Patent Application
20180368911
The invention relates to a microsurgical fine gripping and diathermy forceps for intraocular surgery. The invention further relates to a membrane forceps for performing a vitreoretinal membrane peel procedure. The invention further relates to a microsurgical cutting and diathermy device.
During ophthalmologic microsurgical procedures conducted to treat, for example, complicated diseases of the retina, it is known to use a pair of tweezers to remove tissue. This procedure can sometimes cause a hemorrhage as a side effect. To stop this bleeding, a diathermy device is known, which has sharp-pointed coaxial bipolar diathermy tip. Such a device can be used to close a blood vessel by cauterization. Using the tip, a blood vessel can be compressed from one side. The exchange of the tweezers for a diathermy instrument takes time and increases the complexity of the procedure. During the exchange of devices inserted in the human body, in particular the eye, the bleeding can increase.
A bipolar diathermy forceps is an instrument known in macro-surgery to seal blood vessels to prevent bleeding during and after surgery. A diathermy in the form of a pair of tweezers allows a blood vessel to be grasped and closed by being pinched, while cauterizing the blood vessel.
U.S. Pat. No. 5,868,728 discloses an intraocular forceps that can be inserted through a retinotomy to perform a choroidal biopsy; the members (which can be two or more in number) may also be rotatably connected to a plunger, and means for rotating members in order to ensure a cleaner incision, or a better cutting and tearing action. An intraocular cauterization device (e.g. electrocauterization probe) can be included to reduce bleeding following the excision of tissue to biopsied and its retraction within a cannula.
It is an aspect of the invention to provide an improved microsurgical fine gripping forceps.
An aspect is to provide a device that makes it possible to use a bipolar diathermy tweezers during microsurgical procedures, and combines the function of a micro-forceps for removal of tissue with the function of a diathermy for cauterization of blood vessels, by creating separate positive pole and negative pole.
Another aspect is to provide a microsurgical diathermy having the shape of forceps, making it more effective to coagulate blood vessels, and thereby preventing bleeding in microsurgical procedures, thereby not having to switch between forceps and diathermy device during microsurgical procedures.
Another aspect is to provide a microsurgical diathermy forceps, which is easy to manufacture.
An aspect of the invention is a microsurgical fine gripping and diathermy forceps, comprising:
a tube defining a conduit and having an outer diameter of at most 1 millimeter; and
forceps jaws protruding from the conduit at a distal end of the tube, the forceps jaws comprising at least a first forceps jaw and a second forceps jaw, wherein the forceps jaws are configured such as to allow grasping a vitreoretinal membrane;
wherein at least two of the first forceps jaw, the second forceps jaw, and the tube are configured such as to form bipolar electrodes for providing a bipolar diathermy at the forceps jaws and/or a distal end of the tube.
The microsurgical device combines a fine gripping forceps with a diathermy. This improves the ability of the device to cauterize tissues, because the forceps allows to cauterize tissues with greater precision and/or to cauterize tissues better. Moreover, the combination improves the efficiency by preventing the need to exchange a forceps for a cauterization probe when a hemorrhage occurs during a tissue removal procedure, such as a membrane peeling procedure.
The forceps may comprise an elongated element which extends through the conduit of the tube and is movable with respect to the tube and comprises at least one electrically conducting core which extends through the conduit of the tube, wherein the forceps jaws are fixed to the elongated element, and wherein the at least one electrically conducting core is electrically connected to at least one of the forceps jaws. The elongated element allows a precise control and fixed alignment of the forceps jaws during the procedure.
The elongated element may comprise an electrically conducting first core, an electrically conducting second core, and an electrically isolating layer which electrically isolates the first core from the second core, wherein a first forceps jaw of the forceps jaws is electrically connected to the first core, and a second forceps jaw of the forceps jaws is electrically connected to the second core, wherein the first core, the second core, and the isolating layer extend from the forceps jaws through the tube towards a proximal end of the tube. This configuration allows the forceps jaws of a microsurgical fine gripping forceps to act as bipolar electrodes during a cauterization procedure.
The isolating layer may comprise an adhesive configured to fix the first core with respect to the second core. This provides an effective way to provide a single elongated element comprising two electrically isolated cores. The isolating layer with the adhesive may thus be configured to fix the first core and the second core to the isolating layer.
A cross section of the first core may have a shape of a circular segment and a cross section of the second core may have a shape of a circular segment, wherein a straight side of the cross section of the first core faces a straight side of the cross section of the second core. This way, an elongated element with a substantially circular cross section may be created. For example, the straight sides of the cross sections may match with respect to length.
The forceps may comprise a further electrically isolating layer configured to electrically isolate the first core and/or the second core from the tube. This avoids an electric shortcut between the two cores.
The tube may be electrically conducting, and the forceps may comprise a further electrically isolating layer configured to electrically isolate the at least one core of the elongated element from the tube. This allows the at least one core and the tube to provide separate electrically conducting paths for two bipolar cauterization electrodes.
The at least one core may be configured to be electrically connected to a first pole and the tube may be configured to be connected to a second pole of a source of electric energy. This allows the at least one core and the tube to provide separate electrically conducting paths between two bipolar cauterization electrodes and the poles of the source of electric energy.
The tube may be longitudinally displaceable with respect to the at least one core and the forceps jaws, so that the forceps jaws can be placed in a retracted position in which the forceps jaws are at least partially retracted inside the tube and an extended position in which the forceps jaws are extended further out of the tube than in the retracted position, and wherein the isolating layer is configured to electrically isolate the forceps jaws from the tube in the retracted position. This allows the forceps jaws and the tube to act as bipolar cauterization electrodes.
The forceps may comprise a further (i.e. inner) tube inside the (i.e. outer) tube, wherein the core extends through the inner tube, wherein the forceps jaws are configured to pinch together when the inner tube is moved in the distal direction and wherein the outer tube is movable in the distal direction so that the distal tip of the outer tube can extend beyond the distal tip of the inner tube. This allows the outer tube to reach out closely to the tip of the forceps jaws.
The further electrically isolating layer may be in between an inner surface of the tube and an outer surface of the further tube. This is a suitable way to provide the further electrically isolating layer. For example, it allows to provide a single electrically isolating layer that electrically isolates the outer tube from all of the inner tube, the core, and the forceps jaws.
The forceps may comprise a first control for controlling the movement of the further tube and a second control for controlling the movement of the tube. This allows to manipulate the tubes of the forceps.
The forceps may comprise a third control for controlling a switch to switch on and off an electric source. This allows to control application of cauterizing electricity.
According to another aspect, a microsurgical cutting and diathermy device is provided, comprising:
a tube defining a conduit and having an outer diameter of at most 1 millimeter; and
a pair of scissor blades protruding from the conduit at a distal end of the tube, the scissor blades comprising at least a first scissor blade and a second scissor blade;
wherein at least two of the first scissor blade, the second scissor blade, and the tube are configured such as to form bipolar electrodes for providing a bipolar diathermy at the scissor blades and/or a distal end of the tube.
This allows microsurgery involving cuts in tissue to be efficiently combined with cauterization by means of the diathermy.
The device may further comprise an elongated element which extends through the conduit of the tube and is movable with respect to the tube and comprises at least one electrically conducting core which extends through the conduit of the tube, wherein the scissor blades are fixed to the elongated element, and wherein the at least one electrically conducting core is electrically connected to at least one of the scissor blades.
In a particular example, the tube may be electrically conducting, and wherein the device comprises a further electrically isolating layer configured to electrically isolate the at least one core from the tube.
The tube may be longitudinally displaceable with respect to the at least one core and the scissor blades, so that the scissor blades can be placed in a retracted position in which the scissor blades are at least partially retracted inside the tube and an extended position in which the scissor blades are extended further out of the tube than in the retracted position, and wherein the isolating layer is configured to electrically isolate the scissor blades from the tube in the retracted position.
The microsurgical cutting and diathermy device may comprise a further tube inside the tube, wherein the core extends through the further tube, wherein the scissor blades are configured to pinch together when the further tube is moved in the distal direction and wherein the tube is movable in the distal direction so that the distal tip of the tube can extend beyond the distal tip of the further tube.
The person skilled in the art will understand that the features described above may be combined in any way deemed useful. Features described in respect of the microsurgical fine gripping and diathermy forceps may be applied in a similar way to the microsurgical cutting and diathermy device, and vice versa.
In the following, aspects of the invention will be elucidated by means of examples, with reference to the drawings. The drawings are diagrammatic and may not be drawn to scale. Throughout the drawings, similar items may be labeled with the same reference numerals.
The following description with reference to the accompanying drawings is provided to assist in a comprehensive understanding of various embodiments of the present disclosure as defined by the claims and their equivalents. It includes various specific details to assist in that understanding, but these are to be regarded as merely exemplary. Accordingly, those of ordinary skill in the art will recognize that various changes and modifications of the various embodiments described herein can be made without departing from the scope and spirit of the present disclosure. In addition, descriptions of well-known functions and constructions may be omitted for clarity and conciseness.
A fine gripping forceps can be used for removing e.g. membranes on the retina (known as epiretinal membranes, ERMs) and/or the inner layer of the retina, in particular the internal limiting membrane (ILM). Such procedures may be necessary in treatment of e.g. macular pucker, macular hole, as well as more complex diseases such as Proliferative Diabetic Retinopathy, and/or Proliferative Vitreoretinopathy.
In case of a hemorrhage during a procedure, a diathermy may be necessary to close a blood vessel.
For example, a combination forceps, which can be used both for removing the relevant tissue and for closing blood vessels, would be a desirable device. For example, treatment of tumors of the retina, such as retinal angiomas or hemangioblastomas. These angiomas are often associated with tractional ERMs, which can be removed successfully using fine gripping forceps, but complete closure of the typical thickened feeder and drainer vessels of the lesion is difficult using the existing diathermy, causing hemorrhage during or after excision of the lesion.
Using the diathermy forceps according to the present disclosure, the blood vessel can be pressed shut by pinching the vessel in between the forceps jaws, and can subsequently be cauterized. The fine gripping and diathermy forceps can also be useful in other applications and/or diseases where both a forceps and/or a diathermy are regularly used.
In certain embodiments, a forceps can be combined with a diathermy for microsurgery (such as intraocular and/or vitreoretinal surgery).
In certain embodiments, a diathermy function may be implemented by replacing a single forceps core by two equal parts, separated longitudinally by electrically isolated material. Each part of the core is electrically and mechanically connected to another forceps jaw. The parts of the core may also be electrically isolated from the surrounding tube. This way, each part of the core (including the respective attached forceps jaw) forms an electric pole, so that the two poles can be charged with respect to each other using an electric radio-frequency (RF) signal generator to cauterize the tissue in between the two forceps jaws.
The two parts of the core may be isolated from each other by means of an electrically isolating adhesive. A suitable adhesive material is Araldite 2014-1. Alternatively a composition comprising such an adhesive material together with another material, preferably another electrically isolating material, may be used. For example, a mixture of Araldite 2014-1 and polyimide may be used. In another example, a multi-layer structure may be used, wherein at least one layer is electrically isolating and at last one layer comprises an adhesive.
Araldite 2014-1, which denotes a two component epoxy paste adhesive, is a trademark of Huntsman Advanced Materials. This material is merely mentioned herein as an example of an adhesive. Other adhesive materials, such as epoxy resins or other adhesives, may be used instead.
Polyimide is a polymer thermoset plastic that has thermal stability, chemical resistance, and tensile strength. These characteristics make polyimide suitable for, inter alia, surgical and medical tubing applications. However, other plastics or other electrically isolating materials may be used instead of polyimide.
For example, a method of creating two forceps core portions may comprise splitting an existing forceps core longitudinally. This splitting can be performed using a laser cutter device, for example. Alternatively, the core portions may be manufactured separately.
According to another example, a diathermy function is implemented by electrically isolating the forceps core (which may be a single core to which both the forceps jaws are electrically and mechanically connected) from the surrounding tube. This creates two electric poles: one pole formed by the core and the forceps jaws, and one pole formed by the tube. This isolation may be performed by for example a tube made of polyimide around the core but inside the tube. For example, the isolation may be adhesive on one side, so that it attaches to either one of the inside wall of the tube or the core, allowing movement of the core with respect to the tube.
According to another example, an inner tube is provided for operating the position of the forceps jaws, to control a pinching action thereof by moving the tube longitudinally. An outer tube is provided to perform a diathermy function. The inner tube may be disposed inside a conduit defined by outer tube. The elongated element may be disposed inside the inner tube. The outer tube may be configured to be movable longitudinally so that the tip of the outer tube reaches out further towards the tip of the forceps jaws than the inner tube can. For example, the conduit defined by the outer tube may be large enough so that the forceps jaws (or scissor blades, as the case may be) may be retracted beyond the widest point of the forceps jaws and/or scissor blades, when they are in the close position.
Independent of the formation of the electric poles, the shape of the forceps jaws may be selected in several different ways, depending on the application. Different forceps jaws may be designed, for example, for peeling of ERM and/or ILM, and for gripping of thickened blood vessels.
The forceps may have one of a plurality of different sizes. For example, the tube size may be in the range of, for example, 0.2 mm to 1 mm. Suitable examples of tube sizes are: 0.9 mm, equivalent to 20-Gauge; 0.6 mm, which is equivalent to 23-Gauge, 0.5 mm, which is equivalent to 25-Gauge, and 0.4 mm, which is equivalent to 27-Gauge. These dimensions relate to the outside diameter of the tube.
Also, different kinds of material may be used to create the forceps. Metals are particularly advantageous. For the electric poles, an electrically conducting material should be used.
At the proximal end, the forceps has terminals to connect a diathermy apparatus. The diathermy apparatus is configured to generate an electric signal, at the terminals which causes electrons to pass through the tissue near the tip of the forceps jaws and/or the tip of the tube, so that the tissue becomes hot and cauterizes. Different brands and types of diathermy apparatus can be connected to the terminals, if necessary by designing the terminals appropriately, according to specifications of the diathermy apparatus. Alternatively, the diathermy apparatus may be integrated in the forceps.
The handle 106 may have a control (not shown) configured to control the movement of the tube with respect to the forceps jaws, and thus vary the forceps jaws between at least a closed position in which the forceps jaws meet to exert a pinching force, and an open position in which the forceps jaws are apart from each other, and wherein the forceps is configured to apply an electric current to the electric terminals with the forceps jaws in the closed position.
The electric wires 107, 108 may be glued to the handle 106 or otherwise disposed therein. The terminals 109 form an interface to a diathermy apparatus, which provides the electricity signals to the bipolar terminals. Such diathermy apparatus is known in the art by itself.
The handle 605 comprises a first control 606. When actuated by a user, the first control 606 causes the inner tube to move in a longitudinal direction (see arrow 617). In the example, the movement of the first control 606 in direction of arrow 607 causes a first end 608 of a pivoting body 624 to move approximately in the direction of arrow 609, and a second end 610 of the pivoting body 624 to move approximately in the direction of arrow 611. The second end 610 is mechanically coupled to the inner tube 603, so that the movement of second end 610 is transferred to the inner tube 603. However, it will be understood that the control of the movement of the inner tube 603 may be implemented in alternative ways.
The handle 605 also comprises a second control 614. When actuated by a user, the second control causes a longitudinal movement of the outer tube 604 in the direction of the arrow 617. In the example, the movement 614 is transferred to the outer tube 604 by means of a pin that is mechanically coupled to both the control 614 and the outer tube 604. However, the control of the movement of the outer tube 604 may be implemented in alternative ways.
The outer tube 604 may form a first electrode and at least one of the forceps jaws 101, 102, together with the core 621, may form a second electrode. In general, the inner tube 603 may be either part of the first electrode or part of the second electrode, or may be not part of either electrode. Appropriate electric isolation layer(s) may be provided to electrically separate the electrodes. In the example described herein, the inner tube 603 is part of the second electrode, together with the forceps jaws 101, 102 and the core 621.
In the situation shown in
After the cauterization is completed, the outer tube 604 may be retracted into the position shown in
Although not shown in the drawing, the scissors can similarly be combined with the configuration with two tubes as described with reference to
Although not shown in the drawing, the scissors can similarly combined with the configuration with the elongated element comprising two electrically conductive cores, as described with reference to
It is noted that the embodiments with the scissors could also be manufactured in a larger size, with a tube diameter of more than 1 millimeter, to generate larger diathermy scissor instruments. Also the embodiments with forceps may be manufactured in larger size, with a tube diameter of more than 1 millimeter, to generate larger diathermy forceps instruments.
It is also possible to produce scissor and/or forceps instruments with more than one elongated element. For example, each forceps jaw or each scissor blade could be fixed to a different elongated element. For example, each elongated element could comprise an electrically conductive core.
To prevent tissue from sticking to the surgical instrument as a consequence of the cauterization, materials may be employed that do not stick. Such materials may be preferably applied for the forceps jaws, scissor blades, and/or the tip of the (outer) tube. Examples of suitable materials include noble metals. The relevant portions may be gilt or provided with a layer of gold or silver. Other suitable materials include rhodium and titanium. An advantage of titanium is that it can resist heat well. Therefore it may be advantageous, in certain embodiments, to use titanium for the forceps and/or for the distal end of the tube or tubes.
Throughout the drawings, the bipolar electrodes have been tentatively labeled “+” and “−”. However, this is only illustrative. The polarity of the poles may be implemented differently.
A microsurgical fine gripping and diathermy forceps may comprise a tube defining a conduit and having an outer diameter of at most 1 millimeter; and forceps jaws protruding from the conduit at a distal end of the tube; wherein the forceps jaws and/or the tube form at least two bipolar electrodes for providing a bipolar diathermy at a distal end of the forceps jaws and/or tube.
The forceps jaws may be configured to grasp a vitreoretinal membrane.
The forceps jaws may be configured such as to allow grasping a vitreoretinal membrane.
The forceps may comprise an elongated element which extends through the conduit of the tube and is movable with respect to the tube and comprises at least one electrical conductor which extends through the conduit of the tube, wherein the forceps jaws are fixed to the elongated element, and wherein the at least one electrical conductor is electrically connected to at least one of the forceps jaws.
A microsurgical cutting and diathermy device may comprise a tube defining a conduit and having an outer diameter of at most 1 millimeter; and a pair of scissor blades protruding from the conduit at a distal end of the tube; wherein the scissor blades and/or the tube form at least two bipolar electrodes for providing a bipolar diathermy at a distal end of the scissor blades and/or tube.
An aspect is a microsurgical fine gripping and diathermy forceps. Another aspect is a membrane forceps for performing a vitreoretinal membrane peel procedure. Another aspect is microsurgical scissors with diathermy.
In a particular example, a microsurgical fine gripping and diathermy forceps is provided. The forceps comprises a tube defining a conduit and having an outer diameter of at most 1 millimeter; and forceps jaws protruding from the conduit at a distal end of the tube, the forceps jaws comprising at least a first forceps jaw and a second forceps jaw, wherein at least two of the first forceps jaw, the second forceps jaw, and the tube are configured such as to form bipolar electrodes for providing a bipolar diathermy at the forceps jaws and/or a distal end of the tube.
The examples and embodiments described herein serve to illustrate rather than limit the invention. The person skilled in the art will be able to design alternative embodiments without departing from the scope of the claims. Reference signs placed in parentheses in the claims shall not be interpreted to limit the scope of the claims. Items described as separate entities in the claims or the description may be implemented as a single hardware or software item combining the features of the items described.
| Number | Date | Country | Kind |
|---|---|---|---|
| 15200265.5 | Dec 2015 | EP | regional |
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/EP2016/081245 | 12/15/2016 | WO | 00 |
