HRP970438A2 - Bipolar small hook for endoscopic surgery - Google Patents

Description

The field to which the invention relates

According to the International Patent Classification (IPC), the subject invention can be classified into the following classes:

A61B 1/00 - Instruments for medical examination of body spaces by means of visual or photographic examination; Endoscopes;

A61B 17/32 - Scalpels or cutting instruments; Endoscopic instruments for cutting

A61B 17/38 - . . electrically heated

A61B 17/40 -.... Electrodes

Technical problem

By using a monopolar hook, all mechanisms of dangerous unwanted organ injuries during endoscopic surgical procedures are possible. Such injuries are especially possible during surgery near important and delicate structures in the body. Applying a monopolar current, which is the only thing possible so far, can lead to current conduction and thermal injury, with a serious and sometimes fatal outcome. /Such cases are described in the surgical literature./ The construction solution of the bipolar hook solves the mentioned problems.

State of the art

Endoscopic surgery is a newer field of surgery. Many endoscopic surgical procedures have almost completely replaced the until recently only method of performing surgery with an open procedure.

In endoscopic surgery, the operating principles have not changed. Endoscopic operations are performed without classic opening (cutting) of the chest wall, abdomen or other areas of the body. Such spaces may already exist (such as the chest) or may be created by blowing gas into previous virtual spaces. A different number of "sheaths" (trocars) are introduced through the skin, through which different endoscopic surgical instruments are introduced. Most of these instruments resemble instruments from classical surgery, except that they are much longer (the supports of the working part are usually about thirty cm long), and the working part (scissors, grippers) are much smaller than those in classical surgery. The diameter of endoscopic instruments is usually 5 or 10 mm.

Electrosurgery (the use of high-frequency electricity - currents with a frequency of 500 kHz - 4 MHz for cutting or coagulation of tissue, i.e. stopping bleeding) has been in use for more than sixty years. It is most often called diathermy: when a high-frequency current passes through the tissue, it heats up as a result of electrical resistance. This leads to loss of water in the tissue (evaporation), its burning (coagulation), and cracking or cutting. Thus, the high-frequency current acts on the tissue, raising its temperature. These effects are well known and the application of high-frequency current in surgery is based on them.

"Polarity" (monopolar and bipolar) refers to the number of electrical poles at the point of application. The basic difference is in the distance between the poles. With monopolar application (current), the other pole (electrode) is a wide plate that is usually placed under the patient's back, and the current flows in unpredictable ways from the application site, through the patient's body, and towards the second electrode. In bipolar current application, the poles (electrodes) are only a few millimeters or even less apart, and the current flows only through the tissue between the electrodes.

The hook is an instrument that appears only in endoscopic (laparoscopic) surgery. As its name suggests, it basically consists of a metal working part in the form of a hook, an insulated extension (about thirty cm long) that passes through the trocar, and a handle on which there is a connector (socket) for the wire from the high-frequency current source.

In endoscopic surgery, diathermy is used far more in endoscopic surgery than in classical surgery. In endoscopic surgery, diathermy is the most important tool for cutting tissue and stopping bleeding. Monopolar current is most often used. Applying such current may cause unwanted injuries to surrounding or distant organs, caused by one of the following:

1. the effect of current outside the field of vision (by the non-insulated part of the instrument)

2. direct coupling with another metal instrument or a metal trocar (direct coupling)

3. sparking between the working electrode and tissues that are not in contact

4. electric charging of a metal trocar without contact with the electrode (capacitive coupling)

5. by transferring energy through the tissue from the site of application

6. remote injuries as a result of tissue conduction, release of accumulated electricity and high-voltage sparks

7. injuries (burns) at the junction of the skin and the second ("negative") electrode

8. heart rhythm changes.

Because of these possible and unwanted consequences, bipolar instruments are increasingly used in endoscopic surgery, which reduce the number of these complications or completely avoid them.

Various bipolar instruments are available for endoscopic surgery (forceps, forceps with built-in cutters).

So far, no bipolar hook for endoscopic surgery (BK) has been made. There are instruments that mimic the appearance of a hook and use bipolar current. They have a constant gap (usually about 4 mm) between the electrodes. Considering such a distance and the bulkiness of the performance, finer dissection and precise operation are impossible with them. On the other hand, due to the large distance between the electrodes, much greater energy is required for coagulation, which makes these instruments closer to monopolar.

There are monopolar and bipolar high-frequency current generators in the operating rooms, as well as other bipolar instruments. However, sometimes the hook is an irreplaceable instrument, which can be used to separate quite delicate adhesions or tissue covering a structure whose supply is necessary for performing endoscopic surgery. Burning and removing that tissue, exclusively and exactly at the desired location, makes the operation safe and successful, and the possibility of complications due to thermal injuries are almost completely avoided.

Presentation of the essence of the invention

The first goal of the invention is to retain all the existing properties of the monopolar hook, so that the new hook can also use monopolar current, when necessary (eg when working in an area where there is less risk of thermal injury, i.e. in an area far from important structures).

Another goal is the possibility of using bipolar current over isolated tissue, which is held by a hook.

Of course, this instrument can also be made for the exclusive use of bipolar current.

The bipolar hook for endoscopic surgery actually consists of two hooks. The first hook (K1) is stationary and corresponds to the previous old hook. The second hook (K2) is movable, and can be moved using the movable part of the handle (3) as follows:

1. in the open state, the movable hook (K2) is fully retracted into the insulated instrument holder (1) so that it does not interfere with the use of the first, stationary hook (K1) (intended for the use of monopolar current and preparation without coagulation)

2. in the closed state, the movable hook (K2) rests against the immovable hook (K1), so that between the hook (K1) and the hook (K2) there is tissue, to which bipolar current is exclusively applied. The non-insulated part is only the part of the hook that is perpendicular to the longitudinal axis of the instrument (see drawing no. 1).

The moving hook (K2) is moved by the moving part of the handle (3), which is located closer to the working part of the instrument. It is moved with the thumb and forefinger, while the stationary parts of the instrument, the carrier (1) and the stationary handle (2), and thus the entire instrument, are held between the other fingers and the palm. After releasing the movable part of the instrument (3), it returns by means of an elastic spring (5) and thus brings the movable hook (K2) to its original, open position. From the stationary handle (2) come the connectors for connecting to the high-frequency current source (4a and 4b).

The accompanying drawings are included in the description and are only one possible way of execution.

The bipolar hook for endoscopic surgery is shown in the attached drawings:

- drawing no. 1. - shows a bipolar hook in section

- drawing no. 2. - shows the enlarged working part of the bipolar hook

A detailed description of at least one way of realizing the invention

The fixed hook (K1) is connected to the support (1) and the fixed part of the handle (2) into a single unit. On the other hand, the movable (K2) hook is connected to the movable part of the handle (3). The support (1) is made of insulating material, as well as the outer part of the stationary (2) and movable (3) handle.

The movable hook (K2) slides through the support (1) and along the fixed hook (K1). Both hooks are insulated, except for the part that is perpendicular to the longitudinal axis of the instrument. Only that part is coagulation (bipolar or monopolar).

In the handle there is a stationary hook (K1) connected by a conductor to the connector for monopolar and bipolar high-frequency current source (4b).

The movable hook (K2) is connected by a conductor only to the bipolar high-frequency current source (4a).

Method of application of the invention

The bipolar hook for endoscopic surgery can be used in the same way as the old monopolar hook. When more precise coagulation and safer monitoring of current propagation and consequent possible thermal injuries is required, bipolar coagulation can be used.

Claims (2)

1. Bipolar hook for endoscopic surgery, indicated by the fact that the stationary hook (K1) is connected to the support (1), and the latter to the handle (2) in which there is a spring (5) connected to the movable part of the handle (3) that slides by the handle (2) and is connected to the movable hook (K2). 2. Bipolar hook for endoscopic surgery according to claim 1, characterized by the fact that the stationary hook (K1) is connected to the connection (4b) for connection with a high-frequency current source for monopolar and bipolar coagulation, and the movable hook (K2) is only connected to the second connection ( 4a) for bipolar coagulation of the same source.