends from a fluid outlet, positioned on the handle, to the distal section (through the main section).
  • the second lumen In a first configuration of the piston, the second lumen is fluidly decoupled from the proximal compartment.
  • the second lumen In a second configuration of the piston, wherein the piston is distally shifted relative to a position thereof in the first configuration, the second lumen is fluidly coupled to the proximal compartment.
  • fluid may flow out of the proximal compartment via the second lumen, bringing about a drop in the pressure within the proximal compartment. This facilitates the expansion of the spring, and the consequent switching back of the piston from the second configuration to the first configuration.
  • the second lumen is fluidly coupled to the (first) distal compartment, thereby regulating pressure in the distal compartment (such as to minimize variations in pressure in the distal compartment during the reciprocating motion of the piston).
  • the fluid-coupling of the chamber to the second lumen is effected via one or more apertures, and/or one-way valves, in a side-surface of the chamber.
  • the surgical tool is configured for debulking hard tissue (e.g. bone tissue).
  • the headpiece is configured for debulking hard tissue by hammering.
  • the headpiece is configured to debulk hard tissue when effecting axial, reciprocating motion at a rate of about 1000, about 5000, about 10,000, about 20,000, about 50,000 SPM or even greater.
  • the SPM may be set according to the type of headpiece attached, that is, whether the headpiece is smooth, eroded or serrated, coated with abrasive material, etc.
  • the headpiece (also referred to as “cutting head”) distally projects from a distal edge of the elongated member.
  • the headpiece is detachably installed on the mounting portion. This allows switching between headpieces characterized by different dimensions and/or tissue cutting properties.
  • the headpiece may be switched with a sharp headpiece (i.e. a cutting element) having soft- tissue cutting properties.
  • the headpiece is excentric in the sense of being laterally offset (laterally displaced) relative to a central axis of the distal section.
  • the offsetting of the headpiece may facilitate treatment of sites to which access would otherwise be difficult or blocked.
  • the distal edge of the elongated member includes or constitutes one or more electrodes, being thereby configured for electrophysiological monitoring and/or neurostimulation.
  • the one or more electrodes are configured to function as, a single electrode.
  • the elongated member is thereby configured to allow establishing a voltage between the one or more electrodes and an external electrode placed on/in a body of a subject during a tissue debulking procedure.
  • the one or more electrodes include at least two electrodes configured to function as two electrodes of opposite polarity.
  • At least part of the elongated member - including the distal edge thereof - is made of an electrically conducting material.
  • the piston assembly may be telescopic further including a second piston and a second return mechanism mechanically associated with the second piston.
  • the first piston may be tubular.
  • a distal end of the first piston may include a hole and the second piston may include mounting portion (thus, having mounted thereon the headpiece).
  • the second piston may be disposed within the first piston such as to be configured for axially, reciprocating motion within the first piston, wherein, at least during at least part of the axial, reciprocating motion, the headpiece distally projects outside the distal edge of the elongated member via the hole in the distal end of the first piston.
  • the additional return mechanism is configured to exert a proximally acting force on the second piston which increases as a distal displacement of the second piston within the first piston is increased, at least beyond a second threshold displacement.
  • the telescopic configuration of the piston assembly may advantageously extend the axial reach of the headpiece.
  • the second return mechanism is spring-based.
  • the second return mechanism includes at least one spring housed in the first piston and connected on a first end thereof to the distal end of the first piston and on a second end thereof to the second piston.
  • a distal tip of the headpiece includes an eroding surface configured for hammering hard tissue.
  • the eroding surface may include one or more protrusions (e.g. formed by diamonds embedded in the eroding surface).
  • the angle between main section and the distal section may be between about 90° and about 120°, about 130°, about 135° about 140°, about 150°, about 160°, about 165°, about 170°, or about 180°.
  • the main section is flexible or malleable such as to allow varying the angle between the main section and the distal section (optionally, also during surgery).
  • the injected fluid includes air and/or nitrogen.
  • the injected fluid may at a body temperature or subbody temperature.
  • the handle may be composed of one or more cast, machined, or injection-molded pieces.
  • a circumferential sidewall of the elongated member may have embedded therein an additional lumen.
  • the additional lumen may proximally extend along the elongated member from a distal end thereof - which is open and which may be positioned on or near the distal edge - to the handle, such as to be fluidly-coupled to an operational input in the handle.
  • the operational input may function as a port for introducing/withdrawing/suction of fluids during a surgical tissue-debulking procedure.
  • the operational input may be configured to allow irrigating a target tissue site in order to cool and/or wash the target tissue site.
  • the operational input may be used to introduce additional surgical instruments (e.g. a tissue dissector, a spatula, an electrophysiological monitoring de vice/neuro- stimulation device, sensors/cameras, and/or the like), which may be utilized during a surgical tissue-debulking procedure.
  • additional surgical instruments e.g. a tissue dissector, a spatula, an electrophysiological monitoring de vice/neuro- stimulation device, sensors/cameras, and/or the like
  • the circumferential sidewall of the elongated member may be double-walled including a (circumferential) outer sidewall disposed about a (circumferential) inner sidewall.
  • the additional lumen may extend along the space between the outer sidewall and the inner sidewall.
  • the inner sidewall may surround the second lumen, while the first lumen may extend through the second lumen.
  • the one or more electrodes may be electrically coupled to the operational input, which, in turn, may be configured to be connected to an electrical power source.
  • the handle may include a dedicated electrical port which is electrically coupled to the one or more electrodes.
  • a circumferential surface of the headpiece may be rough, being thereby configured for polishing/grating.
  • the shape and dimensions of the headpiece may be configured to allow positioning the headpiece adjacently to hard tissue surface such as to allow fragmenting the hard tissue by grating/polishing the hard tissue.
  • the headpiece may be excentric.
  • a method for debulking hard tissue may be performed utilizing a surgical tool, such as surgical tool 100, surgical tool 200, surgical tool 300, or a surgical tool similar thereto, as described above.
  • the method includes: (i) guiding the distal section of the surgical tool to a target site in a vicinity hard tissue intended for removal; (ii) positioning the headpiece of the surgical tool in proximity to the hard tissue such as to allow hammering thereof; and (iii) effecting axial, reciprocating motion of the headpiece such as to hammer and break up/fragment the hard tissue.

Landscapes

  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Engineering & Computer Science (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Dentistry (AREA)
  • Surgical Instruments (AREA)

Abstract

La présente invention concerne un outil chirurgical de réduction tumorale des tissus comprenant : une poignée comprenant une entrée de fluide, un élément allongé s'étendant de manière distale à partir de la poignée et comprenant une section courbée située de façon distale et une chambre au moins partiellement positionnée de manière distale par rapport à la section courbée, une première lumière s'étendant de manière distale depuis l'entrée de fluide vers la chambre, un ensemble piston logé à l'intérieur de la chambre et comprenant un piston et un mécanisme de retour, et une pièce de tête positionnée de manière distale par rapport à la chambre et associée de manière fonctionnelle au piston. La pièce de tête est configurée pour effectuer la réduction tumorale des tissus en les frappant, lors d'un mouvement axial alternatif. En fonctionnement, la chambre reçoit un fluide sous pression, qui est injecté par l'intermédiaire de l'entrée de fluide. Le fluide pousse de manière distale le piston et la pièce de tête jusqu'à ce que leurs mouvements soient inversés par le mécanisme de retour, de manière à effectuer un mouvement axial alternatif de la pièce de tête.
PCT/IL2021/051422 2020-12-14 2021-11-30 Dispositifs pneumatiques de réduction tumorale des tissus Ceased WO2022130368A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US202063124999P 2020-12-14 2020-12-14
US63/124,999 2020-12-14

Publications (1)

Publication Number Publication Date
WO2022130368A1 true WO2022130368A1 (fr) 2022-06-23

Family

ID=82058558

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/IL2021/051422 Ceased WO2022130368A1 (fr) 2020-12-14 2021-11-30 Dispositifs pneumatiques de réduction tumorale des tissus

Country Status (1)

Country Link
WO (1) WO2022130368A1 (fr)

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0746245B1 (fr) * 1994-04-07 2002-11-20 Derio Medical Instruments Ltd. Dispositif pour enlever les occlusions endoluminales
US20030014051A1 (en) * 2001-06-18 2003-01-16 Arthrocare Corporation Electrosurgical apparatus having compound return electrode
US20150342619A1 (en) * 2012-09-11 2015-12-03 Carevature Medical Ltd. Tissue removal device

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0746245B1 (fr) * 1994-04-07 2002-11-20 Derio Medical Instruments Ltd. Dispositif pour enlever les occlusions endoluminales
US20030014051A1 (en) * 2001-06-18 2003-01-16 Arthrocare Corporation Electrosurgical apparatus having compound return electrode
US20150342619A1 (en) * 2012-09-11 2015-12-03 Carevature Medical Ltd. Tissue removal device

Similar Documents

Publication Publication Date Title
CN106491203B (zh) 用于抓握、解剖和/或凝结生物组织的器械
EP2531120B1 (fr) Dispositif de retrait de tissu
EP2502580B1 (fr) Instrument chirurgical pneumatique
EP2588011A1 (fr) Dispositifs et procédés médicaux de découpe et/ou d'évacuation de tissu
US20190159799A1 (en) Devices, systems, methods and kits for performing selective dissection of lung tissue
KR101583630B1 (ko) 볼탄도식 체외 충격파 치료기
CN109070324A (zh) 具有传递可控的、可重复的和可逆的冲击力的发射质块的矫形冲击设备
WO2021209987A1 (fr) Dispositif de réduction des tissus
EP3310274A1 (fr) Lame chirurgicale à ultrasons destinée à être utilisée avec des instruments chirurgicaux à ultrasons
EP2226029A3 (fr) Sutureur-resecteur de vaisseaux
CN104546116A (zh) 适配器元件、hf外科手术器械、适配器附接件和系统
WO2022130368A1 (fr) Dispositifs pneumatiques de réduction tumorale des tissus
US10675182B2 (en) Hollow needle for an ophthalmic surgical instrument
JP2025100551A (ja) 結石破砕のための交換可能なプローブ端
EP3875045B1 (fr) Dispositif de lithotripsie
US5772676A (en) Endoscopic cutting device
JPH10151137A (ja) 内視鏡用処置具
JP7454115B2 (ja) 腹腔鏡可撓性吸引装置
JP3852923B2 (ja) 腹腔鏡下手術用ドレナージ器具
KR20210154801A (ko) 조직 치료 장치 및 방법
CN218391207U (zh) 一种髓腔锉手柄
CN214761326U (zh) 一种新型可调刮匙
JP6432751B1 (ja) 骨粉砕機
US10893877B2 (en) Guided punch for talar augments
CA2528565A1 (fr) Cartouche de pompe reutilisable

Legal Events

Date Code Title Description
121 Ep: the epo has been informed by wipo that ep was designated in this application

Ref document number: 21905982

Country of ref document: EP

Kind code of ref document: A1

NENP Non-entry into the national phase

Ref country code: DE

122 Ep: pct application non-entry in european phase

Ref document number: 21905982

Country of ref document: EP

Kind code of ref document: A1

32PN Ep: public notification in the ep bulletin as address of the adressee cannot be established

Free format text: NOTING OF LOSS OF RIGHTS PURSUANT TO RULE 112(1) EPC (EPO FORM 1205A DATED 16/10/2023)

122 Ep: pct application non-entry in european phase

Ref document number: 21905982

Country of ref document: EP

Kind code of ref document: A1