JPS6034436A - Apparatus for performing operation through urethra - Google Patents

Abstract

(57) [Summary] This bulletin contains application data before electronic filing, so abstract data is not recorded.

Description

DETAILED DESCRIPTION OF THE INVENTION The present invention is a device for transurethral surgery within the prostate region, comprising:
It has an external operating position and a guide tube for the transmission of a radiofrequency-supplied cutting snare or similar cutting member at the inner end, and advantageously also located inside the guide tube, for the operation. It relates to a type in which special optical devices for viewing and illuminating the position and a cleaning liquid guiding device are provided.

Devices of the above type with which transurethral surgery can be carried out are already known. This known device has a resection snare at the front end of a guide tube or resection shaft that can be inserted into the urethra, the snare surface being bent at approximately 90° transversely to the longitudinal axis of the guide tube. There, the anus is formed into a circular shape (approximately 1'). The snare can be pulled back from the spring-loaded front end position via an external handgrip.

In order to handle this device in practice, 4', If
It has been found that considerable skill and skill is required to avoid perforation of the lateral gland red during I-JJ removal. During operation, the snare must be reciprocated in a suitably measured manner relative to the organ cutting movement, and at the same time, the glandular tissue located somewhat further distal in the radial direction must be reciprocated. Requires pivoting or reversing movement to be able to reach the range. Finally, manual rotation must be performed about the longitudinal axis of the device in order to capture the glandular tissue that extensively surrounds the urethra. The operation of the device is difficult, since the individual movements have to be carried out in combination and in coordination with each other.

SUMMARY OF THE INVENTION It is therefore an object of the invention to provide a device of the type mentioned at the outset, which is improved, in particular simplified, and which can be operated safely, even without great skill, with at least a significantly reduced risk of perforation. there were.

In order to solve this problem, the present invention provides, in particular, that the cutting element to which the high-frequency waves are applied is constructed approximately rotationally symmetrically with respect to the longitudinal axis of the guide tube and is freely rotatable within said tube for a rotary cutting movement. I would like to suggest that you support me. In particular, due to the above-described configuration and arrangement of the cutting element, the actual cutting movement is carried out by continuous rotation of the cutting element, thereby eliminating the otherwise necessary dangerous combination of manual longitudinal reciprocation in the cutting process. Movement and guiding movements can be omitted. This means that lWj is significantly simplified and the operator can concentrate on other still necessary positioning movements.Moreover, the adjustment of the interlocking movements of n et al. can be further eliminated.

In one embodiment of the invention, the cutting member has at least one cutting bar, the cutting bar having a cutting face oriented generally in the longitudinal direction of the guide tube. Such cutting rings are easy to manufacture and can be adapted to specific requirements by varying the materials used or the strength of the materials.

In an advantageous embodiment of the invention, the guide tube or the like has an opening or a recess at its front open end in the area where the cutting element is located, and preferably has a viewing device. and the like, the exit pupil of which is directed approximately towards the recess in the front end region and optionally has an optical axis bent, for example, by approximately 12° relative to the longitudinal axis.

Therefore, there is a defined cutting range and a particularly good observation of said range is possible when the cutting/removal member rotates.

Advantageously, as a transmission device for the rotary movement from the outside to the resection section, a drive tube is preferably provided, which is mounted concentrically inside the guide tube, and at its front end there is an approximately diametrically arranged drive tube. The ends of a snare or the like are insulated and secured on at least one side. Such a transmission can be implemented with a simple construction.

As drive device for the rotational movement of the cutting element, a motor, for example an electric motor, is preferably used, such as a hydraulic motor, which is optionally driven at the same time by the cleaning liquid. Using a hydraulic motor eliminates the need for additional conductive wires for the drive motor and this also greatly simplifies construction.

Further embodiments of the invention are set out in the dependent claims.

The invention will now be described in detail with reference to the illustrated embodiments.

The device for transurethral surgery in the prostatic region (FIG. 1) primarily has a guide tube 3 that can be introduced into the urethra 2, which guide tubes I, I
Also known as the J shaft. The guide tube is provided at its outer end with a grip, an eyepiece 5 and connections 6 and 7 for the cleaning liquid and a connection 8 for the light source sump.

The actual cutting member 9 is at the forward end of the guide tube 3 and projects somewhat beyond that end. In the illustrated example, the cutout area 9
is configured as an ablation snare 10 whose snare surface is oriented generally in the longitudinal direction of the guide g3, as can be clearly seen in FIG. The cutting element 9 is constructed approximately rotationally symmetrically with respect to the longitudinal axis of the guide tube 3 and is rotatably supported within the guide tube. For this purpose, a drive tube 11 (FIGS. 2 and 3) is provided in the guide tube 3, which is supported concentrically on the skeleton, and at the forward end of the drive tube is provided approximately diametrically. The end of the cutting snare 10 is fixed within the insulator sleeve 12. The cutting snare 10 is supplied with a high-frequency current during cutting in a manner not shown in detail. In FIG. 3, a conductor line 13 which is guided insulated on at least one side and is located in the drive tube 11 is indicated by a dash-dotted line.

Particularly in the area of the grip, a connection member may also be provided for supplying a high-frequency current, in which case the transmission to the drive tube 11 rotating during the operation can be effected, for example, by a sliding contact or the like. You can go through things.

During surgery, irrigation fluid is supplied to the surgical site and withdrawn from there again. For this purpose two connections 6 and 7 are provided.
is helpful. By the way, in the surgical device 1 according to the invention, a hydraulic motor 14 is provided as an embodiment of the drive device for the guide tube 3 and thus for the circumcision member 9, which is preferably driven at the same time by the cleaning liquid. Besides being particularly simple in construction, this arrangement has the additional advantage that the surgical device does not have to be supplied with any other supply or drive medium, such as electric current, compressed air, etc. A particularly simple design of the drive device allows the entire surgical device 1 to be of reasonable size and light weight, and thus to be easy to operate.

Advantageously, the grip part is provided with a device 24. for adjusting the rotational speed of the cutting member 9. may be placed. The rotational speed of the cutting element 9 may be in the range from approximately 0.3 to 15 revolutions/second and is preferably for example 1.5 revolutions/second. The rotational speed of the rotor is also consistent with the cutting speed possible in radiofrequency ablation.

In FIG. 2, the cutting snare 1o is shown in two different rotational positions, the direction of rotation being indicated by the arrow Pf l
Indicated by Il. Moreover, the concentric arrangement of the guide tube 3 and of the drive v11 which rotates within it during the operation is also evident. Inside the drive tube 11, an optical device 16 is provided in the tube 15 for viewing and illuminating the surgical position. This optical device consists of an image transmission optical system arranged in the central part, as is known from endoscopes, and a light waveguide arranged in the peripheral part of the chamber for illuminating the surgical position. good.

From FIGS. 1 and 3, it can be seen that the guide tube 3 has a notch 1 with an open side periphery in the area of the front open end where the cutting member 9 is located.
It is clear that it has a value of 8. This recess 18 has specially defined cutting flanks so that the monitoring and guidance of the cutting or grinding part can be well monitored and also particularly well positioned. The exit pupil of the optical device 16 has an observation center approximately at the notch 18vc with respect to the notch.
It is adjusted to be. This is achieved in that the observation device has an observation optical axis bent, for example, by #y12° with respect to the longitudinal axis of the device. The axial length of the notch 18 is approximately 6-7 mm or more, in which case the outer curved portion 19 of the cutting snare still projects from the open end 17 of the guide tube. Therefore, excisional surgery 1
The length l of the free cut portion of 0 is, for example, 10 mmK (FIG. 3). The notch 18 is located somewhat in front of the front end of the drive tube 11 and is connected to the cutting snare lO.
It ends with Furthermore, in FIG. 3, it is possible to provide an insulator 20 at least in the region of the cutting snare 10, so that direct contact with the guide tube 3 is avoided in the event of possible bending of the snare 10. Guide tube 3
It is indicated by a dotted line inside.

By configuring the surgical device according to the invention with a resection member 9 that rotates and thus performs approximately one reversal movement, the actual resection action is carried out by rotation of the resection sleeve.
, - The male surgeon can concentrate on positioning. The combination of the linear movement of the resection snare and the rotational movement of the entire device that is continuously adjusted to the movement makes it difficult to measure the shape of the prostate, which was previously necessary. Trivial movements are now unnecessary. The very easy, possibly circular, pivoting movement of the device already produces a movement approximately adapted to the spherical nozzle shape of the protection element within the resection area. This greatly simplifies the operation of the surgical device. However, in one modified embodiment, only longitudinal movement of the snare is possible under certain conditions.
The cutting element 9 can also be mounted movably in the longitudinal direction.

Furthermore, it is also possible to make the cutting member visible from the guide tube 3 on its end side. Particularly in this case, the optical axis of the observation device is approximately parallel to the longitudinal axis of the device (0°
(optical axis).

In FIG. 1, the surgical device 1 is in the deployment position.

In this case, the front end 21 of the guide tube 3 is introduced together with the cutting element 9 into the interior of the prostate. In addition, a part of the bladder following the prostate gland is shown in the drawing. Inside the prostate, various resection areas are indicated by dashed lines, which are achieved by pivoting the entire surgical device 1 according to the double arrow Pf 2.

In addition, the cutting member 9 may optionally be constituted by a plurality of cutting snares that are mutually parallel in the direction of rotation.
You can leave it there. If necessary, a hollow cylindrical cutting body to which high frequency waves are supplied may be provided as the cutting part 9.

All the features shown in the specification, claims and drawings can constitute the subject matter of the invention individually or in any arbitrary combination with each other.

[Brief explanation of the drawing]

Fig. 1 is a side view of one embodiment of the device of the present invention in a working state, Fig. 2 is an enlarged sectional view of the same embodiment taken along the line ■-M in Fig. 3, and Fig. 3 is the same embodiment. FIG. 3... Guide tube, 9... Resection member, 10... Resection snare, 11... Drive tube, 14... Motor, 17
... open end, 18 ... notch, 20 ... insulator,
24...adjustment device

Claims (1)

[Claims] 1. A device for transurethral surgery in the prostate region, comprising an external operating position and a guide tube for transmission of a resection snare or similar resection force supplied with high frequency at the internal end. , and advantageously also located inside the guide tube,
special optical equipment for viewing and illuminating the surgical position;
In the type in which a cleaning liquid guide device is provided, the resection part benefit [9] to which high frequency is supplied is connected to the guide tube (3).
A device for transurethral surgery 2, characterized in that it is configured substantially rotationally symmetrically with respect to the longitudinal axis of the resection member ( 9) has at least one resection snare (10), the snare surface of the resection snare is a hollow guide v [3]
2. The device of claim 1, wherein the device is longitudinally oriented. δ, the guide tube [3] or the same type has a 1J cutout (18) with an opening at the periphery of almost the side surface in the area where the cutting member (9) is provided at the open end (17) on the Ail side. death,
It is also advantageous if the exit pupil of the observation device and the like extends approximately in the front end region towards the notch (18) and is optionally bent at an angle of, for example, approximately 12° to the longitudinal axis.
Claim 1 or 2, which has an optical axis of J〒
Apparatus described in section. 4-1 A concentrically supported drive tube (11) is provided inside the guide tube (3) as a transmission device for the rotational movement from the outside to the cutting member (9). Claims 1 to 3, characterized in that approximately diametrically at the front end of the device there is fixed an end of a lO or the like in an insulating manner on at least one side. The device described. ,5. the notch (18) of the guide tube (3) or the like extends approximately to the area of the fastening surface of the snare (10) or the same, and the tube section with the notch (18) is a shank of the full length of the snare; 6. A device according to any one of the claims 1 to 6, covering a snare (10) or the like with an insulated connecting end and advantageously a drive tube. It is connected to a conductive line guided inside the wall, the conductive line having at its outer end a connecting conductive line, preferably via a sliding contact. 7. The device according to claim 1, wherein the guide tube (3) has an inner insulator (20) at least in the area of the cutting member (9) or the like. 8. A device according to any one of paragraphs 1 to 6.8 A motor (14) is provided as a drive for the rotary movement of the cutting element (9), for example an electric motor, optionally a hydraulic motor simultaneously driven by the cleaning liquid. 9. The device according to claim 1, wherein the device comprises a cutting element (9) or A similar device for adjusting the rotational speed (
2) are arranged and the rotational speed of the cutting element (9) is approximately 0.3 to 15 revolutions/second, preferably 1.5 revolutions/second,
An apparatus according to any one of claims 1 to 8. 10. The guide tube (3) has a front, substantially end-side opening for the rip removal member (9), and the optical axis of the observation device (9) optionally extends substantially parallel to the longitudinal axis of the device; An apparatus according to any one of claims 1 to 9. 11. Device according to any one of claims 1 to 10, characterized in that the spacing member (9) is movably supported substantially in the longitudinal direction of the device.