DE69631261T2 - Flüssigkeitsunterstützte elektrochirurgische Vorrichtung mit rollender Kugel - Google Patents

Flüssigkeitsunterstützte elektrochirurgische Vorrichtung mit rollender Kugel Download PDF

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DE69631261T2
DE69631261T2 DE69631261T DE69631261T DE69631261T2 DE 69631261 T2 DE69631261 T2 DE 69631261T2 DE 69631261 T DE69631261 T DE 69631261T DE 69631261 T DE69631261 T DE 69631261T DE 69631261 T2 DE69631261 T2 DE 69631261T2
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M. Peter Mulier
F. Michael HOEY
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Medtronic Inc
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    • 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
    • A61B18/1402—Probes for open surgery
    • 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
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/1815—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using microwaves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00053—Mechanical features of the instrument of device
    • A61B2018/00184—Moving parts
    • A61B2018/00196—Moving parts reciprocating lengthwise
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00053—Mechanical features of the instrument of device
    • A61B2018/00273—Anchoring means for temporary attachment of a device to tissue
    • A61B2018/00291—Anchoring means for temporary attachment of a device to tissue using suction
    • 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
    • A61B18/1206—Generators therefor
    • A61B2018/1246—Generators therefor characterised by the output polarity
    • A61B2018/1253—Generators therefor characterised by the output polarity monopolar
    • 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
    • A61B2018/1405—Electrodes having a specific shape
    • A61B2018/1417—Ball
    • 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
    • A61B2018/1472—Probes or electrodes therefor for use with liquid electrolyte, e.g. virtual electrodes
    • 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
    • A61B2018/1475—Electrodes retractable in or deployable from a housing
    • 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
    • A61B18/18—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves
    • A61B18/1815—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using microwaves
    • A61B2018/1861—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by applying electromagnetic radiation, e.g. microwaves using microwaves with an instrument inserted into a body lumen or cavity, e.g. a catheter
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2218/00—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2218/001—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body having means for irrigation and/or aspiration of substances to and/or from the surgical site
    • A61B2218/002—Irrigation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2218/00—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2218/001—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body having means for irrigation and/or aspiration of substances to and/or from the surgical site
    • A61B2218/007—Aspiration

Description

  • Diese Erfindung bezieht sich allgemein auf das Gebiet medizinischer Instrumente und insbesondere auf eine Elektrokaustik-Vorrichtung.
  • Auf dem Gebiet der Medizin sind verschiedene Typen von Elektrokaustik-Vorrichtungen zum Einschneiden und Ausbrennen (kauterisieren) von Körpergewebe bekannt und in Gebrauch. Typischerweise umfassen solche Vorrichtungen eine leitende Spitze oder Nadel, die als Elektrode in einem elektrischen Stromkreis dient, der über eine mit dem Patienten gekoppelte Erdungselektrode vervollständigt ist. Der Gewebeeinschnitt wird dadurch ausgeführt, dass eine Elektroenergiequelle (am häufigsten eines Hochfrequenzgenerators) an die Spitze angelegt wird. Beim Anlegen der Spitze an das Gewebe wird ein Spannungsgradient erzeugt, wodurch ein Stromfluss und in Verbindung damit eine Wärmeerzeugung am Kontaktpunkt induziert werden. Mit ausreichend hohen Pegeln der Elektroenergie ist die erzeugte Wärme ausreichend, um das Gewebe zu schneiden, wobei vorteilhaft mehrere Blutgefäße gleichzeitig ausgebrannt werden.
  • Es ist im Stand der Technik weitgehend anerkannt, dass die häufig große Menge an Rauch, die durch die Elektrokaustik des Gewebes erzeugt wird, wenigstens unangenehm, in einigen Fällen Besorgnis erregend oder sogar gefährlich für den operierenden Arzt und das weitere anwesende medizinische Personal ist. Im Ergebnis wurde vorgeschlagen und ist es üblich, eine Elektrokaustik-Vorrichtung mit Rauchabsaugfähigkeiten zu verwenden, so dass der von der Elektrokaustik erzeugte Rauch schnell aus dem Bereich des Einschnitts ab gezogen wird. Ein Aufsaugen des Rauchs kann dadurch ausgeführt werden, dass im Griff der Elektrokaustik-Vorrichtung in der Nähe der Elektrokaustik-Spitze/Elektrode eine Einlassöffnung vorgesehen ist, die mit einer Unterdruck- oder Saugquelle gekoppelt ist. Beispiele hierfür sind beschrieben im US-Patent Nr. 4.307.720 an Weber mit dem Titel "Electrocautery Apparatus and Method and Means for Cleaning the Same"; im US-Patent Nr. 5.242.442 an Hirschfeld mit dem Titel "Smoke Aspirating Electrosurgical Device"; und im US-Patent Nr. 5.269.781 an Hewell mit dem Titel "Suction Assisted Electrocautery Unit".
  • US-A-5.395.363 offenbart ein Elektrokaustik-Instrument mit einer radähnlichen drehbaren Elektrode.
  • Außerdem ist im Stand der Technik erkannt worden, dass die Ansammlung von geronnenem Blut, Gewebetrümmern und anderen Bruchstücken an der Elektrode/Spitze der Elektrokaustik-Vorrichtung ein Problem für den operierenden Arzt darstellen kann, welches die periodische Reinigung der Spitze z. B. durch Wischen der Spitze über sterilisierten Verbandmull oder dergleichen erforderlich macht. Da die Notwendigkeit, die Elektrode/Spitze zu reinigen, dazu neigt, das Einschnittverfahren zu unterbrechen und die Risiken im Zusammenhang mit der Verunreinigung der Spitze oder dem Einschnitt, der Beschädigung der Spitze, einer Verletzung für den operierenden Arzt und dergleichen erhöht, wird dies allgemein als unerwünscht betrachtet. Um dieses Problem zu behandeln, ist im Stand der Technik vorgeschlagen worden, ein Elektrokaustik-Instrument zu schaffen, in dem die Elektrode/Spitze in gleitendem Eingriff mit dem Griff des Instruments ist, so dass irgendwelche anhängenden Bruchstücke, wenn die Spitze in die Hand zurückgezogen wird, automatisch auf die Spitze des Griffs abgekratzt werden. Ein solches Instrument ist in dem obenbeschriebenen '720-er Patent an Weber, Jr., vorgeschlagen. Obgleich diese Anordnung einen gewissen Nutzen haben kann, kann es dennoch erforderlich sein, die Spitze des Griffs abzustreifen, wenn die Spitze zurückgezogen wird. Es wird angenommen, dass ein direkterer und wirksamerer Zugang zu dem Problem darin besteht, die Menge der während des Elektrokaustik-Prozesses erzeugten Bruchstücke zu verringern und dadurch die Notwendigkeit, die Elektrode/Spitze zu reinigen, zu beseitigen oder wenigstens zu verringern.
  • Das Vorhofflimmern ist der Zustand, in dem die normalen rhythmischen Kontraktionen des Herzens durch schnelle unregelmäßige Zuckungen der Herzmuskelwand ersetzt sind. Wenigstens 1 Million Menschen in den USA leiden an Vorhofflimmern. Es gibt wenigstens drei nachteilige Nebenwirkungen, die während des Vorhofflimmerns auftreten: ein schneller, unregelmäßiger Herzschlag; eine eingeschränkte Herz-Hämodynamik wegen des Verlusts der AV-Synchronie; und eine erhöhte Anfälligkeit für Thromboembolien. Surgical Treatment of Cardiac Arrhythmias, von Hurst, J. Willis, M. D., u. a., S. 867.
  • Die typische Behandlung des Vorhofflimmerns besteht darin, den Patienten Medikamente zu verabreichen. Für die meisten Patienten mit Vorhofflimmern ist diese Behandlung lediglich mäßig wirksam und erzeugt typischerweise unerwünschte Nebenwirkungen.
  • Angesichts der Probleme bei der medikamentösen Behandlung des Vorhofflimmerns ist es als wünschenswert erkannt worden, eine operative Behandlung zu finden, die das Vorhofflimmern dauerhaft heilt. Cardiovascular Device Update, Juli 1995, S. 1. Obgleich sich die Hochfrequenz-Katheterabtragung (RFCA) als sichere und wirksame Möglichkeit zur Behandlung der meisten nicht rezidivierenden Ursachen der supraventrikulären Tachykardie (SVT) wie etwa der Wolff-Parkinson-White- und der AV-Knoten-Reentry-Tachykardie erwiesen hat, hat sich die Verwendung der Abtragung zur Behandlung des Vorhofflimmerns als schwierig erwiesen.
  • Zur Behandlung des Vorhofflimmerns wurde das so genannte "Labyrinth"-Verfahren entwickelt. In dem "Labyrinth"-Verfahren werden über ein Operationsverfahren am offenen Brustkorb Einschnitte in den rechten und in den linken Vorhof vorgenommen. Diese Einschnitte werden so gelegt, dass sie sämtliche potenziellen Wiedereintritts-Stromkreismuster, die in den Vorhof auftreten und zum Vorhofflimmern führen können, unterbrechen. Der klinische Erfolg mit dem "Labyrinth"-Verfahren ist gut.
  • Ein Problem bei dem "Labyrinth"-Verfahren besteht darin, dass es eine Operation am offenen Brustkorb erfordert, was unerwünscht ist. Es ist erkannt worden, dass es wünschenswert ist, das "Labyrinth"-Verfahren mit der Abtragung zu reproduzieren. Dies würde die Möglichkeit zulassen, ein "labyrinth"-ähnliches Verfahren thoraskopisch auszuführen. Allerdings ist auch erkannt worden, dass momentan keine Abtragungstechnologie entwickelt worden ist, die das "Labyrinth"-Verfahren mit der Abtragung zu reproduzieren ermöglicht.
  • Ein Problem bei der Abtragung des Standes der Technik besteht darin, dass die Abtragungsspitze, wenn sie zu lange mit einem Gewebestück in Kontakt verbleibt, das Gewebe durchbrennt und durchlocht. In vielen Anwendungen hat sich die Abwägung als schwierig erwiesen, eine Abtragungsspitze während einer ausreichenden Zeitdauer an einem Gewebestück an der Stelle zu lassen, um die Abtragung des Gewebes zu ermöglichen, sie aber nicht während einer solchen Zeitdauer an der Stelle zu lassen, dass das Gewebe durchbrennt und dadurch durchlocht wird.
  • Ein weiteres Problem bei den Abtragungsvorrichtungen des Standes der Technik besteht darin, dass die Spitze an dem Gewebe, das abgetragen wird, "klebt", wenn die Abtragungsspitzen zu lange mit dem Gewebe in Kontakt gelassen werden. Beim Entfernen der Spitze werden häufig große Gewebeabschnitte, die an der Spitze angebracht sind, entfernt.
  • Dies ist nicht nur ein Ergebnis, das wegen des Gewebeschadens zu vermeiden ist, sondern ist auch zeitaufwändig und ärgerlich für den Mediziner. Dies sind eindeutig Probleme, die zu vermeiden sind.
  • Angesichts der vorstehenden Betrachtungen ist die vorliegende Erfindung auf ein verbessertes Elektrokaustik-Instrument gerichtet.
  • In Übereinstimmung mit der Erfindung ist ein fluidunterstütztes Elektrokaustik-Instrument mit einem Griff vorgesehen, der mit einem mit einer leitenden Spitzte versehenen Rohr verbunden ist, wobei wenigstens ein Abschnitt des Rohres ein Lumen bzw. einen Hohlraum aufweist, wobei das Lumen mit einem Kanister leitender Flüssigkeit zur Ausgabe bzw. zum Ausstoß leitender Flüssigkeit aus der leitenden Spitze in fluider Kommunikation steht, wobei der Kanister in dem Griff aufgenommen ist.
  • Vorzugsweise wird auf das proximale Ende der hohlen Elektrode/Spitze ein leitendes Fluid aufgetragen, das während der Elektrokaustik von deren distalem Ende ausgestoßen wird. Eine distale Kugelpunktspitze ermöglicht, dass die distale Spitze direkt auf das Gewebe aufgebracht und entlang des Gewebes "gerollt" oder gleiten gelassen wird. Dies ermöglicht, dass die distale Spitze über das Gewebe bewegt wird, ohne an dem Gewebe zu ziehen oder sich zu verhaken. Außerdem macht das von der distalen Spitze ausgestoßene leitende Fluid ferner die distale Spitze gleitfähig, während sie sich über das Gewebe bewegt.
  • In Übereinstimmung mit einer weiteren Ausführungsform der Erfindung leitet das leitende Fluid, das von der Elektrode/Spitze ausströmt, die HF-Elektrokaustik-Energie von der distalen Spitze weg, so dass es anstelle der distalen Spitze hauptsächlich das Fluid ist, das tatsächlich die Kauterisierung des Gewebes bewirkt. Das heißt, das Fluid dient als "virtuelle" Elektrokaustik-Elektrode. Da es das Fluid anstelle der distalen Spitze ist, das kauterisiert, gerinnen lässt und abträgt, werden keine Verbrennungen oder Durchlochungen an dem Gewebe erzeugt, was die Menge der Bruchstücke an der Abtragungsstelle verringert. Außerdem neigt die Strömung des Fluids durch die Elektrode/Spitze dazu, die distale Spitze sauber und kühl zu halten.
  • Die vorstehenden und weitere Aspekte der vorliegenden Erfindung können möglicherweise am besten mit Bezug auf eine ausführliche Beschreibung einer spezifischen Ausführungsform der Erfindung, die lediglich beispielhaft gegeben wird, verstanden werden, wenn sie in Verbindung mit der beigefügten Zeichnung gelesen wird, in der:
  • 1 eine perspektivische Ansicht eines Elektrokaustik-Instruments ist,
  • 2 eine perspektivische Ansicht des Instruments aus 1 ist, das von dem Griff getrennt ist,
  • 3 eine vergrößerte perspektivische Ansicht des distalen Endes der Elektrokaustik-Vorrichtung aus 1 ist, die die Elektrode/Spitze zeigt,
  • 4 eine Querschnittsansicht der Elektrode/Spitze der Vorrichtung aus den 1, 2 und 3 ist,
  • 5 eine Querschnittsansicht einer weiteren Ausführungsform der Elektrode/Spitze gemäß der Erfindung ist.
  • Anhand von 1 ist eine perspektivische Ansicht einer fluidgestützten Elektrokaustik-Vorrichtung 10 gezeigt. Die Elektrokaustik-Vorrichtung 10 umfasst einen Griff 12 und eine Elektrokaustik-Elektrode/Spitze 14. Der Griff 12 ist vorzugsweise aus einem sterilisierbaren, starren und nicht-leitendem Material wie etwa Nylon oder dergleichen hergestellt. Die Elektrode/Spitze 14 ist an dem Griff 12 befestigt.
  • Die Elektrode/Spitze 14 ist, wie in der stark vergrößerten perspektivischen Ansicht und in der Querschnittsansicht der 3 bzw. 4 gezeigt ist, vorzugsweise unter Verwendung eines hohlzylindrischen Rohrs 16 mit einer "Kugelspitze" an ihrem distalen Ende realisiert. Wie zu sehen ist, wird die Kugel 18 in einem Hohlraum gehalten, der durch Sicken des Metallrohrs 16 um die Kugel ausgebildet ist. Sowohl die Kugel 18 als auch das Rohr 16 sind vorzugsweise aus einem elektrisch leitenden Metall wie etwa aus rostfreiem Stahl hergestellt. Das Rohr 16 ist bei 20 bzw. 22 sowohl proximal als auch distal zu der Kugel 18 gesickt.
  • Die Kugel 18 kann einen beliebigen Durchmesser besitzen, wobei aber festgestellt wurde, dass Kugeln 18 mit Durchmessern von etwa 1 bis etwa 5 mm besonders wirksam für die Abtragung sind. Wie hier erläutert wird, muss das Rohr 16 einen Durchmesser besitzen, der dem Durchmesser der Kugel 18 entspricht. Folglich besitzt das Rohr 16 insbesondere an seinem distalen Ende vorzugsweise einen Innendurchmesser von etwa 1 bis etwa 5 mm.
  • Das Sicken kann durch eine Anzahl von Techniken einschließlich, aber nicht beschränkt auf, das Anordnen einer Reihe von "Sicken" 24 um den Umfang des Rohrs 16 ausgeführt werden, die ins Innere 26 des Rohrs 16 gerichtet sind. Außerdem wird das distale Ende 28 des Rohrs 16 dadurch "gesickt", dass es ins Innere 26 des Rohrs 16 abgerundet wird. Auf diese Weise wird die Kugel 18 zwischen den "Sicken" 24 und dem abgerundeten distalen Ende 28 gehalten. Das Sicken sollte so erfolgen, dass ein Abschnitt der Kugel 18 distal über das distale Ende 28 hinaus verläuft.
  • Vorzugsweise besitzt das Rohr 16 einen Innendurchmesser 26, der etwas größer als der Durchmesser der Kugel 18 ist. Auf jeden Fall sollte der Abschnitt des Rohrs 16, der die Kugel 18 umgibt, nach dem wie obenbeschriebenen Sicken einen etwas größeren Innendurchmesser als die Kugel 18 haben.
  • Dies ermöglicht, dass sich die Kugel 18 zwischen den Sicken 24 und dem distalen Ende 28 frei dreht und weiter in der Elektrode/Spitze 14 gehalten wird.
  • Vorzugsweise umgibt das Rohr 16 im Wesentlichen entlang seiner gesamten Länge ein elektrischer Isolator 30, der in kurzem Abstand von dem distalen Ende 28 endet. Der Isolator 30 verhindert, dass an anderen Stellen als an der Elektrode/Spitze 14 eine versehentliche Kauterisierung stattfindet, falls das Rohr 16 versehentlich während eines Verfahrens mit dem Gewebe des Patienten in Kontakt gelangt.
  • Es werden zwei Verbindungen zu der Elektrokaustik-Vorrichtung 10 hergestellt. Ein Anschluss (z. B. der positive) eines Hochfrequenzgenerators (HF-Generators) (der in 1 nicht gezeigt ist) ist über einen an dem Rohr 16 angebrachten Draht 32 elektrisch mit der Elektrode/Spitze 14 gekoppelt. Wie im Folgenden ausführlicher beschrieben wird, liefert der Kontakt zwischen der Kugel 18 und dem Rohr 16 ein elektrisches Potenzial für die Kugel 18.
  • Bei Instrumenten aus dem Stand der Technik ist mit dem Rohr 16 über eine biegsame Eingangsleitung 34 eine Quelle für das von der Elektrode/Spitze 14 auszustoßende Fluid gekoppelt. Die Eingangsleitung 34 ist vorzugsweise ein Rohr oder ein Schlauch. Durch das Rohr 16 wird der Elektrode/Spitze 14 mit Druck beaufschlagtes leitendes Fluid zugeführt. Wie in 2 gezeigt ist, wird das leitende Fluid durch die Eingangsleitung 34, die an eine Fluideinlassöffnung 36 am Rohr 16 angeschlossen ist, in das Rohr 16 eingeführt. Das leitende Fluid läuft von der Einlassleitung 34 über die Fluideinlassöffnung 36 in das Rohr 16 durch und wird entlang der Länge des Rohrs 16 an die Elektrode/Spitze 14 übertragen, um von deren distalem Ende ausgestoßen zu werden. Dies erzeugt eine so genannte "virtuelle Elektrode" zum Ausführen der Elektrokaustik.
  • Die Infusion eines leitenden Fluids gleichzeitig mit dem Anlegen der HF-Energie ist ausführlicher diskutiert in: US-Patent Nr. 5.431.649 mit dem Titel "Method and Apparatus for R-F Ablation", eingereicht am 27. August 1993 im Namen von Peter M. J. Mulier und Michael F. Hoey, im US-Patent Nr. 5.609.151 mit dem Titel "Method and Apparatus for RF Ablation", eingereicht am B. September 1994 im Namen von Peter M. J. Mulier; und im US-Patent Nr. 6.063.081, mit dem Titel "Fluid Assisted Electrocautery Device", eingereicht im Namen von Peter M. J. Mulier und Michael F. Hoey am 22. Februar 1995.
  • Wie in den obigen HF-Abtragungspatenten beschrieben ist, erzeugt die Infusion des leitenden Fluids in den Bereich der Anwendung der HF-Energie eine "virtuelle Elektrode", deren Größe und Form gesteuert geändert werden kann und die mehr oder weniger leitend gemacht werden kann, wodurch die Ausbreitung der HF-Energie verändert werden kann. Durch Ändern solcher Faktoren wie der HF-Energie und -Dauer, der Infusionsrate der leitenden Flüssigkeit und der Leitfähigkeit der Infusionslösung können die Größe, die Form, die Stärke der "virtuellen Elektrode" – d. h. die Stärke der Wärmeerzeugung in dem Bereich, gesteuert werden. Im Fall der Elektrokaustik-Vorrichtung in Übereinstimmung mit der vorliegenden Erfindung hilft das Anlegen der leitenden Lösung während der Anwendung der HF-Energie weiter dabei, das Überhitzen der Elektrode/Spitze über denjenigen Punkt hinaus, bei dem es ansonsten normalerweise zum Brennen oder zum Transport von Gewebe kommen würde, zu verhindern. Um diese Wirkung zu verbessern, wird beabsichtigt, dass die Lösung, die zur Infusion verwendet wird, zunächst gekühlt werden kann.
  • Leitende Lösungen, von denen angenommen wird, dass sie für die Herstellung der virtuellen Elektrode geeignet sind, umfassen u. a. eine Salzlösung, eine gesättigte Salzlösung und eine Ringer-Bikarbonatlösung. In Bezug auf die Quelle für das leitende Fluid wird betrachtet, ein kleiner, zuvor mit Druck beaufschlagter Metallbehälter mit der leitenden Lösung verwendet werden kann, so dass keine Pumpe erforderlich ist. Der Griff 12 kann so konfiguriert sein, dass er in sich einen solchen mit Druck beaufschlagten Metallbehälter aufnimmt, was die Notwendigkeit der Eingangsleitung 34 beseitigt.
  • Außerdem kann mit dem leitenden Fluid ein Farbstoff gemischt sein, um das Fluid während des Verfahrens unter Verwendung der Vorrichtung 10 besser sichtbar zu machen. Beispiele eines solchen Farbstoffs umfassen, sind aber nicht beschränkt auf, Methylenblau.
  • Es ist erwünscht, das leitende Fluid der Elektrode/Spitze 14 unter einem Druck zuzuführen, der gesteuert ist. Insbesondere ist es wichtig, dass keine Strömungsgeschwindigkeit bzw. -rate vorliegt, die ermöglicht, dass das leitende Fluid übermäßig aus dem distalen Ende 28 der Elektrode/Spitze 14 herausströmt. Es ist gezeigt worden, dass eine übermäßige Fluidströmung die elektrische Stromdichte über einen großen Gewebebereich verteilt und dadurch die Abtragungswirkung minimiert und in einigen Fällen verhindert.
  • In Gebrauch wird das elektrische Potenzial von einem wie oben beschriebenen Hochfrequenzgenerator (HF-Generator) an das Rohr 16 angelegt. Da das Rohr 16 aus einem elektrisch leitenden Metall besteht, ist das gesamte Rohr 16 auf einem elektrischen Potenzial, das durch den Hochfrequenzgenerator (HF-Generator) bestimmt ist. Das leitende Fluid wird der Vorrichtung 10 unter Druck zugeführt, so dass das leitende Fluid um die Kugel 18 von der Elektrode/Spitze 14 ausgestoßen wird.
  • Der Anwender der Elektrokaustik-Vorrichtung 10 ordnet die Elektrode/Spitze 14 in einem abzutragenden Bereich an und bewegt die Elektrode/Spitze 14 mittels der Kugel 18, die mit dem Gewebe in Kontakt ist, über das Gewebe. Die Kugel 18 kann entweder über das Gewebe rollen oder gleiten. Das vom distalen Ende 28 ausgestoßene Fluid macht das Gewebe gleitfähig und erleichtert unabhängig davon, ob die Kugel 18 über das Gewebe rollt oder gleitet, die Bewegung der Kugel 18 über das Gewebe.
  • In-Vitro-Experimente haben das folgende gezeigt: Je größer der Durchmesser der Kugel 18 ist, desto breiter und tiefer ist die an dem Gewebe erzeugte Ablations- bzw. Abtragungs-"Spur"; die langsame Bewegung der Elektrode/Spitze 14 über das Gewebe erzeugt tiefere Schädigungen, als wenn die Elektrode/Spitze 14 schnell bewegt wird; und die Strömungsgeschwindigkeit des leitenden Fluids durch die Vorrichtung 10 und aus der Elektrode/Spitze 14 sollte angemessen sein, um die Oberfläche des Gewebes zu befeuchten und gleitfähig zu machen, wobei sie aber nicht so hoch sein sollte, dass sie sich über das Gewebe ausbreitet und die zum Ausführen der Abtragung erforderliche elektrische Stromdichte verteilt. Als Beispiele wünschenswerter Strömungsgeschwindigkeiten des leitenden Fluids durch die Vorrichtung 10 wurde gezeigt, dass bei einem Hochfrequenzgenerator (HF-Generator) mit bzw. bei 50 Watt eine Strömungsgeschwindigkeit im Bereich von etwa 0,5 bis 2 cm3/Minute angemessen war, während gezeigt wurde, dass bei einem Hochfrequenzgenerator (HF-Generator) mit 25 Watt eine Strömungsgeschwindigkeit von etwa zwischen 1 und 2 cm3/Minute angemessen war. Wie bei der Praxis unter Verwendung der Erfindung deutlich wird, können andere Strömungsgeschwindigkeiten in diesen Leistungsbereichen oder diese oder andere Strömungsgeschwindigkeiten für andere Leistungseinstellungen ebenfalls verwendet werden. Die obengegebenen Beispiele sind für Erläuterungszwecke gegeben worden und sollen nicht beschränkend sein.
  • Die Vorrichtung 10 kann insbesondere in Verbindung mit dem obenbeschriebenen so genannten "Labyrinth"-Verfahren verwendet werden, um einen Bereich des Herzens abzutragen, um sämtliche potenziellen Wiedereintritts-Stromkreismuster, die im Vorhof auftreten und zum Vorhofflimmern führen können, zu unterbrechen. Um nur einige mögliche Anwendungen zu nennen, kann die Vorrichtung 10 außerdem vorteilhaft zur Entfernung von Hämorriden oder Krampfadern oder zum Anhalten von Speiseröhrenblutungen verwendet werden. Die Vorrichtung beseitigt das Risiko der Durchlochung, das üblicherweise bei anderen Kauterisierungstypen gefunden wird, mit ihr lässt sich leicht "Schreiben" und sie ermöglicht eine tiefe und breite Eindringung und nachfolgende Abtragung.
  • Wegen ihrer Ähnlichkeit mit einem Kugelschreiber schafft die Erfindung eine Elektrokaustik-Vorrichtung 10, mit der es sich leicht "Schreiben" lässt. Das heißt, da die Kugel 18 über das Gewebe rollt, lässt sich die distale Elektrode/Spitze 14 leicht über das abzutragende Gewebe bewegen. Außerdem gleitet die Kugel 18 auch dadurch über das abzutragende Gewebe, dass aus der Elektrode/Spitze 14 Fluid ausgestoßen wird.
  • Obgleich der Draht 32 und die Eingangsleitung 34 bei dem Instrument aus 1 getrennt gezeigt sind, ist beabsichtigt, dass diese Verbindungen mit der Vorrichtung 10 zu einer einzelnen Leitung vereinigt sein können, in der es neben einem isolierten elektrischen Leiter einen fluidleitenden Hohlraum für die Eingabe der leitenden Lösung gibt.
  • Verschiedene alternative Konfigurationen der Elektrode/Spitze 14 sind ebenfalls beabsichtigt. In einer in 5 gezeigten Ausführungsform ist die Kugel 18 in dem Rohr 16 am distalen Ende 28 des Rohrs 16 enthalten. Anstelle der Sicken 24 in der Nähe der Kugel 18 ist aber in dem Rohr 16 in der Nähe der Kugel 18 ein Block 38 angeordnet. Vorzugsweise besitzt der Block 38 einen mittigen Hohlraum 40, der von seinem proximalen zu seinem distalen Ende verläuft, um zu ermöglichen, dass Fluid im Innern des Rohrs 16 zur Kugel 18 durchläuft, wo es vom distalen Ende 28 ausgestoßen werden kann. In jeder anderen Weise ist diese Ausführungsformvergleich völlig gleich zu der obenbeschriebenen bevorzugten Ausführungsform.
  • Die Kugel 18 kann auch aus einem porigen bzw. porösen elektrisch leitenden Material hergestellt sein. In dieser Ausführungsform ermöglicht das poröse Wesen der Kugel 18, dass das Fluid nicht nur um die Kugel 18 durchläuft, um vom distalen Ende 28 ausgestoßen zu werden, sondern ermöglicht es auch, dass Fluid durch die Kugel 18 durchläuft und ausgestoßen wird.
  • In einer alternativen Ausführungsform kann die Kugel 18 durch ein nicht kugelförmiges Kontaktelement wie etwa durch einen länglichen elektrisch leitenden Stopfen ersetzt sein. In dieser Ausführungsform wird der Stopfen weiter am distalen Ende 28 des Rohrs 16 im Rohr 16 gehalten, so dass Fluid um den Stopfen durchlaufen kann, um vom distalen Ende 28 ausgestoßen zu werden. Der Stopfen wird durch irgendwelche obenbeschriebenen Mittel einschließlich, aber nicht beschränkt auf, die Sicken 24 und das abgerundete distale Ende 28 gehalten. Da der Stopfen nicht kugelförmig ist, kann der Stopfen aber nicht rollen, während er in Kontakt über das abzutragende Gewebe bewegt wird. Statt dessen gleitet der Stopfen über das Gewebe. Auch in dieser Ausführungsform kann der Stopfen aus einem elektrisch leitenden porösen Material hergestellt sein.
  • Obgleich die Erfindung in Verbindung mit der Verwendung eines leitenden Fluids zum Erzeugen einer virtuellen Elektrode für die Elektrode/Spitze 14 beschrieben worden ist, ist klar, dass viele der Vorteile der Erfindung wie etwa die stetige Strömung der Elektrode/Spitze 14 ebenfalls erzeugt werden, wenn das leitende Fluid durch ein nichtleitendes Fluid wie etwa Reinwasser ersetzt ist. Somit liegt es auch im Umfang der Erfindung, die Verwendung eines nichtleitenden Fluids aufzunehmen.
  • Außerdem kann auf Wunsch zu der Vorrichtung 10 ein Saugrohr hinzugefügt werden, das es ermöglicht, Rauch oder überschüssiges Fluid aus dem Operationsgebiet zu entfernen. Ein solches Saugrohr ist in der obenbeschriebenen '082-er Anmeldung beschrieben.
  • Außerdem kann das Rohr 16 mit Ausnahme eines Abschnitts an seinem distalen Ende, der mit der Kugel 14 in Kontakt kommt, aus einem elektrisch isolierenden Material hergestellt sein. Dieser Abschnitt des Rohrs 16, der mit der Kugel 14 in Kontakt kommt, sollte elektrisch leitend sein. In dieser Ausführungsform verläuft der Draht 24 bis zu diesem elektrisch leitenden Abschnitt des Rohrs 16.
  • Aus der vorstehenden ausführlichen Beschreibung einer spezifischen Ausführungsform der Erfindung ist offensichtlich, dass eine Vorrichtung zum Ausführen einer fluidgestützten Elektrokaustik von Körpergewebe offenbart worden ist, bei der Fluid, das aus einer hohlen Elektrokaustik-Elektrode/Spitze geliefert wird, eine virtuelle Elektrode erzeugt, die das Gewebe einschneidet und kauterisiert.

Claims (14)

  1. Fluidunterstütztes Elektrokaustik-Instrument mit einem Griff (12), der mit einem mit einer leitenden Spitze ausgebildeten Rohr (16) verbunden ist, wobei wenigstens ein Abschnitt des Rohres ein Lumen bzw. einen Hohlraum (26) aufweist, wobei das Lumen mit einer Quelle leitender Flüssigkeit zur Ausgabe bzw. zum Ausstoß leitender Flüssigkeit aus der leitenden Spitze in fluider Kommunikation steht, dadurch gekennzeichnet , dass die Quelle leitender Flüssigkeit ein Kanister ist, wobei der Kanister in dem Griff (12) aufgenommen ist.
  2. Instrument nach Anspruch 1, bei welchem der Griff (12) aus sterilisierbarem Material hergestellt ist.
  3. Instrument nach einem der vorstehenden Ansprüche, bei welchem der Griff (12) aus einem starren Material hergestellt ist.
  4. Instrument nach einem der vorstehenden Ansprüche, bei dem der Griff (12) aus einem nichtleitenden Material hergestellt ist.
  5. Instrument nach einem der vorstehenden Ansprüche, bei welchem das Rohr (16) ein zylindrisches Hohlrohr ist.
  6. Instrument nach einem der vorstehenden Ansprüche, bei welchem das Rohr (16) als starrer Schaft aus leitendem Material ausgebildet ist.
  7. Instrument nach einem der Ansprüche 1 bis 5, bei dem das Rohr als starrer Schaft aus einem isolierenden Material mit Ausnahme eines Bereiches an seinem distalen Ende ausgebildet ist.
  8. Instrument nach einem der vorstehenden Ansprüche, welches ein Saugrohr umfasst.
  9. Instrument nach einem der vorstehenden Ansprüche, bei welchem die leitende Spitze ein leitendes Kontaktelement aufweist.
  10. Instrument nach Anspruch 9, bei dem das leitende Kontaktelement sphärisch ausgebildet ist.
  11. Instrument nach einem der Ansprüche 9 oder 10, bei dem das leitende Element als Ball bzw. Kugel ausgebildet ist.
  12. Instrument nach Anspruch 9, bei dem das leitende Element nichtsphärisch ausgebildet ist.
  13. Instrument nach einem der Ansprüche 9 bis 12, bei dem das leitende Element ein Stecker ist.
  14. Instrument nach einem der Ansprüche 9 bis 13, bei dem das leitende Element porös bzw. porig ausgebildet ist.
DE69631261T 1995-11-02 1996-10-02 Flüssigkeitsunterstützte elektrochirurgische Vorrichtung mit rollender Kugel Expired - Lifetime DE69631261T2 (de)

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CN108420527B (zh) * 2018-04-02 2020-05-08 李又春 一种多功能肝胆外科临床用止血器

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EP1245196A1 (de) 2002-10-02
CA2376365A1 (en) 1997-05-09
US7422588B2 (en) 2008-09-09
US6358248B1 (en) 2002-03-19
WO1997016127A1 (en) 1997-05-09
US5897553A (en) 1999-04-27
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CA2234676A1 (en) 1997-05-09
AU7514096A (en) 1997-05-22
US6585732B2 (en) 2003-07-01
DE69631261D1 (de) 2004-02-05
DE69626300T2 (de) 2003-10-16
US6764487B2 (en) 2004-07-20
US20020010463A1 (en) 2002-01-24
US20070208332A1 (en) 2007-09-06
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US7364579B2 (en) 2008-04-29
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US20060074414A1 (en) 2006-04-06
ATE232699T1 (de) 2003-03-15
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US20030181902A1 (en) 2003-09-25
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US20040236324A1 (en) 2004-11-25
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US7166105B2 (en) 2007-01-23
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Date Code Title Description
8364 No opposition during term of opposition
8328 Change in the person/name/address of the agent

Representative=s name: KUDLEK & GRUNERT PATENTANWAELTE PARTNERSCHAFT, 803