RU2428949C2 - Monopolar electric surgical instrument - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: instrument consists of handle with located on it units of connection of ESHF generator, irrigation-aspiration device and motionlessly fixed in handle stem of electrode, including dielectric covering and working tip on distal end. Dielectric covering is made in form of detachable screen, located coaxially and in upper part of stem with possibility of its longitudinal movement by means of control organ along stem until complete lapping of naked working tip.

EFFECT: application of invention makes it possible to reduce probability of injuries to surrounding tissues by electric burns, extend functional possibilities of instrument due to efficient sanitary instrument processing.

12 dwg

Description

The invention relates to the field of medical equipment, namely to electrosurgical instruments for coagulation and dissection of tissues, equipped with an internal channel for aspiration and irrigation, used in endoscopic surgery and mini-access surgery.

Power tools for coagulation and dissection of tissues are widely represented on the medical equipment market, and due to their design features and functional purpose, they are divided into reusable and disposable power tools, bipolar and monopolar, with a channel for aspiration and irrigation and without a channel, with a retractable and non-extendable electrode used in endoscopic, open operations, operations from mini-access.

Bipolar power tools [1, 2] are less versatile, require more complex electrodes, but are safer, as they affect tissues locally. Unipolar electrosurgery is the most common way of dissecting tissues and providing hemostasis in both open and laparoscopic interventions.

Before describing the essence of analogues and prototype, we note that according to [1, 3, 4, 5, 6] of the established terminology of elements of electrosurgical instruments, the concept of an electrode includes the concept of a barrel made in the form of a tube or rod coated with a dielectric coating on top and a working tip made, for example, in the form of a needle, scapula, ball, letters L, G, etc.

Monopolar electrosurgical instruments (RF- “Axiom”, “Endomedium”) with a channel, with the shape of a working tip located in the distal part of the electrode itself, made, for example, in the form of a scapula, letters L and G are known [3, 4, 5]. These tools reusable and are intended for coagulation and dissection of tissues during preparation on the abdominal organs during endoscopic operations, including cholecystectomy, appendectomy and hernia repair.

The main disadvantages of the known tools are expressed in the fact that for the dissection of tissues with simultaneous coagulation, it is necessary to carry out traction of tissues, often with considerable effort. At the moment of dissection of the tissues, the exposed working tip located at the distal end of the electrode continues to move and may touch surrounding tissues causing electrical injuries. Electro-burn complications in the form of burn injuries of surrounding tissues during uncontrolled movement of the bare distal end of the electrode are associated not so much with a violation of the technology of the operation as with an insufficiently optimal design of the working tip of the electrode.

Known monopolar electrosurgical instrument without a channel, which is designed for coagulation and gentle dissection of tissues during endoscopic and open operations [7]. The tool consists of a handle with control buttons located on it, a cable for connecting to the EHF generator, a removable barrel made in the form of a round bar with the shape of a distal part made in the form of a needle, and a movable dielectric screen located coaxially and on top of the barrel.

The disadvantages of such a tool include:

- the high complexity of the design, which leads to the difficulty of manipulating the dielectric screen, which increases the cost of its manufacture and maintenance, and as a consequence, low reliability;

- the lack of a channel for aspiration and irrigation limits functionality

Closest to the claimed invention by its technical nature is a monopolar electrosurgical instrument (США- “tyco”) [8]. The instrument consists of an electrosurgical pen (electrode holder) and a working insert (electrode). The Opti reusable electrosurgical pen is designed for interchangeable laparoscopic inserts with extendable and non-extendable Opti electrodes. The tool performs coagulation and dissection of tissues, aspiration and irrigation. On the handle body are switches for aspiration / irrigation. Cable for connecting the EHF generator and two pipes made of polymer material for connection to an aspiration-irrigation device located on the proximal side of the handle. Extendable electrodes are located inside hollow working inserts 280 mm long. The design of the working inserts is non-separable. Work inserts are delivered in a sterile form and are intended for single use.

The disadvantages of such a tool include:

- is a tool for single use;

- high price;

- low efficiency of the aspiration procedure, because the effective cross section of the internal flushing channel is partially occupied by the electrode.

A new technical task of the invention is the improvement of operational characteristics that reduce the likelihood of electric burn damage to surrounding tissues, expand the functionality of the instrument, reduce the cost of a separate surgical operation and reduce the cost of manufacturing the instrument

To solve the problem in a monopolar electrosurgical instrument, consisting of a pen, with ECHF generator connection nodes located on it, an irrigation – aspiration device and an electrode barrel fixed in it, including a dielectric coating and a working tip at the distal end, the dielectric coating is made in the form of a removable a screen located coaxially and on top of the barrel with the possibility of longitudinal movement with the help of a control along the barrel until the bare about the working tip.

Also, the control is placed on the proximal side of the screen and is made in the form of a coil made of dielectric material. Also, the barrel of the electrode can be performed both with a channel and without a channel.

The use of a retractable dielectric shield in the claimed electrosurgical instrument in order to localize the exposure of the exposed working tip located at the distal end of the electrode at the time of dissection of the tissues reduces the likelihood of electro-burn damage to surrounding tissues.

The implementation of the electrode barrel with a washing channel expands the functionality by simultaneously carrying out the aspiration-irrigation procedure with the coagulation and cutting process, which ultimately leads to a reduction in the cost of a separate surgical operation.

The execution of the control of the extension of the dielectric screen in the form of a coil made of dielectric material located on the proximal side of the screen, solves the problem of reusable use of the most complex parts of the tool. This ultimately leads to lower tool manufacturing costs.

The invention is illustrated by drawings of the main components of the tool.

Figure 1 presents a side view of the tool in its original state.

Figure 2 shows a side view of the instrument at the time of complete overlap of the bare distal end of the electrode.

Figure 3 shows a side view of a tool with a removed dielectric screen.

Figure 4 presents a side view of the removed dielectric screen.

Figure 5 shows a cross section of a dielectric screen with a control.

Figure 6 shows a cross section of the distal part of the electrode in the initial state.

7 shows a cross section of the distal part of the electrode corresponding to the moment of complete overlap of the exposed distal end of the electrode (side view).

On Fig shows a cross section of the distal part of the electrode in the initial state, corresponding to the moment of selection and retention of the tissue site (side view).

Figure 9 shows a cross section of the distal part of the electrode in the initial state, corresponding to the moment of selection and retention of the tissue site (top view).

Figure 10 shows a cross section of the distal part of the electrode corresponding to the moment of localization of the exposure of the exposed distal end of the electrode to the tissue (top view).

Figure 11 shows a cross section of the distal part of the electrode corresponding to the moment of coagulation with local exposure to the bare distal end of the electrode on the tissue (top view).

On Fig shows a cross section of the distal part of the electrode corresponding to the moment of rupture of the coagulated tissues (top view).

The monopolar electrosurgical instrument shown in Fig 1-12 contains a pen 1, a plug connector for connecting to the EHF generator 2, Luer-Lock connection for the suction-irrigation device 3, the electrode 4, the working tip 5, the barrel of the electrode 6, a removable dielectric screen 7, the control element for the movement of the dielectric screen 7 in the form of a coil 8 (Fig.1-6).

A monopolar electrosurgical instrument works as follows.

In the process of surgical intervention, the tissue site 9 to be dissected is taken with the working tip 5 (Fig.6-9). Then, a high-frequency current is supplied from the EHF generator to the working tip of the tool 5. At the same time, the operating surgeon shifts the movable dielectric screen 7 with the control 8 in the direction of the exposure area (Figs. 10, 11), thereby localizing the impact area for the working tip. After tissue coagulation, the surgeon, overcoming tissue resistance, additionally moves the movable dielectric screen 7 in the distal direction and breaks the coagulated tissue without additional tissue tension (Fig. 12). Due to the localization of 7 crossed tissues by a movable dielectric screen, rupture always occurs at the site of coagulation.

Clinical example 1. Patient C. 63 years old, medical history N1056 / 961, operated on for chronic calculous cholecystitis. Operation laparoscopic cholecystectomy. Previously, the patient underwent a resection of the stomach and there was an extensive adhesion process in the upper floor of the abdominal cavity. Isolation of the gallbladder from the bed and coagulation of the bed with the goal of hemostasis was performed by monopolar coagulation with the claimed electrode. Under the conditions of the adhesive process and significant swelling of the colon during the operation, the electrode body during coagulation repeatedly contacted the common bile duct and the intestinal wall. When examining these areas of the common bile duct and intestine, any tissue changes indicating the presence of a possible electric burn damage in this case were not detected. The postoperative period is smooth. Recovery.

Clinical example 2. Patient A., 49 years old, medical history N234 / 90, operated on for chronic calculous cholecystitis. Performed laparoscopic cholecystectomy. In this case, to isolate the gallbladder from the bed, an L-shaped electrode for monopolar coagulation by Axiom was used. During the separation of tissues in the neck of the gallbladder due to the presence of a cicatricial process, significant efforts had to be made to dissect the tissues. When moving the end of the electrode after rupture of tissues, a burn and perforation of the wall of the duodenum occurred. Peripheral laparotomy performed, defect sutured. Recovery. In this case, the use of significant traction for dissecting tissues led to an uncontrolled movement of the end of the electrode with damage to a nearby organ.

Thus, the proposed monopolar electrosurgical instrument can reduce the likelihood of electric burn damage to surrounding tissues due to localization of the exposure of the exposed working tip of the distal end of the electrode due to the retractable dielectric shield at the moment of dissection of the tissues. The design of the extension control of the dielectric screen in the form of a coil made of dielectric material and placed on the proximal side of the screen, solves the problem of reusable use of the most complex parts of the tool. The implementation of the electrode barrel with a washing channel expands the functionality by simultaneously carrying out the aspiration-irrigation procedure with the coagulation and cutting process, which ultimately leads to a reduction in the cost of a separate surgical operation.

Claims (1)

A monopolar electrosurgical instrument, consisting of a handle with connecting nodes for the EHF generator and an irrigation-aspiration device and an electrode barrel fixed in it, including a dielectric coating and a working tip at the distal end, characterized in that the dielectric coating is made in the form of a removable screen, located coaxially and on top of the barrel with the possibility of longitudinal movement with the help of a control along the barrel until the bare overlap of the exposed work onegnik.

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