DE10162933B4 - Device for tissue extraction - Google Patents

Abstract

Device for extracting tissue, in particular a rongeur, with a hollow shaft (1) which has in a front region a separating mechanism (2) for separating and introducing tissue into the hollow shaft (1) and in a rear region an actuating device (3) for operating the Having separation mechanism (2),
wherein on or in the hollow shaft (1) a drive element (5) drivable mechanical transport element (4) for transporting separated tissue within the hollow shaft (1) is arranged from the front to the rear,
characterized,
the mechanical transport element (4) is designed as a displaceable carriage which has at least one driver (6) for the severed tissue.

Description

Technical application

The The present invention relates to a device for tissue extraction, especially Rongeur, with a hollow shaft, in a front Area a separation mechanism for separating and inserting Tissue in the hollow shaft and in a rear area an actuator for the activity having the separation mechanism, wherein on or in the hollow shaft one of a drive drivable mechanical transport element for transport of separated tissue within the hollow shaft from the front is arranged in the rear area.

In some medical specialties, such as spinal surgery, have to Removed pieces of tissue from the area of the spine during various procedures become. An example of this is the Posterior Lumbar Intercorporeal Fusion (PLIF) at the spine, targeted decompression in the area of the ligamentum flavum Tissue removal and the insertion of a cage are performed. Tissue removal takes place with a rongeur that is at the top a separation mechanism for separating and receiving bone tissue having.

State of the art

at the handling of such a rongeur causes the surgeon to tip This instrument with the integrated separation mechanism to the for tissue removal provided point and operated via a Actuator arranged at the proximal end of the rongeur, the separating mechanism. As a result, tissue is separated from the bone and into a cavity recorded at the top of the rongeur. In general, the rongeur has to removed each separation process from the surgical opening and the therein Managed separated tissues are cleared manually. Through the permanent removal However, the rongeur from the surgical field becomes the focus interrupted by the surgeon. Continue to extend this repeated process and the associated cleaning operations the duration of an operation.

To improve this situation is out of the US 6,142,997 a rongeur is known which has a larger receiving volume at the tip for severed tissue. This configuration allows the surgeon to perform multiple separation steps at the surgical site before removing the rongeur and removing the severed tissue. The document also discloses an embodiment of a rongeur in which the separated tissue is automatically removed by means of a connected vacuum pump via a hollow shaft of the rongeur during the operation. However, this embodiment is not practical for practical use, since it leads to a rapid obstruction of the hollow shaft due to the highly adhesive tissue.

The publication US 3,945,375 describes a device for tissue extraction according to the preamble of claim 1. The device described in this document, however, is not a Rongeur, but rather an endoskopartiges device with which by a minimally invasive intervention tissue components are removable from the body. The device has in its hollow shaft as a mechanical transport element on a rotationally driven screw conveyor, which also serves as a separation mechanism. The device described has advantages in the tissue removal of soft material, but can not readily be configured as a functional Rongeur, must be removed with the pieces of tissue from a bone.

outgoing from this prior art, the object of the present Invention to provide a device for tissue extraction, especially for an insert suitable as a rongeur facilitates and facilitates the work of the surgeon to a shorter one Operating time leads.

Presentation of the invention

The The object is achieved with the device according to claim 1. advantageous Embodiments of the device are the subject of the dependent claims.

The present device has a hollow shaft, which in a Front area with a separating mechanism for separating and inserting Fabric in the hollow shaft and in a rear area with one actuator for the operation of the Separating mechanism is equipped. On or in the hollow shaft is a Drivable by a drive mechanical Trans port element for transport of separated tissue within the hollow shaft from the front arranged in the rear area, as a sliding carriage is formed, which has at least one driver for the separated tissue.

This embodiment of the present device enables automated material transport within the hollow shaft from the surgical site to the proximal end of the device. The device need not be removed from the surgical field to remove the separated tissue. Especially at the beginning Spinal surgery mentioned is thus the operation time, in particular the decompression process, considerably shortened. The concentration of the surgeon is not interrupted by previously necessary cleaning operations. The means for automatic material transport in the form of the mechanical transport element, which can generate a very high force, ensure complete transport of material through the hollow shaft. The forces which can be generated by these means are readily sufficient to transport the still moist and therefore highly adhesive material from the front to the rear end of the hollow shaft.

The The present device is preferably in view of the separation mechanism and the actuator like a conventional one well-known rongeur. additionally is the shaft of this rongeur with a hollow channel, d. H. as a hollow shaft, formed, wherein on or in the hollow shaft, the device for automatic Material transport integrated with the mechanical transport element is.

The mechanical transport element is in the present device formed as slidable within the hollow shaft carriage, the at least one driver for having the separated tissue. The sled is going through a in the rear region of the hollow shaft, preferably at the rear, d. H. proximal end, arranged drive between the front and the back area is moved back and forth. Upon actuation of the separation mechanism by the operator, the carriage is at the front, d. H. distal end, leaving the severed tissue behind the carriage arranged driver pressed and after the closing movement the separating mechanism with the carriage to the rear end of the hollow shaft is transported. Subsequently the carriage moves again, driven by the drive in the front position.

Of course it is Also, an education of the separation mechanism in a known manner possible at the hollow shaft with two mutually displaceable components, For example, jaws are formed, which in a closing movement, in which both jaws meet, close an opening in the hollow shaft and of which at least one has a cutting edge for separating the fabric when performing the closing movement having. One of these jaws can by a through the hollow shaft self-formed counter surface are formed, against which the other cheeks along the hollow shaft is displaceable.

The In the rear area of the hollow shaft transported tissue can through an opening either manually removed or via a corresponding transport line a collection container or a device for further processing. The opening is preferably at the end of the hollow shaft, but can also be arranged laterally on the hollow shaft. In one embodiment of present device is in the rear of the hollow shaft a device for rinsing of the separated tissue from the back or in the back Area provided transport element. Such flushing automates the removal of the severed tissue, so too this process no longer needs to be done manually. In addition to one flushing is also a mechanical transport device for the removal of the Separated tissue from the present device possible, eg. by the separated tissue is transported in special sleeves to the rear end, the then over one for that intended pipeline to be transported.

In a further advantageous embodiment of the present device is in the front region of the hollow shaft a light source for illuminating the Integrated instrument tip. This light source is preferably formed by an optical fiber extending from the rear area of the hollow shaft extends into the front area and in the rear area is connected to a corresponding lighting device. This embodiment leads To better illuminate the surgical site, which usually Not easily accessible by a surgeon's headlamp is. This improves perception and makes the procedure more comfortable and made safer. On a headlamp can with the present Configuration of the device can be omitted.

In a further advantageous embodiment of the present device this is with a separator for separating inhomogeneous tissue, in particular for separating soft tissue and cartilage tissue from bone tissue, connected. This connection can, for example. Via a transport or flushing line be realized.

Such an embodiment of the device enables the provision of already separated bone tissue for further use during the operation, for example for pressing into a cage. The separator is composed of a container, a membrane inserted into the container, an actuator and means for mechanically separating at least a first of at least one second type of tissue of the inhomogeneous tissue. The membrane inserted into the container divides the inner volume of the container into two partial volumes. The actuator is connected to a corresponding drive, which moves this while maintaining a gap distance between the membrane and actuator on the membrane to be introduced into the container to spread inhomogeneous tissue over the membrane.

Of the Separator thus uses a means for mechanical separation of first of the second type of tissue, in particular of cartilage and / or soft tissue of bone tissue, in conjunction with a membrane for the first Permeable to tissue and for the second type of fabric impermeable is. At a feeder of inhomogeneous tissue in the actuator having the first partial volume of the container and operation of the actuator thus accumulates the first type of tissue in the other subvolume. The second type of fabric may be from the first Partial volume taken or over a corresponding opening of the container, which is connected to the first sub-volume, be dissipated.

When Means for mechanically separating the first from the second type of tissue Different mechanisms can be used, even in combination. Preferably, these agents are characterized by a roughened surface of the Membrane and / or the actuator formed, so that by brushing of inhomogeneous tissue the roughened surface the membrane is a mechanical separation of the first of the second Tissue, comparable to a peeling process is effected. Just that Separation of the soft tissue of bone tissue can be by using a membrane with a roughened surface very realize advantageous. A roughening of the actor is here not necessary in any case, so that too the problem of Liability of the tissue is avoided on the actuator.

Next a roughened surface the membrane can in the present separator also water jet nozzles or ultrasonic transmitter in or on the container and / or the actuator may be arranged to provide a mechanical separation to reach the first of the second tissue type. The water jet nozzles are dimensioned and aligned so that they are characterized by their mechanical Action to mechanically separate the first from the second tissue. In the event of the separation of cartilage and soft tissue from the bone tissue become the flow characteristics and the water pressure suitably chosen that the cartilage and soft tissue washed off the bone tissue and rubbed against the membrane without destroying the bone tissue. Of the Water pressure pushes while the detached cartilage and soft tissue through the membrane into the other sub-volume.

at Use of the ultrasonic separation technique becomes the ultrasound source adjusted to specific frequencies of the cartilage or soft tissue, For example, their resonance frequencies. Crush the ultrasound movements only these two types of tissue, which are then due to the movement of the actuator be discharged through the membrane in the other part volume. The actuator itself can hereby by suitable design serve as an ultrasound source.

Basically the gap distance between the actuator and the membrane chosen such that the Tissue by the relative movement between these two components not damaged becomes. When separating softer tissue pieces from a hard bone core the actuator is moved at the optimum speed, so that the abraded switch by this movement through the membrane in the other partial volumes are pressed.

to Compliance with a defined gap distance must be the shape of the actuator of course be adapted to the shape of the membrane - or vice versa. The membrane itself can form a flat surface, wherein the actuator in this case, for example, may be formed in the form of a slider.

In an advantageous embodiment, the membrane is approximately bowl or funnel-shaped and the actuator has the shape of a rotatable about a longitudinal axis rotating body on, in the annular space enclosed by the membrane part volume is driven in rotation.

Brief description of the drawings

The The present device will now be described with reference to exemplary embodiments without restriction of the general concept of the invention with reference to the drawings again briefly explained. in this connection demonstrate:

1 a first example of the embodiment of the present device;

2a An exemplary representation of the operation of the device according to 1 ;

3 accounts;

4 another example of an embodiment of the present device;

5 an exemplary embodiment of the separation mechanism of the present device;

6 an example of an embodiment of the device in connection with other components for further processing of the separated tissue;

7 an example of the design of a separator for separating inhomogeneous tissue;

8th an example of a cage press; and

9 an example of an embodiment of the present device with integrated lighting device.

Ways to carry out the invention

1 shows a first example of a possible embodiment of the present device for extracting tissue, in particular bone tissue from an operation site. The device has a hollow shaft 1 on, at the front end of a separation mechanism 2 for separating and introducing tissue into the hollow shaft 1 is trained. The separation mechanism is in this example by two mutually displaceable jaws 7 educated. One of these jaws is through the lower boundary of the hollow shaft 1 formed, the other by a along the hollow shaft movable counterpart. This counterpart is by a at the rear end of the hollow shaft 1 arranged actuator 3 moved by a certain way forward or backward, so that either an opening, the so-called cutting chamber 8th , to the hollow shaft 1 is released or closed. The sliding part has a cutting edge 9 on to a closing movement of the jaws 7 to be able to cut off corresponding tissue. The separated tissue is thereby in the hollow shaft 1 taken and one in this representation in the rear of the hollow shaft 1 shown carriage 4 transported to the rear. The sled 4 is by a corresponding engine 5 at the rear end of the hollow shaft 1 driven. The sled 4 has a driver 6 for the severed tissue.

When opening the jaws 7 is the sled 4 in the front area under the thus released opening 8th , When closing the jaws 7 the tissue is in the sled 4 introduced and by means of the engine 5 automatically in the rear area of the hollow shaft 1 transported. There, the tissue can then out of the sled 4 be removed. This may, for example, via a device for rinsing the carriage 4 carried out so that the tissue can thereby be rinsed automatically and removed via a corresponding line not shown in this figure.

The 2a -D show the different stages of operation of this device in more detail. 2a shows here the tip of the hollow shaft 1 with open cheeks 7 , In this open position, the device is placed on the tissue to be separated. The sled 4 is here in the opening. Then the cheeks 7 closed by pressing the actuator. By closing the tissue is separated and in the carriage 4 pressed. The sled 4 will after closing the jaws 7 by the drive over the hollow shaft 1 transported to the rear, as in 2 B indicated by the arrow. 2c shows this transport of the sled 4 again omitting the cover of the hollow shaft 1 , After transporting the fabric into the back area of the hollow shaft 1 this can be removed by rinsing ( 2d ).

4 shows an example of an embodiment of the present device, wherein in the rear region of the hollow shaft 1 a rinsing device 10 is provided for rinsing the separated tissue. Through this flushing device 10 For example, the severed tissue transported backward via the transport mechanism is automatically removed from the hollow shaft 1 or the means of transport flushed out and via a correspondingly connected supply and discharge line 13 removed. This supply and discharge line 13 For example, it can be connected to a collection container or a separator for separating the bone tissue of soft and cartilage tissue.

5 shows an exemplary embodiment of the separation mechanism 2 the present device, in which designed as a slide or slider mechanical transport element 4 a cutting edge 9 having. During a movement of the carriage or slide 4 in the direction of the arrow, the tissue is separated by interaction of the cutting edge 9 on the slide or slide 4 with the cutting edge 9 at the hollow shaft 1 ,

6 shows an embodiment of the present device, in which this with a separator fourteen connected to separate the tissue. The figure shows schematically the present device with the hollow shaft 1 and the separation mechanism provided in the front area 2 , By actuating the actuating device 3 becomes from a schematically illustrated tissue area 15 For example, during surgery on the spine, through the separation mechanism 2 a part separated and in the hollow shaft 1 via the transport mechanism 4 , which is shown schematically by the arrow, in the rear region of the hollow shaft 1 transported. In this illustration is additionally a light source 11 in the front area of the hollow shaft 1 arranged to illuminate the surgical site. The separated tissue transported to the rear is via a flushing line 13 a separator fourteen in which the mixed, inhomogeneous tissue consisting of bone material, soft tissue and cartilage tissue is separated. In particular, the bone tissue in the separator fourteen separated from the rest of the tissue and another transport line 16 a cage press 17 fed. In this press 17 into a cage 18 is inserted, the bone tissue in the cage 18 compacted. The cage filled with the bone tissue 18 is then used in the further course of surgery again at the split point of the spine.

By an embodiment of the present device in conjunction with a separator fourteen and possibly a cage press 17 numerous steps, in particular the removal of the separated tissue as well as the separation of the tissue are automated and thus relieve the surgeon.

7 shows an example of a separator fourteen how it can be used, for example, with the present device. The device consists of a container 19 with an internal volume into which a bowl-shaped membrane in the present case 20 is used. The membrane 20 divides the inner volume of the container 19 in two sub-volumes, in this case an upper and a lower sub-volume on. The container 19 has a bottom-side central outlet 21 , which has a connecting channel with a bottom opening 22 the membrane 20 connected is. The bottom-side central opening 22 is opposite the lower partial volume of the container 19 suitably sealed.

The membrane 20 which may also function as a sieve is designed to allow passage of soft tissue or cartilage tissue, but is impermeable to bone parts.

Within the upper part volume is an actuator 23 arranged around a longitudinal axis 24 can be driven in rotation. The corresponding drive can not be seen in this figure. The actor 23 is designed such that it has a defined gap distance 25 to the inner surface of the membrane 20 both at rest and during rotation. The container 19 is closed during operation, wherein inhomogeneous tissue, in the present example consisting of bone, cartilage and soft tissue, via correspondingly provided feeds 26 over the edge of the membrane 20 in the gap 25 between membrane 20 and actor 23 is supplied. The shape of the gap 25 is designed so that the inserted tissue during rotation of the actuator 23 in cooperation with gravity in the direction of the outlet opening 21 at the bottom of the container 19 is transported further. The membrane 20 is in this example at her the actor 23 roughened inner surface roughened such that by the transport of the tissue within the gap 25 the cartilage and soft tissue is peeled off the bone tissue. By this separation in the gap 25 During the flow, the peeled cartilaginous and soft tissue through the membrane 20 deposited in the lower part volume of the container, so that at the outlet opening 21 only the healthy bone tissue remains. This bone tissue can be flushed out, for example, with autologous blood for further processing or storage.

In support of the separation process can in the container 19 a liquid is filled in which the soft tissue or cartilage tissue is detached from the bone or dissolved altogether. Due to the simultaneous mechanical circulation in the gap 25 by rotation of the actuator 23 The detached tissue is deposited in the lower part volume.

For erosive separation through the roughened surface 27 the membrane 20 becomes the rotational speed of the actuator 23 adjusted so that the abraded materials through the membrane 20 be pressed into the lower part volume.

8th shows an example of a cage press 17 as related to the 6 can be used. Cage Press 17 consists of a holder 28 for a cage 18 , which may be formed in the form of a die. Above this bracket 28 is a pressing device with a stamp 29 arranged. The pressing device presses the punch 29 by a linear feed movement down into one in the holder 28 inserted cage 18 with filled bone material. The drive of the pressing device is preferably carried out with a motor 30 ,

When operating this Cagepresse becomes an empty Cage 18 in the holder 28 placed. Subsequently, the separated bone tissue in the cage 18 given. The amount may, for example, about weight measurement or a mark on the holder 28 to be controlled. Finally, the device is powered by the motor 30 pressed, leaving the stamp 29 the bone tissue with defined pressure in the cage 18 pressed. Then the filled cage 18 from the holder 28 removed and supplied for further use.

In a further development of this Cagepresse 17 is additionally a gas supply within the holder 28 or the stamp 29 provided in order to achieve a better cancellous structure of the solidified bone material in the cage. The gas is for this purpose under defined pressure during the pressing process in the cage 18 pressed.

9 Finally, FIG. 1 shows an embodiment of the present device in which a light source 11 in the front area of the hollow shaft 1 is arranged. In the present example, this light source 11 through an optical fiber 12 formed, extending from the rear of the hollow shaft 1 at the hollow shaft up to the front area he stretches to well illuminate the surgical site, ie the place where tissue is to be separated. The other end of the fiber optic cable 12 is connected to a corresponding illumination device through which the required light power in the optical waveguide 12 is coupled.

1

hollow shaft

2

separation mechanism

3

actuator

4

mechanical transport element

5

Drive / motor

6

takeaway

7

displaceable to bake

8th

Opening / cutting chamber

9

cutting edge

10

flushing

11

light source

12

optical fiber

13

To- or discharge line

14

separator

15

tissue area

16

transport line

17

Cage Press

18

Cage

19

container

20

membrane

21

outlet

22

bottom opening of the membrane

23

actuator

24

longitudinal axis of the actor

25

gap

26

additions

27

Surface of the membrane

28

bracket for cage

29

stamp

30

engine

Claims (19)

Device for tissue extraction, in particular Rongeur, with a hollow shaft ( 1 ), which in a front area a separation mechanism ( 2 ) for separating and introducing tissue into the hollow shaft ( 1 ) and in a rear area an actuator ( 3 ) for the operation of the separation mechanism ( 2 ), wherein on or in the hollow shaft ( 1 ) one of a drive ( 5 ) drivable mechanical transport element ( 4 ) for transporting separated tissue within the hollow shaft ( 1 ) is arranged from the front to the rear region, characterized in that the mechanical transport element ( 4 ) is designed as a sliding carriage, the at least one driver ( 6 ) for the severed tissue. Device according to claim 1, characterized in that the separating mechanism ( 2 ) by two mutually displaceable components ( 7 ) formed during a closing movement in which both components ( 7 ), an opening ( 8th ) in the hollow shaft ( 1 ) and at least one of which has a cut edge ( 9 ) for separating the fabric when performing the closing movement. Apparatus according to claim 1 or 2, characterized in that as drive ( 5 ) an electric drive at the rear end of the hollow shaft ( 1 ) is provided. Device according to one of claims 1 to 3, characterized in that in the rear region of the hollow shaft ( 1 ) An institution ( 10 ) for rinsing the separated tissue from the rear region of the hollow shaft ( 1 ) and / or the transport element ( 4 ) is arranged. Device according to one of claims 1 to 4, characterized in that in the front region of the hollow shaft ( 1 ) a light source ( 11 ) is integrated. Apparatus according to claim 5, characterized in that the light source ( 11 ) through an optical waveguide ( 12 ) formed on or in the hollow shaft ( 1 ) from the rear to the front. Device according to one of claims 1 to 6, which via a purge line ( 13 ) with a separator ( fourteen ) for separating inhomogeneous tissue into which the severed tissue is transported. Apparatus according to claim 7, characterized in that the separator ( fourteen ) from a container ( 19 ) with an internal volume passing through the container ( 19 ) used membrane ( 20 ), which is permeable to at least one first type of tissue, is divided into two sub-volumes, an actuator ( 23 ), which adheres to a gap distance ( 25 ) between the membrane ( 20 ) and the actuator ( 23 ) over the membrane ( 20 ) is moved to the container ( 19 ) introduced tissue across the membrane ( 20 ) and means for mechanically separating the first from at least one second type of fabric. Apparatus according to claim 8, characterized in that the means for mechanical separation by a roughened surface ( 27 ) of the membrane ( 20 ) and / or the actuator ( 23 ) are formed. Apparatus according to claim 8 or 9, characterized characterized in that the means for mechanical separation by in the container ( 19 ) and / or actuator ( 23 ) arranged water jet nozzles are formed. Apparatus according to claim 8 or 9, characterized in that the means for mechanical separation by on or in the container ( 19 ) and / or actuator ( 23 ) arranged ultrasonic transmitter are formed. Device according to one of claims 8 to 11, characterized in that the container ( 19 ) is formed closable. Device according to one of claims 8 to 12, characterized in that the actuator ( 23 ) is designed as a slide. Device according to one of claims 8 to 12, characterized in that the actuator ( 23 ) than about a longitudinal axis ( 24 ) rotatable rotational body is formed, the drive in one of the membrane ( 20 ) annularly enclosed partial volume rotates. Device according to one of claims 8 to 13, characterized in that the membrane ( 20 ) forms a flat surface. Device according to one of claims 8 to 14, characterized in that the membrane ( 20 ) is approximately bowl-shaped or funnel-shaped. Apparatus according to claim 16, characterized in that the container ( 19 ) a bottom-side outlet opening ( 21 ) into which the membrane ( 20 ) opens. Device according to one of claims 8 to 17, characterized in that a device ( 17 ) for pressing separated bone tissue into a cage ( 18 ), which is a holder ( 28 ) for inserting the cage ( 18 ) and one above the bracket ( 28 ) arranged pressing device with a stamp ( 29 ) having. Device according to claim 18, characterized in that the holder ( 28 ) and / or the stamp ( 29 ) are equipped with a gas supply, via which during the pressing process additionally a gas in the cage ( 18 ) can be pressed.