DE102012204679A1 - System and method for monitoring an endoscopic procedure - Google Patents

Abstract

The invention relates to a system (1) for monitoring an endoscopic procedure, comprising an endoscopic instrument (2) with an endoscope shaft (3), a proximal rinsing solution inlet (4) and a used rinse solution proximal rinsing solution outlet (5) connected to the rinsing solution inlet Rinsing solution pump (10), and at least one with the rinsing solution outlet (5) connected collecting container (20, 30) for used rinse solution. The invention further relates to a corresponding method for monitoring an endoscopic procedure. The system (1) according to the invention is characterized in that a temperature sensor (21, 31, 32), by means of which the temperature of the used rinsing solution can be monitored or monitored, is arranged downstream of the rinsing solution outlet (5) in the direction of flow of the rinsing solution.

Description

The invention relates to a system for monitoring an endoscopic procedure comprising an endoscopic instrument having an endoscope shaft, a proximal irrigation solution inlet and a used irrigation solution proximal flush solution outlet, a irrigation solution pump connected to the irrigation solution inlet, and at least one used irrigation solution collection container connected to the irrigation solution outlet. The invention further relates to a corresponding method for monitoring an endoscopic procedure.

The invention particularly relates to such systems in which endoscopic interventions take place with rinsing solution entry into body cavities, as occurs in particular in HF surgery or endoscopic resections. In these cases, a flow of current at the endoscope tip, ie distal, for treatment, for example, for resection, used by body tissue and expanded the corresponding body cavity by means of a rinsing solution on the one hand and on the other hand ablated tissue with the rinsing fluid discharged from the body cavity. Thus, during the operation in monopolar or bipolar HF surgery or resection, for example a transurethral resection, a rinsing solution is permanently introduced via the endoscopic instrument and discharged again. The rinsing solution serves, on the one hand, in particular during transurethral resection, for filling and expanding the bladder and, on the other hand, for draining tissue and blood. Depending on the nature of the application, the rinse solution may be an isotonic or a hypotonic solution, for example saline or glycol. Before use, the rinse solution is prewarmed to approximately 37 ° C, ie normal body temperature. This ensures the best possible compatibility of the rinsing solution with the body of the patient to be operated on.

In HF surgery, a high-frequency alternating current generated by a high-frequency generator in a known monopolar or bipolar application technique is used to locally heat the treated tissue. The heating can be used to cauterize or cut tissue.

During the resection, a current flows through a wire loop, with which diseased tissue is removed layer by layer. Occurring bleeding are thereby electrically eroded or cauterized.

In the mentioned surgical procedures, it may happen that the rinsing solution heats up to a level that is beneficial for the patient due to the introduction of the HF voltage or the electrical current at the resectoscope. This can become a problem when temperature-sensitive areas, such as the urinary bladder, become highly heated. For the patient, this can have health consequences.

It is therefore an object of the present invention to provide a system and a method with which hazardous conditions in patients with RF surgery and electrical sections are avoided.

This object is achieved by a system for monitoring an endoscopic procedure comprising an endoscopic instrument with an endoscope shaft, a proximal irrigation solution inlet and a used irrigation solution proximal flush solution outlet, a irrigation solution pump connected to the irrigation solution inlet, and at least one used irrigation solution collection container connected to the irrigation solution outlet. dissolved, which is further developed in that in the flow direction of the rinsing solution behind the Spüllösungsauslass a temperature sensor is arranged, by means of which the temperature of the used rinse solution is monitored or monitored.

In endoscopic systems with permanent irrigation solution flow, the temperature of the used irrigation solution, ie the irrigation solution, which emerges from the body cavity through the outlet arranged proximally on the surgeon side, exits the body cavity and then checks whether it is hazardous to health Upper temperature limit has been exceeded or threatens to be exceeded. With this previously unavailable additional information, it is possible to avoid health-threatening conditions during an intervention

For this purpose, it is preferably additionally provided that a control or measuring unit is included, by means of which a warning signal is output or can be output when exceeding a predeterminable or predetermined upper temperature limit of the used rinsing solution and / or a preheating of the rinsing solution is reduced or reduced and / or Volume flow of the pumped rinse solution is increased or can be increased and / or a power of an RF generator is reduced or reduced. The upper limit of the temperature must be determined as a function of the organ affected by the procedure and the surgical technique. In response to such a temperature overshoot, a warning signal is preferably output so that the surgeon or surgeon can estimate whether the procedure needs to be stopped or interrupted, and / or the pre-heating of the rinse solution is reduced, so that the steady flow of rinse solution Temperature in the Operating field can be lowered within limits. An increase in the volume flow of the rinsing solution may additionally or alternatively be considered in order to dissipate excessively heated rinsing liquid and to replace it with cooler ones. However, this is also to be kept within the scope that the treated organ endures, as this is accompanied by a certain pressure increase in the organ, for example the bladder or the like. If the rinsing solution is actively aspirated, a greater increase in the volume flow is possible. As a quick-acting measure, the power of the HF generator can be lowered, so that the immediate source of heat input is attenuated.

In an advantageous embodiment, the temperature sensor is integrated in a sleeve, which is placed around a connected to the Spüllösungsauslass the endoscopic instrument tube or is laid or incorporated into a hose or hose adapter. A hose adapter is in particular a connector for hoses. The temperature sensor can also be cast in the hose. Alternatively or additionally, the temperature sensor may be designed as a radiation pyrometer. Both temperature sensor types can be used side by side or in combination. The temperature sensor may also be a temperature-dependent electrical resistance element.

Preferably, the temperature sensor is arranged on or in a collecting container for the used rinsing solution and / or in or on a closure of a collecting container.

The endoscopic instrument is preferably designed for performing HF procedures or as a resectoscope.

The object underlying the invention is also achieved by a method for monitoring an endoscopic procedure, in particular in a system according to the invention described above, wherein a rinsing solution is preheated and pumped by a rinsing solution pump through an endoscope shaft of an endoscopic instrument into a body cavity, wherein used rinsing solution the body cavity passes through the endoscope shaft to a proximal rinsing solution outlet and then into a collecting container, which is further developed by monitoring the temperature of the used rinsing solution in the direction of flow of the rinsing solution downstream of the proximal rinsing solution outlet.

With this monitoring, it is possible to detect when the temperature of the rinse solution in the treated body cavity exceeds a patient-tolerable upper temperature limit.

Preferably, the monitoring of the temperature of the used rinse solution comprises a contact measurement with a thermal sensor or a non-contact measurement by means of a radiation pyrometer. A radiation pyrometer measures the intensity profile of the heat radiation as a function of the radiation frequency or the radiation spectrum and allows a rapid measurement of the temperature. Such a measurement preferably takes place at a location where there is a direct view of the rinse solution flow. Alternatively, such a measurement can also take place in a collecting container for the rinsing solution. A direct contact measurement takes place, for example, on the hose or at the entrance to the collecting container for the used rinsing solution.

Advantageously, a warning is issued when a predetermined or predeterminable upper temperature limit of the rinsing solution is exceeded. This is to be selected depending on the tolerance of the treated organ as well as the surgical technique.

Additionally or alternatively, it is preferably provided that when a predetermined or predeterminable upper temperature limit of the rinse solution is exceeded, the preheating of the rinse solution is reduced and / or the volume flow of the pumped rinse solution is increased and / or a power of an RF generator is reduced. It is also possible to specify different upper temperature limits, at the exceeding of which, for example, more intensive warning signals are output or, for example, in addition to a warning signal, first a reduced heating of the rinsing solution and, with a further increase in the rinsing solution temperature, also an increase in the volume flow or vice versa. Even without the aforementioned measures, it is advantageously provided that when a first limit value is exceeded, a first warning is generated and when a second limit value is exceeded, an urgent warning is generated, whereas if, for example, a third limit value is exceeded, a direct termination must follow. The number and consequence of the corresponding threshold values and limit values can be expediently applied as a function of the case.

The features, properties and advantages mentioned with regard to the subject matter of the invention, that is to say the system according to the invention and the method according to the invention, also apply without restriction to the respective other subjects of the invention, which relate to one another.

Further features of the invention will become apparent from the description of embodiments according to the invention together with the claims and the accompanying drawings. Embodiments of the invention may satisfy individual features or a combination of several features.

The invention will be described below without limiting the general inventive concept using exemplary embodiments with reference to the drawing, reference being expressly made to the drawing with respect to all in the text unspecified details of the invention.

1 shows a schematic representation of a system according to the invention 1 with a resectoscope 2 , which may also be an endoscopic instrument operated with HF technology. The resectoscope 2 has an elongated endoscope shaft 3 on, at the distal tip not shown channels end and a not shown, traversed by electric current loop, which is used for ablation and cauterization of tissue in a body cavity. Corresponding channels serve, on the one hand, for introducing and removing rinsing solution and, on the other hand, inter alia for accommodating an optical system in order to keep an eye on the surgical field during the procedure.

A flushing solution pump 10 sucks through a hose 11 Rinsing solution, which is preheated to a temperature of 37 ° C, from a container, not shown, or other device and pumps it through a hose 12 into a stream 14 the fresh rinse solution to a rinse solution inlet 4 at the resectoscope 2 , Through the rinse solution inlet 4 the rinse solution enters a first channel in the endoscope shaft 3 and through the distal tip into the body cavity to be operated, for example a bladder or a prostate. Through a second channel in the endoscope shaft 3 The used rinse solution returns to the proximal part of the resectoscope 2 where they pass through a rinse solution outlet 5 into a stream 15 the used rinse solution exits. From there it reaches a collection container 20 . 30 , The current 14 the fresh rinse solution and the stream 15 the used rinse solution are each marked by solid lines.

In the flow direction of the rinse solution downstream of the rinse solution outlet 5 Several different possibilities of monitoring according to the invention are shown schematically. The current 15 The used rinse solution is therefore dashed at this point to represent that in a system 1 only one of the alternatives shown or several of the alternatives shown can be realized.

A first alternative is right below in 1 shown. It is a collection container 20 in its closure 22 a radiation pyrometer 21 is admitted. This looks, characterized by dashed lines, on an area of the surface of the rinsing solution already collected in the collecting container and detects its temperature. The field of view of the pyrometer 21 may also be directed to the incoming rinse solution. From the pyrometer 21 branches a signal line 41 . 40 off, back to the flushing pump 10 that leads into the in 1 is also designed as an evaluation unit or warning unit and can output a warning signal corresponding to the measured values when a temperature upper limit is exceeded. In addition, if necessary, the rinsing solution pump can, for example, cause a greater or lesser throughput of the rinsing solution, if it is necessary to displace excessively heated rinsing solution from the organ. Also, the device, not shown, from which the fresh rinse solution is obtained, be instructed to accomplish a stronger or weaker preheating of the rinse solution.

Furthermore, in 1 , below, an alternative container 30 with a thermosensor 31 at his lock 33 shown. This thermosensor 31 is in direct contact with the hose 16 putting the used rinse solution in the collection container 30 initiates. This thermosensor is also via a signal line 42 . 40 in a similar way with the flushing solution pump 10 or a corresponding control or warning device.

In a third alternative, the in 1 bottom left is located at a point on the hose 16 between the rinsing solution outlet on the resectoscope 2 and a non-illustrated collecting container a cuff sensor 32 , which cuffs around the hose 16 is wound, and which includes a corresponding thermal sensor. Also at this point, the temperature of the rinsing liquid can be measured and a signal line 43 . 40 be issued to the warning unit and optionally a control unit.

A warning may expediently directly to the flushing solution pump 10 , at the resectoscope 2 or dispensed on a separate device.

All mentioned features, including those of the drawing alone to be taken as well as individual features that are disclosed in combination with other features are considered alone and in combination as essential to the invention. Embodiments of the invention may be accomplished by individual features or a combination of several features.

LIST OF REFERENCE NUMBERS

1

 system

2

 resectoscope

3

 endoscope shaft

4

 Spüllösungseinlass

5

 Spüllösungsauslass

10

 rinse solvent pump

11, 12

 tube

14

 Stream of fresh rinse solution

15

 Stream of used rinse solution

16

 tube

20

 receptacle

21

 pyrometer

22

 shutter

30

 receptacle

31

 thermal sensor

32

 cuff sensor

33

 shutter

40-43

 signal line

Claims (10)

System ( 1 ) for monitoring an endoscopic procedure comprising an endoscopic instrument ( 2 ) with an endoscope shaft ( 3 ), a proximal rinse solution inlet ( 4 ) and a proximal rinse solution outlet ( 5 ) for used rinse solution, a rinse solution pump connected to the rinse solution inlet ( 10 ), and at least one with the flushing solution outlet ( 5 ) associated collecting container ( 20 . 30 ) for used rinsing solution, characterized in that in the flow direction of the rinsing solution behind the rinsing solution outlet ( 5 ) a temperature sensor ( 21 . 31 . 32 ) is arranged, by means of which the temperature of the used rinse solution is monitored or monitored. System ( 1 ) according to claim 1, characterized in that a control or measuring unit is included, by means of which a warning signal is output or can be output and / or a preheating of the rinsing solution is reduced or reduced when exceeding a predeterminable or predetermined upper temperature limit of the used rinsing solution and / or or the volume flow of the pumped rinse solution is increased or can be increased and / or a power of an HF generator is reduced or reduced. System ( 1 ) according to claim 1 or 2, characterized in that the temperature sensor ( 21 . 31 . 32 ) in a cuff ( 32 ) integrated with the flushing solution outlet ( 5 ) of the endoscopic instrument ( 2 ) connected hose ( 16 ) or is layable, or is incorporated in a hose or hose adapter. System ( 1 ) according to one of claims 1 to 3, characterized in that the temperature sensor ( 21 . 31 . 32 ) as a radiation pyrometer ( 21 ) is trained. System according to one of claims 1 to 4, characterized in that the temperature sensor ( 21 . 31 . 32 ) on or in a collecting container ( 20 . 30 ) for the used rinse solution and / or in or on a closure ( 22 . 33 ) of a collecting container ( 20 . 30 ) is arranged. System ( 1 ) according to one of claims 1 to 5, characterized in that the endoscopic instrument ( 2 ) is designed to carry out RF interventions or as a resectoscope. Method for monitoring an endoscopic procedure, in particular in a system ( 1 ) according to one of claims 1 to 6, wherein a rinsing solution preheated and by means of a flushing solution pump ( 10 ) through an endoscope shaft ( 3 ) of an endoscopic instrument ( 2 ) is pumped into a body cavity, wherein used rinse solution from the body cavity through the endoscope shaft ( 3 ) to a proximal rinse solution outlet ( 5 ) and then into a collecting container ( 20 . 30 ), characterized in that the temperature of the used rinsing solution in the direction of flow of the rinsing solution downstream of the proximal rinsing solution outlet ( 5 ) is monitored. A method according to claim 7, characterized in that the monitoring of the temperature of the used rinse solution, a contact measurement with a thermal sensor ( 31 . 32 ) or a contactless measurement by means of a radiation pyrometer ( 21 ). A method according to claim 7 or 8, characterized in that a warning is issued when a predetermined or predeterminable upper temperature limit of the rinse solution is exceeded. Method according to one of claims 7 to 9, characterized in that when exceeding a predetermined or predeterminable upper temperature limit of the rinsing solution, the preheating of the rinsing solution is reduced and / or the volume flow of the pumped rinse solution is increased and / or a power of an RF generator is reduced.

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