Abstract
The invention relates to a resectoscope for endoscopic surgery with a tubular shaft and a handle, the shaft comprising a longitudinally displaceable electrode instrument and, at its distal end, an electrically insulating insert, the electrode instrument having an elongated shaft section with one or two support arms and, in its distal end region, an electrode that can be acted upon by high-frequency current, characterized in that the insulating insert has one or more guide elements for holding a support arm, the support arm being longitudinally displaceable in the guide element.
Claims
1. Resectoscope (10) for endoscopic surgery with a tubular shaft (12) and a handle (14), wherein the shaft (12) comprises a longitudinally displaceable electrode instrument (16) and at its distal end an electrically insulating insert (18), wherein the electrode instrument (16) has an elongated shaft section (20) with one or two support arms (22) and in its distal end region an electrode (24) which can be acted upon with high-frequency current, characterized in that the insulating insert (18) has one or more guide elements (26) for holding a support arm (22), the support arm (22) being longitudinally displaceable in the guide element (26).
2. Resectoscope (10) according to claim 1, characterized in that the electrode instrument (16) has two support arms (22).
3. Resectoscope (10) according to one of claim 1 or 2, characterized in that the distance between the distal end of the shaft (12) and the guide element or elements (26) is 1 cm or less.
4. Resectoscope (10) according to one of the preceding claims, characterized in that the guide element or elements (26) are arranged on the inner wall (28) of the insulating insert (18).
5. Resectoscope (10) according to one of the preceding claims, characterized in that the longitudinal axes (LF) of the guide element or elements (26) run parallel to the longitudinal axis (LS) of the shaft (12).
6. Resectoscope (10) according to one of the preceding claims, characterized in that the guide element or elements (26) enclose the respective support arm (22) over 90° or more of its circumference.
7. Resectoscope (10) according to one of the preceding claims, characterized in that the guide element or elements (26) enclose the respective support arm (22) over 240° or more of its circumference, preferably over 360°.
8. Resectoscope (10) according to one of the preceding claims, characterized in that the electrode (24) is a loop electrode.
9. Electrode system (44) for use in a resectoscope (10) for endoscopic surgery, characterized in that it comprises an electrode instrument (16) and an electrically insulating insert (18), wherein the electrode instrument (16) has an elongated shaft section (20) with one or two support arms (22) and in its distal end region an electrode (24) which can be charged with high-frequency current, and, wherein the insulating insert (18) has one or more guide elements (26) for holding a respective support arm (22) of the electrode instrument (16), the support arm (22) being arranged in the guide element (26) so as to be longitudinally displaceable.
10. Electrode system (44) according to claim 9, characterized in that the guide element or elements (26) surround the respective support arm (22) over 240° or more of its circumference, preferably over 360°.
Description
BRIEF DESCRIPTION OF THE FIGURES
[0031] Exemplary embodiments of the invention are shown schematically in the drawings. The figures are as follows:
[0032] FIG. 1 is a lateral, schematic sectional illustration of a resectoscope from the prior art, which comprises an electrode instrument with guide elements which are attached to the electrode instrument;
[0033] FIG. 2 is a lateral, schematic sectional illustration of a resectoscope according to the invention, which has an insulating insert with guide elements for the support arms of an electrode instrument;
[0034] FIG. 3 is a lateral, schematic sectional illustration of the distal end region of a resectoscope from the prior art, which comprises an electrode instrument with guide elements which are attached to the electrode instrument and which are supported on the optics of the system;
[0035] FIG. 4 is a lateral, schematic sectional illustration of the distal end region of a resectoscope according to the invention, which has an insulating insert with guide elements (shown in dashed lines) for the support arms of an electrode instrument;
[0036] FIG. 5 is a schematic front view of the shaft of a resectoscope according to the invention, which has an insulating insert with guide elements for the support arms of an electrode instrument;
[0037] FIG. 6 is a schematic front view of the shaft of an alternative resectoscope according to the invention, which has an insulating insert with guide elements for the support arms of an electrode instrument and in which the support arms run between inner tube and jacket tube and in which the guide elements do not completely enclose the support arms;
[0038] FIG. 7 is a schematic front view of the shaft of an alternative resectoscope according to the invention, which has an insulating insert with guide elements for the support arms of an electrode instrument and in which the support arms run between inner tube and jacket tube and in which the guide elements do not completely enclose the support arms; and,
[0039] FIG. 8 is a lateral, schematic sectional illustration of the distal end region of an electrode system according to the invention, which comprises an insulating insert with guide elements (shown in dashed lines) for the support arms of an electrode instrument and a corresponding electrode instrument.
EXEMPLARY EMBODIMENTS
[0040] Further advantages, characteristics and features of the present invention will become apparent in the following detailed description of exemplary embodiments with reference to the accompanying drawings. However, the invention is not restricted to these exemplary embodiments.
[0041] FIG. 1 shows a schematic, lateral sectional illustration of a resectoscope 10 from the prior art in which arranged on the inner tube 40 is an insulating insert 18 and guide elements 26 are arranged on the electrode instrument 16 thereof and are supported on optics (not shown) inside the inner tube 40. FIG. 3 shows a schematic, lateral sectional illustration of the distal end region of the same resectoscope 10 from the prior art.
[0042] The resectoscope 10 has a shaft 12 which comprises a jacket tube 38 (outer tube) shown in dashed lines. An inner tube 40 runs inside the jacket tube 38 and an electrode instrument 16 runs inside the inner tube 40, as well as optics 42 shown in FIG. 3 and a lighting means (not shown), for example in the form of an optical fiber bundle. In addition, other elements, not shown here, can run in the resectoscopes, such as a separate irrigation tube and the like. In its distal end region, the jacket tube 38 includes openings through which the contaminated irrigation fluid can flow into the space between jacket tube 38 and inner tube 40 and flow away through the resectoscope shaft 12.
[0043] As can be seen in FIG. 1 and in greater detail in FIG. 3, an electrode instrument 16 in this conventional instrument is to be protected against displacements deviating from the longitudinal direction of the shaft 12, for example transverse to the longitudinal direction, by means of a guide element 26 with a partially circular cross-section. The electrode instrument 16 is borne in the inner tube 40 so as to be longitudinally displaceable. The guide element 26 has a shape complementary to the outer wall of the optics 42 and has a partially cylindrical shape. The guide element 26 is fastened in a shaft segment 20 of the electrode instrument 16 to two support arms (fork tubes) 22 (FIG. 5). The support arms 22 run close to one another within the resectoscope shaft 12 and only diverge from one another in the distal end region of the resectoscope shaft 12 in order to receive and support between their ends an electrode 24 in the form of a loop electrode. The guide elements 26 of the electrode instrument 16 do not help prevent bending of the electrode instrument 16 in the region which is located distal from the guide elements 26.
[0044] The electrode instrument 16 can be moved axially in the distal and proximal direction by actuation of a handle 14 in a forcibly guided manner. It can be pushed beyond the distal end of the inner tube 40 and jacket tube 38. This enables the surgeon to manipulate tissue further away from the resectoscope tip. For this purpose, the inner tube 40 and/or electrode instrument 16 are also borne rotatable about their longitudinal axis. At its distal end, the electrode instrument 16 has an electrode 24 which is designed as a cutting loop and by means of which tissue can be removed by electrosurgical ablation. Here, a high-frequency electrical voltage is applied to the electrode 24 in order to cut tissue.
[0045] The resectoscope 10 shown has a passive transporter, in which the carriage 36 is displaced in the distal direction against the distal, first handle part 32 by a relative movement of the handle parts 30 and 32 arranged proximally from the resectoscope shaft on the handle 12 against a spring force applied by a spring bridge 34. When the carriage 36 is displaced in the distal direction against the handle part 32, the electrode instrument 16 is displaced in a positively guided manner in the distal direction in a manner not shown. When the handle parts 30, 32 are relieved, the spring force generated by the spring bridge 34 forces the carriage 36 back into its rest position, the electrode instrument 16 being pulled in the proximal direction. When the carriage 36 is moved back, an electrosurgical intervention with the electrode instrument 16 can be carried out without manual force from the surgeon, that is to say, passively.
[0046] The insulating insert 18 of the resectoscope 10 is non-detachably connected to the distal end of to the latter by an adhesive bond. The insulating insert 18 does not contain any guide elements. It is made of an electrically insulating ceramic.
[0047] FIG. 2 and FIG. 4 show schematic, lateral sectional illustrations of a resectoscope 10 according to the invention. The resectoscope 10 according to the invention differs from that shown in FIG. 1 and FIG. 3 in that the guide elements 26 for stabilizing the longitudinal movement of the electrode instrument 16 are not arranged on the shaft segment 20 of the electrode instrument 16, but on the inner wall 28 of the insulating insert 18. By attaching the guide elements 26 inside the insulating insert 18, the maximum distance between the guide elements 26 and the electrode 24 is reduced to a minimum. This significantly reduces the risk of the distal end region of the electrode instrument 16 being bent, even if the electrode instrument 16 is displaced maximally in the distal direction. The guide elements 26 are spaced approximately 0.5 cm from the distal end of the insulating insert 18. The longitudinal axis of the guide element (LF) is approximately parallel to the longitudinal axis of the shaft part (LS). In FIG. 4 it can be seen that the guide elements 26 are elongated in the longitudinal direction of the shaft 12.
[0048] In FIG. 5, which shows parts of the same resectoscope 10 as in FIG. 2 and FIG. 4, namely a schematic front view of the shaft 12, it can be seen that the electrode instrument 16 has two support arms 22, between the distal ends of which an electrode 24 which has the shape of a loop electrode is held. The support arms 22 are traversed in their interior by a conductive wire and also comprise an insulating layer which encases the wire and which electrically insulates the support arms 22 from the outside. The inner tube 40 also has optics 42 which run between the support arms 22.
[0049] It can also be seen that the insulating insert 18, which is arranged at the distal end of the resectoscope shaft 12, has two guide elements 26. The guide elements 26 lie opposite one another as viewed from the sagittal plane of the insulating insert 18. Each of the two support arms 22 of the electrode instrument 16 runs through a guide element 26 of the insulating insert 18. In order to save space, the guide elements 26 are at least partially complementary in shape to the support arms 22. The guide elements 26 each have a partial circular shape, and their ends are connected to the inner wall 28 of the insulating insert 18. In the embodiment shown, the guide elements 26 are formed in one piece with the insulating insert 18 from an electrically insulating ceramic. The guide elements 26 completely surround the respective support arm 22, i.e. over 360° of its circumference.
[0050] FIG. 6 shows a schematic front view of the shaft 12 of an alternative resectoscope 10 according to the invention, which has an insulating insert 18 with guide elements 26 for the support arms 22 of an electrode instrument 16. The resectoscope 10 differs from that shown in FIG. 5 in that the support arms 22 of the electrode instrument 16 are not arranged within the inner tube 40, but instead are arranged between the inner tube 40 and the jacket tube 38. In addition, in contrast to those shown in FIG. 5, the guide elements 26 do not completely enclose the support arms 22. The guide elements 26 each have an interruption which can be used for laterally introducing the support arms 22. For this purpose, the guide elements 26 are sufficiently flexible to allow the interruption to be enlarged during assembly or disassembly without bending or breaking. In the embodiment shown, the interruption in the guide elements 26 is formed in the direction of the optics or in the direction of the second support arm 22. The interruptions in the two guide elements 26 thus lie opposite one another. The interruptions extend in a manner not shown here in the longitudinal direction of the instrument over the entire length of the guide elements 26.
[0051] FIG. 7 shows an alternative design to FIG. 6 for support arms 22 which are not designed to completely enclose guide elements 26. The guide elements 26 each have an interruption here, as well. The interruption is formed in the direction of a transverse plane of the resectoscope shaft 12. The interruptions extend in a manner not shown here in the longitudinal direction of the instrument over the entire length of the guide elements 26.
[0052] FIG. 8 is a lateral, schematic sectional illustration of the distal end region of an electrode system 44 according to the invention, which comprises an insulating insert 18 with guide elements 26 (shown in dashed lines) for the support arms 22 of an electrode instrument 16 and a corresponding electrode instrument 16. The electrode system 44 is designed for single use and can be disposed of after use in a medical procedure. Alternatively, an electrode system 44 designed for multiple use is also possible. The insulating insert 18 in the electrode system 44 facilitates the assembly of the electrode system on the resectoscope shaft 12, since the insulating insert 18, in contrast to the sensitive electrode instrument 16, can be touched during assembly without the risk of bending. The insulating insert 18 can include latching mechanisms (not shown here) or other fastening means for fastening, such as the fastening means described in DE 10 2019 102 841.8. In this case, the guide elements 26 are designed to completely enclose the respective support arm 22.
[0053] Although the present invention has been described in detail with reference to the exemplary embodiments, it is obvious to the person skilled in the art that the invention is not restricted to these exemplary embodiments, but rather that modifications are possible in such a way that individual features may be omitted or other combinations of the individual features presented may be realized, provided the scope of protection of the appended claims is not exceeded. The present disclosure includes all combinations of the individual features presented.
