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
  • A61B18/042—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating using additional gas becoming plasma
• • 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
  • 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
  • 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
  • A61B2018/1427—Needle with a beveled end
• • 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
  • A61B2018/1475—Electrodes retractable in or deployable from a housing

Definitions

• the invention relates to an electrosurgical instrument for an endoscope or a catheter.
• the electrode When coagulating with touching surgical electrodes, the electrode can stick to coagulated tissue, which can cause bleeding or even perforations on thin tissue structures when the electrode is lifted off.
• coagulating large-area bleeding areas it is known (DE 41 39 029 A1) to arrange the surgical electrode in the flow path of an ionizable gas, for example argon, and to increase the high-frequency voltage at the electrode to such an extent that a plasma discharge of ionized gas between the surgical electrode and the tissue Gas ignites. With the help of such a plasma coagulation, large-area bleeding areas can be breast-fed without contact.
• an ionizable gas for example argon
• the invention is based on an electrosurgical instrument for an endoscope, which comprises:
• an insertable into an instrument channel of the endoscope which is electrically non-conductive at least on its outer surface its distal end is an open, preferably flexible tube, the proximal end of which can be connected to a gas source for ionizable gas, in particular argon, an electrode connecting line which can be displaced longitudinally in the tube and whose proximal end can be connected to a high-frequency current generator, an electrosurgical electrode at the distal end of the electrodes - Connection line, a handling device connected to the proximal end of the electrode connection line, by means of which the
• Electrosurgical electrode can be pushed out of the distal end of the tube via the electrode connecting line and can be completely retracted into the tube.
• the improvement according to the invention is characterized in that an electrode which is stationary relative to this end is arranged at the distal end of the tube and is electrically conductively connected to a contact element which is arranged in the tube at a distance from the distal end and which, when the electrosurgical electrode is drawn into the tube, in electrical contact with the electrosurgical electrode and / or the electrode connecting line.
• the electrosurgical electrode is pushed out of the tube and is not in electrical contact with the stationary electrode or the contact element. It is drawn into the tube for plasma coagulation operation. Since the electrosurgery electrode or its connecting line in the retracted position is reliably conductively connected to the stationary electrode via the contact element, the plasma discharge from the stationary electrode is ignited and maintained.
• the stationary electrode is safe to touch, arranged in the tube or otherwise insulated so as to prevent contact burns during plasma coagulation operation - A - be avoided.
• the contact element is dimensioned and arranged in such a way that the high-frequency current is only reliably supplied to the stationary electrode when the electrosurgical electrode which can be moved in the tube has been withdrawn sufficiently far into the tube and the distal end of which is located within the tube.
• the instrument according to the invention therefore does not require visual monitoring of the electrode insertion position via the optics of the endoscope, which simplifies the use of the instrument.
• the tube which is expediently designed as an electrically insulating, flexible plastic tube, insulates both the retracted electrosurgical electrode and the stationary electrode from the outside.
• the electrical connection between the active electrode surface of the stationary electrode and the contact element to the electrosurgical electrode can be electrically isolated; for example by an insulating material sleeve provided axially between the active electrode surface of the stationary electrode and the contact element.
• the electrode connecting line and / or the electrosurgical electrode can be at least partially provided with an insulation coating which is recessed at a point which overlaps with the contact element in the completely retracted position. Only in the fully retracted position is the contact element then connected through the recess in the insulation coating to the electrode lead or the electrosurgical electrode.
• the distal end of the tube expediently carries a sleeve made of heat-resistant, electrically insulating material, for example a ceramic sleeve, in order to prevent the plastic tube from being thermally damaged by the plasma discharge.
• the contact element is designed as a sleeve made of electrically conductive material inserted into the tube.
• the sleeve can be a section of a metal wire coil or act a section of a metal pipe.
• the stationary electrode can be formed integrally with the contact element in a simple manner, for example by providing the metal wire coil section with an end leg that forms the stationary electrode and extends essentially to the distal end of the tube, or the sleeve for forming the stationary one Electrode is extended to the distal end of the tube.
• the sleeve is provided with an extension which forms the stationary electrode.
• the extension can be integrally formed on the sleeve; however, the extension is preferably a separate conductor piece, for example a piece of wire, which is conductively attached to the sleeve, for example welded on.
• the material of the sleeve and the extension can thus be selected independently of one another.
• the sleeve is preferably a piece of metal tube made of stainless steel, while the extension is a tungsten wire.
• the contact element is formed by the sleeve.
• the sleeve only serves as a carrier that holds the contact element at the distal end of the tube.
• the sleeve can thus carry an extension which forms the stationary electrode and extends essentially to the distal end of the tube and which forms the contact element at an axial distance from the distal end of the tube.
• the extension forming the stationary electrode can protrude in the area of the distal end of the tube essentially centrally to the tube towards its distal end and form the contact element in the area of the sleeve. If the surgical electrode is designed as a flexible wire loop, it can be pushed out of the tube past the extension.
• the centrally arranged extension threads into the wire loop until it lies in an electrically conductive manner on the contact element in the fully retracted position.
• the contact element thus also forms an end stop for the retraction movement of the wire loop.
• the sleeve can also be provided with at least one radially resilient tongue which forms the contact element and, if appropriate, extend substantially to the distal end of the tube and at the same time form the stationary electrode.
• the tongue can either be integrally formed on the sleeve or attached to it, for example welded on.
• the extension of the sleeve between an area forming the stationary electrode at the distal end and an area forming the contact element at the proximal end can be provided with insulation.
• the insulation can be omitted if the handling device comprises stop means that limit the movement of the electrosurgery electrode in the position that is completely retracted into the tube.
• Such attachment means are also advantageous in other constructions of the stationary electrode or the contact element, since they mechanically signal to the operator that the electrosurgical electrode has been drawn in sufficiently.
• the treatment parameters of the high-frequency generator can be set manually (e.g. using foot pedals) between the high-frequency power required for the touching treatment with rel. low voltage and the parameters required for plasma coagulation can be switched with high voltage.
• the switchover can also take place automatically if the handling device comprises sensor means, in particular in the form of a switch, which, depending on the position of the electrode connecting line relative to the tube, detect the fully retracted position of the electrosurgical electrode.
• the sensor means can be provided at the proximal end of the tube, with the result that control lines along the instrument channel of the endoscope are eliminated.
• the electrosurgical instrument according to the invention can for touching coagulation or cutting with any electrosurgical electrodes.
• electrosurgical electrodes for example, flexible wire loops or injection needles for sclerotherapy or the like are suitable.
• the electrosurgery electrode can be constructed bipolar for the contacting coagulation operation or can be coated with an insulation which limits the active electrode area and avoids undesirable tissue contact, as is described for example in DE 100 28413 A1.
• Figure 1 is a partially sectioned, schematic representation of an electrosurgical instrument with a loop electrode.
• Fig. 2 is a sectional view of the distal region of a variant of the
• Instruments from Fig. 1; 3 shows a sectional illustration of a further variant of the distal region of the instrument from FIG. 1;
• Fig. 4 is a sectional view of the distal area of a variant of the instrument with a sclerotic needle as an electrosurgical
• FIG. 5 and 6 are sectional views of further variants of the distal region of the instrument from FIG. 1.
• the instrument 5 has a closed-walled, flexible guide tube 7 that can be slid into the instrument channel 1, here in the form of an Insulating plastic material existing hose, in which a flexible connecting or connecting line 9, for example in the form of a coiled strand, is in turn guided in a longitudinally displaceable manner.
• a flexible connecting or connecting line 9 for example in the form of a coiled strand
• an electrosurgical electrode 11 At the distal end of the connecting line 9 is an electrosurgical electrode 11, here in Form of a resection loop, attached, which can be pushed out with the aid of a handling device 13 as indicated at 11 'from the distal end of the guide tube 7 or fully retracted into the guide tube 7. In the fully retracted state, the electrode 11 is arranged at a distance from the distal end of the guide tube 7.
• the handling device 13 has a shaft 15 adjoining the proximal end of the guide tube 7, along which a finger grip 17, which is connected to the proximal end of the connecting line 9 in a manner that is resistant to tension and compression, can be displaced.
• the proximal end of the shaft 15 carries a thumb ring 19.
• a stop 21 on the shaft 15 limits the displacement movement of the finger grip 17 in the fully retracted position of the electrode 11 shown in FIG. 1 With the finger grip 17 in the position indicated at 17 ′, the electrode 11 is pushed out of the distal end of the guide tube 7 via the connecting line 9.
• the finger grip 17 carries a plug contact 23 connected to the proximal end of the connecting line 9, to which a high-frequency current generator 25 can be connected.
• the electrode 11 attached to the distal end of the connecting line 9 allows touching coagulation and cutting of biological tissue under the action of the high-frequency current of the generator 25.
• the generator 25 comprises a large-area counterelectrode (not shown in any more detail) which bears against tissue which is not to be treated.
• the electrode 11 can have an overall exposed contact area.
• electrodes with an insulating jacket are also suitable, in which the insulating jacket reduces the active electrode area, as is described, for example, in DE 100 28 413 A1.
• bipolar electrodes are also suitable insofar as the connecting line 9 is of two-wire design.
• the electrosurgical instrument 5 also allows reliable, large-area plasma coagulation of the tissue.
• the handling device 13 is provided with a gas connection 27, via which ionizable gas, for example argon, can be supplied from a gas source 29 at the proximal end of the guide tube 7.
• ionizable gas for example argon
• the proximal end of the guide tube 7 is sealed, as indicated at 31, so that the gas emerges from the distal end of the guide tube 7.
• a stationary electrode 33 for the tissue to be coagulated is arranged in a contact-safe manner in the guide tube 7 and is electrically connected to a contact sleeve 37 via a connecting region 35. In the fully retracted position of the electrode 11, the latter rests elastically on the inner circumference of the contact sleeve 37 and connects the stationary electrode 33 to the connecting line 9 in an electrically conductive manner.
• the finger grip 17 is pulled back up to the stop 21. This ensures that the electrode 11 designed for contacting coagulation is completely retracted into the distal end of the guide tube 7, without this requiring an optical control of the optics of the endoscope.
• the gas source 29 and the high-frequency current generator 25 are then switched on, the current strength of the generator 25 possibly being increased manually to a value sufficient to ignite a plasma discharge in the gas stream emerging at the distal end of the guide tube 7.
• a double-pedal foot switch (not shown) can be used to switch the high-frequency voltage of the generator 25 from the low value required for the contacting treatment by means of the electrode 11 to the higher value required for the plasma coagulation.
• a switch 39 can also be provided on the handling device 13, for example in the area of the stop 21, which controls the switchover of the generator 25 automatically or else manually.
• the guide tube 7 is designed as an overall non-conductive hose. It goes without saying that that Guide tube can also be designed as a coil spring coated with an insulation on the outside, provided that the contact sleeve 37, the connection region 35 and the stationary electrode 33 are insulated from the metallic coil spring. Insofar as the retraction movement of the finger grip 17, as shown in FIG. 1, is limited by a stop 21, which defines the fully retracted position of the electrode 11, the stationary electrode 33, the connection area 35, and also the electrode 11 can be bare because the generator 25 is only switched to the parameters required for the plasma coagulation in the position determined by the stop 21.
• the connecting region 35 forming the stationary electrode 33 at its end is designed as an elongated extension projecting from the contact sleeve 37.
• the contact sleeve 37 is expediently a metal tube section, for example made of stainless steel, on which the extension can be integrally formed.
• the extension is preferably a piece of wire that is conductively attached to the contact sleeve, for example soldered or welded on, preferably a piece of tungsten wire.
• the electrosurgical electrode 11a connected to the distal end of the connecting line 9a is again designed as a flexible loop electrode, which spreads itself outside the guide tube 7a, similar to FIG. 1.
• the guide tube 7a is in turn a flexible one Plastic hose.
• the contact sleeve 37a is designed as a section of an elastic metal wire coil, on which an end leg 41 protruding in a straight line along the guide tube 7a is integrally and integrally formed in the manner of a leg spring in order to form the electrode 33a extending to the distal end of the guide tube 7 and the connecting region 35a.
• Plastic hose section may be used. Additionally or alternatively, the region of the electrode 11a, including the connecting line 9a, projecting towards the proximal end in the completely retracted position of the electrode 11, can also be encased with insulating material, as indicated at 45. It is sufficient if the casing 45 extends over the axial length of the electrode 33a, the connecting region 35a and the contact sleeve 37a.
• the electrosurgical electrode 11b connected to the distal end of the connecting line 9b is again designed as a loop electrode.
• a metal sleeve 47 which terminates with the distal end of the guide tube 7b, is inserted into the distal end of the guide tube 7b and forms the contact sleeve 37b in the region of its proximal end and the stationary electrode 33b at its distal end and integrally the connection region 35b therebetween.
• the sleeve 47 can be a section of a rigid metal tube or else a flexible wire coil.
• the inner jacket of the metal sleeve 47 can be lined with an insulating coating 43b, for example in the form of a plastic tube section, which, however, expediently ends at a distance from the distal end of the guide tube 7b in order to enlarge the active area of the stationary electrode 33b, as shown in Fig. 3 at 49.
• the area of the electrode 11b and the connecting line 9b projecting towards the proximal end are covered with insulating material 45b, similar to FIG. 2.
• the isolations 43b and 45b can optionally be omitted.
• the electrosurgical electrode 11c is designed, for example for sclerotherapy purposes, as an injection needle, which is connected to the handling device via a tubular connecting line 9c.
• Treatment liquid can be supplied at the proximal end of the tubular connecting line 9c in a manner not shown in detail.
• the connecting line 9c comprises a metal wire coil 51, the outer jacket of which is covered with a plastic tube 53.
• the metal wire coil 51 ends at a metal head 55 which holds the metallic injection needle of the electrode 11c and which, when the electrode 11c is completely retracted into the guide tube 7c, contacts the contact sleeve 37c which is designed here as a section of a wire coil.
• the wire helix 37 is integrally provided with a leg 41c, the distal end of which forms the stationary electrode 33c and connects to the contact sleeve 37c via the connecting region 35c.
• the guide tube 7c is narrowed between the contact sleeve 37c and its distal end to form a guide section 57 for centering and guiding the electrode 11c. 4, the area between the electrode 33c and the contact sleeve 37c can also be provided with an insulating lining 43c.
• a connection is connected to the proximal end of the tube 53, which at the same time is in electrical contact with the wire helix 51, that is to say at the same time takes over the function of the plug contact 23 from FIG. 1. In this way, unintentional touching of the treatment liquid connection during coagulation is prevented.
• the wire helix 51 of the connecting line 9c it can also be designed as a separate strand or the like inside or outside of the hose 53.
• the wire coil 51 can also enclose the tube 53 on the outside.
• FIG. 5 shows a variant in which a sleeve 59 designed here as a helical spring section is inserted into the guide tube 7d, which is again designed as a plastic tube.
• the sleeve 59 serves as a carrier for an extension 61 which extends approximately centrally in the guide tube 7d to the distal end thereof and which forms the stationary electrode 33d at the distal end of the guide tube 7d.
• the extension 61 is an end leg protruding from the helical spring section forming the sleeve 59.
• the extension 61 consisting of metal wire, for example tungsten wire, including the helical spring section of the sleeve 59 carries electrical insulation 65.
• the electrosurgical electrode 11d is designed as a flexible resection loop and can be provided with electrical insulation 45d in a manner known per se, including its connecting conductor 9d which can be displaced in the guide tube 7d.
• the resection loop 11d can be pushed past the extension 61d out of the guide tube 7d for the touching coagulation and cutting of biological tissue. Since the extension 61 forming the stationary electrode 33d is arranged centrally in the guide tube 7d, the extension 61 is threaded onto the extension 61 when the resection loop 11d is pulled in until the resection loop 11d in the fully retracted position on the contact area 63 for the plasma Coagulation operation is present. It goes without saying that the sleeve 59 can also be designed as a metal tube section.
• the extension 61 can be integrally formed on the metal tube.
• the extension 61 can, however, also be designed as a wire section, for example welded on, conductively attached to the metal tube section.
• the metal tube section can optionally have an insulating coating on its inside.
• the sleeve 59e extends to the distal end of the guide tube 7e and at the same time forms the stationary electrode 33e there. Except for the contact spring tongues 67, the inner circumference of the sleeve 59e is lined with an insulating coating 71 in an electrically insulating manner. As in the exemplary embodiment shown, a resection loop designed as an electrosurgical electrode 11e and the connecting line 9e are also provided with an electrically insulating coating 45e, which only omits the contact area of the sleeve 69.
• the contact spring tongues 67 are integrally formed on the sleeve 59e. It is understood that the
• Contact spring tongues can optionally also be formed separately from the sleeve 59e.
• the sleeve 59e can be made entirely

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• Health & Medical Sciences (AREA)
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• Engineering & Computer Science (AREA)
• Life Sciences & Earth Sciences (AREA)
• Biomedical Technology (AREA)
• Molecular Biology (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Plasma & Fusion (AREA)
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Cited By (11)

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Citations (4)

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• 2003
  • 2003-06-17 DE DE10327237A patent/DE10327237A1/de not_active Withdrawn
• 2004
  • 2004-06-16 WO PCT/EP2004/006488 patent/WO2004110294A1/de not_active Ceased
  • 2004-06-16 US US10/559,523 patent/US7517347B2/en active Active
  • 2004-06-16 DE DE112004000844.1T patent/DE112004000844B4/de not_active Expired - Lifetime
  • 2004-06-16 JP JP2006515957A patent/JP4658929B2/ja not_active Expired - Fee Related
  • 2004-06-16 CN CNB200480016876XA patent/CN100358480C/zh not_active Expired - Lifetime

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