WO2001034046A1 - Vorrichtung zur schonenden gewebeentnahme aus tierischem oder menschlichem gewebe - Google Patents
Vorrichtung zur schonenden gewebeentnahme aus tierischem oder menschlichem gewebe Download PDFInfo
- Publication number
- WO2001034046A1 WO2001034046A1 PCT/EP2000/010987 EP0010987W WO0134046A1 WO 2001034046 A1 WO2001034046 A1 WO 2001034046A1 EP 0010987 W EP0010987 W EP 0010987W WO 0134046 A1 WO0134046 A1 WO 0134046A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- hollow cannula
- tissue
- cannula
- hollow
- intermediate space
- Prior art date
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B18/04—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating
- A61B18/12—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body by heating by passing a current through the tissue to be heated, e.g. high-frequency current
- A61B18/14—Probes or electrodes therefor
- A61B18/1482—Probes or electrodes therefor having a long rigid shaft for accessing the inner body transcutaneously in minimal invasive surgery, e.g. laparoscopy
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B18/00—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2018/00571—Surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body for achieving a particular surgical effect
- A61B2018/00601—Cutting
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2218/00—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2218/001—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body having means for irrigation and/or aspiration of substances to and/or from the surgical site
- A61B2218/002—Irrigation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B2218/00—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body
- A61B2218/001—Details of surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body having means for irrigation and/or aspiration of substances to and/or from the surgical site
- A61B2218/007—Aspiration
Definitions
- the invention relates to a device for gentle tissue removal from animal or human tissue, with a hollow cannula having a hollow channel.
- a large number of different methods and devices are known for targeted tissue removal from animal or human bodies, which are used for the purposes of tissue examination.
- Starting from the well-known classic surgical procedure using a scalpel creating a through-channel to the tissue area to be separated and examined in order to separate tissue in this area by targeted cuts and to remove it from the body through the working channel
- Disadvantages associated with surgical technique to make the surgical intervention minimally invasive by means of suitable auxiliary tools Although it was possible with the classic method to extract a sufficient amount of tissue material from the body for the examinations, the surgical intervention and the associated tissue sections involve irreversible tissue irritation, the healing process of which takes a long time. In addition, there is a risk of tissue spreading in such a way that tissue that may have had tumors and has been separated and removed extracorporeally through the working channel is also carried away into tissue areas that are not affected by malignant tissue.
- punch biopsy devices which allow tissue to be removed from targeted intracorporeal tissue areas by means of a single needle puncture through the body cover.
- This is the combination of a hollow cannula with one running inside the hollow cannula Mandrin, in which a recess is worked into the distal side, into which tissue can be embedded, which can be separated with the help of the hollow cannula sharply ground on the distal side.
- This type of tissue extraction is minimally invasive and involves only slight tissue irritation which results from the insertion of the cannula arrangement into the interior of the body.
- a disadvantage of the known punch biopsy is the only small amount of tissue that can be removed with a single cannula stitch.
- the tissue area is very stressed and irritated due to the large number of cannula punctures.
- the invention is based on the object of designing a device for gentle tissue removal from animal or human tissue with a hollow cannula having a hollow channel in such a way that the disadvantages described above can be largely avoided.
- the aim is to minimize the irreversible tissue irritation caused by the intervention by means of a minimally invasive intervention in the tissue area to be examined. Tissue cell injuries caused by the intervention should also be minimized and the risk of bleeding reduced to a minimum.
- Tissue cell injuries caused by the intervention should also be minimized and the risk of bleeding reduced to a minimum.
- the solution to the problem on which the invention is based is specified in claim 1.
- a device for the gentle removal of tissue from animal or human tissue with a cannula having a hollow channel, is designed such that the hollow cannula is designed as a multi-walled hollow cannula and provides at least two cannula walls including at least one space, which is open on the distal side.
- a cutting wire that can be supplied with electrical energy protrudes from the distal side and is preferably designed in a shape that corresponds to the cross-sectional contour of the intermediate space and is spaced apart from it on the distal side.
- a supply line for a material flow opens into the intermediate space of the multi-wall hollow cannula, the supply line and the intermediate space being connected to one another and designed in such a way that the material flow flows through the intermediate space and emerges from it on the distal side.
- An electrically non-conductive rinsing liquid for example a glycol solution, is used as the preferred material flow.
- the rinsing fluid should have approximately the same mineral content as the human or animal tissue fluid or at least chemical inertness, so that the mineral balance of the surrounding tissue is not impaired by intracorporeal rinsing.
- a vacuum source can be connected on the proximal side of the hollow channel of the preferably double-walled multi-wall hollow cannula.
- the multi-wall hollow cannula which is preferably designed as a double-walled hollow cylinder, preferably has an outer contour which is adapted to the inner contour of a hollow channel which is designed as a lock and which acts as a working channel for intracorporeal introduction of endosurgical instruments into it Interior of the body, also used to insert the hollow cannula designed according to the invention.
- lock arrangements which provide a helical screw thread on the outside and which provide a tapering screw thread shape on the distal side, whereby the screw tip is the distal end part of a stylet protruding through the sheath, which is carried out for the purpose of introducing the sheath arrangement into the interior of the body.
- a lock arrangement can be seen, for example, from DE 199 35 976.8.
- the particular advantage of such a lock device lies in the fact that the tissue is not cut when the lock arrangement is inserted, but rather is distilled through the helically arranged tip, so that natural separation points in the tissue or in the cell assemblies, which are penetrated by the distal screw tip, give way, cutting blood vessels, nerves or cells as far as possible.
- the positioning of a lock in this regard can be checked with the aid of ultrasound, X-ray or MR monitoring methods for the purpose of a controlled position positioning relative to a tissue area to be examined.
- the multi-wall hollow cannula is preferably double-walled and designed as a hollow cylinder, the cannula length of which is selected to be greater than the length of the lock, so that the multi-wall hollow cannula can protrude from the distal side of the lock and can penetrate the tissue area to be examined accordingly.
- the process of penetration of the distal end of the multi-wall hollow cannula is distinguished in particular by the fact that the cutting wire arranged immediately in front of the open end of the intermediate space of the multi-wall hollow cannula, the shape of which essentially corresponds to the cross-sectional shape of the intermediate space and is slightly spaced therefrom, with electrical energy, preferably with a HF current is applied and is thereby heated, as a result of which the tissue which comes into contact with the cutting wire is thermally severed, and at the same time there is a coagulative process in the tissue material which prevents subsequent bleeding.
- the cutting wire serves, as it were, as a kind of high-frequency surgical cutting device, which immediately protects cell clusters from further bleeding by thermal coagulation during their severing. It is also conceivable that the tissue to be separated is severed by means of an erosion process, ie the tissue does not come into direct contact with the cutting wire, but is thermally denatured by the spark discharges which occur on the cutting wire due to the high electrical voltages. The formation of sparks creates a plasma that leads to the desired erosion effects.
- a volume of tissue is separated by the cutting wire, which is preferably designed in the manner of a full circle, and brought into the interior of the hollow cannula, which has the shape of a full cylinder. So that the tissue parts separated by the cutting wire from the remaining tissue area reach the interior of the hollow wall cannula completely, the hollow channel of the multi-wall hollow cannula is connected to a vacuum source, whereby any separated tissue areas can get into the interior of the multi-wall hollow cannula.
- a material stream preferably a glycol solution, emerges through the intermediate space on the distal side and is supplied to the hollow cannula on the proximal side via a feed line.
- the glycol solution is able to significantly support the separation process and the removal of the separated tissue areas into the interior of the hollow channel.
- the glycol solution also provides for a desired cooling of the tissue area surrounding the heated cutting wire, as a result of which the heat input to the surrounding tissue is minimized.
- this provides a cutting wire web which is directed towards the center of the hollow channel surrounded by the double-walled multi-wall hollow cannula.
- the multi-wall hollow cannula together with the cutting wire arrangement is rotated about the longitudinal axis of the hollow cannula, as a result of which the cutting wire web completely separates the tissue core located inside the multi-wall hollow cannula from the distal side from the residual tissue.
- the tissue sample separated in this way from the residual tissue inside the body is now held in the multi-wall hollow cannula by means of negative pressure within the hollow channel and can simply be removed from the inside of the body through the working channel of the lock.
- the vacuum source is connected to a single-walled hollow cannula, at the distal end of which a meshwork or a similarly designed arrangement is provided, so that the distal one At the end of the single-walled hollow cannula only predominantly liquid or gas parts can be aspirated through the hollow cannula and separated solid parts, such as the tissue sample itself, are held in front of the hollow cannula by the meshwork.
- the hollow cannula is formed on the proximal side in the hollow channel of the double-walled during the separation process Multi-walled hollow cannula introduced, the insertion depth of the single-walled hollow cannula within the double-walled multi-walled hollow cannula is selected such that there is a sufficiently large distance between the distal end of the double-walled multi-walled hollow cannula and the distal end of the single-walled hollow cannula connected to the negative pressure source, so that there is sufficient tissue material can be drawn into the interior of the hollow channel.
- the receiving volume of the hollow channel of the double-walled multi-walled hollow cannula is larger than the actually separated tissue volume. Due to the negative pressure acting inside the hollow channel, the separated tissue sample is held firmly on the single-walled hollow cannula, so that removal of the single-walled hollow cannula with the tissue core located on the distal end of the hollow cannula is possible.
- a new tissue removal can be carried out by changing the angle of the lock using the thermal cutting device.
- the sluice which is equipped with an external thread as described above, is replaced by a hollow cannula which has a recess at its distal area, for example in the form of a cutout running halfway to the hollow channel axis, it is possible to repeatedly take tissue in the radial environment around the Carry out hollow cannula without moving the sluice or the working channel, which can further limit possible tissue irritation. This is done in such a way that the multi-wall hollow cannula is pushed into the correspondingly prepared hollow cannula up to a maximum of the proximal edge of the cutout.
- a negative pressure applied inside the multi-wall hollow cannula ensures that tissue material which is located radially to the distal end of the hollow cannula directly opposite the cutout is drawn laterally into the interior of the hollow cannula. Then the Multi-walled hollow cannula with the heated cutting wire pushed distally and the tissue material drawn in within the cut-out was separated and transferred extracorporeally using the technique already described. This tissue separation process can be repeated accordingly after the hollow cannula has been slightly rotated about its longitudinal axis. The hollow cannula is twisted without any tissue irritation.
- tissue can be separated piece by piece from the body.
- the separation process is preferably carried out under visual surveillance, for example by means of X-ray observation, so that targeted tissue areas around the cannula arrangement can be removed in a gentle manner.
- the latter is connected via an electrical connection that runs inside the intermediate space on the proximal side, the electrical connection running on the proximal side via the supply line through which the intermediate space supplies the glycol solution becomes. Since both the flushing liquid and the electrical feed line are led through one and the same intermediate space, it is imperative that the flushing liquid is not designed to be electrically conductive.
- the cutting current which is fed to the cutting wire in the manner of an HF current, targeted coagulations can be carried out at the interface, which denatures the cell clusters and thus prevents subsequent bleeding and cell carryover.
- the sluice serving as the working channel can be removed, the essentially dilated tissue returning to its original position and being able to heal quickly there.
- a particular advantage for the subsequent tissue analysis is the partial longitudinal cut within the tissue sample, which is caused by the cutting wire web Full cylinder has been severed, especially since the longitudinal section as a marking aid enables a clear subsequent assignment of the original position before the severing process within the tissue area to be examined.
- FIG. 1 a shows a schematically, highly simplified illustration of a hollow hollow cannula 1 provided with a helical external screw thread, which is completely penetrated by a stylet 2 for insertion, for example, through the skin layers of a human body, which is shown in FIG. 1 b.
- the stylet 2 has at its distal tip a conical screw thread 3, by means of which it is possible to delicate and insert the sluice 1 in an intracorporeal area, which is gentle on the tissue.
- the cannula arrangements shown in FIGS. 1a and 1b are described in detail in DE 199 35 976.8.
- the cylindrical multi-wall hollow cannula 4 has an inner wall 41 and an outer wall 42, which enclose an intermediate space 43 (shown hatched in FIG. 1e).
- the open space 43 which is open on the distal side, is surmounted by an annular cutting wire 44 which provides a cutting wire web 45 which projects into the center of the hollow channel of the multi-wall hollow cannula 4.
- an electrical feed line that runs through the intermediate space 43 on the proximal side.
- the double-walled multi-wall hollow cannula 4 is connected at its proximal area to a hose-like feed line 5, which ends at one end in the intermediate space 43 and is connected at its other end to an adapter piece 6, which provides two connection areas 7, 8.
- a glycol solution is fed into the feed line 5, through which the glycol solution reaches the intermediate space 43 and exits at the distal end area of the hollow cannula 4.
- the electrical supply line runs through the supply line 5 and ends in the connection area 8 in order to be able to be connected there to a corresponding RF energy source.
- the multi-wall hollow cannula 4 is open on both the distal side and the proximal side, so that a single-walled hollow cannula 9 can be inserted into the multi-wall hollow cannula 4 on the proximal side.
- the hollow cannula 9 is connected to a vacuum source 12, not shown.
- the distal end of the hollow cannula 9 is provided with a mesh 10, as shown in Fig. 1e.
- the meshwork 10 prevents tissue material sucked into the interior of the multi-wall hollow cannula 4 from being able to escape through the hollow cannula 9 as well.
- the arrangement shown in Fig. 1e from the double-walled multi-walled hollow cannula 4 and the single-walled hollow cannula 9 shows the state of the single-walled hollow cannula 9 fully inserted into the double-walled multi-walled hollow cannula 4, with sufficient space being provided within the multi-walled hollow cannula 4 to separate tissue material into to spend the interior of the multi-wall hollow cannula 4.
- the hollow cannula 9 connected to the vacuum source 12 has a slide switch 11, by means of which the negative pressure prevailing in the interior of the hollow cannula 9 can be quickly released. This is necessary to get the detached and tissue sample taken from the hollow cannula 4 can be easily taken from the distal end of the hollow cannula 9.
- FIG. 1f A further hollow cannula 13 is shown in FIG. 1f, which provides at its distal end a cutout 14 which extends over half the cannula circumference and has a length l of approximately 1-2 cm.
- the hollow cannula is used when additional tissue material is to be removed, which lies radially against the cannula arrangement according to FIG. 1e.
- the hollow cannula 13 has a length such that the hollow cannula 13, at least with its cutout 14, projects beyond the lock 1 on the distal side.
- a mechanical stop 16 is provided on the hollow cannula 13, which limits the maximum depth of penetration of the hollow cannula 13 into the lock.
- a spacer ring 15, which is provided on the hollow cannula 9, provides a mechanical stop with respect to the proximal end of the multi-wall hollow cannula 4 and has a spacer ring thickness, so that the hollow cannula 9 extends as far as possible to the proximal end of the cutout 14, especially since it is ensured in this way is that severed tissue can be drawn in completely within the multi-wall hollow cannula 4 over the length I. It is also possible to pull the spacer ring 15 off the hollow cannula 9, so that the hollow cannula 9 can penetrate deeper into the hollow wall cannula 4. This is particularly advantageous when slightly less tissue volume is to be removed than when the spacer ring 15 is provided.
- the tissue removal with the help of the hollow cannula 13 takes place in the manner described below.
- the tissue area along the cannula extension is either separated by means of the cannula arrangement and brought out extracorporeally or at least dilated.
- the tissue area that extends radially around the distal end area of the cannula arrangement must now be gently removed.
- the multi-wall hollow cannula is pushed proximally, so that the cutout 14 is free.
- the tissue lying directly on the cutout 14 is drawn into the hollow cannula 13.
- the multi-wall hollow cannula 4 is then pushed distally, the cutting wire severing the tissue drawn into the hollow cannula 13.
- the separated tissue is sucked into the interior of the multi-wall hollow cannula 4. The tissue can then be moved extracorporeally.
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- Health & Medical Sciences (AREA)
- Surgery (AREA)
- Engineering & Computer Science (AREA)
- Life Sciences & Earth Sciences (AREA)
- Biomedical Technology (AREA)
- Otolaryngology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Plasma & Fusion (AREA)
- Physics & Mathematics (AREA)
- Heart & Thoracic Surgery (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Surgical Instruments (AREA)
Abstract
Description
Claims
Priority Applications (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US09/869,837 US6387057B1 (en) | 1999-11-09 | 2000-11-07 | Device for gently removing tissue from animal or human tissue |
EP00979538A EP1139896A1 (de) | 1999-11-09 | 2000-11-07 | Vorrichtung zur schonenden gewebeentnahme aus tierischem oder menschlichem gewebe |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
DE19953938.3 | 1999-11-09 | ||
DE19953938A DE19953938A1 (de) | 1999-11-09 | 1999-11-09 | Vorrichtung zur schonenden Gewebeentnahme aus tierischem oder menschlichen Gewebe |
Publications (1)
Publication Number | Publication Date |
---|---|
WO2001034046A1 true WO2001034046A1 (de) | 2001-05-17 |
Family
ID=7928470
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/EP2000/010987 WO2001034046A1 (de) | 1999-11-09 | 2000-11-07 | Vorrichtung zur schonenden gewebeentnahme aus tierischem oder menschlichem gewebe |
Country Status (4)
Country | Link |
---|---|
US (1) | US6387057B1 (de) |
EP (1) | EP1139896A1 (de) |
DE (1) | DE19953938A1 (de) |
WO (1) | WO2001034046A1 (de) |
Families Citing this family (7)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US7988642B2 (en) * | 2003-10-14 | 2011-08-02 | Suros Surgical Systems, Inc. | Vacuum assisted biopsy device |
US8357103B2 (en) | 2003-10-14 | 2013-01-22 | Suros Surgical Systems, Inc. | Vacuum assisted biopsy needle set |
US8048003B2 (en) | 2003-10-14 | 2011-11-01 | Suros Surgical Systems, Inc. | Vacuum assisted biopsy device |
EP1673015B1 (de) * | 2003-10-14 | 2014-03-19 | Suros Surgical Systems, Inc. | Vakuumgestütztes biopsienadelset |
US20070142816A1 (en) * | 2005-12-19 | 2007-06-21 | Carstens Jerry E | Absorbent article and system comprising thong-shaped holder |
US20110237975A1 (en) * | 2010-03-24 | 2011-09-29 | United States Endoscopy Group, Inc. | Multiple biopsy device |
KR101756626B1 (ko) | 2010-11-15 | 2017-07-10 | 진테스 게엠베하 | 뼈 결손용 이식편 수집 및 격납 시스템 |
Citations (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4301802A (en) * | 1980-03-17 | 1981-11-24 | Stanley Poler | Cauterizing tool for ophthalmological surgery |
US5019036A (en) * | 1989-11-28 | 1991-05-28 | Stahl Norman O | Method and apparatus for removing gelatinous tissue |
US5797907A (en) * | 1989-11-06 | 1998-08-25 | Mectra Labs, Inc. | Electrocautery cutter |
WO1999044523A1 (en) * | 1998-03-05 | 1999-09-10 | Scimed Life Systems, Inc. | Pmr device and method |
DE19935976A1 (de) | 1999-11-16 | 2001-02-01 | Norbert Heske | Kanülenanordnung zum Einbringen endoskopischer Instrumente in einen menschlichen oder tierischen Körper |
Family Cites Families (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5133360A (en) * | 1991-03-07 | 1992-07-28 | Spears Colin P | Spears retriever |
-
1999
- 1999-11-09 DE DE19953938A patent/DE19953938A1/de not_active Withdrawn
-
2000
- 2000-11-07 US US09/869,837 patent/US6387057B1/en not_active Expired - Fee Related
- 2000-11-07 EP EP00979538A patent/EP1139896A1/de not_active Withdrawn
- 2000-11-07 WO PCT/EP2000/010987 patent/WO2001034046A1/de not_active Application Discontinuation
Patent Citations (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4301802A (en) * | 1980-03-17 | 1981-11-24 | Stanley Poler | Cauterizing tool for ophthalmological surgery |
US5797907A (en) * | 1989-11-06 | 1998-08-25 | Mectra Labs, Inc. | Electrocautery cutter |
US5019036A (en) * | 1989-11-28 | 1991-05-28 | Stahl Norman O | Method and apparatus for removing gelatinous tissue |
WO1999044523A1 (en) * | 1998-03-05 | 1999-09-10 | Scimed Life Systems, Inc. | Pmr device and method |
DE19935976A1 (de) | 1999-11-16 | 2001-02-01 | Norbert Heske | Kanülenanordnung zum Einbringen endoskopischer Instrumente in einen menschlichen oder tierischen Körper |
Also Published As
Publication number | Publication date |
---|---|
EP1139896A1 (de) | 2001-10-10 |
DE19953938A1 (de) | 2001-05-10 |
US6387057B1 (en) | 2002-05-14 |
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