WO2024003421A1 - Guide for a medical instrument, assembly comprising a guide and such an instrument, and installation comprising such an assembly - Google Patents

Guide for a medical instrument, assembly comprising a guide and such an instrument, and installation comprising such an assembly Download PDF

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Publication number
WO2024003421A1
WO2024003421A1 PCT/EP2023/068265 EP2023068265W WO2024003421A1 WO 2024003421 A1 WO2024003421 A1 WO 2024003421A1 EP 2023068265 W EP2023068265 W EP 2023068265W WO 2024003421 A1 WO2024003421 A1 WO 2024003421A1
Authority
WO
WIPO (PCT)
Prior art keywords
guide
orifices
orifice
support
slot
Prior art date
Application number
PCT/EP2023/068265
Other languages
French (fr)
Inventor
Caroline BERTRAND
Eric GAUDARD SURLIUGA
Antoine Leroy
Original Assignee
Koelis
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 Koelis filed Critical Koelis
Publication of WO2024003421A1 publication Critical patent/WO2024003421A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
    • A61B10/02—Instruments for taking cell samples or for biopsy
    • A61B10/0233—Pointed or sharp biopsy instruments
    • A61B10/0241—Pointed or sharp biopsy instruments for prostate
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3403—Needle locating or guiding means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3403—Needle locating or guiding means
    • A61B2017/3405—Needle locating or guiding means using mechanical guide means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3403—Needle locating or guiding means
    • A61B2017/3405—Needle locating or guiding means using mechanical guide means
    • A61B2017/3411—Needle locating or guiding means using mechanical guide means with a plurality of holes, e.g. holes in matrix arrangement
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3403—Needle locating or guiding means
    • A61B2017/3413—Needle locating or guiding means guided by ultrasound

Definitions

  • the invention aims in particular to provide a guide which makes it easier to act on the targeted organ.
  • the invention also relates to a set of a guide and an associated instrument.
  • the invention also relates to an installation comprising such an assembly.
  • a set of a guide and a medical instrument comprising: - a base intended to be carried by a device comprising a medical imaging probe associated with the medical instrument, and - a support extending the base and in which at least one column is provided comprising at least one orifice, the column extending along a first axis, the medical instrument being able to extend through at least the orifice between a proximal face and a distal face of the support.
  • the orifice is shaped like a slot and/or only extends over only part of the support between the distal face and the proximal face of the guide so that the guide allows a clearance of at least one part of the medical instrument relative to the distal face of the support along at least one axis of movement which is inclined or orthogonal to the first axis.
  • the invention allows the instrument to be guided since the walls of the orifice restrict the movements of the instrument, while allowing clearance at the level of the distal face of the support which allows an operator to be able to act more easily on a targeted organ (such as for example and without limitation a prostate).
  • the term “slit” means a narrow opening stretched in a particular direction.
  • the medical instrument is a needle.
  • the orifice has a section which widens or narrows between the proximal face and the distal face of the guide.
  • the orifice opens at its distal end in a slot provided in the support so that the slot itself opens at the level of the distal face of the guide.
  • the assembly has several orifices.
  • several orifices open into said slot.
  • the orifice makes it possible to lock in position at least one portion of the instrument.
  • the invention also relates to a guide of an assembly as mentioned above.
  • the invention also relates to an assembly as mentioned above as well as an apparatus comprising a medical imaging probe.
  • FIG. 1 Figure 1 schematically represents an installation according to a particular embodiment of the invention, acting on a patient;
  • Figure 2a Figure 2a is a guide according to a first option of the installation illustrated in Figure 1;
  • Figure 2b Figure 2b is a rear view of the guide illustrated in Figure 2a;
  • Figure 3a Figure 3a is a schematic cross-sectional view of a part of a guide according to a second option of the installation illustrated in Figure 1;
  • Figure 3b is a schematic view in axial section of the guide part illustrated in Figure 3a; [Fig. 4a] Figure 4a is a three-dimensional view of a guide according to a third option of the installation illustrated in Figure 1; [Fig. 4b] Figure 4b is a sectional view of the guide shown in Figure 4a; [Fig. 5a] Figure 5a is a three-dimensional view of a guide according to a fourth option of the installation illustrated in Figure 1; [Fig. 5b] Figure 5b is a sectional view of the guide shown in Figure 4a; [Fig. 6] Figure 6 is a guide according to a fifth option of the installation illustrated in Figure 1; [Fig.
  • Figure 7 is a guide according to a sixth option of the installation illustrated in Figure 1, instruments being shown arranged in said guide;
  • Figure 8 is a guide according to a seventh option of the installation illustrated in Figure 1.
  • Figure 1 illustrates an installation 1 according to a first embodiment of the invention.
  • the installation 1 also comprises a control device 2 generally extending longitudinally along an axis Z in order to facilitate its insertion into a rectum of a patient.
  • the device 2 comprises a base 3, extending parallel to the axis Z, which is intended to be grasped at its proximal end by an operator and which is extended at its distal end by a recess 4 of the device 2.
  • Said recess 4 is itself even extended by a medical imaging probe 5 of the device 2 to allow the generation of three-dimensional images of the prostate 100 and its environment, probe 5 also extending along the Z axis. so, the device 2 is more easily manipulated by the operator due to the recess 4.
  • the installation 1 can include a system for co-manipulating the device 2, linked to the The proximal end of the device 2.
  • the co-manipulation system is for example a robot, an articulated arm, etc.
  • the probe 5 is here an ultrasound probe which is therefore intended to be introduced into the rectum of the patient. This application is of course not restrictive and the installation can be used with other types of imaging, ie other types of probes.
  • the installation 1 includes a guide 10 secured to the device 2. More precisely here, the guide 10 is carried by the probe 5.
  • the guide 10 is therefore arranged on the device 2 downstream of the recess 4 (according to one direction going from base 3 to probe 5).
  • the guide 10 is slidably mounted on the probe 5 (for example along the Z axis) in order to be able to modify its position with respect to the patient.
  • the guide 10 thus comprises a base 11 which is the attachment part to the device 2 and a support 12 extending the base 11 and in which is provided at least one column 13 comprising at least one orifice 14 (only one being referenced at Figure 1), the column 13 extending along a second axis X which is orthogonal to the axis Z.
  • the guide 10 is in the form of a post.
  • the guide 10 thus comprises a single column 13 with at least one orifice 14 extending along the axis X.
  • the guide 10 is a needle guide and the medical instrument of the installation 1 is therefore a needle 6.
  • the guide 10 is thus shaped so that the needle 6 can extend through each of the orifices 14 (or the single orifice 14) of the column 13 between a proximal face 15 (i.e. that closest to an operator holding the device 2) and a distal face 16 of the support 12 (i.e. that closest to the patient).
  • the needle 6 can thus be inserted into the guide 10 at a different height (along the axis X) which makes it possible to define the height at which the needle 6 is inserted into the perineum.
  • guide 10 includes graphic markers (graduations, alphanumeric characters, etc.) to identify the potential different orifices 14 of column 13.
  • guide 10 includes letters to identify each orifice 14.
  • the different orifices 14 are for example all identical to each other.
  • the guide 10 also includes a groove 7 formed in the base 11 and/or the support 12.
  • This groove 7 makes it possible, in use, to pass an additional instrument through the guide 10 (instrument of larger dimensions than the medical instrument passed through one of the orifices 14) such as for example a pipe for inflating an endocavitary balloon.
  • the groove 7 can be centered in the guide 10 relative to the column 13 or can be offset in the guide 10 relative to the column 13.
  • the groove 7 has a larger section than the section of the orifices 14 at the level of the proximal face 15 of the support 12.
  • the groove 7 has for example an at least partially circular section .
  • the guide 10 may also not include such a groove 7.
  • the guide 10 allows movement of at least part of the medical instrument relative to the distal face 16 of the support 12 according to at least one axis of movement which is inclined or orthogonal to the axis along at least one axis of movement Y which is orthogonal to the axis is orthogonal to the two-dimensional acquisition plane of the probe 5.
  • the medical instrument remains visible on the ultrasound image provided to the operator while being able to be moved relative to the distal face 16 of the support 12.
  • the ultrasound plane here includes the Z axis and the X axis. Different options of the guide 10 are thus considered (it being understood that what has been said above is applicable to the different options indicated below).
  • the column 13 comprises a plurality of orifices 14.
  • the different orifices 14 (only one being referenced here) all extend rectilinearly parallel to each other and to the Z axis.
  • the different orifices 14 all open at their proximal end on the proximal face 15 of the support 12 and at their distal end 16 in a slot 17 common to at least two orifices 14, and here to all the orifices 14.
  • the orifices 14 have the same section over their entire length (considered along the Z axis).
  • Slot 17 has the same section over its entire length (considered along the Z axis).
  • Said slot 17 is itself formed in the support 12 so as to open out at the distal face 16 of the support 12.
  • the slot 17 is for example of oblong section.
  • the slot 17 is arranged so as to form an opening stretched parallel to the axis opposite the distal face 16 of the support 12 around the aforementioned axis Y of movement.
  • This clearance is preferably between 5 and 15 degrees, and preferably between 8 and 12 degrees and preferably between 9 and 11 degrees and is preferably 10 degrees.
  • the guide 10 is thus less permissive at its proximal face 15 than at its distal face 16.
  • the column 13 has a single orifice 14.
  • Said orifice 14 extends rectilinearly parallel to the axis Z.
  • the orifice 14 opens at its proximal end on the proximal face 15 of the support 12 and at its distal end on the distal face 16 of the support 12.
  • the orifice 14 has the same section over its entire length.
  • the orifice 14 is shaped into a slot 17.
  • the slot 17 is for example of oblong section.
  • the slot 17 is arranged so as to form an opening stretched parallel to the axis of the medical instrument.
  • the guide 10 is thus as permissive at its proximal face 15 as at its distal face 16.
  • the column 13 has a single orifice 14. Said orifice 14 s 'extends rectilinearly parallel to the axis Z.
  • the orifice 14 is shaped into a first slot 17.
  • the first slot 17 is for example of oblong section.
  • the first slot is arranged so as to form an opening stretched parallel to the axis substantially equal to that of the medical instrument.
  • the orifice 14 opens at its proximal end onto the proximal face 15 of the support 12 and at its distal end 16 into a second slot 18.
  • the orifice 14 has the same section over its entire length (considered according to the Z axis).
  • the second slot 18 has the same section over its entire length (considered along the Z axis).
  • the second slot 18 is itself formed in the support 12 so as to open out at the distal face 16 of the support 12.
  • the second slot 18 is for example of oblong section.
  • the second slot 18 is arranged so as to form an opening stretched parallel to the axis other (and here parallel to the Z axis).
  • the second slot 18 has a length (considered along the Z axis) greater than that of the first slot 17.
  • the two slots have the same length or the first slot 17 has a greater length than the second slot 18.
  • the first slot 17 has a larger section than the second slot 18.
  • the guide 10 is thus more permissive at its proximal face 15 than at its distal face 16.
  • a variant of this third option consists in the second slot 18 having a section of larger dimension than the first slot 17. The guide 10 will then be less permissive at its proximal face 15 than at its distal face 16.
  • the column 13 comprises a plurality of orifices 14 (only one being referenced here).
  • the different orifices 14 all extend rectilinearly parallel to each other and to the axis Z.
  • the different orifices 14 all open at their proximal end on the proximal face 15 of the support 12 and at their distal end in slot 17 common to at least two orifices 14, and here to all the orifices 14.
  • the orifices 14 have the same section over their entire length (considered along the Z axis).
  • Slot 17 has the same section over its entire length (considered along the Z axis).
  • Said slot 17 is itself formed in the support 12 so as to open out at the distal face 16 of the support 12.
  • the slot 17 is for example of oblong section.
  • the slot 17 is arranged so as to form an opening stretched parallel to the axis X.
  • the orifices 14 have a larger section than that of the first option.
  • the orifices 14 thus have a section allowing a portion of the medical instrument to be accommodated in each of the orifices 14.
  • the proximal end thereof can form a plate in a different material than that of the needle. It is therefore at least a portion of this plate which could be received in the orifice 14.
  • At least one of the orifices is thus shaped so that the section of the orifice 14 is substantially equal to that of said portion of the medical instrument.
  • the orifice 14 blocks (for example by friction) said portion of the instrument in the orifice 14.
  • the medical instrument will thus not or barely be able to move relative to the proximal face 15 of the support 12 due to its blocked portion.
  • the free end of the medical instrument will be able to struggle due to the fact that the length of the medical instrument is much greater than that of the slot 17.
  • the guide 10 will then be less permissive at the level of its proximal face 15 than at the level of its distal face 16.
  • the column 13 has at least one orifice 14.
  • the orifice 14 extends rectilinearly parallel to the axis Z.
  • the orifice 14 opens at its proximal end on the proximal face 15 of the support 12 and at the level of its distal end on the distal face 16 of the support 12.
  • the orifice 14 has a section which narrows or increases between its proximal end and its distal end (depending on whether it is desired for the guide 10 to be more permissive or less permissive at the level of its proximal face 15).
  • the orifice 14 is shaped into a slot 17.
  • the slot 17 is for example of oblong section.
  • the column 13 comprises a first column of orifices 14a and a second column of orifices 14b.
  • the different orifices 14a of the first column all open at their proximal end onto the proximal face 15 of the support 12 and at their distal end in a slot 17 common to at least two orifices, and here to all the orifices.
  • the different orifices 14b of the second column all open at their distal end on the distal face 16 of the support 12 and at their proximal end in the slot 17.
  • the slot 17 is thus common to all the orifices of the first column of orifices 14a and the second column of orifices 14b. Slot 17 has the same section over its entire length (considered along the Z axis). The slot 17 is for example of oblong section. Slot 17 is arranged so as to form an opening stretched parallel to the axis X. Furthermore, guide 10 is configured so that each orifice 14a of the first column of orifices faces an orifice 14b of the second column of orifices and for example is collinear with said orifice 14b of the second column of orifices.
  • At least one orifice is shaped to facilitate the exit of the medical instrument from the support 12.
  • the orifice is shaped like a funnel from the slot 17 towards the associated face of the support 12 (distal or proximal).
  • the orifices of the second column of orifices 14b are shaped like a funnel from the slot 17 to the distal face 16 of the support 12 (ie their section shrinks as one approaches the distal face 16) and/or the orifices of the first column of orifices 14a are shaped like a funnel from the slot 17 to the proximal face 15 of the support 12 (ie their section narrows as one approaches the proximal face 15).
  • the funnel shape of the orifices of the second column of orifices 14b makes it easier to remove the medical instrument from the support 12.
  • the funnel shape of the orifices of the first column of orifices 14a makes it possible to encourage the inclination of the medical instrument relative to the distal face 16 of the support 12 if this is desired.
  • the guide 10 is thus as permissive at its proximal face 15 as at its distal face 16.
  • the orifices of the first column of orifices 14a are arranged at regular intervals and/or the orifices of the second column of orifices 14b are arranged at regular intervals.
  • the orifices of the first column of orifices 14a and the orifices of the second column of orifices 14b are arranged at intervals regular with the same spacing between two successive orifices of the first column of orifices 14a as the spacing between two successive orifices of the first column of orifices 14b.
  • the invention is not limited to the embodiments described but encompasses any variant falling within the scope of the invention as defined by the claims.
  • the guide is shaped like a post, the guide could be shaped differently and for example shaped like a grid.
  • the grid may extend in a plane substantially normal to the Z axis.
  • the grid will include orifices arranged in columns and arranged in lines on the grid.
  • the medical instrument associated with the guide is a needle, the medical instrument could be another instrument.
  • the guide may be shaped so as to allow a movement around the Y axis with respect to the distal face of the support different from what has been indicated and for example a movement of 10 degrees minimum, 17 degrees minimum, 17.7 degrees minimum, 28 degrees minimum, 30 degrees minimum...
  • the different options can be combined with each other. For example, we could associate with an orifice of variable section (as proposed in the fifth option) a slot according to for example the first option.
  • the guide can define the guide according to whether we want it to be more permissive at the level of its proximal face, its distal face or whether it is equally permissive at the level of its distal and proximal faces. For this purpose, you can modify any option described above or combine one or more options (modified or not) with each other.
  • the support is always closed laterally (the orifice(s), the slot(s), etc. only opening out at the level of the proximal and distal faces of the support), the support may include at least one lateral opening.
  • the lateral opening could extend between the inside of the slot and the outside of the slot in a direction which is orthogonal to the axes X and/or Z.
  • the opening lateral is for example opening at a first end into a slot provided in the support and at a second end outside the support.
  • the lateral opening is shaped to allow the medical instrument to pass through even if it extends obliquely between the distal face and the proximal face of the support.
  • the side opening has a greater height (along the X axis) than that of the medical instrument.
  • Such a lateral opening could itself open onto the proximal face and/or the proximal face of the support.
  • the guide may be partly or entirely transparent, for example, to help the user guide their needle more easily.
  • the guide may include one or more markings for example to help the user to guide the instrument more easily: lines (for example connecting an orifice of the first orifice column to an orifice of the second orifice column which is at the same height), alphanumeric mark...

Abstract

Assembly comprising a guide (10) and a medical instrument, the guide comprising: - a base (11) intended to be borne by an apparatus comprising a medical imaging probe associated with the medical instrument, and - a support (12) which continues the base and in which there is formed at least one column (13) of orifices, the column extending along a first axis, the medical instrument being able to extend through at least one of the orifices (14) between a proximal face and a distal face of the support, a displacement of at least part of the medical instrument relative to the distal face of the support being authorized along at least one displacement axis, which is inclined or orthogonal to the first axis. Corresponding guide and installation.

Description

Guide pour instrument médical, ensemble d’un guide et d’un tel instrument, installation comprenant un tel ensemble ARRIERE PLAN DE L’INVENTION Afin d’effectuer une biopsie d’une prostate d’un patient ou bien de traiter la prostate d’un patient de manière localisé, il est connu d’avoir recours à une aiguille (de traitement et/ou de biopsie). Usuellement, une sonde échographique est insérée dans le rectum du patient et permet de visualiser ainsi l’insertion de l’aiguille dans le patient pour s’assurer de la bonne trajectoire de l’aiguille. On a l’habitude de faire porter par la sonde un guide-aiguille dont la grille va rester externe au patient en regard de sa zone pelvienne, la grille comprenant des orifices la traversant de part en part et à travers lesquels l’aiguille peut être insérée pour venir ensuite traverser le patient. Un tel guide permet ainsi d’assurer que l’aiguille sera bien insérée dans le plan d’acquisition de la sonde, et donc que l’insertion de l’aiguille en profondeur dans la prostate pourra être contrôlée par échographie. Malheureusement ce type de guide ne permet pas toujours un accès précis à toutes les zones de la prostate. OBJET DE L’INVENTION L’invention a notamment pour but de proposer un guide qui permet plus aisément d’agir sur l’organe visé. L’invention concerne également un ensemble d’un guide et d’un instrument associé. L’invention concerne également une installation comprenant un tel ensemble. A cet effet, on prévoit, selon l’invention un ensemble d’un guide et d’un instrument médical, le guide comprenant : - une base destinée à être portée par un appareil com- prenant une sonde d’imagerie médicale associée à l’instru- ment médical, et - un support prolongeant la base et dans lequel est ménagé au moins une colonne comprenant au moins un orifice, la colonne s’étendant selon un premier axe, l’instrument médical étant apte à s’étendre à travers au moins l’orifice entre une face proximale et une face distale du support. Selon l’invention, l’orifice est conformé en une fente et/ou ne s’étend que sur une partie seulement du support entre la face distale et la face proximale du guide de sorte que le guide autorise un débattement d’au moins une partie de l’instrument médical relativement à la face dis- tale du support selon au moins un axe de débattement qui est incliné ou orthogonal au premier axe. Ainsi, l’invention permet à l’instrument d’être guidé puisque les parois de l’orifice restreignent les mouvements de l’instrument, tout en autorisant un débattement au ni- veau de la face distale du support ce qui permet à un opérateur de pouvoir agir plus aisément sur un organe visé (comme par exemple et de manière non limitative une pros- tate). Pour la présente demande par « fente » on entend une ou- verture étroite et étirée selon une direction particulière. Optionnellement l’instrument médical est une aiguille. Optionnellement l’orifice présente une section qui s’élar- git ou se rétrécit entre la face proximale et la face distale du guide. Optionnellement l’orifice débouche à son extrémité distale dans une fente ménagée dans le support de sorte que la fente elle-même débouche au niveau de la face distale du guide. Optionnellement l’ensemble comporte plusieurs orifices. Optionnellement, plusieurs orifices débouchent dans ladite fente. Optionnellement, l’orifice permet de bloquer en position au moins une portion de l’instrument. L’invention concerne également un guide d’un ensemble tel que précité. L’invention concerne également un ensemble tel que précité ainsi qu’un appareil comprenant une sonde d’imagerie médi- cale. D’autres caractéristiques et avantages de l’invention res- sortiront à la lecture de la description qui suit de modes de réalisation particuliers et non limitatifs de l’inven- tion. BREVE DESCRIPTION DES DESSINS Il sera fait référence aux dessins annexés, parmi les- quels : [Fig. 1] la figure 1 représente schématiquement une ins- tallation selon un mode de réalisation particulier de l’in- vention, en train d’agir sur un patient ; [Fig. 2a] la figure 2a est un guide selon une première option de l’installation illustrée à la figure 1 ; [Fig. 2b] la figure 2b est une vue arrière du guide illustré à la figure 2a ; [Fig. 3a] la figure 3a est une vue schématique en coupe transversale d’une partie d’un guide selon une deuxième option de l’installation illustré à la figure 1 ; [Fig. 3b] la figure 3b est une vue schématique en coupe axiale de la partie de guide illustrée à la figure 3a ; [Fig. 4a] la figure 4a est une vue en trois dimensions d’un guide selon une troisième option de l’installation illus- trée à la figure 1 ; [Fig. 4b] la figure 4b est une vue en coupe du guide re- présenté à la figure 4a ; [Fig. 5a] la figure 5a est une vue en trois dimensions d’un guide selon une quatrième option de l’installation illus- trée à la figure 1 ; [Fig. 5b] la figure 5b est une vue en coupe du guide re- présenté à la figure 4a ; [Fig. 6] la figure 6 est un guide selon une cinquième option de l’installation illustrée à la figure 1 ; [Fig. 7] la figure 7 est un guide selon une sixième option de l’installation illustrée à la figure 1, des instruments étant représentés agencés dans ledit guide ; [Fig. 8] la figure 8 est un guide selon une septième option de l’installation illustrée à la figure 1. DESCRIPTION DETAILLEE DE L’INVENTION La figure 1 illustre une installation 1 selon un premier mode de réalisation de l’invention. L’installation 1 comporte par ailleurs un appareil 2 de contrôle s’étendant généralement longitudinalement selon un axe Z afin de faciliter son insertion dans un rectum d’un patient. De préférence, l’appareil 2 comporte une embase 3, s’éten- dant parallèlement à l’axe Z, qui est destinée à être sai- sie au niveau de son extrémité proximale par un opérateur et qui est prolongée à son extrémité distale par un décro- chement 4 de l’appareil 2. Ledit décrochement 4 est lui- même prolongé par une sonde 5 d’imagerie médicale de l’ap- pareil 2 pour permettre la génération d’images en trois dimensions de la prostate 100 et de son environnement, sonde 5 s’étendant également selon l’axe Z. De la sorte, l’appareil 2 est plus aisément manipulable par l’opérateur du fait du décrochement 4. Pour faciliter le travail de l’opérateur, l’installation 1 peut comprendre un système de co-manipulation de l’appareil 2, lié à l’extrémité proximale de l’appareil 2. Le système de co-manipulation est par exemple un robot, un bras arti- culé … La sonde 5 est ici une sonde échographique qui est donc destinée à être introduire dans le rectum du patient. Cette application n’est bien entendu pas limitative et on pourra utiliser l’installation avec d’autres types d’imageries i.e. d’autres types de sondes. En outre, l’installation 1 comporte un guide 10 solidaire de l’appareil 2. Plus précisément ici, le guide 10 est porté par la sonde 5. Le guide 10 est donc agencé sur l’appareil 2 en aval du décrochement 4 (selon un sens al- lant de l’embase 3 à la sonde 5). De préférence, le guide 10 est monté coulissant sur la sonde 5 (par exemple le long de l’axe Z) afin de pouvoir modifier sa position vis-à-vis du patient. Le guide 10 comprend ainsi une base 11 qui est la partie d’attache à l’appareil 2 et un support 12 prolongeant la base 11 et dans lequel est ménagé au moins une colonne 13 comprenant au moins un orifice 14 (un seul étant référencée à la figure 1), la colonne 13 s’étendant selon un deuxième axe X qui est orthogonale à l’axe Z. Optionnellement, le guide 10 se présente sous la forme d’un poteau. Le guide 10 comporte ainsi une seule colonne 13 d’au moins un orifice 14 s’étendant selon l’axe X. Dans le cas présent, le guide 10 est un guide-aiguille et l’instrument médical de l’installation 1 est donc une ai- guille 6. Le guide 10 est ainsi conformé de sorte que l’aiguille 6 puisse s’étendre à travers chacun des orifices 14 (ou l’unique orifice 14) de la colonne 13 entre une face proxi- male 15 (soit celle la plus proche d’un opérateur tenant l’appareil 2) et une face distale 16 du support 12 (soit celle la plus proche du patient). L’aiguille 6 peut ainsi être insérée dans le guide 10 à une hauteur différente (selon l’axe X) ce qui permet de définir la hauteur à laquelle l’aiguille 6 vient s’enfoncer dans le périnée. Préférentiellement le guide 10 comporte des repères gra- phiques (graduations, caractères alphanumériques ...) pour identifier les potentiels différents orifices 14 de la co- lonne 13. Optionnellement, le guide 10 comporte des lettres pour identifier chaque orifice 14. Les différents orifices 14 (si la colonne 13 en comporte plusieurs) sont par exemple tous identiques entre eux. Le guide 10 comporte par ailleurs une rainure 7 ménagée dans la base 11 et/ou le support 12. Cette rainure 7 permet en service de pouvoir faire passer un instrument addition- nel à travers le guide 10 (instrument de plus grande di- mensions que l’instrument médical passé à travers l’un des orifices 14) tel que par exemple un tuyau pour gonfler un ballon endocavitaire. La rainure 7 peut être centrée dans le guide 10 relativement à la colonne 13 ou peut être décalé dans le guide 10 relativement à la colonne 13. La rainure 7 présente une section plus importante que la sec- tion des orifices 14 au niveau de la face proximale 15 du support 12. La rainure 7 présente par exemple une section au moins partiellement circulaire. Le guide 10 pourra éga- lement ne pas comprendre une telle rainure 7. Selon l’invention, le guide 10 autorise un débattement d’au moins une partie de l’instrument médical relativement à la face distale 16 du support 12 selon au moins un axe de débattement qui est incliné ou orthogonal à l’axe X et/ou à l’axe Z. Par exemple le guide 10 autorise un débattement d’au moins une partie de l’instrument médical relativement à la face distale 16 du support 12 selon au moins un axe de débattement Y qui est orthogonal à l’axe X et à l’axe Z. De préférence, le guide 10 autorise un débattement d’au moins une partie de l’instrument médical autour d’un axe Y qui est orthogonal au plan d’acquisition en deux dimensions de la sonde 5. De la sorte, l’instrument médical reste visible sur l’image échographique fournie à l’opérateur tout en pouvant être déplacé relativement à la face distale 16 du support 12. Le plan échographique comprend ici l’axe Z et l’axe X. Différentes options du guide 10 sont ainsi envisagées (étant entendu que ce qui a été dit ci-dessus est appli- cables aux différentes options indiquées ci-dessous). En référence aux figures 2a et 2b, selon une première op- tion, la colonne 13 comporte une pluralité d’orifices 14. Les différents orifices 14 (un seul étant référencé ici) s’étendent tous rectilignement parallèlement les uns aux autres et à l’axe Z. Les différents orifices 14 débouchent tous au niveau de leur extrémité proximale sur la face proximale 15 du sup- port 12 et au niveau de leur extrémité distale 16 dans une fente 17 commune à au moins deux orifices 14, et ici à tous les orifices 14. Les orifices 14 présentent une même sec- tion sur toute leur longueur (considérée selon l’axe Z). La fente 17 présente une même section sur toute sa longueur (considérée selon l’axe Z). Ladite fente 17 est elle-même ménagée dans le support 12 de sorte à déboucher au niveau de la face distale 16 du support 12. La fente 17 est par exemple de section oblongue. La fente 17 est agencée de sorte à former une ouverture étirée parallèlement à l’axe X. Le guide 10 est conformé de sorte à autoriser un débatte- ment d’un instrument médical inséré dans l’un de ses ori- fices 14 vis-à-vis de la face distale 16 du support 12 autour de l’axe Y de débattement précité. Ce débattement est de préférence compris entre 5 et 15 degrés, et de préférence entre 8 et 12 degrés et de préfé- rence entre 9 et 11 degrés et est de préférence de 10 degrés. Le guide 10 est ainsi moins permissif au niveau de sa face proximale 15 qu’au niveau de sa face distale 16. En référence aux figures 3a et 3b, selon une deuxième op- tion, la colonne 13 comporte un unique orifice 14. Ledit orifice 14 s’étend rectilignement parallèlement à l’axe Z. L’orifice 14 débouche au niveau de son extrémité proximale sur la face proximale 15 du support 12 et au niveau de son extrémité distale sur la face distale 16 du support 12. L’orifice 14 présente une même section sur toute sa lon- gueur. L’orifice 14 est conformé en une fente 17. La fente 17 est par exemple de section oblongue. La fente 17 est agencée de sorte à former une ouverture étirée parallèlement à l’axe X. Afin d’assurer un guidage de l’instrument médical, la fente 17 présente une largeur (selon l’axe de débattement Y) sensiblement égale à celle de l’instrument médical. Le guide 10 est ainsi autant permissif au niveau de sa face proximale 15 qu’au niveau de sa face distale 16. En référence aux figures 4a et 4b, selon une troisième option, la colonne 13 comporte un unique orifice 14. Ledit orifice 14 s’étend rectilignement parallèlement à l’axe Z. L’orifice 14 est conformé en une première fente 17. La première fente 17 est par exemple de section oblongue. La première fente est agencée de sorte à former une ouverture étirée parallèlement à l’axe X. Afin d’assurer un guidage de l’instrument médical la pre- mière fente 17 présente une largeur (selon l’axe de débat- tement Y) sensiblement égale à celle de l’instrument médi- cal. L’orifice 14 débouche au niveau de son extrémité proximale sur la face proximale 15 du support 12 et au niveau de son extrémité distale 16 dans une deuxième fente 18. L’orifice 14 présente une même section sur toute sa longueur (consi- dérée selon l’axe Z). La deuxième fente 18 présente une même section sur toute sa longueur (considérée selon l’axe Z). La deuxième fente 18 est elle-même ménagée dans le support 12 de sorte à déboucher au niveau de la face distale 16 du support 12. La deuxième fente 18 est par exemple de section oblongue. La deuxième fente 18 est agencée de sorte à former une ouverture étirée parallèlement à l’axe X. La première fente 17 et la deuxième fente 18 s’étendent dans le prolongement l’une de l’autre et coaxialement l’une de l’autre (et ici parallèlement à l’axe Z). Optionnellement, la deuxième fente 18 présente une longueur (considérée selon l’axe Z) plus importante que celle de la première fente 17. En variante, les deux fentes ont la même longueur ou la première fente 17 a une plus grande longueur que la deuxième fente 18. La première fente 17 présente une section de plus grande dimension que la deuxième fente 18. Le guide 10 est ainsi plus permissif au niveau de sa face proximale 15 qu’au niveau de sa face distale 16. Une variante de cette troisième option consiste à ce que la deuxième fente 18 présente une section de plus grande dimension que la première fente 17. Le guide 10 sera alors moins permissif au niveau de sa face proximale 15 qu’au niveau de sa face distale 16. En référence aux figures 5a et 5b, selon une quatrième option, la colonne 13 comporte une pluralité d’orifices 14 (un seul étant référencé ici). Les différents orifices 14 s’étendent tous rectilignement parallèlement les uns aux autres et à l’axe Z. Les différents orifices 14 débouchent tous au niveau de leur extrémité proximale sur la face proximale 15 du sup- port 12 et au niveau de leur extrémité distale dans une fente 17 commune à au moins deux orifices 14, et ici à tous les orifices 14. Les orifices 14 présentent une même sec- tion sur toute leur longueur (considérée selon l’axe Z). La fente 17 présente une même section sur toute sa longueur (considérée selon l’axe Z). Ladite fente 17 est elle-même ménagée dans le support 12 de sorte à déboucher au niveau de la face distale 16 du support 12. La fente 17 est par exemple de section oblongue. La fente 17 est agencée de sorte à former une ouverture étirée parallèlement à l’axe X. Les orifices 14 présentent une section plus importante que celle de la première option. Les orifices 14 présentent ainsi une section permettant de pouvoir loger une portion de l’instrument médical dans chacun des orifices 14. Dans le cas où l’instrument médical est une aiguille, l’extrémité proximale de celle-ci peut former une platine dans une matière différente que celle de l’aiguille. C’est donc au moins une portion de cette platine qui pourrait être reçu dans l’orifice 14. De préférence, au moins l’un des orifices est ainsi con- formé de sorte que la section de l’orifice 14 soit sensi- blement égale à celui de ladite portion de l’instrument médical. De la sorte, l’orifice 14 bloque (par exemple par frottement) ladite portion de l’instrument dans l’ori- fice 14. L’instrument médical ne va ainsi pas ou peu pouvoir se déplacer relativement à la face proximale 15 du support 12 du fait de sa portion bloquée. Toutefois l’extrémité libre de l’instrument médical va pouvoir se débattre du fait que la longueur de l’instrument médical est bien plus impor- tante que celle de de la fente 17. En particulier il est ainsi possible d’insérer l’instrument médical de manière oblique à travers le guide 10 et ce manière sécurisé. Le guide 10 sera alors moins permissif au niveau de sa face proximale 15 qu’au niveau de sa face distale 16. Selon une cinquième option, visible à la figure 6, la co- lonne 13 comporte au moins un orifice 14. L’orifice 14 s’étend rectilignement parallèlement à l’axe Z. L’orifice 14 débouche au niveau de son extrémité proximale sur la face proximale 15 du support 12 et au niveau de son extrémité distale sur la face distale 16 du support 12. L’orifice 14 présente une section qui rétrécit ou qui aug- mente entre son extrémité proximale et son extrémité dis- tale (selon que l’on souhaite que le guide 10 soit plus permissif ou moins permissif au niveau de sa face proximale 15). Optionnellement, l’orifice 14 est conformé en une fente 17. La fente 17 est par exemple de section oblongue. La fente 17 est agencée de sorte à former une ouverture étirée parallèlement à l’axe X. Afin d’assurer un guidage de l’instrument médical, la fente 17 présente une largeur (selon l’axe Y) sensiblement égale à celle de l’instrument médical. En référence à la figure 7, selon une sixième option, la colonne 13 comporte une première colonne d’orifices 14a et une deuxième colonne d’orifices 14b. Les différents orifices 14a de la première colonne débou- chent tous au niveau de leur extrémité proximale sur la face proximale 15 du support 12 et au niveau de leur ex- trémité distale dans une fente 17 commune à au moins deux orifices, et ici à tous les orifices. Les différents orifices 14b de la deuxième colonne débou- chent tous au niveau de leur extrémité distale sur la face distale 16 du support 12 et au niveau de leur extrémité proximale dans la fente 17. La fente 17 est ainsi commune à tous les orifices de la première colonne d’orifices 14a et de la deuxième colonne d’orifices 14b. La fente 17 présente une même section sur toute sa longueur (considérée selon l’axe Z). La fente 17 est par exemple de section oblongue. La fente 17 est agencée de sorte à former une ouverture étirée parallèlement à l’axe X. Par ailleurs, le guide 10 est configuré de sorte que chaque orifice 14a de la première colonne d’orifices soit en re- gard d’un orifice 14b de la deuxième colonne d’orifices et par exemple soit colinéaire audit orifice 14b de la deu- xième colonne d’orifices. De la sorte, en introduisant un instrument médical dans un des orifices 14a de la première colonne d’orifices 14a il est possible de lui faire traverser l’orifice 14b en regard de la deuxième colonne d’orifices 14b (l’instrument médical s’étendant alors rectilignement et optionnellement paral- lèlement à l’axe Z) ou bien de lui faire traverser un orifice 14b de la deuxième colonne d’orifices 14b qui n’est pas en regard de l’orifice 14a concerné de la première colonne d’orifices 14a. Optionnellement, les différents orifices 14a, 14b s’éten- dent tous rectilignement parallèlement les uns aux autres et à l’axe Z. Les orifices 14a, 14b présentent une même section sur toute leur longueur (considérée selon l’axe Z). En variante, au moins un orifice (de préférence de la deu- xième colonne d’orifices 14b) est conformé pour faciliter la sortie de l’instrument médical du support 12. Par exemple, l’orifice est conformé en entonnoir depuis la fente 17 en direction de la face du support 12 (distale ou proximale) associée. De préférence, les orifices de la deuxième colonne d’ori- fices 14b sont conformés en entonnoir depuis la fente 17 jusqu’à la face distale 16 du support 12 (i.e. leur section rétrécit à mesure que l’on se rapproche de la face distale 16) et/ou les orifices de la première colonne d’orifices 14a sont conformés en entonnoir depuis la fente 17 jusqu’à la face proximale 15 du support 12 (i.e. leur section ré- trécit à mesure que l’on se rapproche de la face proximale 15). La forme en entonnoir des orifices de la deuxième colonne d’orifices 14b permet de faciliter la sortie de l’instru- ment médical du support 12. La forme en entonnoir des ori- fices de la première colonne d’orifices 14a permet de fa- ciliter l’inclinaison de l’instrument médical relativement à la face distale 16 du support 12 si cela est souhaité. Le guide 10 est ainsi autant permissif au niveau de sa face proximale 15 qu’au niveau de sa face distale 16. De préférence, les orifices de la première colonne d’ori- fices 14a sont agencés à intervalle régulier et/ou les orifices de la deuxième colonne d’orifices 14b sont agencés à intervalle régulier. De préférence, les orifices de la première colonne d’orifices 14a et les orifices de la deu- xième colonne d’orifices 14b sont agencés à intervalle régulier avec le même espacement entre deux orifices suc- cessifs de la première colonne d’orifices 14a que l’espa- cement entre deux orifices successifs de la première co- lonne d’orifices 14b. Ceci permet de plus facilement définir à l’avance l’angle que va dessiner l’instrument médical avec un axe parallèle à l’axe Z. Bien entendu, l’invention n’est pas limitée aux modes de réalisation décrits mais englobe toute variante entrant dans le champ de l’invention telle que définie par les revendications. En particulier, bien qu’ici le guide soit conformé en un poteau, le guide pourra être conformé autrement et par exemple conformé en une grille. La grille pourra s’étendre dans un plan sensiblement de normale l’axe Z. La grille comportera des orifices agencés en colonnes et agencés en lignes sur la grille. Bien qu’ici l’instrument médical associé au guide soit une aiguille, l’instrument médical pourra être un autre ins- trument. Le guide pourra être conformé de sorte à autoriser un dé- battement autour de l’axe Y vis-à-vis de la face distale du support différent de ce qui a été indiqué et par exemple un débattement de 10 degrés minimum, de 17 degrés minimum, de 17,7 degrés minimum, de 28 degrés minimum, de 30 degrés minimum … Les différentes options pourront se combiner entre elles. Par exemple on pourra associer à un orifice de section variable (comme proposé à la cinquième option) une fente selon par exemple la première option. On pourra définir le guide selon que l’on souhaite qu’il soit davantage permissif au niveau de sa face proximale, de sa face distale ou qu’il soit autant permissif au niveau de sa face distale comme proximale. A cet effet, on pourra modifier n’importe quelle option décrite ci-dessus ou com- biner une ou plusieurs options (modifiées ou non) entre elles. Bien qu’ici le support soit toujours fermé latéralement (le ou les orifices, la ou les fentes … ne débouchant qu’au niveau des faces proximale et distale du support), le sup- port pourra comporter au moins une ouverture latérale. Par exemple comme illustré à la figure 8, l’ouverture latérale pourra s’étendre entre l’intérieur de la fente et l’exté- rieur de la fente selon une direction qui est orthogonale aux axes X et/ou Z. L’ouverture latérale est par exemple débouchante à une première extrémité dans une fente ménagée dans le support et à une deuxième extrémité à l’extérieur du support. De la sorte une fois l’instrument en place dans le corps du patient, il s’avère possible de retirer le guide en faisant passer l’instrument par l’ouverture laté- rale prévue à cet effet. De préférence, l’ouverture laté- rale est conformée pour laisser passer l’instrument médical même si celui-ci s’étend obliquement entre la face distale et la face proximale du support. Par exemple l’ouverture latérale présente une hauteur (selon l’axe X) plus impor- tante que celle de l’instrument médicale. Une telle ouver- ture latérale pourra elle-même être débouchante sur la face proximale et/ou la face proximale du support. Le guide pourra être en partie ou en totalité transparent par exemple pour aider l’utilisateur à guider plus facile- ment son aiguille. En variante ou en complément, le guide pourra comporter un ou plusieurs marquages par exemple pour aider l’utilisateur à guider plus facilement l’instru- ment : lignes (par exemple reliant un orifice de la pre- mière colonne d’orifice à un orifice de la deuxième colonne d’orifice qui est à la même hauteur), repère alphanumérique … Guide for medical instrument, assembly of a guide and such an instrument, installation comprising such an assembly BACKGROUND OF THE INVENTION In order to carry out a biopsy of a patient's prostate or to treat the prostate of a patient a patient in a localized manner, it is known to use a needle (for treatment and/or biopsy). Usually, an ultrasound probe is inserted into the patient's rectum and makes it possible to visualize the insertion of the needle into the patient to ensure the correct trajectory of the needle. It is usual for the probe to carry a needle guide whose grid will remain external to the patient facing his pelvic area, the grid comprising orifices passing through it from side to side and through which the needle can be inserted to then pass through the patient. Such a guide thus ensures that the needle will be well inserted in the acquisition plane of the probe, and therefore that the insertion of the needle deep into the prostate can be controlled by ultrasound. Unfortunately this type of guide does not always allow precise access to all areas of the prostate. OBJECT OF THE INVENTION The invention aims in particular to provide a guide which makes it easier to act on the targeted organ. The invention also relates to a set of a guide and an associated instrument. The invention also relates to an installation comprising such an assembly. For this purpose, according to the invention there is provided a set of a guide and a medical instrument, the guide comprising: - a base intended to be carried by a device comprising a medical imaging probe associated with the medical instrument, and - a support extending the base and in which at least one column is provided comprising at least one orifice, the column extending along a first axis, the medical instrument being able to extend through at least the orifice between a proximal face and a distal face of the support. According to the invention, the orifice is shaped like a slot and/or only extends over only part of the support between the distal face and the proximal face of the guide so that the guide allows a clearance of at least one part of the medical instrument relative to the distal face of the support along at least one axis of movement which is inclined or orthogonal to the first axis. Thus, the invention allows the instrument to be guided since the walls of the orifice restrict the movements of the instrument, while allowing clearance at the level of the distal face of the support which allows an operator to be able to act more easily on a targeted organ (such as for example and without limitation a prostate). For the present application, the term “slit” means a narrow opening stretched in a particular direction. Optionally the medical instrument is a needle. Optionally the orifice has a section which widens or narrows between the proximal face and the distal face of the guide. Optionally the orifice opens at its distal end in a slot provided in the support so that the slot itself opens at the level of the distal face of the guide. Optionally the assembly has several orifices. Optionally, several orifices open into said slot. Optionally, the orifice makes it possible to lock in position at least one portion of the instrument. The invention also relates to a guide of an assembly as mentioned above. The invention also relates to an assembly as mentioned above as well as an apparatus comprising a medical imaging probe. Other characteristics and advantages of the invention will become apparent on reading the following description of particular and non-limiting embodiments of the invention. BRIEF DESCRIPTION OF THE DRAWINGS Reference will be made to the appended drawings, among which: [Fig. 1] Figure 1 schematically represents an installation according to a particular embodiment of the invention, acting on a patient; [Fig. 2a] Figure 2a is a guide according to a first option of the installation illustrated in Figure 1; [Fig. 2b] Figure 2b is a rear view of the guide illustrated in Figure 2a; [Fig. 3a] Figure 3a is a schematic cross-sectional view of a part of a guide according to a second option of the installation illustrated in Figure 1; [Fig. 3b] Figure 3b is a schematic view in axial section of the guide part illustrated in Figure 3a; [Fig. 4a] Figure 4a is a three-dimensional view of a guide according to a third option of the installation illustrated in Figure 1; [Fig. 4b] Figure 4b is a sectional view of the guide shown in Figure 4a; [Fig. 5a] Figure 5a is a three-dimensional view of a guide according to a fourth option of the installation illustrated in Figure 1; [Fig. 5b] Figure 5b is a sectional view of the guide shown in Figure 4a; [Fig. 6] Figure 6 is a guide according to a fifth option of the installation illustrated in Figure 1; [Fig. 7] Figure 7 is a guide according to a sixth option of the installation illustrated in Figure 1, instruments being shown arranged in said guide; [Fig. 8] Figure 8 is a guide according to a seventh option of the installation illustrated in Figure 1. DETAILED DESCRIPTION OF THE INVENTION Figure 1 illustrates an installation 1 according to a first embodiment of the invention. The installation 1 also comprises a control device 2 generally extending longitudinally along an axis Z in order to facilitate its insertion into a rectum of a patient. Preferably, the device 2 comprises a base 3, extending parallel to the axis Z, which is intended to be grasped at its proximal end by an operator and which is extended at its distal end by a recess 4 of the device 2. Said recess 4 is itself even extended by a medical imaging probe 5 of the device 2 to allow the generation of three-dimensional images of the prostate 100 and its environment, probe 5 also extending along the Z axis. so, the device 2 is more easily manipulated by the operator due to the recess 4. To facilitate the operator's work, the installation 1 can include a system for co-manipulating the device 2, linked to the The proximal end of the device 2. The co-manipulation system is for example a robot, an articulated arm, etc. The probe 5 is here an ultrasound probe which is therefore intended to be introduced into the rectum of the patient. This application is of course not restrictive and the installation can be used with other types of imaging, ie other types of probes. In addition, the installation 1 includes a guide 10 secured to the device 2. More precisely here, the guide 10 is carried by the probe 5. The guide 10 is therefore arranged on the device 2 downstream of the recess 4 (according to one direction going from base 3 to probe 5). Preferably, the guide 10 is slidably mounted on the probe 5 (for example along the Z axis) in order to be able to modify its position with respect to the patient. The guide 10 thus comprises a base 11 which is the attachment part to the device 2 and a support 12 extending the base 11 and in which is provided at least one column 13 comprising at least one orifice 14 (only one being referenced at Figure 1), the column 13 extending along a second axis X which is orthogonal to the axis Z. Optionally, the guide 10 is in the form of a post. The guide 10 thus comprises a single column 13 with at least one orifice 14 extending along the axis X. In the present case, the guide 10 is a needle guide and the medical instrument of the installation 1 is therefore a needle 6. The guide 10 is thus shaped so that the needle 6 can extend through each of the orifices 14 (or the single orifice 14) of the column 13 between a proximal face 15 (i.e. that closest to an operator holding the device 2) and a distal face 16 of the support 12 (i.e. that closest to the patient). The needle 6 can thus be inserted into the guide 10 at a different height (along the axis X) which makes it possible to define the height at which the needle 6 is inserted into the perineum. Preferably, guide 10 includes graphic markers (graduations, alphanumeric characters, etc.) to identify the potential different orifices 14 of column 13. Optionally, guide 10 includes letters to identify each orifice 14. The different orifices 14 (if column 13 includes several) are for example all identical to each other. The guide 10 also includes a groove 7 formed in the base 11 and/or the support 12. This groove 7 makes it possible, in use, to pass an additional instrument through the guide 10 (instrument of larger dimensions than the medical instrument passed through one of the orifices 14) such as for example a pipe for inflating an endocavitary balloon. The groove 7 can be centered in the guide 10 relative to the column 13 or can be offset in the guide 10 relative to the column 13. The groove 7 has a larger section than the section of the orifices 14 at the level of the proximal face 15 of the support 12. The groove 7 has for example an at least partially circular section . The guide 10 may also not include such a groove 7. According to the invention, the guide 10 allows movement of at least part of the medical instrument relative to the distal face 16 of the support 12 according to at least one axis of movement which is inclined or orthogonal to the axis along at least one axis of movement Y which is orthogonal to the axis is orthogonal to the two-dimensional acquisition plane of the probe 5. In this way, the medical instrument remains visible on the ultrasound image provided to the operator while being able to be moved relative to the distal face 16 of the support 12. The ultrasound plane here includes the Z axis and the X axis. Different options of the guide 10 are thus considered (it being understood that what has been said above is applicable to the different options indicated below). With reference to Figures 2a and 2b, according to a first option, the column 13 comprises a plurality of orifices 14. The different orifices 14 (only one being referenced here) all extend rectilinearly parallel to each other and to the Z axis. The different orifices 14 all open at their proximal end on the proximal face 15 of the support 12 and at their distal end 16 in a slot 17 common to at least two orifices 14, and here to all the orifices 14. The orifices 14 have the same section over their entire length (considered along the Z axis). Slot 17 has the same section over its entire length (considered along the Z axis). Said slot 17 is itself formed in the support 12 so as to open out at the distal face 16 of the support 12. The slot 17 is for example of oblong section. The slot 17 is arranged so as to form an opening stretched parallel to the axis opposite the distal face 16 of the support 12 around the aforementioned axis Y of movement. This clearance is preferably between 5 and 15 degrees, and preferably between 8 and 12 degrees and preferably between 9 and 11 degrees and is preferably 10 degrees. The guide 10 is thus less permissive at its proximal face 15 than at its distal face 16. With reference to Figures 3a and 3b, according to a second option, the column 13 has a single orifice 14. Said orifice 14 extends rectilinearly parallel to the axis Z. The orifice 14 opens at its proximal end on the proximal face 15 of the support 12 and at its distal end on the distal face 16 of the support 12. The orifice 14 has the same section over its entire length. The orifice 14 is shaped into a slot 17. The slot 17 is for example of oblong section. The slot 17 is arranged so as to form an opening stretched parallel to the axis of the medical instrument. The guide 10 is thus as permissive at its proximal face 15 as at its distal face 16. With reference to Figures 4a and 4b, according to a third option, the column 13 has a single orifice 14. Said orifice 14 s 'extends rectilinearly parallel to the axis Z. The orifice 14 is shaped into a first slot 17. The first slot 17 is for example of oblong section. The first slot is arranged so as to form an opening stretched parallel to the axis substantially equal to that of the medical instrument. The orifice 14 opens at its proximal end onto the proximal face 15 of the support 12 and at its distal end 16 into a second slot 18. The orifice 14 has the same section over its entire length (considered according to the Z axis). The second slot 18 has the same section over its entire length (considered along the Z axis). The second slot 18 is itself formed in the support 12 so as to open out at the distal face 16 of the support 12. The second slot 18 is for example of oblong section. The second slot 18 is arranged so as to form an opening stretched parallel to the axis other (and here parallel to the Z axis). Optionally, the second slot 18 has a length (considered along the Z axis) greater than that of the first slot 17. Alternatively, the two slots have the same length or the first slot 17 has a greater length than the second slot 18. The first slot 17 has a larger section than the second slot 18. The guide 10 is thus more permissive at its proximal face 15 than at its distal face 16. A variant of this third option consists in the second slot 18 having a section of larger dimension than the first slot 17. The guide 10 will then be less permissive at its proximal face 15 than at its distal face 16. With reference to Figures 5a and 5b, according to a fourth option, the column 13 comprises a plurality of orifices 14 (only one being referenced here). The different orifices 14 all extend rectilinearly parallel to each other and to the axis Z. The different orifices 14 all open at their proximal end on the proximal face 15 of the support 12 and at their distal end in slot 17 common to at least two orifices 14, and here to all the orifices 14. The orifices 14 have the same section over their entire length (considered along the Z axis). Slot 17 has the same section over its entire length (considered along the Z axis). Said slot 17 is itself formed in the support 12 so as to open out at the distal face 16 of the support 12. The slot 17 is for example of oblong section. The slot 17 is arranged so as to form an opening stretched parallel to the axis X. The orifices 14 have a larger section than that of the first option. The orifices 14 thus have a section allowing a portion of the medical instrument to be accommodated in each of the orifices 14. In the case where the medical instrument is a needle, the proximal end thereof can form a plate in a different material than that of the needle. It is therefore at least a portion of this plate which could be received in the orifice 14. Preferably, at least one of the orifices is thus shaped so that the section of the orifice 14 is substantially equal to that of said portion of the medical instrument. In this way, the orifice 14 blocks (for example by friction) said portion of the instrument in the orifice 14. The medical instrument will thus not or barely be able to move relative to the proximal face 15 of the support 12 due to its blocked portion. However, the free end of the medical instrument will be able to struggle due to the fact that the length of the medical instrument is much greater than that of the slot 17. In particular it is thus possible to insert the medical instrument obliquely through the guide 10 and in this secure manner. The guide 10 will then be less permissive at the level of its proximal face 15 than at the level of its distal face 16. According to a fifth option, visible in Figure 6, the column 13 has at least one orifice 14. The orifice 14 extends rectilinearly parallel to the axis Z. The orifice 14 opens at its proximal end on the proximal face 15 of the support 12 and at the level of its distal end on the distal face 16 of the support 12. The orifice 14 has a section which narrows or increases between its proximal end and its distal end (depending on whether it is desired for the guide 10 to be more permissive or less permissive at the level of its proximal face 15). Optionally, the orifice 14 is shaped into a slot 17. The slot 17 is for example of oblong section. The slot 17 is arranged so as to form an opening stretched parallel to the axis medical instrument. With reference to Figure 7, according to a sixth option, the column 13 comprises a first column of orifices 14a and a second column of orifices 14b. The different orifices 14a of the first column all open at their proximal end onto the proximal face 15 of the support 12 and at their distal end in a slot 17 common to at least two orifices, and here to all the orifices. The different orifices 14b of the second column all open at their distal end on the distal face 16 of the support 12 and at their proximal end in the slot 17. The slot 17 is thus common to all the orifices of the first column of orifices 14a and the second column of orifices 14b. Slot 17 has the same section over its entire length (considered along the Z axis). The slot 17 is for example of oblong section. Slot 17 is arranged so as to form an opening stretched parallel to the axis X. Furthermore, guide 10 is configured so that each orifice 14a of the first column of orifices faces an orifice 14b of the second column of orifices and for example is collinear with said orifice 14b of the second column of orifices. In this way, by introducing a medical instrument into one of the orifices 14a of the first column of orifices 14a it is possible to make it pass through the orifice 14b facing the second column of orifices 14b (the medical instrument is then extending rectilinearly and optionally parallel to the axis Z) or else to make it pass through an orifice 14b of the second column of orifices 14b which is not facing the orifice 14a concerned of the first column of orifices 14a. Optionally, the different orifices 14a, 14b all extend rectilinearly parallel to each other and to the Z axis. The orifices 14a, 14b have the same section over their entire length (considered along the Z axis). Alternatively, at least one orifice (preferably from the second column of orifices 14b) is shaped to facilitate the exit of the medical instrument from the support 12. For example, the orifice is shaped like a funnel from the slot 17 towards the associated face of the support 12 (distal or proximal). Preferably, the orifices of the second column of orifices 14b are shaped like a funnel from the slot 17 to the distal face 16 of the support 12 (ie their section shrinks as one approaches the distal face 16) and/or the orifices of the first column of orifices 14a are shaped like a funnel from the slot 17 to the proximal face 15 of the support 12 (ie their section narrows as one approaches the proximal face 15). The funnel shape of the orifices of the second column of orifices 14b makes it easier to remove the medical instrument from the support 12. The funnel shape of the orifices of the first column of orifices 14a makes it possible to encourage the inclination of the medical instrument relative to the distal face 16 of the support 12 if this is desired. The guide 10 is thus as permissive at its proximal face 15 as at its distal face 16. Preferably, the orifices of the first column of orifices 14a are arranged at regular intervals and/or the orifices of the second column of orifices 14b are arranged at regular intervals. Preferably, the orifices of the first column of orifices 14a and the orifices of the second column of orifices 14b are arranged at intervals regular with the same spacing between two successive orifices of the first column of orifices 14a as the spacing between two successive orifices of the first column of orifices 14b. This makes it easier to define in advance the angle that the medical instrument will draw with an axis parallel to the Z axis. Of course, the invention is not limited to the embodiments described but encompasses any variant falling within the scope of the invention as defined by the claims. In particular, although here the guide is shaped like a post, the guide could be shaped differently and for example shaped like a grid. The grid may extend in a plane substantially normal to the Z axis. The grid will include orifices arranged in columns and arranged in lines on the grid. Although here the medical instrument associated with the guide is a needle, the medical instrument could be another instrument. The guide may be shaped so as to allow a movement around the Y axis with respect to the distal face of the support different from what has been indicated and for example a movement of 10 degrees minimum, 17 degrees minimum, 17.7 degrees minimum, 28 degrees minimum, 30 degrees minimum… The different options can be combined with each other. For example, we could associate with an orifice of variable section (as proposed in the fifth option) a slot according to for example the first option. We can define the guide according to whether we want it to be more permissive at the level of its proximal face, its distal face or whether it is equally permissive at the level of its distal and proximal faces. For this purpose, you can modify any option described above or combine one or more options (modified or not) with each other. Although here the support is always closed laterally (the orifice(s), the slot(s), etc. only opening out at the level of the proximal and distal faces of the support), the support may include at least one lateral opening. For example as illustrated in Figure 8, the lateral opening could extend between the inside of the slot and the outside of the slot in a direction which is orthogonal to the axes X and/or Z. The opening lateral is for example opening at a first end into a slot provided in the support and at a second end outside the support. In this way, once the instrument is in place in the patient's body, it becomes possible to remove the guide by passing the instrument through the side opening provided for this purpose. Preferably, the lateral opening is shaped to allow the medical instrument to pass through even if it extends obliquely between the distal face and the proximal face of the support. For example, the side opening has a greater height (along the X axis) than that of the medical instrument. Such a lateral opening could itself open onto the proximal face and/or the proximal face of the support. The guide may be partly or entirely transparent, for example, to help the user guide their needle more easily. Alternatively or in addition, the guide may include one or more markings for example to help the user to guide the instrument more easily: lines (for example connecting an orifice of the first orifice column to an orifice of the second orifice column which is at the same height), alphanumeric mark…

Claims

REVENDICATIONS
1. Ensemble d'un guide et d'un instrument médical, le guide (10) comprenant : 1. Set of a guide and a medical instrument, the guide (10) comprising:
- une base (11) destinée à être portée par un appareil comprenant une sonde d'imagerie médicale associée à l'instrument médical, et - a base (11) intended to be carried by a device comprising a medical imaging probe associated with the medical instrument, and
- un support (12) prolongeant la base et dans lequel est ménagé au moins une colonne (13) comprenant au moins un orifice (14), la colonne s'étendant selon un premier axe (X), l'instrument médical étant apte à s'étendre à travers au moins l'orifice entre une face proximale (15) et une face distale (16) du support, l'ensemble étant caractérisé en ce que l'orifice est conformé en une fente et/ou ne s'étend que sur une partie seulement du support entre la face distale et la face proximale du guide de sorte que le guide autorise un débattement d'au moins une partie de l'instrument médical relativement à la face distale du support selon au moins un axe de débattement qui est incliné ou orthogonal au premier axe. - a support (12) extending the base and in which is provided at least one column (13) comprising at least one orifice (14), the column extending along a first axis (X), the medical instrument being capable of extend through at least the orifice between a proximal face (15) and a distal face (16) of the support, the assembly being characterized in that the orifice is shaped like a slot and/or does not extend that on only part of the support between the distal face and the proximal face of the guide so that the guide allows movement of at least part of the medical instrument relative to the distal face of the support along at least one axis of movement which is inclined or orthogonal to the first axis.
2. Ensemble selon la revendication 1, dans lequel l'instrument médical est une aiguille (6). 2. Assembly according to claim 1, wherein the medical instrument is a needle (6).
3. Ensemble selon l'une des revendications précédentes, dans lequel l'orifice (14) présente une section qui s'élargit ou se rétrécit entre la face proximale (15) et la face distale (16). 3. Assembly according to one of the preceding claims, wherein the orifice (14) has a section which widens or narrows between the proximal face (15) and the distal face (16).
4. Ensemble selon l'une des revendications précédentes, dans lequel l'orifice (14) débouche à son extrémité distale dans une fente (17) ménagée dans le support de sorte que la fente elle e distale 4. Assembly according to one of the preceding claims, in which the orifice (14) opens at its distal end into a slot (17) formed in the support so that the slot is distal
5. Ensemble selon l'une des revendications précédentes, comprenant plusieurs orifices (14). 5. Assembly according to one of the preceding claims, comprising several orifices (14).
6. Ensemble selon la revendication 4 et la revendication 5, dans lequel plusieurs orifices (14)débouchent dans ladite fente (17). 6. Assembly according to claim 4 and claim 5, wherein several orifices (14) open into said slot (17).
7. Ensemble selon l'une des revendications précédentes, dans lequel l'orifice permet de bloquer en position au moins une portion de l'instrument. 7. Assembly according to one of the preceding claims, in which the orifice makes it possible to lock in position at least a portion of the instrument.
8. Guide d'un ensemble selon l'une des revendications précédentes. 8. Guide of an assembly according to one of the preceding claims.
9. Installation comprenant un ensemble selon l'une des revendications 1 à 7 ainsi qu'un appareil comprenant une sonde d'imagerie médicale. 9. Installation comprising an assembly according to one of claims 1 to 7 as well as a device comprising a medical imaging probe.
PCT/EP2023/068265 2022-07-01 2023-07-03 Guide for a medical instrument, assembly comprising a guide and such an instrument, and installation comprising such an assembly WO2024003421A1 (en)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
FR2206808 2022-07-01
FR2206808A FR3137264A1 (en) 2022-07-01 2022-07-01 Guide for medical instrument, assembly of a guide and such an instrument, installation comprising such an assembly

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WO2024003421A1 true WO2024003421A1 (en) 2024-01-04

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Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20110257594A1 (en) * 2008-12-22 2011-10-20 Luc Lacoursiere Needle guide
US8747331B2 (en) * 2009-06-23 2014-06-10 Hologic, Inc. Variable angle guide holder for a biopsy guide plug
US20190290362A1 (en) * 2016-05-25 2019-09-26 Medical Templates Ag Method for planning intracorporeal positioning of a medical needle unit to be introduced percutaneously into a patient
CN111513828A (en) * 2020-06-03 2020-08-11 苏州市立普医疗科技有限公司 Adapter, needle groove plate assembly, puncture support and biopsy device
WO2020183226A1 (en) * 2019-03-12 2020-09-17 B-K Medical Aps Ultrasound-guided transperineal and/or transrectal biopsy
CN211723366U (en) * 2020-01-18 2020-10-23 淄博市妇幼保健院 Needle seat of ultrasonic probe puncture guiding device

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20110257594A1 (en) * 2008-12-22 2011-10-20 Luc Lacoursiere Needle guide
US8747331B2 (en) * 2009-06-23 2014-06-10 Hologic, Inc. Variable angle guide holder for a biopsy guide plug
US20190290362A1 (en) * 2016-05-25 2019-09-26 Medical Templates Ag Method for planning intracorporeal positioning of a medical needle unit to be introduced percutaneously into a patient
WO2020183226A1 (en) * 2019-03-12 2020-09-17 B-K Medical Aps Ultrasound-guided transperineal and/or transrectal biopsy
CN211723366U (en) * 2020-01-18 2020-10-23 淄博市妇幼保健院 Needle seat of ultrasonic probe puncture guiding device
CN111513828A (en) * 2020-06-03 2020-08-11 苏州市立普医疗科技有限公司 Adapter, needle groove plate assembly, puncture support and biopsy device

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FR3137265A1 (en) 2024-01-05
FR3137264A1 (en) 2024-01-05

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