A vessel harvesting apparatus for removing a blood vessel from a patient includes collection and conditioning (i.e., treatment) of expelled insufflation gas prior to releasing the gas into the air of the operating room. An endoscopic instrument has a distal end with a vessel harvesting tip and has a proximal end with a handle. An insufflation channel is configured to convey an insufflation gas subcutaneously into a dissected space within the patient. A removal channel is configured to evacuate fluidic contents from the dissected space, wherein the fluidic contents include insufflation gas and biological impurities. A processor/separator is coupled to the removal channel to process the fluidic contents to retain at least some of the biological impurities and to exhaust the insufflation gas.

A vessel harvesting apparatus for removing a blood vessel from a patient includes collection and conditioning (i.e., treatment) of expelled insufflation gas prior to releasing the gas into the air of the operating room. An endoscopic instrument has a distal end with a vessel harvesting tip and has a proximal end with a handle. An insufflation channel is configured to convey an insufflation gas subcutaneously into a dissected space within the patient. A removal channel is configured to evacuate fluidic contents from the dissected space, wherein the fluidic contents include insufflation gas and biological impurities. A processor/separator is coupled to the removal channel to process the fluidic contents to retain at least some of the biological impurities and to exhaust the insufflation gas.

A surgical treatment apparatus comprises a waterjet configured to fragment tissue and provide intact cells such as stem cells with the fragmented tissue. The intact cells can be used in one or more of many ways such as for genetic or other testing, and the intact cells can be identified as stem cells. In many embodiments, the intact cells comprise stem cells. In many embodiments, a waterjet is configured to fragment tissue. The fragmented tissue can be collected with a filter having pores sized smaller than the tissue fragments. In many embodiments cavitation with a waterjet is used to fragment the tissue comprising the intact stem cells. The waterjet may comprise a waterjet immersed in a liquid comprising water so as to form a plurality of shedding pulses. The plurality of shedding pulses can be generated with a frequency sufficient to fragment the tissue. The shedding pulses can generate cavitations that fragment the tissue.

A medical apparatus includes a therapy component for performing a therapeutic procedure on the patient. The therapy component includes sensing circuitry for sensing electrical signals from one or more sensing electrodes of the therapy component that are placed on and/or in the patient. With the medical apparatus powered on, a determination is made as to when the therapy component is actively engaged in performing the therapeutic procedure on the patient. When the therapy component is actively engaged in performing the therapeutic procedure on the patient, the one or more sensing electrodes of the therapy component are electrically connected to the sensing circuitry. When the therapy component is determined to not be actively engaged in performing the therapeutic procedure on the patient, the one or more sensing electrodes of the therapy component are electrically isolated from the sensing circuitry.

An aspiration thrombectomy system, comprising a vacuum source comprising a controllable vacuum valve, a pressure source comprising a controllable pressure valve, an aspiration catheter having a proximal end and a distal end, wherein the proximal end of the aspiration catheter comprises connection tubing having a lumen configured to accommodate fluid, and wherein the connection tubing acts as a common conduit for fluid communication between the aspiration catheter and the vacuum and pressure sources via the vacuum and pressure valves, respectively, and a controller configured to open and close the vacuum and vent valves in a predetermined cycle to change a level of vacuum at the distal end of the aspiration catheter and control flow in and out from the distal end of the catheter.

An energy source is coupled to a probe mounted on a robotic arm, and a processor configured with instructions to release energy to resect tissue in coordination with movement of the robotic arm and probe. The tissue can be resected in accordance with a defined tissue resection volume that can be determined based on images of the patient. The probe can be moved to a plurality of positions with movement of a distal end of the robotic arm and tissue resected in accordance with the treatment plan. The distal end of the robotic arm can be configured to move to a plurality of locations and orientations to provide an appropriate position and orientation of the probe tip and energy source. The processor can be configured with instructions to pivot the probe at a location to decrease tissue movement near the pivot such as an internal location of the patient.

An energy source is coupled to a probe mounted on a robotic arm, and a processor configured with instructions to release energy to resect tissue in coordination with movement of the robotic arm and probe. The tissue can be resected in accordance with a defined tissue resection volume that can be determined based on images of the patient. The probe can be moved to a plurality of positions with movement of a distal end of the robotic arm and tissue resected in accordance with the treatment plan. The distal end of the robotic arm can be configured to move to a plurality of locations and orientations to provide an appropriate position and orientation of the probe tip and energy source. The processor can be configured with instructions to pivot the probe at a location to decrease tissue movement near the pivot such as an internal location of the patient.

A surgical atherectomy apparatus for removing particles such as plaque from an interior of a vessel having a motor housing slidable axially between a proximal position and a distal position. An axially fixed sheath extends from the outer housing and a catheter is connected to the motor housing and is positioned within the sheath. A rotatable shaft is positioned within the lumen of the catheter and is operatively connected to the motor for rotational movement, the rotatable shaft and catheter movable by movement of the motor housing between the proximal and distal positions. The rotatable shaft has an atherectomy bit extending therefrom for dislodgement of particles when rotated by the motor and dislodged particles are aspirated in the lumen of the catheter.

A surgical atherectomy apparatus for removing particles such as plaque from an interior of a vessel having a motor housing slidable axially between a proximal position and a distal position. An axially fixed sheath extends from the outer housing and a catheter is connected to the motor housing and is positioned within the sheath. A rotatable shaft is positioned within the lumen of the catheter and is operatively connected to the motor for rotational movement, the rotatable shaft and catheter movable by movement of the motor housing between the proximal and distal positions. The rotatable shaft has an atherectomy bit extending therefrom for dislodgement of particles when rotated by the motor and dislodged particles are aspirated in the lumen of the catheter.

This disclosure describes techniques and devices for improvement of surgical outcomes for tissue removal surgeries. A surgical instrument with adjustable and selective resection is described. The disclosed devices and methods allow selective tissue removal.