U.S. patent number 3,850,175 [Application Number 05/268,806] was granted by the patent office on 1974-11-26 for resectoscope with continuous irrigation.
Invention is credited to Jose J. Iglesias.
United States Patent |
3,850,175 |
Iglesias |
November 26, 1974 |
RESECTOSCOPE WITH CONTINUOUS IRRIGATION
Abstract
An improved resectoscope for transurethral resection of prostate
and bladder tumors provides continuous irrigation of the operative
field with clear fluid and continuous drainage of bloody fluid from
the bladder. This is accomplished by means of an outflow conduit
positioned above the telescope shaft, with its inlet located beyond
the objective lens. There are several alternative structures and
arrangements for the inlet of the outflow conduit. In one a baffle
is provided for guiding and separating the inflowing clear fluid
stream and the outflowing bloody fluid; in another an opening in
the upper part of the beak of the resectoscope sheath to permit
passage of the bloody fluid in the bladder to the outflow conduit
inside the sheath; while in another there are two entrances to the
outflow system, the first being through the opening in the beak of
the sheath and the second in a baffle plate below the beak, the
latter being effective only when the first is closed by surrounding
tissue. The outflow conduit may be provided by space within a tube
within the sheath within which tube the telescope shaft is housed,
or it may be provided by the space between outer and inner walls of
the sheath above a telescope shaft.
Inventors: |
Iglesias; Jose J. (Elizabeth,
NJ) |
Family
ID: |
23024566 |
Appl.
No.: |
05/268,806 |
Filed: |
July 3, 1972 |
Current U.S.
Class: |
606/46; 600/105;
600/156 |
Current CPC
Class: |
A61B
1/12 (20130101); A61B 1/00091 (20130101); A61B
1/307 (20130101); A61B 18/149 (20130101); A61B
1/018 (20130101); A61B 1/00135 (20130101); A61B
1/015 (20130101) |
Current International
Class: |
A61B
18/14 (20060101); A61B 1/015 (20060101); A61B
1/12 (20060101); A61B 1/07 (20060101); A61B
1/018 (20060101); A61B 1/06 (20060101); A61B
1/012 (20060101); A61B 1/307 (20060101); A61b
017/32 () |
Field of
Search: |
;128/7,240,241,303.15 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Laudenslager; Lucie H.
Attorney, Agent or Firm: Scrivener Parker Scrivener &
Clarke
Claims
I claim:
1. A urological endoscopic instrument, comprising an elongated
cylindrical beaked sheath,
a tube within and extending longitudinally of the sheath with its
distal end within the beak of the sheath, and being of less cross
sectional area than the sheath to provide between the sheath and
the tube an inflow conduit for irrigating fluid for the operative
field,
means at the proximate end of the sheath for supplying irrigating
fluid to the inflow conduit,
a telescope having a tubular shaft within and extending
longitudinally of the tube and being of less cross sectional area
than the tube to provide between the tube and the telescope shaft
an outflow conduit for turbid fluid from the operative field,
an outflow connection at the proximate end of the tube for removal
of turbid fluid from the outflow conduit,
the telescope having an objective lens at the distal end of the
shaft which is proximate to the distal end of the tube.
2. An endoscopic instrument according to claim 1, comprising in
addition, a buffer plate at the distal end of the tube positioned
externally of the tube at the upper part thereof and closing the
inflow conduit between the upper part of the sheath and the upper
part of the tube.
3. An endoscopic instrument according to claim 2, in which the
buffer plate is positioned normal to the axes of the tube and
sheath.
4. An endoscopic instrument according to claim 2, comprising in
addition a flange connected to the buffer plate and positioned
distal thereto and being upwardly inclined to the axis of the tube
and sheath from its lower edge to its upper edge.
5. An endoscopic instrument according to claim 4, in which the
flange has an aperture therein at and adjacent its upper edge.
6. An endoscopic instrument according to claim 1, comprising in
addition the provision of an opening in the upper wall of the beak
of the sheath on the distal side of the objective lens of the
telescope.
7. An endoscopic instrument according to claim 6, in which the
proximate edge of the opening is on the distal side of the
objective lens of the telescope.
8. An endoscopic instrument according to claim 6, in which the
buffer plate is positioned beneath the proximate edge of the
opening, and comprising in addition a flange within the sheath
positioned beneath the distal part of the opening and having a
vertical extent approximately equal to that of the buffer plate and
being inclined forwardly of the sheath from its lower edge to its
upper edge.
9. An endoscopic instrument according to claim 8, in which an
aperture is provided by notching the edge of the flange.
10. A urological endoscopic instrument, comprising an elongated
cylindrical sheath, means for supplying clear irrigating fluid to
the interior of the sheath at the proximate end thereof for
delivery to the distal end of the sheath to irrigate the operative
field, the sheath having two spaced walls at the upper part thereof
extending from end to end of the sheath providing an outflow
conduit for removal of turbid fluid from the operative field.
Description
BACKGROUND OF THE INVENTION
Endoscopic instruments, as widely used in urology, are introduced
through the urethra into the bladder in order to visualize the
operative field and permit the performance of various operative
procedures, typical instruments being the resectoscope, urethra
cystoscope, lithotriptor, lithotrite and biopsy endoscopic forcep.
All of these instruments include an elongated hollow sheath which
is itself introduced through the urethra.
A resectoscope is an endoscopic instrument for the transurethral
resection of pathological tissues from the prostate and bladder
without incision. In the use of known resectoscopes it is necessary
to interrupt the procedure frequently to evacuate accumulated
bloody fluid from the bladder, this being done to avoid the
dangerous over-distension of the bladder by the introduction of
clear fluid at high pressure in order to maintain clear vision.
A resectoscope of known and conventional construction is comprised
of an arrangement of four principal, easily detachable elements,
these being a sheath, a telescope, a cutting loop electrode and a
working element. These parts are disclosed in FIGS. 1 and 2, which
illustrates a resectoscope of the prior art as background for
disclosure of the invention, and comprise the tubular sheath 2
which provides a passageway through the human urethra to the area
of visual and operative interest, and which has a beak 3 at its
distal end. At its proximate end the sheath has a socket base 4 at
which there is a connection 6 for the introduction of irrigation
fluid, such as sterile water, with a stop cock 8, and a thumb screw
10 for attaching the sheath to the working element when the
instrument is assembled for performance of an operation.
The assembled resectoscope comprises the sheath and its enclosed
parts and the working element and its parts. The parts within the
sheath are the telescope holder tube 20 through which the telescope
shaft and light conductor cables are passed, the cutting loop
electrode 22, a tube 24 for holding the rigid stem of the cutting
loop electrode leads 26, and an outflow conduit 28 which is
provided in some resectoscope models for transmitting fluid from
the clear inflow pathway to the proximate end of the sheath for
removal through a connection 30 and stop cock 32.
The telescope comprises shaft 30, objective lens 32 at the distal
end of the shaft, and an ocular lens (not shown) and eyepiece 34 at
the proximal end, a light connection 38, and a light conductor
inside the shaft, running from connection 38 to the distal end for
providing illumination. The telescope shaft extends from the
working element and is attached to it by suitable means.
The cutting loop electrode 22 comprises an approximately
semi-circular cutting loop formed by a thin bare wire which is
charged with high frequency electrical current and is used to
resect pathological tissue and coagulate bleeding vessels, the two
symmetrical lateral branches 26 which are electrically insultaed
and connect the cutting loop to the rigid stem which transmits
reciprocating movement of the working element to the cutting loop,
and a bare metal end (not shown) for connection to the dielectric
block 50 of the working element. High frequency electricity is
supplied at connection 40 for energizing the cutting loop.
The telescope and the cutting loop electrode are assembled with the
working element before they are introduced into the sheath. In
surgical operations the procedure is as follows: first the sheath
is passed through the urethra, and then the working element, with
the telescope and the cutting loop electrode attached, is plugged
into the sheath's socket base and firmly tightened. Thereafter, the
working element and the electrode are the operative mechanism of
the instrument.
The working element comprises a metal bridge formed by end metal
bridge members 50 and 52 which are connected by one top bar 54 and
two spaced parallel rods 56 which serve as runners for the
reciprocating movement of the dielectric block 50, which movement
is transmitted to the cutting loop. High frequency electric energy
is supplied to the plug-in electric inlet 40 and by internal
connections is transmitted to the cutting loop electrode.
The rotary thumb holder 60 is operated by the surgeon in order to
move the block 50 forwardly of the instrument against the resilient
return force of steel leaf spring 62.
Proper endoscopic visualization requires the presence of a clear
fluid medium at the operative field between the objective lens of
the telescope and the tissues being observed, and this is provided
by the inflow of a clear fluid through the sheath which is
delivered by gravity from an overhead reservoir and is controlled
at the instrument's inlet 6 by stop cock 8. However, blood is
produced by the resected tissues, making a turbid bloody medium at
the operative field, and vision is made possible only by
maintaining an inflow of clear fluid in front of the objective
lens. Hydrostatic pressure is increased in the bladder by the
continuous inflow of clear fluid which is accumulated in the
bladder, but if the inflow rate of clear fluid is reduced the
turbidity is often sufficient to impair vision, and at this point
the surgeon must stop the operation and detach the working element
from the sheath in order to empty the turbid bloody fluid from the
bladder. This interruption of the surgical procedure must be
performed frequently when presently known resectoscopes are used,
and these periodic interruptions produce dangerous difficulties
such as temporary loss of visual orientation, prolonged bleeding,
extended operative time, and sometimes require further anesthesia.
To avoid these difficulties some surgeons maintain a clear medium
at the operating field by increasing the volume of the clear fluid
inflow by raising the exterior reservoir, but this practice
increases the intravesical hydrostatic pressure, overdistending the
bladder and making possible dangerous complications such as
perforation of the bladder, extravasation of fluid, and entrance of
irrigating fluid into the circulation system of the body through
open veins at resected tissues, which may produce hypervolemic and
toxic syndromes which may be fatal.
An outflow conduit such as that shown at 28 in FIG. 1 is sometimes
provided within the sheath and has its distal or inlet end spaced
well inwardly of the distal end of the sheath, and at its proximate
end is connected to discharge through the lateral outlet 30 having
a stop cock 32. The distal end of such an outflow conduit is
located in a plane disposed substantially inwardly of the distal
end of the closed, or full-round, section of the sheath which is
indicated by line B-B in FIG. 1, and between that plane and the
inlet of the conventional outflow conduit 28, clear fluid flows
toward the distal end of the sheath with a pressure greater than
the pressure inside the bladder. Consequently, the turbid fluid
inside the bladder can never reach the inlet of such an outflow
conduit because it cannot pass through the described region within
the sheath where there is the higher hydrostatic pressure of the
clear fluid. Thus, part of the inflowing clear fluid in the sheath
is drained through such an outflow conduit and never reaches the
operative field in front of the lens, which is always located under
the beak of the sheath. When such an outflow conduit is provided
the net result is a reduction of the inflow rate, which has an
adverse effect on the visibility in front of the lens, and the
clear fluid which is drained before reaching the end of the sheath
is entirely ineffective and is wasted. This explains why every time
the stop cock of the outflow conduit is opened only a clear inflow
fluid is drained, and is the reason why several modern
resectoscopes have eliminated this outflow conduit.
SUMMARY OF THE INVENTION
The invention provides an endoscopic urological instrument with an
outflow conduit having its distal, or inlet, end positioned in a
plane at the distal side of the objective lens of the telescope,
and having means for constantly providing a supply of clear
irrigating fluid beneath the beak of the resectoscope, whereby
clear vision of the operative field is constantly available.
DESCRIPTION OF THE DRAWINGS
FIG. 1 is a side view, partly in section, of a resectoscope
according to the prior art;
FIG. 2 is a sectional view taken on line 2--2 of FIG. 1;
FIG. 3 is an enlarged view of the distal end of a resectoscope
according to the invention;
FIG. 4 is a sectional view taken on line 4--4 of FIG. 3;
FIG. 5 is similar to FIG. 3 but shows a modified form of the
invention;
FIG. 6 is a sectional view taken on line 6--6 of FIG. 5;
FIG. 7 is a view similar to FIG. 3 showing a modified form of the
embodiment of the invention disclosed in FIG. 3;
FIG. 8 is a sectional view taken on line 8--8 of FIG. 7;
FIG. 9 is similar to FIG. 3 and shows a further embodiment of the
invention;
FIG. 10 is a sectional view taken on line 10--10 of FIG. 9;
FIG. 11 is similar to FIG. 3 and shows a further embodiment of the
invention;
FIG. 12 is a sectional view taken on line 12--12 of FIG. 11;
FIG. 13 is similar to FIG. 4 and shows a further modification of
the form of the invention disclosed in FIGS. 9 to 11;
FIG. 14 is a sectional view taken on line 14--14 of FIG. 13;
FIG. 15 is a vertical sectional view through any of FIGS. 3, 5, 7,
9, 11 and 13 showing a modified sectional shape of the outflow
conduit;
FIG. 16 is a side view, partly in section, of a urological
endoscopic instrument having an outflow conduit according to the
invention but of different construction than that disclosed in
FIGS. 3 to 13, and
FIG. 17 is a sectional view taken on line 17--17 of FIG. 16.
DESCRIPTION OF THE INVENTION
A urological endoscopic instrument, such as a resectoscope,
constructed in accordance with this invention comprises the same
four separable but readily connectable elements of the conventional
instrument described above, which are the sheath and telescope and,
in the case of the resectoscope, the cutting loop electrode and
working element. The telescope may be conventional, as the
invention does not modify its structure but only its position
within the sheath relative to other parts. The cutting loop
electrode may comprise two smaller lateral stems instead of the
larger one beneath the telescope because there the space is
slightly reduced, but otherwise the cutting loop electrode is not
modified by the invention.
Means are provided by the invention for facilitating and insuring
the removal of turbid fluid from the operative field into and
through the resectoscope in such a manner that the visual field of
the telescope is not impaired by such fluid. Such means comprise,
first, the provision of an outflow conduit above the telescope tube
and having its distal end positioned on the distal side of the
objective lens of the telescope. A first embodiment of such means
is disclosed in FIGS. 3 and 4 and comprises an elongated tube 80
which is positioned within the sheath and extends longitudinally
thereof and is smaller in cross section than the interior of the
sheath, thus leaving a space 82 between the two which provides a
conduit for the inflow of clear irrigating fluid to the operative
field. The telescope shaft 30 is positioned within this tube and is
smaller in cross section than the interior of the tube and is
positioned at the lower part of the tube, leaving a space 84 above
the telescope shaft and within the tube which functions as the
outflow conduit for turbid fluid from the operative field. In
further accordance with the invention, and as clearly shown in FIG.
3 the distal end of the tube 80 is positioned outwardly of the
distal end of the closed section of the sheath, which end is
denoted by the line B-B in FIGS. 1 and 6 and outwardly of the
objective lens of the telescope.
The clear liquid used to irrigate the operative field is
transmitted to the distal end of the sheath through the space
within the sheath and outside the tube 80. This space is denoted 82
in the drawings and clear fluid is supplied to it through the tube
connection 6 and stop cock 8 as described above.
It will be noted that distal of plane B-B the sheath opens under
the beak and there is a drop in the hydrostatic pressure of the
inflow fluid, which mixes in all directions with the fluid in the
bladder. The operative field is under the beak and is where most of
the heavy bleeding occurs, and therefore the whole inflow of clear
fluid will mix there with the blood, and the mixture will be
drained through the outflow conduit.
In FIGS. 5 and 6 there is illustrated another embodiment of the
invention which further improves the efficiency of the outflow
conduit in withdrawing turbid fluid, and in which the space 82
between the upper part of tube 80 and the upper half section of the
sheath is blocked at the distal end of the tube 80 by a transverse
buffer plate 90 which acts to separate the outflow and inflow
streams, causing the inflowing stream of clear liquid in passage 82
to enter the area beneath the beak only at the lower part of the
sheath. This arrangement prevents shortcircuiting of any part of
the inflowing clear liquid within the sheath and outside of tube 80
into the outflow conduit in the space beneath the beak which is at
low pressure because of the discharge thereof of the inflowing
clear fluid. Although the system shown in FIGS. 3 and 4 is a major
improvement over the prior art and is simple enough to be
economically implemented, the further development described in this
paragraph and illustrated in FIGS. 5 and 6 represents an added
feature, increasing the efficiency of the removal of turbid fluid
and better utilizing the clear fluid for washing the operative
field.
In FIGS. 7 and 8 there is illustrated a modified form of the
embodiment of the invention disclosed in FIGS. 5 and 6, in which
the transverse buffer 92 at the distal end of tube 80 is inclined
rearwardly of the sheath from its lower to its upper edge, thereby
directing the inflowing stream of clear irrigating fluid downwardly
and improving the separation of that stream and the outflowing
turbid stream.
A further, and very important, modification of the embodiments of
the invention disclosed in FIGS. 3 to 8 is disclosed in FIGS. 9 and
10 and provides a completely novel concept in the structure and
operation of a urological endoscopic instrument such as a
resectoscope. In this form of the invention an orifice 100 is
provided in the upper wall of the beak of the sheath with its
distal edge positioned inwardly of the distal end of the beak and
its proximate edge positioned just outwardly, i.e., toward the end
of the beak, from the objective lens 32 of the telescope tube.
Buffer means may, if desired, be provided in association with
orifice 100, and such means are shown in FIGS. 11 and 12 and
comprise a plate 100 which extends longitudinally of and within the
tube 80 which encloses the telescope shaft and provides the outflow
conduit, and is welded to this tube and extends outwardly toward
the end of the beak of the sheath from the distal end of the tube.
At that end of the tube and extending upwardly to the inner wall of
the sheath the plate has a vertical flange 104 which, like the
flange of FIGS. 5 to 8, blocks the inflow of clear irrigating fluid
through the upper part of the sheath. The plate 102 is extended
outwardly, i.e., toward the distal end of the sheath, from the
flange 104, and this part of the plate underlies the orifice 100
and at its outer end is inclined upwardly toward the sheath as
shown at 106.
The orifice 100 provides an entrance through the sheath and into
the outflow conduit 84 for the turbid fluid in the bladder. All the
clear irrigating fluid will flow along the path of the arrow A in
FIG. 11 thereby washing the operative field in front of the
objective lens 32 of the telescope and causing continuous clear
vision of the operative field, and also washing the turbid fluid
produced at the field toward the bladder so that this is constantly
drained downwardly through the orifice 100 and outwardly through
the upper part of the outflow tube 80. This is a highly efficient
irrigation system, providing clear fluid to wash the operative
field in front of the objective lens and continuously removing only
turbid fluid from the bladder.
In FIGS. 13 and 14 there is disclosed a modified form of the
embodiment illustrated in FIGS. 11 and 12, and in this modified
form the upwardly and outwardly inclined flange 106 is provided
with an aperture 108 which extends downwardly from its upper edge.
This aperture provides, in combination with the sheath aperture
100, a double inlet for the outflow conduit 84. In spite of the
fact that the orifice 100 is near the end of the sheath, it is out
of the visual field and there is a remote possibility that tissue
may shut it off without being noticed by the surgeon. It may also
be closed during operations being performed within the urethra. The
second aperture 108 prevents stopping of drainage under such
extraordinary conditions, but in order to prevent a greater
proportion of the drainage being taken through this alternative
inlet it is made much smaller than the orifice 100 in the top of
the sheath. Therefore, under normal conditions most of the drainage
fluid will be taken through the inlet orifice 100.
While the tube 80 which encloses the telescope shaft 30 and also
provides the outflow conduit may have the generally elliptical
cross sectional shape shown in FIGS. 3 to 14, it may have different
cross sectional shapes such as that disclosed in FIG. 15 in which
it has a lower part 120 of part-circular shape which partially
surrounds the telescope shaft 30 and an upper part 122 which is
transversely enlarged and therefore provides an outflow conduit of
greater volume and capacity than the elliptical tube 80.
The outflow conduit for the removal of turbid fluid may be provided
by means other than the tube 80 which has been described and which
serves also enclose the telescope tube. One such alternative means
is disclosed in FIGS. 16 and 17 and comprises a sheath 140 having
two spaced walls 142, 144 at its upper part which provide between
them a crescent shaped passage 146 opening at the distal end of the
sheath and providing an outflow conduit connected to discharge
through connection 148 and stop cock 150. As in other embodiments
of the invention the interior of the sheath provides a conduit for
the inflow of clear liquid to the operative field from a connection
6 and stop cock 8. It will be seen that the inlet or distal end of
the outflow conduit 146 is distal of the objective lens 32 of the
telescope, and in all other respects the position, relative
position, operation and functions of the outflow conduit 146
correspond to those of the tube 80 of the other embodiment of the
invention.
* * * * *