Patent Application
20220354564
The present invention relates to an articulated endoscopic instrument and, in particular, an endoscopic dissection knife capable of precise articulation along a plane at or near its distal end.
During surgical procedures, such as endoscopy and laparoscopy, in which a targeted site for the application of a tool or instrument is difficult to access, the instruments must be steered within or towards a target organ or tissue from a position outside the body. Examples of endoscopic procedures include sigmoidoscopy, colonoscopy, esophagogastroduodenoscopy, and bronchoscopy. Traditionally, an end portion of an endoscopic instrument is advanced by pushing it forward and retracted by pulling it back. The instrument can also be manually moved side to side to achieve lateral movement of the device. The tip of the device, such as a knife or blade, may be directed by twisting and general up/down and left/right movements. Oftentimes, this limited range of motion makes it difficult to negotiate acute angles in small areas which can create patient discomfort and increase the risk of trauma to surrounding tissues.
The present invention provides an instrument capable of precise articulation near its distal end to assist the user in performing procedures. The articulation reduces or eliminates the need to pull or push the instrument back and forth or perform up/down and left/right movements to position the tip of the instrument in the desired position.
In a first aspect, disclosed is an endoscopic instrument that includes a conductive center wire having a first end and a second end and a tool secured to the second end of the center wire, a first actuator secured to the first end of the center wire and configured to move the center wire in a linear manner back and forth, one or more pull wires each having a first end and a second end, and a second actuator secured to the first end of the one or more pull wires and the second end of the one or more pull wires secured to an end section of the instrument housing the tool; and the second actuator is configured to angularly articulate the tool in a single plane by moving the one or more pull wires to change the position of the end section.
In an example of aspect 1, the second actuator can move the end section and tool up to 90 degrees in a single plane.
In another example of aspect 1, the second actuator is secured to a second pull wire having a first end and a second end. The second actuator is secured to the first end of the second pull wire and the end section of the instrument is secured to the first end of the second pull wire.
In another example of aspect 1, the second actuator is configured to angularly articulate the end section and tool ±90 degrees in a single plane by moving the one or more pull wires. The arc radius of the angular articulation of the end section and the tool in the single plane can be in the range of 0.2 to 10 centimeters, 0.4 to 5 centimeters or 1 to 3 centimeters.
In another example of aspect 1, the one or more pull wires are in direct contact with guides for positioning the pull wires at 180 degrees relative to one another to form a plane in which an end section of the instrument can angulate. The guides are positioned on an end of a guide section connected to an elongated housing containing the one or more pull wires.
In another example of aspect 1, the center wire is an electrode.
In another example of aspect 1, the tool is an electrocautery knife, a snare or a clip.
In another example of aspect 1, a portion of the center wire and a portion of the one or more pull wires are positioned in an elongated housing, for example a coiled housing, and the elongated housing is covered by an insulating sheath.
In another example of aspect 1, the instrument further includes a rotation actuator configured to rotate an end section housing the tool, the end section has an open end configured to pass the tool therethrough and the open end defining the end face of the instrument.
In another example of aspect 1, the center wire includes a flexible section positioned near a second end of the one or more pull wire. The flexile section of the center wire is further secured to an end portion of the center wire, which is secured to the tool.
In another example of aspect 1, the instrument further includes an electrical coupler for coupling the center wire to an electrical source. In an example, the electrical coupler is positioned adjacent or near the first actuator.
In another example of aspect 1, a spring blade is positioned between a guide section secured to the end of the elongated housing and the end section, and the spring blade is articulated ±90 degrees in a single plane by moving the one or more pull wires.
In a second aspect, there is an endoscopic instrument that includes the following features: an elongated housing having a first end and a second end, a center wire having a first end and a second end and a portion of the center wire positioned in the elongated housing, a first actuator secured to the first end of the center wire and the first actuator configured to move the center wire in a linear manner, a tool secured to the second end of the center wire and the tool configured to pass in and out of a first end of an end section by use of the first actuator, a pair of pull wires, each pull wire having a first end and a second end and a portion of the pair of pull wires positioned in the elongated housing, a second actuator secured to the first end of each of the pair of pull wires and the second end of each of the pair of pull wires secured to a second end of the end section, and the second actuator is configured to angularly articulate the tool ±90 degrees in a single plane by moving the pair of pull wires.
In an example of aspect 2, the elongated housing is a coiled metal housing.
In another example of aspect 2, the elongated housing is secured to a handpiece containing the first and second actuators at one end and the opposite end of the housing is secured to a guide section having two guides for the pair of pull wires.
In another example of aspect 2, the pair of pull wires are in direct contact with guides for positioning the pair of pull wires at 180 degrees relative to one another and to form a plane in which the end section can angulate.
In another example of aspect 2, the guides are secured to a guide section, the guide section connected to the second end of the elongated housing such that the pair of pull wires pass through the elongated housing and into the guide section.
In another example of aspect 2, a spring blade is positioned between a guide section and the end section of the instrument, the spring blade can be articulated ±90 degrees in a single plane by moving the pair of pull wires.
In another example of aspect 2, the spring blade has a first end and a second end, the first end of the spring blade secured to the second end of the end section and the second end of the spring blade secured to the first end of a guide section.
In another example of aspect 2, the spring blade has a first end and a second end, the first end of the spring blade extends into the second end of the end section and the second end of the spring blade extends into the first end of a guide section.
In another example of aspect 2, the spring blade is elastic and configured to return to its unarticulated shape.
Any one of the above aspects (or examples of those aspects) may be provided alone or in combination with any one or more of the examples of that aspect discussed above; e.g., the first aspect may be provided alone or in combination with any one or more of the examples of the first aspect discussed above; and the second aspect may be provided alone or in combination with any one or more of the examples of the second aspect or first aspect discussed above; and so-forth.
Additional features and advantages will be set forth in the detailed description which follows, and in part will be readily apparent to those skilled in the art from that description or recognized by practicing the embodiments as described herein, including the detailed description which follows, the claims.
The above and other features, examples and advantages of aspects or examples of the present disclosure are better understood when the following detailed description is read with reference to the accompanying drawings, in which:
Example embodiments are described and illustrated herein. These illustrated examples are not intended to be a limitation on the present embodiments. For example, one or more aspects of the system can be utilized in other embodiments and other types of instruments. Such systems may, however, be embodied in many different forms and should not be construed as limited to the embodiments set forth herein. Like, but not necessarily the same, elements in the various figures are denoted by like reference numerals for consistency. Terms such as “first,” “second,” “front,” and “rear” are used merely to distinguish one component (or part of a component or state of a component) from another. Such terms are not intended to denote a preference or a particular orientation.
Herein, when a range such as 5-25 (or 5 to 25) is given, this means preferably at least or more than 5 and, separately and independently, preferably not more or less than 25. In an example, such a range defines independently 5 or more, and separately and independently, 25 or less.
The present disclosure relates to an endoscopic instrument that provides articulation of a tool such as an electrocautery knife at its tip or distal end. Electrocautery uses electrical current to heat a conductive wire that is then applied to target tissue in order to burn or coagulate a specific area of tissue. Heat is passed through a resistant metal wire which is used as an electrode. This hot electrode is then placed directly onto the treatment area destroying that specific tissue. Such endoscopic submucosal surgeries benefit from a high degree of instrument mobility very close to the target site. Presently, ablation instruments have ablation tools with very limited mobility and require a large area to operate. The endoscopic instrument disclosed herein allows controlled movement near the end of the instrument, similar to bending the furthest joint on one finger as opposed to bending the whole finger. By providing a defined bend moment near the end of the instrument, the instrument can be operated with reduced movement around the target site and lessen radially impact at the target site in a patient during procedures. In addition, a bending moment near the end of the instrument provides for more precise control at the target site leading to a more efficient and successful result. The instrument also can be sized such that it can pass through working lumens of an endoscope along with other instruments, as necessary. For instance, the main body of the endoscopic instrument, for example, the insulated elongated housing and tip portion containing the tool, can have outer diameters in the range of 1 to 4 mm.
As described herein, the endoscopic instrument can be used in connection with an endoscopic submucosal dissection (ESD) or electrocautery (e-knife) knife and can angulate up to 180 degrees at the tip portion of the instrument in a single plane, optionally rotate up to 360 degrees, and extend and retract through an end section or standard channel gastroscope. The tool (e.g., knife) has a retractable tip connected to a conducting center wire, which is linearly moveable and connected to an electrical source for transmitting electrical current to the tool. To enhance flexibility and angular movement of the tip portion of the instrument housing the tool, from an articulated to the unarticulated position or the base position, a flexible spring blade can be optionally arranged in the instrument near the tool and end portion one or more pull wires. Angulation of the end section of the instrument and tool is controlled by moving and tensioning one or more pull wires that can be positioned along with the center wire along the length of the instrument, for example, within a channel centrally located within an elongated housing and outer plastic insulating skin surrounding or coating the housing. The operator moves the tip of the tool by rotating a directional actuator knob, which controls the movement of directional pulling wires and the instrument end. More specifically, the rotation movement of a knob or disc directs the movement of the pull wires to change the angular position of the tip portion of the instrument. As such, surgeries performed with the instrument provide surgeons with increased control over the dissection and an overall increase in safety and length of procedure.
The figures illustrate various embodiments and features of the endoscopic instrument.
The first actuator 20 can include any suitable configuration, for example, one or more loops for accommodating a user's hand and fingers for gripping the instrument and moving the first actuator during operation. In an example, the first actuator can include one or more fixed finger loops positioned adjacent a slider. The slider, attached to one end of the center wire, can slide along a shaft or coupler for moving the center wire in a linear motion to extend and retract the tool from the end of the instrument. In another example, as shown in
The handpiece further includes a second actuator 30. The second actuator 30 is configured to manipulate a position of a tool coupled to an end of the center wire of the instrument, such as an electrocautery knife, in an angular manner by movement of a tip portion 70 of the instrument. The second actuator 30 can include any suitable configuration, for example, a rotatable disc with a gripping feature or knob. The instrument is also fitted with a connector 40 that is used to couple the first actuator 20 and the second actuator 30 to a first end 50 of a flexible elongated housing 60, for example a coiled metal tube. The connector 40 is generally a hollow insulating member made of a plastic or other suitable material and can include one or more portions to provide a suitable connection between the handpiece and the elongated housing 60 that houses and guides the center wire and pull wires. The connector 40 can further include a rotation actuator 45 at one end. The rotation actuator 45 is secured to a first end 50 of the elongated housing 60, for example, near the second actuator 30 as shown in
Regarding the tool for use with the instrument, it is to be appreciated that other surgical tools, such as a loop electrode, electrosurgical scalpel, or any other suitable tip can be implemented and connected to the center wire. It is to be further appreciated that the tool described herein can be used in an electrosurgery application, if desired. As further shown in
Turning to
Also shown in
The second actuator 31 is similar to the second actuator 30 of
As shown in
The center wire 160 extends further upstream of tool 150 through guide section 200 and back to the actuator through the elongated housing. The center wire 160 can be any suitable conductive wire for providing electrical current to the tool. The center wire 160 can be a single monofilament or a wire made up of multiple filaments, for example, filaments twisted or combined together in any configuration. In another example, the center wire 160 can be made up of multiple sections of wire such that at least two of the sections are different from one another. For instance, the main portion of the center wire connected to the first actuator and extending to the tip portion and through the guide section 200 can be a monofilament, which is connected to a flexible portion of a braided or twisted wire of multiple filaments positioned between the guide section 200 and the end section 140, which is further connected to another monofilament section at or near end section 140 and connected at one end to tool 150. By incorporating a flexible section in the center wire between guide section 200 and end section 140, actuation of the end section is enhanced as the pull wires 190 are engaged with the second actuator to angulate end section 140 and tool 150.
As further shown in
The guides 210 facilitate movement of the pull wires laterally farther away from one another, as compared to their relative spacing within the elongated housing, as the second actuator is engaged to move and tension one of the pull wires. That is, an actuator is moved to pull one of the pulling wires towards the handpiece thereby shortening the pull wire as compared to the other pull wire. This movement of one pull wire leads to a moment arm, which causes end section 140 to actuate in an angular manner up to 90 degrees (e.g., the α- and β-angles described above). As such, the pull wires, by being tensioned one at a time, angulate the end section 140 and also the center wire 160 and tool 150 attached thereto. The end section 140 does not rotate about a mechanical hinge, however, the end section, in an angulated position, can be rotated by the rotation actuator described above secured to elongated housing and positioned at or near the handpiece of the instrument.
The pull wires 190, by being attached to one end of the end section 140, allow a bending moment to be positioned at or near the end of the instrument between end section 140 and guide section 200 as illustrated in
The tip portion 70 of the instrument, upon angulation should naturally tend to return to center position after single-plane actuation such that end section 140 is aligned with guide section 200. To assist the end section 140 to be in line with guide section 200 and promote travel along the single plane actuation as the pull wires are engaged, as shown in
The tool 152 can include any desired configuration depending upon the procedure desired. As shown, the tool 152 can be a snare. A snare can grasp, dissect, and transect tissue during a procedure, for instance, gastrointestinal endoscopy procedures. The snare includes a retractable loop, for example, of metal wire, that can be extended from end section 140 to form a loop with an opening 153. The loop opening 153, during a procedure, can be partly or completed closed by retracting the tool 152 back into end section 140 with the first actuator and thereby reducing the size of the loop as desired. One end of the tool 152 can be secured, for example by a weld or the like, to the end of moveable center wire 160 that can, in certain instances, pass through end section 140 for extending and retracting the tool. The snare can be any suitable shape, such as a circle, oval, hexagon shaped, diamond shape and the like.
The tool 154 can include any desired configuration depending upon the procedure desired. As shown, the tool 154 can be a clip such as an endoscopic clip or endoclip. The clip is a metal mechanical device that can close or secure surfaces together, for example tissue in the gastrointestinal tract, without the need for surgery or suturing. The clip includes a pair of arms 155 that can open and close by actuating wire 160.
Although embodiments described herein are made with reference to example embodiments, it should be appreciated by those skilled in the art that various modifications are well within the scope and spirit of this disclosure. Therefore, the scope of the example embodiments is not limited herein. The disclosure is intended to include all such modifications and alterations disclosed herein or ascertainable herefrom by persons of ordinary skill in the art without undue experimentation. It will be appreciated that an endoscopic instrument configured in accordance with the examples shown herein can be used for a wide variety of other procedures.
This application claims priority to and any other benefit of U.S. Provisional Patent Application Ser. No. 63/184,851 filed May 6, 2021, the contents of which are incorporated herein in their entirety by reference.
| Number | Date | Country | |
|---|---|---|---|
| 63184851 | May 2021 | US |
