Capsule suction punch instrument and method of use
BACKGROUND OF THE INVENTION; 
     1. Field of the Invention 
     This invention relates to an instrument for cutting tissue and, more particularly, to an instrument for creating a hole or flap in the lens capsule of the eye. 
     2. Description of Related Art 
     Many surgical procedures require incision of membranes and the like for insertion of instruments. For example, when incising the lens capsule, straight cuts are typically made with cutting instruments having extremely sharp blades and instruments are thereafter inserted to carry out the desired surgical procedure. However, stress concentration occurs at edges of the straight cut when instruments are manipulated in the incision, which may result in tearing of the incision. To eliminate the problems of stress concentration, circular cuts have been proposed. However, the physical nature of tissue being cut often precludes a clean incision, since the tissue may collapse or distort when initial penetration is made with the cutting instrument. Thus, conventional instruments do not facilitate a clean cut since the tissue cannot be properly held during the cutting operation. Further, precise circular cuts cannot be made with conventional instruments due to their slow cutting speeds. 
     In other surgical procedures, clean cuts are also required to retrieve biopsy specimens or to remove a precise segment of tissue for transplants. For example, in keratoplasty utilizing corneal transplantation, a precise piece of the cornea must be removed. 
     SUMMARY OF THE INVENTION 
     An object of the invention is to provide an instrument for cutting the lens capsule which overcomes the problems associated with the conventional instruments by producing an incision which resists tearing. 
     Another object of the invention is to provide an instrument for cutting the lens capsule which ensures that a tissue specimen will not be inadvertently cut or punched during positioning of the instrument. 
     A further object of the invention is to provide an instrument which is capable of holding eye tissue during the cutting procedure so as to facilitate a clean cut in the lens capsule. 
     The foregoing and other objects are realized by providing a surgical suction punch instrument which includes a tubular body having a proximal portion and a distal portion. A cutting member which has a distal cutting edge is longitudinally received within the tubular body for guided reciprocal movement therein between a cutting position wherein the cutting edge projects from the distal portion and a non-cutting position wherein the cutting edge is retracted within the tubular body. An urging mechanism is further provided, preferably within the tubular body, for urging the cutting member toward its cutting position. A vacuum source is coupled to the tubular body and/or the cutting member and provides a vacuum to hold tissue to be cut during the cutting procedure. 
     Another object of the present invention is the provision of the device of the type described, which is simple in construction, effective in operation and economical to manufacture and maintain. 
     Other objects, features, and characteristics of the present invention, as well as the methods of operation and functions of the related elements of the structure, and the combination of the parts and economies of manufacture, will become more apparent upon consideration of the following detailed description and the appended claims with reference to the accompanying drawings, all of which form a part of the specification. 
    
    
     BRIEF DESCRIPTION OF THE DRAWING 
     FIG. 1 is a schematic sectional view of an instrument provided in accordance with the invention, shown with its cutting member in a retracted, non-cutting position; 
     FIG. 2 is a schematic sectional view of the instrument of FIG. 1, shown with its cutting member in transition from a non-cutting to a cutting position; 
     FIG. 3 is a schematic sectional view of the instrument of FIG. 1, shown with its cutting member in a cutting position; 
     FIG. 4 is an enlarged schematic sectional view of a portion of the instrument showing a pivoted finger slide; 
     FIG. 5a is an enlarged view of a distal end of an instrument in accordance with the invention showing a cutting member having a flared blade in a retracted position; 
     FIG. 5b is an enlarged view of the distal end of the instrument showing the cutting member with a flared blade in an extended position; 
     FIG. 6a is a schematic view of the distal portion of the instrument engaging tissue, with a vacuum being exerted on the tissue to hold the tissue prior to cutting; 
     FIG. 6b is a schematic view of the distal portion of the instrument with the cutting member cutting the tissue; 
     FIG. 7 is a schematic sectional view of a second embodiment of the invention, shown with its cutting member in a retracted, non-cutting position; 
     FIG. 8 is a schematic sectional view of the instrument of FIG. 7, shown with its cutting member in transition from the non-cutting position to the cutting position; 
     FIG. 9 is a schematic sectional view of the instrument of FIG. 7, shown with its cutting member in the cutting position; 
     FIG. 10 is a schematic top plan view of the instrument of FIG. 7; 
     FIG. 11 is an end view of the cutting member disposed within the distal portion of the tubular body of the instrument; 
     FIG. 12 is a sectional side view of a portion of the cutting member disposed within the distal portion of the tubular body; 
     FIG. 13 is a perspective view of a portion of the cutting member extending from the distal portion of the tubular body; 
     FIG. 14 is a partially cutaway perspective view of a portion of the cutting member retracted within the distal portion of the tubular body; 
     FIG. 15 is a side view of a portion of the cutting member extending from the distal portion of the tubular body; 
     FIG. 16 is an end view of an elliptical cutting member provided in accordance with the invention; 
     FIG. 17 is a sectional side view of a portion of the elliptical cutting member of FIG. 16, shown disposed within the distal portion of the tubular body; 
     FIG. 18 is a partial top view of the elliptical cutting member of FIG. 16, shown disposed within the distal portion of the tubular body; 
     FIG. 19 is an end view of a portion of another elliptical cutting member of the invention; 
     FIG. 20 is a sectional side view of a portion of the elliptical cutting member of FIG. 19, shown disposed within the distal portion of the tubular body; 
     FIG. 21 is a partially cutaway top view of a portion of the elliptical cutting member of FIG. 19, shown disposed within the distal portion of the tubular body; 
     FIG. 22 is a schematic view showing an elliptical cutting member cutting a circular hole; 
     FIG. 23 is a schematic sectional view of a third embodiment of the invention, shown with its cutting member in a retracted, non-cutting position; 
     FIG. 24 is a schematic sectional view of the instrument of FIG. 23, shown with its cutting member in transition from the non-cutting position to the cutting position; 
     FIG. 25 is a schematic sectional view of the instrument of FIG. 23, shown with its cutting member in the cutting position; 
     FIG. 26 is a schematic top plan view of the instrument of FIG. 23; 
     FIG. 27 is a schematic sectional view of a fourth embodiment of the invention, shown with its cutting member in a retracted, non-cutting position; 
     FIG. 28 is a schematic sectional view of the instrument of FIG. 27, shown with its cutting member in transition from the non-cutting position to a cutting position; 
     FIG. 29 is a schematic sectional view of the instrument of FIG. 27, shown with its cutting member in the cutting position; 
     FIG. 30 is a schematic sectional view of a fifth embodiment of the invention, shown with its cutting member in a non-cutting position; 
     FIG. 31 is a schematic sectional view of the instrument of FIG. 30, shown with its cutting member in transition from the non-cutting position to the cutting position; 
     FIG. 32 is a schematic sectional view of the instrument of FIG. 30, shown with its spring loaded slide in contact with the thrust plate; 
     FIG. 33 is a schematic side plan view of the instrument of FIG. 30, shown with its cutting member in the cutting position; 
     FIG. 34 is a view of a portion of a spring arm of the invention, shown in a relaxed position; 
     FIG. 35 is a view of the spring arm of FIG. 34, shown in a biased position; 
     FIG. 36 is a schematic sectional view of a sixth embodiment of the invention, shown with its cutting member in a retracted, non-cutting position; 
     FIG. 37 is a schematic sectional view of the instrument of FIG. 36, shown with its cutting member in transition from the non-cutting position to a cutting position; 
     FIG. 38 is a schematic sectional view of the instrument of FIG. 36, shown with its spring loaded slide in contact with the thrust plate; 
     FIG. 39 is a schematic side plan view of the instrument of FIG. 36, shown with its cutting member in the cutting position; 
     FIG. 40 is an end view of the distal portion of the tubular body showing a tissue manipulator disposed thereon; 
     FIG. 41 is a perspective view of a portion of the distal portion of the tubular body having a partial tissue manipulator; 
     FIG. 42 is a side view of a portion of an angled distal portion of the tubular body having a partial tissue manipulator; 
     FIG. 43 is a side view of a portion of the distal portion of the tubular body having a partial tissue manipulator; 
     FIG. 44 is an end view of the distal portion of the tubular body having a complete tissue manipulator; 
     FIG. 45 is an end view of an elliptical distal portion of the tubular body having a complete tissue manipulator; 
     FIG. 46 is an end view of an elliptical distal portion having a partial tissue manipulator; 
     FIG. 47 is a perspective view of a another embodiment of a portion of the cutting member extending from the distal portion of the tubular body for creating a flap in tissue; and 
     FIG. 48 is a side view of the cutting member of FIG. 47. 
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     Referring to the drawings, several embodiments of a surgical instrument which embodies of the principles of the present invention, are shown. 
     In general, the instrument of the invention is utilized to hold tissue, such as the lens capsule of the eye, with a vacuum while performing a quick-action cut of the tissue, resulting in a clean circular cut, as shown in FIGS. 6a and 6b. When the eye is incised, the instrument reduces the pressure on the inside of the lens capsule. The instrument permits removal of part of the capsule and lens tissue or creates a flap in the capsule so as to make room for other surgical instruments or implants. Upon completion of the cutting procedure, the instrument may be disposed of, or sterilized for further use. It can be appreciated that the instrument can be used to cut eye tissue other than the lens capsule, such as the cornea, and body tissue other than eye tissue. 
     With reference to the embodiment of FIG. 1, the instrument 10 includes a tubular body 12 having a distal portion 14, a proximal portion 16 and a mid portion 18. The distal portion of the tubular body extends from the mid portion and may have a diameter less than that of the mid portion, as shown. In the embodiment of FIG. 1, the edge 22 of the distal portion 14 is in a plane perpendicular to the longitudinal axis of tubular body 12 and is blunt. The shape of edge 22 is chosen to match the contour of the tissue to be cut. Thus, it can be appreciated that end or edge 22 of the distal portion may be angled, as shown in FIG. 7, to properly hold during cutting tissue that is curved. 
     Disposed centrally within the tubular body 12 is a cutting member 24 which is mounted for guided reciprocal movement within the tubular body. The cutting member 24 is of hollow tubular construction having distal 26 and proximal 28 ends. The distal end 26 of the cutting member includes a cutting edge or blade 30. As shown in FIGS. 5a, 5b, and 11-21, the cutting blade 30 may have a variety of configurations, but each is preferably peripherally continuous, serrated and adapted to make a circular or oval hole. FIGS. 5a and 5b show a cutting blade 30 having a flared end. The flared end is provided so there is no gap between the inner side of the distal end 14 and the cutting member 24, while permitting infusion or vacuum to flow through the space between the grooves of the cutting member. The flared end also acts as a spring member to hold the cutting member 24 from sliding until the shoulder means or thrust plate 39 thrusts it forward, as will become more apparent below. 
     In the illustrated embodiment, the proximal end 28 of the cutting member 24 is coupled to a flexible tube 32 which is connected to a vacuum source 33, as will become more apparent below. 
     To provide a quick-acting cutting instrument, an urging mechanism, generally indicated at 34, is provided which is coupled to the cutting member 24 so as to urge the cutting member toward a cutting position (FIG. 3) from a non-cutting position (FIG. 1). Urging mechanism 34 spring loads the cutting member for selective release to cut tissue. Thus, in one embodiment, the urging mechanism 34 includes a finger slide 36 disposed about the cutting member 24. A spring member 38 is disposed forward of the finger slide 36, between the finger slide and a thrust plate 39. The thrust plate 39 is coupled to the periphery of the cutting member 24. 
     The urging mechanism further includes a diaphragm member 40 having an outer periphery 42 and an inner periphery 44. The outer periphery 42 of the diaphragm member 40 is sealingly coupled with the mid portion 18 of the tubular body. The inner periphery of the diaphragm member is sealingly coupled with the cutting member 24. The diaphragm member 40 is made of resilient material so that when it is moved from a first rest state (FIG. 1) through a cocked or loaded state (FIG. 2) to a second rest state (FIG. 3), the diaphragm member moves the cutting member from the non-cutting position to the cutting position, as will become apparent below. The diaphragm member 40 further ensures that a vacuum is confined to the cutter and to the distal portion 14 to assist in holding, severing and capturing part of the capsule or other tissue to be severed. 
     As shown in FIG. 1, when the finger slide 36 is disposed at the rear of channel 46, the distal end 26 of the cutting member 24 is disposed within the tubular distal portion 14 of the tubular body, with the diaphragm member in a rest state. 
     FIG. 2 shows the diaphragm member 40 in a &#34;cocked&#34; state just prior to release. Thus, the finger slide 36 is moved forward with spring 38 compressed. Diaphragm member 40 is deformed which moves the cutting member 24 slightly forward. 
     FIG. 3 shows the finger slide 36 moved all the way to the forward end of channel 46. The spring member 38 forces the thrust plate 39 forward which causes the diaphragm member 40 to spring forward to a rest, released state, thus moving the cutting member to an extended cutting position. In such a position, the distal end 26 of the cutting member projects from the distal portion 14 of the tubular body so as to protrude from blunt end 22. A stop 48 defines an end of channel 46 to limit movement of the finger slide 36 and thus, movement of the cutting member 24. The use of the diaphragm member 40 to actuate the cutting member increases the speed at which tissue can be cut by the instrument 10. The serrated distal end 26 of the cutting member facilitates holding, piercing and penetrating of tissue, as shown in FIGS. 6a, 6b. To prevent air bubbles from entering the body organ being cut, the cutting member 24 may be filled with a fluid such as saline. 
     As is apparent from the foregoing, the invention provides an instrument which enables tissue, whether hard or soft, to be effectively held and cut, even at substantial depths, without affecting other adjacent areas. 
     FIG. 4 shows a variation of the finger slide 36&#39;. As shown, the slide 36 includes a pivot 50 which, when rotated, moves sliding member 52. 
     FIG. 4 also shows an infusion port 58 connected to the mid portion 18 of the tubular body and communicating with the space between the inner periphery of the distal portion 14 of the tubular body and the outer periphery of the cutting member 24 to provide infusion of materials required during the tissue extraction procedure. The infusion port may also be used to release the vacuum. 
     FIGS. 7-10 illustrate a second embodiment of the present invention. The second embodiment is substantially similar to the first embodiment; however, the urging mechanism 34 has been modified. As shown in FIG. 10, the finger slide 36&#34; is disposed within channel 46. The channel 46 has a stop 48 at one end thereof and a latch 54 at the opposite end thereof. When the cutting member 24 is retracted within the tubular body into a non-cutting position, the finger slide 36&#34; is engaged with latch 54 to prevent movement of the cutting member. As shown in FIG. 7, the spring member 38&#39; is disposed rearwardly of the finger slide 36&#34;, between the finger slide and surface 56. In the non-cutting position, the cutting member 24 is retracted within the tubular body with the spring member 38&#39; compressed. As the finger slide 36&#34; is released from latch 54 (by rotation), spring member 38&#39; is free to expand, moving the finger slide 36&#34; forward. The finger slide 36&#34; contacts the thrust plate 39 which moves the cutting member 24 forward so as to extend from the distal portion 14 of the tubular body, as shown in FIG. 9. A stop 57 is defined by or mounted to the tubular body 12 to engage the thrust plate 39 to limit the movement of the cutting member 24. 
     A retracting member 60 is provided on the proximal portion of the cutting member 24. Engagement of the finger slide and the retracting member retracts the cutting member during &#34;cocking&#34; of the spring. 
     Referring to FIGS. 23-26, a third embodiment of the present invention is shown. The third embodiment is substantially similar to the second embodiment; however, a triggering mechanism, generally indicated at 64, is employed. It has been found that in using the spring loaded finger slide, the surgeon may move his hand when he pushes the slide 36, which may damage adjacent tissue. Therefore, a remote electric, mechanic or pneumatic tripping device 66 is employed whereby the user&#39;s hand can be kept as steady as possible. The tripping device is disposed in a channel 68. As shown in FIG. 26, the tripping device 66 is remotely actuated to disengage the slide 36 from latch 54. 
     FIGS. 27-29 disclose a fourth embodiment of the invention having a pneumatically controlled trigger device 70 that is easy to use and simple to manufacture. As shown, a port 72 communicates with the interior of the mid portion 18 of the tubular body so as to move slide member 74, disposed about cutting member 24. A pump/vacuum 75 is used to move the slide member forward into the cutting position or backward to move the cutting member 24 into the retracted position. When the slide member 74 moves forward, it contacts thrust plate 39 which moves the cutting member 24 forward to extend from end 22. A diaphragm seal 78 limits the forward movement of cutting member 24. Stop 76 is provided to limit rearward movement of the slide member 74. 
     At the forward end of the mid portion 18, the diaphragm seal 78 is provided. When the sliding member 74 contacts the thrust plate 39, the thrust plate is moved forward to contact the diaphragm seal 78. The diaphragm seal ensures that the vacuum is only provided within the interior of the cutting member and cannot be released into chamber 41 of mid portion 18 of the tubular body. Seals 80 and 82 are also provided about the sliding member 74 and about the proximal end of the cutting member 24 so as to prevent loss of vacuum. 
     FIGS. 24 and 28, in particular, show an infusion port 58 communicating with a chamber between the outer periphery of the cutting member 24 and the inner periphery of the distal portion 14 of the tubular body. This port 58 can be used to release the vacuum that is provided in the flexible tube 32. The port can also be used to provide infusion. Of course, the port must be sealed when vacuum is applied. 
     FIGS. 30-35 illustrate a fifth embodiment of the present invention which is substantially similar to the third embodiment of the invention; however, the fifth embodiment has a modified remote actuating mechanism. As shown, the mid portion 18 of the tubular body includes a hub 84 which is coupled to the distal portion 14 of the tubular body. The other end of the hub is coupled to a cavity tube 86. The cavity tube 86 is attached to a spring retainer 88. 
     A wedge trip slide 90 is provided which slides in cavity 92 of cavity tube 86. The wedge trip slide 90 is preferably covered by a film cover plate 94 and held in place, preferably by a tape 96 attached to the cavity tube and a trip wire guard 98. The wedge trip slide 90 is attached to a trip wire 100. The wedge trip slide, when pushed against spring arm 102 of the spring loaded slide 104, unlatches slide 104 so as to slide along groove 106. The spring loaded slide 104 is pushed by the spring member 38. The spring loaded slide 104 makes contact with the thrust plate 39, which moves the cutting member 24 forward. The spring arm 102 is shown in its relaxed state in FIG. 34, whereas FIG. 35 shows the spring arm 102 in a biased state. 
     An anti-rotation tab or protrusion 108 extends from thrust plate 39 into groove 106. This prevents rotation of the cutting member 24 in operation. 
     A seal 59 is provided between the cavity tube and the cutting member. The seal 59 also acts as a shock absorber when contacted by the thrust plate 39. 
     A retractor 110 is provided about the cutting member 24 so as to permit the cutting member to be retracted within tubular body 12 after cutting the desired tissue. 
     FIGS. 36-39 illustrate a sixth embodiment of the present invention. The sixth embodiment is similar to the fifth embodiment; however, manual, instead of remote, actuation is required. As shown, a notch 112 is defined in the mid portion 18 near the spring arm 102. The notch 112 is covered by a flexible film cover plate 94 which is held in place by tape 96 attached to the cavity tube 86. When the cover plate 94 is manually depressed, spring arm 102 is moved downward. Spring member 38 forces the spring loaded slide 104 to move along the mid portion 18 of the tubular body. The slide 104 slides along groove 106. The spring loaded slide 104 is pushed by the spring member 38 and contacts the trust plate 39, which moves the cutting member 24 forward so as to extend from the distal end of the tubular body, thereby defining the cutting configuration of the instrument. As in the previous embodiment, seal 59 acts as a stop or shock absorber when contacted by thrust plate 39. 
     As shown in FIGS. 40-46, a tissue manipulator 114 is preferably provided on the periphery of the distal portion 14 near end 22. As shown in FIGS. 40-43, the manipulator 114 may be partially disposed about distal portion 14. However, as shown in FIGS. 44 and 45, the manipulator 114 may be disposed about the entire periphery of the distal portion 14 of the tubular body. The tissue manipulator or retracting means 114 is used to retract the iris during the tissue extraction or flap creation procedure. The tissue manipulator can be either sharp or blunt. 
     Instead of creating a circular incision in the capsule or other tissue, it may be preferable to leave the tissue connected to surrounding tissue at the incision site. Therefore, in accordance with a further aspect of the invention the cutting member 24 may be used to cut a flap in tissue. Referring to FIGS. 47 and 48, the cutting member has been modified to create a flap. As shown, the cutting member includes a cut-out 116. Thus, tissue will not be cut at the cut-out, thereby creating the flap. 
     In accordance with a further feature of the invention, angular cutting members (FIGS. 11-15) may be used to cut elliptical holes in tissue. In addition, elliptical cutting members 24&#39; are provided in accordance witch the invention and are shown in FIGS. 16-22, 45 and 46. FIG. 22 illustrates how an elliptical cutter can be used to cut a circular hole in accordance with the invention. 
     Thus, it can be appreciated that the invention provides increased assurance that tissue specimens will not be cut or punched and incisions not made during positioning of the instrument. The invention provides a vacuum connected to the flexible tube 32 to retain tissue prior to severing (FIG. 6a). By the particular cooperation between the cutting member 24 and end 22 of the distal portion 14 of the tubular body, tissue is retained in position by the blunt end 22 while the cutting member 24 is in position ready to be released and quickly cut the tissue, without tearing. 
     While the invention has been described in connection with what is presently considered to be the most practical and preferred embodiments, it is to be understood that the invention is not limited to the disclosed embodiments but, on the contrary, is intended to cover various modifications and equivalent arrangements included within the spirit and scope of the appended claims.