Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
  • A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
  • A61B1/018—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor for receiving instruments
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
  • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
  • A61B18/14—Probes or electrodes therefor
  • A61B18/1485—Probes or electrodes therefor having a short rigid shaft for accessing the inner body through natural openings
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
  • A61B8/06—Measuring blood flow
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
  • A61B8/12—Diagnosis using ultrasonic, sonic or infrasonic waves in body cavities or body tracts, e.g. by using catheters
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
  • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
  • A61B18/14—Probes or electrodes therefor
  • A61B18/1442—Probes having pivoting end effectors, e.g. forceps
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
  • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
  • A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
  • A61B18/24—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor with a catheter
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B2017/00017—Electrical control of surgical instruments
  • A61B2017/00022—Sensing or detecting at the treatment site
  • A61B2017/00057—Light
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B2017/00017—Electrical control of surgical instruments
  • A61B2017/00022—Sensing or detecting at the treatment site
  • A61B2017/00084—Temperature
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B2017/00017—Electrical control of surgical instruments
  • A61B2017/00022—Sensing or detecting at the treatment site
  • A61B2017/00106—Sensing or detecting at the treatment site ultrasonic
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B2017/00017—Electrical control of surgical instruments
  • A61B2017/00115—Electrical control of surgical instruments with audible or visual output
  • A61B2017/00128—Electrical control of surgical instruments with audible or visual output related to intensity or progress of surgical action
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
  • A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
  • A61B2017/003—Steerable
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B2017/00973—Surgical instruments, devices or methods, e.g. tourniquets pedal-operated
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/12—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord
  • A61B2017/12004—Surgical instruments, devices or methods, e.g. tourniquets for ligaturing or otherwise compressing tubular parts of the body, e.g. blood vessels, umbilical cord for haemostasis, for prevention of bleeding
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B2018/00005—Cooling or heating of the probe or tissue immediately surrounding the probe
  • A61B2018/00011—Cooling or heating of the probe or tissue immediately surrounding the probe with fluids
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
  • A61B2018/00434—Neural system
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
  • A61B2018/00434—Neural system
  • A61B2018/00446—Brain
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
  • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
  • A61B18/1206—Generators therefor
  • A61B2018/1246—Generators therefor characterised by the output polarity
  • A61B2018/1253—Generators therefor characterised by the output polarity monopolar
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
  • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
  • A61B18/1206—Generators therefor
  • A61B2018/1246—Generators therefor characterised by the output polarity
  • A61B2018/126—Generators therefor characterised by the output polarity bipolar
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
  • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
  • A61B18/14—Probes or electrodes therefor
  • A61B2018/1472—Probes or electrodes therefor for use with liquid electrolyte, e.g. virtual electrodes
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
  • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
  • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
  • A61B18/14—Probes or electrodes therefor
  • A61B2018/1495—Electrodes being detachable from a support structure
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
  • A61B8/08—Detecting organic movements or changes, e.g. tumours, cysts, swellings
  • A61B8/0808—Detecting organic movements or changes, e.g. tumours, cysts, swellings for diagnosis of the brain

Definitions

• the present invention relates to a new surgical instrument or auxiliary apparatus that can be employed for locating an unintentional bleeding and to stop it.
• the instrument consists of one or more sensors as well as one or more devices for coagulation.
• the sensor shall give the operator information regarding the location of the source of bleeding so that the instrument is introduced manually (or automatically) towards the bleeding source and so that the bleeding is stopped by means of a coagulator.
• This new instrument will be utilized in situations where unintentional bleeding can occur, but where because of reduced or no visual control the operator is prevented from finding the bleeding in order to stop the same (e.g. within endoscopic surgery) .
• the instrument can be designed in various manners, either as an independent instrument or integrated into another surgical instrument.
• Endoscopic surgery in the brain has increased during the recent years since technology has been developed that is suitable for this purpose.
• These techniques are based upon rigid and flexible endoscopes being provided with a light source, optics and one or more work channels.
• the work channel(s) there may be introduced surgical instruments and/or flushing or suction can be performed.
• Surgical tools or instruments of interest are e.g. diathermic devices, scissors, biopsy forceps, lasers etc. The tool is guided into position by means of optical observation from the tip of the endoscope.
• endoscopic surgery is mainly employed for punctuating cysts (abnormal liquid collection) or for removing small tumors. Since the operation is controlled by means of optical observation from the tip of the endoscope, the employment of endoscopes in the brain is restricted to the immediate proximity of ventricles and cysts. It is not possible to operate in massive brain tissue.
• a problem with these operation techniques is uncon ⁇ trolled bleeding. If accidentally a blood vessel is ruptured this will bleed and in the course of a few seconds the whole liquid-filled cavity will be filled up with blood. Visi ⁇ bility will be lost for the surgeon and it is not possible to find the bleeding spot or site in order to stop the bleeding.
• the most common way of solving the problem is to flush with clean water into the cavity and wait until the bleeding has decreased and visibility is sufficient for being able to find the bleeding source and stop it perma ⁇ nently with a coagulation intstrument. Alternatively it may be attempted to stop the bleeding by establishing a counter- pressure by inflating a balloon or introducing water at a high pressure. If none of these methods are sucsessful, there must be performed an open surgical operation in order to stop the bleeding.
• blood When a blood vessel is ruptured blood will be pumped out into the liquid-filled cavity.
• the blood pressure will cause blood to be discharged from the blood vessel at a certain velocity and there will be a jet emitted from the bleeding source.
• the density of blood is higher than that of the biological water filling the cavity. This means that such bleeding will be somewhat similar to a waterfall, as a jet is pumped out from the vessel and gravity pulls the jet downwards.
• the discharged blood will have a temperature close to 37 degrees at the outlet.
• the liquid in the cavity will have a temperature that can vary between ambient temperature (37 degrees) and the temperature of the flushing liquid being introduced.
• a lower temperature of the flushing liquid e.g. 25 degrees
• Accord- ing to the invention this can be utilized for finding the blood jet by mounting a temperatur sensitive sensor on a movable instrument. At the moment when the sensor is intro ⁇ quizd into a blood jet a temperatur increase will be obtain ⁇ ed because of heat conduction.
• the temperature sensor can be connected to a unit which e.g. generates a pipe or whistle signal the frequency of which varies with the temperature. This makes it possible for the surgeon to seek out the blood jet and to follow it to its origin.
• the blood is quickly cooled, which means that a small bleeding can only be detected by substantially direct contact and relatively close to its origin.
• Endoscopic surgery in the brain is today primarily restricted to liquid-filled cavities.
• the reason for this is the use of optical observation as guidance.
• ultrasonic imaging from the surface of the brain and/or from the tip of the surgical instrument (such as the endoscope)
• bleeding occures before a cavity i ⁇ established, possibly in a small cavity, there will be no well defined blood jet being discharged and sinking like a waterfall. Blood will flow around the instrument in a complicated movement pattern that will make it more difficult to localize by means of a sensor.
• this problem can be solved by introducing flushing water through the instrument for the purpose of cooling down the tissue and the blood.
• By correct selection of liquid temperature one can cool down the outermost layer of tissue which surrounds the instrument. If bleeding arises one continues to flush with water in order to cool the blood quickly and suck this out from the region conserned. Blood which is pumped out from the injured blood vessel will have a higher temperature than the ambient tissue and the water.
• By moving a temperature sensitive sensor along the wall of the tissue the bleeding can be detected when the sensor is localized in immediate proximity of the bleeding source.
• Another possible field of use is during transnasal surgery in the hypophyses whereby the operation takes place through a sleeve of about 15 mm width, being inserted through the nose. Visual observation and access for surgical tools and instruments are restricted by the metal sleeve through which the operation takes place.
• thermosensors have been employed for quanti ⁇ zing blood flow in blood vessels being intact, for monitor ⁇ ing blood flow during an operation [1].
• Ultrasonic Doppler has been described during surgical operations in the brain for the purpose of detecting blood vessels in good time so as to avoid a critical situation [2].
• Optical techniques have also been employed in order to record blood flow within massive biological tissue [3]. It is common to these methods that they are used for quantizing blood flow in intact blood vessels or for localizing intact blood vessels.
• Methods for coagulating blood vessels in order to stop bleeding are per se well-established techniques being em ⁇ ployed in various relationships, also endoscopically. Both unipolar and bipolar diathermy, laser and other methods are used.
• the present invention comprises the utilization of such known techniques in combination with a sensor for detecting a bleeding. What is novel here is the combination of a sensor and a coagulator for detecting and stopping an unintended bleeding in surgical relations, based upon a manual instrument which preferably is conventional or of a common standard type.
• Patent specification [6] is directed to an operation tool based on visual control and having means for bleeding control, but without any sensor for detecting bleeding.
• Patent specifications [7] and [8] relate to methods and techniques corresponding more or less to the contents of the two patent specifications just referred to above.
• an advantageous new surgical instrument the novel and specific features of which consist in the first place in a carrier member with an end portion adapted to be introduced manually to the operation site or cavity, at least one sensor element mounted at the end portion of the carrier member and adapted to detect bleeding and to localize a source of bleeding, a coagulator device being mounted on or being adapted to be introduced through the end portion adjacent to the sensor element, an electronic unit connected to the sensor element for providing an operator signal during detection and localizing of a bleeding, and a coagulation apparatus connected to the coagulator device for activation thereof in response to said operator signal.
• the carrier member can be a preferably rigid, elongated element that can be used for bringing the sensor and the coagulator to the desired position during the operation.
• a carrier member can consist of a more or less conventional endoscope or it can be combined with an endoscope.
• the endoscope itself can be rigid or flexible and comprise one or more elements being common to endoscopes, such as a source of light, optics and at least one work channel.
• the sensor element can also comprise a laser fibre or an acoustic transducer for (passive) detection of acoustic waves emanating from the bleeding.
• the instrument according to the invention can be made rigid or flexible in miniature design in order to be intro- quizd through a work channel in an endoscope, e.g. a tool in the form of scissors, biopsy forceps, laser, ultrasonic aspirator, diathermic device and so forth.
• an endoscope e.g. a tool in the form of scissors, biopsy forceps, laser, ultrasonic aspirator, diathermic device and so forth.
• the coagulator device at the tip or end portion of the carrier member can comprise unipolar or bipolar diathermic electrodes.
• Another possible form of coagulator consists in a laser fibre connected to a suitable laser.
• the laser can be considered to belong to a coagulation apparatus serving to drive or energize the coagulator device referred to.
• the apparatus in general can be e.g. an electric diathermy apparatus or an argon beam instrument.
• the actual surgical instrument according to the invention advantageously is adapted to be manually movable.
• the operator signal referred to can be presented as an audible signal or visually as the excursion of a pointer or as varying light intencity, blinking or the like, possibly as a mechanical or electrical stimulation of the skin, e.g. at the hand of the surgeon.
• the blood discharge may have the form of a jet entering into a liquid- filled cavity.
• the blood flow or jet is characterized by a certain velocity, a cross section, density, direction and temperature. These parameters are in part determined by the blood pressure, blood viscosity and the size of the cut or rupture in the blood vessel concerned.
• FIG. 1 schematically and simplified shows a surgical instrument based upon the invention, with associated equipment or units.
• Fig. 2 shows in an larged perspective view the outer end of a carrier member incorporated in the instrument according to an embodiment of the invention
• Fig. 3 shows another embodiment in a corresponding way as Fig. 2,
• Fig. 4 shows the situation in an operation cavity with a bleeding and an instrument according to the inven ⁇ tion introduced into the cavity.
• Fig. 5 shows a specific embodiment of electronic circuits for providing an audible operator signal
• Fig. 6 shows an alternative embodiment of electronic circuits for providing and audible operator signal
• Fig. 7 shows a specific embodiment of the instrument according to the invention, based upon a bipolar diathermic forceps
• Fig. 8a shows the movable carrier member of an instrument according to a further embodiment of the inven ⁇ tion.
• Fig. 8b shows in more detail and in perspective view the outer end portion of the carrier member in Fig. 8a
• Fig. 9 shows a design of the end portion of the carrier member, whereby sensor and coagulator means are introduced through a work channel in an endoscope,
• Fig. 10 shows an embodiment where an endoscope tip or end portion has a sensor element and a coagulator device integrated into its structure
• Fig. 11 shows an embodiment being somewhat modified in relation to the one in Fig. 10, i.e. with a coagulator device introduced through a work channel in an endoscope,
• Fig. 12 shows a simplified and schematic system for full or partial automatic control of the surgical instrument according to the invention, in order that the tip or end portion thereof shall seek toward a bleeding and the actual bleeding source
• Fig. 13a shows a further embodiment of the instrument according to the invention, based upon a biopsy forceps of substantially conventional form
• Fig. 13b shows in more detail how the tip of the instrument in Fig. 13a can be designed
• Fig. 14a shows a separate sleeve provided with a sensor and adapted to be mounted on a manual surgical instru- ment
• Fig. 14b shows the sleeve member in Fig. 14a as mounted on a biopsy forceps
• Fig. 14c shows in detail an advantageous design of the tip of the instrument in Fig. 14b
• Fig. 14d shows the same detail as Fig. 14c, but in lateral view and with the sleeve member retracted
• Fig. 14e shows the same detail as Figs. 14c and 14d, but with the sleeve member pushed forward
• Fig. 15a shows a similar, separate sleeve member as in Fig. 14a, but being additionally provided with flushing and suction channels
• Fig. 15b shows the sleeve member in Fig. 15a mounted on a biopsy forceps
• Fig. 15c in further enlargement shows the tip of the sleeve member in Figs. 15a and 15b.
• Fig. 1 shows a catheter-like combination instrument based upon a carrier member 3 having at least one sensor 1 and at least one coagulator 2 at its tip, which can be flexible and controllable.
• the combination instrument 3 is connected to a coagulation apparatus 4 which is activated by a pedal 7.
• the combination instrument 3 is connect ⁇ ed to an electronic unit 5 for converting the sensor signal into an operator signal.
• the operator signal can give information back to the operator through a loudspeaker 6 whereby an increasing temperature can give an increased frequency of a whistle tone.
• the bleeding can e.g. also be detected by an ultrasonic Doppler signal converting blood velocity to an acoustic signal.
• bleeding can be detected by an optical Doppler signal converting blood velocity to an acoustic signal.
• FIG. 2 A possible design of the tip or end portion 3A of the combination instrument 3 is shown in Fig. 2, where the sensor 12 is a thermo-element and localized at the middle of the cross section, whereas electrodes for diathermy are localized around the circumference.
• the sensor 12 is a thermo-element and localized at the middle of the cross section, whereas electrodes for diathermy are localized around the circumference.
• there are two electrodes 10 being connected to one of the conduc ⁇ tors to the diathermy apparatus (indicated with the symbol "- ”) and two electrodes ll being connected to the other conductor (indication "+”) .
• diathermic coagulator can be more efficient, e.g. a design where two electrodes project somewhat from the tip so that they penetrate somewhat into the tissue at a light pressure. In this manner the electrod ⁇ es will be able to enclose the vessel somewhat more in similarity to what is obtained with bipolar diathermic forceps.
• the sensor at the tip of the combination instrument 3 consists of two ultrasonic transducers, i.e. one for emission 21 and one for reception 22. Electrodes 10 and 11 for diathermy can be as described with reference to Fig. 2.
• Fig. 4 shows a typical situation for use of the combi- nation instrument 3, where this is positioned within a liquid-filled cavity 42 which e.g. lies within massive brain tissue 43.
• the liquid is biological salt water.
• a blood vessel has been subjet to a leakage and emits a blood jet 41 into the liquid-filled cavity 42 from the bleeding source 40. Blood jet 41 will be deflected downwards because of gravity and the fact that blood has a higher density than biological salt-water which fills the cavity 42.
• thermo-element 50 represents a heat sensitive electrical resistor which is connected to a voltage divider and an electronic amplifier 51.
• the amplifier has an electric voltage output applied to the voltage/frequency converter 52.
• Converter 52 delivers a voltage to a piezo- electric element 53 which provides for an audible signal.
• thermo-element The temperature of the thermo-element is converted to a whistle tone the frequency of which is proportional to the temperature.
• Fig. 6 shows an implementation of the electronic unit 5 in Fig. 1 based upon continuous ultrasound Doppler measure ⁇ ment (CW Doppler) .
• An emitter transducer 21 is connected to an ultrasonic transmitter 61.
• a receiver transducer 22 is connected to a receiver 62 which is further connected to a Doppler processing unit 63 delivering an acoustic observer signal in loudspeaker 64.
• This method makes it possible to measure the velocity of the blood jet, but there will not be presented any information with respect to the distance to the blood jet.
• PW Doppler pulsed Doppler
• This method additionally gives the possibility of determining the distance to the blood jet by measuring the Doppler shift a certain time after each emitted pulse.
• Fig. 7 shows a possible implementation of a self-con ⁇ tained surgical instrument consisting of a bipolar dia ⁇ thermic forceps 71 having an electric connection 72 for the coagulation instrument. Accordingly forceps 71 constitute the carrier member of the instrument. Electrodes 74 for diathermy are mounted at the tip of forceps 71, and a sensor 73 is mounted at one of the electrodes. Various configu ⁇ rations can be contemplated, where one or more sensors are mounted at one or both electrodes. E.g. a laser or ultra- sonic Doppler sensor can be mounted at one electrode and a thermistor at the other electrode. The Doppler sensor is used to localize bleeding at a distance, whereas the thermo- element is used adjacent to the bleeding source when the tip of the instrument is positioned in the blood jet.
• Fig. 8a shows how sensor and coagulator can be mounted at the tip 82 of a carrier member in the form of a flexible and controllable suction element 81.
• a flexible suction element or tool will be appli ⁇ cable in several types of minimal invasive surgical ope ⁇ rations, inter alia during evacuation of intracerebral brain bleeding through a thin (4-8 mm) channel in the normal brain (sound brain part) . During such operations there is a re ⁇ quirement for tearing loose fragments of coagulated blood being adhered to the brain wall.
• the proximal end of the instrument consists of a hand ⁇ grip 83 having a device 84 for controlling the flexible tip 82, as well as connections for suction 85, coagulator 86 and sensor 87.
• Fig. 8b shows a possible implementation where two sensors 88 (e.g. two thermistors) , are mounted between two bipolar diathermic electrodes 89 around a suction channel 89b at the tip of the catheter 81.
• two sensors 88 e.g. two thermistors
• Fig. 9 shows an embodiment in which the instrument is introduced through a work channel 95 in an endoscope 91.
• a light source 93 optical fibre
• optics 92 and a channel 94 for flushing and/or suction.
• Other functions can also be present in the.endoscope, e.g. separate channels for flushing and suction.
• the instrument is guided through the work channel 95.
• the instrument is a biopsy forceps 96 with a sensor 97 mounted to one of the teeth and with bipolar electrodes 98 mounted on both teeth.
• Biopsy forceps are regularly used in the work channel of endoscopes. By integrating a sensor and a coagulator into such biopsy forceps it will be possible to localize and stop bleedings without changing the endoscope or the tool in the work channel when bleeding occurs. This is important since it is difficult to seek back to the same spot if the endo ⁇ scope is removed, and the visibility is poor or zero.
• Fig. 10 shows a possible embodiment in which sensor and coagulator are integrated at the tip of an endoscope 101. Also here the endoscope is provided with optics 102, light source 103, channel 104 for flusing and/or suction, and at least one work channel 105. A sensor 106 such as the end of a laser fibre, is also mounted at the end surface of the endoscope, whereas bipolar electrodes 107 are placed along the circumference of the endoscope tip.
• a higher coagulation effect will be obtained if the electrodes can be made movable to enclose the bleeding vessel.
• This can be implemented in various ways: i) Two or more electrodes lie in recesses in the endoscope, possibly at the outside thereof, and are moved forward before use. The electrodes are urged into the tissue around the bleeding vessel by moving the endoscope forward- ly. Coagulation is started. The effect will be still higher if in addition the electrodes could be clamped together around the bleeding vessel and exert a pressure on the vessel structure. ii) Two or more electrodes can be articulated at the tip of the endoscope so that they are pointing backwardly
• Fig. 11 shows a possible embodiment in which a sensor 115, which is e.g. based on a laser, is integrated into the tip of an endoscope 111, while a coagulator 117 is mounted on a thin tool element 116 being introduced through a work channel 118.
• the endoscope has optics 112, light source 113 and channel 114 for flushing and/or suction.
• the coagulator device can e.g. consist of two bipolar diathermic electrodes 117 mounted at the tip of element 116.
• the coagulator can also be a laser fibre, biopsy forceps with bipolar electrodes as described, a unipolar diathermic device or the like.
• Fig. 12 shows a possible embodiment wherein the carrier member 120 of the instrument contains three wires being attached to the tip of the carrier member.
• a tip 121 is flexible and controllable in a hemispherical region by means of three servomotors 122.
• the whole catheter/carrier member 120 or only the flexible tip can be moved along the catheter axis by means of a separate servomotor 123 as mentioned above.
• the servomotors are controlled manually from a control unit 124 which is operated by the operator with at least one operating device, e.g. a control stick 125 or a 3D mouse.
• the instrument can be controlled directly by the operator without any form of automatic means in that the angular movements of the control stick determines the degree of deflection of the catheter tip, whereas e.g. two push buttons control the longitudial movement.
• the operator takes advantage of an operator signal 126 from converter 127 as a guide in seeking the bleeding.
• Control unit 124 can then in cooperation with an imaging apparatus 128 (e.g. based on ultrasound) provide three dimensional images of the cavity.
• an imaging apparatus 128 e.g. based on ultrasound
• a selfcontained, manual instrument consisting of a biopsy forceps the rod-shaped part 131 of which constitutes a carrier member, as explained above.
• This rod-shaped carrier member 131 projects from a handgrip as generally denoted 130 and is operated by the surgeon.
• the functional elements in Fig. 13a are in general shown at 134 at the outer end of rod part 131.
• Fig. 13b shows more in detail the design at the tip of rod or carrier member 131, i.e. two movable jaws or teeth 134A and 134B forming therebetween a gap. The drawing here shows these teeth 134A/134B in an open position.
• a sensor element 133 is shown at the outer end of tooth 134A.
• Fig. 13a shows a terminal 139 for a further connection to electronics incorporated in a complete system.
• Two electrodes 137A and 137B are mounted each on one of the two teeth 134A and 134B. The electrodes are adapted to cause a coagulating effect by diathermy.
• Fig. 13a shows a terminal 138 at the operating handgrip.
• Diathermic electrodes as mentioned here can be unipolar or bipolar. With electrically connective teeth and an electrically insulated rod or carrier member 131, the gap between the teeth can constitute a unipolar diathermic electrode.
• bipolar diathermy can be provided for by mounting an insulating electrode at one of the teeth, whereas the rest of the jaw or gap can constitute the other electrode.
• Figs. 13a and 13b represent a favourable design in which the coagulator device, in particular one or two electrodes therein, are movable in relation to each other or in relation to the carrier member.
• Figs. 14a,b,c show an embodiment with specific advantages, based upon a separate, sleeve-shaped carrier member 141 adapted to be mounted (Fig. 14b) on a rod-shaped part belonging to a biopsy forceps 140 or similar standard instrument for surgical use.
• the outer end of sleeve member 141 has a sensor element 143 being electrically connected to a terminal 148 at the opposite end of the sleeve member.
• Advantageously sleeve member 141 is replaceable and together with the rod-shaped part of the biopsy forceps constitute a combined carrier member having the same function as the above described carrier members.
• sleeve member 141 is adapted to be pushed onto the instrument rod part 140, which can be done before the surgeon begins an operation, so as to use the sleeve during the whole operation, or it can be mounted if and when a bleeding occurs.
• the embodiment of Fig. 14b has a jaw-shaped coagulator device 144 which is to cooperate with sensor element 143. Coagulation can be based upon unipolar or bipolar diathermy or other principles as described above.
• Fig. 14c shows how sensor element 143 suitably can be positioned at a small distance (a few milli ⁇ meters) retracted from the outer end of coagulator device 144. While this is shown from the side in Fig.
• coagulator device 144 is engaging a blood vessel, and more particularly a blood vessel fragment 145 at one side of a bleeding source 149, with the blood vessel con ⁇ tinuing at the other side in the form of vessel fragment 146. Accordingly in the situation shown, the coagulating function will be favourable after the sensor 143 has localized the bleeding source 149.
• Figs. 14d and 14e show a structure with a displaceable sleeve member 141, as illustrated in Figs. 14d and 14e.
• the latter Figure shows sleeve member 141 in a position pushed forward on rod member 140, so that sensor element 143 is located in a position relative to coagulator device 144 corresponding substan- tially to the relationship ⁇ in Figs. 14b and 14c.
• Fig. 14d shows sleeve member 141 retracted so that sensor
• a displaceable sleeve member 141 can be adjustable without steps in its longitudinal direction, or possibly can be adapted to assume certain fixed possitions, e.g. provided by mean ⁇ of snap elements.
• sensor element 143 with its associated projection 143A will not significantly impede the visibility for the surgeon and the same applies to the normal function of the standard instrument concerned, such as a biopsy forceps having a main part or rod-shaped member 140 as discussed above.
• Figs. 15a, 15b and 15c show a specific solution according to the invention, for such situations or ope ⁇ rations. As a starting point Figs. 15a and 15b correspond to Figs.
• a manual instrument such as a biopsy forceps 150 is provided with a replaceable sleeve member 151 having a sensor element 153 with an associated electrical terminal 158 and besides there is indicated an end portion 152 at the outer end of sleeve 151.
• a coagulator device having e.g. jaws or teeth like the device 144 in Fig. 14b-14e.
• sleeve member 151 is provided with several through-going channels in the longitudinal direction, and these channels have openings in an outer end wall at portion 152.
• One channel 152A can be utilized for flushing effect and another channel 152B can be utilized for suction, as known per se in surgi- cal methods.
• Corresponding outlets or connections at the opposite, inner end of sleeve member 151 are shown at 155 and 156 in Fig. 15a and 15b. At 155 and 156, respectively, it will thus be possible to connect hoses for the flushing and suction respectively, as mentioned.
• a third and larger channel or passage 152C extends through the whole length of sleeve member 151, namely for the mounting of the sleeve member on the rigid, rod-shaped part (not shown) incorporated in the manual instrument 150, in the same way as explained with respect to instrument 140 in Fig. 14b-14e.
• sleeve member 151 can be made to be not only replace ⁇ able, but also displaceable in its longitudinal direction in relation to the main part of instrument 150.
• Such a combined instrument which comprises the posi- bility of flushing and/or suction as well as localizing of bleeding by means of a sensor element, may also be employed within other fields than laparascopic surgery.
• the two channels 152A and 152B for flushing and suction respectively can be replaced by one common channel, where flushing and suction must take place in sequence.
• Besides such channels can be arranged in various manners. It may be expedient, inter alia, to have several inlets for the suction channel distri ⁇ ubbed over end portion 152, so that this will not so easily be clogged when contacting biologic tissue.
• Another particularly preferred embodiment of the instrument according to the invention is based upon a flexible carrier member which can be introduced through the work channel in a flexible and controllable endoscope.
• the instrument can be designed es ⁇ entially as shown in Figs. 13a and 13b, with the modification that shaft 131 is made flexible instead of being rigid.
• a sensor and a device for coagulation can be designed as previously described, whereby one possible example is given by Fig. 13b.
• the tip of the instrument By introducing the instrument through the work channel in an endoscope, the tip of the instrument will be controllable in that the tip of the endoscope is manually controllable, and in that the instrument can be pushed out and inwards through the work channel.
• a sensor and a coagu- lator mounted on the instrument which according to the kind of operation, shall be used in the work channel, so that if a bleeding occurs it will not be necessary to change instru ⁇ ment.
• the instrument can be designed only for the purpose of localizing and stopping bleeding. In such case the operator must change instrument when bleeding occurs.

Landscapes

• Health & Medical Sciences (AREA)
• Life Sciences & Earth Sciences (AREA)
• Surgery (AREA)
• Engineering & Computer Science (AREA)
• Public Health (AREA)
• Animal Behavior & Ethology (AREA)
• Veterinary Medicine (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Biomedical Technology (AREA)
• Heart & Thoracic Surgery (AREA)
• Medical Informatics (AREA)
• Molecular Biology (AREA)
• General Health & Medical Sciences (AREA)
• Physics & Mathematics (AREA)
• Pathology (AREA)
• Biophysics (AREA)
• Radiology & Medical Imaging (AREA)
• Otolaryngology (AREA)
• Plasma & Fusion (AREA)
• Optics & Photonics (AREA)
• Hematology (AREA)
• Surgical Instruments (AREA)

Applications Claiming Priority (3)

Publications (1)

Family

ID=19898747

Family Applications (1)

Country Status (4)

Families Citing this family (33)

Family Cites Families (2)

• 1995
  • 1995-11-10 NO NO954552A patent/NO954552D0/no unknown
• 1996
  • 1996-11-08 WO PCT/NO1996/000263 patent/WO1997017014A1/en not_active Application Discontinuation
  • 1996-11-08 AU AU76568/96A patent/AU7656896A/en not_active Abandoned
  • 1996-11-08 EP EP96939369A patent/EP0957754A1/en not_active Withdrawn
• 1998
  • 1998-04-30 NO NO981956A patent/NO981956L/no unknown

Non-Patent Citations (1)

Also Published As

Similar Documents

Legal Events