WO1992006641A1 - Scalpels favorisant la coagulation - Google Patents

Scalpels favorisant la coagulation Download PDF

Info

Publication number
WO1992006641A1
WO1992006641A1 PCT/US1991/007510 US9107510W WO9206641A1 WO 1992006641 A1 WO1992006641 A1 WO 1992006641A1 US 9107510 W US9107510 W US 9107510W WO 9206641 A1 WO9206641 A1 WO 9206641A1
Authority
WO
WIPO (PCT)
Prior art keywords
coagulating
dissecting
cutting
scalpel
distal end
Prior art date
Application number
PCT/US1991/007510
Other languages
English (en)
Inventor
Krishna M. Bhatta
Thomas Edgar Haw
Original Assignee
The General Hospital Corporation
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by The General Hospital Corporation filed Critical The General Hospital Corporation
Priority to AU89070/91A priority Critical patent/AU8907091A/en
Publication of WO1992006641A1 publication Critical patent/WO1992006641A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/32—Surgical cutting instruments
    • A61B17/3209—Incision instruments
    • A61B17/3211—Surgical scalpels, knives; Accessories therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/20—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser
    • A61B18/22—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor
    • A61B18/24—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using laser the beam being directed along or through a flexible conduit, e.g. an optical fibre; Couplings or hand-pieces therefor with a catheter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00005—Cooling or heating of the probe or tissue immediately surrounding the probe
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00607—Coagulation and cutting with the same instrument
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00982—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body combined with or comprising means for visual or photographic inspections inside the body, e.g. endoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2218/00—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2218/001—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body having means for irrigation and/or aspiration of substances to and/or from the surgical site
    • A61B2218/002—Irrigation

Definitions

  • the invention relates to coagulating scalpels.
  • Laser scalpels simultaneously cut and coagulate tissue.
  • One of the primary advantages of these instruments is that the flow of blood from cut tissue is very greatly reduced by heat induced coagulation in the tissue adjacent to the incision. Reduction of the flow of blood, or hemostasis, is particularly important in endoscopic surgery.
  • Laser scalpels have taken a number of forms, reflecting e.g., efforts to combine laser coagulation with mechanical cutting, to adapt laser cutting to particular surgical procedures, and to direct or limit the path of the laser-induced incision.
  • Komi_ U.S. Patent No. 4 f :>49,533 describes a laser knife including a laser radiat ⁇ n transmission member and a pair of elongate resilient strips to hold a target.
  • Prozorov et al. U.S. Patent No. 4,185,633 describes a laser surgery-apparatus which combines a mechanical cutting element and an adjacent structure for forming a laser beam support near the cutting element's edge.
  • 3,865,113 describes a laser device which includes a leg which extends beyond the distal end of the laser conduit.
  • Auth et al. U.S. Patent No. 4,126,136 describes a photocoagulating system including a scalpel having a sharp, transparent blade for forming an incision, and a laser optically coupled to the blade for coagulating the adjacent incision.
  • Komiya U.S. Patent No. 4,266,547 describes a laser knife suited for endoscopy including a laser radiation emitter located on one of a pair of holders, the holders adapted to hold an affected part sandwiched therebetween, and a laser radiation acceptor located on the other holder.
  • Sunago et al., U.S. Patent No. 4,492,230 describes an extension mechanism for a laser scalpel which extends beyond the tip of the scalpel and limits the depth of cutting.
  • the invention features a coagulating scalpel, preferably suitable, e.g., for endoscopic or hand held use, including a cutting and coagulating element and one or more dissecting element.
  • a dissecting element (which includes a distal tip or end and which has a longitudinal axis) is disposed adjacent to the cutting and coagulating element, such that a line coaxial with the longitudinal axis of the cutting and coagulating element and extending beyond the tip of the cutting and coagulating element does not intersect the dissecting element.
  • the cutting and coagulating element and the dissecting element are disposed such that cutting radiation emitted from the distal tip of the cutting and coagulating element, and preferably from the face of the distal tip, is not completely obstructed, absorbed, or blocked by the dissecting element.
  • the cutting zone produced by the cutting and coagulating element is proximal to the distal tip of the dissecting means (preferably the dissecting means over which tissue to be cut passes) e.g., the cutting zone is between the distal tip of the cutting and coagulating means and the end of one or more (or all) of the dissecting elements; the cutting zone is adjacent the distal surface of the cutting and coagulating element; the cutting zone is at or near the surface of the distal tip of the cutting and coagulating element, i.e., it is within a distance equal to 1-10, preferably 1-5, more preferably 1-2 diameters of the cutting and coagulating element; the dissecting element and cutting and coagulating element are positioned and configured and of such size that tissue to be cut can pass over or along a surface of the dissecting element and into the cutting zone of the scalpel, wherein the surface of the dissecting element is adapted to permit substantially free passage of the tissue along or over the surface of the dissecting element
  • distance on a line perpendicular to the proximal-distal (or long) axis of the instrument, between the distal tip of the cutting and coagulating element or the cutting zone, and the surface of the dissecting element which faces the cutting and coagulating element, or cutting zone, and over or along which tissue to be cut passes is less than 600 microns, preferably less than 300 microns, more preferably less than 120 microns, more preferably less than 60 microns, and more preferably less than 10 microns (In a particularly preferred embodiment there is essentially no gap: the cutting and coagulating element lies adjacent and in contact with the dissecting element) ; the lateral distance between the outer surface (i.e., the surface opposite the surface which faces the cutting and coagulating element, or cutting zone) of the dissecting element (preferably the dissecting element over or along which tissue to be cut passes) and the center of the distal tip of the cutting and coagulating element or cutting zone, is less than about 5 millimeters, preferably less than
  • Preferred embodiments include those in which the cutting and coagulating element is an optical filament capable of transmitting laser light, an electrocautery element, a radio frequency cautery element, or an ultrasound element.
  • Cutting and coagulating can result from cutting radiation from the cutting and coagulating means impinging on tissue, or, from tissue coming into contact with the cutting and coagulating element, preferably when the cutting and coagulating element is self-heated, e.g., by residual absorption of a laser beam.
  • the configuration of the cutting and coagulation elements and dissecting element differ in various preferred embodiments.
  • the distal end of the dissecting element (or elements) is flush with the distal end of the cutting and coagulating element (a configuration which is useful e.g., in blunt dissection), wherein the distal end of the dissecting element extends beyond the distal end of the cutting and coagulating element (a configuration which is useful e.g., in adhesiolysis) , wherein the distal end of the cutting and coagulating element extends beyond the distal end of the dissecting element (which is useful e.g.
  • the cutting and coagulating element is slidably mounted with respect to the dissecting element so that the position of the distal tip of the cutting and coagulating element relative to the distal tip of the can be adjusted.
  • the cutting and coagulating element can be locked in any of these (or intermediate) positions.
  • Preferred embodiments of the laser scalpel include those in which the dissecting element includes a sharp edge, a blunt edge, and/or cooling means e.g., refrigerating means e.g., a channel through which a coolant can be circulated or passed, within a dissecting element.
  • Other preferred embodiments of the laser scalpel include means for removing unwanted material from the area of cutting and coagulating, e.g., aspiration means, and/or means for irrigating the area of cutting and coagulating with an irrigating solution. Aspiration or irrigation could be via channels leading through the dissecting element to ports on a surface of the dissecting element.
  • the coagulating scalpel includes a first and a second or auxiliary dissecting element.
  • the cutting and coagulating element is disposed in a gap between the first dissecting element and the second or auxiliary dissecting element.
  • the width of the gap is less than about 0.075 millimeters, preferably less than about 0.4 millimeters, more preferably less than about 0.8 millimeters, more preferably less than 4 millimeters, and more preferably less than about 8 millimeters.
  • the distal tips of the first and second dissecting elements extend beyond the distal tip of the cutting and coagulating element forming a notch, with a plane perpendicular to the long axis of the scalpel passing through the distal face of the cutting and coagulating element forming the bottom of the notch and the dissecting elements forming the sides of the notch, the notch having a volume of no more than about 1, preferably no more than about 5, more preferably no more than about 7-8, more preferably no more than about 50, and yet more preferably of no more than about 100 cubic millimeters.
  • the coagulating scalpels of the invention can be used in surgical procedures, e.g., in endoscopic procedures, wherein a first structure is dissected, preferably with the dissecting element, from a second structure.
  • the invention features a surgical method for cutting a first biological structure laying adjacent a second biological structure.
  • the method includes: providing a coagulating scalpel as described herein; hooking and lifting the first structure using a dissecting element of the scalpel; and activating the cutting and coagulating element to cut the first structure.
  • Preferred embodiments include those in which: the first, second, or both structures are subsequently cut, preferably with the cutting and coagulating element of a coagulating scalpel; the method further comprises moving the scalpel to impart mechanical force to the first structure; activation of the cutting and coagulating element and movement of the scalpel are performed simultaneously, thereby combining the action of the cutting and coagulating element, e.g., heat, with mechanical force, e.g., pressure, stretching, or tension, imparted to the tissue by movement of the scalpel; the first and/or second structure is a planar structure, e.g., a skin, an adhesive, or a membrane; the first structure is a membrane adjacent the gallbladder; the first and/or second structure is a hollow organ, e.g., the gallbladder; and less than about 10, preferably less than about 8, and more preferably less than about 6 watts of power are supplied to the cutting and coagulating device.
  • the first and coagulating element e.g
  • the invention includes a method of separating a first structure from a second structure including, hooking and lifting the first structure with the dissecting element of a coagulating scalpel of the invention, and cutting the first structure with the cutting and coagulating element of the coagulating scalpel.
  • the method further includes moving the scalpel e.g., in the direction of a portion of the second structure to be cut, thereby combining the action of the cutting and coagulating element e.g., heat, with the mechanical force imparted by the movement; and less than about 10, preferably less than about 8, and more preferably less than about 6 watts of power are supplied to the cutting and coagulating device.
  • the scalpel e.g., in the direction of a portion of the second structure to be cut, thereby combining the action of the cutting and coagulating element e.g., heat, with the mechanical force imparted by the movement; and less than about 10, preferably less than about 8, and more preferably less than about 6 watts of power are supplied to the cutting and coagulating device.
  • the invention features, a coagulating scalpel the distal end of which comprises a cutting and coagulating element, a first dissecting element, and a second dissecting element, the cutting and coagulating element being positioned in a gap between the first and the second dissecting elements, the scalpel having one or more of the following characteristics: the longitudinal axes of the first and second dissecting elements and the longitudinal axis of the portion of the cutting and coagulating element that lies adjacent the dissecting elements are essentially parallel; the distal tips of the first and second dissecting elements extend beyond the distal tip of the cutting and coagulating element forming a notch with a plane perpendicular to the long axis of the scalpel passing through the distal face of the cutting and coagulating element forming the bottom of the notch and the dissecting elements forming the sides of the notch; or, the distal tip of the scalpel is essentially spatulate in shape.
  • the notch has a volume of no more than about 1, preferably no more than about 5, more preferably no more than about 7- 8, more preferably no more than about 50, and yet more preferably of no more than about 100 cubic millimeters; the scalpel further includes means for adjusting the position of the distal end of the cutting and coagulating element relative to the distal end of the first (or second or both) dissecting elements; the distal end of one o.
  • both of the dissecting elements is flush with the distal end of the cutting and coagulating element; the distal end of the cutting and coagulating element extends beyond the distal end of one or both of the dissecting elements; the distal end of one or both of the dissecting elements extends beyond the distal end of the cutting and coagulating element; the distal end of one (or all) dissecting element extends (or can be positioned to extend) no more than about 30, preferably no more than about 15, more preferably no more than about 10, more preferably no more than about 5, and even more preferably no more than 1 millimeter beyond the distal end of the cutting and coagulating element or the cutting zone (in a particularly preferred e .bodiment the tip of the dissecting element extends 6-7 millimeters beyond the tip of the cutting and coagulating element) ; the lateral distance between the outer surface of the first dissecting element and the outer surface of the second dissecting element is less than about 10 millimeters, preferably less than about 4 millimeters
  • heat of the cutting and coagulating element and to mechanical force, e.g., compression or tension imparted by movement (e.g., movement away from, e.g., in a forward, (i.e., movement in the direction of the cut to be made in the tissue to be cut) upward, outward, lateral, or lifting direction, (with respect to the original position or conformation of the tissue cut or the tissue underlaying the tissue to be cut)) , of the scalpel (or tissue) thereby allowing the cutting action of the cutting and coagulating element, e.g., heat, to be combined with mechanical cutting action, tension, pressure, or stretching applied to the tissue to be cut by the device preferably allowing the tissue to be cut with less heat than would be needed to cut the tissue in the absence of the mechanical force.
  • mechanical force e.g., compression or tension imparted by movement (e.g., movement away from, e.g., in a forward, (i.e., movement in the direction of the cut to be made in the
  • the invention teaches, a surgical method for cutting a biological structure e.g., a planar structure, e.g., a membrane or adhesion including; providing a alpel of the invention; engaging all or a portion of the structure in the gap or notch between the first and the second dissecting elements; moving the scalpel to impart mechanical force to the structure; and activating the cutting and coagulating element to cut the structure.
  • a biological structure e.g., a planar structure, e.g., a membrane or adhesion
  • Preferred embodiments include those in which: the method further includes moving the scalpel in the direction in which the first structure is to be cut to impart the mechanical forces to the structure; the activation of the cutting and coagulating element and the movement are performed simultaneously, thereby combining the action of the cutting and coagulating element e.g., heat, with the mechanical force imparted by movement of the scalpel to cut tissue; the method is performed endoscopically; the structure is a membrane adjacent the gallbladder; less than 10, preferably less than 8, and more preferably less than 6 watts of power are supplied to the cutting and coagulating element.
  • the method further includes moving the scalpel in the direction in which the first structure is to be cut to impart the mechanical forces to the structure; the activation of the cutting and coagulating element and the movement are performed simultaneously, thereby combining the action of the cutting and coagulating element e.g., heat, with the mechanical force imparted by movement of the scalpel to cut tissue; the method is performed endoscopically; the structure is a membrane adjacent
  • the invention features a method of separating a first biological structure from a second biological structure including simultaneously applying to tissue joining the first and second structure heat and mechanical force, the heat, in combination with the mechanical force, being sufficient to seperate the first and second biological structure by parting the tissue.
  • the heat is preferably produced by delivery of less than 10 watts, preferably less than 8 watts, and more preferably less than 6 watts, to the instrument transferring heat to the structure to be cut and, in any case, the amount of heat is less than the amount of heat which would be required to part the tissue in the absence of mechanical force.
  • the cutting and coagulating elements need not be powered during some phases of use, e.g., during some blunt dissections.
  • Cutting radiation means electromagnetic, heat, sound, or other energetic radiation that can cut and coagulate tissue.
  • Dissecting refers to manipulating a structure, e.g., an anatomical feature or structure. This can include changing the position of the structure, e.g., changing its position relative to a second structure. Dissecting may, or may not, involve vaporizing, cutting, tearing, or other types of separation.
  • a coagulating and cutting element is an element which cuts and coagulates tissue, including lasers, electrocautery element, ultrasound elements, and radio frequency cautery devices.
  • Preferred lasers are those the emissions of which can be transmitted through an optical fiber or filament, e.g., a flexible fused silica or quartz fiber.
  • C0 2 lasers the emissions of which can not be transmitted through fibers, are less preferred.
  • Cutting zone refers to the zone in which cutting occurs.
  • the cutting zone is or includes: the region immediately adjacent the distal tip of the cutting and coagulating element; the focal point of the cutting and coagulating element; a region in which cutting occurs essentially upon entry into the zone; or a region in which cutting occurs essentially upon entering the zone if simultaneous mechanical force, e.g., tension is applied to the tissue to be cut. Adjustment of power settings, or the presence and amount of mechanical tension, can affect cutting zone size and shape.
  • Proximal refers to the end of the device (or end of a component of the device) nearest the operator.
  • Distal refers to the end of the device (or end of a component of the device) nearest the patient.
  • the distal end or tip of the cutting and coagulating element is the end nearest the patient and is the energy emitting end.
  • the distal end or tip of the dissecting element is the end nearest the patient.
  • Devices and methods of the invention provide for the simultaneous application of heat, e.g. , from a laser, and mechanical force to cut tissue with less heat than would be required to cut the same tissue in the absence of heat.
  • This method of cutting referred to as heat separation or heat-based separation, allows cutting of tissue with minimal tissue vaporization, charring, or other forms of thermal damage.
  • Devices and methods of the invention allow surgical procedures to be performed easily, rapidly while minimizi n g the power, e.g., the power supplied to a laser cuti ig and coagulating element, used to cut tissue, for example, the combination of heat with mechanical pressure allows heat- based separations. as opposed to heat or light based vaporization, burning, or similar destruction of tissue.
  • coagulating scalpels of the invention As compared to conventiional laser cutting, heat-based separation minimizes tissue loss (through for e.g., vaporization) and charring associated with surgical procedures.
  • the coagulating scalpels of the invention simultaneously cut and coagulate (thereby minimizing bleeding) , facilitate both blunt and sharp dissections, and minimize thermal damage to tissue in the surgical field.
  • the design of coagulating scalpels of the invention allows protection of the cutting and coagulating element, e.g., a laser filament, from damage, and reproduce the feel, in the hand of the surgeon, of a traditional steel scalpel.
  • the ability to facilitate blunt and sharp dissections is particularly desirable in separating adhesions, e.g., when a first structure, e.g., a membrane, must be hooked and lifted away from a second underlying structure e.g., an organ, prior to cutting.
  • a first structure e.g., a membrane
  • a second underlying structure e.g., an organ
  • the size, placement, and configuration of the cutting and coagulating element and the dissecting element allow the operator to lift or hook or otherwise engage, (e.g., in the fork or notch between two dissecting elements) a tissue with the dissecting element, slide the tissue over or along a surface of a dissecting element (e.g., by a slight motion of the instrument in the direction of the tissue) to bring the tissue into the cutting zone.
  • the device By activating the cutting and coagulating element and lifting, pushing, or otherwise applying mechanical force, e.g., pressure, tension, or compression, to the tissue to be cut preferably in the direction the cut is to be made, the device allows the cutting action of the cutting and coagulating element, e.g., heat, to be combined with mechanical force applied to the tissue to be cut by the device.
  • mechanical force e.g., pressure, tension, or compression
  • Coagulating scalpels of the invention allow simultaneous effecting of blunt dissection (preferably made with the dissecting element) and sharp incisions (preferably made with the cutting and coagulating element) , both in unzipping operations and in other procedures, e.g., in lifting and separating the gallbladder from its bed.
  • FIG. 1 is a not to scale side view of a laser scalpel.
  • FIG. 2 is a not to scale top view of the laser scalpel of Fig. 1.
  • FIG. 3 is a not to scale diagram of a method of surgical unzipping.
  • FIG. 4 is a not to scale diagram of an alternative embodiment of a laser scalpel. Structure and Use
  • Figs. 1 and 2 show laser scalpel 10 including hollow handpiece or tubular conduit 15, headpiece 20, primary dissection prong 25 with lateral surface 30, outer surface 35, inner surface 40, and distal tip 45, auxiliary dissecting prong 50 with lateral surface 55, outer surface 60, inner surface 65, and distal tip 70, laser beam transmitting filament 75 with distal tip 80 and proximal end 85, locking nut 90, irrigation/aspiration connector 95, irrigation/aspiration connector lumen 100, irrigation/aspiration channel 105, and irrigation/aspiration port 110.
  • Laser filament 75 passes through locking nut 90, handpiece 15, and headpiece 20 to emerge disposed between primary dissecting prong 25 and auxiliary dissection prong 50.
  • Locking nut 90 holds filament 75 in place but can be loosened to allow adjustment of the position of laser filament distal tip 80 relative to primary dissection prong distal tip 70.
  • the appropriate placement of distal tip 80 of laser filament 75 in relation to distal tip 45 and distal tip 70 of the dissecting prongs for a given surgical procedure is determined by methods known to those skilled in the art. In many applications it is desirable that distal tip 45 of primary prong 25 extends beyond distal tip 80 of laser filament 75.
  • Locking nut 90 and irrigation/ aspiration connector 95 can be fabricated from a standard 2-way connector by methods known to those skilled in the art.
  • the lumen of irrigation/aspiration connector 100 is continuous with the interior of handpiece 15 and irrigation channel 105, allowing aspiration of unwanted material from the surgical field or the introduction of irrigating solution (or other solutions) to the surgical field through irrigation/aspiration port 110.
  • the device can include separate lumens and channels for irrigation and aspiration.
  • an irrigating fluid could be conducted to the surgical field through one dissecting prong and material in the surgical field aspirated through a second dissecting prong.
  • both passages could pass through a single dissecting prong.
  • the handpiece and headpiece could have multiple lumens or channels to carry irrigating fluid to the surgical field or to aspirate the surgical field.
  • Handpiece or tubular conduit 15 can be thermally insulated to protect the surgeon and patient from heat buildup. (The handpiece may also be electrically insulated) .
  • the laser conducting filament can be any flexible filament capable of transmitting laser emissions, e.g., a 600 ⁇ m quartz filament.
  • the dissecting and auxiliary dissecting prongs can be fabricated from any material that can withstand the heat of the laser, e.g., a refractory noble metal, e.g., rhodium, palladium, platinum, or platinum-iridium alloys, stainless steel, copper, platinum coated copper, palladium coated copper, or ceramic materials, e.g., alumina nitride, silicon carbide or sapphire.
  • the prongs In applications where it is desirable that the prongs be hot, e.g., to assist in dissections, a material which is a less efficient conductor of heat, e.g., steel, should be used. If heat buildup in the prongs is undesirable the prongs can be cooled by providing coolant channels in the interior of the prongs and circulating coolant, e.g., water or refrigerant, through the channels. Control of the prong temperature can be regulated by a sensor, e.g., a thermocouple, which controls the flow of coolant. The flow of irrigating solution, or the flow of aspiration material, can also be used to control temperature.
  • a sensor e.g., a thermocouple
  • the various edges of the primary and auxiliary dissecting prongs may be sharp or blunt, or otherwise formed as required by a particular surgical procedure.
  • a material such as teflon may help prevent sticking of tissue to the scalpel and may be applied, e.g., by spraying, to the instrument.
  • Gold plating (with or without an additional layer of Paralyne (Union Carbide) ) can be applied to the dissecting elements to reduce sticking.
  • the proximal end of the filament 75 is connected to a laser source, e.g., a Nd:YAG, KTP, or Holmium:YAG laser source, and irrigation/aspiration connector 95 is connected to a source that can provide irrigating solution and/or vacuum.
  • the laser scalpel of Figs, l and 2 is particularly useful in procedures where both sharp dissection, e.g., cutting, as with a standard steel scalpel or a laser beam, and blunt dissection, e.g., the separation of one object from another by manipulation of blunt instruments, e.g., fingers, the side and blunt edge of a steel scalpel blade, or the dissecting prong of the device in Figs. 1 and 2, are required, for example, where a first structure is blunt dissected away from a second structure and the first structure then cut by sharp incision.
  • An example of such a procedure is the removal or opening (unzipping) of a membrane which covers an organ or other underlying surface or object, e.g., where the membrane is opened followed by incision of the membrane with the cutting and coagulating element.
  • Fig. 3 The use of the laser scalpel of Fig. 1 and 2 to unzip a membrane is shown in Fig. 3.
  • primary dissecting prong 25 of the laser scalpel is used to hook and lift membrane 200 and make initial cut 190 in the membrane.
  • membrane 200 is separated from underlying structure 210 using primary dissecting prong 25 and inner surface 40 to hook the membrane at position 220 on initial cut 190 and lift it away from underlying structure 210.
  • the surgeon moves the laser scalpel in the direction indicated by the arrow in Fig. 3b.
  • uncut membrane comes into close proximity or contact with laser filament 75 and is cut, as shown in Fig.
  • the coagulating scalpels of the invention are particularly useful in endoscopic, e.g., laparoscopic surgical procedures.
  • the coagulating scalpels of the invention can be made suitable for use in endoscopic procedures by constructing them from miniaturized and/or flexible components, by methods known to those skilled in the art.
  • the distal end of the laser scalpel was configured essentially as shown in Figs. 1 and 2, with a 600 ⁇ m flexible quartz laser transmitting filament disposed between two dissecting prongs.
  • the tips of the primary dissecting and auxiliary dissecting prongs extended about 2mm beyond the tip of the laser filament.
  • the distance between the laser filament and the dissecting prong was about 300 ⁇ m and the distance between the laser filament and the auxiliary dissecting prong was about 300 ⁇ m.
  • the structure formed by the two prongs was flattened and spatulate, as shown in Figs. 1 and 2. Taken together the dissecting prongs formed a structure about 80-lOOmm long, about 2mm thick, and about 4.5mm wide (where width is the distance from the outside face of the auxiliary prong to the outside face of the primary prong) .
  • the length of the tubular conduit was about 15-30cm.
  • the laser scalpel was passed through a 5mm instrument port of an endoscope and the proximal end of the laser filament connected to a continuous wave Nd:YAG laser with an output of 20 watts.
  • the gallbladder is usually dissected from the liver with an electrocautery device or a laser.
  • the laser scalpel of the invention produced little thermal damage and gave a clean plane of dissection, as compared to that produced by electrocautery.
  • the ability to irrigate the field of dissection was useful in keeping the field clean and unobstructed and in cooling the dissecting prongs.
  • a laser scalpel similar to the one described above was used to perform 15 human laparoscopic gynecologic procedures at Massachusetts General Hospital. The surgeries were performed by one reproductive surgeon (KI) and consisted of 2 ovarian cystectomies, 1 paraovarian cystectomy, 1 tuboplasty and 11 adhesiolysis.
  • a KTP 532 nm laser (Laserscope) was used in a continuous mode at 7 watts power. Laser energy was transmitted via a 600 micron quartz optical fiber. By placing the tissue to by lysed under tension, the device enabled the surgeon to perform the above procedures in a more rapid and hemostatic fashion than would be possible using conventional bare fiber techniques.
  • coagulating scalpels of the invention can be used in gynecological, cardiothoracic, urological, gastrointestinal, opthalmic, or ENT (ear, nose, and throat) procedures and particularly in endoscopic variants of surgical procedures.
  • Embodiments of the invention are useful in separating adhesions, e.g., in membrane separations, e.g., in establishing a surgical plane between adjacent membranes.
  • the size, shape, and placement of the dissecting prong or prongs can be varied to suit a given surgical procedure, e.g., the dissecting prong or prongs can be elongate, shortened, hooked, curved, bulbous, blunt, sharp, smooth, or serrated.
  • the handpiece can have a variety of shapes and lengths, it can possess hollow joints, and it can be flexible or rigid, as required by a particular application.
  • the tip of the cutting and coagulating element can have any suitable shape, e.g. , the distal face can be flat, or the distal end of the cutting and coagulating element can be bulbous or spherical.
  • the device can be miniaturized and otherwise adapted for endoscopic use.
  • the device can be fitted with joints or other modifications known to those skilled in the art to allow articulation as desired by the surgeon, e.g., the device may be hinged, e.g., just proximal to the cutting and coagulating element and dissecting means, to allow side- to-side manipulation, e.g., to change the angle between the long axis of the hand piece and the long axis of the dissecting means.
  • a segment of the device between the dissecting element and handset can be made of a coiled member, or of flexible plastic, to allow deflection of the tip, in essentially any direction, by central wires running from the dissecting element to the proximal end of the device.
  • the flexible segment could be made of a material which retains the new shape into which it is deflected.
  • the cutting and coagulating element and/or the dissecting element can be mounted on the hand piece such that they can be rotated (along their long axis) with respect to the hand piece.
  • the device may also include other surgical tools.
  • devices of the invention 10 can include an integral electrocautery element (separate from the cutting and coagulating means) to allow the surgeon to switch to conventional electrocautery without changing surgical instruments.
  • current is supplied to the dissecting element 20 or elements e.g., by a power lead 30 attached to a point on the handpiece which is electrically connected to the dissecting element or elements. (The patient is normally connected to ground) .
  • the dissecting elements can thus be used as an electrocautery element, independently or in conjunction with other capabilities of the device.
  • the device of the invention can also include a loop or snare for snaring (at the distal end of the instrument) and securing a portion of tissue, e.g., a polyp; a hydrodissecting element; and a channel or other element to allow the device to be negotiated over a guide wire.
  • Devices of the invention can also include means for illuminating and viewing the surgical field.
  • the device 10 can include a conventional optical fiber 40 for transmitting a view of the surgical field to the operator and an optical fiber 50 for illuminating the surgical field.
  • the device in Fig. 4 also includes a cooling channel 60 in a dissecting element.
  • the laser scalpels of the invention are particularly useful as surgical scalpels. Some devices and methods of the invention may, however, find application in other areas.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Animal Behavior & Ethology (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • General Health & Medical Sciences (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Physics & Mathematics (AREA)
  • Optics & Photonics (AREA)
  • Electromagnetism (AREA)
  • Otolaryngology (AREA)
  • Laser Surgery Devices (AREA)
  • Surgical Instruments (AREA)

Abstract

Scalpel favorisant la coagulation (10), comprenant un élément coupant et coagulant (75) et un élément de dissection (25). L'élément de dissection (25) et l'élément coupant et coagulant (75) présentent une grandeur, un profil et une position tels que les tissus devant être coupés peuvent passer au-dessus ou le long d'une surface (40) de l'élément de dissection (25) pour pénétrer dans la zone de coupe du scalpel. La surface (40) de l'élément de dissection (25) est conçue pour permettre le passage pratiquement libre des tissus au-dessus ou le long de la surface (40) de l'élément de dissection (25) lorsque le scalpel (10) est en mouvement.
PCT/US1991/007510 1990-10-11 1991-10-11 Scalpels favorisant la coagulation WO1992006641A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU89070/91A AU8907091A (en) 1990-10-11 1991-10-11 Coagulating scalpels

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
US59544890A 1990-10-11 1990-10-11
US595,448 1990-10-11
USNOTFURNISHED 2006-03-02

Publications (1)

Publication Number Publication Date
WO1992006641A1 true WO1992006641A1 (fr) 1992-04-30

Family

ID=24383276

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US1991/007510 WO1992006641A1 (fr) 1990-10-11 1991-10-11 Scalpels favorisant la coagulation

Country Status (1)

Country Link
WO (1) WO1992006641A1 (fr)

Cited By (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5342358A (en) * 1993-01-12 1994-08-30 S.L.T. Japan Co., Ltd. Apparatus for operation by laser energy
WO1996000527A2 (fr) * 1994-06-30 1996-01-11 American Medical Systems, Inc. Appareil et procede de traitement interstitiel au laser
US5571098A (en) * 1994-11-01 1996-11-05 The General Hospital Corporation Laser surgical devices
EP0919196A3 (fr) * 1997-11-25 2000-04-26 S.L.T. Japan Co., Ltd. Appareil de traitement médical
US6221069B1 (en) 1996-11-26 2001-04-24 S.L.T. Japan Co., Ltd. Apparatus for medical treatment
US6558376B2 (en) 2000-06-30 2003-05-06 Gregory D. Bishop Method of use of an ultrasonic clamp and coagulation apparatus with tissue support surface

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4211229A (en) * 1977-12-01 1980-07-08 Richard Wolf Medical Instruments Corp. Laser endoscope
US4249533A (en) * 1977-05-16 1981-02-10 Olympus Optical Co., Ltd. Laser knife
DE3209444A1 (de) * 1981-03-20 1982-10-07 Laser Industries Ltd., Tel Aviv Endoskopisches zusatzgeraet fuer einen chirurgischen laser
US4492230A (en) * 1981-07-07 1985-01-08 Sumitomo Electric Industries, Ltd. Extension mechanism of adaptor for laser scalpel

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4249533A (en) * 1977-05-16 1981-02-10 Olympus Optical Co., Ltd. Laser knife
US4211229A (en) * 1977-12-01 1980-07-08 Richard Wolf Medical Instruments Corp. Laser endoscope
DE3209444A1 (de) * 1981-03-20 1982-10-07 Laser Industries Ltd., Tel Aviv Endoskopisches zusatzgeraet fuer einen chirurgischen laser
US4492230A (en) * 1981-07-07 1985-01-08 Sumitomo Electric Industries, Ltd. Extension mechanism of adaptor for laser scalpel

Cited By (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5342358A (en) * 1993-01-12 1994-08-30 S.L.T. Japan Co., Ltd. Apparatus for operation by laser energy
WO1996000527A2 (fr) * 1994-06-30 1996-01-11 American Medical Systems, Inc. Appareil et procede de traitement interstitiel au laser
WO1996000527A3 (fr) * 1994-06-30 1996-02-29 American Med Syst Appareil et procede de traitement interstitiel au laser
AU694776B2 (en) * 1994-06-30 1998-07-30 American Medical Systems, Inc. Apparatus and method for interstitial laser treatment
AU719108B2 (en) * 1994-06-30 2000-05-04 American Medical Systems, Inc. Method for interstitial laser treatment
EP0865767A3 (fr) * 1994-06-30 2000-06-07 American Medical Systems, Inc. Dispositif et procédé de traitement interstitiel au laser
US5571098A (en) * 1994-11-01 1996-11-05 The General Hospital Corporation Laser surgical devices
US6221069B1 (en) 1996-11-26 2001-04-24 S.L.T. Japan Co., Ltd. Apparatus for medical treatment
EP0919196A3 (fr) * 1997-11-25 2000-04-26 S.L.T. Japan Co., Ltd. Appareil de traitement médical
US6558376B2 (en) 2000-06-30 2003-05-06 Gregory D. Bishop Method of use of an ultrasonic clamp and coagulation apparatus with tissue support surface

Similar Documents

Publication Publication Date Title
US11134835B2 (en) Endoscopic vessel harvesting system components
US6802842B2 (en) Electrosurgical tonsilar and adenoid electrode
JP3261143B2 (ja) 腹腔鏡検査用器具および電気メス器具
US20190381290A1 (en) Surgical device with integrated visualization and cauterization
US5171311A (en) Percutaneous laparoscopic cholecystectomy instrument
US6383179B1 (en) Diode laser scalpel
US5071419A (en) Percutaneous laparoscopic cholecystectomy instrument
US4562838A (en) Electrosurgery instrument
US6348051B1 (en) Preparation instruments
KR960010983B1 (ko) 레이저광 조사에 의한 치료장치
US5254115A (en) Coagulating scalpels
EP0957795B1 (fr) Ablation de tissus par electrochirurgie
JP5062577B2 (ja) 内視鏡手術用多機能装置
US5401272A (en) Multimodality probe with extendable bipolar electrodes
US6358249B1 (en) Scissorlike electrosurgical cutting instrument
US6562035B1 (en) Insulated surgical scissors including cauterizing tip
US7549990B2 (en) Surgical scissors with argon plasma coagulation capability
GB2311468A (en) Electrosurgical interstitial resector
JP2013085963A (ja) 切断及び凝固のための超音波装置
AU2007203086A1 (en) Endoscopic vessel harvesting system components
US20210219835A1 (en) Endoscopic vessel harvesting system components
US6231578B1 (en) Ultrasonic snare for excising tissue
US20080188711A1 (en) Dual-action rotational and linear actuating mechanism
WO1992006641A1 (fr) Scalpels favorisant la coagulation
JP2009011495A (ja) 内視鏡血管採取システムのコンポーネント

Legal Events

Date Code Title Description
AK Designated states

Kind code of ref document: A1

Designated state(s): AU CA JP

AL Designated countries for regional patents

Kind code of ref document: A1

Designated state(s): AT BE CH DE DK ES FR GB GR IT LU NL SE

122 Ep: pct application non-entry in european phase
NENP Non-entry into the national phase

Ref country code: CA