WO1998055036A1 - Procedure pour l'enlevement de tissu fortement vascularise - Google Patents

Procedure pour l'enlevement de tissu fortement vascularise Download PDF

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Publication number
WO1998055036A1
WO1998055036A1 PCT/AU1998/000328 AU9800328W WO9855036A1 WO 1998055036 A1 WO1998055036 A1 WO 1998055036A1 AU 9800328 W AU9800328 W AU 9800328W WO 9855036 A1 WO9855036 A1 WO 9855036A1
Authority
WO
WIPO (PCT)
Prior art keywords
tissue
electrode
highly vascularised
electro
blood vessels
Prior art date
Application number
PCT/AU1998/000328
Other languages
English (en)
Inventor
Kanag Baska
Original Assignee
Nathan Surgicals Pty. Ltd.
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 Nathan Surgicals Pty. Ltd. filed Critical Nathan Surgicals Pty. Ltd.
Priority to AU71999/98A priority Critical patent/AU7199998A/en
Publication of WO1998055036A1 publication Critical patent/WO1998055036A1/fr

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Classifications

    • 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
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1485—Probes or electrodes therefor having a short rigid shaft for accessing the inner body through natural openings
    • 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
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B2018/1405—Electrodes having a specific shape
    • A61B2018/1407—Loop
    • A61B2018/141—Snare

Definitions

  • the present invention relates to a procedure for the removal of the palatine tonsils of a patient. More particularly the invention relates to the use of an electro-surgical device in a new way to bring about excision of the palatine tonsils and other highly vascularised tissues.
  • Such electro-surgery has been used for a variety of surgical procedures for the cutting of tissue and the cauterising of blood vessels. It has also been used in association with a snare to sever small lightly vascularised tissues, such as polyps in the intestinal tract, from some underlying tissue.
  • the palatine tonsils are a pair of masses of lymphoid tissue situated in the tonsillar fossa in each lateral wall of the oropharynx. Their projecting medial surfaces are each free and covered by a mucus membrane , while their lateral surfaces are each covered by a capsule that separates it from the superior constrictor muscle of the pharynx. Removal of each palatine tonsil is relatively easy because of the rounded lateral aspect of the gland presented by the capsule. The tonsil is however loosely attached to underlying tissues and is richly supplied with blood vessels.
  • the mucus membrane covering the tonsil is typically cut and the tonsil loosened from the underlying tissue.
  • a snare is then placed around the tonsil and drawn tight to cut the vessels and other tissues that are holding the tonsil to the underlying tissue.
  • the blood vessels and connective tissue are ruptured by the snare as it is drawn tight.
  • the ruptured blood vessels obviously bleed profusely and steps must be taken to stop the flow of blood resulting from the operation. To do this pressure is typically applied initially to the area of bleeding.
  • the cut blood vessels are then sought by the surgeon and individually cauterised or otherwise ligated.
  • the major problem confronting a surgeon in carrying out a tonsillectomy is the suppression of bleeding after the tonsil has actually been removed. This is typically done by suture, ligature or electrodessication. It may be necessary to resort to further measures including cautery or by one of several methods of applying pressure . In severe cases it may be necessary to use coagulant chemicals and/or vasoconstrictors to stop the bleeding. It is to be noted that in those tonsillectomies where electro-surgical procedures have been used they have been used only for the purpose of stopping blood flow from the ruptured blood vessels after the tonsil has been removed.
  • haemorrhoids are distended veins associated with the anus. They may be internal with respect to the anal orifice or they may be external to it. External haemorrhoids are covered with skin while internal haemorrhoids are covered with mucus membrane. While haemorrhoids are common they do not require treatment until they become enlarged and symptomatic. Treatment may be by medication and dietary modification or by operative intervention. In the latter case the haemorrhoids may be treated by injection of an irritant chemical into the loose areolar tissue above the internal haemorrhoid; by rubber band ligation; by cryosurgery; or by surgical excision.
  • the present invention is directed to a procedure for the removal of a highly vascularised tissue, such as a palatine tonsil or haemorrhoid, from a patient in which the vascularised tissue is loosened from its surrounding tissue and the blood vessels and other tissue connecting the vascularised tissue to the underlying tissue is severed by electro-surgery while simultaneously at least partly cauterising the blood vessels so severed.
  • a highly vascularised tissue such as a palatine tonsil or haemorrhoid
  • the blood vessels are cut and cauterised at the one time as compared with the conventional procedure in which the vessels are cut and then cauterised in a second step.
  • the arrangement according to the present invention has the advantage that the blood vessels are cauterised as they are cut and the risk of excessive bleeding is substantially reduced.
  • the fact that the surgeon does not have to search among the surrounding muscle fibres to find the vessels that require cauterisation means that there is far less muscle damage caused by the operation than would otherwise be the case.
  • the patient therefor is more comfortable and recovers more quickly than with conventional tonsillectomy.
  • the tonsillectomy procedure according to the present invention is preferably carried out by loosening the tonsil from the underlying tissue in the traditional manner and then placing around the tonsil a snare that can act as an active electrode in a monopolar electro-surgical system or as both electrodes in a bipolar system.
  • the snare is then drawn tight around the tissue and blood vessels and a current applied to the electrode(s). Further tightening of the snare will cut through the blood vessels and other tissue and cause coagulation and cauterisation of the blood vessels as they are severed.
  • Figure 2 is a side elevational view of the other side of the electro- surgical snare of fig. 1,
  • Figure 3 is a diagrammatic representation of a first stage of a tonsillectomy procedure according to the present invention
  • Figure 4 is a diagrammatic representation of a second stage of a tonsillectomy procedure according to the present invention.
  • Figure 5 is a diagrammatic representation of a third stage of a tonsillectomy procedure according to the present invention. Best Mode for Carrying Out the Invention
  • the procedure according to the present invention preferably uses an electro-surgical snare such as that shown in figs. 1 and 2.
  • the snare 10 comprises a handle 11, an elongate tube 12 extending from the handle 11, a slide 13 mounted slidably on the handle 11. and an electrode 14 connected at one end to the slide 13 and extending along the tube 12 to emerge at its free end.
  • the handle 11 is formed of an electrically insulating material such as a synthetic plastics material. It comprises a grippable portion 15, that can be gripped by a user, and an elongate portion 16 extending laterally from the top of the grippable portion in the manner of the barrel of a pistol. A slot 17 is provided longitudinally of the elongate portion 16.
  • the slide 13 is positioned on the handle 11 so that it is slidable along the handle 11.
  • the slide 13 projects below the elongate portion 16 of the handle 11 such that a loop 18 may be contacted by a finger of a user gripping the handle 11. The use may thus move the slide 13 along the handle while the handle 11 is being gripped.
  • the elongate tube 12 is connected to the end of the elongate portion 16 distal to the grippable portion 15. It is formed of an electrically non- conductive material that is sufficiently stiff to contain and deform the electrode in a manner that will be described later in this specification.
  • the electrode 14 comprises an elongate wire 19 that is provided at its free end with a doubled over section of spring wire 21.
  • the wire 19 is coimected at one end to the slide 13 so that movement of the slide causes corresponding movement of the electrode 14.
  • the wire 19 runs along the elongate tube 12 . When the slide 13 is moved to the end of handle 11 closer to the tube 12 the spring wire 21 of the electrode 14 will be caused to protrude a distance beyond the end of the tube 12.
  • the spring wire 21 when the slide is retracted to the other end of the handle 11 the spring wire 21 will be drawn at least almost completely within the tube 12.
  • the spring wire 21 is formed to take on the configuration of an open loop. Retraction of the spring wire 21 into the tube 12 contracts the loop.
  • the snare 10 forms one electrode in an electro-surgical system (not shown).
  • the other electrode is attached to the patient ' s body at a point distant to the site of the surgical procedure.
  • Each of the electrodes is electrically connected to an RF frequency generator also forming part of the electro-surgical system.
  • this electrical connection includes a lead 24 which is electrically connected to a terminal 25 on the slide 13 which is in turn electrically connected to the electrode 14.
  • the slot 17 in the handle facilitates the connection of the electrode 14 to the terminal 23.
  • the usual operative procedures are followed to the stage of making an incision through the mucosa starting at the at the upper pole of the tonsil and carried anteriorly and posteriorly just within the respective tonsil pillars.
  • This situation is depicted in Fig.3.
  • the tonsil is then grasped by forceps and everted from its bed by traction on the forceps.
  • the traction causes gaping of the anterior mucosal incision.
  • a dissecting instrument is inserted and used to separate the capsule from its bed.
  • the anterior pillar is separated first and then the upper pole.
  • the posterior pillar is visualised by everting the upper pole, and under direct vision it is dissected free from the tonsil.
  • the finger may also be used as a dissecting instrument in this procedure. In carrying out this dissection the surgeon should as far as possible avoid cutting any of the various blood vessels supplying the tonsil.
  • the loop of wire 21 of the snare 10 is placed over the tonsil and drawn firm about the anterior pole and the blood vessels.
  • a coagulation current is then caused to flow from the electrode 14 to the patient.
  • a maximum power of about 30 W is probably sufficient to bring about the simultaneous cutting of the tissue ensnared by the loop and to cauterise the blood vessels.
  • Simple trial and experiment with any particular electro-surgical device will indicate the best power setting for any given patient.
  • the tonsil is removed in the usual way after completion of the electro-surgical procedure. Any continuing bleeding can be staunched in the usual manner.
  • Haemorrhoidectomy is carried out in a manner essentially similar to the tonsillectomy described above. The patient with second- or third-degree haemorrhoids will be treated in the lithotomy position.
  • the sphincter will be widely stretched and the internal haemorrhoids prolapsed by traction on the skin tags, or on skin of the anal margin.
  • Each haemorrhoid will be treated by being picked up with dissecting forceps and traction is exerted.
  • the forceps When the haemorrhoid is free of the underlying tissue the forceps will be removed and the loop of an electro- surgical snare slid over the haemorrhoid and it will be then grasped again with the forceps.
  • the loop of the snare will be slid up as close as possible to the base of the haemorrhoid and the loop tightened around the haemorrhoid.
  • the RF generator of the electro-surgical device will then be activated and the loop slowly tightened further.
  • the haemorrhoid will be severed from the underlying tissue and the blood vessels therein will be simultaneously cauterised by the action of the tightening loop through which a cauterising current is being applied to the patient.
  • the severed haemorrhoid may then be removed with the forceps.

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

Abstract

L'invention concerne un procédé permettant de couper des corps tissulaires vascularisés, tels que les amygdales et les hémorroïdes, et de cautériser simultanément et au moins partiellement tout vaisseau sanguin coupé. Le découpage du corps tissulaire vascularisé s'effectue au moyen d'une anse (10) pouvant fonctionner comme une électrode (14), qui est resserrée autour du corps tissulaire fortement vascularisé et sur laquelle un courant électrique est appliqué.
PCT/AU1998/000328 1997-06-04 1998-05-07 Procedure pour l'enlevement de tissu fortement vascularise WO1998055036A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU71999/98A AU7199998A (en) 1997-06-04 1998-05-07 Procedure for removal of highly vascularised tissue

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
AUPO7165A AUPO716597A0 (en) 1997-06-04 1997-06-04 Procedure for removal of highly vascularised tissue
AUPO7165 1997-06-04

Publications (1)

Publication Number Publication Date
WO1998055036A1 true WO1998055036A1 (fr) 1998-12-10

Family

ID=3801456

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/AU1998/000328 WO1998055036A1 (fr) 1997-06-04 1998-05-07 Procedure pour l'enlevement de tissu fortement vascularise

Country Status (2)

Country Link
AU (1) AUPO716597A0 (fr)
WO (1) WO1998055036A1 (fr)

Citations (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4898169A (en) * 1987-05-08 1990-02-06 Boston Scientific Corporation Medical instrument for therapy of hemorrhoidal lesions
US5026371A (en) * 1990-10-01 1991-06-25 Everest Medical Corporation Handle for polypectome snare with bipolar electrodes
US5078716A (en) * 1990-05-11 1992-01-07 Doll Larry F Electrosurgical apparatus for resecting abnormal protruding growth
US5158561A (en) * 1992-03-23 1992-10-27 Everest Medical Corporation Monopolar polypectomy snare with coagulation electrode
WO1993021845A1 (fr) * 1992-05-01 1993-11-11 Hemostatix Corporation Anse chirurgicale bipolaire et ses procedes d'utilisation
US5290286A (en) * 1991-11-12 1994-03-01 Everest Medical Corporation Bipolar instrument utilizing one stationary electrode and one movable electrode
US5514131A (en) * 1992-08-12 1996-05-07 Stuart D. Edwards Method for the ablation treatment of the uvula
WO1996032898A1 (fr) * 1995-04-20 1996-10-24 Symbiosis Corporation Electrodes en boucle pour sondes d'electrocauterisation s'utilisant avec un resectoscope
US5571098A (en) * 1994-11-01 1996-11-05 The General Hospital Corporation Laser surgical devices
WO1996037156A1 (fr) * 1995-05-22 1996-11-28 Issa Muta M Ensemble d'electrodes de resectoscope a decoupe et a coagulation simultanees

Patent Citations (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4898169A (en) * 1987-05-08 1990-02-06 Boston Scientific Corporation Medical instrument for therapy of hemorrhoidal lesions
US5078716A (en) * 1990-05-11 1992-01-07 Doll Larry F Electrosurgical apparatus for resecting abnormal protruding growth
US5026371A (en) * 1990-10-01 1991-06-25 Everest Medical Corporation Handle for polypectome snare with bipolar electrodes
US5290286A (en) * 1991-11-12 1994-03-01 Everest Medical Corporation Bipolar instrument utilizing one stationary electrode and one movable electrode
US5158561A (en) * 1992-03-23 1992-10-27 Everest Medical Corporation Monopolar polypectomy snare with coagulation electrode
WO1993021845A1 (fr) * 1992-05-01 1993-11-11 Hemostatix Corporation Anse chirurgicale bipolaire et ses procedes d'utilisation
US5514131A (en) * 1992-08-12 1996-05-07 Stuart D. Edwards Method for the ablation treatment of the uvula
US5571098A (en) * 1994-11-01 1996-11-05 The General Hospital Corporation Laser surgical devices
WO1996032898A1 (fr) * 1995-04-20 1996-10-24 Symbiosis Corporation Electrodes en boucle pour sondes d'electrocauterisation s'utilisant avec un resectoscope
WO1996037156A1 (fr) * 1995-05-22 1996-11-28 Issa Muta M Ensemble d'electrodes de resectoscope a decoupe et a coagulation simultanees

Also Published As

Publication number Publication date
AUPO716597A0 (en) 1997-07-03

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