WO2024153901A1 - Manchon électriquement isolant pour boroscope chirurgical, boroscope chirurgical et système de visualisation chirurgicale - Google Patents

Manchon électriquement isolant pour boroscope chirurgical, boroscope chirurgical et système de visualisation chirurgicale Download PDF

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Publication number
WO2024153901A1
WO2024153901A1 PCT/GB2023/053260 GB2023053260W WO2024153901A1 WO 2024153901 A1 WO2024153901 A1 WO 2024153901A1 GB 2023053260 W GB2023053260 W GB 2023053260W WO 2024153901 A1 WO2024153901 A1 WO 2024153901A1
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WO
WIPO (PCT)
Prior art keywords
lumen
surgical
electrode
distal end
borescope
Prior art date
Application number
PCT/GB2023/053260
Other languages
English (en)
Inventor
Faye WARREN
Francis Amoah
Jason Brewer
Original Assignee
Alesi Surgical Limited
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 Alesi Surgical Limited filed Critical Alesi Surgical Limited
Publication of WO2024153901A1 publication Critical patent/WO2024153901A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/04—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances
    • A61B1/042—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances characterised by a proximal camera, e.g. a CCD camera
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00064—Constructional details of the endoscope body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00131—Accessories for endoscopes
    • A61B1/00135—Oversleeves mounted on the endoscope prior to insertion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
    • A61B1/018—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor for receiving instruments
    • 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
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A61B17/3423—Access ports, e.g. toroid shape introducers for instruments or hands
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1482—Probes or electrodes therefor having a long rigid shaft for accessing the inner body transcutaneously in minimal invasive surgery, e.g. laparoscopy
    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B03—SEPARATION OF SOLID MATERIALS USING LIQUIDS OR USING PNEUMATIC TABLES OR JIGS; MAGNETIC OR ELECTROSTATIC SEPARATION OF SOLID MATERIALS FROM SOLID MATERIALS OR FLUIDS; SEPARATION BY HIGH-VOLTAGE ELECTRIC FIELDS
    • B03C—MAGNETIC OR ELECTROSTATIC SEPARATION OF SOLID MATERIALS FROM SOLID MATERIALS OR FLUIDS; SEPARATION BY HIGH-VOLTAGE ELECTRIC FIELDS
    • B03C3/00—Separating dispersed particles from gases or vapour, e.g. air, by electrostatic effect
    • B03C3/017—Combinations of electrostatic separation with other processes, not otherwise provided for
    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B03—SEPARATION OF SOLID MATERIALS USING LIQUIDS OR USING PNEUMATIC TABLES OR JIGS; MAGNETIC OR ELECTROSTATIC SEPARATION OF SOLID MATERIALS FROM SOLID MATERIALS OR FLUIDS; SEPARATION BY HIGH-VOLTAGE ELECTRIC FIELDS
    • B03C—MAGNETIC OR ELECTROSTATIC SEPARATION OF SOLID MATERIALS FROM SOLID MATERIALS OR FLUIDS; SEPARATION BY HIGH-VOLTAGE ELECTRIC FIELDS
    • B03C3/00—Separating dispersed particles from gases or vapour, e.g. air, by electrostatic effect
    • B03C3/34—Constructional details or accessories or operation thereof
    • B03C3/40—Electrode constructions
    • B03C3/41—Ionising-electrodes
    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B03—SEPARATION OF SOLID MATERIALS USING LIQUIDS OR USING PNEUMATIC TABLES OR JIGS; MAGNETIC OR ELECTROSTATIC SEPARATION OF SOLID MATERIALS FROM SOLID MATERIALS OR FLUIDS; SEPARATION BY HIGH-VOLTAGE ELECTRIC FIELDS
    • B03C—MAGNETIC OR ELECTROSTATIC SEPARATION OF SOLID MATERIALS FROM SOLID MATERIALS OR FLUIDS; SEPARATION BY HIGH-VOLTAGE ELECTRIC FIELDS
    • B03C3/00—Separating dispersed particles from gases or vapour, e.g. air, by electrostatic effect
    • B03C3/34—Constructional details or accessories or operation thereof
    • B03C3/82—Housings
    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B03—SEPARATION OF SOLID MATERIALS USING LIQUIDS OR USING PNEUMATIC TABLES OR JIGS; MAGNETIC OR ELECTROSTATIC SEPARATION OF SOLID MATERIALS FROM SOLID MATERIALS OR FLUIDS; SEPARATION BY HIGH-VOLTAGE ELECTRIC FIELDS
    • B03C—MAGNETIC OR ELECTROSTATIC SEPARATION OF SOLID MATERIALS FROM SOLID MATERIALS OR FLUIDS; SEPARATION BY HIGH-VOLTAGE ELECTRIC FIELDS
    • B03C3/00—Separating dispersed particles from gases or vapour, e.g. air, by electrostatic effect
    • B03C3/34—Constructional details or accessories or operation thereof
    • B03C3/86—Electrode-carrying means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00292—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
    • A61B2017/00336—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means with a protective sleeve, e.g. retractable or slidable
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00982—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body combined with or comprising means for visual or photographic inspections inside the body, e.g. endoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M39/00—Tubes, tube connectors, tube couplings, valves, access sites or the like, specially adapted for medical use
    • A61M39/02—Access sites
    • A61M39/0247—Semi-permanent or permanent transcutaneous or percutaneous access sites to the inside of the body
    • A61M2039/0279—Semi-permanent or permanent transcutaneous or percutaneous access sites to the inside of the body for introducing medical instruments into the body, e.g. endoscope, surgical tools
    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B03—SEPARATION OF SOLID MATERIALS USING LIQUIDS OR USING PNEUMATIC TABLES OR JIGS; MAGNETIC OR ELECTROSTATIC SEPARATION OF SOLID MATERIALS FROM SOLID MATERIALS OR FLUIDS; SEPARATION BY HIGH-VOLTAGE ELECTRIC FIELDS
    • B03C—MAGNETIC OR ELECTROSTATIC SEPARATION OF SOLID MATERIALS FROM SOLID MATERIALS OR FLUIDS; SEPARATION BY HIGH-VOLTAGE ELECTRIC FIELDS
    • B03C2201/00—Details of magnetic or electrostatic separation
    • B03C2201/26—Details of magnetic or electrostatic separation for use in medical or biological applications

Definitions

  • the present invention relates an electrically insulating sleeve for a surgical borescope and a surgical borescope.
  • the present invention further relates to a surgical viewing system.
  • Particulate matter in aerosol form is commonly encountered during surgical procedures.
  • Therapeutic agents are often delivered to surgical sites in aerosolized form, including agents for effecting rapid clotting of blood and for treating diseases such as cancer.
  • particulate matter is also generated during surgical procedures which utilise “energy-based” surgical instruments. These instruments are typically used to deliver a therapeutic effect such as cutting or coagulating patient tissue, and the typical forms of energy used to deliver these effects include radiofrequency (RF) electrical energy, ultrasonic vibrational energy and lasing radiation energy.
  • RF radiofrequency
  • Particulate matter created in an aerosolized form by energy-based instruments is problematic because it rapidly obscures the visual field of the surgeon thereby slowing the surgical procedure, and creates a risk of accidental harm to the patient caused by poor visibility.
  • vacuum-based systems have been used to extract the aerosolised particulate matter from the surgical field.
  • this is a dilution-based process it is inefficient at rapidly removing the particulate matter and improving the visual field quality.
  • the resulting exchange of gas dries and desiccates tissue which has a detrimental effect for the patient.
  • the adoption of vacuum-based systems has been poor.
  • WO2011/010148 discloses an alternative approach for managing aerosolized particulate matter in surgical procedures via an apparatus for the reduction and removal of surgical smoke and other aerosolized particulates generated during electrosurgical procedures.
  • the apparatus generates a stream of electrons from an electrode placed near the surgical site, such as within an abdominal cavity, and the electrons emitted from the electrode attach themselves to the aerosolized particles suspended nearby.
  • the apparatus further establishes an electrical potential difference between the electrode and the patient for attracting the ionized particles away from the surgical site and thus improving the surgeon’s view of the site.
  • the electrode that is deployed into the abdomen for example can require an additional incision within the abdominal wall which is undesirable.
  • the effectiveness of the apparatus is also dependent on the positioning of the electrode relative to the site of surgery, and other surgical instruments may obstruct the distribution of ions and thus the efficacy of smoke/particulate removal. While it is desirable to place the ion-generating electrode near the distal end of the operative surgical instrument, so that it is positioned close to the surgical site, it is also important to avoid obscuring the view of the site by the electrode itself, such as with a laparoscopic telescope or borescope.
  • the present invention addresses at least some of the above-mentioned limitations.
  • an electrically insulating sleeve for a surgical borescope comprising a first lumen having a proximal end through which a body of the borescope is insertable, and a distal end through which at least a portion of the body can extend for viewing a surgical site, the sleeve further comprising at least one second lumen comprising an electrode, the at least one second lumen extending along the sleeve between the proximal and distal ends thereof, the at least one second lumen comprising a distal end which is spaced longitudinally of the sleeve, from the distal end of the first lumen, between the proximal and distal ends of the first lumen, a distal end of the electrode being arranged to extend out from the distal end of the at least one second lumen.
  • the electrode is arranged to extend along the sleeve, substantially within the sleeve.
  • the distal end of the electrode is spaced radially outwardly away from the first lumen, and the at least one second lumen extends along the sleeve substantially parallel to a longitudinal axis of the first lumen.
  • the sleeve comprises a liner portion and a cover portion, the liner portion being disposed radially inwardly of the cover portion.
  • the liner and cover portions may be formed of the same material, or alternatively the liner and cover may be formed of different materials.
  • the cover may comprise a more durable material than the liner and/or the liner may be more electrically resistive than the cover.
  • the liner and cover effectively form a nested arrangement of layers which, in use, extend around the surgical borescope.
  • the at least one second lumen is disposed radially between an outer diameter of the liner portion and an outer diameter of the cover portion.
  • the second lumen may be formed between the liner and cover or in an alternative embodiment, the at least one second lumen may be disposed within the cover portion itself.
  • the at least one second lumen is disposed radially between an outer diameter of the liner portion and an inner diameter of the cover portion. The second lumen may thus be formed between discrete sleeve layers of the liner and cover, for example.
  • the sleeve further comprises a spacer for radially spacing the at least one second lumen from the first lumen. It is desirable to maintain a minimum separation of the distal end of the electrode from any exposed portion (typically the distal end) of the borescope, to avoid any reduction in potential difference between the electrode and a patient, since this would otherwise reduce the efficacy of the electrode to function as an ionising electrode to ionise aerosolised particulates in the vicinity of the surgical site.
  • the spacer can thus serve to maintain a desired separation to minimise any reduction in potential difference.
  • the spacer can assist in spacing the electrode from the borescope to extend the effective angular range of ionisation within the surgical field.
  • the borescope will effectively eclipse particulate matter disposed at the side thereof which is opposite the side to which of the electrode extends. By spacing the electrode further from the borescope, the effective angular range for ionising aerosolised matter increases.
  • the spacer is disposed between the liner portion and the cover portion, the at least one second lumen being disposed radially between the spacer and the cover portion.
  • the sleeve comprises at least two second lumens, each comprising an electrode, angularly separated around the sleeve.
  • the provision of two second lumens and thus two electrodes reduces the eclipsing effect of the borescope and so better exposes aerosolized particulates within the complete volume of the surgical field to the ionising effects of the electrodes.
  • the electrode comprises a distributed electrode which extends around the sleeve.
  • the distributed electrode may comprise a cylindrical shape whereby a longitudinal axis of the electrode and a longitudinal axis of the first lumen are co-aligned.
  • the or each electrode is configured to electrically couple with an electrical source for generating an electrical field from the distal end of the or each electrode, proximate a site of the surgical procedure, for ionising and removing particles suspended proximate the surgical site.
  • the or each electrode comprises an electrically insulating jacket which extends substantially along the length thereof, the distal end of the or each electrode being exposed to define an ion emission zone.
  • the distal end of the or each electrode is preferably spaced longitudinally from the distal end of the first lumen by distance in the range 10-50mm.
  • a surgical borescope comprising an electrically insulating sleeve according to the first aspect.
  • a surgical borescope comprising a body having a proximal end via which a surgeon may view a surgical site and a distal end which is positionable proximate the surgical site, the body comprising a body wall defining a first lumen comprising viewing means for enabling a surgeon to view a surgical site, and at least one second lumen comprising an electrode, the first lumen extending between the proximal and distal ends of the body, the at least one second lumen comprising a distal end which is spaced longitudinally from the distal end of the body, between the proximal and distal ends of the body, a distal end of the electrode being arranged to extend out from the distal end of the at least one second lumen.
  • first and at least one second lumen extend in a substantially parallel arrangement, and the at least one second lumen is disposed radially outwardly of the body from the first lumen.
  • the body of the borescope may be formed of an electrically insulating material.
  • the or each electrode is configured to electrically couple with an electrical source for generating an electrical field from the distal end of the or each electrode proximate a site of the surgical procedure, for removing particles suspended proximate the surgical site.
  • the or each electrode comprises an electrically insulating jacket which extends substantially along the length thereof, the distal end of the or each electrode being exposed to define an ion emission zone.
  • the distal end of the or each electrode is spaced longitudinally from the distal end of the sleeve by distance in the range 10-50mm.
  • a surgical viewing system for viewing a surgical site, the system comprising a surgical borescope according to the second or third aspects, an electrical source for electrically coupling with the electrode for generating an electrical field from the distal end of the electrode proximate a site of the surgical procedure, for removing particles suspended proximate the surgical site, and an illumination source for illuminating the surgical site via the borescope.
  • Figure 1 is a schematic side view of a surgical borescope comprising an electrically insulating sleeve according to an embodiment of the present invention
  • Figure 2 is an exploded side view of the surgical borescope and sleeve illustrated in Figure 1 ;
  • Figures 3a is a plan view and figure 3b is a cross-sectional view of the surgical borescope and sleeve illustrated in Figure 1 ;
  • Figures 4a is a magnified view of the distal region of the surgical borescope and sleeve illustrated in figure 1
  • figure 4b is a sectional side view of the distal end of the surgical borescope and sleeve illustrated in figure 4a
  • figure 4c is a magnified sectional view of the surgical borescope and sleeve illustrated in figure 4a, taken along line A-A
  • figure 4d is a sectional view of the surgical borescope and sleeve taken across line B-B of figure 4c;
  • Figure 5 is a schematic illustration of a surgical borescope according to an embodiment of the present invention.
  • Figures 6a-d are axial views of the distal end of a surgical borescope according to different embodiments of the present invention.
  • Figure 7 is a schematic illustration of a surgical viewing system according to an embodiment of the present invention during use on a patient
  • Figure 8 is a schematic illustration of a sleeve according to an embodiment of the present invention fitted to a borescope.
  • Figure 9 is a schematic illustration of a surgical viewing system according to an embodiment of the present invention during use on a patient.
  • the borescope 200 comprises an elongate body 210 having a substantially cylindrically shaped body wall 211 comprising a length in the range of 100-400mm and an external diameter in the range of 3-12mm.
  • An eyepiece or image capture device 220 is coupled at a proximal end 212 of the body via which a surgeon may view a surgical site, and a viewing lens 230 or similar is disposed at a distal end 213 of the body 210 for capturing the view of the surgical site.
  • the borescope 200 may further comprise a lensing and waveguide arrangement (see figure 6) disposed within the body 210 for communicating the images of the surgical site to the eye-piece or image capture device 220.
  • the sleeve 100 is formed of an electrically insulating material, such as polyethylene or polypropylene and is arranged to receive the elongate body 210 of the borescope to prevent any undesired electrical coupling between the borescope 200 and a patient during use.
  • the sleeve 100 comprises a substantially cylindrical shape and is sized to substantially correspond with the length of the body 210.
  • the sleeve 100 may be of a suitable length to be compatible with the range of commercially available surgical borescopes and endoscopes which include scopes for different anatomical procedures such as laparoscopy, arthroscopy and hysteroscopy procedures.
  • the sleeve 100 may be formed of an elastic material so that the sleeve 100 can form an intimate fit with the body 210 when fitted to the body 210.
  • the sleeve 100 comprises a first lumen 110 which extends along the length of the sleeve between a proximal end 111 and a distal end 112 thereof.
  • the first lumen 110 is arranged to receive the body 210 of the borescope 200 and extends along the length of the body 210, such that when the body 210 is fully inserted, only a limited distal region of the borescope can extend out from the distal end 112.
  • a distal end of the borescope 200 may be set back from the distal end 112 of the first lumen 110, within the first lumen 110, so that it is completely shrouded by the sleeve 100, yet still capable of capturing images of the surgical site.
  • the sleeve 100 further comprises at least one second lumen 120 formed therein which extends along the sleeve 100 between a proximal and distal end of the first lumen 110. Referring to figures 4a-c of the drawings, the sleeve 100 comprises two second lumina 120 diametrically disposed across the sleeve 100, however, the skilled person will recognize that any number of second lumina 120 may be used.
  • the proximal end 111 of the first lumen extends at the same longitudinal position along the sleeve 100 as a proximal end 121 each of the second lumina 120, however the distal ends 122 of the second lumina 120 are spaced from the distal end 112 of the first lumen 110.
  • the second lumina 120 do not extend along the full length of the sleeve 100 and are arranged to terminate at a position intermediate the proximal and distal ends 111 , 112 of the first lumen 110.
  • a longitudinal axis of each of the second lumina 120 extends substantially parallel with a longitudinal axis of the first lumen 110, but is spaced radially outwardly of the sleeve 100 from the first lumen 110.
  • Each of the second lumina 120 comprise a separate electrode 130.
  • a distal end 132 of each electrode 130 is arranged to extend out from the distal end 122 of the second lumina 120 and a proximal end 131 of each electrode 130 is electrically coupled within a housing 140 to a respective electrical termination 150.
  • the terminations 150 enable the electrodes 130 to be electrically coupled to a source of high voltage electricity via respective electrical conduits 151.
  • the electrodes 130 comprise an electrically insulating jacket 133 which extends along the length thereof, however, the distal end 132 of each electrode 130 is exposed and may comprise a sharpened or fibrous portion.
  • the exposed portion of each electrode forms an ionemission zone and is arranged to emit electrons therefrom (when coupled to the electrical source) which attach themselves to particulate matter to ionize the particulates.
  • the sleeve 100 comprises a cylindrically shaped liner portion 160 which is arranged radially innermost and which is arranged to extend adjacent the body 210 of the borescope 200, and a cylindrically shaped cover portion 170 which forms the outermost portion of the sleeve.
  • Both the liner and cover portion may be formed of an electrically insulating material, but it is envisaged that the cover portion 170 may comprise a more durable material given that it will be exposed to external impacts and abrasions.
  • the liner portion 160 may instead be formed of an electrically conductive material.
  • the second lumina may be formed between the liner 160 and cover portions 170, or within the cover portion 170 itself.
  • the liner and cover portions 160, 170 may comprise discrete layers which are bonded together (such as via an ultrasonic welding or via an adhesive) in a nested arrangement, or alternatively, the liner and cover portions 160, 170 may be formed integrally.
  • the sleeve 100 further comprises a spacer 180 disposed radially between the liner and cover portions 160, 170.
  • the spacer 180 comprises a substantially cylindrical shape and is nested between the liner and cover portions 160, 170.
  • the spacer 180 may similarly comprise a discrete layer of the sleeve 100 which is bonded to the liner and cover portions 160, 170, or instead may be formed integrally within the liner and cover portions 160, 170.
  • the second lumina 120 are arranged to extend along the sleeve 100 at a radial position which is between an outer diameter of the spacer 180 and an outer diameter of the cover portion 170, such that the spacer 180 serves to further radially separate the electrodes 130, and specifically the distal ends 132 of the electrodes, from the borescope 200.
  • the borescope 200 may typically comprise a body 210 formed of an electrically conductive material, such as stainless steel, and as such the conductive body 210 acts to lower the potential difference between the electrodes 130 and the return path (which will typically comprise the patient - see later). This in turn will act to reduce the efficacy of the electrodes 130 for generating electrons therefrom and thus the ability of the electrodes 130 to ionize particulates for clearing the view of the surgical site.
  • the potential difference between the electrodes 130 and the return path can be preserved by electrically insulating the body 210 from the electrodes 130 and by spacing the distal ends 132 of the electrodes 130 from the borescope 200 itself.
  • the spacer 180 also helps to minimize the eclipsing effect of the borescope 200 to particulates within the surgical environment.
  • the borescope 200 will typically shield the portion of the surgical field which is opposite the side of one of the electrodes 130. The ability of an electrode 130 to ionize particulates at the opposite side of the borescope 200 is thus reduced.
  • the electrode 130 by spacing the electrode 130 further from a longitudinal axis of the borescope 200, then the angular range exposed to the surgical site by the electrode 130 is increased.
  • each electrode (only one is illustrated) is exposed and extends out from beneath the cover portion. However, the region of the cover portion from which the electrode extends is notched 171 and the distal end of each electrode is located within the notch 171. This positioning of the distal end of the electrode(s) protects the electrode(s) when the borescope 200 is inserted, during use, through a seal (not shown) of a port (440, 640) (see later) and further minimizes any tearing or cutting of the seal that may otherwise occur by a contact between the distal end of the electrode(s) and the seal.
  • the sleeve 100 may comprise a single second lumen having an annulus shape in cross-section for housing a cylindrically shaped electrode which extends around the borescope.
  • the second lumen of this embodiment comprises a longitudinal axis which is co-aligned with a longitudinal axis of the first lumen.
  • This distributed electrode may comprise a serrated or sharpened exposed, distal end for example, for generated electrons from a distributed position around the borescope.
  • the borescope 300 comprises a body 310 formed of an electrically insulating material, such as a rigid plastics material, having a length in the range of 100-400mm and an external diameter in the range of 3-12mm.
  • the body 310 further comprises a diameter which is compatible with a range of commercially available surgical ports.
  • the body 310 comprises a proximal end 311 which is coupled with a hub 320 and a distal end 312 which is positionable proximate the surgical site.
  • the body 310 comprises a body wall 313 which defines a first lumen 330 comprising viewing means, such as a lensing and waveguide arrangement 350, for enabling a surgeon to view a surgical site, and at least one second lumen 340 comprising an electrode 360.
  • the borescope 300 comprises two second lumina 340 diametrically opposed across a longitudinal axis of the borescope 300 and which extend substantially parallel with a longitudinal axis of the first lumen 330.
  • the first lumen 330 extends between the proximal and distal ends 311 , 312 of the body 310 and itself comprises a proximal 331 and a distal end 332.
  • the second lumina 340 similarly comprise a proximal and a distal end 341, 342, and the distal end 342 of each of the second lumina 340 is spaced longitudinally from the distal end 312 of the first lumen 330.
  • the distal end 312 of the body 310 comprises a stepped profile with an inner portion 314 having a first outer diameter and an outer portion 315 having a second outer diameter which is greater than the first diameter.
  • the inner portion 314 extends longitudinally beyond a distal end 315a of the outer portion 315 such that an annular end-face 316 is formed.
  • a distal end of the inner portion 314 of the body 310 forms the distal end of the body 312.
  • the distal end 342 of the second lumina 340 terminate in the end-face 316 and the electrode 360 within each of the second lumina 340 extend out from the end-face to present an exposed region of the electrode.
  • the exposed region of each electrode forms an ion-emission zone and is arranged to emit electrons therefrom (when coupled to the electrical source) which attach themselves to particulate matter to ionize the particulates.
  • the proximal end of the borescope 300 comprises a hub 320 from which the body 310 extends.
  • the hub 320 may be coupled with an eye-piece or imaging device (not shown in figure 5) for enabling a surgeon to view the surgical site.
  • the hub 320 further comprises two electrical terminations 370 which are separately electrically coupled to a respective electrode 360.
  • the skilled reader will recognize that an alternative number of terminations may be required depending on the number and configuration of the electrodes.
  • FIG. 6a there is illustrated the distal end of various embodiments of borescopes 300, each having a different electrode configuration.
  • a single electrode 360 extending out from a single second lumen 340, disposed radially outwardly from the first lumen 330.
  • FIG 6b of the drawings there is illustrated the embodiment shown in figure 5 comprising two second lumina 340 each comprising a respective electrode 360.
  • the second lumina 340 and thus the electrodes 360 disposed therein are diametrically opposed within the body 310, either side of the first lumen 330.
  • Figure 6c of the drawings illustrates the configuration comprising four second lumina 340 which are angularly separated around the first lumen 330 by approximately 90°.
  • Figure 6d of the drawings illustrates a further embodiment in which the electrode 360 comprises a distributed electrode having a substantially cylindrical shape. The distributed electrode extends around the first lumen 330 in a cylindrically shaped second lumen 340.
  • FIG 7 of the drawings there is illustrated a surgical viewing system 400 according to a first embodiment of the present invention.
  • the system is illustrated in use upon a patent P who is undergoing laparoscopic surgery.
  • the system 400 comprises a surgical borescope 300 as described in relation to figures 5 and 6.
  • the system 400 further comprises a source of high voltage DC electricity 410, with the negative pole of the electrical source 410 being electrically coupled with the electrode(s) 130, 360 disposed within the sleeve/borescope 100, 300 via the electrical terminations (not shown in figure 7) and an electrical conduit 411 , and the positive pole of the electrical source 410 being electrically coupled with the patient P via a conductive pad 420 which is bonded to the patient, such as the leg, using a conductive gel/adhesive.
  • the pad 420 is electrically coupled with the positive pole via an electrically insulated wire or conduit 421.
  • the system 400 further comprises an illumination source 430, such as a white LED, which is optically coupled with the viewing means of the borescope via a waveguide 431 , such as an optical fibre, to illuminate the abdominal cavity of the patient P during the surgical procedure.
  • the surgical borescope 200 with sleeve 100, or the surgical borescope 300 is inserted through the abdominal wall W of the patient P via a first surgical port 440 and the distal end of the borescope is located proximate to the surgical site so that the site can be suitably illuminated via the illumination source 430, and so that the surgeon has a direct view of the surgical site.
  • An electrosurgical instrument such as a diathermy forceps device 510, which does not form part of the viewing system 400 is inserted through the abdominal wall W of the patent via a second surgical port 520.
  • the electrosurgical device 510 which forms part of a surgical system 500 for performing the surgical procedure, is supplied with power along a power supply conduit 531 from the electrosurgical generator 530 and may be used for the removal of tissue T in the abdomen A of the patient P. During this process, smoke particles S are released into the abdomen and these particles obscure the surgeons view of the surgical site.
  • the system may further comprise a timing arrangement (450) for timing the application electrical power to the one or more electrodes in dependence of the surgeons use of the surgical instrument.
  • a timing arrangement for timing the application electrical power to the one or more electrodes in dependence of the surgeons use of the surgical instrument.
  • the timing arrangement is arranged to electrically couple the high voltage DC source with the electrode(s) to create an electrical potential difference between the electrode 130, 360 and the patient P. This potential difference and the physical structure of the distal end of the electrode(s) 130, 360 causes electrons to emanate from the electrode(s) and these electrons attach themselves to the atoms within the smoke particles.
  • the negatively charged smoke particles S quickly become attracted toward the interior of the abdominal wall W, owing to the positive charge applied to the patient via the electrical coupling with the positive pole of the DC electrical source 410, and as a result clears the surgeons view of the surgical site.
  • the application of electrical power to the electrode(s) may be automated and timed in relation to the surgeons activation of the surgical instrument. Alternatively, or in addition thereto, the electrical power to the electrodes 130, 360 may be activated manually by the surgeon on demand via the timing arrangement 450. The smoke particles S which precipitate on the inside of the patient’s abdominal cavity can then be washed away following the surgical procedure.
  • a surgical borescope 200 comprising a body 210 formed of an electrically conductive material, such as stainless steel.
  • the borescope 200 is fitted with an electrically insulating sleeve 100 comprising two second lumina each having a respective electrode 130, as described above, but in this embodiment, the liner portion 160 of the sleeve 100 is formed of an electrically conductive material to form an electrical contact with the body 210 of the borescope 200.
  • a proximal end of the sleeve 100 comprises a housing 140 which comprises two electrical terminations 150 which are separately electrically coupled to a respective electrode 130.
  • the housing 140 further comprises an additional termination 150’ which is electrically coupled with the liner portion 160.
  • the additional termination 150’ comprises an electrical resistor (not shown) of typically 20MQ, and the termination 150’ is used to electrically couple with a wire or other electrical conduit (not shown) for providing an electrical pathway to a pad secured to the patient.
  • the pad, electrical conduit and termination 150’ thus enable any electrostatic charge build-up on the body 210 of the borescope 200 to safely discharge through the patient back to the source of electrical energy.
  • Figure 9 illustrates a surgical viewing system 600 according to a second embodiment of the present invention.
  • the system 600 is illustrated in use upon a patent P who is undergoing laparoscopic surgery.
  • the system 600 comprises a surgical borescope 200 as described in relation to figures 1-4 and 8, whereby the borescope body 210 is formed of an electrically conductive material.
  • the system 600 is substantially the same as the system 400 described above in relation to figure 7 and so like features have been referenced using the same numerals but increased by 200.
  • the body 210 is electrically coupled to the patient P via an electrically conductive strap 601 which is coupled at one end to termination 150’ and at the other end to the patient P.
  • the termination 150’ does not comprise a resistor, it is envisaged that the strap 601 itself may be formed of an electrically resistive material having the same effective resistance as the resistor.
  • the high voltage source includes a proximity detector (not shown) for sensing the pathway impedance between the ion emission zone of the electrode(s) and the exposed conduction regions, which in the case of a borescope formed of stainless steel for example, would comprise the distal end of the borescope which extends out from the distal end of the first lumen of the sleeve.
  • the impedance has close correlation to the physical separation and in an embodiment, the high voltage source is configured to emit an audible tone when the ion emission zone is inadequately separated from the conduction region.
  • This control is provided through the termination of one or both ends of the ion-generating electrode 130 with one or more high value resistors (of order 1- 100MQ, preferably 10MQ) or the use of a high resistivity material to form the ion-generating electrode 130 of similar overall resistance renders more benign the charges stored within the surgical borescope or the electrode.
  • a further means of dealing with the increased energy storage risks arising from the greater proximity between the ion-generating electrode and the conductive region of the surgical borescope is the reduction of DC voltages achievable at the ion-generating electrode relative to the patient return pad.
  • a precipitation of surgical smoke requires a minimum ion emission zone potential difference of 3kV with improving smoke clearing rates at increasing potential differences.
  • the primary current limit of 10pA under electronic control is backed-up by the 50pA limit that provides a total output resistance of 200MQ, such that under normal fault free conditions the maximum ion emissions occurs at about 8kV de ion emitter voltages. Therefore, in this alternative, the 10kV de output voltage of the upstream high voltage supply is reduced to close to 8kV de difference between the patient connection and the 50pA secondary current limit is provided by independent electronic means.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Animal Behavior & Ethology (AREA)
  • Veterinary Medicine (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • General Health & Medical Sciences (AREA)
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  • Radiology & Medical Imaging (AREA)
  • Plasma & Fusion (AREA)
  • Otolaryngology (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention concerne un manchon électriquement isolant pour un borescope chirurgical. Le manchon comprend une première lumière ayant une extrémité proximale à travers laquelle un corps du borescope peut être inséré, et une extrémité distale à travers laquelle au moins une partie du corps peut s'étendre pour visualiser un site chirurgical. Le manchon comprend en outre au moins une seconde lumière comprenant une électrode, la ou les secondes lumières s'étendant le long du manchon entre ses extrémités proximale et distale, la ou les secondes lumières comprenant une extrémité distale qui est espacée longitudinalement de l'extrémité distale du manchon, entre les extrémités proximale et distale du manchon. Une extrémité distale de l'électrode est agencée pour s'étendre hors de l'extrémité distale de la ou des secondes lumières. L'invention concerne également un borescope chirurgical et un système de visualisation chirurgicale.
PCT/GB2023/053260 2023-01-16 2023-12-15 Manchon électriquement isolant pour boroscope chirurgical, boroscope chirurgical et système de visualisation chirurgicale WO2024153901A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
GB2300606.7A GB2626194A (en) 2023-01-16 2023-01-16 An electrically insulating sleeve for a surgical borescope, a surgical borescope and a surgical viewing system
GB2300606.7 2023-01-16

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WO2024153901A1 true WO2024153901A1 (fr) 2024-07-25

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Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20070088247A1 (en) * 2000-10-24 2007-04-19 Galil Medical Ltd. Apparatus and method for thermal ablation of uterine fibroids
US20090275798A1 (en) * 2008-05-01 2009-11-05 Olympus Medical Systems Corp. Overtube and endoscope system suitable for treatment such as submucosal dissection
US20100324363A1 (en) * 2008-03-05 2010-12-23 Board Of Regents, The University Of Texas System Disposable sheath designs for the stimulating endoscope and needle endoscopes having distal electrodes for nerve block under direct vision and methods for making and using same
WO2011010148A2 (fr) 2009-07-23 2011-01-27 Asalus Medical Instruments Limited Améliorations apportées à la réduction et l’élimination de particules
US20190178510A1 (en) * 2017-12-08 2019-06-13 National Cheng Kung University Electronic apparatus capable of air pollution reduction

Family Cites Families (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
GB201414533D0 (en) * 2014-08-15 2014-10-01 Asalus Medical Instr Ltd Laparoscopic access port

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20070088247A1 (en) * 2000-10-24 2007-04-19 Galil Medical Ltd. Apparatus and method for thermal ablation of uterine fibroids
US20100324363A1 (en) * 2008-03-05 2010-12-23 Board Of Regents, The University Of Texas System Disposable sheath designs for the stimulating endoscope and needle endoscopes having distal electrodes for nerve block under direct vision and methods for making and using same
US20090275798A1 (en) * 2008-05-01 2009-11-05 Olympus Medical Systems Corp. Overtube and endoscope system suitable for treatment such as submucosal dissection
WO2011010148A2 (fr) 2009-07-23 2011-01-27 Asalus Medical Instruments Limited Améliorations apportées à la réduction et l’élimination de particules
US20190178510A1 (en) * 2017-12-08 2019-06-13 National Cheng Kung University Electronic apparatus capable of air pollution reduction

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GB202300606D0 (en) 2023-03-01

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