GB2261170A

GB2261170A - Bladed surgical instrument and guard therefor

Info

Publication number: GB2261170A
Application number: GB9221809A
Authority: GB
Inventors: Josaphat Joseph Kabukoba
Original assignee: Individual
Current assignee: Individual
Priority date: 1991-10-16
Filing date: 1992-10-16
Publication date: 1993-05-12
Also published as: GB9221809D0; AU2798192A; WO1993007822A1; GB9121937D0

Abstract

A part attachable to a bladed surgical instrument comprises a guard (26) which lies adjacent the blade (20) and controls the depth to which the blade may enter tissue. The part may be attachable to the blade or to a handle of the instrument, and may include means enabling adjustment of the position of the guard relative to the blade. The spacing of the guard and blade may be adjustable as may the relative heights thereof. The part may be provided with a clip (22) allowing it to be attached to the handle at various positions along the handle -the clip being formed integrally with an extending arm which carries the guard. The guard may be a single element carried to one or other side of the blade or be two elements respectively lying on either side of the blade. Resectors are also described having a blade the angle of which relative to the handle may be varied and having a curved or curvable handle including optical fibres allowing light to be carried to the blade and a view of tissue being cut by the blade to be seen by a user.

Description

SURGICAL INSTRUMENTS AND PARTS THEREFORE DESCRIPTION The invention relates to surgical instruments and parts therefore, in particular surgical instruments used for cutting, scraping and/or cauterising human tissue.

Surgical instruments for cutting, scraping and cauterising human tissue are known and are generally provided with a blade which may be of conventional form that is to say a sharpened metal blade - or be a heated metal part operable to cut, scrape and at the same time cauterise human tissue as the blade is drawn across the surface of tissue.

One example of such an instrument is an endometrial loop resector - an instrument which comprises an elongate handle having an electrical power connection therealong to supply electrical power to a loop shaped blade carried at one end of the handle to extend generally at an angle (e.g. at right angles) to the longitudinal axis of the handle. With this instrument a surgeon inserts the blade into the womb of the patient, applies electrical power to the lead extending along the handle to increase the temperature of the blade to a level at which it will scrape, cut and cauterise the inner surface of the womb of the patient. The surgeon then manipulates the handle to ensure that the heated blade is operable to cut, scrape, or cauterise the inner surface of the womb.

It will be appreciated there can be difficulty in controlling the depth to which the blade passes into the tissue of the womb as it is manipulated by a surgeon.

This difficulty is found generally with many surgical instruments with which there is need to accurately control the depth to which a blade (either a conventional metal blade or an electrically heated blade) will pass into tissue as it is being used.

Specifically, there is a danger in an endometrial resection procedure of the blade cutting too deeply into the wall of the womb which can lead to perforation and injury of adjacent abdominal structures.

A first object of the invention is the provision of means which will alleviate or overcome the difficulty noted above and provide a ready method of controlling the depth by which a blade used in cutting, scraping or cauterising may pass into tissue on which it is being used.

A second object of the invention is the provision of a device attachable to a bladed surgical instrument to ensure the depth of cut of the blade may be controlled.

A third object of the invention is the provision of a bladed surgical instrument, the instrument further including means enabling the control of the depth of any cut of the blade of the instrument.

It is highly desirable that the angle at which a resector blade rests on tissues may be readily altered - as in this way a surgeon using the instrument may more readily work on curved (convex or concave) surfaces. It proves in practice to be extremely difficult to obtain this variation at which the blade rests on a tissue surface when the blade is fixed at a rigid angle relative to a generally elongate handle.

Objects of the present invention include the provision of a resector in which this difficulty is overcome.

Further difficulties arise when making use of an endometrial loop resector within a patients womb specifically arising from the difficulty a surgeon has in viewing the surface he is treating.

Another object of the present invention is to provide an arrangement which alleviates and/or overcomes this difficulty.

In one aspect the invention provides a part attachable to a bladed surgical instrument, said part comprising guard means adapted when the part is attached to the instrument to lie adjacent the blade of the instrument and thereby be operable to control the depth to which the blade may enter tissue.

The part may be attachable to the blade of the instrument, or to a handle of the instrument.

The part preferably includes means enabling adjustment of the position of the guard means relative to the blade.

The spacing of the guard means and blade may be adjustable.

Advantageously, the part is attachable to a handle of the instrument and movable therealong.

The part desirably includes clip means enabling the part to be attached to a handle of a surgical instrument, said clip means being formed with an arm extending therefrom which arm carries said guard means.

In one arrangement embodying the invention the guard means comprises a single guard element. This guard element may be carried, in use, to the side of the blade of the instrument adjacent the handle, or in the alternative to the side of the blade of the instrument spaced from the handle.

In another arrangement embodying the invention the guard means comprises two guard elements which, in use, respectively lie on either side of the blade of the surgical instrument.

Advantageously the or each guard element lies, in use, substantially parallel to and spaced from the blade of the surgical instrument.

Again advantageously, the or each guard element may be provided with a portion extending, in use, generally normally of a blade with which is it associated in use.

Desirably, the position of the guard means is adjustable to enable variation and control of the depth to which the blade may cut into tissue.

A second aspect of the invention provides a surgical instrument incorporating a part as defined above.

The instrument may be an endometrial loop resector.

An endometrial loop resector embodying the invention may comprise a generally elongate handle carrying at one end thereof a blade, the resector further incorporating a part attachable to the handle and formed integrally with an arm extending towards the blade and carrying adjacent the blade a guard member.

The arm is preferably deformable enabling movement of the guard member relative to the blade such that the relative heights of the guard member and the blade may be adjusted.

The part is advantageously fixable to the handle at various positions along its length enabling adjustment of the spacing of the guard member from the blade.

The guard member may comprise a pair of guard elements respectively positioned on either side of the blade of the instrument.

Alternatively, the guard member may comprise a single guard element located to that side of the blade adjacent the handle of the instrument.

The shape of the or each guard element preferably approximates to that of the blade.

Desirably, each guard element extends, in use, generally parallel to blade and is provided, at the extremity thereof, with a portion extending generally normally of said blade.

Another arrangement embodying the invention provides an endometrial loop resector comprising an elongate handle supporting at one end a blade and further incorporating a part fixable on the blade, said part being provided with slots receiving side portions of said blade Yet another arrangement embodying the invention provides an endometrial loop resector comprising an elongate handle supporting at one end a blade and further incorporating a resilient member centrally apertured in which the blade of the resector may be passed and held by the resilient action of said part, the arrangement being such that the position of said part of said blade may be adjusted.

An endometrial loop resector as defined above may be provided with a blade which is pivotally supported on the end of said handle and is movable about the axis of said pivot such that the angle of the plane of the blade may be varied relative to the plane including the longitudinal axis of the handle.

Desirably said blade is spring biased to a first position.

Preferably, when said blade is in said first position it lies in a plane extending normally of a plane including the longitudinal axis of said handle.

The resector may be further provided with means attached to the blade and extending along the length of the handle to the end thereof remote from said blade, the arrangement being such that movement of said means by a surgeon holding the device at the said remote end of the handle will cause the blade to pivot from said first position - with advantage said means comprises a cord or cords. Said guard member may be arranged to move with said blade.

An endometrial loop resector as defined above may further be provided with a handle, or a support therefor, which is non-linear or capable of being deformed to a nonlinear shape.

With advantage the the handle of said instrument or said support therefore incorporates a plurality of light fibres allowing light to be taken to a position adjacent the said blade and a view of tissue adjacent the blade to be seen by a person using the instrument.

The above and other aspects, features and advantages of the invention will become apparent from the following description of an embodiment of the invention made with reference to the accompanying drawings, in which: Figure 1 shows at A, B and C a side, plan and end views respectively of an endometrial loop resector having a part embodying the present invention, Figure 2 shows a modified form of the resector of Figure 1, Figure 3 illustrates modifications which may be made to the form of the guard members of Figures 1 and 2, and Figures 4 to 6 illustrate further embodiments of the invention.

Figure 1 shows an endometrial loop resector to comprises an elongate hollow handle 10, of metal and/or plastics material, which has passing therealong electrical leads 12 operable to supply power to a generally arcuate blade 14 supported at one end of handle 10 on a pair of arms 16 extending from one end of the handle.

The arms 16 are cranked at 18 such that the lowermost part 20 (as viewed in Figures 1 and 3) of blade 14 lies just below the longitudinal axis of handle 10.

As described so far the instrument shown in the Figure is a standard endometrial loop resector.

In accordance with an embodiment of the invention the resector shown in the Figure is fitted with a part controlling the depth by which blade 14 may pass into tissue as the instrument is used.

This part comprises a clip 22 of malleable metal or plastics material which is crimped onto the handle 10 as shown. Clip 22 carries an arm extending forwardly towards the head of the instrument - which passes the end of handle 10. Thereafter the arm 24 diverges into two arms 26 each of which is cranked at 28 such that they lie generally parallel to the arms 16 supporting the blade 14 of the instrument.

The ends of arms 26 remote from clip 22 carry an arcuate guard element 30 which, when the clip is fitted to the instrument, lies generally parallel to the blade 14.

The lowermost edge of guard element 30 lies a short distance - shown in Figure 1A at 32 - above the lowermost edge of part 20 of blade 14 and defines the extent to which blade 14 may enter tissue as the instrument is used.

The spacing of the guard element 30 from blade 14 - - indicated at 34 in Figure 1A - again acts to control the depth to which the lowermost part 20 of blade 14 may enter tissue as the instrument is used.

A surgeon may, if he desires, vary the spacings 32 and 34 and thus the depth of cut permitted. Variation of spacing 32 being effected by simply bending arms 26 upwardly or downwardly (as viewed in Figure 1A).

Similarly the spacing 34 may be varied by repositioning clip 22 along the length of handle 10.

Figure 2 illustrates a modified form of the part which embodies the invention.

The part shown in Figure 2 is carried on an endometrial loop resector substantially the same as that shown in Figure 1 and parts of that instrument are given the same reference numerals.

The arrangement of Figure 2 provides a clip 42 crimped onto handle 10 of the resector as shown.

The part shown in Figure 2 differs from that shown in Figure 1 in so far as its arms 44 overlie (as viewed in Figure 2) the arms 16 of the instrument. At the end of the arms 44 remote from clip 42 there are provided-two guard elements 46 and 48.

Guard element 46 is, it can be seen from the Figure, to the side of the blade 14 remote from the handle 10 whilst guard element 48 depends from arms 44 between arms 16 and lies between blade 14 and the end of handle 10.

This arrangement - in providing two guard element - more effectively acts to control the depth to which blade 14 can enter tissue as the instrument is used by a surgeon.

The particular arrangements described are thought to have particular efficacy in various respects: the parts attachable to the endometrial loop resector shown in Figure 1 and Figure 2 are relatively easily fitted to a standard instrument; moreover they may - after the instrument has been used in an operational procedure - be readily dispos of.

The variation in the positioning of the guard element (and guard element 46 and 48) relative to the blade 14 of the resector enables variation to be made - if the surgeon desires - of the depth of cut obtained with the instrument.

It will be appreciated that various modifications can be made to the described arrangements without departing from the scope of the invention.

Most notably if desired, the part which has been described in Figures 1 and 2 for attachment to a surgical instrument may be provided integrally with the instrument.

The particular form of the guard element can be varied - they may be provided as solid members rather than loops (as shown) and can be of any shape which conforms generally to the shape of the blade of the instrument.

Figure 3A is a scrap side view of a head portion of an endometrial loop resector fitted with a part embodying the invention. From this Figure the blade 14 can be seen to have associated with it guard element 46 and 48 (as described with reference to Figure 2). Each of these guard elements is provided at its lowermost (as viewed in the Figure) end with a portion 47 and 49 which is turned away from the blade 14 - that is to say the portions 47 and 49 extend generally normally of the plane of the blade 14.

It will be appreciated that by providing that the guard element associated with the blade 14 are shaped in this way the efficacy of the guard in preventing that the blade cutting too deeply into human tissue will be increased.

The forms parts 47 and 49 may have when viewed in plan, may vary and three different shapes are shown in Figures 3B, 3C and 3D. Again, the form of the portions 47 and 49 when viewed from the side may be varied - as shown in Figure 3E - to further ensure the instrument will move smoothly over tissue when fitted with a part embodying the invention.

Figure 4 shows a further embodiment of the invention in which the part for controlling the depth which the blade of an endometrial resector can cut into tissue is clipped directly onto the blade and is not attached to the handle of the instrument.

In this arrangement the part 50 is, as illustrated, positioned directly on the head 52 of the resector. Part 50 comprises a mass of any suitable metal or plastics material which is formed with slots 54 sized such that the arms 56 of the loop resector blade are resiliently held or are a friction fit in them. It will be noted that an element 58 of the part 50 extends above the arms 60 which support the blade to ensure the part 50 remains at a desired position on the head - the lower edge of part 50 being at a spacing 62 above the lowermost, cutting, edge of the blade of the resector.

A A further embodiment of the invention is shown in Figure 5 in which the part for controlling the depth of cut shown at 70 to comprise a resilient metal or plastics element having a central aperture 72 in which the blade 74 of a resector is received. Part 70 is positioned on the blade 74 by pushing the two ends of the part 70 inwardly to widen the central aperture 72 - against the natural resilience of the material of which the part is made - to enable it to be positioned on blade 74 at a height desired by a surgeon. It will be appreciated that when the pressure on the opposed ends of the elements 70 is released - whilst the blade 74 is within the aperture 72 - the natural resilience of the material of which the part 70 is made will cause it grip the head 74.

The arrangements described in Figures 4 and 5 may be modified, if desired. For example, the parts 50 and 70 which are disclosed therein may comprise separate elements formed with inter-engaging means enabling them to be positioned on the blade of the instrument and then pushed together such that they are clamped in the desired location.

The method of fixing the part to the instrument may of course be varied - it is envisaged for example that the handle part 10 of the instrument shown in Figures 1 to 4 can be provided with a clip operable to secure the part onto the instrument in use. Other forms of attachment of the part to the instrument may be used - any suitable means for attachment of the part to the instrument being effective.

Figure 6 illustrates a modified form of resector generally such as shown in Figure 1, showing at A and B respectively plan and side views of this modified form of resector.

The resector shown in Figure 6 has a handle 80 supporting a loop resector blade 82 pivotally mounted at 84 on one end of the handle.

The blade 82 extends both above and below the plane including the longitudinal axis - indicated generally at 86 in Figure 6A - of the handle 80.

The resector is further provided with a spring member 88 attached to and carried by handle 80 and bearing on an upper part 90 of blade 82, part 90 being above the plane 86 including the longitudinal axis of the handle as viewed in Figure 6A.

The upper extremities of the part 90 of blade 82 are attached to the ends of cords 94 joined as shown to a single cord 96. Cord 96 runs along the length of the handle 80 - passing through guide loops 98 formed thereon.

At the end of the handle 80 remote from the blade 82 cord 96 is attached to an operating lever 100 mounted at 102 on the end of the handle 80 remote from the blade.

Mounting 102 provides pivotal mounting of lever 100 on the end of handle 80 but also is arranged to provide frictional resistance to movement of lever 100 so that the lever will maintain any position to which it is moved by a user against the bias of spring 88 on blade 82. Thus it will be seen that a surgeon may move the lever 100 (e.g. in the direction of arrow X) to cause movement of the blade 82 about pivot 84 (e.g. in the direction of arrow Y) to a position in which the blade will, thereafter, be held until the lever 100 is again moved.

The spring member 88 acts to bias the blade against the frictional resistance in mounting 102 (via the tension in cords 94 and 96 and holds the blade in any desired position.

It will be appreciated that a modified form of resector shown in Figure 6 may be used with the guard arrangements shown in Figures 1 to 5. The guards (which are not shown in Figure 6) may be fixed relative to the movable blade 82 (such as in the arrangements of Figure 1 and 2) or be carried with that blade (such as in the arrangements of Figures 3, 4 and 5).

It will be seen that the particular configuration shown in Figure 6 may be varied without departing from the scope of the invention. Alterations which may be made include the relative positioning of blade 82 and handle 80 may be altered (e.g. the blade may be located wholly beneath the plane 86); the points of attachment of cords 94; and the location of spring 88 (it may be provided beneath handle 80 if blade 82 is wholly beneath the handle).

The operating lever 100 may be replaced by any suitable means enabling movement, and the cords may be replaced a rod or any other suitable means for transmitting that movement along the length of handle 80. The means for transmitting movement along the handle 80, may if desired pass along the interior of a hollow handle.

The variation in the resector blade angle provided by this arrangement is important as it allows a surgeon to work on a curved surface without straining his arm or neck.

The ease with which he may operate over the entire surface of a womb not only reduces the probability of fatigue but also reduces the chances of perforation.

It is believed that with an endometrial loop resector modified in accordance with the arrangement of Figure 6 the ease with which difficult areas in a womb may be resected - for example the fundus of a womb - may be significantly increased.

Another modification which may be made to the arrangements so far described is that a handle for an endometrial loop resector - or a support therefore - may be provided as a conduit which may be either permanently curved or be deformable (e.g. be provided with a section or deformable sheath) to allow a surgeon to blend it to any desired curvature. The interior of the conduit may include bundles of optical fibres, irrigation systems and the like.

It will be appreciated that with such an arrangement light from the one of the handle remote from the resector may transmitted along the length of the handle to illuminate the area being resectored. Furthermore it will be appreciated that an image of the area being resected can be transmitted from the resector to the end of the handle remote therefrom.

The fact that the handle is curved enables a surgeon readily to reach all surfaces of a curved, convex or concave, womb without himself assuming difficult postures or positions.

It will be appreciated that many modification not described may be made to arrangements which fall within the scope of this invention.

The arrangements of guards described in with reference made to Figures 1 to 5 may be used in combination with the arrangement shown in Figures 6 and 7.

Resectors of forms other than those shown may of course be used with the arrangements now described - for example contact laser resectors which are coming into more widespread use at present.

It is believed that the arrangements now described are of significant benefit to surgeons in enabling the ready control of the depth of cut of a bladed instrument which they are using.

Although described as attached to an endometrial loop resector it will be appreciated that the principles of the present invention as defined above are applicable to other bladed surgical instruments.

Claims

1. A part attachable to a bladed surgical instrument, said part comprising guard means adapted when the part is attached to the instrument to lie adjacent the blade of the instrument and thereby be operable to control the depth to which the blade may enter tissue.

2. A part as claimed in Claim 1, when attachable to the blade of the instrument.

3. A part as claimed in Claim 1, when attachable to a handle of the instrument.

4. A part as claimed in any one of claims 1 to 3, wherein means are provided enabling adjustment of the position of the guard means relative to the blade.

5. A part as claimed in Claim 4, wherein, in use, the spacing of the guard means and blade is adjustable.

6. A part as claimed in Claim 3 and Claim 4, or as claimed in Claim 3 and Claim 5, when said part is attachable to a handle of the instrument and movable therealong.

7. A part as claimed in Claim 6, including clip means enabling the part to be attached to a handle of a surgical instrument, said clip means being formed with an arm extending therefrom which arm carries said guard means.

8. A part as claimed in any one of claims 1 to 7, wherein said guard means comprises a single guard element.

9. A part as claimed in Claim 8 and any one of Claims 3, 5, 6 and 7, wherein said part is provided such that the guard element is carried, in use, to the side of the blade of the instrument adjacent the handle.

10. A part as claimed in Claim 8 and any one of Claims 3, 5, 6 and 7, wherein said part is provided such that the guard element is carried, in use, to the side of the blade of the instrument spaced from the handle.

11. A part as claimed in any one of claims 1 to 7, wherein said guard member comprises two guard elements which, in use, lie on either side of the blade of the surgical instrument.

12. A part as claimed in any one of the preceding claims, wherein the or each guard element lies, in use, substantially parallel to and spaced from the blade of the surgical instrument.

13. A part as claimed in Claim 12, wherein the or each guard element is provided with a portion extending, in use, generally normally of a blade with which is it associated in use.

14. A part as claimed in any one of claims 1 to 13, wherein the position of the guard means is adjustable to enable variation and control of the depth to which the blade may cut into tissue.

15. A surgical instrument incorporating a part as claimed in any one of claims 1 to 14.

16. A surgical instrument as claimed in Claim 15 and formed as an endometrial loop resector.

17. An endometrial loop resector comprising a generally elongate handle carrying at one end thereof a blade, the resector further incorporating a part attachable to the handle and formed integrally with an arm extending towards the blade and carrying adjacent the blade a guard member.

18. A resector as claimed in Claim 17, wherein said arm is deformable enabling movement of the guard member relative to the blade such that the relative heights of the guard member and the blade may be adjusted.

19. A resector as claimed in Claim 17 or Claim 18, wherein said part is fixable to the handle at various positions along its length enabling adjustment of the spacing of the guard member from the blade.

20. A resector as claimed in any one of Claims 17 to 19, wherein said guard member comprises a pair of guard elements spaced on either side of the blade of the instrument.

21. A resector as claimed in any one of claims 17 to 19, wherein said guard member comprises a single guard element located to that side of the blade adjacent the handle of the instrument.

22. A resector as claimed in any one of claims 17 to 21, wherein the shape of the or each guard element approximates to that of the blade.

23. A resector as claimed in any one of claims 1 to 22, wherein each guard element extends, in use, generally parallel to blade and is provided, at the extremity thereof, with a portion extending generally normally of said blade.

24. An endometrial loop resector comprising an elongate handle supporting at one end a blade and further incorporating a part fixable on the blade, said part being provided with slots receiving side portions of said blade

25. An endometrial loop resector comprising an elongate handle supporting at one end a blade and further incorporating a resilient member centrally apertured in which the blade of the resector may be passed and held by the resilient action of said part, the arrangement being such that the position of said part of said blade may be adjusted.

26. An endometrial loop resector comprising a generally elongate handle carrying at one end thereof a pivotally supported blade which is movable about the axis of said pivot such that the angle of the plane of the blade may be varied relative to the plane including the longitudinal axis of the handle.

27. An endometrial loop resector as claimed in any one of claims 17 to 25, wherein said blade is pivotally supported on the end of said handle and is movable about the axis of said pivot such that the angle of the plane of the blade may be varied relative to the plane including the longitudinal axis of the handle.

28. A resector as claimed in Claim 26 or Claim 27, wherein said blade is spring biased to a first position.

29. A resector as claimed in Claim 28, wherein when said blade is in said first position it lies in a plane extending normally of a plane including the longitudinal axis of said handle.

30. A resector as claimed in any one of claims 26 to 29, further provided with means attached to the blade and extending along the length of the handle to the end thereof remote from said blade, the arrangement being such that movement of said means by a surgeon holding the device at the said remote end of the handle will cause the blade to pivot from said first position.

31. A resector as claimed in Claim 30, wherein said means attached to the blade comprises a cord or cords.

32. A resector as claimed in any one of claims 26 to 31, wherein said guard member moves with said blade.

33. An endometrial loop resector as claimed in any one of claims 17 to 32, wherein the handle of the instrument, or a support therefor, is non-linear or capable of being deformed to a non-linear shape.

34. A resector as claimed in Claim 33, wherein the handle of said instrument or said support therefore incorporates a plurality of light fibres allowing light to be taken to a position adjacent the said blade and a view of tissue adjacent the blade to be seen by a person using the instrument.

35. An endometrial loop resector as claimed in Claim 17 and substantially as described with reference to Figure 1 of the accompanying drawings.

36. An endometrial loop resector as claimed in Claim 17 and substantially as described with reference to Figures 2 and 3 of the accompanying drawings.

37. A part as claimed in Claim 1 for use with an endometrial loop resector and substantially as described with reference to Figures 4 of the accompanying drawings.

38. A part as claimed in Claim 1 for use with an endometrial loop resector and substantially as described with reference to Figure 5 of the accompanying drawings.

39. An endometrial loop resector as claimed in Claim 35 or 36, when modified as shown in Figure 6.