The present application relates to electric resection apparatuses of a hysteroscopic surgical treatment system, and more particularly to a single-piece uterine cavity electric resection ring and a single-piece uterine cavity electric resection needle that can be separated from a hysteroscope.
In resectoscopes, electric resection apparatuses such as electric resection rings and electric resection needles are usually packaged together with the endoscope, and the cutting electrodes and operating rods of electric resection rings and electric resection needles are fixed vertically to each other. During intrauterine treatment, in order to avoid the damage of the cutting electrodes and other parts (for example, when entering and exiting the external cervical orifice, cervical canal and internal orifice), the electric resection rings and electric resection needles need to be retracted into the inside of the resectoscope. Therefore, the diameter of the resectoscope is larger, which results in that the uterine orifice needs to be expanded to 8-11 mm when in used, and the greater the uterine orifice expanded, the greater damage to the cervix, the greater the possibility of cervical insufficiency caused after surgery. Furthermore, the resectoscope has a fine structure, and the price of the resectoscope is higher, which is easy to be damaged during operation, such that the hysteroscopic surgery in outpatient departments has many constraints.
Due to fact that the electric resection ring and electric resection needle in the resectoscope are fixed with the operating rod, and the angle cannot be adjusted independently during the electric resection treatment, which leads to the electric resection treatment is complex and the time of electric resection treatment is increased with the development of lesions (for example, the larger the submucosal fibroids) when polyps, intrauterine adhesions, and submucosal fibroids are found in the uterine cavity during hysteroscopy. Further, the incidence of hyponatremia and water poisoning increased significantly, and the difficulty of hysteroscopic surgery in the outpatient department is increased.
Chinese patent CN208426206U disclosed a foldable electrode resectoscope, in which the electric resection apparatus uses a spring to connect the cutting electrode and the metal sleeve, so that the cutting electrode can be rotated at a certain angle, and the resecting is completed by pushing and pulling, which improves the surgical efficiency of decompression of renal cyst. However, the electric resection apparatuses and the endoscope of the Chinese patent CN208426206U are still in an integrated structure, and the resectoscope is large in size. Furthermore, the spring part is a conductor and is connected to the cutting electrode as a whole, and also used for resecting. Therefore, the electrode resectoscope needs a large size of uterine orifice expanded when the electrode resectoscope is used in intrauterine surgery, and it is easy to damage the normal tissue next to the lesion during operation, which increases the risk of complications.
At present, there are no reports of a single-piece uterine cavity electric resection device used in conjunction with an independent hysteroscope.
One of objects of the present application is to provide a single-piece uterine cavity electric resection device.
In order to solve above-mentioned object, the technical solution adopted in the present application as following:
The single-piece uterine cavity electric resection device includes: a fixing rod, an operating handle, a traction wire, and a cutting electrode. The fixing rod is provided with a guide sliding sleeve and a support body that can swing to any end (for example, a front end and rear end) of the fixing rod, the operating handle is arranged at one end (for example, the rear end) of the fixing rod, and two ends of the traction wire are respectively extended along a turn-back channel formed by the guide sliding sleeve at the other end (for example, the front end) of the fixing rod, and connected to the operating handle and the support body, a tensioning wire extending outward and connected to the support body is arranged in the fixing rod; the cutting electrode is arranged on the support body, and the cutting electrode is connected with a cable extending along the fixing rod.
Optionally, the guide sliding sleeve includes a bending tube body and a straight tube body, an inner concave side of the bending tube body is covered on one end (for example, the front end) of the fixing rod, and the straight tube body is extended to the other end (for example, the rear end) of the fixing rod where the operating handle is arranged.
Optionally, the support body is in a shape of an arc-shaped shell, one end of the support body is connected to the fixing rod by a pin, and the other end of the support body is connected to the cutting electrode configured to be a ring electrode; one end of the cable is connected to an extraction electrode arranged inside the fixing rod, or arranged on an outer surface of the fixing rod, a main body of the cable is arranged inside the fixing rod, and the other end of the cable is extended to a position where the ring electrode is connected with the support body.
Optionally, the support body is in a shape of a hollow cylinder, one end of the support body is connected to the fixing rod by a pin, and the other end of the support body is connected to the cutting electrode configured to be a needle electrode; one end of the cable is connected to an extraction electrode arranged inside the fixing rod or arranged on an outer surface of the fixing rod, a main body of the cable is arranged inside the fixing rod, and the other end of the cable is extended onto the support body.
Optionally, the operating handle includes a pair of handle bodies that are mutually hinged, the tensioning wire is connected with one of the pair of handle bodies engaged on a corresponding end (for example, the rear end) of the fixing rod, and the other one of the pair of handle bodies is connected with the traction wire.
Optionally, a cross-sectional dimension of the fixing rod is gradually decreased from one end (for example, the rear end) of the fixing rod provided with the operating handle to the other end (for example, the front end) of the fixing rod.
Optionally, a swing angle of the support body is ranged from 30 degree to 120 degree.
Optionally, a diameter of the cutting electrode is ranged from 0.5 mm to 1.5 mm.
The beneficial effects of the present application are as follows:
In the present application, electric resection device of the present application can drive the traction wire move along the guide sliding sleeve on the fixing rod by opening and closing the operating handle, so as to control the support body connected with the traction wire, and drive the cutting electrode (such as needle electrode and ring electrode) to unfold, fold and change the opening angle under the limitation of pulling back or pulling of the tension wire. The cutting electrode can be retracted when entering and exiting the uterine cavity, which can make the electric resection device enter and exit the uterine cavity easily without expanding the uterine orifice or reducing the size of expanding the uterine orifice, and the cutting electrode is not easy to be damaged. In hysteroscopic treatment, a hysteroscope and the electric resection device of the present application can be hold respectively and cooperated with each other to complete the operation, which can not only continuously complete the operation of removing lesions (polyps, intrauterine adhesions, submucosal fibroids) at different angles and depths (with greater scope and flexibility) in a certain field of vision by the doctors, so as to make the treatment process simple and achieves better therapeutic effect, but also the operation process is safer. Furthermore, the popularization and application of the present application can also reduce the cost of the apparatuses (the price of the existing integrated hysteroscope is much higher than the price of the single-piece uterine cavity electric resection device), the treatment cost and time, reduce the degree of treatment pain, and complete the corresponding surgical operations in the outpatient department.
Furthermore, when the present application is applied to hysteroscopy and vaginal endoscopy, according to the size of the lesion, different opening angles of the cutting electrode (for example, 45-120 degrees) are formed by operating the swing angle of the support body, which can not only perform the electric resection treatment for polyps, intrauterine adhesions, submucosal fibroids, etc., but also provide effective electric coagulation for small blood vessels in the uterine cavity.
Furthermore, the present application can maximize the tissue cutting by using a cutting electrode with a larger diameter, thereby shortening the operation time and reducing the risk of complications such as water poisoning.
Furthermore, in the present application, the operating handle of the electric resection device is located at the thicker rear end of fixing rod, and the fixing rod gradually tapers towards the front end. In the treatment, the front end of the electric resection device is easier to enter (for example, along the uterine cavity to check the scope body) and pass through the narrower part of the uterine cavity (for example, the internal opening of the cervix), so as to improve the operation efficiency.
Furthermore, the support body is arranged in a shape of an arc-shaped shell or in a shape of a hollow cylinder, which in combination with flexible angle adjustment, the electric resection of non-cutting electrodes on tissues can be effectively reduced, and the injuring and damage to normal tissues caused by misoperation in the electric resection can be avoided.
In the drawings, reference signs are listed as following:
The present application will be further described in detail below in combination with the drawings and embodiments.
At present, all the hysteroscopes used are cylindrical, with a diameter of more than 8 mm, which are developed from the male prostate resectoscope. However, the structure of the male urethral system is quite different from that of the female vaginal and uterine reproductive systems. In order to make good use of the physiological structure of women themselves, the present application separates the uterine cavity examination system of the resectoscope from the electric resection system, and improves the structure of the electric resection system, thus a single-piece electric resection system is formed. The cutting electrode of which can effectively avoid rubbing with tissues when entering and leaving the uterine cavity, and can play a therapeutic role in a wider range with the cooperation of the inspectoscope, so as to make better use of the physiological structure of women themselves for treatment, which can reduce the difficulty and cost of treatment, and further reduce the pain of patients.
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The method of using above-mentioned single-piece electric resection ring:
As an independent electric resection device, the hysteroscopy can first be used to perform the inspection. When the electric resection treatment is needed, one of the methods is to use a vaginal speculum to expand the uterus properly according to the tightness of the uterine orifice. Generally, a diameter of the uterine orifice is required to be about 6 mm. According to the position of the uterus examined by hysteroscope, the single-piece electric resection ring is first sent into the uterine cavity, and then the single-piece electric resection ring is fixed with one hand, and the other one hand holds the hysteroscope and enters the uterine cavity from one side of the single-piece electric resection ring. The other method is not to use a vaginal speculum. Under the vaginal endoscope technology, the hysteroscopy is first be used to perform the inspection. When the electric resection treatment is needed, the hysteroscope is operated by one hand, the single-piece electric resection ring is hold by another hand, and the single-piece electric resection ring is first sent to the neck canal near the inner opening of the uterine cavity along the hysteroscope, then the hysteroscope is withdrawn back to the neck canal, and then the single-piece electric resection ring is sent into the uterine cavity under the direct vision of the hysteroscope, and then the hysteroscope is sent into the uterine cavity from one side of the single-piece electric resection ring. If the uterine orifice is relatively loose, the single-piece electric resection ring can also directly sent into the uterine cavity along the hysteroscope.
When the lesions requiring electric resection such as intrauterine polyps, intrauterine adhesions, and submucosal fibroids are detected, the single-piece electric resection ring is operated under hysteroscope for treatment. The handle is hold tightly to open the ring electrode 4, and different opening angles of the handle can be selected according to the required cutting position and depth. When electrification treatment is needed, stepping on the electrode plate to make the current flow into the ring electrode 4 through the extraction electrodes 6 and cable 5. For the single-piece electric resection ring (using the pulling back tension wire 1-6), except that the fixing rod 1-5 can be used to pull back or push forward, the angles of the ring electrode 4 can also be adjusted by opening or closing the handle, that is, the polyps, leiomyomas and other lesions can be removed by rotating the ring electrode 4, which is more in line with the principle of hoe weeding, so that the lesions can be completely removed to achieve better therapeutic effect. When necessary, the energized ring electrode 4 can also be used for coagulation during resection.
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The use method of the above single-piece electric resection needle is basically the same as that of the single-piece electric resection ring in Embodiment 1, that is, the angle of the needle electrode 7 is adjusted by opening or closing the handle, and the needle electrode 7 is used for electric resection treatment of uterine cavity adhesions, submucosal myomas and other lesions under the energized state, which is more in line with the principle of electric resection treatment from shallow to deep, so as to achieve better therapeutic effect. When necessary, the energized needle electrode 7 can also be used for coagulation during resection.
When the electric resection device (electric resection ring or electric resection needle) in the above embodiments are used with the hysteroscope for treatment, the uterine orifice is pulled into an oval shape. The cross-sectional area of a hysteroscope with a diameter of 5 mm is 6.25π, which plus an electric resection device with a diameter of 4 mm and a cross-sectional area of 4π, the combined cross-sectional area of the two instruments is 10.25π, while the cross-sectional area of the uterine orifice with a diameter of 6 mm is 9π, and the cross-sectional area of the uterine orifice with a diameter of 7 mm is 12.25π. For most patients, the uterine orifice is about 6 mm, so there is no need to expand the uterine orifice. The smaller the expansion of the uterine orifice is, or even no uterine orifice expansion is required, then the damage to the cervix of the patient can be reduced to the minimum. Moreover, the operation of the hysteroscope and the electric resection device in the above embodiments is completed without the restriction of the speculum and cylindrical metal wrapping, so that the vision is wider and the range of activity is larger.
The single-piece electric resection ring and electric resection needle provided by the present application have the following characteristics:
Number | Date | Country | Kind |
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202020627002.4 | Apr 2020 | CN | national |
202010642586.7 | Jul 2020 | CN | national |
202021302233.4 | Jul 2020 | CN | national |
Filing Document | Filing Date | Country | Kind |
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PCT/CN2020/134858 | 12/9/2020 | WO |