Method for selectively elevating and separating tissue layers and surgical instrument for performing the method
A method for the selective elevation and separation of tissues comprised of multiple layers and a surgical instrument for performing the method. The method may be performed without the requirement of a solid mechanical device insertion or transection through the mucosal layer. In particular, the method and surgical instrument may be used for the selected separation and/or resection of selected portions of benign or malignant tissues (e.g. defining tissue planes, polyp elevation and removal, submucosal tissue tunneling, endoscopic mucosa resection, etc).
1. A surgical method comprising:
providing a device for feeding in at least one liquid;
selectively transferring the liquid into a specified layer within a target tissue, wherein the liquid is transferred using a pressure suitable for selective liquid transfer, the pressure being at a level such that the liquid accumulates within the specified layer within the target tissue and does not pierce or transfer into an underlying layer, thereby separating or elevating a portion of the target tissue; and
resecting the separated or elevated portion of the target tissue, wherein the resection is performed using at least one liquid delivered by the device for feeding in at least one liquid, wherein the liquid used for resection is delivered at a pressure suitable for resection.
2. The method of claim 1 , wherein a distal end of the device for feeding in the at least one liquid does not mechanically transect or pierce a target tissue during the transferring.
3. The method of claim 2 , further comprising placing the distal end of the device for feeding in at least one liquid on the target tissue before transferring the liquid.
4. The method of claim 2 , further comprising placing the distal end of the device for feeding in at least one liquid near a target tissue, such that the distal end is directed at but does not touch the target tissue, before transferring the liquid.
5. The method of claim 1 , wherein the pressure suitable for selective liquid transfer is configured such that the liquid integrates with and alters the physical tissue characteristics of the specified layer within the target tissue.
6. The method of claim 5 , wherein the liquid is retained within the specified layer in the target tissue for a period of time which allows for resection of the separated or elevated portion without requiring reintroduction of liquid into the specified layer.
7. The method of claim 5 , wherein the liquid is retained within the specified layer in the target tissue for a period of time which allows for coagulation of the separated or elevated portion without requiring reintroduction of liquid into the specified layer.
8. The method of claim 1 , wherein the underlying layer is a fibrin-rich muscularis layer.
9. The method of claim 1 , wherein the pressure suitable for selective liquid transfer is between about 10 bar and about 70 bar.
10. The method of claim 1 , wherein the at least one liquid is a biocompatible solution.
11. The method of claim 10 , wherein the at least one liquid is a NaCl solution.
12. The method of claim 1 , wherein the separated or elevated portion of the target tissue is benign.
13. The method of claim 1 , wherein the separated or elevated portion of the target tissue is malignant.
14. The method of claim 1 , wherein the resection is performed using a high frequency surgical cutting device.
15. The method of claim 1 , wherein the resection is performed using high frequency surgical cutting of the separated or elevated portion of the target tissue combined with coagulation of the separated or elevated portion of the target tissue.
16. The method of claim 1 , further comprising coagulating the separated or elevated portion of the target tissue.
17. The method of claim 16 , wherein the coagulation is performed using a high frequency surgical coagulation device.
18. A surgical method comprising:
providing a device for feeding in at least one liquid; and
selectively transferring the liquid into a specified layer within a target tissue; and
resecting the separated or elevated portion of the target tissue,
wherein the liquid is transferred into the specified layer using a pressure suitable for selective liquid transfer, the pressure being at a level such that the liquid accumulates within the specified layer within the target tissue and does not pierce or transfer into an underlying layer, thereby separating or elevating a portion of the target tissue,
wherein a distal end of the device for feeding in the at least one liquid does not mechanically transect or pierce a target tissue during the transferring, and
wherein the resection is performed using at least one liquid delivered by the device for feeding in at least one liquid, wherein the liquid used for resection is delivered at a pressure suitable for resection.
19. A surgical method comprising:
providing a device for feeding in at least one liquid; and
selectively transferring the liquid into a specified layer within a target tissue,
wherein the liquid is transferred using a pressure suitable for selective liquid transfer, the pressure being at a level such that the liquid accumulates within the specified layer within the target tissue and does not pierce or transfer into an underlying layer, thereby separating or elevating a portion of the target tissue,
wherein the pressure suitable for selective liquid transfer is configured such that the liquid integrates with and alters the physical tissue characteristics of the specified layer within the target tissue, and
wherein the liquid is retained within the specified layer in the target tissue for a period of time which allows for coagulation of the separated or elevated portion without requiring reintroduction of liquid into the specified layer.
20. A surgical instrument comprising:
a device for feeding in at least one liquid and for providing the liquid at a suitable pressure such that the liquid may be selectively transferred into a selected tissue layer such that the liquid accumulates within, integrates with and alters the physical characteristics of the selected tissue layer, wherein the suitable pressure is between about 10 bar and about 70 bar; and
a device for high frequency surgery,
wherein the surgical instrument comprises at least one channel comprising the device for feeding in at least one liquid and at least one additional channel for the device for high frequency surgery.
21. The surgical instrument of claim 20 , wherein the suitable pressure is at a level to allow selective liquid transfer such that the liquid may be transferred into the selected tissue layer without mechanically piercing an overlying layer with the device for feeding in the at least one liquid and without transferring liquid into an underlying layer.
22. The surgical instrument of claim 21 , wherein the overlying layer is a mucosal layer and the selected tissue layer into which the liquid is selectively transferred is a submucosal layer and the underlying layer into which liquid is not transferred is a fibrin-rich muscularis layer.
23. The surgical instrument of claim 20 , wherein the device for high frequency surgery is a high frequency needle.
24. The surgical instrument of claim 23 , where the high frequency needle includes an insulated tip.
25. The surgical instrument of claim 20 , wherein the device for high frequency surgery is a high frequency hook.
26. The surgical instrument of claim 20 , wherein the device for high frequency surgery is a high frequency spatula.
27. The surgical instrument of claim 20 , wherein the device for high frequency surgery is a snare wire.