Auxiliary endoscope sheath for en bloc resection of bladder tumor

Abstract

The present invention relates to an auxiliary scope sheath for en bloc resection of bladder tumors, comprising a scope sheath, an auxiliary tool and a driving assembly. The auxiliary tool is used to expose the tumor base and can be movably mounted on the scope sheath; the driving assembly is used to drive the extension and retraction of the auxiliary tool relative to the scope sheath and / or drive the angle of the auxiliary tool relative to the scope sheath. The surgeon brings the auxiliary scope sheath close to the bladder tumor or against the bladder tumor, drives and adjusts the extension and retraction of the auxiliary tool relative to the scope sheath through the driving assembly, and / or tilts the auxiliary tool relative to the scope sheath at a certain angle through the driving assembly, so that the part of the tumor in contact with the auxiliary tool can move to a different position, so that the tissue is separated and the tumor base is exposed, thereby preventing the surgical field from being blocked, facilitating identification of tissue layers, and mastering the depth of tumor resection.

Description

Technical Field

[0001] The invention belongs to the technical field of tumor resection, and in particular relates to an auxiliary scope sheath used for en bloc resection of bladder tumors. Background Art

[0002] Bladder tumor is one of the most common malignant tumors of the urinary system. According to whether bladder cancer invades the muscle layer, it can be divided into non-muscle invasive bladder cancer (NMIBC) and muscle invasive bladder cancer (MIBC). The treatment principles of the two are completely different, of which non-muscle invasive bladder cancer accounts for more than 70%. Transurethral resection of bladder tumor (TURBT) is widely used in the diagnosis and treatment of non-muscle invasive bladder cancer. TURBT is also an important diagnostic method for bladder tumors. In addition to removing all visible tumors, the removed tumor tissue and its base and bladder muscle layer are pathologically examined to correctly grade and stage the bladder tumor and guide further treatment.

[0003] Traditional TURBT has the advantages of simple operation and short operation time, but the traditional TURBT surgical steps are: 1. Resection of the protruding bladder part of the tumor in pieces; 2. Resection of the base part of the tumor (including the muscular layer) in pieces; 3. Resection or electrocauterization of the surrounding mucosa of the tumor; 4. Cold biopsy of the tumor base. This procedure has certain limitations. Since it adopts piecemeal resection, it has the following disadvantages: 1. Cutting the tumor into pieces can easily cause bladder tumor dissemination and implantation; 2. Block resection of the tumor base cannot accurately determine the invasion of the tumor into the muscular layer, which is not conducive to tumor staging; 3. Repeated cutting of tumor blood vessels causes more bleeding and unclear vision; 4. Each piece of tissue has electric burns, which affects the pathological diagnosis. For this reason, in recent years, as urologists have a deeper understanding of bladder tumors, the concept of en bloc resection has gradually been recognized and accepted by everyone. En bloc resection refers to En bloc transurethral resection of bladder tumor, referred to as ETURBT, which is to remove the bladder tumor together with the bladder muscular layer tissue at the tumor base in one piece. It has the following advantages: 1. Accurate removal of the tumor and the base, with a relatively accurate removal depth; 2. Accurate pathological staging of the completely removed tumor and the base specimen containing the muscle layer, improving the accuracy of postoperative diagnosis and being more conducive to precise treatment; 3. Less bleeding and a clear surgical field of view; 4. It can effectively reduce intraoperative complications such as obturator nerve reflex and bladder perforation, shortening the hospital stay and the time of postoperative catheterization. For example, a Chinese utility model patent "Transurethral Bladder Tumor Snare Resection Device" with patent number ZL201821705206.4 (authorization announcement number CN209377734U) discloses a transurethral bladder tumor snare resection device, including an outer sleeve and an adjustment cap installed at one end of the outer sleeve, and the other end of the bearing ring is respectively installed with a first inner core and a second inner core, an electric cutting ring is arranged between the first inner core and the second inner core, and a winding shaft is arranged at the bottom of the rotating plate. The transurethral bladder tumor snare resection device can push the electric cutting ring out of the built-in tube horizontally through the rotation of the plug, and the electric cutting ring naturally opens to form a ring shape, which is convenient for inserting the electric cutting ring from the top of the tumor into the tumor until the electric cutting ring is located at the base of the tumor, which is convenient for determining the specimen at the base of the bladder tumor and making a pathological judgment on whether the base of the bladder tumor invades the muscle layer after surgery. By shrinking the second inner core and winding it back on the winding shaft, the electric cutting ring can be tightened, which is convenient for electric cutting of the bladder tumor under direct vision, thereby improving the integrity of the tumor and reducing the potential risk of implantation recurrence. However, when using the snare resectoscope method, especially when the tumor is large, the base is covered by the tumor, the surgical field is blocked, and the tissue layers are difficult to identify, making it difficult to grasp the depth of tumor resection. This limits the application and promotion of ETURBT such as the snare resectoscope. Summary of the invention

[0004] The first technical problem to be solved by the present invention is to provide an auxiliary scope sheath for en bloc resection of bladder tumors, which can prevent the surgical field from being blocked, in view of the above-mentioned existing technical status.

[0005] The second technical problem to be solved by the present invention is to provide an auxiliary scope sheath for en bloc resection of bladder tumors suitable for surgeons to operate and effectively expose the base of bladder tumors in view of the above-mentioned existing technical status.

[0006] The third technical problem to be solved by the present invention is to provide an auxiliary endoscope sheath for en bloc resection of bladder tumors, which can effectively expose the base of bladder tumors in view of the above-mentioned existing technical status.

[0007] The technical solution adopted by the present invention to solve the above-mentioned first technical problem is: the auxiliary mirror sheath for en bloc resection of bladder tumors comprises a mirror sheath, which is characterized in that: it also comprises

[0008] An auxiliary tool, used for exposing the tumor base, which can be movably mounted on the endoscope sheath; and

[0009] A driving assembly is used to drive the extension and retraction of the auxiliary tool relative to the mirror sheath and / or drive the angle of the auxiliary tool relative to the mirror sheath.

[0010] The auxiliary tool can be extended and retracted relative to the scope sheath and / or the angle of the auxiliary tool relative to the scope sheath can be driven. In order to make it more suitable for the surgeon to operate and effectively expose the base of the bladder tumor, a more preferred solution is to integrate the adjustment of the extension and retraction of the auxiliary tool relative to the scope sheath and the driving angle of the auxiliary tool relative to the scope sheath in a driving component, and the driving component includes a limiting member, which can prevent the adjustment of the angle of the auxiliary tool relative to the scope sheath when the auxiliary tool is extended and retracted relative to the scope sheath. Because the surgeon puts the auxiliary tool into the bladder, it must first extend to the position of the bladder tumor and then use the auxiliary tool to expose the base of the tumor. In this process, it is necessary to first control the extension depth of the auxiliary tool relative to the bladder tumor and then control the angle of the auxiliary tool relative to the bladder tumor. However, this solution combines the two into one, that is, it can first adjust the extension depth of the auxiliary tool relative to the bladder tumor without adjusting the angle of the auxiliary tool relative to the bladder tumor, and then adjust the angle of the auxiliary tool relative to the bladder tumor after adjusting the extension depth of the auxiliary tool relative to the bladder tumor.

[0011] In order to adjust the extension depth of the auxiliary tool relative to the bladder tumor first without adjusting the angle of the auxiliary tool relative to the bladder tumor, and then adjust the angle of the auxiliary tool relative to the bladder tumor after adjusting the extension depth of the auxiliary tool relative to the bladder tumor, preferably, the driving component is arranged on the mirror sheath and away from the end of the auxiliary tool, and the driving component includes:

[0012] The mounting seat is a tubular structure that can be sleeved on the mirror sheath and has an enlarged accommodating groove at least in the central part, and one of the groove walls of the accommodating groove has a limiting hole along the direction of extension and retraction of the auxiliary tool relative to the mirror sheath;

[0013] A first follower, arranged in the receiving groove and connected to the auxiliary tool, and having a first tube body that can be sleeved on the mirror sheath, the end of the first tube body having a first rack portion, and the end of the first tube body having a first connecting wall and a second connecting wall that are higher than the first rack portion and are oppositely arranged, the first connecting wall having a first connecting hole that penetrates the limiting hole, and the second connecting wall having a second connecting hole corresponding to the first connecting hole;

[0014] A first handle is arranged in a direction perpendicular to the extension and retraction of the auxiliary tool relative to the mirror sheath, and the end of the first handle has a first driving gear meshing with the first rack portion, the first driving gear passes through the accommodating groove and can drive the first driven portion to slide relative to the mirror sheath when the first handle is rotated;

[0015] A second driven part, comprising a second tube body sleeved on the end of the first driven part, the outer surface of the second tube body comprising a second rack part, and the second driven part is linked with the auxiliary tool;

[0016] a transmission member, located between the second driven part and the auxiliary tool, and capable of converting the sliding force of the second driven part into an angle adjustment of the auxiliary tool relative to the mirror sheath; and

[0017] The second handle is arranged facing the first handle, and the end of the second handle has a second driving gear meshing with the second rack part, and the end of the second handle passes through the limiting hole of the accommodating groove of the mounting seat and the first connecting hole of the first driven part in sequence, so that the second driving gear is limited between the second connecting holes of the first connecting wall and the second connecting wall, wherein the limiting hole of the accommodating groove of the mounting seat and the first connecting hole of the first driven part together constitute a limiting member of the second handle, when the first handle drives the first driven part to slide relative to the mirror sheath, the second driven part and the second handle can only follow the first driven part to slide relative to the mirror sheath due to the limiting effect of the limiting hole of the accommodating groove and the first connecting hole of the first driven part, and when the first handle stops driving the first driven part to slide relative to the mirror sheath, the second handle can drive the second driven part to slide, thereby adjusting the angle of the auxiliary tool relative to the mirror sheath.

[0018] The auxiliary tool can have various structures. Preferably, from the perspective of easy manufacturing, the auxiliary tool includes a sleeve movably mounted on the sheath and a plate movably connected to the sleeve and used to expose the base of the tumor. The end of the sleeve is connected to the first driven part. The end of the sleeve is provided with a hinge seat for the plate to be hinged, and the sleeve has at least a guide tube arranged along the extension and retraction direction of the sheath. The transmission member includes a transmission rod, the first end of which is connected to the second driven part, and the second end of the transmission rod penetrates from one end of the guide tube, passes through the hollow part of the guide tube, and then passes out through the other end of the guide tube and is connected to the plate through the hinge seat. In this way, the sleeve moves with the movement of the first driven part, thereby realizing the extension and retraction of the plate relative to the sheath; when the second handle is turned, the second driving gear drives the second driven part, and the second driven part drives the plate to rotate relative to the sleeve through the transmission rod, thereby adjusting the angle of the plate relative to the sheath.

[0019] In order to make it easier to expose the tumor base, preferably, the bottom center of the plate body has an arc-shaped notch that is concave upward from bottom to top, and the edge of the plate body and the mouth wall of the arc-shaped notch form a blunt part for contacting the tumor. Compared with the sharp structure, the blunt part has a larger contact area with the tumor, so when the plate body acts on the tumor, it is easier to expose the tumor base.

[0020] To solve the third technical problem, preferably, the scope sheath includes an endoscope tube body, and the endoscope used to observe bladder tumors can extend and retract relative to the endoscope tube body, wherein the sleeve includes a sleeve portion, the sleeve portion partially has an open portion so that the sleeve can be directly sleeved on the endoscope tube body, and a first connecting portion connected to the first follower portion and a second connecting portion connected to the plate body, the second connecting portion has a second notch portion that can fully expose the end of the endoscope tube body.

[0021] When the endoscope is extended relative to the endoscope tube body, the end of the endoscope can be completely exposed in the second notch portion without being covered by the sleeve portion, so that the endoscope can fully observe the position of the bladder tumor in the bladder. With the help of the observation of the endoscope, auxiliary tools can act on the appropriate position of the bladder tumor, thereby effectively exposing the base of the bladder tumor.

[0022] Surgeons need to use cutting tools when performing en bloc resection of bladder tumors. To facilitate cutting of bladder tumors, preferably, the scope sheath also includes a cutting tube body located below the endoscope tube body, and the cutting tool used to cut bladder tumors can be extended and retracted relative to the cutting tube body. Correspondingly, the sleeve and the guide tube are sequentially located above the endoscope tube body. The sleeve and the guide tube are arranged above the endoscope tube body, and the cutting tool is arranged below the endoscope tube body, so that the cutting tool will not be hindered by the sleeve and the guide tube when it needs to cut the bladder tumor, thereby facilitating cutting of the bladder tumor.

[0023] When performing a bladder tumor en bloc resection operation, the surgeon needs to first insert the outer sheath into the patient's bladder. In order to connect the auxiliary sheath to the outer sheath, preferably, the sheath also includes a connector that is sleeved on the endoscope tube body and connected to the mounting seat, and the connector is arranged closer to the plate body of the auxiliary tool than the mounting seat, wherein the connector includes a body, which has a first working channel for the endoscope tube body together with the sleeve and the threading tube to pass through, and a second working channel for controlling the cutting tool through which a control part at least partially passes and is connected to the cutting tube body. The auxiliary sheath is connected to the outer sheath by the connector, and the auxiliary sheath is not easy to move, so that the endoscope can be used to observe the location of the bladder tumor first, and the auxiliary tool can be extended and retracted relative to the sheath and / or the angle of the auxiliary tool relative to the sheath can be controlled by the driving component of the auxiliary sheath to expose the tumor base, and then the tumor can be removed by the cutting tool.

[0024] The connector can have a variety of structures. Preferably, in order to facilitate the disassembly and assembly between the connector and the outer sheath, the outer peripheral wall of the body of the connector has a convex ring, and the end face of the convex ring extends toward the plate body of the auxiliary tool with at least one clamping portion, and the clamping portion is connected to the outer sheath used to establish a working channel after entering the urethra. The setting of the convex ring allows a gap to be formed between the clamping portion and the outer peripheral wall of the part of the body opposite to the clamping portion, and the outer sheath is sleeved outside the body and located in the gap, so that the outer sheath is plugged into the connector, which has the advantage of convenient disassembly and assembly.

[0025] The clamping part can have a variety of shapes. Preferably, the clamping part is L-shaped, including a first clamping pin extending along the extension and contraction direction of the auxiliary tool plate and a second clamping pin perpendicular to the extension and contraction direction of the auxiliary tool plate. The second clamping pin acts on the outer sheath, the contact area is larger, the connection between the clamping part and the outer sheath is more stable, and the direction of the second clamping pin acting on the outer sheath is perpendicular to the extension and contraction direction of the outer sheath, so that the friction between the second clamping pin and the outer sheath is larger, thereby preventing the auxiliary mirror sheath from shaking during tumor resection surgery.

[0026] Compared with the prior art, the advantages of the present invention are: providing an auxiliary sheath for en bloc resection of bladder tumors, the auxiliary sheath having an auxiliary tool that can be movably mounted on the sheath for exposing the tumor base, and a driving component for driving the extension and retraction of the auxiliary tool relative to the sheath and / or adjusting the angle of the auxiliary tool relative to the sheath. The surgeon brings the auxiliary sheath close to the bladder tumor or against the bladder tumor, drives and adjusts the extension and retraction of the auxiliary tool relative to the sheath through the driving component, and / or tilts the auxiliary tool relative to the sheath at a certain angle through the driving component, so that the part of the tumor in contact with the auxiliary tool can be moved, so that tissues are separated and the tumor base is exposed, thereby preventing the surgical field from being blocked, facilitating the identification of tissue layers, and mastering the depth of tumor resection. BRIEF DESCRIPTION OF THE DRAWINGS

[0027] Figure 1 It is a schematic diagram of the three-dimensional structure of an embodiment of the present invention;

[0028] Figure 2 for Figure 1 Schematic diagram from another angle;

[0029] Figure 3 for Figure 1 Exploded diagram of

[0030] Figure 4 It is a schematic diagram of the three-dimensional structure of the mounting base in an embodiment of the present invention;

[0031] Figure 5 Schematic diagram of the three-dimensional structure of the sleeve (after removing the hinge seat and the guide tube) in the embodiment of the present invention;

[0032] Figure 6 for Figure 1 A schematic diagram of the three-dimensional structure after removing one side wall of the mounting base;

[0033] Figure 7 for Figure 1 A three-dimensional diagram after removing the mounting base;

[0034] Figure 8 is a cross-sectional view of an embodiment of the present invention;

[0035] Fig. 9 for Figure 8 Schematic diagram of another state;

[0036] Fig.10 for Figure 8 Schematic diagram of another state. DETAILED DESCRIPTION

[0037] The present invention is further described in detail below with reference to the accompanying drawings.

[0038] Example 1

[0039] like Figures 1 to 10 FIG. 1 is a preferred embodiment of the auxiliary endoscope sheath for en bloc resection of bladder tumors according to the present invention.

[0040] The auxiliary scope sheath for en bloc resection of bladder tumors in this embodiment comprises a scope sheath 1, an auxiliary tool 2 for exposing the tumor base and movably mounted on the scope sheath 1, and a driving assembly for driving the extension and retraction of the auxiliary tool 2 relative to the scope sheath 1 and driving the angle of the auxiliary tool 2 relative to the scope sheath 1. In other embodiments, the driving assembly may also be used only to drive the extension and retraction of the auxiliary tool 2 relative to the scope sheath 1, or the driving assembly may also be used only to drive the angle adjustment of the auxiliary tool 2 relative to the scope sheath 1.

[0041] Among them, the more preferred scheme of the driving component is: the extension and retraction of the auxiliary tool 2 relative to the mirror sheath 1 and the angle of the auxiliary tool 2 relative to the mirror sheath 1 are combined together. Because the surgeon puts the auxiliary tool 1 into the bladder, it must first extend to the position of the bladder tumor and then use the auxiliary tool 2 to expose the tumor base. In this process, it is necessary to first control the extension depth of the auxiliary tool 2 relative to the bladder tumor, and then control the angle of the auxiliary tool 2 relative to the bladder tumor. However, this scheme combines the two in one driving component, that is, it can achieve the adjustment of the extension depth of the auxiliary tool 2 relative to the bladder tumor without adjusting the angle of the auxiliary tool 2 relative to the bladder tumor first, and after adjusting the extension depth of the auxiliary tool 2 relative to the bladder tumor, the angle of the auxiliary tool 2 relative to the bladder tumor is adjusted, so that it is more suitable for the surgeon to operate to effectively expose the bladder tumor base. The following specifically expands the scheme that the driving component combines the extension and retraction of the auxiliary tool 2 relative to the mirror sheath 1 and the angle of the auxiliary tool 2 relative to the mirror sheath 1 in one driving component.

[0042] Specifically, the driving assembly includes a limiting member, which can prevent the auxiliary tool 2 from adjusting its angle relative to the mirror sheath 1 when the auxiliary tool 2 is extended or retracted relative to the mirror sheath 1. The driving assembly is arranged on the mirror sheath 1 and away from the end of the auxiliary tool 2, and the driving assembly includes a mounting seat 3, a first driven part 4, a first handle 5, a second driven part 6, a transmission member and a second handle 7. The mounting seat 3 is a tubular structure that can be sleeved on the mirror sheath 1, and has an enlarged accommodating groove 31 in the central part, and one of the groove walls of the accommodating groove 31 (corresponding to the right side wall of the mounting seat 3 in the state of actual operation by the surgeon) has a limiting hole 32 along the direction of extension and retraction of the auxiliary tool 2 relative to the mirror sheath 1. The first driven part 4 is arranged in the receiving groove 31 and connected with the auxiliary tool 2, and has a first tube body 41 that can be sleeved on the mirror sheath 1, and the end of the first tube body 41 has a first rack part 411, and the end of the first tube body 41 has a first connecting wall 42 and a second connecting wall 43 that are higher than the first rack part 411 and are arranged opposite to each other, the first connecting wall 42 has a first connecting hole 421 that penetrates the limiting hole 32, and the second connecting wall 43 has a second connecting hole 431 corresponding to the first connecting hole 421. The first handle 5 is arranged in a direction perpendicular to the extension and retraction of the auxiliary tool 2 relative to the mirror sheath 1, and the end of the first handle 5 has a first driving gear 51 that meshes with the first rack part 411, and the first driving gear 51 passes through the receiving groove 31 and can drive the first driven part 4 to slide relative to the mirror sheath 1 when the first handle 5 is rotated. The second follower 6 has a second tube body sleeved on the end of the first follower 4, and the outer surface of the second tube body has a second rack portion 61. The second follower 6 is linked with the auxiliary tool 2. The transmission member is located between the second follower 6 and the auxiliary tool 2, and can convert the sliding force of the second follower 6 into an angle adjustment of the auxiliary tool 2 relative to the mirror sheath 1. The second handle 7 is arranged facing the first handle 5, and the end of the second handle 7 has a second driving gear 71 meshing with the second rack portion 61. The end of the second handle 7 passes through the limiting hole 32 of the accommodating groove 31 of the mounting seat 3 and the first connecting hole 421 of the first follower 4 in sequence, so that the second driving gear 71 is limited between the first connecting wall 42 and the second connecting wall 43. The limiting hole 32 of the accommodating groove 31 of the mounting seat 3 and the first connecting hole 421 of the first follower 4 together constitute the second connecting hole 431 of the first connecting wall 43. The limiting parts of the second handle 7 are such that when the first handle 5 drives the first follower part 4 to slide relative to the mirror sheath 1, the second follower part 6 and the second handle 7 can only slide together with the first follower part 4 relative to the mirror sheath 1 due to the limiting effect of the limiting hole 32 of the accommodating groove 31 and the first connecting hole 421 of the first follower part 4. When the first handle 5 stops driving the first follower part 4 to slide relative to the mirror sheath 1, the second handle 7 can drive the second follower part 6 to slide, thereby adjusting the angle of the auxiliary tool 2 relative to the mirror sheath 1.

[0043] For ease of manufacturing, the auxiliary tool 2 includes a sleeve 21 movably mounted on the scope sheath 1 and a plate 22 movably connected to the sleeve 21 and used to expose the base of the tumor.

[0044] The plate body 22 can be made of a transparent material so as not to affect the surgical field of view of the endoscope 200; the bottom center of the plate body 22 has an arc-shaped notch 221 that is concave upward from bottom to top, and the edge of the plate body 22 and the mouth wall of the arc-shaped notch 221 form a blunt portion 222 for contacting the tumor. Compared with the sharp structure, the blunt portion 222 has a larger contact area with the tumor, so when the plate body 22 acts on the tumor, it is easy to expose the base of the tumor. The movable connection between the plate body 22 and the sleeve 21 can be a hinge in this embodiment, or a spherical rotating joint can be used. In this embodiment, the end of the sleeve 21 is provided with a hinge seat 215 for the plate body 22 to be hinged, the end of the sleeve 21 is connected to the first driven part 4, and the sleeve 21 has a guide tube 211 arranged along the direction of extension and retraction of the mirror sheath 1. The transmission member includes a transmission rod 8, which can be an iron rod. The first end of the transmission rod 8 is connected to the second driven part 6, and the second end of the transmission rod 8 penetrates from one end of the guide tube 211, passes through the hollow part of the guide tube 211, and then passes through the other end of the guide tube 211 and is connected to the plate body 22 through the hinge seat 215. In this way, the sleeve 21 moves with the movement of the first driven part 4, so that the plate body 22 can be extended and retracted relative to the mirror sheath 1; when the second handle 7 is turned, the second driving gear 71 drives the second driven part 6, and the second driven part 6 drives the plate body 22 to rotate relative to the sleeve 21 through the transmission rod 8, so as to adjust the angle of the plate body 22 relative to the mirror sheath 1.

[0045] In order to connect the sleeve 21 to the endoscope body 11 without causing significant interference to the field of view of the endoscope 200, a preferred solution is: the sleeve 21 (see Figures 4 to 6) includes a sleeve portion 212, the middle portion of the sleeve portion 212 has an open portion 212a for the sleeve 21 to be directly sleeved on the endoscope tube body 11, and a first connecting portion 213 connected to the first follower portion 4 and a second connecting portion 214 connected to the plate body 22, the first connecting portion 213 has a first notch portion 213a for fully exposing the end of the endoscope tube body 11, and the second connecting portion 214 has a second notch portion 214a for fully exposing the end of the endoscope tube body 11. In this way, when the endoscope 200 is extended relative to the endoscope tube body 11, the end of the endoscope 200 can be completely exposed in the second notch portion 214a without being covered by the sleeve portion 212, and the endoscope 200 can fully observe the position of the bladder tumor in the bladder. With the help of the observation of the endoscope 200, the auxiliary tool 2 can act on the appropriate position of the tumor, thereby effectively exposing the base of the bladder tumor; and, the setting of the first notch portion 213a allows the end of the endoscope tube body 11 to be completely exposed in the first notch portion 213a, so that when assembling the auxiliary tool 2, the position of the auxiliary tool 2 relative to the endoscope tube body 11 can be observed at any time, which facilitates the quick installation of the sleeve 21 of the auxiliary tool 2 on the middle part of the endoscope tube body 11.

[0046] In order to make the auxiliary scope sheath able to be used in conjunction with the outer sheath (not shown in the figure), endoscope 200 and cutting tool (not shown in the figure) used in the existing bladder tumor en bloc resection surgery, the outer sheath is used to establish a working channel after entering the urethra, the endoscope 200 is used to observe the bladder tumor to be cut, and the cutting tool is used to cut the bladder tumor, wherein the scope sheath includes an endoscope body 11, a cutting body 12 located below the endoscope body 11, and a connector 100 sleeved on the endoscope body 11 and connected to the mounting seat 3. Specifically, the sleeve 21 and the threading tube 211 are sequentially located above the endoscope body 11, and the endoscope 200 used to observe the bladder tumor can be extended and retracted relative to the endoscope body 11. The specific structure of the endoscope 200 can adopt the existing technology, for example, including an eyepiece 300, etc. The cutting tool for cutting bladder tumors passes through the cutting body 12 and can be extended and retracted relative to the cutting body 12. The cutting tool can be a holmium laser or a monopolar electric knife in the prior art. The connecting member 100 is arranged closer to the plate 22 of the auxiliary tool 2 than the mounting seat 3, wherein the connecting member 100 includes a main body 101, and the main body 101 has a first working channel 101a for the endoscope tube body 11 together with the sleeve 21 and the guide tube 211 to pass through, and a second working channel 101b for the control part 400 for controlling the cutting tool to partially pass through and communicate with the cutting tube body 12. The auxiliary sheath is connected to the outer sheath by the connecting member 100, and the auxiliary sheath is not easy to move, so that the endoscope 200 can be used to observe the location of the bladder tumor first, and the auxiliary tool 2 can be extended and retracted relative to the sheath 1 and the angle of the auxiliary tool relative to the sheath 1 can be controlled by the above-mentioned driving component of the auxiliary sheath to expose the base of the tumor, and then the tumor can be removed by the cutting tool. In order to facilitate the disassembly and assembly between the connecting member 100 and the outer sheath, the outer peripheral wall of the main body 101 of the connecting member 100 has a convex ring 101c, and the end face of the convex ring 101c extends in the direction of the plate body 22 of the auxiliary tool 2 with two clamping parts 10, and the clamping part 10 is connected to the outer sheath 2 used to establish a working channel after entering the urethra. The setting of the convex ring 101c allows a gap to be formed between the clamping part 102 and the outer peripheral wall of the part of the main body 101 opposite to the clamping part 102, and the outer sheath is sleeved outside the main body 101 and located in the gap, so that the outer sheath is plugged into the connecting member 100, which has the advantage of convenient disassembly and assembly. The clamping part 102 can be set in different shapes, and the clamping part 102 can be L-shaped or straight-shaped. The clamping portion 102 in this embodiment includes a first clamping pin 1021 extending along the extension and contraction direction of the plate body 22 of the auxiliary tool 2 and a second clamping pin 1022 perpendicular to the extension and contraction direction of the plate body 22 of the auxiliary tool 2, that is, L-shaped.The second clamping pin 1022 acts on the outer sheath, with a larger contact area, and the connection between the clamping part 102 and the outer sheath is relatively stable. In addition, the action direction of the second clamping pin 1022 on the outer sheath is perpendicular to the extension and contraction direction of the outer sheath, so that the friction between the second clamping pin 1022 and the outer sheath is relatively large, thereby preventing the auxiliary mirror sheath from shaking during tumor resection surgery.

[0047] This embodiment is suitable for resecting larger bladder tumors.

[0048] The use principle and working process of the auxiliary endoscope sheath for en bloc resection of bladder tumor in this embodiment are as follows.

[0049] 1. When performing an en bloc resection of a bladder tumor, the surgeon first inserts an outer sheath (not shown) through the patient's urethra into the bladder to establish a working channel.

[0050] 2. Connect the auxiliary mirror sheath to the outer sheath through the clamping portion 102 of the connecting piece 100.

[0051] 3. Next, the endoscope 200 is inserted into the endoscope tube body 11 , and after the cutting tool is connected to the operating unit 400 , the cutting tool is inserted into the cutting tube body 12 , and the location of the bladder tumor is observed through the endoscope 200 .

[0052] 4. Then, the depth of the auxiliary tool 2 extending relative to the bladder tumor is adjusted by the driving assembly. Specifically, the first handle 5 is rotated, the first handle 5 drives the first driving gear 51 to rotate, the first driving gear 51 drives the first driven part 4 to slide relative to the mirror sheath 1, and the first driven part 6 drives the auxiliary tool 2 to extend and retract relative to the mirror sheath 1 during the sliding process, so as to move the auxiliary tool 2 to the target position in the bladder and make the plate 22 of the auxiliary tool 2 contact the tumor. At this time, because the second driving gear 71 is limited between the first connecting wall 42 and the second connecting hole 431 of the second connecting wall 43 of the first driven part 4, wherein the limiting hole 32 of the accommodating groove 31 of the mounting seat 3 and the first connecting hole 421 of the first driven part 4 together constitute the limiting member of the second handle 7, when the first handle 5 drives the first driven part 4 to slide relative to the mirror sheath 1, the second driven part 6 and the second handle 7 can only slide together with the first driven part 4 relative to the mirror sheath 1 due to the limiting effect of the limiting hole 32 of the accommodating groove 31 and the first connecting hole 421 of the first driven part 4.

[0053] For example, Figure 8 The first handle 5 is rotated counterclockwise to the initial state. The second follower 6 is stationary relative to the first follower 4, and the first follower 4 is retracted (i.e., Figure 8 The first driven part 4 will move to the right) and drive the auxiliary tool 2 to retract relative to the mirror sheath 1 (i.e., from Figure 8The auxiliary tool 2 will move to the right, that is, move closer to the surgeon), and we get Fig. 9 status, Fig. 9 The dotted line in Figure 8 The position of the plate 22 of the auxiliary tool 2 in the initial state. Figure 8 If the first handle 5 is rotated clockwise, the first driven part 4 will drive the auxiliary tool 2 to extend relative to the scope sheath 1 (not shown in the figure), that is, move in a direction away from the surgeon.

[0054] 5. Next, the angle of the auxiliary tool 2 relative to the bladder tumor is adjusted by the driving assembly. Specifically, the second handle 7 is rotated, the second handle 7 drives the second driving gear 71 to rotate, the second driving gear 71 drives the second driven part 6 to slide relative to the first driven part 4, and the second driven part 6 drives the transmission rod 8 to move during the sliding process, so that the plate body 22 connected to the transmission rod 8 is flipped relative to the sleeve 21, so that the plate body 22 is rotated relative to the sleeve 21 through a certain angle.

[0055] For example, Figure 8 In the initial state, after the second handle 7 is rotated clockwise, the second driven part 6 slides relative to the first driven part 4 (i.e., Figure 8 The second driven part 6 will slide to the left relative to the first driven part 4, that is, move away from the surgeon) and the plate 22 of the auxiliary tool 2 will be turned upwards by the transmission rod 8, so that Fig.10 status, Fig.10 The dotted line in Figure 8 The position of the plate 22 of the auxiliary tool 2 in the initial state. Figure 8 If the second handle 7 is rotated counterclockwise, the second driven part 4 will drive the auxiliary tool 2 to retract relative to the scope sheath 1 (not shown in the figure) through the transmission rod 8, that is, move it towards the direction close to the surgeon.

[0056] In this way, when the plate body 22 rotates a certain angle relative to the sleeve 21, the part of the tumor in contact with the plate body 22 moves accordingly, so that the tissue is separated and the base of the tumor is exposed, thereby preventing the surgical field from being blocked, making it easier to identify the tissue layers and grasp the depth of tumor resection.

[0057] 6. Finally, the manipulation unit 400 acts on the cutting tool to remove the tumor together with the base containing the muscle layer.

[0058] Example 2

[0059] The structure is basically the same as that of Example 1, except that: the bottom center of the plate body 22 has an outwardly protruding convex portion instead of an arc-shaped notch 221, and the convex portion can be easily placed in the tumor base, and the convex portion can also play a role in tissue separation, making it easy to expose the tumor base.

Claims

1. An auxiliary scope sheath for en bloc resection of bladder tumors, comprising a scope sheath (1), characterized in that: Also includes An auxiliary tool (2), used for exposing the base of a tumor, which can be movably mounted on the scope sheath (1); and A driving assembly, used for driving the extension and retraction of the auxiliary tool (2) relative to the mirror sheath (1) and / or driving the angle of the auxiliary tool (2) relative to the mirror sheath (1); The driving assembly comprises a limiting member, which can prevent the auxiliary tool (2) from adjusting its angle relative to the mirror sheath (1) when the auxiliary tool (2) is in an extended or retracted state relative to the mirror sheath (1); The driving assembly is arranged on the mirror sheath (1) and is away from the end of the auxiliary tool (2), and the driving assembly comprises: The mounting seat (3) is a tubular structure that can be sleeved on the mirror sheath (1), and has an enlarged accommodating groove (31) at least in the central portion, and one of the groove walls of the accommodating groove (31) has a limiting hole (32) along the direction of extension and retraction of the auxiliary tool (2) relative to the mirror sheath (1); A first driven part (4) is arranged in the receiving groove (31) and connected to the auxiliary tool (2), and comprises a first tube body (41) which can be sleeved on the mirror sheath (1), the end of the first tube body (41) comprises a first rack part (411), and the end of the first tube body (41) comprises a first connecting wall (42) and a second connecting wall (43) which are higher than the first rack part (411) and are arranged opposite to each other, the first connecting wall (42) comprises a first connecting hole (421) which is in communication with the limiting hole (32), and the second connecting wall (43) comprises a second connecting hole (431) which corresponds to the first connecting hole (421); A first handle (5) is arranged in a direction perpendicular to the extension and retraction of the auxiliary tool (2) relative to the mirror sheath (1), and the end of the first handle (5) has a first driving gear (51) meshing with the first rack portion (411), the first driving gear (51) passes through the accommodating groove (31) and can drive the first driven portion (4) to slide relative to the mirror sheath (1) when the first handle (5) is rotated; The second driven part (6) comprises a second tube body sleeved on the end of the first driven part (4), the outer surface of the second tube body comprises a second rack part (61), and the second driven part (6) is linked with the auxiliary tool (2); A transmission member is located between the second driven part (6) and the auxiliary tool (2), and is capable of converting the sliding force of the second driven part (6) into an angle adjustment of the auxiliary tool (2) relative to the mirror sheath (1); as well as The second handle (7) is arranged facing the first handle (5), and the end of the second handle (7) has a second driving gear (71) meshing with the second rack portion (61), and the end of the second handle (7) passes through the limiting hole (32) of the receiving groove (31) of the mounting seat (3) and the first connecting hole (421) of the first driven portion (4) in sequence, so that the second driving gear (71) is limited between the second connecting hole (431) of the first connecting wall (42) and the second connecting wall (43), wherein the limiting hole (32) of the receiving groove (31) of the mounting seat (3) and the first connecting hole (421) of the first driven portion (4) together constitute the The limiting part of the second handle (7) is such that when the first handle (5) drives the first driven part (4) to slide relative to the mirror sheath (1), the second driven part (6) and the second handle (7) can only slide together with the first driven part (4) relative to the mirror sheath (1) due to the limiting effect of the limiting hole (32) of the accommodating groove (31) and the first connecting hole (421) of the first driven part (4), and when the first handle (5) stops driving the first driven part (4) to slide relative to the mirror sheath (1), the second handle (7) can drive the second driven part (6) to slide, thereby adjusting the angle of the auxiliary tool (2) relative to the mirror sheath (1); The auxiliary tool (2) comprises a sleeve (21) movably sleeved on the scope sheath (1) and a plate (22) movably connected to the sleeve (21) and used to expose the base of the tumor, wherein the plate (22) is made of a transparent material.

2. The auxiliary scope sheath for en bloc resection of bladder tumor according to claim 1, characterized in that: The end of the sleeve (21) is connected to the first driven part (4), and the end of the sleeve (21) is provided with a hinge seat (215) for hinged connection with the plate body (22), and the sleeve (21) at least has a guide tube (211) arranged along the extension and retraction direction of the mirror sheath (1), and the transmission member includes a transmission rod (8), the first end of the transmission rod (8) is connected to the second driven part (6), and the second end of the transmission rod (8) is inserted from one end of the guide tube (211), passes through the hollow part of the guide tube (211), and then passes out through the other end of the guide tube (211) and is connected to the plate body (22) through the hinge seat (215).

3. The auxiliary scope sheath for en bloc resection of bladder tumor according to claim 2, characterized in that: The bottom center of the plate body (22) is provided with an arc-shaped notch (221) that is concave upward from bottom to top, and the edge of the plate body (22) and the mouth wall of the arc-shaped notch (221) form a blunt part (222) for contacting the tumor.

4. The auxiliary scope sheath for en bloc resection of bladder tumor according to claim 3, characterized in that: The scope sheath (1) comprises an endoscope tube body (11), and an endoscope (200) for observing bladder tumors can be extended and retracted relative to the endoscope tube body (11), wherein the sleeve (21) comprises a sleeve portion (212), the sleeve portion (212) partially having an open portion (212a) for allowing the sleeve (21) to be directly sleeved on the endoscope tube body (11), a first connecting portion (213) connected to the first driven portion (4) and a second connecting portion (214) connected to the plate body (22), the second connecting portion (214) having a second notch portion (214a) for allowing the end of the endoscope tube body (11) to be completely exposed.

5. The auxiliary endoscope sheath for en bloc resection of bladder tumor according to claim 4, characterized in that: The endoscope sheath (1) further comprises a cutting tube body (12) located below the endoscope tube body (11), and a cutting tool for cutting bladder tumors can be extended and retracted relative to the cutting tube body (12). Correspondingly, the sleeve (21) and the guide tube (211) are sequentially located above the endoscope tube body (11).

6. The auxiliary scope sheath for en bloc resection of bladder tumor according to claim 5, characterized in that: The scope sheath (1) also includes a connector (100) which is sleeved on the endoscope tube body (11) and connected to the mounting seat (3), wherein the connector (100) is arranged closer to the plate body (22) of the auxiliary tool (2) than the mounting seat (3), wherein the connector (100) includes a main body (101), the main body (101) having a first working channel (101a) for the endoscope tube body (11) together with the sleeve (21) and the guide tube (211) to pass through, and a second working channel (101b) for at least partially passing through the control part (400) for controlling the cutting tool and communicating with the cutting tube body (12).

7. The auxiliary scope sheath for en bloc resection of bladder tumor according to claim 6, characterized in that: The outer peripheral wall of the main body (101) of the connecting piece (100) has a convex ring (101c), and the end face of the convex ring (101c) extends toward the plate body (22) of the auxiliary tool (2) to have at least one clamping portion (102), and the clamping portion (102) is connected to an outer sheath used to establish a working channel after entering the urethra.

8. The auxiliary scope sheath for en bloc resection of bladder tumor according to claim 7, characterized in that: The clamping portion (102) is L-shaped and includes a first clamping pin (1021) extending along the extension and contraction direction of the plate body (22) of the auxiliary tool (2) and a second clamping pin (1022) perpendicular to the extension and contraction direction of the plate body (22) of the auxiliary tool (2).

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