DE2160466A1 - Excision forceps - Google Patents

Description

PATENT ADVOCATE DR. GERHARD SGHAEFBR DI PLOM PHYSIKE R

8023 Munich - Pullach "Seitaerstraße 13 Telephone 7 93 09Oi

OLYMPUS OPTICAL CO., LTD. No.4 ^ -2, Hatagaya 2-chom® Shibuya-ku, Tokyo / Japan

The invention relates to an Exzi si one pliers, in particular for use with an endoscope, with a prosimal Control part and a flaxibls elongated over a © Tube with this connected distal end part, made of which a wire soleplate can be pushed out.

In particular, the invention relates to © in® Exzialons-Zang®, the material * protruding in a hollow part, for example in the hollow part of a leb®ndan K8rp @ rs growing®

Sch / D. 209828/0870 ^{e /} '

Polyps, capture, detach and remove, without the parts surrounding the protruding material, for example destroy the tissue surrounding the polyps.

So far, no such pliers have been developed that protruding® parts, such as polyps, from the stomach, esophagus or similar parts of the living body.

Known pliers of the type described above use a Loop of wire extending forward from the distal end portion of the forceps. The above grasped by the wire loop Matter is separated by the fact that the material emanating from the grinding® and following through the elongated tube rearward extending wire ends from in the proximal control part arranged control means are drawn to the Draw the loop together.

With such a pair of pliers, the loop © in wire is used with a relatively large diameter used to to avoid that it breaks off during repeated use of the pliers. The cutting process is through a thick However, wire deteriorates. There is a risk of the tissue surrounding the above matter to be separated off to destroy.

Furthermore, it was very difficult to separate the "matter, for example the polyp, without making a mistake, if I move the organ pearly, what the actuation made difficult by the pliers.

The invention is based on the above-mentioned object Avoid detriments and create a pair of pliers that work with an endoscope is usable, and the above matter such as one growing in a cavity of a living body Polyps, to be captured, separated and removed. Permitted, without damaging the surrounding tissue.

This is achieved by making the distal © end part consists of two legs separated from one another by a slot and the wire at the distal end into the slot is pivotally attached.

When by pressing the with the rear end of the wire connected control means the wire is pushed forward is, its front end part is bent and forms «lae Loop in the area of the thighs. This creates space between the wire loop and the legs ©. the wire is pulled back and you see it Slot moved, with the boards of the slot slightly larger Is than the diameter of the wire that forms at least one

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the longitudinal edges of the two legs have a cutting edge. This interacts with the wire when it is pulled will. That allows in the space between the loop of the wire and the cords located, for example a polyp, to capture and separate.

In the surface of one leg that is directed towards the other leg, an inclined receiving surface can be used be provided to hold the cut part by the wire on this.

A sharp cutting edge may be provided on one or both legs, sloping from the side of the outer surface to the slot and extending along the longitudinal edge of the leg to more effectively sever the protruding material. Alternatively, the connecting part pivotable to the pin can be designed as a cutting knife.

OeaS® From a further guide "frn ^ ft 4p invention, a first wire form a loop whose ends check slidably through the flexible tube extend, una min" further wire slidably extending through the flexible tube, the front loading pivotally since the dlatalen The band part of the grinding wire is connected to the first wire for both wires

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209626- / 0870

'Each «Ine control device is provided in the * proximal controlled is * at <ϋκτ pointed »dear second wire» can be an eye provided> the kind of a U-shaped bent part on the German "TaOten end" of the loop, the first wire attached to pivot ^ is CPigv 2S). According to a further embodiment, for ro the invention; can, tin 0 ** fifth connection »part old one Scnisitz. be arranged in which by means of a pen a connector for the front end of the second wire is pivotally attached (Fig. 36).

can according to a development of the invention Pliers rides a clamp of a high-frequency electrical power source ©, connected setn * its other terminal with the one to be operated for sale is in connection.

Further details and advantages of the invention can be found in the following description of the shown in the drawings Implementation examples are taken. Ss show:

Pig> t «ine enlarged side view of the distal

End part »of a known pair of pliers for use: with an endoscope

. a bi »12 T * üaw! iehts * R of a first embodiment of the inventor's pliers »namely

BATH ORIGINAL 2 09 8 26 / 067Ö

2 ISO46β

Fig. 2 shows the disfcal end part in an enlarged

fcer representation,
Fig. 3 shows a longitudinal section along the Einte

k-ä in F / ig. S *
4 shows a cross section along the line

B ^ B iß Figv 2,
Fig. 5 is an enlarged scale of a side

view of the proximal end of the tetter

partly the pliersj

Fig. 6 to 9 de «cross section along the line C-C in Fig.

9 and various operating steps of the Pliersj

Pig. 10 "to 12 the way the above matter in successive Steps like »ie in Fig. 7 to 9 are shown, separated

Flg. 13 htm 17 views of a modification of the forceps like them

is shown in Figs. 2 to 12, namely 13 is a view of the distal end portion of the forceps seen from the upper side.

Flg. 14 a longitudinal sons along the line B-D in Fig. 13 »

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21804S8

Pig. 15 a cross-section along the line E-E in Pig, 13,

Pig. 16 shows the longitudinal section similar to FIG. 1% bit of the representation of the separation of a protruding matter which is caught by the wire from the capture surface /

Fig. 18 shows the cross section along the line F-P in Pig. 161

Pig. iß to 21 views of a further embodiment of the

Pliers shown in FIGS. 2 to 12, which are provided with a cutting part *, namely

18 shows a view of the outer end part of FIGS. 2 & ₉ as seen from the upper side, FIG. 19 shows a longitudinal section along the line

© - © tft PIg. 18

20 shows a section along the line

HH in Flg. 18
Fig. Si one of the Flg. 19 Innlteh® Aneicht,

at the ύ & ® Sciinttetell & m du® dl-

staien end part h @ r & usg @ set £ fankt 1st

and ready is ftlr ubb hbtr & vn & n by

• were © insnder. ^ t «Pie s

20982S / 0S70 BAD ORiQlNAL

Pig. 22 to 26 a further modification of the one shown in FIGS.

2 to 12 pliers shown, namely

22 is a view of the distal end portion

i
seen from the top,

23 shows a longitudinal section along the line II in FIG. 22,

FIG. 24 shows a cross section along the line JJ in FIG. 22;

FIG. 25 shows a section similar to FIG. 23,

However, the above matter is encased between the distal end portion and the wire,

Fig. 26 is a cross section taken along line KK in Fig. 25, showing how the protruding matter is severed between the distal end portion and the wire;

Fig. 27 is a schematic perspective view

the essential part of the distal end part of the second embodiment of the forceps according to the invention;

Fig. 28 is a view of the connection of the in Fig.

27 pliers used wires;

209826/0670 bad orkb.nal ■ / ·

Pig. 29 is a perspective view of FIG. 28j

Pig. 30 is an enlarged partial view of the distal

End part of the pliers shown in FIG

Pig. 51 is a front view of the formation of the distal End part of Fig. 30;

Pig. 52 is a partial view of the proximal control portion

the forceps of FIG. 27;

Figures 33 to 35 are views showing how to use the pliers

Fig. 27, the above matter is detected and separated;

Pig. 36 and 37 partial views of a modification of the connection

the first wire to the second wire;

Pig. 38 is a partial view similar to that in FIG. 36

further embodiment of the connection of the first and second wire «

Fig. 1 shows a known excision forceps in which a wire 2 forms a loop which extends forward from the distal end part 1 of the forceps. The distal end part I of the forceps

^{P? 6} ° 209826/0670 " ^A

- '- ORIGINAL INSPECTED

is connected to a (not shown) proximal control part by an elongated flexible tube, of which only the part adjoining the distal end part 1 is shown. The ends of the wire 2 extend from the loop through the distal end portion 1 and the elongated tube. Their rear ends are connected to control means (not shown) which are arranged in the proximal control part, so that the wire 2 can be pushed forward or withdrawn by actuating the control means. In operation, the wire 2 is first pushed forward after the distal end part 1, together with an endoscope with which the forceps are to be used, has been pushed into the hollow part to be operated on. As a result , the wire loop 2 is enlarged and it catches the above matter, for example a polyp that grows into the hollow part. Then the wire 2 is pulled backwards by the actuation of the control means, whereby

* the loop grasps the protruding part 3 and cuts it off. But since with such a forceps the distal end of the loop formed by the wire 2 is bent towards the Uok when it is actuated, which results in a bend S? forms, the wire 2 tends to break easily at the "kink 2" when the operation of the pliers is repeated. It is difficult to grasp the above matter with such a pair of pliers. Their activity is therefore so laborious and difficult

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209I28 / ÖI7Ö originally inspected

time consuming. In addition, there is a risk that the wire 2 will break.

FIGS. 2 to 12 show a first embodiment of the invention Tongs. The forceps shown comprises a distal end portion 11 and a proximal control portion 12, the is connected to the distal end portion 11 by an elongated flexible tube 13, which consists of a tightly wound helix consists.

The distal end 11 has two parallel legs 16 which extend from the front end part 11 and the front are separated from one another by a narrow slot 15.

The base part II ^{1 of} the distal end part 11 is provided with a bore through which a displaceable wire 14 extends. The front end of the wire 14 is attached to a connecting part 19 by, for example, soldering 19a. The connecting part 19 itself is pivotable about a pin 18 which is fastened to the legs 16 and which extends into the slot 15 from the side.

The rear end of the wire Ik extends out of the cylindrical part of the proxlaalen control part 12 through an elongated slot 12a in the cylindrical part and

-4L

BAD ORIGINAL ^P36 °, 209826/0670 ^ * ^A

is attached to an operating ring 20, i.e. a Control means which is slidably mounted in the cylindrical part by means such as the plumbing 20a shown, so that the wire 1.4 by actuating the actuating ring 20 can be pushed forward or pulled backward.

Therefore, when the wire 14 is pushed forward, the front part of the wire 14 located between the connecting part 19 and the base part 11 'is bent so that it forms a loop, whereby a gap 24 is created between the loop and the legs 16, in which above matter J can be easily grasped. When the wire 14 is pulled backwards, the loop "is pulled together so that the wire 14 moves into the slot 15 in a tensioned state.

According to the invention, the longitudinal edge 17 is at least one of the Provide the legs with a sharp cutting edge. The width of the slot 15 is made slightly larger than the diameter of the wire 14 so that it is easily drawn into the slot can be, the close contact of the cutting edge 17 with the wire 14 is ensured. '

Therefore, the above matter becomes J when the forceps are operated in the space between the loop of wire 14 and

209826/0670 _{BAD 0R | G | NAL}

the legs l6 easily and effectively through the cutting edge 17 separated when the wire 14 is pulled backwards by the actuating ring 20. This will bring the wire 14 in Contact with the cutting edge without destroying any part of the area surrounding the above matter 3. The thus separated matter 3 is through the tensioned wire

14 held in the slot 15.

Figs. 6 to 12 show the manner in which the foregoing matter is detected, separated and held in the slot 15.

The pin 21, which is located between the legs 16 in the slot

15 extends, prevents the wire 14 from extending in opposite, flexes in the direction shown in the figures so that the wire loop 14 is formed on the side is, on which the cutting edge 17 is formed on the legs 1β is.

In the drawing, the slot 15 is shown so that it extends from one circumferential surface to the diametrically opposite one Extends circumferential area. However, it can be in the form of a notched groove have a longitudinal floor area.

The Pig. 13 bla 17 show a modification of the In der PIg. 2 pliers shown. The pliers of FIGS. 13 to 17 are in the

2 09 8 26/0670 ^BAD

2180466

essentially similar to that shown in FIG. Only is a catch surface on the inner surface of one of the legs 15 ', which has no cutting edge 17. As shown, it can be inclined to the wall of the slot 15. she can also have the shape of a concave surface, as shown, or it can have the shape of a surface parallel to the longitudinal axis of the distal end portion 11 have extending flat surface.

The action of the forceps in FIG. 13 is similar to that in FIG Fig. 2, except that the separated protruding matter 3 is more securely in the slot by the presence of the catch surface 15 ' 15 is held as shown in FIG.

18 to 21 show a further embodiment of the pliers shown in FIG. In this embodiment, a cutting member 22 in the form of a lever with a cutting edge 22 'is provided along a longitudinal edge in place of the connecting part 19 in FIG. 2, which is pivotably attached at its end to the pin 18, as shown in the drawing. The free end of the link 22 is pivotally connected to the front end of the wire 14 so that the part 22 is pivoted out of the slot 15 when the wire 14 is pushed forward, while the link 22 is moved into the sole 15 when the wire 14 is pulled backwards. The width of the cutting member 22 is small

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BAD ORfGlNAL

smaller than the width of the slot V), so that the free pivoting movement of the cutting member 22 in and out of the slot 15 is possible while its cutting edge 22 'is brought into contact with the cutting edge 17 of the leg 16 when it is pivoted into the slot 15 will.

The operation of the arrangement according to FIG. 18 is essentially similar to that of Fig. 2.

Figures 22 through 26 show another embodiment of a Pliers according to Fig. 2.

This embodiment form is essentially similar to that in 2, except that on one of the outer surfaces of the legs 16, a surface 23a is formed which merges into the longitudinal edge of the same and forms a sharp cutting edge 23 there, as can be seen from FIG can. The foregoing matter 3 »that between the wire 14 and the leg 16 is detected, can by the interaction the cutting edge 23 and the tensioned wire 14 very much be effectively separated.

FIGS. 27 to 32 show another embodiment of the pliers according to the invention. This embodiment includes a first wire 104 that forms a loop that extends forward

BATH ORIGINAL

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20 9 826/067 0

dlstalen end portion 107 »us extends, the ends or Parts of the wire 10% apart from each end of the Extend the loop through the flexible tube 13 to the proximal control part 12. Extend the ends of the wire 10% through an elongated slot (not shown) provided in the cylindrical guide tube 111 and are bits of a first actuating ring 112, i. connected to a first control means which is slidable in "the cylindrical tube IU is guided so that the wire can be pushed forward to enlarge the loop or pulled back to make the loop larger to contract. The loop of the wire 10% serves that purpose Grasping the foregoing and cutting it off when the loop is pulled together.

A second wire 105 also extends through the flexible tube 13. It is connected to a Eye 106 "in the curved lower part 10% a, which is molded 10% on the distal end of the loop of the wire" can be pivoted attached, while the rear end extends through the elongated slot in the cylindrical guide tube 111 and with a swelled support ring 113, which is slidably guided on the cylindrical guide tube, is attached when the actuating ring 113 is operated, dtr wire 103 is pushed forward to loop «int

t 360 ./·

20 Ι2β / Οβ70 -

to form in the area between the eye "106 and the diatal end portion 107, or it is pulled backwards * in order to draw the loop of the wire 15 together." The second wire IO5 serves to hold the separated protruding matter. Fixed stop rings ^{1 Il4: are attached to the cylindrical * MihrüngärhF * Hl;} ä & ¥ ^; pikBa: · paint control part ΪΪ2 , "so'dal'deir stroke of each of the actuating rings ΪΪ2 "'and limited iat 113 suitably ^Weisö;: the position jafdes the Anschiagringe 114 may be adjustable, u» the stroke of each of the rings 112, 113 in a suitable manner festzüsetseriV depending on the conditions, untor which the operation is performed. ""■ ^

In Fig. J51 a bore 109 is provided in the surface of the distal end part Ϊ0Τ, through which the second wire 105 slidably passes, while the elongated opening ring iOB for the passage of the ends of the twisted 104 / dl® extends from "the loop of the wire 104 auö'back he ~ ^ y used Wii? * ^Ϊ́ "^t;? ^^ ^{"Χΐν>: /}

The Pig. 33 to 35 show the way in which a protruding matter, as an example, shows a poI ^ p, ¹ which extends from the inner wall a "hollow space of a living body / through the in * fig. '27 'pliers shown are caught and disconnected .- ^ ■ - ■ "" ■ · **' - ~~ ^? ■ '-' ■ "■ '"'' ^Λ """ ^;" ^: ' - ^: ^ '- ' ■■■ '"■" - ■ - ■ - "

BATH ORIGINAL

f 360 ./, · '■>

20 98 26 / QUi ^ · '·' - '■' * · "

2180486

First, the first and the second 'wire , 104 ·: and .105 " ³ ^ are pushed forward by actuating the" actuation mechanism ;; 112 and 113 "after the distal end portion 10? together »it» *. c an endoscope into the hollow part which has been inserted to-operleretListi, ' r-1 . There the above "Materfr ^ viHPaer" Seliletf e "de" wire 104 urid is used to help the observation of the above matter with an endoscope; the "SöhleiJf-e:. ^ of the wire 105 is detected, as. This is shown in Fig. 33. Then the" actuating ring 112 is moved manually "to the rear to tighten the wire 104 and the loop of the. .; Wire 104. This covers the above. Matter. At the same time or after actuation of the first actuating ring 112, the second actuation ring * 13 is moved around the loop of the wire 15 to contract so that the separated above matter is held by the wire 105 as shown in Fig. 35 i * t. .... ~ = ■■■. «-. * ■ * ■: ■> - *. .- ■ ■ · - ·. ·· ■ ": * - '■ ■ ^..: _ä,.-....- t ^ .-- .. / .; r "

The-Fig. 36Eund> 7 see ¹ - 'a ^ modification of the connection, ^ j? between the wire 104: and the wire 105 ^ ΜλH- ^ c5ralge9Ä i © connection "t" ll 116; which has a slot 115 ^ Aatv ^ c de "the end of the wire" * 104 attached to the ends of the Qabel ^ s of the part * 106 ^ as shown in: Pig * 36 -? is. Aa part 116 is a pin 118 attached and extends into itUlien de · slots * 1151 · 1λ AcJw «nkb« rtr part

209826 / 06TO

which is connected to the lethal end of the wire 103 » Let pivotally attached to the pin Il8 In Schutt 115. The mode of action of this “for” 1st © milch der shown in FIG.

38 shows a further modification of the connection between wires 104 and 105. In this embodiment, an eye 119 is provided at the lethal end of the loop formed by wire 104. The eye 119 is pivotally engaged with the eyes 106 of the wire 105.

GenKfi another feature of the invention can be performed during. the actuation of the pliers electrical high frequency are applied.

In this case, the forceps are electrically connected to the endoscope, which brought the forceps into the operating position 1st, isolated. One of the Kleseen of a (not shown) electrical power source tat hurries the long connected, while the other klesae of the electric power source are old de "body is connected, in whose hollow" skin an opera * tion should take place with a pair of pliers.

The switch is activated by appropriately actuating the switch

BATH ORIGINAL

P 360 ./.

209828/0670

~ 20 -

of the electric power source while the forceps are actuated, high-frequency electrical current is applied by the forceps guided the part of the body on which an operation with the forceps is to take place. Hence the part that goes through the forceps is separated, heated locally, causing damage, for example from blooming of the part that is being operated on, be kept to a minimum.

p 360 ./.

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BATH ORIGINAL

Claims (11)

Claims 1.) Excision forceps, especially for use with a Endoscope, with a proximal control part and an over an elongated flexible tube © with this connected distal end part, from which a wire loop can be pushed out, characterized in that the distal end part (11) consists of two through a slot (15) legs (16) which are separate from one another and the wire (14) is pivotable at the distal end in the slot (15) is attached. 2. Pliers according to claim 1, characterized in that the wire (14) is attached to a connecting part (19) 'which is a perpendicular z \ m Sehlits (15) at the dist & - fixed len end pin (l8) is pivotable. 3. Pliers n & cft claim 1 or 2, characterized in that that the proximal part of the slot (15) is a stop (21) is arranged. 4. Pliers according to one of the preceding claims, characterized in that at least one leg (16) has a recessed catching surface (15 ^! ) On its upper edge (Pig, U). BATH ORIGINAL iV70 5. Pliers according to one of the preceding claims, characterized in _t that a longitudinal edge (17) is formed of one of the legs (16) as a cutting edge (Pig. 22) β. Pliers according to one of the preceding claims, characterized in that the one pivotable about the pin (18) Connecting part (22) is designed as a cutting knife (Pig. 18). 7. Forceps, preferably for use with an endoscope, with a proximal control part and a distal end part connected via an elongated flexible tube ait this®, from which a wire loop can be pushed out isfcg characterized in that a first wire (10%) is a® grinding ®, the ends of which extend slidably through the flexible tube (13) «» and • in the second wire '(105) «I am shipping !? extends through the flexible tube, the front end (106) of which is pivotably connected to the distal band part of the Schltif® on the first wire (104) and wherein a control device "is provided in the proximal control part for each of the two wires (104, 105) is. P 560 ./, BATH ORIGINAL In 8 forceps according to claim J _s by & Β ά at the top of the second wire (105) an eye (106) is provided which is shaped U-bend to a part. (1Q4 &) at the distal end of the loop of the first Dr & Htee (104 ) is pivotably attached (Fig. 28). 9 · Pliers according to claim f, characterized in that a U-shaped connecting part (116) with a slot (115) is arranged at the oistal end of the loop of the first wire (104 · -), in which a pin (118 .. ) a connecting part (117) for the front end of the second wire (105) is pivotally attached (Fig. 36). 10. Pliers according to claim 7, with a first eye (lO ^ a), the at the distal end of the loop of the first wire. (104) and a second eye (106) that is at the top of the second Wire (1Q5) is formed, the first eye (iO4a) with the second eye (106) is pivotable in Eirgrlff. 11. Pliers according to one of the preceding claims, characterized characterized that the forceps from »endoscope electric is isolated and that an electrical high-frequency power source 1st provided, one gill old of the forceps and the other gill with the suoperating part in Connection. 209326/0: 670 Blank page