U.S. patent number 3,805,791 [Application Number 05/265,806] was granted by the patent office on 1974-04-23 for apparatus for the diathermic removal of growths.
Invention is credited to Peter Deyhle, Kurt Seuberth.
United States Patent |
3,805,791 |
Seuberth , et al. |
April 23, 1974 |
APPARATUS FOR THE DIATHERMIC REMOVAL OF GROWTHS
Abstract
The present apparatus is a so called polypectome for the
diathermic removal of growths, such as polyps, especially from the
intestinal tract, by means of a high frequency heated wire loop
which is extended out of and pulled back into a flexible tubular
member. A guide bushing for the wire loop is located at the outer
end of the tubular member. The guide bushing comprises guide means
therein which guides the loop so that it forms an oval in its
extended position and substantially an eight in its retracted
position. The wire loop has a bent tip having a diameter which is
smaller than the inner diameter of the guide bushing to facilitate
the controlled shaping of the loop.
Inventors: |
Seuberth; Kurt (D-855
Forchheim/Ofr., DT), Deyhle; Peter (CH-8006 Zurich,
CH) |
Family
ID: |
5812417 |
Appl.
No.: |
05/265,806 |
Filed: |
June 23, 1972 |
Foreign Application Priority Data
Current U.S.
Class: |
606/47;
30/116 |
Current CPC
Class: |
A61B
17/32056 (20130101); A61B 18/14 (20130101); A61B
2018/1407 (20130101); A61B 18/1492 (20130101); A61B
2018/141 (20130101) |
Current International
Class: |
A61B
17/32 (20060101); A61B 18/14 (20060101); A61b
017/38 () |
Field of
Search: |
;128/303.14,303.15,303.16,304,305,130,310,3B ;30/116 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Laudenslager; Lucie H.
Attorney, Agent or Firm: Fasse; W. G.
Claims
What is claimed is:
1. In an apparatus for the diathermic removal of growths of the
type comprising a tubular member, actuator means, flexible
connecting means, and a wire loop having two arms, wherein the
inner end of said arms is connected to said actuator means by said
flexible connecting means extending through said tubular member to
form a Bowden connection, wherein said loop has a bent tip
interconnecting said two loop arms at the outer end thereof and
wherein means are provided for supplying to said wire loop high
frequency power, the improvement comprising a guide bushing located
at an end of said tubular member remote from said actuator means
and adjacent to said wire loop, said bushing comprising guide means
for said loop, said bushing having a longitudinal bore
therethrough, said bore having a given diameter, said bent tip
having a diameter smaller than said given diameter, said guide
means in the bushing controlling the shape of the loop as the loop
is moved in and out of the bushing so that the bight formed at the
outer end of the loop in its extended outer position has the shape
of an oval and the size of said bight is reduced as the loop is
pulled into the bushing.
2. The apparatus according to claim 1, wherein said actuator means
comprise a hollow body connected to said tubular member at its end
remote from said wire loop, an actuator rod axially movable back
and forth in said hollow body, said actuator rod having an inner
end connected to said flexible connecting means extending through
said tubular member, said actuator rod including an outer end
extending out of said hollow body and handle means attached to said
outer end of the actuator rod.
3. The apparatus according to claim 2, wherein said actuator rod
has a piston attached to its inner end for sliding back and forth
in said hollow body, sealing means between said piston and said
hollow body for closing an inner chamber in said hollow body
against the outer end of the hollow body, an inlet port in said
hollow body for connecting said inner chamber to a source of a
protective gas and gas outlet aperture means in said bushing
adjacent to said wire loop whereby an uninterrupted and
substantially closed gas conduit is provided from said inlet port
through said chamber and tubular member to said aperture means in
the bushing.
4. The apparatus according to claim 2, wherein said actuator rod
has a longitudinal bore therethrough, means at said outer end of
the actuator rod for connecting said bore to a source of a
protective gas, sealing means between said actuator rod and said
hollow body to provide an inner chamber in said hollow body between
the inner end of the actuator rod and the tubular member, and gas
outlet aperture means in said bushing adjacent to said wire loop
whereby an uninterrupted and substantially closed gas conduit is
provided from said bore in the actuator rod through said chamber
and tubular member to said aperture means in said bushing.
5. The apparatus according to claim 2, wherein said actuator rod
includes conductor means, insulating means for electrically
insulating said handle means from said conductor means, said
flexible connecting means between said wire loop and said actuator
rod comprising an electrical conductor and connector means at the
outer end of said actuator rod for connecting a source of high
frequency power through said actuator rod and through said flexible
connecting conductor to said wire loop.
6. The apparatus according to claim 1, wherein said bent tip at the
outer end of the wire loop has the shape of a semicircle, the
diameter of which is smaller than said given inner diameter of said
bushing.
7. The apparatus according to claim 1, wherein said guide means of
said bushing comprise a chamfer extending along the outer end of
said bushing to surround said longitudinal bore through the bushing
at the outer end thereof.
8. The apparatus according to claim 7, wherein said guide means of
said bushing comprise a further chamfer extending along the inner
end of said bushing to surround said longitudinal bore through the
bushing at the inner end thereof.
9. The apparatus according to claim 1, wherein said bushing is
inserted into said tubular member with a snug fit.
Description
BACKGROUND OF THE INVENTION
The present apparatus is a so called diathermy wire loop or snare
for the diathermic removal of growths, more specifically, of rank
growths or so called proud flesh, tumors, polyps, and the like. The
present apparatus is especially suitable for use in the entire
intestinal tract.
For viewing and examining the intestinal tract, so called
esophagus-scopes, gastro-scopes, duodeno-sopes and colonoscopes as
well as endoscopes are used. These scopes comprise substantially a
long tubular light conductor which includes a conduit or channel
for the insertion of an instrument. It is known to insert through
this instrument channel so called biopsy tongues to bring the
tongues close to a viewing window of the endoscope in order to
remove tissue samples for test purposes.
An earlier development of our diathermy snare includes a thin steel
wire forming the loop which is connected to an insulated handle by
means of a flexible wire extending through a tubular member whereby
a so called Bowden cable is formed. When the handle is operated the
snare may be extended out of the end of the tubular member or it
may be drawn into the tubular member. The wire with the loop
attached thereto is connected to one electrode of a high frequency
source delivering a frequency of, for example, 1 Mega Hz and a
power of about 40 to 80 watts. The other electrode at the high
frequency source is connected to the patients body.
The just described snare works satisfactorily. However, it has been
found that there is room for improvement with regard to the control
of the shape of the snare as it is moved into and out of the
tubular member to avoid tangling.
OBJECTS OF THE INVENTION
In view of the above, it is the aim of the invention to achieve the
following objects singly or in combination:
To provide a device by means of which it is possible to remove an
internal growth such as polyps, or the like;
To perform the operation under a steady supply of protective gas in
order to avoid the ignition of gases which may be present in the
intestinal tract;
To perform such removal without a laparotomy, whereby an opening of
the body will be avoided;
To provide a removal instrument which will avoid or prevent
bleeding at the place where the removal is carried out, for example
by assuring a quick coagulation; and
To provide an instrument, the snare of which may be controlled as
to its shape as it is moved in and out of a tubular member whereby
to avoid tangling of the wire loop or snare.
SUMMARY OF THE INVENTION
According to the invention there is provided an apparatus for the
diathermic removal of growths which comprises a springy wire loop
adapted for connection to a high frequency source of power. The
loop may be pulled tight and opened by means of a connecting wire
extending from actuator means through a flexible, tubular member to
the loop whereby a so called Bowden cable is formed. The outer end
of the loop has a bent tip of, for example, substantially
semicircular shape and has a diameter smaller than the inner width
of a guide bushing through which the loop extends. The guide
bushing is provided with guide means shaped in such a manner that
the wire loop in its extended position forms a oval which is
twisted and its two arms are pressed together when the loop is
pulled into said guide bushing so that the loop as it moves into
the guide bushing and inside thereof assumes the shape of a
somewhat longitudinal eight.
In order to avoid during the operation a possible ignition of the
gases which are generated in the intestinal tract, the invention
further teaches to provide a hollow handle or actuator means of the
present apparatus with a connecting flange to which is attachable a
hose or pipe connected to a source of protective gas. The above
mentioned guide bushing is provided adjacent to its outer end, that
is, adjacent to the loop with lateral aperture means whereby the
hollow actuator means together with the flexible tubular member
forms a continuous, substantially uninterrupted supply path for the
protective gas from the inlet at the actuator means to the lateral
aperture means in the guide bushing.
BRIEF FIGURE DESCRIPTION
In order that the invention may be clearly understood, it will now
be described, by way of example, with reference to the accompanying
drawings, wherein:
FIG. 1 illustrates the complete apparatus in a side view partially
in section;
FIG. 2 shows a detail of the loop end of the present apparatus on
an enlarged scale with the loop substantially fully extended and
illustrating the guide bushing;
FIG. 3 is a view similar to that of FIG. 2 but with the loop in a
partially retracted position;
FIG. 4 is also a view similar to that of FIG. 2 but with the loop
fully retracted; and
DETAILED DESCRIPTION OF EXAMPLE EMBODIMENTS
The apparatus for the diathermic removal of growths comprises
actuator means including a hollow body 1 which is connected to a
flexible guide conduit or tubular member 2 which may, for example
be 2.5 meters long. The actuator means further include an actuator
rod 11 which is axially movable back and forth inside the hollow
body 1 by means of a handle 3 for actuating a wire loop 5 through a
flexible connecting means or loop slider 4 which may be made of
spring wire. The just described elements may form a so called
Bowden-or push-pull arrangement whereby the connecting wire 4 is
connected at one end thereof through the rod 11 to the operating
handle 3 and at the other end to the wire loop 5. The guide hose or
tubular member 2 is preferably made of elastic, synthetic,
insulating material.
The wire loop 5 is made of stainless spring steel having a diameter
of approximately 0.2 mm and a length of about 50 to 60 mm. The wire
loop 5 is bent in such a manner that its front end forms a bent tip
6 having, for example, a substantially semicircular shape with a
diameter smaller than the inner width or given diameter of a bore
7' extending longitudinally through a guide bushing 7.
The guide bushing 7 is preferably, but not necessarily, made of
stainless steel and is securely connected to one end of the tubular
member 2. Preferably, the guide bushing is inserted into the end of
the tubular member 2. The bushing 7 is provided with guide means 8
and 8' which may be in the form of chamfers as shown in FIGS. 2 to
4 at the inner and outer ends of the bushing 7. The chamfers
control the shape of the spring steel wire loop 5, which in its
extended position (FIG. 2) has the shape of a oval, so as to cause
the two arms of the loop to move toward each other when the loop is
pulled into the guide bushing 7 so that the two arms assume a
predetermined shape and position, preferably in such a manner that
the loop in its retracted position (FIG. 4) inside the bushing 7
assumes the shape of a somewhat elongated eight.
FIG. 3 shows the loop 5 drawn into the guide bushing 7 for about
half of its stroke or back and forth movement. It will be noted
that the arms of the loop 5 glide along the chamfers 8, 8' in order
to assume said somewhat longitudinal eight shape including an inner
bight 5'. This gliding contact will first be established with the
outer end chamfer 8 and then with the inner end chamfer 8'. At a
particular intermediate instant the bights of the eight may contact
both chamfers 8, 8'.
Incidentally, in an actual embodiment the guide bushing 7 may have,
for example, an outer diameter of 1.6 mm to snugly fit into the
tubular member 2 which may have an outer diameter of about 2.1 mm
and an inner diameter of about 1.5 mm to assure said snug fit. The
bore through the bushing may have a diameter of about 1.0 mm
leaving a wall thickness for the bushing of about 0.3 mm. The
chamfers 8, 8' may be considered to be part of the bore through the
guide bushing so that the diameter of the bent tip 6 as taught by
the invention, should be smaller than the widest diameter of the
chamfer.
The hollow body 1 comprises a hollow cylinder to which is attached
a connecting flange 9 which is connected through a hose 10 to a
source not shown of protecting gas. Such source of protecting gas
may, for instance, contain carbon dioxide. The operating handle 3,
preferably of insulating material, is connected to one end of said
actuator or push rod 11, the other end of which is formed as a
guide piston 12 which is movable back and forth in the hollow body
1. The push rod 11 is sealed relative to the hollow body 1 by means
of a ring seal 12' so that a sealed or closed chamber is formed in
the lower end of the hollow body 1 for the admission of the
protective gas from the gas container through the hose 10, the
connecting flange 9, said chamber and the tubular member 2 all the
way to the guide bushing 7, the outlet end of which is provided
with at least one lateral aperture 13 whereby the protective gas
may emerge laterally and not only forwardly in the direction of the
loop 5. Thus, the entire area in which the loop is operated is
continuously scavenged with the protective gas. This has the
advantage that ignitions are avoided which otherwise might occur
because under adverse conditions small sparks may occur during the
removal work. Such sparks are as such not dangerous, however, they
could cause an ignition if the area in which the loop is being
operated is filled with ignitable gases such as methane. The supply
of the protective gas effectively eliminates any ignition
danger.
The actuator rod 11 may be made of conducting material and the
handle member 3 which is made of insulating material may be
provided with connecting means 14 such as an inner thread for
electrically connecting a high frequency source through the
actuator 11 and through the push-pull wire 4 to the loop 5. As a
modification of the embodiment of FIG. 1, it is possible to supply
the protective gas instead of through the connecting flange 9
through the handle member 3. For this purpose, the hose 10 could be
connected to the inner thread 14 in the handle member 3. The push
rod 11 would be hollow so that the protective gas may be supplied
through the push rod to the tubular member 2.
The apparatus according to the invention is operated as follows.
The tubular member 2 acts as a guide conduit. The wire loop 5 is
drawn into the bushing 7, and the apparatus is inserted into the
instrument channel or conduit of an endoscope, not shown, which has
been inserted into the patient previously. The member 2 is pushed
through the channel of the endoscope until the front end of the
tubular member 2 exits from the instrument channel of the
endoscope. Thereafter the handle member 3 is pushed toward the
hollow body 1 whereby the wire loop 5 is extended as shown in FIGS.
1 and 2. With the optical aid of the endoscope, the loop 5 is
placed around the growth to be removed. Thereafter, the protective
gas is supplied and the high frequency energy switched on. By
pulling the handle member 3, the loop 5 is slowly closed whereby
the growth such as a polyp is removed without any spilling of blood
due to the coagulation caused by the diathermic loop.
In view of the above, it will be appreciated that the apparatus
according to the invention may be used for the internal removal of
growths such as rank growths, polyps, and the like, whereby the
springy wire loop is placed around the growth in the manner of a so
called electric knife whereby the wire loop is connected at its
opposite end through a metallic gliding member 11 with a
conventional high frequency surgical power source. As the loop is
slowly closed, the growth is cut off while bleeding is
simultaneously prevented due to the coagulation caused by the high
frequency heated loop.
Thus, it is possible to avoid the so called "bloody" operation
which requires the opening of the abdomen. Moreover, the patient
may take nurishment immediately after the removal of the growth and
may also leave the bed forthwith.
Although the invention has been described with reference to
specific example embodiments, it is to be understood, that it is
intended to cover all modifications and equivalents within the
scope of the appended claims.
* * * * *