WO2022063788A1

WO2022063788A1 - Join-up loop wth camera for radiofrequency surgical removal of diseased tissue

Info

Publication number: WO2022063788A1
Application number: PCT/EP2021/075965
Authority: WO
Inventors: Johannes Roth
Original assignee: Johannes Roth
Priority date: 2020-09-22
Filing date: 2021-09-21
Publication date: 2022-03-31

Abstract

The present invention relates to a loop for radiofrequency surgical removal of diseased tissue from hollow organs of the body and for removal of all types of foreign bodies from hollow organs of the body, characterized in that the loop consists of two separate halves, a first loop half (A) and a second loop half (B), wherein the first loop half (A) and the second loop half (B) can, by closure of these two halves, be adapted to form a completely connected loop; and wherein at least one loop half (A, B) is additionally provided with a camera (E), via which a corresponding camera image can be transmitted to a monitor.

Description

Joinable sling with camera for high-frequency surgical removal of diseased tissue

The present invention relates to a snare for high-frequency surgical removal of diseased tissue from hollow body organs and for removing all types of foreign bodies from hollow body organs, the snare consisting of two adaptable halves and a camera being located on one snare half.

Loops for high-frequency surgical removal of diseased tissue from hollow body organs and for removing all types of foreign bodies from hollow body organs, also referred to as polypectomy loops, are known from the prior art and are, for example, in DE 20 2010 005 677 U1, DE 2009 036 158 A1 and EP2 959 855 B1.

So-called polypectomy snares are used to remove polyps (also called adenomas) and also foreign bodies from hollow body organs, in particular from the entire gastrointestinal tract.

Today, the diseased tissue is usually removed using the so-called mucosectomy technique. The diseased tissue (polyp) is first lifted after being injected with a NaCl solution. The polypectomy snare is then guided over the polyp to the base, with healthy raised tissue also being introduced into the snare in order to achieve safe removal in healthy (in sano) areas. After tightening the snare, the tissue to be removed is separated from the surrounding healthy tissue using high-frequency surgical current application and then recovered. Removal of such polyps is necessary because malignant tumors develop from these polyps over the years. In addition, large polyps can lead to acute bleeding, but over a longer period of time it can also lead to chronic anemia.

In the case of a wide variety of foreign bodies, such as batteries or spoons, which patients have accidentally or intentionally swallowed, these can be inserted laterally into the opening of the polypectomy snare in order to then retrieve them. This is often done in the upper gastrointestinal tract. The present invention is based on the problem that the polypectomy loops used according to the current state of the art (FIG. 1) have a loop (a) that is already completely closed when the loop is extended (FIG. 1), so that both a polyp as well as a foreign body must be introduced into this closed snare opening in order to separate the polyp or to recover the foreign body. This is often difficult for anatomical reasons, since, for example, the diseased tissue is located in an unfavorable place in the intestine, such as in the flexures of the large intestine or in the very tortuous course of the sigmoid. Another example is when, for example, there is a foreign body in the upper gastrointestinal tract such as in the fundus of the stomach or in the duodenum.

In addition, there is often no view of the rear (dorsal) portion of the loop due to the structure of the polyp itself located in front of it, which becomes increasingly important as the polyp grows in size. This view is made even more difficult by the healthy mucosa that is sprayed up as a result of the mucosectomy technique described above. In the case of so-called stalked polyps with a very large polyp head, it is also not always possible to guide the snare over the polyp head in order to place the snare up to the stalk base in order to then remove the polyp at its stalk base.

This results in the following additional problems:

When removing a pedicled polyp, it is often difficult to guide the polypectomy snare down over the often much larger polyp head to the base of the pedicle for removal. It is also possible that this is not possible at all for anatomical reasons (unfavorable position in the intestinal lumen) due to the size of a polyp head. Then the head of the polyp must first be partially removed and thus reduced in size, and then at the end of the removal the polypectomy snare is brought to the base of the polyp's stalk over the reduced head of the polyp in order to then remove it. This requires additional examination time, and the partial removal can also lead to bleeding complications with negative consequences for the patient, since, for example, the anesthesia is prolonged or circulatory problems with shock symptoms can occur due to bleeding, which induces the necessary administration of blood supplies.

However, the aforementioned problems of partial removal also arise in the case of a large number of polyps with a different growth morphology, for example in cauliflower-like growth of the polyps, but also in very large polyps (so-called giant adenomas).

When removing a polyp, the view of the rear (dorsal) side through the polyp is also limited due to the already mentioned different growth configurations, such as size or cauliflower-like growth, but also due to the anatomical location in the intestine, such as growth around intestinal folds itself not given.

This leads to other various problems. First, this can result in failure to insert the entire polyp into the snare opening, resulting in an incomplete resection. This necessitates removal of the polyp in several portions (so-called piece-meal resection), with corresponding disadvantages. If a polyp is resected in several portions, there is an increased recurrence rate, i.e. the polyp then has a higher percentage of chance of growing back at this point. Therefore, an en-bloc resection is aimed for, which of course is made more difficult if the rear (dorsal) side of the polyp cannot be seen. However, due to the lack of a dorsal view, it can also happen that too much tissue, and then possibly also healthy tissue that has been injected as described above and not diseased tissue, is introduced dorsally into the sling opening. This increases the risk of cutting a hole (perforation) in this tissue. The piece-meal resection also leads to a longer examination time with the aforementioned complications.

When removing foreign bodies, it is often not possible to open the polypectomy snare completely for anatomical reasons due to narrowed conditions (e.g. in the duodenum). This makes it more difficult to place the foreign body in the opening, which is then too small, of the primarily self-contained polypectomy loop. This in turn results in a prolonged examination time or makes it impossible to retrieve the foreign body.

A failed removal would then result in an operation with additional possible side effects for the patient.

It is therefore the object of the present invention to provide a sling with which the aforementioned disadvantages are eliminated. In particular, the object of the present invention is to provide a sling that also makes it possible to see the dorsal area of a sling. A further object is to provide a snare that enables the polyp or foreign body to be grasped and completely removed in one step, regardless of the shape.

The object is achieved by means of the present invention. The present invention provides a snare for high-frequency surgical removal of diseased tissue from hollow body organs and for removal of all types of foreign bodies from hollow body organs, characterized in that the snare consists of two separate halves, a first snare half and a second snare half, consists, wherein the first and the second sling halves can be adapted to form a completely connected sling by closing these two halves; and wherein a camera is additionally located on at least one half of the sling, via which a corresponding camera image can be transmitted to a monitor.

The sling according to the invention is particularly characterized in that it has primarily two separate halves (left and right) in the first step of opening. These primarily separated two halves of the newly developed polypectomy snare (FIGS. 2 (A) and (B)) can, for example, in the case of a polyp with a peduncle, be grasped directly on the left and right of its pedicle. The snare is then tightened further until the two ends connect, in order to then carry out the ablation. As a result, the entire closed polypectomy snare no longer has to be laboriously guided over the head of the polyp. A partial removal of the polyp head with the aforementioned negative consequences or the complete failure of such a removal is thus significantly minimized or no longer takes place. This significantly reduces the removal time. Foreign bodies can also be grasped directly (frontally) without first having to be inserted laterally into the opening of the primarily closed polypectomy snare (e.g. when retrieving a battery). Furthermore, the camera makes it possible on the one hand to provide a better visual view, in particular of the dorsal area of a polyp, for example, and on the other hand to facilitate the joining of the snare halves to form a snare. The snare according to the invention allows the tissue to be removed to be separated from the healthy surrounding tissue and recovered by means of high-frequency surgical current application after connecting the snare halves and then tightening the snare. The sling according to the invention comprises appropriate elements that enable the application of current.

Preferably, the first sling half and the second sling half can be moved independently of one another and/or the first sling half and the second sling half can be releasably connected to one another in order to form a sling.

Furthermore, the first snare half and the second snare half can be magnetically connected to one another in order to form a snare. The magnetic elements can be permanent magnetic elements or magnetic elements that can be activated, such as electromagnets. If electromagnets are used, this is referred to as an electromagnetic connection within the meaning of the invention. The first snare half and the second snare half can preferably be connected to one another magnetically or electromagnetically in order to form a snare.

This makes it possible for the loop halves to be connected either automatically when they are fed to one another, or for the connection to be connected to one another, in particular releasably, by activating an electromagnet.

The first snare half preferably has a first magnet, for example a permanent magnet or electromagnet, which is arranged at the distal end of the first snare half. This magnet can contact the distal end of the second snare half to form a snare. The second loop half preferably has a substance at the distal end that can enter into a detachable connection with the first magnet. This substance can consist, for example, of iron, cobalt, nickel and/or alloys containing the aforementioned metals.

More preferably, the first snare half has a first magnet disposed at the distal end of the first snare half and the second snare half has a second magnet disposed at the distal end of the second snare half, the first and second magnets being so configured that they connect to form a noose. Distal ends of the snare halves are the ends that form a snare by bringing them together and connecting (connecting).

Preferably only the distal end of one snare half is magnetic or electromagnetic. In this case, the distal end of the other half of the loop is included equipped with an element that allows interaction with the magnetic or electromagnetic end to form a loop. For example, this end contains iron, cobalt, nickel, alloys containing these metals, or a substance that interacts with a magnet or electromagnet.

In a further preferred embodiment, the first snare half has a hook at the distal end and the second snare half has a loop at the distal end, the hook and the loop being connectable to one another to form a snare.

Cylindrical thickenings are preferably present at the distal ends of the two halves of the snare, one end being open in the shape of a cup, so that the other end can fit into it with a precise fit. The cylindrically shaped ends of the two halves of the snare preferably have magnetic properties in order to ensure a precise connection.

In a preferred embodiment, the camera is arranged at the distal end of a snare half.

Furthermore, the camera preferably has a resolution of at least 10,000 pixels, preferably 20,000 pixels and more preferably 30,000 pixels.

In a further preferred embodiment, the camera comprises an image sensor which has dimensions of 1.5 mm×1.5 mm or smaller, preferably has dimensions of 1.0 mm×1.0 mm or smaller.

In one embodiment, the snare for the high-frequency surgical removal of diseased tissue from hollow body organs and for the removal of all types of foreign bodies from hollow body organs consists of two separate halves (left and right), which only become a completely connected one as these two halves increasingly close Adapt sling. Cylindrical thickenings are preferably present at the ends of the two halves of the sling, one end being open in the shape of a cup, so that the other end can fit into it with a precise fit. The cylindrically shaped ends of the two halves of the snare also preferably have magnetic properties in order to ensure the precise connection. More preferably, there is also a camera at one end of the sling, via which a corresponding camera image can be transmitted to a monitor. The above refinements, embodiments and developments can be combined with one another as desired, insofar as this makes sense. Further possible refinements, developments and implementations of the invention also include combinations of features of the invention described above or below with regard to the exemplary embodiments that are not explicitly mentioned. In particular, the person skilled in the art will also add individual aspects as improvements or additions to the respective basic form of the present invention.

1 shows the prior art of a polypectomy snare with a closed snare (a);

Fig. 2 Invention with the two separate snare halves, first snare half (A) and second snare half (B) and the cylindrical ends (C) and (D) in the open/extended state, with the second snare half (B) at the distal end (D ) is provided with a camera (E);

Fig. 3 invention with the two separate snare halves, first snare half (A) and second snare half (B) and the cylindrical ends (C) and (D) in the closed state, with the second snare half (B) at the distal end (D). the camera (E);

Fig. 4 invention with the two separate loop halves, first loop half (A) and second loop half (B) and the cylindrical ends (C) and (D) in the open, Fig. 4a, and closed state, Fig. 4b, shown, where the second loop half (B) is provided with the camera (E) at the distal end (D).

As already explained, FIG. 1 shows a polypectomy snare according to the prior art with a closed snare (a).

2 shows a sling according to the invention with a camera (E) in the open state. To ensure that the two parts of the snare, the first half (A) and the second half (B), connect exactly when the snare is tightened, there are cylindrical thickenings at the distal ends of the two snare halves, (C) and (D). Fig. 2 shows the sling in the open state, with one distal end being open in the shape of a cup (C), so that the other distal end (D) after the complete tightening of the sling can be adapted to fit in it. The camera (E) is located at the distal end (D) of the second half of the snare.

3 shows the sling according to the invention with a closed sling consisting of the connected sling halves (A) and (B) which are detachably connected to one another via the connections (C) and (D).

FIG. 4 shows the enlarged view of the distal ends (C) and (D) of the first snare half (A) and the second snare half (B) in the open state, FIG. 4a, and in the closed state, FIG. 4b Exact connection is necessary so that the circuit is closed in order to then be able to carry out the high-frequency surgical ablation. So that this necessary connection can be made more securely, it makes sense to equip the two cylindrically shaped ends (C, D) with magnetic properties, so that one thickened distal end (D) of the second half of the loop points in the exact direction of the cup-shaped end (Fig. 2- 4 (C)) can be found.

The problem of the lack of visibility of the dorsal side of a polyp, but also foreign bodies, is solved with the camera (E) as shown in Fig. 2-4 at the distal end (D) of one half of the snare, here the second half of the snare (B). The camera (E) is arranged at the distal end (D). The examiner can now see exactly how much and which tissue he has wrapped in the snare when removing a polyp. This facilitates complete removals. In particular, this also reduces the risk of perforation due to incorrect entanglement of healthy, non-injected intestinal wall on the dorsal portion of the polyp.

When rescuing foreign bodies, a camera (E) is also a relief if it is arranged appropriately on the sling, since it can be seen whether the foreign body has actually been completely grasped.

LIST OF REFERENCE NUMERALS a Closed loop according to the prior art

A first half of the loop

B second loop half

C Cylindrical cup-shaped formation at the distal end of the first half of the loop

D Cylindrical thickening at the distal end of the second loop half (B)

E Camera at the distal end (D) of the second half of the snare (B)

Claims

Claims snare for high-frequency surgical removal of diseased tissue from hollow body organs and for removing all types of foreign bodies from hollow body organs, characterized in that the snare consists of two separate halves, a first snare half (A) and a second snare half (B), the first (A) and the second sling half (B) being adaptable by closing these two halves to form a fully connected sling; and wherein a camera (E) is additionally located on at least one half of the sling (A, B), via which a corresponding camera image can be transmitted to a monitor. Sling according to Claim 1, characterized in that the first sling half (A) and the second sling half (B) can be moved independently of one another; and/or the first sling half (A) and the second sling half (B) are releasably connectable to each other to form a sling. Sling according to one of the preceding claims, characterized in that the first sling half (A) and the second sling half (B) can be connected to one another magnetically or electromagnetically in order to form a sling. Snare according to one of the preceding claims, characterized in that the first snare half (A) has a first magnet which is arranged at the distal end of the first snare half (A); or the first snare half (A) has a first magnet located at the distal end of the first snare half (A) and the second snare half (B) has a second magnet located at the distal end of the second snare half (B) is arranged, wherein the first and the second magnet are configured to connect to form a loop. Snare according to one of the preceding claims, characterized in that the first snare half (A) has a hook at the distal end and the second snare half (B) has a loop at the distal end, the hook and the loop being connectable to form a sling . Snare according to one of the preceding claims, characterized in that there are cylindrical thickenings at the distal ends of the two snare halves (A, B), one end being open in the shape of a cup (C) so that the other end (D) fits snugly can insert in it. Snare according to Claim 6, characterized in that the cylindrically shaped ends (C, D) of the two snare halves (A, B) have magnetic properties in order to ensure the precise connection. Snare according to one of the preceding claims, characterized in that the camera (E) is arranged at the distal end of one half of the snare. Sling according to one of the preceding claims, characterized in that the camera (E) has a resolution of at least 10,000 pixels, preferably 20,000 pixels and more preferably 30,000 pixels. Snare according to one of the preceding claims, characterized in that the camera (E) comprises an image sensor which has a dimension of 1.5 mm x 1.5 mm or smaller, preferably a dimension of 1.0 mm x 1.0 mm or has smaller.