RU2314056C1 - Bipolar hook-electrode for performing video laparoscopic cholecystostomy operation - Google Patents

Abstract

FIELD: medical instruments.

SUBSTANCE: hook-electrode has case made of dielectric material and working end disposed proximally to patient. Working end is made in form of two mirror-disposed L-shaped cutting parts, plated with isolation. Cutting parts have attritional curve directly in front of cutting part of hook in plane being perpendicular to plane of L-shaped curve. Cutting parts are separated by dielectric plate. Working surfaces of cutting parts of hook are released from isolation coating and are turned one to other. One cutting part of working end of bipolar hook is connected with positive pole of electro-surgical unit; other cutting part is connected with electrically negative pole by conductors disposed in case of instrument. Conductors are isolated one from other. Bipolar hook-electrode allows performing operations onto patients having metal structures in their bodies and leveling damage effect of current onto remote tissues and organs of patient to be operated.

EFFECT: improved reliability; higher safety.

2 cl, 2 dwg

Description

The invention relates to medicine, in particular to instruments for electrosurgery, and can be used when conducting video laparoscopic operations.

Monopolar devices for electrosurgery are known in which the cutting part is an active electrode, and the passive electrode is placed during the operation and comes into contact with the patient’s skin (Zaporozhan V.N., Grubnik V.V., Saenko V.F. Video endoscopic operations in surgery and gynecology . - Kiev: Health'ya, 2000).

A feature of the operation of monopolar instruments is that when the circuit is closed, an electric current passes through the patient’s body tissues, which causes the following limitations:

- patients with metal structures in the body (plates for metal osteosynthesis, artificial heart valves, etc.) are not subject to surgical treatment with monopolar electrode hooks, because an electric current is shorted to the metal structure, which can cause serious complications;

- in addition, when working with a monopolar electrode, for example, when video-laparoscopic cholecystectomy is possible, the damaging effect of the current on hepatocytes is possible, because the electric current passes through the liver tissue itself;

- in the event of an accidental breakdown of the electric current between the working part of the hook and the working tool or trocar, tissue damage is possible up to destruction.

A bipolar medical instrument is known in the art (according to US Patent Application No. 2005/0267469 A1, published December 1, 2005), comprising an elongated electrode holder, an active electrode embedded in the distal end of the electrode holder, and a neutral electrode adjacent to the active electrode, which pass in the housing of the holder and are installed entirely on the distal end of the active electrode, while the neutral electrode and the active electrode are separated from each other in the transverse direction longitudinally to the direction of the holder. This tool is designed to work in a liquid medium, for example, during urological operations and is made with a system of channels for supplying and aspirating the washing liquid, which contacts the active and passive electrodes at the time of cutting the fabric, as a result of which the circuit closes. Moreover, the active electrode is formed as a wire loop, and the neutral electrode is like a loop of a tape (film).

However, this tool cannot be used when working in the abdominal cavity, for example, during video-laparoscopic cholecystectomy (VHLC), where it is necessary to use the working part of the tool, formed in the form of a hook, i.e. completely different from the above.

Closest to the proposed invention for its intended purpose is a hook-electrode for laparoscopic cholecystectomy according to patent No. 2228156 (publ. May 10, 2004), comprising a housing distal to the patient end in the form of a connector for connecting to the electrosurgical unit using a cable and proximal in relation to the patient, the working end having an insulating coating and curved in the form of the letter "G" with an additional bend immediately before the cutting part of the hook in a plane perpendicular to the plane of the L-shaped bend cutting part of the hook by an amount sufficient to pass successively through the working part of reducer 5 mm to 10 mm, and further through the 10 mm trocar.

The main disadvantages of this hook, as well as of all monopolar instruments, are that when the circuit is closed, an electric current passes through the body tissues located between the active (cutting part of the hook) and the passive (located on the patient’s body surface) electrode, which prevents conducting such operations in patients with metal structures in the body (plates for metal osteosynthesis, artificial heart valves, etc.), a damaging effect on the hepatocytes of the liver is observed and the risk of accidental th breakdown of electric current between the working part of the hook and the working tool or trocar.

The objective of the invention is the creation of a hook-electrode, using which the action of electric current would be directed exclusively to the tissues and organs of the patient only in the working area, which will reduce contraindications for the use of high-frequency electric current in surgery.

The task is achieved due to the fact that, unlike the prototype, the hook-electrode is made bipolar and is characterized by the following distinctive features:

- the working end proximal with respect to the patient is made in the form of two mirrored at a distance from each other and curved in the form of the letter “G” with an additional bend immediately in front of the cutting part of the hook in a plane perpendicular to the plane of the L-shaped bend, cutting parts between which a dielectric plate is 0.5-1 mm thick;

- each cutting part of the working end of the hook-electrode has an insulating coating over the entire surface, except for the working surface, which is freed from the insulating coating;

- the working surfaces of the cutting parts are facing each other;

- a dielectric plate located between the cutting parts of the hook-electrode, shorter than the cutting parts by an amount equal to the length of the working surface of the cutting part of the hook-electrode;

- one cutting part of the working end of the bipolar hook is connected to the positive pole of the electrosurgical unit, and the second cutting part is connected to the electronegative pole of the electrosurgical unit using two conductors located isolated from each other in the tool body made of a dielectric.

A comparative analysis with well-known proposals shows that the claimed tool is characterized in that the working end is made in the form of two mirrored and curved in the form of the letter “G” with an additional bend directly in front of the cutting part of the hook in a plane perpendicular to the plane of the L-shaped bend, cutting parts separated from each other by a dielectric plate, the working surfaces of the cutting parts of the hook-electrode are freed from the insulating coating and facing each other, the tool body is made dielectric material, along the entire length of the instrument in its body there are two conductors isolated from each other and transmitting voltage to the working end, for which one of them connects one cutting part with the positive pole of the electrosurgical unit, and the other - the second cutting part with a negative pole electrosurgical unit, while the connector at the distal end for connection to the electrosurgical unit is made bipolar.

Using the proposed bipolar hook-electrode allows not only to get the tissue lying behind the spherical surface of the calculus by the cutting part of the tool, and to dissect them; to obtain a larger radius of motion of the cutting part of the working end of the hook, using rotational movements of the hook around its own axis, but also due to the closure of the electric circuit between the working surfaces of two mirror-shaped and curved in the form of the letter "G" with an additional bend directly in front of the cutting part in a plane perpendicular the plane of the L-shaped bend, parts of the working end of the hook, exert an electric shock on the tissues and organs of the patient only in the working area, because the electric discharge has a strictly directed action between the opposed working surface with a positive charge and the working surface with a negative charge. This allows you to drastically reduce the area of electrothermal effects on biological tissues, reduces the risk of damage to neighboring areas, also reduces the formation of smoke, which improves the visualization of the area of operational impact. In addition, this technical solution eliminates the passage of electric current through the removed tissues of the body due to the absence of a passive electrode in contact with the surface of the skin of the patient. All this allows to reduce contraindications for the use of high-frequency electric current in surgery.

Thus, the analysis of the well-known technical solutions of hooks-electrodes for video laparoscopic cholecystectomy allows us to conclude that there are no signs similar to the distinctive features in the claimed instrument, and gives the right to recognize the proposed technical solution in accordance with the criteria of "inventive step" and "novelty".

Figure 1 presents a schematic representation of a bipolar hook-electrode in a direct projection (A) and a top view (B).

Figure 2 presents a schematic representation of the end face of the working end of the bipolar hook-electrode in magnification, indicated in figure 1 by the number I.

The bipolar hook-electrode contains a housing 1, in which the conductors 2 and 3 are located, the working end 4, connector 5 with electrical contacts 6 for connection to an electrosurgical unit (not shown).

The working end 4 contains a mirror-mounted, coated with insulation parts 7 and 8, separated from each other by a dielectric plate 9 with a thickness of 0.5-1 mm, and the cutting part 7 is connected respectively to a conductor 2 connected to the positive pole of the electrosurgical unit, and the cutting part 8 is connected to a conductor 3 connected to the negative pole of the electrosurgical unit by means of a bipolar connector 5. The working surfaces 10 and 11 of the cutting parts 7 and 8 of the hook electrode are freed from the insulation coating and facing each other, and the plate 9, located between the cutting parts 7 and 8 of the hook-electrode, is shorter than these cutting parts by an amount equal to the length of the working surface 10 or 11.

Work with this device is as follows. A bipolar hook-electrode is connected to the electrochirurgic unit using a bipolar cord. During operation, when the circuit is closed, voltage is supplied to the mirror-mounted cutting parts 7 and 8 of the working end 4 of the hook electrode. The resulting discharge between the positive charge of the working surface 10 and the negative charge of the working surface 11 cuts the fabric taken by the hook, affecting only the fabrics located in the working area. This design prevents the passage of electric current through the mass of body tissues.

Using the proposed hook-electrode due to the directed action of an electric current only on tissues located in the working area allows you to:

- to operate on patients with the presence of metal structures in the human body (artificial joints, heart valves, plates for metal osteosynthesis, etc.);

- level the damaging effect of the current on the removed tissues and organs of the operated person, since the electric current always selects the shortest path between the two poles, which in this case are in close proximity to each other.

As a result of this, it is possible to reduce contraindications for the use of electric current in surgery. In addition, it becomes possible to reduce surgical trauma to tissues close to the elements of the hepatoduodenal ligament, the damage of which is fraught with fatal complications.

Claims (2)

1. A bipolar hook-electrode for video laparoscopic cholecystectomy, comprising a body proximal to the patient working end, having an insulating coating and curved in the form of the letter G with an additional bend immediately in front of the cutting part of the hook in a plane perpendicular to the plane of the L-shaped bend of the cutting part, a connector for connecting to an electrosurgical unit, characterized in that the working end is made in the form of two mirror-located L-shaped cutting parts having an insulating coating, which are separated by a dielectric plate, the working surfaces of the cutting parts of the hook are freed from the insulating coating and facing each other, while one cutting part of the working end of the bipolar hook is connected to the positive pole of the electrosurgical unit, and the second cutting part is connected to the electronegative pole of the electrosurgical unit using two conductors located isolated from each other in the tool body. 2. The bipolar electrode hook according to claim 1, characterized in that the tool body is made of dielectric, and the dielectric plate separating the cutting parts is made with a thickness of 0.5-1 mm and a length shorter than the cutting parts by an amount equal to the length of the working surface.

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