• 专利附录
  • 专利说明
  • 权利要求
  • 类似技术
  • 同族专利
  • 引用文献
  • 法律状态
  • 优先权
    • 专利摘要:
    Ultrasonic surgical instrument (1) comprising a proximal portion (11) forming a base attached to an ultrasonic vibration generator, and a distal portion (12), said instrument extending from the proximal portion to the distal portion along the long axial direction (X), said instrument comprising a fluid line (4), the distal portion comprising a cutting portion (2), a fluid outlet (41) and one or two radial bumps (3) extending radially outwardly , the radial bumps being arranged at a longitudinal position substantially corresponding to the longitudinal position of the cutting portion, so that said radial boss provides a mark and / or a tactile mark under the skin for the surgeon.
    公开号:FR3018184A1
    申请号:FR1451895
    申请日:2014-03-07
    公开日:2015-09-11
    发明作者:Herve Noui；Shinichi Tanaka；Bruno Lamoureux
    申请人:NSK FRANCE；NSK NAKANISHI Inc；
    IPC主号:
    专利说明:

    [0001] The present invention relates to surgical instruments, in particular ultrasonic instruments; it relates in particular to the instruments adapted for the surgical remodeling of the nasal framework in the field of rhinoplasty, both for reconstructive surgery and for plastic surgery. Surgical procedures concerning the bone and / or cartilaginous structure of the nose can be practiced according to two operating techniques: - the so-called 'open' techniques, for which the structure is discovered by lifting the skin which was previously incised at the base of the nose, the so-called 'closed' techniques, for which small incisions are made at the base of the nostrils in order to slide a surgical instrument between the skin and the bone structure of the nose, in which case the doctor can not have direct vision of the operative end of the surgical instrument.
    [0002] Furthermore, the techniques currently used in the field of rhinoplasty are most often using conventional surgical instruments, osteotomes, gouges, knife-gouges, that is operated either manually by striking them with a mallet, or associated with a small electric actuator motor type.
    [0003] It is furthermore known, in the field of precision surgery, to use instruments excited by a mechanical movement with an ultrasonic frequency, such as those described in document WO2008012359. The so-called 'closed' techniques involve smaller scars and faster recovery of the patient; thus, the inventors have identified a need to improve the techniques of the prior art in the context of so-called 'closed' procedures, with no direct visibility of the clinical site by the surgeon. For this purpose, the subject of the invention is an ultrasonic surgical instrument comprising a proximal portion forming a base intended to be fixed to an ultrasonic vibration generator, and a distal portion, said instrument extending from the proximal portion to the distal portion along a general axial direction, said instrument comprising a fluid conduit, the distal portion comprising a cutting portion, at least one fluid outlet and at least one radial boss extending radially outwardly, said radial boss being arranged at a longitudinal position in correspondence with the longitudinal position of the cutting portion, so that said radial boss provides a tactile mark (a mark) for the surgeon who can locate the distal portion, in particular the cutting portion, at through the skin when this instrument is slipped under the skin and the surgeon can not have a direct line of sight e the distal portion. This locating function is particularly well suited for rhinoplasty type surgery in the so-called 'closed' technique. In various embodiments of the invention, one or more of the following arrangements may also be used.
    [0004] Two radial bosses 31, 32 are preferably provided, namely a first radial boss 31 corresponding to a first end of the cutting portion and a second radial boss 32 corresponding to the second end of the cutting portion; whereby the surgeon can have a tactile aid to locate the cutting segment in its entirety. According to one option, the first radial boss and the first end of the cutting portion are located at a first identical axial position and the second radial boss and the second end of the cutting portion are located at a second identical axial position; whereby the surgeon can precisely locate the cutting segment in its entirety, the bumps and the ends of the cutting portion being arranged vis-a-vis in a radial direction perpendicular to the general axial direction. Said radial boss may be offset axially by a predetermined distance from the cutting portion, with the distal portion having a bend whose end carries the cutting portion; thus the surgeon is offered the possibility of locating the cutting part even in the case of a curved distal part. The instrument may advantageously comprise an intermediate portion with two consecutive deflected portions having respective inclinations opposite and symmetrical with respect to the longitudinal axis; so that this intermediate portion acts as amplifier and / or impedance adapter ultrasonic vibrations. The first deflected portion is inclined at an angle between 5 ° and 20 ° with respect to the general axial direction; which makes it possible to obtain an optimized amplification effect for the transmission of ultrasonic vibrations.
    [0005] The proximal portion extends along a first longitudinal axis X1 and the distal portion extends along a second longitudinal axis X2, either offset angularly with respect to the first axis, or parallel to the first axis but offset laterally from the first axis; so that the shape of the instrument can have a shape particularly suitable for each surgical operation envisaged, in particular for rhinoplasty operations. The cutting portion may be provided with teeth; which forms an effective solution for osteotomy operations on bone or cartilage structure.
    [0006] The cutting portion may extend parallel to the general axial direction X; which is practical in the case of incision along the bridge of the nose. The cutting portion may extend transversely to the general axial direction X; this is practical in the case of incision transversely to the bridge of the nose. The distal portion is preferably equipped with at least two fluid outlets one on each side of the cutting portion. This optimizes the cooling of the clinical site and the cooling of the instrument. The cutting part can be a rasp. This makes it possible to flatten the bone surface locally. The cutting part can be presented as a sphere part. This makes it possible to obtain a slightly concave bone and / or cartilaginous surface. The present invention will be better understood and other features and advantages will become apparent upon reading the following detailed description comprising embodiments given by way of illustration with reference to the appended figures, in which: FIG. Fig. 2 is a side view schematically illustrating a medial osteotomy configuration with the surgical instrument according to the invention; Fig. 3 is a view of three of the bone structure of the nose of an individual; FIGS. 4A and 4B illustrate a medial osteotomy saw-type instrument, seen from the side and from below, respectively: FIGS. 5A and 4A show a lateral osteotomy configuration with the surgical instrument according to the invention; 5B illustrate a saw-like instrument for lateral osteotomy, seen from the side and from above respectively, - FIGS. 6A and 6B illustrate a typing instrument. Fig. 7A and 7B show a raster-type instrument, seen from the side and from above, respectively. Figs. 8A and 8B illustrate a diamond ball-type instrument, respectively. viewed from the side and from above, - Figure 9 is a schematic view of a system in which the instrument is used. In the different figures, the same references designate identical or similar elements.
    [0007] Figure 1 partially shows a skull with the bone structure 8 of the nose of an individual. In addition to the bone structure, the nasal appendage also includes a cartilaginous structure not shown in FIG. 1. Surgical procedures on the bone and cartilaginous structure of the nose can relate to various situations, among others: reconstructive surgery after trauma, rectification of the position of the nasal septum, and more and more frequently plastic surgery which consists of modifying the aesthetic appearance of the patient's nose. In particular, it involves performing osteotomy operations to remove bone tissue, in particular a medial osteotomy in the marked area 91, a lateral osteotomy in the marked zone 92, a transverse osteotomy in the marked zone 93. In addition, the intervention may consist in remodeling the bone structure by abrasion, especially in the areas marked 94 and 95 (upper and lower base of the nose). In the context of so-called 'closed' surgical procedures, it is a question of reaching the intervention zones 91-95 by making a small incision 61 in the nostril base. After which, as shown in Figure 2, the surgeon will slide a surgical instrument 1 between the skin on the one hand 6 and the other bone and cartilage structure of the nose. In the context of the present invention, use is preferably made of an ultrasound-type surgical instrument, that is to say, to which an ultrasonic vibration generator 7 imparts small amplitude movements at frequencies in the ultrasound band, which allows to preserve the soft tissues (muscles, vessels nerves) by working selectively only on the harder tissues (bone and cartilage).
    [0008] In the closed technique, the surgeon has no direct visibility of the operative clinical site; advantageously according to the present invention, the surgical instrument is equipped with a tactile tracking means which can facilitate the task of the surgeon. Of course, it should be noted that the surgical instruments that are described in the present application can be used not only in the context of the so-called 'closed' technique, but also in the context of the 'open' technique. More specifically, the surgical instrument 1 comprises in its distal portion a cutting portion 2, intended to attack the bone structure or cartilaginous, and vis-à-vis this cutting portion, there is provided at least one radial boss 3. By radial boss means a projection which extends in a direction substantially perpendicular to the general axial direction X of the surgical instrument, the latter axial direction being in particular most often coincides with the axis of the distal portion.
    [0009] The radial boss has a convex shape without sharp edge, so that it causes no injury in the inner surface of the skin 6, but it is still clearly perceptible to the touch by the practitioner. The height of the radial boss, relative to the body of the instrument, is preferably chosen between 0.5mm and 1mm. The top of the hump is preferably rounded. The surgical instrument 1 is made of stainless metal, for example a stainless steel for medical use, or another metal alloy for medical use. As illustrated in FIG. 3, according to the "closed" intervention technique, to prepare the operation, the surgeon makes an incision 61 at the base of the right nostril of the patient, preferably in an inner zone of the base of the patient. the nostril so that the resulting scar will hardly be visible. Another incision is made symmetrically in the left nostril (not shown). Then the surgeon slides the surgical instrument 1 upwards until the cutting portion 2 reaches the target clinical site 91. As illustrated in Figure 2, the aforementioned radial boss forms a corresponding hump under the skin 6 which can be sensed by the surgeon practitioner.
    [0010] As shown in Figures 4 to 9, several variants of surgical instruments are presented. All of these, however, have the following characteristics in common: a proximal portion 11 is intended to be fixed to the ultrasonic vibration generator 7, and comprises a base 18 fixed by clipping, screwing, or keying, to the vibration generator, distal portion 12, which comprises the cutting portion 2 and the radial boss 3 mentioned above, - a first intermediate portion 13 adjacent to the proximal portion, - a second intermediate portion 14 interposed between the first intermediate portion and the distal portion 12. The instrument 1 extends from the proximal portion to the distal portion along a general axial direction X. In addition, the surgical instrument comprises a fluid line 4, which carries an irrigation fluid and cooling at the clinical site.
    [0011] The first intermediate portion 13 may advantageously comprise two consecutive deflected portions 131, 132 having respective opposite and symmetrical inclinations with respect to the general axial direction, so as to contribute to the good transmission of the ultrasonic vibrations from the generator 7 to the distal portion 12 , the detail of the geometry of these deviated portions will be given later. It is specified that the range of ultrasonic frequencies used preferably in the targeted applications ranges from 26 kHz to 36 kHz, preferably in the range 30-33 kHz. According to a first particular variant (FIG. 4A, 4B), the surgical instrument 1 has a total length L of between 60 mm and 80 mm; the proximal portion 11 has a length of between 10 mm and 20 mm. The first intermediate portion 13, with the two deflected portions 131, 132, has a length of 20 mm and 35 mm. The second intermediate portion 14 has a length of between 10 mm and 30 mm.
    [0012] The main body of the surgical instrument has a constant section, which allows a relatively simple fabrication, including for the formation of the irrigation channel 4. The diameter of the fluid channel 4 is in the illustrated example of the order 0.5 mm.
    [0013] The diameter of the body of the instrument is, on the majority of the length or the section is substantially constant, between 1 mm and 3 mm. The first deflected portion 131 deviates from the axis X of the proximal portion at an angle α1, preferably between 5 ° and 20 °; similarly the second deflected portion 132 deviates from the X axis of the distal portion at an angle a2, preferably also between 5 ° and 20 ° and advantageously symmetrical to the angle ai. Advantageously in this case, the first radial boss 31 has a position along the axis identical to the axial position of the front end 21 of the cutting portion. Similarly, the second radial boss 32 has a position along the axis identical to the axial position of the rear end 22 of the cutting portion. This allows the surgeon to locate very precisely the position of the cutting segment of the distal portion 12. According to a second particular variant (Fiq 5A, 5B), the surgical instrument 1 has in addition to the previously described characteristics about the first variant, lateral misalignment of the first and second intermediate portions 13,14. A first elbow at an angle a4 is formed in the proximal portion or at the beginning of the first intermediate portion, a second elbow of an angle a5 is formed in the second intermediate portion.
    [0014] Such an off-axis configuration makes it possible to reach and work in the central zone 94 of the nose by having introduced the surgical instrument 1 by one of the lateral incisions 61 mentioned above. Such an off-axis configuration also makes it possible to work in lateral zones 92 of the bone framework of the nose.
    [0015] According to a third particular variant (Fiq 6A, 6B), the surgical instrument 1 has a bent distal portion, in the example shown with a 90 ° elbow. Note the amplitude a8 can be between 45 ° and 130 °. Here, the cutting portion is further away from the axis of the distal portion. In this particular case, the two radial bumps 31, 32 have an axial position offset with respect to the axial position of the cutting portion, the offset being marked by the predetermined length D2; for example D2 will be between 3mm and 5mm. In this third variant, a lateral misalignment arranged in the second intermediate portion is also illustrated; more precisely, this second intermediate portion comprises a deflection of angle a6 and an opposite deflection of angle a7. The bent distal portion being flat and very thin, the two fluid outlets 41, 42 are arranged in the vicinity of the position of the radial bumps.
    [0016] According to a fourth particular variant (FIG. 7A, 7B), the surgical instrument 1 has, instead of a distal portion in the shape of a saw, a distal portion in the form of a rasp 28. The active portion of the rasp is relatively flat, and comprises a central channel 43 for supplying the irrigation fluid, which complements a point fluid outlet 41 in the rear part of the rasp. The radial bumps 31, 32 are arranged on the main axis respectively vis-à-vis the front end of the rasp and the rear end of the rasp.
    [0017] According to a fifth particular variant (FIG. 8A, 8B), the surgical instrument 1 has, instead of a distal portion in the form of a saw, a distal portion in the form of a hemispherical rasp 9. Here again, the radial bumps 31, 32 are arranged on the main axis respectively vis-à-vis the front end of the rasp forming hemisphere and the rear end of the hemisphere rasp. As shown in FIG. 9, in a typical configuration, the surgical tool 1 is mounted on a handpiece 70 which contains the aforementioned ultrasonic generator 7, said handpiece 70 being connected by a flexible pipe 72 to a main apparatus 73 The flexible pipe 72 contains electrical cables and a fluid pipe. The main apparatus 73 also contains a peristaltic pump 75 which injects the irrigation fluid in the direction of the surgical instrument. The surgeon uses a foot (pedal) control 74 to control the generation of ultrasonic vibrations as well as the activation of the Peristaltic pump 75. Advantageously according to the present invention, it is understood that the surgeon, although having no direct visibility of the clinical site, can perfectly identify the position of the cutting portion of the instrument by touching the radial boss in correspondence of the cutting portion in the distal portion. The tactile location of the clinical site can be supplemented advantageously by identifying marks on the skin of the patient, made in color felt by the surgeon before the start of the actual surgical procedure. During the procedure, the surgeon can thus align the radial boss on the mark (s) color felt, which is particularly practical and greatly improves the accuracy of the surgical gesture.
    权利要求:
    Claims (13)
    [0001]
    REVENDICATIONS1. Ultrasonic surgical instrument (1) comprising a proximal portion (11) forming a base for attachment to an ultrasonic vibration generator, and a distal portion (12), said instrument extending from the proximal portion to the distal portion along a general axial direction (X), said instrument comprising a fluid conduit (4), the distal portion comprising a cutting portion (2), at least one fluid outlet (41) and at least one radial boss ( 3) extending radially outwards, said radial boss being arranged at a longitudinal position substantially corresponding to the longitudinal position of the cutting portion, so that said radial boss provides a mark and / or a tactile mark under the skin for the surgeon.
    [0002]
    2. Instrument according to claim 1, wherein there are two radial bosses, namely a first radial boss (31) in correspondence with a first end (21) of the cutting portion and a second radial boss (32) in correspondence with the second end (22) of the cutting portion; whereby the surgeon can have a tactile aid to locate the cutting segment in its entirety.
    [0003]
    3. Instrument according to claim 2, wherein the first radial boss (31) and the first end (21) of the cutting portion have a first identical axial position and the second radial boss (32) and the second end (22) of the cutting part have a second identical axial position; whereby the surgeon can precisely locate the cutting segment in its entirety.
    [0004]
    4. The instrument of claim 1, wherein said radial boss is offset axially by a predetermined distance (D2) from the cutting portion, with the distal portion having a bend whose end carries the cutting portion.
    [0005]
    5. Instrument according to one of claims 1 to 4, wherein the instrument comprises an intermediate portion (13) with two deflectant portions (131,132) having respective inclinations opposite and symmetrical with respect to the longitudinal axis; so that this intermediate portion acts as an amplifier of ultrasonic vibrations.
    [0006]
    6. The instrument of claim 5, wherein the first deflected portion (131) is inclined at an angle between 5 ° and 20 ° relative to the general axial direction.
    [0007]
    7. Instrument according to one of claims 1 to 6, wherein the proximal portion (11) extends along a first longitudinal axis (X1) and the distal portion (12) extends along a second longitudinal axis (X2). it is offset angularly with respect to the first axis (a10) or parallel to the first axis but offset laterally from the first axis (a4, a5, a6, a7).
    [0008]
    8. Instrument according to one of claims 1 to 7, wherein the cutting portion (2) is provided with teeth (20).
    [0009]
    9. Instrument according to one of claims 1 to 8, wherein the cutting portion extends parallel to the general axial direction X.
    [0010]
    10. Instrument according to one of claims 1 to 8, wherein the cutting portion extends transversely to the general axial direction X.
    [0011]
    11. Instrument according to one of claims 1 to 4, wherein the distal portion is equipped with at least two fluid outlets (41,42), one on each side of the cutting portion (3).
    [0012]
    12. Instrument according to one of claims 1 to 11, wherein the cutting portion is in the form of a rasp (28).
    [0013]
    13. Instrument according to one of claims 1 to 11, wherein the cutting portion is in the form of a sphere portion (9).
    类似技术:
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    法律状态:
    2015-03-27| PLFP| Fee payment|Year of fee payment: 2 |
    2016-03-30| PLFP| Fee payment|Year of fee payment: 3 |
    2017-02-24| PLFP| Fee payment|Year of fee payment: 4 |
    2018-01-29| PLFP| Fee payment|Year of fee payment: 5 |
    2019-01-28| PLFP| Fee payment|Year of fee payment: 6 |
    2020-01-27| PLFP| Fee payment|Year of fee payment: 7 |
    2021-12-10| ST| Notification of lapse|Effective date: 20211105 |
    优先权:
    申请号 | 申请日 | 专利标题
    FR1451895A|FR3018184B1|2014-03-07|2014-03-07|ULTRASONIC SURGICAL INSTRUMENT FOR RHINOPLASTY|
    FR1451895|2014-03-07|FR1451895A| FR3018184B1|2014-03-07|2014-03-07|ULTRASONIC SURGICAL INSTRUMENT FOR RHINOPLASTY|
    CN201580014904.2A| CN106456187B|2014-03-07|2015-03-06|Ultrasonic surgical instrument|
    EP15708219.9A| EP3113693B1|2014-03-07|2015-03-06|Ultrasonic surgical instrument|
    PCT/EP2015/054771| WO2015132401A1|2014-03-07|2015-03-06|Ultrasonic surgical instrument|
    ES15708219T| ES2711915T3|2014-03-07|2015-03-06|Ultrasonic surgical instrument|
    JP2016572916A| JP6662794B2|2014-03-07|2015-03-06|Surgical ultrasonic instrument|
    US15/123,838| US10624665B2|2014-03-07|2015-03-06|Ultrasonic surgical instrument|
    KR1020167027797A| KR102376300B1|2014-03-07|2015-03-06|Ultrasonic surgical instrument|
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