DE102014203920B4 - Device for laser lithotripsy - Google Patents

Abstract

Device (1) for laser lithotripsy of bladder stones comprising a laser source (10) and an endoscopic instrument (2), wherein an optical fiber (7) is guided from the laser source through the endoscopic instrument (2) and using the endoscopic instrument (2) in front of the stone to be broken up can be positioned, the endoscopic instrument (2) also being designed to conduct a rinsing liquid and a pump (11) connected to the endoscopic instrument (2) via a liquid-conducting connecting line (14) for conveying the rinsing liquid through the endoscopic instrument (2 ) is provided, characterized in that the connecting line (14) between the pump (11) and the endoscopic instrument (2) has a vibration decoupling (15), the vibration decoupling (15) being an at least sectional configuration of the connecting line (14) between the pump (11 ) and endoscopic element (2) as corrugated hose or hose with corrugation ter wall with a periodically changing diameter in the axial direction, the changing diameter being found both on the inside and on the outside of the connecting line (14).

Description

The invention relates to a device for laser lithotripsy, in particular of bladder stones, and a connecting element, in particular for retrofitting laser lithotripsy devices.

In order to remove larger bladder or kidney stones, it is known to break them up so that the resulting fragments can be removed from the kidney ducts and/or the urinary tract by a natural passage or simply by surgery, possibly minimally invasively. One technique known in the art for breaking up bladder stones is laser lithotripsy.

In laser lithotripsy, an endoscope, i. H. Minimally invasive, the first end of an optical fiber is brought up to the bladder stone to be broken up and a laser pulse introduced into the optical fiber at the second end is focused on the surface of the bladder stone. One or more laser pulses can break up the stone sufficiently for eventual removal.

In order to ensure a sufficient field of vision during a corresponding endoscopic intervention, it is also known to use a rinsing liquid to fill the body cavity containing the stone to be broken up and to widen it so that the surgical area and in particular the stone to be broken up for are clearly visible to the surgeon through the endoscope. The rinsing fluid is regularly fed in and removed through the endoscope itself. A continuous flow of rinsing liquid can also prevent clouding of the field of vision due to suspended matter or the like.

Due to the energy introduced by a laser pulse, it is imperative, in order to avoid damage to the surrounding tissue, that the first end of the optical fiber is aimed completely at the bladder stone to be broken up and that the laser pulse does not, even partially, impinge on the surrounding tissue. In order to ensure a correspondingly precise positioning of the first end of the optical fiber, it is necessary to be able to guide the position of the first end of the optical fiber as precisely as possible.

In the case of the laser lithotripsy devices known from the prior art, despite the guidance of the optical fiber in the endoscope, an aiming inaccuracy can be observed when positioning the first end of the optical fiber.

The document DE 39 17 663 A1 relates to an endoscope for laser lithotripsy with a light guide which can be connected proximally to a laser light source and which runs through an endoscope channel and the distal end of which can be aligned with the calculus to be destroyed under visual control with the endoscope optics.

In document DE 39 19 441 A1 describes a flexible probe channel with a furrow-like structured lateral surface for the passage of flexible auxiliary instruments and for the supply and removal of a rinsing liquid.

The document DE 10 2012 204 680 A1 is directed to a system for supplying rinsing solution during endoscopic interventions with a rinsing solution pump, by means of which rinsing solution can be conveyed from a rinsing solution supply to an endoscopic instrument.

The document DE 600 18 950 T2 describes a corrugated hose connection for connecting tubular medical devices. The corrugated hose connection is designed as a so-called bellows connection.

In document U.S. 5,431,637 a tracheal suction catheter is treated, the free end of which is to be inserted into the trachea and has a wavy shape on the outside.

The object of the invention is to provide a device for laser lithotripsy that is improved over the prior art and a connecting element that can be retrofitted to improve existing laser lithotripsy devices.

This object is achieved by a device according to the main claim and a connecting element according to the independent claim 6. Advantageous developments are the subject matter of the dependent claims.

Accordingly, the invention relates to a device for laser lithotripsy comprising a laser source and an endoscopic instrument, with an optical fiber being routed from the laser source through the endoscopic instrument and being positionable in front of the stone to be broken up using the endoscopic instrument, the endoscopic instrument also being used to conduct a rinsing fluid and a pump connected to the endoscopic instrument via a liquid-conducting connecting line is provided to convey the rinsing liquid through the endoscopic instrument, the connecting line between the pump and the endoscopic instrument having a vibration decoupling, the vibration decoupling having at least a section-wise embodiment of the The connecting line between the pump and the endoscopic element is a corrugated hose or hose with a corrugated wall with a diameter that changes periodically in the axial direction, with the changing diameter being found both on the inside and on the outside of the connecting line.

The invention further relates to a connecting element for the liquid-conducting connection of a pump for a rinsing liquid to an endoscopic instrument, the connecting element comprising a connecting line with vibration decoupling, the vibration decoupling having at least a sectioned design of the connecting line between the pump and the endoscopic element as a corrugated hose or hose with a corrugated wall has a periodically changing diameter in the axial direction, with the changing diameter being found both on the inside and on the outside of the connecting line.

The invention is based on the finding that, particularly in devices for laser lithotripsy in which the optical fiber is guided through the same instrument as the flow of rinsing liquid, vibrations from the pump for the rinsing liquid can be transmitted to the optical fiber, causing it to vibrate. This applies in particular to devices for laser lithotripsy in which the rinsing liquid flows directly around the optical fiber, for example because it is guided through the supply channel for the rinsing liquid. These oscillations adversely affect the targeting accuracy of the optical fiber or of the laser pulse transmitted through this fiber. The vibrations of the pump can be transmitted via the connecting line between the pump and the endoscopic instrument or through the rinsing liquid contained therein.

By providing a vibration decoupling in the connecting line between the pump and the endoscopic instrument according to the invention, the transmission of vibrations from the pump to the endoscopic instrument or the optical fiber can be reduced, which means that the target accuracy is significantly increased compared to the prior art.

The vibration decoupling is achieved by designing the liquid-conducting connecting line between the pump and the endoscopic element, at least in sections, with a diameter that changes periodically in the axial direction. The wall thickness of the connecting line can be constant in this section, so that the changes in diameter are then reflected on the inside and outside of the connecting line. A corresponding configuration of the connection between the pump and the endoscopic element in at least one section can significantly reduce the transmission of vibrations from the pump to the optical fiber.

In particular, the section of the connecting line for vibration decoupling is designed as a corrugated hose, corrugated pipe, hose with a corrugated wall or pipe with a corrugated wall. A corrugated hose or corrugated pipe is a hose or pipe with a periodically changing diameter, namely a diameter that changes in the form of a wave. The same applies to a hose or pipe with a corrugated wall, but the diameter alternately increases linearly and then decreases again linearly, resulting in a triangular changing diameter. A hose or pipe with a corrugated wall therefore has an accordion-shaped wall. Corrugated pipes or pipes with a corrugated wall are basically rigid, while corrugated hoses or hoses with a corrugated wall are basically elastic and permanently flexible.

If the changing diameters are reflected both on the inside and on the outside of the connecting line in the area of the vibration decoupling, the transmission of vibrations can be reduced both via the connecting line itself and by the flushing liquid contained therein. If the latter is not required, e.g. due to the pump used, the inside of the connection in the area of the vibration decoupling can be smooth, i. H. with a constant diameter, designed to reduce the flow resistance for the rinsing liquid.

In this case, the mentioned changes in the diameter relate solely to the outside of the connecting line in the area of the vibration decoupling, which corresponds to a variation in the thickness of the wall in this area given a constant inside diameter. As a result, vibrations that are transmitted via the connecting line between the pump and the endoscopic element can be effectively reduced without increasing the flow resistance for the rinsing liquid.

The connecting line between the pump and the endoscopic instrument is preferably designed to be flexible, at least in part, in order to allow the operator freedom of movement that is as unrestricted as possible. For this purpose, the connecting line between the pump and the endoscopic instrument is often at least partially designed as a flexible connecting tube. If, in this case, a flexible section with a periodically changing diameter (e.g. a A corrugated hose or a hose with a corrugated wall) is provided, this section for vibration decoupling can be designed in one piece with the connecting hose. The vibration decoupling is preferably provided in the area of one end or in the area of both ends of the connecting hose. The two-sided arrangement reduces the risk of incorrect assembly of the connecting hose. It is also possible for the corresponding vibration decoupling to extend over the entire length of the connecting hose, ie the entire connecting hose is designed, for example, as a corrugated hose or hose with a corrugated wall. Here, too, the risk of incorrect assembly is reduced.

If the section of the connecting line between the pump and the endoscopic instrument for vibration decoupling is not designed in one piece with a flexible connecting hose as part of this connection between the pump and the endoscopic instrument, e.g. H. rigid, is to be designed, the vibration decoupling can preferably be arranged between the connecting hose and the pump itself. However, it is also possible to arrange the vibration decoupling at a different point, so that it is connected to a flexible connecting hose on each side, for example.

It is preferred if the vibration decoupling is arranged so close to the end of the connecting line that the vibration decoupling is free-floating when the pump is properly installed. "Floating" in this context means that the vibration decoupling is only connected to the subsequent elements of the connection between the pump and endoscopic instrument. In particular, the vibration decoupling should not touch or rest on any other component of the device for laser lithotripsy according to the invention, in order to ensure the best possible vibration reduction. The vibration decoupling is preferably arranged directly adjacent to the pump.

The section of the connecting line between the pump and the endoscopic instrument designed as a vibration decoupling preferably has a minimum internal diameter of 1.5 mm to 10 mm, more preferably 4 mm to 8 mm, more preferably 6 mm. The difference between the outside and inside diameters in this section is preferably 1 mm to 5 mm, the wall thickness in this section is preferably 1 mm to 3 mm, more preferably 2 mm. If the inside of the connection is smooth in this area, the depth of the indentations on the outside or the variation in wall thickness in this section is preferably 1 mm to 3 mm. The section designed as a vibrating element preferably has a length of 8 cm to 20 cm, more preferably a length of 9 cm to 15 cm, more preferably a length of 10 cm.

In the device for laser lithotripsy, the rinsing liquid supplied through the endoscopic instrument can preferably also be drained off again through the latter, for example through a separate drainage channel. The drained flushing liquid can then be collected in a collection container and then disposed of. However, it is also possible for the outflow of rinsing liquid via the endoscopic instrument to be regulated via an outflow pump connected to the endoscopic instrument. In this case, it is preferred if the connecting line between the endoscopic instrument and the discharge pump has a vibration decoupling according to the invention. To explain this vibration decoupling, reference is made to the above statements.

The invention also relates to a connecting element for the liquid-conducting connection of a pump for a rinsing liquid to an endoscopic instrument, the connecting element comprising a connecting line with vibration decoupling, the vibration decoupling being an at least section-wise configuration of the connecting line between the pump and the endoscopic element as a corrugated hose or hose with corrugated walls with a periodically changing diameter in the axial direction, the changing diameter being found both on the inside and on the outside of the connecting line. With such a connecting element, for example, already existing devices for laser lithotripsy according to the prior art can be retrofitted to a device according to the invention. For explanation, reference is made to the above statements.

• 1: ein erstes Ausführungsbeispiel einer erfindungsgemäßen Vorrichtung; und
• 2a-c: verschiedene Alternativen zur Ausführung der Vibrationsentkopplung der Vorrichtung aus 1.

The invention will now be described by way of example on the basis of advantageous embodiments with reference to the accompanying drawings. Show it:

• 1 : a first exemplary embodiment of a device according to the invention; and
• 2a-c : different alternatives for performing the vibration decoupling of the device 1 .

In 1 a device 1 according to the invention for laser lithotripsy of bladder stones is shown schematically. The device 1 comprises an endoscopic instrument 2 with a shaft 3 and an elongated rod-shaped optics 4 arranged therein.

The endoscopic instrument 2 is also designed for the supply and removal of rinsing liquid, for which purpose it has a supply channel 5 arranged in a ring around the optics 4 and a discharge channel 6 for rinsing liquid.

An optical fiber 7 is guided through the supply channel 5, the first end 8 of which is arranged in such a way that it can be guided through the endoscopic instrument 2 using the optics 4 to a bladder stone to be broken up. At the other, second end 9 of the optical fiber 7 there is a laser source 10 which is designed to introduce a laser pulse into the optical fiber 7 . The laser pulse introduced at the second end 9 emerges from the optical fiber 7 at the first end 8 and, if it is focused there on a bladder stone, can shatter it. The optical fiber 7 is arranged in the supply channel 5 and consequently the rinsing liquid conducted through the supply channel 5 flows around it.

A pump 11 is connected to the endoscopic instrument 2 and is used to introduce the rinsing liquid from a reservoir 12 into the supply channel 5 of the endoscopic instrument 2 . The discharge channel 6 is connected to a collection container 13 . During the use of the device 1 for laser lithotripsy, the rinsing liquid is pumped through the supply channel 5 of the endoscopic instrument into the body cavity in which the minimally invasive procedure is performed, in order to fill the body cavity and widen it so that the operating area and in particular the The stone to be broken up is clearly visible to the surgeon through the optics 4 . The rinsing liquid is fed in continuously to ensure a continuous flow of rinsing liquid. The drainage of the rinsing liquid takes place through the discharge channel 6 of the endoscopic element 2. Any tissue or blood that may have been severed and that got into the rinsing liquid is also discharged in the process. The used rinsing liquid is collected in the collection container 13 .

A connecting line 14 is provided between the pump 11 and the endoscopic instrument 2 , through which the rinsing liquid passes from the pump 11 to the endoscopic instrument 2 or into its supply channel 5 . So that the operator can move the endoscopic instrument 2 as freely as possible, the connecting line 14 is designed entirely or at least for the most part as a flexible connecting hose.

In order to avoid the transmission of vibrations from the pump 11 to the endoscopic instrument 2 and in particular the optical fiber 7 , the connecting line 14 has a vibration decoupling 15 . The vibration decoupling 15 can reduce vibrations that are transmitted from the pump 11 to the endoscopic instrument 2 or to the optical fiber 7 arranged therein, so that the targeting accuracy of the device is improved compared to a device without a corresponding vibration decoupling 15 . Depending on the configuration, the vibration decoupling 15 can reduce the vibrations that are transmitted directly via the connecting line 14 and/or the rinsing liquid located therein.

In 2a-c are different, preferred alternatives for the design of the vibration decoupling 15 from 1 shown.

As a vibration decoupling 15 is according 2a a section 16 which is formed in one piece with the connecting line 14 and has a diameter which changes periodically in the axial direction is provided. In the exemplary embodiment shown, the part of the connecting line 14 in which the vibration decoupling 15 is arranged is designed as a connecting hose.

Section 16 has the shape of a hose with corrugated walls, in which the diameter increases in an accordion-like manner, alternating linearly from an inner diameter 17 to an outer diameter 18 and then linearly decreases again, resulting in a triangularly changing diameter. The inside diameter 17 of this section 16 corresponds to the inside diameter of the remaining connecting line 14. The wall thickness in section 16 is constant.

The vibration decoupling 15 or the section 16 is near one end of the connecting line 14 and therefore in the inserted state - arranged immediately adjacent to the pump 11 - as shown. Due to the corresponding arrangement immediately adjacent to the pump 11, the vibration decoupling 15 is generally free-floating. Preferably, a vibration decoupling 15 or a corresponding section 16 according to 2a also be provided at the other end of the connecting line 14. This can reduce the risk of incorrect assembly, for example due to the wrong arrangement of the two ends of the connecting line.

In 2 B is a to 2a alternative embodiment of the vibration decoupling 15 shown. In this embodiment, the vibration decoupling 15 is designed as a corrugated pipe 19 with a diameter that changes in the axial direction in a corrugated manner. The corrugated tube 19 is at one end directly to the Pump 11, connected at its other end via a connector 20 to the rest of the connecting line 14, wherein the rest of the connecting line 14 can be designed in particular as a connecting hose.

The corrugated tube 19 is part of the connecting line 14 and thus forms a section 16 of the connecting line 14 with a diameter that changes periodically in the axial direction.

Similar to 2a indicates the corrugated pipe 19 2 B an inner diameter 17 and an outer diameter 18, the inner diameter 17 corresponding to the diameter of the rest of the connecting line 14. The wall thickness of the corrugated tube 19 is also constant in the area of its corrugated configuration.

In 2 B the vibration decoupling 15 is configured as a rigid corrugated pipe 19 . However, it is also possible to use a flexible corrugated hose instead of a corrugated pipe 19 .

In 2c a further embodiment variant for a vibration decoupling 15 is shown. The vibration decoupling 15 is designed as a tube 21 with a corrugated wall, which is connected on both sides to other parts of the connecting line 14, in particular to flexible connecting hoses. The vibration decoupling 15 is therefore - unlike in 2a and 2 B - Not located immediately next to the pump 11.

The tube 21 with a corrugated wall has a constant inside diameter 17, so that only the outside diameter 18 changes periodically in the axial direction. Here, too, the diameter is changed in the manner of an accordion, i. That is, the outer diameter 18 alternately increases linearly and then linearly decreases again, resulting in a triangular shape. The difference between the maximum and minimum outside diameter 18 is the depth 20 of the indentations visible on the outside of the tube 21 .

Due to the constant inner diameter 17, which essentially corresponds to the inner diameter of the rest of the connecting line 14, the flow resistance for the rinsing liquid can be compared to the embodiment variants according to FIG 2a and 2 B be reduced. However, in the variant according to 2c vibrations transmitted by the flushing liquid itself are less reduced.

The inside diameter 17 at the in 2a-c illustrated embodiment variants can be 6 mm, the difference between the inner and outer diameter 17, 18 can be 3 mm. In the variants according to 2a and 2 B the wall thickness can be 2 mm. The depth 19 of the indentations in the variant according to 2c is 3mm. The length of the sections 16 is preferably 10 cm in all illustrated embodiment variants.

It is of course possible to combine the individual aspects of the various in 2a-c to combine the embodiment variants shown in order to arrive at further embodiment variants according to the invention.

The connecting element according to the invention for the liquid-conducting connection of a pump 11 for a rinsing liquid with an endoscopic instrument 2 essentially corresponds to the connecting line 14 with vibration decoupling 15, as in connection with the device 1 based on FIG 1 and 2a-c is described. With a corresponding connecting element, already existing devices for laser lithotripsy according to the prior art can be converted into a device 1 according to the invention, as shown in 1 is shown to be retrofitted. For an explanation of the connecting element according to the invention, reference is made to the above statements.

Claims (7)

Device (1) for laser lithotripsy of bladder stones comprising a laser source (10) and an endoscopic instrument (2), wherein an optical fiber (7) is guided from the laser source through the endoscopic instrument (2) and using the endoscopic instrument (2) in front of the stone to be broken up can be positioned, the endoscopic instrument (2) also being designed to conduct a rinsing liquid and a pump (11) connected to the endoscopic instrument (2) via a liquid-conducting connecting line (14) for conveying the rinsing liquid through the endoscopic instrument (2 ) is provided, characterized in that the connecting line (14) between the pump (11) and endoscopic instrument (2) has a vibration decoupling (15), the vibration decoupling (15) being an at least sectional configuration of the connecting line (14) between the pump (11 ) and endoscopic element (2) as a corrugated hose or hose with handles lter wall with a periodically changing diameter in the axial direction, the changing diameter being found both on the inside and on the outside of the connecting line (14). device after claim 1 characterized in that the vibration decoupling (15) is formed in one piece with the connecting line (14). Device according to one of the preceding claims, characterized in that the vibration decoupling (15) is arranged so close to the end of the connecting line (14) that when the pump (11) is set up correctly, the vibration decoupling (15) is freely suspended. Device according to one of the preceding claims, characterized in that the section (16) of the connecting line (14) designed as a vibration decoupling (15) has an inside diameter of 1.5 mm to 10 mm, the difference between the outside and inside diameter in this section ( 16) is 1 mm to 5 mm, and/or the wall thickness in this section is 1 mm to 3 mm. Device according to one of the preceding claims, characterized in that the section (16) of the connecting line (14) designed as a vibration decoupling (15) has a length of 8 cm to 20 cm. Connecting element for the liquid-conducting connection of a pump (11) for a rinsing liquid to an endoscopic instrument (2), characterized in that the connecting element comprises a connecting line (14) with vibration decoupling (15), the vibration decoupling (15) being an at least section-wise configuration of the connecting line (14) between the pump (11) and the endoscopic element (2) as a corrugated hose or hose with a corrugated wall with a diameter that changes periodically in the axial direction, the changing diameter changing both on the inside and on the outside of the connecting line (14) finds. connecting element claim 6 , characterized in that the connecting line (14) according to one of claims 2 until 5 is designed.

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