Medical Instrument for Minimally Invasive Therapy, Comprising at Least Two Separate Suction Lines

Abstract

Disclosed is a medical instrument for use in minimally invasive therapy that generates, by at least two independent devices, an aspiration that advantageously causes the stability of the distension and the viewing conditions by adjusted flow rates.

Claims

1. A medical instrument for flushing cavities in minimally invasive surgery, comprising (i) a storage container (1) for the flushing liquid, (ii) a supply line (2) for supplying flushing liquid into the body cavity (11), (iii) a controlled pump (3) for liquid supply, (iv) a controlled first negative-pressure pump (4), (v) a controlled second negative-pressure pump (5), (vi) a first medical instrument (6) with a first suction line (7), (vii) a second medical instrument (8) with a second suction line (9), (viii) a waste container (10) connected to the first suction line (7) and the second suction line (9).

2. The medical instrument of claim 1, characterized by that the waste container (10) is connected by the line (12) to the first suction line (7), the second suction line (9), and the controlled second negative-pressure pump (5).

3. The medical instrument of claim 1 or 2, characterized by that the controlled pump (3) for liquid supply is a roller wheel pump.

4. The medical instrument of claim 1, 2, or 3, characterized by that the controlled first negative-pressure pump (4) and/or the controlled second negative-pressure pump (5) is a roller wheel pump.

5. The medical instrument of a least one of claims 1 to 4, characterized by that the controlled first negative-pressure pump (4) and/or the controlled second negative-pressure pump (5) are different.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0040] FIG. 1 provides an illustration of an embodiment of a medical instrument for minimally invasive therapy which includes two separate suction lines.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

[0041] The present invention will be explained in more detail with reference to the following examples, without any limitation being intended by the examples. The person skilled in the art can develop, based on the present descriptions and his or her skills in this field, further embodiments of the invention, without inventiveness being required.

[0042] A possible configuration of the pump devices and of the cavity may be such that the inflow pump is connected via a supply line to the endoscope for viewing the cavity, and to the outflow roller wheel is connected, on the negative-pressure side, an RF instrument as well as a medical instrument with moving blades (e.g., a shaver) that can be controlled by a pinching device or a valve for the individual tube. The pump device generating a negative pressure is directly connected via the negative-pressure vessel to the cavity (third suction line, see the end of this section). The outflow roller wheel is also connected, on the positive pressure side, to the negative-pressure vessel that serves as a collection vessel and that correspondingly can be designed sufficiently large so that, during a typical procedure, there is no need to replace or empty it. The suction branch at the roller wheel is closed in operation and standstill so that the negative pressure is not affected by the operating condition of the roller wheel. The two suction lines at the outflow roller wheel can be individually occluded by pinching devices so that the following conditions [0043] 1-0 (negative-pressure pump off-outflow roller wheel stopped), [0044] 0-1 (negative-pressure pump closed-outflow roller wheel moving), [0045] 1-1 (negative-pressure pump off-outflow roller wheel moving) per pinching device and condition, [0046] 0-0 (negative-pressure pump closed-outflow roller wheel stopped), can be generated through the standstill of the roller wheel.

[0047] The condition of the third suction line can be controlled through control of the negative-pressure pump.

[0048] It is advantageous to arrange the pinching device between outflow roller wheel and medical instrument and to control it through a tripping device accessible for the surgeon. This solution enables the device to provide fluid management for detecting the condition of the pinching device and to include it in the pressure and flow control process.

[0049] Example 1: In the embodiment outlined above, when using the medical instruments (for instance, shaver or RF), an in/outflow management can be performed, without depending on the detection of the operating conditions of the medical instruments. The outflow roller wheel pump and the pump device generating a negative pressure provided in the design concept of the device for providing fluid management can provide separately controllably the respectively required negative pressures and flow rates for the suction lines, i.e., the fluid connections of the cavity to the device. Both pump devices are controllable, the outflow roller wheel being able, for instance, to accept a higher aspiration of the medical instrument (e.g., shaver/RF), and the pump device generating a negative pressure securing a continuous flow. It is a big advantage for the surgeon that changing the connections or closing the cock at the trocar, which is the typical sleeve used for introducing the endoscope, can be dropped.

[0050] In the scenario of arthroscopy, in this example, fast pressure changes are avoided, since in prior art solutions, high demand of re-supply will occur, when the suction lines to a medical instrument (e.g., shaver/RF) are open, by the occurring pressure drop at the sensor at the inflow roller wheel, and this can only relatively late be compensated, whereby due to the pressure peaks, larger extravasation of the fluid will result, than with the solution according to the invention. Extravasation leads to disadvantageous swellings in the environment of the distended cavity. This embodiment of the solution according to the invention allows for the first time a “low-pressure arthroscopy” with slightly more than 30 mm Hg cavity pressure in the joint, since with the prior art devices the pressure variations are too large and the cavity will collapse.

[0051] Example 2: In the embodiment outlined above, a medical instrument with a high demand of flow rate (e.g., a shaver, morcellator, or other devices that separate and/or suck off tissue pieces) can directly be connected at the outflow roller wheel that transfers into the negative-pressure vessel, and a medical instrument with high flow resistance (e.g., an RF instrument) can directly be connected at the pump device generating a negative pressure and via the same suction line at the cavity. The medical instrument with high flow resistance is disconnected through a valve, and only upon activation, the suction line is opened there.

[0052] The advantage is a fast aspiration effect at the medical instrument with high flow resistance at a very stable cavity pressure and a flow that is adjustable independently on the cavity pressure. In addition, this example has the advantage for the surgeon that changing the connections or closing the cock at the trocar can be dropped.

[0053] Example 3: In the embodiment outlined above, the outflow roller wheel can directly be connected to the cavity, and the pump device generating a negative pressure can be connected to a medical instrument with moving blades (e.g., shaver, morcellator or other devices that separate and/or suck off tissue pieces). Thus, the cavity pressure can easily be monitored, and the in- and outflow can adequately be controlled. When the medical instrument with moving blades is activated, there will be, due to the pumping principle, no pressure variations, and a stable cavity wall results thereby. This is particularly helpful in cavities with very flexible walls such as a uterus.

[0054] Example 4: In the embodiment outlined above, the outflow roller wheel and the inflow roller wheel can directly be connected to an endoscope with separated channels for in- and outflow, that endoscope being located in the cavity, for generating a continuous flow. The pump unit generating a negative pressure can be connected to an aspiration instrument or additionally via a valve in a removable manner to the endoscope. In urology, for stone removal in the region of the ureters or the renal calyx, the stone is fixed with an instrument that grips around the stone (stone extractor basket). The procedure of gripping around can be promoted by activation of the suction line with an additional aspiration pulse created by the pump unit generating a negative pressure, so that by the additional aspiration process, the stone is positioned in the instrument. This pulse-like aspiration increase is very advantageous, since the situation in the cavity is not changed, and only an additional suction in the direction of the aspiration opening is generated, the effect of which can be compensated by an increased inflow. Due to the length and diameter of the tube (i.e., flow resistance), an enormous pre-pressure is required that can best be generated with the pumping principle of the pump unit generating the negative pressure. In normal operation, an exact pressure control over the smallest amount is required (risk of damage to the renal calyx region), which can best be achieved with peristaltic pumps, however, they cannot generate quickly enough the pre-pressure required for a suction pulse, or would be by far overbuilt if they did.

LIST OF REFERENCES

[0055] (1) storage container for the flushing liquid, [0056] (2) supply line for supplying flushing liquid into the body cavity (11), [0057] (3) controlled pump for liquid supply, [0058] (4) controlled first negative-pressure pump, [0059] (5) controlled second negative-pressure pump, [0060] (6) first medical instrument, [0061] (7) first suction line at first medical instrument, [0062] (8) second medical instrument, [0063] (9) second suction line at second medical instrument, [0064] (10) waste container, [0065] (11) body cavity, [0066] (12) line from the waste container to the controlled second negative-pressure pump.