GB2273875A

GB2273875A - Driving tool for conjunctivo-rhinostomy

Info

Publication number: GB2273875A
Application number: GB9227102A
Authority: GB
Inventors: Vishwas Vasant Kayarkar
Original assignee: Individual
Current assignee: Individual
Priority date: 1992-12-30
Filing date: 1992-12-30
Publication date: 1994-07-06
Also published as: GB9227102D0

Abstract

A driving tool for the creation of a conjunctive-rhinostomy tract comprises a trocar (5, Fig. 7) mounted on a first end of a first shaft 1 via a trocar support 3 and an abutment 4 on a first end of a second shaft 2. The tool may have the support 3 made of two movable parts (3a, 3b, Fig. 8) and a means (3d, Fig. 8) to restrain the relative movement of the said parts. A catch 9 and screw 8 may provide self retaining ability and an indicator 10 may be used to measure the size of the conjunctive-rhinostomy tube required by the patient. Electric cautery points 11a and 11b may be provided. <IMAGE>

Description

DRIVING TOOL FOR CONJUNCTIVO-RH This invention relates to the field of ophthalmie aurger@ for the relief of waterins from the eye.

In the usual surgery of creation of new passage for the flow of tears from the eye to the nase for the relief of waterins from the eye there is ususaly a fair amount of tissue damage and bleedins. The sursery is technicall@ quite demandins and time consumins.

This present invention is devised to simplify this surgery.

It facilitates the creation of coniunctivo-thinostomy tract (passase between the conijnctival sac of the eye and the nasal cavity) with minimal effort, whith very little surgical damage to the surrounding tissues, with minimal bleeding and in a very short time.

This invention is a special type of tool to create a tract through the tissue between the inner canthus of the eye and the nase. It can optinally have self retainins ability. It can optionally have the ability to measure the size of the coniunctivol-thinostomy tube reguired. It can optionally have the unipolan@ bipolar cautery facility to further reduce the bleedirs durins surgery.

The taol will naw be described by way of examples.

The tool is a driving tool for drivins a trocar (5 shown in Figure 5 and Figure 7) througt, the tissue comprising first (1 in Figures 1 to 5, and in Figures 8 to 10) and second (2 in Figures 1 to 4, and Figure 6) shafts, a trocar support (3 in Figures 1 to 5; and 3a, 3b and 3d in Figures 8 to 10) at a first end of the first shaft (Figures 1 to 5, and Figures 8 to 10), an abutment (4 in Figures 1 to 4, and Figure 6) at the corresponding first end of second shaft (2 in Figures 1 to 4, and Figure 6) and connecting means (12 in Figures 1 to 4, and 12e, in Figures 2 and 4) connecting the shafte for relative movement to drive the trocar aupport towards the abutment.

AT THE FIRST END OF THE FIRST SHAFT : It has The trocar supprt (3) which is a empty cylinder of uniform diameter, except at it's end near the shaft where it is broadened (3c in Figures 1 to 5) and has screw threads on the inside to match those on the trocar (5 in figure 7). The trocar swpport is substantially rectilinear and it's lang axis is transverse to the length of the first shaft and is transverse to the length of the second shaft, when the trocar support is close to the abutment (4).

Optionally the trocar support (3) can have a different design wherin instead of the teing comprised of one empty cylindrical shafe which is broader at the end near the first shaft, in this design it consists of two relatively movable portions (3a and 3b in Figures 8 to 10) lying at the opposite sides of the axis of the trocar support, and a fixing ring (3d in Figure 8).One of the said portions (3b in Figures 8 to 10) is mounted on the associated shaft (1 in Figures 8 to 10) indirectly via the other portion (3a in Figures 8 to 10). these two portions (3a and 3b) of the trocar support are relatively slidable along the axis of the trocar support becauss of the vertically matched design of ridge and the groove as shown in Figures 9 and 10, so that when these two portions 3a and 3b, are assembled together they form the uniform cylindrical barrel of the trocar support as shown in Figure 8 and 9. These two portions, 3a and 3b, are slightly broadened (3c in Figure 8) near the end close to the first shaft, like in the ariginal design of the trocar support shown in Figures from 1 to 5, and these broadened ends have screw threads on the inside to match those on the outside of the fixins ring (3d in Figure 8).

The fixing ring (3d in Figure 8) has screw threads on the outside and screw threads on the inside. The threads on the outside match exactly those on the inside of the broadened ends (3c in Figure 8) of the two slidable Portions (3a and 3b in Figures 8 and 10), and the threads on the inside match exactly with those on the trocar (5 in Figure 7). The fixing ring has serrations at it's top edge for ease of turning it to Put in Position or remove it.

Once the two slidable Portions, 3a and 3b, are assembled together then the fixing ring is screwed in Position at the broadened end, 3c in Figure 8. This Prevents the two Parts, 3a and 3b, slidins over each other and provides.

stability to form a cylindrical trocar support. Then the trocar can be screwed in Position as usual as the threads on the inside of the fixing ring match exactly those on the of the trocar.

The trocar (5 in Figures 5 and 7) is a solid cylinder which is Pinted at one end and has a head with serrations at the other end for good grie. The solid cylinder of the trocar is slightly broadened just under it's head ans on this broadened area it has screw threads which match exactly with the threads on the inside of the broadened end of the tracar support (8c in Figures 1 to 5) or those on the inside of the fixing ring (3d in Figure 8). When the trocar is assembled in the trocar support the fit of the cylinders of the trocar and the trocar support is exact and the lower Pointed end of the trocar just Protrudes through the lower end of the trocar support as shown in Figure 5.

AT THE FIRST END OF SECOND SHAFT (2 in Figures 1 to 4, and Figure 6) there is an abutment (4 in Figures 1 to 4, and Figure 6) which consists of a small cup with sharp adge.

the size of the cup is such that it can receive the sharp end of the trocar.

THE SECOND ENDS of the shafts are used mainly for hand grip. The tool can have a cross-action design as in Figures 1 and 3 or it can have a Parallel bar design like in Figures 2 and 4. Generally the two shafts are Parallel to each other when the trocar support is brought in contact with the abutment. Excessive approximation of two shafts is Prevented by supportive blocks (7a and 7b; and 6a and 6b) while applying the hand grip.

In the cross-actiond esign the shafts are con means of joint (12 in Figures 1 and 3).

In the Parallel bar design they are connected By solid vertical bars (12 and 12a in Figures 2 and 4) from the second shaft gaing at right angle to it's long axis and going through a designed hole in the first shaft and also going across the long axis of the first shaft. the vertical bars are centred in the middle of the supportive blocks (6a, 7a and 6b, 7b) with a kind of well in the blocks wherein metalic springs are positioned around the vertical bars to Meep the two shafts apart; the two shafts can still be approximated by applying a hand grip and compressing the springs. The vertical bars are broadened at the free end to prevent total seperation of the two shafts.

Optionally the tool can have self retaining mechanism. In the cross-action design it can be in the form of catch (9 in Figure 3) on one shaft (7 in Figure 3) and movable long screw (8 in Figure 3) with a butterfly nut (8a in Figure 3) on the other shaft (6 in Figure 3). Instead of the hutterfly nut it could be a solid disc with centmal hole with screw threads.

In the Parallel bar design the vertical bar (12 in Figure 4) has the screw threads with either solid disc with central hole with screw threads (8a in Figure 4) or a butterfly nut to act as the optional self retaining mechanism.

Optionally the tool can have a indicator (10 in figures 3 and 4) Projecting from the lower shaft going acmoss it's long axis of both the shafts to help measure the size of the conjunctivo-rhimostomy tugbe requined for each individual Patient.

Optionally the tool can have electric cautery Points (11a and lib in Figures 3 and 4) for use of unipolar or bipolar cautery to reduce the bleeding.

The tool has been so designed that when the tromar is assembled in the trocar support and the two shafts are approximated - the lower edge of the trocar support is just in contact with the edge of the cup on the abutment, the Pointed end of the trocar ietting out of the trocar support fits into the cup of the abutment, the supporting blocks are in apposition to each other; and if the tool has a optional indicator to measure the size of the conjunctivochinostomy tube required that measure will mead 0 milimetens.

Now the operating procedure using this tool will be described so that use of this tool can be explained in detail.

Fit surgery first the trocar (5) is assembled into the trocar support (3, 3a, 3b, 3d). Then the camumcle at the medial canthus is excised. Then the abutment (4) at the first end of the second shaft (2) is introduced into the facing somewhat laterally and moved up along the nasal cavity ti 1 1 the trocar Point comes f to f the level of medial canthus. Now the abutment is pressed on to the lateral wall of the nase and keeping it pressed that way the tool grip is gently closed until the point of the trocar is just in contact with the medial canthus. At this point if the tool has the optional indicator to measure the size of the conjunctivo-chinostomy tubs the indicator should be read.

This is. the actual distance between the lateral wall 1 of the nose and the medial canthus and hence the size of the tube required.

Once this has teen done the Sr-i P on the tool is increased so that the point of the trocar, along with the trocar support, enters the soft tissue between the medial canthusof the eye and the lateral bomy wall of the nose until the point of the trocar reaches the bone itself. Fit this point if the tool has the optional self retaining design then this should now be applied. In the absence of such devise the tool grip should be maintained. Now the trocar is unscrewed from it's position and removed from the tool. Then using a bone drill of the carrect size and length the bony lateral wall of the nose is drilled till the drill bit enters the nasal cavity. This will be indicated by the contact of the drill end with the cup of the abutment on the second shaft.The abutment will prevent any inadvertant damage to the nasal structures from the drill.

Once the tract is made the drill is removed and any devbri in the tract is also removed. Now that the tract is complete and clean the tool is removed and the coniunctivorhinostomy tube can now be introduced in position.

When doing the surgery using a tool with the trocar support made of two movable portions (3a and 3b) and the fixing ring (3d) the procedure remains the same till the newly formed conjunctivo-rhinostomy tract is cleaned of all debri. At this stage the surgeon should unscrew and remove the fixing ring (3d) from the tool and then remove the slidable part of the trocar support (3b) from the tool leaving the rest of the tool still in position. As the remaining part of the trocar support (3a) is still in position it will prevent the surrounding soft tissue from crowding the newly formed tract and will allow the surgeon to introduce the coniunctivo-rhinostomy tube in position rhinostomy tube reaches the abutment in the nasal cavity the tool is removed and the tube pushed in further into position.

Claims

1. A driving tool for driving a trocar through tissue comprising first (1) and second (2) shafts, a trocar support (3) at a first end of the first shaft, an abutment (4) at a corresp[onding first end of the second shaft, and connecting means (12, 12a) connecting the shafts for relative movement to drive the trocar support towards the abutment.

2. A tool according to Claim 1 wherein the trocar support defines an axis which coincides with the axis of the trocar (5), when supported by the trocar support, and wherein the axis of the trocar support intersects the abutment, when the trocar support approaches closely the abutment.

3. A tool according to Claim 2 wherein the axis of the trocar support is transverse to the length of the first shaft and is transverse to the length of the second shaft, when the trocar support is close to the abutment.

4. A tool according to any Preceding claim wherein the trocar support is elongated, is substantially rectilinear and is arranged with its length transverse to the length of the first shaft.

5. A tool according to any Preceding claim wherein the trocar support is substantially cylindrical and is hollow.

6. A tool according to any one of Claime 2 to 5 wherein the trocan support comprises two relatively moveable Portions lying at opposite sides of the axis of the trocar support and wherein one of said Portions (3b) is mounted on the associated shaft indirectly via the other portion (3a).

7. A tool according to Claim 6 wherein said portions of the trocar support are relatively slidable along the axis of the trocar support.

8. A tool according to Claim 6 or Claim 7 further comprising restraining means (3d) for releasably restraining relative movement of said portions of the trocar support.

9. A tool according to any Preceding claim wherein the abutment has a concave face directed towards the trocar support.

10. A tool according to any preceding claim wherein the shafts have respective Portions which are adjacentto the trocar support and the atutment respectively, and which are sutstantially Parallel to each other when the trocar support is close to the abutment.

11. A tool according to any preceding claim fun comprising releasable restraining means for res relative movement of the shafts and thereby preu movement of the trocar support and abutment awa other.

12. A tool according to any preceding claim further comprising a respective handle figid with each shaft.

13. A tool according to any preceding claim further comprising an indicator for indicationg the spacing between the abutment and the trocar support, the indicator being remote from the trocar aupport and remote from the abutment.

14. A tool according to any preceding claim wherein each shaft has a respective connector for cautery commection.

15. A combination comprising a trocar and a tool according to any preceding claim, the trocar being supported by the trocar support of the tool with a piercing tip of the trocar facing towards the abutment.

16. A combination according to Claim 15 wherein the trocar support and the tracar have respective cooperating formations which restrain lonsitudinal movement of the trocar relative to the support.