US20080058588A1 - Surgical endoscopic cutting device and method for its use - Google Patents
Surgical endoscopic cutting device and method for its useDownload PDFInfo
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- US20080058588A1 US20080058588A1US11/929,940US92994007AUS2008058588A1US 20080058588 A1US20080058588 A1US 20080058588A1US 92994007 AUS92994007 AUS 92994007AUS 2008058588 A1US2008058588 A1US 2008058588A1
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- endoscope
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- tissue
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Images
Classifications
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B17/32—Surgical cutting instruments
- A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
- A61B17/32002—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes with continuously rotating, oscillating or reciprocating cutting instruments
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
- A61B1/018—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor for receiving instruments
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/12—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor with cooling or rinsing arrangements
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B17/32—Surgical cutting instruments
- A61B17/320016—Endoscopic cutting instruments, e.g. arthroscopes, resectoscopes
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B17/42—Gynaecological or obstetrical instruments or methods
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/30—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
- A61B90/361—Image-producing devices, e.g. surgical cameras
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods
- A61B17/42—Gynaecological or obstetrical instruments or methods
- A61B2017/4216—Operations on uterus, e.g. endometrium
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2217/00—General characteristics of surgical instruments
- A61B2217/002—Auxiliary appliance
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- A—HUMAN NECESSITIES
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- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2217/00—General characteristics of surgical instruments
- A61B2217/002—Auxiliary appliance
- A61B2217/007—Auxiliary appliance with irrigation system
Definitions
- the present inventionrelates to a surgical endoscopic cutting device.
- Surgical cutting devicesare generally known and used for the removal of hard and/or soft tissue, such as in the vicinity of the knee joint. Such cutting devices are used in, for example, a joint cavity, where they can be guided endoscopically by separately inserting a viewing device having a light source and an observation portion. Such operations are successfully used in organs and joints lying not too deep underneath the skin.
- tissuehas to be removed from the uterus, prostate, or urinary bladder, such as mucous membrane or other tissues, it was customary until now to use a so-called “loop.”
- Thisis a loop-shaped cutting wire which is brought to a first potential, while the wall of the uterus is brought to a second, different potential. Tissue is removed by moving the loop along the uterus wall.
- Dilationis carried out by introducing a fluid.
- a non-conducting fluidis used, for example a 5% sorbitol solution.
- WO 96/11638discloses a cutter including a hollow stem and a cutting head accommodated inside a rigid housing. This rigid housing likewise contains a viewing channel with the necessary optics.
- U.S. Pat. No. 5,195,541describes a laparoscopic discectomy apparatus. For a laparoscopic method it is essential to inflate the related cavity using gas. The gas feed is discontinuous and has no effect on viewing of the operation site.
- Fluidis introduced by way of a space between the stem and the rigid housing and discharged together with the detached tissue through the hollow stem of the cutter.
- This devicecould be satisfactory for the removal of tissues from certain body cavities, such as from the bladder.
- An example of thisis the uterus, in which it is important that the amount of enlargement of the organ be accurately controlled.
- the irregular discharge of fluid through the hollow stem of the cutter, caused partly by the irregular release of tissue,means that it cannot be guaranteed that the pressure inside the cavity is accurately controlled.
- Such a deviceis consequently not very suitable for use in the treatment of such a cavity.
- the object of the present inventionis to provide a device which can perform such a treatment.
- a further outlet channelis provided, the function of which is independent of whether or not detached tissue has been released.
- a regular discharge of fluidcan occur through this further outlet channel. Since only a minor part of the fluid is now discharged through the outlet, in which there are detached pieces of tissue, the pressure inside the body cavity can be regulated and controlled accurately. This makes it possible to remove undesired tissue from cavities such as the uterus. The applicability of the removal of tissues by cutting is consequently considerably increased.
- the further outlet channel described aboveis formed by an insertion tube fitted around the endoscopic device.
- This insertion tubeserves to clear a space for the endoscopic device.
- the front side of the insertion tubecan be provided with an insertion mandrel, which is removed after the positioning of the insertion tube and replaced by the endoscopic device described above.
- the further outlet channelcan be defined between the endoscopic device and the insertion tube.
- Discharge of the tissue material which has been detachedcan be achieved either by making the stem on which the cutting elements are fitted hollow, or by fitting a protective tube around the cutter.
- a protective tubecan also be used without the space between protective tube and stem serving as an outlet channel.
- the cuttercan be designed as a separate unit which can be coupled to the rigid housing, which has advantages in particular for purposes of sterilization. Namely, the device can then be detached in a simple way.
- the rigid housingFor the removal of tissue from a uterus it is essential for the rigid housing to have a length which is sufficient to reach all tissue parts, i.e. a length of at least 30 cm.
- the observation part of the device described aboveincludes a light channel in the housing, provided near one end with a lens and near the other end with an observation mechanism.
- the lattercan include an eyepiece or a connection for a camera so that the surgeon can carry out the operation using a monitor and others can possibly look at the same time.
- the cutting elements described abovecan include any cutting element known in the prior art.
- a cutting head with cutting facescan be used, but it is also possible to use constructions with teeth, meshing with the protective tube or otherwise.
- the protective tubeis preferably provided with a lateral opening through which a part of the cutting elements extends so that on each revolution, part of the tissue is removed and can be discharged directly through the interior of the drive/discharge tube of the cutter.
- the inventionalso relates to a method for the removal of uterus tissue in which the device described above is used.
- a machining operationis now applied with the use of a physiological fluid which can be electrically conducting without any problem, while at the same time the removed tissue is sucked out. It is, of course, possible to suck out the tissue at a later stage.
- the machining operationis carried out by a rotating action.
- an outlet and a further outletare present, and the pressure inside the body cavity is regulated by metering the quantity of fluid which moves through the further outlet.
- the insertion of the surgical endoscopic cutting deviceis preferably carried out in the manner described above using an insertion mandrel and insertion tube.
- FIG. 1shows the endoscopic cutting device according to the invention in the assembled state, in side view and partially in section;
- FIG. 1 ashows the viewing/receiving part of the cutting device of FIG. 1 in section along the line Ia-Ia;
- FIG. 2shows a side and partially cut-away view of the viewing/receiving part of the cutting device of FIG. 1 ;
- FIG. 3shows a partially cut-away perspective view of the device of FIG. 1 , with the insertion end enlarged;
- FIG. 4shows a partially sectional side view of the cutter of the cutting device of FIG. 3 ;
- FIG. 5shows a variant of the cutter shown in FIG. 4 ;
- FIG. 6shows an insertion mandrel according to the invention.
- the endoscopic cutting deviceis indicated in its entirety by 1 in FIG. 1 . It comprises a viewing/receiving part 3 , which is shown in FIG. 2 , a cutting part 2 , which is shown in greater detail in FIGS. 4 and 5 , and an insertion mandrel, which is shown in FIG. 6 .
- the viewing/receiving part 3is composed of an outer tube 4 in which a main channel 5 and viewing channel 6 are defined. Viewing channel 6 ends at one side in a lens 13 and at the other side in a viewing tube 7 , on which an eyepiece or camera connection is placed. A connection 8 for a light source is also present, for connection to a fibre optics bundle which provides for lighting at the end of lens 13 . Near the control end, tube 4 is provided with a fluid inlet 9 connected to a hose 12 , for adding a physiological salt solution.
- a shut-off valveis indicated by 10 .
- the length of the actual outer tube 4is indicated by A and is more than 30 cm.
- FIG. 4shows details of the cutter or the cutting part 2 , which is composed of a protective tube 16 inside of which a drive/suction tube 17 is fitted. Near the working end, tube 17 is provided with teeth 19 which mesh with teeth 18 provided in an opening 26 in the end part of protective tube 16 . Near the other end, drive/suction tube 17 is provided with a coupling 20 , which can be connected at one end to a rotating drive motor 21 , not shown in detail, and at the other end is provided with an opening 22 through which fluid and removed material can be discharged by way of suction tube 17 to the discharge hose 23 . A pressure regulator can be present in this discharge hose 23 , which is connected to a vacuum source.
- Insertion partis indicated by 27 .
- This insertion partis composed of an insertion tube 28 which is provided with openings 29 at one end and near the other end, the insertion part 27 is provided with a bayonet connection 30 and an outlet 31 .
- Insertion tube 28is designed in such a way that tube 4 can be fitted therein, as shown in FIGS. 1 and 3 , while it is also possible to fit insertion mandrel 40 , provided with stem 41 and mandrel 42 , in insertion tube 28
- Inlet 38for fluid.
- Inlet 38extends to channel 14 ( FIG. 1 a ), i.e. the space bounded between the outer tube 4 and the protective tube 16 and 36 , respectively from FIG. 4 or 5 .
- a shut-off valve 39which is connected to channel 14 , is present, while the further outlet is indicated by 31 .
- a discharge hose 23 for tissue and fluidis shown.
- some of the fluidwill be discharged through outlet 23 . This relatively small amount will be mixed with a mixture released during the cutting operation.
- Most of the fluidwill be discharged through the further outlet 31 . This discharge is unimpeded and occurs through openings 29 .
- Pressure variations occurring due to the presence or absence of removed tissue in channel 17 ( FIG. 4 )have little or no influence on the pressure inside the body cavity owing to the presence of the further outlet 31 .
- insertion mandrel 40will first be inserted, with shut-off valve 39 open, into insertion tube 28 with bayonet 30 .
- This assemblyis then placed in the uterus in a relatively simple manner due to the shape of mandrel 42 .
- Mandrel 42is then removed by manipulating stem 41 , and the construction shown in FIG. 2 is placed in tube 28 . Connection is made here to bayonet 30 .
- the cutting actioncan then begin after the uterus has been dilated by the introduction of fluid.
- This fluidcan be a physiological flushing and distension fluid, such as a physiological salt solution (NaCl 0.9%).
- tube 17By switching on motor 21 , tube 17 is set in rotation and teeth 19 move regularly along cutting edge 18 of protective tube 16 which remains stationary. While they are moving along each other and picking up tissue material between them, a cutting, detaching action on the tissue material is occurring. The cut, detached material is removed through the interior of tube 17 and outlet 23 .
- the appropriate area of the uteruscan be treated by moving parts 18 and 19 along the uterus wall or along tissue to be removed, which can be observed through viewing tube 7 by supplying light through connection 8 .
- FIG. 5shows a variant of the end of the cutter.
- the cutter or cutting partare indicated in their entirety by 32 .
- the protective tubeis indicated by 36 and is beveled near the end.
- the drive/suction tubeis indicated by 37 and provided with a cutting head near the end. In this embodiment, there is either no interaction between cutting head 35 and protective tube 36 , or head 35 and tube 36 interact near the edge of tube 36 , which is adapted for that purpose by grinding.
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Abstract
Description
- This application is a divisional application of and claims priority to U.S. application Ser. No. 11/780,759, filed on Jul. 20, 2007, which is a continuation application of and claims priority to U.S. application Ser. No. 09/486,977, filed on Mar. 6, 2000.
- The present invention relates to a surgical endoscopic cutting device.
- Surgical cutting devices are generally known and used for the removal of hard and/or soft tissue, such as in the vicinity of the knee joint. Such cutting devices are used in, for example, a joint cavity, where they can be guided endoscopically by separately inserting a viewing device having a light source and an observation portion. Such operations are successfully used in organs and joints lying not too deep underneath the skin.
- When operations are being carried out on organs lying deeper, other techniques are currently used. If, for example, tissue has to be removed from the uterus, prostate, or urinary bladder, such as mucous membrane or other tissues, it was customary until now to use a so-called “loop.” This is a loop-shaped cutting wire which is brought to a first potential, while the wall of the uterus is brought to a second, different potential. Tissue is removed by moving the loop along the uterus wall. In order to be able to carry out such an operation, it is necessary to dilate the uterus. Dilation is carried out by introducing a fluid. In order to maintain the effect of the potential difference, a non-conducting fluid is used, for example a 5% sorbitol solution. Because wounds are caused during the treatment described above, a good part of this fluid is resorbed into the patient's bloodstream (by way of the uterus). This can lead to highly dangerous electrolyte displacements. It has been found that the tissue can be removed more easily by working with a high-frequency monopolar electric current, but there is a risk of high-frequency electric current leading to internal and external burns. The loop is generally fitted on an endoscope and moved back and forth along the uterus wall with the endoscope. The tissue cut off during this treatment has to be removed from the uterus, which considerably extends the duration of the operation. Furthermore, the doctor has to check that all detached material actually has been removed.
- This means that such operations are very time-consuming and require the surgeon to repeatedly move the device back and forth. This is tiring and consequently difficult to learn. Moreover, the patient has to be monitored continually during the operation, in order to prevent the undesirable phenomena described above. It is not uncommon for such an operation to be broken off because the patient's life is endangered by the side effects.
- On the other hand, it is desirable to be able to carry out such operations instead of simply performing a hysterectomy.
- WO 96/11638 discloses a cutter including a hollow stem and a cutting head accommodated inside a rigid housing. This rigid housing likewise contains a viewing channel with the necessary optics. U.S. Pat. No. 5,195,541 describes a laparoscopic discectomy apparatus. For a laparoscopic method it is essential to inflate the related cavity using gas. The gas feed is discontinuous and has no effect on viewing of the operation site.
- Fluid is introduced by way of a space between the stem and the rigid housing and discharged together with the detached tissue through the hollow stem of the cutter.
- This device could be satisfactory for the removal of tissues from certain body cavities, such as from the bladder. However, in the case of other body cavities, it is necessary to “blow up” the cavity before treatment can be carried out. An example of this is the uterus, in which it is important that the amount of enlargement of the organ be accurately controlled. The irregular discharge of fluid through the hollow stem of the cutter, caused partly by the irregular release of tissue, means that it cannot be guaranteed that the pressure inside the cavity is accurately controlled.
- Such a device is consequently not very suitable for use in the treatment of such a cavity.
- The object of the present invention is to provide a device which can perform such a treatment.
- According to the invention, a further outlet channel is provided, the function of which is independent of whether or not detached tissue has been released. In other words, a regular discharge of fluid can occur through this further outlet channel. Since only a minor part of the fluid is now discharged through the outlet, in which there are detached pieces of tissue, the pressure inside the body cavity can be regulated and controlled accurately. This makes it possible to remove undesired tissue from cavities such as the uterus. The applicability of the removal of tissues by cutting is consequently considerably increased.
- The further outlet channel described above is formed by an insertion tube fitted around the endoscopic device. This insertion tube serves to clear a space for the endoscopic device. For this purpose, the front side of the insertion tube can be provided with an insertion mandrel, which is removed after the positioning of the insertion tube and replaced by the endoscopic device described above. In this case the further outlet channel can be defined between the endoscopic device and the insertion tube.
- In the case of such a construction it is desirable for a coupler to be present to provide a coupling between the rigid housing and the insertion tube described above.
- Discharge of the tissue material which has been detached can be achieved either by making the stem on which the cutting elements are fitted hollow, or by fitting a protective tube around the cutter. Such a protective tube can also be used without the space between protective tube and stem serving as an outlet channel. This means that the cutter can be designed as a separate unit which can be coupled to the rigid housing, which has advantages in particular for purposes of sterilization. Namely, the device can then be detached in a simple way.
- For the removal of tissue from a uterus it is essential for the rigid housing to have a length which is sufficient to reach all tissue parts, i.e. a length of at least 30 cm.
- The observation part of the device described above includes a light channel in the housing, provided near one end with a lens and near the other end with an observation mechanism. The latter can include an eyepiece or a connection for a camera so that the surgeon can carry out the operation using a monitor and others can possibly look at the same time.
- The cutting elements described above can include any cutting element known in the prior art. In other words, a cutting head with cutting faces can be used, but it is also possible to use constructions with teeth, meshing with the protective tube or otherwise. In the latter instance, the protective tube is preferably provided with a lateral opening through which a part of the cutting elements extends so that on each revolution, part of the tissue is removed and can be discharged directly through the interior of the drive/discharge tube of the cutter.
- The invention also relates to a method for the removal of uterus tissue in which the device described above is used. In other words, a machining operation is now applied with the use of a physiological fluid which can be electrically conducting without any problem, while at the same time the removed tissue is sucked out. It is, of course, possible to suck out the tissue at a later stage. The machining operation is carried out by a rotating action.
- According to a further embodiment of the method, an outlet and a further outlet are present, and the pressure inside the body cavity is regulated by metering the quantity of fluid which moves through the further outlet. The insertion of the surgical endoscopic cutting device is preferably carried out in the manner described above using an insertion mandrel and insertion tube.
- The invention will be explained in greater detail below with reference to an exemplary embodiment shown in the drawings, in which:
FIG. 1 shows the endoscopic cutting device according to the invention in the assembled state, in side view and partially in section;FIG. 1 ashows the viewing/receiving part of the cutting device ofFIG. 1 in section along the line Ia-Ia;FIG. 2 shows a side and partially cut-away view of the viewing/receiving part of the cutting device ofFIG. 1 ;FIG. 3 shows a partially cut-away perspective view of the device ofFIG. 1 , with the insertion end enlarged;FIG. 4 shows a partially sectional side view of the cutter of the cutting device ofFIG. 3 ;FIG. 5 shows a variant of the cutter shown inFIG. 4 ; andFIG. 6 shows an insertion mandrel according to the invention.- The endoscopic cutting device according to the invention is indicated in its entirety by1 in
FIG. 1 . It comprises a viewing/receiving part3, which is shown inFIG. 2 , a cuttingpart 2, which is shown in greater detail inFIGS. 4 and 5 , and an insertion mandrel, which is shown inFIG. 6 . - With reference to
FIG. 2 , it can be seen that the viewing/receiving part3, is composed of an outer tube4 in which a main channel5 andviewing channel 6 are defined.Viewing channel 6 ends at one side in alens 13 and at the other side in aviewing tube 7, on which an eyepiece or camera connection is placed. A connection8 for a light source is also present, for connection to a fibre optics bundle which provides for lighting at the end oflens 13. Near the control end, tube4 is provided with a fluid inlet9 connected to ahose 12, for adding a physiological salt solution. - A shut-off valve is indicated by10.
- The length of the actual outer tube4, is indicated by A and is more than 30 cm.
FIG. 4 shows details of the cutter or the cuttingpart 2, which is composed of aprotective tube 16 inside of which a drive/suction tube17 is fitted. Near the working end, tube17 is provided with teeth19 which mesh with teeth18 provided in anopening 26 in the end part ofprotective tube 16. Near the other end, drive/suction tube17 is provided with acoupling 20, which can be connected at one end to arotating drive motor 21, not shown in detail, and at the other end is provided with anopening 22 through which fluid and removed material can be discharged by way of suction tube17 to thedischarge hose 23. A pressure regulator can be present in thisdischarge hose 23, which is connected to a vacuum source.- In
FIG. 1 the insertion part is indicated by27. This insertion part is composed of aninsertion tube 28 which is provided withopenings 29 at one end and near the other end, theinsertion part 27 is provided with abayonet connection 30 and anoutlet 31.Insertion tube 28 is designed in such a way that tube4 can be fitted therein, as shown inFIGS. 1 and 3 , while it is also possible to fitinsertion mandrel 40, provided withstem 41 andmandrel 42, ininsertion tube 28 - The construction described above has an
inlet 38 for fluid.Inlet 38 extends to channel14 (FIG. 1 a), i.e. the space bounded between the outer tube4 and theprotective tube FIG. 4 or5. A shut-offvalve 39, which is connected to channel14, is present, while the further outlet is indicated by31. Adischarge hose 23 for tissue and fluid is shown. During the removal of tissue, with a substantially continuous supply of fluid throughinlet 38, some of the fluid will be discharged throughoutlet 23. This relatively small amount will be mixed with a mixture released during the cutting operation. Most of the fluid will be discharged through thefurther outlet 31. This discharge is unimpeded and occurs throughopenings 29. Pressure variations occurring due to the presence or absence of removed tissue in channel17 (FIG. 4 ) have little or no influence on the pressure inside the body cavity owing to the presence of thefurther outlet 31. - If the device is to be inserted into, for example, a uterus,
insertion mandrel 40 will first be inserted, with shut-offvalve 39 open, intoinsertion tube 28 withbayonet 30. This assembly is then placed in the uterus in a relatively simple manner due to the shape ofmandrel 42.Mandrel 42 is then removed by manipulatingstem 41, and the construction shown inFIG. 2 is placed intube 28. Connection is made here to bayonet30. The cutting action can then begin after the uterus has been dilated by the introduction of fluid. This fluid can be a physiological flushing and distension fluid, such as a physiological salt solution (NaCl 0.9%). In the event of the (unavoidable) resorption of the physiological fluid into the blood, electrolyte displacement, with fatal consequences for the patient, will not occur. Owing to the absence of electrical current, the burns described above are also ruled out. - By switching on
motor 21, tube17 is set in rotation and teeth19 move regularly along cutting edge18 ofprotective tube 16 which remains stationary. While they are moving along each other and picking up tissue material between them, a cutting, detaching action on the tissue material is occurring. The cut, detached material is removed through the interior of tube17 andoutlet 23. - The appropriate area of the uterus can be treated by moving parts18 and19 along the uterus wall or along tissue to be removed, which can be observed through
viewing tube 7 by supplying light through connection8. - Through the use of a continuous flow system, a constantly clear view is obtained for the observer even if blood and/or mucous is/are in the mixture. Moreover, the pressure can be maintained as low as possible, in order to prevent intravasation.
FIG. 5 shows a variant of the end of the cutter. The cutter or cutting part are indicated in their entirety by32. The protective tube is indicated by36 and is beveled near the end. The drive/suction tube is indicated by37 and provided with a cutting head near the end. In this embodiment, there is either no interaction between cuttinghead 35 andprotective tube 36, orhead 35 andtube 36 interact near the edge oftube 36, which is adapted for that purpose by grinding.- It is understood that such cutting elements can be designed in any way known in the prior art.
- These and further modifications are considered to lie within the scope of the present application, to be immediately obvious to the person skilled in the art after reading the description, and to lie within the scope of the appended claims. For instance, it is possible to effect the supply of working fluid and the discharge of cleaning material in another way, i.e., to arrange the interior of housing4 slightly differently. Furthermore, the method described above can be used for the removal of other tissue material, such as prostate tissue through the urethra, or for the removal of tissue from the wall of the urinary bladder.
Claims (24)
1. A method comprising:
inserting a cutter into a lumen of an endoscope through a valve of the endoscope, the lumen having a longitudinal axis extending from the valve to a distal end portion of the endoscope, and
inserting the endoscope into a distensible organ.
2. The method ofclaim 1 further comprising introducing a fluid into the organ.
3. The method ofclaim 2 further comprising introducing the fluid through the endoscope.
4. The method ofclaim 1 further comprising cutting tissue with the cutter.
5. The method ofclaim 1 further comprising discharging fluid and cut tissue through the cutter.
6. The method ofclaim 1 further comprising providing a tube defining a lumen for receiving the endoscope.
7. The method ofclaim 6 further comprising discharging fluid through the tube.
8. The method ofclaim 1 wherein the cutter is inserted after the endoscope is inserted.
9. The method ofclaim 1 further comprising controlling pressure within the distensible organ.
10. The method ofclaim 1 wherein the valve comprises a shut-off valve.
11. The method ofclaim 1 wherein the endoscope comprises a viewing channel configured to enable a user to view an interior of the distensible organ.
12. The method ofclaim 11 wherein the endoscope further comprises a lens at an end of the viewing channel.
13. The method ofclaim 12 further comprising a camera coupled to the viewing channel for viewing the interior of the distensible organ.
14. A method comprising:
inserting a cutter into a distensible organ through a shut-off valve of an endoscope, the shut-off valve defining an opening for receiving the cutter, the opening being aligned with a longitudinal axis of the endoscope.
15. The method ofclaim 14 further comprising introducing a fluid into the organ.
16. The method ofclaim 15 further comprising introducing the fluid through the endoscope.
17. The method ofclaim 14 further comprising cutting tissue with the cutter.
18. The method ofclaim 14 further comprising discharging fluid and cut tissue through the cutter.
19. The method ofclaim 14 further comprising providing a tube defining a lumen for receiving the endoscope.
20. The method ofclaim 19 further comprising discharging fluid through the tube.
21. The method ofclaim 14 further comprising controlling pressure within the distensible organ.
22. The method ofclaim 11 wherein the endoscope comprises a viewing channel configured to enable a user to view an interior of the distensible organ.
23. The method ofclaim 22 wherein the endoscope further comprises a lens at an end of the viewing channel.
24. The method ofclaim 22 further comprising a camera coupled to the viewing channel for viewing the interior of the distensible organ.
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| US13/446,202US8893722B2 (en) | 1997-09-04 | 2012-04-13 | Surgical endoscopic cutting device and method for its use |
| US14/081,801US9089358B2 (en) | 1997-09-04 | 2013-11-15 | Surgical cutting device and method for its use |
| US14/493,017US9750520B2 (en) | 1997-09-04 | 2014-09-22 | Surgical endoscopic cutting device and method for its use |
| US14/744,611US9226650B2 (en) | 1997-09-04 | 2015-06-19 | Surgical cutting device and method for its use |
| US14/744,583US9226765B2 (en) | 1997-09-04 | 2015-06-19 | Surgical cutting device and method for its use |
| US14/951,941US9427247B2 (en) | 1997-09-04 | 2015-11-25 | Surgical cutting device and method for its use |
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| NL1006944ANL1006944C2 (en) | 1997-09-04 | 1997-09-04 | Surgical endoscopic cutting device. |
| NLPCT/NL98/00504 | 1998-09-04 | ||
| PCT/NL1998/000504WO1999011184A1 (en) | 1997-09-04 | 1998-09-04 | Surgical endoscopic cutting device and method for its use |
| US48697700A | 2000-03-06 | 2000-03-06 | |
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| US11/780,759Expired - Fee RelatedUS8061359B2 (en) | 1997-09-04 | 2007-07-20 | Surgical endoscopic cutting device and method for its use |
| US11/929,940AbandonedUS20080058588A1 (en) | 1997-09-04 | 2007-10-30 | Surgical endoscopic cutting device and method for its use |
| US11/929,938AbandonedUS20080058842A1 (en) | 1997-09-04 | 2007-10-30 | Surgical endoscopic cutting device and method for its use |
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| US14/081,801Expired - Fee RelatedUS9089358B2 (en) | 1997-09-04 | 2013-11-15 | Surgical cutting device and method for its use |
| US14/493,017Expired - Fee RelatedUS9750520B2 (en) | 1997-09-04 | 2014-09-22 | Surgical endoscopic cutting device and method for its use |
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| US14/951,941Expired - Fee RelatedUS9427247B2 (en) | 1997-09-04 | 2015-11-25 | Surgical cutting device and method for its use |
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Also Published As
| Publication number | Publication date |
|---|---|
| US9427247B2 (en) | 2016-08-30 |
| JP4172910B2 (en) | 2008-10-29 |
| US20150012023A1 (en) | 2015-01-08 |
| WO1999011184A1 (en) | 1999-03-11 |
| NL1006944C2 (en) | 1999-03-11 |
| US7249602B1 (en) | 2007-07-31 |
| EP0996375B1 (en) | 2006-03-15 |
| DE69833869T2 (en) | 2006-11-09 |
| DE69833869D1 (en) | 2006-05-11 |
| US20080058842A1 (en) | 2008-03-06 |
| US9089358B2 (en) | 2015-07-28 |
| JP2001514037A (en) | 2001-09-11 |
| US20080015621A1 (en) | 2008-01-17 |
| US20120197280A1 (en) | 2012-08-02 |
| US9226765B2 (en) | 2016-01-05 |
| US20160074058A1 (en) | 2016-03-17 |
| US8061359B2 (en) | 2011-11-22 |
| CA2302185A1 (en) | 1999-03-11 |
| US9750520B2 (en) | 2017-09-05 |
| AU746894B2 (en) | 2002-05-02 |
| US20150282829A1 (en) | 2015-10-08 |
| ATE320222T1 (en) | 2006-04-15 |
| EP0996375A1 (en) | 2000-05-03 |
| US8893722B2 (en) | 2014-11-25 |
| BR9812171A (en) | 2000-07-18 |
| US20140074136A1 (en) | 2014-03-13 |
| US9226650B2 (en) | 2016-01-05 |
| AU9007498A (en) | 1999-03-22 |
| US20150282698A1 (en) | 2015-10-08 |
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Legal Events
| Date | Code | Title | Description |
|---|---|---|---|
| AS | Assignment | Owner name:SMITH & NEPHEW, INC., TENNESSEE Free format text:ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:EMANUEL, MARK HANS;REEL/FRAME:020760/0379 Effective date:20000306 | |
| STCB | Information on status: application discontinuation | Free format text:EXPRESSLY ABANDONED -- DURING EXAMINATION |