Surgery – Endoscope – With tool carried on endoscope or auxillary channel therefore
Reexamination Certificate
1999-07-03
2001-06-12
Dvorak, Linda C. M. (Department: 3739)
Surgery
Endoscope
With tool carried on endoscope or auxillary channel therefore
C600S106000, C600S107000, C606S046000
Reexamination Certificate
active
06245011
ABSTRACT:
CROSSREFERENCE OF PENDING APPLICATION
This application is a continuation of pending international application PCT/EP 98/06898.
BACKGROUND OF THE INVENTION
The present invention relates to an endoscopic instrument with cutting tool, having a shaft for introduction into duct-like body passages such as the rectum, trachea, or esophagus, and having an endoscopic optical system.
An instrument of this kind is known from the company brochure of Karl Storz GmbH & Co., Tuttlingen: “STORZ, THE WORLD OF ENDOSCOPY, PROCTOLOGY, FIFTH EDITION 1/92,” 1992, page PRO 2. The instrument described there is a proctoscope.
A proctoscope is used in medicine for inspection of the anal duct and the lower portion of the rectum of a patient. For this purpose, the proctoscope is introduced into the anal duct with an obturator, inserted into a tube, whose distal end is of beveled configuration. The obturator is then pulled back out of the tube, and instead an insert with lateral windows is introduced into the tube; with this, the anal duct can be inspected via an endoscopic optical system in order to detect proctological diseases.
If a tumor in the intestinal wall is detected during the proctological examination, it must then be surgically removed. For surgical removal of deep tumors in the lower rectum, it is necessary to introduce a circular incision into the intestinal wall in the circumferential direction. This operation is very difficult and time-consuming and cannot be performed with the conventional proctoscope alone, instead requiring a special surgical incision instrument.
The invention is not limited, however, to a proctoscope of this kind. Further comparable endoscopic instruments that are introduced into duct-like body passages in order to inspect the body passage are the rectoscope, esophagoscope, and tracheoscope. Rectoscopes are also introduced into the bowel in order to inspect the bowel. An esophagoscope is used to inspect the esophagus, and a tracheoscope to inspect the bronchial tubes. In the case of these endoscopic instruments as well, the only ones available at present are those with which the corresponding body passages can be inspected, but with which it is not possible to introduce a circular incision into the wall of the respective body passage.
DE-A-27 37 014 discloses an endoscope for slitting through urethra constrictions. The endoscope has a shaft tube in which a knife for slitting through the constriction is provided distally. The knife can be pivoted out about a transverse axis through a longitudinal slot in the shaft by way of a longitudinally displaceable wedge arranged distally from it, using a proximal handle via a wire pull, from a rest position in which the knife lies recessed in the shaft. The knife is used to make an incision in the longitudinal direction of the shaft axis.
Also known from U.S. Pat. No. 4,674,500 is a surgical incision instrument that is used in arthroscopy and in those surgical procedures in which access to the surgical site is limited or difficult. This instrument accordingly has a very thin shaft, bent over laterally at the distal end, in which a knife blade is received displaceably in the longitudinal direction of the shaft. The knife is of bendable configuration, so that by being advanced, it can be pushed out of the laterally curved distal end of the thin shaft in order to make an incision. This instrument with a curved shaft is not suitable, however, for use in a duct-like body passage.
It is therefore the object of the invention to improve an endoscopic instrument of the kind cited initially in such a way that it is possible with the instrument not only to perform an inspection of the respective body passage, but also to surgically remove a tumor by introducing an incision into the wall of the body passage.
SUMMARY OF THE INVENTION
According to the present invention, this object is achieved by an endoscopic instrument, having a shaft for introduction into a duct-like body passage, said shaft having a periphery, an endoscopic optical system extending through said shaft, a cutting tool arranged in said shaft, wherein said cutting tool is movable between a retracted position where said cutting tool is completely disposed inside said shaft and an extended position where said cutting tool extends out of said shaft beyond said periphery of said shaft, and wherein in said extended position, said cutting tool is arranged for introducing an incision in said body passage in circumferential direction of said body passage, and a displacement mechanism for moving said cutting tool between said retracted position and said extended position.
According to another aspect of the present invention, a method for introducing an incision into a wall of a duct-like body passage comprises the steps of providing an instrument having a shaft for introduction into said duct-like body passage and a cutting tool disposed within said shaft that by way of a displacement mechanism can be extended out of said shaft beyond a periphery of said shaft, introducing said instrument with said cutting tool in its retracted position into said body passage such that said periphery of said shaft is positioned at a portion of said wall where said incision is to be introduced, extending said cutting tool beyond said periphery of said shaft by way of said displacement mechanism whereby said cutting tool engages said wall, and turning said shaft about its longitudinal axis thereby introducing said incision into said wall of said body passage in circumferential direction.
Because a cutting tool is integrated into the instrument according to the present invention in the shaft, it can be used not only for inspection purposes but also as a surgical instrument for cutting out, for example, tumors. In this context, the operation can advantageously be observed and monitored with the endoscopic optical system. Because the cutting tool can be extended out beyond the periphery of the shaft, the required incision can be made, for example in the case in which the instrument according to the present invention is configured as a proctoscope, in the circumferential direction of the intestinal wall, by rotating the shaft, with the cutting tool extended, about its longitudinal axis; as a result, the cutting tool introduces into the intestinal wall an incision to a depth corresponding to the extension span, or corresponding to the width to which the cutting tool projects out beyond the periphery of the shaft. Because the cutting tool can be retracted into the shaft and thus can be recessed, the shaft can readily be introduced into the body passage without injuring the wall of the passage with the cutting tool as the instrument is introduced. Blades for mechanical cutting, wire electrodes for cutting with high-frequency current, ultrasonic cutting applicators, or lasers can be used as cutting tools. “Retractable” is understood to mean, for the purposes of the subject matter of the present invention, for example a radial movement or an outwardly pivoting or bending movement of the cutting tool, or also the activation, enabling, or expansion of the working radius of a laser cutting tool.
The object of the invention is completely achieved in this manner.
In a preferred embodiment, the cutting tool is lockable in the maximally extended position and in the retracted position.
Because the cutting tool can be locked in the maximally extended position, the incision to be performed can be made safely, with no danger that the cutting tool will be pushed back into the shaft during cutting. The incision can thus be made reliably. The fact that the retracted position can be locked guarantees that the cutting tool does not prematurely extend upon introduction of the shaft into the body passage and, in the case where the instrument is used for inspection purposes, does not extend inadvertently and injure, for example, the intestinal wall. The reliability of the instrument according to the present invention is thus improved.
In a further preferred embodiment, the cutting tool is lockable in a plurality of positions of dif
Dittrich Horst
Dudda Werner
Weller Thomas
Dvorak Linda C. M.
Karl Storz GmbH & Co. KG
Ram Jocelyn
St. Onge Steward Johnston & Reens LLC
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