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WO1999038549A1 - Systeme de tubes permettant de maintenir une pression de fluide en chirurgie - Google Patents

Systeme de tubes permettant de maintenir une pression de fluide en chirurgie Download PDF

Info

Publication number
WO1999038549A1
WO1999038549A1 PCT/US1999/002058 US9902058W WO9938549A1 WO 1999038549 A1 WO1999038549 A1 WO 1999038549A1 US 9902058 W US9902058 W US 9902058W WO 9938549 A1 WO9938549 A1 WO 9938549A1
Authority
WO
WIPO (PCT)
Prior art keywords
tube
fluid
chamber
eye
aspiration
Prior art date
Application number
PCT/US1999/002058
Other languages
English (en)
Inventor
David Bastable
Original Assignee
Mentor Corporation
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 Mentor Corporation filed Critical Mentor Corporation
Publication of WO1999038549A1 publication Critical patent/WO1999038549A1/fr

Links

Classifications

    • 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
    • A61M1/74—Suction control
    • A61M1/743—Suction control by changing the cross-section of the line, e.g. flow regulating valves
    • 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
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F9/00—Methods or devices for treatment of the eyes; Devices for putting in contact-lenses; Devices to correct squinting; Apparatus to guide the blind; Protective devices for the eyes, carried on the body or in the hand
    • A61F9/007—Methods or devices for eye surgery
    • A61F9/00736—Instruments for removal of intra-ocular material or intra-ocular injection, e.g. cataract instruments
    • A61F9/00745—Instruments for removal of intra-ocular material or intra-ocular injection, e.g. cataract instruments using mechanical vibrations, e.g. ultrasonic

Definitions

  • This invention relates to maintaining fluid 5 pressure in a body chamber such as the eye during surgery.
  • the anterior region of the eye is a small, fluid- filled chamber.
  • fluid balance in the eye is maintained by supplying irrigation fluid to the 0 eye and aspirating fluid from the eye using a surgical instrument.
  • a surgical instrument particularly useful in removing cataracts, is a phaco-emulsification instrument.
  • a phaco-emulsification instrument includes an ultrasonically vibrated hypodermic needle inserted into s an incision in the eye to break up the cataract lens. The lens fragments and aspirated fluid are removed by suction through the needle.
  • the surgical instrument is connected to a source of irrigation fluid and a drainage container by a tube o set that includes a series of individual, interconnected irrigation and aspiration tubes.
  • the tubes run along parallel lines and are connected along at least a portion of their lengths.
  • the rate 5 at which irrigating fluid is supplied to the eye and aspirated is controlled to ensure that the intraocular pressure remains within acceptable limits.
  • the rate of fluid flow in a tube set for irrigating and aspirating fluid may be controlled, e.g., by a peristaltic pump that 0 induces a vacuum in the aspiration tube.
  • a peristaltic pump that 0 induces a vacuum in the aspiration tube.
  • lens particles from the eye may collect in the tip of the needle and occlude the aspiration flow out of the eye. Such an occlusion causes the fluid pressure in the aspiration tube to drop as fluid continues to be withdrawn from the tube by the induced vacuum.
  • This invention features managing fluid flow in the eye during surgery using an aspiration tube and an irrigation tube, one being disposed within the other. This arrangement causes fluid to be injected into the eye at the same rate it is withdrawn when an occlusion at the tip of the surgical instrument is broken, thus maintaining the stability of the fluid pressure in the eye .
  • the invention features an apparatus for supplying fluid to and withdrawing fluid from a body chamber during surgery, including a first tube for carrying fluid, and a second tube disposed around the first tube and forming a space around the first tube for carrying fluid.
  • the invention features an apparatus for supplying fluid to and withdrawing fluid from a body chamber during surgery, including a first tube for carrying fluid and having a proximal end and a distal end, a second tube for carrying fluid disposed around the first tube, and a check valve at the proximal end of the second tube for avoiding flow of fluid out of the chamber (e.g., backflow through the second tube) .
  • the invention features a system for performing surgery on a body chamber, including a surgical instrument for supplying fluid to and withdrawing fluid from the chamber, and a first tube and a second tube connected to the instrument, the second tube being disposed around the first tube and forming a space around the first tube.
  • the invention features a method for maintaining fluid pressure of a body chamber during surgery, including withdrawing fluid from the chamber by a first tube and supplying fluid to the chamber by a second tube disposed around the first tube.
  • the first tube may be configured to withdraw the fluid from the chamber and the second tube may be configured to supply the fluid to the chamber. At least one of the first tube or said second tube may be configured to deform in response to a vacuum level.
  • the first and second tubes which may be coaxial or concentric, may be made from silicone rubber or polyvinylchloride .
  • the apparatus may include a spacer, which may be in the form of an elongated strip of material, connected between the first tube and the second tube.
  • the first and second tubes and the spacer may be formed as an integral unit from a unitary piece of material, which may be autoclavable .
  • the proximal end of the tubes may be connectable to a fluid source and a pump, and the distal ends may be connectable to a surgical instrument .
  • the surgical instrument of the system may be a phaco-emulsification instrument .
  • An advantage of this invention is the use of tubes to balance fluid flow into and out of the eye during surgery, rather than relying on electronic or other external devices.
  • the check valve may help to avoid flow of fluid out of the eye when an occlusion breaks.
  • the use of spacers also helps in the priming of the surgical system prior to use.
  • Another advantage of this invention is the formation of the tube arrangement as an integral unit, which may be autoclavable.
  • a further advantage of this arrangement is avoiding an extended evacuated aspiration tube that may quickly fill with fluid from the eye when the occlusion breaks .
  • Fig. 1 schematically shows an eye surgery system.
  • Fig. 2 illustrates a lengthwise view of an arrangement of concentric aspiration and irrigation tubes and the flow of fluid therein.
  • Fig. 3 shows a cross section of the tubes of Fig. 2.
  • Fig. 4 illustrates the deformation of the aspiration tube in the arrangement of Fig. 2 during an occlusion.
  • Fig. 5 shows a cross section of the tubes of Fig. 2 formed as an integral unit .
  • Fig. 1 shows a system 10 for supplying fluid to and withdrawing fluid from the eye during surgery. Fluid is supplied to the eye by irrigation tube 20 and is withdrawn from the eye by aspiration tube 22. The proximal end of irrigation tube 20 is connected to an IV bottle 12 which supplies fresh fluid. The proximal end of aspiration tube 22 is disposed within a waste disposal container 18. The distal ends of irrigation and aspiration tubes 20 and 22 are inserted into a handpiece 30, including a hydraulic nozzle 32, of a surgical instrument such as a phaco-emulsification unit for manipulation in eye 42.
  • a surgical instrument such as a phaco-emulsification unit for manipulation in eye 42.
  • the fluid pressure at the proximal end of the irrigation tube 20 is determined by the height of the IV 5 bottle 12 above the patient's eye (typically 60 cm) .
  • a peristaltic pump 50 induces a vacuum in o aspiration tube 22 by alternately contracting and releasing a section 22a of tube set 22.
  • the induced vacuum draws aspirated fluid from eye 42 into aspiration tube 22.
  • aspiration tube 22 s is disposed within irrigation tube 20 along a section 40 between an endpiece 52 and a fitting 54 on handpiece 30.
  • Section 40 is preferably 6 to 10 feet long, or approximately half the length of the fluid path from source 12 to the eye 42.
  • Tubes 20 and 22 are coaxial, o and preferably concentric, in section 40.
  • Endpiece 52 preferably has connectors such as luers (not shown) for attaching irrigation tube 20 and aspiration tube 22 between section 40, and fluid source 12 and disposal container 18, respectively.
  • Irrigation and aspiration tubes 20 and 22 may be made, e.g., from silicone rubber, polyvinylchloride (PVC) or a similar pliable, biocompatible material. In particular, the material should be sufficiently pliable to allow for both compression and expansion of aspiration 0 tube 22, and return to its original shape after deformation.
  • PVC polyvinylchloride
  • arrows 34 and 36 show the flow of fluid in aspiration tube 22 and irrigation tube 20 in section 40.
  • arrow 34 shows fluid flow into 5 the page
  • arrows 36 show fluid flow out of the page.
  • a check valve 14 is disposed in irrigation tube 20 at endpiece 52 to avoid flow of irrigation fluid out of the eye .
  • irrigation tube 20 is sized to allow adequate fluid flow around aspiration tube 22.
  • the inner diameter 26 and outer diameter 28 of aspiration tube 22 may be .065 in. and .105 in., respectively, thereby defining an aspiration tube wall thickness of .020 in.
  • the coaxial irrigation tube may have an outer diameter of .250 in. and a thickness of ⁇ o .032 in. This provides an annular chamber having a width 29 of .081 in.
  • spacers 24 located along the length of tubes 20 and 22.
  • the spacers preferably form four is chambers in the space between the irrigation and aspiration tubes.
  • Spacers 24 may be thin pieces of material connected to the outer surface of aspiration tube 22 and the inner surface of irrigation tube 20. In the example described above, the spacers may have a width
  • Spacers 24 allow fluid to flow around aspiration tube 22 in irrigation tube 20 within section 40. In particular, spacers 24 prevent the inner tube from coiling within the outer tube, which would block the flow of fluid in the tubes. The use of spacers 24 also
  • the irrigation tube 20, aspiration tube 22 and spacers 24 are preferably manufactured as a single, integral unit from a unitary piece of material, e.g., by
  • Such an integral unit may be disposable or reusable if made from an autoclavable material .
  • the user connects the irrigation and aspiration tubes 20 and
  • the proximal end of irrigation tube 20 is connected to IV bottle 12.
  • the proximal end of aspiration tube 22 is disposed within disposal container 18, and tube portion 22a is placed in pump 50.
  • Irrigation tube 20 and aspiration tube 22 are then attached to endpiece 52 of section 40.
  • the distal ends of tubes 20 and 22 at the distal end of section 40 are connected to handpiece 30 of the surgical instrument by fitting 54.
  • Handpiece 30 is constructed to receive irrigation fluid from tube 20 and expel irrigation fluid into tube 22 through fitting 54.
  • the irrigation and aspiration lines may be coaxial within handpiece 30, but other types of handpieces may be used with the combination of irrigation tube 20 and aspiration tube 22.
  • system 10 When the surgical procedure is started, system 10 is primed by opening pinch valve 16 and completely filling tubes 20 and 22 with irrigation fluid from IV bottle 12. Fluid may be pumped directly into aspiration tube 22 before it is connected to handpiece 30, or a test chamber placed over nozzle 32 allows fluid to flow from the irrigation tube 20 into aspiration tube 22.
  • priming is accomplished by repeatedly applying a relatively strong vacuum to aspiration tube 22 several times using pump 50 and allowing fluid to flow into irrigation tube 20. Priming eliminates air or other gases from the tubes. Spacers 24 provide increased surface area for the fluid that pushes against the air in the tubes during priming.
  • the purpose of the arrangement in which the aspiration tube 22 is disposed inside the irrigation tube 20 is to reduce the surge of fluid out of the eye caused by the aspiration tube 22 returning to its original shape after having been collapsed due to a temporary occlusion at the tip of the surgical instrument.
  • aspiration tube 22 collapses due to the induced vacuum in the tube when there is an occlusion at the tip of the surgical instrument. Aspiration tube 22 deforms due to the pliable characteristics of the material from which it is made. As shown by arrows 36, fluid from IV bottle 12 fills the extra space created between the irrigation tube 20 and the collapsed aspiration tube 22. After the occlusion breaks free, aspiration tube 22 returns to its original shape. In returning to its original shape, the expanding inner diameter of aspiration tube 22 acts as a pump to draw fluid out of the eye, while the expanding outer diameter pumps irrigation fluid from the space between the tubes into the eye.
  • check valve 14 at endpiece 52 limits the flow of fluid out of the eye 42.
  • fluid is pulled out of the eye by the expanding aspiration tube 22 in section 40, and fluid flows into the eye from irrigation tube 20.
  • the singular action of the expanding aspiration tube 22 in section 40 causes fluid flow in both directions at the same time and in the same proportions. This fluid flow avoids damage to the eye during the surge that results from an occlusion that has broken free, without requiring additional equipment to maintain the proper fluid flow.
  • the irrigation tube 20 may be located within the aspiration tube 22.
  • the spacers 24 may be located periodically along the length of section 40.
  • the irrigation tube 20, aspiration tube 22 and spacers 24 may be manufactured as separate pieces that are connected together, with the spacers molded to either of the tubes by extrusion.
  • the arrangement of a pliable aspiration tube within the irrigation tube may also be used to control chamber stability of any body chamber undergoing a surgical procedure requiring irrigation and aspiration, such as for liposuction in which canulas are used to pump fluid into and out of the body.

Landscapes

  • Health & Medical Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Biomedical Technology (AREA)
  • Vascular Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • Anesthesiology (AREA)
  • Hematology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Pulmonology (AREA)
  • External Artificial Organs (AREA)

Abstract

En chirurgie, il est possible de réguler la pression de fluide dans une chambre corporelle comme l'oeil (42), par le biais d'un tube d'aspiration (22) et d'un tube d'irrigation (20), l'un étant placé à l'intérieur de l'autre. L'invention concerne un procédé et un dispositif permettant d'amener et d'évacuer un fluide, en cours de chirurgie effectuée sur la chambre considérée (42). Le dispositif comprend un premier tube (22), et un second tube (20) qui entoure le premier (22) et qui forme par ailleurs un espace autour de celui-ci (22). Un clapet de retenue (14) situé à l'extrémité proximale du second tube (20) peut être utilisé pour éviter l'écoulement du fluide hors de la chambre (42). Un système chirurgical peut comprendre un instrument chirurgical relié aux premier et second tubes (22, 20).
PCT/US1999/002058 1998-01-28 1999-01-27 Systeme de tubes permettant de maintenir une pression de fluide en chirurgie WO1999038549A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US1503198A 1998-01-28 1998-01-28
US09/015,031 1998-01-28

Publications (1)

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WO1999038549A1 true WO1999038549A1 (fr) 1999-08-05

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Cited By (18)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2005110008A2 (fr) 2004-04-15 2005-11-24 Alcon, Inc Reduction ou elimination de l'introduction d'air dans un fluide introduit dans un champ chirurgical
WO2006069016A1 (fr) * 2004-12-20 2006-06-29 Bausch & Lomb Incorporated Tubulure d'irrigation-aspiration a amortissement de sautes de pression
US7101402B2 (en) 1998-09-10 2006-09-05 Percardia, Inc. Designs for left ventricular conduit
WO2009068665A1 (fr) * 2007-11-30 2009-06-04 Coloplast A/S Ensemble tubulaire utilisable dans un système de drainage des plaies
US7981074B2 (en) 2006-11-02 2011-07-19 Novartis Ag Irrigation/aspiration system
US8631831B2 (en) 2008-09-04 2014-01-21 Alcon Research, Ltd. Multi-compliant tubing
WO2014152376A1 (fr) * 2013-03-15 2014-09-25 Novartis Ag Systèmes et procédés pour chirurgie oculaire
US9126219B2 (en) 2013-03-15 2015-09-08 Alcon Research, Ltd. Acoustic streaming fluid ejector
US9149387B2 (en) 2008-09-04 2015-10-06 Novartis Ag Varying material properties of a single fluidic line in ophthalmology tubing
US9545337B2 (en) 2013-03-15 2017-01-17 Novartis Ag Acoustic streaming glaucoma drainage device
US9693896B2 (en) 2013-03-15 2017-07-04 Novartis Ag Systems and methods for ocular surgery
CN106994191A (zh) * 2017-04-14 2017-08-01 曹挺 一种肺部治疗仪
WO2017159183A1 (fr) * 2016-03-16 2017-09-21 オリンパス株式会社 Élément de tuyauterie médical
US9861522B2 (en) 2009-12-08 2018-01-09 Alcon Research, Ltd. Phacoemulsification hand piece with integrated aspiration pump
US9915274B2 (en) 2013-03-15 2018-03-13 Novartis Ag Acoustic pumps and systems
US9962288B2 (en) 2013-03-07 2018-05-08 Novartis Ag Active acoustic streaming in hand piece for occlusion surge mitigation
US10182940B2 (en) 2012-12-11 2019-01-22 Novartis Ag Phacoemulsification hand piece with integrated aspiration and irrigation pump
WO2022219525A1 (fr) * 2021-04-16 2022-10-20 Alcon Inc. Cassette chirurgicale et procédé d'amorçage de ladite cassette

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5015232A (en) * 1989-04-20 1991-05-14 Cook Incorporated Decompression enteroclysis balloon catheter
US5178605A (en) * 1991-09-23 1993-01-12 Alcon Surgical, Inc. Coaxial flow irrigating and aspirating ultrasonic handpiece
US5269750A (en) * 1992-06-22 1993-12-14 Stryker Corporation Tip unit for fluid transfer surgical handpiece

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5015232A (en) * 1989-04-20 1991-05-14 Cook Incorporated Decompression enteroclysis balloon catheter
US5178605A (en) * 1991-09-23 1993-01-12 Alcon Surgical, Inc. Coaxial flow irrigating and aspirating ultrasonic handpiece
US5269750A (en) * 1992-06-22 1993-12-14 Stryker Corporation Tip unit for fluid transfer surgical handpiece

Cited By (29)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US7101402B2 (en) 1998-09-10 2006-09-05 Percardia, Inc. Designs for left ventricular conduit
WO2005110008A2 (fr) 2004-04-15 2005-11-24 Alcon, Inc Reduction ou elimination de l'introduction d'air dans un fluide introduit dans un champ chirurgical
JP2007532236A (ja) * 2004-04-15 2007-11-15 アルコン，インコーポレイティド 手術部位に導入される流体内の空気の減少又は排除
EP1735029A4 (fr) * 2004-04-15 2008-05-21 Richard J Mackool Reduction ou elimination de l'introduction d'air dans un fluide introduit dans un champ chirurgical
WO2006069016A1 (fr) * 2004-12-20 2006-06-29 Bausch & Lomb Incorporated Tubulure d'irrigation-aspiration a amortissement de sautes de pression
JP2008523959A (ja) * 2004-12-20 2008-07-10 ボシュ・アンド・ロム・インコーポレイテッド サージ抑制灌注／吸引管
AU2005319353B2 (en) * 2004-12-20 2009-01-29 Bausch & Lomb Incorporated Surge dampening irrigation-aspiration tubing
JP4691110B2 (ja) * 2004-12-20 2011-06-01 ボシュ・アンド・ロム・インコーポレイテッド サージ抑制灌注／吸引管
KR101192510B1 (ko) 2004-12-20 2012-10-17 보오슈 앤드 롬 인코포레이팃드 서지 감쇄용 관류-흡입 관
US7981074B2 (en) 2006-11-02 2011-07-19 Novartis Ag Irrigation/aspiration system
WO2009068665A1 (fr) * 2007-11-30 2009-06-04 Coloplast A/S Ensemble tubulaire utilisable dans un système de drainage des plaies
US9149387B2 (en) 2008-09-04 2015-10-06 Novartis Ag Varying material properties of a single fluidic line in ophthalmology tubing
US8631831B2 (en) 2008-09-04 2014-01-21 Alcon Research, Ltd. Multi-compliant tubing
US9861522B2 (en) 2009-12-08 2018-01-09 Alcon Research, Ltd. Phacoemulsification hand piece with integrated aspiration pump
US10182940B2 (en) 2012-12-11 2019-01-22 Novartis Ag Phacoemulsification hand piece with integrated aspiration and irrigation pump
US9962288B2 (en) 2013-03-07 2018-05-08 Novartis Ag Active acoustic streaming in hand piece for occlusion surge mitigation
US9750638B2 (en) 2013-03-15 2017-09-05 Novartis Ag Systems and methods for ocular surgery
US9693896B2 (en) 2013-03-15 2017-07-04 Novartis Ag Systems and methods for ocular surgery
AU2014239833B2 (en) * 2013-03-15 2017-07-13 Alcon Inc. Systems and methods for ocular surgery
WO2014152376A1 (fr) * 2013-03-15 2014-09-25 Novartis Ag Systèmes et procédés pour chirurgie oculaire
RU2634627C2 (ru) * 2013-03-15 2017-11-02 Новартис Аг Способы и системы, применяемые в глазной хирургии
US9545337B2 (en) 2013-03-15 2017-01-17 Novartis Ag Acoustic streaming glaucoma drainage device
US9915274B2 (en) 2013-03-15 2018-03-13 Novartis Ag Acoustic pumps and systems
CN105190034A (zh) * 2013-03-15 2015-12-23 诺华股份有限公司 用于眼科手术的系统和方法
US9126219B2 (en) 2013-03-15 2015-09-08 Alcon Research, Ltd. Acoustic streaming fluid ejector
WO2017159183A1 (fr) * 2016-03-16 2017-09-21 オリンパス株式会社 Élément de tuyauterie médical
JP6275348B1 (ja) * 2016-03-16 2018-02-07 オリンパス株式会社 医療用配管部材
CN106994191A (zh) * 2017-04-14 2017-08-01 曹挺 一种肺部治疗仪
WO2022219525A1 (fr) * 2021-04-16 2022-10-20 Alcon Inc. Cassette chirurgicale et procédé d'amorçage de ladite cassette

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