JP2006006692A - Electric surgical probe for resecting adenoids - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an improved electric surgical probe for resecting adenoids. <P>SOLUTION: The electric surgical curette probe 10 for resecting adenoids consists of an electric connector 28 for receiving electric surgical high-frequency currents and an electrically insulated slender body with a connection clamp 22 for supporting a suction conduit 24 at an end on the proximal side when the probe is held by hand. The electric connector is internally connected to an active electrode at the distal end of the body, and an exposed sharp blade attached to an arm disposed between ends of a hook-shaped part of the body is made of the active electrode. The ends of the hook-shaped part are bent downward as seen from above, and the blade 20 is attached in the direction perpendicular to the extension of a center shaft of the body in the longitudinal direction. The sharp edge of the blade 20 faces upward. A nozzle opening 40 of the suction conduit 24 stored in the body and connected to the connection clamp terminates just behind an end of the hook-shaped part and faces the end of the hook-shaped part. <P>COPYRIGHT: (C)2006,JPO&NCIPI

Description

The present invention relates to an electrosurgical probe for surgical treatment of adenoidectomy.

  Adenoidectomy is a necessary treatment for relief of nasal obstruction, sleep apnea, recurrence of chronic infections and chronic ear disease. The procedure is surgical excision of hypertrophic adenoid tissue from the retronasal cavity and along the ridge. The procedure itself using a conventional curette is well known, and it was 234 of “Surgical Pediatric Otolaryngology” published by Thieme in New York in 1997. -235 and FIGS. 20-1A-H, which are described in detail in this specification for reference.

  Adenoidectomy is one of the most commonly performed operations on children in the 20th century. The most common adenoidectomy is the conventional curette, and the main challenge with using a conventional curette is to visualize it except for persistent bleeding. In addition, general anesthesia is always required, and patients also need to be hospitalized for 1-3 days. In order to always control and prevent postoperative bleeding, the surgical site must be packed after surgery. A special liquid diet is always prescribed after surgery.

  The object of the present invention is to provide an improved surgical procedure in adenoid resection.

  We have invented a new monopolar electrode for use in electrosurgical adenoid resection procedures. This electrosurgical procedure using the new electrodes allows surgeons to be effectively and easily learned, thus providing patients with treatments that are performed at significantly reduced costs, and for surgical use. Compared to the procedure performed with a female curette, there is less tissue damage and superior results can be obtained.

  Treatment with the new electrode is based on intranasal electrosurgery, ie, excising part or all of the adenoid via the nasal cavity. The electrode of the present invention is formed on its own so that the active tip can reach and ablate hypertrophic adenoid tissue while avoiding damage to surrounding tissue.

  In a preferred embodiment, the new electrode is an electrically isolated, elongated, electrical connector that receives high frequency electrosurgical current and a fitting that supports the suction conduit at the end that is in front of the probe when it is held. It features a main body. The electrical connector is internally connected to the active electrode at the tip of the main body, and the bare sharp blade attached to the arm at the claw-shaped end of the main body is composed of the active electrode. When viewed from above, the claw-shaped end bends downward, the blade is mounted perpendicular to the extension of the central axis in the longitudinal direction of the body, and the sharp cutting edge of the blade faces upward ing.

  Terminating just behind the claw-shaped end and facing the bent claw-shaped end is the nozzle opening of the suction conduit housed in the body and connected to the connection fitting . After the elongate body has been inserted into the nasal cavity, the surgeon typically moves the blade of the bare blade in an upward trajectory to perform tissue resection.

  During the surgical procedure, the insulating part of the body serves to position and guides the cutting edge of the active blade. Electrosurgical procedures have the very important advantage of ablating adenoid tissue sections while coagulating the resected tissue capillaries to minimize bleeding. The electrosurgical current used is preferably above 2 MHz and more preferably above 3 MHz. At these high levels of radio frequencies commonly seen in radiosurgery, ablation is accomplished by volatilization of the intracellular fluid at the point of contact of the conducting electrode, which involves a small spread of heat mainly in the lateral direction. Since only that can occur, keeping the tissue temperature low reduces damage to adjacent cell layers.

The high-frequency adenoid cutting blade of the present invention has the following advantages.
a) Since the treatment with the high frequency adenoid resection blade is performed by local anesthesia rather than general anesthesia, the treatment can be performed in an office and does not require a hospital-like environment.
b) With a high frequency low temperature energy source connected to a high frequency adenoid cutting blade probe, adenoid tissue can be cut precisely and finely with a high frequency blade curette.
c) Normally, no packing is required after the operation.
d) With the adenoidectomy probe of the present invention, a clear field of view can be realized without obstructing the surgical site.
e) No special meal is required.

  As far as this specification relating to the probe of the present invention is concerned, in the probe when held horizontally with respect to the central axis in the longitudinal direction extending horizontally, “downward” means, as shown in FIG. It means the south direction (direction toward the bottom margin in the figure) that intersects the central axis of the direction. “At the bottom” means that the probe is located below the central axis in the probe held at the same position shown in the figure. “Upward” means the north direction, and “upper” means that the probe is located above the central axis in the probe held at the same position shown in the figure.

  The present invention not only provides a sharp cutting edge set for precise and fine cutting, for excising the part of the tissue that the radiofrequency probe has targeted for excision and that is clearly diagnosed as adenoid, Furthermore, for a clearer view, suction is provided only inside the claws to simultaneously remove blood, tissue and high-frequency vapor from the surgical site.

  The adenoid tissue at the upper nostril and the adenoid tissue along the ear canal can be cut very thinly and removed. Increased surgical precision has made it easier to remove hypertrophic adenoid tissue from the retronasal cavity and along the ridge.

  Therefore, a more thorough and complete adenoid resection can be achieved without difficulty. By using a high-frequency megahertz frequency, a low temperature can be maintained, and symptom experienced by tissue regrowth and previous surgery is minimized, and postoperative pain tends to decrease.

  FIG. 1 illustrates a preferred embodiment of the novel electrosurgical probe 10 of the present invention. The probe 10 is terminated by a handle 14 at the first end (left side in FIG. 1) that is in front when it is held in the hand, and a downwardly extending claws 18 to which a cutting blade 20 is attached from the bottom. It consists of an elongate structure having a central axis 12 including a second end mandrel 16 which is the tip opposite the first end. A fitting 22 for supporting the conduit 24 that can assist suction is attached to the first end.

  The conduit 24 is then connected to a conventional suction generator 26. A female electrical connector 28 connected to a conventional electrosurgical instrument 32 through a cable 30 in a conventional manner is also attached to the first end. By way of example only and not limiting, the electrosurgical instrument 32 may be an AAOP Surgitron FFPF model or Dual-Frequency Unit (dual frequency device) available from Ellman of Hewlett, NY. Ellman devices are preferred due to their high operating frequency, usually above 2 MHz, preferably 3.8 MHz.

  The handle 14 and the mandrel 16 as a single body are made of a conductive material such as stainless steel, but the entire assembly excluding the connection fitting 22 and the blade 20 is electrically connected to the connection fitting 22. It is completely covered with an insulating coating 34 so that only the blade 20 is present. The electrical connector 28 is electrically connected to the conductive main body.

  As a result, for example, a stainless steel metal blade 20 is attached to the claw-shaped end 18 and is electrically connected to the electrically conductive body portion and thus electrically connected to the electrical connector 28. Then, when the electrosurgical instrument 32 is activated, an electrosurgical current flows through the electrical connector 28 to the body and then to the cutting blade 20. The connection fitting 20 used is usually covered with a plastic cable terminal 36. Thus, in use, the entire assembly is protected from electrosurgical current except for the cutting blade 20, which functions as the active electrode.

  Extending in the longitudinal direction through the body is a tube 38 made of, for example, stainless steel. The front end of the tube 38 is pneumatically coupled to the suction fitting 22, and the opening 40 facing the inside of the claws 18 is the opposite end of the tube 38 and is terminated below the central shaft 12. . When the suction generator 26 is activated, the suction generated by the suction generator 26 is guided to the opening 40 through the connection fitting 22 and the internal tube 38.

  In order to perform adenoid resection with a probe, in order to reach the adenoid tissue, the probe must be inserted through the nasal cavity and pass through the nasal cavity so that the blade is positioned under the tissue to be ablated. is important.

  In a preferred embodiment, the upper edge of the cutting edge 42 is sharp so that the blade having that sharp cutting edge 42 that contacts or contacts tissue is upward when the electrosurgical instrument is operating. If it moves quickly, the cutting operation will be performed.

  An important dimension is the length of the mandrel 16 including the claws 18 represented as 44 in FIG. The height 46 of the claws including the blade 20, the width 48 of the claws that support the blade 20 (FIG. 2), and the axial spacing 50 between the suction opening 40 and the cutting blade 20 are also important. The latter is important because it determines the efficiency of the suction effect at the surgical site.

  The horizontal dimension shown as 52 in FIG. 3 represents the exposed active portion of the blade. The blade is preferably narrow and about 1-2 mm in height. The corners of the blade are also covered with an electrically insulating coating 34. The claw 18 extends essentially transversely downward with respect to the longitudinal central axis 12. The blade 20 is also mounted so that it is essentially transverse to the longitudinal central axis 12 but in a direction perpendicular to the end of the claws (towards the plane of FIG. 1). ing.

Suitable dimensions for these parts are as follows.
a) The length 44 of the mandrel 16 including the claws 18 is 10.0-11.5 cm, preferably 10.8 cm.
b) The height 46 of the claws 18 including the blade 20 is 12.0-13.0 mm, preferably 12.5 mm.
c) The width 48 of the claws that support the blade 20 is 12.0-13.0 mm, preferably 12.5 mm.
d) The axial interval 50 between the suction opening 40 and the cutting blade 20 is 19.0 to 20.0 mm, preferably 19.5 mm.

  The overall structure of the monopolar probe is hard and sturdy and does not bend during use. The dimensions may be reduced for probes used for very small children. Also connected to the electrosurgical instrument 32 is an ordinary mediocre plate that contacts the patient's body during use. When the electrosurgical instrument 32 and the suction generator 26 are energized, a high frequency electrosurgical current is generated and coupled through the conductive tube 38 and directed to the active blade 20 at the tip. In the usual manner, the doctor will hold the handle 14 while the patient is operating on the working edge of the probe blade 20 in the area desired to be treated.

  The electrically insulating coating 34 may be plastic, for example, Teflon. The use of the probe will be described below.

  After the patient has been pre-treated with appropriate oral anesthesia and lowered his head on his back while under local anesthesia, the surgeon should insert the instrument through the nasal cavity with the claws 18 facing down and should be resected, i.e. thinly The instrument is inserted into the nasopharynx until the cutting edge 42 is positioned under the adenoid tissue to be scraped or scraped. After activating the electrosurgical instrument 32 and the suction source, the cutting edge 42 is slowly moved upward using an appropriate fulcrum. The tissue that has been thinned or excised, and the smoke and blood associated with the excision, are removed by the suction generated at the suction nozzle end 40, which is located at a distance from the inside of the claws, which is inside the claws. And therefore effective at the surgical site.

  The electrosurgical current coagulates the capillaries that tend to bleed to avoid the need for nasal packing at the time of resection. This procedure may be repeated to remove any remaining adenoid tissue from the retronasal cavity and along the ridge.

  This procedure includes that described in US Pat. No. 5,571,101 by the applicant for the nasal mucosa region and that the electrode mandrel of the electrode of the present invention is 3-4 times longer to reach the adenoid tissue. The cutting edge 42, which is similar except that a sharp blade instead of an L-shaped needle crosses upward, terminates in the mandrel and is attached to the lower edge of the claw-shaped end 18 protruding downwards. Used. The Ellman instrument uses a current that is fully rectified or cut to harden the capillaries at a power setting of 3 to 4 times. There are few traumas and the sore throat felt by the patient can be easily controlled with microanesthetics and anti-inflammatory drugs.

  From the above description and drawings, the electrically insulating coating 34 covering the entire surface other than the bare blade 20 functions to prevent unwanted contact and possible burns in the adjoining region of the adenoid tissue and in the vicinity of the tissue. It is clear.

  The described procedure is effective in reducing the effects of adenoid tissue disease and offers the advantage of avoiding the use of mechanical scalpels and curettes, bleeding, patient trauma, pre- and post-operative procedures To do.

  The foregoing is merely illustrative of embodiments of the invention and many variations and modifications can be made by those skilled in the art without departing from the scope of the claims.

The side view which shows one form of the probe for adenoid resection of this invention connected to the electrosurgical instrument and the suction generator. FIG. 2 is a bottom view of the electrode portion of FIG. FIG. 2 is a front view of the probe shown in FIG. 1 when FIG. 1 is viewed from the right side.

Explanation of symbols

10 Probe
12 Center axis
14 Handle
16 mandrel
18 claws
20 Cutting blade
22 Connection bracket
24 conduit
26 Suction generator
28 Female electrical connector
30 cables
32 electrosurgical instruments
34 Insulating coating
36 terminals
38 tubes
40 openings
42 Cutting blade
46 Height
48 width

Claims (10)

An elongate body having a longitudinal axis and comprising an electrical connector for receiving electrosurgical high-frequency current and a fitting for receiving suction at the front end when holding the probe;
A suction conduit in the main body, one end of which is connected to the connection fitting,
A main body portion having a claw member consisting of arms spaced from each other at the tip, and the claw member is bent downward when viewed from directly above,
An active electrode at the tip of the main body that forms a bare sharp blade attached to the arm of the claw member;
Means for connecting the electrical connector with a bare sharp blade,
A suction conduit having an opening at the tip facing the inside of the claw member;
During adenoidectomy, when electrosurgical current is applied to the electrical connector and suction is applied to the fitting, the electrosurgical current contacts or passes through the adjacent site of the tissue to be excised or the peripheral site of the tissue. An electrosurgical probe for adenoid tissue excision, which is composed of a portion of the main body portion other than the exposed sharp blade, which is electrically insulated to prevent damage.   2. The electrosurgical probe according to claim 1, wherein the blade is attached in a direction perpendicular to the extension of the longitudinal axis of the main body.   2. The electrosurgical probe according to claim 1, wherein the blade has a sharp cutting edge, and the sharp cutting blade faces upward with respect to the inside of the claw-shaped member.   4. The electrosurgical probe according to claim 3, wherein the main body portion is coated with a conductive electrically insulating coating, and a portion of the main body composed of the claws is hard.   The main body comprises a handle and a mandrel connected to the claw-shaped member, and the length of the mandrel including the claw-shaped member is about 10.0-11.5 cm. Electrosurgical probe.   The electrosurgical probe according to claim 1, characterized in that the height of the claw-shaped member including the blade is about 12.0-13.0 mm.   The electrosurgical probe according to claim 6, characterized in that the claws have a width of about 12.0-13.0 mm.   6. The electrosurgical probe according to claim 5, wherein the axial distance between the suction opening and the cutting blade is about 19.0-20.0 mm. An electrosurgical instrument capable of supplying a high frequency electrosurgical current;
A suction generator;
An electrical connector with a longitudinal axis and connected to an electrosurgical instrument to receive an electrosurgical high frequency current at the front end when holding the probe and connected to a suction generator to receive suction A long and slender main body made of connected fittings,
A suction conduit in the main body, one end of which is connected to the connection fitting,
A body part having a claw member consisting of arms spaced from each other at the tip, and when viewed from above, the claw member is bent downward,
An active electrode at the tip of the body that forms a bare sharp blade attached to the arm of the claw member;
Means for connecting the electrical connector with a bare sharp blade,
A suction conduit having an opening at the tip facing the inside of the claw member;
During adenoidectomy, when electrosurgical current is supplied to the electrical connector and suction is applied to the fitting, the electrosurgical current contacts or passes the adjacent area of the tissue to be excised or the surrounding area of the tissue. Parts of the main body other than the sharply exposed blade that is electrically insulated to prevent
A combination device with an electrosurgical probe for ablating adenoid tissue composed of   10. The combination device according to claim 9, wherein the high-frequency current has a frequency exceeding 2 MHz.

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