Surgery – Truss – Perineal
Patent
1988-12-01
1990-03-06
Grieb, William H.
Surgery
Truss
Perineal
604280, A61B 100
Patent
active
049056670
DESCRIPTION:
BRIEF SUMMARY
CROSS REFERENCE TO RELATED APPLICATION(S)
This U.S. application stems from PCT International Application No. PCT/DE88/00279 filed May 10, 1988.
The invention relates to an apparatus for the endoscopic-transpapillary exploration of a biliary tract where a side-view duodenoscope is provided for introduction into the duodenum with its distal end at the duodenal papilla, where a probe catheter is slidable through the side-view duodenoscope and the duodenal papilla into the common bile duct and where a guide wire is provided for arrangement in the side-view duodenoscope and the probe catheter.
A known apparatus (DE-PS 34 47 642) of this type only comprises the side-view duodenoscope, the probe catheter and the guide wire and permits only an examination of the common bile duct. There is, however, the problem of reliable and reproducible representation of the human gall bladder by endoscopic-transpapillary means. A known method is the percutaneous transhepatic puncture and drainage of the gall bladder. This method has its drawbacks in that an artificial access has to be provided through the skin, the risk of tissue injuries is quite high and the stress condition for the patient is correspondingly problematic.
It is the object of the present invention to provide an apparatus of the type initially referred to which permits reliable, systematic and reproducible representation of the gall bladder lumen by endoscopic-retrograde means. In overcoming this problem, the apparatus according to the invention is characterized in that the probe catheter and the guide wire are suitably constructed to be advanced as far as the cystic duct, in that a guide catheter is provide to slide over the guide wire, in that the probe catheter is preformed with bends corresponding to the Judkins or right-coronary catheter and is formed with a conically shaped tip which, with the guide wire retracted, is deflected into the cystic duct, in that a probe wire with a flexible tip piece is slidable through the guide catheter and through the cystic duct into the gall bladder lumen and in that, with the guide catheter retracted, an irrigating catheter or a small endoscope is capable of being slid by means of the probe wire into the gall bladder lumen.
The apparatus according to the invention permits reliable exploration of the cystic duct, the outlet passage of the gall bladder, although the cystic duct which has a diameter of abt. 1-2 mm is difficult to find and, moreover, has a spiral configuration and is narrowed by several valves, the so-called Heister valves, which open in the direction of the gall bladder lumen. The apparatus warrants reliable, systematic manipulation for the exploration of the cystic duct. The parts of the apparatus are introduced by a commercial side-view dudenoscope.
The proportioning of the preforming of the guide catheter corresponds to the branches of the biliary tract. The probe wire is constructed with a distal end that is easily bent while the remainder is stiff and not easily bent. The flexibility serves to bypass obstructions. The balloon of the irrigation catheter serves for the closure of the gall bladder and irrigation for the endoscopic transpapillary lysis of gall stones.
It is specially desirable and advantageous if the irrigation catheter is formed with several conduits for irrigation, evacuation and dilation. This facilitates the operation of the irrigation catheter.
It is also specially desirable and advantageous if the small endoscope is provided with a guide rail or a working conduit for sliding it up onto the probe wire. This facilitates its operation. Alternatively, it is possible to slide an auxiliary catheter over the probe wire and, on retraction of the probe wire, to slide the small endoscope through the auxiliary catheter.
Furthermore, it is specially desirable and advantageous if the flexible tip piece is formed by a spiral wire and provided on its outside with a smooth plastic coating. The plastic coating prevents tissue being squeezed between the wire coils as the spiral wire piece flexes.
Mor
REFERENCES:
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patent: 4033331 (1977-07-01), Guss et al.
patent: 4253467 (1981-03-01), Frazier
patent: 4774949 (1988-10-01), Fogarty
patent: 4800870 (1989-01-01), Reid, Jr.
Percutaneous Transfemoral Selective Coronary Arteriography, by Melvin Judkins, M.D. Radiology clinics of North America. vol. VI, No. 3, Dec. 1968, p. 467.
Domschke Wolfram
Foerster Ernst
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