FR2658443A1 - Instrumental endoscopy, rotary scissors, clamps mounted on cylinders - Google Patents

Abstract

These rotary scissors relate particularly to surgery and endoscopy. Clamps mounted on cylinders may be manufactured according to the same principle. Two cylinders, revolving one inside the other, carry a blade at their distal end. The internal cylinder, rotating on itself, moves the two blades closer together and allows a scissor cut on each revolution. These scissors may be mounted at the end of a flexible shaft of great length and may leave a passage for an endoscope, an instrument, a washing or suction tube within it. These scissors may be used through an operating channel (duct) in surgery, or percutaneously.

Description

The classic scissors formed of two blades, joined and crossed on a pivot (entablature) are not suitable for endoscopy.

Vascular, tubal or other microsurgery must use new instruments.

The present invention relates to rotary scissors particularly intended for surgery and endoscopy.

These scissors, of elongated shape, comprise three parts: the distal or cutting end, the body, the proximal end or handle.

The distal end comprises an outer hollow cylinder carrying an outer and distal blade; and an internal cylinder, full or hollow, carrying an internal and distal blade.

These two cylinders are attached to the body of the instrument, the outer cylinder to the outer sheath, the inner cylinder to the axis.

The blades most often resemble a fraction of an intravenous needle bevel. The blades have a base, which attaches them to their cylinder, a more or less rounded point, a sharp or cutting edge, and a foam edge. The two blades are different, their cutting edges are face to face. The internal blade is often sharper. the blades can be of different colors, golden and matt black for example. The tips of the blades are often asymmetrical, more rounded towards the foam edge. The outer blade is an extension of the outer cylinder so that the instrument slides perfectly within a channel. the blade can even be concave inside. The blades can be offset from each other so that they cross at only one point, the cutting point. The cylinder and the internal blade can have a very slight external concavity to promote plating of the inner blade on the outer blade.

Between the two cylinders, there is a virtual space; or a liquid joint, cilicon or other; even cold light fibers. The two cylinders include blocking elements, allowing only the rotation of the two cylinders. The internal cylinder is fixed either directly to a rotating axis, or connected by a rotating step to a translating axis only (pull-type axis)
The body of the instrument has an outer sheath and an axis.

The outer sheath is made of needle-tube, spring-tube or moldable materials (fluorocarbons or others)
The axis, most often metallic, is solid or hollow. If it is hollow, it allows the passage of fluids such as a washing liquid or the passage of instruments such as an endoscope, crutchable or not, with or without channels. Indeed, the miniaturization of endoscopes (less than 0.5 mm) allows such a system.

Between the axis and the sheath, the space can be virtual, or occupied by lubricants, liquid or optical fibers. The space between the axis and the sheath can be large, compartmentalized, allowing the passage of many elements. The axis may not be strictly parallel to the sheath in order to promote cutting.

A washing channel can be lined with reflective material, the liquid serving as a conductor of cold light. It can be a simple metal surface. such a system increases the illuminating power of the endoscope at its distal end, in fact the miniaturization of the latter reduces the number of fibers and therefore the supply of light.

The proximal end or handle has either a pusher, or eyelets, concave surfaces or the like facilitating manual rotation of the axis relative to the sheath; more often than not a motor at a more or less slow speed. This motor allows rotation of the axis while immobilizing the sheath.

If the axis is hollow it does not obstruct the passage of the elements which cross the light of the axis. There is of course, at this level a mark of the exact position of the blades (scissors open or closed)
The materials used are those usually used in medicine: stainless metals, titanium, fluorocarbons, silicones, ceramics or others.

Specific aspects
The parts which carry the blades can be portions of cylinders,
The blades of the ends can be replaced by branches, striated or squared, with or without claws, thus forming a clamp. In this case only incomplete rotations and back and forth movement is possible.

The central axis is full, and the instrument is of small diameter (for example equal to 1.5 mm). The axis may be hollow and may allow the passage of a LASER fiber or current conducting wires intended for the destruction, coagulation, fulguration of the tissue fragments contained in or protruding from the forceps. In this case the external diameter of the clamp may be greater.

The miniaturization of endoscopes, less than 0.5 mm in diameter, makes it possible to introduce them into the axis. The endoscope can be independent of the axis, it can serve as a mandrel or guide to the instrument; it is fixed to the axis, in this case during the rotations the optics of the endoscope remains stationary. The fibers can rotate relative to the optics or the image sensor so that the image does not rotate during the rotations of the axis.

The light from the scissors allows the passage of a suction channel or forceps in order to recover fragments. A retractable protective sheath can cover the blades during catheterization.

The outer sheath can be composed of metallic elements, moldable materials, resins, ect ...

A scissor-clamp instrument can be made up of three or four cylinders. The same cylinder can carry several blades or several branches; a blade can have a flat edge and thus ensures the double blade-branch function.

Flexible rotary scissors or tweezers can be beqiiillable
The endoscope can be replaced by a miniature camera, an endocavity ultrasound system.

This invention is particularly intended for vascular, tubal, canal, cavity or other surgery; the repair of industrial pipes.

For exemple
Rotating scissors, 75 cm long, 3 mm in external diameter, have been designed. The cylinders are 3 or 4 mm thick.

The blades are slightly concave towards the inside of the cylinder so as not to traumatize the healthy wall of a vessel for example
The axis has a light of 1.4 mm in diameter, which allows the passage of an endoscope of 0.85 mm in diameter. Between the endoscope and the internal wall of the axis circulates the washing liquid. A free rotation LUER nozzle is attached to the proximal end of the axis. An anti-reflux valve prevents the liquid from leaking, while allowing the passage of the endoscope. An electric motor, controlled by a pedal, facilitates the slow rotations of the axis, while keeping the outer sheath and the LUER endpiece stationary.

 This model is particularly intended for the rapid devaluation of saphenous grafts, for the unblocking of certain arterial or tubal stenoses.

other scissors, 0.80 m long, 1.5 mm in diameter, with a solid axis of 0.5 mm in diameter and a spring-catheter tube whose wall is 0.4 mm thick, are can be used through an operating channel of certain endoscopes. clamps mounted on a cylinder, of the same diameter allow tissue fragments to be recovered.

Claims (9)

1-Scissors characterized in that they are composed of at least two cylinders, or parts of cylinder, the distal end of which comprises at least one blade and that the rotation of one cylinder relative to the other allows the approximation blades, allowing cutting. 2-Rotary scissors characterized in that the blades are in the extension of the cylinders and therefore that they do not interfere with the progression of the scissors in a tube, in a conduit. 3-Rotating scissors characterized in that they are mounted at the flexible end of great length and that they can progress within curved channels. 4-Scissors characterized in that the blades are of different colors (golden and matt black for example). 5-Rotating scissors or clamps mounted on cylinders characterized in that they have channels within them allowing the passage of elements as diverse as an endoscope, such as a fluid for example.  6-Rotating scissors characterized in that they have a tip at the proximal end or close to the handle LUER free or not to rotate. 7-Endoscope or image sensor, within a rotary instrument, characterized in that it has elements of free rotation, in order to preserve a fixity of the image during the rotations of parts of the instrument. 8-Endoscope or endoscopic instrument characterized in that its washing channel has a reflecting surface or that the washing liquid is used as a conductor of cold light. 9-Endoscopy forceps scissors characterized in that they can combine the two functions on the same instrument having three or four cylinders.