US3835842A - Endoscope with continuous irrigation - Google Patents

Abstract

Urological endoscopic instruments known before this invention do not permit continuous clear vision of the operative field because such vision is periodically obscured by the turbid fluid produced at the operative field. The invention produces continuous clear vision of the operative field by causing continuous inflow of clear irrigating fluid to the operative field and continuous outflow of turbid fluid from the operative field, thus providing a continuously flowing system which is provided by two conduits, one for inflowing clear fluid having its outflow port within the beak of the sheath and below and in front of the objective lens of the telescope which forms part of the instrument, and one for turbid outflowing fluid from the operative field having its inlet port in the exterior of the sheath above the objective lens and to the rear of the beak, so that the inflowing clear fluid must pass through the operative field to reach the inlet port of the outflow conduit, the outflow of fluid being maintained by suction applied to the outflow conduit.

Description

United States Patent [191 [111 3,835,842 Iglesias Sept. 17, 1974 1 ENDOSCOPE WITH CONTINUOUS Primary ExaminerLucie H. Laudenslager IRRIGATION [76] Inventor: Jose J. Iglesias, 1341 North Ave.,

Elizabeth, NJ. 07208 [22] Filed: Sept. 20, 1973 [21] Appl. No.: 399,197

Related US. Application Data [63] Continuation-in-part of Ser. No. 268,806, July 3, 1972, and a continuation-in-part of Ser. No. 368,186, June 8, 1973.

52 U.s. ci... .l 128/7, 123/3015 [51] Int. Cl A6lb 1/30 [58] Field of Search 128/4, 6, 7, 240, 241, 128/303.15

[56] References Cited UNITED STATES PATENTS 1,184,970 5/1916 Larssen 128/240 2,038,393 4/1936 Wappler 128/7 2,494,088 1/1950 Dulity 128/240 3,720,203 3/1973 Brown 128/4 5 7 ABSTRACT Urological endoscopic instruments known before this invention do not permit continuous clear vision of the operative field because such vision is periodically obscured by the turbid fluid produced at the operative field. The invention produces continuous clear vision of the operative field by causing continuous inflow of clear irrigating fluid to the operative field and continuous outflow of turbid fluid from the operative field, thus providing a continuously flowing system which is provided by two conduits, one for inflowing clear fluid having its outflow port within the beak of the sheath and below and in front of the objective lens of the telescope which forms part of the instrument, and one for turbid outflowing fluid from the operative field having its inlet port in the exterior of the sheath above the objective lens and to the rear of the beak, so that the inflowing clear fluid must pass through the operative field to reach the inlet port of the outflow conduit, the outflow of fluid being maintained by suction applied to the outflow conduit.

13 Claims, 12 Drawing Figures Jillll PAIENTEDSEP! 1:924

SHEET Z (If 5 PATENIEU SEP 1 11974 SHEET 5 BF 5 ENDOSCOPE WITH CONTINUOUS IRRIGATION RELATION TO OTHER CASES OF OTHER CASES This application is a continuation-in-part of my copending applications Ser. No. 268,806, filed July 3, 1972 for Resectoscope With Continuous Irrigation, and Ser. No. 368,186, filed June 8, 1973, for Endoscope With Continuous Irrigation.

DESCRIPTION OF THE DRAWINGS FIG. 1 is a side view, partly in section, of a resectoscope according to the prior art;

FIG. 2 is a sectional view taken on line 2-2 of FIG.

FIG. 3 is a side view, partly in section, showing one embodiment which the invention may take, the part in section being enlarged to more clearly disclose the internal structure of the instrument;

FIG. 4 is a sectional view taken on line 4-4 of FIG.

FIG. 5 is a side view, partly in section and similar to FIG. 3, showing a second embodiment of the invention;

FIG. 6 is a sectional view taken on line 6-6 of FIG.

FIG. 7 is a side view, partly in section and similar to FIGS. 3 and 5, showing another embodiment of the invention;

FIG. 8 is a sectional view taken on line 8-8 of FIG.

FIG. 9 is a perspective view of parts shown in FIGS. 7 and 8;

FIG. 10 is a side view, partly in section and similar to FIGS. 3, 5 and 7, showing a fourth embodiment of the invention;

FIG. 11 is a sectional view taken on line I111 of FIG. 10; and,

FIG. 12 is a perspective view of the cutting loop assembly illustrated in FIG. 10.

BACKGROUND OF THE INVENTION Endoscopic instruments are widely used in urology and are introduced through the urethra to perform various operative procedures at the operative field such as the bladder, prostate or urethra, typical instruments being the resectoscope, urethro-cystoscope, lithotriptor, and biopsy endoscopic forcep.

In this specification the invention will be described in specific connection with the endoscopic instrument known as the resectoscope, which is the most complex urological instrument, but this is for illustration only as the invention is applicable to all urological endoscopic instruments.

A resectoscope is an endoscopic instrument for the transurethral resection of pathological tissues from the prostate or bladder without incision. A resectoscope of known and conventional construction is disclosed in FIGS. 1 and 2 as background for disclosure of the invention, and comprises thetubular sheath 2 which pro-. vides a passageway through the human urethra to the area of visual and operative interest, and which has abeak 4 at its distal end the shape of which is such that the side walls thereof recede in the proximate direction from the upper part of the distal end of the beak to the lower part. At its proximate end the sheath has asocket base 6 at which there is atube 8 withstopcock 10 for the introduction of clear irrigating fluid, athumb screw 12 for attaching the sheath s socket to the workingelement 14 for activating the cutting electrode in performing an operation. Within the sheath are thetelescope 16, the cuttingloop electrode assembly 18, and anoutflow conduit 20.

The telescope has anobjective lens 22 at its distal end and an ocular lens (not shown) andeyepiece 24 at its proximal end. Light conductors (not shown) extend through the telescope from anexternal connection 26 to the distal end for providing illumination.

The cuttingloop electrode assembly 18 comprises the elongatedhollow stem 28 from the distal end of which there protrude the twoparallel arms 30 which are connected at their distal ends by a depending semicircular barewire cutting loop 32 which is activated by high frequency electrical energy to resect pathological tissues and coagulate bleeding vessels. Thestem 28 andarms 30 transmit reciprocating movement of theworking element 14 to the cutting loop.

The workingelement 14 is connected bybridge member 32 to the cuttingloop assembly stem 28 through thesocket base 6 and may be moved toward and away from the socket base onrunners 34 against the force ofspring 36 by the surgeons operation ofthumb holder 38, which movement is transmitted to the cutting loop throughstem 28.

In transurethral operative procedures there must be a fluid medium at the operative field, and proper visualization requires the presence of a clear fluid medium between the objective lens of the telescope and the tissues being observed. In known resectoscopes this is intended to be provided by the inflow of more than 300 c.c. per minute of clear fluid through the sheath which is delivered by gravity from a reservoir which is elevated more than 50 cm. above the bladder, and is controlled at thetube 8 bystopcock 10. However, blood is produced by the resected tissues, making a turbid bloody medium at the operative field with consequent obscuring of the field and dangerous over-distention of the bladder. At this point the surgeon must stop the operation and remove the working element from the sheath in order to empty the turbid bloody fluid from the bladder through the sheath, which remains in place within the urethra. This procedure causes the fluid at the operative field to flood through the sheath, drenching the surgeon and the adjacent area of the operating theater, and this undesirable occurrence has become a conventional and expected feature of present transurethral operations. This interruption of the surgical procedure must be performed frequently when known resectoscopes are used, and these periodic interruptions produce dangerous difficulties such as temporary loss of visual orientation, prolonged bleeding and extended operative time. To avoid these frequent interruptions some surgeons attempt to maintain a clear medium at the operating field for a longer time by increasing the volume of clear fluid inflow by raising the exterior reservoir. This practice increases the intravesical hydrostatic pressure, over-distending the bladder and making possible dangerous complications when the intravesical pressure exceeds 30 cm. of water, which is the critical pressure for the absorption of the irrigant fluid into the circulatory system, producing the dangerous and sometimes fatal hypervolemic syndromes.

In an attempt to relieve over-distention of the bladder during an operative procedure, an outflow conduit such as that shown at 20 in FIG. 1 has sometimes been provided within the sheath of known resectoscopes, and therefore within the inflow conduit which is provided by the sheath, having its distal or inlet end spaced a considerable distance proximate to the distal end of the sheath and the objective lens of the telescope, and

at its proximate end is connected to discharge through a lateral outlet (not shown). When the intravesical pressure increases, a part of the clear fluid inflow is drained through this outflow conduit thus preventing over-distension of the bladder. The turbid fluid from the operative field never reaches the inlet of such an outflow conduit because it cannot pass through the re gion of higher hydrostatic pressure of the inflowing clear fluid in the sheath, and part of the inflowing clear fluid in the sheath is therefore drained through the outflow conduit and never reaches the operative field in front of the lens. When such an outflow conduit is provided the net result is a reduction of the inflow rate, which has an adverse effect on the visibility in front of the lens, and the clear fluid which is drained before reaching the end of the sheath is entirely ineffective and is wasted. This explains why every time the stopcock of the outflow conduit is opened only a. clear inflow fluid is drained, and is the reason why several modern resectoscopes have eliminated this outflow conduit.

SUMMARY OF THE INVENTION An endoscopic urological instrument according to the invention has continuous clear vision of the operative field caused by continuous inflow of clear irrigating fluid to the operative field and simultaneous continuous outflow of turbid fluid from the operative field. This is done by providing two separate conduits within the sheath of the instrument through one of which clear irrigating fluid is constantly supplied to the operative field and through the other of which turbid fluid is constantly removed from the field under the influence of suction. The outlet port of the inflow conduit is within the beak of the sheath and below and in front of the objective lens of the telescope which forms part of the instrument, and the inlet port of the outflow conduit opens from the exterior of the sheath above and to the rear of the objective lens and to the rear of the beak, so that clear fluid flowing through the inflow conduit is compelled to pass in front of the lens and into the operative field before reaching the entrance to the outflow conduit. The two conduits are of substantially the same size to permit substantially equal fluid flows and the continuous flow of clear and turbid fluids is maintained by suction applied to the outflow conduit.

DESCRIPTION OF THE INVENTION A resectoscope constructed in accordance with the invention is disclosed in FIGS. 3 and 4. In this instrument theoutflow conduit 40 is provided in the upper wall of thesheath 2, being formed by apart 42 of the upper wall of the sheath and alower wall 44 which is spaced below thewall part 42. At its proximal end, at thesocket base 6,conduit 40 communicates with a source of suction throughexternal tube 48 which is controlled bystopcock 50. In the disclosedembodiment tube 48 communicates with adisposal container 52 throughflexible tube 54 andclosure 56, and apump 58 exhausts thecontainer 52 thus applying suction tooutflow conduit 40. Theoutflow conduit 40 is closed at its distal end as shown at 60 and the inlet to this conduit from the operative field is provided by one ormore ports 62 in the upper wall of the sheath which are above and to the rear of theobjective lens 22 of the telescope and to the rear of thebeak 4. The second orinflow conduit 46 is formed by the interior of the sheath itself. The distal or outflow port of this conduit is open and within thebeak 4 and below and in front of the objective lens of the telescope. At its proximate end this conduit communicates with anexternal tube 8 andstopcock 10 through which clear irrigating fluid is supplied to the operative field through the interior of the sheath. The two conduits are of such size that they conduct substantially equal flows of fluid, and it will be apparent that by manipulation ofstopcocks 10 and 50 the inflow of clear fluid throughconduit 46 and the outflow of turbid fluid throughconduit 40 may be adjusted and controlled, thus also controlling the degree of distention of the bladder.

In order to accommodate theupper conduit 40 and permit it to be of sufficient size, the telescope tube I6 is lowered from its conventional position at the upper part of the sheath and made concentric with the sheath as shown in FIG. 4, thus enlarging the space available forconduit 40.

In a second form of resectoscope which the invention may take, which is disclosed in FIGS. 5 and 6, one of the two conduits is provided by a tube which surrounds the telescope tube but is larger in cross section, and the second conduit is provided by the space within the sheath and outside the tube which provides the first conduit. In this embodiment thetelescope 16 is surrounded throughout substantially its entire length by a second tube which engages the bottom and sides of the telescope and thespace 72 between the upper part of the telescope and the upper part oftube 70 provides the outflow conduit, which is connected at thesocket base 6 to a source of suction throughexternal tube 48 andstopcock 50 as disclosed in FIG. 3. Theoutflow conduit 72 is closed at its distal end as shown at 74 and the inlet to this conduit is provided by registeringports 76, 78 in the upper wall of thesheath 2 and the upper wall oftube 70, which are to the rear of and above the objective lens of the telescope. The inflow conduit is provided by thespace 80 within thesheath 2 and outside thetube 70 and this conduit communicates throughexternal tube 8 andstopcock 10 with a source of clear irrigating fluid. The outlet port of this inflow conduit, at the distal end thereof, is within the beak of the sheath and below and in front of the objective lens of the telescope, and the two conduits are of such size that they conduct substantially equal flows of fluid.

A further embodiment of the invention is disclosed in FIGS. 7, 8 and 9. In this embodiment thetelescope tube 16 is positioned at the upper part of thesheath 2 and is surrounded throughout substantially all of its length by a tube which is semi-circular in cross section with itsarcuate wall 92 adjacent or abutting the inner wall of the upper part of the sheath and its flatlower wall 94 lying substantially in the center of the cross section of the sheath.Tube 90 is larger in cross section than the telescope tube and thefree space 96 within it provides the outflow conduit according to the invention, while theinflow conduit 98 is provided by the space within the sheath and beneathtube 90. At its distal end theoutflow conduit 96 is closed by awall 100 and the inlet to this conduit is provided by one or more pairs of registeringopenings 102, 104 in the upper wall of the sheath and theupper wall 92 oftube 90, respectively, which are to the rear of the beak of the sheath and above and to the rear of the objective lens of the telescope. The distal end of theinflow conduit 98 is within the beak of the sheath and below and in front of the objective lens of the telescope. At its proximate end, at the socket base, theoutflow conduit 96 is connected throughexternal tube 48 andstopcock 50 to the source of suction as shown in FIG. 3, and at its proximate end the inflow conduit is connected throughexternal tube 8 and stopcock to the source of inflowing clear fluid which is maintained more than 50 cm. above the level of the bladder. The two conduits are of such size that they conduct substantially equal flows of fluid.

In a further form which the invention may take, which is disclosed in FIGS. 10 to 12, afine metal tube 110 extends longitudinally within thesheath 2 and surrounds thetelescope 16 and the stem and arms of the cuttingloop assembly 18 and is larger than these parts in cross section, whereby the interior of the tube forms theinflow conduit 112 of the instrument. This tube is smaller in cross sectional area than the sheath, leaving aspace 114 between the tube and the sheath which forms the outflow conduit. Thetube 110 is cylindrical in shape at its distal end and proximal to this cylindrical part the sides of its lower part converge downwardly to provide a generally triangular shape as shown at 116 in FIG. 11 in order to increase the capacity of theoutflow conduit 114.

At its proximal end at thesocket base 6 of the instrument the inflow conduit provided by the interior oftube 110 communicates withexternal tube connection 8 through which clear irrigating fluid is provided to the operative field. At the distal end of the instrument theoutflow conduit 114 is closed by aring 118 which extends radially from the circular exterior wall of thetube 110 to the interior wall of thesheath 2, thus closing the distal end of theoutflow conduit 114, the inlet to which is provided by two ormore openings 120 in thesheath 2 adjacent the distal end thereof, which are to the rear of the objective lens of the telescope. At its proximal end at the socket base the outflow conduit] 14 communicates with a source of suction throughexternal tube 48, and turbid fluid from the operative field is discharged through this external tube connection to the disposal container, the discharge being accelerated by suction to compensate the difference of pressure between the inflow pressure cm. of water) and the intravesical pressure below 30 cm., avoiding the accumulation of turbid fluid in the bladder. At its distal end theinflow conduit 112 is open and within the beak and is below and in front of the objective lens of the telescope.

In the preferred form of this embodiment of the invention the closure at the distal end of the outflow conduit is provided by causing the interior wall of the sheath to converge slightly from its proximate end to the distal end, the difference in diameters at the two ends being of the order of 1 mm. The exterior diameter of theclosure ring 118 is made equal to the interior diameter of the sheath at its distal end so that when the tube and itsclosure ring 118 are inserted into the sheath from the proximate end thereof the insertion will be stopped by engagement of the periphery of theclosure ring 118 with the smaller end of the sheath at the distal end thereof, thereby providing the required closure of the outflow conduit. The parts are so constructed that this engagement of the closure ring with the interior of the sheath will take place at a point in front of, Le, on the distal side of, the ports which provide the inlet to the outflow conduit.

Thetube 110 surrounds thestem 20 and thearms 30 of the cuttingloop assembly 18 as well as thetelescope 16. In accordance with the invention thearms 30 of the cutting loop assembly are elongated by approximately 2 centimeters with respect to the length of the arms of the conventional cutting loop assembly and because of this elongation thebare cutting wire 32 of the cutting loop assembly is positioned outside the distal end oftube 110 in the normal, un-extended position of the cutting loop assembly, and as the cutting loop assembly is operated thearms 30 are stabilized by sliding engagement with the inner walls oftube 110 as illustrated in FIG. 11. In order to support and further stabilize the cutting loop assembly a short tube is mounted on the distal end ofstem 20 and surrounds the distal end of thetelescope tube 16 and slides along that tube when the cutting loop assembly is reciprocated in performing an operation.

In accordance with the invention the parts are so designed and constructed that the inflow and outflow conduits are of substantially the same size so that they will conduct substantially the same volume of fluid per unit of time, thus permitting the continuous inflowoutflow fluid system which is provided for the first time by this invention, and the outflow conduit is subjected to suction in the manner and with the results described above.

In further accordance with the invention the arrangement of the parts of the instrument is such that the outlet port of the inflow conduit and the inlet port of the outflow conduit are separated in space, with the objective lens of the telescope and the operative field itself in the path of flow of fluid from the inflow conduit to the outflow conduit so that clear inflowing fluid is constantly in front of the objective lens, giving continuous clear vision.

The application of the invention to cystoscopes other than resectoscopes will be apparent to urological surgeons and others skilled in the arts to which the invention relates, and will usually involve the choice of which of the two conduits is to be used for inflow or outflow.

I claim:

1. A urological endoscopic instrument, comprising an elongated cylindrical beaked sheath, a telescope extending longitudinally and interiorly of the sheath and having an objective lens at its distal end, an inflow conduit extending longitudinally and interiorly of the sheath having its discharge port below and in front of the objective lens and within the beak of the sheath, an external fluid conducting connection at the proximate end of the inflow conduit for connection to a source of clear irrigating fluid, an outflow conduit extending longitudinally and interiorly of the sheath and having an inlet port provided by at least one opening from the outside of the sheath above and to the rear of the objective lens and to the rear of the beak, and means for applying suction to the outflow conduit.

2. An instrument according to claim 1, in which the two conduits are of substantially the same size to conduct substantially the same volume of fluid.

3. An instrument according to claim 1, in which the inflow conduit is formed by the interior of the sheath and the outflow conduit is formed by the space between the upper wall of the sheath and a second wall spaced radially inwardly of the sheath therefrom.

4. An instrument according to claim 3, in which the distal end of the outflow conduit is closed and the inlet to the outflow conduit is provided by a port in the upper wall of the sheath adjacent its distal end which communicates with the outflow conduit.

5. An instrument according to claim 1, in which the telescope and the sheath are concentric.

6. An instrument according to claim 1, comprising a tube extending longitudinally and interiorly of the sheath and surrounding the telescope and being larger than the telescope and smaller than the sheath in cross section, the outflow conduit being provided by the inte rior space of the tube and the inflow conduit being provided by the space between the tube and the sheath.

7. An instrument according toclaim 6, in which the lower part of the tube engages the lower part of the telescope and the outflow conduit is provided by the space between the upper part of the telescope and the upper part of the tube.

9. An instrument according toclaim 6, comprising in addition a closure between the distal end of the tube and the interior wall of the sheath, and at least one opening in the sheath proximate to the closure forming an inlet for the outflow conduit.

10. An instrument according to claim 1, comprising a tube extending longitudinally and interiorly of the sheath and surrounding the telescope and being larger than the telescope and smaller than the sheath in cross section, the inflow conduit being provided by the interior space of the tube and the outflow conduit being provided by the space between the tube and the sheath.

11. An instrument according to claim 10 comprising in addition a closure between the distal end of the tube and the interior wall of the sheath and at least one opening in the sheath proximate to the closure forming an inlet for the outflow conduit.

12. An instrument according toclaim 10, in which the walls of the tube forming the inflow conduit converge downwardly throughout at least a part of their length whereby to increase the cross sectional area of the outflow conduit between the tube and the sheath.

13. An instrument according toclaim 10, in which the interior wall of the sheath converges from the proximal to the distal end of the sheath, and at the distal end the internal diameter of the sheath is substantially equal to the external diameter of the closure.

Claims (13)

1. A urological endoscopic instrument, comprising an elongated cylindrical beaked sheath, a telescope extending longitudinally and interiorly of the sheath and having an objective lens at its distal end, an inflow conduit extending longitudinally and interiorly of the sheath having its discharge port below and in front of the objective lens and within the beak of the sheath, an external fluid conducting connection at the proximate end of the inflow conduit for connection to a source of clear irrigating fluid, an outflow conduit extending longitudinally and interiorly of the sheath and having an inlet port provided by at least one opening from the outside of the sheath above and to the rear of the objective lens and to the rear of the beak, and means for applying suction to the outflow conduit.

2. An instrument according to claim 1, in which the two conduits are of substantially the same size to conduct substantially the same volume of fluid.

3. An instrument according to claim 1, in which the inflow conduit is formed by the interior of the sheath and the outflow conduit is formed by the space between the upper wall of the sheath and a second wall spaced radially inwardly of the sheath therefrom.

4. An instrument according to claim 3, in which the distal end of the outflow conduit is closed and the inlet to the outflow conduit is provided by a port in the upper wall of the sheath adjacent its distal end which communicates with the outflow conduit.

5. An instrument according to claim 1, in which the telescope and the sheath are concentric.

6. An instrument according to claim 1, comprising a tube extending longitudinally and interiorly of the sheath and surrounding the telescope and being larger than the telescope and smaller than the sheath in cross section, the outflow conduit being provided by the interior space of the tube and the inflow conduit being provided by the space between the tube and the sheath.

7. An instrument according to claim 6, in which the lower part of the tube engages the lower part of the telescope and the outflow conduit is provided by the space between the upper part of the telescope and the upper part of the tube.

8. An instrument according to claim 6, in which the tube is substantially semicircular in cross sectional shape, and the outflow conduit is provided by the space between the telescope and the sides of the tube.

9. An instrument according to claim 6, comprising in addition a closure between the distal end of the tube and the interior wall of the sheath, and at least one opening in the sheath proximate to the closure forming an inlet for the outflow conduit.

10. An instrument according to claim 1, comprising a tube extending longitudinally and interiorly of the sheath and surrounding the telescope and being larger than the telescope and smaller than the sheath in cross section, the inflow conduit being provided by the interior space of the tube and the outflow conduit being provided by the space between the tube and the sheath.

11. An Instrument according to claim 10, comprising in addition a closure between the distal end of the tube and the interior wall of the sheath and at least one opening in the sheath proximate to the closure forming an inlet for the outflow conduit.

12. An instrument according to claim 10, in which the walls of the tube forming the inflow conduit converge downwardly throughout at least a part of their length whereby to increase the cross sectional area of the outflow conduit between the tube and the sheath.

13. An instrument according to claim 10, in which the interior wall of the sheath converges from the proximal to the distal end of the sheath, and at the distal end the internal diameter of the sheath is substantially equal to the external diameter of the closure.

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