Surgery – Means for introducing or removing material from body for... – Treating material introduced into or removed from body...
Reexamination Certificate
2000-02-23
2003-04-29
Mendez, Manuel (Department: 3763)
Surgery
Means for introducing or removing material from body for...
Treating material introduced into or removed from body...
C604S158000
Reexamination Certificate
active
06554793
ABSTRACT:
The invention concerns a trocar in the form of a flexible access tube for insertion into body cavities, preferably with the use of an invertible hose system for diagnosis and surgical interventions, particularly in the colon area.
The invention especially concerns a flexible access tube whereby diagnoses can be performed, for example by inserting a coloscope, as well as operations in accordance with the minimally invasive surgery technique, by inserting corresponding surgical instruments into the access tube through the anus. Among other things, this new type of flexible access tube thereby takes over the function of trocars known until now, and for reasons of simplification will be called a “flexible trocar” in the following.
BACKGROUND OF THE INVENTION
When striving towards ever better and more specialized surgical techniques, whereby ever smaller operating areas suffice and are therefore less demanding on the patient's organism, the technically meaningful application of the so-called minimally invasive surgery technique is constantly expanded with the development of new instruments and auxiliary means. Diagnoses as well as complete operations are already being performed on human organs by inserting so-called trocars as auxiliary surgical means through the abdominal wall or the thorax, through which surgical instruments as well as optics can be moved to the organ to be diagnosed or operated.
Such auxiliary means and instruments however cannot be used in all cases.
For example, to surgically remove large tumors such as carcinomas etc. from the colon, except for the end area of the intestine, according to conventional usage required a major operation until now, i.e. the patient's abdomen had to be opened in order to reach the intestine. The basis for this expensive surgical technique, which is extremely demanding on the patient, is among other things that the intestine must be steadied for a precise operation, i.e. the intestine is removed from the respective area of the abdomen and is clamped or steadied by suitable means only then is the surgeon able to remove the tumor by means of precise steps and then close the intestine with sutures.
It is obvious that this intervention not only represents an expensive operation which is very demanding on the patient and could possible entail a great risk, particularly for elderly patients, but that it also incurs great costs which on the one hand are caused by the extensive surgical effort, and on the other by the patient's mandatory long recovery period in the hospital.
Until now it was only possible to remove carcinomas from a maximum depth of about 20 cm from the anus into the intestine without the above mentioned procedure. This takes place by means of a so-called rectoscope. A rectoscope is a rigid cone-shaped tube part which is inserted into the anus and expands the latter by several centimeters. In that way the surgeon has enough space to reach the diseased area of the intestine with special tools and perform the operation.
One disadvantage of this surgical technique however is that the rectoscopy is only suitable for surgical interventions in an area of the colon within the first 20 cm from the anus, and only a few specialized surgeons are able to perform this operation. Starting with this problem it is the task of the invention to create a totally new type of device enabling both diagnoses as well as surgical interventions in the colon area through the end of the intestine.
This task is accomplished by a device with the features of claim
1
. Further advantageous configurations of the invention are the subject of the remaining subclaims.
The invention begins with the following consideration: Through endoscopy it is already possible to examine the entire intestine of a patient through the anus by means of so-called coloscopes. These coloscopes are essentially used to visually examine the intestine through the anus. To that effect the distal end of the coloscope is equipped with a lighting device and optics, preferably a camera chip which is connected by lines inside an endoscope or coloscope shaft to a camera control at the end of the shaft. The camera control in turn is connected by a video processor to an external monitor on which the treating physician can see the areas to be examined. The distal end of the shaft being introduced into the cavity is designed to bend in all directions and can be manually curved like a finger by means of a handle, preferably via two steering wheels with a brake in the coloscope's end-section. As a rule at least two channels pass through the coloscope shaft and open at the frontmost point of the distal end. When required, cleaning fluid can be directed through these channels to clean an area to be examined, or CO
2
(air) to expand the cavity, or various working tools for example forceps or scissors for removing tissue samples, biopsy needles, heatable cutting wires, coagulation electrodes etc. can be inserted, and can also be manually actuated at the rear end of the coloscope shaft by means of operating wires or Bowden cables inside the internal channel. After the distal end has reached the respective area, a miniature forceps can for example be inserted into the channel from the rear section of the coloscope shaft and be pushed toward the distal end to remove a tissue sample. After the sample has been obtained, the forceps are withdrawn and removed from the channel so that further examination can proceed.
The coloscope generally has a lengthwise extended tubular form with a diameter of about 9 to 15 mm, and consists of a flexible material so that it can follow bends in the cavity to be examined, for example intestinal convolutions.
An endoscope of this type is known from the state of the art, for example according to U.S. Pat. No. 5,259,364, issued Nov. 9, 1993; and U.S. Pat. No. 5,568,968, issued Dec. 24, 1996. This endoscope essentially consists of an endoscope head or distal end to which an endoscope shaft made of a flexible tube body is connected, and an operating device at the rear end of the endoscope shaft. The operating device has a number of actuating wheels which are able to rotate in the endoscope shaft and are actively connected to the distal end by operating wires or Bowden cables located inside the endoscope shaft. A rear end-section of the endoscope furthermore contains a first driving or advancing device which exerts a driving force on the endoscope shaft through driving wheels.
At least the front section of the endoscope shaft has an invertible hose which is driven by a second driving or advancing device. Here the invertible hose consists of an inner hose section which can slide along the endoscope's jacket surface and is inverted to form the front of an outer hose section in the endoscope's distal end area. The front of the outer hose section is furthermore routed back to the second driving device and is attached to its housing. In the endoscope's rear area the inner hose section is inverted to form an external rear hose section, which is also routed to the second driving device and is attached to the axial end of its housing opposite the front of the outer hose section.
Here the second driving device acts on the inner invertible hose section to move it in the axial direction of the endoscope. To that end the second driving device has a kind of sleeve or collar, which contracts in the radial direction and exerts frictional pressure against the inner hose section; it can also move like a piston in the endoscope's axial direction. The radial pressure force of the sleeve is large enough so that at least a portion of the applied pressure force is transmitted through material deformation to the jacket surface of the endoscope shaft, thereby driving the endoscope shaft together with the inner invertible hose.
Since with this only type of driving by the second driving device the advancing speed (and path) of the invertible hose is only half as large in its inverted front area as that of the endoscope shaft, i.e. the shaft would exit from the i
Pauker Fritz
Pauker Robert
Viehbach Thomas
Weiglhofer Gerhard
Jones William W.
Mendez Manuel
STM Medizintechnik Starnberg GmbH
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