Retrieval bag instrument for retrieving resected tissue during endoscopic resection, retrieval bag, method for making a retrieval bag and method for making a retrieval bag instrument

Description

[0001] The present invention relates to a retrieval bag for retrieving resected tissue during an endoscopic resection, a retrieval bag instrument comprising the retrieval bag, a method for manufacturing a retrieval bag for the retrieval bag instrument, and a method for manufacturing the retrieval bag instrument.

[0002] In endoscopic surgery, particularly transurethral resection (through the urethra) of a bladder tumor using an endoscope or resectoscope, the challenge lies in removing the resected specimen from the body in one piece ("en bloc"). The resected specimen is usually a piece of non-muscle-invasive bladder cancer (NMIBC) that must be removed from the body after resection. Re-fragmentation of the resected tumor can lead to an increased risk of tumor reimplantation and cell seeding, meaning the spread of tumor cells. Currently, resected specimens with a diameter greater than 2 cm cannot be removed en bloc, i.e., in one piece.In the prior art, cutting devices are used in such a case that can cut the resected specimen into smaller pieces, but these are complex and carry the risk of cell seeding.

[0003] Medical instruments for retrieving body tissue to be removed during endoscopic operations, for example from a fluid-filled bladder or gallbladder, are known in various embodiments.

[0004] In a known embodiment, a pouch ("retrieval pouch") is held at the distal end of the shaft of the medical instrument by means of a clip made of a spring-elastic material. When the instrument is delivered, the pouch is, for example, rolled up and, with the clip compressed, is located within a sheath tube surrounding the shaft. In this state, the shaft is inserted through a trocar. If the sheath tube is pulled back along the shaft towards its proximal end, the clip and the pouch attached to it emerge from the distal end of the sheath tube, allowing the pouch to unroll and the clip to unfold, forming a filling opening in the pouch. After the material to be retrieved or the resected specimen has been placed in the pouch, it can be closed by pulling on the clip, which is gradually compressed again and drawn back into the sheath tube.Another possible way to close the pouch is with a so-called "tobacco pouch seam." This involves pulling a loop of thread through a channel in the pouch. The channel surrounds the pouch around its opening, tearing the pouch away from the springy clip and sealing the opening. However, if the pouch is pulled out, it can burst, being drawn into the casing tube and thus sealed. Any trapped fluid (gas and / or liquid) can then no longer escape, potentially causing the pouch to burst.

[0005] For example, German patent application DE 42 20 785 C2 discloses a laparoscopy bag made of a flexible material with drawstrings attached to the opening, particularly for use in a trocar, characterized in that the bag consists of a working part to which a tube section is attached, which is dimensioned so that it can be removed through the trocar when filled. Laparoscopy (keyhole surgery) is a minimally invasive surgical procedure in which small incisions (ports) are made in the abdominal wall through which thin instruments and a camera can be inserted.

[0006] Furthermore, for example, US Patent 5,785,677 A discloses a laparoscopy bag made of a flexible material, which is provided with drawstrings at its opening or mouth, particularly for use in a trocar, and wherein the bag consists of a working section to which a tubular part or tubular extension is attached or which is provided with a tubular extension.

[0007] Furthermore, the publication DE 20 2011 051 747 U1 discloses a medical instrument with a retrieval bag for retrieving material to be removed from a body to be operated on during an operation, in particular an endoscopic operation, which is held on a shaft by means of a bracket, wherein the cut shape of the retrieval bag is oriented in a distal direction, wherein the flat retrieval bag projects distally beyond the bracket with respect to the longitudinal axis of the shaft.

[0008] Furthermore, US Publication 5,352,184 A1 describes a container for receiving and removing body samples, US Publication 11,642,113 B2 describes an intervention device for sample collection, and US Publication 10,154,833 B2 describes a sample collection device with a bag stop.

[0009] However, a problem arises: during the closing process of the retrieval bag, bag material can be drawn into the tube, the bag depth can be reduced, and the resected specimen suspended in the fluid can be forced out of the retrieval bag (hereinafter referred to as the "trampoline effect"). Furthermore, there is room for improvement regarding the handling of the retrieval bag.

[0010] This leads to the task of providing an improved retrieval bag instrument that can be used in endoscopic resection of tissue and simplifies the capture of a resected specimen in liquid.

[0011] This problem is solved according to the invention by the subject matter of the independent claims. Advantageous embodiments of the invention are the subject matter of the dependent claims and the description.

[0012] One key idea of ​​the invention is, for example, that drainage holes are provided in the retrieval bag of the retrieval bag instrument, allowing fluid (gas and / or liquid) to escape from the retrieval bag when the bag is closed. Furthermore, another key idea of ​​the invention is to improve the closing mechanism by using a fixed overall length for the retrieval bag instrument and by modifying the accordion-like threading of the bag material onto the retaining rope.

[0013] According to one aspect of the disclosure, a retrieval bag is provided for retrieving resected tissue during an endoscopic resection, wherein the retrieval bag is bag-shaped with a bag base and a closable retrieval opening opposite the bag base, the retrieval bag has a plurality of drainage holes of a predetermined diameter suitable for allowing fluid to escape from the retrieval bag to the outside, the retrieval bag has a connecting tab at a proximal end of the retrieval bag which is configured to be attached to the sheath tube, the retrieval bag has passage openings arranged around the retrieval opening which are configured to allow a retaining rope to pass through by which the retrieval bag can be held in the region of the sling, and wherein the retrieval bag has a tubular tube section at a distal end opposite the proximal end.through which the retaining cable is guided in the circumferential direction of the trap opening.

[0014] In other words, a retrieval bag is provided for a retrieval bag instrument used to retrieve tissue that can be removed, for example, during an endoscopic, particularly transurethral, ​​resection. Transurethral resection is a urological surgical technique in which diseased tissue is removed from, for example, the bladder or prostate. The procedure can be performed endoscopically through the urethra without an external incision and can be carried out under general anesthesia or spinal anesthesia, including an obturator nerve block. The retrieval bag instrument can also be used in conjunction with a resectoscope, a trocar, an endoscope, a rectoscope, and / or a cytoscope.

[0015] A trocar is a medical instrument used to create a sharp or blunt access point to a body cavity (e.g., abdominal cavity, thoracic cavity) and to keep it open with a tube (endotracheal tube). Trocars can be used in minimally invasive surgery to create working and viewing channels.

[0016] An endoscope is a medical instrument used to examine the inside of hollow organs or body cavities. It typically consists of a thin, flexible tube with a light source and a camera at its distal end. Depending on their intended use, endoscopes come in various forms and may be called by different names, such as rectoscope, cytoscope, resectoscope, etc.

[0017] A rectoscope, for example, is a special endoscope used to examine the rectum. It can be approximately 10-20 centimeters long and have a diameter of about 1-2 centimeters. With a rectoscope, surgeons can detect and treat polyps, tumors, or other abnormalities in the rectum.

[0018] A cytoscope is another specialized endoscope that can be used to examine the bladder. It can be inserted into the bladder through the urethra and allows for viewing the bladder wall. Cytoscopes can be used to diagnose bladder cancer or other bladder diseases, for example.

[0019] A resectoscope is a specialized endoscope used to remove tissue growths in hollow organs such as the bladder, prostate, or uterus. It may consist of a thin, flexible tube with a light source, a camera, and an electrical loop at its distal end. Using a resectoscope, surgeons can grasp, cut, and / or remove tissue through the loop while monitoring the procedure visually through the optics. The removed tissue can be sent to a laboratory for examination, for example, to confirm that a tumor has been completely removed. Resectoscopes can be used to treat benign growths such as polyps or to remove precancerous lesions. They can also be used to treat bladder tumors, enlarged prostates, and other conditions.

[0020] A transurethral resection can be performed, for example, using a resectoscope. A resectoscope, such as a backflush resectoscope, can have an outer shaft that rests atraumatically (without injuring) in the urethra, with a channel for fluid intake and a channel for suction. The inner shaft of the backflush resectoscope can contain optics and a transport mechanism for longitudinal movement of a resection loop. A light source and a video camera for imaging can be connected to the optics.

[0021] For transurethral resection, a wire loop can be used, through which an electric current can be passed. This allows diseased tissue in the bladder or prostate to be removed layer by layer, which is usually then examined histologically. Any bleeding that occurs can be stopped electrically (cauterization). During the operation, an irrigation fluid can be introduced via the resectoscope and aspirated in a controlled manner, ensuring constant bladder filling and good visibility. At the end of the operation, the resected tissue is rinsed, and after sufficient hemostasis, an irrigation catheter is inserted.

[0022] The retrieval bag instrument comprises the pouch-shaped retrieval bag, which can be used for the removal of resected tissue. "Pocket-shaped" here means, for example, sack-like or approximately frustoconical, with the retrieval bag forming the lateral and top surfaces of a downwardly tapering truncated cone. The base of the truncated cone is formed by the retrieval opening. Of course, this is an idealization, as the retrieval bag may be made of a flexible plastic material in which the corners and edges may be rounded during the manufacturing process. Furthermore, the diameter along the height of the truncated cone may not only taper linearly but may also include cylindrical sections or sections with an increasing diameter.The retrieval bag is closed by the top surface of the truncated cone, and this top surface and the adjacent part of the lateral surface thus form a closed end of the bag or truncated cone shape. This closed end is also referred to as the bag base. In other words, the bag base encompasses the closed end of the bag or truncated cone shape and is therefore a closed section of the retrieval bag that has a maximum volume (i.e., an internal volume at the bag base when the retrieval bag is at its maximum size), into which the resected specimen can be placed. The bag base is also referred to as the lower end of the retrieval bag. Opposite the bag base is the collection opening, which can be opened and closed by means of a retaining cord. The collection opening thus forms the upper end of the retrieval bag.

[0023] In addition to the collection opening, the retrieval bag features numerous drainage holes of a predetermined diameter, designed to allow any fluid (gas and / or liquid) contained within the bag to escape. In other words, the drainage holes are sized to retain tissue fragments larger than the diameter, thus enabling the retention of even small resection specimens with an average diameter of, for example, 3 mm, 2 mm, or 1 mm, while still allowing fluid to drain from the bag. The retrieval bag is constructed of a liquid-impermeable and gas-tight material, ensuring that the fluid can only escape through the collection opening or the drainage holes.Because the fluid can drain out through the drainage holes, the tendency for ejection or the trampoline effect is significantly reduced when the retrieval bag is closed, and the resected specimen can be safely captured.

[0024] Preferably, the retrieval bag of the retrieval bag instrument is made of a stable plastic, and it is particularly preferred if the retrieval bag is made of a high-tensile-strength, liquid-tight, elastic and / or thermoplastic plastic. In particular, it is preferred that the retrieval bag of the retrieval bag instrument is made of polyurethane.

[0025] A general procedure for using the retrieval bag instrument is described below. After resection of, for example, tumor tissue during a transurethral resection procedure using an endoscope, the user of the retrieval bag instrument can insert it through a working channel of the endoscope or trocar. Once the distal end of the retrieval bag instrument appears in the camera image, the user can use this image to navigate the retrieval bag to the resected specimen.

[0026] If necessary, the user can use the capture port to grasp a portion of the resected specimen and position it favorably with respect to the camera image and the capture port, specifically by moving it across the capture port in the direction of gravity. In this position, reopening the capture port allows the resected specimen to fall into the retrieval bag. The user can then close the retrieval bag to enclose the resected specimen. Thus, the user can also utilize the retrieval bag instrument as a manipulator to grasp and manipulate tissue.

[0027] In current technology, retrieval bags are usually permanently attached to the setup sling, which is a disadvantage during the capture process. As a result, when the retrieval bag is closed, bag material is drawn into the tube, which in turn reduces the bag depth and forces the slightly suspended resected specimen out of the retrieval bag ("trampoline effect"). Therefore, current technology retrieval bags are unsuitable for grasping tissue.

[0028] However, the drainage holes of the recovery bag of the present disclosure allow the recovery bag to be closed with a significantly reduced tendency to eject fluid, since contained fluid can flow out through the drainage holes.

[0029] Furthermore, the fixed length of the retaining cord in relation to the handle section of the hand kinematics ensures that the retrieval bag does not disappear from the camera image when it is closed. In the prior art, a retrieval bag's closing mechanism is achieved by pulling back the retrieval bag loop. This moves the loop, along with the attached retrieval bag, proximally and into the tube. This increases the distance between the retrieval bag and the resected specimen and greatly complicates the capture process, especially in a fluid-filled environment.

[0030] The user can then withdraw the retrieval bag instrument through the trocar. The retrieval bag is compressed and must be pulled out against resistance. This further reduces the volume of the retrieval bag, and the drainage holes effectively prevent the bag from bursting, as any fluid inside can easily drain away. The absence of drainage holes at the bottom of the bag prevents cell seeding during withdrawal.

[0031] If the resected specimen is too large for the trocar, the trocar can be withdrawn along with the retrieval bag. Here, too, the drainage holes are particularly advantageous in preventing the retrieval bag from bursting, as any fluid inside can simply drain out. However, conventional retrieval bags are not suitable for retrieving a captured and enclosed resected specimen through the urethra if, due to its size, it does not fit through either the inner or outer sheath of the resectoscope or cystoscope.

[0032] After extraction, the retrieval opening can simply be opened, the resected specimen removed, and the retrieval bag instrument reused at least for the same patient in the same operation.

[0033] The invention thus offers the advantage of being designed and intended for use in environments filled with fluid, particularly liquid. If the retrieval bag is closed using the retrieval bag instrument, any liquid contained within can drain away particularly advantageously through the drainage holes. The invention is also advantageous in a gas-filled environment, as it prevents the retrieval bag from bursting, for example, when it is being withdrawn. Tissue can be securely contained within the retrieval bag, and no trampoline effect or bursting of the bag occurs when it is closed, since, as the volume of the retrieval bag decreases, the fluid escapes through the drainage holes rather than through the collection opening.This allows the user of the retrieval bag instrument to capture a resected specimen particularly safely and to pull it out of the patient's body (outwards) in the retrieval bag, thus preventing the retrieval bag from bursting.

[0034] The invention includes further embodiments that offer additional advantages.

[0035] According to an advantageous embodiment, the retrieval bag has a plurality of openings arranged around the capture opening through which the retaining rope is passed to hold the retrieval bag in the area of ​​the loop. In particular, the retrieval bag has a tubular section at its distal end through which the retaining rope is passed. In other words, the retaining rope is passed alternately from the inside out and from the outside in through the openings, thereby encircling the capture opening. The tubular section through which the retaining rope is passed is formed at the distal end of the retrieval bag, which is also the distal end of the retrieval bag instrument. In particular, the tubular section is formed in a tobacco pouch-like manner.In the area of ​​the openings, the retaining cord is not attached to the retrieval bag, allowing the bag material to slide along the cord. In the section of tubing that runs circumferentially around the retrieval opening at the distal end of the bag, the retaining cord is firmly attached to the bag, primarily by adhesive bonding, preventing it from sliding relative to the bag. This facilitates the fully opening of the retrieval opening when it is pushed open, as the tubing prevents the retaining cord from being forced through a gap between two openings without opening the bag.In other words, if there were no hose section, it could happen that a rescue bag, once closed, could no longer be opened, because when the casing tube is pulled back, the retaining rope could push through all the openings, and the accordion-like collapsed upper edge of the rescue bag could slide down the retaining rope as a whole without unfolding.

[0036] When the sheath tube is moved towards the tubing section, i.e., towards the distal end of the retrieval bag instrument, the retrieval bag's opening is pulled closed, or rather, compressed like an accordion. Similar to a leporello fold, this allows the bag material to be compressed particularly tightly, resulting in a very secure closure of the retrieval bag's opening.

[0037] The rescue bag can have reinforcement in the area of ​​the openings, so that the trap opening in this area, i.e., the upper edge of the rescue bag, is particularly tensile-resistant. This reinforcement can be achieved, for example, by doubling and gluing the bag material.

[0038] According to a further advantageous embodiment, the drainage holes are arranged in one, two, or more rows. Advantageously, each row contains between three and seven drainage holes, and in particular, five drainage holes. The drainage holes arranged in rows can be staggered from row to row to create a particularly tear-resistant retrieval bag structure. Specifically, no drainage hole is located at the bottom of the bag, and the drainage holes can be evenly distributed so that even if one or more of the drainage holes are obstructed or blocked, for example, by the resected specimen, optimal drainage is ensured when the retrieval bag is compressed. The drainage holes are advantageously located closer to the collection opening than to the bottom of the bag. This means that no drainage holes are present in the area of ​​the bag's bottom.This arrangement allows for excellent drainage of the enclosed fluid. Furthermore, it prevents the captured resected specimen from being expelled through the endoscope or via the trocar when the retrieval bag is withdrawn. Since the resected specimen remains undamaged, cell seeding is reliably avoided.

[0039] According to a further advantageous embodiment, the drainage holes have a predetermined diameter in the range of 0.1 mm to 3 mm, and in particular in the range of 0.5 mm to 1 mm, the collection opening in an open state has a diameter in the range of 10 mm to 70 mm, and in particular in the range of 40 mm to 60 mm, and / or the collection bag has a depth in the range of 30 mm to 100 mm, and in particular a depth in the range of 40 mm to 60 mm.

[0040] A drainage hole diameter in the range of 0.1 mm to 3 mm has proven advantageous, as smaller diameters increasingly impede fluid drainage, while larger diameters increase the risk of resected tissue passing through the holes. In particular, the drainage hole diameter can be in the range of 0.5 mm to 1 mm, which allows for a particularly tear-resistant structure of the retrieval bag.

[0041] For the retrieval opening, a range of 10 mm to 70 mm, and particularly 40 mm to 60 mm, has proven advantageous. A smaller opening is generally unsuitable for capturing a resected specimen. If the opening is too large, there is a risk that too much bag material will have to be moved through the trocar / endoscope, and the retrieval bag instrument will already have an excessively large diameter by the time it can be inserted into the patient's body, potentially complicating the endoscopic procedure. Therefore, an opening diameter of 40 mm to 60 mm has proven particularly suitable. This ensures that the retrieval bag has an appropriate depth and opening width to enclose large resected specimens (up to 5-6 cm in size).

[0042] A depth of 30 mm to 100 mm is advantageous for the retrieval bag, and a depth in the range of 40 mm to 60 mm is particularly advantageous. At a depth of less than 30 mm, the maximum volume of the retrieval bag may become too small, thus reducing its suitability as a retrieval tool, and at a depth greater than 100 mm, the amount of bag material may become excessive. However, depending on the intended use and / or location, the retrieval bag may also have a depth of 50 mm or more.

[0043] According to a further advantageous embodiment, the edge of the retrieval bag is color-coded in the area of ​​the capture opening. In particular, the edge of the retrieval bag in the area of ​​the capture opening can be color-coded. This facilitates easier navigation of the retrieval bag by the user, who has only limited visibility via the endoscope's camera, and it simplifies handling the retrieval bag instrument as a manipulator. Specifically, the capture opening of the retrieval bag instrument can be used as a gripper, with which the resected specimen can be partially grasped to bring it into a favorable position for complete capture. Color coding is particularly advantageous here, as it makes it easier to see in the camera image where the opening is located and how it is oriented.Furthermore, the color-coded capture opening makes it particularly easy to recognize opening and closing in the endoscopic image.

[0044] According to a further advantageous embodiment, the casing tube has a predetermined diameter, preventing the bag material from being drawn into the casing tube when the retrieval opening is closed. In other words, when the retrieval opening is closed, the casing tube pushes the bag material together on the retaining rope, and the casing tube has such a small diameter that the bag material cannot enter it (its free inner diameter is primarily occupied by the single or double retaining rope). Because the bag material is not drawn into the casing tube when the retrieval bag is closed, the depth of the retrieval bag hardly changes, and the retrieval bag volume is not significantly reduced by being drawn into the casing tube. This further reduces the tendency for resected material to be ejected or to experience a trampoline effect.

[0045] According to a further advantageous embodiment, the retaining cord is firmly attached to the handle section of the hand mechanism and, in particular, has a predetermined length. This allows the surgeon to use the retrieval bag instrument as a manipulator under observation, for example, by a camera mounted in the endoscope. For instance, it is possible to partially capture a resected specimen floating or located in the fluid with the retrieval bag, then, using the closed retrieval bag, position the specimen above the bag in the direction of gravity, and then open the bag again. The resected specimen can then fall into the retrieval bag under the influence of gravity, after which the bag can be closed and the specimen finally removed from the body cavity.Because the retaining rope has a predetermined fixed length and is firmly connected to the handle section of the hand kinematics, and because the sheath tube can be used as a movable closing component and moved along the retaining rope, the distal end of the retrieval bag and thus the distal end of the retrieval bag instrument can remain in the same location despite the closing process, and the probability of a resected specimen floating away or being blown away is significantly reduced.

[0046] According to a further advantageous embodiment, the sheath tube is guided through a sealing plug, which is movably arranged on the sheath tube along its direction of travel. This seal, when used with a trocar and / or endoscope, seals the working opening of the trocar's working channel into which the retrieval bag instrument can be inserted. In other words, the sheath tube penetrates a universally applicable push-on valve (the sealing plug), which ensures easy connection and leak-free operation with the endoscope. Retrieval bag instruments in the prior art cannot be connected to the working channel or "bridge" of the resectoscope or cytoscope without leakage.

[0047] According to a further aspect of the invention, a retrieval bag instrument for retrieving resected tissue during endoscopic resection comprises a bag-shaped retrieval bag with a bag base and a closable retrieval opening opposite the bag base, wherein the retrieval bag has a plurality of drainage holes with a predetermined diameter suitable for allowing a fluid contained in the retrieval bag to escape from the retrieval bag to the outside, a hand kinematics with a handle section and an actuating section, wherein the actuating section is movable from a starting position to an end position, and a sheath tube arranged between the retrieval bag and the hand kinematics, wherein a distal end of the sheath tube is attached to the retrieval bag and a proximal end of the sheath tube is attached to the actuating section, and a retaining rope attached to the handle section of the hand kinematics.is guided through the sheath tube and forms a loop surrounding the catch opening, wherein the rescue bag is movable at least section by section with respect to the retaining rope, wherein when the actuating section is moved from the starting position to the end position the sheath tube is moved towards the distal end in order to close the catch opening of the rescue bag.

[0048] Furthermore, the retrieval bag instrument features a hand mechanism with a handle section and an actuating section. The hand mechanism is a device that can be held by the user of the retrieval bag instrument, and by actuating the actuating section, the user can move the actuating section from a starting position to an end position and vice versa. Any intermediate position between the starting and end positions can also be selected by the user; that is, the user can set the actuating section to any position between the starting and end positions. The sheathing tube is attached to the actuating section.

[0049] The retrieval bag is attached to the distal end of the retrieval bag instrument, i.e., the end that can be inserted into the patient's body. The hand mechanism, on the other hand, is located at the proximal end, i.e., the end operated by the user (surgeon) of the retrieval bag instrument and which always remains outside the patient's body.

[0050] The retrieval bag instrument further comprises a sheath tube positioned between the retrieval bag and the hand mechanism. The sheath tube can have a length of, for example, 30 cm to 70 cm, and particularly 40 cm to 60 cm. A distal end of the sheath tube is attached to the retrieval bag, for example, by gluing or plastic welding via a flap, and a proximal end of the sheath tube is attached to the actuating section. When the actuating section of the hand mechanism is actuated by the user of the retrieval bag instrument, the sheath tube can be moved forward or backward, i.e., toward the distal end of the sheath tube (forward) or toward the proximal end of the sheath tube (backward), depending on the actuation. The sheath tube has a diameter that is as small as possible to be suitable for endoscopic surgical techniques.For example, the retrieval bag instrument is inserted into a body cavity or the bladder via a trocar. The distal end of the retrieval bag instrument can therefore be inserted through a trocar or through a working channel of the resectoscope and should thus have a small diameter.

[0051] The hand kinematics can be designed such that a closing movement of the hand (or finger(s)) operating the hand kinematics moves the sheath tube forward, or towards its distal end. Alternatively, the hand kinematics can be designed such that an opening movement of the hand (or finger(s)) moves the sheath tube towards its distal end. The hand kinematics can also include a position scale to inform the user. This scale ranges from a value representing the starting position of the hand kinematics to a value representing the end position, thus indicating to the user how open or closed the retrieval bag's opening is. The scale can, for example, be located on the handle section of the hand kinematics and can indicate a relative opening width of the retrieval opening.

[0052] The retrieval bag device also includes the retaining cord. The retaining cord is attached to the handle section of the hand mechanism, passes through the sheath tube, and forms a loop surrounding the capture opening. The retaining cord can be a single piece, specifically a stranded wire or a single-core rope, and can be made of a biocompatible material. It can also be resistant to stretching and can be made of nitinol or a similar material. Furthermore, the retaining cord can be coated, for example, to reduce friction within the sheath tube. The retaining cord can pass through the sheath tube twice (back and forth) to form the loop surrounding the capture opening, with both ends of the retaining cord attached to the handle section of the hand mechanism.Alternatively, the retaining rope can simply be guided through the casing tube in order to reduce the necessary minimum diameter of the casing tube, and can be connected to the loop surrounding the capture opening at a connection point in the area of ​​the distal end of the casing tube.

[0053] When the actuating section moves from its starting position to its end position, the sheath tube is moved forward relative to the retaining cord towards its distal end. Since the retaining cord is fixed to the handle section, it is thus drawn into the sheath tube (relative to the sheath tube). Because the retrieval bag is held slidably on the retaining cord in the area of ​​the catch opening, moving the actuating section from its starting position to its end position causes the retrieval bag to collapse like a curtain or accordion, thus closing the catch opening. It is important to speak of a closing rather than a pulling motion of the catch opening, as the position of the distal end of the retrieval bag instrument hardly changes in relation to hand kinematics.

[0054] The retaining rope is guided from the handle section through the outer tube to the retrieval bag, is routed around the catch opening to encircle it, and is guided back through the outer tube to the handle section. The outer tube is slidable along the retaining rope to allow the catch opening to be closed. The retaining rope can pass through a plurality of openings, preferably 10 or more, and even more preferably 20 or more. A large number of openings is advantageous to transmit a large tensile force to the bag without the risk of the openings tearing out. The retrieval bag can be symmetrical, particularly axially symmetrical, with respect to a diameter direction of the catch opening when viewed from above.The ability to slide the catch opening closed, and the arrangement of the retaining rope in relation to the casing tube and the catch opening of the recovery bag, is also referred to as the sliding mechanism.

[0055] According to a further aspect of the disclosure, a method for manufacturing a retrieval bag for a retrieval bag instrument according to the preceding description is provided, wherein the method comprises the following steps. First, the retrieval bag is thermoformed or deep-drawn from a polymer material and / or plastic. It is particularly preferred that the retrieval bag is made of a high-tensile-strength, liquid-tight, elastic and / or thermoplastic material. Preferably, the retrieval bag is made of polyurethane.

[0056] In the next step, drainage holes are created, for example by punching the drainage holes or cutting them out by laser cutting.

[0057] In the next step, the openings can be created. These openings can be created, as before, by punching or laser cutting, or by other methods known in the prior art.

[0058] As an optional step, a color marking can be applied to the upper edge of the recovery bag. For this purpose, a dark color can be applied to the upper edge of the recovery bag, providing a high light / dark contrast to the rest of the bag material. Preferably, a blue or black color can be applied. This step can also be carried out at any suitable point in the process described above, and can, for example, also be performed before thermoforming the recovery bag.

[0059] As an optional step, the material of the recovery bag can be reinforced in the area of ​​the openings and / or the drainage holes to make the bag more tear-resistant. This reinforcement can be achieved, for example, by gluing on an additional layer of the bag material. Advantageously, the reinforcement of the recovery bag material can be carried out before the respective holes are created.

[0060] According to a further aspect of the invention, a method for manufacturing a retrieval bag instrument for retrieving resected tissue during endoscopic resection is provided, the method comprising the following steps. First, a retrieval bag is manufactured according to the preceding description. Subsequently, the sheath tube is attached to the retrieval bag. This can be done, for example, by gluing or welding the flap of the retrieval bag to the sheath tube.The retaining rope is then threaded or guided through the casing tube, through the openings of the retrieval bag on one side of the capture opening, alternating between the outside and inside, like a curtain. It is then guided through the tubular section of the retrieval bag like a tobacco pouch, or lengthwise around the circumference of the capture opening. On the other side of the capture opening, it is guided through the openings of the retrieval bag again, alternating between the inside and outside, like a curtain, before finally being guided back through the casing tube. The retrieval bag is then attached to the retaining rope in the area of ​​the tubular section, for example, by gluing the retrieval bag to the retaining rope within that section.Finally, the retaining rope is attached to the handle section of the hand kinematics and the sheathing tube is attached to the actuating section of the hand kinematics.

[0061] Further features of the invention will become apparent from the claims, the figures, and the description of the figures. The features and combinations of features mentioned above in the description, as well as the features and combinations of features mentioned below in the description of the figures and / or shown in the figures alone, are not only usable in the combinations specified, but also in other combinations or on their own.

[0062] The invention will now be explained in more detail with reference to a preferred embodiment and the drawing. The drawing shows: Fig. 1a a schematic representation of a distal end of a retrieval bag instrument in a side view; Fig. 1b a schematic top view of the distal end of the retrieval bag instrument in an open state; Fig. 1c a schematic top view of the distal end of the retrieval bag instrument in a semi-closed state; Fig. 2a a schematic representation of a hand kinematics of the retrieval bag instrument in a side view; Fig. 2b a schematic representation of a hand kinematics according to a further embodiment in a top view; Fig. 3a a schematic representation of a sliding mechanism in a further embodiment in an open state; Fig. 3b a schematic representation of a sliding mechanism in the further embodiment in a closed state; Fig. 4a a schematic flowchart of a method for manufacturing a retrieval bag; and Fig.Four-legged schematic flowchart of a procedure for manufacturing the rescue bag instrument.

[0063] In the figures, identical or functionally equivalent elements are provided with the same reference symbols.

[0064] Fig. 1a Figure 1 shows a schematic side view of the distal end of a retrieval bag instrument for retrieving resected tissue during endoscopic resection. The retrieval bag instrument has a pouch-shaped retrieval bag 10, which is attached to a sheath tube 24 by means of a connecting tab 28. The retrieval bag 10 is pouch-shaped and has a bag base 18 and a closable retrieval opening 12 opposite the bag base. A retaining cord 16 is passed through the sheath tube and around the retrieval opening 12 through openings 22 and a tubular section 20 to encircle the retrieval opening 12. The retrieval bag 10 is located at the distal end of the retrieval bag instrument, and the tubular section 20, through which the retaining cord 16 passes and to which the retaining cord 16 is firmly connected, is located at the distal end of the retrieval bag 10.The retaining rope 16 can, for example, be made in one piece, have a stranded section, or be single-core. Furthermore, the retaining rope 16 can be made of a biocompatible material, be stretch-resistant, and, for example, be made of nitinol. The retrieval bag 10 has a plurality of drainage holes 14 with a predetermined diameter near the capture opening 12, which are suitable for allowing a fluid (gas and / or liquid) contained in the retrieval bag 10 to escape to the outside. The retrieval bag 10 is made of a liquid-impermeable or gas-impermeable material. The drainage holes 14 each have the same predetermined diameter, which can be, for example, in the range of 0.1 mm to 3 mm, and in particular in the range of 0.5 mm to 1 mm.

[0065] Fig. 1b shows a schematic top view of the distal end of the retrieval bag instrument in an open state and thus of the capture opening 12 of the retrieval bag instrument, wherein the capture opening 12 is located according to Fig. 1b in the open state. Only the retrieval bag 10 is shown in a sectional view. It can be seen that the retaining rope 16 is alternately guided from the inside out and from the outside in through the passage openings 22 and surrounds the catch opening 12. In the area of ​​the hose section 20, the retaining rope 16 is guided lengthwise or along the circumferential direction of the catch opening 12, or in a tobacco pouch-like manner, through the hose section 20. The hose section thus encloses the retaining rope 16 in a tubular or tube-like manner. The retaining rope 16 is firmly connected to the retrieval bag 10 in the hose section 20. The arrow 26 indicates a closing direction of the sheathing tube 24 when the actuating section 32 of the hand kinematics is moved from a starting position to an end position. The retrieval bag 10 is attached to the sheathing tube 24 by means of a connecting tab 28.

[0066] Fig. 1c shows a schematic top view of the distal end of the retrieval bag instrument in a semi-closed state and thus of the capture opening 12 of the retrieval bag instrument, wherein the capture opening 12 is located according to Fig. 1c is in a semi-closed state. It can be seen that the casing tube 24 has been advanced along the draw-in direction 26 towards the distal end or the hose section 20 of the retrieval bag 10, whereby the retaining cable 16 is drawn into the casing tube 24 with respect to the casing tube 24, or the casing tube is pushed over the retaining cable 16. The catch opening 12 is thereby closed, in contrast to the open state according to Fig. 1a (with respect to the diameter and / or opening area of ​​the collection opening 12) is reduced, and the collection bag 10 is compressed or pushed onto the retaining rope 16 in a curtain-like or accordion-like manner. By compressing the collection opening 12, the volume of the collection bag 10 is reduced slightly, but some of the contained liquid may be forced out. The drainage holes 14 ensure that only a small amount of the contained fluid is forced out through the collection opening 12 (trampoline effect).

[0067] Fig. 2a Figure 1 shows a schematic representation of the hand kinematics of the retrieval bag instrument in an exemplary embodiment in a side view, wherein the hand kinematics comprise a handle section 30 (handpiece) and an actuating section 32. In this exemplary embodiment, the actuating section 32 is connected to the handle section 30 via a pivot axis 34. The retaining cable 16, or rather the two ends of the retaining cable 16, are rigidly connected to the actuating section 32. The sheathing tube 24 is rigidly connected to the actuating section 32. When the actuating section 32 is actuated, the sheathing tube 24 is displaced in the direction of the closing direction 26 towards the distal end of the retrieval bag instrument. This allows the catch opening 12 to be closed.

[0068] Fig. 2b Figure 1 shows a schematic top view of a hand kinematic device according to a further embodiment. Here, a grip section 30 is designed, for example, for the user's thumb, so that the user can grasp the hand kinematic device by inserting their index and middle fingers through the actuating section 32 and their thumb through the grip section 30. By opening the hand, the actuating section 32 can then be moved in the direction of the closing direction 26 towards the distal end of the retrieval bag instrument. This moves the sheathing tube 24 towards the retrieval bag 10, and the capture opening 12 can thus be closed.

[0069] It should be noted that the hand kinematics according to Fig. 2a closes the rescue bag with a closing hand movement and the hand kinematics according to Fig. 2b The rescue bag 10 closes with an opening hand movement. This allows for better and more intuitive operation of the rescue bag instrument.

[0070] Fig. 3a shows a schematic representation of a sliding mechanism in a further embodiment in an open state and Fig. 3b Figure 1 shows a schematic representation of the closing mechanism according to the further embodiment in a closed state. In this embodiment, the retaining cable 16 is simply guided through the sheathing tube 24, with a connection point 40 connecting the retaining cable 16, which is guided through the sheathing tube 24, to the loop 42, which surrounds the catch opening 12 (as did the retaining cable 16 previously). If the sheathing tube 24 is moved in the direction of the closing direction 26 towards the distal end of the retrieval bag instrument, according to Figure 40, the mechanism is opened in the direction of the closing direction 26 towards the distal end of the retrieval bag instrument. Fig. 3b It is evident that the connection point 40 is pulled into the casing tube 24, which in turn reduces the loop of the retaining cable 16 around the catch opening 12. In the Fig. 3a und 3b The retrieval bag 10 and further details of the retrieval bag instrument are not shown. This embodiment has the advantage that the sheathing tube 24 can be made thinner over a large area, thus reducing the strain on the patient caused by the retrieval bag instrument.

[0071] Fig. 4a Figure 1 shows a schematic flowchart of a process for manufacturing a retrieval bag 10 for a retrieval bag instrument according to the preceding description. In step S1, a basic shape of the retrieval bag 10 is formed from a polymer material and / or stable plastic by thermoforming and / or deep drawing. It is particularly preferred that the bag material is made of a high-tensile-strength, liquid-tight, elastic, and / or thermoplastic material. Preferably, the retrieval bag 10 is made of polyurethane. In step S2, the drainage holes 14 are introduced or created in the thermoformed retrieval bag, for example, by laser cutting or punching. In step S3, the through-openings 22 are introduced or created in the thermoformed retrieval bag, for example, by laser cutting or punching.

[0072] In an optional step not shown here, the material of the recovery bag 10 can be reinforced in the area of ​​the through-openings 22. Reinforcing the material of the recovery bag 10 can be achieved, for example, by bonding the material to another layer of the same material. In In a further step not shown here, a color marking can optionally be applied to the upper edge of the recovery bag 10. These two optional steps can be carried out before or after any of the aforementioned other process steps.

[0073] In Fig. 4b A schematic flowchart of a process for manufacturing the retrieval bag instrument for retrieving resected tissue during endoscopic resection is shown. In step S4, a retrieval bag 10 is manufactured according to the preceding procedure. In step S5, the sheathing tube 24 is attached to the retrieval bag 10. For example, the connecting tab 28 is glued or welded (plastic welding) to the sheathing tube 24. In step S6, the retaining cable 16 is threaded through the sheathing tube 24 and the retrieval bag 10. The retaining cable 16 is guided through the openings 22 in a curtain-like fashion (alternating from the inside out and from the outside in), is guided along the circumferential direction of the retrieval opening 12 through the tube section 20 of the retrieval bag 10, and is subsequently threaded through the remaining openings 22 in a curtain-like fashion.The retaining cable 16 is then guided back through the sheathing tube 24. In step S7, the retaining cable 16 is attached to the handle section 30 of the hand kinematics. Furthermore, in this step, the retaining cable 16 is attached to the retrieval bag 10 in the area of ​​the hose section 20, and the sheathing tube 24 is attached to the actuating section 32 of the hand kinematics.

[0074] It is a retrieval bag instrument for retrieving tissue during endoscopic resection, comprising a pouch-shaped retrieval bag 10 with a closable retrieval opening 12, wherein the retrieval bag has a plurality of drainage holes 14 with a predetermined diameter through which a fluid contained in the retrieval bag 10 can escape from the retrieval bag to the outside, a hand kinematics with a handle section 30 and an actuating section 32 and a sheathing tube 24 arranged between the retrieval bag and the hand kinematics, wherein the sheathing tube is attached to the retrieval bag and to the actuating section, a retaining rope 16 which is guided from the handle section through the sheathing tube and forms a loop 42 surrounding the retrieval opening, wherein the retrieval bag is movable at least partially with respect to the retaining rope,wherein, when the actuating section moves from the starting position to the end position, the sheathing tube is moved towards the distal end in order to close the catch opening of the recovery bag.

[0075] A particularly preferred embodiment is described below.

[0076] The retrieval bag of the retrieval instrument features drainage holes on two levels, with five drainage holes (perforations) per level. There is no drainage hole at the bottom of the bag to prevent tearing. The drainage holes are evenly distributed to ensure optimal drainage during compression and retrieval, even if the resected specimen obstructs the drainage openings. A round opening (approximately 5 cm in diameter) and sufficient depth allow for the collection and enclosure of the resected specimen.

[0077] Unlike conventional bags, the retrieval bag is not glued to the sling or retaining rope. Instead, the retrieval bag of the retrieval instrument is equipped with reinforced openings around the retrieval opening, through which the retaining rope is sewn like a curtain. A large number of openings (eyelets) allows it to withstand high tensile forces during retrieval of the resected specimen.

[0078] The retrieval bag of the retrieval bag instrument is threaded onto the tube. When closing the bag, the material is not drawn into the tube or the sheath. Therefore, the depth of the bag does not change. The bag volume is thus only slightly reduced in the area of ​​the retrieval opening, resulting in significantly less ejection of the resected specimen.

[0079] The bag loop or retaining cord is firmly attached to the instrument's handle on the retrieval bag instrument. The sheath tube (tube) serves as a movable closing component and can be repositioned or moved. This ensures that the opening of the retrieval bag remains stably positioned despite the closing process, significantly reducing the likelihood of the resected specimen floating away.

[0080] The retrieval bag's opening (loop) is ideal for grasping and holding a partially suspended resected specimen, as the instrument features this integrated opening. The retrieval bag is color-coded around the opening, clearly indicating when it is opened and closed in the endoscope's camera view. When the bag is (almost) closed (grasped), the specimen can be lifted and held. Rotating the handle of the hand mechanism directs the retrieval bag downwards (the opening facing upwards against gravity). Opening the bag then allows the specimen to fall inside. The instrument can then be brought close to the endoscope's camera lens to view the contents of the bag. This allows the user to easily verify that the specimen is properly packaged.

[0081] The instrument's tube features an integrated and universally applicable plug-in valve, which ensures uncomplicated connection and leakage-minimized operation. BEZUGSZEICHENLISTE:

[0082] 10 Retrieval bag 12 Catching opening 14 Drainage hole 16 Retaining rope 18 Bag base 20 Hose section 22 Passage opening 24 Sheath tube 26 Pulling direction 28 Connecting tab 30 Handle section 32 Actuating section 34 Pivot axis 40 Connection point 42 Loop

Claims

1. A retrieval bag (10) for retrieving resected tissue during an endoscopic resection for a retrieval bag instrument, wherein - the retrieval bag instrument comprises a sheath tube (24), a retaining string (16) and a sling (42), - the retrieval bag (10) is bag-shaped with a bag base (18) and a closable capture opening (12) opposite the bag base (18), - the retrieval bag (10) comprises a plurality of drain holes (14) with a predetermined diameter, which are suitable for allowing a fluid located in the retrieval bag (10) to leak out from the retrieval bag (10) to an outside, and - the retrieval bag (10) comprises a connecting tongue (28) at a proximal end of the retrieval bag (10), which is adapted to be attached to the sheath tube (24), characterized in that - the retrieval bag (10) comprises a plurality of passage openings (22), which are arranged around the capture opening (12) and which are adapted to guide through the retaining string (16), at which the retrieval bag (10) can be held in the region of the sling (42), and - the retrieval bag (10) comprises a tubular tube section (20) at a distal end opposite the proximal end, through which the retaining string (16) can be guided in the circumferential direction of the capture opening (12).

2. The retrieval bag according to claim 1, wherein the drain holes (14) are arranged in one or two rows, and wherein advantageously between three and seven drain holes (14), in particular five drain holes (14), are arranged in each row.

3. The retrieval bag according to any one of the preceding claims, wherein the drain holes (14) comprise a predetermined diameter in the range of 0.1 mm to 3 mm, in particular in the range of 0.5 mm to 1 mm, - the capture opening (12) in an opened state comprises a diameter in the range of 10 mm to 70 mm, in particular in the range of 40 mm to 60 mm, and / or - the retrieval bag (10) comprises a depth in the range of 30 mm to 100 mm, and in particular comprises a depth in the range of 40 mm to 60 mm.

4. The retrieval bag according to any one of the preceding claims, wherein the edge of the retrieval bag (10) is color-marked in the region of the capture opening (12).

5. A retrieval bag instrument with the retrieval bag (10) according to any one of the preceding claims for retrieving resected tissue during an endoscopic resection, comprising - the retrieval bag (10), - a hand kinematics with a grip section (30) and an actuation section (32), wherein the actuation section (32) is movable from an initial position into an end position, and - the sheath tube (24), which is arranged between the retrieval bag (10) and the hand kinematics, wherein a distal end of the sheath tube (24) is attached to the retrieval bag (10) and a proximal end of the sheath tube (24) is attached to the actuation section (32), - the retaining string (16), which is attached to the grip section (30) of the hand kinematics, is guided through the sheath tube (24) and forms the sling (42) surrounding the capture opening (12), wherein the retrieval bag (10) is movable at least in sections with respect to the retaining string (16), - wherein during a movement of the actuation section (32) from the initial position into the end position the sheath tube (24) is moved in the direction of the distal end in order to push close the capture opening (12) of the retrieval bag (10).

6. The retrieval bag instrument according to any one of the preceding claims, wherein the sheath tube (24) comprises a predetermined diameter, so that during a push closing of the capture opening (12) the retrieval bag (10) is not pulled into the sheath tube (24).

7. The retrieval bag instrument according to any one of the preceding claims, wherein the retaining string (16) is fixedly connected to the grip section (30) of the hand kinematics and in particular the retaining string (16) comprises a predetermined length.

8. The retrieval bag instrument according to any one of the preceding claims, wherein the sheath tube (24) is guided through a sealing plug, which is movably arranged on the sheath tube (24) in the direction of the sheath tube (24) in order to achieve a sealing of the opening into which the retrieval bag instrument is insertable during a use with a trocar and / or an endoscope.

9. A method for manufacturing a retrieval bag (10) according to any one of claims 1 to 7 comprising the steps: - forming a basic shape of the retrieval bag (10) from a polymer material and / or plastic by thermoforming and / or deep-drawing, wherein the retrieval bag comprises a connecting tongue (28) and a tube section (20), which is opposite the connecting tongue (28), - creating the drain holes (14) in the bag material, - creating the passage openings (22) in the bag material and - forming the tubular tube section (20), through which a retaining string (16) can be guided.

10. A method for manufacturing a retrieval bag instrument for retrieving resected tissue during an endoscopic resection, comprising the steps of: - manufacturing a retrieval bag (10) according to the method according to the preceding claim, - attaching the sheath tube (24) to the retrieval bag (10), - guiding the retaining string (16) through the sheath tube (24), guiding the retaining string (16) through the passage openings (22) and guiding the retaining string (16) through the tube section (20) of the retrieval bag (10), - attaching the retrieval bag (10) to the retaining string (16) in the region of the tube section (20), - attaching the retaining string (16) to the grip section (30) of the hand kinematics, and - attaching the sheath tube (24) to the actuation section (32) of the hand kinematics.