Abstract
A vacuum system is described for endoscopic intracavity, intraluminal or intracorporeal vacuum therapy, for aspirating body fluids, wound secretions or gases from a hollow volume, such as a body cavity, a hollow organ, a tissue abscess or an intestinal lumen, particularly in the production of a temporary endoscopic closure of an intestinal lumen. Based on this, many embodiments of an endoscopy arrangement are described.
Claims
1. Vacuum system for endoscopic intracavitary intraluminal or intracorporeal vacuum therapy for aspirating body fluids, wound secretions or gases from a hollow space, such as a body cavity, a hollow organ, a tissue abscess or an intestinal lumen, in particular in creating of a temporary endoscopic closure of an intestinal lumen, the vacuum system comprising: a vacuum pump having a control input for receiving a control signal for control of its vacuum and having, on its negative pressure side, a connection for a vacuum drainage arrangement, and connected or connectable to the control input of the vacuum pump, a pressure regulating unit, having a test signal input for receiving at least one pressure test signal, which provides a measure for a pressure or negative pressure prevailing at the hollow space to be treated and which is designed, .[.upon specification.]. a) .Iadd.upon specification .Iaddend.of a negative pressure at the hollow space to be treated, being selectable from a predefined negative pressure value interval, and b) .[.of.]. an evacuation period.[., the value of which, situated.]. between 0.5and 5seconds, .[.is selectable,.]. i) figuring in a predetermined dead volume of the vacuum drainage device arrangement that is connectable to the vacuum pump, to determine a first suction capacity of the vacuum pump, required for generating the specified negative pressure at the hollow space to be treated within the specified evacuation period, and to transmit a corresponding first control signal to the control input of the vacuum pump, ii) upon generating the specified negative pressure at the hollow space to be treated, to monitor the pressure test signal and to determine, as a function of the current pressure test signal, a second suction capacity of the vacuum pump, required for maintaining the specified negative pressure, and to transmit a corresponding second control signal to the control input of the vacuum pump; and iii) upon generating the specified negative pressure at the hollow space to be treated, if a deviation of the measured pressure or negative pressure from the specified negative pressure exists that exceeds a pre-defined threshold of the measured pressure or negative pressure, to determine a third suction capacity that is required for generating the specified negative pressure within the specified evacuation period and to transmit an appropriate third control signal to the control input of the vacuum pump; the vacuum pump being designed, as a function of the control signal currently being applied to its control input, to generate a suction capacity determined by the control signal.
2. Vacuum system according to claim 1, wherein the predetermined negative pressure value interval extends across negative pressure values relative to a surrounding pressure between a minimum negative pressure of 60mm Hg and a maximum negative pressure of 500mm Hg.
3. Vacuum system according to claim 1, .[.which.]. .Iadd.wherein the evacuation period is selectable and the vacuum system .Iaddend.additionally comprises a user input unit connected to the pressure regulating unit and is designed to accept a user input of the evacuation period and/or a negative pressure value and to transmit it to the pressure regulating unit, and in which the pressure regulating unit is designed to determine the control signal concerned figuring in the current user input and to transmit it to the control input of the vacuum pump.
4. Vacuum system according to claim .[.1.]. .Iadd.3.Iaddend., wherein the user input unit has a lockable mode switch that allows user-side setting of either a therapy mode or an endoscopy mode, the pressure regulating unit being designed to output, in the therapy mode, only the second or third control signal, but not the first control signal, and the predefined negative pressure value interval in the therapy mode extending across negative pressure values relative to a surrounding pressure between a minimum negative pressure of 60 mm Hg and a maximum negative pressure of 250mm Hg.
5. Vacuum system according to claim 1, having a vacuum drainage arrangement which is connected to the vacuum pump on the negative pressure side and having a negative pressure-resistant secretion collection container, which is designed to accept and/or discharge secretions and gas that occur during operation and aspirated by the vacuum pump and in which the pressure regulating unit is designed to figure in a volume of the secretion collection container as part of the dead volume.
6. Vacuum system according to claim 5, in which the vacuum drainage device additionally has a presecretion collection container which is connected upstream of the secretion collecting container and is connected to it and fluid-conducting, and in which the pressure regulating unit is designed to figure in a volume of the secretion collection container as an additional part of the dead volume.
7. Vacuum system according to claim 5, wherein the pressure regulating unit is designed to figure in an additional volume, which embodies at least one negative pressure-resistant fluid communication element, in particular a drainage hose, which is distally connectable to a fluid collection element and proximally to the secretion collection container or the presecretion collection container as an additional part of the dead volume.
8. Vacuum system according to claim 1, wherein the vacuum pump comprises a pump combination of at least two pump units, of which a first pump unit is designed to generate a prevacuum that has a lower negative pressure than the specified negative pressure, and a second pump unit is designed to generate the vacuum after generating the prevacuum.
9. Vacuum system according to claim 1, wherein the pressure regulating unit is designed to initially and temporarily specify for the vacuum pump a predeterminable first higher negative pressure and after a period of time, determinable by user input, to adjust the negative pressure to a predeterminable second, comparably lower, negative pressure value.
10. Vacuum system according to claim 1, wherein the vacuum pump has a plurality of vacuum-side connections for both ends of a single drainage hose or one or a plurality of ends of a plurality of drainage hoses, and wherein the pressure regulating unit is designed to control the vacuum pump upon a corresponding user input via the user input unit so as to aspirate or flush optionally either unilaterally only one of the connections or alternating two of the ports or simultaneously two connections.
11. Endoscopy arrangement with a vacuum system according to claim 1, an overtube unit which is connected to the vacuum pump of the vacuum system on the negative pressure side by at least one fluid communication element and carries a fluid collection element, an endoscope which is introduced or introduceable into the overtube unit and is displaceable relative to the overtube unit in a direction facing from proximal to distal or vice-versa direction, and a negative pressure sensor which is connected to the pressure regulating unit of the vacuum system.
12. Endoscopy arrangement according to claim 11, wherein the endoscope is connected to the vacuum pump of the vacuum system on the negative pressure side by a fluid communication element in the form of drainage hoses and/or in the form of a channel in the endoscope and carries an additional fluid-collecting element.
13. Endoscopy arrangement according to claim .[.11.]. .Iadd.12.Iaddend., wherein the fluid collection element is attached to the distal end of the overtube unit and/or the additional fluid collection element to the distal end of the endoscope.
14. Endoscopy arrangement according to claim 12, wherein the endoscope has at least one working channel extending in its inside and having outward perforation openings, by means of which the additional fluid collection element is connected fluid-conductive.
15. Endoscopy arrangement according to claim .[.11.]. .Iadd.12.Iaddend., wherein the fluid collection element and the additional fluid collection element has a polyurethane sponge.
16. Endoscopy arrangement according to claim .[.11.]. .Iadd.12.Iaddend., wherein the fluid collection element or the additional fluid collection element is an open-pore fluid-conducting film or wherein the fluid collection element and the additional fluid collection element additionally has, on its outer surface, an open-pore fluid-conducting film.
17. Endoscopy arrangement according to claim 16, wherein the film is designed fluid-conductive in the direction of the endoscope.
18. Endoscopy arrangement according to .[.any of the.]. claim .[.11.]. .Iadd.12.Iaddend., wherein, as additional fluid collection element, the endoscope carries a polyurethane sponge, while the overtube unit, as fluid collection element, carries a film.
19. Endoscopy arrangement according to claim .[.11.]. .Iadd.12.Iaddend., .[.with a vacuum system according to claim 9.]. .Iadd.wherein the pressure regulating unit is designed to initially and temporarily specify for the vacuum pump a predeterminable first higher negative pressure and after a period of time, determinable by user input, to adjust the negative pressure to a predeterminable second, comparatively lower, negative pressure value.Iaddend., .Iadd.and .Iaddend.wherein both longitudinal ends of the drainage hose have a port for connection to the vacuum pump and wherein the .[.sponge drainage unit.]. .Iadd.fluid collection element .Iaddend.is attached between the longitudinal ends of the drainage hose.
20. Endoscopy arrangement according to claim 11, wherein the fluid collection element and/or the additional fluid collection element is provided with a surface seal for closing open pores in sections and in other sections does not have the surface seal.
21. Endoscopy arrangement according to .[.any of the.]. claim .[.11.]. .Iadd.12.Iaddend., wherein distally the drainage hose ends in a conical tip.
22. Endoscopy arrangement according to claim 21, wherein, at the tip of the drainage hose, a grasping bead, string-wire loop, eyelet and/or a string is attached tension-proof; wherein, in the latter case, the tip has a transverse channel, into which the string can be introduced.
23. Endoscopy arrangement according to claim 22, wherein the distal tip of the drainage hose is a projectile-like pointed top-seated attachment made of plastic or metal which is designed tension-proof, attachable, using a plug-in and/or screwed element, to the end of the drainage hose.
24. Endoscopy arrangement according to claim .[.11.]. .Iadd.23.Iaddend., wherein the drainage hose is designed to permit the introduction of a guidewire into the lumen of the drainage hose and wherein, for this purpose, a distal tip of the drainage hose and the pointed top-seated attachment has a longitudinal channel, into which the guidewire can be introduced.
25. Endoscopy arrangement according to any of the claim 11, wherein a sponge body of the fluid collection element ends distally in a tip and, at the tip and/or integrated into the sponge body, a grasping bead, string-wire loop, eyelet and/or string is attached tension-proof.
26. Endoscopy arrangement according to claim .[.11.]. .Iadd.13.Iaddend., wherein .[.one of the.]. .Iadd.a .Iaddend.negative pressure .[.sensors.]. .Iadd.sensor .Iaddend.is arranged in, on or at the distally arranged fluid collection element and is connected to the pressure regulating unit of the vacuum system.
27. Endoscopy arrangement according to claim 26, wherein .[.this.]. .Iadd.the .Iaddend.negative pressure sensor is designed wire-shaped and is conducted to the fluid collection element via the drainage hose.
28. Endoscopy arrangement according to claim 11, wherein the overtube has, proximally and distally directly adjacent to the fluid collection element seated on it, in each case, an annular lip-like thickening.
29. Endoscopy arrangement according to claim .[.11.]. .Iadd.12.Iaddend., wherein, in different longitudinal sections, the drainage hose has different diameters.
30. Endoscopy arrangement according to claim 11, wherein the fluid collection element has a sponge body, which has, on its outer surface, at least one recess or, in its inside, a channel for receiving a sensor, which, for operating the endoscopy arrangement, can be inserted into the recess or the channel.
31. Endoscopy arrangement according to claim .[.11.]. .Iadd.30.Iaddend., wherein, in .[.a.]. .Iadd.the .Iaddend.sponge body of the fluid collection element, a channel running from proximal to distal, is arranged, through which runs a tube not connected fluid-conductive to pores of the sponge body for passage of body fluids such as secretions or saliva.
32. Endoscopy arrangement according to claim 31, wherein the tube is negative pressure-resistant and has a length of 5cm to 20cm and an inside diameter of 5mm to 20cm.
33. Endoscopy arrangement according to claim 31, wherein the tube is internally hydrophilic and wherein a surface seal of the fluid collection element are hydrophilic.
34. Endoscopy arrangement according to claim 31, wherein a proximal and/or a distal end of the tube relative to a central section of the tube are movable outward and spreadable open subject to negative pressure application.
35. Endoscopy arrangement according to claim 31, wherein the tube lies in the channel without any attachment.
36. Endoscopy arrangement according to claim 11, wherein the outside diameter of the fluid communication element and the fluid collection element are adapted to an inside diameter of an inner working channel of the endoscope in such a way that they are displaceable within the working channel and their placement can be achieved via the inner working channel of the endoscope.
37. Endoscopy arrangement according to claim 11, wherein the fluid collection element has a sponge body, and a channel situated in the sponge body is provided with a surface seal, which is made of a longitudinally profiled film which is profiled by fluid-conducting channels in a direction going from proximal to distal.
38. Endoscopy arrangement according to claim 11, wherein the overtube.[.,.]. .Iadd.and .Iaddend.the fluid collection element.[., the pusher and the outer working channel.]. are provided with a longitudinal slot that extends over the entire length.
Description
(1) Preferred embodiments according to the invention are described hereinafter with reference to figures.
(2) Additional preferred embodiments according to the invention will be explained hereinafter with reference to the accompanying figures according to their structure and handling.
(3) FIG. 1a is a schematic representation of an exemplary embodiment of a vacuum system;
(4) FIG. 1b is a block diagram with further details of the pressure regulating unit of the vacuum system of FIG. 1a;
(5) FIG. 2 is a partial longitudinal section of the vacuum system of FIG. 1a;
(6) FIG. 3 is a schematic representation of another exemplary embodiment of a vacuum system;
(7) FIG. 4 is a schematic representation of an arrangement of a fluid collection element;
(8) FIG. 5 is a schematic partial longitudinal section of the arrangement of FIG. 4;
(9) FIG. 6 is a longitudinal section of a fluid collection element 64, which is connected, fluid conducting, to two fluid communication elements 63,
(10) FIG. 7 is a longitudinal section of a fluid collection element, in which both a fluid conducting fluid communication element and imposed on it, a wire-like negative pressure sensor is arranged.
(11) FIG. 8 shows an embodiment of a longitudinally slotted overtube;
(12) FIG. 9 is a longitudinal section of FIG. 8;
(13) FIG. 10 is a cross-section of an overtube;
(14) FIG. 11 is a cross-section of a different variant of an overtube;
(15) FIG. 12 shows an additional embodiment of an overtube;
(16) FIG. 13 is a cross-section of the overtube of FIG. 12;
(17) FIG. 14 is a different representation of the embodiment of FIGS. 12 and 13;
(18) FIG. 15 is a longitudinal representation of FIG. 14;
(19) FIG. 16 is a representation of an overtube, which forms a variant of the overtube of FIGS. 12 to 15;
(20) FIG. 17 is a representation of a different variant of an overtube;
(21) FIG. 18 is a longitudinal section of the overtube of FIG. 17;
(22) FIG. 19 shows a variant of the representations of the embodiments of FIG. 17 and FIG. 18;
(23) FIG. 20 is a longitudinal section of the overtube FIGS. 18 and 19;
(24) FIG. 21 is an additional longitudinal section of the overtube of FIGS. 18 to 20;
(25) FIG. 22 is a representation of a distal end of an endoscope;
(26) FIG. 23 is a longitudinal section of the endoscope of FIG. 22;
(27) FIG. 24 is an additional longitudinal section of the endoscope of FIG. 22;
(28) FIG. 25 is a representation of a fluid collection element suitable for use on the overtube, the endoscope and the support sleeve;
(29) FIG. 26 is a longitudinal section of the fluid collection element of FIG. 25;
(30) FIG. 27 is a representation of a different fluid collection element;
(31) FIG. 28 is a longitudinal section of FIG. 27;
(32) FIG. 29 is a representation of a support sleeve for a fluid collection element;
(33) FIG. 30 is a longitudinal section of the support sleeve of FIG. 29;
(34) FIG. 31 is a representation of a support sleeve having, attached on it between lip-like rings, a longitudinally slotted fluid collection element;
(35) FIG. 32 is a longitudinal section of the support sleeve FIG. 31;
(36) FIGS. 33 a-i show different variants of cross-sectional profiles of lip-like ring closures;
(37) FIG. 34 is a representation for explaining, how a flexible endoscope is inserted or removed via the longitudinal slot of the overtube;
(38) FIG. 35 shows an endoscopy arrangement according to a different exemplary embodiment;
(39) FIGS. 36 a-n show a schematic representation of the examination process of a video endoscopy treatment;
(40) FIG. 37 is a representation of a vacuum drainage with partial surface sealing of the sponge body;
(41) FIG. 38 is a longitudinal section of the fluid collection element of FIG. 37;
(42) FIG. 39 is a representation of a different embodiment of a vacuum drainage;
(43) FIG. 40 is a longitudinal section of the vacuum drainage of FIG. 39;
(44) FIG. 41 is a representation of a vacuum drainage with a profiled surface seal;
(45) FIG. 42 is a cross section of the vacuum drainage of FIG. 41;
(46) FIG. 43 is a representation of a vacuum drainage with a tube attached in a sponge body;
(47) FIG. 44 is a representation of a different embodiment of a vacuum drainage having a tube attached in a sponge body;
(48) FIG. 45 is a longitudinal section of the vacuum drainage of FIG. 43;
(49) FIG. 46 is a representation of an additional embodiment of a vacuum drainage having a drainage hose in a sponge body;
(50) FIG. 47 is a longitudinal section of an additional vacuum drainage having a tube situated in the sponge body;
(51) FIG. 48 is a representation of the vacuum drainage of FIG. 47, in this representation, a negative pressure being applied to the drainage hose;
(52) FIG. 49 is a representation of an additional embodiment of a sponge drainage;
(53) FIG. 50 is a longitudinal section of the sponge drainage of FIG. 49;
(54) FIG. 51 is a representation of an additional embodiment of a sponge drainage;
(55) FIG. 52 is a longitudinal section of the sponge drainage of FIG. 51;
(56) FIG. 53 is a representation of an additional embodiment of a sponge drainage;
(57) FIG. 54 is a longitudinal section of the sponge drainage of FIG. 53;
(58) FIGS. 55 a to h show different variants of a distal end of a sponge drainage, each in a longitudinal section.
(59) FIGS. 56 a to f are different representations of a drainage hose and pointed top-seated attachments;
(60) FIGS. 57 a to f are different representations of an endoscopic insertion instrument;
(61) FIGS. 58 a to e are different representations of an additional endoscopic insertion instrument;
(62) FIG. 59 is a representation of insertion accessory with a sleeve for attachment to a distal end of an endoscope;
(63) FIG. 60 is a representation of two different different-size insertion accessories;
(64) FIG. 61 shows a cross section of an insertion accessory and of an attachment sleeve with a valve;
(65) FIG. 62 shows a representation of an insertion accessory with an attachment sleeve on a distal end of an endoscope; and
(66) FIG. 63 is a representation of an insertion accessory with an attachment sleeve on a distal end of an endoscope.
(67) FIG. 1a is a schematic representation of an exemplary embodiment of a vacuum system having a vacuum pump 11, a secretion container 12 on the pump, a fluid communication element 13, which leads from the vacuum pump to a fluid collection element 14. Into the fluid communication element, via a lateral input 15, a negative pressure sensor 16 is introduced, which electronically transmits to the vacuum pump, via a pressure regulating unit 17, measured values for adjusting, presetting and controlling via connecting elements 18. Connected to the pressure regulating unit but not illustrated here in detail (but compare FIG. 1b), is a user input unit. The pressure regulating unit 17 has a test signal input for receiving test signals from negative pressure sensor 16. The latter is designed to control the vacuum pump 11 during operation for generating and maintaining a vacuum at the hollow space to be treated at a predetermined negative pressure of, in this example, between 60 mm Hg and 500 mm Hg, within a predetermined evacuation period between 0.5 and 5 seconds. For this purpose, the vacuum pump 11 has a control input 11.1.
(68) FIG. 1b shows a simplified block diagram with further details of the pressure regulating unit 17 of the vacuum system of FIG. 1a. The pressure regulating unit 17 has a control unit 17.1 implemented as a programmable microprocessor or a microcontroller or a special integrated circuit (ASIC). The control unit receives test signals generated by the negative pressure sensor 16. Furthermore, it is with the user input unit UI. Via the user input unit UI, the physician can input parameters, such as a negative pressure to be set, an evacuation period and a potentially present dead volume. This input need not necessarily take the form of specific values. It may alternatively or additionally, for instance, instead be intended, via user input unit UI, to identify a predefined therapy or examination type by menu selection or text input, for which purpose, in a memory 17.2 of the pressure regulating unit, predefined negative pressure parameters (if applicable, of its development over time) and the evacuation period are stored and can be called up via the input. The dead volume that may have to be taken into account for determining a suction capacity of the connected vacuum pump 11 can be either input quasi automatically by user input, alternatively instead by reading in a code. The pressure regulating unit is designed to determine the required suction capacity of the pump using the negative pressure value on the hollow space to be treated, which (value) is selectable from a predefined negative pressure value interval (automatic value monitoring for reliability after input, using prestored threshold values) and an evacuation period, the value between 0.5 and 5 seconds of which is selectable. Depending on the situation additional parameters are taken into account: i) figuring in a predetermined dead volume of the vacuum drainage arrangement that is connectable to the vacuum pump, to determine a first suction capacity of the vacuum pump, required for generating the specified negative pressure at the hollow space to be treated within the specified evacuation period, and to transmit a corresponding first control signal to the control input 11.1 of the vacuum pump 11, ii) upon generating the specified negative pressure at the hollow space to be treated, to monitor the pressure test signal and to determine, as a function of the current pressure test signal, a second suction capacity of the vacuum pump, required for maintaining the specified negative pressure, and to transmit a corresponding second control signal to the control input 11.1 of the vacuum pump 11; and iii) upon generating the specified negative pressure at the hollow space to be treated, if a deviation of the measured pressure or negative pressure from the specified negative pressure exists that exceeds a predefined threshold of the measured pressure or negative pressure, to determine a third suction capacity that is required for generating the specified negative pressure within the specified evacuation period and to transmit an appropriate third control signal to the control input 11.1 of the vacuum pump 11.
(69) In the cases ii) and iii), the dead volume must, as a principle, be taken into account as well. It can be neglected for mere maintenance of a vacuum in a variant. In case iii) it must, however, preferably be taken into account.
(70) Via a switch S, which may even be directly integrated into the user input unit UI, it is possible to switch from an endoscopy mode to a therapy mode and back. The difference between the modes lies in the range of values available for the negative pressure. No patient should be exposed to high negative pressure values in the therapy mode without a physician present. Such higher negative pressure values are, therefore, only available in the endoscopy mode. Another difference lies in the input options via the user input unit UI. They are limited in the therapy mode, so that the patient cannot make any undesirable, harmful parameter changes. The switch is secured by a key and can only be activated by the treating physician.
(71) FIG. 2 is a partial longitudinal section of the vacuum system of FIG. 1. Into the fluid communication element, via a lateral input 15, the negative pressure sensor 16 is inserted, which, via the pressure regulating unit 17, transmits the measured values for regulating, preadjusting and controlling to the vacuum pump by means of connecting elements 18.
(72) FIG. 3 is a schematic representation of a different exemplary embodiment of a vacuum system with a presecretion container 39 for faster suction build-up and with secretion container 32. The presecretion container is connected to the secretion container via a filter/valve 310. The pressure regulating unit 37 for the negative pressure values, time settings, evacuation periods and for alarm functions is connected to vacuum pump 31 by means of connecting elements 38. A fluid collection element 34 is connected to the pump unit by means of a fluid communication element 33.
(73) FIG. 4 is a schematic representation of an arrangement of a fluid collection element 44, which is fluid-conducting and connected to a fluid communication element 43. Into the fluid communication element, via a lateral input, through a valve 411, a wire-like negative pressure sensor 46 has been pushed forward up to the fluid collection element 44. The negative pressure sensor is connected to a measuring and pressure regulating unit 47, which can forward the test signals of the negative pressure sensor via an electronic connection 48.
(74) FIG. 5 is a schematic partial longitudinal section of the arrangement of FIG. 4. The fluid collection element 44 is connected to the fluid communication element 43, at the distal end of which fluid-conducting openings 412 exist for suction. Into the fluid communication element, a wire-like negative pressure sensor 46 has been advanced up to the fluid collection element. At the distal end of negative pressure test probe 413 of the sensor is attached. The test probe is connected to a measuring and pressure regulating unit 47, which can forward the information via an electric connection 48.
(75) FIG. 6 is a longitudinal section of a fluid collection element 64, which is fluid-conducting and connected to two fluid communication elements 63 into one of the fluid communication elements, a wire-like negative pressure measuring sensor 66 has been advanced up to the fluid collection element. At its distal end, a negative pressure sensor 613 is attached. Another negative pressure sensor 613a exists in the fluid collection medium.
(76) FIG. 7 is a longitudinal section of a fluid collection element 74, in which is arranged both, a fluid-conducting fluid communication element 73 and, imposed on it, a wire-like negative pressure sensor 76. The negative pressure sensor 76 is connected to a pressure regulating unit 77 and is equipped, at its distal end, with a negative pressure sensor 713 which is located in the fluid collection element. The pressure regulating unit is enhanced by an alarm function. Electronic control signals are transmitted for regulation of the negative pressure, in particular to the vacuum pump. Alarms regarding a malfunction can be triggered.
(77) FIG. 8 is a representation showing an embodiment of a longitudinally slotted overtube 81. At its distal end, overtube 81 is conically tapered to prevent injury during insertion. Over the entire length, a complete slot 86V exists. At its proximal end 83, overtube 81 is designed funnel-shaped to facilitate insertion of an endoscope. The overtube is provided with a fluid communication element 84V in the form of a drainage line, which is integrated in the wall and extends from proximal to distal. It ends at the distal end in lateral openings 85V and perforates the wall of the overtube by means of them. At the proximal end, it exits hose-like (84V) and can be connected here to the vacuum device.
(78) FIG. 9 is a longitudinal section of the overtube 81 of FIG. 8, including representation of overtube 81, which tapers at the distal end 82, widens funnel-shaped at the proximal end 83, and includes fluid communication element 84V, which ends at its distal end in fluid-conducting wall openings 85V, and is conducted out hose-like from the wall.
(79) FIG. 10 is a cross-section of a different exemplary embodiment of an overtube 101 with a fluid communication element 104V integrated in the wall. The overtube 101 is shown with a longitudinal slot 106V.
(80) FIG. 11 is a cross-section of a different variant of an overtube 111, having, integrated in the wall, a fluid communication element 114V, which is fluid-conducting and perforates the wall by means of an opening 115V and is fluid-conducting and connected to the outside wall of overtube 111. The cross-section is drawn at the level of wall opening 115V. The overtube is represented with a longitudinal slot 116V.
(81) FIG. 12 is a representation showing an embodiment of an overtube 121. Over entire length, a longitudinal slot 126V exists. Overtube 121 is equipped with a fluid communication element 124V in the form of a working channel integrated in the wall and extending from a proximal wall opening 127 of the overtube to the distal tip and ends here with a distal wall opening 128.
(82) FIG. 13 is a cross-section of the overtube 121 of FIG. 12, the channel-type fluid communication element 124V being provided with a longitudinal slot 1210. The fluid communication element is integrated into the wall of overtube 121. The overtube is also represented with the longitudinal slot 126V.
(83) FIG. 14 is a different representation of the embodiment of FIGS. 12 and 13, into the fluid communication element 124V, via the proximal opening 127, a medical instrument 1220, herein a guidewire, having been introduced and conducted out through it via the distal opening 128.
(84) FIG. 15 is a longitudinal section of overtube 121 which shows the working channel 129 that is integrated into the wall of overtube 121 as well as the proximal wall opening 127 and the distal wall opening 128.
(85) FIG. 16 is a representation of an overtube 161 that embodies a variant of the overtube of FIGS. 12 to 15. A working channel integrated into the wall of overtube 161 has, over the entire length between proximal wall opening 167 and distal wall opening 168, a longitudinal slot 1610. Overtube 161 also has a longitudinal slot 166V over the entire length in this embodiment.
(86) FIG. 17 is a representation of an overtube 171, over the entire length of which a complete slot 176V exists. Overtube 171 is equipped with two fluid communication elements 174V in the form of drainage lines, which are integrated into the wall of the overtube. They end in lateral openings 175V at the distal end of the overtube. The proximal ends 1711 of the fluid communication elements are fluid-conducting and connected to the vacuum unit. Attached to the overtube, proximal and distal relative to the lateral openings 175V of the fluid communication elements are annular lip-like swells 1712V.
(87) FIG. 18 is a longitudinal section of overtube 171 of FIG. 17, which shows the two fluid communication elements 174V, which are fluid-conducting and end laterally in the distal end of the overtube with openings 175V. Proximal and distal of these, the annular lip-shaped swells 1712V are attached to the overtube.
(88) 19 shows a variant of the representations of the embodiments of FIG. 17 and FIG. 18, here, at the level of the distal wall openings 175V, between the annular swells 1712V, additionally, the fluid collection element 1713V being attached. The fluid collection element is also provided with a longitudinal slot 176V on the longitudinal axis of overtube 171.
(89) FIG. 20 is a longitudinal section of overtube 171 of FIGS. 18 and 19, which shows clearly the fluid communication elements 174V with the fluid-conducting wall openings 175V, fluid collection element 1713V attached above and proximal and distal lip-like swells 1712V.
(90) FIG. 21 is an additional longitudinal section of the overtube of FIGS. 18 to 20, which shows the fluid communication elements 174V, with the fluid-conducting wall openings 175V and the proximal and distal lip-like swells 1712V. In addition, a wire-like measuring sensor 1719 is represented, which was introduced into one of the fluid communication elements and which ends distally in a negative pressure measuring unit 1721. The measuring sensor 1719 has been introduced into the fluid communication element 174V via a valve 1722.
(91) FIG. 22 is a representation of a distal end of an endoscope 2214. At the distal end of endoscope 2214, lateral fluid-conducting wall openings 225E of a fluid communication element incorporated in the endoscope are represented. Proximal and distal relative to these wall openings 225E, lip-like rings 2212E are attached to endoscope 2214.
(92) FIG. 23 is a longitudinal section of endoscope 2214 of FIG. 22 showing the internally-situated fluid communication element 224E, the lip-like rings 2212E proximal and distal relative to the lateral openings 225E of fluid communication element 224E.
(93) FIG. 24 is an additional longitudinal section of endoscope 2214 of FIG. 22. In this representation, above the fluid-conducting openings of fluid communication element 224E, between the lip-like rings 2212E, a fluid collection element 2213E is inserted.
(94) FIG. 25 is a representation of a fluid collection element 2513V, 2513E, 2513T, which is suitable for use on the overtube, the endoscope and the support sleeve. In this embodiment, the fluid collection element has, at its ends, a conical taper 2515. A channel 2516 is arranged centrally along the longitudinal axis of the fluid collection element.
(95) FIG. 26 is a longitudinal section of fluid collection element 2513V, 2513E, 2513T of FIG. 25. The conical taper 2515 can be recognized at the ends and at the central channel 2516 along the longitudinal axis.
(96) FIG. 27 is a representation of another fluid collection element 2713V, 2713E, 2713T for overtube, endoscope and support sleeve, a lip-like ring 2712V, 2712E, 2712T being attached to each end of the element. A joint central channel 2716 extends through the fluid collection element.
(97) FIG. 28 is a longitudinal section of FIG. 27 with fluid collection element 2713, 2713E, 2713T, a lip-like ring (2712V, 2712E, 2712T) being attached to each end.
(98) FIG. 29 is a representation of a support sleeve 2917 for a fluid collection element, shown with a longitudinal slot 296T, fluid-conducting wall perforations 295T and lip-like rings 2912ST proximal and distal relative to the wall perforations 295T. The rings are also slotted.
(99) FIG. 30 is a longitudinal section of the support sleeve of FIG. 29 and shows the fluid-conducting wall perforations 295T and the lip-like rings 2912T proximal and distal relative to the wall perforations 295T.
(100) FIG. 31 is a representation of a support sleeve 3117 having, attached on it, between lip-like rings 3112T, a longitudinally slotted fluid collection element 3113T. Wall perforations 315 of the support sleeve are indicated by dashed lines.
(101) FIG. 32 is a longitudinal section of the support sleeve of FIG. 31, on support sleeve 3117, between the lip-like rings 3112T and fluid-conducting with the wall perforations 315T, fluid collection element 3113T being attached.
(102) FIGS. 33 a-i show different variants of cross-sectional profiles of the lip-like ring closures 3112V, 3112E, 3112T, which are mounted to an exterior wall 3118V, 3118E, 3118T of overtube, endoscope or support sleeve.
(103) FIG. 34 shows a flexible endoscope 3414 in a state, in which it is introduced and removed via longitudinal slot 346V of an overtube 341. To the endoscope and the overtube, fluid collection elements 3413E, 3413V are mounted, in each case at the distal end. The fluid communication element 344V is connected fluid-conductive to the fluid collection element of overtube 3413V.
(104) FIG. 35 shows an endoscopy arrangement according to an additional exemplary embodiment. Represented is a vacuum pump unit 3521 having a secretion collection container 3522, to which an overtube 351 and an endoscope 5614 are connected. To the distal ends of overtube 351 and endoscope 3514, fluid collection elements 3513V and 3513E are attached, which are connected to vacuum pump unit 3521 via the fluid-communication elements 354V (overtube) and 354E (endoscope).
(105) FIG. 36 a-n is a schematic representation of the examination process of a vacuum endoscopy. The treatment comprises the following steps: a) insertion of endoscope 3614 with fluid collection element 3613E into an intestine 3625 of a patient; b) Subsequent insertion of overtube 361 with fluid collection element 3613V above the endoscope; c) Subjecting fluid collection element 3613V to a vacuum; d) Pushing endoscope 3614 forward in the intestine; e) Subjecting fluid collection element 3613E on endoscope 3614 to a vacuum; during this step, no vacuum application to fluid collection element 3613V on overtube 361; f) Pushing overtube 361 on above the attached endoscope 3614; g) Subjecting both fluid collection elements 3613E and 3613V to a vacuum; h) Optional straightening maneuver if necessary, by retracting the fluid collection element 3613E together with the fluid collection element 3613V, both subject to vacuum application; i) Disconnecting the vacuum application to fluid collection element 3613E while maintaining the vacuum application to fluid collection element 3613V; j) Pushing endoscope 3614 forward while overtube 361 is held in place by the vacuum; k) Maintaining the vacuum application to fluid collection element 3613E, disconnecting the vacuum application to fluid collection element 3613V; l) Pushing overtube 361 on with endoscope 3614 held in place by the vacuum; m) Vacuum application to both fluid collection elements 3613E and 3613V; n) Straightening maneuvers by retracting fluid collection element 3613E together with fluid collection element 3613V, both subject to the vacuum;
(106) Thereafter, the examination can be continued using Step i) and following.
(107) FIG. 37 is a representation of a fluid collection element (a vacuum drainage device) in the form of a sponge body 371 with partial surface seal 374 of sponge body 371. Into a drainage hose 372, which is introduced into sponge body 371, a guidewire 373 is introduced in this representation.
(108) FIG. 38 is a longitudinal section of fluid collection element 371 of FIG. 37. The surface seal 374 of sponge body 371 with drainage hose 372, which has lateral perforation openings 372a and into which a guidewire 373 is introduced, are shown.
(109) FIG. 39 is a representation of a different embodiment of a vacuum drainage device 391 with a drainage hose 392 and a guidewire 393 situated therein. On the outside of sponge body 391, a bowl-shaped seal 395 is arranged, which has a funnel-shaped flare 395a at its proximal end.
(110) FIG. 40 is a longitudinal section of the vacuum drainage device 391 of FIG. 39 and also shows the bowl-shaped seal 395 on the outside of the sponge body of vacuum drainage device 391 which is flared funnel-like at the proximal end (395a). Also shown is drainage hose 392, which has lateral perforation openings 392a and in which a guidewire 393 is situated.
(111) FIG. 41 is a representation of a vacuum drainage device in the form of a sponge body 411 having a profiled surface seal 416 of sponge body 411. In drainage hose 412, a guidewire 413 is introduced. The surface seal 416 has a riffled profile 416a with longitudinal grooves running side by side in the longitudinal direction of sponge body 411.
(112) FIG. 42 is a cross section of the vacuum drainage device of FIG. 41. In drainage hose 412, guidewire 413 is situated. The surface seal shows its longitudinal profile 416a.
(113) FIG. 43 is a representation of a vacuum drainage device having a tube 437 attached in sponge body 431. Into sponge body 431, a drainage hose 432 is inserted, in which a guidewire 433 is situated. At the proximal end of the vacuum drainage device, a funnel-shaped flare 437a exists. Into tube 437, an insertion rod 438 is introduced, which is conically tapered at its distal end 438a. Into insertion rod 438, an additional guidewire is inserted. At the proximal end of the insertion rod, a pusher 439 is imposed.
(114) FIG. 44 is a representation of a different embodiment of a vacuum drainage device having, attached in a sponge body 441, a tube 447, which has a funnel-shaped flare at its proximal end. In the tube, an endoscope 4410 is introduced. On the proximal end of endoscope 4410, a pusher 449 is imposed. Tube 447, sponge body 441 and pusher 449 are provided with a complete lateral longitudinal slot 4412. In sponge body 4411, a drainage hose 442 is inserted; in it, a guidewire 443 is situated.
(115) FIG. 45 is a longitudinal section of the vacuum drainage device of FIG. 43. In sponge body 431 lies tube 437, which has its funnel-like flare 437a at the proximal end. In tube 437, insertion rod 438 is situated. In insertion rod 438, a guidewire 433 is introduced. On the insertion rod, pusher 439 is imposed. In sponge body 431 lies the drainage hose 432 with lateral openings 432a. In drainage hose 432 lies an additional guidewire 433a.
(116) FIG. 46 is a representation of an additional embodiment of a vacuum drainage device with drainage hose 462 in sponge body 461. In the sponge body of the vacuum drainage device, a tube 467 is situated, which has proximal and distally split ends 467b. Arrows indicate, in which direction the split ends 467b can open.
(117) FIG. 47 is a longitudinal section of an additional vacuum drainage device having, situated in sponge body 471, a tube which, subject to suction, can be opened outward by its ends 477b. Into tube 477, an endoscope 4710 is introduced. In sponge body 471 lies a drainage hose 472 with lateral openings 472a. The vacuum drainage device is situated in a section of the intestine, of which an intestinal wall 4713 is indicated.
(118) FIG. 48 is a representation of the vacuum drainage device of FIG. 47, in this representation, a negative pressure being applied to drainage hose 472. Sponge body 471 has, therefore, collapsed and intestinal wall 4713 abuts sponge body 471. Movable ends 477b of tube 477 are folded outward in the direction of the arrows.
(119) FIG. 49 is a representation of an additional embodiment of a vacuum drainage (device), which is identified as sponge drainage (device), with the same meaning, within the framework of the application herein. A sponge body 491 is attached to a drainage hose 492a. Drainage hose 492 exits proximally and distally from the sponge body. Into drainage hose 492a, a guidewire 493 was introduced.
(120) FIG. 50 is a cross-section of the sponge drainage device of FIG. 49. Sponge body 491 is attached on drainage hose 492a above the perforation openings 494. A guidewire 493 is introduced into the drainage hose.
(121) FIG. 51 is a representation of an additional embodiment of a sponge drainage device. Two sponge bodies 511 are attached on a drainage hose 512a at a (certain) distance (from each other). Into drainage hose 512a, a guidewire 513 was introduced. This embodiment is advantageous, if, for instance, a section of the intestine is to be functionally disabled by means of a fistula.
(122) FIG. 52 is a cross-section of the sponge of the drainage device of FIG. 51. The two sponge bodies, attached at a distance (from each other) on drainage hose 512a above perforation openings 514, are recognizable. Guidewire 513 is introduced into the drainage hose.
(123) FIG. 53 is a representation of an additional embodiment of a sponge drainage device. A sponge body 531 is attached on a drainage hose 532a. Drainage hose 532a tapers to form a small-lumen drainage hose 532b. In the drainage hose, a guidewire 533 is introduced.
(124) FIG. 54 is a cross-section of the sponge drainage device of FIG. 53. Sponge body 531 is attached on drainage hose 532a above perforation openings 534. Drainage hose 532a tapers toward a small-lumen drainage hose 532b. Guidewire 533 is introduced into the drainage hose.
(125) FIGS. 55 a to h show different variants of a distal end of a sponge drainage device 551, each in a corresponding cross-section. Sponge body 551 is attached on a drainage hose 552a above perforation opening 554. Drainage hose 552a ends in a tip 555. In FIG. 55a, a string 556 is attached to tip 555. In FIG. 55b, a string or wire loop 557 is attached to tip 555. In FIG. 55c, a string 556 is attached to tip 555. Here, however, the tip has a channel 558, through which a guidewire 553 can be conducted. In FIG. 55d, sponge body 551 is designed as a tip at its distal end. Here, too, the sponge body has a channel 558, through which a guidewire was installed. In FIG. 55e, sponge body 551 is also designed as a tip at the distal end. Sponge body 551 has a channel 558, through which a guidewire 553 was installed. To the sponge body, a string or wire loop 57 is attached. In FIG. 55f, a grasping bead 559 is attached to tip 555. In FIG. 55g, at the tip, an eyelet 5510 is attached, through which a string 5511 was pulled. In FIG. 55h, grasping bead 559 lies in sponge body 551.
(126) FIGS. 56 a to f are different representations of a drainage hose 562a and pointed top-seated attachments 5612. FIG. 56a is a representation of a drainage hose 562a and a pointed top-seated attachment 5612. The pointed top-seated attachment has, at its distal end, a grasping bead 569, at the proximal end a screw string 5612a. FIG. 56b is a representation, in which pointed top-seated attachment 5612 is screwed to drainage hose 562a. FIG. 56c is a longitudinal section of FIG. 56a with drainage hose 562a and pointed top-seated attachment 5612. FIG. 56d is a longitudinal section of FIG. 56c with pointed top-seated attachment 5612 screwed onto drainage hose 562. FIG. 56e is a longitudinal section of pointed top-seated attachment 5612 which is screwed onto drainage hose 562a and is equipped with a transverse channel 5612b. FIG. 56f is a longitudinal section of a variant of pointed top-seated attachment 5612 which is screwed onto drainage channel 562a. The pointed top-seated attachment is equipped with a channel 5612c. Through channel 5612c and the drainage hose, a guidewire 563 is inserted.
(127) Hereinafter, new insertion instruments are described which are suitable for vacuum endoscopy.
(128) Endoscopic insertion or grasping instruments are used for the placement of vacuum drainage devices. The placement can either be made using an orthograde forward-push technique or a pull-(through) technique. When using orthograde placement, an endoscopic insertion instrument is introduced into the working channel of the endoscope and an outer working channel. It is performed on the distal end of the endoscope. The placement of the drainage device using the pull-(through) technique is used, if the wound to be treated can, on the one hand, be endoscopically reached from the inside via a natural or artificial access route and, on the other hand, an additional external access route, for example in the form of an external fistula, exists.
(129) The pull-(through) technique is also used, if the endoscopic vacuum therapy is used in combination with open or laparothoracoscopic surgery (rendezvous procedure). It can also be used for inserting conventional drains in laparoscopy.
(130) Based on a therapy example in the case of esophageal leakage with outward fistulization, the pull-through technique will be explained. Using a guidewire or an endoscope, the insertion instrument will be preplaced from the outside above the fistula opening up to the esophagus. At the same time, an endoscope is inserted through the mouth into the esophagus and moved forward to the leakage point. When the insertion instrument has arrived at the leak of the esophagus, it is grasped using a loop and moved back out retrograde through the mouth. The insertion instrument will be coupled and attached by its attachment mechanism to the distal end of the fluid communication element, the pointed top-seated attachment or the sponge body. Under endoscopic vision, the insertion instrument is then subjected to a pull, the drainage occurs subject to pull by way of the mouth into the esophagus. The exact positioning is endoscopically controlled via the esophagus. The insertion instrument will be detached from the coupling to the drainage device and removed by further pulling. If the tip of the fluid communication element, the pointed top-seated attachment or the sponge body is reinforced by a string, the maneuver above can be performed using the string subject to application of the above technique.
(131) The application of the pull-(through) procedure is particularly advantageous if a drainage device design was selected, in which the sponge body lies in the central section of the fluid communication element. In that case, the sponge body can be positioned by pulling on one end of the fluid communication element. Aspiration is then possible via only one leg of the fluid communication element, simultaneously via both legs or alternating.
(132) The insertion instrument consists of a bead grabber. In a plastic sleeve, a metal or plastic core is introduced. The distal end of the core splits into two or a plurality of leaves. At the distal end of the core, an outward tension of the leaves exists so that it opens blossom-like when it emerges from the distal end of the sleeve and closes during retraction into the sleeve. At their ends, the leaves are molded spoon-like, so that upon closing of the core, a spherical or lenticular cavity forms. At the distal end, after closing, a small opening remains. Into the blossom-like opened core, the grasping bead of the pointed top-seated attachment, the fluid communication element or the fluid collection element can be introduced. When the core is closed, the bead is firmly seated. During opening, it detaches easily again and insertion instrument and grasping bead are uncoupled.
(133) It is particularly advantageous if the insertion instrument is designed to receive a guidewire. The bead grabber may be introduced into the working channel of an endoscope. The insertion instrument is particularly 80 cm to 250 cm long.
(134) An additional insertion instrument consists of a hook. Into a plastic sleeve, a wire-like metal or plastic core is introduced. At the distal end, the core is provided with a hook, by means of which a string loop or an eyelet can be grasped. After release of the hook from the sleeve, the string loop or eyelet of the pointed top-seated attachment, the fluid communication element or the fluid collection element can be attached by retracting the hook. Upon opening of the hook, the connection releases again. It is particularly advantageous to introduce a guidewire into the insertion instrument. The hook can be inserted into the working channel of an endoscope.
(135) Furthermore, it has been found to be helpful to provide a grasping bead, string-wire loop, eyelet and/or a string, attached tension-proof, at the tip, in the latter case, the tip having a transverse channel, into which the string can be introduced.
(136) FIGS. 57 a to f are different representations of an endoscopic insertion instrument 5713a/b, by means of which a grasping bead 579 can be grasped. FIG. 57a is a representation of an opened instrument. Out of a sleeve 5713a, a dual-leaf core 5713b, which has opened, is conducted out. Moreover, a guidewire 573 exits from the sleeve. In FIG. 57b, the guidewire 573 is retracted, the grasping bead 579 is grasped using core 5713b. FIG. 57c shows how the grasping bead was grasped. The core 5713b was retracted into sleeve 5713a; during this process, core 5713b has closed. In FIG. 57d, the closed core 5713b is represented having grasped grasping bead 579 and being retracted into sleeve 5713a. FIG. 57e is a longitudinal section of 57a with sleeve 5713a, opened core 5713b, guidewire 573 and grasping bead 579. FIG. 57f is a longitudinal section of 57d. The closed core 5713b with the grasped grasping bead 579 has been retracted into sleeve 5713a.
(137) FIGS. 58 a to e are different representations of an additional endoscopic insertion instrument, by means of which an eyelet 5810 can be grasped. FIG. 58a is a representation of the opened instrument. Out of a sleeve 5814a, a hook 5814b is conducted out. Moreover, a guidewire 583 is conducted out of the sleeve. In FIG. 58b, the guidewire 583 is withdrawn, the eyelet 5810 is grasped using hook 5814b. FIG. 58c shows how the hook was retracted into sleeve 5814a using the grasped eyelet 5810. FIG. 58d is a longitudinal section of the insertion instrument of FIG. 58a, with sleeve 5814a, hook 5814b, guidewire 583 and eyelet 5810. FIG. 58e is a longitudinal section of FIG. 58c. The hook 5814b has been retracted back into the sleeve 5814a using the grasped eyelet 5810.
(138) FIG. 59 is a representation of insertion aid 591 with a sleeve 592 for attachment to a distal end of an endoscope. Insertion aid 591 is beveled at its distal end, the longer side of the bevel coming to lie on the endoscope, in order to avoid injury during insertion of the endoscope. At the proximal end, a valve 593 is located to prevent leakage of the examination gas.
(139) 60 is a representation with 2 insertion aids 601 of different sizes.
(140) FIG. 61 shows a longitudinal section of an insertion aid 611, an attachment sleeve 612 with valve 613.
(141) FIG. 62 shows a representation of an insertion aid 621 having an attachment sleeve 622 at a distal end of an endoscope 624
(142) FIG. 63 is a representation of an insertion aid 631 having an attachment sleeve 632 at a distal end of an endoscope 634. Into the insertion aid, endoscopic forceps 635 were introduced.
