WO2011064416A1

WO2011064416A1 - Suprapubic instrument used specifically in endoscopic prostate surgery

Info

Publication number: WO2011064416A1
Application number: PCT/ES2010/000414
Authority: WO
Inventors: Natalia PÉREZ CAMEO
Original assignee: Universidad De Zaragoza
Priority date: 2009-10-16
Filing date: 2010-10-14
Publication date: 2011-06-03
Also published as: ES2357823A1; ES2357823B1

Abstract

The invention relates to a single tool that complements the technique performed by a resectoscope (4), which combines puncturing and subsequently extracting the irrigation liquid and remains of the extracted tissues, optimising said processes and increasing the intervention time, being suitable for treating prostates or larger bladder stones. Said suprapubic instrument (1) includes a puncturing means (10), suitable for making a cut in the outer suprapubic area of the patient, coinciding with the bladder (3), in which the bottom end of the suprapubic instrument (1) will be inserted; an evacuation means (20), which contains the puncture means (10) and is suitable for extracting the irrigation liquid injected by a resectoscope (4); and a connection means (30) suitable for securely attaching the puncture means (10) and the evacuation means (20).

Description

SPECIAL SUPRAPUBIC INSTRUMENT APPLICATION IN

ENDOSCOPIC PROSTATIC SURGERY

D E S C R I P C I Ó N

OBJECT OF THE INVENTION

The present invention belongs to the field of surgery, and more specifically to surgical instruments for extracting, treating or transporting tissues or liquids from the human body.

The main object of the present invention is a suprapubic instrument of special application in prosthetic endoscopic surgery, and it can also be used in other interventions such as cystolithotripsy.

BACKGROUND OF THE INVENTION The surgical intervention of transurethral prostate resection (TUR), which consists in the removal of tissue that, due to its growth, obstructs the bladder neck making it difficult or preventing urination is widely known. In this intervention, the surgical weight is borne by the resectoscope, which is introduced through the patient's urethra, and is adapted to insert irrigation fluid into the bladder. Said operation can be performed by intermittent washing, continuous washing through the resector (Iglesias), or continuous washing through suprapubic trocar (Reuter). A third technique involves replacing the Reuter trocar with an Amplatz tube. Intermittent washing involves removing the resector from time to time to remove water from inside the bladder, which means shortening the time available for surgery, poor endoscopic vision and increased intravesical pressure. With the use of the Reuter suprapubic trocar, what happens is that the irrigation fluid enters through the resector and exits through the trocar, so that it is controlled by direct vision (from inside the bladder, through the resector chamber ) and abroad (auxiliary personnel). This takes advantage of the entire inner gauge of the resector, so that the electric cutting handle can be larger, and the performance of the intervention is increased.

In 1992 the Venezuelan urologist Paúl Escobar replaced the Reuter trocar with a thicker, 10 mm tube. in diameter: the Amplatz instrument for percutaneous nephrolitectomy. In this intervention, the puncture and dilation of the patient's tissues is performed in several phases, first a Reuter trocar is used, then a urethral catheter is used and finally the Amplatz tube is placed inside the bladder . Then a thick tube with free outlet is connected, and the liquid column aspirating the contents of the bladder.

The disadvantages presented by the surgical tools mentioned above are the following:

- To perform suprapubic extraction of the irrigation fluid introduced by the resectoscope into the patient's bladder, several devices are needed, one to perform the puncture (cutting of the tissues until reaching the bladder), and another to introduce an outlet channel for the evacuation of said liquid.

- The puncture performed by surgeons with existing surgical tools is very dangerous, since they must apply a lot of force on the patient's skin to pierce it, this being a complex operation that can damage several organs. - The irrigation fluid evacuation channels available in the current surgical tools are relatively narrow, so the duration of the intervention is reduced to avoid endangering the patient's life, so the size of the prostates that They can be treated is small.

- These surgical tools do not have an alternative outlet channel, in case you need to immediately evacuate the irrigation fluid from the bladder and the normal outlet channel is not enough.

DESCRIPTION OF THE INVENTION

By means of the present invention, the aforementioned drawbacks are resolved by providing a suprapubic instrument intended to be used mainly, but not only, as a complement to a resectoscope during the transurethral resection surgery of the prostate, and with which said intervention is considerably optimized, combining in a single tool the puncture and evacuation of the irrigation liquid, increasing the operating time and with it the size of the prostates that can be treated.

Said resectoscope, intended to be introduced through the patient's urethra, constitutes the most important surgical tool in the transurethral resection operation, since it is she who performs the removal of the tissue that obstructs the bladder neck. This resectoscope introduces an irrigation liquid intended to be carried away with it the remains of the excised tissues, which is filling and increasing the pressure of the bladder. It is here that the suprapubic instrument of the present invention comes into play, which is adapted to perform a puncture in the suprapubic outer area of the patient for subsequent partial insertion into the bladder. Furthermore, said suprapubic instrument is adapted for the extraction of the irrigation liquid introduced by the resectoscope and that is housed in the bladder, so that it empties and decreases the pressure in the latter.

Said suprapubic instrument, preferably of a cane-shaped configuration, comprises:

- punching means, adapted to make a cut in the suprapubic outer area of the patient coinciding with his bladder, in which the lower end of the suprapubic instrument object of the invention is intended to be introduced,

- evacuation means, inside which the puncture means are located, and which are adapted for the extraction of the irrigation liquid introduced by the resectoscope, and

- connecting means adapted for fixing and closing the punching means and the evacuation means.

The punching means preferably comprise:

- a sharpened body of elongated configuration, which has at its lower end a scalpel adapted to make a cut in the suprapubic area of the patient coinciding with its bladder, presenting at its other end a grip element adapted for removal after making said cut, Y

- a hollow cylindrical body, inside which the stabbing body is housed, shorter than this, whose lower end has a beveled surface, so that the puncture is favored by gradually dilating the tissues. Preferably said beveled surface additionally has a thread, whereby it is even easier if the puncture fits without turning the suprapubic instrument of the invention, thus avoiding having to exert great efforts on the part of the surgeon that could cause serious damage to the patient. .

Also the evacuation means, preferably of plastic material, and adapted for the extraction of the irrigation liquid introduced by the resectoscope comprise:

- an upper head, which has a curved configuration evacuation channel, whose outlet is intended to be joined with an outer plastic tube through which the excised tissues are removed for final deposition in a filter, and

- an intermediate tube of cylindrical and elongated configuration, inside which the puncture means are initially located, which are extracted once the cut and made said intermediate tube inside the bladder, being then adapted to evacuate the liquid from irrigation contained in the bladder.

Said evacuation channel is wide enough to allow an exit of the irrigation liquid with the same flow rate with which it is introduced by the resectoscope, also making it possible to extend the duration of the operation for more than 1 hour (current recommended duration), so that larger prostates can be resected.

In the case where it is necessary to quickly reduce the pressure of the bladder or an obstruction occurs during the exit of the excised tissues, it is provided that the upper head additionally has an alternative outlet channel, initially plugged by a valve security. Thus, for the opening of said alternative channel, the surgeon must simply pull out the safety valve, then allowing the excised tissues to be dislodged by a second available outlet at its upper end.

It is envisaged that the intermediate tube preferably has a pair of tabs arranged at its upper end in a facing manner, intended to be held by the hands of a surgeon, as well as a pair of vertical grooves preferably of U-configuration, being able to be in V or rectangular, by means of which it is possible to tear the intermediate tube from top to bottom, to be able to remove it completely once the operation is finished, and after having introduced into it a bladder catheter, which will allow the patient the continuous washing of the necessary bladder during the first 24-48 hours of the postoperative period.

For their part, the joining means are preferably comprised of washers and seals, which are adapted for the secure fixing of the different parts that make up the suprapubic instrument object of the invention.

Preferably, the suprapubic instrument of the present invention additionally has fixation means adapted to provide stability and fastening of the suprapubic instrument to the surgical field, so as to avoid deviations and unwanted movements that can cause errors during the intervention of the surgeon, which They can cause serious damage to the patient.

Finally, the suprapubic instrument additionally has support means, adapted for the installation and assembly of other surgical equipment or devices, arranged at the end of the upper head, by means of which the suprapubic instrument described here can be used to perform other surgical interventions, for example, cistolitotricia (stones or stones present in the bladder).

Therefore, by means of the suprapubic instrument described in the present invention, a surgical tool complementary to the technique used by a resectoscope is provided, combining in a single tool the realization of the puncture, and subsequent extraction of the irrigation liquid and remains of excised tissues. In addition, these processes of puncture and evacuation of fluid are optimized, making it possible to increase the intervention time in order to treat prostate or larger bladder stones.

DESCRIPTION OF THE DRAWINGS

To complement the description that is being made and in order to help a better understanding of the features of the invention, according to a preferred example of practical implementation thereof, a set of drawings is attached as an integral part of said description. where for illustrative and non-limiting purposes, the following has been represented:

Figure 1.- Shows a general view of the suprapubic instrument object of the present invention.

Figure 2 - Shows a sectional view of the suprapubic instrument object of the invention where its inner ducts are appreciated.

Figure 3.- Shows a sectional view of the inside of a patient who is undergoing a transurethral resection, where the application areas of the resectoscope and suprapubic instrument object of the invention.

Figure 4 - Shows a perspective view of the punching means, where the puncturing body and the hollow cylindrical body are appreciated.

Figure 5 - Shows a perspective view of the evacuation means.

Figure 6.- Shows a schematic view of the upper head showing the passage of the irrigation liquid through the evacuation channel, with the safety valve closed.

Figure 7 - Shows a schematic view of the upper head where the open safety valve is shown, allowing the irrigation liquid to pass through the alternative channel.

PREFERRED EMBODIMENT OF THE INVENTION

A suprapubic instrument (1) for use in the surgical intervention of transurethral resection of the prostate (2) is shown in Figures 1 and 2, which has a cane-shaped configuration, comprising:

- punching means (10), adapted to make a cut in the suprapubic outer area of the patient coinciding with his bladder (3), in which the lower end of the suprapubic instrument object of the invention is intended to be introduced, as shown figure 3,

- evacuation means (20), inside which the punching means (10) are located, and which are adapted for extraction of the irrigation liquid introduced by a resectoscope (4), and

- connection means (30) adapted for fixing and closing the punching means (10) and the evacuation means (20).

The punching means (10), shown in Figures 1, 2 and 4, comprise:

- a pointed body (11) of elongated configuration, which has at its lower end a scalpel (12), containing at its other end a gripping element (13) adapted for removal at the moment in which the surgeon considers it appropriate, Y

- a hollow cylindrical body (14), inside which the sharp body (11) is housed, shorter than this, whose lower end has a beveled surface (15) which additionally has a thread (16) shown in the figure 4, so that the puncture is favored by gradually dilating the tissues.

Also in Figures 1, 2 and 5 are shown the means of evacuation (20), of plastic material, and adapted for the extraction of the irrigation liquid introduced by the resectoscope (4), which comprise:

- an upper head (21), which has an evacuation channel (22) of curved configuration, whose outlet is intended to be joined with an outer plastic tube through which the excised tissues are removed for final deposition in a filter , Y

- an intermediate tube (26) of cylindrical and elongated configuration, inside of which the puncture means (10) are initially located, which are removed once the cut and made said intermediate tube (26) inside the bladder (3), being then adapted to evacuate the irrigation liquid contained therein. As can be seen in Figure 7, in case it is necessary to quickly reduce the pressure of the bladder (3) or there is an obstruction during the exit of the excised tissues, it is provided that the upper head (21) additionally have an alternative outlet channel (23), initially plugged by a safety valve (24), as shown in figure 6. Thus, for opening said alternative channel (23) the surgeon must simply pull out of the safety valve (24), allowing then to remove the excised tissues by a second outlet (25) also shown in Figures 6 and 7.

Likewise, in Figures 1, 2, 3 and 5 it is shown that the intermediate tube (26) has a pair of tabs (27) arranged at their upper end in a facing manner, intended to be held by the surgeon's hands, thus as of a pair of U-shaped vertical slots (28), by means of which it is possible to tear the intermediate tube (26) from top to bottom, so that it can be completely removed once the operation is finished, and after having introduced a bladder catheter into it , which will allow the patient the continuous washing of the bladder (3) necessary during the first 24-48 hours of the postoperative period.

On the other hand, the joining means (30) are comprised of washers and seals, which are adapted for the secure fixation of the different parts that make up the suprapubic instrument (1).

Figure 2 shows that the suprapubic instrument (1) additionally has fixing means (40) adapted for its stability and attachment to the surgical field, so as to avoid deviations and unwanted movements. Finally, the suprapubic instrument (1) additionally has support means (50) represented in figures 2 and 5, arranged at the end of the upper head (21) and adapted for the installation and assembly of other equipment or devices of surgery, by means of which other surgical interventions can be performed, for example the cistolitotricia

(stones or stones present in the bladder (3)).

Claims

1.- Suprapubic instrument (1) of special application in prosthetic endoscopic surgery characterized in that it comprises:

- punching means (10), adapted to make a cut in the suprapubic outer area of the patient coinciding with his bladder (3), in which the lower end of the suprapubic instrument (1) is intended to be introduced,

- evacuation means (20), inside which the puncture means (10) are located, and which are adapted for the extraction of the irrigation liquid introduced by a resectoscope (4), and

2 - Suprapubic instrument (1) according to claim 1, characterized in that the punching means (10) comprise:

- a hollow cylindrical body (14), inside which the sharp body (11) is housed, shorter than this, whose lower end has a beveled surface (15).

3. Suprapubic instrument (1) according to claim 2, characterized in that the beveled surface (15) additionally has a thread (16).

4. - Suprapubic instrument (1) according to claim 1, characterized in that the evacuation means (20) comprise:

- an intermediate tube (26) of cylindrical and elongated configuration, inside of which the puncture means (10) are initially located, which are removed once the cut and made said intermediate tube (26) inside the bladder (3), being then adapted to evacuate the irrigation liquid contained therein.

5. - Suprapubic instrument (1) according to claim 4, characterized in that the upper head (21) additionally has an alternative channel (23) for exiting the irrigation liquid and excised tissues.

6. - Suprapubic instrument (1) according to claim 5, characterized in that the alternative channel (23) is plugged by a safety valve (24).

7. - Suprapubic instrument (1) according to claim 6, characterized in that the alternative channel (23) has a second outlet (25) for the extraction of the irrigation liquid and excised tissues once the safety valve (24) is opened.

8. - Suprapubic instrument (1) according to claim 4, characterized in that the intermediate tube (26) has a pair of tabs (27) arranged at its upper end facing each other, as well as a pair of vertical grooves (28 ), by which it is possible to tear the intermediate tube (26) from top to bottom, to be able to remove it completely once the operation is finished, and after having introduced a bladder catheter into it.

9. - Suprapubic instrument (1) according to claim 1, characterized in that the joining means (30) comprise washers and seals.

10. - Suprapubic instrument (1) according to claim 1, characterized in that it additionally comprises fixing means (40) adapted for its stability and subjection to the surgical field, so that deviations and unwanted movements are avoided.

11. - Suprapubic instrument (1) according to claim 1, characterized in that it additionally has support means (50) arranged at the end of the upper head (21) and adapted for the installation and assembly of other equipment or apparatus for surgery, by means of which other surgical interventions can be performed.