JPH04325151A - Electric surgery instrument - Google Patents

Abstract

PURPOSE: To modify an electrosurgical needle which excises a tissue to cauterize and coagulate the part thereof. CONSTITUTION: A bullet shaped tip 22 made of a ceramic is fixed at a far end 16 of a bendable tubular member 12, a hole is made at the center thereof and the surface of the member is covered with an electric layer to form a first inactive electrode. A conductor linked to the surface is returned to the near end of the tubular member 12 through an internal cavity thereof and linked to a dynamo. Another conductor running through the internal cavity is located outside an opening 26 of a tip member 22. A hub 36 having a spring-loaded plunger 34 is fixed at the near end 14 of the tubular member 12, the plunger 34 is linked to the conductor and when the plunger 34 is pushed, the far end 16 of the conductor sticks by a short length outside the tip 22. A second conductor is linked to an electrosurgical dynamo and acts as active electrode within a bipolar couple.

Description

[Detailed description of the invention]

0001

FIELD OF THE INVENTION This invention relates generally to electrosurgical instruments, and more particularly to bipolar electrosurgical instruments that can be used with endoscopes to perform surgical procedures in the gastrointestinal tract.

0002

BACKGROUND OF THE INVENTION In various surgical procedures performed within the gastrointestinal tract, an endoscope is first inserted through a suitable body orifice and its distal end is positioned within the body cavity in which the surgical procedure is to be performed. be advanced until Typically,
The endoscope has a fiber optic tube that illuminates the affected area for observation. Surgical tools are then inserted through the endoscope and used to ablate or excite tissue. For example, if gallstones grow to a size such that they cannot pass through the duodenal process from the common bile duct, the opening of the process can be enlarged by surgically cutting the active dilator muscle surrounding the opening.

0003

Surgical removal of polyps from the intestines can also be performed by passing appropriate electrosurgical tools through an endoscope. Srings for polyp removal are commonly used in this case, although smaller, less developed polyps may be removed using an electrosurgical needle.

0004

SUMMARY OF THE INVENTION The present invention is directed to the design of an electrosurgical instrument having bipolar electrodes that can be passed through an endoscope, the bipolar electrodes of said instrument being able to perform ablation and subsequent coagulation. It is used to do both. In one aspect of the invention, the device includes an elongated, flexible tubular member having a proximal end, a distal end, and a plurality of lumens extending between the proximal and distal ends. Contains. A bullet-shaped ceramic tip is secured to the distal end of the tubular member, which has a centrally located longitudinal hole passing through its side wall. A conductive layer is coated on the outer surface of the ceramic tip to form a first relatively large area electrode. An electrical lead connected to the electrode surface passes through the lumen of the tubular member and returns to its proximal end where it is connected to an electrosurgical generator. A second conductor also extends through the lumen within the elongate tubular member and is adapted for longitudinally transporting said second conductor such that its distal end projects out of an opening formed in the tip member. equipment is provided. A hub with a spring-loaded plunger is attached to the proximal end of the tubular member to facilitate reciprocating movement of the distal end of the conductor relative to an aperture formed in the metal-covered ceramic tip. and the plunger is connected to a conductor. A small gap exists between the metallized surface on the tip and the lead, and when the two are connected to an electrosurgical generator and a suitable high frequency voltage is applied,
An electric arc is generated in the lead electrodes, and the current flows to the metallized ceramic return electrodes, which are in contact with the tissue to be ablated.

Another feature of the invention is that the metallized surface on the ceramic bullet-shaped tip is effectively separated by an insulating gap to create two electrodes rather than one electrode surface. Good too. During ablation, these two electrode surfaces are connected in common to provide a single electrode and cooperate with the reciprocable needle to create a bipolar pair, where the surface area of the needle is significantly smaller than the area of the metallized surface on the ceramic tip. The device of the present invention may also be used to coagulate blood; in this mode, the electrode area formed in the ceramic tip is separately electrically coupled to the coagulation output of the electrosurgical generator. It is used independently of the reciprocating needle electrode.

Rather than having an elongated, flexible catheter-like tubular member, a relatively short, rigid tubular member can be secured to the plunger mechanism for use as a cooperative device.

[0007]

DESCRIPTION OF THE PREFERRED EMBODIMENTS The above-described features and advantages of the present invention will become apparent to those skilled in the art upon consideration of the following detailed description of the preferred embodiments, particularly when considered in conjunction with the accompanying drawings. . In the figures, like numbers in several figures indicate like parts.

Referring to FIG. 1, the electrosurgical instrument of the present invention is designated by the numeral 10 and includes an elongated flexible plastic tubular member 1 having a proximal end 14 and a distal end 16.
It consists of 2. The cross-sectional view of FIG. 2 shows that the tube 12 is
It is shown having a lumen 18 and a second lumen 20. The tube may be molded with two lumens, or it may be formed into two separate tubes by passing a second, smaller tube of a different diameter within a single lumen of the first tube. A lumen may be formed.

Fixed to the distal end 16 of the tubular member 12 is a smoothly rounded, bullet-shaped ceramic member 22 having a longitudinal aperture 24 completely extending therethrough; This defines an opening 26 in the surface of ceramic tip 22. The ceramic employed may be aluminum nitride or aluminum oxide, but is not limited to these two candidates.

A conductive layer 28 of a suitable metal, such as silver or nickel, is plated, sprayed, immersed, screened, or otherwise formed on the outer surface of the ceramic tip 22, and the metal is biologically compatible. Compatible with each other and non-toxic. The metal has a gap 30 of a predetermined size.
, the purpose of which will be explained in more detail below.

A first conductive wire 32 passes through the lumen 20 and a hole 24 formed in the ceramic tip. The proximal end of the conductor 32 is mechanically coupled to the proximal end of a plunger 34, which is connected to the elongated flexible tubular body 12.
It fits into a hole formed in a cast plastic hub 36 secured to the proximal end 14 of the tube. A return spring 38 surrounds the plunger shaft 34 and cooperates with the hub 36 and thumb button 40 to normally keep the plunger proximally biased. Pushing the plunger 34 against the force of the spring causes the distal end 42 of the lead 32 to protrude through the aperture 26 formed in the ceramic tip 22 . Subsequent release of the plunger draws the proximal portion 42 of the conductor 32 back into the interior of the tip 22.

As further shown in FIG. 2, a second conductive wire 44 extends through the lumen 18, the distal end of the conductive wire 44 being connected to a metallized layer 28 formed on the ceramic tip. The instrument 10 is connected by a wire 46 to the output terminal of an electrosurgical generator, such as the type described in Stasz Patent Application No. 071254,203, assigned to the assignee of the present application, dated October 6, 1989. There is. The conductors in wire 46 are electrically coupled to conductors 32 and 44 within molded housing 36.

The surgical field viewed through the endoscope is cleaned of blood and other body fluids by introducing a suitable flushing fluid through the luer fitting 48, which communicates with the lumen 20 formed in the catheter body 12. can also be excluded.

In use, tool 10 has a tubular body portion 12 that is passed through an endoscope to a location within the body at which an electrosurgical procedure is to be performed. When the distal tip 22 reaches that position, the surgeon presses the thumb button 40 and
A distal end portion 42 of the conductive wire 32 projects from the opening 26. A high frequency voltage is then generated between the protruding portion 42 of the lead 32 and the metallization layer 28 covering the ceramic tip 22 by depressing the "off" foot pedal on the electrosurgical generator. Due to the considerable difference in electrode area between the protruding conductor 42 and the metallization layer 22, said portion 42 plays the role of an active bipolar electrode, and the metallization layer 22 becomes a return electrode. When the two electrodes come into contact with the tissue to be ablated, an electric arc is generated between the active electrode and the tissue and flows to the return electrode, which ablates the tissue. At the same time, a medicinal salt or other suitable solution is applied to the luer fitting 48.
and exit through the lumen 20 and out the distal hole 26 to clean the affected area and facilitate viewing the surgical area through an endoscope.

The principles of the present invention may also be applied to hand-held cooperative electrosurgical instruments in which tubular member 12 is relatively short and flexible. Other structural features are the same as described above. This type of tool can be employed to ablate tissue and then coagulate blood at the surgical site. Equipment modified in this way is
a more rigid handle than manipulated through an endoscope;
It would be used similarly to a type of electrosurgical scalpel having a remotely disposed blade supporting the requisite electrode surface.

FIGS. 4 and 5 show another embodiment of the invention which has an additional feature of coagulation. The equipment shown in Figure 4 is shown in Figure 1.
It differs from that primarily in the pattern of metallization at the distal tip. In the device of FIG. 4, the distal tip does not have a uniformly coated metallization, and the metallization is separated by an insulating gap 54 into substantially two relatively equivalent regions 50 and 52. It is divided into. Conductor 4
4 connects to one of said two regions, and another conductor 56 connects to lumen 1.
8 and connects with other metallized regions. Conductor 56
returns to the proximal hub 36, which connects with other conductors in the electrical wire 46 that are connected to an electrosurgical tool generator (not shown).

When the tool of FIGS. 4 and 5 is used in the "cutting" mode, the proximal portion 42 of the lead 32 projects from the aperture 26 and cooperates with the metallized regions 50 and 52, in this case The regions are connected in a common state. When the device is used to coagulate blood and other tissue, the plunger is released and the return spring 38 pushes the plunger proximally, causing the distal portion 4 of the lead 32 to
into the opening formed in the ceramic tip member 22. When operating in the condensation mode, conductors 44 and 56 are no longer electrically coupled in common at the electrosurgical generator; instead, they are separated by the high frequency waves from the generator. The metallized regions 50 and 52 form a bipolar condensing electrode pair.

It should be apparent to those skilled in the art that since conductors 44 and 56 pass through the same lumen 18, it is necessary to insulate them from each other over their entire length. . If uninsulated conductors are to be used, an additional lumen would be provided in tubular member 12 to keep conductors 44 and 56 insulated from each other.

The present invention is herein described in considerable detail in order to comply with the patent regulations and to provide the art with the information necessary to apply the new principles to the art, and to explain such special features as necessary. We have made it possible to manufacture and use various components. However, the invention may be carried out with particularly different equipment and equipment, and various modifications may be made, both to the details of the equipment and to the operating procedure, without departing from the scope of the invention itself. You should be able to understand that.

[Brief explanation of drawings]

1 is a partially sectional side view of an electrosurgical instrument according to the invention; FIG.

FIG. 2 is a cross-sectional view taken along line 2-2 of FIG. 1;

FIG. 3 is a cross-sectional view taken along line 3-3 of FIG. 1;

FIG. 4 is a partial cross-sectional view of another embodiment of the invention.

FIG. 5 is a cross-sectional view taken along line 5-5 of FIG. 4.

[Explanation of symbols]

10 electrosurgical instrument 12 tubular member 14 proximal end of the tubular member 16 distal end of the tubular member 18, 20 lumen 22 tip member 24 bore 26 aperture 28 metallized surface 32 first lead 34 plunger 36 hub 42 distal end of first lead 44 Second conductive wire 50, 52 First and second regions of metallized surface 56 Third conductive wire

Claims (8)

[Claims] [Claim 1] In an electrosurgical tool, (a)
an elongated tubular member having a proximal end, a distal end, and a plurality of lumens extending between the proximal and distal ends; (b) a bullet-shaped member secured to the distal end of the tubular member; a ceramic tip member, the tip member having a longitudinal aperture formed therein, the aperture exiting from an opening on the exterior of the tip member, which extends in the longitudinal direction of the tubular member; (c) a first conductor disposed in one of the lumens; (c) a first conductor disposed in one of the lumens; and (d) at the proximal end of the tubular member. a device coupled and coupled to the first conductor for selectively moving the first conductor, whereby the distal end of the first conductor extends through the longitudinal hole and the opening; (e) an electrically conductive surface affixed to the exterior of the tip member and surrounding the aperture with a gap therebetween; and (f) the plurality of and a second electrical lead passing through another lumen of the lumen and electrically coupled to the electrically conductive surface. 2. The electrosurgical instrument of claim 1, wherein the electrically conductive surface has first and second regions insulatively separated from each other on the tip member. . 3. The electrosurgical tool according to claim 2, further comprising: a second lumen penetrating said other lumen of said plurality of lumens; An electrosurgical instrument including a third conductor connected to an area not connected to the second conductor. 4. An electrosurgical instrument according to any one of claims 1 to 3, wherein the ceramic is selected from the group consisting of aluminum oxide and aluminum nitride, and the electrically conductive surface is silver. 5. The electrosurgical instrument of claim 1, further comprising a portion of the first conductor coupling the first conductor and the second conductor to a high frequency voltage and extending outwardly from the aperture. and said conductive surface contact human tissue;
An electrosurgical instrument including a device for generating an electric arc between the portion of the first conductor and the surface. 6. The electrosurgical instrument of claim 3, further comprising a device for coupling said second conductor and third conductor to said high frequency voltage to coagulate body fluid. 7. The electrosurgical instrument of claim 1, wherein the device coupled to the proximal end of the tubular member is a hub, the hub having a spring loaded plunger passing through the hub; An electrosurgical instrument, wherein the plunger is coupled to the first lead. 8. The electrosurgical instrument according to claim 3, wherein the second conductive wire and the third conductive wire are in common with each other when the first conductive wire is connected to a high frequency voltage source. Articulated electrosurgical tools.