Note: Descriptions are shown in the official language in which they were submitted.
CA 02953869 2016-12-29
1
DEVICE FOR PERFORMING THE RESECTION OF AN ORGAN
The present invention relates to devices for
resecting ah l or part of an organ situated in a cavity of
a living body, in particular of a human being, regardless
of the nature of the organ, whether healthy or unhealthy,
and more particularly it relates to devices known in the
field under the term "resectoscopes".
Such a known device essentially comprises: a guide
defined between a proximal end and a distal end, the
guide having a through duct opening out at both ends; two
electrically conductive wires that are insulated and
slidably mounted in the duct, each of these two wires
having first and second ends suitable for emerging, when
the wires are moved in translation in the duct,
respectively from the proximal and distal ends of the
duct, the two first ends of the two wires having means
for connection to two poles of an electrical energy
source; an open loop defined between two free terminais
and made of a resistive electrically conductive material
in order to produce heat by the Joule effect and thus
enable ail or part of the determined organ to be ablated
by burning; and means for electrically connecting the two
free terminais of the open loop respectively to the two
second ends of the two conductive wires.
Inside the duct, there are also provided channels
e.g. for passing surgical instruments or the like, or
introducing or insufflating various fluids into the
cavity, in particular gaseous fluids, for sucking out any
elements present in the cavity, etc. These means are
themselves well known and are not described in greater
detail herein since they do not come within the ambit of
the present invention.
Resectoscopes known in the prior art have a loop of
overall section, even outside the duct, that is no
greater than the overall inside section of the duct, so
as to be relatively easy to move in translation in the
CA 029539 2016-129
2
duct and sa as ta enter therein and exit therefrom just
as easily.
Such resectoscopes are known, e.g. those described
in US 2009/182324, JP 2008/206994, WO 2013/064577.
In particular, US 2009/182324 describes a
resectoscope having at its outlet two electrical
conductors that are mechanically connected together by a
piece of insulating material preventing them from passing
the same electric current.
However, in certain applications, in particular for
ablating an organ such as a polyp, a tumor, a synechia, a
malformation, or the like, in a cavity such as a uterus,
once the guide has been inserted in the cavity, the
cavity is expanded, e.g. by insufflating a fluid under
pressure. As a result, the section of the cavity becomes
greater than the outside section of the guide. Since the
section of the loop is no greater than the section of the
duct, it is then poorly adapted ta achieve good ablation
of the organ flush with its root, and it is necessary for
the practitioner ta apply great dexterity in order ta
perform such ablation, even after several manipulations.
Thus, an abject of the present invention is ta
provide a device for resecting ail or part of an organ,
as defined above, in a cavity of a living body, in
particular of a human being, that mitigates ta a
considerable extent the above-mentioned drawbacks of
resectoscopes known in the prior art.
More precisely, the present invention provides a
device for resecting an organ in a cavity of a living
body, in particular a human being, the device comprising
at least:
= a guide defined between a proximal end and a
distal end, said guide defining a duct opening out at
bath ends;
= two electrical conductors, each conductor being
defined along a longitudinal axis and slidably mounted in
said duct, said two longitudinal axes being substantially
CA 029539 2016-129
3
parallel, each conductor having a first end and a second
end, both suitable for emerging respectively from the
proximal and distal ends of said duct, the respective
first ends of the two conductors including means for
connecting te at least one pole of an electrical energy
source;
= an open loop terminated by two free terminais,
said loop being made of a material that is electrically
conductive and resistive so as te be suitable for
producing heat by the Joule effect; and
- means for electrically connecting the two free
terminais of the open loop respectively to the second
ends of the two conductors;
the device being characterized by the fact that said
open loop is arranged in such a manner as te be suitable
for taking on two states, namely:
- a first state in which an orthogonal projection of
its overall section onto a plane perpendicular te the
longitudinal axes lies within the inside section of said
duct defined in the same plane; and
- a second state in which its overall section is
greater than the inside section of said duct.
Other characteristics and advantages of the present
invention appear from the following description given
with reference te the accompanying drawings by way of
non-limiting illustration, in which:
= Figure 1 is a general diagrammatic view in
perspective of a device for resecting ail or part of an
organ in a cavity of a living body, in particular of a
human being;
- Figure 2 is an end view of an embodiment of the
device of the invention;
= Figures 3 and 4 are perspective views of two
embodiments of the "loop" portion of the device of the
invention;
CA 02953869 2016-12-29
4
= Figure 5 is a diagrammatic perspective view
showing a detail of a part of the "loop" portion of a
device of the invention; and
= Figure 6 is a block diagram of the device of the
invention.
It is firstly specified that, in the present
description, if the adverb "substantially" is associated
with a word qualifying any given means, then qualifying
word should be understood as covering both its strict
meaning and an approximate meaning.
The present invention relates to a device for
resecting, by burning, an organ in a cavity of a living
body, in particular of a human body, and it finds a
particularly advantageous application in the field of
hysteroscopy for intra-uterine surgery. Such a device is
known to practitioners under the term "resectoscope" and
it enables inter-uterine interventions to be performed in
order to ablate ail or part of an organ, e.g. a polyp, a
tumor, a synechia, a malformation of the uterus, or the
like.
With reference to the figures, the device comprises
at least one guide 10 defined between a proximal end 11
and a distal end 12, the guide defining a through duct 13
that opens out at both ends, two electrical conductors
21, 22, each conductor being defined along a longitudinal
axis and being slidably mounted in the duct 13, the
conductors aise being arranged in such a manner that
their longitudinal axes are or remain substantially
parallel to each other. In known manner, these
conductors are aise covered in electrically insulating
mate rial.
Each conductor has a first end 21-1, 22-1 and a
second end 21-1, 22-2 both suitable for emerging
respectively from the proximal and distal ends 11 and 12
of the duct 13 when the conductor is moved in translation
= in the duct. The respective first ends 21-1, 22-1 of the
two conductors include means for connecting to of least
CA 029539 2016-129
one pole of an electrical energy source 100 that may be a
direct current (DC) source or an alternating current (AC)
source (of frequency that is adjustable, should that be
necessary), for ablating the organ and then cauterizing
5 the wound.
Specifically, in certain circumstances, and in known
manner, it is possible to connect these two electrical
conductors 21, 22 to a single terminal of the electrical
energy source, with the other terminal then being
connected by way of example to the duct 13 which is made
of electrically conductive material, or even to some
other conductor for certain surgical procedures.
An open loop 40 is also provided that is terminated
by two free terminais 41 and 42, together with means 30
for electrically connecting the two free terminais 41 and
42 of the open loop to respective ones of the second ends
21-1, 22-2 of the two conductors 21 and 22. This open
loop 40 is not electrically insulated and it is made of a
material that is electrically conductive and resistive so
as to be suitable for producing heat by the Joule effect
up to some suitable temperature, e.g. 1000 C, so as to
make it possible in known manner to ablate the determined
organ by burning, optionally followed by cauterizing the
wound.
According to an essential characteristic of the
invention, the open loop 40 is arranged in such a manner
as to be capable of taking on two states El and E2,
namely a first state El, shown in Figures 3 and 6, in
which an orthogonal projection of its overall section
onto a plane perpendicular to the longitudinal axes of
the conductors lies within the inside section of the duct
13 as defined in the same plane, and a second state E2,
shown in Figure 4, in which its overall section is
greater than the inside section of the duct 13.
In the present description, the term "section" is
used essentially to define the area of a surface.
Nevertheless, when the section has a well-determined
CA 029539 2016-129
6
shape, e.g. that of a circle or an ellipse, the term may
be used exceptionally to define one of the linear
dimensions of the surface, e.g. the diameter of a circle
or the minor or major axis of an ellipse.
In an embodiment, the loop 40 has at least two
branches 40-1 and 40-2, each branch being defined between
a first end and a second end 43, 44, the respective first
ends of the two branches constituting the two free
terminals 41, 42, and it also has means for mounting the
portions of the two branches having the second ends 43
and 44 to co-operate in such a manner that these branch
portions move relative to each other while remaining
continuously in contact at at least one point for
ensuring electrical continuity.
In an embodiment as shown in Figure 3, the means for
mounting the portions of the two branches that include
the second ends 43 and 44 in co-operation are constituted
by two rings 53 and 54 located respectively at these two
ends, these two branch portions passing in slidable
manner respectively through the two rings.
In another embodiment as shown in Figure 4, the
means for mounting the portions of the two branches that
include the second ends 43, 44 in co-operation are
constituted by a ring 53 at the second end of one of the
two branches, the other branch portion that includes the
second end of that other branch being slidably mounted in
the ring, and the second end of that other branch
including an abutment 54 against which the ring 53 is
suitable for coming into abutment.
More particularly, in this latter embodiment, as
shown in Figure 4, the ring 53 is formed by folding over
the portion of one of the two branches that carnes the
second end of that branch, and the abutment 54 is
constituted by a rounded bend in the portion of the other
branch that includes the second end of that other branch.
This embodiment presents manifest assembly advantages.
CA 029539 2016-129
7
Most advantageously, the device also has means for
passing the loop 40 as described above from its first
state El (Figure 3) ta its second state E2 (Figure 4) and
vice versa. These means may be embodied in various ways.
In particular, they may be of automatic type, such
as those shown functionally and diagrammatically in
Figure 5. Under such circumstances, they comprise
resilient means 60 mounted ta co-operate between one of
the conductors and the branch that is connected ta that
conductor sa as ta cause it ta pivot about an axis that
coincides substantially with the longitudinal axis of the
conductor.
For example, these resilient means 60 as shown in
Figure 5 are constituted by a spring 160 having a first
of its ends surrounding the first end 41 of the branch
40-1 that is connected ta the conductor 21, and having
its other end bearing against the same branch 40-1.
When the loop 40 is inside the duct, the spring 160
is in a compressed state. In contrast, when the loop 40
is extended from the duct 13, the spring 160 relaxes and
the branch 40-1 is driven resiliently ta turn clockwise,
this turning being obtained by elastic deformation of the
branch, or possibly by means of a pivot or the like
between the branch and the conductor 21.
The same may apply ta the other branch 40-2, which
would then be caused ta turn counterclockwise.
Passing the loop 40 from its state El ta its state
E2 enables a surgical operating area and/or length ta be
obtained that is greater than when the loop is in its
state El, thereby facilitating the work of the
practitioner.
When ablating the organ has terminated, the
practitioner exerts traction on the two conductors 21, 22
relative ta the guide 10 in order ta return the loop 40
into the duct 13. By application of reaction forces
acting in particular via the edge of the distal end 12 of
the guide 10, the two branches close together,
CA 02953869 2016-12-29
8
compressing the spring(s) 160, with the loop returning to
its state El in the duct. The practitioner can then
remove the guide from the cavity without difficulty.
When the loop 40 is made up of two branches as
described above, the means for causing it to pass from
its state El to its state E2, and vice versa, may be
embodied in a different manner. For example, they may be
constituted by means, as shown diagrammatically at 200 in
Figure 6, for causing each conductor to pivot about its
respective longitudinal axis. In this embodiment, when
the loop 40 is outside the duct 13, in order to cause it
to pass from its state El to its state E2, it suffices
for the practitioner to cause the two conductors to pivot
in mutually opposite directions, e.g. by hand.
In order to cause the loop to pass from its state E2
to its state El, the practitioner causes the two
conductors to pivot in the opposite directions. When the
loop is thus returned to its state El, the practitioner
can cause it to return into the duct 13 by pulling the
conductor relative to the guide 10, prior to extracting
the guide from the cavity.
In the above-described embodiments, the open loop 40
has two branches that slide over each other.
Nevertheless, the open loop could be made as a single
piece.
When it is made as a single piece, the means for
causing the loop 40 to pass from its state El to its
state E2, and vice versa, comprise means, as shown
diagrammatically at 300 in Figure 6, for moving the two
conductors 21 and 22 in translation substantially along
their respective longitudinal axes, independently of each
other.
Such an embodiment is advantageous, in particular
when the duct 13 is in the shape of a circular cylinder
and the loop 40 is substantially in the shape of an
ellipse of minor axis that is no greater than the
CA 02953869 2016-12-29
9
diameter of the duct 13 and of major axis that is much
greater.
Under such circumstances, when the loop 40 is in the
duct 13, in its state El, it lies in a plane that is
oblique relative to the longitudinal axes of the two
conductors and the axis of the duct 13. In order to
cause it to pass into its state E2 after exiting the duct
13, it suffices for the practitioner to move the two
conductors 21 and 22 in translation in opposite
directions to each other so as to cause the loop to
pivot, e.g. until it lies in a plane that is
substantially perpendicular to the three above-mentioned
axes.
In another embodiment that may be advantageous when
the duct 13 is in the form of a circular cylinder and
when the loop 40 is made as a single piece, the means for
causing the loop 40 to pass from its state El to its
state E2, and vice versa, includes means, as shown
diagrammatically at 400 in Figure 6, for moving the two
conductors 21 and 22 relative to each other in a
direction that is substantially perpendicular to their
respective longitudinal axes, so as to move them apart
from each other or towards each other. The loop passes
from one of its two states to the other by deforming.
Such an embodiment is advantageous, in particular
when the loop 40 in its state El is substantially
circular in shape having a diameter that is no greater
than the inside diameter of the duct 13, or having a
shape that is substantially elliptical of minor axis no
greater than the diameter of the duct 13, as described
above, it being possible for the above-described means
200 and 400 to be combined.
It is specified that the loop 40 is made of a
material that is electrically conductive and resistive,
e.g. an alloy of platinum, iridium, rhodium, or stainless
steel, and shaped so as to be simultaneously relatively
flexible and rigid so as to be capable of being subjected
CA 029539 2016-129
to elastic and/or plastic deformations. The person
skilled in the art knows how to select the solution
appropriate for the surgical problem that is posed.
The way the above-described device is used can be
5 deduced without difficulty from the description. If
necessary, a better understanding may be obtained from
the use of similar devices of the prior art, and use of
the device is not described in greater detail herein
purely for the purpose of simplifying the present
10 description, particularly since this use does not corne
within the ambit of protection of the invention.
It is merely emphasized that the structure of the
device of the invention as described above greatly
facilitates the work of the practitioner, particularly
but not exclusively when the cavity in which the device
is to be used for ablating an organ by burning e.g. a
uterine cavity, presents, as explained in the
introduction of the present description, a portion having
a section that is much greater than the section of its
entrance, for whatever reason.
