WO1993022979A1

WO1993022979A1 - A device in flushing liquid systems for use in medical or surgical operations

Info

Publication number: WO1993022979A1
Application number: PCT/SE1993/000371
Authority: WO
Inventors: Torbjörn FRYKLUND
Original assignee: Fryklund Torbjoern
Priority date: 1992-05-08
Filing date: 1993-04-28
Publication date: 1993-11-25
Also published as: SE9201449D0; SE500960C2; SE9201449L

Abstract

A device in flushing liquid systems for use in medical and surgical operations comprises at least one first container (1) for unused flushing liquid, first means (2) for supply of the flushing liquid from the first container to the place of the operation, at least one second container (3) for used flushing liquid and second means (4) for the returning of flushing liquid from the place of the operation to the second container (3). The device comprises a carrying arrangement (22) designed to simultaneously carry the first container (1) for unused flushing liquid and the second container (3) for used flushing liquid, and a weighing means is arranged for the weighing of the carrying arrangement (22) and the containers carried by the latter to make it possible to register the reduction of weight of the liquid by means of the weighing means, which reduction of weight corresponds to the resorption of liquid in the body of the one that is operated on.

Description

A device in flushing liquid systems for use in medical or surgical operations

FIELD OF THE INVENTION AND PRIOR ART

This invention relates to a device in flushing liquid systems for use in medical or surgical operations. As examples of such operations might be mentioned certain gynecological and urological operations such as transcervical endometrium resection (TCER), transurethral prostatec¬ tomy (TUR-P) and transurethral bladder tumour resection (TUR-T).

As a complement to uterine operation through the abdomen (hysterectomy) transcervical endometry resection (TCER) was intro¬ duced about 10 years ago. This means operative removing of the endometrium and its rudiments by means of a resectoscope that is in¬ troduced through the vagina and the uterine neck. The TUR-P and TUR-T operations have been used as a matter of routine for more than 40 years.

The resectoscope that, by way of example, has been used in the TCER operation is a tubular instrument, originally developed for urological use. It consists of an optical part (optics) which is equipped with fibre light and an outer light source, which permits inspection of the ute e cavity. This can be done by the eye or by means of a camera -..at is fastened to the optics and gives a picture on a monitor or a video equipment. The second part of the resectoscope is formed by a work channel that consists of a double sheathed flushing channel with in- and outflow tubes for the flushing liquid and a diathermical loop (electrical) shaped as a half circle that cuts out the mucous membrane and tissues in chip-like structures. The method is medically established since a number of years.

Flushing liquid is used for widening the usually shrunken uterine cavity and for keeping free sight during the operation that is otherwise disturbed by blood products and tissue pieces. The type of flushing liquid that is used varies between different clinics and countries. The requirements of the flushing liquid are however that it must not be electrically conducting, must have good optical properties, must not be harmful in contact with human tissues or operation instruments, and be isosmotic together with the blood to cause the least possible damage when it unintentionally gets into the circulation of the blood (resorption) of the patient, which always occurs to a varying extent through the endometrium, the blood vessels of the uterus or the peritoneum.

There is no flushing liquid that is totally without disadvantages and risks. The liquid that best corresponds to the requirements and is most often used is 1.5% glycine solution. A large and rapid resorption of glycine solution is a known and feared complication to the TCER, TUR-P and TUR-T operations. This is usually called the TUR syn¬ drome and means among other things electrolyte changes in the blood, disturbances of consciousness and influence on the circulation. The amount of liquid that is required for this to happen depends among other things on the size and speed of the resorption, the age and general condition of the patient etc.

Because of the risk for this complication, TCER has not been intro¬ duced at a number of clinics.

The existing way of measuring the resorption to the circulation of the patient is done by means of volumetric technique. One measures the difference between used amount of flushing liquid and the returning liquid that is taken up from the departure channel of the resectoscope and the funnel-like plastic bag (commercially available) that is taped at the thigh of the patient. The current volumetric method is unsatisfying as it is:

1) time wasting. The operation is to be interrupted during the measur¬ ing. This increases the length of the operation and thereby the risks for the patient.

2) uncertain. Mistakes in calculation and misunderstandings come up easily. Resorption might happen very rapidly between the periods of measuring and is then discovered too late.

SUMMARY OF THE INVENTION

The object of the invention is to produce a device that makes it possible to superintend the resorption of flushing liquids rationally, ac- curately and continuously, especially at TCER, TUR-P and TUR-T.

According to the invention this object is obtained by the characteristics defined in the following claims, and more particularly in claim 1.

The device forms a closed system where the total weight of the included flushing liquids and returning liquids is continuously mea¬ sured and the amount of liquid that leaves the system corresponds to the resorption to the circulation of the patient. This is achieved thanks to the device comprising a carrying arrangement designed to simulta- neously carry the first container for unused flushing liquid and the other container for used flushing liquid and that a weighing means is arranged for the weighing of the carrying arrangement and the con¬ tainers carried by the latter.

Advantageous further developments of the invention are objects of the dependent claims.

BRIEF DESCRIPTION OF THE DRAWINGS

With reference to the accompanying drawings a closer description of an embodiment of the invention, given as an example, will follow below. In the drawings:

Fig 1 is a perspective, partially cut and schematic view illustrating the device according to the invention and

Fig 2 is a partially cut view of a frame, that according to the invention is included in the device, and the weighing means intended for co¬ operation therewith.

DETAILED DESCRIPTION OF A PREFERRED EMBODIMENT

The device in flushing liquid systems for use in medical and surgical operations according to the invention comprises at least one first container 1 for unused flushing liquid, first means 2 for supply of the flushing liquid from the first container to the place of the operation, at least one second container 3 for used flushing liquid and second means 4 for the returning of flushing liquid from the place of the opera¬ tion to the second container 3.

In this example the means 2 for supply of the flushing liquid from the first container 1 to the place of the operation comprises the operation instrument 5 itself. Accordingly, the flushing liquid is supplied to the place of the operation through the operation instrument since the latter has an inlet 6 to an internal flushing liquid channel. Suitably, the instruments include an optical device for examination of the place of the operation and light, for instance through fibre optics, is provided at a connection indicated at 7.

The operation instrument 5 can also be said to be part of the second means for the returning of flushing liquid from the place of the opera¬ tion to the container 3, as the instrument in this case has an internal return channel, from which the returning liquid goes out from the instrument through an outlet 8 to be forwarded to the container 3 via a flexible conduit 9. In the present case the operation instrument is formed by the resec¬ toscope described initially.

The means 4 for the returning of flushing liquid also includes a device 10 for gathering of liquid, arranged to be located in the vicinity of the place of the operation to gather flushing liquid that is supplied there. Here, the device 10 has the character of a funnel or the like, from which liquid is sent to the container 3 through a conduit 11. In the ex¬ ample, the conduits 9 and 11 from the resectoscope and the device 10 for gathering go together to one conduit 12, which in its turn is connected to an inlet 13 in the container 3.

In the example, the provision of flushing liquid to the instrument 5 is executed by means of a pump 13 that receives flushing liquid from the container 1 via a conduit 14 and sends this liquid under pressure to the instrument 5 via the conduit 15. In this conduit a pressure limiting de¬ vice 16 might suitably be incorporated. For pressure control, a conduit 17 is connected to the conduit 15 upstream the pressure limiting device 16, which cond^" t 17 is connected to a pressure control input 18 of the pump devie_* 13, i.e. an input that is possible to throttle depending on the wished feed pressure.

The device further comprises a suction arrangement 19 which is ar¬ ranged to bring the inside of the container 3 to an underpressure condition via a conduit 20 connected to said inside, for the establish¬ ment of a suction effect in the conduit 12 for returning of liquid. This suction effect means that a suction is established in the operation in¬ strument 5 as well as in the device 10 for gathering.

The pump arrangement 13 and the suction arrangement 19 might be co-ordinated into one single apparatus indicated with 21.

The device according to the invention comprises a carrying arrange¬ ment generally indicated with 22 and designed to simultaneously carry the first container 1 for unused flushing liquid and the other container 3 for used flushing liquid. A weighing means 23 is arranged for the weighing of the carrying arrangement 22 and the containers 1 , 3 carried thereby.

The weighing means 23 is carried by a frame 24 and the carrying arrangement 22 is carried by the frame 24 via the weighing means 23.

The carrying arrangement 22 comprises a first carrier 25 meant for the first container 1 and a second carrier 26 meant for the second con¬ tainer 3. It is preferred that the first carrier 25 is located on a higher level than the second carrier 26. Furthermore, it is preferred that the weighing means 23 is arranged on a higher level than the first carrier 25.

The first and second carriers 25, 26 are mutually connected by means of force transmitting elements 27. These force transmitting elements are preferred to be of the traction force transmitting type and they are suitably flexible, for example in the shape of lines, chains or the like 27.

The carrying arrangement 22 comprises a third carrier 28 which is load transmittingly associated with the weighing means 23 and which is ar¬ ranged to carry the first and second carriers 25, 26. The third carrier 28 and the first carrier 25 are mutually associated by means of force transmitting elements 29 which similarly to the elements 27 also, ad- vantageously, are of the traction force transmitting type, for example flexible elements in the shape of lines, chains or the like.

The force transmitting elements 27, 29 extends within uprights 30 of the frame. As can be seen from Fig 1 in this case the frame comprises four uprights and in every one of those the elements 27, 29 run. Of course, it is possible that the elements 27 and 29, extending in a single upright 30 form part of one and the same line, chain or the like, which at one place 31 is connected to the first carrier 25, at one place 32 to the second carrier 26 and at one place 33 to the third carrier 28.

In a way that can be seen from Figs 1 and 2, every carrier 25, 26 and 28 can exhibit sections that protrude into the interiors of each of the uprights 30 respectively through slots 34. Inside the uprights, these sections are fastened to the elements 27, 29 in a force transmitting way. These sections 35 could for example have the character of pieces that would be detachably connected to the carriers 25, 26 and 28 respectively via any suitable type of fastening, for example screw fastening for disassembling and assembling respectively.

As can be seen from Fig 1 , the frame 24 might exhibit rolls 36 for the facilitation of the moving of the frame. In the bottom area, the uprights 30 of the frame are mutually connected through fixed transverse means 37. The frame 24 further exhibits means 38 to carry the weighing means 23. In the example, this means 38 has the character of a relatively firm shelf comprising a plate 39 and transverse pieces

40 extending between the uprights 30 and carrying said plate.

Accordingly, the framework of the weighing means 23 rests on said shelf 38. On the upper mobile part of the weighing means the already mentioned carrier 28 rests, which in the example comprises two rods

41 that are those which at their ends are carrying the sections 35 that protrude into the interior of the uprights through the slots 34, and that are mutually connected through transverse pieces 42, which are those that rest on the mobile part of the weighing means 23.

The first carrier 25 is located just beneath the shelf 38 carrying the weighing means 23 and suitably exhibits two rods 43, the end sections of which protrude into the interiors of the uprights 30 through the slots 34 and there are associated with the elements 27, 29. The two rods 43 are mutually connected by means of one or more transverse pieces 44 arranged to carry a plurality of the first containers 1 , for instance via hooks 45. In practice, it is preferred that the first containers 1 have the character of bags.

Likewise, the second carrier 26 has the character of a shelf on which the container 3 for returning liquid is arranged. The number of con- tainers might of course be two or more. Also the second carrier 26 exhibits sections protruding into the interior of the uprights 30 through the slots 34 in a way that has already been described.

In the area between the first and second carriers 25, 26, the frame exhibits carrying means 46 fixed to the frame. These carrying means 46 serve to carry required extra equipment, in the example, the pump and suction arrangements 13, 19 described earlier. The carrying means 46 have the character of a shelf.

From what is said appears that the carrying arrangement 22 including the three carriers 25, 26 and 28 and the elements 27, 29 is vertically mobile in relation to the frame 24 and is carried by the weighing means 23. This one suitably exhibits a display 47 that might be mounted somewhere on the frame 24 or otherwise in the vicinity of the place of the operation, and might, furthermore, be connected to a computer 48 so that the resorption of flushing liquid can be shown graphically and be computerized in a suitable way.

The described device is used in the following way. Before the opera¬ tion, a requisite number of containers 1 with flushing liquid are hung up on the carrier 25. The conduits in question 9, 11 , 12 and 14, 15, 17 are connected to the instrument 5, the containers 1 , 3 and the apparatus 21. The funnel 10 for gathering is applied on the patient.

At this point the weighing means 23 is tared and the operation is started.

As a closed weighing means system now has been achieved, a resorption of flushing liquid in the body of the one that is being operated can be read off directly and continuously on the display 47 as a reduction of weight of the carrying arrangement 22 and the containers of liquid 1 , 3 carried by the latter. The resorption is documented after consumption of each hung up set of containers 1 of liquid, and summoned. Of course, the described invention is not at all limited just by the em¬ bodiment described as an example. In this context it might be men¬ tioned that the pump arrangement 13 could be left out and that instead the supply of liquid from the container 1 to the instrument 5 could be made dependent only on the level of the container 1 above the instru¬ ment 5. Furthermore, also the suction arrangement 19 might be left out, in which case the returning of liquid from the gathering arrange¬ ment 10 and/or the instrument 5 becomes dependent only on the container 3 being located beneath the arrangement 10 and the instru- ment 5 so that the return flow occurs under the influence of the gravity. For a good functioning with such an embodiment, it is of importance that the carrier 25 of the container with unused liquid is located relatively high on the frame 24 while, on the other hand, the container 3 for used flushing liquid ought to be located low on the frame.

To achieve increased simplicity in Figs 1 and 2 it has been indicated how slots 34 are arranged not only inwards on the uprights of the frame but also outwards. In Fig 2 is thereby illustrated how end sections of elements of the different carriers 25, 26 and 28 are protruding through slots 34 straight through the uprights 30. Naturally, the slots located outwards on the uprights can here be left out. In this context, the essential part of the concept of the invention is that each carrier respectively shall be vertically freely mobile in relation to the frame and that the force transmitting elements 27, 29 also shall run freely within the uprights. Within the frame of these limitations a multitude of different embodiments can be considered.

Claims

1. A device in flushing liquid systems for use in medical and surgical operations, comprising at least one first container (1) for unused flushing liquid, first means (2) for supply of the flushing liquid from the first container to the place of the operation, at least one second container (3) for used flushing liquid and second means (4) for the re¬ turning of flushing liquid from the place of the operation to the second container, characterized in that it comprises a carrying arrangement (22) designed to simultaneously carry the first container (1) for unused flushing liquid and the second container (3) for used flushing liquid, and that a weighing means (23) is arranged for the weighing of the carrying arrangement (22) and the containers (1 , 3) carried by the lat¬ ter.

2. A device according to claim 1 , characterized in that the weighing means (23) is carried by a frame (24) and that the carrying arrangement is carried by the frame (24) through the weighing means (23).

3. A device according to any of the preceding claims, characterized in that the carrying arrangement (22) comprises a first carrier (25) meant for the first container (1) and a second carrier (26) meant for the second container (3).

4. A device according to claim 3, characterized in that the first carrier (25) is located on a higher level than the second carrier (26).

5. A device according to claim 4, characterized in that the weighing means (23) is arranged on a higher level than the first carrier (25).

6. A device according to claim 3, 4 or 5, characterize!--- in that the first and second carriers (25, 26) are mutually connected by means of force transmitting elements (27).

7. A device according to claim 3, 4 or 5, characterized in that the car¬ rying arrangement (22) comprises a third carrier (28), which is load transmittingly associated with the weighing means (23) and is ar¬ ranged to carry the first and second carriers (25, 26), and that the three carriers are mutually connected by means of force transmitting elements (27, 29).

8. A device according to claim 6 or 7, characterized in that the force transmitting elements are of the traction force transmitting type.

9. A device according to claim 8, characterized in that the traction force transmitting elements (27, 29) are flexible, for example lines, chains or the like.

10. A device according to claim 8 or 9, characterized in that the force transmitting elements (27, 29) at least partially run within uprights (30) of the frame (24).