Guide for a medical instrument, a set of a guide and such an instrument, an installation comprising such a set
The guide assembly with movable orifices addresses the challenge of precise prostate access, enhancing the accuracy of needle insertion and control during biopsies and treatments.
Patent Information
- Application Number
- FR2023007065
- Authority / Receiving Office
- FR · FR
- Patent Type
- Patents
- Current Assignee / Owner
- Priority Date
- 2022-07-01
- Filing Date
- 2023-07-03
- Publication Date
- 2025-12-05
- Estimated Expiration
- 2043-07-03
AI Technical Summary
Existing needle guides for prostate biopsies and treatments do not allow precise access to all areas of the prostate, limiting the ability to accurately target the organ.
A guide assembly with a base and a support that includes a column with orifices, allowing the medical instrument to move relative to the distal face along an inclined or orthogonal axis, providing enhanced access to the targeted organ.
The guide assembly facilitates easier and more precise insertion of medical instruments into the prostate, enabling better targeting and control during procedures.
Smart Images
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Abstract
Description
Title of the invention: Guide for a medical instrument, assembly of a guide and such an instrument, installation comprising such an assembly
[0001] BACKGROUND OF THE INVENTION
[0002] In order to perform a biopsy of a patient's prostate or to treat a patient's prostate in a localized manner, it is known to use a needle (for treatment and / or biopsy).
[0003] Typically, an ultrasound probe is inserted into the patient's rectum, allowing visualization of the needle insertion to ensure the correct needle trajectory. The probe is usually fitted with a needle guide whose grid remains external to the patient, positioned over their pelvic area. The grid has openings through which the needle can be inserted and then pass through the patient.
[0004] Such a guide thus makes it possible to ensure that the needle will be properly inserted in the acquisition plane of the probe, and therefore that the insertion of the needle deep into the prostate can be controlled by ultrasound.
[0005] Unfortunately, this type of guide does not always allow precise access to all areas of the prostate.
[0006] SUBJECT OF THE INVENTION
[0007] The invention aims in particular to provide a guide which makes it easier to act on the targeted organ.
[0008] The invention also relates to an assembly of a guide and an associated instrument.
[0009] The invention also relates to an installation comprising such an assembly. Summary of the invention
[0010] For this purpose, the invention provides an assembly of a guide and a medical instrument, the guide comprising:
[0011] - a base intended to be carried by a device comprising an imaging probe medical associated with the medical device, and
[0012] - a support extending the base and in which at least one column is provided comprising at least one orifice, the column extending along a first axis, the medical instrument being able to extend through at least the orifice between a proximal face and a distal face of the support.
[0013] According to the invention, the orifice is shaped into a slot and / or extends only over a portion of the support between the distal and proximal faces of the guide, so that the guide allows movement of at least a portion of the medical instrument. relative to the distal face of the support along at least one axis of movement which is inclined or orthogonal to the first axis.
[0014] Thus, the invention allows the instrument to be guided since the walls of the orifice restrict the movements of the instrument, while allowing a deflection at the level of the distal face of the support which allows an operator to act more easily on a targeted organ (such as, for example and without limitation, a prostate).
[0015] For the present application, "slit" means a narrow opening stretched in a particular direction.
[0016] Optionally the medical instrument is a needle.
[0017] Optionally the orifice has a section which widens or narrows between the proximal and distal face of the guide.
[0018] Optionally the orifice opens at its distal end into a slot formed in the support so that the slot itself opens at the level of the distal face of the guide.
[0019] Optionally the assembly includes several orifices.
[0020] Optionally, several orifices open into said slot.
[0021] Optionally, the orifice allows at least a portion of the instrument to be locked in position.
[0022] The invention also relates to a guide for an assembly such as the one mentioned above.
[0023] The invention also relates to an assembly as described above and to a device including a medical imaging probe.
[0024] Other features and advantages of the invention will become apparent from the following description of particular, non-limiting embodiments of the invention. Brief description of the drawings
[0025] Reference will be made to the attached drawings, among which:
[0026] [Fig-1] [Fig.1] schematically represents an installation according to a mode of particular realization of the invention, acting on a patient;
[0027] [Fig.2a] [Fig.2a] is a guide according to a first option of the installation illustrated in the [Fig.l];
[0028] [Fig.2b] [Fig.2b] is a rear view of the guide illustrated in [Fig.2a];
[0029] [Fig. 3a] [Fig. 3a] is a schematic cross-sectional view of part of a guide according to a second option of the installation illustrated in [Fig.1];
[0030] [Fig. 3b] [Fig. 3b] is a schematic axial cross-sectional view of the guide part illustrated in [Fig.3a];
[0031] [Fig.4a] [Fig.4a] is a three-dimensional view of a guide along a third installation option illustrated in [Fig.1];
[0032] [Fig.4b] [Fig.4b] is a cross-sectional view of the guide shown in [Fig.4a];
[0033] [Fig. 5a] [Fig. 5a] is a three-dimensional view of a guide according to a fourth installation option illustrated in [Fig.1];
[0034] [Fig.5b] [Fig.5b] is a cross-sectional view of the guide shown in [Fig.4a];
[0035] [Fig.6] [Fig.6] is a guide according to a fifth option of the installation illustrated in the [Fig.l];
[0036] [Fig.7] [Fig.7] is a guide according to a sixth option of the installation illustrated in the [Fig.1], instruments being shown arranged in the said guide;
[0037] [Fig.8] [Fig.8] is a guide according to a seventh option of the installation illustrated in [Fig.1]. DETAILED DESCRIPTION OF THE INVENTION
[0038] Fig. 1 illustrates an installation 1 according to a first embodiment of the invention.
[0039] The installation 1 also includes a control device 2 generally extending longitudinally along a Z axis to facilitate its insertion into a patient's rectum.
[0040] Preferably, the device 2 comprises a base 3, extending parallel to the Z-axis, which is intended to be grasped at its proximal end by an operator and which is extended at its distal end by a notch 4 in the device 2. Said notch 4 is itself extended by a medical imaging probe 5 of the device 2 to allow the generation of three-dimensional images of the prostate 100 and its surroundings, probe 5 also extending along the Z-axis. In this way, the device 2 is more easily manipulated by the operator due to the notch 4.
[0041] To facilitate the operator's work, the installation 1 may include a co-manipulation system for the device 2, linked to the proximal end of the device 2. The co-manipulation system is, for example, a robot, an articulated arm...
[0042] Probe 5 is an ultrasound probe intended for insertion into the patient's rectum. This application is not limited to this purpose, and the system can be used with other types of imaging, i.e., other types of probes.
[0043] In addition, the installation 1 includes a guide 10 attached to the device 2. More specifically here, the guide 10 is carried by the probe 5. The guide 10 is therefore arranged on the device 2 downstream of the step 4 (in a direction going from the base 3 to the probe 5).
[0044] Preferably, the guide 10 is mounted to slide on the probe 5 (for example along the Z axis) so that its position can be changed with respect to the patient.
[0045] The guide 10 thus comprises a base 11 which is the part for attaching to the device 2 and a support 12 extending from the base 11 and in which is provided at least one column 13 comprising at least one orifice 14 (only one being referenced in [Fig. 1]), the column 13 extending along a second axis X which is orthogonal to the axis Z.
[0046] Optionally, the guide 10 is in the form of a post. The guide 10 thus comprises a single column 13 with at least one orifice 14 extending along the X axis.
[0047] In the present case, the guide 10 is a needle guide and the medical instrument of the installation 1 is therefore a needle 6.
[0048] The guide 10 is thus shaped so that the needle 6 can extend through each of the orifices 14 (or the single orifice 14) of the column 13 between a proximal face 15 (i.e., the one closest to an operator holding the device 2) and a distal face 16 of the support 12 (i.e., the one closest to the patient).
[0049] The needle 6 can thus be inserted into the guide 10 at a different height (along the X axis) which makes it possible to define the height at which the needle 6 is inserted into the perineum.
[0050] Preferably the guide 10 includes graphic markers (graduations, alphanumeric characters ...) to identify the potential different orifices 14 of the column 13. Optionally, the guide 10 includes letters to identify each orifice 14.
[0051] The different orifices 14 (if the column 13 has several) are for example all identical to each other.
[0052] The guide 10 also includes a groove 7 formed in the base 11 and / or the support 12. This groove 7 allows, in use, an additional instrument to pass through the guide 10 (an instrument larger than the medical instrument passed through one of the orifices 14), such as, for example, a tube for inflating an intracavitary balloon. The groove 7 may be centered in the guide 10 relative to the column 13 or may be offset in the guide 10 relative to the column 13. The groove 7 has a larger cross-section than the orifices 14 at the proximal face 15 of the support 12. The groove 7 may, for example, have a cross-section that is at least partially circular. The guide 10 may also not include such a groove 7.
[0053] According to the invention, the guide 10 allows a movement of at least a part of the medical instrument relative to the distal face 16 of the support 12 along at least one axis of movement that is inclined or orthogonal to the X axis and / or the Z axis. For example, the guide 10 allows a movement of at least a part of the medical instrument relative to the distal face 16 of the support 12 along at least one axis of movement Y that is orthogonal to the X and Z axes.
[0054] Preferably, the guide 10 allows a movement of at least part of the medical instrument around a Y axis which is orthogonal to the two-dimensional acquisition plane of the probe 5. In this way, the medical instrument remains visible on the ultrasound image provided to the operator while being able to be moved relative to the distal face 16 of the support 12. The ultrasound plane here includes the Z axis and the X axis.
[0055] Different options from guide 10 are thus envisaged (it being understood that what has been said above is applicable to the different options indicated below).
[0056] With reference to figures 2a and 2b, according to a first option, column 13 has a plurality of orifices 14. The different orifices 14 (only one being referenced here) all extend straight parallel to each other and to the Z axis.
[0057] The various orifices 14 all open at their proximal end onto the proximal face 15 of the support 12 and at their distal end 16 into a slot 17 common to at least two orifices 14, and here to all the orifices 14. The orifices 14 have the same cross-section along their entire length (considered along the Z-axis). The slot 17 has the same cross-section along its entire length (considered along the Z-axis).
[0058] Said slot 17 is itself provided in the support 12 so as to open at the level of the distal face 16 of the support 12.
[0059] The slot 17 is for example of oblong cross-section.
[0060] The slot 17 is arranged so as to form an opening stretched parallel to the X axis.
[0061] The guide 10 is shaped so as to allow a movement of a medical instrument inserted in one of its orifices 14 vis-à-vis the distal face 16 of the support 12 around the aforementioned Y axis of movement.
[0062] This range of motion is preferably between 5 and 15 degrees, and preferably between 8 and 12 degrees, and preferably between 9 and 11 degrees, and is preferably 10 degrees.
[0063] The guide 10 is thus less permissive at the level of its proximal face 15 than at the level of its distal face 16.
[0064] With reference to figures 3a and 3b, according to a second option, the column 13 has a single orifice 14. Said orifice 14 extends straight parallel to the Z axis.
[0065] The orifice 14 opens at its proximal end onto the proximal face 15 of the support 12 and at its distal end onto the distal face 16 of the support 12. The orifice 14 has the same cross-section over its entire length.
[0066] The orifice 14 is shaped into a slot 17. The slot 17 is, for example, oblong in cross-section. The slot 17 is arranged so as to form an opening elongated parallel to the X axis.
[0067] In order to ensure guidance of the medical instrument, the slot 17 has a width (along the Y axis of travel) substantially equal to that of the medical instrument.
[0068] The guide 10 is thus as permissive at the level of its proximal face 15 as at the level of its distal face 16.
[0069] With reference to figures 4a and 4b, according to a third option, the column 13 has a single orifice 14. Said orifice 14 extends straight parallel to the Z axis.
[0070] The orifice 14 is shaped into a first slot 17. The first slot 17 is, for example, oblong in cross-section. The first slot is arranged so as to form an opening stretched parallel to the X axis.
[0071] In order to ensure guidance of the medical instrument, the first slot 17 has a width (along the Y axis of travel) substantially equal to that of the medical instrument.
[0072] The orifice 14 opens at its proximal end onto the proximal face 15 of the support 12 and at its distal end 16 into a second slot 18. The orifice 14 has the same cross-section along its entire length (considered along the Z-axis). The second slot 18 has the same cross-section along its entire length (considered along the Z-axis).
[0073] The second slot 18 is itself provided in the support 12 so as to open at the level of the distal face 16 of the support 12.
[0074] The second slot 18 is for example of oblong cross-section.
[0075] The second slot 18 is arranged to form an elongated opening parallel to the X-axis.
[0076] The first slot 17 and the second slot 18 extend in line with each other and coaxially with each other (and here parallel to the Z axis).
[0077] Optionally, the second slot 18 has a greater length (considered along the Z axis) than the first slot 17. Alternatively, the two slots have the same length or the first slot 17 has a greater length than the second slot 18.
[0078] The first slot 17 has a larger cross-section than the second slot 18.
[0079] The guide 10 is thus more permissive at the level of its proximal face 15 than at the level of its distal face 16.
[0080] A variant of this third option consists in the second slot 18 having a larger cross-section than the first slot 17. The guide 10 will then be less permissive at its proximal face 15 than at its distal face 16.
[0081] With reference to Figures 5a and 5b, according to a fourth option, the column 13 comprises a plurality of orifices 14 (only one being referenced here). The various orifices 14 all extend straight parallel to each other and to the Z-axis.
[0082] The various orifices 14 all open at their proximal end onto the proximal face 15 of the support 12 and at their distal end into a slot 17 common to at least two orifices 14, and here to all the orifices 14. The orifices 14 have the same cross-section along their entire length (considered along the Z-axis). The slot 17 has the same cross-section along its entire length (considered along the Z-axis).
[0083] Said slot 17 is itself provided in the support 12 so as to open at the level of the distal face 16 of the support 12.
[0084] The slot 17 is for example of oblong cross-section.
[0085] The slot 17 is arranged so as to form an opening stretched parallel to the axis X.
[0086] The orifices 14 have a larger cross-section than that of the first option.
[0087] The orifices 14 thus have a cross-section allowing a portion of the medical instrument to be housed in each of the orifices 14. In the case where the medical instrument is a needle, its proximal end may form a plate made of a material different from that of the needle. It is therefore at least a portion of this plate that could be received in the orifice 14.
[0088] Preferably, at least one of the orifices is shaped so that the cross-section of the orifice 14 is substantially equal to that of said portion of the medical instrument. In this way, the orifice 14 locks (for example by friction) said portion of the instrument in the orifice 14.
[0089] The medical instrument will therefore have little or no movement relative to the proximal face 15 of the support 12 due to its blocked portion. However, the free end of the medical instrument will be able to move because the length of the medical instrument is much greater than that of the slot 17.
[0090] In particular, it is thus possible to insert the medical instrument obliquely through the guide 10 in a secure manner.
[0091] The guide 10 will then be less permissive at the level of its proximal face 15 than at the level of its distal face 16.
[0092] According to a fifth option, visible in [Fig.6], the column 13 has at least one orifice 14. The orifice 14 extends straight parallel to the Z axis.
[0093] The orifice 14 opens at its proximal end onto the proximal face 15 of the support 12 and at its distal end onto the distal face 16 of the support 12.
[0094] The orifice 14 has a section which narrows or increases between its proximal end and its distal end (depending on whether the guide 10 is to be more or less permissive at its proximal face 15).
[0095] Optionally, the orifice 14 is shaped into a slot 17. The slot 17 is, for example, oblong in cross-section. The slot 17 is arranged so as to form an opening elongated parallel to the X-axis.
[0096] In order to ensure guidance of the medical instrument, the slot 17 has a width (along the Y axis) substantially equal to that of the medical instrument.
[0097] With reference to [Fig.7], according to a sixth option, column 13 comprises a first column of orifices 14a and a second column of orifices 14b.
[0098] The various orifices 14a of the first column all open at their proximal end onto the proximal face 15 of the support 12 and at their distal end into a slot 17 common to at least two orifices, and here to all the orifices.
[0099] The various orifices 14b of the second column all open at their distal end onto the distal face 16 of the support 12 and at their proximal end into the slot 17.
[0100] The slot 17 is thus common to all the orifices of the first column of orifices 14a and of the second column of orifices 14b.
[0101] The slot 17 has the same cross-section along its entire length (considered along the Z-axis). The slot 17 is, for example, oblong in cross-section. The slot 17 is arranged so as to form an opening elongated parallel to the X-axis.
[0102] Furthermore, the guide 10 is configured so that each orifice 14a of the first column of orifices is opposite an orifice 14b of the second column of orifices and, for example, is collinear with said orifice 14b of the second column of orifices.
[0103] In this way, by introducing a medical instrument into one of the orifices 14a of the first column of orifices 14a it is possible to make it pass through the orifice 14b opposite the second column of orifices 14b (the medical instrument then extending straight and optionally parallel to the Z axis) or to make it pass through an orifice 14b of the second column of orifices 14b which is not opposite the orifice 14a concerned of the first column of orifices 14a.
[0104] Optionally, the various orifices 14a, 14b all extend straight parallel to each other and to the Z axis. The orifices 14a, 14b have the same cross-section over their entire length (considered along the Z axis).
[0105] Alternatively, at least one orifice (preferably from the second column of orifices 14b) is shaped to facilitate the exit of the medical instrument from the support 12. For example, the orifice is funnel-shaped from the slot 17 towards the associated face of the support 12 (distal or proximal).
[0106] Preferably, the orifices of the second column of orifices 14b are funnel-shaped from the slot 17 to the distal face 16 of the support 12 (i.e. their cross-section narrows as one approaches the distal face 16) and / or the orifices of the first column of orifices 14a are funnel-shaped from the slot 17 to the proximal face 15 of the support 12 (i.e. their cross-section narrows as one approaches the proximal face 15).
[0107] The funnel shape of the orifices in the second column of orifices 14b makes it easier to remove the medical instrument from the support 12. The funnel shape of the orifices in the first column of orifices 14a makes it easier to tilt the medical instrument relative to the distal face 16 of the support 12 if desired.
[0108] The guide 10 is thus as permissive at the level of its proximal face 15 as at the level of its distal face 16.
[0109] Preferably, the orifices of the first column of orifices 14a are arranged at regular intervals and / or the orifices of the second column of orifices 14b are arranged at regular intervals. Preferably, the orifices of the first column of orifices 14a and the orifices of the second column of orifices 14b are arranged at regular intervals with the same spacing between two successive orifices of the first column of orifices 14a as the spacing between two successive orifices of the first column of orifices 14b.
[0110] This makes it easier to define in advance the angle that the medical instrument will draw with an axis parallel to the Z axis.
[0111] Of course, the invention is not limited to the embodiments described but encompasses any variant falling within the scope of the invention as defined by the claims.
[0112] In particular, although here the guide is shaped as a post, the guide can be shaped differently and, for example, as a grid. The grid can extend in a plane substantially normal to the Z-axis. The grid will have openings arranged in columns and arranged in rows on the grid.
[0113] Although here the medical instrument associated with the guide is a needle, the medical instrument may be another instrument.
[0114] The guide may be shaped to allow a deflection around the Y-axis with respect to the distal face of the support different from that indicated, and for example a deflection of at least 10 degrees, 17 degrees, 17.7 degrees, 28 degrees, 30 degrees, etc.
[0115] The different options can be combined with each other. For example, a slot according to, for example, the first option can be associated with an orifice of variable cross-section (as proposed in the fifth option).
[0116] The guide can be defined according to whether it is desired to be more permissive at its proximal face, its distal face, or equally permissive at its distal and proximal faces. To this end, any option described above can be modified, or one or more options (modified or unmodified) can be combined.
[0117] Although the support is always closed laterally (the orifice(s) or slot(s) opening only at the proximal and distal faces of the support), the support may have at least one lateral opening. For example, as illustrated in [Fig. 8], the lateral opening may extend between the inside and outside of the slot in a direction orthogonal to the X and / or Z axes. The lateral opening may, for example, open at one end into a slot in the support and at the other end outside the support. In this way, once the instrument is in place in the patient's body, it is possible to remove the guide by passing the instrument through the lateral opening provided for this purpose. Preferably, the lateral opening is shaped to allow the passage of the medical instrument even if it extends obliquely between the distal and proximal faces of the support.For example, the lateral opening has a greater height (along the X-axis) than the medical instrument. Such a lateral opening may itself lead to the proximal face and / or the proximal face of the support.
[0118] The guide may be partially or fully transparent, for example, to help the user guide the needle more easily. Alternatively or in addition, the guide may include one or more markings, for example, to help the user guide the instrument more easily: lines (for example, connecting an orifice in the first column of orifices to an orifice in the second column of orifices that is at the same height), alphanumeric markers, etc.
Claims
Demands
1. A guide and a medical instrument assembly, the guide (10) comprising: - a base (11) intended to be carried by a device comprising a medical imaging probe associated with the medical instrument, and - a support (12) extending from the base and in which is provided at least one column (13) comprising at least one orifice (14), the column extending along a first axis (X), the medical instrument being able to extend through at least the orifice between a proximal face (15) and a distal face (16) of the support,the assembly being characterized in that • it comprises only a single column having only a single orifice shaped as a slot or • the orifice extends only over a portion of the support between the distal and proximal faces of the guide such that the guide allows movement of at least a portion of the medical instrument relative to the distal face of the support along at least one axis of movement which is inclined or orthogonal to the first axis, the orifice (14) opening at its distal end into a slot (17) formed in the support such that the slot itself opens at the level of the distal face (16) and / or such that the slot (17) opens into different orifices forming a column, said orifices thus all opening at their distal end onto the distal face and at their proximal end into the slot (17).
2. Assembly according to claim 1, wherein the medical instrument is a needle (6).
3. Assembly according to any one of the preceding claims, wherein the orifice (14) has a section which widens or narrows between the proximal face (15) and the distal face (16).
4. Assembly according to any one of the preceding claims, comprising several orifices (14).
5. Assembly according to claim 4, wherein several orifices (14) open into the slot (17).
6. 12 Assembly according to any one of the preceding claims, wherein the orifice allows at least a portion of the instrument to be locked in position.
7.
8. Guide for an assembly according to one of the preceding claims. Installation comprising an assembly according to one of claims 1 to 6 and an apparatus comprising a medical imaging probe.