U.S. patent number 3,859,986 [Application Number 05/371,935] was granted by the patent office on 1975-01-14 for surgical device.
This patent grant is currently assigned to Jiro Okada, Olympus Optical Co., Ltd.. Invention is credited to Toshiyuki Mori, Jiro Okada.
United States Patent |
3,859,986 |
Okada , et al. |
January 14, 1975 |
SURGICAL DEVICE
Abstract
A surgical device includes a flexible inner tube having one end
dipped in a liquid refrigerant, a flexible outer tube receiving the
inner tube and having a freezing tip disposed at a distance from
the other end of the inner tube to define a space therebetween, and
a vacuum pump for evacuating the outer tube and space, so that the
refrigerant is introduced into the space through the inner tube to
be evaporated therein to cool the freezing tip.
Inventors: |
Okada; Jiro (Kamakura,
JA), Mori; Toshiyuki (Tokyo, JA) |
Assignee: |
Okada; Jiro (Kanagawa-ken,
JA)
Olympus Optical Co., Ltd. (Tokyo, JA)
|
Family
ID: |
23466021 |
Appl.
No.: |
05/371,935 |
Filed: |
June 20, 1973 |
Current U.S.
Class: |
600/104; 606/20;
600/107 |
Current CPC
Class: |
A61B
1/00098 (20130101); A61B 18/02 (20130101); A61B
1/307 (20130101); A61B 1/12 (20130101); A61B
1/07 (20130101); A61B 2018/0212 (20130101) |
Current International
Class: |
A61B
18/00 (20060101); A61B 18/02 (20060101); A61B
1/12 (20060101); A61B 1/307 (20060101); A61b
001/30 (); A61b 017/36 () |
Field of
Search: |
;128/6,7,8,303.1,303.15 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Pace; Channing L.
Claims
What we claim is:
1. A surgical device for treating a diseased portion comprising an
inner tube having one end dipped in a liquid refrigerant and the
other end provided with a nozzle, an outer tube spaced from and
surrounding at least the other end portion of the inner tube and
the nozzle, said tubes being movably disposed relative to each
other, the outer tube having a freezing tip at one end disposed at
a distance from the nozzle to define an evaporating space
therebetween, vacuum means for evacuating the space between the
outer periphery of the inner tube and the inner periphery of the
outer tube and the evaporating space, to introduce the liquid
refrigerant from said one end of the inner tube to the evaporating
space, whereby the refrigerant is evaporated in said evaporating
space to cool said freezing tip, the evaporated refrigerant then
passing through the space between the inner and outer tubes to
thermally insulate from the ambient the liquid refrigerant passing
through the inner tube, said vacuum means being connected to an
outer sleeve fixed to the inner sleeve, an inner sleeve coaxially
inserted in said outer sleeve and movable along its axis, one end
of said inner sleeve being connected to the other end of said outer
tube, and a member for fixing the position of the inner sleeve
relative to the outer sleeve, whereby to adjust the distance
between the nozzle and freezing tip to control the dimensions of
the evaporating space.
2. The surgical device according to claim 1 wherein said inner and
outer tubes are flexible tubes.
3. The surgical device according to claim 2 wherein said flexible
tubes are made of thermal insulating substance.
4. The surgical device according to claim 3 wherein the thermal
insulating substance is polyfluoroethylene.
5. The surgical device according to claim 2 wherein the freezing
tip is attached to the end of the outer tube and made of metal.
6. The surgical device according to claim 1 which further comprises
means for observing the freezing tip.
7. The surgical device according to claim 6 wherein said observing
means is a cycstoscope comprising a sheath through which the outer
tube is inserted to extend the freezing tip from an open end of the
sheath, and a light guide inserted in the sheath for illuminating
the area around the freezing tip.
8. The surgical device according to claim 6 wherein said observing
means is a cystoscope comprising a sheath with an opening and
window which are formed near one end of the sheath, a light guide
inserted in the sheath to illuminate the viewing field of the
window, and a telescope slidably inserted in the sheath and having
an ocular and optical system optically connecting the ocular to the
window, the outer tube being slidably inserted through the sheath
with the freezing tip extended from the opening in the sheath.
9. The surgical device according to claim 6 wherein said observing
means is an endoscope comprising a distal end with a viewing
window, illuminating window, opening, and a raising mechanism, a
flexible tube on one end of which the distal end is mounted, and a
control unit mounted on the other end of the flexible tube having
an inlet opening and an ocular optically connected to the viewing
window in the distal end, the outer tube being slidably inserted
into the control unit inlet opening and through the endoscope, so
that said one end of the outer tube and the freezing tip are
extended from the opening in the distal end, and the extended
portion of the outer tube end being adjustably inclined by the
raising mechanism.
10. The surgical device according to claim 1 which further
comprises a container for the liquid refrigerant in which said one
end of the inner tube is dipped.
11. The surgical device according to claim 10 wherein said one end
of the inner tube is provided with a filter.
Description
BACKGROUND OF THE INVENTION
This invention relates to a surgical device for freezing and
treating the diseased portion of the cavity wall such as the inner
wall of the stomach.
In surgical operations for cancer of the urinary bladder,
hypertrophy of the prostatic gland and the like, there is commonly
used a surgical device for freezing the diseased portion to destroy
the affected cellular tissue. In the device, the diseased portion
is frozen by a freezing metal tip which is cooled in contact with
and by evaporation of a liquid refrigerant such as liquid nitrogen.
The liquid refrigerant is supplied from a refrigerant container
through an inner tube to be evaporated near the metal tip and then
the evaporated refrigerant is discharged through an outer tube.
In the conventional device, such a liquid refrigerant is supplied
into the first tube by means of pressuring the liquid in the
container. Such a means tends to give rise to a complicated
construction and difficulties in adjusting the temperature of the
metal tip. Further other means to thermally insulate a liquid
refrigerant flowing through the inner tube from the outside is
unable to satisfy the following requirements. The means has been
required to have an excellent insulation and permit the outer tube
to be of a small outer diameter.
SUMMARY OF THE INVENTION
It is an object of this invention to provide a surgical device
which is simple in construction and provides sufficiently
controllable low temperature for freezing the diseased portion.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a sectional view of a surgical device having a surgical
instrument and a cystoscope;
FIG. 2 is a side view of a surgical device having the surgical
instrument and another cystoscope;
FIG. 3 is a perspective view of an endoscope combined with the
surgical instrument; and
FIG. 4 is an enlarged sectional view showing the part of the
endoscope illustrated in FIG. 3.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
FIG. 1 shows a surgical device having a surgical instrument 1 and a
cystoscope 2 to perform an operation for cancer of the urinary
bladder. The surgical instrument 1 includes an elongated flexible
outer tube 3 formed of, for example, polytetrafluoroethylene or
synthetic resin and a flexible inner tube 4 of a freezing-resistant
material e.g., fluorine resin which is inserted in the outer tube
3. The outer diameter of the inner tube 4 is made slightly smaller
than the inner diameter of the outer tube 3 so as to provide a
cylindrical space between the tubes 3 and 4. The outer tube,
however, is movably disposed relative to the inner tube.
Preferably, the outer tube 3 has a plurality of adiabatic ribs on
its inner surface which extend in the lengthwise direction and are
equally spaced apart from each other so that the inner tube 4 may
be coaxially supported by the outer tube 3. This insures that
refrigerant flowing through the inner tube is thermally insulated
from the outer tube 3. Alternatively, it is possible to form
adiabatic ribs on the outer surface of the inner tube 4.
A freezing metal tip 5 is sealingly mounted on one end of the outer
tube 3. A nozzle 6 is formed at one end of the inner tube 4 and
slightly spaced apart from the inner surface of the metal tip 5 to
define a space therebetween.
A rigid inner sleeve 7 is tightly connected at one end to the other
end of the outer tube 3. The inner sleeve 7 is slidably inserted in
an outer sleeve 8 which is closed at one end facing the other end
of the inner sleeve 7. An O-ring seal 9 is fitted on the outer wall
of the inner sleeve 7 so as to enable the inner sleeve 7 to slide
through the outer sleeve 8 in an air-tight manner. A threaded hole
is formed in the side wall of the outer sleeve 8, preferably near
the open end of the outer sleeve 8. A screw 10 is inserted in the
threaded hole to fix the inner sleeve 7 to the outer sleeve 8.
Since the outer tube 3 is connected to the inner sleeve 7 and the
inner tube 4 is fixed to the outer sleeve 8, the distance between
the nozzle 6 and the metal tip 5 is easily adjusted by sliding the
inner sleeve 7 through the outer sleeve 8. The adjusted distance
may be maintained by tightening the screw 10 to fix the inner
sleeve 7 to the outer sleeve 8.
An exhaust pipe 11 is connected at one end to the outer sleeve 8
near the closed end and at the other end to a vacuum pump 12. The
exhaust pipe 11 has a vacuum gauge 12a so as to measure vacuum
pressure in the exhaust pipe 11, outer sleeve 8, inner sleeve 7,
and the outer tube 3.
The inner tube 4 inserted in the outer tube 3 extends through
sleeves 7 and 8 into refrigerant such as a liquid nitrogen in a
refrigerant container 13. To the end of the inner tube 4 dipped in
the refrigerant is attached a filter 14 which permits only the
refrigerant to pass through the inner tube 4. Part of the inner
tube 4 extending from the closed end of the outer sleeve 8 to the
container 13 is covered with an adiabatic member 15 of, for
example, polystyrene foam.
The surgical instrument 1 may be assembled with the cystoscope 2
wherein the end portion of the outer tube 3 is inserted movably
through the sheath 16 of the cystoscope. The freezing tip 5 is
extended from one end of the sheath 16. A light guide 17 made of an
optical fiber bundle is inserted into the sheath 16 to illuminate
the area around the diseased part and freezing tip 5. The sheath 16
is provided with a water inlet 18 and outlet 19 to pass the water
through the sheath thereby melting the ice formed on the periphery
of the outer tube 3.
The operation of the surgical instrument 1 and cystoscope 2 to
treat cancer of the urinary bladder is described below.
First, the diseased portion is located with the naked eye through
the sheath while illuminating the inner wall of the urinary
bladder. Then, the freezing tip 5 is brought close to the diseased
portion. In this condition, the outer sleeve 8 and outer tube 3 are
evacuated by operating the vacuum pump 12 so that the refrigerant
in the container 13 may be conducted through the inner tube 4 to
the nozzle 6 and projected from the nozzle 6 to the freezing tip 5.
The refrigerant, when projected from the nozzle 6, is evaporated
and discharged through the outer tube 3. The freezing tip 5 is
cooled in contact with the refrigerant and also by evaporation of
the refrigerant. While observing both the tip 5 and the diseased
portion through the cystoscope 2, the tip 5 which is cooled is
brought into direct contact with exactly the diseased portion to
freeze the diseased portion and treat the cancer of the urinary
bladder.
Another type of the cystoscope 20 which may be assembled with the
surgical instrument 1 will be illustrated with reference to FIG.
2.
The cystoscope 20 includes a sheath 21 with a closed top end, an
opening 22 for the surgical instrument and window 23. A telescope
24 is slidably inserted in the sheath through a guide formed in the
sheath, which is provided with an ocular 25 at one end and an
observing window 26 at its other end. An optical system constructed
with lenses and a prism is mounted in the telescope 24 to optically
connect the ocular 25 to the observing window 26. The telescope 24
is further provided with a light guide 27 made of a bundle of
optical fibers, which guides a light from a light source (not
shown) to the windows 23, 26.
The flexible outer tube 3 of the surgical instrument 1 is inserted
through the sheath 21 at an opening formed on the base side
thereof. The top portion of the outer tube 3 and metal tip 5 are
extended from the opening 22 near the window 23. The extended
portion of the outer tube 3 may be controlled to vary its inclined
angle to the longitudinal axis of the telescope by operating an
angle adjusting mechanism 28. The mechanism 28 may be designed to
have the same construction as a conventional forceps raising
mechanism of an endoscope. The mechanism 28 includes a pivoted arm
mounted in the sheath and a wire one end of which is connected to
the arm and the other end of which is connected to a lever 29
mounted on the base of the sheath. The arm may be pivoted by the
operation of the lever 29 to change the inclined angle of the outer
tube 3.
The operation of the surgical device shown in FIG. 2 is
substantially similar to that of FIG. 1 and thus omitted in the
description.
FIGS. 3 and 4 show a well known endoscope 30 combined with the
surgical instrument 1 described above, which includes a control
unit 31, a flexible tube 32 to be inserted into the body cavity and
a distal end 33 attached to the end of the flexible tube 32. The
distal end 33 is provided with a viewing window 34, an illuminating
window 35 for illuminating the viewing field of the window 34 and a
forceps opening 36, which are formed on the front side of the
distal end 33. The viewing window 34 is optically connected to an
ocular 37 mounted on the control unit 31 through a bundle of
optical fibers arranged in the flexible tube 32. The illuminating
window 35 is optically connected to a light source (not shown)
through a light guide disposed in the flexible tube 32 and control
unit 31. The control unit 31 also includes a forceps inlet opening
39 through which a forceps (not shown) may be inserted into the
forceps channel provided in the flexible tube 32 until the end of
the forceps extends out through the forceps opening 36 of the
distal end 33. In the distal end near the forceps opening 36 there
is arranged a forceps raising mechanism 40 which is mechanically
connected to the control unit 31 through a wire, so that the
raising mechanism 40 is operated by the control unit 31 to change
the inclined angle of the extended portion of the forceps. The
endoscope 30 is further provided with a bending mechanism (not
shown) which is also operated by the control unit to adjustably
vary the bending angle of the portion of the flexible tube 32 near
the distal end 33.
In operation, the surgical instrument 1 is combined with the
endoscope 30, as shown in FIG. 3. The outer tube 3 of the surgical
instrument is inserted into the forceps inlet opening 39 of the
latter endoscope to extend the top of the outer tube 3 and the
metal tip 5 from the forceps opening 36 in the distal end 33,
instead of a conventional forceps. The distal end 33 and flexible
tube 32 are inserted into the cavity of a human body, together with
the outer tube 3 and metal tip 5 of the surgical instrument. Then,
the diseased portion is observed through the ocular 37 and viewing
window, and the inclined angle of the extended portion of the outer
tube 3 is adjusted by operating the forceps raising mechanism to
allow the metal tip 5 to contact with the diseased portion.
Operation of the surgical instrument is similar to that detailed in
connection with FIG. 1 and thus omitted in the description.
With the described surgical devices, the diseased portion of the
human body may be frozen by direct contact with the metal tip which
has been cooled in the following manner. The liquid refrigerant
contained in the container 13 is sucked into the inner tube 4 and
then sprayed or projected from the nozzle 6 into the evaporating
space between the nozzle 6 and the inner surface of the metal tip
5, by driving the vacuum pump 12 to evacuate said evaporating space
through the discharge tube 11 and the outer tube 3. The projected
refrigerant may be evaporated in the evaporation space to
effectively cool the metal tip, since the evaporating space has
large dimensions relative to the opening of the nozzle. The
dimensions of the evaporating space may be adjustably changed by
moving the inner sleeve 7 through the outer sleeve 8 along its
longitudinal axis, so that the temperature of the metal tip may be
easily controlled.
The vacuum means such as pump 12 evacuates the cylindrical space
between the outer tube 3 and inner tube 4, so that the liquid
refrigerant in the container 13 may be introduced into the
evaporating space through the inner tube 4, and also the nozzle 6
and the liquid refrigerant flowing through the inner tube may be
thermally insulated from the outside.
In the surgical device according to the present invention
supplemental means for pressuring the liquid refrigerant may be
added to the vacuum means so as to introduce the refrigerant into
the evaporating space.
* * * * *