Surgery – Instruments – Light application
Reexamination Certificate
1998-10-14
2001-01-23
Dvorak, Linda C. M. (Department: 3739)
Surgery
Instruments
Light application
C606S007000, C606S016000, C600S106000, C600S153000
Reexamination Certificate
active
06176855
ABSTRACT:
BACKGROUND OF THE INVENTION
The present invention relates to an endoscopic instrument for the therapy of the heart muscle, in which by way of laser energy channels are incorporated into the heart muscle.
In heart muscle therapy which is described in an abbreviated manner with TMR (transmyocardial revascularization) by way of laser energy several channels are drilled into the heart muscle temporally between the heart beats, when the heart chamber is filled with blood. In this way in the course of time blood may enter into the channels by which means the heart muscle may be supplied with blood enriched with oxygen. At the same time new vessels are formed in the heart muscle.
Amongst physicians there is the great desire to be able to carry out this therapy with minimal-invasive surgery. Since this is effected at the beating heart, a local restraining of the heart muscle must be achieved.
BRIEF SUMMARY OF THE INVENTION
It is therefore an object of the present invention to provide an instrument with which in a simple and gentle manner by way of laser energy a number of channels can be incorporated into the partially restrained heart muscle with a visual control. This object is achieved by an instrument having a shank tube and at least one instrumentation channel for a laser fiber; an optical system for observing the locus of treatment is preferably disposed within the central axis of the shank tube. A vacuum is applied to the distal end of the shank tube and to the locus of treatment so as to suction the instrument against the heart muscle thereby at least partially restraining the heart muscle.
With the instrument according to the present invention in a simple manner a number of channels may be incorporated in the heart muscle which is partially restrained in a gentle manner. This way an improved flow of blood and an improved oxygen supply of the heart muscle tissue is achieved without laying the hitherto customary bypasses. Furthermore the operational time and costs may be considerably reduced with this minimal invasive instrumentation.
Preferably the instrumentation channel of the laser fiber lies eccentrically to the longitudinal axis of the shank tube as well as of the optics running centrically through the shank tube, and the instrumentation channel and the optics are rotatable in the shank tube as a so that within a certain heart muscle region a defined number of channels may be placed into the heart muscle by simple rotation of the eccentrically arranged instrumentation channel.
It is advantageous that the optics have an exit view which is directed slightly laterally. In this way it is achieved that the optical axis and the axis of the operating channel meet at a defined distance.
In an alternative embodiment the endoscopic instrument according to the present invention is provided with several instrumentation channels which are arranged preferably evenly distributed about the optics running centrically through the shank tube wherein the instrument channels and the optics together are rotatable as a single unit in the shank tube. Accordingly, by rotating of the instrumentation channels about the optical axis a simplification of the method can be achieved and yet in a simple manner several channels may be placed into the heart muscle within a certain surface area.
With the instrument according to the present invention it is further advantageous when the optics and each instrument channel can be axially adjusted in the shank tube together.
The distal end region of the shank tube which can be set under vacuum is elastic in a preferred embodiment of the present invention, i.e. it is rubber-elastically deformable so that this end region e.g. may assume the shape of a suction bell with which the heart wall may be locally suctioned with a vacuum under elastic deformation of the suction bell and thus at least partially restrained without danger of injury.
In an alternative embodiment the distal end region of the shank tube may comprise one or more lateral openings whilst the end face of the distal shank tube end comprises a tubular vacuum channel which is open on the side of the organ for suctioning the heart muscle surface. Furthermore the laser fiber within the instrumentation channel and each instrumentation channel may be axially adjustable in the shank tube.
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Heckele Helmut
Hehrlein Friedrich-Wilhelm
Schueck Reinhard
Seebach Martin
Cohen & Pontani, Lieberman & Pavane
Dvorak Linda C. M.
Richard Wolf GmbH
Yarnell Bryan K.
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