Resectoscope device, and resectoscope

Abstract

The present invention relates to a resectoscope device (10) comprising: an insertion sleeve (12), which can be fed at least in part into a cavity (14) of a patient and defines a longitudinal axis (16); a shaft (18), which extends inside the insertion sleeve (12); and a resection tool (20); wherein the shaft (18) and the resection tool (20) can be fed into the cavity (14) together with the insertion sleeve (12); and wherein the shaft (18) and the resection tool (20) can be independently moved relative to the insertion sleeve (12) along the longitudinal axis (16). (Fig. 1)

Description

[0001] Resectoscope device and resectoscope

[0002] The present invention relates to a resectoscope device and a resectoscope.

[0003] A resection is the surgical removal of tissue from an organ or tumor. Depending on the goal and anatomical conditions, different types of resection can be performed. For difficult-to-access tissue, surgical removal can be performed endoscopically using a resectoscope. Such a resectoscope is used, for example, in transurethral resection, in which diseased tissue is removed from the bladder or prostate. The operation is performed endoscopically through the patient's urethra, without the need for an incision.

[0004] A conventional resectoscope for transurethral resection comprises a shaft with a viewing lens, a rinsing device, and a resection tool arranged at its distal end. The shaft allows access to the bladder through the urethra and provides stability during the procedure. The distal end of the shaft can therefore be positioned within the bladder during the procedure by sliding the shaft back and forth along the urethra and pivoting the shaft. A proximal portion of the shaft is coupled to an operating assembly, which is held and moved by a user during the procedure. The operating assembly also includes an actuating device by means of which the resection tool can be moved relative to the distal end.

[0005] A resection with such a conventional resectoscope is usually performed as follows: The user grasps the resectoscope by the operating assembly. They then push the shaft through the patient's urethra until the distal end of the shaft extends into the bladder. The bladder is then filled using the irrigation device. The imaging device is now activated, and the user receives an overview of the interior of the bladder through endoscopic observation. This allows them to identify the tissue areas within the bladder that are to be removed. To remove these areas, the user advances the shaft and pivots it as needed until the distal end is close to the tissue area in question. They then align the imaging device so that the tissue area is clearly visible in the field of view.To remove the tissue, the user activates the actuating device, thereby moving the resection tool back and forth. In an iterative process, the tissue can be removed layer by layer by activating the actuating device. To reach a larger area of ​​tissue with the resection tool, which is regularly necessary, the user also moves the shaft along the urethra.

[0006] In the manner described, transurethral resection can be used primarily to treat superficial bladder carcinoma for resection within a urinary bladder. The inventors of the present invention have recognized that this is difficult for the user to perform and that complications can arise. During the resection, the user must pivot the resectoscope vigorously and move it intensively along the urethra according to the prior art. This can impair the precision of the tissue removal. Furthermore, complications can arise for the patient, with the forward and backward movement of the shaft in particular often leading to postoperative discomfort for the patient. For example, during the procedure, not directly visible injuries to muscles and tissue or severe irritation of the mucous membranes can occur. These complications can subsequently lead to

[0007] This can lead to urinary incontinence. As mentioned, however, regular movement of the shaft back and forth in the urethra is absolutely necessary to complete the treatment.

[0008] Based on the prior art, the object of the invention is to provide a resectoscope by means of which a resection can be carried out precisely and / or gently for a patient.

[0009] The object is achieved according to the invention by a resectoscope device and a resectoscope as described herein and defined in the claims.

[0010] The present invention provides a resectoscope device, in particular for transurethral resection of tissue. The resectoscope device comprises an insertion sleeve that can be partially introduced into a patient's cavity and defines a longitudinal axis. The resectoscope device further comprises a shaft that extends within the insertion sleeve and a resection tool. The shaft and the resection tool can be introduced into the cavity together with the insertion sleeve. Furthermore, the shaft and the resection tool are movable independently of one another relative to the insertion sleeve along the longitudinal axis. The present invention also provides a resectoscope, in particular for transurethral resection of tissue, with a resectoscope device according to the invention.

[0011] The features of the invention allow for precise and gentle transurethral resection for the patient. Patient comfort is increased and the risk of complications such as urinary incontinence is reduced. This, in turn, increases the acceptance of transurethral resections, thus reducing the consequences of long-postponed resections. Due to the independent mobility of the shaft and resection tool relative to the introducer sleeve, a resection can be performed during which friction between the shaft and the urethra is greatly reduced. The shaft itself no longer contacts the urethra, but is instead displaced within the introducer sleeve. The introducer sleeve thus provides access to the bladder, similar to a trocar. To perform the resection, the shaft and introducer sleeve are first pushed together into the urethra.The introducer sleeve then remains in position during the subsequent tissue removal; however, the shaft and resection tool are moved back and forth within the introducer sleeve to perform a tissue removal movement. Once the introducer sleeve is in position, handling is comparable to conventional resectoscopes, allowing users to draw on their experience with conventional resectoscopes when performing procedures.

[0012] Due to the reduced friction between the shaft and introducer sheath compared to the friction between the shaft and the urethra in conventional resection, the ablation movement can be performed more safely, precisely, evenly, and more comfortably for the user. Since the shaft can be guided within the introducer sheath, there can be an expected and constant resistance to the ablation movement for the user. In contrast, the ablation according to the prior art is often performed jerkily, as an initial resistance must be overcome when advancing the shaft. This can lead to unintentional perforations of the bladder wall and injuries to the urethra. However, the risk of a perforation can be reduced with the present invention. The easier handling of the resectoscope also facilitates the training of trainees, which subsequently leads to improved patient care.A “resectoscope device” should be understood in particular as a preferably functional component, in particular a subassembly and / or a structural and / or functional component of a resectoscope. Preferably, the resectoscope device can form the resectoscope at least partially, preferably at least to a large extent, and particularly preferably completely. For example, the resectoscope device can be configured to be inserted at least partially and preferably at least to a large extent into a hollow space or into a particularly artificial and / or natural cavity, in particular a body cavity, in particular in order to examine it and to modify parts thereof, in particular to remove them. The resectoscope device can be a medical resectoscope device.Within the scope of this disclosure, "configured" can be understood to mean, in particular, specifically programmed, designed, configured, and / or equipped. Within the scope of this disclosure, the fact that a component is configured for a specific function can be understood to mean, in particular, that the component fulfills and / or performs this specific function in at least one application and / or operating state.

[0013] The introducer sheath can be designed as an elongated tube and / or comprise one, along whose longitudinal axis in particular a guide channel can run. In particular, it can be configured to provide access to the urinary bladder of a patient. For this purpose, it can be arranged in a urethra of the patient and / or inserted into it. Arranged therein, the longitudinal axis and in particular the guide channel can extend along the urethra. In this case, the introducer sheath extends from a proximal side to a distal side. The shaft and / or the resection tool can be guided at least partially and / or sectionally in the guide channel and in particular can be guided forward. In some embodiments, the shaft can be guided in the introducer sheath and the resection tool on the shaft.The introducer sleeve can thus accommodate the shaft and the resection tool, in particular at a portion that can be arranged within the urethra. Other components can also be accommodated in the introducer sleeve, for example, a rinsing device with a supply channel and a suction channel. The introducer sleeve can be attached to the shaft in a captive manner. In other words, the introducer sleeve can be movable relative to the shaft and fastened to the shaft. Intuitive operability can be achieved in particular when the shaft has a linear degree of freedom of movement and a rotational degree of freedom relative to the introducer sleeve, in particular an axial mobility in combination with a rotatability but a fixed position with respect to a radial position. In some embodiments, a rotational position can be fixed and / or fixable. For this purpose, the resectoscope device can comprise a locking mechanism that can be operated by the user.In the locked state, only axial mobility can remain. Alternatively or additionally, an axial position can also be locked. A locking mechanism can also be provided for this purpose, in particular the locking mechanism mentioned. In this case, only rotational mobility can remain as a degree of freedom in the locked state. Particularly intuitive operation is achieved when the shaft can be moved linearly and rotated relative to the insertion sleeve.

[0014] In other words, the introducer sleeve can function similarly to a trocar, specifically a captive trocar, as is known from minimally invasive surgery. It can thus provide trocar-like access to the cavity, particularly the bladder.

[0015] The longitudinal axis can run parallel to the main extension direction of the introducer sleeve. When at least partially inserted into the cavity, a longitudinal axis of the shaft can also run parallel to the main extension direction of the introducer sleeve and / or its longitudinal axis.

[0016] The insertion sleeve may have a smaller longitudinal extent than the shaft. In some embodiments, the longitudinal extent of the insertion sleeve may be, for example, at most 95%, in particular at most 80%, preferably at most 70%, particularly preferably at most 50%, of the longitudinal extent of the shaft. The longitudinal extent refers to the extent along the longitudinal axis. The shaft may, for example, be between 20 cm and 40 cm, in particular between 20 cm and 30 cm, preferably between 20 cm and 25 cm long.

[0017] The introducer sheath can have an annular, in particular circular, cross-section, in particular in a distal end section. The wall thickness of the introducer sheath can be, for example, 0.5 mm to 1.5 mm. An outer diameter can be, for example, up to 10 mm, in particular up to 9 mm, preferably up to 8 mm. In principle, a small diameter is desirable in order to keep stress on the patient to a minimum. The introducer sheath can be made of stainless steel, a medical plastic, titanium, polyetheretherketone and / or the like. In some embodiments, the introducer sheath is intended for single use or is a single-use product. On its inner surface, the introducer sheath can have a friction-reducing coating, for example made of Teflon, silicone and / or the like.

[0018] The resectoscope device can further comprise a proximal operating assembly that is movable as a whole relative to the insertion sleeve. The insertion sleeve can therefore remain stationary and / or move only minimally during movement of the proximal operating assembly. If the insertion sleeve is correspondingly guided toward a urethra, movement of the insertion sleeve relative to the urethra can thereby be reduced, wherein longitudinal mobility of the shaft and / or the resection tool is not restricted. The shaft and / or the resection tool can, for example, be coupled proximally to the operating assembly. By moving the operating assembly back and forth, the user can move the shaft and the resection tool, in particular jointly, relative to the insertion sleeve and in particular perform an ablation movement.

[0019] The shaft and the resection tool can therefore be moved independently of one another, in particular by a user, with the movement being carried out relative to the introducer sheath. For a resection, the user can introduce the introducer sheath together with the shaft and the resection tool into the urethra. This can also be done sequentially, for example if the various assemblies are of different lengths. “Jointly” can be understood to mean that the insertion can be a single process and the user does not have to grasp the individual assemblies one after the other and advance them individually through the urethra. When partially inserted into the urethra or cavity, the user can optionally advance the resection tool and / or the shaft further, in particular to explore the bladder and / or perform a resection.

[0020] In some embodiments, the proximal operating assembly further comprises an actuation mechanism by means of which the resection tool can be moved along the longitudinal axis independently of the shaft. By actuating the actuation mechanism, the user can push the resection tool forward and backward, in particular independently of the shaft and / or the insertion sleeve, in particular to perform an ablation movement.

[0021] In other words, the shaft and the resection tool can be configured to be moved within the introducer sleeve after being inserted into the cavity during tissue removal. Thus, unlike a conventional resection, a component in contact with the urethra is no longer displaced during tissue removal.

[0022] The introducer sleeve can be detachably coupled to the operating assembly. For example, the operating assembly can form a coupling mechanism together with the introducer sleeve, which is designed to detachably connect the introducer sleeve to the operating assembly. This allows the introducer sleeve to be released as needed, for example, after it has been inserted into the cavity together with the shaft and the resection tool. Likewise, the introducer sleeve can be mechanically recoupled to the operating assembly as needed to remove the introducer sleeve, together with the shaft and the resection tool, from the cavity.

[0023] According to the above embodiments, the resectoscope device can have different positions, which can be defined by a different longitudinal position of the resection tool relative to the shaft and to the insertion sleeve and / or a different longitudinal position of the shaft relative to the resection tool and to the insertion sleeve.

[0024] As already described, the introducer sheath can be configured to remain atraumatically stationary while tissue is being removed. Patient comfort is increased and postoperative complications are reduced. It is understood that the introducer sheath could move slightly relative to the ureter. However, this movement can be negligibly small or significantly smaller than a relative movement between a shaft and the urethra during a conventional resection. In other words, the introducer sheath can be configured to remain at least substantially stationary with respect to the surrounding and, in particular, contacting tissue when the shaft is positioned within the cavity.

[0025] A cavity can be understood as a bladder and also the urethra. In some embodiments, the introducer sheath is designed to be positioned in the urethra such that a distal portion of the introducer sheath extends into the bladder. In some embodiments, however, the introducer sheath can also be, in particular slightly, shorter than the urethra of the treated patient or, when positioned in the urethra, not extend all the way to the bladder neck.

[0026] "Distal" is understood to mean, in particular, when operating the device facing a patient and / or away from an operator and / or user. In particular, "proximal" is the opposite of distal. "Proximal" is understood to mean, in particular, when operating the device facing away from a patient and / or away from an operator and / or user.

[0027] An “elongated part” is to be understood in particular as a component whose main extension is at least a factor of five, preferably at least a factor of ten, and particularly preferably at least a factor of twenty greater than a greatest extension of the component perpendicular to its main extension, i.e. in particular a diameter of the component. A “main extension” of a component is to be understood in particular as its longest extension along its main extension direction. A “main extension direction” of a component is to be understood in particular as a direction which runs parallel to a longest edge of a smallest imaginary cuboid which just completely encloses the component and which preferably runs through a geometric center and / or through a center of mass of the component.

[0028] The resection tool can be configured to remove tissue by cutting and / or vaporization. The resection tool can comprise an electrically conductive material, in particular a wire, through which an electrical current can flow. The resection tool can be designed as an HF (high-frequency) tool. The resection tool can comprise a resection loop. The resection tool can be loop-shaped, hook-shaped, or spherical.

[0029] The resection tool can, in particular, comprise an HF loop (high-frequency loop). Alternatively or additionally, the resection tool can comprise a laser for cutting and / or vaporization. The laser can, in particular, be designed for holmium laser enucleation or KTP laser vaporization, or can be a continuous-wave laser. These laser processes differ in the wavelength and energy of the laser light used, in particular in their energy effect on the tissue and their penetration depth. Alternatively or additionally, the resection tool can comprise a monopolar or bipolar HF tool (high-frequency tool). The monopolar HF tool can be designed as a hook electrode, ball electrode, or spatula electrode for cutting and / or vaporization. The bipolar HF tool can, in particular, be designed as bipolar forceps or pliers for cutting and / or vaporization.The resection tool can also be configured to perform contact coagulation on tissue. Depending on the application, a described configuration of the resection tool may be particularly suitable.

[0030] A safe and precise removal movement can be achieved if the shaft includes a guide device for longitudinally guiding the resection tool. The guide device can, for example, comprise a guide groove extending along the longitudinal axis. It can be recessed into the shaft, for example, on the upper side of the shaft.

[0031] A space-saving, compact resectoscope device can be provided if the resection tool comprises two support arms and a tool tip, in particular an HF resection loop, arranged between the support arms. The shaft can be arranged between the support arms. A support arm can be configured to connect the tool tip to a proximal assembly, in particular the operating assembly. If the tool tip is electronically operated, an electrical supply line, for example a cable, can be guided within the support arm and / or the support arm can form such a supply line. In some embodiments, the support arm can be tubular and accommodate at least one further functional unit and / or further supply lines. In addition, a support arm can be rigid and / or mechanically stable.For example, the tool tip can be moved distally relative to the shaft. In a distally moved state, the resection tool can, for example, protrude up to 10 cm beyond a distal end of the shaft. In this case, the support arm is designed to be so rigid and / or stable and / or stiff that the tool tip does not kink and / or bend significantly. A precise resection can be performed if the support arms are guided in the guide device of the shaft. The guide device can comprise two guide grooves that partially accommodate the support arms. The support arms can extend along the longitudinal axis of the introducer sleeve and / or a longitudinal axis of the shaft.

[0032] The shaft can also comprise a rinsing device, which can be used to rinse an area that can be processed by the resection tool. During tissue removal, the removed tissue can be rinsed away, ensuring a clear view of the tissue to be processed. The rinsing device can comprise a channel that is incorporated into the shaft and / or extends along the longitudinal axis of the shaft. This allows rinsing fluid to be introduced proximally into the channel and guided along the shaft into the cavity.

[0033] Endoscopic imaging can be performed if an image capture device is arranged at a distal end piece of the shaft, which defines an observation area. The image capture device can be configured to image objects within the observation area, in particular an interior of the cavity, and / or to generate image data. An object can, for example, comprise tissue, in particular a section of the bladder wall. Based on the image data, a representation of the interior of the cavity can be generated on a display device. The user can thus use the display device to observe the interior of the urinary bladder and the progress of the resection or removal of tissue. The image capture device can be positionable, in particular by the user, within the cavity independently of the resection tool.

[0034] The image capture device may comprise at least one image capture unit, which may be configured, in particular, by an input optics and / or an image sensor for image generation, in particular a CCD chip or CMOS chip. The input optics may be arranged, for example, on a distal end surface of the shaft.

[0035] If an outlet of the rinsing device is arranged radially below the image capture device and in the distal end piece, targeted and reproducible rinsing can be performed during tissue removal. The rinsing fluid can exit the outlet for rinsing. In a distal view of a distal end of the resectoscope device, the outlet can be arranged below the entrance optics of the image capture device. It is understood that the resectoscope device and / or the shaft could be rotated, and thus the outlet can be arranged radially above the image capture device, particularly with respect to an orientation of the insertion sleeve.

[0036] A large observation area for endoscopic imaging can be achieved if the image acquisition device comprises at least two image acquisition units directed in different viewing directions. Each of the image acquisition units can be configured by an input optics and / or an image sensor for image generation, in particular a CCD chip or CMOS chip. The arrangement of multiple image acquisition devices with different viewing directions improves the image of a tissue to be removed available to a user. The at least two image acquisition devices can in particular comprise a first image acquisition device and a second image acquisition device, wherein the first image acquisition device is directed in a distal viewing direction and wherein the second image acquisition device is directed in a proximal viewing direction.The view from two different sides further improves the image available to the user by taking pictures from different perspectives, and in particular improves visibility when setting a starting point for tissue removal.

[0037] In some embodiments, the image capture device comprises exactly two, exactly three and / or several or at least two image capture units directed in different viewing directions, wherein the image capture units together define a continuous observation area.

[0038] The viewing direction can be directed in a proximal direction relative to the shaft. The viewing direction can be directed in a distal direction relative to the shaft. The viewing direction can be defined by a viewing angle relative to the longitudinal axis of the shaft. A viewing angle of 0° to less than 90° can be considered to be directed in a distal direction, and a viewing angle of more than 90° to 180° can be considered to be directed in a proximal direction.

[0039] The image capture device can comprise at least three image capture units directed in three different viewing directions. The arrangement of several image capture units with different viewing directions improves the image of a tissue to be removed available to a user. The at least three image capture units can define three different imaging regions and in particular each define one imaging region, wherein the different imaging regions can at least partially overlap. The imaging regions can therefore each have a sub-region that lies within an adjacent imaging region. With overlapping imaging regions that are viewed from different viewing directions, the image of a tissue to be removed available to the user is further improved. The overlapping imaging regions can jointly define the observation region.The plurality of image acquisition units can be arranged offset in a longitudinal direction and / or with respect to a longitudinal axis of the shaft, in particular the distal end piece of the shaft, in particular arranged one behind the other. The plurality of image acquisition devices can be arranged offset in a transverse direction of the shaft, in particular the distal end piece of the shaft, in particular arranged side by side.

[0040] The one or more image capture units can each be formed by camera modules, in particular camera modules with short lenses or so-called camera cubes with wafer-level optics. The one or more image capture units each have a single viewing angle. The single viewing angle can be, for example, 60°, 65°, 70°, 75°, 80°, 85°, 90°, 95°, 100°, 105°, or 110°.

[0041] The viewing direction of an image acquisition unit can be a main viewing direction of the respective image acquisition unit. For example, the viewing direction can be a central axis of an input optics of the respective image acquisition unit. The individual viewing angle can be an angle spanned with respect to the viewing direction. In particular, the central axis can be a bisector of the individual viewing angle. Depending on the design of the image acquisition units, this can be defined by two individual viewing angles that are spanned perpendicular to one another. These can, for example, define a viewing angle with respect to a transverse axis or a viewing angle with respect to a vertical axis, each of which is perpendicular to the central axis and / or the viewing direction.Particularly in cases where an image capture unit comprises a rectangular image sensor, both viewing angles belonging to the image capture unit can be assigned to a short and a long side of the rectangular image sensor. The specification of an individual viewing angle can also be understood as the largest viewing angle of the respective image capture unit and / or as a viewing angle corresponding to a diagonal of the respective image sensor. An image capture unit can also be described by a horizontal viewing angle, a vertical viewing angle, and a diagonal viewing angle. Specifications relating to a viewing angle can refer to any of these three quantities and preferably refer to a diagonal viewing angle.

[0042] To illuminate the interior of the cavity, the imaging regions, and / or the observation region, an illumination device configured to provide illumination light can be arranged on a distal end piece of the shaft. Illumination of the imaging region, the imaging regions, and / or the observation region supports the acquisition of an image thereof with the image capture device and thus, in particular, increases the image quality of an image provided to the user. The illumination device can comprise a plurality of illumination units, which are directed, in particular, in different illumination directions. The individual illumination units can be formed by light-emitting diodes and / or laser diodes and / or optical fibers.In particular, in embodiments in which the illumination unit comprises a light guide, the resectoscope device may have an optical connector on a proximal side and / or in the vicinity thereof, which is configured for connection to a light source device.

[0043] A compact resectoscope device can be provided if the image capture device is formed integrally with the illumination device. In particular, the distal end piece can be designed to be compact and efficient in use of space. In some embodiments, the image capture device and the illumination device can be formed in pairs. This can mean that one illumination unit is formed integrally with each image capture unit.

[0044] Furthermore, the resectoscope device can comprise a return line for a rinsing fluid, wherein the return line is formed between the insertion sleeve and the shaft. Tissue residues resulting from the removal can be flushed out of the bladder in order to reduce clouding of the fluid, in particular the rinsing fluid, in the bladder and to ensure a good view of the tissue to be removed. In some embodiments, a clearance can be provided between the insertion sleeve and the shaft, whereby a gap can be created. This gap can form the return line. The outer diameter of the shaft can be approximately up to 10%, in particular up to 7%, preferably up to 4%, smaller than an inner diameter of the insertion sleeve. The resectoscope device can be connected proximally to a suction device, by means of which a suction pressure can be generated in order to convey the rinsing fluid up from the cavity, in particular the bladder.

[0045] The present invention is described below by way of example with reference to the accompanying figures. The drawings, the description, and the claims contain numerous features in combination. Those skilled in the art will expediently consider the features individually and use them in meaningful combination within the scope of the claims.

[0046] If there is more than one instance of a particular object, only one of them may be provided with a reference symbol in the figures and in the description. The description of this instance can be transferred accordingly to the other instances of the object. If objects are named using numerical terms, such as first, second, third object, etc., these serve to name and / or assign objects. Accordingly, for example, a first object and a third object, but not a second object, may be included. However, a number and / or sequence of objects could also be derived using numerical terms.

[0047] They show:

[0048] Fig. 1 is a schematic representation of a resectoscope device in a side view;

[0049] Fig. 2 is a schematic representation of the resectoscope device in a distal view;

[0050] Fig. 3 is a perspective schematic representation of the resectoscope device in a first position;

[0051] Fig. 4 is a perspective schematic representation of the resectoscope device in a second position; Fig. 5 is a schematic side view of a resectoscope device in a third position; and

[0052] Fig. 6 is a schematic representation of a resectoscope comprising the resectoscope device, a control unit and a display device.

[0053] Figure 1 shows a schematic representation of a resectoscope device 10 in a side view. The resectoscope device 10 is configured to perform a resection and comprises an insertion sleeve 12 having a longitudinal axis 16, a shaft 18, and a resection tool 20. The resectoscope device 10 is shown in one of many possible positions. The positions are defined by the relative position of the insertion sleeve 12, the shaft 18, and the resection tool 20. These assemblies 12, 18, 20 are movable independently of one another.

[0054] The introducer sheath 12 is shown inserted into a urethra 13. A distal end portion 15 of the introducer sheath 12 extends into a bladder 11. It is also conceivable that in other situations, for example, depending on a patient's anatomy, the introducer sheath 12 may not extend into the bladder 11. Since the introducer sheath 12 is tubular and defines a guide channel 17, it provides trocar-like access to the bladder 11 for the shaft 18 and the resection tool 20.

[0055] The shaft 18 and the resection tool 20 extend along the longitudinal axis 16 of the introducer sleeve 12 through the guide channel 17 into the cavity 14, in this case the bladder 11. These assemblies 18, 20 can be inserted into the urethra 13 together with the introducer sleeve 12 by being mechanically coupled to one another. Once the introducer sleeve 12 is positioned in a desired direction, the shaft 18 and the resection tool 20 can be advanced further distally.

[0056] The shaft 18 has, at its distal end piece 34, an image capture device 36 for endoscopic imaging of the interior of the bladder 11 and an illumination device 46 for illuminating the interior of the bladder 11. The image capture device 36 and the illumination device 46 are formed integrally with one another. Furthermore, a guide device 24, which is designed as a guide groove, is formed on a surface of the shaft 18. Furthermore, the shaft 18 comprises a

[0057] Flushing device 32 comprising a channel 33 and an outlet 40. The channel 33 extends along a longitudinal axis of the shaft 18 from proximal to distal to a distal end piece 34 of the shaft 18. A flushing fluid can be passed through the channel 33 and exits at the outlet 40. The flushing fluid can be used to fill the bladder 11 for resection and also to flush away tissue residues resulting from the resection.

[0058] The image capture device 36 comprises three image capture units 42 that define different viewing directions 44, 44', 44". One image capture unit 42 has a distal viewing direction 44', and another image capture unit 42 has a proximal viewing direction 44". The image capture units 42 together define a continuous observation area 38. Each of the image capture units 42 has its own imaging area 54. These each have a partial area 56 that partially overlaps an imaging area 54 of an adjacent image capture unit.

[0059] The image capture units 42 each comprise an input optics and an image sensor for image generation (neither shown in detail), which in particular comprises a CCD chip or CMOS chip. The image capture units 42 are formed integrally with illumination units (not shown in detail) of the illumination device 46, which are designed as LEDs.

[0060] The guide device 24 extends along a large part of the shaft 18 into the distal end piece 34. The end of the guide device 24 in the distal end piece 34 is provided as an open guide groove. The guide device 24, in particular the guide groove, partially accommodates support arms 26 of the resection tool 20. As a result, the support arms 26 are guided linearly along the longitudinal axis 16 in the guide device 24. The support arms 26 can therefore be displaced linearly from proximal to distal and vice versa in the guide device 24. Through this displacement, a tool tip 28 can be moved linearly relative to the shaft 18 and independently of it. In particular, the tool tip 28 can be moved beyond a distal end 58 of the shaft 18 (see Fig. 4). In the present case, the tool tip 28 is designed as a conventional HF resection loop 30.

[0061] Furthermore, the resectoscope device 10 includes a proximal operating assembly (see Fig. 6) that is movable as a whole relative to the introducer sheath 12. A user can hold the resectoscope device 10 by the operating assembly and operate a resectoscope comprising the resectoscope device 10 (see Fig. 6).

[0062] Using the resectoscope device 10, the user can perform a resection as follows. First, the user guides the shaft 18 and the resection tool 20 together with the insertion sleeve 12 into the cavity 14, in this case the urethra 13 and partially the bladder 11. In doing so, the user brings the insertion sleeve 12 into a desired position within the urethra 13. The user then fills the bladder 11 using the irrigation device 32 to expand it. Subsequently, the user positions the distal end piece 34 of the shaft 18, comprising the image capture device 36, within the bladder 11. To do so, the user advances the shaft 18 distally relative to the insertion sleeve 12. The insertion sleeve 12 remains in its original position. This reduces the total distance traveled by a relative movement between a resectoscope device and the urethra compared to the prior art.

[0063] During advancement, the resection tool 20 is coupled to the shaft 18. This means that both assemblies 18, 20 are advanced together. By pivoting the shaft 18 and advancing it as needed, the user can gain an overview of the interior of the bladder 11 and examine the tissue 22 on an inner wall of the bladder 11. This allows them to identify tissue to be removed that might exhibit a pathological change. An example of such tissue is cancerous tissue.

[0064] This identified tissue can then be removed using the tool tip 28. To do this, the user brings the distal end portion 34 of the shaft 18 into close proximity with the tissue by pivoting the shaft 18 and longitudinally positioning the shaft 18. During longitudinal positioning, the introducer sheath 12, as already described, remains stationary relative to the urethra 13 or the cavity 14. In other words, the introducer sheath 12 rests atraumatically.

[0065] After positioning the distal end piece 34, the user moves the resection tool 20 relative to the shaft 18, with the introducer sleeve 12 also resting in a stationary, atraumatic manner, and brings the tool tip 28 into contact with the tissue. After activating the tool tip 28, if it is designed, for example, as an HF resection loop, the tissue can be removed layer by layer. For this purpose, the tool tip 28 is iteratively stroked over the tissue, superficially processing and ablating the tissue to be removed. To stroke the tissue, the resection tool 20 can be moved relative to the shaft 18. Furthermore, the shaft 18 can be moved together with the resection tool 20, although the introducer sleeve 12 remains stationary in the urethra 13.

[0066] During the removal of the tissue, constant flushing is carried out by means of the flushing device 32 and flushing fluid is transported out of the bladder 11 by means of the return line 48.

[0067] After the resection has been completed, the shaft 18 can be pulled out of the cavity 14 together with the resection tool 20 and the insertion sleeve 12.

[0068] The shaft 18 and the resection tool 20 are thus configured to be moved within the insertion sleeve 12 after being introduced into the cavity 14 during the removal of tissue 22. The insertion sleeve 12 is configured to remain atraumatically stationary during the removal of tissue 22.

[0069] Fig. 2 shows a schematic representation of the resectoscope device 10 in a distal view of a distal end 58 of the shaft 18 or of a distal end surface of the resectoscope device 10. A distal end surface 59 of the shaft 18 can be seen, on which an illumination unit 47 of the illumination device 56 is arranged, which is designed as an LED. An input optics 43 of one of the image acquisition units 42 is also arranged on the distal end surface 59. The outlet 42 of the rinsing device 32 is arranged radially below the image acquisition device 36.

[0070] Also visible is the guide device 24, the distal end of which is laterally recessed into the distal end surface 59. The support arms 26 are guided in the guide device 24. The resection tool 20 comprises two support arms 26. The tool tip 28, in particular the HF resection loop 30, is arranged between the support arms 26. The shaft 18 is arranged between the support arms 26. The shaft 18 has play in the insertion sleeve 12. Therefore, a gap 49 can be seen between the insertion sleeve 12 and the shaft 18. This gap 49 forms the return line 48. The rinsing fluid can thus be suctioned through the gap 49.

[0071] In the illustrated embodiment, the insertion sleeve 12 has an outer diameter of 9 mm and an inner diameter of 7.5 mm. The shaft 18 has an outer diameter of 6.5 mm. The shaft 18 has a length of 30 cm. The insertion sleeve 12 has a length of 25 cm. Significantly shorter insertion sleeves 12 are also conceivable, for example, half the length of the shaft 18. Even shorter insertion sleeves 12 are also conceivable. The dimensions mentioned are merely examples.

[0072] Figures 3 and 4 each show a perspective schematic representation of the resectoscope device 10 in different positions. These positions are defined by a different relative position of the resection tool 20 with respect to the shaft 18.

[0073] Fig. 3 shows the resection device 10 with the image capture device 36 and the rinsing device 32 in the distal end piece 34 of the shaft 18. Also visible is the resection tool 20 with the tool tip 28 and one of the support arms 26. Also visible is the insertion sleeve 12, which is guided toward the urethra 13. The shaft 18 and the resection tool 20 extend through the insertion sleeve 12 and into the urinary bladder 11. The shaft 18 and the resection tool 20 can be moved together relative to the insertion sleeve 12, with the insertion sleeve 12 remaining stationary in the urethra 13. In the position shown in Fig. 3, the tool tip 28 is arranged flush with the distal end 58 of the shaft 18.

[0074] As shown in Fig. 4, the resection tool 20 can be moved independently of the shaft 18 relative to the shaft 18 and the insertion sleeve 12. In the position shown in Fig. 4, the tool tip 28 is arranged distally beyond the distal end 58 of the shaft 18. The insertion sleeve 12 remains in the same position as shown in Fig. 3. The resection tool 20 has thus been moved independently of the shaft 18.

[0075] Fig. 5 shows a schematic side view of the resectoscope device 10 in another position. In the position shown, the distal end piece 34 of the shaft 18 is completely enclosed by the insertion sleeve 12. The resection tool 20 also does not extend distally beyond the insertion sleeve 12. In the position shown, the resectoscope device 10 could, for example, be introduced into the cavity 14. However, other positions are also conceivable, in which at least one of the assemblies 18, 20 extends distally beyond the insertion sleeve 12.

[0076] Fig. 6 shows a schematic representation of the resectoscope 60, which comprises the resectoscope device 10. Furthermore, the proximal operating assembly 50 can be seen, which is movable as a whole relative to the insertion sleeve 12. The proximal operating assembly 50 also includes an actuating device 51, by means of which the resection tool 20 can be operated, in particular pushed forward and backward.

[0077] The resectoscope 60 is connected to a control unit 62, which can, for example, process image data and control a function of the resectoscope 60. In particular, the image acquisition device can be controlled by the control unit 62. The control unit 62 is connected to a display device 64, on which a representation of an endoscopic image can be generated. Using the display, the user can view the interior of the bladder 11 and thus also monitor the performance of the resection.

[0078] List of reference symbols

[0079] 10 Resectoscope device

[0080] 11 Bladder

[0081] 12 introducer sleeve

[0082] 13 Urethra

[0083] 14 Cavity

[0084] 15 distal end piece

[0085] 16 Longitudinal axis

[0086] 17 Guide channel

[0087] 18 shaft

[0088] 20 Resection tool

[0089] 22 fabrics

[0090] 24 guidance device

[0091] 26 support arm

[0092] 28 tool tip

[0093] 30 HF resection loop

[0094] 32 Flushing device

[0095] 33 Channel

[0096] 34 distal end piece

[0097] 36 Image capture device

[0098] 38 Observation area

[0099] 40 outlet

[0100] 42 Image acquisition unit

[0101] 43 Entrance optics

[0102] 44 Direction of view

[0103] 46 Lighting equipment

[0104] 47 Lighting unit

[0105] 48 Return

[0106] 49 gap

[0107] 50 proximal control module

[0108] 51 Actuating device

[0109] 52 viewing angles

[0110] 54 imaging area

[0111] 56 sub-area

[0112] 58 distal end

[0113] 59 distal end surface

[0114] 60 Resectoscope 62 Control unit

[0115] 64 Display device

Claims

Claims 1. Resectoscope device (10), comprising: an introducer sleeve (12) which can be partially fed into a cavity (14) of a patient and which defines a longitudinal axis (16), a shaft (18) which extends within the introducer sleeve (12), and a resection tool (20), wherein the shaft (18) and the resection tool (20) can be fed together with the introducer sleeve (12) into the cavity (14), and wherein the shaft (18) and the resection tool (20) are movable independently of one another relative to the introducer sleeve (12) along the longitudinal axis (16).

2. Resectoscope device (10) according to claim 1, wherein the shaft (18) and the resection tool (20) are adapted to be moved within the insertion sleeve (12) after being fed into the cavity (14) during removal of tissue (22).

3. Resectoscope device (10) according to claim 1 or 2, wherein the insertion sleeve (12) is adapted to rest atraumatically during removal of tissue (22).

4. Resectoscope device (10) according to one of the preceding claims, wherein the shaft (18) has a guide device (24) for longitudinal guidance of the resection tool (20).

5. Resectoscope device (10) according to one of the preceding claims, wherein the resection tool (20) comprises two support arms (26) and a tool tip (28), in particular an HF resection loop (30), arranged between the support arms (26), and wherein the shaft (18) is arranged in particular between the support arms (26).

6. Resectoscope device (10) according to claim 4 and 5, wherein the support arms (26) are guided in the guide device (24) of the shaft (18).

7. Resectoscope device (10) according to one of the preceding claims, wherein the shaft (18) comprises a rinsing device (32) by means of which an area that can be processed by the resection tool (20) can be rinsed.

8. Resectoscope device (10) according to one of the preceding claims, wherein on a distal end piece (34) of the shaft (18) a Image capture device (36) is arranged which defines an observation area (38).

9. Resectoscope device (10) according to claim 7 and 8, wherein an outlet (42) of the rinsing device (32) is arranged radially below the image capture device (36) and in the distal end piece (34).

10. Resectoscope device (10) according to claim 8 or 9, wherein the image acquisition device (36) comprises at least two image acquisition units (42) directed in different viewing directions (44).

11. Resectoscope device (10) according to one of the preceding claims, wherein on a distal end piece (34) of the shaft (18) a Lighting device (46) is arranged, which is designed to provide illumination light.

12. Resectoscope device (10) according to claim 11 and one of claims 8 to 10, wherein the image capture device (36) is formed integrally with the illumination device (46).

13. Resectoscope device (10) according to one of the preceding claims, further comprising a return line (48) for a rinsing liquid, wherein the Return (48) is formed between the insertion sleeve (12) and the shaft (18).

14. Resectoscope device (10) according to one of the preceding claims, further comprising a proximal operating assembly (50) which is movable as a whole relative to the insertion sheath (12).

15. Resectoscope (60) with a resectoscope device (10) according to one of the preceding claims.

Images