EP3410960A1

EP3410960A1 - Surgical stone catching instrument

Info

Publication number: EP3410960A1
Application number: EP17703405.5A
Authority: EP
Inventors: Thomas HEMS; Christopher JANSSEN
Original assignee: Uromed Kurt Drews GmbH
Current assignee: Uromed Kurt Drews GmbH
Priority date: 2016-02-05
Filing date: 2017-02-03
Publication date: 2018-12-12
Also published as: WO2017134229A1; DE102016001292A1; BR112018013943A2; DE102016001292B4; ZA201804208B

Abstract

The invention relates to a surgical stone catching instrument (1) comprising a gripping element (6) arranged at the distal end of a shaft (2) that has a tube (4) through which a pulling wire (5) runs, the distal end of the wire being secured to the gripping element (6), which can be folded together by axially sliding the tube (4). A handle (3) with two handle pieces (3, 10) is arranged at the proximal end of the shaft (2), wherein the proximal end of the pulling wire (5) is secured to the stationary handle piece (3), and the proximal end of the tube (4) is secured to the movable handle piece (10). The invention is characterized in that the tube (4) has a visible marking (13) on the tube exterior in the longitudinal region of the gripping element (6), which is completely surrounded by the tube, and the position of the marking (13) indicates the position of the gripping element (6).

Description

Surgical stone catching instrument

background

The invention relates to a surgical stone trap instrument according to the preamble of claim 1. Such a stone trap instrument is known from WO 2010/133245 A1, Figures 19A-20B.

It is described here a construction in which the gripping element is folded by sliding over the hose and unfolded by pulling back the hose. The stone catching instrument can thus be advanced with the gripping element into a narrow body canal or into a hollow organ, for example the ureter or kidney, into the area of a stone sitting there. When unfolded gripping element can then be caught with this the stone and pulled out of the body together with the stone catching instrument.

The construction of the cited document has over older prior art, in which the hose is fixed and the pull wire is moved, the advantage that the kinematics reversed running so that when moving the hose, the gripping member is stationary. The advantage here is that the gripping element is not moved in its unfolding relative to the body tissue. The fact that there is no change in position during the unfolding of the gripping element, a correction of the optics is not required and accidental displacement of the stone fragment almost impossible. This results in a particularly careful and secure development. However, the known construction has a disadvantage. When placing the stone trapping instrument in the body, the gripping element, especially in the case of a very sensitive wire basket, should be inside the hose, otherwise it would be bent by the advancing movement in the optics and in the narrow body channel or would not be pushed forward. This has the consequence that the surgeon can not see the gripping element, since it is located inside the tube. He only sees the hose and has to estimate how he has to arrange this to the stone to be removed, to have later after retraction of the hose and exposing the gripping element, the latter in a favorable position. It therefore often comes to inaccurate placement of the gripping element, so that this must be corrected by removing the tube, which has the disadvantages mentioned.

The object of the present invention is to further develop a surgical stone trapping instrument of the type described in the preamble of claim 1 such that the risk of incorrect placement of the gripping element is reduced.

Description This object is achieved with the features of the characterizing part of claim 1. An associated method is specified in claim 12.

Thus, in a first aspect, the invention relates to a surgical stone-trapping instrument having a gripping member disposed at the distal end of a shank having a hose passed through by a puller wire at the distal end of which the gripping member is secured Hose is collapsible, wherein at the proximal end of the shaft, a handle with two grips is arranged on the fixed handle the proximal end of the puller wire and its moving handle, the proximal end of the hose are fastened, characterized in that the hose in the longitudinal region of the completely enclosed by him gripping element has an externally visible mark.

According to the invention, an externally visible marking, for example, provided on the outside of the hose, is provided in the longitudinal region in which the gripping element lies. As long as the hose and the gripping element are not moved relative to each other, so called the location of the highly visible mark exactly the position of the not yet visible gripping element. In a preferred embodiment, the position of the marking thus denotes the position of the gripping element. If the position of the marking designates the position of the gripping element, then this means that the position of the marking makes it possible to identify the position of the gripping element. In particular, the position of the marker then designates the position of the gripping element when the tube is displaced maximally in the distal direction, ie in its distal, secured end position. According to the invention, in this position, the gripping element or the middle or end (s) of the gripping element thus usually within the tube at the position on the outside of the hose, the corresponding mark is visible, if the mark denotes the position of the folded gripping element ,

When the tube is displaced maximally distally, the tube encloses the gripping element substantially completely. In other words, the tube encloses the gripping element in this position completely in the longitudinal direction of the tube (but not at the distal and proximal end of the gripping element). This allows a secure placement of the gripping element, although it sits in the tube during this process and can not be seen. If the tube is subsequently withdrawn (in the proximal direction) and the gripping element is exposed in order to unfold, it sits exactly in the desired position. Significant additional costs for the stone catching instrument do not arise. However, there is a significant advantage through the fast and secure placement.

The proximal end refers to the end that is typically closest to the healthcare professional in handling, ie, the end facing the handle. Accordingly, the distal end is the one which is opposite the proximal end and is usually closest to the site of the medical procedure. Herein, the distal end of the instrument is the end that includes the gripping member. In one embodiment, the shaft has a further, ie second, tube through which the first tube extends. The second tube is therefore also referred to herein as the outer tube. Through the use of two hoses, the opening behavior is optimized during the retraction and advancement, since the active tube (first tube) runs in the second tube and thereby tolerances at z. B. bending can be compensated. An uncontrolled shifting of the components to each other is thus prevented. Preferably, the first tube, if it is displaced maximally in the distal direction, projects beyond the outer tube approximately by the length of the gripping element. The first tube can be withdrawn proximally so far or moved so far in the proximal direction that it no longer encloses the gripping element. In this, displaced maximally in the proximal position, the first tube is therefore completely or almost completely enclosed by the outer tube and thus covered.

The marking can be arranged in different ways assigned to the position of the gripping element. In addition, the marker may consist of one or more markers.

For example, a very short mark may indicate, ie indicate, the center or one of the ends of the gripping element. "Marking" in this context means that, as long as the tube is maximally distally displaced along the longitudinal axis of the shaft, it can be seen from the short mark on the tube where the center or one of the ends of the (folded) grasping element within the Hose is located or will be located after the gripping element is fully opened (ie the tube is maximally retracted in the proximal direction.) If the marking designates the position of the folded gripping element, this usually means that the gripping element or the middle or end (n) of the gripping element is located inside the hose at the position at which the corresponding marking is visible on the outside of the hose.The marking may indicate the position of the folded or fully opened gripping element or the position of said sections of the gripping element in FIG collapsed or fully opened r position. "Short" in this context refers to a length which corresponds to half the length of the gripping element in folded-together form or less, preferably one quarter of the length of the gripping element in collapsed form or less Such a short marking may preferably designate the proximal end of the gripping element. In this way, since the gripping element in the tube typically terminates at the distal end, both ends of the grasping element are clearly shown by the medical practitioner, the proximal end through the mark and the distal end through the end of the tube the position of the center of the fully open gripping element. Alternatively, the marker may consist of two or more short, eg three, markers, preferably two markers. This z. B. the position of a short mark indicate the position of the distal and the proximal end of the gripping element. If the mark consists of three short markings, then z. B. in each case the position of a short mark denote the position of the distal and proximal ends of the gripping element and its center.

The mark can also be a longer mark, z. B. a mark corresponding to the length of the folded or the length of the fully open gripping element.

The surgeon can then be sure of where the gripping element is based on this mark. Advantageously (according to claim 2 and 3), the length of the marking corresponds to the length of the gripping element, so that its position and z. B. its length in relation to the length of a stone to be taken better predictable.

The marker may be mounted on the tube in different ways. The mark can z. B. be a colored mark, or a change in the surface structure of the hose. A colored marking will have the greatest possible contrast to the basic color of the tube. In this way, the mark is well displayed with optical devices used during the procedure. The colored mark can be z. B. be printed on the tube. Alternatively, z. Example, a color different shrink tubing or a sleeve on the tube be applied so that the shrink tube or the sleeve is substantially flat with the tube surface. In another embodiment, the marking may also be formed by the color of the tube. Does the shaft z. For example, as set forth hereinabove, another outer tube, the externally visible marker may be formed by having the (inner) tube of a different color than the outer tube. Furthermore, it is also conceivable that the marking is a mark visible in X-ray images.

The shaft of the stone catching instrument according to the invention can be designed to be rigid, for example, which could have advantages for special applications. However, the flexural elastic design of the shaft is in most cases an advantage, since the shaft can better follow a tortuous body canal without overloading it too much. Thus, in a preferred embodiment, the shaft is flexurally elastic. Advantageously, a distal end stop for the moving handle is provided on the handle. During the longitudinal displacement of the tube controlled thereby, a secured end position with a defined position of the gripping element relative to the marking results when moving in the distal direction. This secured end position is also referred to herein as maximally displaced in the distal direction position of the hose.

The gripping element can, for. B. as pliers, as shown for example in US 2015/0142009 A. Preferably, however, it is designed as a wire basket, as is known per se from WO 2010 133245 A1, for example, and offers advantages here, in particular with regard to the space required. In a preferred embodiment, the gripping element is thus formed as a wire basket. The group of wire baskets suitable according to the invention comprises both open and closed wire baskets. The skilled person is aware of suitable wire baskets.

The claimed method specifies steps with which the stone catching instrument according to the invention is advantageously used. More particularly, in a second aspect, the invention therefore relates to a method for removing a stone from a body passage with a stone catching instrument according to the invention, characterized by first advancing the tube to its distal end position, then placing the stem with the mark next to the stone, then the tube is withdrawn to release the gripping element and finally the stone with the wire basket and is pulled out together with the stone catching instrument from the body passage.

In a further aspect, the invention relates to a stone catching instrument according to the invention for use in a method of removing a stone from a body duct or hollow organ, e.g. B. in the inventive method. The inventive method and stone catching instrument for use herein may also be characterized in that the handle of the stone trapping instrument has a distal end stop for the moving handle and the marker is oriented relative to the stone, the moving handle being in alignment with the distal end stop maximum approximated. During alignment, the marking (and thus also the gripping element) is usually arranged next to the stone. The surgeon can z. B. the indicated by the mark center of the gripping element immediately adjacent to the stone, z. B. place next to the middle of the stone. It is known to those skilled in the art that a gripping element of a particular shape should be oriented towards a stone in a soft manner. The maximum approximation of the moving handle to the distal end stop will usually cause the handle and the distal end stop to abut (abut) one another. If the handle is in this position, the tube is displaced maximally distally and the gripping element is enclosed by the tube and folded.

Brief description of the figures

In the drawings, embodiments of the invention are shown schematically. Show it:

FIGS. 1 to 3 show a stone catching instrument according to the invention in a side view in characteristic operating positions;

Fig. 4 is a section along line 4-4 in Fig. 1 and

5 shows a partially cut enlarged detail of FIG. 1 in the region of

Handle.

embodiments

Further advantages, characteristics and features of the present invention will become apparent in the following detailed description of embodiments with reference to the accompanying drawings. However, the invention is not limited to these embodiments.

Figures 1 - 3 show in different operating positions a stone catching instrument 1 with a shaft 2, at the proximal end of a handle 3 is arranged.

The shaft 2 essentially consists of a hose 4, which, as shown in FIGS. 1-3, has a flexurally elastic design in the illustrated preferred embodiment. In the interior of the hose 4, a pull wire 5, which is also correspondingly flexurally elastic and extends over the substantial length of the hose 4, extends. He is connected at its distal end to the proximal end of a gripping element in the form of a wire basket 6 or, depending on the construction, designed as such.

Figures 1 - 3 show different feed positions of the movable tube relative to the fixed puller wire 5. In the position shown in FIG. 1, the tube 4 is advanced (in the distal direction), slightly withdrawn as shown in FIG. 2 and completely (in FIG proximal direction) withdrawn. In this case, the relative to the hose 4 fixed wire basket 6 is gradually released more and more until it is completely free in the position shown in FIG. 3 and unfolds in the embodiment in the illustrated form.

The design of the handle 3 is shown in Fig. 5 in a simple example. It can be seen that the puller wire 5 is fixed in the exemplary embodiment with a connecting piece 7 on the housing of the handle 3. The hose 4, however, passes freely through an opening 8 of the housing and is connected in its interior via a connecting web 9 with a knob / handle 10, with its longitudinal movement, for example by the surgeon's thumb, the hose 4 relative to the housing of the handle 3 held pull wire 5 can be moved back and forth. The connecting web 9 is shown extending in the illustrated embodiment by a slot 1 1 of the handle 3.

As shown in FIG. 5, the hose 4 can be moved back and forth relative to the housing 3 fixed in the hand of the surgeon as far as the longitudinal extension of the slot 11 permits. Thus, an end stop 14 for the connecting web 9 is provided, in particular in the distal direction, which limits the forward displacement of the hose 4 in a defined end position. As a result, the position of the hose 4 is fixed in FIG. 1 and it is ensured that the hose 4 is in a defined position to the wire basket 6. Fig. 4 shows in section along line 4-4 in Fig. 1, the tube 4 with the inner pull wire 5. It can be seen at the distal end of the puller wire 5 arranged wire basket 6 with its, in the illustrated embodiment, four splayed wires arranged in The position of FIG. 1 abut from the inside of the tube 4 and be prevented by this at its further unfolding.

For the purposes described, the wire basket 6 must be designed to be self-expanding outward, so from a resilient wire material such as Example of a suitable spring-elastic steel, a suitable nickel / titanium alloy (eg nitinol), other shape memory alloys or a suitable plastic. The puller wire 5 may consist of appropriate material. The state of the art indicates a wide variety of suitable constructions and materials for this purpose.

Figures 1 - 3 show an exemplary use of the stone catching instrument 1. It is intended to remove a stone 12, which is shown in Figures 1-3 as an example of a mineral kidney stone with relatively sharp edges. The stone should sit in the example described in the ureter, for example, halfway between bladder and kidney. The ureter has been omitted to simplify the drawing. It can be assumed that he encloses the stone very tightly, typically with spastic narrowing of his tube muscle.

In the next step according to FIG. 2, the tube 4 is retracted by actuation of the adjusting knob 10 on the handle 3 via the intermediate position of FIG. 2 into the proximal end position of FIG. In this case, as the figures show, the wire basket 6 is released and can unfold into the open end position of FIG. 3. In this case, the stone 12 enters the wire basket 6. In subsequent steps, not shown, can now be narrowed in the usual way, the wire basket again to hold the stone 12. Subsequently, the entire stone catching instrument 1 with the stone 12 is pulled out of the body. As the comparison of Figures 1-3 shows, in the position of Fig. 3, the stone 12 in the middle of the wire basket 6 stand. This means, however, that in the arrangement of FIG. 1 it lies in the middle of the longitudinal extent of the wire basket 6. The surgeon controlling the placement of the stone trapping instrument 1 usually performs this work under optical control with an endoscope, through the working channel of which the shaft 2 is laid. The viewing conditions are not good and in particular the viewing angle is unfavorably close to the extension direction of the shaft. 2

It is therefore very difficult for the surgeon to estimate where the wire basket 6 lies, which is still hidden within the tube 4 at this time.

It has to be taken into account that the surgeon's work is very difficult anyway and requires a high concentration as well as a special talent. It not only difficult spatial coordination tasks have to be solved, but all this with a mostly very poor view, eg bleeding in the operating area, which can reduce the vision significantly, in some cases almost completely. In this task, the surgeon is supported by the present invention, which provides on the outside of the tube a mark 13 which, as the comparison of Figures 1-3 shows, sits exactly in the place at the in the position of Fig. 1st within the tube 4 of the folded wire basket 6 is located. With the marking 13 it is much easier for the surgeon to achieve an exact positioning.

The mark 13 should be clearly visible, especially with a high contrast of the remaining color of the tube 4 differ. Under certain circumstances, a marking effect in the X-ray region may also be advantageous since operations of this type are frequently carried out under X-ray control.

In place of the wire basket 6, which is formed without a tip, and a basket may be provided in embodiment with a tip, as shown in WO 2014/086917 A1.

Although the present invention has been described in detail with reference to the embodiments, it will be understood by those skilled in the art that the invention is not limited to these embodiments, but rather modifications are possible in such a way that individual features omitted or other combinations of individual features presented realized unless the scope of the appended claims is exceeded. The present disclosure includes all combinations of the featured individual features.

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LIST OF REFERENCE NUMBERS

1 stone catching instrument

2 shaft

3 handle

4 hose

5 pull wire

6 wire basket

7 connector

8 opening

9 connecting bridge

10 adjusting knob / moving handle

1 1 slot

12 stone

13 mark

14 end stop

Claims

claims

1 . Surgical stone trapping instrument (1) with a gripping element (6) which is arranged at the distal end of a shaft (2), which has a hose (4), which is traversed by a puller wire (5), at the distal end of which the gripping element (6 ), which is collapsible by axially pushing over the tube (4), wherein at the proximal end of the shaft (2) a handle (3) with two gripping pieces (3, 10) is arranged, on whose stationary handle (3) the proximal End of the puller wire (5) and on the moving handle (10), the proximal end of the hose (4) are fastened, characterized in that the hose (4) in the longitudinal region of the fully enclosed by him gripping element (6) has an externally visible mark (13), wherein the position of the marking denotes the position of the gripping element.

2. stone trapping instrument according to claim 1, characterized in that the length of the marking (13) corresponds to the length of the folded gripping element (6).

3. stone trapping instrument according to claim 1, characterized in that the length of the marking (13) corresponds to the length of the fully open gripping element (6).

4. stone trapping instrument according to claim 1, characterized in that the marking (13) denotes the position of the center, one of the ends or both ends of the folded or fully open gripping element (6).

5. stone trapping instrument according to claim 1 or 4, characterized in that the marking (13) the position of the proximal end and / or the distal end of the folded or fully open gripping member (6), preferably the proximal end of the gripping element (6).

6. stone trapping instrument according to claim 4, characterized in that the marking (13) denotes the position of the center of the fully open gripping element (6).

7. Stone catching instrument according to one of the preceding claims, characterized in that the marking (13) is a colored marking.

8. stone trapping instrument according to one of the preceding claims, characterized in that the marking (13) by the color of the hose (4) is formed.

9. Stone trapping instrument according to one of the preceding claims, characterized in that the shank (2) is formed elastically bending.

10. stone catching instrument according to one of the preceding claims, characterized in that the handle (3) has a distal end stop (14) for the moving handle (10).

1 1. Stone catching instrument according to one of the preceding claims, characterized in that the gripping element is designed as a wire basket (6).

12. A method for removing a stone (12) from a body passage or hollow organ with a stone catching instrument (1) according to one of the preceding claims, characterized in that first the tube (4) is advanced to its distal end position, then the shaft (2 ) is placed with the mark (13) next to the stone (12), then the hose (4) is retracted to release the gripping element (6) and finally the stone (12) with the Wire basket (6) and is pulled out of the body passage together with the stone catching instrument (1).

13. Stone trapping instrument according to one of claims 1 to 1 1 for use in a method for the removal of a stone (12) from a body passage or hollow organ.

14. Stone catching instrument for use according to claim 13, in a method according to claim 12.

15. The method according to claim 12 or stone catching device for use according to one of claims 13 or 14, characterized in that the handle (3) of the stone trapping instrument (1) has a distal end stop (14) for the moving handle (10) and the marking ( 13) relative to a stone (12) is aligned, wherein the moving handle (10) during the alignment of the distal end stop (14) is at maximum approximated.