JP2005502423A - Apparatus and method for polypectomy - Google Patents

Abstract

A polypectomy device and method having a shringer cable, a fixed jaw and a movable jaw. The Schlinge cable passes through both the fixed jaw and the movable jaw. The Schlinge cable forms a loop around the polyp. The jaw part is positioned around the base of the polyp by shortening the Schringer cable, and the jaw part is closed by further shortening the Schernge cable. The fixed jaw has a heating member for cauterizing the base of the polyp. The polyp is cut by the closure of the jaw part and the heat of the heating member to seal the tissue.

Description

【Technical field】
[0001]
The present invention relates to medical devices and, more particularly, to devices for performing polypectomy.
[Background]
[0002]
A polyp is defined as a tumor or mass protruding from the mucosa. Polyps can occur anywhere in the mucosa of the nose, ears, mouth, lungs, heart, stomach, intestines, bladder, uterus and cervix. Most polyps are benign tumors that eventually stop growing. However, some of these polyps continue to grow. Genetic mutations can turn them into cancerous tumors. Such cancerous tumors continue to grow as they become larger and enter the tissues that support the polyps. In the final stage, cancer invades the blood and lymph system, and malignant cells of the tumor metastasize to other organs. This problem is particularly acute in the large intestine and is treated immediately. Colorectal cancer is the second leading cause of cancer death in the United States. If cancer is detected and treated at an early stage, more than 90% can be cured. Thus, early detection and removal of colorectal polyps, whether benign, pre-cancerous or cancerous, is very effective in avoiding or treating colorectal cancer.
[0003]
A polyp may attach to the mucous membrane by a thin stalk, or a polyp may have a wide base. A polyp attached by a thin handle is called a pedunculated polyp, and a polyp attached by a wide base is called a sessile polyp. Various devices have been proposed so far to remove polyps, especially stalk polyps, from the body. For example, US Pat. No. 6,015,415 (January 18, 2000) to Avellanet, Polypectomy Snare Instrument, describes a polypectomy device that uses a snare loop connected to a power supply that supplies ablation current. Teach. The polyp is captured using the shringe loop, and when the shringe is tightly closed around the polyp, a current is passed through the shinge loop to cauterize the polyp. US Pat. No. 5,746,747 (May 5, 1998) to McKeating of Polypectomy Instrument teaches a polypectomy device using a grasping forceps that holds the polyp and a shrimp wire that cuts the polyp To do. While holding the grasping forceps on the body of the polyp, an electric current is passed through the Schlenge wire to cut and cauterize the polyp. US Pat. No. 5,906,620 (May 25, 1999) of Nakao et al., Surgical Cauterization Snare with Ligating Suture, teaches a polypectomy device using two Shringe loops. The first loop cauterizes the polyp, and the second loop functions as a sewing thread for ligating the polyp. The second loop is left in the large intestine.
DISCLOSURE OF THE INVENTION
[Problems to be solved by the invention]
[0004]
The polypectomy device and method according to the present invention effectively removes polyps from the body.
[Means for Solving the Problems]
[0005]
The apparatus has a first jaw part and a second jaw part. One of the jaws has a heating member for cauterizing the polyp structure. A Schlinge cable passes through each jaw. The Schlinge cable forms a loop for catching polyps. When the Shringe cable is pulled proximally, it places the jaws at the base or handle of the polyp. As the Shringer cable is pulled further, it closes the chin. The jaw closure operates with a heating element to cut and seal the tissue between the jaws.
BEST MODE FOR CARRYING OUT THE INVENTION
[0006]
FIG. 1 shows an overview of a polypectomy device inserted into the large intestine of a patient 1. The polypectomy device 2 has an elongated flexible catheter 3 extending from the distal end of the endoscope 4. The distal end of the catheter includes a fixed jaw portion 5, a movable jaw portion 6, and a Shringer cable 7. The Shringe cable can be manipulated to capture the polyp 8, and when the length of the Shringe cable is shortened, the polyp is pulled into the jaw and the movable jaw is pulled toward the fixed jaw. The heating member 17 (see FIGS. 2 and 3) on the fixed jaw can be operated to necrotize the tissue captured between the jaws. The combination of heat and pressure disrupts the tissue, thereby cutting the polyp from the intestinal wall 9 of the large intestine 10.
[0007]
FIG. 2 shows an overall side view of the polypectomy device 2. The proximal end of the device includes a two-wire electrical connector 12 and a handle 13. The two-wire electrical connector connects the catheter 3 to a power source (not shown). The handle includes a cable trigger 14 and a fixed finger hold 15. The cable trigger can be manipulated to pull the Schlinge cable 7, whereby the polyp is captured and the movable jaw 6 is manipulated. By driving the power source for heating the heating member 17 with the jaw assembly closed, the polyp is cut and the tissue is sealed.
[0008]
FIG. 3 shows an enlarged cross-sectional view of the distal end of the polypectomy device. The Schlinge cable 7, the fixed jaw portion 5 and the movable jaw portion 6 extend from the distal end portion of the catheter body 3. The fixed jaw is attached to the catheter body, and the movable jaw is operably connected to the catheter body by a hinge 16. In the above description, the fixed jaw portion and the movable jaw portion are referred to. However, both jaw portions may be movable. Both jaws may be hinged to the catheter or may be fixed to the catheter so that they can rotate relative to each other.
[0009]
The fixed jaw 5 includes a heating member 17, a heat insulating tube 18 and a lumen 19. The movable jaw portion 6 has a hole 20 (through which a Shringe cable passes) at a distal end portion thereof, a hinge 16 and a silicon pad 21 at a proximal end portion thereof. A terminal outlet is formed by a lumen 19 of the fixed jaw that extends completely through the fixed jaw. The fixed jaw part and the movable jaw part close to each other by the action of scissors. Each surface of the fixed jaw portion and the movable jaw portion that are combined with each other is a gripping surface. The silicon pad 21 of the movable jaw part is disposed along the gripping surface of the movable jaw part, and the portion of the heat insulating tube 18 facing the movable jaw part becomes the gripping surface of the fixed jaw part.
[0010]
The fixed jaw and the movable jaw can be made of stainless steel or other suitable metal, plastic, or ceramic. The fixed jaw also has a thermal insulation tube made of a PTFE / polyimide mixture (other thermal insulation materials may be used) such as polyimide, fluorinated polymer, or Xylan®. The heat insulating tube 18 insulates the heating member 17 from the stainless steel portion of the fixed jaw portion, thereby preventing the heating member from heating the entire fixed jaw portion.
[0011]
The heating member is made of a conductive material such as nichrome having a resistance suitable for heating sufficiently when an electric current flows. The heating element may be about 1 / 10,000 nichrome wire having a length of about 10 mm. The power source can generate about 3 to 30 watts of power and the heating element consumes about 2 to 7 watts of power. Other forms of heating members may be used such as ceramic heating members, RF heating members, monopolar or bipolar heating members. Moreover, a heating member may be arrange | positioned at any jaw part, and may be arrange | positioned at both jaw parts.
[0012]
The end portion of the Schringe cable 7 is fixed to the catheter body 3 (although it may be fixed to the end portion of the movable jaw portion), passes through the hole 20 at the end portion of the movable jaw portion, and is outside the movable jaw portion 6. It extends along. The cable then enters the distal outlet 22 of the fixed jaw 5 and extends through the lumen 19 to the cable trigger 14 located at the proximal end of the device. The fixed jaw portion lumen 19 has a friction liner 23. The friction liner can be made of nylon or Teflon® that reduces the friction caused by the Shringe cable 7 moving through the lumen of the fixed jaw, which allows the Shringe cable to be operated smoothly and easily. .
[0013]
The fixed jaw 5 is formed as a cylindrical tube, and the movable jaw 6 is formed as a concave semi-cylindrical body that fits into the fixed jaw. The fixed jaw and the movable jaw are similar to a hair curling iron having a cylindrical heating tube and a semi-cylindrical movable jaw that fits together with the curled hair. In the field of curling irons, the fixed jaws are called barrels and the movable jaws are called clips, which function in the same way as the fixed and movable jaws of this device. Therefore, for analogy, the fixed jaw portion may be called a barrel and the movable jaw portion may be called a clip.
[0014]
The outermost layer of the catheter body is an insulating catheter jacket 24. Within the catheter body are an electrical wire 25, a mesh conductor 26, a lumen, and a Schlinge cable 7. The electric wire is connected to the end portion of the heating member 17 located on the gripping surface of the fixed jaw portion, and supplies current from the power source to the heating member. The current flows from the power source to the heating member 17 through the electric wire 25 through the two-wire electrical connector 12. The current then flows from the heating member through the conductive crimp 27 located at the proximal end of the heating member to the mesh conductor 26 and back to the two-wire electrical connector to complete the circuit. The mesh conductor may be replaced with an electric wire if there is space.
[0015]
In use, the endoscope is inserted into the patient's body up to the site where the polyp is. An endoscope is used to look inside a patient's body for polyps. If a polyp is found, the surgeon inserts a polypectomy catheter into the working lumen of the endoscope. The surgeon then moves the distal end of the catheter toward the polyp and spreads the Schringe cable to form a loop that can capture the polyp. The surgeon manually rotates the catheter and places the ring of the Shringe cable over the polyp in the proper orientation. Manual rotation of the catheter is effected by rotation of the handle.
[0016]
When the polyp is surrounded by the shrimp cable, the surgeon moves the cable trigger and pulls the shringer cable proximal to the catheter to close the loop around the polyp. When the surgeon pulls the Shringer cable, the fixed jaw and the movable jaw are pulled into place on both sides of the polyp. As the surgeon pulls further on the Shringer cable, the Shringer cable actuates the movable jaws to pull toward the fixed jaws, thereby pulling each jaw together. And a power supply is driven and the heating member arrange | positioned at a fixed jaw part is heated. As a result, each jaw is held closed, and the heating member and jaw act together to cut and seal the tissue. The power source may be driven by a foot switch (not shown) or may be activated by a switch or button located on the catheter or power source. Further, the power source may be driven by a limit switch that is activated by an operation toward the proximal end side of the cable trigger.
[0017]
As mentioned above, polyps are formed in the mucous membranes, which are present in many parts of the body. Polyps can also form in the patient's large intestine 10. One way to look for polyps in a patient's large intestine is colonoscopy. During colonoscopy, the surgeon inserts the endoscope 4 into the large intestine from the patient's anus 28 (see FIG. 1). If a polyp is found, the surgeon inserts the polypectomy device 2 into the working lumen of the endoscope and performs the above procedure.
[0018]
Similarly, polyps formed in the paranasal sinuses can also be removed by this device, as shown in FIG. Similar treatment is performed. The endoscope 4 is inserted into the sinus 29 through the patient's nostril 30. If there is a polyp, the polypectomy device 2 is inserted into the endoscope. The Schlinge cable 7 extends to form a loop that allows the surgeon to capture the polyp. When the polyp is surrounded by the Shringer cable, the surgeon drives the cable trigger 14 to pull the Shringer cable proximally. As shown in FIG. 5, when the surgeon pulls the Shringer cable proximally, the fixed jaw portion 5 and the movable jaw portion 6 are pulled to appropriate positions on both sides of the polyp 8. When the surgeon pulls the Shringer cable further, the Shringer cable is actuated so that the movable jaws are pulled toward the fixed jaw, so that the jaws fit into each other, or at least the polyps trapped between the jaws. Each chin moves to a position close to the handle. Along with the operation of the movable jaw part, a power source for heating the heating member on the fixed jaw part is driven. The power source is driven by a foot switch (not shown). Thereby, each jaw part is held in a closed state, and the heating member and each jaw part cooperate to cut and seal the tissue.
[0019]
Polyps in the patient's uterus can also be removed with this device, as shown in FIG. In this case, the same treatment is performed. The endoscope 4 is inserted into the uterus 31 through the patient's vagina 32. If a polyp is found, the surgeon inserts the polyp removal device 2 into the working lumen of the endoscope and performs the procedure as described above.
[0020]
Similar treatment can be performed on other parts of the body where polyps and other abnormal tissue growth occurs. Examples of colonic polyps, sinus polyps, and uterine polyps show treatments that can be easily applied to other situations. Thus, while the preferred embodiments of the apparatus and method have been described with reference to the environment in which they have evolved, they are merely illustrative of the principles of the present invention. Other embodiments and configurations may be devised without departing from the spirit of the invention and the appended claims.
[Brief description of the drawings]
[0021]
FIG. 1 is a schematic view of a polypectomy device inserted into a large intestine of a patient.
FIG. 2 is an overall side view of a polypectomy device having a handle, an electrical connector and a jaw assembly.
FIG. 3 is an enlarged cross-sectional view of a jaw assembly located at the end of the polypectomy device.
FIG. 4 is a schematic view of a polypectomy device inserted into a patient's paranasal sinus with a shrimp wire surrounding the base of the polyp.
FIG. 5 is a view similar to FIG. 4 in a state in which the Shringe wire is pulled to the proximal end side in order to align the jaws of the polypectomy device.
FIG. 6 is a schematic view of a polypectomy device inserted into a patient's uterus having a shrimp wire surrounding the base of the polyp.
[Explanation of symbols]
[0022]
DESCRIPTION OF SYMBOLS 1 ... Patient 2 ... Polypectomy device 3 ... Catheter 4 ... Endoscope 5 ... Fixed jaw part 6 ... Movable jaw part 7 ... Shringe cable 8 ... Polyp 9 ... Intestinal wall 10 ... Large intestine 12 ... Electrical connector 13 ... Handle 14 ... Cable Trigger 15 ... Fixed finger hold part 16 ... Hinge 17 ... Heating member 18 ... Insulation tube 19 ... Lumen 20 ... Hole 21 ... Silicon pad 22 ... Terminal outlet 23 ... Friction liner 24 ... Insulating catheter jacket 25 ... Electric wire 26 ... Reticulated conductor 27 ... conductive crimp 28 ... anus 29 ... sinus 30 ... nostril 31 ... uterus 32 ... vagina

Claims (7)

A catheter having a proximal end and a distal end;
A cable trigger operably connected to the proximal end of the catheter;
A pair of jaws extending from the distal end of the catheter;
A Schlenge cable passing through the pair of jaws and connected to the cable trigger;
A heating member disposed between at least one jaw portion between the pair of jaw portions;
A device for removing polyps equipped with. A catheter having a proximal end and a distal end;
A cable trigger operably connected to the proximal end of the catheter;
A first jaw extending from the distal end of the catheter;
A second jaw extending from the distal end of the catheter and rotatable relative to the first jaw;
A Schlenge cable connected to the second jaw part and extending from the second jaw part through the first jaw part to the cable trigger;
A heating member disposed between at least one jaw portion between the first jaw portion and the second jaw portion;
A polypectomy device comprising: A catheter having a proximal end and a distal end;
A handle having a cable trigger operably connected to the proximal end of the catheter;
An electrical connector connected to the proximal end of the catheter;
A first jaw extending from the distal end of the catheter;
A second jaw that extends from the distal end of the catheter and is rotatable relative to the first jaw;
A Schlinge cable connected to the cable trigger from the first jaw part through the second jaw part;
A heating member connected to the electrical connector and disposed on the first jaw, and disposed between the first jaw and the second jaw;
A device for removing polyps equipped with. A catheter having a proximal end and a distal end;
A handle having a cable trigger operably connected to the proximal end of the catheter;
An electrical connector connected to the proximal end of the catheter;
A first jaw extending from the distal end of the catheter;
A second jaw that extends from the distal end of the catheter and is rotatable relative to the first jaw;
A Schlinge cable connected to the cable trigger from the first jaw part through the second jaw part;
A heating member connected to the electrical connector and disposed on the first jaw, and disposed between the first jaw and the second jaw;
A device for removing polyps equipped with. A lumen, a catheter having a proximal end and a distal end;
A handle having a cable trigger operably connected to the proximal end of the catheter;
An electrical connector connected to the proximal end of the catheter;
A first jaw extending from the distal end of the catheter, attached to the catheter, and wherein the lumen of the catheter extends through a central portion;
A second jaw extending from the distal end of the catheter, rotatable relative to the first jaw, and having a hole in the distal end;
The first jaw portion extends from the lumen and passes through the hole of the second jaw portion, has a distal end portion and a proximal end portion, the distal end portion is fixed to the catheter, and the proximal end portion is A Schlinge cable connected to a cable trigger;
A heating member connected to the electrical connector and disposed on the first jaw, and disposed between the first jaw and the second jaw;
A polypectomy device comprising: A catheter having a proximal end and a distal end;
A first jaw having a first gripping surface, extending from the distal end of the catheter toward the distal end and having a hole therethrough;
A second gripping surface extending from the distal end of the catheter toward the distal end and opened to the first jaw to bring the first gripping surface and the second gripping surface into close proximity to each other; A second jaw portion rotatable relative to the first jaw portion between a position and a closed position;
A shinge cable having a proximal end and a distal end and extending from the proximal end of the catheter to the distal end of the catheter, wherein the jaw is pulled by pulling the proximal end of the shringe cable toward the proximal end. A Schlenge cable in which the end portion of the Shringe cable is engaged with the first jaw part and the second jaw part so that the part moves toward a closed position;
A heating member positioned between the first gripping surface and the second gripping surface;
A power source for selectively supplying heating power to the heating member;
A polypectomy device comprising: A method of removing a polyp from a patient's body,
A catheter having a proximal end and a distal end, a first gripping surface, extending from the distal end of the catheter to the distal side, having a first jaw portion having a through-hole, and a second gripping surface, Extending from the distal end of the catheter to the distal side, between the open and closed positions relative to the first jaw to bring the first gripping surface and the second gripping surface in close proximity to each other A Shringe cable having a second jaw portion rotatable with respect to the first jaw portion, a proximal end portion and a distal end portion, and extending from the proximal end portion of the catheter to the distal end portion of the catheter, By pulling the base end portion of the Shringe cable toward the base end side, the distal end portion of the Shringe cable is engaged with the first jaw portion and the second jaw portion so that the jaw portion moves toward the closed position. The Shringe cable A heating member positioned between the first gripping surface and said second gripping surface, a polypectomy device having a selectively supplying power to the heating power to the heating element is prepared,
Placing the distal end of the catheter close to the polyp,
To open the jaw and form a ring of the Shringe cable that extends from the distal end of the catheter, push the Schering cable toward the distal end of the catheter;
Manipulate the ring to surround the polyp,
In order to draw a polyp in place between the gripping surfaces of the first jaw and the second jaw and to close the first jaw and the second jaw on the polyp, the Schlinge cable is connected to the catheter. Pull to the proximal side,
Supplying heating power to the heating member to cut a polyp from surrounding tissue;
A method characterized by that.