DE102015106749A1 - Multifunctional ultrasonic cutting device for attachment to a device for a minimally invasive procedure - Google Patents

Abstract

Ultrasound cutting device for attachment to a device for a minimally invasive procedure, in particular on an endoscope or laparoscope, comprising: - a housing, which is provided on a first side with attachment means for attachment to a tip of the endoscope or laparoscope to be introduced into the body; A cutting blade disposed on a second side of the housing; - Electro-mechanical drive means, which are integrated in the housing and in operative connection with the cutting blade, are connected to the exercise of cutting movements.

Description

The invention relates to an ultrasonic cutting device for attachment to a device for a minimally invasive procedure, in particular on an endoscope or laparoscope.

Field of the invention:

In the field of blades for cutting devices, there are a number of applications US20l30123774, EPI311197 , US20090136894, US 20120130380, US20070275348, US20110295294, CN203458441 . EP1192lJ07 , US5263957, US5263957, CN103431894 , US20140163595.

There are also a number of ultrasonic lancets, including: EP2066255 . US5674235 . EP2233085 . US20090326535 . CN1561919 . CNl01828943 . US20030099917 . US20140243864 . EP0238667 . EP1110509 . US2000167235 . US20080161809 . US20080188878 . US20020103497 . US20120095472 . EP1372495 . US20090228032 . EP0384672 . US4823790 . US20030144680 . EP2174601 . US20140276849 . US20140277028 . EP2763603 ,

These ultrasound lancets are also partially capable of cutting bone tissue and have multiple blades. However, the ultrasound functionality is not integrated directly into the blade and has no variety of functions.

The ultrasound lancets use technology that creates the ultrasonic vibrations in the grip, which prevents them from being used in flexible endoscopes. Also, the blades are only inserts for these devices and therefore no independent ultrasound device.

Overview of the invention:

To solve the above-mentioned problems, an invention according to the features of the claims is proposed.

• – ein Gehäuse, das an einer ersten Seite mit Befestigungsmitteln zur Befestigung an einer in den Körper einzuführenden Spitze des Endoskops oder Laparoskop versehen ist. Diese Verbindung kann steckend, schraubend oder klemmend erfolgen.
• – eine Schneidklinge die an einer zweiten Seite des Gehäuses angeordnet ist;
• – elektro-mechanische Antriebsmittel, vorzugsweise ein piezoelektrisches Material, die in dem Gehäuse integriert und mit der Schneidklinge in Wirkverbindung stehen zur Ausübung von Schneidbewegungen.

In particular, it is a miniaturized integrated ultrasonic cutting device for attachment to a device for a minimally invasive procedure, in particular an endoscope or laparoscope, in which the cutting blade is in direct communication with a mechanical drive means. This includes

• - A housing which is provided on a first side with fastening means for attachment to a tip of the endoscope or laparoscope to be inserted into the body. This connection can be stuck, screwed or clamped.
• A cutting blade disposed on a second side of the housing;
• - Electro-mechanical drive means, preferably a piezoelectric material, which are integrated in the housing and in operative connection with the cutting blade for performing cutting movements.

In a preferred embodiment, the invention includes a cylindrical housing whose shape and size provides a flush transition to the tip of the endoscope or laparoscope.

The housing preferably has a diameter of 1-20mm and a length of 1-40mm.

In a preferred embodiment, the housing tapers in the direction of the cutting blade to form a flowing tapered transition to the cutting blade.

In an alternative embodiment, the cutting blade widens conically to extend into the housing. Here, the housing may be tubular and the cutting blade to the housing have a round extension, so that the round extension fits precisely into the tubular housing, with sufficient clearance can be given to transmit the vibration of the electro-mechanical drive means, which in the housing is arranged and which acts on the back of the cutting blade.

The length of the cutting blade is preferably 5-20 mm and / or the teeth project 1-8mm.

The housing has on the first side at least two electrical connections, in particular plug connections, via which voltage is provided for the electro-mechanical drive means. In addition, there may be a third electrical connection that outputs its energy directly to the cutting edge.

The first two terminals pass energy to one or more piezo elements, the piezo elements preferably being ceramic piezo elements, which are preferably lead-free.

Further, the invention may include a fluid delivery channel which preferably extends through the housing and communicates with one side with a channel in the endoscope or laparoscope and another with an opening in the region of the blade for fluid communication. Outlet has.

Also, the invention may include a fluid suction channel which preferably extends through the housing and communicates with one side with a channel in the endoscope or laparoscope, and with another side in the region of the blade has an opening for fluid suction Has.

The openings preferably occur in the conical region which is arranged at the transition from the housing to the blade, and preferably laterally from the blade.

• – dass durch Steuerung der Spannung und/oder deren Amplituden und Frequenzen der Spannung am ersten und zweiten elektrischen Anschluss eine Frequenz im Bereich von mehr als 55 kHz an der Klinge erzeugt wird, um Weichgewebe zu schneiden.

Die Steuerung ist in der Regel über das Endoskop oder Laparoskop verbunden und dessen Anschlüsse von außen mit der Ultraschallschneidvorrichtung verbunden.Another part of the invention is a controller for an ultrasonic cutting apparatus as described above that is configured and adapted to have a frequency in the range of 22 by controlling the voltage and / or the amplitudes and frequencies of the voltage at the first and second electrical terminals on the blade -44 kHz is generated so that a power on the blade of preferably 4 to 60 watts is achieved to cut bone tissue, and / or

• - That by controlling the voltage and / or their amplitudes and frequencies of the voltage at the first and second electrical connection, a frequency in the range of more than 55 kHz is generated on the blade to cut soft tissue.

The control is usually connected via the endoscope or laparoscope and its connections are connected from the outside to the ultrasonic cutting device.

Further, the controller may implement coagulation, welding or brazing by the cutting blade, preferably by burning / melting the soft tissue

Ablation can also be performed with the blade and the third port.

In another embodiment, the controller allows for irrigation. Cooling may be achieved through the blade and channels, preferably by introducing a physiological saline solution.

Also, the controller may be used to achieve material extraction by driving the blade and channel to aspirate fluid by extracting the remaining physiological fluids, blood, and cut remnants of both mineralized and soft tissue, via a vacuum pump Channel a pressure difference is transferred to the area of the blade.

Also, drug delivery may be accomplished via the blade and the fluid delivery channel, the controller applying a voltage across the first and second electrical leads, which is preferably configured at a frequency such that proteins and minor chemical agents may be released by use of the Cavitation bubbles are transported.

Another part of the invention is the use of the invention for carrying out the following and above steps.

Also, the controller may be used to provide images of the area of the cutting blade and material processed thereon by detecting the response and behaviors of the blade and piezoceramic, detecting and displaying the modified vibrations, amplitudes or frequencies in response to cutting forces.

The integration of the piezoelectric material into the tip allows the development of a miniaturized tool that can be used for a variety of useful applications, e.g. to selectively cut hard or soft materials, for soldering, welding and heating. In addition, the integration of piezoelectric technology directly into the blade allows for connection to existing products such as endoscopes and laproscopes with minimal effort.

This invention achieves the goal of providing a miniaturized multifunctional blade. There is thus the integration of a lead-free, non-toxic piezoelectric material into a precisely shaped blade which vibrates at a frequency in the ultrasonic range.

The development of the blade can be done as a medical minimally invasive device. Lead-free piezoelectric materials are particularly suitable for medical applications. For example, it is possible to cut bone with minimal iatrogenic injury to the soft tissue, which is a critical property for certain medical procedures. The blade allows this selective cutting by very precise ultrasonic vibrations at a suitable frequency and energy output. The precise movement of the blade is achieved by a piezoelectric material optimized thereon and preferably by a corresponding design of the invention. In addition, the blade also has many other functions in connection with a suitable control, such as the cutting and ablation of tissue, as well as a unipolar coagulation. In addition, the blade is cooled with isotonic saline, which can also be used for rinsing, and it has the ability to cut material to the outside dissipate. All functions may be performed by a single blade element of preferably one-half centimeter size (other sizes are conceivable), which allows ultrasound to be cut in a minimally invasive surgery (MIS) device such as a laparoscope or endoscope , The following does not explicitly distinguish between laparoscope and endoscope, although technically different, but similar in use. The device according to the invention is particularly suitable for complicated operations, such as operations in the neurological area or operations on the spinal column, since in these operations the patients are exposed to a high risk of collateral damage in the event of a medical error.

The technological parameters of the invention will be described below.

Piezoelectric material: The vibration is preferably generated by a piezoelectric ceramic, which has excellent properties compared to the currently available materials. This piezoelectric ceramic can be lead-free. A piezoelectric material is used which can achieve high vibrational speeds and shifts and additionally has a suitable blocking force with little dissipation of heat. The necessary energy density should also be achieved at the required scale, which represents a technical difficulty that can only be solved with a suitable design. Here, a monolithic or a multi-layered material design can be used.

Oscillation of the blade: First, a suitable design is needed to achieve the desired vibrations. In order to achieve an oscillating movement of a very small blade at very high frequencies, the correct geometric design of the blade in conjunction with the piezoceramics must be chosen. With the help of advanced multiphysics simulation software, it is possible to calculate the effects of the piezoceramics on the vibration of the blade in advance. The goal is to achieve a geometry such that the natural frequency of the blade, i. whose resonance coincides with the electrical signal driving the piezoceramics.

Material selection of the blade: A suitable choice of material for the hardness of the blade tip and the resistance to abrasion is a possible key to guarantee a good functionality of the device. In addition, a low frictional resistance is desired to minimize heat production during the division of hard materials. Furthermore, a surface treatment of the blade tip can take place. The ability to cut various hard materials and to ensure the efficiency of the cutting process. Once the mechanical behavior of the blade is adapted to the electrical behavior of the piezoceramics, it is possible to adjust the cutting motion very precisely by means of a controllable power supply or control.

Biomedical factors: On the one hand, by adjusting the resonant frequency of the blade, preferably between 24 and 36 kHz and with a peak power of 4 to 60 watts, it is possible to cut exclusively bone tissue and thus prevent softer tissue such as skin or nerves, get hurt. In addition, the blade of the present invention is designed to be capable of selectively cutting soft tissue as well as ablating tissue, coagulating, rinsing, and extracting tissue. Soft tissue can be cut by laying the tip at a second resonant frequency greater than 55 kHz (this is the upper limit of the frequency that soft tissue can endure), or applying stronger external forces, or placing stress on the tip becomes. Tissue removal and unipolar coagulation can be achieved by applying the correct voltage to the conductive tip. This is a technology provided by a control unit. The rinsing and the extraction of cut tissue during the operation takes place via two channels in the so-called endoscopic arm and corresponding pumps, which are approached by the control. These channels are located in or near the blade, ensuring maximum integration and miniaturization.

Integration: The blade can be integrated into commercially available endoscopes and controllers, as well as other minimally invasive devices. The desired functions of the blade are integrated into commercially available, existing arms and control units.

In order to evaluate the behavior of the blade during oscillation at ultrasonic frequencies, a theoretical model based on the finite elements can be used. This allows simulation of the blade, along with the piezoelectric material, whereby various mechanical and electrical parameters can be analyzed simultaneously. Several design options can be numerically tested and continuously improved. Different geometries for the blade and the piezoceramics can be modeled. Also, different materials for the tip can be analyzed by numerical methods: titanium, steel, aluminum and 3D printed Polyamides. Various piezoceramic materials can also be tested.

• • Neuartiges Design, das die Größe des Gerätes im Vergleich zur derzeit verfügbaren Technologie entscheidend verringert und damit erstmalig die Verwendung für MIC ermöglicht.
• • Nutzung von neuartigen, vorzugsweise ungiftigen piezoelektrischen Materialien mit und ohne Blei in Verbindung mit den bekannten Vorteilen des Schneidens von Knochen auf Basis von Ultraschall.
• • Kompatibilität mit bereits vorhandenen endoskopischen und laparoskopischen Instrumenten.
• • Durch das einfache und durchdachte Design ermöglicht das Gerät eine Fülle von Funktionalitäten, die so in den aktuell kommerziell verfügbaren Produkten nicht gegeben ist.

Meeting all these challenges allows the development of an ultrasound blade several millimeters thick, yet with sufficient performance to be used in a procedure for endoscopically cutting bone tissue in the MIC. The invention thus has the following essential features:

• • Novel design that dramatically reduces the size of the device compared to currently available technology, allowing it to be used for MIC for the first time.
• Use of novel, preferably non-toxic leadless and leadless piezoelectric materials in conjunction with the known advantages of ultrasonic bone cutting.
• • Compatibility with existing endoscopic and laparoscopic instruments.
• • The device's simple and sophisticated design provides a wealth of functionality not available in today's commercially available products.

• • Für Patienten: Kleinere iatrogene Verletzungen, welche weniger Schmerzen und eine kürzere Genesungszeit mit sich bringen.

An ultrasonically integrated multifunctional tip has not yet been used in the field of MIC, where precision is the ultimate goal. The blade fits very well with the MIC for complicated spinal surgery and neurological surgery, as it provides significant benefits to all involved
brings with it:

• • For Patients: Minor iatrogenic injuries that result in less pain and a shorter recovery time.

The present technology is therefore preferably directed to all surgical procedures requiring a high degree of accuracy, such as e.g. highly complex procedures close to important nerves or close to the brain.

In addition to the novel design, the use of non-toxic or lead-containing piezoelectric materials may be of crucial importance. The geometry of the piezo drive may be rectangular or circular, a monolithic plate / cylinder / block or a ring. Further, it may be a rectangular or round multilayer actuator having 2 to 50 layers with a varying thickness of the active layers of 20 to 100 μm. The electrodes may be made of Ag, Ni, Ni-Pd, Al or others. The piezoelectric properties are a conductive electrode on the surface, voltage of 10-1000V, operating temperature of 25 to 250 ° C, with coatings for electrical insulation. The piezoceramic is preassembled in a cavity in the cutting blade via a plug, a bead or a curing adhesive. The piezoceramic is located between the blade and the laparoscopic / endoscopic device. A mechanical bias of the piezoceramic is ensured by the rigid connection and promotes optimum processability.

The cutting blade can be made of steel, titanium, aluminum or ceramic. It may be coated or uncoated with titanium nitride or diamond-like carbon. The narrow thin cutting blade with its sharp tips is connected to a solid base in a round or rectangular shape, which are preferably monolithic. The cutting blade is 5-20 mm, with sharp cutting edges of 2-8 mm. It is machined material for optimum strength and with a coating to increase hardness and cutting ability. The cutting blade is connected to the laparoscopic / endoscopic device via the housing by a screw, an integrated thread, a mechanical plug, or a clip.

In addition, cable connections are provided as power supplies, which have a low resistance and can consist of metallic alloys (Ag, Ni, Ni-Pd, Al and others). The cable connections have a round or flat cross-section so that they can transmit a voltage of 10-1000 V and a current in the range of 10-50 mA, with a corresponding coating for insulation. The conductive cables are inserted or glued along the side of the blade and extend from the fixed base to the sharp edge.

There are basically 2 channels; on the one hand for providing fluid, on the other hand for sucking off fluid. These channels have been formed from a metal alloy or from a flexible polymer. They preferably have a circular cross section and are formed as a long flexible hose. The inner diameter is preferably only 5-2 mm, so that a maximum internal pressure of 10 KPa (kilopascals) to 2 MPa (megapascals) can be maintained. A coating is also provided to provide oxidation protection. The channels are located adjacent to the blade and in one possible embodiment, not shown, use a support ring connected to the fixed base, whereby a close connection of the channel and the blade can be achieved. To achieve a higher degree of miniaturization, a channel could also be expanded within the blade, which then extends from the fixed base along the sides of the blade, if necessary, to the tip. Such a channel is assembled directly in the vicinity of the sheet, using a Support ring, it is connected to the solid base. In addition to the fluid channel also a vacuum channel is provided, the structure of which is similar, but which preferably withstands an internal pressure of 1-30 kilopascals. Again, for the purpose of miniaturization, an arrangement may be provided within the sheet in the side area or laterally of the sheet.

Should it be intended, for example, to cut a hard material such as bone, the piezoceramic preferably receives an input voltage of 10 to 1000 V. Further, a frequency of 22 to 44 kHz is to be generated. The voltage may be continuously applied or modulated in the form of a sine wave by the controller, taking into account the resonance of the blade, to achieve a moderate or maximized cutting effect. The modulation frequency can be kept below 100 Hz and can be determined as a modulation wave as a sinusoidal input signal. The piezoceramic is subjected to vibrations in the vertical direction of the amplitudes in the range of 1 to 200 μm. The output power ranges from 4 to 60 watts. The forces are in the range of 0.1 N (10 g) and 2 N (200 g), which are used for a correct cut.

Due to the vibration, weak spots occur within the solid material which promote the tendency of crystalline materials to separate (cleavage). Cavitation mist helps cut the bone by accurately adjusting the acoustic impedance of the bone and cutting device. Also, the cavitation helps to remove cut remnants.

The advantages of the invention are cutting of the mineralized bone tissue, without cuts and lesions in the soft tissue, and particularly in neurovascular structures in a minimally invasive environment with rigid or flexible devices compatible with laparoscopes or endoscopes.

As already stated above, the invention can also be used under certain parameters for cutting soft tissue (soft material). For this purpose, a hot wire or the blade or cutting blade can be used. By selecting the vibration frequency of the blade at values greater than 55 kHz, by applying an external force of 0.1-2N, or by applying a unipolar / bipolar voltage with a maximum amplitude of 180 V and a frequency of 0.2 to 3.3 MHz without modulation, a soft tissue can be cut.

Coagulation / welding / brazing can also be done by the blade or cutting blade. Coagulation is accomplished by burning soft tissue by applying alternate, unipolar / bipolar voltage amplitudes of 180-1200V and frequencies of 0.2-3.3 MHz with a modulation of preferably less than 10% duty cycle. The duty cycle indicates, for a periodic sequence of pulses, according to standardization, the ratio of the pulse duration to the period duration. Soldering consists of melting the material according to the same principle. In this case, a third electrical connection is preferably used.

At this time, an electric current flows through the soft material and generates heat. This damages the tissue and can have various effects depending on the electrical signals.

Ablation is achieved with the blade and the third port. Biological tissue is delivered from the host body by applying an alternating, unipolar / bipolar voltage with amplitudes of 180-1200V and frequencies of 0.2-3.3MHz, preferably with a modulation of 25 to 75% duty cycle. This connection can increase the tension at the tip of the cutting blade. This allows for unipolar tissue cutting, coagulation or ablation. The piezoelectric element is independent of this and does not need to be operated.

Irrigation / cooling can occur through the blade and tracks. Thus, a physiological saline solution at a temperature of 4-25 ° C can be used for irrigation, as well as other types of physiological sterile solutions that perform the same function. A volume flow of 0 to 80 ml / min is passed through the channel. By cooling, a temperature increase in the cutting area can be kept below +4 ° C.

Material extraction can be accomplished through the blade and vacuum channel, where extraction of the remaining physiological fluids, blood, and cut remnants of both mineralized and soft tissues occurs. Here, a vacuum pump and a channel is used, through which the pressure difference is transferred to the area of the blade. This creates a cleaned work area.

A medication supply takes place over blade and the channel. Here a frequency of the pulses in the range of 500 kHz to 2 MHz is applied. This wave is modulated with a wave in the range of 1 Hz to 200 Hz. Modulation is understood in this case as a method in which the amplitude of a high-frequency signal is changed depending on the low-frequency signal to be transmitted. The output power is 4 to 60 watts. As a result, the transport of genetic Material, proteins and minor chemical agents can be achieved by cavitation bubbles. Also, permissible transport of drugs through cell membranes and disruption of vesicles that carry drugs due to ultrasonic vibration and cavitation may occur. Thus, an exponential increase in the efficiency of delivery of genetic material, proteins and chemical agents is achieved. It can thus be summarized as an improved transport and absorption, and a Zellpermeabilisierung and Kapillarbruch be spoken.

Imaging can be achieved through the blade and piezoceramics. The vibrations, amplitudes and frequencies are modified in response to cutting forces. These changes are detected and translated into reaction forces on the vibrating piezoelectric material that can be converted to electrical output by the direct piezoelectric effect. The direct piezoelectric effects and reactions and generated displacement of the material can be detected by electrical signals that can be analyzed and evaluated. These are then visualized and can then be displayed.

Figures Description:

In the following, a description of the invention with reference to the figures.

1 - 3 show an embodiment of the invention in a perspective view of several sides;

4 shows a plan view of the invention with a profile for a section AA;

5 shows a plan view 4 rotated by 90 °, with a course of a section BB;

6 shows a section according to 4 and section AA;

7 shows a section according to 5 and section BB;

8th shows the connection of the endoscope or laparoscope, at the end of the ultrasonic cutting device according to the invention is attached;

9 shows an interface view of the present invention to be attached thereto at the endoscope or laparoscope;

10 shows a view from the front of the cutting blade with her teeth;

11 shows an alternative embodiment with a curved cutting edge;

12 shows the invention and the endoscope or laparoscope just before the connection with each other;

13 shows a view from the front of the cutting blade with her teeth;

14 shows a side view with a section AA;

15 shows a 90 ° to 14 rotated side view with the course of a section BB;

16 shows the cut according to 15 along BB;

17 shows the cut according to 14 along AA;

Description of embodiments along the figures:

The 1 - 3 show perspective views of the present invention with a housing 5 in which one or more piezoelectric elements 2 are located. From the housing extends forward a cutting blade 1 , the teeth 8th having. Furthermore, two channels emerge laterally of the cutting blade 6 and 7 from which serve to suck fluid or supply fluid. These channels exit on the back and are there with the endoscope or laparoscope 9 brought into operative connection. In addition, the back has three electrical connections 3 . 4 . 5 on, which serve the piezoelectric element 2 To drive or serve to create a tension on the cutting blade or at the top of the cutting blade to deliver there corresponding currents. The 4 and 5 serve to illustrate a section that in the 6 and 7 is indicated. The 6 and 7 show the interior of the device according to the invention. That is how it is 7 to take the arrangement of the piezoelectric elements. In the illustrated embodiment, these are 2 piezoelectric elements, in the embodiment, in the figures from 11 on the other hand, it is an embodiment which has only one piezoelectric element. The number of piezoelectric elements is no restriction. It is clear that 6 and 7 to take the course of the channels and the power supply. The connections 3 and 4 serve to supply voltage to the piezoelectric elements. The connection 5 gives over the housing its tension to the cutting blade 1 further. The cutting blade 1 is in the case 5 inserted and surrounded by the housing in some areas. The cutting blade has a narrow tapered area, which is formed sword-shaped and with teeth 8th is provided, which then widens on the opposite side in a circular cylindrical portion which is then in operative connection with the piezoelectric elements. As a result, the vibration is transmitted to the cutting edge. The 8th shows the coupling sleeve into which the device according to the invention is introduced. In this case, the invention is clamped in a tubular connection, and then comes with its 5 connections to the endoscope or laparoscope in operative connection. The 9 shows the corresponding 5 connections of the device according to the invention in plan view. The 11 - 17 show a modified form of the embodiment of the 1 - 10 , the main differences being that the cutting blade 1 is bent in its end so that the teeth are directed upwards or downwards, and according to 16 Only one piezoelectric element is used to drive the cutting blade. Otherwise, the figures substantially correspond to the figures of the embodiment 1-10. 12 shows the device according to the invention shortly before entering an endoscope or laparoscope 9 to be led. The 13 shows the device according to the invention from the front. The 14 . 15 . 16 and 17 again show the sectional view of the present invention. Of the 16 It can clearly be seen that only one piezoelectric element is present.

LIST OF REFERENCE NUMBERS

1

 cutting blade

2

 Piezoelectric element

3

 Connection for positive voltage supply

4

 Connection for negative voltage supply

5

 Housing to the cover, which is connected to the cutting blade, in addition, the projection can be used as a third electrical connection to increase the voltage at the tip of the cutting blade. This allows for unipolar tissue cutting, coagulation or ablation. The piezo-electronic element is independent of this and does not have to be operated.

6

 Channel for fluid supply

7

 Channel for aspirating fluid

8th

 teeth

9

 Endoscope or laparoscope

QUOTES INCLUDE IN THE DESCRIPTION

This list of the documents listed by the applicant has been generated automatically and is included solely for the better information of the reader. The list is not part of the German patent or utility model application. The DPMA assumes no liability for any errors or omissions.

Cited patent literature

• EP 311197 [0002]
• CN 203458441 [0002]
• EP 119207 [0002]
• CN 103431894 [0002]
• EP 2066255 [0003]
• US 5674235 [0003]
• EP 2233085 [0003]
• US 20090326535 [0003]
• CN 1561919 [0003]
• CN 01828943 [0003]
• US 20030099917 [0003]
• US 20140243864 [0003]
• EP 0238667 [0003]
• EP 1110509 [0003]
• US 2000167235 [0003]
• US 20080161809 [0003]
• US 20080188878 [0003]
• US 20020103497 [0003]
• US 20120095472 [0003]
• EP 1372495 [0003]
• US 20090228032 [0003]
• EP 0384672 [0003]
• US 4823790 [0003]
• US 20030144680 [0003]
• EP 2174601 [0003]
• US 20140276849 [0003]
• US 20140277028 [0003]
• EP 2763603 [0003]

Claims (22)

Ultrasonic cutting device for attachment to a tip of a device of a miniaturized tool, in particular for a minimally invasive procedure, in particular on an endoscope or laparoscope, comprising: A housing provided on a first side with attachment means for attachment to a tip of the minimally invasive device to be inserted into the body; A cutting blade disposed on a second side of the housing; - An electro-mechanical drive means which are integrated in the housing and in operative connection with the cutting blade for performing ultrasonic cutting movements. Ultrasonic cutting device according to the preceding claim, comprising a tubular housing whose shape and size provides a flush transition to the tip of the endoscope or laparoscope. Ultrasonic cutting device according to the preceding claim, wherein the housing has a diameter of 1-20mm and / or a length of 1-40mm. An ultrasonic cutting apparatus according to one or more of the preceding claims, wherein the housing tapers towards the cutting blade to form a smooth transition to the cutting blade, or wherein the cutting blade expands to extend into the housing. An ultrasonic cutting apparatus according to the preceding claim, wherein the housing is tubular, and the cutting blade has a snug extension to the housing so that the extension fits snugly into the tubular housing in the shape that the vibrations of the electro-mechanical drive means to the tip of the cutting blade are transferable. An ultrasonic cutting apparatus according to one or more of the preceding claims, wherein the cutting blade is sword-shaped and has a cutting edge on the side facing away from the housing, and wherein the cutting edge is serrated and forms teeth or is smooth. Ultrasonic cutting device according to one or more of the preceding claims, wherein the length of the cutting blade is 5-20 mm and / or the teeth protrude 1-8mm. Ultrasonic cutting device according to one or more of the preceding claims, wherein the housing on the first side has at least two electrical connections, in particular plug connection, is provided via the voltage for the electro-mechanical drive means Ultrasonic cutting device according to one or more of the preceding claims, wherein the electro-mechanical drive means comprises at least one or more piezoelectric elements, wherein the piezoelectric elements are preferably ceramic piezoelectric elements, which are preferably lead-free. Ultrasonic cutting device according to the preceding claim, wherein the piezo elements are characterized by one or more of the following properties: - Frequency controllable in a range of 22-44 kHz and over 55 kHz to 2 MHz; - Apply a voltage of 10-1000V - Temperature resistant from 25-250 degrees, - Output power from 4 to 60 watts. Ultrasonic cutting device according to the preceding claim, wherein due to the geometry of the cutting blade matches the natural frequency of the cutting blade with the electrical signal that drives the piezoceramics. An ultrasonic cutting device according to one or more of the preceding claims, comprising a fluid delivery channel preferably extending through the housing and communicating with one side with a channel of the minimally invasive device and with another side in the region of Blade has an opening for a fluid outlet, and or comprising a fluid suction channel preferably extending through the housing and communicating with one side with a channel of the minimally invasive device and having an opening for fluid suction with another side in the region of the blade , Ultrasonic cutting device according to the preceding claim, wherein the openings in the conical region are arranged at the transition from the housing to the blade, preferably laterally of the blade. An ultrasonic cutting device according to one or more of the preceding claims, comprising a third electrical connection to provide tip tension for unipolar tissue sections, coagulation, or ablation. Control for an ultrasonic cutting device according to one or more of the preceding claims, which is designed and adapted, - that by controlling the voltage at the first and second electrical connection, a frequency in A range of 22-44 kHz is generated at the blade, and that power at the blade of 4 to 60 watts is achieved to cut bone tissue, and / or that by controlling the voltage at the first and second electrical terminals a frequency in the Range of more than 55 kHz at the blade is generated to cut soft tissue. The controller according to the preceding claim, wherein soft tissue is cut by applying a unipolar or bipolar voltage to the third electrical connection, preferably with a maximum amplitude of 180 V and a frequency of 0.2 to 3.3 MHz. The controller according to one or more of the preceding control claims, wherein coagulation, welding or brazing is performed by the cutting blade, preferably by burning / melting the soft tissue, by applying alternating unipolar / bipolar voltage amplitudes of 180-1200V and frequencies of 0.2- 3.3 MHz at the third electrical connection. The controller according to one or more of the preceding control claims, wherein ablation is performed with the blade and the third terminal, preferably by removing tissue from the host body by applying an alternating unipolar / bipolar voltage, the voltage having amplitudes of 180-1200V and frequency 0.2-3.3 MHz, preferably with a modulation of 25 to 75% duty cycle. The controller according to one or more of the preceding control claims, adapted to achieve irrigation / cooling through the blade and channels, preferably by using a physiological saline solution at a temperature of 4-25 ° C for irrigation or other types of physiological sterile solutions, Preferably, a volume flow of 0 to 80 ml / min is passed through the channel for fluid supply, so that by cooling a temperature increase in the cutting region can be kept below +4 ° C. The controller according to one or more of the preceding control claims, arranged to achieve material extraction by driving the blade and the fluid aspiration channel, wherein extraction of the remaining physiological fluids, blood, and cut remnants of both mineralized and soft tissue occurs a pressure difference is transferred into the area of the blade by a vacuum pump via the channel. The controller according to one or more of the preceding control claims, adapted to provide drug delivery via the blade and the fluid delivery channel, wherein control of the voltage at the first and second electrical connections is made, preferably to a frequency of the pulses in the Range from 500 kHz to 2 MHz, and then to modulate this wave in the range of 1 Hz to 200 Hz, the output power is preferably 4 to 60 watts, whereby the transport of genetic material, proteins and smaller chemical agents is achieved by cavitation , The controller according to one or more of the preceding control claims, arranged to achieve imaging using the blade and the piezoceramic, wherein the modified vibrations, amplitudes or frequencies are detected and displayed in response to cutting forces.

Images