This invention relates to an endoscope power supplying appliance, and in particular to an endoscope power supplying appliance capable of endoscopic surgical operation with a single skin incision. Further this invention relates to a power supplying appliance suitable for blocking operation of nerve fibers such as sympathetic nerves and parasympathetic nerves, and in particular, blocking operation of sympathetic nerves in thoracic part under thoracoscope.
In conventional so called endoscopic operations, surgical operations using endoscope, an endoscope and operational devices such as electric knives and electrodes for cautery are inserted from different skin incisions. Consequently at least two skin incisions and in some cases more than three incisions are necessary in such operations. And bar shaped devices with no cavities are used for the operation devices such as electric knives and electrodes for cautery for perfect sterilization and prevention of pollution. Consequently cylindrical shaped devices are not used.
However to reduce patients"" load and to facilitate earlier recovery after surgical operations, it is preferred to reduce the number of skin incisions and the size thereof. It is necessary to insert an endoscope and power supplying appliance from a same incision to finish off the operation with only one cut. Further it is necessary to make endoscope and power supplying appliance as thin as possible so as to minimize the size of incision. Conventionally there was no endoscope power supplying appliance that satisfies above requirements.
The present invention relates to an endoscope power supplying appliance of which an endoscope and an operational device can be inserted into a body from a same skin incision and procedures such as electric cautery, electrocoagulation and electro scission can be performed while observing an operation site through the endoscope to resolve above said problems. More specifically, this invention relates to an endoscope power supplying appliance in a cylindrical shape having an electrode for electric coagulation and electro scission at a distal end of the cylinder in which an endoscope can be inserted and moved minutely along the cylinder. Further the present invention relates to an endoscope power supplying appliance having a slit at the distal end of the appliance.
The power supplying appliance of this invention used while an endoscope is inserted therein is composed of a control unit, a cylinder unit and an electrode, where the electrode is set at the distal end of the cylinder unit, the control unit at the other end of the cylinder unit, the optical lens of the endoscope inserted in the power supplying appliance can protrude beyond the distal end of the power supplying appliance and the endoscope can move in the axial direction of the power supplying appliance. The endoscope is composed of a bar-shaped insert part in diameter of 2 mm to 3 mm having an optical lens at the distal end thereof and a display unit attached thereto such as TV monitor. Commercial endoscopes for surgery operation under endoscope may be optionally used for the endoscope of the present invention. The insert part having an optical lens inserted into the power supplying appliance of this invention must be inserted while nearly contacting inside wall of the hard power supplying appliance, and should be a linear shape or a curved shape with a constant radius having a constant sectional shape so that the insert part can move minutely in the axial direction of the cylinder unit. Although the sectional shape of the insert part is optional, a round shape conforming to the optical system of the endoscope is generally preferred.
The power supplying appliance is formed of a hard and tough material such as metals, for example, stainless steal and ceramics. The appliance has an electrode at the distal end of the cylinder unit where the electrode is electrically connected to the control unit. When the cylinder unit of the appliance is made of an electroconductive material such as metal, the outside wall and inside wall of the cylinder unit except for the electrode must be insulated from the outside in order not to connect to the endoscope. The insulation treatment may be performed by coating treatment, coating and hardening, baking finish of an insulation material. Although the electrode may be monopolar or bipolar, monopolar is preferred when performing a micro-structural operation because the monopolar electrode is capable of concentrating electric power in a comparatively narrow area.
When the distal end of the power supplying appliance is used for incision, it is preferred to make the distal end sharp as a blade. Further it is preferred to arrange the optical lens of the endoscope close to the distal end of the cylinder unit so as not to form a too broad gap between the lens and the distal end. In case too broad gap is formed between the optical lens and the distal end, body liquid such as blood, fat, body tissue fragments formed during the incision will intrude the gap during the operation, which will contaminate other parts in the body or raise troubles to the endoscopic observation by narrowing the view through the endoscope.
The optical lens of the endoscope of the endoscope power supplying appliance of this invention can protrude beyond the distal end of the cylinder unit, and the endoscope may be moved minutely in the axial direction of the cylinder unit to a specific position. Endoscopic observation is facilitated by protruding beyond the distal end of the cylinder unit because the endoscopic view is not disturbed by the cylinder unit. Further since the lens is capable of moving a specific position in the axial direction of the cylinder unit, an operator can observe an operation site in the body with a wide view to specify the target area of the operation by protruding the endoscope beyond the distal end of the cylinder unit when looking for an operation site, and when performing the operation, it is possible to focus both on the subject area and on the electrode concurrently by pulling it in the cylinder unit. The distance of the movement is very short and generally 5 mm to 7 mm is sufficient. By adopting above said configurations, it is possible for the operator to keep the electrode always in his/her view when performing the treatment with the electrode because the electrode and the endoscope move along the same axial line, and further the operator is capable of performing a cautery while precisely approaching the electrode to the operation site specified by the search. The movement of the endoscope may be done manually or electrically by linear motor and the like. In the case of electric-motor driven devices, the linear motor may be controlled by dials, levers and the like on the control unit, which is capable of moving the lens to a desired position through one-touch operation and facilitates the control during operation. It is not necessary to take the endoscope out of the body each time during operation. Further it eliminates the need for procedures such as checking on the direction of the view and focusing each time the endoscope or electrode is moved, the operation is facilitated and may be proceeded promptly because the moving direction of the endoscope and the power supplying appliance and viewing direction of the endoscope become all concentric.
The electrode at the distal end of the cylinder unit must have a shape which does not block the movement of the endoscope so that the endoscope can protrude beyond the distal end of the cylinder unit in order that the electrode or the distal end of the cylinder unit may not get in the view of endoscope. Consequently when the insert part of the endoscope has a circular section, it is preferred that the electrode also has a circular shape or an arc shape constituting a part of the circular shape conforming to the sectional shape of the endoscope. When adopting bipolar electrode, in particular, it is preferred to configure an arc shape. The electrode may be cylinder shape of which distal end cutting perpendicular to an axial direction or cutting on the slant to the axial direction, or further the distal end can be a needle shape or a linear shape. The electrode in the needle shape or the linear shape enable operations such as micro-area cautery or coagulation and electric stimulation for searching by the electrode. For example, when an operator want to identify a nerve fiber to block among a bundle of nerve fibers, week electric stimulations may be conducted to respective nerve fibers by the distal end of the needle shape electrode and observing the response against the stimulation, the operator can confirm which part of the body the nerve fiber connects to. Further blocking of a specific nerve fiber is made possible by the needle shape electrode in the nerve blocking operation which is conventionally very difficult to do.
Further the endoscope power supplying appliance of this invention is effective to treatments such as coagulation of microvessels performed under endoscope and only one minimized skin incision allows the operation, in particular, in the, case of blocking operation of sympathetic nerves in the chest region performed under endoscope. Because it is not necessary to insert the device into the body or pull it out of the body each time changing the device during the operation, the case of frictional irritation to the incised portion is limited to the time of insertion and extraction of the device in the course of operation, which can minimize the damage of the incised portion. Consequently the patient does not necessarily hospitalize for a long time, and moreover the patient can leave the hospital and return home on the day of the operation.
In the case of such blocking of nerve fiber, side effects may arise if nerve fiber other than aimed one should be unnecessarily blocked. Therefore the decision of which nerve fiber among a number of nerve fibers running in parallel should be blocked is important and sometimes it may decide success or failure of the operation. In the operation using the appliance of this invention, the endoscope inserted in the power supplying appliance is protruded beyond the power supplying appliance so that the power supplying appliance is outside the view field of the endoscope, the operator observes an incising portion in wide view field by a display, easily finding a bundle of nerve fiber, once the operator brings the target nerve fiber fascicle into view, moves gradually the endoscope into the power supplying appliance while keeping the nerve fiber fascicle in view. And focusing by controlling the position of the endoscope with fine adjustment so that both the nerve fiber fascicle and the electrode of the power supplying appliance are in view of the endoscope. After setting the endoscopes at said position, search for identifying nerve fibers to be blocked is performed. More specifically, as said above, approaching the electrode to specific nerve fibers and stimulating the nerve fibers by week power current while controlling the voltage by a voltage controller. While observing responses to the stimulation of respective parts of the body, repeating the electric stimulation to respective nerve fibers sequentially, target nerve fiber is stepwise identified. After identifying the nerve fiber, the power current is strengthened for nerve-fiber blocking to block the target nerve fiber. In this manner, using needle-shaped electrode, only target nerve fiber may be blocked by identifying the target nerve fiber by observing responses of respective parts of the body against electric stimulation by stimulating a specific nerve fiber in the nerve fiber fascicle with the weak power current. Typical cases where such nerve fiber blocking is effective are, for example, hyperhidrosis, Raynaud""s syndrome and reflex sympathetic dystrophy syndrome (RSD).
It is preferred to make a slit at the end area, especially at the side of the end, of the power supplying appliance of this invention. The slit is a hole penetrating through inside to outside the cylinder unit of the power supplying appliance. There is no limitation in particular as to the shape of the slit and the shape may be a circle, a semicircle or polygons such as tetragon, however a circle or semicircle is preferred in view of easiness of processing or sterilization. The number of slit may be one or more than two. The slit enables the operator to observe continuously the view inside and outside the cylinder unit through the slit while electrification treatment is performed in the operation when the endoscope is drawn into the power supplying appliance, further the slit enable the operator to avoid losing view because of white smoke formed by electrification inside the cylinder unit during coagulation or cautery by ventilating white smoke in front of the endoscope optical lens through the slit. Although use of transparent plastics, glass or lens may be enough if only observing outside the cylinder unit, the important role of the slit is to ventilate the white smoke formed in the cylinder unit to outside the cylinder unit. In the case of needle-shaped electrode, the slit may be made near to the electrode. The operator thereby may observe an operation area through the opening of the inside wall of the cylinder unit and outside the cylinder unit through the slit.