WO2019238918A1

WO2019238918A1 - Resectoscope with longitudinally movably mounted irrigation sheath

Info

Publication number: WO2019238918A1
Application number: PCT/EP2019/065665
Authority: WO
Inventors: Martin Horn
Original assignee: Olympus Winter & Ibe Gmbh
Priority date: 2018-06-15
Filing date: 2019-06-14
Publication date: 2019-12-19
Also published as: DE102018114448A1

Abstract

The invention relates to a resectoscope for endoscopic surgery, comprising a tubular shank, which in turn comprises an elongated outer sheath and an inner sheath arranged in said outer sheath, and, next to the inner sheath, an irrigation sheath arranged in the outer sheath, an optical system being located in the inner sheath. The resectoscope is characterized in that the irrigation sheath is longitudinally movably mounted in the outer sheath.

Description

Resectoscope with flush-mounted irrigation tube

background

The invention relates to a resectoscope of the type mentioned in the preamble of claim 1. Resectoscopes of the generic type are used primarily in urology for surgical work in the bladder and in the ureter. They are usually used for resection and vaporization of tissue, for example tissue in the lower urinary tract. For this purpose, the resectoscopes comprise a longitudinally displaceable electrosurgical passage instrument which, after the resectoscope has been inserted, with its distal working end out of the distal end of the shaft tube of the

Resectoscope can be pushed out. The electrosurgical passage instrument can comprise an electrosurgical electrode in the form of a loop or plasma button at its distal working end. Examples of such instruments are the OES PRO resectoscopes (Olympus).

The instruments contain an optical system by means of which the site of the intervention can be monitored during the operation. In order to flush away any local bleeding that occurs during the procedure and to protect the tissue from heat damage due to the high-frequency electrosurgical application, the resectoscopes are equipped with a rinsing device that permanently rinses the tissue lying in front of the distal end of the shaft. In conventional irrigation devices, irrigation fluid is continuously passed through an inner shaft and emerges at the distal end of the resectoscope. The backflow of the rinsing liquid usually occurs through a gap between the inside and Outer shaft. The outer shaft has numerous rinsing holes for liquid absorption.

The short distance between the liquid escaping from the inner tube and the resumption of the liquid on the outer tube can result in turbulence, which can impair the view of the medical personnel at least briefly on the area of intervention. For this reason, in some cases, the gap between the outer tube and the inner tube of the resectoscope is not used for liquid suction, but instead a separate suprapubic overflow regulator is used, which must be introduced invasively through the abdominal wall into the bladder. Due to the greater distance between the liquid outlet and the absorption, the rinsing liquid can flow without swirling, so that no bleeding is swirled in front of the optics. However, since this procedure requires invasive puncture of the abdominal wall, it is associated with a higher risk and a longer regeneration time. There is therefore a need for non-invasive procedures that circumvent the problem of fluid vortexing before optics.

Another disadvantage of the usual resectoscopes is the rinsing bores arranged in the distal end area of the outer shaft, which entail an increased risk of injury. It would be desirable to be able to make the outer shaft more atraumatic without flushing holes, and thus to prevent potential strictures, for example.

description

This object is achieved by a resectoscope with the features of claim 1. In particular, the object is achieved by using a rinsing tube which can be displaced longitudinally in the resectoscope shaft and which, after insertion of the distal end of the resectoscope, can be pushed to the point of intervention in the distal direction beyond the end of the cladding tube.

In a first aspect, the invention thus relates to a resectoscope for endoscopic surgery with a tubular shaft which comprises an elongate cladding tube and an inner tube arranged in the cladding tube and an irrigation tube arranged in the cladding tube next to the inner tube, an optical system being arranged in the inner tube , characterized in that the flushing tube is mounted in the jacket tube so as to be longitudinally displaceable. Holes can optionally be arranged in a wall of the distal end region of the irrigation tube. Because the backflow of the flushing liquid no longer occurs according to the invention via the gap between the outer and inner shaft, but rather via the extendable flushing tube, the flushing liquid flows away from the instrument in a uniform manner, similar to the use of a suprapubic overflow regulator. Turbulence in front of the optics is thus reduced to a minimum. Furthermore, according to the invention, there is no need to provide the distal end of the cladding tube with flushing bores. It is therefore preferred that the cladding tube of the resectoscope according to the invention has no rinsing holes. The cladding tube is therefore more atraumatic than comparable cladding tubes in conventional resectoscopes.

The resection system according to the invention is particularly suitable for prostate resection, since particularly heavy bleeding can occur here. At the same time, the resectoscope can also be used for a variety of other operations, such as bladder resections. The length by which the irrigation tube is pushed beyond the distal end of the cladding tube can be adapted to the anatomical conditions and the operating conditions.

In the usual embodiment, the resectoscope has a tubular shaft. In addition to this shaft part, the resectoscope for holding and operating comprises a handle system, which usually consists of two handle parts.

The endoscope shaft comprises an elongated cladding tube. An inner tube is arranged in the interior of the cladding tube. A flushing tube is arranged radially next to the inner tube in the interior of the cladding tube. In other words, the inner tube and the flushing tube pass through the cladding tube next to one another. It is particularly contemplated that the irrigation tube is arranged above a transverse plane of the resectoscope. In a spatial orientation, a resectoscope can be divided into different areas by a transverse plane that intersects the shaft tube in the longitudinal direction and horizontally and a sagittal plane that is perpendicular to the transverse plane, the longitudinal axis of a shaft tube lying both in the sagittal plane and in the transverse plane. The transverse plane cuts the shaft tube transversely and in a position of use of the resectoscope in a horizontal orientation and the sagittal plane cuts the shaft tube vertically and in a position of use of the resectoscope in a vertical orientation. The sagittal plane can in particular lie parallel to a movement plane which is described in the case of a relative movement of, for example for the actuation of a slide of the resectoscope, pivotally mounted handle parts on the resectoscope. In a particularly preferred embodiment, the irrigation tube is arranged in a 12 o'clock position above the inner tube, so that the longitudinal axis of the irrigation tube lies in the sagittal plane of the resectoscope. In addition, it is advantageous if the longitudinal axis of the inner tube also lies in the sagittal plane of the resectoscope.

The inner tube will usually include various components that are common in resectoscopes. This includes the optics and an electrode tool, both of which pass through the inner tube. The shaft preferably has an electrode tool arranged in the interior of the inner tube, the electrode tool in particular comprising a cutting loop. Alternatively, the electrode tool can also comprise a plasma button or another electrosurgical cutting tool at its distal end. By separating these working components running inside the inner tube from the rest of the inside of the cladding tube, the components are protected against mechanical stress. In addition, it is contemplated to make the inner tube rotatable about its longitudinal axis in the usual manner. By rotating the inner tube, the optics and electrode tool can be brought into a working position more precisely at the point of intervention and, if necessary, rotated. The inner tube is therefore preferably rotatably mounted in the cladding tube.

So that the medical specialist has a clear view of the area to be treated during the treatment via the optics, a rinsing liquid is guided through the shaft into the interior of the body during the procedure. This rinsing liquid can be used, for example, to wash away pieces of tissue that are released during resectoscopy. Furthermore, the rinsing liquid serves to remove cloudiness, for example caused by blood, from the field of view of the optics. The rinsing liquid is preferably supplied to the inside of the body through an inflow through the inner tube. The contaminated rinsing liquid is drained through a drain element. According to the invention, this drainage element is formed by a flushing pipe. Correspondingly, the irrigation tube is inserted in order to have irrigation and / or body fluids flowing through it, preferably in the proximal direction. For this purpose, holes (flushing bores) can be formed in a wall of the distal end region of the flushing tube. The flushing liquid can be removed or sucked off into the flushing pipe through the holes. Alternatively, however, an outflow of the liquid through the open distal end of the flushing tube can also be sufficient, so that alternative embodiments without flushing holes in a wall of the flushing tube are conceivable. A rinsing device or a pump can be assigned to the proximal end of the resectoscope or the shaft, so that the rinsing liquid can first be introduced into the interior of the body at a predetermined pressure. As a rule, excess liquid will run off spontaneously through the flushing pipe. However, it is also possible to ensure the drainage by applying a slight negative pressure to the flushing pipe.

For good visual conditions during the operation, it is essential that the irrigation liquid forms a laminar flow when it enters the body cavity, which flow is at least almost parallel to a longitudinal axis of the shaft or an optical axis of the optics and permits visual inspection of the extended electrode. As soon as the flushing liquid does not flow in a laminar or even turbulent manner, the view through the optics can become so poor that an operation cannot be carried out. For this purpose, according to the invention, the flushing tube is mounted in a longitudinally displaceable manner in the cladding tube. The distal end region of the irrigation tube can thus be displaced beyond the distal end of the cladding tube after the instrument has been inserted atraumatically into the body of a patient. It is preferred that the irrigation tube can be pushed at least 2 cm, for example at least 3 cm, beyond the distal end of the cladding tube.

In order to ensure the longitudinal displacement of the flushing tube, the flushing tube, for example in its proximal end region, can be designed to be telescopically extendable and insertable. In this embodiment, the rinsing tube is constructed in several parts, for example from a plurality of sub-elements which can be pushed into one another. The sub-elements are axially displaceable relative to one another, i.e. they can be moved back and forth in the axial direction. Appropriate systems are known to those skilled in the art. It is understood that the system of sub-elements is liquid-tight against the exterior of the flushing pipe. Alternatively, however, it is also conceivable for the proximal end region of the flushing tube to be flexible, for example tubular. Such a flexible end region can be pulled out of the resectoscope, for example the main body of the resectoscope, and inserted again.

For a safe guidance of the flushing tube within the cladding tube, according to a preferred embodiment it is contemplated that the cladding tube has at least one guide device along its inner wall, which receives the flushing tube in a longitudinally displaceable manner. The rinsing tube can, for example, be clamped between the inner wall of the cladding tube and one or more holding elements formed in the inner wall of the cladding tube. Thus, the inner wall of the cladding tube preferably one or more, preferably at least two, holding elements. The holding elements support the irrigation tube and possibly also the inner tube against movements transverse to the longitudinal axis of the resectoscope. This means that the holding elements secure the flushing pipe and possibly also the inner pipe at least in regions against lateral evasion. For this purpose, the holding elements can be designed, for example, as protuberances on the inner wall of the cladding tube, the protuberances preventing movements of the flushing tube transversely to the longitudinal axis and extending parallel to the longitudinal axis of the shaft. The flushing pipe is thus clamped in the transverse direction. In order to prevent movements of the flushing tube transversely to the longitudinal direction of the shaft, the holding elements can, for example, essentially fill the space in the interior of the cladding tube outside the inner tube and the flushing tube. It goes without saying that the free rotation of the inner tube and the longitudinal displacement of the flushing tube are not impaired by the holding elements.

The resectoscope also has an actuation system by means of which the irrigation tube can be moved axially in the distal and proximal directions. The actuation system will generally be arranged at least partially on the handle or main body of the resectoscope. The actuation system can include, for example, conventional slide controls, lever systems and / or rotary controls. Thus, in one embodiment, the actuation system can comprise a slider that is displaceable in the longitudinal direction and the longitudinal displacement of which is transferred directly into a longitudinal displacement of the flushing pipe. Alternatively, the actuation system can comprise a lever system, a force being exerted on the flushing pipe in the axial direction via a lever arm. Finally, it is also conceivable to provide the actuation system with a rotary wheel for actuation. The rotary wheel can, for example, around the main body of the resectoscope, i.e. be rotatable about the longitudinal axis of the resectoscope. The rotary movement can be transferred into a longitudinal displacement of the flushing pipe via a corresponding thread. Experts are able to implement and design these and other suitable actuation mechanisms.

According to the invention, the cross section of the cladding tube will generally have an oval shape, since the flushing tube and inner tube are arranged next to one another. Nevertheless, the outer diameter of the shaft is comparable to the outer diameters of known resectoscopes, since the gap between the inner tube and the cladding tube, which was required in the prior art for the backflow of the rinsing liquid, can be dispensed with. According to the invention, it is preferred that the inner wall of the cladding tube in sections adjacent to the outer wall of the inner tube. Of course, this also should not impair the free rotatability of the inner tube, so that minimal distances required for the free rotatability can be provided between the inner tube and the inner wall of the cladding tube. The inner tube will generally have an essentially round cross section.

In order to adapt the flushing tube to the shape specifications of the cladding tube and the inner tube in a space-saving manner, it is preferred that the flushing tube has a cross section with a convexly curved section and a concave-curved section, i.e. a cross section in sickle shape. The sickle shape preferably has rounded corners or tips. The concave section - the inside of the sickle shape - preferably borders at least in sections on the outer wall of the inner tube. Where the concave section does not adjoin the inner tube, the flushing tube can adjoin the holding elements described elsewhere.

The various tubes of the shaft, namely the cladding tube, the flushing tube and the inner tube, can be made of different materials. Suitable materials are known to those skilled in the art. It is preferred that the rinsing tube is made of plastic, for example made of polyether ether ketone (PEEK).

In order to facilitate cleaning and assembly of the resectoscope, the irrigation tube can be designed for single use ("single-use") and can be disposed of accordingly after its use. In this way, the use of contaminated or damaged rinsing pipes is completely ruled out and instrument assembly is simplified as much as possible.

Brief description of the figures

Exemplary embodiments of the invention are shown schematically in the drawings. Show it:

Figure 1 is a schematic side view of a resectoscope according to the invention, in which the irrigation tube for inserting the instrument is retracted to the site of engagement in the shaft. FIG. 2 shows a schematic side view of the resectoscope from FIG. 1, in which the irrigation tube is pushed distally in the longitudinal direction of the shaft beyond the distal end of the cladding tube;

Figure 3 is a schematic cross-sectional view taken along line 2-2 in Figures 1 and 2; and

4 shows a schematic, perspective view of the distal end region of the resectoscope according to the invention from FIG. 2.

embodiments

Further advantages, characteristics and features of the present invention will become clear in the following detailed description of exemplary embodiments with reference to the attached drawings. However, the invention is not restricted to these exemplary embodiments.

1 and 2 show highly schematic side views of a resectoscope 10 according to the invention, in which the rinsing tube 18 for withdrawing the instrument is retracted into the shaft 12 (FIG. 1) or distally in the longitudinal direction of the shaft 12 via the distal end of the shaft 12 Cladding tube 14 is pushed out (Fig. 2). The resectoscope 10 comprises a shaft 12 which has a cladding tube 14. A rinsing tube 18 and an inner tube 16 run inside the cladding tube 14.

The flushing pipe 18 is arranged to be longitudinally displaceable in the cladding pipe 14 and is protected against transverse displacements by holding elements 36, 38 (not shown here) (see FIG. 3). The flushing tube 18 can be moved axially in the distal and proximal direction by an actuating mechanism, not shown here, in a positively guided manner. As shown in FIG. 2, it can be pushed over the distal end of the cladding tube 14. The flushing tube 18 has holes 24 in its distal end region, which are provided as flushing openings. The washing liquid and other liquids can be sucked into the washing pipe 14 through the holes 24. For this purpose, a vacuum can be applied to the flushing pipe 14. Alternatively, the liquid can flow off the flushing pipe 14 without applying a vacuum. In its proximal end region 32, the flushing tube 23 is designed to be telescopically extendable in a manner not shown. The inner tube 16 is mounted rotatably about its longitudinal axis in the cladding tube 14 and is traversed by a rod-shaped lens 20 and an electrode tool 40. An embodiment is shown in which the electrode tool 40 and the optics 20 protrude slightly beyond the distal end of the cladding tube 14. In this regard, however, a large number of variations are conceivable. The inner tube 16 and the flushing tube 18 can, as shown, be made somewhat shorter than the cladding tube 14 or the same length or longer. The electrode tool 40 has a cutting loop 42 at its distal end, by means of which tissue can be removed by electrosurgical ablation. Here, a high-frequency electrical voltage is applied to the cutting loop 42 in order to cut tissue.

An eyepiece or alternatively a camera for displaying the treatment area can be arranged at the proximal end of the optics 20. At the distal end of the optics 20, this has, for example, a lens, not shown, which is directed towards the area to be operated. An electronic sensor, such as a CCD chip, can also be assigned to the optics 20.

The resectoscope 10 shown has a passive transporter in which the slide 52 is displaced in the distal direction against the distal, first handle part 44 by a relative movement of the handle parts 44 and 46 arranged proximally from the shaft 12 against a spring force applied by a spring bridge 48. When the carriage 52 is displaced in the distal direction against the handle 44, the electrode tool 40 and / or the optics 20 are positively guided to the distal in a manner not shown. When the handle parts 44, 46 are relieved, the spring force generated by the spring bridge 48 forces the slide 52 back into its rest position, the shaft 12 and thus also the electrode tool 40 and / or the optics 20 being pulled in the proximal direction. When the carriage 52 is moved back, an electrosurgical intervention with the electrode tool 40 can be carried out without manual operator force, that is to say passively.

3 shows a schematic cross-sectional view of the shaft 12 along the line 2-2 in FIGS. 1 and 2. It can be seen that the cladding tube 14 has an inner wall with holding elements 36, 38 which are formed from protuberances of the inner wall. The holding elements 36, 38 each extend over the length of the shaft 12 in the longitudinal direction and prevent movements of the flushing tube 18 transversely to the longitudinal direction of the shaft 12. The flushing tube 18 has a crescent-shaped cross section with a convexly curved section 26 and a concavely curved section 28. The Correspondingly, flushing pipe 18 has a concave and a convex side. The sickle tips adjoin the holding elements 36, 38.

In the direction of the transverse plane T, the inner tube 16, which is enclosed on more than 50% of its surface by the inner wall 34 of the cladding tube 14, then lies on the concavely curved side of the flushing tube 18. The inner tube 16 comprises the optics 20 and an electrode tool 40 in the manner described elsewhere.

FIG. 4 shows a schematic, perspective view of the distal end region of the resectoscope according to the invention from FIG. 2. The distal end region 23 of the irrigation tube 18 is pushed distally over the cladding tube 14. The arrow marking in the figure indicates that the irrigation tube 18 is reversibly displaceable in the distal or proximal direction. The flushing tube 18 has holes 24 in its distal end region, which are designed as flushing openings. Through the flushing openings, the backflow of the flushing liquid and any contamination of this liquid takes place during an operation. A holding element 36 can also be seen, which stabilizes the flushing pipe 18 during a longitudinal displacement.

A ceramic tip 50 in the form of an annular end piece is permanently assigned to the inner tube 16, which is not visible here. This ceramic tip 50 is used for the electrical insulation of the working instrument against the cladding tube 14. A formation of the end piece from plastic is also conceivable.

Although the present invention has been described in detail with reference to the exemplary embodiments, it is self-evident to the person skilled in the art that the invention is not restricted to these exemplary embodiments, but rather that modifications are possible in such a way that individual features are omitted or other combinations of the individual features presented are realized can, provided that the scope of protection of the appended claims is not left. The present disclosure includes all combinations of the individual features presented.

Reference list resectoscope

shaft

cladding tube

inner tube

flush pipe

optics

Wall of flushing pipe

distal end area of irrigation tube

holes

convex section

concave section

Outer wall inner tube

proximal end area of flushing pipe

Inner wall of cladding tube

retaining element

electrode tool

cutting loop

First handle part

Second handle part

spring bridge

ceramic tip

carriage

transverse plane

sagittal plane

Claims

claims

1. resectoscope (10) for endoscopic surgery with a tubular shaft (12), which has an elongated cladding tube (14) and an inner tube (16) arranged in the cladding tube (14) and an in the cladding tube (14) next to the inner tube ( 16) arranged flushing tube (18), wherein an optic (20) is arranged in the inner tube (16), characterized in that the flushing tube (18) in the cladding tube (14) is mounted for longitudinal displacement.

2. resectoscope (10) according to claim 1, characterized in that the

Cross section of the cladding tube (14) has an oval shape.

3. Resectoscope (10) according to one of claims 1 or 2, characterized in that the rinsing tube (18) has a cross section with a convexly curved section (26) and a concavely curved section (28).

4. resectoscope (10) according to any one of the preceding claims, characterized in that the concavely curved section (28) adjoins the outer wall (30) of the inner tube (16).

5. resectoscope (10) according to any one of the preceding claims, characterized in that the rinsing tube (18) in its proximal end region (32) is telescopically extendable and insertable.

6. resectoscope (10) according to any one of the preceding claims, characterized in that the inner tube (16) in the cladding tube (14) is rotatably mounted.

7. resectoscope (10) according to any one of the preceding claims, characterized in that the inner wall (34) of the cladding tube (14) has holding elements (36, 38) which the inner tube (16) and the irrigation tube (18) against movements transverse to Support the longitudinal axis of the shaft (12).

8. resectoscope (10) according to any one of the preceding claims, characterized in that the cladding tube (14) has no rinsing holes.

9. resectoscope (10) according to any one of the preceding claims, characterized in that the irrigation tube (18) is made of plastic.

10. Resectoscope (10) according to any one of the preceding claims, characterized in that the shaft (12) has an electrode tool (40) mounted in the interior of the inner tube (16), the electrode tool (40) in particular comprising a cutting loop (42).