DE202020104255U1 - Device for removing raised cell tissue, in particular tumors - Google Patents

Abstract

Device (10) for removing masses located within the bloodstream from raised cell tissue (46),
with a cannula (12) which has a distal end (14) and a proximal end (38),
with a closing tube (16) which can be displaced in the cannula (12) and has a distal end (22) and a proximal end (40),
with a first cord (18), which is displaceable in the closure tube (16) and forms a first loop (24) at the distal end (22) of the closure tube, with a collection bag (28) on the first loop (24) for placement over a tumor (46 ) is attached,
with a second cord (20) which is displaceable in the closing tube (16) and which forms a second loop (26) at the distal end (22) of the closing tube (16) and which can be laid around the tumor (46) at least in sections, the arrangement being such that the closing tube (16) can be displaced in the distal direction relative to the first and / or second cord (18, 20) in order to tighten the first and / or second loop (24, 26).

Description

The invention relates to a device for removing masses from raised cell tissue, such as tumors, and in particular myxomas, polyps, infected conglomerates, deposits, blood clots or thrombi, located within the blood circulation, i.e. the vessels and the heart.

Myxomas are rare, benign tumors that have only a sparse vascular supply and contain spindle-shaped, fibroblastic cells. Myxomas form in particular in the left atrium and can lead to cardiac arrhythmias or blood clots or, through embolization, to dangerous arterial vascular occlusions, some of which can lead to serious secondary diseases. However, myxomas can also form in the skin, breast, nerve tissue or thyroid gland.

To remove myxomas and intracardiac masses, it is known to carry out an operation with the aid of the heart-lung machine on the open heart in order to remove the myxoma or otherwise pathologically altered tissue in accordance with the tissue present.

Devices for removing and collecting tumors, polyps or myxomas are for example from the EP 2 085 045 B1 , the U.S. 5,486,182 or the WO 99/53851 known.

The present invention is based on the object of providing a device for removing, in particular, raised masses with which, on the one hand, a safe separation of the cell tissue and, on the other hand, a safe removal of the separated cell tissue as a whole and without losses is possible. In particular, it should be ensured that there is no carryover of separated particles into the bloodstream and thus a risk of embolization and vascular occlusion.

The object is achieved by a device for removing cell tissue with the features of claim 1.

Such a device provides in particular a cannula which has a distal end and a proximal end. The device also provides a closing tube which can be displaced in the cannula and has a distal end and a proximal end. Furthermore, a first displaceable first cord, which is provided in the sealing tube and forms a first loop at the distal end of the sealing tube, is attached to the first loop with a collection bag for placing over the tumor and for catching the removed tumor. A further displaceable second cord, which forms a second loop at the distal end of the closing tube, is provided in the closing tube, the second loop being provided in particular in the area within the first loop and being able to be placed at least in sections around the tumor, and in particular around a tumor neck. The arrangement of the cannula, closing tube, first cord and second cord is such that the closing tube can be displaced in the distal direction relative to the first and / or second cord in order to tighten the first and / or second loop.

The arrangement therefore has the advantage that the first and second loops can initially be placed around the tumor, and that the first and / or the second loop can then be closed at least largely by moving the closing tube. This has the effect that the closing tube is moved in the distal direction in order to tighten the loops and that the distal end of the respective loop does not change its relative position when the loop is tightened. As a result, the cell tissue to be removed, and in particular a myxoma, can be securely enclosed by the loops, and when the loop is tightened, it can be achieved that the cell tissue remains within the loops and thus also within the collecting bag.

The first and / or second cord are preferably designed like a wire. You can consist of an alloy, and in particular of a shape memory alloy such as NiTiNol. However, it is also conceivable that the cords are formed from a suitable plastic. The collection bag as such can in particular be designed in the manner of a net or mesh and, for example, have the structure of a stent. The collection bag can also be made of a suitable alloy, and in particular a shape memory alloy, or it can be formed from a plastic.

It is also advantageous if the cords are arranged displaceably independently of one another in the closing tube, so that the first and second loops can be drawn in the proximal direction independently of one another. This has the advantage that the loops, and thus also the collection bag, can be drawn closed on the one hand by moving the closing tube distally and on the other hand by moving the respective cord proximally. Due to such a tightening it can be ensured that a cell tissue enclosed by the loops or by the collecting bag, and in particular a myxoma, remains within the loops during the tightening process.

In order to enable a secure tightening of the respective loop, it can be provided that the ends of the first and / or second cord facing away from the respective loop at the proximal end of the cannula can be displaced relative to the closing tube by means of an actuating device. The actuating device can consequently be arranged in particular at the proximal end of the cannula or also formed by this in order to move the cords, and thus the loops, in the proximal and distal directions. The actuating device can be driven by a motor or can be actuated manually.

Correspondingly, it is conceivable that the proximal end of the closing tube is arranged to be displaceable in the cannula relative to the cannula by means of an actuating device. This actuating device can also be motor-driven or manually operable. It is also conceivable that a common actuating device is provided, which moves on the one hand the cords and on the other hand the closing tube, each independently of one another, relative to the cannula.

A further advantageous embodiment provides that a cutting edge is provided at the distal end of the closing tube, with which the second loop interacts when the second loop is pulled shut to cut off the tumor. By means of the second loop, a safe separation of the tumor can be achieved in a simple manner, with the first loop being able to ensure a safe collection of the tumor by means of the collecting bag after separation.

Furthermore, it has been found to be advantageous if the diameter d _{1 of} the first cord is greater than the diameter d _{2 of} the second cord, in particular the ratio of the diameter d ₁ to the diameter d ₂ in the range of 1: 0.25 and more preferably in area 1 : 0.5 and more preferably in the range of 1: 0.75. It can thereby be achieved that the first cord defines the shape and position of the second cord; In particular, it can be achieved that the second loop follows the shape and position of the first loop.

According to a further development of the invention, it is conceivable that the collecting bag has a proximal end section which faces away from the first loop and which is fastened in the region of the distal end of the cannula. This ensures that the collecting bag is unfolded safely, in particular when the first loop is moved away from the cannula in the distal direction.

Furthermore, it has proven to be advantageous if the device is designed in such a way that the first loop, the second loop and the collecting bag can assume an insertion position within the distal end of the cannula. In this insertion position it is conceivable to bring the distal end of the cannula through a maneuvering catheter to the intended location in the body. At the intended location, the collecting bag can then be unfolded by moving the first and second cord in the distal direction and placed over the tumor to be removed.

• - Einführen des distalen Endes der Kanüle in den Körper an die Stelle, wo der Tumor entfernt werden soll,
• - Bewegen der ersten und zweiten Schnur in distaler Richtung, so dass die erste und zweite Schlaufe vergrößert werden und sich der Fangsack entfaltet,
• - Platzieren der der ersten und der zweiten Schlaufe um den Tumor,
• - Zuziehen der ersten und zweiten Schlaufe, und zwar
  • - durch Bewegen des Schließschlauches in distaler Richtung, und/oder
  • - durch Bewegen der ersten und/oder zweiten Schnur in proximaler Richtung,
• - Abtrennen des Tumors durch weiteres Bewegen der zweiten Schnur in proximaler Richtung und/oder durch Bewegen des Schließschlauches in distaler Richtung,
• - Schließen des Fangsacks durch weiteres Bewegen der ersten Schnur in proximaler Richtung und/oder durch Bewegen des Schließschlauches in distaler Richtung, und
• - Entfernen der Kanüle samt Schließschlauch und dem im Fangsack gefangenen Tumor.

The device according to the invention can be used as follows:

• - inserting the distal end of the cannula into the body where the tumor is to be removed,
• - moving the first and second cord in the distal direction so that the first and second loops are enlarged and the collection bag unfolds,
• - placing the first and second loops around the tumor,
• - Tightening the first and second loops, namely
  • - by moving the closing tube in the distal direction, and / or
  • - by moving the first and / or second cord in the proximal direction,
• - Separating the tumor by moving the second cord further in the proximal direction and / or by moving the closing tube in the distal direction,
• - Closing the collecting bag by moving the first cord further in the proximal direction and / or by moving the closing tube in the distal direction, and
• - Remove the cannula including the closing tube and the tumor trapped in the collecting bag.

As a result, a cell tissue, and in particular a myxoma, can be removed in a simple and safe manner. In particular, when a cutting edge is provided at the distal end of the closing tube, the tumor can be separated in a simple manner by pulling the second loop closed.

Further details and advantageous embodiments of the invention can be found in the following description, on the basis of which exemplary embodiments of the invention are described and explained in more detail.

• 1 eine erfindungsgemäße Vorrichtung mit weit geöffneter erster und zweiter Schlaufe;
• 2 die Vorrichtung gemäß 1 mit weitgehend verschlossenem Fangsack;
• 3 eine schematische Darstellung der Vorrichtung gemäß 1 in einer Einführlage;
• 4 die Darstellung gemäß 3 mit in distaler Richtung bewegten Schlaufen;
• 5 einen vergrößerten Ausschnitt des distalen Endes der Kanüle in 4;
• 6 eine Draufsicht auf die Ausführungsform gemäß 5 mit einem zu entfernenden Tumor;
• 7 die in 6 dargestellte Ansicht in Seitenansicht; und
• 8 die in den 6 und 7 dargestellte Ausführungsform nach dem Abtrennen des Tumors.

Show it:

• 1 a device according to the invention with a wide open first and second loop;
• 2 the device according to 1 with largely closed collection bag;
• 3 a schematic representation of the device according to 1 in an insertion position;
• 4th the representation according to 3 with loops moved in the distal direction;
• 5 an enlarged section of the distal end of the cannula in 4th ;
• 6th a plan view of the embodiment according to 5 with a tumor to be removed;
• 7th in the 6th shown view in side view; and
• 8th those in the 6th and 7th The embodiment shown after the tumor has been severed.

In the 1 and 2 is a device 10 shown for removing cell tissue such as tumors and particularly for removing myxomas. The device 10 has a cannula 12th on whose distal end 14th in the 1 and 2 is shown. Inside the cannula 12th is a closing tube 16 arranged displaceably. Inside the closing tube 16 are two strings 18th and 20th provided, which are designed as wires. Both cords 18th , 20th emerge from the distal end 22nd of the closing tube 16 out and each form a loop 24 and 26th . On the one of the string 18th formed first loop 24 is a collecting bag 28 , the one from the loop 24 formed opening 30th having. That of the opening 30th distant, proximal end portion 32 of the collecting bag 28 is at the distal end 14th the cannula 12th attached.

The collection bag 28 can, as in 1 and 2 is shown, be formed by a braid, the end loops 34 around the first loop 24 are braided, so that ultimately the collection bag 28 to open it 30th around the first loop 24 is attached.

The second loop 26th , which is preferably at least partially within the first loop 24 is arranged to run, is used to be placed around the tumor and to separate it.

In the 1 is the device 10 with a comparatively large opening 30th shown so that the collection bag 28 can be placed over a tumor. To tighten the loops 24 , 26th or to close the opening 30th can, as in 2 shown is the closing tube 16 in the distal direction relative to the two cords 18th , 20th be moved. Such a forward pushing of the closing tube 16 consequently causes both loops to be tightened synchronously 24 , 26th .

Reached the opening 30th a suitable size, only the second cord can be used in a next step 20th withdrawn in the proximal direction, creating the second loop 26th further closes. Another retraction of the second cord 20th , and thus a further closing of the second loop 26th , can cause the tumor to separate. The first cord can be used during or shortly after the tumor is severed 18th be withdrawn in the proximal direction, ultimately creating the opening 30th of the collecting bag 28 is closed and the tumor can be safely trapped within the collecting bag and removed.

In the 3 until 8th is the device 10 , or parts of this are shown schematically.

In the 3 is a longitudinal section through the device 10 shown, the device 10 here is in an insertion position. Here is the collection bag 28 in the distal end of the cannula 12th completely housed. There is also the distal end 22nd the closing tube 16 within the distal end 14th the cannula 12th . The two loops too 24 and 26th are completely inside the cannula 12th . In this insertion position, the cannula 12th for example, be introduced into the body through a maneuvering catheter placed towards the tumor to be removed.

After the distal end 14th the cannula 12th has reached its intended position, as in 4th shown is the closing tube 16 be advanced in the distal direction, so that it comes out of the distal end 14th the cannula 12th steps out. Furthermore, the two cords 18th , 20th be advanced in the distal direction so that the loops 24 and 26th a suitable opening 30th to enclose the tumor. The cords 18th and 20th as well as the collection bag 28 can in particular be made of a shape memory alloy, so that it is ensured that they adopt their intended shape.

For moving the closing hose 22nd in the distal and proximal directions, as well as to move the cords independently 18th , 20th in the distal and proximal direction, one in the 4th indicated actuator 36 at the proximal end 38 the cannula 12th be provided. The actuator 36 can be driven manually or by motor. In particular, the actuating device can be on the one hand at the proximal end 40 the closing tube 16 and on the other hand at the proximal ends 42 of the cords 18th and 20th attack.

As from the 5 it becomes clear that the distal end 22nd the closing tube 16 shows in an enlarged view, can at the distal end 22nd the closing tube 16 a cutting edge in the form of a sharp blade should be provided, which aids in severing the tumor.

As in the 6th and 7th shown can be the one on the loop 24 attached collection bag 28 with its opening 30th via an accumulation of cell tissue 46 such as, for example, a tumor can be turned inside out. In a next step, the two loops can 24 and 26th , as already mentioned, by moving the closing tube 16 are closed in the distal direction until the tumor 46 from the collection bag 28 is conveniently enclosed. Such closing of the loops 24 and 26th by moving the closing tube 16 in the distal direction has the advantage that the position of the distal end sections of the loops 24 and 26th not changed and so the tumor does not come out of the opening when the loops are closed 30th got out.

To separate the tumor 46 becomes the cord 20th , and with it the loop 26th withdrawn in the proximal direction so that the tumor 46 or its tumor neck 48 from the loop 26th against the edge 44 is acted upon, causing the tumor 46 is cut off.

In a next step, as in 8th the collection bag is shown 28 by moving the cord further 18th in the proximal direction are completely closed, creating the cut tumor 46 safely in the collection bag 28 is trapped. Then the closing hose 16 along with the cords 18th and 20th be withdrawn in the proximal direction so that the collecting bag 28 is reduced overall. Then the cannula can 12th along with the one in the collection bag 28 existing tumor 46 removed from the body in the proximal direction.

The device according to the invention 10 overall has the advantage that the loops 24 and 26th and with it the opening 30th of the collecting bag 28 on the one hand by moving the closing tube 16 in the distal direction and to the other by pulling back the cords 18th , 20th can be closed in the proximal direction. Furthermore, regardless of the size of the opening 30th over the cord 18th or the loop 26th , the tumor 46 be separated.

QUOTES INCLUDED IN THE DESCRIPTION

This list of the documents listed by the applicant was 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.

Patent literature cited

• EP 2085045 B1 [0004]
• US 5486182 [0004]
• WO 9953851 [0004]

Claims (9)

Device (10) for removing masses located within the bloodstream from raised cell tissue (46), with a cannula (12) which has a distal end (14) and a proximal end (38), with a closing tube (16) which can be displaced in the cannula (12) and has a distal end (22) and a proximal end (40), with a first cord (18) which can be displaced in the closing tube (16) and forms a first loop (24) at the distal end (22) of the closing tube, a collection bag (28) on the first loop (24) for placement over a tumor (46 ) is attached, with a second cord (20) which is displaceable in the closing tube (16) and which forms a second loop (26) at the distal end (22) of the closing tube (16) and which can be laid around the tumor (46) at least in sections, the arrangement being such that the closing tube (16) can be displaced in the distal direction relative to the first and / or second cord (18, 20) in order to tighten the first and / or second loop (24, 26). Device (10) according to Claim 1 , characterized in that the two cords (18, 20) are arranged independently of one another in the closing tube (16) for pulling the first and / or second loop (24, 26) in a displaceable manner in the proximal direction. Device (10) according to Claim 1 or 2 , characterized in that the ends (42) of the first and / or the second cord (18, 20) facing away from the respective loop (24, 26) at the proximal end (38) of the cannula (12) by means of an actuating device (36) are arranged displaceably to the closing tube (16). Device (10) according to Claim 1 , 2 or 3 , characterized in that the proximal end (40) of the closing tube (16) is arranged to be displaceable relative to the cannula (12) by means of an actuating device (36). Device (10) according to one of the preceding claims, characterized in that a cutting edge (44) is provided at the distal end (22) of the closing tube (16) with which the second loop (26) for closing the second loop (26) Separating the tumor (46) cooperates. Device (10) according to one of the preceding claims, characterized in that the diameter d _{1 of} the first cord (18) is greater than the diameter d _{2 of} the second cord (20), in particular the ratio of the diameter d ₁ to the diameter d ₂ is in the range of 1: 0.25 and preferably in the range of 1: 0.5 and more preferably in the range of 1: 0.75. Device (10) according to one of the preceding claims, characterized in that the collecting bag (28) has a proximal end section (32) facing away from the first loop (24), which is fastened in the region of the distal end (14) of the cannula (12) . Device (10) according to one of the preceding claims, characterized in that the first loop (26), the second loop (24) and the collecting bag (28) can assume an insertion position within the distal end of the cannula. Device (10) according to one of the preceding claims, which is set up to be used as follows: - Introducing the distal end (14) of the cannula (12) into the body at the point where the tumor (46) is to be removed, - Moving the first and second cords (18, 20) in the distal direction so that the first and second loops (24, 26) are enlarged and the collection bag (28) unfolds, - placing the first and second loops (24, 26) around the tumor (46), - Tightening the first and second loops (24, 26), namely - by moving the closing tube (16) in the distal direction, and / or - by moving the first and / or second cord (18, 20) in the proximal direction, - Separating the tumor (46) by moving the second cord (20) further in the proximal direction and / or by moving the closing tube (16) in the distal direction, - Closing the collecting bag by moving the first cord (18) further in the proximal direction and / or by moving the closing tube (16) in the distal direction, and - Remove the cannula (12) including the closing tube (16) and the tumor (46) caught in the collecting bag (28).

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