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US20190307972A1 - Medical pump with improved desufflation - Google Patents

Medical pump with improved desufflation Download PDF

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Publication number
US20190307972A1
US20190307972A1 US16/470,290 US201716470290A US2019307972A1 US 20190307972 A1 US20190307972 A1 US 20190307972A1 US 201716470290 A US201716470290 A US 201716470290A US 2019307972 A1 US2019307972 A1 US 2019307972A1
Authority
US
United States
Prior art keywords
pressure
insufflation
line
suction pump
controller unit
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.)
Abandoned
Application number
US16/470,290
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English (en)
Inventor
Yves Koeth
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.)
WOM World of Medicine GmbH
Original Assignee
WOM World of Medicine 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 WOM World of Medicine GmbH filed Critical WOM World of Medicine GmbH
Publication of US20190307972A1 publication Critical patent/US20190307972A1/en
Abandoned legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M13/00—Insufflators for therapeutic or disinfectant purposes, i.e. devices for blowing a gas, powder or vapour into the body
    • A61M13/003—Blowing gases other than for carrying powders, e.g. for inflating, dilating or rinsing
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3474—Insufflating needles, e.g. Veress needles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2218/00—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
    • A61B2218/001—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body having means for irrigation and/or aspiration of substances to and/or from the surgical site
    • A61B2218/007—Aspiration
    • A61B2218/008—Aspiration for smoke evacuation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2202/00—Special media to be introduced, removed or treated
    • A61M2202/02—Gases
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/33—Controlling, regulating or measuring
    • A61M2205/3331—Pressure; Flow
    • A61M2205/3334—Measuring or controlling the flow rate
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/33—Controlling, regulating or measuring
    • A61M2205/3331—Pressure; Flow
    • A61M2205/3337—Controlling, regulating pressure or flow by means of a valve by-passing a pump
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/33—Controlling, regulating or measuring
    • A61M2205/3331—Pressure; Flow
    • A61M2205/3344—Measuring or controlling pressure at the body treatment site
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/75—General characteristics of the apparatus with filters

Definitions

  • the present invention relates to an insufflator for laparoscopy, comprising a suction pump, the suction pump being connected to the patient by means of a separate hose and permitting a controlled ventilation.
  • Laparoscopy a medical procedure, wherein the abdomen and the organs therein can visually be examined.
  • small skin incisions 0.3 to 2 centimeters
  • a trocar is introduced therethrough, which in turn can accommodate an optical device.
  • endoscope laparoscope
  • the abdomen can be inspected.
  • diagnostic laparoscopy the abdomen is solely visually inspected, and in therapeutical laparoscopy, surgeries can also be performed.
  • suction devices e.g., DE4219859 A1, WO 2004/009167 A1 or WO 2011/041387 A1
  • suction devices e.g., DE4219859 A1, WO 2004/009167 A1 or WO 2011/041387 A1
  • an insufflation device for use in medical engineering comprising
  • insufflation line and the desuffiation line have one pressure sensor and one volume flow sensor each
  • the insufflator comprises a device for controlled ventilation of the gas present in the patient
  • controller unit controls the power of the suction pump as a function of the pressure measurement of the pressure sensors
  • controller unit contains an activation blocking system that prevents an activation of the suction pump, when the pressure measured by means of the pressure sensor in the insufflation line is lower than a preset threshold value
  • activation blocking system further prevents an activation of the suction pump, when the pressure measured by means of the pressure sensor in the insufflation line and the pressure measured by means of the pressure sensor in the ventilation line are not identical.
  • the insufflator is connected to the patient by means of two hoses.
  • the first hose is used for insufflation. Gas is supplied to the patient during the surgery, in order to be able to, build up the pressure in the abdomen. Furthermore, the abdominal pressure measurement is performed through this line.
  • Inc second hose may already be connected to the patient during the surgery, in order, instance, to implement a combustion gas discharge ( FIG. 1 ).
  • suction pumps can be used electronically controlled pumps, as described, for instance, in the device of DE 102013016063 or similar documents.
  • the suction pump may be controlled via a bypass valve ( FIG. 2 ).
  • the pump may be preset to a certain power, which is to the greatest extent constant, and the control of the power is then performed via the bypass valve.
  • a control valve may also be positioned directly in the ventilation line ( FIG. 3 ). In this, way, even external pumps may be used, for instance the all exhaust system existing in the operating room.
  • the controller unit of the insufflator then controls the suction power via the shown control valve.
  • the insufflator After stopping the insufflation, the insufflator offers the user the possibility to start the desufflation.
  • the insufflator first checks the measured abdominal pressure via the insufflation line. If it is lower than an adjustable threshold value ( ⁇ 5 mmHg, preferably ⁇ 3 mmHg), an activation blocking system prevents the start of the desufflation.
  • the mentioned threshold value may be preset in the device.
  • a selector switch or another selection device may be provided, by means of which the threshold value can be preset pre-operatively by the staff. If the measured abdominal pressure is higher than the preset threshold value, then abdominal pressure measured via the insufflation line is compared to the measured pressure in the ventilation line. If this is identical, it can be assumed that both hoses are connected to the patient. The two measured pressure values are assumed as identical, when their difference is smaller than 2 mmHg.
  • the suction pump can be activated.
  • the suction must not be too high, however, it should not be too mall, either, in order not to unnecessarily prolong the treatment.
  • 1 to 5 l/min. has been found, preferably approx. 3 l/min.
  • the abdominal pressure is monitored via the insufflation line. Once the abdominal pressure is below a certain limit (e.g., 5, 4 or 3 mmHg), the desufflation stopped.
  • the pressure limit (of e.g., 5, or 3 mmHg) may be preset in the device.
  • a selector switch or another selection device is provided, by means of which the pressure limit can be preset by the staff before the surgery.
  • the insufflation line cannot measure correctly the abdominal pressure anymore by a closure (e.g., by closing the stop cock at the trocar) or by a missing connection (e.g., early removal of the trocar), there will be a risk of too late an deactivation of the desufflation and thus of a negative pressure in the patient.
  • a closure e.g., by closing the stop cock at the trocar
  • a missing connection e.g., early removal of the trocar
  • the desufflation is interrupted in an interval-like manner. After turning the suction pump off, a certain time is waited, until pressure balancing has occurred. This depends, among other things, on the flow resistance, and is variable depending on the specific application. In order, on the one hand, to quickly reduce the abdominal pressure and on the other hand, to guarantee the waiting time for pressure balancing, it should preferably be waited dynamically. The end of the waiting time is reached, when a stable pressure exists on the suction side. Subsequently, it is tested whether the measured abdominal pressure in the insufflation line corresponds to the measured pressure in the desufflation line. When this is not the case, the desufflation is stopped. Otherwise, the desufflation continued.
  • the time interval, in which sucking occurs is for instance between 10 and 1 seconds, particularly preferably 5 to 3 seconds.
  • the measuring interval typically is between 5 and 0.5 seconds.
  • the abdominal pressure rise during the insufflation of the patient is determined, is put in a relation to the insufflated volume and is stored. In this way, it can for instance be determined that for a pressure rise of 1 mmHg a gas flow of 0.35 liter is required. This value is stored in the controller unit. For the desufflation of the same patient, it can be expected, that per 0.35 liter pumped-off gas, a pressure drop of 1 mmHg will occur (expected value: 0.35 l/mmHg). During the desuffiation, the pressure drop per gas volume is monitored. Should the expected value significantly be exceeded or fallen below (e.g., by more than 20%), the desufflation will automatically be stopped.
  • a continuous verification of the abdominal pressure with the aid of the pressure sensor on the suction side can be performed.
  • This verification is based on a mathematical observer model (e.g., Luenberger observer) that has been designed based on a model in control theory.
  • Luenberger observer e.g., Luenberger observer
  • Such models are described in prior art (WO 2016/119773 A1) and thus do not need any further explanations here.
  • a synchronism of the two pressure sensors can be monitored and the desufflation can be interrupted in case of a deviation.
  • a closure in the suction line must also be detected, in order not to cause any tissue damage (e.g., sucking organs).
  • tissue damage e.g., sucking organs.
  • On the suction side in case of the reduction of the sucked-off volume flow or of too high an underpressure, a closure on the suction side is detected, and the desufflation is also interrupted. In these cases, it is afterwards checked whether the measured abdominal pressure in the insufflation line corresponds to the measured pressure in the desufflation line. When this is not the case, the desufflation is stopped. Otherwise, the desufflation is continued.
  • Ventilation can be performed by means of special suction trocars.
  • Classical trocars essentially pin-type (cylindrical) tubes with a circular opening that is positioned in the abdomen of the patient, and with various connection possibilities outside of the patient. With ventilation of gas during desufflation, there is a risk that the suction opening adheres to sensitive tissue parts. This risk is reduced, when the trocars are configured such that the cylinder wall in the end portion comprises openings.
  • the trocar contains recesses in the area of the opening aeration ( FIG. 4 ).
  • FIG. 1 shows an embodiment of an insufflator according to the invention.
  • the insufflator ( 1 ) is connected to a gas source ( 2 ), e.g., in the form of a CO 2 gas bottle.
  • a gas source 2
  • Via a proportional valve ( 3 ), a pressure sensor ( 4 ), a volume flow sensor ( 5 ) and a filter (F) the insufflation trocar ( 6 ) is introduced.
  • the separate desufflation trocar ( 9 ) is connected via a hose to the insufflator, the gas flow first being directed again through a filter (F), a volume flow sensor ( 10 ), a pressure sensor ( 11 ) to a suction pump ( 12 ).
  • the output of the suction pump leads to a device outlet ( 13 ).
  • the device outlet ( 13 ) may of course be provided with an additional filter.
  • the measured data of the pressure sensors ( 4 , 11 ) and of the volume flow sensors ( 5 , 10 ) are transmitted to the calculation unit ( 7 ) with a connected memory ( 8 ).
  • the calculation unit ( 7 ) controls the proportional valve ( 3 ) and the suction pump ( 12 ).
  • the positions of the pressure sensors and the volume flow sensors may also be located at other positions: it is of course possible that the insufflation flow is first directed through the volume flow sensor ( 5 ) and then through the pressure ( 4 ). In a similar way it is possible that the volume flow sensor ( 10 ) of the desufflation line is positioned behind the suction pump ( 12 ), in the direction of flow.
  • FIG. 2 shows a device according to the invention, wherein the suction pump ( 12 ) is continuously working and the suction power is controlled by a bypass valve ( 14 ).
  • the bypass valve ( 14 ) is also controlled via the calculation unit ( 7 ) (not Shown FIG. 2 ).
  • FIG. 3 shows another variant of the device according to the invention.
  • a connection port ( 16 ) for an external pump is provided in the device.
  • Many hospitals are equipped with corresponding pumps that can be used for the intended application of an insufflator according to the invention.
  • a control valve ( 15 ) is required, in order to control the suction rate of the external pump (not shown).
  • FIG. 4 shows embodiments of suction trocars.
  • FIG. 4 a shows a conventional (cylindrical) trocar with corresponding connection ports.
  • FIG. 4 b shows different suction trocars according to the invention that either have openings in the cylinder wall (on the left) or are irregularly configured in the area of the cylinder (middle) or have openings in the cylinder wall as well as an irregularly shaped end piece (on the right). It is crucial, herein, that the end of the cylinder does not sit on tissue and cannot adhere thereto. By the provided openings, such an adhesion is effectively prevented.
  • the individual components of the device according to the invention are mostly known from earlier documents, such as, e.g., U.S. Pat. Nos. 6,299,592, 5,411,474, WO1996001132A1, WO 2011041387A1, U.S. Pat. No. 5,800,381, DE 4219859B4, DE 102015000845A1, however not in conjunction with a device according to the invention, as defined by the claims.
  • a controller unit serves a correspondingly programmed microcomputer with respective memory and input and output devices.
  • Volume flow sensors are already known from other medical devices (e.g., for breathing apparatus), so that they need not be explained here in more detail.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • General Health & Medical Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Animal Behavior & Ethology (AREA)
  • Engineering & Computer Science (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Biomedical Technology (AREA)
  • Hematology (AREA)
  • Anesthesiology (AREA)
  • Surgical Instruments (AREA)
  • Endoscopes (AREA)
  • Surgery (AREA)
  • Pathology (AREA)
  • Molecular Biology (AREA)
  • Medical Informatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Infusion, Injection, And Reservoir Apparatuses (AREA)
US16/470,290 2016-12-16 2017-12-18 Medical pump with improved desufflation Abandoned US20190307972A1 (en)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
DE102016014980.9A DE102016014980A1 (de) 2016-12-16 2016-12-16 Medizintechnische Pumpe mit verbesserter Entlüftung
DE102016014980.9 2016-12-16
PCT/DE2017/000428 WO2018108200A1 (fr) 2016-12-16 2017-12-18 Pompe technique médicale à désufflation améliorée

Related Parent Applications (1)

Application Number Title Priority Date Filing Date
PCT/DE2017/000428 A-371-Of-International WO2018108200A1 (fr) 2016-12-16 2017-12-18 Pompe technique médicale à désufflation améliorée

Related Child Applications (1)

Application Number Title Priority Date Filing Date
US17/236,828 Continuation US12214120B2 (en) 2016-12-16 2021-04-21 Medical device with improved desufflation

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US20190307972A1 true US20190307972A1 (en) 2019-10-10

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US16/470,290 Abandoned US20190307972A1 (en) 2016-12-16 2017-12-18 Medical pump with improved desufflation
US17/236,828 Active 2039-01-09 US12214120B2 (en) 2016-12-16 2021-04-21 Medical device with improved desufflation

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US (2) US20190307972A1 (fr)
EP (1) EP3554598B1 (fr)
JP (1) JP7080233B2 (fr)
CN (1) CN110049798B (fr)
DE (1) DE102016014980A1 (fr)
ES (1) ES2831858T3 (fr)
WO (1) WO2018108200A1 (fr)

Cited By (2)

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EP4166096A4 (fr) * 2020-06-15 2023-12-06 Nanjing Tuge Healthcare Co., Ltd. Insufflateur à débit variable à pression constante
US20230414885A1 (en) * 2022-04-20 2023-12-28 W.O.M. World Of Medicine Gmbh Insufflator with Filter Loading Detection Device

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DE102016014980A1 (de) 2016-12-16 2018-06-21 W.O.M. World Of Medicine Gmbh Medizintechnische Pumpe mit verbesserter Entlüftung
DE102018004211A1 (de) * 2018-05-25 2019-11-28 W.O.M. World Of Medicine Gmbh Insufflationsvorrichtung und damit durchführbare Betriebsverfahren
DE102018005314A1 (de) * 2018-07-05 2020-01-09 W.O.M. World Of Medicine Gmbh lnsufflationsvorrichtung mit intelligenter Steuerung der Rauchgasabsaugung
WO2021048429A1 (fr) * 2019-09-12 2021-03-18 Fundación Para La Investigación Del Hospital Universitario Y Politécnico La Fe De La Comunidad Valenciana Système modulaire de surveillance et de régulation de l'homéostasie dans des cavités, et procédé de génération d'un volume de fluide dans une cavité
CN114945399B (zh) * 2019-12-18 2024-08-02 Wom医药世界公司 集成有液体分离方案的烟气过滤系统的壳体装置
CN112057122A (zh) * 2020-09-18 2020-12-11 西安交通大学医学院第一附属医院 内科胸腔镜自动充气装置
DE102021002547A1 (de) * 2021-05-17 2022-11-17 W.O.M. World Of Medicine Gmbh Medizintechnische Pumpe für die Endoskopie

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CN110049798B (zh) 2021-11-26
US12214120B2 (en) 2025-02-04
EP3554598B1 (fr) 2020-08-19
JP2020501643A (ja) 2020-01-23
US20210361886A1 (en) 2021-11-25
EP3554598A1 (fr) 2019-10-23
CN110049798A (zh) 2019-07-23
WO2018108200A1 (fr) 2018-06-21
JP7080233B2 (ja) 2022-06-03
ES2831858T3 (es) 2021-06-09
DE102016014980A1 (de) 2018-06-21

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