INVASIVE INSTRUMENT FOR TREATING VESSELS
It is provided an invasive instrument for the treatment of a vessel, which possibly includes secondary vessels, with a tip formed for the dissection of tissue at the distal end of a shaft to be introduced into the body. The tip includes at least one recess, in particular a vessel receptacle, which is arranged and formed such that in the operating condition of the instrument always at least one functional unit of the shaft is kept clear, so that working on the vessel, a secondary vessel and/or on the surrounding tissue is possible using or by means of the functional unit.
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This invention relates to an invasive instrument for treating vessels and to a method.
It is known to harvest the endogenous vessels used for a bypass, i.e. veins and arteries, by an invasive, frequently also minimally invasive method under endoscopic control. This method is called Endoscopic Vessel Harvesting (EVH). In this method, especially developed instruments are employed.
Before the actual vessel harvesting takes place, the vessel must be separated from the tissue enclosing the vessel. First, an access is created by means of a small cut in direct vicinity of the vessel to be harvested, for example for harvesting the Vena saphena magna in the region of the knee-joint gap. Subsequently, the introduction of a suitably shaped instrument and the stepwise separation (dissection) by advancing along the vessel axis are effected under visual control and/or endoscopic view.
The known instruments can be used e.g. with an endoscope and/or a camera. From the patent specification U.S. Pat. No. 6,042,538 it is known that an endoscope optics can be integrated into the instrument. The instrument can be formed both as disposable and as reusable product. In a reusable product, the endoscope optics also can inseparably be integrated into the instrument.
Corresponding to the prior art, the endoscope which frequently is integrated into the instrument is connected with a video camera, so that the treating physician can observe his actions on a screen.
From the patent specification U.S. Pat. No. 5,928,138 it is known that a tip can be fabricated of a visually transparent material, so that during the dissection a good forward visibility is ensured for the operating surgeon via the endoscope. Such a transparent tip also is referred to as optical dissector.
The vessel to be harvested is connected with further, smaller peripheral vessels and after dissection from the surrounding tissue must also be separated from said vessels.
According to the prior art, this is effected by cutting devices integrated into the instrument. From the patent specification U.S. Pat. No. 6,022,313 it is known that such cutting device can be designed e.g. with scissors, which are advanced in a working channel of the instrument.
From the patent specification U.S. Pat. Nos. 5,928,138 and 6,022,313 it is known that devices for guiding the vessel to be harvested can be integrated into the instrument.
From the patent specification U.S. Pat. No. 7,645,289 it is known that a transparent tip can be shifted along the longitudinal axis of the instrument by means of a manipulator integrated at the handle. In addition, it is known from the patent specification U.S. Pat. No. 7,645,289 that the side of the tip facing the instrument is provided with a cutout. The design of the cutout allows the accommodation and/or fixation of the peripheral vessels to be separated.
It is furthermore known to support the endoscopically assisted vessel harvesting by means of CO2 gas insufflation. It is known that CO2 gas can selectively be introduced into the body through cavities and/or channels of an instrument for endoscopic procedures.
SUMMARYIt is the object to create an instrument for the invasive, preferably endoscopic treatment, in particular for harvesting vessels, with which in particular surrounding tissue can efficiently be treated in situ.
This object is solved by an invasive instrument for treating a vessel, which possibly includes secondary vessels, with a tip formed for the dissection of tissue at the distal end of a shaft to be introduced into the body. The tip includes at least one recess, in particular a vessel receptacle, which is arranged and formed such that in the operating condition of the instrument always at least one functional unit of the shaft is kept clear, so that working on the vessel, a secondary vessel and/or on the surrounding tissue is possible using or by means of the functional unit. By keeping clear a functional unit (e.g. a working channel for a cutting device), it is easier for the treating physician to work in situ, e.g. without having to replace the tip. With an instrument designed in this way, several functions can be carried out at the same time, such as e.g. holding the vessel (i.e. the vessel receptacle for the main vessel) and simultaneously working on the secondary vessel and/or on the surrounding tissue.
Advantageously, the tip at least partly includes a conical region, a prismatic region, a region in the form of a dolphin nose, a region with a frustoconical shape and/or a region with the shape of a triangle. With these shapes, an efficient dissection of the surrounding tissue can be achieved.
In a further advantageous embodiment, the vessel to be treated can be fixed in a spatial position with the at least one vessel receiving means, wherein the tip is movable relative to the shaft by means of a guide element. After introducing the invasive instrument into the body, the treating physician hence can perform e.g. a preparation of the vessel in situ.
It is also advantageous when the tip is shiftable in axial direction and/or pivotable about the longitudinal axis by up to 180°, so that during the procedure a vessel arranged in the at least one vessel receiving means can be spaced selectively in particular from a cutting device. By creating a rather large distance between vessel and e.g. a cutting device, the risk of a damage of the vessel is minimized. Spacing can also be expedient for other functional units, e.g. an endoscope, since a large visual range hence can be adjusted in situ.
For the handling of the tip it is advantageous when a manipulator is arranged in particular at a handle. With the same, shifting in axial direction and/or rotating the tip can be effected selectively.
Furthermore, it is advantageous when the guide element is formed substantially rod-shaped and is attached at a point of the tip which is located opposite the vessel receiving means. By a rather large spacing between the pivot point of the tip and the vessel receiving means it is possible to turn the vessel receiving means far away from functional units in the shaft. It is also advantageous that the guide channel and the working channel are arranged on opposite sides of the shaft.
Functional units which can be arranged in the shaft and/or in the handle of the instrument are formed at least as an endoscope channel, at least as a working channel for receiving a cutting device, at least as a guide channel for receiving a guide element, at least as an irrigation channel and/or at least as an insufflation channel.
It is also advantageous when the tip with the recess is designed such that the cutting device and/or an endoscope can be moved past the tip in an axially retracted position and/or also in an axially extended position.
Advantageously, the distance between extended tip and instrument tip is adjustable steplessly or in discrete steps. In this way, a particularly efficient preparation of the vessel can be achieved.
It is advantageous when the handle and/or the shaft are designed as reusable instrument. It is also advantageous when the tip, the guide rod and/or the manipulator (13) are designed as disposable components.
For working in situ it is advantageous when at least one channel for conducting rinsing liquid and/or for sucking off undesired liquids is integrated in the shaft.
Advantageously, the endoscope tip protrudes out of the instrument tip and into the retracted transparent tip.
In particular for cleaning purposes it is advantageous when gas, in particular CO2 gas for the insufflation, can be passed to the instrument tip in an insufflation channel. It is particularly advantageous when the insufflation channel and/or the irrigation channel are arranged relative to the endoscope tip such that the endoscope tip can be cleaned with the gas and/or the rinsing liquid, in particular by diverting the gas stream and/or the liquid stream on the back of the tip and directing the same to the endoscope tip.
In a further development, a video camera is arranged at the instrument tip, wherein the video camera includes a video sensor, e.g. a CCD or CMOS sensor, along with associated electronics and suitable optics, and glass fibers, a flexible optical waveguide and/or a solid polymer rod are guided in a separate illumination channel from the handle via the shaft to the instrument tip.
For a good illumination in situ it is particularly advantageous when LEDs are arranged at the instrument tip for illumination.
It is furthermore advantageous when the shaft at least partly has a circular or elliptical cross-section. An elliptical cross-section can be advantageous for the arrangement of the instruments in the interior of the shaft. The shaft possibly can also be formed slightly flatter than would have been the case with a circular cross-section.
Further embodiments are subject-matter of the sub-claims and/or will be described in more detail below with reference to the Figures.
In the following an instrument is described, which is particularly formed for harvesting vessels such as the Vena saphena magna (see
Other human vessels 14, which can be treated for example with the instrument 1, include the Vena saphena parva (subcutaneous calf vein), the Vena cephalica brachii & antebrachii (subcutaneous vein of the upper and lower arm) or the Vena basilica (deep vein in the upper arm). The invention is, however, not limited to the treatment of these vessels 14.
The instrument 1 serves to invasively treat a vessel 14 (also referred to as main vessel) in the body of a human being (possibly also of an animal) (dissection), so that it can be harvested from the body.
The instrument 1 includes a shaft 2 to be introduced into the body and a handle 3 at the proximal end. At the distal end of the shaft 2 (instrument tip 15) a tip 10 of transparent material is arranged, whose shape and function will yet be explained below.
As shown in connection with
In alternative embodiments, the functional units in the shaft 2 can be arranged otherwise or also be realized in another number. For example, two or more working channels 6 can be present.
In the embodiment shown in
The transparent tip 10 substantially has a basic structure with a conical part, wherein a vessel receiving means 17 in the form of a recess (or also depression) is arranged at the circumference. The recess 17, or in this case the vessel receiving means 17 with an anatomically shaped receptacle for the vessels 14, has a dual function which will yet be explained in connection with
The tip 10 is formed such that a separation of tissue is possible with the same when it is introduced into the body. In the embodiment shown here, the tip 10 is slightly rounded, in order to avoid damages at the tissue to be separated. As will be shown later on with reference to examples, the tip 10 also can assume other shapes.
The cross-section of the shaft 2 and the base surface of the tip 10 are formed circular in this embodiment. In principle, it is also possible that the shaft 2 and the tip 10 have polygonal or elliptical cross-sections. In this case, transparent means that the tip 10 is transparent for those wavelengths at which an observation takes place. For an endoscopic observation with a usual video camera, e.g. optically transparent polymers (e.g. PMMA) can be used. The tip 10 is hollow from inside, so that the wall thickness of the tip 10 everywhere substantially is the same. This is expedient, in order to ensure a best possible observability with an endoscope 5 through the transparent tip 10.
The connecting point between guide element 9 and transparent tip 10 is not located in the middle axis of the substantially conical body of the transparent tip 10, but offset laterally. As can be seen in
When the transparent tip 10 is rotated by 180° by means of the guide element 9, the concave vessel receiving means 17 points downwards. As can be seen in
Hence it becomes clear that the vessel receiving means 17 as recess has a dual function. On the one hand, it ensures that also in the operating position shown in
In alternative embodiments, there can also be provided more than one endoscope channel 4, more than one working channel 6 and/or more than one guide channel 8.
In the sectional view of
In the following, the function of the design will be explained above all with respect to
When a vessel 14 is to be separated from the surrounding tissue (not shown in
The transparent tip 10 here is designed such that a vessel 14 to be harvested can be picked up or held by the tip 10 such that it is kept away from the cutting device 7, which is arranged in the working channel 6, and/or is protected against inadvertent damage.
For this purpose, the transparent tip 10 (with the vessel receiving means 17 pointing downwards) is moved by means of the manipulator 13 (see
The manipulator 13 (see
After positioning the transparent tip 10 in axial direction, the transparent tip 10 is pivoted by means of the manipulator 13 about the axis of the guide element 9 by up to 180°, so that the vessel 14 is arranged in the depression-like vessel receiving means 17 (see also
The cutting device 7 then can, as shown in
In alternative embodiments, the vessel receptacle 17 can be formed as notch or as U-shaped indentation. In any case, it is possible to dispose the vessel 14 in a vessel receptacle 17 such that it cannot easily slip out laterally.
It is possible to adjust the axial distance between the extended transparent tip 10 and the instrument tip 15 by means of the manipulator 13 and the guide rod 9 steplessly or in discrete steps.
With the illustrated embodiment it is possible that the transparent tip 10 is designed such that both in the retracted position 18a (see
This allows the operating surgeon to prepare vessels 14, secondary vessels 40, and also separate the same from the surrounding tissue, during each phase of the procedure. The tip 10 is formed such that in each phase a functional unit, here the working channel 6 with the cutting device 7 arranged therein, is operable.
The operating surgeon even can axially move the cutting device 7 further in distal direction beyond the tip 10, in order to cut before the actual instrument 1 and/or the tip 10. The vessel receiving means 17 then can be used to spatially fix the vessel 14 in a position in which an operating surgeon can work particularly well. The rotatability of the guide element 9 allows an arbitrary positioning, wherein in each case the necessary distance to the cutting device 7 is maintained. Due to the axial shiftability and/or rotatability (i.e. movements relative to the shaft 2), it is also possible to align the vessel 14 with the attached secondary vessels 40 such that a preparation or separation of the secondary vessel 40 is possible.
This allows in particular the vessel harvesting without change of the instrument and/or removal of the transparent tip 10.
In a further exemplary embodiment of the instrument 1, the components handle 3 and/or shaft 2 are designed as reusable instrument. The same are shaped such that they can be prepared mechanically and subsequently be sterilized with commonly used sterilization methods, in particular the steam sterilization. The tip 10, the guide element 9 and/or the manipulator 13 can be designed as disposable components and due to their modular construction can easily be mounted in the reusable instrument and again be removed from the same.
In a further embodiment (see
A further exemplary embodiment (see
In a further exemplary embodiment (
In a further embodiment (
In a further exemplary embodiment, the glass fibers 28 in the disposable instrument are replaced by LEDs 31 positioned at the instrument tip 15. In principle, combination possibilities are also conceivable.
The same can be designed in an arbitrary, space-saving shape which is suitable for illuminating the field of view of the video camera 27.
When the tip 10 now is brought into the proximal position (
In
At the proximal end of the transparent tip 10 a baffle plate 25 is arranged, at which e.g. rinsing liquid can be diverted according to the procedure in
- 1 instrument
- 2 shaft
- 3 handle
- 4 endoscope channel
- 5 endoscope
- 6 working channel
- 7 cutting device
- 8 guide channel
- 9 guiding device
- 10 transparent tip
- 11 opening of the endoscope channel
- 12 opening of the working channel
- 13 manipulator of the guiding device
- 14 vessel
- 15 instrument tip
- 16 instrument axis
- 17 vessel receiving means
- 18a retracted position of the tip
- 18b extended position of the tip
- 19 endoscope tip
- 20 irrigation channel
- 21 port of irrigation channel
- 22 insufflation channel
- 23 port of gas channel
- 24 cutout
- 25 baffle plate
- 26 diverting means
- 27 video camera
- 28 glass fibers
- 29 illumination channel
- 30 solid polymer rod
- 31 LED
- 40 secondary vessel
Claims
1. An invasive instrument for treating a vessel, which possibly includes secondary vessels, comprising:
- an elongated shaft extending along a longitudinal axis and having a proximal end and a distal end to be introduced into a body of a subject, the distal end having a working opening of a working channel that is located in the elongated shaft;
- a dissection tip coupled to a guide element that is operably coupled to the shaft so that the dissection tip has a retracted tip position proximal to the distal end of the shaft and a shifted tip position spaced apart from the distal end of the shaft that is shifted relative to the retracted position, wherein the dissection tip is formed for the dissection of tissue, wherein the dissection tip includes at least one vessel receptacle in the form of an anatomically shaped recess extending substantially along the longitudinal axis of the elongated shaft;
- at least one functional unit operably coupled with the shaft so as to have a retracted functional position within the working channel of the shaft when the dissection tip is in the retracted tip position and have a dissection functional position when the at least one functional unit is extended from the distal end of the shaft when the dissection tip is in the shifted tip position such that the at least one vessel receptacle is spaced apart from the at least one functional unit.
2. The invasive instrument according to claim 1, wherein the dissection tip at least partly includes a conical region, a prismatic region, a region in the form of a dolphin nose, a region with a frustoconical shape and/or a region with the shape of a triangle.
3. The invasive instrument according to claim 1, wherein the dissection tip is shiftable in axial direction and/or pivotable about the longitudinal axis by up to 180°, so that during the procedure a vessel arranged in the at least one vessel receptacle can be spaced selectively in particular from a cutting device of the functional unit.
4. The invasive instrument according to claim 1, further comprising a handle at the proximal end of the shaft, and a manipulator, in particular arranged at the handle, for axially shifting and/or rotating the dissection tip relative to the distal end of the shaft between the retracted tip position and the shifted tip position.
5. The invasive instrument according to claim 1, wherein the guide element is formed substantially rod-shaped and is attached at a point of the dissection tip which is located opposite the vessel receptacle.
6. The invasive instrument according to claim 1, wherein a guide channel having the guide element and the working channel having the at least one functional unit are arranged on opposite sides of the shaft.
7. The invasive instrument according to claim 1, wherein in the shaft and/or in the handle of the instrument at least one endoscope channel, at least one working channel for receiving a cutting device, at least one guide channel for receiving a guide element, at least one irrigation channel and/or at least one insufflation channel are arranged.
8. The invasive instrument according to claim 1, wherein the dissection tip with the recess is designed such that the cutting device and/or an endoscope can be moved past the dissection tip in an axially retracted position and/or also in an axially extended position.
9. The invasive instrument according to claim 1, wherein the distance between extended dissection tip and instrument tip is adjustable steplessly or in discrete steps.
10. The invasive instrument according to claim 1, wherein the handle and/or the shaft are designed as reusable instrument.
11. The invasive instrument according to claim 1, wherein the dissection tip, the guide element and/or the manipulator are designed as disposable components.
12. The invasive instrument according to claim 1, further comprising at least one channel integrated into the shaft for conducting rinsing liquid and/or for sucking off undesired liquids.
13. The invasive instrument according to claim 1, wherein an endoscope tip operably coupled with the shaft protrudes out of the instrument tip and into the retracted transparent tip.
14. The invasive instrument according to claim 1, further comprising an insufflation channel such that a gas, in particular CO2 gas, for the insufflation can be passed to the instrument tip in the insufflation channel.
15. The invasive instrument according to claim 1, wherein the insufflation channel is arranged relative to the endoscope tip such that the endoscope tip can be cleaned with the gas, in particular in that the gas stream is diverted on the back of the dissection tip and directed to the endoscope tip.
16. The invasive instrument according to claim 1, wherein at the instrument tip a video camera is arranged, wherein the video camera includes a video sensor, e.g. a CCD or CMOS sensor, along with associated electronics and suitable optics, and glass fibers, a flexible optical waveguide and/or a solid polymer rod are guided in a separate illumination channel from the handle via the shaft to the instrument tip.
17. The invasive instrument according to claim 1, wherein at the instrument tip at least one LED is arranged for illumination.
18. The invasive instrument according to claim 1, wherein the dissection tip includes at least one diverter for an irrigation jet.
19. The invasive instrument according to claim 1, wherein the shaft has an at least partly circular or elliptical cross-section.
20. The invasive instrument according to claim 1, wherein when in the retracted tip position the at least one vessel receptacle of the dissection tip is aligned with the working channel so that the at least one functional unit is movable relative to the dissection tip when the at least one functional unit is moved between an axially retracted position and an axially extended position.
21. The invasive instrument according to claim 1, wherein when in the retracted tip position the endoscope is aligned with the working channel so that the endoscope is movable relative to the dissection tip when the endoscope is moved between an axially retracted position and an axially extended position.
22. A surgical method performed with an invasive instrument, wherein
- a) forming a cut into the skin of a body,
- b) introducing a dissection tip of the invasive instrument into the cut along a vessel, in order to separate surrounding tissue from the vessel,
- c) during introduction and/or in the end position of the dissection tip treating the surrounding tissue, a secondary vessel and/or a vessel with a functional unit through a recess at the dissection tip, without separating the connection of the dissection tip from the instrument.
23. The surgical method according to claim 22, wherein after being introduced through the cut, at least one functional unit is at least partly cleaned by a gas and/or a rinsing liquid.
Type: Application
Filed: Jan 18, 2019
Publication Date: May 23, 2019
Applicant: W.O.M. WORLD OF MEDICINE GMBH (Berlin)
Inventors: Esther FELS (Berlin), Marsha WILKE (Berlin), Nils GELBERT (Berlin), Johannes TSCHEPE (Berlin), Karl-Heinz SCHÖNBORN (Berlin)
Application Number: 16/252,151