Patent Publication Number: US-2020289189-A1

Title: Electrode instrument and resectoscope with gripping function

Description:
BACKGROUND 
     The invention relates to electrode instruments for use in a resectoscope of the type cited in the preamble of claim  1  and to a resectoscope of the type cited in the preamble of claim  10 . 
     Electrode instruments and resectoscopes of this generic type are used above all in urology for electrosurgical work in the bladder and urethra. They are usually used for resection and vaporization of tissue, for example tissue in the lower urinary tract. For this purpose, the resectoscopes comprise an electrode instrument that is supported in a longitudinally displaceable manner within the resectoscope shaft and, after insertion of the resectoscope, can be pushed with its distal working end out of the distal end of the shaft. The electrode instrument comprises an electrosurgical electrode at its distal working end, for example in the form of a loop or vaporization button (e.g., PlasmaButtons). Examples of such instruments include the OES PRO resectoscopes (Olympus) or other continuous-irrigation resectoscopes per Iglesias. 
     If the electrode instruments are used for resection of tissue, it is often desirable or necessary to remove the separated tissue from the site of the intervention, for example in order to prevent further spreading of a disease, such as in the case of a tumoral disease, and/or in order to take a tissue sample for diagnostic purposes. At present, tissue removal is often not performed by means of the resectoscope but rather using a separately inserted gripping instrument. However, this procedure entails the risks of tissue fragments being lost if the instruments are introduced successively or of different insertion openings having to be employed when the instruments are introduced at the same time, so that the intervention is less gentle on the patient. For this reason, it is desirable to be able to use the same instrument for resection and tissue extraction. 
     Existing resectoscopes have been used at times both for tissue resection and for tissue removal. After the electrosurgical separation of a tissue fragment from the surrounding tissue, for example by means of a loop electrode, the tissue fragment is clamped between the loop electrode and the inner tube that is arranged in the resectoscope shaft or the optics. The electrode instrument, tissue fragment, and inner tube were then pulled together from the outer shaft (cladding tube) of the resectoscope and thus also from the patient. However, this approach entails the risk of damaging the sensitive electrode. In addition, this gripping function depends on the geometry and arrangement of the electrode and inner tube, so that structural changes to these elements can lead to a loss or a change in the gripping function. 
     There is therefore a need for improved electrode instruments and corresponding resectoscopes for electrosurgical surgery by means of which tissues can both be severed and removed from the body. 
     DESCRIPTION 
     This object is achieved by an electrode instrument with the features of claim  1  and by a resectoscope with the features of claim  10 . According to the invention, a provision is made in particular that a tissue contact part is arranged on at least one of the support arms of the electrode instrument between which and the distal end of the inner tube and/or a pass-through instrument tissue fragments can be clamped or on which tissue fragments can be impaled. The tissue fragments that are held in this manner on the electrode instrument or the resectoscope can then be removed from the patient&#39;s body. 
     In a first aspect, the invention therefore relates to an electrode instrument for use in a resectoscope, wherein the electrode instrument having an elongate shaft portion with two support arms through which a conductor extends that forms an electrode at the distal end of the electrode instrument that can be subjected to high-frequency current and is arranged between the distal ends of the support arms, characterized in that at least one of the support arms has in its distal end region a tissue contact part for holding tissue fragments that is arranged on the outer wall of the support arm and angled in relation to the longitudinal axis of the support arm. 
     In a second aspect, the invention relates to a resectoscope for endoscopic surgery with a cladding tube, characterized in that an electrode instrument according to the invention is supported so as to be longitudinally displaceable within the cladding tube. The resectoscope according to the invention is suitable for various interventions in endoscopic surgery, particularly in electrosurgical surgery. For instance, the resectoscope can be used for prostate resection. At the same time, the resectoscope can also be used for a variety of other operations, such as bladder resections. 
     In the standard embodiment, the resectoscope according to the invention has a tubular shaft. The resectoscope shaft comprises an elongate cladding tube. In addition to the shaft, the resectoscope for holding and operating comprises a handle system, which usually consists of two handle parts. 
     The electrode instrument according to the invention is used as a pass-through instrument in such a resectoscope. For this purpose, the electrode instrument is supported in a longitudinally displaceable manner in the resectoscope, preferably within the cladding tube of the resectoscope. The electrode instrument can be arranged outside an inner tube extending in the cladding tube, i.e., between the cladding tube and the inner tube, or inside the inner tube. In addition to the electrode instrument, further pass-through instruments can be arranged in the shaft of the resectoscope. The resectoscope usually additionally comprises rod-shaped optics, an illuminating means, and/or an irrigation system, for example. 
     In a conventional embodiment, the electrode instrument has an elongate shaft portion which, as described above, is arranged so as to be longitudinally displaceable and, optionally, rotatable about the longitudinal axis in the interior of the resectoscope shaft. The proximal end of the shaft portion is functionally connected to a carriage of the resectoscope transporter that can be actuated by means of the handle. An electrode that can be subjected to high-frequency current is formed at the distal end of the electrode instrument. 
     The electrode instrument has two support arms, particularly in the shaft portion. The electrode can be held securely between the distal ends of the two support arms without substantially impairing the view of the site of intervention. The support arms can extend from the distal end substantially straight to the proximal end of the electrode instrument. Alternatively, the support arms can be embodied as fork tubes and brought together in a fork proximally to the electrode. This arrangement has been found to be particularly space-saving and stable in some resectoscopes. Those skilled in the art are familiar with other suitable designs of the shaft portion. For example, it is also possible to have the support arms proximal to the electrode merge into a tubular electrode shaft. It is thus possible for the electrode instrument to also be used as an inner tube. According to the invention, it is therefore only necessary for the electrode instrument to have two support arms in its distal end region between which the electrode can be held. 
     A conductor extends through the support arms or the shaft portion and forms an electrode at the distal end of the electrode instrument to which high-frequency current can be applied. This conductor is electrically conductive and can be a conductor wire, for example. The conductor is electrically insulated from the resectoscope shaft, for example, toward the outside in the vicinity of the support arms. The support arms generally comprise an insulating sleeve—i.e., an electrically insulating sleeve—that encloses the conductor for this purpose. The insulating sleeve can have a hollow cylindrical shape in the interior of which the conductor extends. At the proximal end of the support arms, the conductor is connected to a power source via the proximal portion of the resectoscope. 
     The electrode formed by the conductor can have different shapes, but it is always supported between the distal ends of the two support arms. The electrode can be a loop electrode or a vaporization button, for example, the former being preferred. 
     According to the invention, at least one of the support arms has in its distal end region a tissue contact part for holding tissue fragments that is arranged on the outer wall of the support arm and angled relative to the longitudinal axis of the support arm. The tissue contact part that is arranged on a support arm enables tissue fragments to be held securely without having to burden the terminal electrode, so that the tissue fragments can be removed from the site of intervention in a safe and simple manner. The tissue fragments held are generally pulled out of the cladding tube of the resectoscope together with an inner shaft and/or the electrode instrument, so that the tissue fragments preferably have a maximum diameter that is smaller than the inside diameter of the cladding tube. However, it is also conceivable for the resectoscope to be removed completely from the site of the intervention along with a held tissue fragment in order to enable larger tissue fragments to also be removed from a patient&#39;s body. 
     The tissue contact part according to the invention is designed and arranged in such a way as to hold tissue fragments, preferably to hold tissue fragments between the tissue contact part and the distal end of an inner tube and/or the distal end of a pass-through instrument of a resectoscope. In these embodiments, the tissue fragment is thus clamped between the tissue contact part and a component of the resectoscope that is arranged proximally from the tissue contact part. In order to achieve this, the electrode instrument is first displaced distally in such a way that the tissue contact part is arranged distally from a severed tissue fragment, and then withdrawn in the proximal direction into the resectoscope shaft in such a way that the tissue fragment is clamped between the proximal surface of the tissue contact part and one of the abovementioned additional components of the resectoscope, preferably the distal end of an inner tube and/or a pass-through instrument, such as an optical system. It is sufficient for the tissue fragment to be supported on one side of the inner tube. It is not necessary for the tissue fragment to completely close the distal end of the inner tube. 
     Alternatively or in addition, the tissue contact part can be designed and arranged for piercing into tissue fragments. In this embodiment, it is not absolutely necessary for the proximal end of the fragment to be supported on an additional component of the resectoscope in order to hold the tissue fragment. Instead, the tissue contact part is long enough to securely hold a skewered tissue fragment. The tissue contact part designed to pierce tissue fragments is preferably flat in at least one dimension in order to enable the tissue fragment to be easily transfixed. The tissue contact part that is designed for piercing is preferably rod-shaped. As will be explained in greater detail below, the rod-shaped or otherwise-shaped tissue contact part can be bent or curved in order to be adapted to the dimensions of the resectoscope shaft. 
     It is also conceivable for the tissue contact part to have a tip that tapers to a point. This ensures that a tissue fragment can be quickly and securely pierced, picked up, and pushed onto the tissue contact part without falling apart during these steps. 
     According to the invention, at least one of the support arms has such a tissue contact part. It is conceivable for tissue contact parts to be arranged on both support arms. This is not necessary according to the invention, however. It may be advantageous for a tissue contact part to be arranged on only one of the support arms. Material and space can be saved in this way, for example. 
     The tissue contact part is arranged in the distal end region of the support arm. The tissue contact part should be arranged in a resectoscope distal from the distal end of the inner tube and/or pass-through instrument. This ensures not only that they are available as clamping partners, but also that there is sufficient space for the tissue fragment inside the cladding tube. When the electrode instrument displaced proximally as far as it will go, the tissue contact part can be arranged in the resectoscope, for example in the vicinity of the insulating tip of the resectoscope. Resectoscopes usually have such an electrically insulating tip at their distal end in order to prevent short circuits between the electrode and the electrically conductive components of the resectoscope. 
     The tissue contact part can be arranged in a portion of the support arm that is encased by an electrically insulating sleeve. The tissue contact part can also be made of an electrically insulating material. This is particularly advantageous, since there is no need to maintain an insulating gap between the tissue contact part and the electrode. Suitable electrically insulating materials are known to those skilled in the art and include ceramics and plastics, for example, particularly thermostable plastics. Alternatively, the tissue contact part can be arranged in a portion of the support arm that is not encased by an electrically insulating sleeve. The tissue contact part could then be arranged directly on the conductor, for example. In this embodiment as well, the tissue contact part can also be made of an electrically insulating material. 
     The tissue contact part is arranged on the outer wall of the support arm and angled relative to the longitudinal axis of the support arm. For example, the longitudinal axis of the tissue contact part can extend transverse or substantially transverse to the longitudinal axis of the support arm. However, the longitudinal axis of the tissue contact part preferably forms at least an angle of 140° to 40°, more preferably an angle of 120° to 60°, e.g., approximately 90°, relative to the longitudinal axis of the support arm. It will readily be understood that the tissue contact part does not have to form this angle along its entire length. Instead, the longitudinal axis of the tissue contact part forms said angles to the longitudinal axis of the support arm at least in some portions, it being preferred if at least one portion that is directly connected to the support arm forms said angle. 
     As already indicated above, the shape of the tissue contact part can be adapted to an inner shape of the resectoscope, meaning that it can be partially complementary to the shape of the resectoscope, e.g., to the inner wall of the cladding tube or inner tube. For example, starting from the support arm, the tissue contact part can extend away from the support arm in a partially circular shape. The curvature of the tissue contact part can correspond to the curvature of a loop electrode, for example. In the case of tissue contact parts that are curved in this way, it is preferred that the tissue contact part not be arranged directly proximally from (or, as seen from distal: behind) the loop electrode, but rather that it be arranged on the side of the support arm that faces away from the side into which the loop of the loop electrode extends. 
     According to the invention, the tissue contact part that is designed for piercing has a length and the tissue contact part that is designed for clamping has a proximal surface that is long or large enough to hold the tissue fragment securely. In particular, the tissue contact part should not slide off the tissue contact part when the inner tube and/or electrode instrument is pulled out of the cladding tube. In order to prevent slippage from the tissue contact part that is designed for piercing, the tissue contact part has, for example, a length that is at least ⅛ of the length of the electrode of the instrument, preferably at least ¼, more preferably at least ½. Starting from the support arm, the tissue contact part can extend at least into a sagittal plane of the electrode instrument that extends from the support arm to ⅛ of the distance to the second support arm, preferably ¼ of the distance. Sagittal planes are all planes that extend through the electrode instrument from top to bottom and proximal to distal; the terms “top” and “bottom” refer to a position of the instrument in which it is normally used and in which the handle of the resectoscope points downward, for example. The sagittal plane in the middle between the two support arms—i.e., the sagittal plane that extends from the support arm to ½ of the distance to the second support arm—can also be referred to as the median plane. 
     In order to render the holding of the tissue fragment between the tissue contact part and an additional component particularly secure, the tissue contact part can be arranged at least in some portions distally from an inner tube that is arranged in the cladding tube and/or from a pass-through instrument that is arranged in the cladding tube. In this context, the term “distal” denotes an arrangement in which the tissue contact part is arranged in a straight, axial extension of the corresponding component. 
    
    
     
       BRIEF DESCRIPTION OF THE FIGURES 
       Exemplary embodiments of the invention are shown schematically in the drawings. In the drawing: 
         FIG. 1  shows a schematic sectional side view of a resectoscope according to the invention; 
         FIG. 2  shows a schematic sectional side view of an electrode instrument according to the invention; 
         FIG. 3  shows a schematic sectional side view of the distal end region of a resectoscope according to the invention; 
         FIG. 4  shows a schematic frontal view of the end region shown in  FIG. 3  (left) and a schematic sectional view along the axis “LG” in  FIG. 3  (right); 
         FIG. 5  shows a schematic sectional side view of the end region shown in  FIG. 3 , a tissue fragment being held on the tissue contact part; 
         FIG. 6  shows a schematic sectional side view of the distal end region of an alternative resectoscope according to the invention; 
         FIG. 7  shows a schematic frontal view of the end region shown in  FIG. 6 ; 
         FIG. 8  shows a schematic top view of the electrode instrument that is used in the resectoscope of  FIG. 6 ; 
         FIG. 9  shows a schematic sectional side view of the end region shown in  FIG. 6 , a tissue fragment being held between the tissue contact part and optics; and 
         FIG. 10  shows a schematic perspective view of the interior of the end region shown in  FIG. 6 . 
     
    
    
     EXEMPLARY EMBODIMENTS 
     Additional advantages, characteristics, and features of the present invention will become clear from the following detailed description of exemplary embodiments with reference to the attached drawings. However, the invention is not restricted to these exemplary embodiments. 
       FIG. 1  shows a sectional representation of a resectoscope  12  according to the invention, which comprises an electrode instrument  10  according to the invention.  FIG. 2  shows the electrode instrument  10  separately from the resectoscope  12 . In the standard design, the resectoscope  12  comprises a handle  42  and a shaft  54  that has an insulating tip  38  at its distal end. The handle  42  is designed to enable the resectoscope  12  to be held in one hand and for the pass-through instruments running through the shaft  54  to be actuated, preferably with one hand. 
     The resectoscope  12  shown has a passive transporter in which the slide  50  is displaced in the distal direction against the distal, first handle part  46  through a relative movement of the handle parts  44  and  46  that are arranged proximally from the shaft  54  against a spring force that is applied by a spring bridge  48 . When the slide  50  is displaced in the distal direction against the handle part  46 , the electrode instrument  10  is positively guided to the distal in a manner not shown. When the handle parts  44 ,  46  are released, the spring force generated by the spring bridge  48  forces the slide  50  back into its resting position, the electrode instrument  10  being pulled in the proximal direction. When the slide  50  is moved back, an electrosurgical intervention with the electrode instrument  10  can be carried out without manual force on the part of the surgeon—that is, passively. 
     The shaft  54  of the resectoscope  12  comprises a cladding tube  36  in whose interior a plurality of elongate pass-through instruments extend, particularly optics (not shown here) and the electrode instrument  10 . The optics and additional pass-through instruments can extend in the inner tube  28 , which is arranged in the cladding tube  36  between the support arms  16 ,  18  of the electrode instrument  10 . For stability in its shaft portion  14 , the electrode instrument  10  is secured by a holding element  40  against radial displacement. The holding element  40  has a partially circular cross section which, in the present instrument, bears against the outer wall of the inner tube  28 . It is also conceivable for a holding element  40  to be supported on other elements of the shaft  54 , for example on the inner wall of the cladding tube  36 . The cross section of the holding element  40  is approximately semicircular in the present case, so that the holding element  40  positively engages against the outer wall of the inner tube  28  and the electrode instrument  10  can still be axially displaced. In other words, the holding element  40  has a shape that is partially complementary to the outer wall of the inner tube  28 . 
     At its distal end, the electrode instrument  10  has an electrode  22  which, in the present case, is embodied as a loop electrode or cutting loop. The instrument is embodied as a bipolar instrument and is provided with a counterelectrode (not shown). The medical staff is able to remove tissue from the site of the intervention during a surgical intervention by means of the loop electrode. 
     In addition, the electrode instrument has a tissue contact part  26  on a support arm  16 . The tissue contact part  26  is arranged in the distal end region  24  of the support arm  16 . The electrode  22  is held in a distally spaced-apart manner at the distal end of the support arm  16 . In the embodiment shown, the tissue contact part  26  extends radially inward from the support arm  16 , i.e., toward the center of the cladding tube  36 . 
       FIG. 3  shows a more detailed schematic sectional side view of the distal end region of an embodiment of the resectoscope  12  according to the invention. The electrode instrument  10  has a tissue contact part  26  which, starting from the support arm  16 , extends in a manner contrary to that shown in  FIGS. 1 and 2 . The tissue contact part  26 , particularly the longitudinal axis LG thereof, forms an angle α of 90° relative to the support arm  16 , particularly to the longitudinal axis LT thereof. For the sake of clarity, the support arm  16  is shown thinner here than in the following figures. In the position shown, the electrode instrument  10  has been displaced as far as it will go proximally and is thus completely retracted into the cladding tube  36 . In this position, both the electrode  22  and the tissue contact part  26  are arranged in the vicinity of the shaft  54  in which the insulating tip  38  forms the distal end of the shaft  54 . At the same time, the tissue contact part  26  is arranged distally from the distal end of the inner tube  28  and pass-through instrument  30 , which is a rod-shaped lens here. 
     As can also be seen particularly in  FIG. 4 , the tissue contact part  26  has the shape of a curved rod and is therefore suitable for piercing into a tissue fragment.  FIG. 4  shows a schematic frontal view of the end region shown in  FIG. 3  (left) and a schematic sectional view along the axis “LG” in  FIG. 3  (right). The support arms  16  and  18  pass through the shaft of the resectoscope  12  between the cladding tube  36  and the inner tube  28 . A pass-through instrument  30  (e.g., a lens) is arranged in the interior of the inner tube  28 . An electrode  22  in the form of a loop is formed between the support arms  16 ,  18  at the distal end of the support arms  16 ,  18 . Both support arms  16 ,  18  have an insulating sleeve  34  that is composed of an electrically insulating material. A conductor  20  in wire form is formed within the insulating sleeve  34  and forms the loop electrode at the distal end of the support arms  16 ,  18 . 
     The tissue contact part  26  is arranged on the support arm  16  and is spaced proximally from the electrode  22  that is arranged on the support arm. The tissue contact part  26  extends from the support arm  16  approximately in the opposite direction relative to the direction in which the electrode  22  extends from the support arm  16 . In this way, the arrangement of the tissue contact part  26  does not hinder the use of the electrode  22 . The length of the tissue contact part  26  corresponds approximately to half the length of the electrode  22 , the curvature of the two elements being approximately identical. The tissue contact part  26  is made to be somewhat thicker than the electrode  22 . 
       FIG. 5  shows a schematic sectional side view of the end region shown in  FIG. 3 , a tissue fragment  32  being held on the tissue contact part. The tissue fragment  32  was first separated from the surrounding tissue of the patient by means of the electrode  22 . The tissue contact part  26  was then impaled into the tissue fragment  32 . Since the tissue fragment  32  has a size that at no point exceeds the inside diameter of the cladding tube  36 , the tissue fragment  32  was then able to be withdrawn together with the electrode instrument  10  through axial proximal displacement of the electrode instrument  10  into the cladding tube  36 . 
       FIG. 6  shows a schematic sectional side view of the distal end region of an alternative resectoscope  12  according to the invention. In contrast to the electrode instrument  10  shown in  FIGS. 3 to 5 , the electrode instrument  10  shown here has a tissue contact part  26  that is primarily intended for holding tissue fragments  32  between the tissue contact part  26  and an additional component of the resectoscope  12 —i.e., not necessarily for the purpose of piercing into a tissue fragment  32 , although that is not excluded.  FIGS. 6 to 10  show a schematic of the same embodiment, but with the size relationships between the resectoscope components being varied for better visibility.  FIG. 7  shows a schematic front view of the end region shown in  FIG. 6 , while  FIG. 8  shows a schematic top view of the electrode instrument used in the resectoscope of  FIG. 6 .  FIG. 9  shows a schematic sectional side view of the end region shown in  FIG. 6 , a tissue fragment  32  being held between the tissue contact part  26  and optics  52 .  FIG. 10  shows a schematic perspective view of the interior of the end region shown in  FIG. 6 . 
     In the embodiment of  FIGS. 6 to 10 , the tissue contact part  26  extends from the support arm  16  in the form of a beak or triangle in the direction of the center point of the cladding tube  36 . The end of the tissue contact part  26  reaches the sagittal plane S between the support arms, which is the median plane between the two arms. There is no direct connection to the second support arm  18 . The connecting surface  56  of the tissue contact part  26  directly adjacent to the outer wall of the insulating sleeve of the support arm  16  has a concave shape that can nestle against the round surface of the support arm  16 . This connecting surface  56  borders on the support arm over 20° or more, preferably 35° or more, of its circumference. Alternatively, the tissue contact part  26  can have a tubular portion that encloses the support arm  16  in a form-fitting manner. An especially secure connection between the tissue contact part  26  and the support arm  16  is thus ensured. 
     The top view of the electrode instrument  10  shown in  FIG. 8  shows that the support arms  16  and  18  extend substantially parallel to one another up to the proximal end of the electrode instrument  10 . Both support arms  16 ,  18  have a conductor  20 , as can be seen in  FIG. 6 , in which figure the insulating sleeve  34  is shown in dashed lines. The conductor  20  passes through both support arms  16 ,  18  and forms an electrode  22  at the distal end of the support arms  16 ,  18 . Here, too, the tissue contact part  26  forms an angle α of approximately 90° with the support arm  16 . In other embodiments, it is contemplated that the tissue contact part  26  be curved—to proximal, for example. 
     Although the present invention has been described in detail with reference to the exemplary embodiments, it is obvious to those skilled in the art that the invention is not restricted to these exemplary embodiments, but rather that modifications can be made in such a way that individual features are omitted or other combinations of the individual features presented are realized, provided that the scope of protection of the appended claims is not exceeded. The present disclosure includes any and all combinations of the individual features presented. 
     
       
         
           
               
             
               
                   
               
               
                 List of Reference Symbols 
               
               
                   
               
             
            
               
                   
               
            
           
           
               
               
            
               
                 10 
                 electrode instrument 
               
               
                 12 
                 resectoscope 
               
               
                 14 
                 shaft portion 
               
               
                 16 
                 support arm 
               
               
                 18 
                 support arm 
               
               
                 20 
                 conductor 
               
               
                 22 
                 electrode 
               
               
                 24 
                 distal end region 
               
               
                 26 
                 tissue contact part 
               
               
                 28 
                 inner tube 
               
               
                 30 
                 pass-through instrument 
               
               
                 32 
                 tissue fragment 
               
               
                 34 
                 insulating sleeve 
               
               
                 36 
                 cladding tube 
               
               
                 38 
                 insulating tip 
               
               
                 40 
                 holding element 
               
               
                 42 
                 handle 
               
               
                 44 
                 handle part 
               
               
                 46 
                 handle part 
               
               
                 48 
                 spring bridge 
               
               
                 50 
                 carriage 
               
               
                 52 
                 optics 
               
               
                 54 
                 shaft 
               
               
                 56 
                 connecting surface 
               
               
                 LT 
                 longitudinal axis support arm 
               
               
                 LG 
                 longitudinal axis tissue contact 
               
               
                   
                 part 
               
               
                 α 
                 angle LT/LG 
               
               
                 S 
                 sagittal plane