JP3217951B2 - Equipment for removing fistulas - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

FIELD OF THE INVENTION The present invention relates to a surgical instrument for removing a fistula, and more particularly to a narrow bar inserted into a fistula tract and an incision cooperating with the bar to cut the fistula tract from a surrounding diseased area. Surgical instrument having a tool.

[0002]

Conventional techniques for removing fistulas near the anus require, for example, a deep incision from the anal edge at the face of the fistula until the incision reaches the fistula. The fistula is then excised from the affected area and removed from the patient.

[0003]

However, such an incision cuts the inferior fibers of the anal sphincter across the course of the incision. Because of this, such procedures cause pain in the patient's bowel movements and flatus, especially when the incision is located a relatively long distance from the anus or is recurrent.
Also, such a procedure leaves a large cavity that usually takes several weeks to heal. During this long healing period, the patient suffers, sometimes requires treatment, and is unable to work. This is an economic loss for the patient. Furthermore, in the case of a fistula near a severely injured anus where the fistula is located a relatively long distance from the anus, the above procedure cannot be used because incontinence is inevitable due to the relatively long incision that would be required.

[0004] Removal of the fistula near the severely anus requires that the excreta be diverted to the colostomy and that the fistula be surgically removed using the above procedure.
This takes 2-3 months than usual. It will be readily appreciated that this procedure for a fistula near a severe anus will cause significant pain and risk to the patient and will be costly.

[0005]

SUMMARY OF THE INVENTION It is an object of the present invention to provide a device for removing fistulas which solves the problems encountered with conventional methods for removing fistulas. In this regard, another object is to minimize the size of the cavities created by removal of the fistula, thus reducing healing time and trauma to the patient's anus and the sphincter. By avoiding incision of the affected area of the anus as well as a relatively large portion of the sphincter, the risk of incontinence is reduced.

In accordance with the principles of the present invention, the foregoing objects are attained by an apparatus for dissecting a fistula having a fistula tract by hollowing out the fistula from a surrounding lesion. The device includes a bar adapted to be inserted into a fistula tract and a dissecting device cooperating with the bar. In one embodiment of the present invention, for example, by using the bar as a supporting member, the dissecting tool moves with respect to the bar in a direction substantially parallel to the long axis of the bar, and cuts out the fistula tract from a surrounding affected part. Dissect the fistula from the patient. In another embodiment of the invention, the bar and the dissecting instrument are coupled to each other so that the cut does not move longitudinally with respect to the bar. Huistel Road
By rotating the entire device or rotating only the incision tool, it is cut out from the surrounding affected area.

[0007]

The objects, aspects and features of the invention, as well as the function and economics of manufacture of the relevant components of the structure, are all part of the description and corresponding parts in the various drawings are numbered the same. BRIEF DESCRIPTION OF THE DRAWINGS The invention will be more apparent from the following description and appended claims, taken in conjunction with the accompanying drawings.

[0009]

Detailed Description of the Preferred Exemplary Embodiment FIG. 1 shows at 30 an apparatus according to the invention for removing fistula 32 from a patient. In the illustrated embodiment, the fistula 32 is a near-anal fistula having a fistula tract 34 extending from the anal conduit 36 to the exterior of the patient near the rectum. This device 30 includes a fistula road 34.
A thin rigid bar 3 similar to a probe that can be inserted into it
8 The incision tool 40 is such that the bar 38 is
A base or a support member for the incision tool 40 so as to be rotatable about the bar 38 and slidable in a direction corresponding to the long axis of the bar 38.
Operates in conjunction with bar 38.

The incision tool 40 has a main body 42 and a cutting blade 44 mounted on the main body 42 and selectively detachable. Since this cutting blade 44 is selectively removable from the body 42, other cutting blades can be used in connection with the body 42. In the embodiment shown, the body 42 is cylindrical, has a thin wall, and surrounds a portion of the bar 38. Handle 4
6 is mounted on the base end of the main body 42, and a cutting blade 44 is mounted on the distal end of the main body.

A cylindrical stabilizer 47 is secured to a portion of the bar 38 outside the patient's body. The body 42 of the cutting tool 40 moves with respect to the stabilizer 47. The stabilizer 47 has a configuration in which the cutting blade 44 has a bar 38.
Make sure to keep away from As a result, the dissector 40 in conjunction with the bar 38 cuts out the fistula tract 34 by removing the lesion around the fistula, thus removing the fistula 32 including the fistula tract 34 from the surrounding lesion. Because the body has a thin wall, the cut away portion of the fistula tract 34 is in the body 42 during the removal procedure.

The cutting blade 44 can be variously modified in shape and size. For example, as shown in FIG. 1, it can take the shape of a pen refill or an arc shape. In the embodiment shown, the cutting edge 48 extending substantially from the distal end of the body 42 to the distal end of the cutting blade 44, the cutting blade 48 is inserted after the cutting blade is inserted into the affected area 35, as indicated by the dotted line in FIG. It functions as an incision plane of 44.

When the bar 38 is advanced through the fistula path 34, a cap 50 may be selectively attached to the tip of the bar 38. The cap 50 has a protection groove 52 for receiving the tip of the cutting blade 44 therein. By moving the incision tool in the direction indicated by the arrow 51, when the incision tool 40 penetrates the affected area 35 around the fistula,
The tip of the cutting blade 44 is inserted into the protection groove 52 and held therein. The entire device with bar 38 and dissector 40 is rotated as shown by arrow 53 to cut out the fistula tract from the surrounding lesion. During this rotation, while the tip of the cutting blade 44 is held in the protection groove 52, the cutting blade 4
The fourth cutting edge 48 cuts the affected area around the fistula tract 34. As a result, the fistula 32 can be dissected from the surrounding lesion and removed from the patient.

FIG. 2 shows a second embodiment of an apparatus, generally designated 60, for removing fistula 32. As in the first embodiment, the device 60 has a bar 38. Also,
The device 60 includes a dissector 62 having a cylindrical body 64 that slides in a direction substantially parallel to the long axis of the bar 38. As in the previous embodiment, a cylindrical stabilizer 6
8 is mounted on the bar 38 so as to maintain a space 66 between the cutting blade 70 and the bar 38. In the illustrated embodiment, the cutting blade 70 mounted on the distal end of the main body 64 is circular and substantially corresponds to the shape of the cylindrical main body 64.

The fistula 32 is removed using the device 60 in a manner similar to that described above for the first embodiment. That is, the dissector 62 is moved in the direction indicated by the arrow 74.
Is displaced, so that the incision tool 62 is
The affected area 35 around 4 is penetrated. Since the cutting blade 70 has an incision edge 71 at its tip so as to separate the diseased part 35 from the fistula path 34, the fistula path 34 is hollowed out from the surrounding diseased part. The hollowed fistula path enters the hollow center of the body 64 during the hollowing procedure because the space 68 is defined between the bar 38 and the cutting blade 70 by the stabilizer 68. Thus, in this embodiment, the fistula tract 34 remains in the cylindrical body 64 as it is cut out of the surrounding lesion 35. Further, this embodiment of the present invention does not require the device 60 to be carefully rotated to cut through the fistula path.

The selectively attachable cap 76 is a bar 3
8 is provided at the tip. The cap 76 has a groove 78 corresponding to the cutting edge 71 for receiving the cutting edge 71 of the cutting blade 70 therein after the cutting of the fistula tract is completed.

FIG. 3 illustrates a third embodiment of an apparatus, generally designated 90, for cutting a fistula in accordance with the principles of the present invention. This device 90 comprises a curved fistula tract 92
A curved bar 94 inserted therein and a curved incision 9
6 is provided. A curved cutting blade, such as the cutting blade 98 shown in FIG. 3, is selectively mounted on the distal end of the body 100 of the cutting implement.

As in the previous embodiment, the device 60 includes a stabilizer 102 mounted on the bar 94 to maintain space between the curved bar 94 and the dissector 96 during the fistula removal process. .

Since the fistula tract 92 is curved,
At least two blades are required to cut fistula tract 92 from surrounding lesion 35. In the illustrated embodiment, the cutting blade 98 cuts around the inside 101 of the fistula path 92 by inserting and rotating the cutting blade 98 as described in the first embodiment. Then, after one side of the fistula tract has been separated from the surrounding lesion, a first cutting blade, eg, cutting blade 98, is removed from the body 100 and a second cutting blade, eg, the cutting shown in dotted lines in FIG. The blade 104 is mounted on the main body 100. This cutting blade 10
4 is the cutting blade 10 as described with respect to the first embodiment.
4 and by rotating the device 90,
The cutting blade 104 has substantially the same shape as the cutting blade 98 except that the cutting blade 104 is specially curved so as to cut the upper side 103 of the fistula path 92.

As in the first embodiment, the cap 1
06 can be selectively attached to the tip of the bar. The cap 106 has a plurality of grooves for receiving the respective tips of the cutting blades so that each is used to cut each side of the fistula tract 92 from the affected area 35.

FIG. 4 illustrates a fourth embodiment of an apparatus, generally designated 120, for removing fistulas in accordance with the principles of the present invention. This device 120 is used for the first and second devices.
Bar 122 which is similar to the bar used in the embodiment of
Having. The bar 122 is inserted into the fistula path 34 of the fistula 32. Unlike the embodiment described above, the bar 122 has a base 128 mounted on the proximal end. The dissector 130 is a bar 12
2 so as to slide in a direction substantially parallel to the long axis of the bar 12.
Work with 2.

The cutting tool 130 has a cutting blade 132 that can be selectively mounted on a main body 134. This body 134
Penetrates the base portion 128 so as to slide and rotate. A handle 136 is provided at the base end of the main body 134, and the cutting blade 132 is attached to the front end thereof. A stabilizer 138 is provided to ensure a predetermined distance between the cutting implement 130 and the bar during insertion of the cutting blade 132 and rotation about the fistula path 34.

In the illustrated embodiment, the cutting blade 132
Affected part 3 around fistula tract 34 with sharp edge 140
5 to facilitate the insertion of the cutting blade 132 into
It is tapered toward the sharp end 140. Both edges 142 of the cutting blade 132 also
So that the cutting of the body 134 from the cutting blade 132 can be performed by rotating the cutting blade 132 around the fistula path.
Can be sharpened.

The use of the device 120 for removing the fistula 32 is similar to that described above with respect to the first embodiment of the present invention. Thus, a detailed description of a method for removing fistulas using the apparatus described with reference to FIG. 4 is omitted.

The mounting of the bar 122 on the base 128 and the joint between the dissector 130 and the stabilizer 138 does not require a large volume for the main body.
20 more stable operation.

FIGS. 5 and 6 show a fifth embodiment of an apparatus, indicated at 150, for removing the fistula tract 34 from the surrounding diseased part 35. FIG. In this example, the cutting blade of the above-described embodiment is replaced with a needle 152 having a large diameter and attached to the main body 154 of the cutting tool 156. The perforated needle 152 has an incision edge 158 that pierces the affected area 35 around the fistula tract 34 by moving the incision tool 156 in the direction indicated by arrow 157. This incision edge 158 is the affected area 35 around the fistula tract 34.
Projecting into the anal conduit 36 from the
Is passed through the perforated needle 152 and attached to the tip of the bar 162. In the illustrated embodiment, this wire 160
Is attached to a cap 164 attached to the tip of the bar 162. Groove 166 is for wire 1 to cap 164
A cap 164 is provided to assist in mounting 60. However, it will be understood that in the present invention, the wire 160 may be attached to the tip of the bar 162 by any means.

The needle 152 with the hole is positioned at the arrow 15
The wire 160 is pulled out by moving the dissector 156 in the direction indicated by 9, and the wire 160 is pulled by the screw 168 combined with the base 170 or the bar 162. In the illustrated embodiment, the wire 160 is wound on the screw 168 such that the wire 160 is wound and rotated in a direction substantially parallel to the long axis of the bar 162 by rotating the screw 168.

The stabilizer 172 is connected to the wire 160
Are maintained to be parallel to the bar 162.

By rotating the dissector 156 about the fistula tract 34, the wire 160 cuts the fistula tract from the surrounding lesion. It will be appreciated that the wire 160 may be a cautery wire so that the affected area is cauterized as it is cut.

In the embodiment shown, a groove 180 is provided in bar 162. In the groove 180, a part hollowed out from the affected part of the fistula path 34 enters. As a result, the fistula tract 34 stably extends forward as it is hollowed out from the surrounding affected area.

FIG. 7 illustrates a sixth embodiment of an apparatus, indicated at 210, for cutting a fistula in accordance with the principles of the present invention. This device 210 is provided with a common base 21
3, the substantially cylindrical dissector 212
With a thin bar 211 fixed along the long axis of the bar.
The common base 213 is fixed in a main body 214 that is to be grasped by a hand by a surgeon. The bar 211 is maintained parallel to the wall of the cutting tool 212 by a disk-shaped stabilizer piece 215. This stabilizer piece is slidable with respect to the bar 211,
Also, it is arranged inside the cutting tool 212. The position of the disc-shaped stabilizer piece 215 is initially maintained by the spring 216 near the distal end of the cutting implement.

The cutting tool 212 has a selectively detachable cutting blade 217 disposed at the tip thereof. The body of the dissector 212 has grooves 218, 219 to minimize friction between the surrounding diseased area 35 and the dissector.

A method for removing fistulas using the apparatus of this embodiment will be described below. The tip of the bar 211 is inserted into the fistula 32 to function as a splint. The device 210 then removes the fistula path 3 as shown by arrow 220 to remove the fistula path.
The slide is inserted along the course of No. 4.

To minimize the likelihood of the bar 211 penetrating the walls of the fistula during operation of the apparatus 210, an additional thin bar of the same diameter as the bar 211 is used for the fistula 3
4 first introduced. Additional bar 221 shown in FIG.
Since this is not associated with any other components, it can be more easily manipulated and properly inserted into the fistula tract 34.
Then, a sheath 222 formed of a material suitable for insertion into the human body, such as surgical metal, is inserted with the bar 221 therein until the sheath 222 reaches the anal conduit 36. It slides along the bar 221. Next, the bar 221 is inserted into the sheath 2 in the fistula.
It is pulled out from the fistula road 34 so that only 22 remains. Thus, the bar 211 can be removed by inserting the bar 211 into the sheath 222 and using the sheath 222 as a guide for the dissector 212. During this removal process, the cutting tool 212 is performed so as not to be displaced from the fistula path.

The cut fistula tract is inserted into the cutting tool 212.
Of the disk-shaped stabilizer piece 2
15 against the force provided by the spring 216. As a result, a space for accommodating the entire length of the cut fistula path is formed.

The cutting edge of the dissector is insulated and may be connected to a cautery diathermy to assist in cutting the fistula tract as well as coagulating the surrounding lesion.

FIG. 9 illustrates a seventh embodiment of an apparatus, indicated at 240, for cutting a fistula in accordance with the principles of the present invention. The device 240 includes a diathermy needle 248
Is similar in operation to the device shown in FIGS. 5 and 6 except that is used as a dissector to remove the fistula tract 34 from the surrounding diseased area 35. The diathermy needle is beneficial because it performs both an incision function and a coagulation function. The device 240 may be connected to the diathermy handle 24 by a coupling piece 246 or base such that the diathermy needle 248 and the thin bar 242 are maintained parallel to each other.
4 having a bar 242 coupled thereto. Stabilizer 250 is provided to further maintain diathermy needle 248 parallel to bar 242. Also, the spring 25
2 is provided between the coupling piece 246 and the stabilizer 250 so as to insert the bar 242 in order to maintain the stabilizer 250 near the tip of the diathermy needle 248 until the diathermy needle 248 is inserted.

After the second stabilizer 254 completes the penetration of the diathermy needle 248 into the affected area 35, the tip of the bar 242 and the diathermy needle 248 are moved to the second position.
Anal conduit 3 so that it can be inserted into a hole in the spring 252 of the
6. The fistula path 34 is removed (excised) by exciting the diathermy needle 248 and rotating the charged diathermy needle about the fistula path 34. The manner in which the bar 242 is inserted into the fistula tract 34 is similar to that described with reference to FIG. That is, the sheath 222 is first inserted into the fistula tract 34 using an additional bar (not shown). A bar 242 is then inserted into the hollow center of the sheath 222 to easily position the device 240 with respect to the fistula tract to be removed.

FIG. 10 illustrates an eighth embodiment of an apparatus, indicated at 270, for cutting a fistula in accordance with the principles of the present invention. In this embodiment, a razor beam-type cutting device 284 is used to separate the fistula tract 34 from the surrounding lesion 35. This laser beam type incision device performs both incision and coagulation, similar to a diathermy needle.

This device 270 includes the first cylinder 27
4 has a thin bar 272 coaxially arranged. The bar 272, the base end, and the base end of the first cylinder 274 are attached to each other via a holding piece 276 such that the bar 272 is maintained parallel to the cylinder 274. A second relatively large diameter cylinder 278 is coaxially aligned with and disposed outside the cylinder 274 and defines a space 280 of about 2 mm between the first cylinder 274 and the second cylinder 278. ing. The coupling device 282 is configured to transmit the laser beam emitted from the laser injection device 284 to the first cylinder 274 and the second cylinder 274.
Space 280 defined between the cylinder 278
A coaxial alignment between the first cylinder 274 and the second cylinder 278 is maintained therethrough. Further, the coupling device 282 is configured such that the laser beam is provided between the outer peripheral surface of the first cylinder 274 and the
8 allows the laser injection device 284 to be rotated so as to rotate along the space 280 between the inner peripheral surface of the laser injection device 8 and the inner peripheral surface of the laser injection device 8. A disc-shaped stabilizer piece 286 is provided in the first cylinder 274 and can slide on the bar 272. This stabilizer piece 286 functions to maintain a parallel, spaced-apart relationship between the bar 272 and the first cylinder 274. A spring 288 maintains the stabilizer piece 286 near the tip of the first cylinder 274.

The operation of the device 270 shown in FIG. 10 will be described below. First, the sheath 222 is inserted into the fistula tract 34 as described above with reference to FIGS. Then, the bar 272 is inserted into the hollow sheath in a state where the tips of the first and second cylinders 274 and 278 surround the fistula path near the fistula path. The razor injection device is energized and rotated about the long axis of the bar, thereby disconnecting the fistula tract 34 from the surrounding lesion 35. The device 270 is advanced along the fistula tract while continuing the lancing procedure. As a result, the disconnected fistula path enters the first cylinder 274 and urges the stabilizer 286 toward the coupling device 282. A second cylinder 278 pulls the surrounding lesion out of the ablation area so that all fistula tracts can be cut out of the surrounding lesion. It will be appreciated that the razor injection device can be rotated manually or by motor drive. Further, a computer can be used to control the operation of the razor injection device.

Although the present invention has been described in connection with the most practical and preferred embodiments presently contemplated, the present invention is not limited to the embodiments described above, but is within the spirit and scope of the appended claims. It will be appreciated that the various modifications included as well as equivalent arrangements are covered.

[Brief description of the drawings]

FIG. 1 is a perspective view, partially in section, of a first embodiment of a method and apparatus for ablating a fistula in accordance with the principles of the present invention.

FIG. 2 is a perspective view, partially in section, of a second embodiment of a method and apparatus for ablating a fistula in accordance with the principles of the present invention.

FIG. 3 is a perspective view, partially in section, of a third embodiment of a method and apparatus for removing a fistula in accordance with the principles of the present invention.

FIG. 4 is a perspective view, partially in section, of a fourth embodiment of a method and apparatus for ablating a fistula in accordance with the principles of the present invention.

FIG. 5 is a perspective view, partially in section, of a fifth embodiment of a method and apparatus for ablating fistulas in accordance with the principles of the present invention.

FIG. 6 is a perspective view showing the operation of the apparatus shown in FIG. 5 in a partially sectional view.

FIG. 7 is a perspective view, partially in section, of a sixth embodiment of a method and apparatus for removing a fistula in accordance with the principles of the present invention.

FIG. 8 is a perspective view showing an additional bar used in the apparatus shown in FIG. 7;

FIG. 9 is a perspective view, partially in section, of a seventh embodiment of a method and apparatus for removing a fistula in accordance with the principles of the present invention.

FIG. 10 is a cross-sectional view illustrating an eighth embodiment of a method and apparatus for ablating a fistula in accordance with the principles of the present invention.

[Explanation of symbols]

30 ... device, 32 ... fistula, 34 ... fistula road,
36 ... anal conduit, 38 ... bar, 40 ... cutting tool, 44 ... cutting blade.

Continued on the front page (72) Inventor Mosin Al-Tameim, Saudi Arabia, 11472 Riyadh, Pio Box 7805, King Saud University and King Carid University Hospital, Department Store (56) References JP-A-3-92144 (JP, A) JP-A-6-197904 (JP, A) JP-A-2-500416 (JP, A) US Patent 3,776,237 (US U.S. Pat. No. 2,447,169 (US, A) US Pat. No. 2,421,319 (SU, A) (58) Field of Investigation (Int. Cl. ⁷ , DB name) A61B 17/32

Claims (15)

(57) [Claims] 1. A device for dissection of a fistula having a fistula tract, comprising: a first bar having a longitudinal axis and adapted to be inserted into the fistula tract; A cooperating dissector, wherein the first bar remains immobile and parallel to the dissector;
A common base for dissecting the fistula tract by moving the device relative to the fistula tract, thus securing the proximal end of the first bar to the proximal end of the dissector so as to cut out the fistula tract from the surrounding diseased area. And to maintain the first bar parallel to the dissector,
An incised portion of the fistula path, comprising: a disc-shaped stabilizer slidable along the first bar in the body of the lancing device; and a spring for holding the stabilizer near a tip of the lancing device. A device that slides between the first bar and the dissector to push the stabilizer, thus compressing the spring as the device is advanced along the fistula path. 2. The apparatus according to claim 1, wherein the cutting tool has a main body and a selectively mountable cutting blade. 3. The device according to claim 1, wherein the first bar and the cutting implement are curved. 4. The apparatus of claim 1, further comprising a cap selectively attachable to a distal end of the first bar, wherein the cap has the first bar therein.
2. A groove for receiving the tip of the bar.
An apparatus according to claim 1. 5. The device of claim 1, wherein the body has a groove on an outer surface that minimizes friction between the dissector and a surrounding diseased part. 6. The apparatus of claim 1, wherein said body has a generally cylindrical shape surrounding a portion of said bar. 7. The device of claim 1, wherein the dissecting instrument has a non-arc shaped dissecting edge at a distal end. 8. The apparatus of claim 8, further comprising an accessory bar having a diameter substantially matching the diameter of the first bar; and a sheath, wherein the accessory bar is adapted to be inserted into a fistula tract, wherein the sheath is Adapted to be inserted over the accessory bar so as to position the sheath within the fistula tract, and wherein the accessory bar can be withdrawn from within the sheath, upon dissection of the fistula tract, The device of claim 1, wherein the device serves as a guide for the first bar. 9. A device for incision of a fistula having a fistula tract, the device comprising a first bar having a longitudinal axis and adapted to be inserted into the fistula tract. An incisor cooperating with one of the bars, wherein the first bar remains immobile and parallel to the incisor;
A common base connecting a first bar to the dissecting device so as to cut the fistula tract by moving the device relative to the fistula tract, and thus cut out the fistula tract from the surrounding affected area; An accessory bar having an aperture substantially matching the aperture; and a sheath, wherein the accessory bar is adapted to be inserted into a fistula tract and the sheath positions the sheath within the fistula tract. Adapted to be inserted over the exterior of the accessory bar to allow the accessory bar to be removed from within the sheath and to provide access to the first bar during dissection of the fistula tract. A device that acts as a guide. 10. A device for dissection of a fistula having a fistula tract, having a longitudinal axis, a bar inserted into the fistula tract, and cooperating with the bar in a direction substantially parallel to the longitudinal axis. An incision tool that is movable with respect to the bar and that cuts out the fistula from a surrounding diseased part, the incision tool includes a main body, a needle having a hole, and attached to the main body; A wire penetrated into the needle after being inserted along, a means for attaching the wire to the tip of the bar, and a tip at the tip of the bar so that the wire functions as a dissector for dissecting the fistula. Means for stretching a wire after being mounted. 11. The bar of claim 10, wherein the means for attaching the wire to the tip of the bar includes a groove for receiving the tip of the bar therein, and a cap selectively attachable to the tip of the bar. apparatus. 12. The bar has a base portion at a base end thereof, and the dissecting tool has a main body rotatable and slidable through the base portion, and a cutting blade mounted on a distal end of the main body. The device of claim 10 comprising: 13. The method of claim 12, wherein the means for tensioning the wire includes a screw coupled to the base portion, the wire being wound on the screw to rotate the screw to tension the wire. The described device. 14. The device according to claim 12, wherein said wire is a cautery wire. 15. The apparatus of claim 12, further comprising a stabilizer device cooperating with the bar and the lancing device and maintaining the bar and the lancing device substantially parallel.