RU2775542C2 - Electrosurgical resector instrument - Google Patents

Abstract

FIELD: medical equipment.

SUBSTANCE: electrosurgical resector instrument contains a rod defining a lumen; an energy transmission structure for transmission of radio frequency (hereinafter – RF) electromagnetic (hereinafter – EM) energy and microwave EM energy through the lumen of the rod, wherein the energy transmission structure contains a coaxial transmission line passing in the longitudinal direction through the lumen, wherein the coaxial transmission line contains an internal conductor separated from an external conductor with dielectric material; and an instrument tip mounted on the distal end of the rod. The instrument tip contains a fixed part containing the first blade element, wherein the first blade element contains a flat dielectric case passing in the longitudinal direction, containing the first electrode on its first side-facing surface; and a movable part containing the second blade element, wherein the movable part is made with the possibility of rotation relatively to the fixed part within the plane of rotation between a closed position, in which the first blade element and the second blade element are located next to each other in a transverse direction perpendicular to the plane of rotation, and an open position, in which the second blade element is spaced with the first blade element by means of a gap for reception of biological tissue. The second electrode is located on the second side-facing surface of the specified flat dielectric case passing in the longitudinal direction, opposite to its first side-facing surface, as a result of which the second electrode is spaced with the first electrode and electrically isolated from it by the specified flat dielectric case passing in the longitudinal direction. An actuator is used to control the relative movement between the movable part and the fixed part. The second blade element has a length corresponding to a length of the first blade element. In the closed position, it is located next to the second side-facing surface of the flat dielectric case passing in the longitudinal direction. The internal conductor is connected to one of the first electrode and the second electrode, and the external conductor is connected to the other of the first electrode and the second electrode, by means of which the first electrode and the second electrode act: as active and reverse electrodes to supply RF energy transmitted from the energy transmission structure for cutting biological tissue taken between blade elements; and the structure of microwave field radiation to supply microwave energy transmitted from the energy transmission structure to coagulate biological tissue taken between blade elements. An electrosurgical device for cutting, coagulation or ablation of biological tissue is disclosed.

EFFECT: providing a combined and compact power supply actuator.

25 cl, 9 dwg

Description

FIELD OF TECHNOLOGY

SUBSTANCE: invention relates to electrosurgical resector instrument intended for cutting, coagulation and ablation of biological tissue. In particular, the invention relates to an electrosurgical resector instrument capable of transmitting radio frequency (RF) energy and/or microwave frequency energy for cutting biological tissues, hemostasis (i.e. sealing ruptured blood vessels by stimulating blood clotting), and tissue ablation.

BACKGROUND OF THE INVENTION

Surgical resection is a method of removing portions of organs within the human or animal body. Such organs can be heavily permeated with vessels. When tissue is cut (that is, divided or dissected), small blood vessels can be damaged or ruptured. After the initial bleeding, the blood clotting system kicks in, creating a blood clot in an attempt to stop the bleeding. It is desirable that the patient lose as little blood as possible during the operation, so various devices have been developed in an effort to provide a bleeding-free incision. In the case of endoscopic procedures, it is also desirable to prevent bleeding and manage it in a manner that is practicable, since blood flow may obstruct the view of the operating surgeon. It is known that RF energy is used instead of a sharp blade to cut biological tissue. The principle behind the RF cutting method is that when an electrical current is passed through the tissue matrix (using the ionic content of the cells), the impedance to the flow of electrons through the tissue generates heat. When a sinusoidal signal is applied to the tissue matrix inside the cells, enough heat is generated to evaporate the water contained in the tissue. Thus, there is a huge increase in the internal pressure in the cell, which cannot be regulated by the cell membrane, which leads to cell rupture. When this occurs over a large area, the tissue can be seen to be dissected.

The above procedure works ideally on muscle tissue, but is less effective on adipose tissue because it has fewer ionic components to facilitate the passage of electrons. This means that the energy needed to vaporize the contents of the cells is much greater, since the latent heat of vaporization of fat is much greater than the latent heat of vaporization of water. RF coagulation works by delivering a less powerful signal waveform to the tissue, which heats the cell contents to about 65°C instead of evaporating, drying the tissue by drying and denaturing the proteins in the vessel walls. This denaturation acts as a stimulus to start the blood clotting system, so clotting increases. At the same time, the collagen in the wall is denatured from a rod-shaped molecule to a helical molecule, causing the vessel to shrink and shrink, giving the blood clot an anchor point and less area to plug.

However, RF coagulation is less effective when adipose tissue is present because the electrical effect is reduced. Thus, it can be very difficult to seal bleeding areas in fatty tissues. Instead of clean white edges, the fabric has a blackened burnt appearance.

SUMMARY OF THE INVENTION

In the most general sense, the present invention provides an electrosurgical resector instrument comprising a power transfer design that provides a variety of surgical techniques that facilitate cutting and sealing biological tissues using radio frequency (RF) electromagnetic energy and/or microwave EM energy. In particular, the invention relates to combined actuators and power delivery mechanisms which are compact enough to allow insertion of an instrument through the instrument channel of a surgical examination device such as an endoscope, gastroscope or bronchoscope. The device can also be used to perform laparoscopic or open surgery, i.e. bloodless resection of a lobe of the liver with an open abdominal cavity.

In one example, an electrosurgical resector instrument may comprise a pair of blades providing a scissor mechanism that may provide the following three additional techniques: (i) a sliding RF incision when the blade elements are closed, (ii) a scissor-type incision made on tissue trapped between the elements blade using a combination of RF energy and applied pressure, and (iii) a coagulation or vascular sealing operation performed on tissue trapped between blade elements using a combination of microwave energy and applied pressure. In addition, RF and/or microwave energy can be applied with any of these methods at a power level sufficient to effect tissue ablation. By appropriately configuring a pair of electrodes on the blade elements, the delivered RF or microwave energy in each of these surgical techniques can be focused to the desired area. A pair of electrodes may be located on the same blade element, or there may be an electrode on each blade element.

In accordance with the present invention, an electrosurgical resector instrument is provided, comprising: a shaft defining a lumen; a power transmission structure for transmitting radio frequency (RF) electromagnetic (EM) energy and microwave EM energy through the rod lumen, the power transmission structure comprising a coaxial transmission line extending longitudinally through the lumen, the coaxial transmission line comprising an inner conductor separated from an outer conductor dielectric material; a tool tip mounted on the distal end of the rod, and the tool tip includes: a fixed part containing the first blade element, and the first blade element; and a movable part comprising a second blade element, the movable part being movable relative to the stationary part between a closed position in which the first blade element and a second blade element are adjacent to each other in an open position in which the second blade element is spaced apart from the first blade element by a clearance distance for receiving biological tissue, wherein the first blade element or the second blade element comprises a longitudinally extending flat dielectric housing containing the first electrode on its first sideways facing surface; a second electrode spaced apart from and electrically insulated from the first electrode by at least a flat dielectric housing; and an actuator for controlling relative movement between the movable part and the fixed part, wherein the length of the second blade element is commensurate with the first blade element, whereby in the closed position it is adjacent to the second sideward facing surface of the longitudinally extending flat dielectric body opposite its first laterally facing surface, wherein the inner conductor is connected to one of the first electrode and the second electrode, and the outer conductor is connected to the other of the first electrode and the second electrode, as a result of which the first electrode and the second electrode function: as active and return electrodes for supplying RF energy transmitted from the power transmission structure; and a microwave field generating structure for supplying microwave power transmitted from the power transmission structure.

In this construction, the first and second blade members may resemble a scissor-type closing mechanism. Thus, the second blade element can be configured to slide behind the first blade element when moving between an open position and a closed position, for example, to perform mechanical cutting by applying a shear force. The movable part may be movable relative to the fixed part in a plane parallel to the plane defined by the flat dielectric body. As used herein, the term "fixed" may mean that the part is fixed with respect to the distal end of the shank in use (ie, when the second blade element moves between an open position and a closed position).

The stem may be flexible, for example suitable for bending or otherwise being manipulated to reach the exposed site. The flexible shaft may enable said device to be used in a surgical examination device such as an endoscope. In other examples, the rod may be rigid, such as for use in open surgery or with a laparoscope.

The first electrode and the second electrode may be located on the cutting contact surface. In one example, both electrodes are on the same blade element, which may be located on either the movable part or the fixed part. For example, the second electrode may be located on the second laterally facing surface of the longitudinally extending flat dielectric body. This can help to ensure uniform power delivery across the cutting contact surface. When both electrodes are on the same blade element, the other blade element may be electrically inactive, such as may be made of plastic or other insulating material.

In another example, the first electrode may be on one blade element and the second electrode on another blade element. For example, a longitudinally extending flat dielectric body may be on the first blade element and a second electrode may extend along the side of the second blade element.

Thus, the first and second electrodes can be located along each side of the cutting contact surface, and between them can be located a flat dielectric body. In this configuration, the RF EM energy supplied to the electrodes flows preferentially between the first and second blade elements through the cutting contact surface. Similarly, when applying microwave EM energy while the blade elements are open, the microwave field radiated from the electrodes has a much greater field strength within the gap between the blade elements than elsewhere.

When in the closed position, the second electrode is separated from the first electrode along most of its length by a flat dielectric body. If RF EM energy is applied in this position, RF EM energy preferentially flows around the distal tip and lateral edge of the closed blade elements, which facilitates a sliding, RF-only cut made by sliding the instrument tip through tissue.

The moving part, and hence the second blade element, can be made of a conductive material with an insulating coating. For example, the moving part may be a stainless steel casting coated with ceramic (eg, alumina), synthetic plastic (eg, Bakelite), or diamond-like carbon (DLC). The second electrode may be formed on the side of the second blade element where the insulating coating has been removed. The second electrode may be the exposed conductive material of the movable part, or may comprise an additional conductive layer (eg, gold or the like) applied to the exposed conductive material or otherwise attached to the exposed conductive material.

The second blade element may include a laterally projecting flange along its side portion. The flange thus protrudes towards the first blade element in the closed position. The second electrode may be formed on the sidewardly facing edge of the laterally projecting flange.

The fixed part may include a support arm on which the movable part is mounted. The support arm may form part of the electrical connection between the power transmission structure and the second electrode. For example, the support arm may be made of a conductive material with an insulating coating and may include a proximal contact area where the insulating coating is removed and which is electrically connected to the inner conductor or outer conductor of the coaxial transmission line. The support arm may have a proximal recess for attachment to the distal end of the coaxial transmission line. Other types of electrical connection may also be used. For example, a flexible conductor may be connected between the power transmission structure (eg, the inner conductor or outer conductor of the coaxial transmission line) and the first electrode or the second electrode. Preferably, the length of any flexible conductor is equal to or less than one-eighth of the wavelength of the microwave energy to prevent it from affecting the generated field.

The coaxial transmission line can be adapted to carry both RF EM energy and microwave EM energy. Alternatively, the power transmission design may have different transmission paths for RF EM energy and microwave EM energy. For example, microwave EM energy may be supplied through a coaxial transmission line, while RF EM energy may be supplied over twisted pair, etc. When a separate power transmission path is provided, the first and second electrodes may comprise separate RF electrode parts and microwave electrode parts to allow the transmission of RF energy and microwave energy through different parts of the tool tip. For example, microwave energy may be supplied through one of the blade elements, while RF energy may be supplied between the blade elements.

The movable part can be mounted on the support arm by means of a swivel joint. For example, the support arm may have a clevis type structure that supports a pin on which the movable part is mounted. The electrical connection between the power transmission structure and the second electrode may be through a swivel. For example, the trunnion may be made of a conductive material, and the insulating coating of the movable part and the support arm may be removed where they respectively contact the trunnion.

The dielectric material and the inner conductor of the coaxial transmission line may extend beyond the distal end of the outer conductor. The inner conductor may include an open distal portion that is electrically connected to the first electrode, for example by directly overlapping and contacting the proximal portion of the first electrode.

The movement between the moving part and the fixed part may be rotational or translational, or a combination of both. In one example, the movable part can be rotated relative to the fixed part, whereby the second blade element is angled relative to the first blade element in the open position. This example may resemble a normal scissor close. The second blade element is movable in an obtuse angle range between an open position and a closed position. This may be useful in order to achieve grip on the tissue to be gripped, especially tissue with a low surface profile.

In another example, it may be preferable that the gap between the electrodes is uniform after tissue has been captured between them, for example, to ensure that energy is applied uniformly along the length of the blade elements. In this example, the movable part may be in a position where the second blade element is parallel to, but spaced from, the first blade element to form a gap therebetween. The movable part can slide from this position to the closed position, for example, during operation of the actuator. Then, the first blade element and the second blade element may be arranged parallel in the longitudinal direction while sliding past each other. The spaced parallel position may be an intermediate position, such as a position from which the movable part can be rotated through some angle relative to the fixed part.

The actuator may comprise a control rod slidably mounted in a flexible rod. The control rod may include a fastening element engaged with the movable part, as a result of which the longitudinal movement of the control rod in the rod causes the movable part to move relative to the fixed part. The fastening element may be a hook or any suitable engagement for transmitting pushing and pulling forces to the moving part.

In one example, the movable portion comprises a curved surface against which a control rod acts to drive a second blade element moving past the first blade element. The curved surface may only be engaged in the final step of the closing operation, for example to provide an additional increase in force to complete the closing. In one example, the curved surface may be provided with a slot in the movable portion. The fastening element contains a section of engagement for placement in the slot. The impact of the curved surface can be provided by the engagement portion sliding along the slot.

The fixed part may include a support arm that provides a mounting base (eg, a hinge base) for the movable part. The flat dielectric body may be a separate piece of material mounted on the support arm, such as glued or otherwise attached to the support arm. The flat dielectric package may be made of ceramic (eg aluminum oxide). In this document, the reference to "flat" material may refer to a flat piece of material, the thickness of which is substantially less than its width and length. The flat dielectric package may have a length dimension aligned in the longitudinal direction, a thickness dimension aligned in the transverse direction, and a width dimension mutually perpendicular to both the length dimension and the thickness dimension. The plane of the flat dielectric body is the plane in which the length and width dimensions lie, i.e. the plane perpendicular to the width dimension.

The first electrode may be a conductive material (eg, gold) deposited or otherwise mounted on the first sideways surface of the flat dielectric body. A second side-facing surface of the flat dielectric body, which faces in a direction opposite to the first side-facing surface, may be exposed on the cutting contact surface.

The tip of the tool may include a protective shield installed around the fixed part. The protective screen may include an insulating cover installed around the fixed part. For example, an insulating protective screen may cover the support arm of the stationary part. The insulating shield can also be used to partially cover the first electrode, for example to ensure that the exposed portion of the first electrode is shaped to control the delivery of RF or microwave energy. The insulating coating may have one or more field-shielding conductive regions, such as metallized areas on its outer surface. These conductive regions can provide shielding for electrical fields, for example to prevent energy from leaking out of the tool at undesirable locations. The protective shield can be molded onto the tool tip after assembly. Alternatively, the shield may be formed from a tube of insulating material that can be cut (eg, laser cut) to a desired shape and then placed over the blade elements. The protective shield may be made of a suitable insulating plastic such as PEEK or the like. The protective screen material may preferably be high temperature resistant.

The first blade element may be in the form of a longitudinally extending pin having a protruding tip at its most distal end. The second blade element may be suitably shaped, such as an elongated pin having a downward protruding tip at its most distal end. The most distal tips can help hold tissue between the jaws when they are closed.

A longitudinally protruding insert may be installed in the lumen of the flexible shaft to prevent relative movement of the actuator or coaxial cable with the shaft, which would result in loss or intermittent movement of the tool tip. The insert may comprise a hollow body having a plurality of longitudinal gaps formed therein, each of

a plurality of longitudinal gaps located below breaks the outer surface of the hollow body. The hollow body is sized to fit snugly against the opening inside such that its fractured peripheral surface defines a plurality of legs that abut against the inner surface of the rod to resist relative movement therebetween.

The coaxial transmission line may comprise a coaxial cable routed in a first lower opening of the hollow body. The actuating mechanism may comprise a control rod slidably mounted in a second lower lumen of the hollow body. The control rod may be provided with a low friction coating (eg PTFE or the like) to facilitate longitudinal sliding relative to the insert. Alternatively, the second lower lumen may comprise a low friction tube mounted therein, wherein the control rod may be slidably mounted in the low friction tube.

The tip of the instrument can be sized to fit into the instrument channel of the surgical examination device. Accordingly, in another aspect, the invention provides an electrosurgical device comprising: an electrosurgical generator for delivering radio frequency (RF) electromagnetic (EM) energy and microwave EM energy; a surgical examination device comprising an attachment cord for insertion into a patient's body, the attachment cord having an instrument channel extending therethrough; and the above-described electrosurgical resector instrument inserted through the instrument channel of the surgical examination device.

The device may include a manual unit for controlling an electrosurgical resector instrument. The handpiece may be placed at the proximal end of the flexible shaft, eg outside the surgical examination device. The hand block may include: a housing; actuating element mounted with the possibility of sliding on the housing; and a rotating device rotatably mounted on the housing. The coaxial transmission line and the flexible shaft of the electrosurgical resector can be positioned to slide relative to the housing with an actuator and rotate relative to the housing with a rotary device. The actuating mechanism of the electrosurgical resector instrument may include a control rod passing through the lumen of the flexible rod, the control rod having a proximal part that is installed in a longitudinally fixed position relative to the body. With such an arrangement, the actuating element is configured to control the movement of the movable part relative to the fixed part, and the rotating device is configured to control the rotation of the electrosurgical resector instrument relative to the instrumental channel.

In use, the handpiece can energize an electrosurgical resector instrument at the distal end of the flexible shaft in combination with both a longitudinal (axial) force (through the control stem) and a rotational force (through the flexible shaft). The longitudinal force can be used to control a terminal device on the tool, such as the movable part described above, or a sliding blade or needle. The force of rotation can be used to control the orientation of the tool.

The connection between the components in the handpiece is made in such a way that the flexible shaft and the coaxial cable slide against the control stem. In other words, the position of the control rod can be changed relative to the flexible rod, thus allowing physical movement at its distal end to control the tool.

The body may be of a cylindrical type which is located on an axis which is aligned with the flexible rod as it extends from the body. The axis of rotation of the rotary device can be aligned or coaxial with the axis of the body. The rotary device may be a sleeve or a ring mounted on the outer surface of the housing. The rotary device can be held on the housing in the longitudinal (axial) direction. For example, the housing may have an annular recess in which a rotary device is installed.

The control rod can rotate relative to the body. This means that all of the following elements: flexible rod, control rod and coaxial cable rotate relative to the housing when the rotary device rotates. Due to this, twisting of the components inside the flexible shaft can be prevented. In one example, the proximal portion of the control rod may be mounted on a rotary device. If the rotator is fixed axially relative to the body, this means that the control rod will rotate with the rotator but will not slide against the body. The proximal portion may include a radial extension that extends through the flexible shaft for connection to the rotator.

The hand block may include an inner shaft that contains the proximal portion of the flexible shaft. The inner rod may be connected to the rotator to rotate with it. The inner rod may be axially slidable along a track formed within the rotator.

The actuating element may include a rod mounted to slide in the longitudinal direction (ie, in the axial direction mentioned above) within the housing. The actuator and housing may include gripping elements, such as finger rings or the like, with which the user can hold the device while operating it.

The handpiece may include a power input port on the actuator. The power input port may be a QMA connector or the like. The power input port can be connected to transmit the power it receives to the coaxial cable. Thus, the proximal end of the coaxial cable can be connected to an actuator to receive power from the power input port. The proximal end of the coaxial cable may be connected to the actuator via a swivel joint to allow relative rotation between them.

The power input port can be connected to an external coaxial cable, such as from an electrosurgical generator. The direction of connection to the power input port may be perpendicular to the direction in which the actuator slides relative to the housing. For example, the power input port may be located on the underside of the actuator.

The term "surgical examination device" may be used herein to refer to any surgical device equipped with an insertion tube, which is a rigid or flexible (eg, steerable) conduit that is inserted into a patient's body during an invasive procedure. The insertion tube may contain an instrumental channel and an optical channel (for example, for transmitting light for illumination and/or obtaining images of the treated area at the distal end of the insertion tube). The instrument channel may have a diameter suitable for receiving invasive surgical instruments. The diameter of the instrumental channel may be 5 mm or less.

In this document, the term "internal" means located in the radial direction closer to the center (eg, axis) of the tool channel and/or coaxial cable. The term "outer" means located in the radial direction further from the center (axis) of the tool channel and/or coaxial cable.

The term "conductive" is used in this document to refer to an electrically conductive element, unless the context requires otherwise.

In this document, the terms "proximal" and "distal" refer to the ends of an elongated probe. In use, the proximal end is closer to the generator to provide RF and/or microwave energy, while the distal end is further away from the generator.

In this description, the term "microwave" can be used in a broad sense to indicate the frequency range from 400 MHz to 100 GHz, but preferably the range from 1 GHz to 60 GHz. The specific frequencies that have been considered are: 915 MHz, 2.45 GHz, 3.3 GHz, 5.8 GHz, 10 GHz, 14.5 GHz and 24 GHz. Conversely, the terms "radio frequency" or "RF" are used herein to indicate a frequency range that is at least three orders of magnitude lower, such as up to 300 MHz, preferably 10 kHz to 1 MHz, and most preferably 400 kHz.

BRIEF DESCRIPTION OF GRAPHICS

Embodiments of the invention are discussed below with reference to the accompanying drawings, in which:

in fig. 1 illustrates a schematic representation of an electrosurgical system which is an embodiment of the present invention;

in fig. 2A and 2B are perspective views of an instrument tip of an electrosurgical resector instrument which is an embodiment of the present invention in an open configuration and a closed configuration, respectively;

in fig. 3A, 3B, 3C and 3D are perspective views of the instrument tip of an electrosurgical resector instrument illustrating various steps in a closure operation;

in fig. 4 illustrates a partially cut away schematic side view of an electrosurgical resector instrument which is an embodiment of the present invention;

in fig. 5 is a partially cutaway perspective view of an electrosurgical resector instrument which is an embodiment of the present invention;

in fig. 6A is a perspective view of a handpiece of an electrosurgical device that is an embodiment of the present invention;

in fig. 6B is a partial cutaway view of the hand block illustrated in FIG. 6A showing parts of the internal structure of the hand block;

in fig. 7A is a perspective view of the contents of an instrument shaft that can be used with an electrosurgical resector instrument, which is an embodiment of the present invention;

in fig. 7B illustrates a cross-sectional view of the shaft of the tool illustrated in FIG. 7A;

in fig. 8A, 8B, and 8C are perspective views of an instrument tip of an electrosurgical resector instrument, which is another embodiment of the present invention; and

in fig. 9A and 9B illustrate perspective views of the instrument tip of an electrosurgical resector instrument, which is another embodiment of the present invention.

DETAILED DESCRIPTION OF THE INVENTION

In FIG. 1 illustrates a schematic representation of a kit electrosurgical system 100 that is an embodiment of the present invention. The system is designed to process (eg, cut or seal) biological tissue using radio frequency (RF) or microwave electromagnetic (EM) energy supplied through the tip of the instrument. System 100 includes a generator 102 for controlled delivery of RF and microwave EM energy. A suitable generator for this purpose is described in WO 2012/076844, which is incorporated herein by reference. The generator 102 is connected to the handpiece 106 by a connecting cable 104. The handpiece 106 may also be connected to receive a fluid supply 107 from a fluid delivery device 108, such as a syringe, although this is not required. If desired, the hand block 106 may include a tool actuator that is controlled by an actuator 109, such as a slider or thumb operated piston. For example, a tool actuator may be used to control the rotary member of the cutting tool blade discussed herein. Other mechanisms may also be included in the hand block. For example, a needle movement mechanism (operated by a suitable trigger on the hand block) may be provided to position the needle in the tool. The function of the hand block 106 is to combine the inlets from the generator 102, the fluid delivery device 108, and the instrument actuator, along with any other inlets that may be needed, into a single flexible shaft 112 that extends from the distal end of the hand block 106 .

The flexible rod 112 may be inserted along the entire length of the instrumental (working) channel of the surgical device 114 for inspection. The flexible shaft 112 includes an instrument tip 118 shaped to pass through the instrument channel of the surgical examination device 114 and protrude (eg, inside the patient) at the distal end of the endoscope's insertion tube. Instrument tip 118 includes a pair of blade elements for grasping biological tissue and an energy delivery structure configured to deliver RF or microwave EM energy transmitted from generator 102. Optionally, instrument tip 118 may also include a retractable hypodermic needle for delivering fluid transmitted from device 108 liquid supply. As described in more detail below, the hand block 106 includes an actuator for opening and closing the blade elements of the tool tip 118. The tip 106 also includes a rotation mechanism for rotating the tip 118 of the instrument relative to the instrument channel of the surgical examination device 114.

The tool tip 118 may be designed to have a maximum outer diameter suitable for passage through the working channel. Typically, the diameter of the working channel in a surgical examination device such as an endoscope is less than 4.0 mm, having, for example, any of the following values: 2.8 mm, 3.2 mm, 3.7 mm, 3.8 mm. The maximum diameter of the flexible rod 112 may be less than these values, such as 2.65 mm. The length of the flexible rod 112 may be equal to or greater than 1.2 m, such as 2 m or more. In other examples, the tip 118 of the instrument may be positioned at the distal end of the flexible shaft 112 after the shaft is inserted through the working channel (and before the connecting cord is inserted into the patient's body). Alternatively, the flexible shaft 112 may be inserted into the working channel from the distal end prior to making its proximal connections. In these arrangements, the distal end assembly 118 may be larger than the operating channel of the surgical examination device 114. The system described above is one way to insert an instrument into the patient's body. Other methods are also possible. For example, the instrument may also be introduced through a catheter.

Although the examples provided herein are presented in the context of a surgical examination device, it should be understood that an electrosurgical resector instrument may be an embodiment in a device suitable for open surgery or laparoscope use.

In FIG. 2A illustrates a perspective view of the instrument tip 200 of an electrosurgical resector instrument, which is an embodiment of the present invention. The tip 200 of the tool is mounted on the distal end of the flexible shaft 204, which may correspond to the flexible shaft 112 described above. In this embodiment, the tool tip 200 includes a fixed portion 202 containing the first electrode 206 and a movable portion 212 containing the second electrode 214. However, the invention need not be limited to this configuration. In other examples, both electrodes may be provided on either the fixed portion 202 or the movable portion 212.

The fixed portion 202 has a proximal region that is attached to the distal end of the flexible shaft 204. The stationary portion 202 extends longitudinally away from the distal end of the flexible shaft 204. At its distal end, the fixed portion 202 defines a first blade element 205 that is the longitudinal direction of the pin containing the protruding tip 210 at its most distal end. The first electrode 206 extends along the top surface of the first blade element 205 .

The movable portion 212 is rotatably mounted on the fixed portion 202. In this embodiment, the movable portion 212 includes a second blade element 207 which is an elongated pin commensurate in length with the first blade element 205. The second blade element 207 includes a downwardly extending tip 216 at its most distal end.

The movable part is rotatable about a pivot located at the proximal end of the first blade element 205, whereby the second blade element 207 can tilt between an open position (shown in FIG. 2A), in which it is tilted away from the first blade element 205, and a closed position. a position (shown in FIG. 2B) in which it is adjacent (ie, laterally adjacent) to the first blade element 205. The range of movement of the movable portion may be such as to allow the second blade element 207 to be at an obtuse angle to the first blade element 205. This can be especially useful for gripping tissue that has a low surface profile.

Thus, the first blade element 205 and the second blade element 207 can define a scissor-type closing mechanism in which the tissue located in the gap between the blade elements 205, 207, in the open position, can have pressure applied to it when the second blade element 207 is moved. to the closed position. The upwardly projecting tip 210 on the first blade element 205 and the downwardly extending tip 216 on the second blade element 207 act to hold tissue in the gap when the second blade element 207 moves to the closed position.

The first blade element 205 includes a flat dielectric body 208, such as ceramic or other suitable electrically insulating material. The flat dielectric body 208 defines a plane parallel to the plane through which the second blade element 207 rotates. The flat dielectric housing 208 provides an insulating barrier between the first electrode 206 and the second blade element 207. For example, the second blade element 207 is slidable past the first surface of the flat dielectric body 208, and the first electrode 206 is formed on the second surface of the flat dielectric body 208, the second surface being on the opposite side of the flat dielectric body 208 with respect to the first surface. The first electrode 206 may be made of a highly conductive conductor such as gold or the like.

The second electrode 214 extends along the side surface of the second blade element 207, which slides past the adjacent side surface of the first blade element 205 (i.e., the first surface of the flat dielectric body 208 mentioned above) when the second blade element 207 moves to the closed position. In this example, the second blade element 207 includes a laterally extending flange along its bottom edge. The second electrode 214 extends along the side facing surface of the flange. The second blade element may be made of an electrically conductive material that is coated with an insulating material. For example, it can be made of stainless steel with a ceramic or diamond-like carbon (DLC) coating. The insulating coating may be removed, for example etched away, from areas where it is not required. For example, the second electrode 214 may be formed by etching the coating from the side edge of the side flange. A layer of gold may be applied to the etched surface to form an electrode. Other parts of the cover may be removed to allow electrical connection to the outer conductor of the coaxial cable, as explained below.

The flexible rod 204 defines a gap through which a coaxial cable (not shown) passes to transmit RF and microwave EM energy, and a longitudinally sliding control rod (shown in FIGS. 3A-3D) to control the movement of the moving part 212.

As described in more detail with reference to FIG. 4, the first electrode 206 is electrically connected to the inner conductor of the coaxial cable, and the second electrode 214 is electrically connected to the outer conductor of the coaxial cable. Thus, the tool tip provides an energy delivery structure that is capable of transmitting RF energy along a current path (e.g., through tissue) between the first electrode and the second electrode, or microwave energy through the microwave field generated by the first electrode and the second electrode.

The tool tip 200 can provide three methods of operation. According to the first method, the tool can be used with the blade elements 205, 207 in the closed position to apply RF EM energy to cut biological tissues. When performing the first RF EM method, energy passes predominantly between the first electrode 206 and the second electrode 214 in the distal cutting zone 230 adjacent to the upper tip 210 on the first blade element 205 and the downward tip 216 on the second blade element 207. Thus, the instrument can be used to move or slide through or through tissue to make an incision.

According to the second method, the blade elements 205, 207 can be used to perform a gripping cut, ie cutting through the tissue caught between the blade elements. In this method, cutting is performed by a combination of physical pressure applied by closing the blade elements 205, 207 and RF EM energy applied during the closing process.

According to a third method, blade members 205, 207 can be used to grip and seal tissue such as a blood vessel or the like. In this technique, microwave EM energy is applied to electrodes that create a microwave field that is designed to coagulate the tissue held within the blade elements.

The movable part 202 may include a dielectric protective shield mounted on its outer surface. In this example, the dielectric protective shield is a thermoplastic polymer such as polyetheretherketone (PEEK) or the like. The dielectric shield may be molded on the device, or may be a cover (eg, formed by laser cutting a suitably sized tube) that can be slid over the tip of the tool when the blade elements are in the closed position. A dielectric protective shield can be used to control the shape of the first electrode 206, for example, to provide a significant exposure of the first electrode 206 only on the upper surface of the first element 205 of the blade. In turn, this can focus the RF and microwave energy delivered through the electrodes to the desired area.

In FIG. 3A, 3B, 3C and 3D are perspective views of the tool tip 200 that illustrate the closing operation. In FIG. 3A-3D illustrate the opposite side of the tool tip 200 illustrated in FIG. 2A and 2B. The dielectric protective shield is omitted in FIG. 3A-3D for clarity.

In FIG. 3A illustrates the tool tip 200 in an open position, with the movable portion 212 positioned such that the second blade element 207 is at an obtuse angle to the first blade element 205. As illustrated in FIG. 3A, the fixed portion 202 includes a longitudinally extending arm 218 which provides a pivot base to which the movable portion 212 is attached. The arm 218 includes a trunnion 226 rotatably mounted therein. The trunnion 226 defines a transverse axis of rotation (ie, the axis of rotation is perpendicular to the longitudinal direction defined by the flexible rod 204).

The sliding control rod 220 protrudes from the flexible shaft 204. The fixed part 202 has a guide channel 221 formed therein, through which the control rod 220 passes. the fastening element 223 is a hook that engages with a slot 224 formed in the fastening plate 222 of the movable part 212. Other types of engagement may be used. The longitudinal sliding movement of the control rod 220 is translated into a rotary movement of the mounting plate 222. The mounting plate 222 may be integral with the second blade element 207 or may be operatively associated with it.

In FIG. 3B illustrates the tool tip 200 in a partially closed configuration in which the control rod 220 is partially retracted into a flexible sleeve 204 and in which an acute angle is formed between the first and second blade elements.

In FIG. 3C illustrates the tool tip 200 in another partially closed configuration in which the control rod 220 is further retracted into a flexible sleeve and in which the downwardly extending tip 216 on the second blade element 207 is about to slide past the protruding tip 210 on the first blade element 205. Upon reaching this position, it can be seen that the distal attachment member 223 of the control rod 220 remains at the first end of the slot 224. The slot 224 provides a curved surface over which the control rod slides to perform the final part of the closing operation as the first and second blade elements slide past each other. friend. In FIG. 3D illustrates the final closed position in which the distal attachment 223 of the control rod 220 has moved to the second end of the slot 224. The slot preferably provides a curved surface against which the distal attachment 223 acts in this final part of the movement operation, for example to increase the closing force to overcome resistance that may occur in the last stages of the cut.

In FIG. 4 illustrates a schematic side view, partially cut away, of an instrument tip 300 for an electrosurgical resector instrument, which is an embodiment of the present invention. The tip 300 of the instrument is located at the distal end of the flexible sleeve 302 through which the coaxial cable 304 is passed and the control rod 312 passes. The fixed portion 318 includes a flat dielectric body 314 attached thereto, for example, with a suitable adhesive, the flat dielectric body 314 extending longitudinally away from the fixed portion 318 to form the first blade element. The first electrode 316 is formed on one side of the flat dielectric body 314.

The movable part 322 is rotatably mounted on the fixed part 318 by means of a pin (not visible in FIG. 4) on the opposite side of the flat dielectric body 314 with respect to the first electrode 316. The movable part 322 includes a second blade element that is slidable past the first blade element is similar to the first and second blade elements 205, 207 discussed above. The movable portion 322 carries a second electrode 324 which is located adjacent to the opposite side of the flat dielectric body 314 when the blade elements are in the closed position.

The coaxial cable 304 includes an inner conductor 306 that is separated from the outer conductor 310 by a dielectric material 308. The dielectric material 308 and the inner conductor 306 extend beyond the distal end of the outer conductor 310. The distal end of the dielectric material 308 abuts against the proximal end of the flat dielectric body 314. The inner conductor 306 extends distally from this connection to overlap and electrically contact the proximal portion of the first electrode 316. The invention need not be limited to this arrangement. In other examples, the inner conductor may be electrically connected to, for example, an electrode on the moving part.

The fixed body 318 includes a support arm on which the movable part is mounted. The flat dielectric body 314 can also be mounted on the support arm, for example with an adhesive or the like. The support arm is made of an electrically conductive material (eg, stainless steel) with an electrically insulating coating. The coating is removed on the proximal contact portion 320, which is electrically connected to the outer conductor 310 of the coaxial cable 304. The movable portion 322 is made of an electrically conductive material (eg, stainless steel) with an electrically insulating coating. The movable portion 322 is in physical engagement with the fixed portion 318 at a hinged joint. The electrical connection between the second electrode 324 and the outer conductor 310 of the coaxial cable 304 is through a swivel. For example, the trunnion itself may be made of an electrically conductive material (eg, stainless steel). The insulating coating of the fixed part 318 may be removed in the sliding engagement area (e.g., holes or recesses for receiving the trunnion) between the fixed part 318 and the movable part 322. Similarly, the insulating coating of the movable part 322 may be removed in this area. Since the second electrode 324 may or may be electrically connected to the electrically conductive material of the movable portion 322, a complete electrical connection may be formed with the outer conductor.

In FIG. 5 is a partially cutaway perspective view of an electrosurgical resector instrument that shows how the schematic elements illustrated in FIG. 4 may be displayed on a device similar to the device illustrated in FIG. 2A and 2B. The general elements shown in FIG. 4 are identified by the same reference numerals and will not be described again.

In FIG. 6A illustrates a handpiece 600 that can be used with an electrosurgical device that is an embodiment of the present invention. The hand block 600 includes a housing 602 and a drive portion 604. The housing 602 includes a hollow cylindrical portion 606 in which a shaft 608 of the drive portion 604 is slidably engaged. Housing 602 also includes a rotator 610 that is rotatably coupled to barrel 606. Drive 604 is connected to an inner shaft 628 that extends through barrel 606 and rotator 610 and protrudes from the distal end of rotator 610. Inner rod 628 moves in the longitudinal direction with the rod 608, but can rotate relative to it. The tool shaft 612 exits the hand block 600 at the distal end of the inner shaft 628. For example, the tool shaft 612 may be the flexible shaft 204 described above, which is connected to the tool tip 200 at its distal end. Tool shaft 612 is rotatably connected to inner shaft 628.

The drive portion 604 is slidable longitudinally relative to the body 602 along its shaft 608 between two positions: a closed position, in which a segment of the shaft 608 is inside the cylindrical portion 606, and an open position, in which the segment of the shaft 608 is outside the cylindrical portion 606 In FIG. 6A illustrates the hand block 600 with the drive portion 604 in the open position. The total range of movement of the drive portion 604 relative to the housing 602 may be about 35 mm. The longitudinal direction of movement of the drive portion 604 relative to the body 602 is aligned with the longitudinal axis of the tool shaft 612, which extends from the inner shaft 628. The shaft 608 may include one or more grooves 614 that engage with protrusions (not shown) within the cylindrical portion 606 to to prevent rotation of the drive portion 604 relative to the housing 602. The housing 602 includes a pair of finger rings 614, 616, and the drive portion 604 includes a thumb ring 618 that can be used to facilitate a user's grip when pushing and pulling the cylindrical portion 606 relative to the drive portion 604. The drive portion 604 further includes an input connector 620 for connecting a connection cable (eg, connection cable 104) that connects the handpiece 600 to a generator (eg, generator 102). The input connector 620 may, for example, be a QMA connector or any other suitable connector for interfacing with the generator.

In FIG. 6B is a cutaway view of the hand block 600, omitting some parts to show the internal structure of the hand block. In describing the features above with reference to FIG. 6A, identical reference numerals are used.

Input connector 620 is electrically connected to circuit board 622 located in stem 608 of drive portion 604. Input connector 620 forms a substantially right angle with circuit board 622 so that it is oriented along a direction that is substantially perpendicular to the direction of relative movement between the drive portion and the housing 602. Thus, the cable that is connected to the input connector 620 may not be exposed to the user. The output connector 624 is attached to the edge of the circuit board 622. The output connector 624 is electrically connected to the coaxial transmission line 626 via a mating connector 627 on the coaxial transmission line 626. The coaxial transmission line 626 extends through the hand block 600 and enters the instrument shaft 612 at the distal end of the hand block 600. The coaxial transmission line 626 may, for example, correspond to the coaxial transmission line 226 described above, which is for transmitting RF and microwave EM energy to the handpiece of the instrument.

The electrical connection between output connector 624 and coaxial transmission line 626 is rotatable, that is, it allows the coaxial transmission line to rotate about its axis relative to output connector 624. Suitable connectors that allow rotation of electrical connections include QMA connectors, micro coaxial ; MCX) and micro-miniature coaxial (MMCX) connectors.

In other embodiments, circuit board 622 may be omitted and replaced with a single rectangular QMA-MCX connector.

As shown in FIG. 6B, the inner shaft 628 extends through both the barrel 606 and the rotator 610 of the body 602 and is slidable longitudinally with respect to both the barrel and the rotator. The distal end of the inner shaft 628 protrudes from the rotary device 610. The length of the protrusion depends on the position of the shaft 608 of the drive section 604. The inner shaft 628 is connected at the proximal end to the shaft 608 of the drive section 604 through an annular recess 630 around the outer surface of the inner shaft 628, which is in engagement with a radial protrusion 632 on the inner surface of the shaft 608. The connection between the shaft 608 and the inner shaft 628 prevents movement of the inner shaft 628 in the longitudinal direction relative to the shaft 608, but allows the inner shaft 628 to rotate about its axis relative to the shaft 608. Therefore, the inner shaft 628 can move in the longitudinal direction back and forth relative to the housing 602, moving the drive portion 604 relative to the housing 602.

The inner shaft 628 may include a proximal portion 631 having a resonator to hold the connector 627 of the coaxial transmission line 626 in a position in which it will remain securely connected to the output connector 624 on the circuit board 622. In addition, the connector 627 on the coaxial transmission line 626 may include a protrusion 633 that is configured to engage with a slot in the proximal portion 630 of the inner shaft 628 to prevent movement of the connector 627 relative to the inner shaft 628. For example, the protrusion 633 may be a nut that is part of the connector 627 or attached (eg, soldered) to the specified connector. In addition, the protrusion 627 may be configured to rotate the connector 627 to the inner shaft 628 such that the rotation of the inner shaft 628 causes the connector 627 to rotate.

Coaxial transmission line 626 passes through the inner shaft 628, and at its distal end it enters the shaft 612 of the tool. The length of the shaft 612 of the tool is located inside the distal part 634 of the inner shaft 628, and it is attached to the inner shaft 628. Thus, the longitudinal and rotational movement of the inner shaft 628 can be transmitted to the shaft 612 of the tool. For example, the tool shaft 612 can be bonded with an epoxy to the distal portion 634 of the inner shaft 628. Adhesion between the tool shaft 612 and the inner shaft 628 can be improved by roughening the surface of the tool shaft 612 prior to application of the epoxy. In some cases, the length of the segment of the shaft 612 of the tool, located in the distal part 634, may be about 22 mm to ensure good adhesion.

The rotator 610 is connected to the cylindrical portion 606 so that it can rotate relative to the cylindrical portion about the longitudinal axis of the hand block 600. In the example shown, the rotator 610 has a proximal portion 642 with an annular recessed channel 644 that receives a radially inward projection 646 on the cylindrical part 606.

Inner rod 628 passes through rotator 610 and engages rotator 610 such that it can slide relative to rotator 610 along its length but cannot rotate relative to rotator 610 (i.e. rotator 610 and inner rod 628 are locked). regarding the possibility of rotation relative to each other). This can be achieved by any kind of interaction that conveys rotational motion. For example, there may be one or more longitudinally oriented cooperating engagement elements (e.g., grooves and teeth) formed on the outer surface of the inner shaft 628 and the inner surface of the rotator 610. The engagement elements may respectively engage with each other to cause the inner shaft to rotate. shaft 628 as the rotator 610 on the cylindrical portion 606 rotates. This in turn causes the instrument shaft 612, which is attached to the inner shaft 628, to rotate, such that the tool tip attached at the distal end of the instrument shaft 612 can also rotate. However, since the inner shaft 628 is not rotatably coupled to the driving portion 604, the driving portion 604 is not rotated when the rotary device 610 is rotated. that the rotation of the rotator 610 causes the inner rod 628 to rotate about its longitudinal axis.

A section of the main control rod 636 is within the inner shaft 628 and exits the hand block through the tool shaft 612. The main control rod 636 may be used to drive a movable portion (eg, a pivoting blade element) on the tool tip connected to the distal end of the tool shaft 612. For example, the main control rod 636 may correspond to the main control rod 242 described above. The proximal end of the main control rod 636 is fixed relative to the body 602 of the hand block 600. Therefore, movement of the body 602 relative to the drive portion 604 may cause the main control rod 636 to move longitudinally along the tool shaft 612. This is because the longitudinal position of the tool shaft 612 is fixed relative to the drive portion 604 (via an inner shaft 628 which is connected at one end to the drive portion 604 and the other end to the tool shaft 612), while the main control rod 636 can be moved with body 602 with respect to the drive portion 604 and hence the shaft 612 of the tool.

Thus, the user can move the drive portion 604 relative to the body 602 to move the main control rod 636 back and forth relative to the tool shaft 612 and to control the opening and closing of a movable portion (e.g., a pivoting blade element) on the tool tip attached at the distal end of the shaft 612 tool.

There are several possible ways to secure the proximal end of the main control rod 636 relative to the body 602 of the hand block 600. In the example shown, the block 638 is attached to the proximal end of the main control rod 636. The block 638 may, for example, be a piece of metal that is soldered or welded to the proximal end main control rod 638. The block 638 may be configured to fit inside a holder (not shown) that is rigidly connected to the rotator 610 such that the longitudinal movement of the body 602 relative to the drive portion 604 is transmitted to the block 638 (and hence the main control stem 636) through the holder. The holder can be connected to the rotator 610 through a hole in the side wall of the inner rod 628.

A portion of the main control stem 636 in the inner stem 628 may be contained in a protective tube 640. The protective tube may be made from any suitable material (eg, PTFE) and may be designed to prevent the main control stem 636 from bending when the hand unit 600 is open. alternatively, a metal tube may be soldered or welded to the main control rod 636 to achieve the same effect.

The relative linear movement between the drive portion 604 and the body 602 directly controls the linear movement of the main control rod 636 relative to the tool shaft 612. This may allow the user to fine-tune the opening and closing of the pivoting blade member on the tool tip at the distal end of the tool shaft 612. In addition, the configuration of the hand block 600 allows the user to comfortably hold the hand block 600 with one hand and control the opening and closing of the blade element with one hand (by inserting the fingers of one hand into the finger rings 614, 616, 618). The user can also simultaneously rotate the rotator 610 with the other hand to rotate the tool tip. The orientation of the input connector 620 can ensure that any cable connected to the input connector 620 does not interfere with the user's work with the handheld unit 600. Thus, the user does not need to hold the handheld unit 600 in an awkward position to place the cable, which could put strain on the wrist. user.

In one example, a heat shrink or other stiffening material may be applied around the proximal portion of the shaft 612 of the tool. The length of this stiffening portion is chosen to occupy a portion of the shaft that will always be outside the endoscope insertion tube, even when the shaft is fully inserted. The stiffening portion may assist in transmitting torque from that portion of the rod to the portion that is inside the insertion tube of the inspection device. It can also prevent the shank of the tool from shaking when it is triggered, as well as when it is rotated. In addition, it may provide the physician (ie, the operator of the examination device) with a larger diameter device so that it can be held for both pivoting and pushing/pulling without the need for interaction with an assistant.

The fact that the hand block 600 includes a freely moving rotary joint allows the clinician to rotate it without the help of an assistant holding the hand block, and also allows the assistant to generate rotation through the hand block if necessary.

In FIG. 7A illustrates a cut away perspective view of the tool shaft 612 as it moves towards the tool tip. The tool shaft 612 includes an outer sleeve 648 that defines a clearance for the input of the coaxial cable 626 and the control rod 636. In this example, the coaxial cable 626 and the control rod 636 are held in a longitudinally extending insert 650. The insert 650 is an extruded piece, for example, formed from a deformable polymer such as PEEK or other plastic with similar mechanical properties. As shown more clearly in FIG. 7B, insert 650 is a cylindrical element having a series of recesses 664 below cut around its outer surface. Below gaps 664 break through the outer surface of the insert 650, defining many individual paws 662 around its circumference. Lumens 664 below may be sized to accommodate components such as coaxial cable 626 or control rod 636, or may be designed to allow fluid flow along the lumen of sleeve 648.

It may be expedient that the insert does not contain any closed underlying gaps. Fully closed, underlying lumens can be prone to retaining deformations when stored in a folded state. When used, such deformations can lead to jerky movement.

Insert 650 may include an underlying clearance to receive coaxial cable 626. In this example, coaxial cable 626 includes an inner conductor 658 separated from outer conductor 654 by dielectric material 656. Outer conductor 654 may in turn include a protective cap or sheath 652, such as formed from PTFE or other suitable low friction material to provide relative longitudinal movement between the insert and the coaxial cable as a rod with a bend in the rod.

Another lower lumen may be configured to receive a standard PTFE tube 660 through which the control stem 636 passes. In an alternative embodiment, the control stem 636 may be provided with a low friction coating (e.g. separate PTFE tubing required.

The insert is designed to fill, i.e. fit tightly inside, the lumen of the sleeve 648 when it is installed with the coaxial cable 626 and the control stem 636. This means that the insert is designed to limit the relative movement between the coaxial cable, the control rod and the sleeve during bending and rotation of the stem 612. In addition, by filling the sleeve 648, the insert helps prevent the sleeve from breaking and losing rotation when over-rotated. The insert is preferably made of a material which is rigid to resist such movement.

In addition, the presence of the insert can prevent "lost" travel of the control rod caused by deformation of the tool shaft 612. Such a lost move can occur in the absence of an insert for two reasons.

First, the control rod 636 can move side to side in the sleeve 648 so that when the sleeve follows a curved path, it can go around the outside of the bends, which is a longer path than the length of the centerline, which is also the length of the sleeve. in a straight line. For example, if the inner diameter of the sleeve is 2.15 mm and the diameter of the control rod is 0.4 mm, then the center line of the control rod may be 0.875 mm from the center line of the sleeve. For each 180 degree bend, if the control rod extends to the outer limit of its possible travel within the sleeve, the travel of the control rod will be 2.75 mm longer than the sleeve centerline length. So five 180 degree bends each can give 13.75mm of "lost" travel.

) к длине по прямой (

) двух изгибов изменение длины близко к изменению для дуги круга, и для этого соотношение длин равно

, а разница (потерянный ход) составляет около

. Например, если приводной шток имеет 6 петель (по 3 в каждом направлении) на длину 2,3 м, и каждая из них дважды обернулась вокруг осевой линии, то=

2300/3=766,666 мм и=

11 мм, а потерянный ход составляет 0,22% или 5 мм. Second, the control rod 636 may follow a tortuous path within the sleeve 648 (even if the sleeve is straight) that is greater than the length of the sleeve. Thus, anywhere the control rod is not supported, it can flex sideways. The curved shape would look like a sine wave. If the stem were not allowed to swing very far to the side, it could have many bends along its length. Inside the sleeve, the control rod may not bend sideways, but must wrap around the inside of the sleeve, with its center within a radius of 0.875 mm from the center of the sleeve. Each turn around the tube is equal to 5.5 mm of bend. The increase in the length of a sinusoidal path along a straight path is calculated using the elliptic integral. In the case of small bending ratios (

) to the length in a straight line (

) of two bends, the change in length is close to the change for the arc of a circle, and for this the ratio of lengths is

, and the difference (lost move) is about

. For example, if the drive rod has 6 loops (3 in each direction) for a length of 2.3 m, and each of them wraps around the center line twice, then =

2300/3=766.666 mm and=

11mm and lost travel is 0.22% or 5mm.

The extruded insert described above has cam tabs that compress against the inside of the sleeve and prevent the control rod from winding around the axis of the sleeve. This reduces the length of the lost stroke described above.

In FIG. 8A, 8B, and 8C illustrate perspective views of the instrument tip 700 of an electrosurgical resector instrument, which is another embodiment of the present invention. With this arrangement, the tip of the tool is modified to provide a parallel closing action between the blade elements as opposed to the scissor type rotary action described above.

Similar to the instrument tip 200 described above, the instrument tip 700 includes a fixed portion 706 that contains the first electrode 708 and a movable portion 710 that contains the second electrode 712. The instrument tip 700 is mounted on the distal end of the flexible shaft 702. connection between the coaxial cable through the shaft 702 and the proximal end of the first electrode 706.

The fixed portion 706 has a proximal region that is attached to the distal end of the flexible shaft 702. The stationary portion 706 extends longitudinally away from the distal end of the flexible shaft 702 and defines the first blade element in the distal region. The first blade element is a longitudinally extending pin having a protruding tip at its most distal end. The first electrode 708 extends along the top and side surfaces of the first blade element.

The movable portion 710 is rotatably mounted on the fixed portion 706. In this embodiment, the movable portion 710 includes a second blade element, which is an elongated pin that is commensurate in length with the first blade element. The second blade element includes a downwardly extending tip at its most distal end.

In this example, the movable part 710 is rotatable about an axis of rotation 711, which itself is movable relative to the fixed part 706. Similar to the construction described above, the tool tip 700 includes a control rod 714 that is slidably mounted in the shaft 702 and that engages in engagement with the slot 716 on the proximal part of the movable part 710. The movable part 710 is connected to the fixed part 706 by a connecting rod 718. sliding on the fixed part 706 in a channel formed therein (not shown).

In FIG. 8A illustrates the tool tip 700 in an open configuration in which the control rod 714 is extended from the shaft 702 to push the connecting rod 718 to a deployed position in which the axis of rotation 711 moves away from the stationary part and the movable part rotates around the axis of rotation 711 thus that the second blade element is at an angle to the first blade element.

In FIG. 8B illustrates the tool tip 700 in an intermediate configuration in which the control rod 714 is partially retracted so that the connecting rod 718 remains in a deployed position in which the axis of rotation 711 is spaced apart from the fixed part 706, but in which the movable part is rotated about the axis of rotation so that that the second blade element is parallel to the first blade element.

In FIG. 8C illustrates the tool tip 700 in a closed configuration, in which the control rod 714 is fully retracted to cause the connecting rod 718 to move to an extended position, in which the axis of rotation 711 is retracted into the stationary portion 706 such that the second blade element extends along the first blade element, while remaining parallel to it.

In FIG. 9A and 9B illustrate perspective views of the instrument tip 800 of an electrosurgical resector instrument, which is another embodiment of the present invention. In this arrangement, the tip of the instrument is modified to provide a wider base for better tissue sealing capabilities by limiting or concentrating the microwave field placed between the electrodes.

Similar to the instrument tip 200 described above, the instrument tip 800 includes a fixed portion 804 that includes a flat dielectric housing 806 on which the first electrode 810 is located, and a movable portion 808 containing the second electrode 812. The instrument tip 800 is mounted on the distal end of the flexible shaft 802 A shielding element 803 is placed over the connection between the coaxial cable inserted through the stem 802 and the proximal end of the first electrode 810.

The fixed portion 804 has a proximal region that is attached to the distal end of the flexible shaft 802. A flat dielectric body 806 extends longitudinally away from the distal end of the flexible shaft 802 and defines the first blade element in the distal region. The first blade element is a longitudinally extending pin having a protruding tip at its most distal end. The first electrode 810 extends along the top and side surfaces of the first blade element.

The movable portion 808 is rotatably mounted on the fixed portion 804. In this embodiment, the movable portion 808 includes a second blade element, which is an elongated pin that is commensurate in length with the first blade element. The second blade element includes a downwardly extending tip at its most distal end. The second electrode 812 extends along the side edge of the second blade element.

In this example, the fixed portion 804 includes a third electrode 814. The third electrode 814 is formed from a conductive material and takes the form of a third blade element having the same shape as the first blade element but laterally spaced from it on the opposite side of the flat dielectric body 806 to the first electrode 810. The third electrode 814 is spaced apart from the first blade element sized to receive the second blade element when rotated from the open position to the closed position in the same manner as described above with reference to FIG. 2A and 2B.

In FIG. 9B illustrates the opposite side of the tool tip 800. The fixed portion 804 includes a trailing arm 816 that supports a pivot pin 818 on which the movable portion 808 is mounted. A channel 822 is cut or otherwise formed in the fixed portion 804 to receive the movable portion 808 as it moves into a closed position.

Rotation of the movable part is controlled by a longitudinally retractable control rod (not shown in FIG. 9B) that extends from the stem 802 through a guide channel 824 to engage with a slot 820 formed in the movable part 808 in a manner similar to that described above with reference to fig. 3A-3D.

The third electrode 814 may be electrically connected to the first electrode 810 via a transverse conductive portion, such as a pin or stem (not shown), that extends through the gap between the third electrode 814 and the first blade element below the second blade element.

With the structure illustrated in FIG. 9A and 9B, the tip of the tool can support a wider area of tissue to be gripped between the blade elements. In addition, the microwave field generated between the second electrode 812 and the first and third electrodes 810, 814 may have a more consistent effect on the trapped tissue on both sides of the second blade element. In this example, it may be desirable that the inner conductor of the coaxial transmission line be connected to the second electrode and the outer conductor to the first and third electrodes, with the first and third electrodes performing the function of shielding the field, while the second blade element is moved into a closed position.

Claims (46)

1. An electrosurgical resector instrument, comprising: a rod that defines the clearance; a power transmission structure for transmitting radio frequency (RF) electromagnetic (EM) energy and microwave EM energy through the rod lumen, the power transmission structure comprising a coaxial transmission line extending longitudinally through the lumen, and the coaxial transmission line comprising an inner conductor separated from an outer conductor with dielectric material; a tool tip mounted at the distal end of the rod, the tool tip comprising: a stationary portion comprising a first blade element, the first blade element comprising a longitudinally extending flat dielectric housing containing a first electrode on its first sideways surface; and a movable part containing a second blade element, wherein the movable part is rotatable relative to the fixed part within the plane of rotation between the closed position, in which the first blade element and the second blade element are located next to each other in a transverse direction perpendicular to the plane of rotation, and open a position in which the second blade element is spaced apart from the first blade element by a biological tissue receiving gap; a second electrode positioned on a second sideward facing surface of said longitudinally extending flat dielectric body opposite its first sideways surface, whereby the second electrode is spaced apart from and electrically isolated from the first electrode by said longitudinally extending flat dielectric body; and an actuator for controlling the relative movement between the moving part and the fixed part, wherein the second blade element has a length corresponding to the length of the first blade element, and in the closed position it is located next to the second side-facing surface of the longitudinally extending flat dielectric housing, and wherein the inner conductor is connected to one of the first electrode and the second electrode, and the outer conductor is connected to the other of the first electrode and the second electrode, whereby the first electrode and the second electrode act: as active and return electrodes for supplying RF energy transmitted from the power transmission structure to cut biological tissue trapped between the blade elements; and microwave field emitting structures for supplying microwave energy transmitted from the power transmission structure to coagulate the biological tissue trapped between the blade elements. 2. An electrosurgical resector instrument according to claim 1, characterized in that the fixed part comprises a support arm on which the movable part is mounted, the support arm being part of the electrical connection between the power transmission structure and the second electrode. 3. An electrosurgical resector instrument according to claim 2, characterized in that the support arm is formed from a conductive material with an insulating coating, and the support arm comprises a proximal contact portion on which the insulating coating is removed to form part of the electrical connection between the power transmission structure and the second electrode. 4. Electrosurgical resector according to claim 2 or 3, characterized in that the movable part is attached to the support arm by means of a swivel joint, wherein the electrical connection between the power transmission structure and the second electrode passes through the swivel joint. 5. Electrosurgical instrument resector according to any one of paragraphs. 2-4, characterized in that the electrical connection between the power transmission structure and the second electrode connects the outer conductor of the coaxial cable to the second electrode. 6. Electrosurgical instrument resector according to any one of paragraphs. 2-5, characterized in that the dielectric material and the inner conductor of the coaxial transmission line extend beyond the distal end of the outer conductor, the inner conductor having an open distal portion which is electrically connected to the first electrode. 7. Electrosurgical resector according to any one of the preceding claims, characterized in that the plane of rotation is parallel to the plane defined by the flat dielectric body. 8. An electrosurgical resector according to any one of the preceding claims, characterized in that the second blade element is capable of sliding past the first blade element during movement between an open position and a closed position. 9. An electrosurgical resector according to claim 8, characterized in that the first blade element and the second blade element are arranged parallel in the longitudinal direction while sliding past each other. 10. An electrosurgical resector according to any one of the preceding claims, characterized in that the second blade element is inclined relative to the first blade element in the open position. 11. An electrosurgical resector according to any one of the preceding claims, characterized in that the second blade element can move in an obtuse angle range between an open position and a closed position. 12. An electrosurgical resector instrument according to any of the preceding claims, characterized in that the actuator comprises a control rod slidably mounted in the rod, and the control rod contains a fastener engaged with the movable part, resulting in longitudinal movement of the control rod in the rod causes the moving part to move relative to the fixed part. 13. An electrosurgical resector according to claim 12, characterized in that the movable part has a curved surface against which a control rod acts to drive the second blade element to move it past the first blade element. 14. An electrosurgical resector instrument according to claim 13, characterized in that the curved surface is provided with a slot in the movable part, and the fastening element contains an engaging part for placement in the slot. 15. An electrosurgical resector instrument according to any one of the preceding claims, characterized in that the tip of the instrument comprises a protective shield fitted around the fixed part. 16. An electrosurgical resector according to any one of the preceding claims, characterized in that the protective shield comprises an insulating coating installed around the fixed part, the insulating coating having one or more conductive field shielding regions on its outer surface. 17. An electrosurgical resector according to any one of the preceding claims, characterized in that the first blade element is in the form of a longitudinally extending stalk containing an upward protruding tip at its most distal end, and wherein the second blade element is in the form of an elongated stalk containing a passing downward tip at its most distal end. 18. An electrosurgical resector instrument according to any of the preceding claims, comprising a longitudinally extending insert mounted in the lumen of the rod, the insert comprising a hollow body containing longitudinal sub-cavities formed therein, each of the longitudinal sub-cavities breaking the outer surface of the hollow corps. 19. An electrosurgical resector according to claim 18, characterized in that the coaxial transmission line comprises a coaxial cable installed in the first longitudinal sub-cavity of the hollow body. 20. An electrosurgical resector according to claim 18 or 19, characterized in that the actuator comprises a control rod slidably mounted in the second longitudinal sub-cavity of the hollow body. 21. An electrosurgical resector as claimed in claim 20, wherein the second longitudinal sub-cavity comprises a low friction tube mounted therein, wherein the control rod is slidably mounted in the low friction tube. 22. Electrosurgical device for cutting, coagulation or ablation of biological tissue, containing: an electrosurgical generator for delivering radio frequency (RF) electromagnetic (EM) energy and microwave EM energy; a surgical examination device comprising an attachment cord for insertion into a patient's body, the attachment cord having an instrument channel extending therethrough; an electrosurgical resector according to any one of the preceding claims, inserted through an instrument channel of a surgical examination device. 23. An electrosurgical device according to claim 22, comprising a manual unit for controlling an electrosurgical resector instrument mounted on the proximal end of the rod, the manual unit comprising: frame; actuating element mounted with the possibility of sliding on the housing; and rotary device mounted on the body with the possibility of rotation, wherein the coaxial transmission line and the rod of the electrosurgical resector instrument are installed in such a way as to slide relative to the body with the help of an actuating element and rotate relative to the body with the help of a rotary device. wherein the actuating mechanism of the electrosurgical resector instrument comprises a control rod passing through the lumen of the rod, and the control rod has a proximal part, which is installed in a position fixed in the longitudinal direction relative to the body, wherein the actuating element is configured to control the movement of the movable part relative to the fixed part, and at the same time, the rotary device is configured to control the rotation of the electrosurgical resector instrument relative to the instrumental channel. 24. An electrosurgical device according to claim 23, characterized in that the handpiece comprises a power input port on the actuating element, and the power input port is connected to transfer the power supplied to it to a coaxial cable. 25. An electrosurgical device according to claim 24, characterized in that the direction of the connection to the power input port is perpendicular to the direction in which the actuator can slide relative to the housing.

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