FR2943237A1 - ENDOSCOPIC CUTTING SURGICAL DEVICE - Google Patents

Abstract

The invention relates to a surgical endoscopic cutting device comprising a guide tube (12) adapted to receive an endoscope optical cable (68), said guide tube comprising a proximal end (14) and opposite a distal end (16) equipped with a cutting head (18). Said cutting head comprises a cutting blade (20) and a housing (28) having a lateral opening (30) and an opposite bottom wall (32), said cutting blade (20) having a free end (38) and the opposite an attachment end (40) rotatably mounted within said housing (28). Said optical cable (68) is adapted to be driven in translation through said housing (28) to cause said cutting blade (20) to pivot from a position in which said free end (38) is housed inside said housing (28) to a position in which said free end (38) projects from said housing (28).

Description

1 Endoscopic cutting surgical device

The present invention relates to a surgical endoscopic cutting device allowing in particular surgical interventions through the carpal tunnel. Known devices comprise a guide tube adapted to receive the optical fiber of an endoscope. In addition, the guide tube which is intended to be introduced precisely into the carpal tunnel, comprises a proximal end through which the optical fiber is threaded and opposite a distal end equipped with a cutting head. The cutting head is equipped with an oblong cutting blade and has a housing adapted to receive the cutting blade. The housing has a lateral opening and opposite the opening a bottom wall facing. As for the oblong cutting blade it has a free end and opposite an attachment end rotatably mounted on a pivot inside the housing. Usually, the device further comprises means for driving the oblong cutting blade which extend inside the guide tube so as to pivotably drive the oblong cutting blade between an inactive position in which the free end blade is accommodated within the housing and an operative position in which the free end projects from said housing through the opening so as to be able to slice tissue around the cutting head, thereby causing translation the guide tube. In addition, to precisely observe the sliceable fabrics, the optical fiber is introduced into the guide tube and into the cutting head within the housing. In this way, through the opening, the optical fiber not only provides a light beam to illuminate the tissue but also to be able to accurately visualize these tissues. However, the guide tube must accommodate both the optical fiber of the endoscope and the means for pivoting the oblong cutting blade. Also, the diameter of this guide tube must necessarily be adapted according to the dimensions of this fiber and the drive means. Specific drive means have been devised for the oblong cutting blade to overcome the space requirement inside the guide tube. Reference can be made to WO 98/36696, describing a guide tube split axially in two parts, one of the parts pivotally receiving the oblong cutting blade inside the housing, the other part comprising the Inside the housing a driving pin, which is engaged in an oblong hole made in the cutting blade near the point of pivoting. Thus, the two slotted portions of the guide tube are adapted to be driven in translation relative to each other to rotate the cutting blade. Thus, the guide tube, by its structure, is adapted to cause the pivoting of the oblong cutting blade while maintaining a free internal space to thread the optical fiber.

However, such a device, even if it makes it possible to obtain guide tubes of smaller diameter or at least to facilitate the passage of the optical fiber, is relatively complex to implement and the head of cutting is not easy to sanitize. In addition, it is necessary to provide a joint plane between the two half-split tubes, which makes the guide tube leak-proof.

Thus, a problem that arises and that the present invention aims to solve is to provide a surgical endoscopic cutting device which not only makes it possible to produce small diameter guide tubes, but, moreover, to be able to implement cutting heads simpler to achieve and therefore less expensive.

In order to solve this problem, the present invention provides a surgical endoscopic cutting device comprising a guide tube adapted to receive an endoscope optical cable, said guide tube comprising a proximal end through which said optical cable is capable of to be introduced and opposite a distal end equipped with a cutting head adapted to receive said optical cable, said cutting head comprising an oblong cutting blade and a housing adapted to receive said cutting blade, said housing having a lateral opening and a bottom wall facing said lateral opening, said cutting blade having a free end and opposite an attachment end rotatably mounted within said housing, said cutting blade being adapted to be pivoted between an inactive position in which said free end is housed inside the it accommodates and close to said bottom wall and an active position in which said free end protrudes from said housing through said opening and spaced from said bottom wall. According to the invention, said optical cable is intended to be driven in translation through said housing to cause the pivoting of said cutting blade from the inactive position in which said free end is housed inside said housing towards said active position in said housing. which said free end extends projecting from said housing. Thus, a characteristic of the invention lies in the implementation of the endoscope optical cable ts, which is in all circumstances necessary to be able both to illuminate and visualize the tissues to reach, to cause the pivoting of the oblong cutting blade so that its free end can extend projecting from the housing. This optical cable is engaged inside a rigid conduit to be used as an actuator. In this way, the interior of the guide tube is fully available to receive the optical cable, since it is no longer necessary to introduce means for pivoting the oblong cutting blade therein. In this way, it is possible to reduce the diameter of the guide tube. In addition, as will be explained below, this simplifies the means for retaining the oblong cutting blade in the cutting head. According to a particularly advantageous embodiment of the invention, said cutting blade is equipped with a tongue articulated on said cutting blade between said two opposite ends of said cutting blade, said tongue being brought closer to said free end of said blade. cutting blade, when said cutting blade is in said inactive position, while said tongue is in abutment against said bottom wall. Thus, the oblong cutting blade, in the inactive position, is likely to be inclined relative to the bottom wall inside the housing, while the tongue bears against the bottom wall and that the free end is close to the tongue. From this position, said optical cable is advantageously adapted to bring said tongue of said fixing end along said bottom wall, while said tongue pivots away from said free end so that said cutting blade pivots to said active position. Advantageously and as will be explained in more detail in the following of the description, the optical cable drives the attachment end of the cutting blade towards the tongue. Advantageously, said tongue is resiliently flexible mounted on said cutting blade to allow the free return of said tongue to said free end and the pivoting of said cutting blade 15 to said inactive position when said optical cable is driven in translation in an opposite direction housing audit. In this way, after the tissue has been sliced, the cutting blade can be retracted inside the housing of the cutting head and then remove the latter from the carpal tunnel without the cutting blade does not interfere with the removal.

According to a preferred embodiment of the invention, said fixing end of said cutting blade is oriented towards said guide tube, whereas said tongue is oriented opposite said guide tube so as to be able to drive said cutting blade. pivoting back to said guide tube. In this way, the tissues can be cut by exerting traction on the guide tube and the cutting head, which makes it possible to improve the control and accuracy of the surgical procedure. Preferably, said tongue further comprises a first proximal wing which extends, said cutting blade being integral with said first proximal wing, while said tongue is articulated on said first proximal wing. Thus, the realization of the cutting head is simplified, since it comes weld the back of the cutting blade on the first proximal wing and the tongue being articulated on the first proximal wing, it is naturally pivotally mounted on the cutting blade . According to a first alternative embodiment, said first proximal wing has an extension itself hinged on said first proximal wing, said extension being terminated by a return end forming support means for said optical cable. In this way, when the optical cable is driven in translation against the end of the extension of the extension, the first proximal wing supporting the cutting blade is itself driven in translation on the bottom wall and pivoted relative to the tongue which in turn is pivoted, and the first proximal wing supporting the cutting blade and the tongue then straighten up to pivot the cutting blade. Advantageously, said return end has a lug, while said bottom wall has a longitudinal guide groove for receiving said lug. Thus, when the optical cable abuts against the return end to drive it in translation on the bottom wall, this return end is precisely guided in an axial direction. According to a preferred embodiment, said tongue and said first proximal wing are formed of a single flexible piece bent in a spring metal strip. In this way, the realization of the articulation between the tongue 20 and the cutting blade does not require complex means to form it. In addition, the realization of such an articulation is inexpensive. According to yet another preferred embodiment, said tongue further comprises a second proximal wing which extends back and away from said first proximal wing forming a bend to maintain said tongue within said housing. As will be explained below, this second proximal wing in addition to maintaining the tongue inside the housing also allows forming an elastic return for the tongue. In addition, said extension and said elbow are advantageously supported on said bottom wall. In this way, when the optical cable drives the end back of the extension, this end is slidably driven on the bottom wall towards the bend. Note that the tongue is also articulated on the second proximal wing at the elbow. Advantageously, and as will be shown by the embodiment of the invention described in more detail in the following description, said cutting blade has a tapered slice able to be oriented opposite to said bottom wall and a slice of support, or back, intended to come opposite said bottom wall. Other features and advantages of the invention will appear on reading the following description of a particular embodiment of the invention, given by way of indication but not limitation, with reference to the accompanying drawings, in which: - Figure 1 is a schematic perspective view of the surgical endoscopic cutting device according to the invention; FIG. 2 is a diagrammatic view in axial section of an element of the device illustrated in FIG. 1 in an inactive situation; Figure 3 is a schematic view of a first detail of the element illustrated in Figure 2; Figure 4 is a schematic view of a second detail of the element shown in Figure 2; Figure 5 is a diagrammatic view in axial section of the element of the device illustrated in Figure 1 in active situation; and - Figure 6 is a schematic view of the detail element shown in Figure 3 in the active situation. Figure 1 illustrates a surgical endoscopic cutting device 10 intended to be introduced in particular into the carpal tunnel of a patient, in order to be able to precisely cut tendinous tissues for example. The device comprises a rigid guide tube 12 with a diameter of 6 mm for example and comprising a proximal end 14 and opposite a distal end 16 provided with a longitudinal cutting head 18. Thus, an optical cable not shown in this Figure is intended to be introduced through the proximal end 14 to be threaded inside the guide tube to the cutting head 18 as will be explained hereinafter . Note that this optical cable is sheathed inside a rigid stainless steel conduit for example, and it has a recording end which will be driven inside the cutting head and a processing end connected to optical sensors forming a camera in order to visualize the scene that takes place at the level of the cutting head. The cutting head 18 comprises an oblong cutting blade 20 here in the active position and which will be described more precisely in the following description. In Figure 2 is further illustrated the distal end 16 of the guide tube and the cutting head 18, the latter being fitted to the free end 22 of the distal end 16. In this sectional view there is the inside of the cutting head 18, the oblong cutting blade 20 in an inactive position and pivoting driving means 23 of the oblong cutting blade. The cutting head 18 will first of all be described in detail and with reference to FIG. 4. The latter has at one end a tubular sleeve 24 intended to be fitted inside the free end 22 of the distal end. 16, and on the opposite, a rounded end 26 which will specifically face and be inserted into the carpal tunnel 20 for example. In addition, this cutting head 18 has a housing 28 and this housing has a longitudinal side opening 30 and opposite a bottom wall 32. The housing 28 comprises two facing lateral walls 34, 36 which extend between the bottom wall 32 and the side opening 30. In addition, the bottom wall 32 has an axial guide groove 35 whose utility will appear hereinafter. The cutting head 18 is made of a single piece of plastic, for example polyamide. Reference will now be made to FIG. 3 illustrating precisely the oblong cutting blade 20 and support means 37 constituting a substantial part of the pivoting drive means 23. The oblong cutting blade 20 having a length of 10 mm for example, has a free end 38 terminated by a point and opposite, an attachment end 40. In addition, it has a tapered slice 42 cutting, and an opposite slice of support 44 constituting the back of the cutting blade 20. Support means 37, here represented in the rest position, consist of a single strip of a spring metal material, for example stainless steel or titanium and pre-folded. This metal strip has a width of between 2.5 and 3.5 mm, for example 2.8 mm and a length of 23 mm for example. In addition, its thickness is between 0.15 and 0.25 mm, for example 0.20 mm in order to give it some flexibility with regard to the efforts that may be exerted on it. It will be observed that for certain applications a strip of plastic material may be suitable. The rest position shown in Figure 3 corresponds to an inactive position of the cutting blade 20. Thus, the support means comprise a tab 46 extended at one of its ends by a first proximal wing 48 inclined by about 130 ° by relative to the tongue 46. The tongue 46 and the first proximal wing 48 are of a substantially equal length close to 5 mm. Thus, thanks to the constitution of the metal band, the tongue 46 is articulated relative to the first proximal wing 48 at a first fold 50 and moreover, as will be explained below, they are likely to to be brought closer to one another and to return to their original position when they are left free. In addition, the first proximal wing has an extension 52 folded opposite the tongue 46 at a second fold 54. The extension 52 is inclined relative to the first proximal wing 48 of an angle, for example between 150 and 170 °. The extension 52 terminates in a return end 56 terminating in a free lug 58. In addition, the oblong cutting blade 20 is welded longitudinally to the first proximal wing 48, between the second fold 54 and the first fold 50, the wafer opposite bearing 44 against the face of the first proximal wing 48 opposite the tongue 46 and substantially perpendicular. Thus, the attachment end 40 of the oblong cutting blade 20 is adjusted adjacent the second fold 54, while the first fold 50 between the tongue 46 and the first proximal wing 48 is substantially mid-way between the attachment end 40 and the tip of the free end 38 of the oblong cutting blade 20. Thus, the tongue 46 and the free end 38 of the cutting blade 20 are they in a close position one of the other and forming an angle close to 60 °. In addition, the tongue 46 is extended back to the other of its ends by a second proximal wing 60 of a length substantially close to that of the tongue 46 and forming a third fold or elbow 62. In turn, second proximal wing 60 has a fastening free end 64 which can be anchored in the thickness of the cutting head 18 near the rounded end 26. Thus, FIG. 2 shows the support means 37 such as described above with the oblong cutting blade 20. The free return end 64 is anchored to the rounded end 26 of the cutting head 18 and at the side opening 30, while the second wing proximal 60 is inclined in the housing 28 so that the third fold 62 bears against the bottom wall 32 of the housing 28. In addition, the cutting head has a stop bar 66 installed across the housing 28 at a distance of the by oi bottom 32 towards the rounded end 26 and against the second proximal wing 60 to maintain it in a fixed position. Thus, the third fold 62 constituting a point of articulation of said other end of the tongue 46, is held in a fixed position against the bottom wall 32. In addition, it will be observed that the stop bar 66 coupled to the end free return 64 anchoring, maintains the support means 37 inside the housing 28.

The tongue 46 is then kept inclined with respect to the bottom wall 32 by an angle close to 25 ° and the first fold 50 between the tongue 46 and the first proximal wing 48 is substantially equidistant between the bottom wall. 32 and the opening 30. Opposite the tongue 46, the first proximal wing 48 also extends inclined relative to the bottom wall 32 at an angle also close to 25 °, while the second fold 54 is in turn bearing against the bottom wall 32. Also, the return end 56 extends substantially perpendicular to the bottom wall 32, while the free pin 58 is engaged in the groove of In addition, FIG. 2 illustrates the optical cable 68 and its recording end 70. It will be observed that this recording end 70 is adapted to abut against the return end 56 of the extension 52. , and this is a carac essential feature of the invention, thanks to the optical cable will be able to cause the pivoting of the oblong cutting blade 20 to an active position projecting from the lateral opening 30 of the cutting head 18. io Indeed, the drive in translation of the optical cable 68 towards the cutting head 38 according to the arrow F, causes a translational movement in the same direction of the extension 52 and the second fold 54 in friction against the bottom wall 32. In this way, a double movement of the tongue 46 and the first proximal wing 48 operates. As the extension 52 is brought closer to the third fold 62, the tongue 46 pivots counterclockwise around the third fold 62, while the first proximal wing 48 pivots in the opposite direction. clockwise around the first fold 50. Also, as shown in FIG. 5, the oblong cutting blade 20 also pivots clockwise since it is integral with the first proximal wing. 48 so that its free end 38 extends protruding through the side opening 30. As illustrated, the tongue 46 is then spaced from the free end 38 of the cutting blade 20, while the fixing end 40 of the cutting blade 20 and the second fold 54 have moved closer to each other.

Referring to Fig. 6, there is shown in more detail the new shape of the support means 37 and the relative position of its different elements with respect to the cutting blade 20. Thus, the cutting blade 20, as well as the first wing proximal 48 is inclined relative to the bottom wall 32 by an angle of 75 °. In addition, the tongue 46 and the first proximal wing 48 are inclined relative to each other by an angle close to 50 °. Referring to Figures 5 and 6, it is understood that the oblong cutting blade 20 is held in this active position as long as the optical cable 68 is held in a fixed position and driven to the cutting head 18. This is indeed its end recording member 70 bears against the return end 56 which keeps the cutting blade 20 in the active position. Moreover, the recording end 70 of the optical cable makes it possible both to illuminate the tissue to be incised at the free end 38 of the cutting blade 20 and to visualize this incision in a direction of view D inclined d The incision of the tissue is then caused by the displacement of the guide tube 16 in a direction opposite to its insertion direction into the carpal tunnel. Moreover, thanks to the constitution of the support means 37, of elastic nature, as soon as the optical cable 68 is released and driven in a direction opposite to the cutting head 18, these support means 37 return to their initial shape as illustrated in FIG. Figures 2 and 3. As a result, the cutting blade 20 retracts itself within the housing 28 of the cutting head 18. The distal end 16 of the guide tube 12 can then be removed. carpal tunnel without damaging the surrounding tissues. In view of the simplicity of the support means 37 and the cutting head 18, their embodiment is very inexpensive and so they can be disposable. Thus it is no longer necessary to sanitize the surgical cutting device according to the invention, unlike those of the prior art.

Claims (12)

REVENDICATIONS1. A surgical endoscopic cutting device comprising a guide tube (12) adapted to receive an endoscope optical cable (68), said guide tube comprising a proximal end (14) through which said optical cable is capable of being introduced and in contrast a distal end (16) equipped with a cutting head (18) adapted to receive said optical cable, said cutting head comprising an oblong cutting blade (20) and a housing (28) adapted to receive said blade said housing having a lateral opening (30) and a bottom wall (32) facing said lateral opening, said cutting blade (20) having a free end (38) and opposite a fixing end ( 40) rotatably mounted within said housing (28), said cutting blade being adapted to be pivotally engaged between an inactive position in which said free end (38) is housed within the interior of said housing (28) and close to said bottom wall (32) and an active position in which said free end (38) projects from said housing through said opening (30) and spaced from said bottom wall; characterized in that said optical cable (68) is adapted to be translationally driven through said housing (28) to cause said cutting blade (20) to pivot from the inactive position in which said free end (38) is housed within said housing (28) to said operative position wherein said free end (38) projects from said housing (28). 2. Surgical cutting device according to claim 1, characterized in that said cutting blade (20) is equipped with a tongue (46) mounted articulated on said cutting blade (20) between said two opposite ends (40, 38). said cutting blade, said tongue (46) being close to said free end (38) of said cutting blade, when said cutting blade (20) is in said inactive position, while said tongue (46) bears against said wall background (32). 30 3. A surgical cutting device according to claim 2, characterized in that said optical cable (68) is adapted to bring said tongue (46) close to said fixing end (40) along said bottom wall (32), while said tongue (46) pivots away from said free end (38) so that said cutting blade (20) pivots to said active position. 4. Surgical cutting device according to claim 3, characterized in that said tongue (46) is mounted elastically flexible on said cutting blade (20) to allow free return of said tongue to said free end (38) and the pivoting said cutting blade (20) to said inactive position when said optical cable (68) is translationally driven in a direction opposite to said housing (28). Surgical cutting device according to claim 3 or 4, characterized in that said fixing end (40) of said cutting blade (20) is oriented towards said guide tube (12), whereas said tongue (46) is biased away from said guide tube (12) so as to cause said cutting blade (20) to pivot back to said guide tube (12). 6. Surgical cutting device according to any one of claims 2 to 5, characterized in that said tongue (46) further comprises a first proximal wing (48) which extends, said cutting blade (20) being mounted integral with said first proximal wing (48), while said tongue is hinged to said first proximal wing (48). 7. surgical cutting device according to claim 6, characterized in that said first proximal wing (48) has an extension (52) articulated on said first proximal wing, said extension being terminated by a return end (56) forming means support for said optical cable (68). 8. surgical cutting device according to claim 7, characterized in that said return end (56) has a lug (58), while said bottom wall (32) has a longitudinal guide groove (35) for receiving said lug. 30 The surgical cutting device according to any one of claims 6 to 8, characterized in that said tongue (46) and said first proximal wing (48) are formed of a single flexible piece bent in a spring metal band. 10. Surgical cutting device according to any one of claims 6 to 9, characterized in that said tongue (46) further comprises a second proximal wing (60) which extends back and away from said first wing proximal (48) forming a bend (62) for holding said tongue within said housing. Surgical cutting device according to claim 7 or 8 and 10, characterized in that said extension (52) and said elbow (62) are supported on said bottom wall (32). 12. Surgical cutting device according to any one of claims 1 to 11, characterized in that said cutting blade (30) has a tapered slice (42) adapted to be oriented opposite said bottom wall (32). and a support slice (44) intended to come opposite said bottom wall.