WO2011081977A1 - Instrument d'électro-cautérisation avec face de compression libérable - Google Patents

Instrument d'électro-cautérisation avec face de compression libérable Download PDF

Info

Publication number
WO2011081977A1
WO2011081977A1 PCT/US2010/060741 US2010060741W WO2011081977A1 WO 2011081977 A1 WO2011081977 A1 WO 2011081977A1 US 2010060741 W US2010060741 W US 2010060741W WO 2011081977 A1 WO2011081977 A1 WO 2011081977A1
Authority
WO
WIPO (PCT)
Prior art keywords
compression face
compression
support tube
tool
cauterizing
Prior art date
Application number
PCT/US2010/060741
Other languages
English (en)
Inventor
Per R. Anderas
Original Assignee
Baycare Clinic, Llp
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 Baycare Clinic, Llp filed Critical Baycare Clinic, Llp
Publication of WO2011081977A1 publication Critical patent/WO2011081977A1/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • 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
    • A61B50/00—Containers, covers, furniture or holders specially adapted for surgical or diagnostic appliances or instruments, e.g. sterile covers
    • A61B50/20—Holders specially adapted for surgical or diagnostic appliances or instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B50/00—Containers, covers, furniture or holders specially adapted for surgical or diagnostic appliances or instruments, e.g. sterile covers
    • A61B50/30—Containers specially adapted for packaging, protecting, dispensing, collecting or disposing of surgical or diagnostic appliances or instruments
    • 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
    • A61B2018/00053—Mechanical features of the instrument of device
    • 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
    • A61B2018/00053—Mechanical features of the instrument of device
    • A61B2018/00107—Coatings on the energy applicator
    • 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
    • A61B2018/00053—Mechanical features of the instrument of device
    • A61B2018/00107—Coatings on the energy applicator
    • A61B2018/0013—Coatings on the energy applicator non-sticking
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00595—Cauterization

Definitions

  • the present invention relates to electrocauterization and in particular to an improved electrocauterization tool.
  • an electrically conductive electrocauterization tool is applied to tissue while connected to a source of electrical power (typically, a high- voltage AC source).
  • the tool may be, for example, a needle, blunt probe, a loop, forceps, or a knife.
  • the electrical current conducted from the tool into the tissue heats the tissue to coagulate blood and stop undesirable bleeding.
  • the electrical current then continues through the body to be collected at a ground pad placed a distance away on the skin. The broad area of the ground pad diffuses the current flow to prevent significant heating of tissue at the ground pad.
  • coagulated blood and tissue can adhere to the electrocauterization tool in such a way that retraction of the tool away from the tissue undesirably tears open the sealed blood vessels in the cauterized region.
  • This adhesion can be prevented to some degree by spacing the tool from the tissue and applying higher voltage to produce an arc between the tool and tissue without contact of the two.
  • the present invention provides an electrocauterization tool having a releasable compression face that may be applied directly to the tissue, for example, to mechanically seal blood vessels before cauterization.
  • the compression face permits the passage of electrical current through the compression face.
  • the compression face may be released from the tool to remain adhered to the tissue by coagulum while allowing the remainder of the tool to be retracted.
  • the compression face is desirably constructed of a biocompatible material that may be retained by the tissue or eventually bio-absorbed.
  • one embodiment of the invention provides a cauterizing tool for use with a cauterizing electrical power source.
  • the cauterizing tool includes an elongate electrical conductor having a distal end attachable to the cauterizing electrical power source and a proximal end positionable within the body adjacent to a cauterization site.
  • a biocompatible compression face attaches electrically to the proximal end of the electrical conductor to press against tissue to be cauterized and to conduct electricity from the electrical conductor through the compression face to the tissue to be cauterized during a cauterization.
  • the compression face is releasably attached to the electrical conductor to separate from the electrical conductor upon completion of the cauterization without tearing of the cauterized tissue.
  • the cauterizing tool may include a support tube releasably supporting a periphery of the compression face and containing the electrical conductor.
  • the compression face may include an inwardly extending lip capturing a corresponding outwardly extending lip of the compression tube. It is thus a feature of at least one embodiment of the invention to provide a simple method of retaining the compression face while maximizing the compressive surface of the tool that is covered by the compression face.
  • the compression face may provide an outer periphery captured by a radially inward extending lip of the compression tube.
  • the cauterizing tool may further include a plunger fitting within the support tube and communicating by a compression shaft to the distal end of the electrical conductor, the plunger operable to push the compression face off of the support tube.
  • the electrocauterization tool may include set of compression faces fitting within the support tube between the plunger and the inwardly extending lip of the support tube for discharge of successive compression faces successively with incremental movement of the plunger.
  • the cauterization tool may further include a plunger actuator at the distal end of the electrical conductor providing controlled movement of the plunger to eject a compression face.
  • the cauterizing tool may further include conductive separators positioned between the compression faces to space the same apart.
  • the invention may provide a compression face dispensing carrier releasably holding a set of compression faces within bores to resist first axial movement of the compression faces into the bore with insertion of the support tube into the bore to engage the compression face and to release the compression face with second axial movement of the support out of the bore with the compression face attached.
  • FIG. 1 is a phantom view of a patient being treated by an endoscopic electrocauterization tool per one embodiment of the present invention showing in a detailed cross-section a proximal end of the tool used to compress a blood vessel to be sealed before cauterization;
  • Fig. 2 is a figure similar to the detailed cross-section of Fig. 1 showing release of a compression face from the electrocauterization tool to preventing tearing of the tissue caused by adhesion of the compression face to the tissue;
  • Fig. 3 is a cross-sectional view of the proximal end of the
  • electrocauterization tool of Fig. 1 showing a first embodiment of the compression face having inward lips to attach to corresponding outward flanges of a support tube;
  • Fig. 4 is an end view of the proximal end of the support tube without the compression face showing slotted walls allowing inward compression of the flanges for snap retention of the compression face;
  • Fig. 5 is an elevational view of a handgrip attachable to a distal end of the support tube of Fig. 3 to control a plunger for ejection of the compression face upon completion of electrocauterization;
  • Fig. 6 is a perspective view of a compression face dispensing carrier used for rapid attachment of a compression face to the support tube of Fig. 3;
  • Fig. 7 is a cross-section along line 7—7 of Fig. 6 showing retention of the compression face by a detent ring in a flexible material of the carrier and a funnel shaped opening in the carrier, the latter used to help alignment of the support tube with the compression face during use; and
  • Fig. 8 is a figure similar to that of Fig. 3 showing an alternative embodiment providing multiple compression faces held within a support tube for sequential dispensing by incremental movement of an internal plunger.
  • an endoscope 10 may be threaded through the esophagus, for example, to a site 12 of a bleeding gastric ulcer to guide a flexible support tube 14 of the electrocauterization tool 15 to the site 12.
  • a compression face 16 attached over the proximal end of the support tube 14 of the electrocauterization tool 15 may be pressed against tissue 18 including a wall of a blood vessel 20 to compress the blood vessel 20 reducing bleeding therefrom.
  • the blood vessel 20 may be sealed by coagulum 22 which also adheres to the compression face 16. This latter adhesion creates the risk of tearing of the tissue (and reopening of the blood vessel 20) when the electrocauterization tool 15 is retracted.
  • the compression face 16 may be released from the support tube 14 upon completion of the cauterization and before retraction of the electrocauterization tool 15, substantially reducing the risk of tearing when the electrocauterization tool is retracted.
  • the compression face 16 may be a disk-shaped metal button whose peripheral edges curl rearward to provide radially inward lips 24.
  • the material of this compression face 16, for example, may be a bio-compatible stainless steel or other conductive material such as a conductive polymer or an insulator with channels supporting conductive material.
  • the inwardly extending lips 24 may capture corresponding outwardly extending flanges 26 on the proximal end of the support tube 14, the latter which may be an insulating material such as a thermoplastic or a conductive material.
  • a series of slots 28 may be cut axially into the proximal end of the support tube 14 and through the flange 26 to permit the flange 26 to move radially inward to release the compression face 16 as described above.
  • this release may be facilitated by an internal plunger 30 sliding axially within the support tube 14 at its proximal end.
  • the internal plunger 30 may communicate with a compression shaft 32 running the length of the support tube 14 to be manipulated from the distal end of the electrocauterization tool 15 by the physician as will be described below.
  • the internal plunger 30 may be conductive to provide a large area low resistance interface to the compression face 16 and maybe attached, by means of a coiled electrical conductor 33 within the support tube 14, to the
  • the electrocauterization power source 34 may be controlled, for example, by foot petal 36 and also communicates with a ground pad 38 attached to a patient's skin, as it is well known in the art.
  • the approximate diameter of the support tube 14 and thus the compression face 16 may be 2 mm.
  • the support tube 14 and thus the compression face 16 may have a diameter of approximately 5 mm.
  • the support tube 14 may be rigid rather than flexible as required by the endoscopic application.
  • the electrical conductor 33 and a compression shaft 32 at the distal end 44 of the electrocauterization tool 15 may be received by a handgrip 42.
  • the electrical conductor 33 may pass through the handgrip 42 to be received by a rear extending cable 46 to pass to the power source 34 described above.
  • the compression shaft 32 may be captured by a lever 48 within the handgrip 42, the lever 48 attached by a ratchet mechanism (not shown) to a pivoting trigger mechanism 50 within a handle 52 of the handgrip 42. Squeezing the trigger mechanism 50 allows a controllable incremental advance of the compression shaft 32, limited by interference between the trigger mechanism 50 and a stop 54 to precisely eject the compression face 16 upon completion of the electrocauterization process.
  • the proximal end of the support tube 14 may be inserted into a funnel-shaped cavity 58 and a carrier 56 constructed of a flexible material.
  • Each of the funnel-shaped cavities 58 opens at a front face of the carrier 56 and holds therein a single compression face 16 with the lips 24 oriented upwards toward open ends of the cavities 58.
  • the proximal end 40 of the electrocauterization tool 15 may be inserted into the cavities 58 guided by a funnel-shaped wall of the cavity 58 to engage the flanges 26 and lips 24, the engagement facilitated by a slight leading chamfer on the flanges 26.
  • the bottom of the cavities 58 may provide support to the compression face 16 preventing downward movement of the compression face 16 during disengagement process.
  • the support tube 14 may be removed bringing with it the compression face 16 released from a retaining groove along the inner wall of the cavity 58.
  • a front and rear chamfer of the proximal end of the support tube 14 may be adjusted so that the force required to attach the compression face 16 to the support tube 14 is less than the force required to disengage the compression face 16 from the support tube 14.
  • the proximal end 40 of the electrocauterization tool 15 may provide for inwardly extending flanges 60 to retain disk shaped convex compression faces 16'.
  • These compression faces 16' may have a periphery without lips 24 and may fit inside of the support tube 14 to be retained by the flanges 60.
  • Multiple compression faces 16' may be loaded, magazine- style, within the support tube 14 optionally separated axially by a spacer material 62 to permit sequential dispensing of individual compression faces 16 by an incremental movement of the plunger 30.
  • the spacer material 62 may, for example, be conductive wadding that is harmlessly discharged into the stomach (in the case of gastrointestinal use). Alternatively, the spacer material 62 may form part of the compression face 16 to be retained with the compression face 16 against the tissue as shown in Fig. 2.
  • the support tube 14 may be conductive to eliminate the need for a separate electrical conductor 33 or the electrical conductor 33 may provide for the ability to transmit compression (for example by tightly spaced coils) eliminating the need for the compression shaft 32.
  • the compression shaft 32 may be centered within the support tube 14 (for example with guides) to directly contact the compression face 16 without the need for plunger 30.
  • the compression face 16 may be retained, for example, by a frictional fit, a slide fit, an adhesive, or the like. It is necessary only that the compression faces 16 transmit current therethrough.
  • a compression face that is partly insulating but provides passages for current conduction therethrough may be possible.
  • Portions of the electrocauterization tool 15 may be treated with nonstick materials such as silicone, fluorocarbons or ceramics known in the art to further eliminate the possibility of adhesion to the electrocauterization tool 15 or the compression face 16.
  • Shapes of the compression faces 16 other than disks are clearly permissible within the scheme of the present invention.

Abstract

L'invention porte sur un instrument d'électro-cautérisation présentant une face de compression libérable pouvant être éjectée par l'instrument après la cautérisation afin d'empêcher lors du retrait de l'instrument d'électro-cautérisation la déchirure du tissu qui serait sinon provoquée par une adhésion du tissu à l'instrument.
PCT/US2010/060741 2009-12-29 2010-12-16 Instrument d'électro-cautérisation avec face de compression libérable WO2011081977A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US29067709P 2009-12-29 2009-12-29
US61/290,677 2009-12-29

Publications (1)

Publication Number Publication Date
WO2011081977A1 true WO2011081977A1 (fr) 2011-07-07

Family

ID=43617899

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US2010/060741 WO2011081977A1 (fr) 2009-12-29 2010-12-16 Instrument d'électro-cautérisation avec face de compression libérable

Country Status (1)

Country Link
WO (1) WO2011081977A1 (fr)

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP3106118A1 (fr) * 2015-06-12 2016-12-21 Covidien LP Instrument chirurgical avec micro-pointes interchangeables

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20020151889A1 (en) * 1994-10-07 2002-10-17 Swanson David K. Surgical method and apparatus for positioning a diagnostic or therapeutic element within the body
US20070129719A1 (en) * 2005-05-26 2007-06-07 Amar Kendale Apparatus and methods for performing minimally-invasive surgical procedures
US20090093809A1 (en) * 2007-10-05 2009-04-09 Anderson Evan R Devices and methods for minimally-invasive surgical procedures

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20020151889A1 (en) * 1994-10-07 2002-10-17 Swanson David K. Surgical method and apparatus for positioning a diagnostic or therapeutic element within the body
US20070129719A1 (en) * 2005-05-26 2007-06-07 Amar Kendale Apparatus and methods for performing minimally-invasive surgical procedures
US20090093809A1 (en) * 2007-10-05 2009-04-09 Anderson Evan R Devices and methods for minimally-invasive surgical procedures

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP3106118A1 (fr) * 2015-06-12 2016-12-21 Covidien LP Instrument chirurgical avec micro-pointes interchangeables

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