WO1999053851A1 - Systeme d'instrument chirurgical d'extraction et procede associe - Google Patents

Systeme d'instrument chirurgical d'extraction et procede associe Download PDF

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Publication number
WO1999053851A1
WO1999053851A1 PCT/US1998/007620 US9807620W WO9953851A1 WO 1999053851 A1 WO1999053851 A1 WO 1999053851A1 US 9807620 W US9807620 W US 9807620W WO 9953851 A1 WO9953851 A1 WO 9953851A1
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WO
WIPO (PCT)
Prior art keywords
loop
cauterization
tubular member
patient
cauterization loop
Prior art date
Application number
PCT/US1998/007620
Other languages
English (en)
Inventor
Naomi L. Nakao
Peter J. Wilk
Original Assignee
Wilk And Nakao Medical Technology, Incorporated
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 Wilk And Nakao Medical Technology, Incorporated filed Critical Wilk And Nakao Medical Technology, Incorporated
Priority to PCT/US1998/007620 priority Critical patent/WO1999053851A1/fr
Priority to AU71230/98A priority patent/AU7123098A/en
Publication of WO1999053851A1 publication Critical patent/WO1999053851A1/fr

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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
    • A61B17/3205—Excision instruments
    • A61B17/32056—Surgical snare instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
    • A61B17/221—Gripping devices in the form of loops or baskets for gripping calculi or similar types of obstructions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3478—Endoscopic needles, e.g. for infusion
    • 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
    • A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
    • 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
    • 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
    • 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
    • A61B2018/1425—Needle

Definitions

  • This invention relates to a surgical instrument assembly for use in removing and
  • invention also relates to an associated method for severing internal organic tissues
  • the present invention provides a method for retrieving the severed organic tissues from the patient. More specifically, the present invention
  • an endoscope is inserted into an internal cavity of a patient, e.g., into the colon, and is used to locate abnormal tissue growths such as
  • the loop and the endoscope are manipulated from outside of
  • the polyp frequently escapes from the capturing instrumentality and falls away into the colon (or other cavity) Especially in cases
  • endoscope must be removed without the polyp and the patient given an enema in an attempt to
  • the polyp is macerated during the retrieval attempt In all such cases, the polyp is macerated during the retrieval attempt In all such cases, the
  • pathologist is unable to determine whether the polyp contains carcinoma in situ (localized) or
  • a surgical instrument assembly comprising a tubular sheath
  • the web member is passed over and substantially surrounds a polyp.
  • the pouch is attached to the cauterization loop, the pouch may inhibit effective visualization of the
  • This injection serves to expand the tissues and elevate the polyp from the internal organic wall, thereby facilitating snare use.
  • polyp injection operation is currently performed by a separate instrument which must be
  • An object of the present invention is to provide an improved method for the removal of
  • a more specific object of the present invention is to provide an improved method for
  • a further object of the present invention is to provide an instrument assembly for use in
  • Another particular object of the present invention is to provide such an instrument assembly which is simple to manufacture and therefore inexpensive.
  • a further particular object of the present invention is to provide such an instrument
  • a tubular member having a diameter sufficiently small so that the tubular member
  • a biopsy channel of a flexible endoscope can be inserted through a biopsy channel of a flexible endoscope, a cauterization loop, an
  • auxiliary loop connected at one end to the auxiliary loop, the auxiliary loop and the shifting member being at least partially disposed in the tubular member, a flexible web member connected to the
  • auxiliary loop so as to form a capture pocket, the auxiliary loop defining a mouth opening of
  • an elongate flexible tube provided at a distal end with a needle point and an
  • the flexible tube being disposed at least partially in the tubular member, and a fluid
  • tubular member may be provided with a septum or a 5 plurality of septums defining at least three separate longitudinally extending lumens, the flexible
  • tubular member is disposed in a biopsy channel of an endoscope which is inserted into a
  • the endoscope is used to visually monitor internal body tissues of the patient. Upon a detection of selected internal tissues to be removed from the patient, the flexible tube is shifted
  • cauterization loop is shifted in a distal direction relative to the tubular member to eject the
  • cauterization loop from the tubular member The ejected cauterization loop is at least partially
  • the operation includes the ejection of the auxiliary loop from the tubular member, the opening
  • auxiliary loop is at least partially closed to capture the severed internal body tissues in the
  • a surgical instrument assembly for use in snare cauterization operations comprises, in 6 accordance with another embodiment of the invention, a tubular member having a diameter sufficiently small so that the tubular member can be inserted through a biopsy channel of a flexible endoscope, a cauterization loop, an electrically conductive wire operatively connected to the cauterization loop, an electrical connector operatively connected to the wire for feeding an electrical current to the cauterization loop via the wire, a flexible web member connected to
  • the wire, as well as the flexible tube are disposed at least partially in the tubular member.
  • the cauterization loop defines a mouth opening of the pocket.
  • tubular member is disposed in a biopsy channel of an endoscope which is inserted into a patient.
  • the endoscope is used to visually monitor internal body tissues of the patient.
  • the flexible tube is shifted
  • cauterization loop is shifted in a distal direction relative to the tubular member to eject the
  • the severed internal body tissues are disposed in the pocket.
  • the present invention provides an improved method and an associated instrument assembly for the removal of flat or receding polyps from patients via snare cauterization.
  • a fluid injection needle is introducible into a hollow internal organ together with a snare cauterization and capture pocket assembly, thereby eliminating the necessity of instrument
  • An instrument assembly in accordance with the present invention allows one to sever a
  • the capture pocket may be placed about the polyp after the cauterization
  • the capture pocket or pouch may be
  • Fig. 1A is a schematic perspective view of a snare cauterization instrument assembly
  • Fig. IB is a schematic longitudinal cross-sectional view of a distal end of the 8 cauterization instrument assembly of Fig 1 A, showing the cauterization loop in a withdrawn or
  • Fig 2A is a schematic partial cross sectional view of a patient's colon with a polyp
  • Fig 2B is a schematic partial cross sectional view similar to Fig 2A, showing a loop of
  • Fig 2C is a schematic partial cross sectional view similar to Figs 2A-2B, showing the
  • Fig 2D is a schematic partial cross sectional view similar to Figs 2A-2C, showing the
  • Fig 2E is a schematic partial cross sectional view similar to Figs 2A-2D, showing the
  • Fig 2F is a schematic partial cross sectional view similar to Figs 2A-2E, showing the
  • Fig 2G is a schematic partial cross sectional view similar to Figs 2A-2F, showing the
  • Figs 3-6 are schematic partial side perspective views, showing different specific
  • Fig 7 is a schematic side elevational view, on an enlarged scale, of another embodiment
  • Fig 8 is a schematic perspective view, also on an enlarged scale, of a modified snare
  • cauterization instrument assembly showing an auxiliary loop attached at three points to a cauterization loop
  • Fig 9 is a schematic top view of another modified snare cauterization instrument assembly, showing an auxiliary loop attached at one point to a cauterization loop
  • Fig 10 is a schematic partial perspective view, on an enlarged scale, of an additional
  • Fig 11 is a schematic partial perspective view, on an enlarged scale, of yet a further
  • Fig 12 is a schematic partial cross sectional view of a patient's colon with a polyp
  • Fig 13 is partially a schematic partial side elevational view and partially a block
  • Fig 14 is partially a schematic partial side elevational view and partially a block
  • FIG. 12 diagram of yet another color deposition instrument alternatively utilizable with the endoscopic 10 snare cauterization instrument assembly of Fig. 12.
  • Fig. 15 is a schematic partial cross sectional view of a patient's colon with a polyp, showing a snare cauterization instrument assembly inserted through an alternately collapsible
  • Fig. 16 is a schematic perspective view of a distal end portion of an endoscopic
  • cauterization instrument assembly showing a cauterization loop of the assembly in use to
  • Figs. 17A-17C are schematic side perspective views, partially in cross-section, of another modified cauterization snare and capture pocket, showing three steps in the use of the
  • Fig. 18 is a schematic side elevational view, partially in cross-section, showing the
  • Fig. 19 is a schematic side elevation view showing a stage in the assembly of the
  • Fig. 20 is a schematic side perspective view, on an enlarged scale, of an endoscopic
  • Figs. 21A-21E are partially schematic cross- sectional views of a colon and partially
  • FIG. 20 showing successive steps in the performance of an endoscopic operation.
  • Figs. 22A-22F are partially schematic cross-sectional views similar generally to Figs. 21A-21E, showing an alternative series of successive steps in an endoscopic operation. 11
  • Fig 23 is a schematic perspective view, on an enlarged scale, of a capture pocket or
  • Fig 24 is a side elevational view of the capture pocket or pouch of Fig 23, showing the capture pocket or pouch in a substantially closed configuration
  • Fig 25 is a schematic perspective view, on an enlarged scale, of a further capture pocket or pouch, showing the capture pocket or pouch in an opened configuration and attached to a cauterization loop
  • Fig 26 is a partial schematic perspective view, on a large scale, showing a technique of
  • Fig 27 is a partial schematic perspective view, on a large scale, depicting another
  • Fig 28 is a partial schematic cross-sectional view, on a large scale, illustrating yet
  • Fig 29 is a schematic partial perspective view, on an enlarged scale, of an endoscopic instrument assembly for removing flat or nonprojecting polyps, in accordance with the present
  • Figs 30A-30D are schematic partial perspective views of an endoscope with the
  • Fig 31 is a schematic partial perspective view, on an enlarged scale, of another
  • Fig 29 is a schematic partial perspective view, on an enlarged scale, of yet another 12 endoscopic instrument assembly for removing flat or nonprojecting polyps, in accordance with the present invention.
  • a snare cauterization instrument assembly comprises a hand held control module 20, a flexible tubular member 22 connected to a distal end of the control
  • a flexible sheet or web 26 specifically in the form of a net is
  • Loop 24 defines the mouth of
  • Control module 20 comprises a body member or frame 28 which includes a pair of
  • Frame 28 has
  • slider member 32 has a pair of finger holes 34a and
  • Wire 36 is sufficiently flexible to bend with tubular member 22 during the negotiation thereby of
  • Slider member 32 is also provided with an electrical connector 38 which is couplable to
  • Capture web 26 is thin and flexible and preferably made of biologically inert flexible
  • web 26 Prior to the 13 beginning of a snare cauterization operation, web 26 is disposed in a closed, folded or
  • slider member 32 is retracted to the proximal end of rails 30a and 30b
  • Tubular member 22 is inserted in a biopsy
  • endoscope 42 is conventionally provided at its distal end
  • the snare cauterization instrument assembly is shifted in a distal direction so that tubular member 22
  • loop 24 and capture web 26 expand from a contracted or closed configuration into an at least
  • Fig. 2B depicts a later stage in the cauterization procedure.
  • instrument assembly of Fig. 1 A is manipulated to pass loop 24 around polyp P, with capture
  • loop 24 encircles a base region or neck N of polyp P and the
  • polyp is surrounded by capture web 26, as shown in Fig. 2C.
  • slider member 32 is pulled back in the proximal direction, whereby
  • Fig. 2F to essentially close the loop.
  • Polyp P is now securely trapped in capture web 26.
  • Fig. 2G the entire snare cauterization instrument assembly including,
  • tubular member 22 is shifted in the proximal direction relative to endoscope 42.
  • Every polyp severed by a snare cauterization instrument as described and illustrated herein is captured immediately. Thus, the time for the capture and retrieval of severed polyps is reduced to a minimum. Trauma to patient is likewise reduced, as are hospitalization
  • FIG. 4 shows a capture web 126 in the form of a net fastened directly to loop 24, while Fig. 4 shows a
  • capture web 226 in the form of a continuous or solid transparent film fastened directly to loop
  • FIG. 5 illustrates a capture web 326 in the form of a net attached to loop 24 via a
  • Loop 24 passes through ringlets 328, which are connected
  • Ringlets 328 are preferably made of a metallic
  • Fig. 6 shows a capture web 426 in the form of a continuous or solid film of
  • Loop 24 passes through ringlets 428, which are connected to a ring-shaped rim element 430 of 15 web 426
  • a snare cauterization instrument assembly comprises a flexible
  • cauterization loop 502 an electrical conductor 504 operatively connected to the cauterization
  • An actuator 510 is
  • cauterization loop 502 operatively connected to cauterization loop 502 and auxiliary loop 506 for alternately
  • a flexible web member 512 in the form of a net (or a continuous transparent membrane) is connected to auxiliary loop
  • auxiliary loop 506 essentially around the circumference thereof to form a capture pocket, auxiliary loop 506
  • net 512 is fixed to auxiliary loop 506 only
  • Actuator 510 is connected to cauterization loop 502 via conductor 504, which
  • auxiliary loop 506 via a flexible wire or rod member 516 which like conductor 504 extends
  • auxiliary loop 506 may be connected at a proximal end
  • cauterization loop 502 at two points 518 and 519, as well as to the distal end of the
  • wire or rod member 516 may be omitted As further shown
  • auxiliary loop 506 is slightly larger than cauterization loop 502
  • web 16 member 512 is fixedly connected to auxiliary loop 506 at a distal end and a proximal end thereof and slidably connected to the auxiliary loop between those ends
  • Fig 9 shows a cauterization loop 520 and an auxiliary loop 522 connected to one
  • cauterization loop 520 and auxiliary loop 522 expand and contract in unison in essentially a common plane
  • auxiliary loops 506 and 522 are not connected to the
  • cauterization loops 502 and 520 along operative portions thereof, thereby eliminating any
  • cauterization operations is furthered by forming cauterization loops 502 and 520 at their distal
  • Extensions 526 and 528 may be coated with an insulating material (not
  • Auxiliary loops 506 and 522 are made of electrically nonconductive material preferably 17 in the form of a synthetic resin or polymeric material such as polyethylene or nylon.
  • cauterization loop 502 or 520 and auxiliary loop 506 or 522 are expanded from a collapsed configuration inside
  • auxiliary loop 506 or 522 is preferably larger than cauterization loop 502 or 520
  • pocket or web member 512 or 523 is opened during the expansion of cauterization loop 502 or 520 and auxiliary loop 506 or 522
  • cauterization loop 502 or 520 The closure of cauterization loop 502 or 520 around a base region of the
  • cauterization procedure serves to capture the severed polyp at the instant of its severance.
  • a modified snare cauterization assembly includes a
  • cauterization loop 530 surrounded along a substantial portion of its length by a tubular jacket or sleeve 532 to which a flexible pocket-defining web member 534 is connected.
  • sleeve 532 is made of a heat-conductive and electricity-conductive material enabling
  • sleeve 532 is provided
  • Color from coating 535 is transferred from the cauterization loop and particularly from sleeve
  • Coating 535 may be a liquifiable solid 18 or a powder.
  • Such a color-transferable coating or layer may be provided directly on any of the cauterization loops described herein. The deposition of a common color on a severed polyp and an unsevered neck or base area serves to facilitate a locating of the polyp's original situs upon a subsequent identification of the polyp as being malignant or a carcinoma. This is
  • another modified snare cauterization assembly comprises a cauterization loop 536 enclosed along essentially its entire length by a tubular jacket or sleeve
  • Sleeve 538 to which a flexible pocket-defining web member 540 is coupled.
  • organic tissues of a polyp or other cell mass to be removed from a patient's body organic tissues of a polyp or other cell mass to be removed from a patient's body.
  • a surgical instrument assembly for use in a snare cauterization operation comprises an endoscope assembly 550 including a biopsy channel 552 and a light outlet 554 at a distal end of an endoscope insertion member 556 for delivering light to a
  • the distal end of the endoscope insertion member 556 is further
  • Light outlet 558 for receiving light reflected from a surgical site.
  • light inlet 558 are located at the distal ends of a fiber optic illumination guide (not
  • a tubular sheath member 560 is inserted through biopsy
  • An electrical supply (not shown in Fig. 12) is operatively connected to
  • wire 562 for feeding an electrical current to loop 564 via the wire.
  • a manually actuatable 19 shifter (not illustrated in Fig 12) is operatively connected to wire 562 at a proximal end
  • a flexible web member 566 is connected to loop 564 to form a capture pocket, the loop
  • defining a mouth opening of the pocket Web member 566 is attached to loop 564 in a manner
  • a tubular member 568 Also extending through biopsy channel 552 is a tubular member 568 connected at a
  • a pressurizable dye or color source 570 such as a hypodermic syringe filled
  • endoscope insertion member 556 Upon an insertion of endoscope insertion member 556 into a patient's colon, endoscope
  • assembly 550 is used to visually monitor internal body tissues of the patient, including the
  • loop 564 and web member 566 are ejected from a distal
  • Loop 564 is
  • loop 564 is closed to
  • Loop 564 is
  • Polyp PO and neck PN may be marked with a biocompatible dye or ink by tubular member 568 prior to the cauterization procedure.
  • Tubular member 568 operates to spray a determinable quantity of liquid dye or ink onto
  • 550 to mark organic tissues inside a patient comprises a tubular member 574 operatively
  • tubular member 574 is provided with a needle 578 for use
  • a proximal end to a pressurized or pressurizable supply 584 of a biocompatible fluidic dye
  • tubular member 582 is provided with a brush 585 for use in applying
  • Instrument 572 of Fig. 13 or instrument 580 of Fig. 14 may be inserted through biopsy
  • tubular member 568 or marking 21 instrument 572 or 580 may be inserted through an alternately expandable and collapsible biopsy channel 586 provided on a sheath 588 surrounding an endoscope insertion member 590,
  • Such an endoscope sheath 588 may take the form described and
  • Sheath 588 is provided with other alternately expandable and collapsible biopsy
  • channels 592 and 594 one of which receives a sheath 596 of a cauterization instrument
  • instrument assembly 598 carries a pair of polyps PI and P2 which have already been marked
  • FIG 15 shows a third polyp P3 being marked by instrument 572 (Fig 13) prior to cauterization and severing by a loop 602 to which web member 600 is attached in a manner to enable cauterization by the loop
  • tissue sample TS from inside a patient comprises a cauterization loop 604 which in an
  • expanded configuration has a bent configuration which arcs at 606 laterally from a plane PLN
  • loop 604 facilitates the capture of polyps by facilitating the
  • Fig 16 The curved design of Fig 16 may be used in any
  • an attached capture pocket or web Loop 604 is provided with a capture pocket 608 and is
  • colored staples may be used to mark a polyp and/or its base, the 22 staples being applied via an endoscopic stapling instrument as disclosed in U.S. Patents Nos. 5,015,249 and 5,049,153 and 5,156,609, the disclosures of which are hereby incorporated by
  • the staples may be applied to the base or neck of a severed polyp either before or after a cauterization procedure.
  • Figs. 17A-17C illustrate steps in using a modified snare including a cauterization loop
  • proximal ringlets 788 are connected via respective threads 790 to an inner surface or side 794
  • threads 790 also limit the extent to which loop 782 may be distanced from the distal end of sheath 792.
  • Fig. 17B shows the sliding of ringlets 786 and 788 in a distal direction relative to loop
  • loop 782 is pushed in a distal direction
  • loop 782 in a proximal direction relative to loop 782.
  • loop 782 is pulled further into sheath 792, as illustrated in Fig. 17C.
  • Ringlets 23 786 and 788 are severed from loop 782 via a burning process, thereby freeing capture pocket
  • the polyp cauterization assembly of Figs 17A-17C may be provided with
  • pocket 784 for ensuring closure of capture pocket 784 upon completion of a polyp severing operation As shown in Fig 18, in packing loop 782 and pocket 784 inside sheath 792, pocket
  • loop 784 may be disposed distally of loop 782, thereby facilitating the packaging process
  • Fig 19 illustrates a step in a manufacturing operation
  • Sheath 792 includes a distal
  • Threads 790 extend through segment 800 and are
  • Threads 790 may be provided additionally with knots 804 which are
  • Knots 804 serve as
  • a surgical instrument assembly 890 for use in snare cauterization operations comprises a tubular instrument guide member 892 defining a plurality
  • Lumens 894 and 896 have
  • Tubular member 892 has a diameter sufficiently small so that the
  • tubular member can be inserted through a biopsy channel 898 of a flexible endoscope insertion
  • Instrument assembly 890 further comprises a cauterization loop
  • An electrically conductive wire 908 is connected to cauterization loop 902, 24 cauterization loop 902 and wire 908 being disposed at least partially in lumen 896 of tubular
  • An electrical supply 909 is operatively connected to wire 908 via a coupling 910
  • shifting member 912 e.g., a wire
  • shifting member 912 is connected at one end to auxiliary loop 904.
  • loop 904 and wire 912 are at least partially disposed in lumen 894 of tubular member 892.
  • handle assembly 914 is provided at the proximal end of wire 912 for facilitating the maneuvering of auxiliary loop 904 from outside the patient. Handle assembly 914 may also be
  • cauterization loop 902 to facilitate the manipulation of the loop to eject the loop
  • Handle assembly 914 is
  • cauterization loop 902 operatively connected to cauterization loop 902 and auxiliary loop 904 so as to allow those two elements to be ejected independently from tubular member or catheter 892.
  • Web member 906 whether a net or a continuous film of polymeric material, may be
  • auxiliary loop 904 connected to auxiliary loop 904 at a plurality of spaced locations, e.g., via ringlets (not
  • Tubular member 892 is preferably flexible so that it may pass along bends in
  • endoscope insertion member 900 upon a deployment thereof during an endoscopic
  • tubular member 892 is moved in a distal direction
  • Cauterization loop 902 is shifted in a distal direction relative to ejected tubular member 892 to
  • ejected cauterization 25 loop 902 is expanded from a collapsed configuration inside tubular member 892 to an opened configuration.
  • Cauterization loop 902 is then manipulated from outside of the patient to pass the expanded cauterization loop over polyp PLP which is to be removed from the patient.
  • cauterization loop 902 is at least partially closed to engage
  • tubular member 892 and cauterization snare relatively towards one another to thereby at least
  • cauterization loop 902 about polyp neck NK an electrical current is conducted through wire
  • cauterization loop 902 Upon a severing of the polyp PLP at the neck NK, cauterization loop 902 is retracted into tubular member 892. Then, auxiliary loop 904 is ejected from tubular member 892, the
  • auxiliary loop and web member or capture pocket 906 being opened from a folded
  • auxiliary loop 904 is
  • auxiliary loop 904 is at least partially closed to capture the severed polyp PLP in web
  • auxiliary loop 904 includes shifting tubular member 892 and the auxiliary loop relatively
  • Biopsy channel 898 of endoscope member 900 may be located in a sheath disposed on the 26 endoscope, as described in U.S. Patent No. 5,217,001, the disclosure of which is hereby
  • the device or instrument assembly of Fig. 20 includes a cauterization wire disposed simultaneously with a separate capture pocket in a common
  • tubular instrument guide member
  • Figs. 22A-22E depict a sequence of steps in another endoscopic polyp removal
  • FIG. 22 A is identical to Fig. 21 A and shows endoscope insertion member 900
  • Insertion member 900 is used to visually monitor internal body
  • tubular member 892 in a distal direction through biopsy channel 98 of endoscope insertion
  • Fig. 22B is identical to Fig. 21B and illustrates subsequent steps of the endoscopic polyp removal procedure.
  • Cauterization loop 902 is shifted in a distal direction relative to ejected tubular member 892 to eject the cauterization loop from the tubular member.
  • ejection, ejected cauterization loop 902 is expanded from a collapsed configuration inside
  • cauterization loop 902 is maneuvered to encircle polyp PLP
  • auxiliary loop 904 and capture pocket 906 are ejected from tubular
  • auxiliary loop 904 is then maneuvered from outside the patient to pass the opened auxiliary
  • B32-002 27 loop 904 and capture pocket 906 over the polyp PLP so that web member or pocket 906
  • tubular member 892 substantially surrounds the polyp. At that juncture, tubular member 892 on the one hand and
  • cauterization loop 902 and auxiliary loop 904 on the other hand are shifted relatively towards
  • cauterization loop 902 Upon closure of cauterization loop 902 about polyp neck NK, an electrical current is conducted through wire 908 and cauterization loop 902 to burn through polyp PLP at base
  • cauterization loop 902 is drawn into tubular member 892. The severed polyp is
  • polyp PLP is removed from the patient together with auxiliary loop 904
  • Figs. 23 and 24 illustrate an improvement in a loop and pouch assembly which may be
  • the assembly comprises a tubular member 920
  • Tubular member 920 has a diameter
  • An elongate flexible shifting member 924 is connected at one end to a
  • a flexible web member 928 is connected to loop 926 so as to form a capture pocket or
  • Loop 926 defines a mouth opening of pocket 928. At least one flexible tensile member
  • tubular member 920 is also connected to tubular member 920 at a pair of holes 938 and 940
  • Tensile members 28 930 and 932 extend from flexible web member 928 into lumen 922 of tubular member 920.
  • Tensile members 930 and 932 are segments of a single flexible tensile tether member
  • a patch 944 is disposed
  • tubular member 920 on an outer surface of tubular member 920 over holes 938 and 940 and over a bight portion
  • Patch 946 of tensile member 942 which is located outside the tubular member.
  • Patch 944 is a thin
  • loop 926 When loop 926 is ejected from tubular member 920, web member or capture pocket
  • tensile segments 930 and 932 hold the proximal end of capture pocket 928 so that the
  • pocket 928 can remain outside the tubular member 920 and yet can be reopened or
  • cauterization operations comprises a tubular sheath member 950, an alternately expandable and
  • wire 954 is thicker than loop 952 and is crimped thereto at 29
  • Wire 954 is slidable longitudinally through sheath member 950, while the sheath is
  • a flexible web member 956 is connected to loop 952 essentially around a circumference thereof to form a capture pocket, loop 952 defining a mouth opening of the
  • web member 956 is slidably attached to loop 952 along a proximal
  • Web member 956 is fixedly
  • loop 952 but removably attached to loop 952 along a distal portion 962 thereof to enable at least a
  • web member 956 is fixed to distal end portion 962 at a plurality of discrete points 964 along a radially outer surface of loop 952. Those attachment
  • points 964 are severable or rupturable, e.g., by the heat of cauterization, so that web member
  • a purse string 966 is attached to web member or pouch
  • Purse string 966 is attached at a proximal end to at least one of wire 954 and tubular
  • string 966 is made of a heat-resistant material such as quartz and is attached to wire 954 proximally to the point of connection 955 of loop 952 to wire 954. Because quartz is prone to
  • purse string 966 must be selected so that the purse string does
  • Fig. 25 is advantageously provided with the tether 930, 30 932, 942 of Fig. 23.
  • the tether is omitted in Fig. 25 for purposes of clarity of illustration.
  • cauterization loop 952 comprises a plurality of metal
  • web member or capture pouch 956 may be attached to the loop via threads 970 inserted under individual strands or filaments 968 of loop 952.
  • web member or capture pouch may be attached to the loop via threads 970 inserted under individual strands or filaments 968 of loop 952.
  • Ringlets 956 may be attached to loop 952 via threads 972 and minute metal ringlets 974. Ringlets 974
  • web member or capture pouch 956 is attached to the radially outer surface of loop 952
  • distal portion 962 extends approximately one-third
  • proximal portion 958 extends approximately two-thirds the length of loop 952.
  • thread ringlets 960 slide back and forth along loop 952 as the loop is alternately extended and retracted into tubular sheath member 950 during attempts to properly position loop 952
  • portion 962 of loop 952 comes into contact with a polyp; the proximal portion 958 is retracted
  • tubular member 950 prior to the conduction of cauterization current.
  • the snare assembly of Figs. 25-28 is designed to solve a problem arising with other
  • the cauterization loop has to cut through the attachment ringlets or threads of the
  • web member or pouch 956 is attached to loop 952 31 only along an outer surface thereof at distal portion 962 This attachment of web member or
  • cauterization loop 952 enables a repositioning of the snare relative to a polyp More specifically, after loop 952 has been partially drawn back into tubular member 950, the loop
  • tubular member 950 can be shifted again in a distal direction relative to tubular member 950 to enable an adjustment
  • the snare may be repositioned relative to the polyp, and pouch 956 remains outside of
  • tubular member 950 after severing of the polyp Pouch 956 is severed from cauterization loop
  • an endoscopic instrument assembly 700 for use in severing
  • tubular member 702 having a diameter sufficiently small so that the tubular
  • a biopsy member can be inserted through a biopsy channel 704 of a flexible endoscope 706 (Figs 30A-
  • Assembly 700 includes a cauterization loop 708 and an electrically conductive wire 710
  • cauterization loop 708 via the wire Assembly 700 further includes an auxiliary loop 716 32 provided at a distal end of an elongate flexible shifting member 718.
  • shifting member 718 are at least partially disposed in tubular member 702.
  • auxiliary loop 716 is connected to auxiliary loop 716 so as to form a capture pocket
  • Assembly 700 also includes an elongate flexible
  • Tube 722 provided at a distal end with a needle point 724 and an aperture 726. Tube 722 is
  • tubular member 702 disposed at least partially in tubular member 702 and is provided at a proximal end with a fluid
  • feed connector 728 for coupling the tube to a pressurizable liquid supply 730, whereby fluid is fed to tube 722 for ejection through aperture 726.
  • Figs. 30A-30D depict successive steps in the use of instrument assembly 700 during an endoscopic tissue removal operation.
  • Tubular member 702 is slidably disposed in biopsy
  • Endoscope 706 and particularly an illumination guide 732 and fiber-optic image guide 734
  • tubular member 702 is shifted in the distal direction to eject a distal end portion of the tubular
  • tube 722 is shifted in the distal direction to
  • needle point 724 eject needle point 724 from tubular member 702. As shown in Fig. 30A, needle point 724 and
  • aperture 726 are inserted into the polyp FP, for example, at the base thereof. Liquid is then transferred through tube 722 from supply 730 and forced out through aperture 726 into polyp
  • tube 722 is retracted back into
  • tubular member 702 and cauterization loop 708 is ejected, expanded from a collapsed
  • shifting member 718 is pushed distally to eject auxiliary loop 716 and web
  • loop 716 opens naturally in response to internal spring biasing forces, whereupon loop 716 and web or pocket member 720 is placed about severed polyp FP. Alternatively, it is possible to place
  • cauterization loop 708, auxiliary loop 716 is at least partially closed to capture the expanded
  • Loop 716 is closed by pushing tubular member 702 in the
  • tubular member 702 defined by a plurality of septums
  • wire 710 and shifting member 718 are slidably disposed in respective ancillary tubes 742 and 744 in turn slidably disposed in an outer tubular member 746.
  • Tubular ancillary tubes 742 and 744 in turn slidably disposed in an outer tubular member 746.
  • biopsy channel 704 Figs. 30A-30D
  • tubular member 746 transportation, storage and use of the instrument assembly of Fig. 29 are
  • FIG. 32 As illustrated in Fig. 32, another surgical instrument assembly 750 for use in snare
  • cauterization operations comprises a tubular member 752 having a diameter sufficiently small so that the tubular member can be inserted through a biopsy channel of a flexible endoscope.
  • Tubular member 752 is provided with a diametric and longitudinally extending septum 754
  • Lumen 756 is slidably traversed by an electrically
  • conductive wire 760 operatively connected at a distal end to a cauterization loop 762, while
  • lumen 758 is slidably traversed by a flexible fluid feed tube 764 provided at a distal end with a
  • Wire 760 is provided at a proximal end with
  • flexible web member 774 is connected to cauterization loop 762 so as to form a capture
  • a fluid feed connector 776 couples tube 764 to a pressurizable fluid supply 778 such
  • cauterization loop 762 and needle point 766 are disposed
  • instrument assembly 750 during an endoscopic polyp removal operation is a variation of that described above with reference to Figs. 30A-30D, the variation resulting from
  • web members or capture pockets 720 and 774 may be provided
  • Fig. 29 et seq. may have a color or hue so that the liquid also functions as a marker for purposes of correlating severed polyps with their respective locations on the wall of

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (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

Cette invention se rapporte à un système d'instrument chirurgical (700) pour opération de cautérisation à anse, qui comprend un élément tubulaire (720) ayant un diamètre suffisamment petit pour qu'on puisse l'insérer dans un canal de biopsie (704) d'un endoscope souple (706). A cet effet, on place en position coulissante dans l'élément tubulaire (720) de multiples éléments endoscopiques, à savoir notamment une boucle de cautérisation (708), une membrane souple (720) reliée à la boucle de cautérisation (708) ou à une boucle auxiliaire (716), afin de former une poche de capture, ainsi qu'un tube d'amenée de fluide souple allongé (722) comportant à une extrémité distale une pointe d'aiguille (724) et une ouverture (726). L'instrument d'amenée de fluide (722) sert à produire l'expansion d'un polype plat ou non saillant, pour qu'on puisse ensuite le sectionner à l'aide de la boucle de cautérisation (708) et capturer le polype ainsi sectionné à l'aide de la membrane (720) ou de la poche de capture.
PCT/US1998/007620 1998-04-17 1998-04-17 Systeme d'instrument chirurgical d'extraction et procede associe WO1999053851A1 (fr)

Priority Applications (2)

Application Number Priority Date Filing Date Title
PCT/US1998/007620 WO1999053851A1 (fr) 1998-04-17 1998-04-17 Systeme d'instrument chirurgical d'extraction et procede associe
AU71230/98A AU7123098A (en) 1998-04-17 1998-04-17 Surgical retrieval assembly and associated method

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/US1998/007620 WO1999053851A1 (fr) 1998-04-17 1998-04-17 Systeme d'instrument chirurgical d'extraction et procede associe

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Cited By (21)

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Publication number Priority date Publication date Assignee Title
US6277083B1 (en) 1999-12-27 2001-08-21 Neothermia Corporation Minimally invasive intact recovery of tissue
US6514248B1 (en) 1999-10-15 2003-02-04 Neothermia Corporation Accurate cutting about and into tissue volumes with electrosurgically deployed electrodes
US6689145B2 (en) 1998-09-03 2004-02-10 Rubicor Medical, Inc. Excisional biopsy devices and methods
US6702831B2 (en) 1998-09-03 2004-03-09 Rubicor Medical, Inc. Excisional biopsy devices and methods
US6936014B2 (en) 2002-10-16 2005-08-30 Rubicor Medical, Inc. Devices and methods for performing procedures on a breast
US7029451B2 (en) 2002-11-06 2006-04-18 Rubicor Medical, Inc. Excisional devices having selective cutting and atraumatic configurations and methods of using same
US7044956B2 (en) 2002-07-03 2006-05-16 Rubicor Medical, Inc. Methods and devices for cutting and collecting soft tissue
US7122011B2 (en) 2003-06-18 2006-10-17 Rubicor Medical, Inc. Methods and devices for cutting and collecting soft tissue
WO2007040800A1 (fr) * 2005-09-16 2007-04-12 Boston Scientific Limited Dispositifs de découpe de tissu aux propriétés hémostatiques et procédés correspondants
US7909850B2 (en) 1999-10-25 2011-03-22 Boston Scientific Scimed, Inc. Forceps for medical use
US7942896B2 (en) 2003-11-25 2011-05-17 Scimed Life Systems, Inc. Forceps and collection assembly and related methods of use and manufacture
US8083686B2 (en) 2003-09-10 2011-12-27 Boston Scientific Scimed, Inc. Forceps and collection assembly with accompanying mechanisms and related methods of use
WO2016044729A1 (fr) * 2014-09-19 2016-03-24 Endochoice, Inc. Procédé de fixation d'un treillis à un élément de boucle revêtu d'un dispositif d'anse chirurgicale
JP2016150044A (ja) * 2015-02-16 2016-08-22 国立大学法人鳥取大学 内視鏡用処置具
JP2016168326A (ja) * 2015-03-12 2016-09-23 コヴィディエン リミテッド パートナーシップ 結紮および標本回収デバイス
WO2017070548A1 (fr) * 2015-10-23 2017-04-27 Endochoice, Inc. Procédé de fixation d'un treillis à un élément de boucle revêtu d'un dispositif d'anse chirurgicale
CN107854154A (zh) * 2017-12-16 2018-03-30 许建民 一种消化内科用碎石器
US10881384B2 (en) 2014-09-19 2021-01-05 Endochoice, Inc. Method of attaching a mesh to a coated loop member of a surgical snare device
DE202020104255U1 (de) 2020-07-23 2021-10-26 Hms Medical Gmbh Vorrichtung zum Entfernen von erhabenem Zellgewebe, insbesondere von Tumoren
DE102020119537A1 (de) 2020-07-23 2022-01-27 Hms Medical Gmbh Vorrichtung und Verfahren zum Entfernen innerhalb des Blutkreislaufs befindlichen Raumforderungen aus erhabenem Zellgewebe
US11547428B2 (en) 2019-11-15 2023-01-10 Applied Medical Resources Corporation Redeploy able tissue retrieval system

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US5336227A (en) * 1991-11-05 1994-08-09 Wilk & Nakao Medical Technology Incorporated Surgical cauterization snare with polyp capturing web net
US5451206A (en) * 1993-08-02 1995-09-19 Quinton Instrument Company Triple lumen catheter
US5535759A (en) * 1994-11-02 1996-07-16 Wilk; Peter J. Endoscopic method of cleaning and operating on a site within a patient

Cited By (31)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6863676B2 (en) 1998-09-03 2005-03-08 Rubicor Medical, Inc. Excisional biopsy devices and methods
US6689145B2 (en) 1998-09-03 2004-02-10 Rubicor Medical, Inc. Excisional biopsy devices and methods
US6702831B2 (en) 1998-09-03 2004-03-09 Rubicor Medical, Inc. Excisional biopsy devices and methods
US6764495B2 (en) 1998-09-03 2004-07-20 Rubicor Medical, Inc. Excisional biopsy devices and methods
US6849080B2 (en) 1998-09-03 2005-02-01 Rubicon Medical, Inc. Excisional biopsy device and methods
US7303531B2 (en) 1998-09-03 2007-12-04 Rubicor Medical, Inc. Excisional biopsy devices and methods
US6514248B1 (en) 1999-10-15 2003-02-04 Neothermia Corporation Accurate cutting about and into tissue volumes with electrosurgically deployed electrodes
US7909850B2 (en) 1999-10-25 2011-03-22 Boston Scientific Scimed, Inc. Forceps for medical use
US6277083B1 (en) 1999-12-27 2001-08-21 Neothermia Corporation Minimally invasive intact recovery of tissue
US7044956B2 (en) 2002-07-03 2006-05-16 Rubicor Medical, Inc. Methods and devices for cutting and collecting soft tissue
US8066727B2 (en) 2002-07-03 2011-11-29 Rubicor Medical Llc Methods and devices for cutting and collecting soft tissue
US6936014B2 (en) 2002-10-16 2005-08-30 Rubicor Medical, Inc. Devices and methods for performing procedures on a breast
US7438693B2 (en) 2002-10-16 2008-10-21 Rubicor Medical, Inc. Devices and methods for performing procedures on a breast
US7029451B2 (en) 2002-11-06 2006-04-18 Rubicor Medical, Inc. Excisional devices having selective cutting and atraumatic configurations and methods of using same
US7615013B2 (en) 2003-06-18 2009-11-10 Rubicor Medical, Inc. Methods and devices for cutting and collecting soft tissue
US7122011B2 (en) 2003-06-18 2006-10-17 Rubicor Medical, Inc. Methods and devices for cutting and collecting soft tissue
US8083686B2 (en) 2003-09-10 2011-12-27 Boston Scientific Scimed, Inc. Forceps and collection assembly with accompanying mechanisms and related methods of use
US8460205B2 (en) 2003-09-10 2013-06-11 Boston Scientific Scimed, Inc. Forceps and collection assembly with accompanying mechanisms and related methods of use
US7942896B2 (en) 2003-11-25 2011-05-17 Scimed Life Systems, Inc. Forceps and collection assembly and related methods of use and manufacture
WO2007040800A1 (fr) * 2005-09-16 2007-04-12 Boston Scientific Limited Dispositifs de découpe de tissu aux propriétés hémostatiques et procédés correspondants
US11083474B2 (en) 2014-09-19 2021-08-10 Endochoice, Inc. Method of attaching a mesh to a coated loop member of a surgical snare device
US10149691B2 (en) 2014-09-19 2018-12-11 Endochoice, Inc. Method of attaching a mesh to a coated loop member of a surgical snare device
US10881384B2 (en) 2014-09-19 2021-01-05 Endochoice, Inc. Method of attaching a mesh to a coated loop member of a surgical snare device
WO2016044729A1 (fr) * 2014-09-19 2016-03-24 Endochoice, Inc. Procédé de fixation d'un treillis à un élément de boucle revêtu d'un dispositif d'anse chirurgicale
JP2016150044A (ja) * 2015-02-16 2016-08-22 国立大学法人鳥取大学 内視鏡用処置具
JP2016168326A (ja) * 2015-03-12 2016-09-23 コヴィディエン リミテッド パートナーシップ 結紮および標本回収デバイス
WO2017070548A1 (fr) * 2015-10-23 2017-04-27 Endochoice, Inc. Procédé de fixation d'un treillis à un élément de boucle revêtu d'un dispositif d'anse chirurgicale
CN107854154A (zh) * 2017-12-16 2018-03-30 许建民 一种消化内科用碎石器
US11547428B2 (en) 2019-11-15 2023-01-10 Applied Medical Resources Corporation Redeploy able tissue retrieval system
DE202020104255U1 (de) 2020-07-23 2021-10-26 Hms Medical Gmbh Vorrichtung zum Entfernen von erhabenem Zellgewebe, insbesondere von Tumoren
DE102020119537A1 (de) 2020-07-23 2022-01-27 Hms Medical Gmbh Vorrichtung und Verfahren zum Entfernen innerhalb des Blutkreislaufs befindlichen Raumforderungen aus erhabenem Zellgewebe

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