Surgery – Means for introducing or removing material from body for... – Material introduced into and removed from body through...
Patent
1998-07-09
1999-07-13
Hirsch, Paul J.
Surgery
Means for introducing or removing material from body for...
Material introduced into and removed from body through...
128DIG13, A61M 100
Patent
active
059219530
DESCRIPTION:
BRIEF SUMMARY
DESCRIPTION
1. Field of the Invention
The invention relates to an apparatus for irrigating body cavities with a fluid in accordance with the introductory clause of Patent claim 1.
Such apparatuses are manufactured and distributed, for instance, by Karl Storz GmbH & Co. by the brand name "Hamou Endomat" or "Uromat/Uropump" and are employed, inter alia, in the field of gynaecology and urology.
2. Prior Art
The fields of gynaecology and urology in particular involve a risk of intravasation (infiltration) when tissue is removed during the dilatation of a treated organ with an irrigating fluid. This operation is normally performed by means of a high-frequency loop, e.g. in the prostate gland or on the mucous membrane of the uterus.
It is therefore necessary to select the intra-uterine or intra-urethral pressure in a way that a sufficient dilatation and partly control of haemorrhage are achieved on the blood vessels by a certain overpressure. This overpressure on the blood vessels is usually termed "control" or "clamping".
If, however, major blood vessels are damaged by incision or section there is a risk of the irrigating fluid entering into the blood circulation. At flow rates of several 100 ml/min in "continuous flow" operation this may easily result in a dangerous infiltration of the irrigating liquid.
Such a situation had serious consequences for the patient's health. With a proper handling of the irrigating pumps employed today, which are provided with optimum pressure and flow control means, this risk may be reduced to a minimum. And yet the operators or the physician performing this operation must additionally still monitor and optimise the pressure and flow control functions during the operation. This means that the operating physician cannot perform the operation with unrestricted concentration. Moreover, it were helpful for less skilled and experienced physicians to obtain additional information for a further reduction of the risk of intravasation.
The company of Olympus Winter & Ibe offers at present an irrigating pump of the claimed general type which indicates the volumetric difference between the consumed volume of the irrigating solution and the aspirated volume of the irrigating solution. In that system the aspirated volume is determined by gravimetric means whilst the volume of consumed irrigating solution is determined by the number of revolutions of the irrigating pump.
This equipment entails the disadvantage that the differential volume furnishes only a definitely incomplete information about the occurrence of intravasation. In this respect the fact must be duly considered in particular that, depending on the surgeon's experience, a more or less substantial amount of irrigating liquid is lost through leaks or as a result of withdrawal of the endoscope or resectoscope, for instance, e.g. for cleansing purposes.
In engineering terms there were the possibility available to counter or collect these additionally lost quantities by a second collector vessel which is located, for instance, underneath the patient. In such a system a weighing cell ought to detect the additional losses. The output signal of this weighing cell could then correct the established differential volume insofar as only the irrigating liquid which entered the body is indicated. This possibility involves, however, the disadvantage of a more difficult handling by the user. Apart therefrom, this approach involves the risk of a certain liquid volume not being detected due to unskilled or improper handling of the instruments, e.g. the liquid volume flowing out between the body and the instrument. Moreover, lack of diligence in handling the collector vessel disposed underneath the patient, with resulting loading or unloading, may lead to the indication of an unduly small volumetric loss.
The laid-open German Patent Application DE 44 17 189 A1 of the prior German Patent Application P 44 17 189.7, which was published after the filing date of this application, discloses an apparatus for perfusion and aspiration of an (irrigating) liq
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Olympus Winter & Ibe GmbH, "Instruction manual: Uteromat fluid control A4060," 1995, pp. 2-53.
Hamou Jacques
Novak Paul
Wattiez Arnaud
Hirsch Paul J.
Storz Endoskop GmbH
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