WO1996002196A1 - Hf-chirurgisches gerät für die minimal-invasive chirurgie - Google Patents
Hf-chirurgisches gerät für die minimal-invasive chirurgie Download PDFInfo
- Publication number
- WO1996002196A1 WO1996002196A1 PCT/EP1995/002554 EP9502554W WO9602196A1 WO 1996002196 A1 WO1996002196 A1 WO 1996002196A1 EP 9502554 W EP9502554 W EP 9502554W WO 9602196 A1 WO9602196 A1 WO 9602196A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- liquid
- electrode
- neutral electrode
- tissue
- shaft
- Prior art date
Links
Classifications
-
- 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
- A61B18/1485—Probes or electrodes therefor having a short rigid shaft for accessing the inner body through natural openings
-
- 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
- A61B18/04—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
- 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
- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/71—Suction drainage systems
- A61M1/77—Suction-irrigation systems
Definitions
- the invention relates to an endoscopic device of the type mentioned in the preamble of claim 1.
- Devices of this type can be used for surgery in any body-lumened cavities, for example in the uterus or in the intestine.
- cuts can be made or bleeding can be stopped by surface coagulation.
- such devices are used in urology, for example to work on the bladder wall and especially in prostate resection.
- the active electrode used for cutting or coagulating is initially in the liquid body. Then no current flows, even if the HF generator is already switched on, since the rinsing liquid is low in electrolytes, ie poorly conductive. When tissue comes into contact, current begins to flow since the tissue is rich in electrolyte, that is to say it is highly conductive. The current then flows through the tissue to the neutral electrode.
- the neutral electrode is arranged at a distance from the body cavity, always on the body surface. In urological operations, the neutral electrode is often wrapped around the thigh on the skin.
- the first disadvantage is the long and thus high-impedance current path through the body from the contact point of the active electrode on the tissue to the distant body surface area which is in contact with the neutral electrode. So-called stray currents are feared here, which e.g. if the patient comes into contact with metallic objects, such as the operating table, can cause skin burns. The simultaneous contact of the patient with other metallic conductors, such as EKG electrodes or the like, is problematic because of such stray currents. In an extremely unpleasant way, HF current can also jump to the surgeon's eye via the optics of the endoscope. Problems often arise with a poorly fitting neutral electrode. If it only has physical contact with a small surface, burns also occur here.
- Another disadvantage is the great depth effect in the tissue below the active electrode.
- the neutral electrode When the neutral electrode is connected to the surface of the body, the current flows from the contact point of the active electrode into the depth of the tissue and can cause thermal damage in the tissue even far below the tissue layers in which a cutting effect is intended. This then results in unintentionally very deep heat damage, which takes a long time to heal and which tends to cause infections.
- bipolar electrode arrangement in which the neutral electrode is arranged in the vicinity of the active electrode in contact with the body surface. This is to ensure that the current between the two electrodes flows through the tissue in the shortest possible way.
- a device is known for example from DE 25 21 719 C2.
- a disadvantage of this is the fact that, due to the design, only small-area contacting of the body tissue by the neutral electrode leads to a high current load on the tissue.
- the object of the present invention is to provide a device of the type mentioned at the outset with which, by eliminating the disadvantages mentioned, it is possible to work more safely both with regard to the depth of cut influence and with regard to general electrical safety.
- the neutral electrode is arranged at a distance from the active electrode in the same liquid body, thus also in the body cavity.
- the current can therefore only flow in the narrower area of the body cavity. All safety problems with stray currents are thereby automatically eliminated.
- the effect of the current on the depth is considerably less.
- the current does not flow from the point of contact of the active electrode to the tissue, but preferably to the side, in order to spread laterally in the body tissue, which conducts better than the liquid body, laterally onto the surface of the body cavity and into the liquid body to enter and flow to the neutral electrode with a low current density. This results in a high current density at the active electrode, as is required there for cutting or coagulating.
- the current with a low surface density that is to say without a cutting action, passes back into the liquid body. This significantly increases the safety with regard to the influence of depth when cutting. Burning of sensitive tissue under the tissue layer to be surgically avoided is avoided.
- the features of claim 2 are advantageously provided. It cannot be avoided that the liquid body always has a certain proportion of electrolyl, ie a higher conductivity. This is due, among other things, to the unavoidable inflows of urine or blood, which lead to electrolyte accumulation. This conductivity is also desirable for the large-area, low-resistance return of the current through the surface of the body cavity to the neutral electrode.
- the liquid body can also be enriched with electrolyte as a whole, for example by adding electrolyte to the rinsing liquid, which is usually continuously supplied to the liquid body in electrosurgical work.
- the electrolyte enrichment of the liquid body ensures good current conduction of the neutral electrode to the body surfaces surrounding it.
- the good conductivity of the liquid body also leads to a current flow directly between the active electrode and the neutral electrode through the liquid wedge body. This direct current flow between the electrodes does not stress the patient's tissue and can therefore be safely approved for medical reasons. This current flow, however, loads the high-frequency current source used for the power supply and can be disadvantageous for these reasons.
- the features of claim 3 are also advantageous. In this way, it is specifically ensured that the liquid body is kept electrolyte-rich outside the working area, that is to say it is highly conductive. Preferably at the same time Working area of the active electrode is supplied with electrolyte-free rinsing liquid and outside this area with electrolyl-rich liquid.
- the electrolyte is advantageously enriched in accordance with claim 4 in the immediate vicinity of the neutral electrode in order to improve the current flow there. In this way, very small neutral electrodes can be used.
- All of the devices mentioned and also the neutral electrode can be laid separately from one another with a plurality of insertion shafts in the cavity.
- the suprapubic puncture technique is suitable, in which access to the bladder through the urethra and another access through a suprapubic shaft are provided.
- the neutral electrode can be laid through the suprapubic shaft. Fluid can flow through one shaft and fluid drain through the other shaft.
- the features of claim 6 are advantageously provided, according to which the neutral electrode and all said rinsing and drainage devices are arranged individually or in groups in the shaft.
- All of the above-mentioned devices are preferably arranged in the shaft, which is designed as a permanent rinsing shaft with a supply line and a discharge line which is common in urology, through which both electrodes are laid and which also contains an electrolyte inflow to the area of the neutral electrode.
- the features of claim 7 are advantageously provided. In this way, the neutral electrode is surrounded by a touch guard which prevents the neutral electrode from coming into contact with the tissue and causing unwanted burns.
- the invention is shown, for example and schematically, in section through a body cavity with an endoscope placed therein.
- the single figure shows a highly schematic section of a part of the body of a male patient with a bladder 1, penis 2, urethra 3 and endoscope 4 which is displaced by the latter.
- the endoscope 4 which is also shown in a highly schematic manner, is arranged with its distal end in the bladder 1, passes through the urethra 3 and ends with its proximal end outdoors. It has a shaft 5, which is open at the distal end and is provided with a closure device 6, not explained in more detail, at the proximal end, which in the schematic exemplary embodiment is e.g. can be designed as a rubber membrane closure element.
- an inflow connection 7 is provided, through which flushing liquid is introduced in the direction of the arrow and which emerges from the distal end of the shaft 5 in the direction of the arrows.
- An outer shaft 8 is arranged around the shaft 5, sealed at both ends, which is provided with drain holes 9 in the distal end region and has a drain connection 10 at the proximal end. Liquid can therefore flow in the direction of the arrow from the bladder 1 through the holes 9 and the space between the outer shaft 8 and the shaft 5 to the drain connection 10 and from there.
- the device shown forms a continuous irrigation instrument that is common in urology.
- an optic 11 is laid through the shaft 5 with a distally arranged oblique-looking lens 12 and a proximally arranged eyepiece 13. Furthermore, a line 15 provided with insulation 14 is laid through the shaft 5, at the distal end an exposed, in the illustrated embodiment designed as a hook active electrode 16 carries. This is connected to an HF generator 18 via a connecting line 17.
- the device shown corresponds to a conventional urological permanent irrigation resection device, with which prostate resections can be performed, for example, or with which, as shown in the figure, on the bladder wall at 19 by contact of the active electrode 16 with the bladder wall into the tissue of the bladder wall can be incised or coagulated there.
- the neutral electrode required to which the HF current flows from the active electrode through the body tissue, would be arranged far outside the illustrated body area, for example on the surface of the thigh.
- the current would therefore flow from the active electrode 16 through the body tissue into the depth.
- the current could, for example, also flow through the tissue to the metal surfaces of the endoscope 4 and jump over to the eye of the surgeon at the eyepiece 13.
- the current below the active electrode 16 would preferably penetrate into the depth of the tissue and would still produce undesirable burns in tissue layers deep below the bladder wall.
- the device shown in the figure is provided with a neutral electrode 20 which, as the distal end of a wire 21, projects beyond an insulating plastic tube 22, which is also sealed by the shaft 5 and laid into the bladder.
- the proximal end of the wire 21 is led out of the hose 22 and connected to the HF generator 18 via a connecting line 23.
- the working area around the active electrode 16 is always supplied with low-electrolyte, poorly conductive liquid by the inflow of rinsing liquid.
- this ensures, in a known manner, that there is good visibility from the lens 12 to the work area 19.
- this ensures that current does not go directly from the active electrode 16 into the liquid, but only on the detour via the tissue, as shown with dashed arrows.
- the area around the neutral electrode 20 is advantageously kept at high conductivity with an inflow of electrolyte-rich liquid.
- the plastic tube 22, which surrounds the wire 21 forming the neutral electrode 20 at its distal end is not only used for isolation from the metallic parts of the endoscope 4, but is proximal to a pump 24 Supply 25 of a saline solution is connected, which is supplied with the pump through the hose 22 to the area around the neutral electrode 20, as indicated by small arrows there.
- the liquid body 1 is uniformly enriched with electrolyte, for example by using electrolyte-enriched rinsing liquid. Then, however, with the HF power supply switched on, a current flows in a shunt between the active electrode 16 and the neutral electrode 20 through the liquid body 1. However, this current only loads the HF generator 18 and therefore has technical disadvantages. The patient is not burdened by this side stream, since this stream does not flow through body tissue, but only through the liquid body 1.
- the neutral electrode 20 is surrounded by a touch guard 26, which is arranged as a cage with openings at the end of the hose 22.
- the touch guard 26 surrounds the neutral electrode 20 at a distance. Its interior is in fluid communication with the liquid body 1 through the openings.
- the touch guard 26 is made of electrically insulating material.
- the neutral electrode 20 does not stand approximately in the middle of the liquid body 1, as ideally shown in the figure, but instead inadvertently touches the tissue surface when the endoscope 4 moves, the circuit would be directly through the tissue between the neutral electrode 20 and the active electrode 16 closed. Both electrodes would have the same cutting or coagulating effect as with a bipolar instrument. However, since the cutting effect with the neutral electrode 20 is undesirable, the contact protection 26 ensures that even when the Tissue the neutral electrode 20 is always kept at a distance and can not achieve a cutting or coagulating effect.
- the neutral electrode 20 can also be constructed in a substantially simpler construction so that it does not protrude beyond the end of the tube 22 just cut off and from its distal end, which then serves as contact protection. is surrounded on all ropes, except for the distal opening of the tube through which the neutral electrode 20 is connected to the liquid body 1 in a conductive connection, which is advantageously strengthened by the inflow of electrolyte.
- the device can be largely varied compared to the embodiment shown.
- the active electrode 16 can have different shapes depending on the application. It can, for example, be designed as a flat plate for coagulation tasks or as a conventional cutting loop, as is usually used for resection tasks. For the sake of drawing simplicity, devices are not shown which are usually provided on devices of this type and which are used to move the active electrode 16 in order to carry out cutting movements back and forth with the endoscope 4 at a standstill.
- the neutral electrode 20 is designed as a wire electrode, which is advantageously provided, in a manner not shown, with devices with which it can be pushed into the illustrated working position and withdrawn from it.
- the neutral electrode 20 can then advantageously also be laid through the suprapubic shaft.
- the neutral electrode can also be installed without a shaft, for example in a flexible catheter which is inserted in the cavity in a suitable manner.
- the optionally provided inflow of electrolyte-rich liquid to the neutral electrode 20 can also be resolved in a manner other than that shown. For example, by means of a separately laid hose that ends in the vicinity of neutral electrode 20.
- the neutral electrode can also be provided as part of the endoscope 4 shown in the constructional simplification in the region of the distal end of the shaft 5 or the outer shaft 8, for example as a non-insulated metal ring which always projects into the liquid body 1.
- the outer areas of the shaft 5 or 8 located proximally from the ring serving as the electrode are to be insulated from the outside, so that current cannot flow directly through the tissue, that is to say the wall of the urethra 3, to the neutral electrode.
- the shaft 5 as a whole can be designed as a neutral electrode, while the outer shaft 8 is made of plastic and provides the necessary insulation.
- the neutral electrode 20 is prevented by the touch guard 26.
- Direct contact of the neutral electrode with the body tissue can also be prevented in other ways.
- the HF current can be monitored with electrical measuring devices in order to interrupt the current when current is applied due to tissue contact of the neutral electrode 20.
- Other electrical test devices can also be used, as described in EP 0 390 937 AI.
- two neutral electrodes connected in parallel to the HF generator 18 can be provided in close proximity, between which the electrical resistance is determined using a measuring device. This resistance between the two neutral electrodes changes greatly when they come into contact with the tissue. This can be determined by the measuring device and used to switch off the current.
- Such an arrangement can be used particularly advantageously if the neutral electrode in the embodiment already mentioned is arranged at the distal end of the shaft 5 or in particular at the distal end of the outer shaft 8. As the figure shows, the neutral electrode is then in close proximity to the body tissue and can often come into tissue contact when the instrument shown is moved. The electrical measuring device then ensures that the HF generator 18 is switched off, so that tissue damage is avoided.
- a neutral electrode can consist of two parts which are electrically connected to the HF generator 18 and are arranged, for example, in the form of narrow electrode strips lying next to one another on the surface of the outer shaft 8 in the immediate vicinity of its distal end.
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- Health & Medical Sciences (AREA)
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- Biomedical Technology (AREA)
- Molecular Biology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Plasma & Fusion (AREA)
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- Heart & Thoracic Surgery (AREA)
- Medical Informatics (AREA)
- Otolaryngology (AREA)
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Abstract
Description
Claims
Priority Applications (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US08/765,642 US5885277A (en) | 1994-07-15 | 1995-07-01 | High-frequency surgical instrument for minimally invasive surgery |
EP95924958A EP0771175A1 (de) | 1994-07-15 | 1995-07-01 | Hf-chirurgisches gerät für die minimal-invasive chirurgie |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
DEP4425015.0 | 1994-07-15 | ||
DE4425015A DE4425015C2 (de) | 1994-07-15 | 1994-07-15 | Endoskopisches HF-chirurgisches Gerät |
Publications (1)
Publication Number | Publication Date |
---|---|
WO1996002196A1 true WO1996002196A1 (de) | 1996-02-01 |
Family
ID=6523241
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/EP1995/002554 WO1996002196A1 (de) | 1994-07-15 | 1995-07-01 | Hf-chirurgisches gerät für die minimal-invasive chirurgie |
Country Status (4)
Country | Link |
---|---|
US (1) | US5885277A (de) |
EP (1) | EP0771175A1 (de) |
DE (1) | DE4425015C2 (de) |
WO (1) | WO1996002196A1 (de) |
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- 1995-07-01 EP EP95924958A patent/EP0771175A1/de not_active Withdrawn
- 1995-07-01 WO PCT/EP1995/002554 patent/WO1996002196A1/de not_active Application Discontinuation
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Also Published As
Publication number | Publication date |
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DE4425015C2 (de) | 1997-01-16 |
EP0771175A1 (de) | 1997-05-07 |
US5885277A (en) | 1999-03-23 |
DE4425015A1 (de) | 1996-01-25 |
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