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WO2010064062A1 - Dispositif de guidage pour chirurgie ophtalmique minimalement invasive - Google Patents

Dispositif de guidage pour chirurgie ophtalmique minimalement invasive Download PDF

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Publication number
WO2010064062A1
WO2010064062A1 PCT/IB2008/000843 IB2008000843W WO2010064062A1 WO 2010064062 A1 WO2010064062 A1 WO 2010064062A1 IB 2008000843 W IB2008000843 W IB 2008000843W WO 2010064062 A1 WO2010064062 A1 WO 2010064062A1
Authority
WO
WIPO (PCT)
Prior art keywords
expandable element
needle
diameter
guiding device
mininvasive
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.)
Ceased
Application number
PCT/IB2008/000843
Other languages
English (en)
Inventor
Stanislao Rizzo
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.)
Asso Hospital SNC
Smart Hospital Rsl
Original Assignee
Asso Hospital SNC
Smart Hospital Rsl
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 Asso Hospital SNC, Smart Hospital Rsl filed Critical Asso Hospital SNC
Priority to PCT/IB2008/000843 priority Critical patent/WO2010064062A1/fr
Publication of WO2010064062A1 publication Critical patent/WO2010064062A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting in contact-lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/00736—Instruments for removal of intra-ocular material or intra-ocular injection, e.g. cataract instruments
    • 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
    • A61B17/3417—Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating
    • A61B17/3421—Cannulas
    • A61B17/3431—Cannulas being collapsible, e.g. made of thin flexible material

Definitions

  • the present invention generally relates to the field of ophthalmic mininvasive microsurgery and, in particular, it relates to a disposable guiding device for vitreous- retinal surgery for treatment of ophthalmic diseases that relate to the retina and/or the vitreous humour. Description of the technical problem
  • vitrectomy consists of removing the vitreous humour by means of micro-ophthalmic surgery techniques. This surgical procedure allows, in particular, to find an effective solution to many conditions otherwise unsolvable .
  • vitrectomy is a microsurgical procedure in the treatment of vitreous-retinal diseases, i.e. for treatment of ophthalmic diseases that relate to the retina and the vitreous humour that up to a few years needle were considered incurable.
  • vitrectomy is used for removing the opacity of the vitreous humour deriving from blood effusions and tractions that the vitreous humour same can apply to the retina.
  • Vitrectomy consists substantially of the removal of the vitreous body and can be necessary in the diseases that are characterised either by an alterated ratio between the retina and the vitreous body or by a loss of transparency of the latter.
  • Vitrectomy provides the use of cannulas, or "trocars", which allow the introduction of the necessary instruments in the site of operation.
  • cannulas or "trocars" which allow the introduction of the necessary instruments in the site of operation.
  • an incision is made of a measured size using a microscalpel, put in the cannula and introduced in the eye up to the site of interest.
  • the microscalpel is withdrawn leaving the cannula inserted in the eye.
  • the cannula during the operation, is used as channel of introduction for the surgical instruments.
  • a parameter that identifies the size of a variety of types of trocars is the so-called “gauge” (g) , or caliber, which indicates a measure of the diameter.
  • Two standard calibers of trocars for ophthalmic microsurgery are common: the 25 g, having inner diameter equal to 450 ⁇ m and outer diameter equal to 500 ⁇ m, and the 23 g, having inner diameter equal to 650 ⁇ m and outer diameter equal to 720 ⁇ m.
  • the trocar In order to arrange in the operation field the trocar, as well as the necessary instruments for operation of ophthalmic surgery, such as optical fibres for internal lighting, micro-tweezers, micro-scissors, cannulas for infusion of physiological solutions, etc. It is therefore necessary to provide preliminarily an incision of a size corresponding up to about 18-20 gauges through the sclera and the conjunctive of the ocular globe. This often causes long time of post-surgical rehabilitation for the high invasivity of the operation.
  • the traditional 25 or 23 gauge ophthalmic trocars do not allow reaching the most peripheral zones of the retina and therefore they can be used only in determined ophthalmic surgical operations. Instead, it would be desirable having a larger trocar, even if to the detriment of invasivity. Summary of the invention
  • one exemplary guiding device for mininvasive ophthalmic surgery, in particular for vitrectomy, comprising: a needle having a first diameter (dl) and having a cutting profile adapted to make a substantially circular incision through the conjunctive and the sclera of an eye; whose main feature is to provide an expandable element associated with said needle adapted to move from a collapsed configuration, at which said expandable element is inserted by the needle in said circular incision, to an expanded configuration, in which said expandable element causes the walls of the substantially circular incision to enlarge up to a second diameter (d2) larger than the first diameter (dl) .
  • the expandable element engages in a removable way with the external surface of the needle at the a not sharpened edge thereof and , furthermore, a thin tube, or ophthalmic trocar, is provided having a diameter corresponding to the second diameter (d2) that is put in the expandable element causing it to enlarge from the first to the second diameter, said needle being eventually withdrawn releasing the expandable element expanded within the incision.
  • the expandable element works as beveled portion for the cannula, which represents the actual duct for introducing the surgical instruments at the site of operation.
  • the expandable element is put on the needle.
  • the above described needle has an axial recess in which the expandable element is housed, and, furthermore, means are provided for leaving the needle to slide free independently from the expandable element.
  • the means to let the needle slide free independently from the expandable element let the needle to be removed from the substantially circular incision by pushing the expandable element out from the recess in order to leave it, once extracted the needle, at the circular incision.
  • the means to let the needle slide free independently from the expandable element comprise a pushing element adapted to keep the expandable element at the substantially circular incision during the withdrawal of the needle.
  • the expandable element is made of a shape memory material.
  • the expandable element is a stent with reticular shape.
  • the expandable element has side wings adapted to be put out of the substantially circular incision to avoid that it can accidentally penetrate in the eye.
  • the first diameter (dl) is set between 24 g and 26 g, preferably it is equal to 25 g, whereas the second diameter is set between 21 g and 19 g, preferably it is equal to 20 g.
  • the elasticity of the tissues turns back to the first diameter, with minimum invasivity of the operation. This allows using surgical instruments and cannulas of relatively large sizes, having, then a reduced flexibility, without the need of providing incisions of large size on the conjunctive, thus reducing the time for the post-surgical rehabilitation.
  • FIGS. 1 and 2 show a partial diagrammatical cross sectional view of an ocular globe subject to an operation of vitrectomy for which the guiding device for mininvasive ophthalmic surgery, according to the invention, is used;
  • Figures from 4 ⁇ to the 4E show diagrammatically a succession of steps through which it is possible to put the necessary instruments for an operation of ophthalmic surgery in the operation field, by an exemplary embodiment of the device shown in figures from 3A to 3F.
  • a device, for mininvasive ophthalmic surgery, in particular for vitrectomy comprises, in a preferred exemplary embodiment, at least one expandable element 15 of tubular shape, capable of moving from a collapsed configuration, in which it has a first diameter (dl), for example equal to 25g, (figure 1) to an extended configuration, in which it has an second diameter (d2), for example equal to 2Og (figure 2).
  • expandable element 15, in the collapsed configuration is put in an incision 9 of a determined diameter (dl) , through the sclera 4 of the eye, for carrying out an operation of ophthalmic surgery.
  • expandable element 15 assumes the extended configuration, allowing the introduction of the instruments necessary to the surgeon at the operation field.
  • an optical fibre 40 for internal lighting, or a cannula for infusion of a physiological solution 45, or a cannula 50 through which instruments such as micro-tweezers, or micro-scissors, are put in the operation field can be necessary.
  • Each instrument can be inserted in the operation field through a corresponding expandable element 15a-15c.
  • Expandable element 15 can be made, for example, of resilient material, for being associated with a needle 10 of diameter (dl) having a cutting profile 11, to make a substantially circular incision 9 through the sclera 4 of the eye, to carry out an operation of ophthalmic surgery.
  • expandable element 15 engages in a removable way with the external surface of needle 10, for example putting it on, at a not sharpened edge 12, for putting it in the substantially circular incision 9 (figures 3A and 3B) .
  • a cannula 50, or ophthalmic trocar, having a diameter equal to diameter d2 is put in expandable element 15 (figures 3B and 3C) causing it to enlarge from diameter dl, to diameter d2 (figure 3D) .
  • Needle 10 is, moreover, withdrawn, in order to remove it from the incision 9 (figure 3E) , releasing in the meantime expandable element 15 in the expanded configuration at incision 9 (figure 3F) .
  • expandable element 15 works as beveled portion for cannula 50, which represents the actual duct for introducing the surgical instruments .
  • needle 10 has an axial recess 12 in which the expandable element of tubular shape is housed 15' .
  • means can be advantageously provided for leaving needle 10 to slide independently from expandable element 15.
  • the means for leaving needle 10 to slide independently from expandable element 15' can comprise a piston 20 operated by a stem 21 movable in recess 13. More in detail, as diagrammatically shown in figure 4B, during the removal of needle 10, expandable element 15' is kept, by a piston 20, at the substantially circular incision 9. Expandable element 15' can be made of a shape memory material, for example of the type used for stents, commonly used in the surgical field. In this case, during the positioning step, expandable element 15' is forcedly kept in place by the inner walls ' of the recess 13 in a contained shape.
  • expandable element 15' is disengaged from recess 13 and can, then, turn back from contained shape (figure 4C) , to one original shape in which it has a larger diameter, in particular, corresponding to d2 (figure 4D) .
  • side wings 16 are provided. Once disengaged from the recess 13, the side wings 16 are moved away from the central body of expandable element 15' and are arranged around incision 9.
  • the device above described allows using surgical instruments and cannulas of relatively large sizes, having, then, a reduced flexibility, without the need of providing incisions of large size on the conjunctive, thus reducing the duration of the post-surgical rehabilitation.

Landscapes

  • Health & Medical Sciences (AREA)
  • Ophthalmology & Optometry (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Prostheses (AREA)

Abstract

L'invention concerne un dispositif de guidage pour chirurgie ophtalmique non invasive, et en particulier pour la vitrectomie, qui comprend une aiguille (10) qui présente un premier diamètre (dl), un profil de découpe (11) adapté pour réaliser une incision (9) essentiellement circulaire dans la membrane sclérotique de l'oeil et un élément dilatable (15) associé à l'aiguille (10) et adapté pour se déplacer depuis une configuration écrasée dans laquelle l'élément dilatable (15) est inséré par l'aiguille (10) dans l'incision (9) et une configuration dilatée dans laquelle l'élément dilatable (15) amène les parois de l'incision (9) à s'agrandir de manière élastique jusqu'à un deuxième diamètre (d2) plus grand que le premier diamètre (dl). Dans un premier mode de réalisation, l'élément dilatable (15) s'engage de manière libérable sur la surface extérieure de l'aiguille (10) en un profil (12) non tranchant de celle-ci et, une canule (50) ou trocart ophtalmique étant en outre prévu et présentant un diamètre qui correspond au deuxième diamètre placé dans l'élément dilatable (15), le trocart (50) agrandissant l'élément dilatable (15) depuis le premier diamètre jusqu'au deuxième diamètre, l'aiguille (10) libérant lorsqu'elle est enlevée l'élément dilatable (15) agrandi par le trocart (50) sur l'incision (9). Dans un deuxième mode de réalisation, l'aiguille (10) présente un creux axial (13) dans lequel l'élément dilatable (15) est logé et des moyens (20) sont prévus pour amener l'aiguille (10) à coulisser librement depuis l'élément dilatable (15), ce qui permet d'enlever l'aiguille (10) de l'incision (9) essentiellement circulaire en repoussant l'élément dilatable (15) hors du creux pour le laisser au niveau de l'incision circulaire (9) une fois que l'aiguille (10) a été extraite.
PCT/IB2008/000843 2008-04-08 2008-04-08 Dispositif de guidage pour chirurgie ophtalmique minimalement invasive Ceased WO2010064062A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
PCT/IB2008/000843 WO2010064062A1 (fr) 2008-04-08 2008-04-08 Dispositif de guidage pour chirurgie ophtalmique minimalement invasive

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
PCT/IB2008/000843 WO2010064062A1 (fr) 2008-04-08 2008-04-08 Dispositif de guidage pour chirurgie ophtalmique minimalement invasive

Publications (1)

Publication Number Publication Date
WO2010064062A1 true WO2010064062A1 (fr) 2010-06-10

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Family Applications (1)

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PCT/IB2008/000843 Ceased WO2010064062A1 (fr) 2008-04-08 2008-04-08 Dispositif de guidage pour chirurgie ophtalmique minimalement invasive

Country Status (1)

Country Link
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Cited By (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8277418B2 (en) 2009-12-23 2012-10-02 Alcon Research, Ltd. Ophthalmic valved trocar cannula
WO2012175344A1 (fr) * 2011-06-24 2012-12-27 Oertli-Instrumente Ag Instrument ophtalmologique
US8343106B2 (en) 2009-12-23 2013-01-01 Alcon Research, Ltd. Ophthalmic valved trocar vent
WO2015046192A1 (fr) * 2013-09-30 2015-04-02 マニー株式会社 Canule
US9198797B2 (en) 2009-09-22 2015-12-01 Doheny Eye Institute Adjustable cannula systems and devices
US9999542B2 (en) 2014-07-16 2018-06-19 Doheny Eye Institute Systems, methods, and devices for cannula insertion
DE102017209425A1 (de) * 2017-06-02 2018-12-06 Carl Zeiss Meditec Ag Augenchirurgiesystem und Verfahren zur Vorbereitung von Eingriffen im Rahmen von Augenoperationen

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3528425A (en) * 1968-09-16 1970-09-15 Surgical Design Corp Apparatus for performing surgical procedures on the eye
US5674240A (en) * 1993-02-04 1997-10-07 Peter M. Bonutti Expandable cannula
US5817099A (en) * 1996-06-06 1998-10-06 Skolik; Stephanie A. Universal port/seal device for ocular surgery
WO2000002616A1 (fr) * 1998-07-08 2000-01-20 Innerdyne, Inc. Procedes, systemes et kits pour l'implantation d'articles
EP1516592A2 (fr) * 2003-09-19 2005-03-23 Tyco Healthcare Group Lp Dispositif d'insertion pour trocar

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3528425A (en) * 1968-09-16 1970-09-15 Surgical Design Corp Apparatus for performing surgical procedures on the eye
US5674240A (en) * 1993-02-04 1997-10-07 Peter M. Bonutti Expandable cannula
US5817099A (en) * 1996-06-06 1998-10-06 Skolik; Stephanie A. Universal port/seal device for ocular surgery
WO2000002616A1 (fr) * 1998-07-08 2000-01-20 Innerdyne, Inc. Procedes, systemes et kits pour l'implantation d'articles
EP1516592A2 (fr) * 2003-09-19 2005-03-23 Tyco Healthcare Group Lp Dispositif d'insertion pour trocar

Cited By (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9198797B2 (en) 2009-09-22 2015-12-01 Doheny Eye Institute Adjustable cannula systems and devices
US10076359B2 (en) 2009-09-22 2018-09-18 Doheny Eye Institute Adjustable cannula systems and devices
US8277418B2 (en) 2009-12-23 2012-10-02 Alcon Research, Ltd. Ophthalmic valved trocar cannula
US8343106B2 (en) 2009-12-23 2013-01-01 Alcon Research, Ltd. Ophthalmic valved trocar vent
US8679064B2 (en) 2009-12-23 2014-03-25 Alcon Research, Ltd. Ophthalmic valved trocar cannula
WO2012175344A1 (fr) * 2011-06-24 2012-12-27 Oertli-Instrumente Ag Instrument ophtalmologique
WO2015046192A1 (fr) * 2013-09-30 2015-04-02 マニー株式会社 Canule
US9999542B2 (en) 2014-07-16 2018-06-19 Doheny Eye Institute Systems, methods, and devices for cannula insertion
DE102017209425A1 (de) * 2017-06-02 2018-12-06 Carl Zeiss Meditec Ag Augenchirurgiesystem und Verfahren zur Vorbereitung von Eingriffen im Rahmen von Augenoperationen
US11083369B2 (en) 2017-06-02 2021-08-10 Carl Zeiss Meditec Ag Eye surgery system and method for preparing interventions within the scope of eye operations

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