Recurrent laryngeal nerve continuous detection hook for endoscope

Abstract

The utility model belongs to the technical field of medical instruments, and particularly relates to a recurrent laryngeal nerve continuous detection hook for an endoscope, which comprises a bent hook-shaped detection electrode formed by bending, an annular cavity is defined by the bent hook-shaped detection electrode, and two ends of the detection electrode along the extension direction are respectively a head end and a tail end. A gap allowing nerves to enter and exit from the annular cavity is formed between the head end and the tail end, the tail end is connected with a wire, and the inner side face of the detection electrode is a detection face and used for being tightly attached to the nerves entering the annular cavity from the gap when the wire is in a pulled state; the hook-shaped detection electrode is hooked at the recurrent laryngeal nerve root, the recurrent laryngeal nerve can be tightly attached to the detection face of the detection electrode after the wire is straightened, then nerve monitoring is started, the process of opening a nerve clamp in an operation is avoided, and operation is simple.

Description

Technical Field

[0001] The utility model belongs to the technical field of medical instruments, and in particular relates to a recurrent laryngeal nerve continuous detection hook for laparoscope. Background Art

[0002] Intraoperative neuromonitoring (IONM) technology refers to the use of electrophysiological principles to electrically stimulate motor nerves during surgery to form nerve impulses and transmit them to the innervated muscles to generate electromyographic signals, forming electromyography (EMG) waveforms and prompt sounds, and then judging the integrity of nerve function. This technology can quickly identify the shape of the recurrent laryngeal nerve, predict variations, distinguish the recurrent laryngeal nerve from surrounding tissues, and protect the integrity of the recurrent laryngeal nerve function; it can also clarify the mechanism of damage to the recurrent laryngeal nerve in real time and reduce the incidence of recurrent laryngeal nerve injury.

[0003] Intraoperative recurrent laryngeal nerve detection technology can currently be divided into two methods: intermittent detection using a stimulation probe and continuous detection using a stimulation electrode. The intermittent stimulation probe used in esophageal surgical laparoscopy has the disadvantages of low signal release efficiency, inability to implement monitoring, the need for frequent replacement of surgical instruments, and increased surgical time. Continuous detection with stimulation electrodes will be able to avoid the shortcomings of intermittent nerve detection. This method places the stimulation electrode clamp directly on the proximal end of the nerve trunk and automatically and continuously sends out stimulation signals. If the receiving electrode at the vocal cord continues to send out normal and stable electromyographic waveforms, it proves that the surgical operation has no effect on the nerve. Therefore, this method can provide early warning of the occurrence of damage when damage is about to occur, making nerve protection more meaningful.

[0004] Currently, there are no recurrent laryngeal nerve continuous stimulation electrodes specifically for laparoscopic esophageal cancer surgery on the market. In other types of surgery, such as open thyroid surgery, there are only similar continuous nerve detection products (a continuous nerve detection clip). In thyroid surgery, if nerve monitoring is performed, additional surgery to expose the vagus nerve trunk is required, so it has been almost unused, and this type of clip is designed specifically for clamping the vagus nerve in the neck, and there is no dedicated clamp for clamping the recurrent laryngeal nerve. The current continuous nerve detection clips on the market have significant design deficiencies and cannot be directly used for recurrent laryngeal nerve detection in laparoscopic radical esophagectomy.

[0005] Taking the most mature Medtronic continuous nerve detection clip as an example, its shortcomings are as follows:

[0006] a) The current clip design clamps on the main trunk of the vagus nerve. The original device also requires additional exposure surgery of the main trunk of the vagus nerve, which increases the difficulty and risk of the surgery and also increases patient damage.

[0007] b) Release signals from the vagus nerve ( Figure 1, the signal is released at the A end), part of the signal will be diverted and cannot be completely received by the signal receiving electrode of the recurrent laryngeal nerve. The strength of the received signal is related to the distribution ratio of the current in each branch, and we have no way to judge this ratio. This will seriously affect the efficiency and increase the intensity of the stimulation current. Therefore, at the end that sends the pulse signal, the voltage, current, and frequency of the release signal will be excessive, and in severe cases, it may even cause new damage to the vagus nerve and recurrent laryngeal nerve.

[0008] c) The stimulation electrode at the inner ring of the clamp is only on one side of the clamp connection line, and the contact surface with the nerve is small. In actual surgery, the electrode on this side often has poor contact with the nerve, affecting the continuous release of the signal.

[0009] d) The clamp is still relatively wide in size and width, which is not conducive to fine operation in a narrow operating space.

[0010] e) The material of the clip is too hard and the degree of opening and closing is poor, making it difficult to clamp the nerve during laparoscopic surgery.

[0011] f) Due to the lack of elasticity, this not only affects the fit between the clamp electrode and the nerve, but the too hard clamp also causes certain physical damage to the nerve itself. Utility Model Content

[0012] The technical problem to be solved by the utility model is: in order to solve the problem that the vagus nerve continuous detection clamp in the prior art has many shortcomings and cannot be directly used for recurrent laryngeal nerve detection in laparoscopic esophageal cancer surgery, a laparoscopic recurrent laryngeal nerve continuous detection hook is provided.

[0013] In order to solve the above technical problems, the utility model adopts the following technical solutions: a continuous recurrent laryngeal nerve detection hook for laparoscopy, comprising a bent hook-shaped detection electrode, which encloses an annular cavity, and the two ends of the detection electrode along its extension direction are respectively a head end and a tail end, and a gap is formed between the head end and the tail end for the nerve to enter and exit the annular cavity, that is, the detection electrode is a non-closed structure, and the tail end is connected to a wire for connecting an external signal generator, the inner side surface of the detection electrode is a detection surface, which is conductive and is used to closely fit the nerve entering the annular cavity from the gap when the wire is under tension.

[0014] When using it, first dissect out the root of the recurrent laryngeal nerve, directly hook the device onto the nerve root, straighten and fix the wire, and give the nerve a slight pulling tension, so that the nerve and the detection electrode can fit closely to avoid falling off. At this point, the device is installed, and then the external signal generator sends out a continuous electrical stimulation signal, and the detection electrode sends out a stimulation current to depolarize the nerve fiber and form a nerve impulse to control the movement of the laryngeal muscles. The recording electrode records the corresponding electromyographic signal, and the corresponding electromyographic waveform is displayed through the electromyographic monitor and a prompt sound is issued, thereby prompting the operator to the functional state of the detected nerve, and to judge whether the nerve is damaged by the presence of a continuous signal.

[0015] The above technical solution uses a hook-shaped detection electrode to hook at the root of the recurrent laryngeal nerve. After straightening the wire, the recurrent laryngeal nerve can be closely fitted with the detection surface of the detection electrode, and then nerve monitoring can be started, avoiding the process of opening the nerve clamp during surgery. The operation is simple, and can effectively reduce the probability of recurrent laryngeal nerve injury during surgery, reduce complications, and significantly improve the overall safety of esophageal cancer surgery and the quality of life of patients after surgery. At the same time, since this equipment can provide real-time feedback on nerve injury during surgery, it will also help to improve the surgeon's understanding of his or her own operation details and the micro-anatomy of the tissues around the recurrent laryngeal nerve, helping the surgeon to improve his or her surgical skills.

[0016] Furthermore, the outer side of the detection electrode is covered with an insulating layer, that is, the inner side of the detection electrode is conductive and is used to contact the nerve to emit a stimulation current, and the outer side is insulated, which can prevent the stimulation signal from being released to non-neural tissue and reduce misjudgment caused by the impact of electrical stimulation on non-target tissue nerves, thereby reducing errors.

[0017] Furthermore, the detection electrode includes a semicircular hook and a neck connecting the hook and the wire, the head end is located at the hook, the tail end is located at the neck, the neck is roughly an arc-shaped structure, the curvature of the hook is much larger than the curvature of the neck, and the neck gradually approaches the head end and then gradually moves away from the head end, thereby forming a closed-end detection electrode to form an "embracing" structure. The inner sides of the detection electrodes are all stimulation electrodes, which greatly increases the contact area. The electrical signal can be directly released into the nerve, avoiding poor contact between the stimulation electrode and the nerve, abnormal release of electrical signals, etc.

[0018] Furthermore, an installation groove for embedding the detection electrode is provided on the inner side surface of the insulation layer, thereby improving the connection strength between the insulation layer and the detection electrode.

[0019] Furthermore, the head end has a first straight segment extending along the tangential direction, which will not hinder the nerves from entering and exiting the annular cavity while increasing the detection electrode area, and the first straight segment is rounded, and the end has a second straight segment extending along the tangential direction, and the first straight segment is parallel to the second straight segment.

[0020] Furthermore, the insulating layer is made of polyurethane, which is relatively soft and can reduce damage to nerve tissue.

[0021] The beneficial effects of the utility model are:

[0022] 1) The nerve detection hook is placed directly at the beginning of the recurrent laryngeal nerve, avoiding the additional surgery of separating the vagus nerve in the neck and avoiding the damage of the vagus nerve.

[0023] 2) Placing the nerve detection hook directly at the starting point of the recurrent laryngeal nerve can reduce the voltage, current and even frequency of the signal release, thereby reducing the chance of injury. In addition, since the original shunt of the signal is eliminated, the accuracy of the signal at the receiving end is greatly improved, and the monitoring sensitivity will also be higher.

[0024] 3) This nerve detection hook adopts an "embracing" structure, and the inner side of the hook can conduct electricity to stimulate the nerve, which greatly increases the contact area. The electrical signal can be directly released into the nerve, avoiding poor contact between the detection electrode and the nerve, abnormal release of electrical signals, etc.

[0025] 4) The volume of the nerve detection hook is significantly reduced, and it does not occupy the already very narrow anatomical space of the esophageal tracheal groove.

[0026] 5) The nerve detection hook is directly changed into a "bent hook" form. During the operation, the nerve can be directly hooked, avoiding the process of opening the nerve clamp during the operation.

[0027] 6) The curvature of the nerve detection hook is reasonably designed, and the outer surface is made of softer material to further protect the nerve.

[0028] 7) This nerve detection hook can be used for continuous nerve monitoring. The release and reception of the signal electrode during surgery is stable. According to the changes in the strength of the received signal, it can help the surgeon to judge the nerve damage in real time and make timely improvements, thereby significantly reducing the probability of recurrent laryngeal nerve damage. BRIEF DESCRIPTION OF THE DRAWINGS

[0029] The utility model is further described below in conjunction with the accompanying drawings and embodiments.

[0030] Figure 1 It is a schematic diagram of the release of the signal of the vagus nerve trunk nerve detection clip in the prior art;

[0031] Figure 2 It is a three-dimensional diagram of the utility model;

[0032] Figure 3 It is the front view of the utility model;

[0033] Figure 4 It is an exploded view of the utility model;

[0034] In the figure:

[0035] 1. detection electrode; 101. annular cavity; 102. head end; 103. end end; 104. notch; 105. detection surface; 106. hook; 107. neck; 108. first straight segment; 109. second straight segment;

[0036] 2. Wire;

[0037] 3. Insulation layer; 301. Installation groove.

[0038] A. Signal release end A; B. Signal release end B; C. Signal receiving end; D. Signal diversion end. DETAILED DESCRIPTION

[0039] Now the utility model is further described in detail with reference to the accompanying drawings. These drawings are simplified schematic diagrams, which only illustrate the basic structure of the utility model in a schematic manner, and therefore only show the components related to the utility model.

[0040] Embodiment 1:

[0041] like Figure 2-Figure 4 As shown, the utility model is a laparoscope continuous detection hook for recurrent laryngeal nerve, which is suitable for the recurrent laryngeal nerve lymph node dissection in the chest by ordinary thoracoscopic and robotic thoracoscopic surgery. The recurrent laryngeal nerve lymph node dissection is mainly used in the radical resection of esophageal cancer, and may also be involved in a few esophageal and gastric junction cancer surgeries. This device can protect the recurrent laryngeal nerve and avoid damage, while recurrent laryngeal nerve damage will not only cause hoarseness, but more seriously lead to aspiration pneumonia, and even serious complications such as death of the patient.

[0042] The detection hook includes a curved hook-shaped detection electrode 1, which is enclosed to form an annular cavity 101. The detection electrode 1 is roughly an arc-shaped structure to avoid damage to the nerves caused by edges and corners, and its width is 5mm. The two ends of the detection electrode 1 along its extension direction are respectively a head end 102 and a tail end 103. A gap 104 is formed between the head end 102 and the tail end 103 for the nerve to enter and exit the annular cavity 101, that is, the detection electrode 1 is a non-closed structure, and the tail end 103 is connected to a wire 2 for connecting an external signal generator. The inner side surface of the detection electrode 1 is a detection surface 105, which is conductive and is used to closely fit the nerve entering the annular cavity 101 from the gap 104 when the wire 2 is under tension.

[0043] The detection electrode 1 includes a semicircular hook portion 106 and a neck portion 107 connecting the hook portion 106 and the wire 2, the head end 102 is located at the hook portion 106, and the end 103 is located at the neck portion 107, the curvature of the hook portion 106 is much greater than the curvature of the neck portion 107, and the neck portion 107 gradually approaches the head end 102 and then gradually moves away from the head end 102, thereby forming a closed-end detection electrode 1 to form an "embracing" structure, and the inner side of the detection electrode 1 is a stimulation electrode, which greatly increases the contact area, and the electrical signal can be directly released into the nerve, avoiding poor contact between the stimulation electrode and the nerve, abnormal release of electrical signals, etc.;

[0044] The head end 102 has a first straight section 108 extending along the tangential direction, which will not hinder the nerves from entering and exiting the annular cavity 101 while increasing the area of ​​the detection electrode 1, and the first straight section 108 is rounded, and the end 103 has a second straight section 109 extending along the tangential direction, and the first straight section 108 is parallel to the second straight section 109.

[0045] The outer side of the detection electrode 1 is covered with an insulating layer 3, that is, the inner side of the detection electrode 1 is conductive and is used to contact the nerve to emit a stimulation current. The outer side is insulated to avoid the stimulation signal from being released to non-nerve tissues, reduce misjudgment caused by the impact of electrical stimulation on non-target tissue nerves, and thus reduce errors. The insulating layer 3 is made of polyurethane, which is relatively soft and can reduce damage to nerve tissue. The inner side of the insulating layer 3 is provided with a mounting groove 301 for the detection electrode 1 to be embedded, thereby improving the connection strength between the insulating layer 3 and the detection electrode 1.

[0046] Working principle:

[0047] When in use, first dissect out the root of the recurrent laryngeal nerve, directly hook the device onto the nerve root, straighten and fix the wire 2, and give the nerve a slight pulling tension, so that the nerve and the detection electrode 1 can fit tightly to avoid falling off. At this point, the device is installed, and then the external signal generator sends out a continuous electrical stimulation signal, and the detection electrode 1 sends out a stimulation current to depolarize the nerve fiber and form a nerve impulse to control the movement of the laryngeal muscles. The recording electrode records the corresponding electromyographic signal, and the corresponding electromyographic waveform is displayed through the electromyographic monitor and a prompt sound is issued, thereby prompting the operator to the functional state of the detected nerve, and to judge whether the nerve is damaged by the presence of a continuous signal.

[0048] Based on the above ideal embodiments of the utility model, the relevant staff can make various changes and modifications without deviating from the technical concept of the utility model through the above description. The technical scope of the utility model is not limited to the content of the specification, and its technical scope must be determined according to the scope of the claims.

Claims

1. A laparoscope-based recurrent laryngeal nerve continuous detection hook, characterized in that: The invention comprises a bent hook-shaped detection electrode (1), which encloses an annular cavity (101); the two ends of the detection electrode (1) along its extension direction are respectively a head end (102) and a tail end (103); a notch (104) for nerves to enter and exit the annular cavity (101) is formed between the head end (102) and the tail end (103); the tail end (103) is connected to a wire (2); the inner side surface of the detection electrode (1) is a detection surface (105), which is used to closely fit the nerve entering the annular cavity (101) from the notch (104) when the wire (2) is under tension.

2. The laparoscopic recurrent laryngeal nerve continuous detection hook according to claim 1, characterized in that: The outer side of the detection electrode (1) is covered with an insulating layer (3).

3. The laparoscopic recurrent laryngeal nerve continuous detection hook according to claim 1, characterized in that: The detection electrode (1) comprises a hook portion (106) and a neck portion (107) connecting the hook portion (106) and the wire (2), the head end (102) is located at the hook portion (106), the tail end (103) is located at the neck portion (107), and the neck portion (107) first gradually approaches the head end (102) and then gradually moves away from the head end (102).

4. The laparoscopic recurrent laryngeal nerve continuous detection hook according to claim 2, characterized in that: The inner side surface of the insulating layer (3) is provided with a mounting groove (301) for embedding the detection electrode (1).

5. The laparoscopic recurrent laryngeal nerve continuous detection hook according to claim 1, characterized in that: The head end (102) has a first straight section (108) extending in the tangential direction, and the tail end (103) has a second straight section (109) extending in the tangential direction.

6. The laparoscopic recurrent laryngeal nerve continuous detection hook according to claim 2, characterized in that: The insulating layer (3) is made of polyurethane.

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