RU2339323C1 - Device for extraction of tumor - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: device for extraction of tumor contains hollow puncture needle with slope on the distal end, pulp extractor with smooth rod and blade. Pulp extractor has screw-shaped blade with sharp outer edge and a lancet-shaped tail part. Pulp extractor is arranged inside the opening of the needle, so that the tail-part of the screw may easily rotate and move onwards and backwards within the slope of the needle. Pulp extractor is connected with reversible electric drive by a coupling sleeve.

EFFECT: creation of surgical instrument for effective removal of tumor of prostate gland within shortest duration time of surgery and with minimal trauma to patients.

2 cl, 10 dwg

Description

The proposal relates to medical equipment, mainly to surgical instruments, and can be used in urological operations associated with the removal of various neoplasms in the prostate gland.

Currently, the most common method for treating prostate diseases is surgery. Two diseases are treated surgically: hyperplasia and prostate cancer. For this, several methods have been created, among them, radical prostatectomy (performed for prostate cancer), open prostatectomy (used for hyperplasia) and transurethral resection of the prostate, see Regg M. Prostate: Diseases and their treatment / per. from English L.L. Bershtein; Under the total. Ed. I.A. Goryacheva, - St. Petersburg, Norint, 2002.

With radical prostatectomy, the patient under general anesthesia removes the entire prostate gland along with the discovered cancerous tissue and nearby lymph nodes.

With open prostatectomy (adenomectomy), an incision is made in the lower abdomen under general anesthesia and the enlarged part of the prostate is cut off with a cutting tool.

During transurethral resection, a cystoscope is inserted (under anesthesia) into the urethra, then a resectoscope with a heated wire loop to cut off pieces of tissue and expand, due to this, the urethral lumen in its prostatic part. Such operations are very difficult for surgeons, and extremely difficult for patients, especially operations associated with radical prostatectomy, which entail various postoperative complications with serious consequences, up to mortality.

The causes of such consequences are known. Firstly, it is a need for general anesthesia or anesthesia of the lower body. Secondly, the significant size of the surgical field, trauma to multiple vessels and nerves associated with removed tissues, which is due to the use of surgical instruments of low-impact action.

Even with the considered most gentle operation - transurethral resection, the prostatic part of the urethra is seriously injured.

Currently, many different surgical instruments have been created to remove poor-quality, necrotic, and the like tissues from diseased organs.

A device for endosurgical instrumental manipulations is known, containing an outer tube and an inner tube with a device for attaching an electric suction hose, with handles at the proximal end and a working part in the form of branches at the distal end in the modification of scissors, a clamp, a dissector, a needle holder, biopsy nippers, see application for the invention of the Russian Federation No. 99107707/14 dated 04/06/99, IPC 7 A61B 17/06.

A device is known for removing necrotic areas of bone tissue, including a rod with a snap and a working part having a main cutting edge, and additionally two parallel cutting side edges on the tubular body, and in the area of the working part in the body there is a recess along the length of the side edges and a cut in the form windows, the lower part of which is formed by a limiter interacting with a beveled area forming the main cutting edge, see the description of the utility model of the Russian Federation No. 26924 of July 1, 2002, IPC A61B 17/16.

Devices do not provide for the entire range of operations and actions required during a urological operation.

The closest analogue is a device for puncture biopsy of parenchymal organs, consisting of a hollow needle and a cutting element with a pulp extractor, which is 5-6 mm longer than the hollow needle, see RF patent for utility model No. 39060 of January 30, 2003, IPC 7 А61В 17 / 00.

The device is provided for the point of introduction into the tissues of the body and extraction of a limited amount of the studied mass.

However, the use of such a device during a urological operation is ineffective and not advisable, since when removing a malignant or benign tumor in the prostate gland, it is not necessary to perform a biopsy, but a more effective operation with the removal of tumor tissue, significant in size and weight.

The technical result of the proposal is the creation of a surgical instrument that provides effective removal of a tumor in the prostate gland with a minimum operation time and minimal trauma to the patient.

This is achieved by the fact that in a device for the extraction of a tumor containing a hollow puncture needle with a bevel at the distal end and a pulp extractor with a smooth rod and with a cutting part, the pulp extractor has a cutting part in the form of a screw with a sharp outer edge and a lanceolate tip and is installed in the needle channel with the possibility of rotation and reciprocating movement of the end of the screw within the bevel of the needle, while the pulp extractor is coupled to the reversible electric drive by a coupling.

Moreover, the device for the extraction of the tumor contains a glass-shaped housing in which a reversible electric drive with an electric power source is located, as well as a connecting sleeve, while a three-position current polarity switch is included in the electric drive power circuit.

The device also contains a needle holder with its fastening elements on the body and with a device for attaching a suction hose or supplying medical drugs (anesthetic, coagulant, etc.).

The coupling is made in the form of a sleeve fixed to the shaft of the electric drive and located in the needle holder with a profiled spiral groove, and the pulp extractor shaft is spring-loaded and has radial protrusions interacting with the profiled coupling groove.

In this case, the needle is made with a wall thickness decreasing towards its distal pointed tip.

In addition, the device is equipped with a support flange mounted with the possibility of longitudinal movement relative to the distal end of the needle and its reinstallation in positions I and II.

The essence of the proposal is illustrated by drawings, where:

figure 1 - General view of the device;

figure 2 is a top view of the device;

figure 3 is a view along section aa;

figure 4 - connection diagram of a reversible electric drive;

figure 5 is a variant of the device with one device (fitting) for attaching the feed / suction hose (enlarged);

figure 6 - section bB (increased);

Fig.7 is a variant of the device with a node for combined control of a reversed electric drive and switching containers to supply analgesic or suction pulp;

Fig.8 is a section along G-G;

figure 9 is a diagram of the introduction of the needle of the device, side view;

figure 10 is a diagram of the introduction of the needle, a view in plan.

The device comprises a hollow needle 1 with an end bevel B and a pulp extractor 2, which has a smooth rod part 2a with a thickened tip 2b, a cutting part made in the form of a screw 2c with a sharp spiral edge D, placed in the channel of the needle with the possibility of rotation and reciprocating formed by bevels of the ribs of the spiral at angles (α, β), and with a lanceolate trailer E (Fig.5, 6).

The needle 1 is fixed in the needle holder 3 with a screw 4. The needle holder is made in the form of a sleeve with internal bores, an end collar and at least one device (fitting) 3a for attaching the hose 3b (Fig. 5) for supplying the anesthetic and / or hose 3c suction pulp.

The needle holder 3 is mounted on the bottom of the glass-like case 5 with a flange 6 and three screws 7. The angular position of the needle holder with the needle is fixed by a pin 8 installed in the case, and the protruding end extends into the longitudinal groove 3g on the upper surface of the needle holder.

In the housing 5 there is a reversible electric drive ED 9 and an electric power source IP 10. Between the electric drive and the power source there is a board 11 for electrical connection by their conductors 11 through a three-position switch 12 (see figure 4), which defines three modes of operation of the device: middle position - ED 9 is disabled; position 1 - drug supply mode, the electric drive ED 9 is supplied with a supply voltage, the polarity of which ensures the rotation of the screw 2B of the pulp extractor in the direction of arrow K (Fig.6), the end of the screw is recessed in the needle channel; position of the key II - the voltage of the opposite polarity on the electric drive, the tumor extraction and pulp removal mode is on, the screw with the trailer is extended and rotates in the direction of arrow L.

The housing 5 is closed by a cover 13. On the shaft of the electric drive ED 9 is fixed a coupling 14 made in the form of a sleeve with radial threaded holes for screws 14a of fastening at the end of the shaft and with screw grooves 14b. In the coupling channel, there is a smooth rod portion 2a of the pulp extractor with a thickened tip 26 (Fig. 5). A pin 15 is inserted in the tip 2b, leading the ends into the screw grooves 14b of the coupling, which ensures the extension of the pulp ejector tip E to the tip of the needle (Fig. 5) during rotation of the electric drive shaft and coupling 14 in the direction of arrow L (in tumor extraction and pulp removal mode II) . To recess the limit switch E by cutting the needle when reversing the electric drive, i.e. in anesthetic delivery mode, spring 16 is installed in clutch 14.

In a simplified embodiment of the device, containers with an analgesic (or other therapeutic agent) and vacuum tanks for suctioning the pulp are placed separately from the device. For their maintenance during the operation, it is advisable to use a trained assistant.

In an embodiment of the device with a combined control unit for reversing the electric drive and the mode of supply of the medicinal product or suction of the pulp on the housing 5 with the help of a clamp 17 and a coupling screw 18 with a nut 19, a switch 12, a three-position faucet 20 (Fig. 7, 8) and two containers are secured one of which is the supplying EP 21 is filled with a medicinal product, and the other is evacuating EB 22, intended for suction of the pulp, can be performed, for example, in the form of a syringe with a spring 21, forcing the piston to force the vacuum to create a vacuum, and equipped with of inverse valve (not shown).

When switching from mode to mode for synchronous transfer of the switch 12 and the faucet 20, their levers are mechanically connected by a bracket 23 (Fig.7 and 8).

On the needle holder 3, a support bracket 24 with a fixing screw 25 can be installed. In this case, on the needle holder in a longitudinal groove 3g, a scale is indicated for mounting the bracket at the required distance from the tip of the needle 1. Depending on the anatomical features of the patient, the bracket can be reset to one of two positions (I -II).

Work with the device is performed in the following order.

In the variant with one fitting 3a, the hose from it with the other end is connected alternately to the containers located away from the device, first to the EA-container 21 with an analgesic, such as novocaine, and then to the evacuating EB-container 22. Hose switching and corresponding manipulations with the containers performed by the assistant of the operating urologist.

After carrying out preparatory actions for the operation, the patient occupies a sitting position in the chair and is fixed at the most bent and extended hips. Inspection and exposure are carried out through the lower opening of the small pelvis of the patient and suprapubic region. The doctor examines the exact position of the prostate 28 and the location of the tumor 28a, the most narrowing urethra in its prostatic part, using an ultrasound machine, and plans the surgical field. The visual and well-palpable (tactile) landmark of the surgical field is the seed tubercle 29a, taken as the base element for accurately determining the site of impact, as well as the pubic fusion 26 at the root of the penis and the anal opening of the rectum 29 (Figs. 9, 10).

Under the control of ultrasound with the average position (0) of switch 12, the doctor first punctures to the right of the urethra to a depth of not less than the length of the bevel of the needle “a” (about 10 mm) in the direction of the prostate 28 and injects an anesthetic fluid. After anesthesia, the doctor, under visual control (ultrasound, X-ray, tomography), inserts the device’s needle into the place of the tumor of the prostate 28a to the right (distal) of the seminal tubercle 29a by 10-12 mm initially in the region of the caudal part of the prostate.

1-2 minutes after administering the analgesic (the start of anesthesia), the hose of the fitting Za is connected to the evacuating EB-container 22 and the electric drive is turned on with the switch 12 to position II, after which the end of the needle and the end of the screw E are gradually moved parallel to the urethra channel towards the bladder 27. This movement is due to the plasticity of the tissues of the pelvic organs, due to a slight rotation of the body 5 of the device in the direction of the arrow W (Fig. 9) relative to the place AND of the needle. After performing 2-3 such manipulations, they advance the needle into the central part of the prostate, where they repeat the same actions. Then, similar actions are performed in a prostate tumor on the other (left) side of the urethra. In this case, the tumor is extracted by penetrating the lanceolate tip E of the screw 2 of the pulp extractor, cutting off its tissue with the sharp edge D of the screw, grabbing, moving along the needle channel and removing the resulting pulp through the nozzle 3a and the hose into the evacuating EB-container 22. As a result, the tissue prostate tumors on both sides of the prostatic part of the urethra are formed to the entire depth of the tumor grooves 30, due to which the compressive effect of the tumor on the urethra is removed.

To fix the position of the device and its needle, it is advisable to use ultrasound inspection of the tip of the needle 1 to set its penetration into the prostate tissue exactly at a predetermined depth. In this case, it is possible to use the support bracket 24, moving it all the way to the tissue above the pubic fusion, and in this position, fix it on the needle holder with the locking screw 25.

Maintenance of a device with a combined control unit for reversing the electric drive ED 9 and the mode of supply of the medicinal product or suction of the pulp is different in that the urologist performs all the actions himself with switching modes and with capacities EA 21 and EB 22. For mode 1, the actions are no different . To actuate the evacuating container EB 22, the doctor must first compress the spring 22a before pressing the bracket 23 over the bracket 23 and the faucet 20 to position II, pressing on the stem of the container 22 (a medical syringe of suitable volume can be used as such a container).

As a final operation in mode 1, a preparation can be introduced into the grooves 30 from the EA 21 container for tissue blockage after extraction containing a locking element (0.3-1 mm) from a material with elastic restoring force (rubber, rubber, silicone, hydrogel) and a coating layer (10 μm) over the locking element made of polyester urethane or polyester, in accordance with the known method, see RF application for invention No. 99111092, АВВ 17/03.

Using the proposed device makes it possible to conduct the most gentle operation, excluding the traumatic effect of both the suprapubic region and the bladder, and the prostate itself, including the urethra in its prostatic part, the seminal tubercle with ejaculatory canals, the mouth of the excretory ducts of the prostate gland, Cooper gland, etc. d.

Thanks to this, it is possible to carry out such operations repeatedly with a frequency determined by the symptoms of the disease.

Claims (2)

1. Device for the extraction of a tumor, mainly a prostate tumor, containing a hollow puncture needle with an end bevel and a pulp extractor in the form of a rod with a smooth and cutting part, characterized in that the pulp extractor has a cutting part in the form of a screw with a lanceolate tip and with a sharp outer edge and installed in the channel of the needle with the possibility of rotation and reciprocating movement of the end of the screw within the bevel of the needle, while the pulp extractor rod is coupled by a coupling with a reversible electric electric drive. 2. The device for extracting a tumor according to claim 1, characterized in that it is equipped with a glass-like case and a needle holder fixed to it, while the case has a power supply and a reversible electric drive connected to the power source through a three-position current polarity switch, and in the needle holder connected to the suction and supply hoses of medicinal preparations, a coupling is arranged in the form of a sleeve fixed to an electric drive shaft with profiled spiral grooves, with which the spring-loaded pulp extractor interacts.

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