Cholangiopancreatography (CCP) suture removal knife

Abstract

This invention provides a choledochoscope suture removal tool, comprising: an outer tube, a connecting rod disposed inside the outer tube, a blade, and a cutting section. The head end of the connecting rod is connected to the blade, and the tail end is connected to a handle. The handle is located at the tail end of the outer tube, and the cutting section is located at the head end of the outer tube or on the blade for cutting Purlin's suture knots. This invention can be inserted through the choledochoscope's forceps channel to cut residual Purlin's suture loops at the bile duct or choledochoenterostomy site.

Description

Technical Field

[0001] This invention relates to the field of minimally invasive surgical instruments, and more particularly to a choledochoscope suture removal knife. Background Technology

[0002] Biliary duct anastomosis and choledochoenterostomy are common surgical procedures for treating iatrogenic bile duct injury, Mirizzi syndrome, periampullary tumors, and other benign and malignant diseases. Furthermore, biliary reconstruction after liver transplantation also utilizes these treatment methods. Exposed Prin sutures inside and outside the bile duct anastomosis lumen are a significant cause of intrahepatic bile duct stones after biliary duct anastomosis and choledochoenterostomy. Currently, absorbable sutures or Prin sutures are often chosen for bile duct reconstruction. Absorbable sutures are made of collagen, but foreign proteins can induce scar hyperplasia, leading to bile duct anastomosis stenosis, and secondary complications such as intrahepatic cholestasis, intrahepatic bile duct stones, and obstructive jaundice. Prin sutures are commonly used in biliary duct anastomosis and choledochoenterostomy. Made of synthetic materials, they have advantages such as a smooth surface, high strength, and low immunogenicity, and are widely used in these procedures. However, Prin sutures are non-absorbable and remain in the body for life. In addition, multiple knots are interlaced to prevent the sutures from loosening. When using purine sutures for bile duct or bile-enteric anastomosis, full-thickness sutures or full-thickness sutures plus seromuscular sutures are generally used. The suture knot is left outside the bile duct wall. During the healing process of the anastomosis, the proliferation of bile duct and intestinal mucosal epithelium can cover the purine suture inside the lumen, thereby restoring the patency of the bile duct.

[0003] Due to differences in common bile duct diameter, bile duct wall thickness, and suturing techniques, in some patients undergoing bile duct or choledochoenterostomy with Purlin's suture, the bile duct mucosa may not completely cover the suture within the lumen. In some cases, even knots from the suture outside the bile duct may migrate into the lumen. Exposed sutures and knots within the anastomotic lumen can impede bile flow. Fiber, bile salts, and proteins within the bile can adhere to the suture, forming biliary sludge and anastomotic stones. These knots and attached stones can cause complications such as bile excretion obstruction and reflux cholangitis, accelerating intrahepatic bile duct dilation, bile stasis, and bile duct stone formation. However, there is no effective preoperative diagnostic method for the presence of sutures within the anastomotic lumen; they are usually discovered during intraoperative cholangioscopy and cannot be detected preoperatively by ultrasound, CT, or MRI.

[0004] After cholangioscopy to remove intrahepatic bile duct stones, to prevent recurrence, it is essential to simultaneously remove any exposed purine lines at the anastomosis. Management options for purine lines unexpectedly discovered during bile duct anastomosis surgery mainly include: 1. Open surgery: During the procedure, the bile duct or choledochoenterostomy is removed, and a cholangioscopy is inserted through the remaining bile duct lumen. A stone retrieval basket is used to remove all bile duct stones, followed by a second bile duct or choledochoenterostomy. This method directly removes the anastomotic tissue containing purine lines, but it results in a large abdominal wall wound, a difficult second bile duct or choledochoenterostomy, and a higher incidence of postoperative complications such as bleeding, anastomotic bile leakage, and bile duct stricture; 2. Laparoscopic surgery: An incision is made in the abdominal wall, and the dilated bile duct above the anastomosis or the efferent loop of the intestine below the anastomosis is cut open laparoscopically. A cholangioscopy is then inserted through the incision to remove transcholeduct stones. However, for Purin's line at the anastomosis, there are no effective choledochoscope instruments. The only option is to make a longitudinal incision at the anastomosis under laparoscopy, cut the suture knot with laparoscopic scissors, remove the Purin's line with forceps, suture the previously incised common bile duct or intestinal segment, and leave a T-tube at the anastomosis. This approach requires incising the anastomosis on top of the existing bile duct or intestinal incision, resulting in a large intra-abdominal wound and increasing the incidence of complications such as bleeding, bile leakage, and anastomotic stenosis. Furthermore, carrying a T-tube increases patient discomfort. 3. Percutaneous transhepatic choledochoscopy: This method is less invasive for treating bile duct stones, but the course of the disease is longer, and the stone removal rate is slightly lower. Due to the lack of choledochoscope instruments, Purin's line at the anastomosis cannot be treated, requiring the patient to undergo a second laparotomy or laparoscopic surgery. Summary of the Invention

[0005] To address the technical problems associated with purine sutures within the anastomotic lumen using existing surgical methods, this invention provides a choledochoscope suture removal tool. This invention primarily utilizes a cutting section located at the tip of the outer sheath or on the blade, employing either a rotary or straight cutting method to sever the purine suture knot.

[0006] The technical means employed in this invention are as follows:

[0007] A cholangioscope suture removal knife includes: an outer tube, a connecting rod placed inside the outer tube, a blade head, and a cutting part. The head end of the connecting rod is connected to the blade head, and the tail end is connected to a handle. The handle is located at the tail end of the outer tube, and the cutting part is located at the head end of the outer tube or on the blade head for cutting purine suture knots.

[0008] Furthermore, the outer sleeve includes connected pipe section I and pipe section II. Pipe section I is located at the head end of the outer sleeve, the cutter head is located inside pipe section I, the connecting rod is located inside pipe section II, and pipe section II has a bending function. The cutting part is set on pipe section I or the cutter head, and the cutting method of the cutting part is rotary cutting or straight cutting.

[0009] Furthermore, the pipe section II is formed by spirally stacking steel wires, with the inner and outer walls being wavy.

[0010] Furthermore, the pipe segment I is a pipe with a smooth inner wall; or the interior of the pipe segment I has a tapered inner cavity.

[0011] Furthermore, when the pipe section I is a pipe with a smooth inner wall, the cutting part is set on the blade head; the blade head has a bird beak-shaped structure with a protruding head, a semi-oblique elliptical groove inside the body, a cylindrical upper section at the tail, and a tapered truncated cone structure from head to tail. The tail end of the lower section is connected to the connecting rod, and the maximum outer diameter of the lower section is smaller than the inner diameter of pipe section I but larger than the inner diameter of pipe section II; the cutting part is a conical blade set at the upper edge of the semi-oblique elliptical groove, and the conical blade bends toward the semi-oblique elliptical groove;

[0012] The cutting method of the cutting part is a straight cut. The bird beak-shaped structure hooks the purlin knot, tightens the handle, and causes the blade head hooked on the purlin knot to return to the outer tube. Pulling back the blade head tightens the purlin, and the purlin knot is cut by increasing the tension on the tapered blade.

[0013] Furthermore, when the pipe section I is a pipe with a smooth inner wall, the cutting part can also be set on the upper section of the pipe wall of the pipe section I. It consists of multiple arc-shaped fan blades distributed in a circle on the pipe wall, with one end of the arc-shaped fan blades having a right angle cutting edge; the cutting head is T-shaped, with its head being a cover sleeve fitted outside the pipe section I, and its body having a tapered structure with its inner diameter gradually decreasing from head to tail. The head end of the body is connected to the top inner wall of the cover sleeve, and the tail end of the body is connected to the connecting rod; the cutting part is located between the cover sleeve and the tapered structure, and the maximum outer diameter of the tapered structure is greater than the inner diameter of the pipe section II;

[0014] The cutting method of the cutting part is rotary cutting. After the blade head approaches the purlin knot, it is pulled back to hook the purlin knot. The blade head is pulled back and rotated to cut or chop the purlin knot.

[0015] Furthermore, when the interior of pipe section I has a conical inner cavity, the wall of the conical inner cavity is provided with a spiral groove whose inner diameter gradually decreases from head to tail, and the cutting part is provided on the blade head; the blade head has a conical structure, the inner diameter of the conical structure gradually decreases from head to tail, the middle part of the blade head is a conical column, and the cutting part is 3 to 5 downward spiral fan-shaped raised structures provided on the side wall of the conical column. The outer diameter of the multiple raised structures decreases sequentially from head to tail, and the multiple raised structures match the spiral groove on the inner wall of pipe section I; one end of the raised structure is at a 90° angle, and the other end is at a 30° acute angle, the acute angle being the blade edge;

[0016] The cutting method of the cutting section is rotary cutting. After the blade head approaches the purine knot, pull back the handle to drag the purine into the outer tube. Rotate the handle to rotate the blade head, and the purine knot in the outer tube is cut or shredded by the blade on the blade head.

[0017] Furthermore, the outer casing is a single-channel tube.

[0018] Furthermore, the handle includes an outer tube handle and a connecting rod wristband, the outer tube handle being connected to the tail end of the outer tube, and the connecting rod wristband being connected to the tail end of the connecting rod.

[0019] Furthermore, the outer wall of the outer sleeve handle is provided with an annular protrusion, the lower inner wall is provided with a threaded groove, and the upper outer wall of the connecting rod wristband is provided with a threaded protrusion, with the threaded groove and the threaded protrusion engaging and connecting.

[0020] Compared with the prior art, the present invention has the following advantages:

[0021] 1. The cholangioscopic suture removal knife provided by this invention is a special instrument for cholangioscopic procedures. It can be inserted through the cholangioscopic forceps channel to cut the purine suture knot, and then the cut purine suture knot can be pulled off using cholangioscopic foreign body forceps.

[0022] 2. The cholangioscopic suture removal knife provided by this invention can have the following structure: the blade can be beak-shaped, bending inward into a groove, causing no damage to the bile duct mucosa. The blade body has a semi-oblique elliptical groove with a large opening, making it easier to hook the Principal's line. A cutting edge is provided at the root of the elliptical groove to cut the Principal's line. The upper part of the tail of the blade is cylindrical, which can prevent the blade from swinging during operation and prevent the beak-like blade from catching on the outer sheath wall when retracting the blade. The lower part of the tail of the blade is truncated cone, with the maximum outer diameter located between the inner diameters of the two sections of the outer sheath, which can limit the depth of blade retraction. The lower end of the tail of the blade is located inside the outer sheath during operation, allowing the blade to enter and exit the outer sheath without resistance. The upper section I of the outer sheath is a metal tube that houses the blade, while the tail section II is made of spirally stacked steel wire, providing a certain degree of flexibility.

[0023] 3. The cholangioscopic suture removal knife provided by this invention can also have a second structure: The blade head has multiple raised rings, all angled downwards with one end forming an acute angle. Pulling back the blade head can draw the purine suture and its coil into the outer sheath. The blade head has a spiral blade; rotating the blade can cut or shred the purine suture between the blade head and the outer sheath. The blade head is conical, and the inner wall of the outer sheath is also conical. As the blade head moves inward, the gap between the blade head and the outer sheath gradually narrows, and the pressure of the blade on the purine suture gradually increases, making it easier to cut or shred the purine suture. The spiral protrusions on the blade head engage with the grooves on the inner wall of the outer sheath, making it easier for the blade head to move up and down within the outer sheath.

[0024] 4. The cholangioscopic suture removal knife provided by this invention can also have a third structure: the tip of the outer sheath is a blade, and pulling back the blade head can directly cut the purine suture pulled into the outer sheath. The blade is composed of multiple fan-shaped blades, and rotating the blade makes it easier to cut or shred the purine suture between the blade head and the outer sheath. The blade head is conical, and the inner wall of the outer sheath is conical. As the blade head moves inward, the gap between the blade head and the outer sheath gradually narrows, and the pressure of the blade on the purine suture gradually increases, making it easier to cut the purine suture. The outer sheath handle and the connecting rod wrist are respectively provided with threaded grooves and threaded protrusions. Tightening the outer sheath handle and the connecting rod wrist can gradually increase the pressure between the purine suture and the blade, making it easier to cut the purine suture.

[0025] In summary, the technical solution of this invention can solve the problem of existing surgical procedures for handling purine lines within the anastomotic lumen.

[0026] Based on the above reasons, this invention can be widely applied in fields such as medicine. Attached Figure Description

[0027] To more clearly illustrate the technical solutions in the embodiments of the present invention or the prior art, the drawings used in the description of the embodiments or the prior art will be briefly introduced below. Obviously, the drawings described below are some embodiments of the present invention. For those skilled in the art, other drawings can be obtained based on these drawings without creative effort.

[0028] Figure 1 This is a schematic diagram of the choledochoscope suture removal knife in Embodiment 1 of the present invention.

[0029] Figure 2 This is a schematic diagram of the cutter head in Embodiment 1 of the present invention.

[0030] Figure 3 This is a schematic diagram of the blade extending in Embodiment 1 of the present invention.

[0031] Figure 4 This is a schematic diagram of the choledochoscope suture removal knife in Embodiment 2 of the present invention.

[0032] Figure 5 This is a schematic diagram of the cutter head in Embodiment 2 of the present invention.

[0033] Figure 6 This is a schematic diagram of the blade extending in Embodiment 2 of the present invention.

[0034] Figure 7 This is a top view of the cutter head in Embodiment 2 of the present invention.

[0035] Figure 8 This is a schematic diagram of the choledochoscope suture removal knife in Embodiment 3 of the present invention.

[0036] Figure 9 This is a schematic diagram of the cutter head in Embodiment 3 of the present invention.

[0037] Figure 10 This is a schematic diagram of the blade extending in Embodiment 3 of the present invention.

[0038] Figure 11 This is a schematic diagram of the arc-shaped fan blade in Embodiment 3 of the present invention.

[0039] In the diagram: 1. Cutting head; 2. Outer tube; 3. Connecting rod; 4. Handle; 5. Tube section I; 6. Tube section II; 7. Semi-oblique elliptical groove; 8. Conical cutting edge; 9. Outer tube handle; 10. Connecting rod wristband; 11. Raised structure; 12. Spiral groove; 13. Arc-shaped fan blade. Detailed Implementation

[0040] It should be noted that, unless otherwise specified, the embodiments and features described in the present invention can be combined with each other. The present invention will now be described in detail with reference to the accompanying drawings and embodiments.

[0041] To make the objectives, technical solutions, and advantages of the embodiments of the present invention clearer, the technical solutions of the embodiments of the present invention will be clearly and completely described below with reference to the accompanying drawings. Obviously, the described embodiments are only some embodiments of the present invention, and not all embodiments. The following description of at least one exemplary embodiment is merely illustrative and is in no way intended to limit the present invention or its application or use. Based on the embodiments of the present invention, all other embodiments obtained by those skilled in the art without creative effort are within the scope of protection of the present invention.

[0042] It should be noted that the terminology used herein is for the purpose of describing particular embodiments only and is not intended to limit the scope of exemplary embodiments according to the invention. As used herein, the singular form is intended to include the plural form as well, unless the context clearly indicates otherwise. Furthermore, it should be understood that when the terms "comprising" and / or "including" are used in this specification, they indicate the presence of features, steps, operations, devices, components, and / or combinations thereof.

[0043] As shown in the figure, the present invention provides a choledochoscope suture removal knife, including: an outer tube 2, a connecting rod 3 placed inside the outer tube 2, a blade head 1 and a cutting part. The head end of the connecting rod 3 is connected to the blade head 1, and the tail end is connected to the handle 4. The handle 4 is set at the tail end of the outer tube 2, and the cutting part is set at the head end of the outer tube 2 or on the blade head 1 for cutting the purine suture knot.

[0044] In a preferred embodiment, the outer tube 2 includes a connected tube segment I5 and a tube segment II6. Tube segment I5 is located at the head end of the outer tube 2, the cutter head 1 is located inside tube segment I5, the connecting rod 3 is located inside tube segment II6, and tube segment II6 has a bending function. The cutting part is set on tube segment I5 or the cutter head 1, and the cutting method of the cutting part is rotary cutting or straight cutting.

[0045] In a preferred embodiment, the pipe section II6 is formed by spirally stacking steel wires, with the inner and outer walls being wavy.

[0046] In a preferred embodiment, the pipe segment I5 is a pipe with a smooth inner wall; or the outer wall of the pipe segment I5 is smooth and has a tapered inner cavity inside.

[0047] In a preferred embodiment, when the pipe section I5 is a pipe with a smooth inner wall, the cutting part is set on the cutter head 1; the cutter head 1 has a bird beak-shaped structure with a protruding head, a semi-oblique elliptical groove 7 inside the body, a cylindrical upper section at the tail, and a tapered truncated cone structure from head to tail. The tail end of the lower section is connected to the connecting rod 3, and the maximum outer diameter of the lower section is smaller than the inner diameter of the pipe section I5 and larger than the inner diameter of the pipe section II6; the cutting part is a conical blade 8 set at the upper edge of the semi-oblique elliptical groove 7, and the conical blade 8 is bent toward the semi-oblique elliptical groove 7;

[0048] The cutting method of the cutting part is a straight cut. The bird beak-shaped structure hooks the purlin knot, tightens the handle 4, and causes the blade 1 that hooks the purlin knot to return to the outer tube 2. Pulling back the blade 1 tightens the purlin, and the purlin knot is cut by increasing the tension of the purlin knot on the conical blade 8.

[0049] In a preferred embodiment, when the pipe section I5 is a pipe with a smooth inner wall, the cutting part can also be set on the upper section of the pipe wall of the pipe section I5. It is composed of multiple arc-shaped fan blades 13 distributed in a circle on the pipe wall, and one end of the arc-shaped fan blade 13 has a right angle cutting edge. The cutting head 1 is T-shaped, and its head is a hollow cap sleeve with an opening facing downwards, fitted outside the pipe section I5. The body is a conical structure with the inner diameter gradually decreasing from head to tail. The head end of the body is connected to the top inner wall of the cap sleeve, and the tail end of the body is connected to the connecting rod 3. The cutting part is located between the cap sleeve and the conical structure, and the maximum outer diameter of the conical structure is greater than the inner diameter of the pipe section II6.

[0050] The cutting method of the cutting part is rotary cutting. After the blade 1 approaches the Prin knot, the blade 1 is pulled back to hook the Prin knot. The blade 1 is pulled back and rotated to cut or chop the Prin knot.

[0051] In a preferred embodiment, when the pipe section I5 has a conical inner cavity, the pipe wall of the conical inner cavity is provided with a spiral groove 12 whose inner diameter gradually decreases from head to tail, and the cutting part is provided on the cutter head 1; the cutter head 1 has a conical structure, the inner diameter of the conical structure gradually decreases from head to tail, the middle part of the cutter head 1 is a conical column, and the cutting part is 3 to 5 downward spiral fan-shaped raised structures 11 provided on the side wall of the conical column. The outer diameter of the multiple raised structures 11 decreases sequentially from head to tail, and the multiple raised structures 11 match the spiral groove 12 on the inner wall of the pipe section I5; one end of the raised structure 11 is at a 90° angle, and the other end is at a 30° acute angle, the acute angle being the cutting edge;

[0052] The cutting method of the cutting part is rotary cutting. After the blade 1 approaches the purine knot, the handle 4 is pulled back to drag the purine into the outer tube 2. The handle 4 is rotated to rotate the blade 1, and the purine knot in the outer tube 2 is cut or shredded by the blade on the blade 1.

[0053] In a preferred embodiment, the outer tube 2 is a single-channel tube.

[0054] In a preferred embodiment, the handle 4 includes an outer tube handle 9 and a connecting rod wristband 10. The outer tube handle 9 is connected to the tail end of the outer tube 2, and the connecting rod wristband 10 is connected to the tail end of the connecting rod. The blade head 1 is rotated by rotating the connecting rod wristband 10.

[0055] In a preferred embodiment, the outer wall of the outer sleeve handle 9 is provided with an annular protrusion, the lower inner wall is provided with a threaded groove, and the upper outer wall of the connecting rod hand ring 10 is provided with a threaded protrusion, with the threaded groove and the threaded protrusion engaging and connecting.

[0056] Example 1

[0057] To address the shortcomings of existing technologies, different surgical approaches are combined to handle the drawbacks of prion lines, such as... Figure 1-3 As shown, the present invention provides a choledochoscope suture removal knife, which is a choledochoscope suture removal hook knife used to remove residual suture loops at the bile duct and bile-enteric anastomosis.

[0058] The choledochoscope suture removal hook knife includes an outer sheath, a connecting rod, a blade, and a handle. The outer sheath is a single-channel tube, comprising section I and section II. Section I has a smooth inner wall, while section II is made of spirally stacked steel wires with wavy inner and outer walls, allowing it to bend. The blade has a beak-like structure with a protruding head and a semi-oblique elliptical groove inside the body. The upper edge of the groove has a conical cutting edge that bends towards the semi-oblique elliptical groove. The tail is conical and connects to the connecting rod. Specifically, the upper section of the tail is cylindrical, and the lower section of the tail has a tapered truncated cone structure from head to tail. The tail end of the lower section connects to the connecting rod. The maximum outer diameter of the lower tail is smaller than the inner diameter of section I but larger than the inner diameter of section II. This invention can be inserted through the choledochoscope's forceps channel to cut residual suture loops at the bile duct or bile-enterointestinal anastomosis.

[0059] At the bile duct or choledochoenterostomy site, the purine suture knot is visible under cholangioscopy. The hook knife is inserted through the cholangioscopy forceps. Once the outer sheath of the hook knife enters the field of view, the handle is released to remove the blade from the sheath. The direction and depth of the cholangioscopy are adjusted, and the beak-like structure at the tip of the hook knife hooks the purine suture knot. The handle is tightened, allowing the blade with the knot to return to the outer sheath. The hook knife is then pulled back to tighten the purine suture, thus cutting it by increasing the tension on the blade. The hook knife is then withdrawn, and a foreign body forceps is inserted through the cholangioscopy to grip the purine suture knot and pull the purine suture out of the tissue.

[0060] This invention is a special instrument for cholangioscopy. It can be inserted through the cholangioscopy forceps channel to cut the purine knot, and then the cut purine knot can be pulled off using cholangioscopy foreign body forceps.

[0061] The blade of this invention is shaped like a bird's beak and bends into the groove, so that the blade does not damage the bile duct mucosa.

[0062] The blade body of the present invention has a semi-oblique elliptical groove with a large opening, making it easier to hook the purlin line. The root of the elliptical groove is provided with a blade that can cut the purlin line.

[0063] The upper part of the tail of the blade of the present invention is cylindrical, which can prevent the blade from swinging during operation and prevent the blade from getting caught on the outer sheath wall when retracting the blade.

[0064] The lower section of the cutter head of this invention is shaped like a truncated cone, with its maximum outer diameter located between the inner diameters of the two sections of the outer sheath, which can limit the depth of the cutter head retraction.

[0065] In the working state, the lower end of the cutter head of the present invention is located inside the outer tube, and the cutter head can enter and exit the outer tube without resistance.

[0066] The upper section I of the outer sheath tube of this invention is a metal tube that houses the cutting head, and the tail section is made of spirally stacked steel wires, which has a certain degree of flexibility.

[0067] Example 2

[0068] Intrahepatic bile duct stones are a common complication after bile duct anastomosis and choledochoenterostomy, one cause of which is exposure of Purlin's sutures at the anastomosis site. Purlin's sutures are commonly used in bile duct and choledochoenterostomy procedures. Made of synthetic materials, they offer advantages such as a smooth surface, high strength, and low immunogenicity. Purlin's sutures are non-absorbable, and multiple knots are interlaced to prevent loosening. The knots are left outside the bile duct wall. During anastomosis healing, the proliferating bile duct and intestinal mucosa covers the sutures. However, in some patients, the bile duct mucosa does not completely cover the sutures within the lumen, and the knots outside the bile duct may even migrate into the lumen. The sutures and knots within the anastomosis lumen can affect bile flow. Fiber, bile salts, proteins, and other substances in the bile can adhere to the sutures, forming biliary sludge and intrahepatic bile duct stones. There is no effective preoperative diagnostic method for the presence of Purlin's line within the anastomotic lumen; it is usually discovered during intraoperative cholangioscopic exploration.

[0069] To prevent recurrence of intrahepatic bile duct stones, it is essential to remove the purine suture from the anastomosis lumen. Current treatment methods mainly include: 1. Open or laparoscopic surgery to remove the bile duct or choledochoenterostomy, followed by re-anastomosis. This procedure is difficult and has a high incidence of postoperative complications such as bleeding, bile leakage, and bile duct stricture. 2. Laparoscopic incision of the anastomosis, cutting the purine suture with laparoscopic scissors, and then using laparoscopic foreign body forceps to pull the purine suture away. This method results in a larger bile duct wound, and the placement of a T-tube at the anastomosis prolongs the course of the disease. Primary suturing is prone to anastomotic stricture. 3. Cholangioscopic removal of the purine suture. One method involves inserting a foreign body forceps through the cholangioscope to clamp the purine suture knot. Mechanical pulling can remove the submucosal purine suture, but it is difficult to remove a full-thickness suture. Forceful manipulation can easily lead to bile duct wall tears, resulting in complications such as bile leakage, bleeding, and bile duct stricture. The second method involves inserting foreign body scissors through a choledochoscope to cut the purine suture. However, because the purine suture is relatively hard and has a smooth surface, it easily slips off the scissor blades, making the process time-consuming and inefficient. The third method involves inserting foreign body forceps connected to a high-frequency generator through a choledochoscope to clamp the purine suture and bring it into contact with the bile duct mucosa. Power is then applied to burn off the purine suture through localized high heat. This method is still inefficient and easily damages the bile duct mucosa, posing a risk of bile duct mucosal bleeding and perforation.

[0070] To address the shortcomings of existing technologies, this paper combines different surgical approaches to handle the drawbacks of purine lines within the anastomotic lumen, such as... Figure 4-7 As shown, the present invention provides a choledochoscope suture removal knife, which is a choledochoscope suture removal spiral knife used to remove residual suture coils at the bile duct and bile-enteric anastomosis.

[0071] The cholangioscopic suture removal spiral knife includes an outer tube, a blade, a connecting rod, and a handle. The outer tube is a single-channel tube, comprising tube segment I and tube segment II. Tube segment I has a smooth outer wall and a conical inner lumen with spiral grooves on the wall, the inner diameter of which gradually decreases from beginning to end. Tube segment II is made of spirally stacked steel wires, with wavy inner and outer walls, allowing it to be bent. The cutter head has a conical structure with an inner diameter that gradually decreases from head to tail. The middle part of the cutter head is a conical column with 3 to 5 downward-sloping spiral fan-shaped ridges on the side wall. The outer diameter of the ridges decreases sequentially from head to tail (from top to bottom). The ridges are paired with the spiral grooves on the inner wall of section I. One end of the ridge is at a 90° angle (the end face of the ridge is perpendicular to the center line of the conical column, i.e., the end face coincides with the outer tangent of the conical column), and the other end is at a 30° angle (the angle between the end face of the ridge and the outer tangent of the conical column is an acute angle of 30°). The acute angle is the cutting edge. The handle includes an outer sheath handle (outer sheath handle) and a connecting rod hand ring. The outer sheath handle is connected to the tail end of the outer sheath, and the connecting rod hand ring is connected to the tail end of the connecting rod. The cutter head can be rotated by rotating the connecting rod hand ring. This invention can be inserted through the choledochoscope's forceps channel, and the blade can be repeatedly pushed out and pulled back to pull the purine line into the outer sheath. Rotating the blade can cut the purine line into pieces.

[0072] When a cholangioscopy reveals a Prin line or knot at the bile duct or choledochoenterostomy site, the outer sheath of this device is inserted through the cholangioscopy channel until the tip of the outer sheath appears in the cholangioscopy field of view. The handle of the outer sheath is then fixed, and the connecting rod hand ring is pushed forward. The cutting head of this device is then pushed out through the outer sheath. The direction and depth of the cholangioscopy are adjusted so that the cutting head of this device is close to the Prin line knot. The hand ring is pulled back, dragging the Prin line into the outer sheath. The connecting rod hand ring is rotated, and the Prin line inside the outer sheath is cut or shredded by the blade on the cutting head of this device. Finally, the device is withdrawn through the cholangioscopy and reinstalled.

[0073] This invention is a special instrument for cholangioscopy, which can be inserted through the cholangioscopy forceps channel and cut the Purlin knot.

[0074] The multiple raised rings on the blade of this invention are all angled downwards, with one end forming an acute angle. Pulling back the blade can pull the purlin wire and the purlin wire coil into the outer sheath.

[0075] The blade of this invention has a spiral blade, and rotating the blade can cut or shred the purlin line between the blade and the outer sheath.

[0076] The blade of this invention is conical, and the inner wall of the outer sheath is also conical. As the blade moves inward, the gap between the blade and the outer sheath gradually narrows, and the pressure of the blade on the purine gradually increases, making it easier to cut or shred the purine.

[0077] The spiral protrusion on the blade of this invention fits into the groove on the inner wall of the outer sheath, making it easier for the blade to move up and down inside the outer sheath.

[0078] Example 3

[0079] Exposed purine sutures inside and outside the bile duct anastomosis lumen are a significant cause of intrahepatic bile duct stone formation after bile duct anastomosis and choledochoenterostomy. Purine sutures are non-absorbable, smooth, strong, and have low immunogenicity, making them widely used in bile duct and choledochoenterostomy. However, in some patients, the purine sutures within the lumen are not completely covered during the mucosal migration of the bile duct anastomosis, and knots in the purine sutures outside the bile duct may even migrate into the lumen. Exposed purine sutures and knots inside and outside the anastomosis lumen can affect bile flow, and substances such as cellulose, bile salts, and proteins in the bile can adhere to the purine sutures, forming biliary sludge and intrahepatic bile duct stones.

[0080] After cholangioscopy to remove intrahepatic bile duct stones, to reduce the recurrence rate, it is essential to simultaneously remove any exposed purine sutures inside or outside the anastomosis. Current treatment methods mainly include: 1. Open or laparoscopic anastomosis resection + secondary anastomosis; this procedure is complex and high-risk; 2. Laparoscopic anastomosis incision + purine suture removal. Generally, laparoscopic scissors are used to cut the purine suture coil, and then laparoscopic foreign body forceps are used to remove the purine suture stump. This method results in significantly less surgical trauma to the anastomosis. Resection, but leaving a T-tube at the anastomosis prolongs the course of the disease, and primary suturing is prone to anastomotic stenosis; 3. Cholangioscopic treatment of purine line, including inserting foreign body forceps through the cholangioscope to pull out purine line, inserting foreign body scissors to cut purine line, and foreign body forceps connected to a high frequency generator to burn purine line. Because purine line is relatively hard and has a smooth surface, full-thickness suturing of the bile duct wall is necessary. Although cholangioscopic treatment is less invasive, it is less efficient and has complications such as mucosal and bile duct wall damage and perforation, bile leakage, and bleeding.

[0081] To address the shortcomings of existing technologies, this paper combines different surgical approaches to handle the drawbacks of purine lines within the anastomotic lumen, such as... Figure 8-11 As shown, the present invention provides a choledochoscope suture removal knife, which is a choledochoscope suture removal cutter used to remove residual suture loops at the bile duct and bile-enterostomy anastomosis.

[0082] The cholangioscopic suture removal cutter includes an outer tube, a cutter head, a connecting rod, and a handle. The outer tube is a single-channel tube, comprising tube segment I and tube segment II. Tube segment I has a smooth inner wall, and the upper section of tube segment I is composed of multiple arc-shaped blades distributed circumferentially on the upper tube wall, with one end of each blade having a right angle. Tube segment II is made of spirally stacked steel wires, with wavy inner and outer walls, allowing it to bend. The cutter head is T-shaped, with its head being a cap cylinder (a hollow, downward-facing, cylindrical structure with a cap) fitted over tube segment I. The body is a tapered shape with its inner diameter gradually decreasing from head to tail. The head of the body is connected to the inner wall of the top of the cap cylinder, and the tail of the body is connected to the connecting rod. The handle includes an outer sheath handle and a connecting rod wristband. The outer wall of the outer sheath handle has an annular protrusion, and the lower inner wall of the outer sheath handle has a threaded groove. The upper outer wall of the connecting rod wristband has a threaded protrusion, and the threaded groove and the threaded protrusion are engaged and connected. This invention can be inserted through the cholangioscope channel. The retracted blade can hook the purine line, and retracting and rotating the blade can cut or shred the purine line.

[0083] When a cholangioscopy reveals a Prin line or knot at the bile duct or choledochoenterostomy site, the outer sheath of this device is inserted through the cholangioscopy channel until the tip of the outer sheath appears in the cholangioscopy field of view. The handle of the outer sheath is then fixed, and the connecting rod hand ring is pushed forward. The cutting head of this device is then pushed out through the outer sheath. The direction and depth of the cholangioscopy are adjusted so that the cutting head of this device is close to the Prin line knot. The hand ring is pulled back, dragging the Prin line into the outer sheath. The connecting rod hand ring is rotated, and the Prin line inside the outer sheath is cut or shredded by the blade on the cutting head of this device. Finally, the device is withdrawn through the cholangioscopy and reinstalled.

[0084] This invention is a special instrument for cholangioscopy, which can be inserted through the cholangioscopy forceps channel and cut the Purlin knot.

[0085] The outer sheath of this invention has a blade at the tip, and pulling back the blade can directly cut the purlin line pulled into the outer sheath.

[0086] The blade of this invention is composed of multiple fan-shaped blades, and the rotating blades make it easier to cut or shred the purlin line between the blade head and the outer sheath.

[0087] The blade of this invention is conical, and the inner wall of the outer sheath is also conical. As the blade moves inward, the gap between the blade and the outer sheath gradually narrows, and the pressure of the blade on the purine line gradually increases, making it easier to cut the purine line.

[0088] The outer sheath handle and the connecting rod wristband of the present invention are respectively provided with threaded grooves and threaded protrusions. Tightening the outer sheath handle and the connecting rod wristband can gradually increase the pressure between the purine line and the blade, making it easier to cut the purine line.

[0089] Finally, it should be noted that the above embodiments are only used to illustrate the technical solutions of the present invention, and not to limit them; although the present invention has been described in detail with reference to the foregoing embodiments, those skilled in the art should understand that modifications can still be made to the technical solutions described in the foregoing embodiments, or equivalent substitutions can be made to some or all of the technical features; and these modifications or substitutions do not cause the essence of the corresponding technical solutions to deviate from the scope of the technical solutions of the embodiments of the present invention.

Claims

1. A choledochoscope suture knife, characterized in that, It comprises an outer sleeve (2), a connecting rod (3) arranged inside the outer sleeve (2), a cutter head (1) and a cutting part, the head end of the connecting rod (3) is connected with the cutter head (1), the tail end is connected with a handle (4), and the handle (4) is arranged at the tail end of the outer sleeve (2); The outer sleeve (2) comprises a pipe segment I (5) and a pipe segment II (6) connected with each other, the pipe segment I (5) is located at the head end of the outer sleeve (2), the cutter head (1) is located in the pipe segment I (5), the connecting rod (3) is located in the pipe segment II (6), and the pipe segment II (6) has a bending function; The pipe segment II (6) is spirally stacked by steel wires, and the inner wall and the outer wall are in a wave shape; The cholangioscope thread cutting knife is a special instrument under the cholangioscope, which can be placed into the cholangioscope channel and cut the prolene knot, and then the prolene knot cut by the cholangioscope foreign body forceps is pulled out; The pipe segment I (5) is a smooth inner wall pipe, the cutting part is arranged on the upper pipe wall of the pipe segment I (5), and is composed of a plurality of arc-shaped blades (13) which are circumferentially distributed on the pipe wall, one end of the arc-shaped blade (13) is a right-angle blade edge; the rotating blade edge can more easily cut the prolene thread between the cutter head and the outer sheath; the cutter head (1) is in a T shape, the head part is a cover cylinder arranged outside the pipe segment I (5), the body part is in a tapered structure with a gradually reduced inner diameter from the head to the tail, the head end of the body part is connected with the top inner wall of the cover cylinder, and the tail end of the body part is connected with the connecting rod (3); the cutting part is located between the cover cylinder and the tapered structure, and the maximum outer diameter of the tapered structure is greater than the inner diameter of the pipe segment II (6); The cutting mode of the cutting part is rotary cutting, after the cutter head (1) is close to the prolene knot, the cutter head (1) is pulled back to hook the prolene knot, and the prolene knot is cut off by pulling back and rotating the cutter head (1). It comprises an outer sleeve (2), a connecting rod (3) arranged inside the outer sleeve (2), a cutter head (1) and a cutting part, the head end of the connecting rod (3) is connected with the cutter head (1), the tail end is connected with a handle (4), and the handle (4) is arranged at the tail end of the outer sleeve (2); 2. A choledochoscope suture knife, characterized by The outer sleeve (2) comprises a pipe segment I (5) and a pipe segment II (6) connected with each other, the pipe segment I (5) is located at the head end of the outer sleeve (2), the cutter head (1) is located in the pipe segment I (5), the connecting rod (3) is located in the pipe segment II (6), and the pipe segment II (6) has a bending function; The pipe segment II (6) is spirally stacked by steel wires, and the inner wall and the outer wall are in a wave shape; The cholangioscope thread cutting knife is a special instrument under the cholangioscope, which can be placed into the cholangioscope channel and cut the prolene knot, and then the prolene knot cut by the cholangioscope foreign body forceps is pulled out; ​ ​ The inner part of the pipe segment I (5) has a conical inner cavity, the tube wall of the conical inner cavity is provided with a spiral groove (12) with a gradually reduced inner diameter from the head to the tail, and the cutting part is arranged on the cutter head (1); the cutter head (1) is in a conical structure, the inner diameter of the conical structure is gradually reduced from the head to the tail, the middle part of the cutter head (1) is a conical column, the cutting part is 3-5 inclined downward spiral fan-shaped raised structures (11) arranged on the side wall of the conical column, the outer diameters of the plurality of raised structures (11) are sequentially reduced from the head to the tail, and the plurality of raised structures (11) are matched with the spiral groove (12) of the inner wall of the pipe segment I (5); one end of the raised structure (11) is a 90° angle, and the other end is a 30° acute angle, and the acute angle is a cutting edge; The cutting mode of the cutting part is rotary cutting, after the cutter head (1) approaches the Prine line knot, the handle (4) is pulled back, the Prine line is dragged into the outer sleeve (2), the handle (4) is rotated to rotate the cutter head (1), and the Prine line knot in the outer sleeve (2) is cut off by the cutting edge on the cutter head (1); the cutter head (1) is conical, the inner wall of the outer sleeve (2) is conical, during the inward movement of the cutter head (1), the gap between the cutter head (1) and the outer sheath gradually decreases, the pressure of the cutting edge on the Prine line gradually increases, and the Prine line is more easily cut off; the spiral protrusion on the cutter head (1) is embedded in the groove on the inner wall of the outer sheath, and the cutter head (1) is more easily moved up and down in the outer sheath.

3. The choledochoscope suture knife of claim 1, wherein, The outer sleeve (2) is a single-channel pipe.

4. The choledochoscope suture knife of claim 1, wherein, The handle (4) comprises an outer sleeve handle (9) and a connecting rod hand ring (10), the outer sleeve handle (9) is connected with the tail end of the outer sleeve (2), and the connecting rod hand ring (10) is connected with the tail end of the connecting rod.

5. The choledochoscope suture knife of claim 4, wherein, The outer wall of the outer sleeve handle (9) is provided with an annular protrusion, the inner wall of the lower section is provided with a threaded groove, the outer wall of the upper section of the connecting rod hand ring (10) is provided with a threaded protrusion, and the threaded groove and the threaded protrusion are connected in a threaded manner.

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