DE8435489U1 - Nephroscope - Google Patents

Description

The invention relates to a nephroscope according to the preamble of claim 1.

Nephroscopes are used for percutaneous kidney stone treatment and, in addition to optics, have at least one probe channel through which auxiliary instruments can be inserted. For nephroscopy, a shaft has to be inserted into the renal pelvis, which is done in a manner known per se for example by means of a guide wire. With the nephroscope, with the help of extraction instruments Extract kidney stones of the size whose outer diameter

knife smaller than the one used for stone extraction Shank (for example 7 mm) is. Lithotripsy is necessary for larger stones, i.e. larger stones must be smashed before extraction. To prevent stone fragments from escaping into the ureter, it is known to insert a ureteral catheter, possibly with a balloon. However, it is fundamentally disadvantageous that in lithotripsy, be it ultrasonic lithotripsy, electrohydraulic shock wave lithotripsy or mechanical Lithotripsy, the stone fragments preserved in each case in the Kidney are distributed. In ultrasonic lithotripsy as well as in electrohydraulic shock wave lithotripsy If the larger kidney stones are shattered, the disadvantage is that the stone fragments also form the mucous membrane of the Injure kidney.

The invention is based on the object of creating a nephroscope according to the preamble of claim 1, which avoids uncontrolled distribution of crushed kidney stones and / or damage to the mucous membrane.

According to the invention, this object is achieved by the subject matter of Claim 1 solved.

The invention creates a nephroscope which, in addition to the usual structure with optics, etc., contains at least one probe channel, are guided by the control members, with the incorporeal

At the end of the nephroscope at the end of the control members a flexible loop is attached, which is used to hold a sack-shaped network is used. The control members enable the opening of the sack-shaped network to contract after detection the desired kidney stone and a fixation of the kidney stone in a position that is suitable for lithotripsy is desired. The nephroscope with the sack-shaped container attached to the flexible loop can be

as known from nephroscopes, through the operating shaft insert into the kidney, the process of Einfar.gens or detection of a kidney stone can be observed via the optics in the nephroscope. The rest of the structure of the nephroscope, including the glass fiber as observation optics, channels for irrigation, inflow and outflow is inherently gotve ..

It is particularly advantageous in a preferred embodiment the possibility of controlling the flexible loop in a direction inclined to the loop plane by means of additional Controls.

In one embodiment, the flexible loop is formed by a spiral spring, the * 'attitude in a simple manner a con- f of the sack-shaped opening trahieren the network at Beibe- the necessary rigidity of the sack-shaped opening for the purpose of introducing * allows a kidney stone.

To guide the control elements of the loop, which leads to the change the loop opening are actuated to their extracorporeal end, each control member is preferably in out of its own channel, each channel preferably having the shape of a hollow needle. One movement of the loop about transverse to the loop level can be through additional Perform controls that are attached approximately in the middle of the loop and via guide channels to the extracorporeal Run at the end of the nephroscope.

With the help of an additional probe channel, the

the Nephroscope advantageously the axis of a bur provide their inkorporales end a milling drill or the like carries%, so that a fragmentation

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a kidney stone held in the network can be carried out under observation. The milling drill with its drive axis can can also be introduced through the instrumentation channel.

The following are preferred embodiments of the nephroscope described with reference to the drawing to explain further features. Show it:

1 is a perspective view of a nephroscope with a nephroscope shaft passed through Loop and sack-shaped net,

2 shows a sectional view through part of the nephroscope to illustrate the guidance of the control members and controls for the sack-shaped net,

3 shows a representation of the loop at the incorporeal end of the nephroscope in the raised state,

4 shows an enlarged view of the incorporeal end of the nephroscope for the purpose of illustration the loop and the net, and

Fig. 5 is a side view of a modified embodiment.

Preferred embodiments of the nephroscope are described below. Fig. 1 shows a perspective view of the Nephroscope with a shaft 1, which as a result of the Dilatation allows the introduction of the nephroscope. The nephroscope, designated 2, has an optic 3 and a Connection 4 to the light source. Furthermore, an inflow 5 and an outflow 6 are provided for flushing in a known manner, wherein the channels within the nephroscope and lying within the shaft 1 are not explained further. Within of a shaft 26 of the nephroscope two control members 7, 8 are provided, which at the extracorporeal end of the nephroscope to the outside and are provided with actuators 9, 10. Serve as control members 7, 8

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for example steel wires or needle-shaped elements which are inserted into guide channels 24, 25 from the outside. the Guide channels 24, 25, preferably in the form of a hollow needle each for guiding one of the control members 7, 8, are arranged inside the nephroscope 2 and on the extracorporeal End of the nephroscope 2 led out of this. The control members 7, 8 are at the incorporeal end of the Nephroscope 2 with a loop 12 in connection. A flexible, hollow metal element is preferably used as the loop 12. In the embodiments described below, the loop 12 is a spiral spring 35 or a spiral spring Wire is provided that has a diameter of 1 mm, for example. The arrangement between control members 7, 8 and actuators 9, 10 on the one hand and the loop 12 on the other hand is made such that through Movement of the actuators 9, 10 in the direction of a Arrow 13, the loop opening is reduced or closed can be. For this purpose, the control members 7, 8 are preferably formed by a nylon thread from the actuator 9 at the extracorporeal end through the guide channel 25 to the incorporeal end and there through the loop runs and then runs through the guide channel 24 back to the actuator 10.

According to a further embodiment, the guide channels are 24, 25, for example hollow needles, in each case a guide channel (not designated) along and within the Nephroscope shaft 26 slidably mounted. These are not designated and guide channels not shown in the figures are preferably formed by hollow needles, their Inside diameter is larger than the outside diameter of the guide channels 24, 25, and are fixed in the nephroscope shaft stored, for example welded to the nephroscope. Through a tubular guide 14, the guide channels are on the extracorporeal End branched off from nephroscope shaft 26 (FIG. 2), as FIG. 1 illustrates.

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It should be mentioned that instead of a nylon thread for the control members 7, 8 a steel wire or the like is provided if the control members 7, 8 should have a higher rigidity.

The incorporeal end of the guides 24, 25 is preferably selected to be smaller than the outer diameter of the spiral wire 35, which leads to a contracting of the loop 12 when the actuating members 9, 10 are moved in the direction of an arrow 13; the ends of the spiral wire 35 forming the loop 12 lie on the incorporeal end of the guides ¹ ! ¹ The guides for the control elements are to be selected so small that a net 17 attached to the loop 12 cannot be drawn into the guide channels 24, 25.

In a preferred embodiment in which the loop 12 is soldered to the hollow needles 24, 25, by pulling the actuating members 9, 10 in the direction of arrow 13 the Loop 12 with net 17 pulled into nephroscope shaft 26 are below an optics and instrument channel 31, 32 (Fig. 2) there is enough space to accommodate part of the network. This allows the hollow

1 2 needles 24, 25 with the loop l) soldered to the in Fig. 3 with 15 designated larger hollow needles withdrawn and so the loop opening outside of the nephroscope can be reduced in size. The hollow needles 15 in FIG. 3 form those described above and in connection with FIGS. 1 and undesignated guides for the guide channels 24,

The bag-shaped net 17 arranged on the loop 12 consists of a suitable material, for example one Synthetic thread or aluminum wire and has a mesh size of preferably less than 1 mm. The mesh material should be light be cleanable or sterilizable, the mesh size

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can be selected larger or smaller if necessary, but should prevent stone fragments from escaping from the network when the network is closed As far as possible, exclude the opening of the loop. Instead of a nylon thread, thin threads can also be used as control elements Steel wires are used, which are to be guided accordingly in the nephroscope.

In the "loose" state of the loop 12, the opening of which is also determined by the spiral wire spring itself, the loop has flexible, but nevertheless stable properties, so that a foot can easily be caught. Furthermore, the net and loop have to be elastic but tear-resistant in order to avoid shock waves in the event of stone shattering. to withstand the test.

The movement of the loop 12 is in a plane related to the loop inclined direction possible in that additional control elements 19, 20 are provided. Each control 19, 20 is formed by a nylon thread or pair of nylon threads and runs through guide channels 27, 28, for example hollow needles, inside the nephroscope to the incorporeal end of the nephroscope, where they emerge from their guide channels 27, 28 exit and to certain points of the loop 12 and run back again. The actuators 19, 2 are moved by corresponding actuators 21, 22, such as will be described below. Instead of the pair of nylon threads 19 or 20, one attached to the loop or knotted nylon thread or the like may be provided.

In addition to the guide channels for the control elements and control elements, the nephroscope has channels in a known manner or probe channels for other aids, e.g. the already mentioned channel 31 for the optics (optical fiber) and the channel 32 for the introduction of grasping forceps, further channels for rinsing and sucking off concretions from the network 17,

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2 shows a perspective sectional view of the incorporeal end of the nephroscope with the surrounding opera tion shaft 1 * As can be seen from Fig. 2, the guide * channels 24, 25 for the control members 7, 8 provided eccentrically to the nephroscope shaft, the guide channel 24 for The control member 7 is guided and the guide channel 25 is used to guide the control member 8. As mentioned, the control members can 7, 8 in the form of a single wire-shaped or thread-shaped Partly be trained. The distance between the ends of the guide channels 24, 25 ensures a predetermined one Opening size of the loop 12 and thus the opening of the net. The control elements 19, 20 are guided in corresponding further guide channels 27, 28 which are located above the guide channels 24, 25 lie. The control elements 19, 20 are attached to the loop 12 at a distance from one another, as indicated by the reference symbols 29, 30 shown. The spaced attachment of the control elements 19, 20 to the loop 12 can be a Achieve defined folding up of the loop 12, for example a stone introduced into the sack-shaped net 17 in a predetermined position in front of the opening of the shaft 1 or 26 to be fixed, for example for the purpose of breaking up the stone by means of a drilling tool. the Actuation of the control elements 19, 20 in the direction of the extracorporeal end of the nephroscope cause the Loop 12, which FIG. 3 illustrates. On the other hand, the control elements 19, 20 can be in the non-actuated state so move out of their guide channels 27, 28 that the inclusion of a stone in the sack-shaped Network 17 is not obstructed. The network 17 has fastening loops on its edge through which the wire 35 passes is performed and thus the network 17 holds.

Fig. 4 shows a front view of the incorporeal end of the shaft 1 or 26. The channel 31 shown in Fig. 2 and the Instrument channels 32 also shown in FIG. 2 are shown in FIG

Fig. 4 is omitted for the sake of clarity. At the Loop 12 is the sack-shaped net 17 by means of fastening loops 34 formed on the net over which the loop 12 arranged essentially determining and designated by 35 spiral wire. Fig. 4 shows that the spiral wire 35 from which the control members 7, 8 forming steel wire or nylon thread 36 is penetrated, starting from the loop 12 enters the associated guide channels 24, 25 and to the actuator = !! 3, 10 sndct.

In the embodiment in which the guide channels 24, 25 in the direction of the axis of the shaft 26 of the nephroscope mounted displaceably and preferably provided in the form of hollow needles can be displaced the hollow needle-like guide channels 24, 25 in the direction of a

Arrow 38 extend the loop 12 far into the renal pelvis and open completely. If the spiral wire 35 is soldered to the ends of the guide channels 24, 25, stiffening can be achieved the loop 12 by advancing the control members 9, 10 in the form of a thin, stiff metal wire through the Reach guide channels 24, 25 in the hollow loop 12, whereby the loop 12 can be directed.

The loop 12 is in each case so elastic, but nevertheless so stiff, that it can, if desired, lead to deliberate deformation can be pressed against the renal pelvis wall to capture a stone located there. The stiffness of the loop 1 2 also ensures the relocation back into theirs original, largely in one plane, as soon as the pressure against the renal pelvic wall is stopped, which is mainly due to the spiral shape of the loop wire.

Due to the mobility of the loop together with the

suspended sack-shaped net 17, it is thus easily possible to insert a kidney stone caught in the net 17 to spend almost any position in front of the end of the shaft 1 to the stone either mechanically by means of a not shown twist drill or to shatter electrohydraulically, in the latter case the probe of a Shock wave generator is inserted through the instrument channel to the end of the shaft 1. The mesh size of the Kstzss is so evjshlt - that also splinters of the shattered Stone does not emerge from the network, in particular not be torpedoed against the mucous membrane and yourself there is no need to look for stone rubble after it has been smashed. The network 17 thus makes it possible to shatter the To completely embrace stone, to smash it and to completely suck off the concrement particles from the network or to be removed together with the net over the shaft. The collection of concrement particles during the shattering also avoids the otherwise inevitable bleeding due to damage to the mucous membrane.

In the embodiments described, the nephroscope has a loop with a sack-shaped loop attached to it Network on. Instead of a net, another, liquid-permeable material can be used has sufficiently high tear strength and elasticity.

In FIGS. 1 to 4, the spiral wire 35 is only partially shown for better illustration of the fastening of the net 17; in fact, the spiral wire 35, however, is soldered over the entire loop 12 extend between the outlets of the guides 24, 25 provided _unc jb i _e one embodiment.

After further training of the nephroscope are related of the control members 7, 8, preferably in the area of the associated actuators 9, 10 Feststelleinrich-

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Lines are provided with the aid of which the opening of the loop 12 can be fixed in any predetermined, contracted state. Correspondingly, in one embodiment of the nephroscope, locking devices can be provided with respect to the control elements 19, 20, also preferably in the area k of the actuating elements 21, 22, in order to keep the loop 12 in every predetermined state inclined with respect to the shaft 1 to keep.

FIG. 5 shows a further embodiment of the nephroscope, the nephroscope being shown inserted into the operating shaft 1. In this embodiment is through the Nephro-; Scope shaft 26 inserted a tubular network, which is denoted by 40 ΐ. The extracorporeal end 40a of the mesh ^; 40, protrudes from the nephroscope and does not require any special

consolidation. The network is preferably made of a thin ';' each running in pairs next to each other, interlaced with each other. ' tenen plastic threads formed existing hose, and has; such flexible properties that it is at the incorporeal end

of the shaft 1 is stretchable and stretchable. By the way of intertwining of the nylon threads to each other is a change in the lumen of the tube to accommodate through tensile and compressive forces of the concrement reached.

The network 40 in the form of a tube runs from the end 40a through the shaft 1 to the loop 12, which is shown in FIG. 5 in a position which assumes an angle of almost 90 ° with respect to the operating shaft 1. The network 40 in FIG. 5 has the shape of a funnel in the form of FIG

; Fig. 5 shown position of the loop 12 and is the same

Way attached to the loop 12 as this is in connection with Figs. 1 to 4 is described. Due to the elongation

:; Shanks of the network 40 can be the loop 12 in each other Move position as explained above. The inclination of the loop 12 is adjusted with the aid

of the control elements 19, 20, while the size of the opening of the loop 12 can be adjusted by the control elements I ₁ 8. «

The control elements 19, 20 also serve as adjustment *> to facilitate the insertion of the tube into |

the nephroscope. The hose network 40 allows extra f

corporally an optical stone extractor 42 with two, three or several robust gripper arms pushed into the renal pelvis to seek out and grab a stone located there. After that, under sight as well radiological image converter control the mesh 40 with the opening of the loop from the nephroscope shaft 26 over the with the Gripping pliers gripped stone are pushed.

In the embodiment according to FIG. 5, the network 40 extends from the loop 12 to the extracorporeal end of the nephroscope shaft envisaged running.

In order to prevent the stone 43 from escaping, the loop 12 is closed by means of the control members 7, 8, see above that the stone 43 is mounted between the closed loop 12 and the stone grasping forceps 42. By a shift the guide or guides 24, 25, the stone 43 is drawn to the nephroscope through the closed loop and fixed for the purpose of shattering. The shattering takes place after the optics have been removed from the optics Stone extractor and by inserting a lithotrypsy probe.

The advantage of the embodiment of FIG. 5 is that with additional instruments, such as the optical stone extractor 42, through the nephroscope shaft into the

Network 40 can be grasped, even if an i

Stone 43 is caught in the net and the loop 12 is ^!

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is closed. Above all, however, can through a larger canal, which overall after possible removal of the nephroscope is formed by the tubular network, the disintegration, removal and suction of the concretions take place.

Due to the close connection of the plastic threads, the hose is almost waterproof, but can be opened by pulling and pushing, e.g. can be changed by actuating the control members 7, 8 or by opening the loop in the lumen.

In a correspondingly finer version, this is shown in Fig. The illustrated net 40 also for catching a ureteral stone by pushing it up from the urinary bladder into the ureter usable.

In one embodiment it is provided that the nephroscope does not have its own nephroscope shaft in addition to the operating shaft; in this embodiment is preferred provided, the probes and guide channels etc. guided on the nephroscope inside and along the shaft through a | to surround tubular housing or the like.

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Claims (12)

Dipl. Ing. Klaus Westphal Waldstrasse33 Telephone 07721-56007,. ,,,, ,,, .-. r. .. Telegr. Westbuch Villingen Dr. rer.nat. Bernd Mussgnug. . #. . . ^ «Q-jrap ^ S-VILLINGEN Telex 5213177 webud Dr. rer. nat. O 11 o Buchner. ! .. "·· *" ·· *! TFJes'sfnanfistrasse 30a Telephone 089-832446 Telegr. Westbuch München Patentanwälte D-8000 MÖNCHEN 60 Telex 5213177 wsbud European Patent Attorneys Talecop. 089-8344618 (CCITT2) attention webu u.Z .: 1643.6 Utility model registration G 84 35 489.5 Richard Wolf GmbH New claims 1. Nephroscope with at least one probe channel for insertion of auxiliary instruments or the like., characterized in, that at least one further probe channel (24, 25, 27, 28) as a guide channel for two control members (7, 8) is provided, the control members (7, 8) being incorporeal to the nephroscope shaft (26) End connected to a flexible loop (12) for holding a sack-shaped container (17; 40) are while they are at their extracorporeal end.i actuators (9, 10). 2. Nephroscope according to claim 1, characterized in that the sack-shaped container (17; 40) through a network is formed. Postal checking account: Kar, lsfghj> J697 & -ts4> Bank account: Deutsche Bank AG Villingen (BLZ 6947Ö039) 146332 3. Nephroscope according to claim 1 or 2, characterized in that that a pair of control elements (19, 20) is provided which are fastened approximately centrally on the loop (12). 4. Nephroscope according to claim 3, characterized in that the control elements are attached to the loop (12) at a distance from one another (29, 30). 5. Nephroscope according to one of the preceding claims, characterized in that the loop (12) through a hollow flexible metal element (35) is formed. 6. Nephroscope according to one of claims 1 to 4, characterized in that that the loop (12) consists of a spiral wire (35) through which a with the Control members (7, 8) connected wire or thread (3Ö passes. 7. Nephroscope according to one of the preceding claims, characterized in that in the nephroscope shaft (26) at least a guide channel (27, 28) is provided for the control elements (19, 20). 8. nephroscope according to claim 7, characterized in that the guide channel or the guide channels (27, 28) for the control elements (19, 20) lie in a plane which is spaced from the plane of the guide channels (24, 25) of the control members (7, 8). 9. Nephroscope according to one of the preceding claims, characterized in that the guide channels (24, 25) for the control members (7, 8) are designed to be adjustable along the axis of the nephroscope shaft (26). m * kit • · · I JL I (rCt 10. Nephroscope according to one of the preceding claims, characterized characterized in that a separate guide channel for each control member (7, 8) and each control element (19, 20) (24, 25, 27, 28) is provided. 11. Nephroscope according to one of the preceding claims, characterized characterized in that the network (40) is provided in the form of a hose and from the loop (12; aiii Nephroscope is arranged to run along its axis. 12. Nephroscope according to claim 11, characterized in that the tubular network (40) through the nephroscope shaft (26) runs.