Method for Radiofrequency Resection of Meniscus and Arthroscopic Instrument for Implementation thereof (Variants)

Abstract

A device for carrying out arthroscopic operations on the knee joints. The device includes handle, a proximal axial rotation control, and a distal linear movement control, a drainage tube and a power cable are connected to the proximal end, and extending from the distal end is an inner tube having an opening into which an electrode loop is inserted, and further having an aspiration opening oriented into a drainage channel.

Claims

1-19. (canceled)

20. A method for radiofrequency resection of meniscus carried out by a system of arthroscopic devices comprising an optical arthroscope and a radiofrequency energizer for connection to an arthroscopic cutting instrument, the method comprising the steps of: setting at least two arthroscopic ports into the knee joint being treated, inserting the optical arthroscope into one of the said arthroscopic ports, identifying an area of the meniscus damage, inserting the arthroscopic cutting instrument into the said knee joint through the other of the said arthroscopic ports, wherein the identified area of the meniscus damage is excised and evacuated from the above said knee joint, and the wounds are sutured, wherein the identified area of the meniscus damage is excised using the arthroscopic cutting instrument for radiofrequency resection of meniscus comprising an outer tube, an inner tube with a loop—electrode rigidly installed into the inner tube, and a handle provided with a starting device and a distal manipulator for the outer tube linear movement, the outer tube with the inner tube fixed therein is inserted into the knee joint being treated when the outer tube is at a closed position, then while transferring the outer tube into an open position, the meniscus resection procedure is carried out, on the resection procedure completion, the outer tube is returned to the closed position, and then it is taken from the knee joint, further the excised fragment of the meniscus is evacuated from the knee joint using an arthroscopic clamp, wherein transferring the outer tube with the inner tube fixed therein from the closed position to the open position and the reverse is carried out at linearly moving the outer tube with the use of the distal manipulator.

21. A method for radiofrequency resection of meniscus carried out by a system of arthroscopic devices comprising an optical arthroscope and a radiofrequency energizer suitable for connection to an arthroscopic cutting instrument, the method comprising the steps of: setting at least two arthroscopic ports are set into the knee joint being treated, inserting the optical arthroscope into one of the said arthroscopic ports, identifying an area of the meniscus damage, inserting the arthroscopic cutting instrument into the said knee joint through the other of the said arthroscopic ports, wherein the identified area of the meniscus damage is excised and evacuated from the above said knee joint, and the wounds are sutured, wherein the identified area of the meniscus damage is excised using the arthroscopic cutting instrument for radiofrequency resection of meniscus comprising an outer tube, an inner tube with a loop—electrode rigidly installed into the inner tube, and a handle provided with a starting device, a distal manipulator for the outer tube linear movement and a proximal manipulator for axial rotation of the inner tube inside the outer tube, in this case, the above said outer tube with the above said inner tube, installed therein with the possibility of axial rotation relative the outer tube, is inserted into the knee joint being treated when the outer tube is at its closed position, then while transferring the outer tube into the open position thereof, the meniscus resection procedure is carried out on imparting axial rotation to the inner tube with the loop-electrode rigidly installed therein, on the resection procedure completion, the outer tube is returned to its closed position, and then it is taken from the knee joint, further the excised fragment of the meniscus is evacuated from the knee joint using an arthroscopic clamp, wherein transferring the outer tube with the above said inner tube, installed therein with the possibility of axial rotation, from the outer tube closed position to the open position thereof and the reverse is carried out at linearly moving of the outer tube with the use of the distal manipulator, and the axial rotation of the inner tube with the loop-electrode rigidly installed therein is carried out with the use of the proximal manipulator.

22. An arthroscopic instrument for radiofrequency resection of meniscus, which is connected to an energizer and a drainage system, the arthroscopic instrument comprising: a handle including a start button; an outer tube located at an outer end of the handle; an inner tube inside the outer tube, the inner tube has an aspiration opening and an opening formed to install a loop-electrode therein, a drainage tube and a power cable located at a proximal end of the handle, wherein the loop-electrode is rigidly installed in the inner tube, the inner tube is fixed inside the outer tube, which is configured to be linearly displaced inside the handle distal end by a distal manipulator arranged on the handle, and the outer tube diameter is not more than 5 mm.

23. An arthroscopic instrument for radiofrequency resection of meniscus, which is connected to an energizer and a drainage system, the arthroscopic instrument comprising: a handle including a start button; an outer tube located at an outer end of the handle; an inner tube inside the outer tube, the inner tube has an aspiration opening and an opening formed to install a loop-electrode therein, a drainage tube and a power cable located at a proximal end of the handle, wherein the loop-electrode is rigidly installed in the inner tube, the inner tube with the loop-electrode rigidly installed therein is designed to axially rotate inside the outer tube by a proximal manipulator arranged on the handle, while the outer tube is configured to be linearly displaced inside the handle distal end by a distal manipulator arranged on the handle, and the outer tube diameter is not more than 5 mm.

Description

BRIEF DESCRIPTION OG THE DRAWINGS

[0046] The essence of the invention is illustrated by the following figures.

[0047] FIG. 1 shows the arthroscopic instrument for radiofrequency resection of the meniscus in the first embodiment.

[0048] FIG. 2 shows the distal end of the arthroscopic instrument for radiofrequency resection of the meniscus in the first embodiment, the top view.

[0049] FIG. 3 shows the distal end of the arthroscopic instrument for radiofrequency resection of the meniscus in the first embodiment, the side view.

[0050] FIG. 4 shows the distal end of the arthroscopic instrument for radiofrequency resection of the meniscus in the first embodiment, the front view.

[0051] FIG. 5 shows the distal end of the arthroscopic instrument for radiofrequency resection of the meniscus in the first embodiment with an aspiration tube, the top view.

[0052] FIG. 6 shows the distal end of the arthroscopic instrument for radiofrequency resection of the meniscus in the first embodiment with an aspiration tube, the side view.

[0053] FIG. 7 shows the distal end of the arthroscopic instrument for radiofrequency resection of the meniscus in the first embodiment with an aspiration tube, the front view.

[0054] FIG. 8 shows the arthroscopic instrument for radiofrequency resection of the meniscus in the first variant.

[0055] FIG. 9 shows the arthroscopic instrument for radiofrequency resection of the meniscus in the second variant.

[0056] FIG. 10 shows the distal end of the arthroscopic instrument for radiofrequency resection of the meniscus in the first and second variants, the top view.

[0057] FIG. 11 shows the distal end of the arthroscopic instrument for radiofrequency resection of the meniscus in the first and second variants in the open position, the side view.

[0058] FIG. 12 shows the distal end of the arthroscopic instrument for radiofrequency resection of the meniscus in the first and second variants in the closed position, the side view.

[0059] FIG. 13 shows the distal end of the arthroscopic instrument for radiofrequency resection of the meniscus in the first and second variants, the front view. (This is Replacement Page 6).

[0060] FIG. 14 shows the distal end of the arthroscopic instrument for radiofrequency resection of the meniscus in the first and second variants with an aspiration tube, the top view.

[0061] FIG. 15 shows the distal end of the arthroscopic instrument for radiofrequency resection of the meniscus in the first and second variants with an aspiration tube, the side view, in the open position

[0062] FIG. 16 shows the distal end of the arthroscopic instrument for radiofrequency resection of the meniscus in the first and second variants with an aspiration tube, the side view, in the closed position.

[0063] FIG. 17 shows the distal end of the arthroscopic instrument for radiofrequency resection of the meniscus in the first and second variants with an aspiration tube, the front view.

[0064] FIG. 18 shows the arthroscopic instrument for radiofrequency resection of the meniscus in the first and second variants in the open position, which is located in the cavity of the knee joint and arranged close to the damaged area of the meniscus.

[0065] FIG. 19 shows the arthroscopic instrument for radiofrequency resection of the meniscus in the first and second variants in the open position, rotated 90 degrees to the right, which is located in the joint cavity and arranged close to the damaged area of the meniscus.

[0066] FIG. 20 shows the cavity of the knee joint with one separate damaged fragment resected from the meniscus.

[0067] FIG. 21 shows the evacuating procedure of the meniscus resected damaged fragment with the use of an arthroscopic clamp.

DETAILED DESCRIPTION OF THE INVENTION

[0068] The first embodiment (FIG. 1) of the claimed arthroscopic instrument consists of handle 1 having “start” button 2 on the surface thereof, at the distal end of the handle, there is inner tube 3 extending therefrom. The above said inner tube has aspiration opening 4 and opening 5 with changeable loop-electrode 6 arranged therein. The handle has drainage tube 7 and power cable 8 attached to the proximal end thereof. To improve the removal of bubbles arising during operation, aspiration tube 9 can be additionally set into aspiration opening 4 in a position adjacent to the electrodes of loop-electrode 6, which fact, in turn, improves visualization of the surgical area. At the same time, the diameter of the inner tube does not exceed 5 mm, making it possible to carry out actions in a narrow joint cavity. The arthroscopic instrument is connected to a radiofrequency energizer (not shown), which, in turn, is connected to a public main having a voltage of 100 to 220 V. The arthroscopic instrument operates in conductive solutions. In most cases, for joint surgery, 0.9% NaCl is used.

[0069] The arthroscopic instrument is made of materials that are resistant to temperature, corrosion and abrasion. The materials in contact with energy-conducting elements are dielectrics.

[0070] Handle 1 and inner tube 3 can be made of either plastic or metal, and they can be made both single-use and suitable for re-sterilization and reutilization.

[0071] The arthroscopic instrument can be made in a monopolar configuration, further requiring the use of a return electrode that is placed in contact with the patient's body.

[0072] In the first variant (FIG. 8), the arthroscopic instrument comprises distal manipulator 10 of linear motion, which is arranged on handle 1 distal of “start” button 2, and outside inner tube 3, there is outer tube 11 with tip 12 beveled at an angle.

[0073] Outer tube 11 can be set in its open position (FIG. 11, FIG. 15) and in its closed one (FIG. 12, FIG. 16). When in closed position, outer tube 11 externally covers inner tube 3, which contains loop-electrode 6 therein, and protects the joint tissue and loop-electrode 6 itself from damage. When in the open position, inner tube 3 and loop-electrode 6 protrude from the outer tube sufficiently for ensuring full access to the “target tissue”.

[0074] Tip 12 of outer tube 11 has a configuration beveled at an angle of 30 to 60 degrees, thereby reducing trauma at introducing the arthroscopic instrument into a joint cavity. At the same time, the diameter of the outer tube does not exceed 5 mm, making it possible to carry out actions in a narrow joint cavity.

[0075] The surface of distal manipulator 10 can be made with stiffening ribs 13 to improve the strength of the contact with the surgeon's hand and increase comfort when working with such an instrument.

[0076] Distal manipulator 10 can be made of both plastic and metal, which are resistant to temperature, corrosion and abrasion.

[0077] In the second variant (FIG. 9), on handle 1, proximal of “start” button 2, the arthroscopic instrument comprises proximal manipulator 14 to provide axial rotation of inner tube 3. Using the above said manipulator, a surgeon provides for rotation of inner tube 3 containing loop-electrode 6 around its axis. This, in turn, increases the functionality of the arthroscopic instrument, ensuring the possibility to monitor and control a cutting line and create comfortable conditions when using such an instrument.

[0078] Proximal manipulator 14 can be made of both plastic and metal, which are resistant to temperature, corrosion and abrasion.

[0079] The surface of proximal manipulator 14 can be configured to have stiffening ribs 13 to improve the strength of the contact with a surgeon's hand and increase the comfort when working with such an instrument.

[0080] The method of radiofrequency resection of the meniscus is carried out as follows.

[0081] The method is carried out using a system of arthroscopic devices: an arthroscope, radiofrequency energizer, drainage system and other arthroscopic devices (shaver, ablator, arthroscopic clamp 15, etc.), and arthroscopic instrument 16 for radiofrequency resection of the meniscus. The system is designed to work in an electrically conductive liquid. For operations on joints, most often 0.9% NaCl is used.

[0082] The energizer-instrument system is designed to transmit radiofrequency oscillations to loop-electrode 6, arranged at the distal end of inner tube 3 of the arthroscopic instrument. Energy flows between the forward and backward parts of loop-electrode 6, which are located in a bipolar configuration. This creates a controlled, focused energy field to create plasma.

[0083] Under anesthesia, after processing the surgical field, arthroscopic ports are installed, into one of those ports, an arthroscope is inserted, and into the other port, there is arranged the arthroscopic instrument for radiofrequency resection of the meniscus when the outer tube (FIG. 12, FIG. 16) is in its closed position, and as soon as the instrument has been already located in the joint cavity, it is transferred to the open (FIG. 11, FIG. 15) position (according to the first and second variants of the instrument). After identification of damaged area 17 of the meniscus, while electrode-loop 6 is approaching the “target tissue”, which is meniscus 18 of the knee joint, the process of molecular dissociation occurs. The state of plasma minimizes damage to the surrounding tissues of the surgical field, and the energy of radio-frequency oscillations, due to the shape of loop-electrode 6, takes an a form of a “blade”, which allows carrying out high-precision discission 19 of the meniscus tissue, prevents excessive destruction of the meniscus tissue and surrounding tissues, as well as deformation of the meniscus. After performing the resection, the instrument is transferred to its closed position (FIG. 12, FIG. 16) (according to the first and second variants of the instrument) and removed from the joint. As a result, this configuration of the instrument allows obtaining one dissected fragment 20 of the meniscus, which can be evacuated from the joint cavity in full using an arthroscopic clamp 16 or destroyed using a shaver or ablator.

[0084] When provided with such an arthroscopic instrument, the resource of surgical support increases by reducing the need for the use of such instruments as a shaver, a cutting device, and an ablator.

[0085] An example of the implementation of the method.

[0086] Under anesthesia, after processing the surgical field with an antiseptic, two ports are installed into the knee joint in traditional places. A camera is inserted into the first port, and an arthroscopic instrument is inserted into the second port when the distal end of inner tube 3 (FIG. 12, FIG. 16) is in the closed position. After introducing the instrument, the distal end of inner tube 3 is moved to the open position by turning distal manipulator 10 (FIG. 11, FIG. 15). The damaged area 17 of the meniscus is identified. Resection of the damaged area 17 of the meniscus is carried out by pressing “start” button 2, this action entails transferring of high-frequency energy to loop-electrode 6 and forming localized plasma on the surface thereof. On bringing loop-electrode 6 closer to the surface of meniscus 18 and controlling the plane by loop-electrode 6 arrangement relative to the surface of meniscus 18 with the help of proximal manipulator 14, a high-precision discission 19 is made, as a result of which one resected damaged meniscus fragment 20 is obtained (FIG. 20). By turning distal manipulator 10, the distal end of inner tube 3 is transferred to the closed position, and the instrument is removed from the joint. The resected damaged fragment 20 is evacuated from the knee joint with an arthroscopic clamp 15 (FIG. 21). With the help of an aspiration system, aspiration opening 4 or aspiration tube 9, bubbles and low molecular weight products of decomposition arising from the process of molecular dissociation of the meniscus tissue are evacuated from the joint, improving the visualization of the surgical field.

[0087] The claimed arthroscopic instrument increases the resource of surgical support for arthroscopic operations, in particular, reduces the need to replace the instrument inserted into the joint, since it functions as a cutting device and an ablator at the same time, it significantly reduces the need to repeat resection cycles, and that is why, the level of trauma of the joint tissues, and also it increases resection accuracy. Target tissue resection process is possible due to molecular dissociation during transmission of radiofrequency energy to the target tissue in the form of plasma, at its volume controlled using an energizer console. The shape of the blade in the form of a loop increases the accuracy of the resection of the target tissue, which gives the ability to control the quality of the resection procedure more effectively. At the instrument distal end, the outer tube protects the inner tube, which includes a loop-electrode in it, from the mechanical contact with soft tissues when the instrument is in the joint.

[0088] The instrument can be made disposable due to the simplicity of the design. This negates the need to waste additional resources for re-sterilization, and essentially eliminates the need in using lots of types of arthroscopic cutting devices, which gradually grow blunt, worn out, and require storage and re-sterilization.

[0089] The dimensions of the astroscopic instrument, namely, the diameter of the distal end of the instrument and the tubes thereof are adapted to the size of an arthroscopic port and do not exceed 5 mm.

[0090] The claimed instrument has improved visualization during surgery, since, in contrast to a cutting device, because of resection, the amount and volume of the dissected parts of the target tissue decreases, which event facilitates the procedure of their evacuation and improves visualization. In this case, the visualization is also improved due to the availability of an aspiration channel for aspiration of bubbles arising because of the process of molecular dissociation.