1. Field of the Invention
This invention relates to an endoscopic resecting system which removes tissue from the abdomen during a general, urological, or gynecological surgical procedure and from the uterus during a hysteroscopic surgical procedure and more particularly to an endoscopic resecting system for permitting visualization into the abdominal cavity or the uterus during tissue resection thereof.
2. Description of the Prior Art
Normal method for surgical removal of pathological tissue from the abdominal cavity is to make a large skin incision over the site within the abdominal cavity where the pathological tissue is located, and dissect into the body through connective tissue, muscle, or other tissues and structures to access the immediate area of the pathology. Then the pathological tissue is actually resected, perhaps including some surrounding healthy tissue, to assure that the entire area of pathology is removed. Finally, connective tissue, muscle, etc. previously dissected through is repaired, sutured together, and the original skin incision is closed. Or a laparoscopic procedure is used in which a medical telescope is inserted into the abdominal cavity along with resecting tools to perform the actual tissue resection.
The laparoscopic technique for removal of pathological substances has significant drawbacks.
Although the laparoscopic device can remove tissue from the abdominal cavity, function of the actual tissue resecting products are inefficient in that either not all of the abnormal tissue is effectively removed, or time to perform the removal is extensive as the hand operated instruments excise only a small volume of tissue each time they bite off a piece of the tissue, and must be constantly removed from the body to clean resected tissue from jaw of the instrument so that it can continue to excise pieces of the pathological material. In addition, larger resecting instruments, although more efficient, are potentially more dangerous in that they can inadvertently also remove normal anatomical structures such as bowel. Also, if any bleeding occurs during resection with hand tools, the procedure must be stopped to control the bleeding, which adds to overall time of surgery.
With most surgical operations of this type, trauma for the patient in the form of post-operative pain and inability to have a normal lifestyle, is caused more by the tissue resection through skin, connective tissue, muscle, etc. to access the pathology than the actual removal of the pathology. In addition, direct medical cost for the post-operative hospital stay, a major component of overall health care cost, is caused more by time to recover from the surgical wounds to access the pathology than from the actual removal of the diseased tissue. Similarly, economic cost of workman's compensation, if a work related injury is involved, for time off from work during recovery to normal, is directly related to the massiveness of the surgical, dissecting wounds. Economic opportunity cost of time off from work, unemployment, or underemployment during recovery from major, open surgery is directly related to extent of the surgical dissection to access pathology, and is significant.
For laparoscopic procedures, general anesthesia is currently used. Some patients complain more about the affects of the anesthesia than the pain associated with removing the pathological tissue.
Prior are for performing certain general, urological, or gynecological surgical procedures within the abdomen are various surgical instruments whose function require that the abdominal cavity be completely exposed by opening it via an incision that extends from just below the diaphragm to the lower abdomen.
Prior art are various surgical devices which have been used, mainly to remove pathological tissue from within body cavities such as the gastrointestinal system, urinary system, orthopaedic joints, etc. These are either single products, or a series of loosely related devices which are used during the operation but which are not coordinated to produce an optimal effect. These devices include medical optical telescopes to view within the body when used in conjunction with light carriers such as a fiber optic bundle, energy form generators and energy form transporters which use electrical, mechanical, laser, etc. energy to cut, burn, or evaporate pathological tissue, suction devices which aspirate the cut pathological tissue from the body, and tubes used to transport these devices into the body cavity.
Additional related prior art is fiber optic light illuminators that are used for medical, endoscopic surgical procedures. Many of these light sources do not provide the light intensity to properly illuminate the abdominal cavity and produce clear images with the medical video camera system that is used in conjunction with the endoscopes.
Additional related prior art is a peristaltic pump used to instill fluid, usually normal saline, into a body cavity to expand its volume, and provide a clear liquid medium to view the body cavity using a generic type of endoscope. This instilled fluid may be removed from the body cavity either through the endoscope or through a separate outflow conduit, usually by applying active suction to the conduit and conecting PVC tubing, the suction being generated by some aspirating external pump. Precise control of rate of inflow is not achieved with prior art instilling pumps, and coordination of volume of inflow to volume of aspiration, through electronic controls is not characteristic of these forms of prior art.
Related prior art is an RF energy electrode introduced separately into the abdominal cavity to control bleeding.
Related prior art are gas insufflators used to expand the abdomen. Although pressure and flow rate from the insufflators can be set and controlled by these machines, measurement of pressure is at the machine, through tubing, and is not measured directly within the abdominal cavity. In addition, no means is provided to instill a treatment drug in the gas which is insufflated, with prior art devices.
Related prior art are machines which function independently including light source illuminators, gas insufflators, and peristaltic pumps, used for surgical procedures other than indicated in this patent application.
Therefore, these devices do not work as efficiently together, extend operating time which increases cost of medical care. Energy form generators and transporters being separate machines, their total cost is greater and they require more effort by personnel to set up and maintain, which also increases cost of medical care.
U.S. Pat. No. 4,132,227, entitled Urological Endoscope Particularly Resectoscope, issued to Wolfgang Ibe on Jan. 2, 1979, teaches a hollow cylinder sheath, a viewing device, an illuminating device, a resecting device and an outflow tube. The hollow cylinder sheath has a proximal end and a distal end. The viewing device is an endoscopic arrangement of optical elements. The illuminating device is a cooperating arrangement of fiber optics which is optically coupled to a light source. The viewing device and the illuminating device are located in the sheath extending from the distal end back to the proximal end. The outflow tube is slidable onto the sheath to surround the sheath and form together with the sheath an intermediate return-flow space between the outer wall of the sheath and the inner wall of the outflow tube, with the outflow tube when in position slid over the sheath tightly surrounding the distal end portion of the sheath. The resecting device is an electrode loop which is electrically coupled to an electromagnetic energy source. Clear rinsing water is introduced into the proximal end of the sheath. Turbid water is removed from the proximal end of the intermediate space. The outflow tube is provided with apertures at the distal end thereof for the flow of clear rinsing water out of the distal end of the sheath and around the end of the endoscope and then through the apertures into the intermediate space. U.S. Pat. No. 4,607,621, entitled Endoscopic Apparatus, issued to Robert C. Wheeler on Aug. 26, 1986, teaches an insertion tube, an electrosurgical generator and an electrode loop which is electrically coupled to the electrosurgical generator.
U.S. Pat. No. 4,713,051, entitled Cassete For Surgical Irrigation And Aspiration And Sterile Package Therefor, issued to Steppe et. al. on Dec. 15, 1987, teaches a cartridge within which is placed an irrigating and irrigating control means, an aspirating and an aspirating control means, and a vacuum and vacuum control means.
U.S. Pat. No. 4,756,309, entitled Endoscope for Removal of Tissue, issued to Hans-Ernst Sachse on Jul. 12, 1988, teaches an endoscope which resects tissue inside body cavities and which includes a hollow outer tube, a rotating shaft and a flushing duct. The shaft carries a grinding or milling head which allows precise removal of scar tissue or other fairly firm tissue under endoscopic control without leaving irregular or thermally damaged wound sites. The endoscope also includes a tube for a lens system and cold light guide and an eyepiece.
U.S. Pat. No. 4,844,062, entitled Rotating Fiberoptic Laser Catheter Assembly with Eccentric Lumen, issued to Lisa D. Wells on Jul. 4, 1989, teaches a catheter assembly which includes a catheter and an optical fiber. The catheter defines a first eccentric lumen which encompasses the center of the catheter and a second lumen. The optical fiber runs through the first eccentric lumen and has a distal end which is eccentric to and encompasses the center of the catheter. U.S. Pat. No. 4,865,018, entitled Control Apparatus for Endoscopes, issued to Masahide Kanno, Katasuyaki Saito and Akihiko Miyazaki on Sept. 12, 1989, teaches a control apparatus which controls a plurality of functions of an endoscope. U.S. Pat. No. 4,550,716, entitled Liquid Supplying Device for Endoscope, issued to Kunio Kinoshita on Nov. 5, 1985, teaches a liquid supplying device which includes a housing with a connecting portion to which a connector of an endoscope is connected. The liquid supplying device also includes a lamp, an air pump, and a liquid supply tank.
U.S. Pat. No. 4,146,019, entitled Multichannel Endoscope, issued to Michael Bass on Mar. 27, 1979 teaches a flexible endoscope with a suction tube that protrudes from the distal end, a laser channel, a fluid delivery channel, and a channel which could accomodate a medical tool. U.S. Pat. No. 4,625,713, issued to Yasunori Hiraoka on Dec. 2, 1986 teaches a device with a trough for collecting and removing debris created when using a resectoscope, including an electode used in conjunction with the trough for coagulating blood. Holes in the trough accomodate an irrigating fluid. The device uses mechanical energy, a slide mechanism to actually remove the debris.
U.S. Pat. No. 3,618,611, entitled Vacuum Rotary Dissector, issued to Julius C. Urban on Nov. 9, 1971, teaches a vacuum rotary dissector which includes a support, an outer tubular member, an inner tubular member and a motor. The outer tubular member extends from the support and has a closed generally hemispherical distal end and a first laterally directed opening adjacent to its distal end extending axially along the outer tubular member and partially along the closed generally hemispherical distal end. The inner tubular member is rotatably mounted in the outer tubular member and has a complementary generally hemisperical distal end frictionally bearing on an inner complementary surface of the closed generally hemispherical distal end of the outer tubular member. The inner tubular member has a second laterally directed opening coextensive with the first laterally directed opening defining generally axially extending cutting edges coincident with the inner surface of the outer tubular member. The motor continuously rotates the inner tubular member relatively to the support and the outer tubular member.
U.S. Pat. No. 4,598,710, entitled Surgical Instrument and Method of Making Same, issued to Larry K. Kleinberg and Donald S. Evans on Jul. 8, 1986, teaches an arthroscopy shaver which includes a pair of co-axially assembled tubes. The tubes have their distal walls in bearing relationship and with registrable openings extending through such distal and annular walls correspondingly joined to their respective distal walls. U.S. Pat. No. 4,203,444, entitled Surgical Instrument Suitable for Closed Surgery Such as of the Knee, issued to Leonard J. Bonnell, Edward H. McHugh, Douglas D. Sjostrom and Lanny L. Johnson on May 20, 1980, also teaches an arthroscopy shaver.