WO1992018049A1 - Apparatus for the controlled irrigation of natural cavities of the body - Google Patents

Apparatus for the controlled irrigation of natural cavities of the body Download PDF

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Publication number
WO1992018049A1
WO1992018049A1 PCT/FR1992/000362 FR9200362W WO9218049A1 WO 1992018049 A1 WO1992018049 A1 WO 1992018049A1 FR 9200362 W FR9200362 W FR 9200362W WO 9218049 A1 WO9218049 A1 WO 9218049A1
Authority
WO
WIPO (PCT)
Prior art keywords
irrigation
circuit
pressure
suction
suction circuit
Prior art date
Application number
PCT/FR1992/000362
Other languages
French (fr)
Inventor
Ivan Lemaire
Bertrand Gonon
Original Assignee
C & D Biomedical S.A.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by C & D Biomedical S.A. filed Critical C & D Biomedical S.A.
Priority to JP4510448A priority Critical patent/JPH06504221A/en
Publication of WO1992018049A1 publication Critical patent/WO1992018049A1/en
Priority to US08/353,879 priority patent/US5586973A/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A61B5/02042—Determining blood loss or bleeding, e.g. during a surgical procedure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/12—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor with cooling or rinsing arrangements
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
    • A61M1/71—Suction drainage systems
    • A61M1/77—Suction-irrigation systems
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
    • A61M1/71—Suction drainage systems
    • A61M1/77—Suction-irrigation systems
    • A61M1/777—Determination of loss or gain of body fluids due to suction-irrigation, e.g. during surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M3/00—Medical syringes, e.g. enemata; Irrigators
    • A61M3/02—Enemata; Irrigators
    • A61M3/0204—Physical characteristics of the irrigation fluid, e.g. conductivity or turbidity
    • A61M3/0208—Physical characteristics of the irrigation fluid, e.g. conductivity or turbidity before use
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M3/00—Medical syringes, e.g. enemata; Irrigators
    • A61M3/02—Enemata; Irrigators
    • A61M3/0204—Physical characteristics of the irrigation fluid, e.g. conductivity or turbidity
    • A61M3/0212—Physical characteristics of the irrigation fluid, e.g. conductivity or turbidity after use
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M3/00—Medical syringes, e.g. enemata; Irrigators
    • A61M3/02—Enemata; Irrigators
    • A61M3/0204—Physical characteristics of the irrigation fluid, e.g. conductivity or turbidity
    • A61M3/0216—Pressure
    • G—PHYSICS
    • G05—CONTROLLING; REGULATING
    • G05D—SYSTEMS FOR CONTROLLING OR REGULATING NON-ELECTRIC VARIABLES
    • G05D16/00—Control of fluid pressure
    • G05D16/20—Control of fluid pressure characterised by the use of electric means
    • G05D16/2006—Control of fluid pressure characterised by the use of electric means with direct action of electric energy on controlling means
    • G05D16/2066—Control of fluid pressure characterised by the use of electric means with direct action of electric energy on controlling means using controlling means acting on the pressure source
    • G05D16/2073—Control of fluid pressure characterised by the use of electric means with direct action of electric energy on controlling means using controlling means acting on the pressure source with a plurality of pressure sources
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/33—Controlling, regulating or measuring
    • A61M2205/3317—Electromagnetic, inductive or dielectric measuring means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M3/00—Medical syringes, e.g. enemata; Irrigators
    • A61M3/02—Enemata; Irrigators
    • A61M3/0202—Enemata; Irrigators with electronic control means or interfaces
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M3/00—Medical syringes, e.g. enemata; Irrigators
    • A61M3/02—Enemata; Irrigators
    • A61M3/0233—Enemata; Irrigators characterised by liquid supply means, e.g. from pressurised reservoirs
    • A61M3/0254—Enemata; Irrigators characterised by liquid supply means, e.g. from pressurised reservoirs the liquid being pumped
    • A61M3/0258—Enemata; Irrigators characterised by liquid supply means, e.g. from pressurised reservoirs the liquid being pumped by means of electric pumps

Definitions

  • the present invention relates to an apparatus for controlled irrigation of natural cavities of the human body, in particular for endoscopes and in particular for urological, gynecological and arthroscopic endoscopes, comprising at least two channels respectively for continuously injecting a liquid of irrigation in one of these cavities and for continuously evacuating this irrigation liquid from this cavity, this apparatus comprising an irrigation circuit coupled to one of said channels and a suction circuit coupled to the other of the channels.
  • the present invention proposes to complete this embodiment to improve the safety of use of the device by permanently controlling the various parameters such as the volume of irrigation liquid and its pressure in the inlet and outlet circuits. outlet, when operating in continuous irrigation.
  • the irrigation device is characterized in that the irrigation circuit and the suction circuit each comprise a pump, a pressure sensor and means for comparing the pressures measured by each of these sensors and to control the pumps according to the pressure differences observed.
  • each of the two circuits is equipped with a weighing device, and these two weighing devices are associated with means for comparing the results of the measurements of each of these devices.
  • the suction circuit includes a conductive sensor to determine the blood losses contained in the irrigation liquid at the outlet of the cavity.
  • the device comprises a reference pressure sensor which is coupled to said means for comparing the pressures measured by the sensors disposed respectively on the irrigation circuit and the suction circuit.
  • the suction circuit of the device can be equipped with a solid particle filter.
  • FIG. 1 represents a schematic view of an irrigation device according to the invention
  • FIG. 2 represents a diagram illustrating the pressure / volume curve during an intervention by means of the controlled irrigation device according to the invention
  • FIG. 3 represents a diagram illustrating the curves of irrigation flow and aspiration as a function of time during an intervention by means of the irrigation apparatus according to the invention.
  • the controlled irrigation apparatus 10 schematically represented by this figure, comprises an irrigation circuit 11 connected to one of the channels 12 of an endoscope 13 to two channels and a suction circuit 14- connected to the other channel 15 of this endoscope.
  • the irrigation circuit 11 essentially comprises a first pump 16 and a first pressure sensor 17 and the suction circuit 14 essentially comprises a second pump 18 and a second pressure sensor 19.
  • These pumps and these 'pressure sensors are connected to a central management unit 20 whose function consists in managing the operating parameters of the device, namely in particular the volume and the flow rate of liquid to be injected into the cavity where the intervention takes place and of the one which is sucked out of this cavity, taking into account in particular the values of the pressures measured by said sensors.
  • the two irrigation and suction circuits also include, respecti ⁇ vely a first weighing device 21 and a second weighing device 22.
  • the suction circuit 14 is equipped with a conductive measuring instrument 23 whose role will be defined later.
  • a third pressure sensor 24, called the reference sensor, is also connected to the central management unit 20.
  • irrigation circuit 11 is directly connected to the corresponding channel 12 of the endoscope 13 while on the suction circuit 14, a solid particle filter 25 is interposed between the corresponding channel 15 of the endoscope 13 and the other components of this circuit, in particular the pump 18.
  • the central management unit 20 which contains an internal clock, can determine in real time, the weight, the volume and the pressure of the irrigation liquid as well as the flow rate of the pump 16. This unit is also designed to memorize the reference pressure supplied by the sensor 24 and the duration of operation of the device.
  • the same measurements of weight are carried out by means of the weighing device 22, and of pressure by means of the pressure sensor 19 and the corresponding values are transmitted to the central unit of management.
  • a measurement additional conductimetry calculates blood loss, that is to say the quantity of red blood cells contained in the liquid aspirated from the cavity in which the intervention is performed. Knowing the weight of injected liquid and aspirated liquid and the conductimetry of the liquid which has been modified at suction due to the presence of red blood cells, we can determine the hemodilution, i.e. the volume of water that has entered the bloodstream.
  • the central management unit is controlled by software that allows automatic global management of the device. It is especially designed for. store pressure drop characteristics corresponding to different types of endoscopes, which considerably reduces the calibration time. The value of the pressures measured by the sensors 17 and 19 is corrected by the central management unit, taking into account in particular the pressure drops corresponding to each endoscope used.
  • the central management unit is designed to activate the device in three modes which correspond respectively to the purge program, the calibration program and the use program.
  • the irrigation and suction pipes are connected together and a purge liquid passes through the pipes to clean them.
  • the irrigation and suction pipes are connected to the endoscope, the endoscope is purged and the pressure drops of the two circuits are corrected, these pressure losses can be from 0 to 700 ml / min.
  • the data corresponding to two calibration curves are stored and, if necessary, these calibration curves are printed using an appropriate printer.
  • the endoscope coupled to the pumps is ready for use.
  • the third pressure sensor 24 is necessary to measure a reference pressure which, in urological or gynecological use, could for example be the pressure corresponding to the height of the table on which the patient is lying, or abdominal pressure.
  • a reference pressure which, in urological or gynecological use, could for example be the pressure corresponding to the height of the table on which the patient is lying, or abdominal pressure.
  • the differential pressure which is in fact the bladder pressure minus the abdominal pressure is called Detrusor pressure and makes it possible to get rid of any changes in table position or abdominal contractions during surgery. .
  • the sensors are zeroed after putting the endoscope and the reference sensor at the height of the organ where the intervention is located.
  • the operator introduces the endoscope and the organ is filled either by manual control or by automatic control.
  • a screen 26 coupled to the central management unit 20 or by means of a printer (not shown), the pressure / volume curve which provides precise indications on the state of "swelling" of the organ. This curve is shown by way of example in FIG. 2. It shows that during the filling of the member, which is generally a pocket, the internal pressure is either constant or slightly increasing until the pocket is full and the injection of an additional volume of liquid causes the pocket to expand. At this time, the expansion of the walls generates a rapid and noticeable increase in pressure.
  • the operator can determine his working area, that is to say the maximum and minimum values of the volumes of physiological liquid to be injected into the cavity where the intervention takes place as a function of the maximum and minimum pressures not to be exceeded. To stay in this work area, vacuum the excess volume by means of the suction circuit.
  • Figure 3 illustrates the curves representing the suction flow (in dashed lines) and the irrigation flow (in solid lines,) as a function of time.
  • This flow regulation can be carried out either by providing an irrigation flow which is equal to the suction flow at constant volume, or by regulating around the volume.
  • the direction of rotation of the pump is reversed d suction 18 for injecting for a period of a few 5 seconds liquid into the suction circuit in order to evacuate the solid particle which obstructs the suction circuit and which is probably at the origin of this pressure difference. If the fault persists, the pumps are stopped to avoid excessive overpressure inside the organ.
  • the two pumps which are arranged to be able to operate automatically or in manual control, can be either independent or replaced by a double pump.
  • the irrigation circuit is continuously checked by measurements which are carried out continuously (volume, pressure, flow). These same measurements are made on the suction circuit and in addition, a comparative verification is carried out on the two circuits.
  • the surgeon When the device is equipped with a printer, the surgeon has a working pressure / duration of the intervention curve printed on a document which constitutes, where appropriate, forensic evidence, also indicating the volume of the minimum work and maximum volume, hemodilution rate and a specific indication of blood loss during the procedure.
  • a manual key empties the organ.
  • the suction circuit is closed on the endoscope.
  • the end of the suction tube is connected to the main end of the endoscope.
  • the solid particles or shavings generated by the intervention inside the organ can be recovered for later analysis.

Abstract

The present invention relates to an apparatus for the controlled irrigation of natural cavities of the human body, particularly for endoscopes and more particularly for urological, gynecological and arthroscopic endoscopes. The irrigation apparatus (10) is comprised of at least two channels (12, 14), the first to inject in a continuous mode an irrigation liquid into one of such cavities and the second to evacuate in a continuous mode said irrigation liquid from the cavity, said apparatus incorporating an irrigation circuit (11) coupled to one of said channels and a suction circuit (14) coupled to the other channel. The irrigation circuit (11) and the suction circuit (14) are each provided with a pump (16, 18), a pressure sensor (17, 19) and means to compare the pressures measured by each of said sensors and to control the pumps (16, 18) as a function of the registered pressure differences. Apparatus for use specifically in medecine.

Description

APPAREIL D'IRRIGATION CONTROLEE DES CAVITES NATURELLES DU CORPSAPPARATUS FOR CONTROLLED IRRIGATION OF NATURAL BODY CAVITIES
La présente invention concerne un appareil d'irrigation contrôlée de cavités naturelles du corps humain, notamment pour endoscopes et en particulier pour endoscopes urologiques , gynécologiques et arthros- copiques , comportant au moins deux canaux respectivement pour injecter d'une façon continue un liquide d'irrigation dans une de ces cavités et pour évacuer de façon continue ce liquide d'irrigation de cette cavité, cet appareil comportant un circuit d'irrigation couplé à l'un desdits canaux et un circuit d'aspiration couplé à l'autre des canaux.The present invention relates to an apparatus for controlled irrigation of natural cavities of the human body, in particular for endoscopes and in particular for urological, gynecological and arthroscopic endoscopes, comprising at least two channels respectively for continuously injecting a liquid of irrigation in one of these cavities and for continuously evacuating this irrigation liquid from this cavity, this apparatus comprising an irrigation circuit coupled to one of said channels and a suction circuit coupled to the other of the channels.
On connaît déjà des appareils de ce type, notamment celui décrit dans le brevet européen publié sous le Ns 224. 487 • Cet appareil décrit en particulier des moyens de correction destinés à pondérer le signal de mesure représentatif de la pression en fonction de certains paramètres tels que la perte de charge, les différences de niveau entre le capteur et la zone d'intervention, afin de déterminer par le calcul la valeur exacte de la pression régnant à l'intérieur d'une cavité dans laquelle a lieu l'intervention endoscopique.There are already known devices of this type, including the one disclosed in European Patent Publication 487 224. N s • This unit describes in particular correction means for weighting the measuring signal representative of the pressure based on certain parameters such as pressure drop, level differences between the sensor and the intervention zone, in order to determine by calculation the exact value of the pressure prevailing inside a cavity in which the endoscopic intervention takes place .
La présente invention se propose de compléter cette réalisation pour améliorer la sécurité d'utilisation de l'appareil en contrôlant d'une manière permanente les différents paramètres tels que le volume de liquide d'irrigation et sa pression dans les circuits d'entrée et de sortie, lorsque l'on opère en irrigation continue.The present invention proposes to complete this embodiment to improve the safety of use of the device by permanently controlling the various parameters such as the volume of irrigation liquid and its pressure in the inlet and outlet circuits. outlet, when operating in continuous irrigation.
A cet effet , l'appareil d'irrigation selon l'invention est caractérisé en ce que le circuit d'irrigation et le circuit d'aspiration comportent chacun une pompe, un capteur de pression et des moyens pour comparer les pressions mesurées par chacun de ces capteurs et pour commander les pompes en fonction des différences de pression constatées . Selon un mode de réalisation préféré, chacun des deux circuits est équipé d'un dispositif de pesée, et ces deux dispositifs de pesée sont associés à des moyens pour comparer les résultats des mesures de chacun de ces dispositifs .To this end, the irrigation device according to the invention is characterized in that the irrigation circuit and the suction circuit each comprise a pump, a pressure sensor and means for comparing the pressures measured by each of these sensors and to control the pumps according to the pressure differences observed. According to a preferred embodiment, each of the two circuits is equipped with a weighing device, and these two weighing devices are associated with means for comparing the results of the measurements of each of these devices.
Selon un mode de réalisation particulièrement avantageux, le circuit d'aspiration comporte un capteur conductimé trique pour déterminer les pertes de sang contenues dans le liquide d'irrigation à la sortie de la cavité.According to a particularly advantageous embodiment, the suction circuit includes a conductive sensor to determine the blood losses contained in the irrigation liquid at the outlet of the cavity.
De préférence, l'appareil comporte un capteur de pression de réfé¬ rence qui est couplé aux dits moyens pour comparer les pressions mesurées par les capteurs disposés respectivement sur le circuit d'irrigation et le circuit d'aspiration.Preferably, the device comprises a reference pressure sensor which is coupled to said means for comparing the pressures measured by the sensors disposed respectively on the irrigation circuit and the suction circuit.
De façon avantageuse, le circuit d'aspiration de l'appareil peut être équipé d'un filtre à particules solides.Advantageously, the suction circuit of the device can be equipped with a solid particle filter.
La présente invention sera mieux comprise en référence à la description d'un exemple de réalisation et du dessin annexé dans lequel :The present invention will be better understood with reference to the description of an exemplary embodiment and the attached drawing in which:
la figure 1 représente une vue schématique d'un appareil d'irrigation selon l'invention,FIG. 1 represents a schematic view of an irrigation device according to the invention,
la figure 2 représente un diagramme illustrant la courbe pres¬ sion/volume au cours d'une intervention au moyen de l'appareil d'irrigation contrôlée selon l'invention, etFIG. 2 represents a diagram illustrating the pressure / volume curve during an intervention by means of the controlled irrigation device according to the invention, and
la figure 3 représente un diagramme illustrant les courbes de débit d'irrigation et d'aspiration en fonction du temps au cours d'une intervention au moyen de l'appareil d'irrigation selon l'invention.FIG. 3 represents a diagram illustrating the curves of irrigation flow and aspiration as a function of time during an intervention by means of the irrigation apparatus according to the invention.
En référence à la figure 1 , l'appareil d'irrigation contrôlée 10 repré- sente schématiquement par cette figure, comporte un circuit d'irrigation 11 connecté à un des canaux 12 d'un endoscope 13 à deux voies et un circuit d'aspiration 14- connecté à l'autre canal 15 de cet endoscope. Le circuit d'irrigation 11 comprend essentiellement une première pompe 16 et un premier capteur de pression 17 et le circuit d'aspiration 14 comprend essentiellement une seconde pompe 18 et un second capteur de pression 19. Ces pompes et ces 'capteurs de pres¬ sion sont connectés à une unité centrale de gestion 20 dont la fonction consiste à gérer les paramètres de fonctionnement de la l'appareil, à savoir notamment le volume et le débit de liquide à injecter dans la cavité où a lieu l'intervention et de celui qui est aspiré hors de cette cavité, en tenant compte en particulier des valeurs des pressions mesurées par lesdits capteurs . Les deux circuits d'irrigation et d'aspiration comportent par ailleurs , respecti¬ vement un premier dispositif de pesée 21 et un second dispositif de pesée 22. Enfin, le circuit d'aspiration 14 est équipé d'un instrument de mesure conductimé trique 23 dont le rôle sera défini par la suite.With reference to FIG. 1, the controlled irrigation apparatus 10 schematically represented by this figure, comprises an irrigation circuit 11 connected to one of the channels 12 of an endoscope 13 to two channels and a suction circuit 14- connected to the other channel 15 of this endoscope. The irrigation circuit 11 essentially comprises a first pump 16 and a first pressure sensor 17 and the suction circuit 14 essentially comprises a second pump 18 and a second pressure sensor 19. These pumps and these 'pressure sensors are connected to a central management unit 20 whose function consists in managing the operating parameters of the device, namely in particular the volume and the flow rate of liquid to be injected into the cavity where the intervention takes place and of the one which is sucked out of this cavity, taking into account in particular the values of the pressures measured by said sensors. The two irrigation and suction circuits also include, respecti¬ vely a first weighing device 21 and a second weighing device 22. Finally, the suction circuit 14 is equipped with a conductive measuring instrument 23 whose role will be defined later.
Un troisième capteur de pression 24, dit capteur de référence est également connecté à l'unité centrale de gestion 20.A third pressure sensor 24, called the reference sensor, is also connected to the central management unit 20.
On notera que le circuit d'irrigation 11 est directement connecté au canal correspondant 12 de l'endoscope 13 alors que sur le circuit d'aspiration 14, un filtre à particules solides 25 est interposé entre le canal correspondant 15 de l'endoscope 13 et les autres composants de ce circuit notamment la pompe 18.It will be noted that the irrigation circuit 11 is directly connected to the corresponding channel 12 of the endoscope 13 while on the suction circuit 14, a solid particle filter 25 is interposed between the corresponding channel 15 of the endoscope 13 and the other components of this circuit, in particular the pump 18.
A partir des informations transmises par le dispositif de pesée 21 et la mesure de la pression fournie par le capteur de pression 17, l'unité centrale de gestion 20 qui contient une horloge interne, peut déterminer en temps réel, le poids , le volume et la pression du liquide d'irrigation ainsi que le débit de la pompe 16. Cette unité est par ailleurs conçue pour mémoriser la pression de référence fournie par le capteur 24 et la durée de fonctionnement de l'appareil.From the information transmitted by the weighing device 21 and the measurement of the pressure supplied by the pressure sensor 17, the central management unit 20 which contains an internal clock, can determine in real time, the weight, the volume and the pressure of the irrigation liquid as well as the flow rate of the pump 16. This unit is also designed to memorize the reference pressure supplied by the sensor 24 and the duration of operation of the device.
En ce qui concerne le circuit d'aspiration 14, les mêmes mesures de poids sont effectuées au moyen du dispositif de pesée 22, et de pression au moyen du capteur de pression 19 et les valeurs corres¬ pondantes sont transmises à l'unité centrale de gestion. Une mesure supplémentaire de conductimétrie permet de calculer les pertes de sang, c'est-à-dire la quantité de globules rouges contenue dans le liquide aspiré de la cavité dans laquelle s'effectue l'intervention. Connaissant le poids de liquide injecté et de liquide aspiré et la conductimétrie du liquide qui a été modifié à l'aspiration en raison de la présence de globules rouges, on peut déterminer l' hémodilution , c'est-à-dire le volume d'eau qui est rentré dans le circuit sanguin.With regard to the suction circuit 14, the same measurements of weight are carried out by means of the weighing device 22, and of pressure by means of the pressure sensor 19 and the corresponding values are transmitted to the central unit of management. A measurement additional conductimetry calculates blood loss, that is to say the quantity of red blood cells contained in the liquid aspirated from the cavity in which the intervention is performed. Knowing the weight of injected liquid and aspirated liquid and the conductimetry of the liquid which has been modified at suction due to the presence of red blood cells, we can determine the hemodilution, i.e. the volume of water that has entered the bloodstream.
L'unité centrale de gestion est pilotée par un logiciel qui permet d'effectuer une gestion globale automatique de l'appareil. Elle est notamment conçue pour . mettre en mémoire des caractéristiques de pertes de charge correspondant à différents types d'endoscopes, ce qui permet de réduire considérablement le temps de calibrage. La valeur des pressions mesurées par les capteurs 17 et 19 est corrigée par l'unité centrale de gestion en tenant compte notamment des pertes de charge correspondant à chaque endoscope utilisé.The central management unit is controlled by software that allows automatic global management of the device. It is especially designed for. store pressure drop characteristics corresponding to different types of endoscopes, which considerably reduces the calibration time. The value of the pressures measured by the sensors 17 and 19 is corrected by the central management unit, taking into account in particular the pressure drops corresponding to each endoscope used.
L'unité centrale de gestion est conçue pour activer l'appareil selon trois modes qui correspondent respectivement au programme purge, au programme calibrage et au programme utilisation. Au cours du programme purge, les tubulures d'irrigation et d'aspiration sont reliées entre elles et un liquide de purge traverse les canalisations pour les nettoyer.The central management unit is designed to activate the device in three modes which correspond respectively to the purge program, the calibration program and the use program. During the purge program, the irrigation and suction pipes are connected together and a purge liquid passes through the pipes to clean them.
Au cours du programme calibrage, on raccorde les tubulures d'irrigation et d'aspiration à l'endoscope, on purge l'endoscope et on effectue des corrections de pertes de charge des deux circuits, ces pertes de charge pouvant être de 0 à 700 ml/mn. On mémorise les données correspondant à deux courbes de calibrage et, le cas échéant, on imprime au moyen d'une imprimante appropriée, ces courbes de calibrage. L'endoscope couplé aux pompes est prêt à l'utilisation.During the calibration program, the irrigation and suction pipes are connected to the endoscope, the endoscope is purged and the pressure drops of the two circuits are corrected, these pressure losses can be from 0 to 700 ml / min. The data corresponding to two calibration curves are stored and, if necessary, these calibration curves are printed using an appropriate printer. The endoscope coupled to the pumps is ready for use.
Le troisième capteur de pression 24 est nécessaire pour mesurer une pression de référence qui, en utilisation urologique ou gynécologique, pourra par exemple être la pression correspondant à la hauteur de la table sur laquelle est allongé le patient, ou la pression abdominale. En urologie, la pression différentielle qui est en fait la pression vési- cale diminuée de la pression abdominale s'appelle Pression du Detrusor et permet de s'affranchir de toutes les modifications de position de la table ou de contractions abdominales en cours d' intervention .The third pressure sensor 24 is necessary to measure a reference pressure which, in urological or gynecological use, could for example be the pressure corresponding to the height of the table on which the patient is lying, or abdominal pressure. In urology, the differential pressure which is in fact the bladder pressure minus the abdominal pressure is called Detrusor pressure and makes it possible to get rid of any changes in table position or abdominal contractions during surgery. .
Lorsqu'on enclenche le programme utilisation, on règle les zéro des capteurs après avoir mis l'endoscope et le capteur de référence à la hauteur de l'organe où se situe l'intervention. L'opérateur introduit l'endoscope et on effectue le remplissage de l'organe soit en com¬ mande manuelle, soit en commande automatique. On règle le débit, le volume, la pression maximale. On visualise au moyen d'un écran 26 couplé à l'unité centrale de gestion 20 ou au moyen d'une imprimante (non représentée) , la courbe pression/ volume qui fournit des indi¬ cations précises sur l'état de "gonflement" de l'organe. Cette courbe est représentée à titre d'exemple par la figure 2. Elle montre qu'au cours du remplissage de l'organe, qui est généralement une poche, la pression intérieure est soit constante, soit faiblement croissante jusqu'au moment où la poche est pleine et que l'injection d'un volume supplémentaire de liquide engendre une dilatation de cette poche. A ce moment, la dilatation des parois engendre une augmentation rapide et sensible de la pression.When the usage program is started, the sensors are zeroed after putting the endoscope and the reference sensor at the height of the organ where the intervention is located. The operator introduces the endoscope and the organ is filled either by manual control or by automatic control. We regulate the flow, the volume, the maximum pressure. We visualize by means of a screen 26 coupled to the central management unit 20 or by means of a printer (not shown), the pressure / volume curve which provides precise indications on the state of "swelling" of the organ. This curve is shown by way of example in FIG. 2. It shows that during the filling of the member, which is generally a pocket, the internal pressure is either constant or slightly increasing until the pocket is full and the injection of an additional volume of liquid causes the pocket to expand. At this time, the expansion of the walls generates a rapid and noticeable increase in pressure.
L'opérateur peut déterminer sa zone de travail, c'est-à-dire les valeurs maximales et minimales des volumes de liquide physiologique à injecter dans la cavité où a lieu l'intervention en fonction des pressions maximales et minimales à ne pas dépasser. Pour rester dans cette zone de travail, on aspire l'excédent de volume au moyen du circuit d'aspiration.The operator can determine his working area, that is to say the maximum and minimum values of the volumes of physiological liquid to be injected into the cavity where the intervention takes place as a function of the maximum and minimum pressures not to be exceeded. To stay in this work area, vacuum the excess volume by means of the suction circuit.
La figure 3 illustre les courbes représentant le débit d'aspiration (en traits interrompus) et le débit d'irrigation (en trait plein, ) en fonction du temps . Cette régulation de débit peut s'effectuer soit en prévoyant un débit d'irrigation qui est égal au débit d'aspiration à volume constant, soit en effectuant une régulation autour du volumeFigure 3 illustrates the curves representing the suction flow (in dashed lines) and the irrigation flow (in solid lines,) as a function of time. This flow regulation can be carried out either by providing an irrigation flow which is equal to the suction flow at constant volume, or by regulating around the volume.
FEUILLE DE REMPLACEMENT minimal et du volume maximal. C'est ce qui est représenté sur la figure 3.REPLACEMENT SHEET minimum and maximum volume. This is what is shown in Figure 3.
Pendant la durée de l'intervention, si la même pression mesurée par les deux capteurs respectivement montés sur le circuit d'irrigation et sur le circuit d'aspiration est différente de plus de 10%, on inverse le sens de rotation de la pompe d'aspiration 18 pour injecter pendant une durée de quelques 5 secondes du liquide dans le circuit d'aspiration afin d'évacuer la particule solide qui obstrue le circuit d'aspiration et qui est vraisemblablement à l'origine de cette diffé¬ rence de pression. Si le défaut persiste, les pompes sont arrêtées pour éviter une surpression excessive à l'intérieur de l'organe. Les deux pompes, qui sont agencées pour pouvoir fonctionner automatiquement ou en commande manuelle, peuvent être soit indé- pendantes , soit remplacées par une pompe double. Le circuit d'irrigation est vérifié en permanence par les mesures qui sont effec¬ tuées d'une manière continue (volume, pression, débit) . Ces mêmes mesures sont effectuées sur le circuit d'aspiration et en outre, une vérification comparative s'effectue sur les deux circuits.During the intervention, if the same pressure measured by the two sensors respectively mounted on the irrigation circuit and on the suction circuit is different by more than 10%, the direction of rotation of the pump is reversed d suction 18 for injecting for a period of a few 5 seconds liquid into the suction circuit in order to evacuate the solid particle which obstructs the suction circuit and which is probably at the origin of this pressure difference. If the fault persists, the pumps are stopped to avoid excessive overpressure inside the organ. The two pumps, which are arranged to be able to operate automatically or in manual control, can be either independent or replaced by a double pump. The irrigation circuit is continuously checked by measurements which are carried out continuously (volume, pressure, flow). These same measurements are made on the suction circuit and in addition, a comparative verification is carried out on the two circuits.
Lorsque l'appareil est équipé d'une imprimante, le chirurgien dispose d'une courbe pression de travail/ durée de l'intervention imprimée sur un document qui constitue, le cas échéant, une preuve médicolégale portant en outre l'indication du volume du travail minimal et du volume maximal, le taux d' hémodilution et une indication précise concernant les pertes sanguines au cours de l'intervention. A la fin de cette intervention, une touche manuelle permet de vider l'organe. Le circuit aspiration est fermé sur l'endoscope. On raccorde l'embout de la tubulure d'aspiration à l'embout principal de l'endoscope. Les particules solides ou copeaux engendrés par l'intervention à l'intérieur de l'organe peuvent être récupérés en vue d'une analyse ultérieure.When the device is equipped with a printer, the surgeon has a working pressure / duration of the intervention curve printed on a document which constitutes, where appropriate, forensic evidence, also indicating the volume of the minimum work and maximum volume, hemodilution rate and a specific indication of blood loss during the procedure. At the end of this intervention, a manual key empties the organ. The suction circuit is closed on the endoscope. The end of the suction tube is connected to the main end of the endoscope. The solid particles or shavings generated by the intervention inside the organ can be recovered for later analysis.
Il est bien entendu que la présente invention n'est pas limitée aux formes de réalisation décrites, mais peut subir différentes modifi-It is understood that the present invention is not limited to the embodiments described, but can undergo various modifications.
FEUILLE DE REMPLACEMENT cations et se présenter sous diverses variantes évidentes pour l'homme de l'art.REPLACEMENT SHEET cations and appear in various variants obvious to those skilled in the art.
FEUIL SHEET

Claims

REVENDICATIONS
1. Appareil d'irrigation contrôlée de cavités naturelles du corps humain, notamment pour endoscopes et en particulier pour endoscopes urologiques, ynécologiques et arthroscopique, comportant au moins deux canaux respectivement pour injecter d'une façon continue un liquide d'irrigation dans une de ces cavités et pour évacuer de façon continue ce liquide d'irrigation de cette cavité, cet appareil comportant un circuit d'irrigation couplé à l'un desdits canaux et un circuit d'aspiration couplé à l'autre des canaux, caractérisé en ce que le circuit d'irrigation (11) et le circuit d'aspiration (14) comportent chacun une pompe, un capteur de pression et des moyens pour comparer les pressions mesurées par chacun de ces capteurs et pour commander les pompes en fonction des différences de pression constatées.1. Apparatus for controlled irrigation of natural cavities of the human body, in particular for endoscopes and in particular for urological, ynecological and arthroscopic endoscopes, comprising at least two channels respectively for continuously injecting an irrigation liquid into one of these cavities and for continuously discharging this irrigation liquid from this cavity, this apparatus comprising an irrigation circuit coupled to one of said channels and a suction circuit coupled to the other of the channels, characterized in that the irrigation circuit (11) and the suction circuit (14) each comprise a pump, a pressure sensor and means for comparing the pressures measured by each of these sensors and for controlling the pumps as a function of the pressure differences observed .
2. Appareil selon la revendication 1, caractérisé en ce que chacun des deux circuits est équipé d'un dispositif de pesée (21, 22) , et en ce que ces deux dispositifs de pesée sont associés à des moyens pour comparer les résultats des mesures de chacun de ces dispositifs.2. Apparatus according to claim 1, characterized in that each of the two circuits is equipped with a weighing device (21, 22), and in that these two weighing devices are associated with means for comparing the results of the measurements of each of these devices.
3. Appareil selon la revendication 1, caractérisé en ce que le circuit d'aspiration (14) comporte un capteur conductimétrique (23) pour déterminer les pertes de sang contenues dans le liquide d'irrigation à la sortie de la cavité.3. Apparatus according to claim 1, characterized in that the suction circuit (14) comprises a conductimetric sensor (23) for determining the losses of blood contained in the irrigation liquid at the outlet of the cavity.
4. Appareil selon la revendication 1 , caractérisé en ce qu'il comporte un capteur de pression de référence (24) qui est couplé auxdits moyens pour comparer les pressions mesurées par les capteurs disposés respectivement sur le circuit d'irrigation (11) et le circuit d'aspiration (14) •4. Apparatus according to claim 1, characterized in that it comprises a reference pressure sensor (24) which is coupled to said means for comparing the pressures measured by the sensors disposed respectively on the irrigation circuit (11) and the suction circuit (14) •
5- Appareil selon la revendication 1, caractérisé en ce que le circuit d'aspiration (14) est équipé d'un filtre à particules solides (25) .5- Apparatus according to claim 1, characterized in that the suction circuit (14) is equipped with a solid particle filter (25).
FEUILLE DE REMPLACEMENT REPLACEMENT SHEET
PCT/FR1992/000362 1991-04-22 1992-04-22 Apparatus for the controlled irrigation of natural cavities of the body WO1992018049A1 (en)

Priority Applications (2)

Application Number Priority Date Filing Date Title
JP4510448A JPH06504221A (en) 1991-04-22 1992-04-22 Device for cleaning natural cavities within the human body
US08/353,879 US5586973A (en) 1991-04-22 1994-12-12 Method and device for controlled irrigation and suctioning of a liquid clarificant during endoscopic surgery

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
FR91/04969 1991-04-22
FR9104969A FR2675367A1 (en) 1991-04-22 1991-04-22 APPARATUS FOR CONTROLLED IRRIGATION OF NATURAL BODY CAVITIES.

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JP (1) JPH06504221A (en)
CA (1) CA2085990A1 (en)
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FR2727847A1 (en) * 1994-12-07 1996-06-14 C & D Biomedical Appts. for supply and extraction of clarifying liquid during surgery, e.g. bladder operations
US5709670A (en) * 1994-05-03 1998-01-20 Aquintel, Inc. Surgical fluid and tissue loss monitor
EP0956081A1 (en) * 1996-07-17 1999-11-17 Aquarius Medical Corporation Improved fluid management system for arthroscopic surgery
WO2007114776A1 (en) * 2006-03-30 2007-10-11 Medical Vision Research & Development Ab Method and device for irrigation of body cavities
EP1900347A1 (en) * 2006-09-14 2008-03-19 Alcon, Inc. Method of controlling an irrigation/aspiration system
US7857794B2 (en) 2004-06-14 2010-12-28 Alcon, Inc. Handpiece tip
US7967775B2 (en) 2007-01-09 2011-06-28 Alcon, Inc. Irrigation/aspiration tip
WO2015086857A1 (en) * 2013-12-13 2015-06-18 Academisch Medisch Centrum System for flushing a pericardial cavity
US9314553B2 (en) 2008-01-10 2016-04-19 Alcon Research, Ltd. Surgical system
US9549850B2 (en) 2013-04-26 2017-01-24 Novartis Ag Partial venting system for occlusion surge mitigation
US9561321B2 (en) 2011-12-08 2017-02-07 Alcon Research, Ltd. Selectively moveable valve elements for aspiration and irrigation circuits
EP4230234A4 (en) * 2020-12-17 2024-04-10 Shanghai Yodo Medical Tech Ag Co Ltd Uterine cavity perfusion system and perfusion method

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DE102012204680B4 (en) 2012-03-23 2019-04-25 Olympus Winter & Ibe Gmbh Method and system for flushing solution supply during endoscopic procedures

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Cited By (20)

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US5709670A (en) * 1994-05-03 1998-01-20 Aquintel, Inc. Surgical fluid and tissue loss monitor
US5944668A (en) * 1994-05-03 1999-08-31 Aquintel Corporation Surgical fluid and tissue loss monitor
US5956130A (en) * 1994-05-03 1999-09-21 Aquintel Corporation Method of surgical fluid analysis
FR2727847A1 (en) * 1994-12-07 1996-06-14 C & D Biomedical Appts. for supply and extraction of clarifying liquid during surgery, e.g. bladder operations
EP0956081A1 (en) * 1996-07-17 1999-11-17 Aquarius Medical Corporation Improved fluid management system for arthroscopic surgery
EP0956081A4 (en) * 1996-07-17 2000-09-13 Aquarius Medical Corp Improved fluid management system for arthroscopic surgery
US7857794B2 (en) 2004-06-14 2010-12-28 Alcon, Inc. Handpiece tip
WO2007114776A1 (en) * 2006-03-30 2007-10-11 Medical Vision Research & Development Ab Method and device for irrigation of body cavities
US8465467B2 (en) 2006-09-14 2013-06-18 Novartis Ag Method of controlling an irrigation/aspiration system
EP1900347A1 (en) * 2006-09-14 2008-03-19 Alcon, Inc. Method of controlling an irrigation/aspiration system
EP2065020A1 (en) * 2006-09-14 2009-06-03 Alcon, Inc. An irrigation/aspiration system
US7967775B2 (en) 2007-01-09 2011-06-28 Alcon, Inc. Irrigation/aspiration tip
US9314553B2 (en) 2008-01-10 2016-04-19 Alcon Research, Ltd. Surgical system
US9561321B2 (en) 2011-12-08 2017-02-07 Alcon Research, Ltd. Selectively moveable valve elements for aspiration and irrigation circuits
US9549850B2 (en) 2013-04-26 2017-01-24 Novartis Ag Partial venting system for occlusion surge mitigation
WO2015086857A1 (en) * 2013-12-13 2015-06-18 Academisch Medisch Centrum System for flushing a pericardial cavity
CN105828850A (en) * 2013-12-13 2016-08-03 阿姆斯特丹大学学术医学中心 System for flushing a pericardial cavity
US20160331888A1 (en) * 2013-12-13 2016-11-17 Academisch Medisch Centrum System for flushing a pericardial cavity
US10195337B2 (en) 2013-12-13 2019-02-05 Academisch Medisch Centrum System for flushing a pericardial cavity
EP4230234A4 (en) * 2020-12-17 2024-04-10 Shanghai Yodo Medical Tech Ag Co Ltd Uterine cavity perfusion system and perfusion method

Also Published As

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FR2675367A1 (en) 1992-10-23
EP0535209A1 (en) 1993-04-07
JPH06504221A (en) 1994-05-19
CA2085990A1 (en) 1992-10-23

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