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EP3128937A1 - Instrument électrochirurgical et un procédé d'insertion d'un applicateur dans une lumière d'un corps - Google Patents

Instrument électrochirurgical et un procédé d'insertion d'un applicateur dans une lumière d'un corps

Info

Publication number
EP3128937A1
EP3128937A1 EP15713485.9A EP15713485A EP3128937A1 EP 3128937 A1 EP3128937 A1 EP 3128937A1 EP 15713485 A EP15713485 A EP 15713485A EP 3128937 A1 EP3128937 A1 EP 3128937A1
Authority
EP
European Patent Office
Prior art keywords
sleeve
guide catheter
electrosurgical instrument
counter
suction opening
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP15713485.9A
Other languages
German (de)
English (en)
Inventor
German Klink
Dana WILLFROTH
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Olympus Winter and Ibe GmbH
Original Assignee
Olympus Winter and Ibe GmbH
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Olympus Winter and Ibe GmbH filed Critical Olympus Winter and Ibe GmbH
Publication of EP3128937A1 publication Critical patent/EP3128937A1/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1492—Probes or electrodes therefor having a flexible, catheter-like structure, e.g. for heart ablation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1477—Needle-like probes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/1485—Probes or electrodes therefor having a short rigid shaft for accessing the inner body through natural openings
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/16—Indifferent or passive electrodes for grounding
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00053—Mechanical features of the instrument of device
    • A61B2018/00273—Anchoring means for temporary attachment of a device to tissue
    • A61B2018/00291—Anchoring means for temporary attachment of a device to tissue using suction
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00315—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for treatment of particular body parts
    • A61B2018/00541—Lung or bronchi
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00577—Ablation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00589—Coagulation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
    • A61B2018/00601—Cutting
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B2018/1467—Probes or electrodes therefor using more than two electrodes on a single probe
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B2018/1475—Electrodes retractable in or deployable from a housing
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B2018/1497—Electrodes covering only part of the probe circumference
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
    • A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
    • A61B18/14—Probes or electrodes therefor
    • A61B18/16—Indifferent or passive electrodes for grounding
    • A61B2018/167—Passive electrodes capacitively coupled to the skin

Definitions

  • the invention relates to an electrosurgical instrument, in particular for bronchoscopy, comprising a guide catheter for introducing an applicator into body lumens along an insertion direction.
  • the invention relates to a guide catheter and a method for introducing an applicator into body lumens.
  • Electrosurgical instruments and guide catheters of the aforementioned type are known in the art. They are used in particular for introducing one or more applicators into body lumens, in particular into the bronchi.
  • Electrosurgical applicators may also be referred to as applicator or application probes and serve, in particular, for the coagulation and / or ablation of biological tissue and / or deposits.
  • An applicator is usually guided along an insertion direction and usually relative to the guide catheter movable in a lumen of the guide catheter.
  • the direction of insertion is understood to be a direction in which a guide catheter or an electrosurgical instrument is introduced into a body lumen. Due to anatomical conditions and because a guide catheter or an electrosurgical instrument can be flexibly designed, the
  • Insertion direction is not necessarily a straight line. Therefore, the feed direction in which the guide catheter or the electrosurgical instrument is essentially advanced is considered as the insertion direction.
  • the insertion direction therefore also corresponds essentially to a longitudinal axis of the guide catheter or of the electro-surgical instrument.
  • the applicator usually has an elongated applicator shaft on which a distal applicator electrode is usually arranged, which can form a distal end of the applicator shaft and furthermore a surface portion of the applicator shaft.
  • a distal end of the distal applicator electrode usually an applicator tip is formed, which may be rounded or pointed or provided with an additional cutting electrode.
  • Such applicators serve, in particular, to deliver high-frequency electrical current to surrounding tissue and are also referred to as coagulation or ablation instruments.
  • Monopolar applicators require only one electrode. In use, this electrode interacts with a large return or neutral electrode, which also communicates with a patient's body.
  • Applicators with at least two applicator electrodes, preferably a distal and a proximal applicator electrode, are provided for a bipolar application.
  • Such bipolar coagulation or ablation instruments can be subjected to a high-frequency (HF) voltage of different potential (bipolar), whereby the tissue surrounding the electrodes is heated to such an extent that it dries out and / or denatures the body's own proteins.
  • HF high-frequency
  • Areas of use of electrosurgical instruments are, in particular, bronchoscopy or the treatment of bronchial carcinomas, in which a guiding catheter is introduced to a site of action or in front of a site of action in the body lumen in order to bring the applicator to or in front of this site of action.
  • the site of action usually lies in a body tissue adjacent to the body lumen.
  • this site of action lies in the bronchi of the lung.
  • To reach the site of action with a distal applicator tip it is therefore usually necessary to penetrate into the body tissue adjacent to the body lumen.
  • the applicator tip when the site of action lies in the bronchi, the applicator tip often has to penetrate into a bronchial wall, which may be cartilaginous.
  • Applicators therefore often have a mechanically-cutting / puncturing applicator tip for mechanical puncturing.
  • this can be disadvantageous because such a mechanically dende / puncturing Applikatorspitze example, unwanted damage to a guide catheter and / or unwanted injury to body tissue may occur.
  • high puncturing forces or impacts are sometimes required in order to allow a mechanically cutting / puncturing applicator tip to penetrate into a cartilaginous bronchial wall, which can lead to an unintentional change in position of the applicator.
  • Electrosurgical instruments are known in which a cutting electrode with a substantially smaller surface is provided at the distal end in addition to the distal coagulation or ablation electrode, as described for example in DE 10 2012 220 682.5.
  • electrosurgical instruments can be costly to manufacture.
  • it is known, for example from DE 10 2013 212 448.1, to provide an anchoring mechanism with which the distal end of a guide catheter can be fastened to a bronchial wall.
  • DE 10 2013 212 521 .6 it is known to provide a catheter electrode which can be used as a cutting electrode for deflecting or fixing the distal end of the catheter.
  • an electrosurgical instrument comprising a guide catheter for insertion of an applicator in the body lumen along an insertion direction and a counter sleeve, wherein the counter sleeve and the guide catheter are arranged axially displaceable to each other, and the guide catheter has at least one radial suction opening in a distal region and the electrosurgical instrument is configured to generate a negative pressure in the guide catheter, and further wherein a cutting element is arranged at the suction opening and / or at a distal end of the counter sleeve.
  • the electrosurgical instrument also provides a mating sleeve adjacent the guide catheter for insertion of an applicator into a body lumen along an insertion direction.
  • the counter sleeve and the guide catheter are longitudinally displaceable relative to each other, so that the counter sleeve relative to the guide catheter along the insertion direction can be pushed back or pulled and / or the guide catheter against the counter sleeve in the insertion and pushed back or can be pulled.
  • the suction opening in the distal region of the guide catheter is aligned radially, that is, directed radially outward relative to a longitudinal axis of the guide catheter.
  • the radial suction opening can also be referred to as a lateral suction opening in the lateral surface of the guide catheter.
  • the electrosurgical instrument is designed to generate a negative pressure in the guide catheter, in particular a temporary negative pressure, which can be used in particular for sucking a wall of a body lumen through the suction opening.
  • the guide catheter can be fixed to the wall of a body lumen.
  • the negative pressure can be generated, for example, by a fluid pump, in particular a gas pump, which is preferably arranged at a proximal end of the electrosurgical instrument.
  • a negative pressure is understood here in particular a pressure that is lower than the ambient pressure.
  • the electrosurgical instrument further includes a cutting element disposed on the suction port or on a distal end of the mating sleeve. It can also be arranged in each case a cutting element at the suction opening and at the distal end of the counter sleeve. If in the following explanations, configurations or advantages are given with respect to a cutting element, these also apply correspondingly to two or more cutting elements.
  • the counter sleeve preferably provides a mating surface, so that a cut or a separation of body tissue takes place between the cutting element at the suction opening and the counter sleeve.
  • the edge of the suction opening or the mantle of the guide catheter forms a corresponding mating surface, so that tissue can be separated or cut between the cutting element and an edge of the suction opening in the guide catheter.
  • these two cutting elements preferably cooperate to cut or separate tissue.
  • the cutting element makes it possible to cut or cut off the wall of a body lumen and thus to weaken the wall of the body lumen, in particular a bronchial wall.
  • an applicator can more easily penetrate into the wall of the body lumen.
  • puncturing of the bronchial wall by the applicator tip can be significantly facilitated in this way.
  • further measures which facilitate puncturing of the bronchial wall such as additional cutting electrodes or mechanical tips or blades on the applicator tip, can be dispensed with or at least reduced.
  • the invention also has the advantage that no or significantly less force is required for introducing the applicator tip into a bronchial wall, and in this case, in particular, flexible applicators can also be used.
  • existing solutions have the disadvantage, among other things, that even flexible applicators must have a sufficiently high rigidity so that the bronchial wall can be punctured or punctured without buckling of the applicator.
  • the bronchial wall is punctured without prior incision of the bronchial wall by the applicator tip, it is required that the bronchi have a sufficiently large diameter for a corresponding curvature of the applicator to pierce and apply a corresponding puncturing force.
  • the solution according to the invention avoids or reduces these disadvantages, since a rounded applicator tip can be used by cutting the bronchial wall and significantly less to no puncture forces have to be applied to it. Since the suction opening is arranged radially in the guide catheter, an application in bronchi with a small diameter is possible.
  • a preferred embodiment of the invention provides that the cutting element is arranged and formed, in an axial movement of the guide catheter and / or the counter sleeve, in particular an axial relative movement between the counter sleeve and guide catheter, a sucked through the radial suction port portion of a wall of a body lumen, in particular a bronchial wall, separate.
  • the cutting element is arranged and designed in such a way that the cutting of a part of a wall of a body lumen drawn in or out through the suction opening is achieved by an axial movement of the guide catheter and / or the counter sleeve in or against the insertion direction. follows, in particular by an axial relative movement between the guide catheter and the counter sleeve. In this way, the use is also facilitated in bronchi with a small diameter.
  • the suction opening and the distal end of the counter-sleeve are arranged and formed such that, in an axial relative movement between see counter sleeve and guide catheter, a sliding movement between the cutting element and the distal end of the counter sleeve or the edge of the suction opening / mantle Guide catheter is done.
  • the suction opening and the distal end of the mating sleeve are preferably arranged and designed such that during an axial relative movement between mating sleeve and guide catheter, a sliding movement between the two cutting elements.
  • the separation or cutting of tissue, in particular the sucked by the radial suction port portion of a wall of a body lumen, in particular a bronchial wall is preferably carried out by this sliding movement between the cutting element and a corresponding counter surface at the distal end of the counter sleeve or at the edge of the suction opening / Sheath of the guide catheter or between two cutting elements.
  • the sliding movement is preferably carried out as an axial relative movement or longitudinal axial displacement between the counter sleeve and guide catheter.
  • the sliding movement preferably takes place by means of a relative movement between the lateral surfaces of guide catheter and counter sleeve, in particular between the inner lateral surface of the outer element and the outer lateral surface of the inner element.
  • a sliding contact or at least a sliding past between guide catheter and counter sleeve in the immediate vicinity preferably, a sliding movement takes place at least between the suction opening or the region of the guide catheter lateral surface surrounding the suction opening and the distal end of the counter sleeve.
  • the cutting element may for example be designed as a mechanical cutting blade to mechanically cut or separate a part of the wall of the body lumen.
  • the cutting element may be formed as an electrosurgical cutting blade to cut or separate the tissue of the wall of the body lumen electrosurgically.
  • An electrosurgical cutting blade is preferably in the form of an electrode formed with a large area neutral electrode or a second electrode, for example, on the applicator, on the mating sleeve, or on the guide catheter, which is electrically isolated from the cutting blade electrode.
  • a particularly preferred embodiment results when the guide catheter is disposed within the counter sleeve, wherein preferably the guide catheter is arranged in the direction of insertion from a distal end of the counter sleeveetched110bar.
  • the counter sleeve surrounds the guide catheter, wherein the inner diameter of the counter sleeve is greater than the outer diameter of the guide catheter.
  • the inner diameter of the counter sleeve is only slightly larger than the outer diameter of the guide catheter in order to produce a contact or at least a close sliding movement between the suction port and the counter sleeve in an axial relative movement can.
  • the counter sleeve can preferably be designed as a collection sleeve of the electrosurgical instrument.
  • the cutting element is formed on the radial suction opening of the guide catheter, can be used as a counter sleeve, preferably already present on the electrosurgical instrument, collection sleeve.
  • collection sleeve can be, for example, the working channel of an electrosurgical instrument, in particular a bronchoscope.
  • the counter sleeve is formed as a separate, additional cutting sleeve, which is preferably arranged between the guide catheter and a collecting sleeve of the electrosurgical instrument.
  • a cutting sleeve may for example have a blunt distal end and serve as a counter surface to a formed on the radial suction port of the guide catheter cutting element or even, preferably at the distal end, have a cutting element.
  • the guide catheter is preferably disposed radially inwardly of the cutting sleeve, and further preferably radially within a collection sleeve of the electrosurgical instrument.
  • the cutting sleeve can, for example, also be arranged radially inside the guide catheter, in particular in the inner lumen of a guiding catheter. Furthermore, it may be preferred that the distal end of the cutting sleeve bevelled and in particular designed as a cutting element. In this way, advantageously, the part of a bronchial wall sucked into a radial suction opening of a guiding catheter surrounding the cutting sleeve can be cut or removed.
  • a further preferred embodiment results when the jacket of the cutting sleeve is cut in a radial region and deformed so that a part of the jacket of the cutting sleeve projects radially inwardly into the lumen of the cutting sleeve and the jacket of the cutting sleeve thus has a radial opening.
  • an applicator guided in the interior of the cutting sleeve can emerge from the cutting sleeve.
  • the projecting into the interior of the cutting sleeve part of the shell advantageously an executive help, such as in the form of a ramp, for the emerging through the radial opening applicator gate.
  • a further preferred embodiment of the electrosurgical instrument provides that the cutting element is arranged on a distal edge portion of the suction opening, wherein preferably the cutting blade is aligned with the suction opening.
  • the cutting element is in particular arranged and extended in this way. directed that the wall of the body lumen can be cut by retracting the guide catheter against the insertion direction.
  • the cutting element is arranged on a radially outer edge portion of the distal end of the counter sleeve, wherein preferably the cutting blade is aligned towards the distal end of the counter sleeve.
  • This embodiment is particularly preferred for cutting the part of the wall of the body lumen drawn in through the suction opening of the guide catheter by advancing the counter sleeve relative to the guide catheter in the insertion direction.
  • the object stated at the beginning is achieved by a guide catheter for introducing an applicator into body lumens along an insertion direction for a previously described electrosurgical instrument, with at least one radial suction opening in a distal area, wherein a cutting element is arranged at the suction opening.
  • a method for introducing an applicator into body lumens along an insertion direction comprising the steps: inserting a previously described electrochemical instrument into a body lumen in the vicinity of a site of action, suctioning a wall of the body lumen at the suction port by creating a negative pressure in the guide catheter; cutting a portion of the wall of the body lumen sucked at the suction port by creating axial relative movement between the mating sleeve and the guide catheter, the method preferably further comprising the step of: applying a high frequency AC voltage to the body; formed as an electrosurgical cutting blade cutting element and another electrode which is electrically isolated from the electrosurgical cutting blade.
  • FIG. 1 shows a distal section of a first exemplary embodiment of an electrosurgical instrument according to the invention
  • FIG. 2 shows a distal section of an exemplary embodiment of a guide catheter according to the invention
  • FIG. 3a shows a further exemplary embodiment of an electrosurgical instrument according to the invention at the site of action in the bronchi;
  • FIG. 3b shows an enlargement of a section from FIG. 3a
  • FIGS. 4a, b show further exemplary embodiments of a counter sleeve designed as a cutting sleeve.
  • FIG. 1 shows an electrosurgical instrument 1, in particular for bronchoscopy, with a guide catheter 10, a counter sleeve 30 designed as a cutting sleeve, and a collecting sleeve 40.
  • the guide catheter 10 has a radial suction opening 11 in its distal region. If a negative pressure is generated in the guide catheter 10, a part of a wall of a body lumen, in particular a part of a bronchial wall, can be aspirated through the suction opening 11.
  • the guide catheter 10 is arranged to be axially displaceable towards the mating or cutting sleeve 30 radially inward in the mating or cutting sleeve 30, so that the mating or cutting sleeve 30 surrounds the guide catheter 10 radially on the outside.
  • the counter or cutting sleeve 30 in turn is also axially displaceable relative to the collecting sleeve 40 radially inwardly disposed therein, so that the collecting sleeve 40, the counter or cutting sleeve 30 encloses.
  • the collection sleeve 40 may be, for example, the working channel of an electrosurgical instrument, in particular a bronchoscope.
  • the suction port 11 of the guide catheter 10 near the site of action is placed on a wall of the body lumen and a negative pressure built up in the guide catheter 10 , so that a part of the wall of the body lumen is sucked through the suction opening 1 1.
  • the guide catheter 10 is fixed with the suction port 1 1 at the site of action.
  • a mechanical blade 31 is formed on the formed as a cutting sleeve counter sleeve 30, which at a radially outer edge portion of the distal end of Counter sleeve 30 is arranged and is aligned towards the distal end of the counter sleeve 30.
  • FIG. 2 shows an exemplary embodiment of a guide catheter 100, which can preferably also be used in an electrosurgical instrument 1, as shown in FIG.
  • the guide catheter 100 as shown in FIG. 2, has a substantially cylindrical jacket 110 with a rounded distal tip 13 which, when the guide catheter 100 is inserted in an insertion direction R, in particular serves neither the working channel of an electrosurgical Instruments, nor the body lumen into which the guide catheter 100 is inserted to damage.
  • a lumen 1 14 is formed, through which an applicator (not shown in Figure 2) in the guide catheter 100 can be performed. Further, in the lumen 1 14 of the guide catheter 100, a negative pressure can be established by a corresponding fluid or gas pump (not shown in Figure 2), in particular a corresponding vacuum pump, at a proximal end of the electrosurgical instrument.
  • a corresponding fluid or gas pump not shown in Figure 2
  • a corresponding vacuum pump at a proximal end of the electrosurgical instrument.
  • a radial Suction opening 1 1 1 formed. Through this radial suction port 1 1 1, a run in the lumen 1 14 of the guide catheter 100 applicator exit with its distal end to be brought to a site of action, such as a tumor.
  • a part of a wall of a body lumen can be sucked through the radial suction opening 1 1 1, if in the lumen 1 14 of the guide catheter 100, a negative pressure, ie a relation to the ambient pressure lower pressure, is constructed.
  • the guide catheter 100 has a cutting element 1 12, which is arranged at a distal edge portion of the suction opening 1 1 1, wherein the cutting blade of the cutting element 1 12 to the suction port 1 1 1 is aligned.
  • the guide catheter 100 shown in FIG. 2 can be used in an electrosurgical instrument 1 as shown in FIG. 1 and cooperate there together with a counter sleeve 30 designed as a cutting sleeve.
  • the guide catheter 100 shown in Figure 2 can also be used in an electrosurgical instrument, in which the cutting sleeve shown in Figure 1 is not present, but only a collection sleeve, as already the guide catheter 100 has a cutting element 1 12.
  • FIGS. 3 a, 3 b show the use of an electrosurgical instrument 200.
  • the electrosurgical instrument 200 may be designed like the electrosurgical instrument 1 shown in FIG. 1 and / or may have a guide catheter such as the guide catheter 100 shown in FIG.
  • the electrosurgical instrument 200 has been inserted into a bronchus 260 as a body lumen proximate to a site of action 250, such as a tumor.
  • the site of action 250 lies behind a bronchial wall 261, so that an applicator 220 has to penetrate into the bronchial wall 261 in order to reach the site of action 250.
  • the applicator 220 has two electrodes 221, 222 electrically insulated from one another, wherein the distal electrode 221 has a Electrode tip 223, which facilitates the penetration of the applicator 220 into the bronchial wall 261.
  • the guide catheter 210 is led out of the distal end of a collecting sleeve 240, wherein the applicator 220 in turn is led out through a suction opening 21 1 arranged in the distal region of the guide catheter 210.
  • the guide catheter 210 shown in Figure 3 has a plurality of radial suction openings 21 1 in the distal region. When generating a negative pressure in the guide catheter 210, a part of the bronchial wall 261 is sucked in each case through the radial suction openings 21 1.
  • the bronchial wall 261 has been weakened by cutting in and out so that the introduction of the applicator 220 through the bronchial wall 261 to the site of action 250 has been facilitated.
  • the provision of a plurality of radial suction openings 21 1 in particular improves the fixation of the guiding catether 210 in the vicinity of the action location 250.
  • FIGS. 4a and 4b show further exemplary embodiments of a counter sleeve 130, 330 designed as a cutting sleeve.
  • the counter-sleeve 130, 330 may preferably be arranged radially within a guide catheter, that is to say in the inner lumen of a guide catheter.
  • the distal end of the counter-sleeve 130, 330 is bevelled and formed as a cutting element 131, 331 and thus can advantageously cut or separate the part of a bronchial wall sucked into a radial suction opening of a guide catheter surrounding the counter-sleeve 130, 330.
  • the embodiment of the counter-sleeve 330 shown in FIG. 4b has a further preferred feature: the jacket of the counter-sleeve 330 is cut in a radial region and deformed such that a part 333 of the jacket of the counter-sleeve 330 projects radially inwardly into the counter-sleeve and the jacket the counter-sleeve 330 has a radial opening 332, can escape from the counter-sleeve 330 through an applicator guided in the interior of the counter-sleeve 330 in the exit direction X, wherein the part 333 of the jacket projecting into the interior of the counter-sleeve 330 advantageously provides a guide aid for the guide radial opening 332 exiting applicator forms.
  • the illustrated embodiments of the electrosurgical instrument or guide catheter according to the invention have in common that, by providing at least one cutting element, the part of the bronchial tube sucked through a radial suction opening Chialwand weakened by a cut and thus the penetration of an applicator in the bronchial wall is significantly simplified at this weakened point.
  • the cutting element is arranged and designed such that a cut can be made by a substantially axial movement of the guide catheter and / or the counter sleeve.

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  • Engineering & Computer Science (AREA)
  • Plasma & Fusion (AREA)
  • General Health & Medical Sciences (AREA)
  • Otolaryngology (AREA)
  • Physics & Mathematics (AREA)
  • Veterinary Medicine (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Public Health (AREA)
  • Cardiology (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention concerne un instrument électrochirurgical, un cathéter de guidage et un procédé d'insertion d'un applicateur dans une lumière d'un corps dans une direction d'insertion. L'instrument électrochirurgical comprend un cathéter de guidage servant à insérer un applicateur dans une lumière d'un corps dans une direction d'insertion et une contre-douille, la contre-douille et le cathéter de guidage étant déplacés axialement l'un par rapport à l'autre, et le cathéter de guidage comportant dans une région distale au moins un orifice d'aspiration radial et l'instrument électrochirurgical étant conçu pour générer une dépression dans le cathéter de guidage, et un élément de coupe étant en outre disposé au niveau de l'orifice d'aspiration et/ou d'une extrémité distale de la contre-douille.
EP15713485.9A 2014-04-10 2015-03-31 Instrument électrochirurgical et un procédé d'insertion d'un applicateur dans une lumière d'un corps Withdrawn EP3128937A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE102014206976.9A DE102014206976A1 (de) 2014-04-10 2014-04-10 Elektrochirurgisches Instrument und Verfahren zum Einführen eines Applikators in Körperlumen
PCT/EP2015/057101 WO2015155076A1 (fr) 2014-04-10 2015-03-31 Instrument électrochirurgical et un procédé d'insertion d'un applicateur dans une lumière d'un corps

Publications (1)

Publication Number Publication Date
EP3128937A1 true EP3128937A1 (fr) 2017-02-15

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EP15713485.9A Withdrawn EP3128937A1 (fr) 2014-04-10 2015-03-31 Instrument électrochirurgical et un procédé d'insertion d'un applicateur dans une lumière d'un corps

Country Status (6)

Country Link
US (1) US20170020602A1 (fr)
EP (1) EP3128937A1 (fr)
JP (1) JP2017514565A (fr)
CN (1) CN106163440A (fr)
DE (1) DE102014206976A1 (fr)
WO (1) WO2015155076A1 (fr)

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Publication number Priority date Publication date Assignee Title
WO2019055800A1 (fr) * 2017-09-14 2019-03-21 Regents Of The University Of California Dispositifs de cryoablation et procédés associés
CN109793601B (zh) * 2019-03-22 2024-07-16 上海市同济医院 一种医用支架回收装置
CN112914820A (zh) * 2021-03-08 2021-06-08 河南省立眼科医院 基于射频技术的眼科手术平台

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Also Published As

Publication number Publication date
DE102014206976A1 (de) 2015-10-15
JP2017514565A (ja) 2017-06-08
US20170020602A1 (en) 2017-01-26
WO2015155076A1 (fr) 2015-10-15
CN106163440A (zh) 2016-11-23

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