DE102011000964B4 - surgical device - Google Patents

Abstract

Surgical device for the treatment of human or animal tissue, comprising - a liquid jet device (1) with a tube section (5) having a nozzle (3), the nozzle (3) being formed at a distal end (7) of the tube section (5); - An electrode device (9) which, in the activated state, is designed for cutting and / or coagulating a tissue by means of a high-frequency current, the tube section (5) of the liquid jet device (1) forming the electrode device (9); - An electrode control device with an HF generator connected to the electrode device for generating the high-frequency current, and - A fluid control device for generating a fluid flow in the liquid jet device (1), the fluid control device for a dissection and / or needleless injection, a fluid flow with a first fluid pressure provides, characterized in that the fluid control device is designed such that it does not generate a fluid flow at the start of the activation of the electrode device (9) and only provides a fluid flow with a second fluid pressure after a predetermined time period after the activation of the electrode device (9), the second fluid pressure is lower than the first fluid pressure, and that the fluid control device is designed such that it conditionally controls the liquid jet device (1) after the predetermined period after the activation of the electrode device (9) Activated that the electrode device (9) is still activated after this period.

Description

The invention relates to a surgical device for the treatment of human or animal tissue according to the preamble of claim 1.

Surgery devices of the type discussed here are known in principle. In particular, they serve to remove tumors in the gastrointestinal tract that are confined to the mucosa. Such tumors should be completely ectomized in one session if possible. In this case, an endoscopic mucosal resection is usually used, in which the mucosa is first injected with liquid, in particular with a NaCl solution, before the resection. Due to the penetration of the liquid into the mucosa, it is clearly detached from the muscularis Propria and a fluid cushion develops under the mucosa (elevation). The fluid cushion provides a safe distance to the Muscularis Propria, which also serves as thermal protection. Subsequently, the mucosal resection is performed by means of an HF treatment. In order to avoid having to change the instrument several times during the operation, multifunctional devices are used, which can perform both the injection and the resection with a single instrument.

The DE 10 2009 017 636 A1 shows, for example, such an instrument, which is explained in more detail below with reference to the figure. The known surgical instrument for treating human or animal tissue shown in the figure comprises a liquid jet device 1 with a one nozzle 3 having pipe section 5 , where the nozzle 3 at a distal end 7 of the pipe section 5 is trained. Furthermore, the surgical device comprises an electrode device 9 for cutting and / or coagulating a tissue by means of a high-frequency current. The figure makes it clear that the pipe section 5 the liquid jet device 1 at the same time the electrode device 9 forms. Purely exemplary is in the figure at the distal end 7 of the pipe section 5 an insulating element 11 arranged, which has a nozzle in fluid communication with the outlet 13 having. The surgical device furthermore has an electrode control device (not shown in the figure), which has one with the electrode device 9 connected RF generator for generating the high-frequency power has or controls this. Furthermore, a fluid control device likewise not shown in the figure for generating a fluid flow in the liquid jet device 1 , ie in particular in the pipe section 5 and the nozzle 3 intended. The fluid control device cooperates with a fluid source, not shown, and a pump unit and can variably dose a water jet pressure depending on the lesion, tissue layer and field of application. In addition, the fluid control device is designed such that it provides a fluid flow with a first fluid pressure, especially for dissection and / or needle-less injection, in particular for injecting tissue.

The surgical device of the type mentioned here thus forms a combined endoscopic multifunctional surgical instrument for uniform handling, with the at least two different steps can be performed, namely on the one hand dissection and / or injection by means of a liquid jet and on the other hand cutting and / or coagulating tissue by means of a Electrode.

Devices of the type discussed here are also from the US 2006/0271034 A1 and the US 2010/0168736 A1 known.

The problem with the surgical devices of the type mentioned here is that the RF cutting / coagulation involves a great thermal load on the electrode device 9 and in particular to the nozzle 3 integral distal end 7 of the pipe section 5 acts. This results in increased demands on the nozzle material and on the nozzle geometry. There is consequently the risk of burn-up of the nozzle, unless high-temperature-resistant material is used for the nozzle, that is to say for the distal end of the pipe section. The production of a burn-off combined electrode nozzle is therefore complicated and costly.

Object of the present invention is therefore to provide a surgical device in which even with the use of a less temperature-resistant material, the erosion of the electrode is reliably avoided.

To solve the above object, a surgical device with the features of claim 1 is proposed. The surgical device is characterized in that the fluid control device is designed such that it does not generate a fluid flow at the beginning of the activation of the electrode device and only after a predetermined time after activation of the electrode device provides a fluid flow with a second fluid pressure, wherein the second fluid pressure for cooling the electrode device is less than the first fluid pressure, which is used for example for injection or for cutting tissue. The activation of the electrode device should be understood to mean that a high-frequency current generated by the HF generator is supplied to the electrode device. In the deactivated state, such a current is not supplied to the electrode device. In other words, the liquid jet device is deactivated at the time of activation of the electrode device, ie it does not conduct water and consequently does not generate a liquid jet. Only after the predetermined period of time, the liquid jet device is activated, thus leading a liquid, if at this time the electrode device is still activated.

An essential point of the invention is therefore that during activation of the electrode device, d. H. while a high frequency current is supplied to the electrode means for coagulating or cutting a tissue, at the same time, the fluid control means controls the volume of a fluid flow such that a cooling fluid flow with a low fluid pressure in the liquid radiator acts. In this way, the heat generated by the activated electrode is continuously reduced or reduced by the simultaneous cooling fluid flow, so that the low heat development, the erosion of the electrode, d. H. avoids the distal end of the tube section. Another advantage of the invention results from the fact that the surrounding tissue is continuously cooled, whereby collateral damage can be avoided. In addition, the electrical conductivity of the treated tissue is improved, whereby a more uniform RF application is realized. In addition, a much more flexible electrode design is possible, especially with regard to the choice of material or the electrode geometry.

In the case of the surgical device according to the invention, moreover, it is crucial that the fluid control device does not generate a cooling fluid flow when the electrode device is marked very briefly by the generation of a resection line by means of coagulation points, for example for marking the surgical field. Only at a longer RF activation of the electrode device does it produce a cooling fluid flow. After a predetermined period of time or time delay after the electrode device has been activated, a fluid flow through the fluid control device is thus activated only if the electrode device is still activated after this predetermined period of time. In this way, it is certainly avoided that in the case of a very short activation of the electrode device, which as a rule does not require cooling of the electrode, the liquid jet device for cooling the electrode is already activated.

The predetermined period of time after the activation of the electrode means may preferably be 0.5 seconds to 2.5 seconds. In addition, it can preferably be provided that the fluid control device and the electrode control device are connected to each other in a communicating manner, in particular via a bus connection. In this way, the fluid control device can detect whether the electrode device is still activated after the predetermined period of time after activation of the electrode device. Preferably, the fluid control device generates. for cooling the electrode, a second, in particular continuous, fluid flow having a fluid pressure which is less than the fluid pressure provided for dissection and / or needleless injection. In particular, the liquid jet device is designed as an injection needle, which is possible only by the continuous cooling of the electrode device according to the present invention.

There is also provided a method of operating a surgical device having a liquid jet device with a nozzle portion having a nozzle at a distal end for dissection and / or needleless injection by means of a liquid. The surgical device furthermore has an electrode device which, in the activated state, is designed to cut and / or coagulate a tissue by means of a high-frequency current, wherein the tube section of the fluid-jet device forms the electrode device. Furthermore, the surgical device has an electrode control device with an HF generator connected to the electrode device for generating the high-frequency current. In addition, a fluid control device for activating the liquid jet device is provided by the generation of a fluid flow in the liquid jet device.

• – aktivieren der Elektrodeneinrichtung, wobei unter der Aktivierung der Elektrodeneinrichtung verstanden wird, dass ein durch den HF-Generator erzeugter hochfrequenter Strom der Elektrodeneinrichtung zugeführt wird;
• – überprüfen des Aktivierungszustandes der Elektrodeneinrichtung nach einer vorbestimmten Zeitspanne nach dem Beginn der Aktivierung der Elektrodeneinrichtung, sodass also nach der bestimmten Zeitspanne überprüft wird, ob die Elektrodeneinrichtung noch aktiviert ist, und
• – aktivieren der Flüssigkeitsstrahleinrichtung nach der vorbestimmten Zeitspanne unter der Bedingung, dass die Überprüfung nach der vorbestimmten Zeitspanne einen aktivierten Zustand der Elektrodeneinrichtung ergeben hat, wobei unter einer Aktivierung der Flüssigkeitsstrahleinrichtung verstanden wird, dass der Flüssigkeitsstrahleinrichtung eine Flüssigkeit zugeführt wird. Im deaktivierten Zustand führt die Flüssigkeitsstrahleinrichtung folglich keine Flüssigkeit.

The process is characterized by the following steps:

• Activating the electrode device, wherein activation of the electrode device means that a high-frequency current generated by the HF generator is supplied to the electrode device;
• Checking the activation state of the electrode device after a predetermined period of time after the start of the activation of the electrode device, so that after the determined period of time it is checked whether the electrode device is still activated, and
• - Activating the liquid jet device after the predetermined period of time under the condition that the check after the predetermined period of time has resulted in an activated state of the electrode device, wherein an activation of the liquid jet means that the liquid jet device is supplied with a liquid. When deactivated, the liquid jet device consequently does not conduct any liquid.

If, after the predetermined period of time has elapsed after the activation of the electrode device, it emerges from the check that the electrode device is no longer activated, no activation of the liquid jet device takes place.

It is understood that the predetermined period of time must be determined so that burnup of the electrodes during this time period is just avoided. This is usually the case for an activated period of the electrode of about 0.5 seconds to 2 seconds. However, the time may vary depending on the electrode material used and the dimensioning of the electrode. After this period of time, the thermal load on the electrode becomes so great that erosion of the electrode can be expected. After the liquid jet device generates fluid flow after the predetermined period of time, if the check has revealed that the electrode device is activated, it preferably generates a continuous flow of cooling fluid having a fluid pressure that is substantially less than a fluid pressure for dissection or injection.

Due to the low thermal load of the distal end, the requirements for the nozzle material and the nozzle geometry are reduced. Furthermore, less expensive techniques / materials can be used for the distal end. For example, the conventional MIM part could be replaced by a VA nozzle electrode. Due to the low thermal load would be conceivable as a distal end and a needle geometry, in particular an injection needle. With this needle geometry, the injection of the syringes, especially of resistant tissue, could be substantially facilitated, and the water pressure required for the elevation of tissue would be much smaller.

It is understood that the electrode device 9 and the liquid jet device 1 may also be designed differently in principle than shown in the exemplary figure. For example, the insulating element 11 not significant to the present invention. All that is decisive is that during active operation of the electrode device, ie during a high-frequency current through the pipe part 5 is guided, simultaneously in the pipe 5 over the nozzle 3 a fluid flow can be performed with a low fluid pressure, the electrode device 9 cools. According to the invention, the cooling fluid flow in the tube 5 only switched on when after activating the electrode means, ie the beginning of the supply of high-frequency current to the tube 5 a predetermined period of time has elapsed after first cooling the electrode to prevent burnup becomes necessary. An unnecessary switching on of the fluid control device or the liquid jet device, if only a short activation of the electrode device is provided, is consequently avoided.

For example, a typical operation of the surgery device may be as follows:
At the beginning of the use of a surgical device according to the invention, a circular resection line is generated around the lesion by means of coagulation points. In this case, the electrode device is activated at intervals only for a short time, which does not require cooling of the electrode device by means of fluid flow. Subsequently, the fluid control device first generates a fluid flow in the liquid jet device with a first fluid pressure, which is suitable, for example, for a needleless injection. In a first step, this fluid flow allows, for example, the metered injection of the mucosa in order to lift it off the muscularis propria and possibly to cut the mucosa. Subsequently, the fluid flow is turned off and in a second step, the electrode device 9 for tissue coagulation with a high-frequency current generated by the RF generator, wherein the electrode control means causes activation of the RF generator. In addition, the electrode control device allows, depending on the particular tissue to be treated, a suitable adjustment of the coagulation parameters, such as the current intensity, etc., of the electrode device 9 is supplied. After a predetermined period of time, from supplying an RF current to the electrode device 9 is measured, the liquid jet device is additionally activated, ie the fluid control device activates a fluid flow in the liquid jet device 1 , However, activation of a fluid flow occurs only when, after the lapse of the time since the beginning of the supply of HF current to the electrode device 9 the supply of HF current is still ongoing. This fluid flow, which is then conducted at the same time as the HF current in the surgical instrument, serves to cool the electrode device 9 and has a lower second fluid pressure than the fluid flow generated for injection or dissection. The second fluid pressure of the fluid flow for cooling the electrode device 9 is in the range between 1 (one) and 10 (ten) bar, preferably in the lower range at 2 (two) bar. This second fluid pressure is largely determined by the cooling capacity required to cool the electrode device. This cooling capacity is influenced by the geometry of the electrode device. The first fluid pressure of the fluid flow, which is used, for example, for injection or cutting, is in the range between 20 (twenty) and 60 (sixty) bar and is largely determined by the application or the conditions of use.

Overall, it is thus clear that at the start time of the electrode activation, ie the beginning of the supply of HF current to the electrode device 9 in which no fluid flow is supplied in the liquid jet device. Only after the predetermined period of time after the start of coagulation, the liquid jet device is activated, ie supplied with a liquid. It is understood that the fluid control device for this purpose must supply corresponding control signals to the aforementioned liquid pump unit or valves must control accordingly.

Overall, the invention provides a cost-effective and flexibly usable surgical device in which the risk of electrode burn-off can be substantially reduced without the use of costly materials.

LIST OF REFERENCE NUMBERS

1

Liquid jet device

3

jet

5

pipe section

7

Distal end

9

electrode means

11

insulating

13

outlet

Claims (6)

A surgical device for the treatment of human or animal tissue, comprising - a liquid jet device ( 1 ) with a nozzle ( 3 ) having pipe section ( 5 ), whereby the nozzle ( 3 ) at a distal end ( 7 ) of the pipe section ( 5 ) is trained; An electrode device ( 9 ) formed in the activated state for cutting and / or coagulating a tissue by means of a high-frequency current, wherein the tube section ( 5 ) of the liquid jet device ( 1 ) the electrode device ( 9 ) forms; An electrode control device with an HF generator connected to the electrode device for generating the high-frequency current, and a fluid control device for generating a fluid flow in the liquid jet device 1 ), wherein the fluid control device for a dissection and / or needle-less injection provides a fluid flow with a first fluid pressure, characterized in that the fluid control device is designed such that at the beginning of the activation of the electrode device ( 9 ) generates no fluid flow and only after a predetermined period of time after the activation of the electrode device ( 9 ) provides fluid flow at a second fluid pressure, wherein the second fluid pressure is less than the first fluid pressure, and that the fluid control device is configured to receive the fluid jet device (12). 1 ) after the predetermined period of time after the activation of the electrode device ( 9 ) is activated on the condition that the electrode device ( 9 ) is still activated after this period of time. Surgery device according to claim 1, characterized in that the predetermined period of time after the activation of the electrode device ( 9 ) Is 0.5 s to 2.5 s. Surgery device according to one of the preceding claims, characterized in that the fluid control device and the electrode control device are communicatively connected with each other. Surgery device according to claim 3, characterized in that the fluid control device and the electrode control device are connected to each other via a bus connection. Surgery device according to one of the preceding claims, characterized in that the fluid flow with the second fluid pressure is continuous. Surgery device according to one of the preceding claims, characterized in that the liquid jet device ( 1 ) is designed as an injection needle.

Images