DE102016011185A1 - System for shredding body tissue - Google Patents

Abstract

The invention relates to a system for mincing body tissue for use in minimally invasive surgical procedures. The system comprises a comminution element, comprising an at least partially conically tapering, tubular shaft, in the distal, cylindrical end region of which a comminution element to be operated by means of an actuator is arranged. The shank of the comminution element may be introduced into a complementarily configured, at least partially conical tube into a body cavity of a patient to comminute the tissue arising in the body cavity and removed from it by a surgical operation. The comminution instrument has a feed device which feeds the tissue to be comminuted to the comminution element. Further, the system may include a bag disposed between the tube and the shank of the shredding instrument.

Description

Technical area

The invention relates to a system for shredding body tissue, for example of organs or large parts thereof in a body cavity of a patient. Preferably, the invention relates to a system for mincing body tissue, which can be used in the context of minimally invasive surgical procedures.

State of the art

Minimally invasive surgical procedures (so-called "buttonhole" or "keyhole surgery") and the associated surgical instruments are known from the prior art, with the term "minimally invasive" designating the access route to the actual operating area. A minimally invasive procedure is a gentle and less burdensome surgical procedure with the least damage to the skin and soft tissues, in which normal body openings or several smaller access routes are used to gain access to the operating area. Since the beginning of the 1990s, the minimally invasive surgery of the abdomen, for example, for the removal of the gallbladder or to perform bowel surgery, has become standard practice. One of the advantages of minimally invasive surgery is the rapid recovery time compared with conventional surgical technique, as well as the more cosmetically favorable scar formation.

Particularly in the surgery of the abdominal cavity, even relatively large organ parts or entire organs in the abdominal cavity can be resected or removed and removed from it by means of minimally invasive procedures. The extractability of the respective organ parts and organs to be removed is limited by the size of the accesses (diameter 5 to max 20 mm).

The previous methods of intraoperative removal of organs are unsatisfactory surgically as well as with regard to the pathological examination of the removed tissue in many respects. Often, tissue pieces in the body cavity are minced using a shredder and the tissue remnants are removed mechanically with laparoscopic forceps. It can be injured in a crushing in particular under limited viewing conditions on the one hand, the surrounding, intact tissue, on the other hand, it can cause the scattering of tissue residues, eg. As well as tumor cells, come into the body cavity.

US 5,735,289 discloses a device for retrieving a sample as part of a minimally invasive surgical procedure, the device comprising a bag with a grid-shaped element arranged therein for comminuting the sample. In order to avoid injury to the bag during the shredding process, it comprises an inflatable element or spring element which holds the bag in a deployed position.

In the US 2014/0276913 A1 For example, a surgical device recovery device comprising a tissue container and a compression device is described. By means of the compression device, the container with the tissue contained therein can be compressed such that it allows at least in terms of its size, size, shape or volume, the passage of the tissue contained therein from the body cavity, either via a natural body opening or a surgical approach, in particular via a trocar tube.

Medical baskets that can be moved from an elongated tubular receptacle to an open position and retracted into the receptacle to a closed position are well known in the art (see DE 4212430 A1 ; US 2014/0276913 A1 ).

The aforementioned devices have the disadvantage that in the context of a minimally invasive surgical procedure, large or very large organs or organ parts can not be removed from the corresponding body cavity of a patient via the existing surgical approaches without having to enlarge them. Furthermore, there is the disadvantage in the known, introduced into the body cavity for crushing these tissues crushing instruments that under restricted viewing conditions on the one hand for the surrounding tissue and on the other hand for an inserted bag for receiving the tissue a significant risk of injury exists. For example, tissue containment devices comprised of activated wires deployed from a tubular shank of a mincing instrument for shredding may severely damage both a tissue bag and surrounding organs. In addition, existing bags for recovering organs or organ parts are often constructed very expensive.

The object of the present invention is to provide a simply constructed and effective system for shredding body tissue, which does not have the disadvantages of the prior art.

Description of the invention

In a first aspect, the invention relates to a system for mincing body tissue. The system includes a shredding instrument having an at least partially tapered tubular shaft having a cylindrical distal end portion. The shaft is insertable into a body cavity of a patient through an at least partially conical tube, wherein the tissue to be shredded is located in the body cavity. In the distal end portion of the shaft, a crushing element is arranged. In the proximal end region of the shaft, an actuator for actuating the comminution element is arranged. The comminution instrument has a feed device which feeds the tissue to be comminuted to the comminution element.

The shredding instrument can be introduced into the body cavity via a tube, for example the tube of a trocar connected to the patient, and brought into the vicinity of the tissue / organ to be shredded. For example, the mincing instrument can be introduced into the abdominal cavity via a trocar tube connected to the abdominal wall of a patient, or into the thorax via a trocar tube connected to the chest wall. A trocar refers to a medical device, which consists of an obturator (metal or plastic +/- cutting tip), a tube (a tube) and a seal. Since both the tube connected to the patient via the body wall and the shank of the comminuting instrument have an at least partially conical shape, the at least partially conical shape of the tube being preferably complementary to the at least partially conical shape of the shaft, it is possible to interpose between the Tubus and the shank of the crushing instrument in use a positive connection can be formed. The tissue can be selectively comminuted in the distally disposed, cylindrical end region of the shaft by means of the comminuting element after actuation of the actuator arranged in the proximal end region of the shaft. In this case, the term "distal" designates the side which is remote from the user of the system according to the invention; accordingly, the term "proximal" refers to the closer side facing the user. The term "actuator" refers to a device which has a physical input z. As an electrical voltage, in a different output, z. As a mechanical signal, can convert. Conventional actuators are well known to those skilled in the art; These actuators work hydraulically, pneumatically or electromechanically. Newer devices use magneto or electrostriction or piezoelectricity. Due to the arrangement of the comminution element in the cylindrical end region of the shaft, the shaft acts as a protective cover. The risk of injury to the surrounding tissue is significantly reduced by this protective effect; For example, comminution of the tissue can still be carried out safely even under limited visibility conditions. By means of the system according to the invention, moreover, the tissue to be shredded can preferably be comminuted continuously in the cylindrical end region by feeding the tissue to be comminuted to the comminuting element through the supply device. Because of feeding by a feeder, the crushing can take place within the tubular interior of the shaft, which in turn significantly reduces the likelihood of damaging the surrounding tissue during crushing.

In a preferred embodiment, the system additionally comprises a pouch for receiving tissue to be shredded, wherein the pouch is fixable between the tapered tube and the tapered shaft. A bag is understood to be a hollow, thin-walled, easily deformable object which is suitable for receiving other objects, with an opening through which it can be filled and emptied. The bag according to the invention consists of a flexible and liquid-impermeable material, is tear-resistant and has a closable opening. The bag may be inserted into the body cavity containing the tissue to be dissected, such as the abdominal cavity or the thorax via the tube connected to the patient. In the body cavity, the tissue can be placed in the pouch using a suitable instrument, such as a grasper or clamp. Before the tissue is shredded, the mouth of the pouch is withdrawn from the body cavity via the tube; then the shredding instrument is inserted through the opening of the bag into the tapered tube such that the bag is firmly fixed between the tapered tube and the tapered shank of the shredding instrument. The fixed fixation can be carried out in the manner of a sealed fixation, which optionally allows inflation of the bag fixed between the tube and the shaft, in order to define a working area for the comminution. When shredding tissue within a pouch, the shredded tissue can be advantageously collected in the pouch. The tissue residues resulting from the morcellation of organs under normal conditions also remain in the bag; Under Morzellierung thereby the operational dismemberment of a difficult to remove as a whole structure, z. B. a whole organ or a large organ part understood. By the Recording the tissue residue in the bag is thus their distribution in the body cavity, z. B. in the abdomen, completely avoided. This is particularly important if the tissue to be shredded must be completely removed, and preferably without coming into contact with surrounding tissue, for example because of any tumor cells contained therein. With the system according to the invention, the tissue to be shredded can advantageously also be comminuted within the bag without or with limited vision, because by the storage of the comminuting element within the cylindrical end region of the shaft acting as a protective sleeve and because of the targeted supply of the tissue to be comminuted to the comminution element the feeding device prevents the bag from getting into the feed zone of the comminution element.

In a further preferred embodiment of the system according to the invention, the feeding device can be designed as a medical catching basket made of a plurality of basket wires. Medical collecting baskets, which can be moved out of an elongated, usually tubular receptacle into an open position and retracted into the receptacle in a closed position, are known from the prior art. According to the invention, the tissue to be shredded can be inserted into the collecting basket, for. B. via an additional gripping or clamping instrument. Alternatively, the tissue in question can also be enclosed by the collecting basket. In particular, in the latter embodiment, there is only a slight risk of injury to be shredded tissue by the feeder or optionally additional gripping or clamping instruments. The designed as a medical catcher feeder can be designed as a distal (away from the cylindrical end portion of the shaft) closed basket, or as distally opened basket, wherein the basket is reduced in both cases to train. With the basket, the tissue to be shredded z. B. only partially seized and the remaining tissue to be reoriented after a first crushing process. By means of the feed device designed as a catcher basket, the tissue to be shredded can be pushed comfortably in the direction of the comminution element located in the distal cylindrical end region of the shaft, so that even larger organs or organ parts can preferably be continuously comminuted.

In a further embodiment, the shaft may be formed with a plurality of guide sleeves for receiving the plurality of basket wires. In this case, a guide sleeve is understood to mean a tubular, elongated, solid casing which, in the present case, is adapted to partially accommodate a wicker wire and to enclose it largely firmly. On the number, the arrangement and the dimensioning of the basket wires, the dimensioning of the collecting basket can be adapted to a variety of areas of operation. This is particularly advantageous for shredding instruments intended for single use. In particular, different tissue or organ weights can be taken into account, as occur, for example, in a cholecystectomy, an appendectomy, or a hysterectomy. Advantageously, the basket wires can be aligned by means of the guide sleeves so that they run substantially parallel to the longitudinal axis of the collecting basket when the collecting basket is in an open position. This arrangement is particularly preferred in a case when distally closed in the open state. Alternatively, the basket wires may be aligned by the guide sleeves so that they extend substantially distally in a radial direction away from the longitudinal axis of the collecting basket when the collecting basket is in an open position; Accordingly, this arrangement is particularly preferred in a opened in the open state to the distal open catcher.

In a preferred embodiment of the system according to the invention, the guide sleeves are arranged on a lateral side of the shaft. The term "lateral" refers to an arrangement in which the guide sleeves are arranged with respect to the tubular interior of the shaft on the side facing away from the interior of the shaft. Advantageously, a lateral arrangement of the guide sleeves ensures the least possible interference of the basket wires and guide sleeves with the comminution element arranged in the cylindrical end region of the shaft: the cylindrical end region develops a stopping action when the inner fabric catcher is guided in the direction of the comminuting element, and prevents that the catcher is fed to the crushing element. A tight abutment of the shaft on the wall of the conically tapering tube or on the bag arranged between the tube and the shaft is ensured in laterally arranged guide sleeves z. B. by known compression or expansion mechanisms with which the compression / expansion of the shaft can be achieved (spring mechanism, basket mechanism, SMA, etc.). Alternatively, the plurality of guide sleeves can be arranged in the wall of the shaft, such that the basket wires can be guided at least in sections in the wall of the shaft.

In a further preferred embodiment of the system according to the invention, the guide sleeves are on a medial side of the shaft arranged. The distal end portion of the shaft may have a catch for positioning the catcher distal to the comminution element. The term "medial" refers to an arrangement in which the guide sleeves are arranged on the interior of the side facing the shaft. Since the feeding device designed as a collecting basket leads the tissue to be shredded in the direction of the comminution element, comminution of the supply device by the comminution element at the end of the comminution process must be avoided, because this, for example, makes the histological examination of the comminuted tissue more difficult. The shaft may be formed with a detent for this purpose, wherein a detent means a mechanical device for detecting moving parts. For example, the shaft can be provided with a detent, a circlip or a securing bolt, so that the catcher is positioned at full retraction distal of the comminution element.

In a preferred embodiment, the shaft is formed with 6 to 8 guide sleeves. About this number of guide sleeves, a corresponding number of basket wires to form a catcher can be performed, which allows the inclusion of a variety of different sized organs or organ parts. The tissue to be shredded can be safely stored without dislocation (not falling back into the body cavity). A simple handling of the crushing instrument is guaranteed.

In a further preferred embodiment, the feeding device is movable. For example, the basket wires may be connected via a mechanical or electromechanical train with an arranged at the proximal end of the shaft actuator over which the basket wires are movable after the deployment of the collecting basket in the direction of the tubular shaft and the crushing element. Different sized organs or organ parts can be supplied to the comminution element by the necessary force is amplified during uniform pulling on the individual elements of the collecting basket by a corresponding reduction. Corresponding operations are known from the prior art. The actuation can be designed, for example, as a lever mechanism, system of communicating rollers, or as a gear mechanism. Advantageously, the actuation may allow for continuous feeding of the fabric to be shredded to the comminution element.

In a preferred embodiment, the comminution element is designed as an electrical comminution element. Such electrical comminution elements are known from the prior art; For example, the crushing element may be a high frequency morcellator. Such a morcellator may, for example, comprise a rotating electrode which forms a resistance with respect to an electric current flowing through it and is thereby heated. By heating the tissue is gently cut. By means of an electrical comminuting element, tissue can be comminuted particularly completely and without residue.

In a preferred development, the comminution element is designed as a mechanical comminution element, for example comprising a rotating cutting edge or a system consisting of a rotating cutting disc in combination with a perforated disc. Preferably, the cutting edges can be changed intraoperatively. By means of the mechanical reduction element, tissue can be cut particularly efficiently.

In another embodiment, the comminution element is disposed in the distal half of the distal, cylindrical end portion of the shaft, preferably 10-30 mm, more preferably 20 mm from the distal edge of the shaft. An arrangement in the distal half excellently ensures the function of the distal, cylindrical end portion of the shaft as a protective sheath for the crushing element. The arrangement of the comminution element more or less distally in the cylindrical end region can be adapted to the respective operating area with the respective tissue to be comminuted. Furthermore, the risk of injury to surrounding tissue or a bag introduced significantly reduced.

Brief description of the figures

Hereinafter, by way of example and not limitation, certain particular embodiments of the invention will be described with reference to the accompanying drawings. The particular embodiments are merely illustrative of the general inventive concept, but do not limit the invention.

1 shows a cross section through the inventive system for mincing body tissue.

2 shows a plan view (left column) on the distal end portion of the crushing instrument from the distal and a cross section thereof (right column). It is in 2A an embodiment with medially arranged guide sleeves of the feeder, and in 2 B an embodiment with laterally arranged guide sleeves shown.

Preferred embodiment of the invention

1 shows a system for mincing body tissue according to the present invention.

The shredding instrument ( 1 ) is via a tube ( 2 ), preferably a trocar tube, which is connected to a body surface of a patient ( 3a ), into a body cavity ( 3 ) introduced; For example, the trocar tube may be connected to the abdominal wall of the patient and the feeding of the crushing instrument ( 1 ) into the abdominal cavity. The tube ( 2 ) converges distally at least partially conically, corresponding to which is the comminuting instrument ( 1 ) with an at least partially tapered, tubular shaft ( 4 ) which has a cylindrical end region at its distal end ( 5 ). In this end area ( 5 ) is in the distal or in the proximal half a crushing element ( 6 ) arranged. At the proximal end region of the shaft ( 4 ) there is an actuator ( 7 ; Symbol) for actuating the comminution element ( 6 ). To the shredded tissue the crushing element ( 6 ), the crushing instrument ( 1 ) a feeding device ( 8th ), which, for example, as a medical catcher ( 9 ) may be formed. Over a defined number of in corresponding guide sleeves ( 10 ) extending basket wires ( 11 ), a catcher ( 9 ), in which the tissue to be shredded, for example, via a gripping device / clamping device can be inserted. The corresponding device for insertion can be introduced, for example via a further access in the body cavity of a patient. The feeder ( 8th ) is movable, ie an actuation ( 12 ) of the feeder, the basket wires ( 11 ) move from a closed position to an open position adapted to receive tissue; Furthermore, the feeder ( 8th ) in the direction of the crushing element ( 6 ), whereby a continuous or, if necessary, discontinuous comminution of the corresponding fabric by means of the comminution element ( 6 ) is effected. In the present case, the medical catcher ( 9 ) formed as distally closed basket, wherein the basket wires ( 11 ) on the medial side of the shaft ( 4 ) at least partially in corresponding guide sleeves ( 10 ). Between the tapered shaft ( 4 ) and the tapered tube ( 2 ) is a bag ( 14 ) firmly fixed. The feeding device ( 8th ) with the inner tissue enclosing bags ( 14 ) completely prevents the scattering of fabric remnants during comminution of tissue in the body cavity of the patient.

2 shows a plan view of distally on the distal end portion of the crushing instrument (left) and a cross section thereof (right). In 2A is the feeder ( 8th ) with guide sleeves ( 10 ) on the medial side of the shaft ( 4 ) arranged. Here is a lock ( 13 ) in the cylindrical end region ( 5 ) arranged so that the catcher ( 9 ) relative to the comminution element ( 6 ) is positionable. The lock ( 13 ) prevents the shredding of the grass catcher ( 9 ) by the crushing element ( 6 ) at the end of the comminution process. A corresponding representation of the delivery device ( 8th ) with on the lateral side of the shaft ( 4 ) arranged guide sleeves ( 10 ) can be found in 2 B , Since the catcher ( 9 ) when retracting automatically at the end of the shaft ( 4 ) is stopped, in this embodiment, no additional locking is necessary, the crushing of the collecting basket by the crushing element ( 6 ) must prevent.

LIST OF REFERENCE NUMBERS

1

crushing instrument

2

tube

3

Body cavity of a patient

3a

Body surface of a patient

4

Shank of the crushing instrument

5

cylindrical end region

6

crushing member

7

actuator

8th

feeder

9

catcher

10

guide sleeve

11

basket wire

12

Operation of the feeder

13

lock

14

bag

QUOTES INCLUDE IN THE DESCRIPTION

This list of the documents listed by the applicant has been generated automatically and is included solely for the better information of the reader. The list is not part of the German patent or utility model application. The DPMA assumes no liability for any errors or omissions.

Cited patent literature

• US 5735289 [0005]
• US 2014/0276913 A1 [0006, 0007]
• DE 4212430 A1 [0007]

Claims (11)

System for shredding body tissue, comprising a shredding instrument ( 1 ) with an at least partially tapered, tubular shaft ( 4 ) having a cylindrical, distal end portion ( 5 ), one in the distal end region ( 5 ) of the shaft ( 4 ) arranged crushing element ( 6 ), an actuator disposed in the proximal end region of the shaft ( 7 ) for actuating the comminuting element ( 6 ), wherein the shaft by an at least partially conical tube ( 2 ) into a body cavity of a patient ( 3 ) is insertable with tissue to be shredded, and wherein the comminution instrument ( 1 ) a feeding device ( 8th ), the tissue to be shredded the crushing element ( 6 ) feeds. System for shredding body tissue according to claim 1, additionally comprising a bag ( 14 ) for receiving tissue to be shredded, the bag ( 14 ) between the at least partially conical tube ( 2 ) and the at least partially conical shaft ( 4 ) is fixable. A system for shredding body tissue according to one of claims 1 or 2, wherein the delivery device ( 8th ) as a medical catcher ( 9 ) of a plurality of basket wires ( 11 ) is trained. A body tissue shredding system according to claim 3, wherein said stem ( 4 ) with a plurality of guide sleeves ( 6 ) for receiving the plurality of basket wires ( 10 ) is trained. System for shredding body tissue according to claim 4, wherein the guide sleeves ( 10 ) on a lateral side of the shaft ( 4 ) are arranged. System for shredding body tissue according to claim 4, wherein the guide sleeves ( 10 ) on a medial side of the shaft ( 4 ) are arranged and the distal cylindrical end portion ( 5 ) of the shaft ( 4 ) a lock ( 13 ) for positioning the collecting basket ( 9 ) distal to the comminution element ( 6 ). System for shredding body tissue according to one of claims 4 to 6, wherein the shaft is provided with 6 to 8 guide sleeves ( 10 ) is trained. A tissue shredding system according to claim 3, wherein the delivery device ( 8th ) is movable. System for shredding body tissue according to one of the preceding claims, wherein the comminution element ( 6 ) as an electrical comminuting element ( 6 ) is trained. System for shredding body tissue according to one of the preceding claims, wherein the comminution element ( 6 ) is designed as a rotating blade or as a system with rotating cutting and perforated disc. System for shredding body tissue according to one of the preceding claims, wherein the comminution element ( 6 ) in the distal half of the distal, cylindrical end portion of the shaft ( 4 ), preferably 10-30 mm, more preferably 20 mm from the distal edge of the shaft ( 4 ) spaced.

Images