Patent Grant
11622753
This application describes embodiments of apparatuses, methods, and systems for visualization and collection of tissue biopsies, for example, gynecological applications such as the collection of endometrial tissue biopsies during a hysteroscopy.
Endoscopes can be used for the inspection of body cavities and other body regions. For example, hysteroscopy is the inspection of the uterine cavity by endoscopy with access through the cervix. Hysteroscopy tends to be a less traumatic and invasive technique than techniques requiring an incision. In brief, a hysteroscope is inserted via the cervix to the uterus after the cervix has undergone mechanical and/or chemical dilatation.
Biopsies involve the removal of tissue samples to be used in further examinations. For example, an endometrial biopsy is the removal of a small piece of tissue from the endometrium, which is the lining of the uterus. This tissue sample can show cell changes due to abnormal tissues or variations in hormone levels. Currently, hysteroscopy procedures use separate instruments for visualization and biopsy, therefore biopsies are often performed blind without any visualization of the biopsy sample site. Consequently, there is a need for improved methods and tools to provide an integrated and accurate and atraumatic hysteroscopy procedures.
Embodiments of the present disclosure relate to devices, methods, and systems for providing tissue biopsy evacuation and visualization for use in gynecological applications. Certain embodiments involve an integrated biopsy evacuation device having visualization. In some embodiments, the integrated hysteroscopy evacuation devices comprise a visualization sensor and an elongated body having a proximal end and a distal end. The distal end of the elongated body may be dimensioned to pass through an opening into the body, such as a minimally invasive body opening. The device may include an integrated camera and light for visualizing the interior of the uterus and the biopsy tissue itself. In certain embodiments, the device may further comprise an integrated articulation mechanism that imparts steerability to at least one of the visualization sensor and the distal end of the elongated body. Further, the device may be configured to evacuate biopsy tissues through aspiration and irrigation.
In certain embodiments, an integrated hysteroscopy device, may comprise:
In certain embodiments, the integrated hysteroscopy device further comprises an illumination element. The visualization element may be a hypotube positioned concentrically or non-concentrically within the elongate body. The visualization element may be configured to vibrate. In some embodiments, the elongate body may be configured to rotate relative to the visualization element. The visualization element may be retractable or extendable within the elongate body. The lumen may be configured to provide irrigation to the visualization element. In certain embodiments, the distal end of the elongate body may comprise a clear, conically shaped tip configured to provide visualization of tissues as the integrated hysteroscopy device is moved to a biopsy tissue. The conically shaped tip can be configured to open and allow the distal end of the tubular body and/or the visualization element to extend outward toward the tissue site. In embodiments, the integrated hysteroscopy device may further comprise a tube extending the length of the elongate body, the tube configured to provide aspiration and irrigation. In certain embodiments, the integrated hysteroscopy device may further comprise a source of infrared illumination. For example, the infrared light may be supplied in the form of an illumination fiber. The integrated hysteroscopy device may comprise an ultrasonic transducer. In embodiments, the integrated hysteroscopy device can comprise a glucose sensor.
In certain embodiments, the visualization element may be retractable or extendable within the elongate body and likewise the elongate body may be retractable and extendable with the visualization element remaining in position. The lumen may be configured to provide irrigation to the visualization element. In certain embodiments, an outer sleeving, overlapping the rigid tubular body, provides a second path for irrigation. In some embodiments the irrigation is directed toward the visualization element. The elongate body may comprise a perforated path for irrigation to help with the evacuation of biopsy tissues. In some embodiments, the outer sleeving may also extend over the distal end of the elongate body providing a means for introducing the device through tissue with minimal disruption of tissue. In embodiments the outer sleeving can be retracted to allow visualization of tissue and a path for irrigation of the visual element.
In some embodiments, the visualization element may be configured to be retractable within an outer tubular body and/or a suction channel. In certain embodiments, irrigation may be directed to clean the window of the visualization element by utilizing an arrangement of optics and irrigation elements configured to direct the irrigation. The elongate tubular body may be retractable or extendable relative to the visualization element. In particular embodiments, the integrated hysteroscopy device may further comprise a second irrigation port in fluid communication with an outer sleeve, the outer sleeve overlapping the elongate tubular body and configured to provide irrigation to the visualization element. In embodiments, the elongate body may be perforated to allow irrigation from the overlapping outer sleeve to aid the suction and evacuation of the biopsy tissue. The outer sleeve may extend and close over the distal end of the tubular body to provide for less disruptive insertion of the device into the soft tissue. In certain embodiments, the elongate tubular body may be rigid. In some embodiments, the elongate tubular body may be flexible.
In some embodiments, a method of evacuating a biopsy tissue may comprise:
In certain embodiments, the visualization element may vibrate while removing the biopsy tissue. In certain embodiments, the elongate body comprises an outer tubular body that rotates relative to the visualization element while removing the biopsy tissue. In some embodiments, the visualization element is retractable or extendable within the elongate body. Irrigation may be provided through the lumen to the visualization element. The distal end of the elongate body may comprises a clear, conically shaped tip, configured to provide visualization of tissues as the integrated hysteroscopy device is moved into a biopsy tissue.
In certain embodiments, an evacuation device includes an elongate body having a proximal end and a distal end, a visualization element located at or near the distal end of the elongate body for transmitting images received from inside of a patient, and an obturator. The elongate body includes one or more lumens, including an evacuation lumen extending along at least part of the length of the elongate body. The elongate body further includes a distal opening in fluid communication with the evacuation lumen at or near the distal end of the elongate body. The obturator is configured to be removably inserted in the evacuation lumen and to close off the distal opening.
In certain embodiments, a method of evacuating a biopsy tissue, tissue, and/or fluid comprises delivering an evacuation device to the biopsy tissue, tissue, and/or fluid with an obturator inserted into an evacuation lumen of the evacuation device, visualizing the biopsy tissue, tissue, and/or fluid utilizing a visualization element positioned on or within the evacuation device, removing the obturator from the evacuation lumen of the evacuation device, and applying suction to the evacuation lumen of the evacuation device to evacuate at least a portion of the biopsy tissue, tissue, and/or fluid.
In certain embodiments, a surgical device for creating an access path to an internal region of a body of a patient includes an outer tubular body having a proximal end and a distal end, a visualization element, one or more instruments for performing an operation, an introducer, and a shielding member. The visualization element is located within the outer tubular body and has a distal end positioned at or near the distal end of the outer tubular body for transmitting images received from inside the body of the patient. The one or more instruments are located within the outer tubular body and has a distal end positioned at or near the distal end of the outer tubular body for performing an operation within the body of the patient. The introducer has an elongate body with a proximal end and a distal end, the distal end of the introducer having an atraumatic tip. The introducer is sized and configured to be removably received within the outer tubular body. The shielding member is coupled to either the distal end of the outer tubular body or the distal end of the elongate body of the introducer. The shielding member has a proximal side and a distal side and is configured to at least partially close off the distal end of the outer tubular body such that the shielding member at least partially shields the distal end of the visualization element. The shielding member is configured to at least partially surround a portion of the distal end of the elongate body of the introducer such that the atraumatic tip may be positioned distally of the distal side of the shielding member.
In certain embodiments, a surgical device for creating an access path to an internal region of a body of a patient includes an outer tubular body, a visualization element, one or more instruments for performing an operation, an introducer, and a balloon. The outer tubular body has a proximal end and a distal end. The visualization element is located within the outer tubular body and has a distal end positioned at or near the distal end of the outer sheath for transmitting images received from inside the body of the patient. The one or more instruments for performing an operation within the body of the patient is located within the outer tubular body and has a distal end positioned at or near the distal end of the outer tubular body. The introducer has an elongate body with a proximal end and a distal end, the distal end having an atraumatic tip. The introducer is sized and configured to be removably received within the outer tubular body. The balloon is joined to the distal end of the elongate body of the introducer and has an interior surface and an exterior surface. The balloon has an inflated configuration and a deflated configuration. The introducer further includes a passage extending from its proximal end to an aperture in a sidewall of the distal end of its elongate body, the aperture being in fluid communication with an interior of the balloon defined by an air-tight seal between the interior surface of the balloon and the elongate body. The balloon is configured to be inflated after insertion of the introducer into the outer tubular body such that in its inflated configuration it at least partially closes off the distal end of the outer tubular body and in doing so at least partially shields the distal end of the visualization element. The balloon is configured in its inflated configuration to at least partially surround a portion of the distal end of the elongate body of the introducer such that at least a portion the atraumatic tip may be positioned distally of the balloon. The balloon is configured to be deflated prior to removal of the introducer from the outer tubular body.
In certain embodiments, a method of removing a biopsy tissue from a uterus, comprises placing an optical introducer through the opening of the cervix of the uterus of a patient to the location of the biopsy tissue. The optical introducer includes an elongate tube having a proximal end and a distal end, wherein the distal end is covered by a transparent window. A visualization element is contained within the elongate tube to assist in placing the optical introducer to the location of the biopsy tissue. The method further comprises guiding an outer cannula to the location of the biopsy tissue using the optical introducer. The outer cannula is guided to the location of the biopsy tissue either simultaneously with the optical introducer or subsequently delivered over the optical introducer. The method further comprises removing the optical introducer from the outer cannula, leaving the outer cannula in place within the uterus, delivering a hysteroscopy device through the outer cannula to the location of the biopsy tissue, and removing the biopsy tissue through the hysteroscopy device.
In certain embodiments, a method of removing a biopsy tissue from the uterus of a patient comprises inserting a combined introducer and hysteroscopy device through the opening of the cervix of the uterus of a patient to the location of the biopsy tissue. The combined introducer and hysteroscopy device includes an introducer having an elongate body. The elongate body of the introducer has a proximal end and a distal end, the distal end having an atraumatic tip. The hysteroscopy device includes an outer tubular body having a proximal end and a distal end. One or more operational elements are disposed within the outer tubular body. The outer tubular body removably receives the introducer, such that the atraumatic tip of the introducer extends beyond the distal end of the outer tubular body. The hysteroscopy device further includes a shielding member joined or joinable to either the distal end of the outer tubular body of the hysteroscopy device or the distal end of the elongate body of the introducer. The shielding member at least partially closes off the distal end of the outer tubular body. During insertion of the combined introducer and hysteroscopy device, the one or more operational elements are shielded by the shielding member and/or introducer from contacting bodily tissue. The method further comprises removing the introducer from the hysteroscopy device, leaving the hysteroscopy device in place within the uterus, and employing the one or more operational elements of the hysteroscopy device to remove the biopsy tissue through the hysteroscopy device.
In certain embodiments, a method of removing a biopsy tissue from the uterus of a patient comprises placing a hysteroscopy device through the opening of the cervix of the uterus of a patient to the location of the biopsy tissue. The hysteroscopy device includes an outer tubular body having a proximal end and a distal end. One or more operational elements are disposed within the outer tubular body. A visualization element for transmitting images received from inside a uterus of a patient is located in the outer tubular body. An atraumatic tip is removably attached to the distal end of the outer tubular body, wherein at least a portion of the atraumatic tip is at least partially transparent to allow for the visualization element to receive images through the atraumatic tip. The atraumatic tip is configured to prevent the one or more operational elements from contacting body tissue when the atraumatic tip is attached to the hysteroscopy device. The method further comprises visualizing images from inside the cervix of the uterus of the patient while the hysteroscopy device is being placed via the visualization element. The method further comprises guiding an outer cannula to the location of the biopsy tissue using the hysteroscopy device, wherein the outer cannula is guided to the location of the biopsy tissue either simultaneously with the hysteroscopy device or subsequently delivered over the outer tubular body. The method further comprises removing the hysteroscopy device from the body, removing the atraumatic tip from the distal end of the outer tubular body of the hysteroscopy device, and reinserting the hysteroscopy device through the outer cannula to the location of the biopsy tissue. The method further comprises employing the one or more operational elements of the hysteroscopy device to remove the biopsy tissue through the hysteroscopy device.
In certain embodiments, a surgical device for creating an access path to an internal region of a body of a patient includes an outer tubular body having a proximal end and a distal end, a visualization element, an atraumatic tip removably attachable to the distal end of the outer tubular body, and one or more instruments for performing an operation within the body of the patient. The visualization element is located within the outer tubular body and has a distal end positioned at or near the distal end of the outer tubular body for transmitting images received from inside the body of the patient. The one or more instruments are located within the outer tubular body and has a distal end positioned at or near the distal end of the outer tubular body. At least a portion of the atraumatic tip is at least partially transparent to allow for the visualization element to receive images through the atraumatic tip. The atraumatic tip closes off or partially closes off the distal end of the outer tubular body to prevent the one or more instruments from contacting body tissue when the atraumatic tip is attached to the surgical device. The atraumatic tip forms an atraumatic distal end on the surgical device such that the surgical device may be atraumatically inserted into the body of the patient to a location where the operation is to be performed.
In certain embodiments, a method of performing a visually guided minimally invasive operation within the body of a patient comprises attaching a shielding member to an endoscope. The endoscope has an elongate body having a proximal end and a distal end, a visualization element for transmitting images received from inside the body, and a working channel extending through the elongate body from the proximal end to the distal end. The working channel of the endoscope is configured to removably receive one or more operational instruments for operating within the body. The shielding member is at least partially transparent and has a proximal side and a distal side. The shielding member is configured to removably attach to the distal end of the elongate body of the endoscope. The shielding member comprises a hole extending from its proximal side to its distal side for receiving an introducer. The method further comprises inserting an introducer through the working channel of the endoscope either before or after the shielding member is attached. The introducer has an elongate body having a proximal end and a distal end, the distal end of the introducer having an atraumatic tip. The introducer is configured to be removably received within the working channel of the endoscope such that the atraumatic tip extends distally of the distal end of the endoscope. The method further comprises positioning the introducer within the endoscope such that at least a portion of the elongate body of the introducer passes from the proximal side of the shielding member to the distal side of the shielding member and such that at least a portion of the atraumatic tip is positioned distally of the shielding member. The method further comprises placing the endoscope into the body of the patient to a location where the operation is to be performed while visualizing images from inside the body of the patient via the visualization element of the endoscope. The shielding member shields the visualization element of the endoscope such that the visualization element is prevented from contacting body tissue during use. The visualization element receives images from inside the body through the at least partially transparent portion of the shielding member. The method further comprises removing the introducer from the endoscope while the endoscope remains in place within the body, inserting the one or more operational instruments through the working channel such that they extend to or through the hole in the shielding member, and employing the one or more operational instruments to perform the operation while visualizing images from inside the body via the visualization element of the endoscope. The method further comprises removing the operational instruments from the working channel of the endoscope and removing the endoscope from the body either simultaneously with the operational instruments or subsequently to the removal of the operational instruments from the working channel of the endoscope.
In certain embodiments, a kit for adapting an endoscope to perform a visually guided minimally invasive operation within the body of a patient includes a shielding member and an introducer. The shielding member is configured to be removably attached to the distal end of an endoscope having a proximal end and the distal end, a working channel extending from the proximal end to the distal end for receiving one or more operational instruments for performing an operation in the body, and a visualization element for transmitting images received from inside the body. The shielding member is configured to shield the visualization element of the endoscope in an attached configuration such that the visualization element is prevented from contacting body tissue during use. A portion of the shielding member is at least partially transparent at a location configured to allow visualization by the visualization element of the endoscope through the partially transparent portion of the shielding member in the attached configuration. The shielding member has a proximal side, a distal side, and a hole extending from its proximal side to its distal side for receiving an introducer. The introducer is configured to be removably inserted through the working channel of the endoscope. The introducer has an elongate body having a proximal end and a distal end, the distal end of the introducer having an atraumatic tip. The introducer is configured to be removably received within the working channel of the endoscope such that the atraumatic tip extends distally of the distal end of the endoscope. The introducer is configured to be removably received within the hole of the shielding member in the attached configuration such that at least a portion of the elongate body of the introducer passes from the proximal side of the shielding member to the distal side of the shielding member and such that at least a portion of the atraumatic tip is positioned distally of the shielding member.
Additional embodiments of hysteroscopy devices (with or without integrated visualization), introducers, trocars, and other devices, and their methods of use, are described below.
Other features and advantages of the embodiments described herein will be apparent from the following detailed description of the invention, taken in conjunction with the accompanying drawings of which:
Embodiments of the present disclosure relate to devices, methods, and systems providing a tissue biopsy collection device and visualization. For example, such devices and techniques may be for use in gynecological applications, particularly for the collection of biopsies of endometrial tissue and other tissues presented in the uterine cavity. One of skill in the art will understand that hysteroscopy devices disclosed herein may be used in other parts of the body such as peritoneal cavities, gall bladder, uterus, bladder, colon, prostate, esophagus, blood vessels, heart, liver, stomach, intestines, medullary cavities, other organs with sphincters. As such, a person of skill in the art will understand that the recitations of uterus, hysteron, and other anatomical terms may at times in this specification be used interchangeably with recitations of body parts such as peritoneal cavities, prostate, gall bladder, uterus, bladder, colon, esophagus, blood vessels, heart, liver, stomach, intestines, medullary cavities, and other organs with sphincters. The integrated visualization biopsy collection devices disclosed herein may be used as general evacuation devices for other applications as well, in addition to or instead of uterine biopsy. For example, the evacuation devices can be used to aspirate/evacuate blood, tissue, fluid, particulate, debris, and/or other material from the body. Before these embodiments are described in greater detail, it is to be understood that this application is not limited to particular embodiments described, as such may, of course, vary. It is also to be understood that the terminology used herein is for the purpose of describing particular embodiments only, and is not intended to be limiting, since the scope of the present disclosure will be limited only by the claims as presented herein or as added or amended in the future. Where a range of values is provided, it is understood that each intervening value between the upper and lower limit of that range and any other stated or intervening value in that stated range, is encompassed within the disclosure. The upper and lower limits of these smaller ranges may independently be included in the smaller ranges and are also encompassed within the disclosure, subject to any specifically excluded limit in the stated range. Where the stated range includes one or both of the limits, ranges excluding either or both of those included limits are also included in the disclosure.
Certain ranges are presented herein with numerical values being preceded by the terms “about,” “around,” and “approximately.” These terms are used herein to provide literal support for the exact number that it precedes, as well as a number that is near to or approximately the number that the term precedes. In determining whether a number is near to or approximately a specifically recited number, the near or approximating un-recited number may be a number which, in the context in which it is presented, provides the substantial equivalent of the specifically recited number.
All publications and patents cited in this specification are herein incorporated by reference as if each individual publication or patent were specifically and individually indicated to be incorporated by reference and are incorporated herein by reference to disclose and describe the methods and/or materials in connection with which the publications are cited. The citation of any publication is for its disclosure prior to the filing date and should not be construed as an admission that the present invention is not entitled to antedate such publication by virtue of prior invention. Further, the dates of publication provided may be different from the actual publication dates which may need to be independently confirmed.
It is noted that, as used herein and in the claims, the singular forms “a”, “an”, and “the” include plural referents unless the context clearly dictates otherwise. It is further noted that the claims may be drafted to exclude any optional element. As such, this statement is intended to serve as antecedent basis for use of such exclusive terminology as “solely,” “only” and the like in connection with the recitation of claim elements, or use of a “negative” limitation.
As will be apparent to those of skill in the art upon reading this disclosure, each of the individual embodiments described and illustrated herein has discrete components and features which may be readily separated from or combined with the features of any of the other several embodiments without departing from the scope or spirit of the present invention. Any recited method can be carried out in the order of events recited or in any other order which is logically possible.
Also provided are kits for use in practicing the subject methods, where the kits may include one or more of the devices described herein the specification, and/or components of the subject systems. In embodiments, the components within the package are pre-sterilized. Further details regarding pre-sterilization of packaging may be found in U.S. Pat. No. 8,584,853, filed Feb. 16, 2012, and hereby incorporated by reference into this specification in its entirety.
In certain embodiments, the controller 6 may comprise a housing having a USB port and a camera button. The camera button may activate the system to collect and/or store a still or moving image. The controller 6 may further comprise a power button, a mode switch button, and brightness controls. The controller 6 can further comprise a display such as a screen 19 for displaying still images and/or video.
Activating the mode switch button 16 may switch the system between different modes such as a procedure mode in which video and/or still images are collected and displayed in real-time on the video screen 19 and a review mode, in which a clinician may selectively display stored images and video on the video screen 19 for analysis. For example, while in procedure mode, the system could display video or images from the visualization sensor in real-time. By real-time, it is meant that the screen 19 can show video of the interior of a tissue site as it is being explored by the clinician. The video and/or images can further be stored automatically by the system for replay at a later time. For another example, while in review mode, the screen 19 may conveniently display specific images or videos that have previously been acquired by the system, so that the clinician can easily analyze the collected images/data, and discuss the images and data with a patient. In some embodiments, the clinician may be able to annotate the images via a touch screen or other suitable means.
In certain embodiments, the screen 19 may be any type of image plane suitable for visualizing an image, such as the screen on an Microsfot Surface Pro, iPad, a camera, a computer monitor, cellular telephone, a display carried by a head worn support such as eyeglasses or other heads up display, or any other types of displays. In certain embodiments, the cable may be avoided by configuring the device and display to communicate wirelessly.
In some embodiments, it may be desirable to remove the cord and provide instead a wireless communication link between the probe and the monitor and possibly also to a centralized medical records storage and/or evaluation location. Local transmission such as to the monitor within a medical suite may be accomplished via a local area network such as, for example, a “WiFi” network based on IEEE 802.11 wireless local area networking standards, Bluetooth wireless personal area networking standard, or the low power consumption ANT wireless protocol. Transceiver chips and associated circuitry are well understood in the art, and may be located within the hand piece housing of the integrated hysteroscopy device 4, which is discussed below.
In certain embodiments, the integrated hysteroscopy device 4 of
In certain embodiments, during biopsy collection, patient recovery status may be monitored using one or more sensing methods, such as but not limited to monitoring of oxygen levels or saturation, rate of carbon dioxide production, heart rate, and/or blood pressure. Also, the sensing element's measure could be used to modulate the intensity, frequency and/or duty cycle of components of the device. Such a feedback process is also known as a closed loop control system. Some embodiments may also include the use of a disposable patient interface (DPI), a sterile, compliant conductive gel/oil pack which interfaces between the ultrasound transducer and the patient.
In certain embodiments, and as described elsewhere in the specification, the elongated body 1102 may have a proximal end 1106 and a distal end 1108. The term “proximal end”, as used herein, refers to the end of the elongated body 1102 that is nearer the user (such as a physician operating the device in a hysteroscopy procedure), and the term “distal end”, as used herein, refers to the end of the elongated body that is nearer the internal target tissue of the subject during use. The elongated body 1102 is, in some instances, a structure of sufficient rigidity to allow the distal end to be pushed through the opening of the cervix of the uterus when sufficient force is applied to the proximal end of the elongated body 1102. As such, in certain embodiments the elongated body 1102 is not pliant or flexible, at least not to any significant extent. In other embodiments, the elongated body 1102 is pliant and flexible, allowing the elongated body 1102 to twist and bend around tissues.
In certain embodiments, the distal end 1108 will be open-ended to provide visualization, illumination, irrigation, and/or aspiration through the open end. The distal end 1108 may be blunted to prevent tissue damage. The elongated body 1102 may be used to traverse through the opening of the cervix and cavity of the uterus to reach a target of interest, such as a tissue biopsy site. The device may provide visualization of tissues through the open end of the elongated body and display these images on a separate screen such as depicted above in
In certain embodiments, as is known in the art, any portion of the hysteroscopy device 1100, such as the outer portion of the elongated body 1102 and/or the inner hypotube 1128, as shown in
As depicted in
In certain embodiments, the control 1116 may selectively activate the acquisition of an image and/or video. The control 1116 may thus be configured to selectively start video recording, stop video recording, and/or capture a still image either during video recording or while video recording is off. In embodiments, these activities may be activated via voice and/or buttons on a tablet. In certain embodiments, a secondary tablet/phone/screen could be kept in a sterile draped bag.
In embodiments, the hand piece 1104 may comprise a luer connection 1120, configured to connect to any fluid source as described herein this section or elsewhere in this specification, such as sterile saline. The luer connection 1120 may be in fluid communication with a lumen extending throughout the length of the elongated body 1102, allowing for the delivery of fluid or agents to the tissue site.
The junction between the hand piece 1104 and the elongated body 1102 may include a hub 1122 that connects the hand piece 1104 to the elongated body 1102. In some embodiments, the hub 1122 may be detachable, allowing the elongated body to be detached from the hand piece 1104. In other embodiments, the elongated body is permanently attached to the hand piece 1104 via the hub 1122 to provide an integrated assembly. The hand piece 1104 may further comprise a strain relief node 1124, configured to attach to an electrical cable (not shown in
In some embodiments, the hysteroscopy device 1100 is configured as an integrated assembly for one time use. The hysteroscopy device 1100 may be pre-sterilized, thus the combination of integration and pre-sterilization allows the hysteroscopy device 1100 to be ready for use upon removal from the packaging. Following use, it may be disposed. Thus, the hand piece 1104, elongated body 1102, and other components, such as the cable, may be all one single unit. By one single unit, it is meant that the various portions described above may be attached together as one single piece not intended for disassembly by the user. In some embodiments, the various portions of the single unit are inseparable without destruction of one or more components. In some embodiments, the display, as described herein this section or elsewhere in the specification, may also be incorporated and sterilized as part of a single unit hysteroscopy device.
With respect to imaging a biopsy sample, methods may include positioning a distal end of the elongated body 1102 in viewing relationship to the target tissue (for example endometrial tissue), and utilizing viewing and/or imaging components integrated into the hysteroscopy device to view the target tissue. By viewing relationship is meant that the distal end may be positioned within about 40 mm, such as within about 10 mm, including within about 5 mm of the target of interest. Positioning the distal end of the hysteroscopy device in relation to the desired target tissue may be accomplished using any convenient approach, including direct linear advance from a percutaneous access point to the target tissue. In embodiments, following positioning of the distal end of the hysteroscopy device in viewing relationship to the target tissue, the target is imaged through use of illumination elements and visualization sensors (such as described elsewhere in the specification) to obtain image data. Image data obtained according to the methods disclosed herein may be output to a user in the form of an image, e.g., using a monitor or other convenient medium as a display means. In certain embodiments, the image is a still image, while in other embodiments the image may be a video.
In system embodiments involving a surgical insertion through the abdominal wall or a cyst wall to gain access to the biopsy site, an endoscope-assisted micro-surgery device frequently known as a trocar may be used in any known manner in combination with the embodiments of the device and system disclosed herein this section or elsewhere in the specification. The hysteroscopy devices disclosed herein this section or elsewhere in the specification may be used within any channel of a trocar, such as those described below. A trocar may be used to help manage and control several devices. Most conventional trocars have either three or four channels. For example, a three-channeled trocar has an elongated tube having a distal end and a proximal handle, two small channels (irrigation channel and outflow channel) and one larger channel to allow a visualization device and/or therapeutic device to be introduced there through. Four-channeled trocars, may have an elongated tube having a distal end and proximal handle, with two small channels (irrigation channel and outflow channel) and two larger channels (for a visualization device such as a scope or an ultrasound diagnostic device, and another channel for a therapy device). In other examples, four-channeled trocars allow procedures such as biopsies and removal of cysts and other obstructions to be performed under direct visualization simultaneously with an endoscope or diagnostic device placed in the visualization channel. Three-channeled trocars require a visualization device to be placed into the working channel first to assess the therapy field, and then removed so that the therapeutic device can be introduced through the same channel to perform the therapeutic procedure. Trocars are usually made of metal but also can be made of polymer, and may have a variable length anywhere between 100-400 mm.
Referring now to
In certain embodiments, the elongated body 1102 may comprise a deflection which may be lateral or sideways. The distal end of the hypotube 1128 may extend laterally away from the outer tubular body 1126. The degree of deflection or distance can be moved and adjusted as desired by moving the inner hypotube 1128 further in any direction. In certain embodiments, the hand piece 1104 can be rotated by 360 degrees, so that rotating the distal end 1108 of the elongate body 1102 will cause the distal portion to access an area within much larger space. The distal end 1108 can be moved up and down within the patient's uterus, thereby deflecting the distal end 1108 to a wide range of space well beyond its original position.
In some embodiments, the distal end of the visualization element may comprise a distal lens 1136 or camera configured to facilitate the imaging of an internal tissue site. The distal lens 1136, or any other lens, or camera may develop defects and imperfections during manufacturing, leading to a distortion in the image. These distortions may be unique to individual lenses or cameras and, thus, in the case of the embodiments disclosed herein this application, may be unique to an individual hysteroscopy device 1100. Thus, to enhance image quality, the device 1100 as depicted in
In certain embodiments, the automatic optical correction may serve to improve the image quality generated by the hysteroscopy device 1100. Lens shading and distortions are common aberrations. It is desired to optimize image quality, but eliminating aberrations in mass produced devices normally increases manufacturing cost. In some embodiments, chromatic aberrations in the hysteroscopy device may be corrected via the aforementioned software algorithm at the time of clinical use, which allows economies during manufacturing. For example, the optical correction may allow for visualization performance from the device with less expensive lenses or cameras that rivals the performance of visualization devices that use far more expensive lenses or cameras with minimal imperfections.
In certain embodiments, the optical correction may be generated by comparing a captured image to a known definition pattern and generating an algorithm that corrects chromatic aberrations and image distortion specific to each individual tissue visualization device. In some embodiments, the optical correction may be unique to an individual tissue visualization device. In particular embodiments, additional information regarding the tissue visualization device may be stored, such as the X,Y position of the center of the lens, the image circle size, and unique characteristic of the LED so as to provide a consistent initial light level. The aforementioned characteristics of the hysteroscopy device and additional characteristics described elsewhere in the specification may be determined during manufacturing and stored in computer memory such as electrically erasable programmable read-only memory (EEPROM). In embodiments, the entirety of the hand piece 1104 and the elongated body 1102 may be an integrated unit. In certain embodiments, the hand piece 1104 further comprises a retraction control 1118, configured to retract the elongated body 1102 to expose the distal lens 1136 of the optical hypotube 1128. In some embodiments, the hand piece 1104 may further comprise a luer 1120, configured to conduct fluid to the internal tissue site via the lumen.
In embodiments, to generate the algorithm at the point of manufacture, the distal optic 1136 or camera is focused on a known definition pattern. A computer can then compare the captured image to the known pattern and create an algorithm that restores the captured image to the true definition pattern. As described above, that algorithm may then be stored in a chip in the hand piece 1104.
When the hand piece 1104 is connected to a displayer 6 at the clinical site, as described previously in relation to
In certain embodiments, the elongated body 1102 may be dimensioned to be slidably moved through the internal passageway of an access device or move directly through tissue without the use of an additional access device. In embodiments, the elongated body 1102 may have a length that is 1.5 times or longer than its width, such as 2 times or longer than its width, including 5 or even 10 times or longer than its width, e.g., 20 times longer than its width, 30 times longer than its width, or longer. At least the distal end of the device may have a longest cross-sectional dimension that is 10 mm or less, such as 8 mm or less and including 7 mm or less, where in certain embodiments the longest cross-sectional dimension has a length ranging from 5 to 10 mm, such as 6 to 9 mm, and including 6 to 8 mm.
In some embodiments, the hypotube 1128 may be biased against the inner diameter of the outer tubular body 1126. For example, the outer tubular body 1126 may comprise dimples on either the outer tubular body 1126 or the hypotube 1128 that would bias the OD of the hypotube 1128 against the ID of the elongated body 1102.
In particular embodiments, the outer tubular body 1126 is not retractable/extendible; instead, the outer tubular body 1126 and the inner hypotube 1128 have a fixed length. For example, the inner hypotube 1128 may be the same length as the outer tubular body 1126 or may be shorter, so that the inner hypotube 1128 is offset inside the outer tubular body 1126. Alternatively, the inner hypotube 1128 may be biased against a side of the outer tubular body 1126.
In embodiments, the distal end 1108 of the elongated body 1102 may comprise a deflected tip to allow for a mechanical means of altering the direction of view of the hypotube 1128 (such as about 5-6 degrees). In some embodiments, the direction of view may be at least about 3 degrees, at least about 6 degrees, at least about 12 degrees, at least about 15 degrees, at least about 20 degrees, at least about 30 degrees, at least about 45 degrees, or greater than 45 degrees off the central longitudinal axis of the hypotube 1128. Wide angle field of view can be accomplished with a lens, or by rotating the fiber optic if the distal end is deflected off axis. A prim can be used as a means for changing the directions of the view.
In some embodiments, surrounding the inner hypotube 1128 is a lumen 1138, as shown in
In certain embodiments, the hysteroscopy device may further include an irrigator and aspirator configured to flush an internal target tissue site and/or a component of the device, such as a lens of the visualization sensor. As such, the elongated body 1102 may further include one or more lumens that run at least the substantial length of the device, e.g., for performing a variety of different functions, as summarized herein this section or elsewhere in the specification. In certain embodiments where it is desired to flush (i.e., wash) the target tissue site at the distal end of the elongated body 1102 (e.g. to remove ablated tissue from the location, etc.), the elongated body 1102 may include both irrigation lumens and aspiration lumens. Thus, the hysteroscopy device can comprise an irrigation lumen extending axially through the elongated body. During use, the irrigation lumen(s) may be operatively connected to a fluid source (e.g., a physiologically acceptable fluid, such as saline) at the proximal end of the device, where the fluid source is configured to introduce fluid into the lumen under positive pressure, e.g., at a pressure ranging from 0 psi to 60 psi, so that fluid is conveyed along the irrigation lumen and out the distal end. While the dimensions of the irrigation lumen may vary, in certain embodiments the longest cross-sectional dimension of the irrigation lumen ranges from about 0.5 mm to 5 mm, such as 0.5 mm to 3 mm, including 0.5 mm to 1.5 mm. In certain embodiments, a blood pressure cuff may be used to generate pressure.
In some instances, the negative pressure source is configured to aspirate or draw fluid and/or tissue from the target tissue site at the distal end into the aspiration lumen under negative pressure, e.g., at a negative pressure ranging from 300 to 600 mmHg, such as 550 mmHg, so that fluid and/or tissue is removed from the tissue site and conveyed along the aspiration lumen and out the proximal end, e.g., into a waste reservoir. In certain embodiments, the irrigation lumen and aspiration lumen may be separate lumens, while in other embodiments, the irrigation lumen and the aspiration functions can be accomplished in a single lumen.
In certain embodiments, the suction should be increased beyond the wall suction described above. For example, wall suction may be used for pulling the biopsy material through the channels and tubing of the device but use higher hand or pump driven suction for getting the biopsy into the device or for a boost for a clogged channel/tubing. In certain embodiments, various controls may be used for irrigation and suction. For example, a control may be located on the hand piece 1104, the cord, the tablet (physical button, soft button, voice activated) and/or on a foot pedal.
However, a common issue that may occur during aspiration of biopsy tissue is that the tissue becomes lodged in the lumen 1138, thereby preventing/limiting further irrigation and aspiration. To address these potential issues, in some embodiments, as depicted and described in
In some embodiments, as depicted and described in
In certain embodiments, as depicted in
As described above, in certain embodiments, the elongated body 1102 may further include one or more infusion lumens 1138 that run at least the substantial length of the device, e.g., for performing a variety of different functions. In certain embodiments where it is desired to flush (i.e., wash) the location of the target tissue at the distal end 1108 of the elongated body 1102 and remove excess fluid, the elongated body 1102 may include both an irrigation and aspiration lumen. During use, the irrigation lumen may be operatively connected to a fluid source (e.g., physiologically acceptable fluid, such as saline) at the proximal end of the device, where the fluid source is configured to introduce fluid into the lumen under positive pressure, e.g., at a pressure ranging from 0 to 500 mm Hg, so that fluid is conveyed along the irrigation lumen and out the distal end.
While the dimensions of the irrigating lumen may vary, in certain embodiments the longest cross-sectional dimension of the irrigation lumen ranges from 0.5 to 3 mm. During use, the aspiration lumen may not or may be operatively connected to a source of negative pressure (e.g., vacuum source) at the proximal end of the device, where the negative pressure source is configured to draw fluid from the tissue location at the distal end into the irrigation lumen under positive pressure, e.g., at a pressure ranging from 50 to 600 mm Hg, so that fluid is removed from the tissue site and conveyed along the irrigation lumen and out the proximal end, e.g., into a waste reservoir. While the dimensions of the aspiration lumen may vary, in certain embodiments the longest cross-sectional dimension of the aspiration lumen ranges from about 1 to 10 mm, about 1 to 4 mm, about 1 to 3 mm, or less than 1 mm. Alternatively, a single lumen may be provided, through which irrigation and/or aspiration may be accomplished. In embodiments, the product packaging may include a single port stopcock as a means to control fluid flow. In particular embodiments, the stopcock or suitable valve may be directly integrated into the device. In further embodiments, more than one port or stopcock may be used, such as two ports and two stopcocks, three ports and three stopcocks, and so on. In some embodiments, a three-way stopcock may be provided so a clinician can ‘toggle’ between infusion and aspiration, or infusion of a first and second fluid, without connecting and reconnecting tubes.
Returning to
In certain embodiments, as depicted in
The integrated circuit component of these sensors may include a variety of different types of functionalities, including but not limited to: image signal processing, memory, and data transmission circuitry to transmit data from the visualization sensor to an extra-corporeal location, etc. The miniature visualization sensors may further include a lens component made up of one or more lenses positioned relative to the photosensitive component so as to focus images on the photosensitive component. Where desired, the one or more lenses may be present in a housing and/or part of the photosensitive component. Specific types of miniature visualization sensors of interest include complementary metal-oxide-semiconductor (CMOS) sensors and charge-coupled device (CCD) sensors. The sensors may have any convenient configuration, including circular, square, rectangular, etc. Visualization sensors of interest may have a longest cross-sectional dimension that varies depending on the particular embodiment, where in some instances the longest cross sectional dimension (e.g., diameter) is 10.0 mm or less, such as 6.0 mm or less, including 3.0 mm or less. Presently 1 mm square and 0.6 mm square CMOS sensors are available.
Visualization sensors of interest may be either front side or back side illumination sensors, and have sufficiently small dimensions while maintaining sufficient functionality to be integrated at the proximal end of the elongated bodies within the hand piece of the devices disclosed herein. Aspects of these sensors are further described in one or more the following U.S. patents, the disclosures of which are herein incorporated by reference in their entireties: U.S. Pat. Nos. 7,388,242; 7,368,772; 7,355,228; 7,345,330; 7,344,910; 7,268,335; 7,209,601; 7,196,314; 7,193,198; 7,161,130; and 7,154,137.
The distal end of the elongated body may be configured for front viewing and/or side-viewing, as desired. In yet other embodiments, the elongated body may be configured to provide image data from both the front and the side, e.g., where the primary viewing axis from the distal end of the waveguide extends at an angle that is greater than about 2 or 5 degrees or 10 or 15 degrees or more relative to the longitudinal axis of the elongated body, described in greater detail below.
Depending on the particular device embodiment, as described above, the elongated body may or may not include one or more lumens that extend at least partially along its length. When present, the lumens may vary in diameter and may be employed for a variety of different purposes, such as irrigation, aspiration, electrical isolation (for example of conductive members, such as wires), as a mechanical guide, etc., as reviewed in greater detail below. When present, such lumens may have a longest cross section that varies, ranging in some instances from 0.5 to 5.0 mm, such as 1.0 to 4.5 mm, including 1.0 to 4.0 mm. The lumens may have any convenient cross-sectional shape, including but not limited to circular, elliptical, square, rectangular, triangular, semi-circular, trapezoidal, irregular, etc., as desired. These lumens may be provided for a variety of different functions, including as irrigation and/or aspiration lumens, as described in greater detail below.
In certain embodiments, as described above in relation to
In certain embodiments, as known in the art, an imaging camera may be provided on the distal end of the hysteroscopy device 1100 in combination with ultrasound. Such an electronic imaging camera may have a light emitting source provided by light emitting diodes (LED) or by light delivered via fiber optics from an external or internal source. The principles of operation are identical to endoscopes, but in this case the camera is incorporated in a single device together with the ultrasound device. Examples of such suitable cameras include but are not limited to devices from MediGus. Ltd, Omer, Israel; Omni Vision, Santa Clara, Calif.; Clear Image Technology, Elyria, Ohio.
As with the visualization sensors described herein this section and elsewhere in the specification, the light sources may include a conductive element, e.g., wire, or an optical fiber or bundle, which runs the length of the elongated body to provide for power and control of the light sources from a location outside the body, e.g., an extracorporeal control device.
Where desired, the light sources may include a diffusion element to provide for uniform illumination of the target tissue site. Any convenient diffusion element may be employed, including but not limited to a translucent cover or layer (fabricated from any convenient translucent material) through which light from the light source passes and is thus diffused. In those embodiments disclosed herein where the system includes two or more illumination elements, the illumination elements may emit light of the same wavelength or they may be spectrally distinct light sources, where by “spectrally distinct” is meant that the light sources emit light at wavelengths that do not substantially overlap, such as white light and infra-red light. In certain embodiments, an illumination configuration as described in U.S. Pat Pub. Nos. US20100121139A1 and US20100121142A1 (the entire disclosures of which are herein incorporated by reference) is present in the device.
In some embodiments, devices of the embodiments described herein may include a linear mechanical actuator for linearly translating a distal end element of the device, such as a tubular body which surrounds a visualization element relative to the visualization element. By “linearly translating” is meant moving the element along a substantially straight path. As used herein, the term “linear” also encompasses movement in a non-straight (i.e., curved) path.
In some embodiments, an integrated articulation mechanism that imparts steerability to the distal end of the elongated body and/or distal end of the visualization element is also present in the device. By “steerability” is meant the ability to maneuver or orient the visualization element, tissue modifier and/or distal end of the elongated body as desired during a procedure, e.g., by using controls positioned at the proximal end of the device. In these embodiments, the devices include a steerability mechanism (or one or more elements located at the distal end of the elongated body) which renders the desired distal end component maneuverable as desired through proximal end control. As such, the term “steerability”, as used herein, refers to a mechanism that provides a user steering functionality, such as the ability to change direction in a desired manner, such as by deflecting the primary viewing axis left, right, up or down relative to the initial axial direction.
The steering functionality can be provided by a variety of different mechanisms. Examples of suitable mechanisms include, but are not limited to one or more axially moveable pull or push wires, tubes, plates, meshes or combinations thereof, made from appropriate materials, such as shape memory materials, music wire, etc. For example, one active deflection mechanism includes providing a plurality of transverse slots spaced apart axially along a first side of the outer tubular body 1126 within the distal segment. A second side of the outer tubular body 1126 within the distal segment, opposite from (i.e., 180° from) the first side acts as an axially non-compressible spine, while the first side may be compressed axially causing a lateral deflection concave in the direction of the first side. Axial compression (or elongation) of the first side relative to the second side, to induce or remove curvature, may be accomplished by an axially movable control wire. The distal end of the control wire may be secured to the outer tubular body 1126 within the distal segment 1108, preferably at the distal end of the distal segment. The control wire extends proximally throughout the length of the outer tubular body 1126, to a proximal deflection control. Manipulation of the control to retract the control wire proximally will collapse the transverse slots, shortening the axial length of the first side relative to the second side, thereby deflecting the distal segment.
In some instances, the distal end of the elongated body may be provided with a distinct, additional capability that allows it to be independently rotated about its longitudinal axis when a significant portion of the operating handle is maintained in a fixed position, as discussed in greater detail below.
The extent of distal primary viewing axis articulations of the device may vary, such as from at least about 5, 10, 25, or 35 degrees or more from the primary viewing axis. The visualization element may be configured for rotating about its axis so that the full range of angles is accessible on either side of the axis of the probe, essentially multiplying the effective viewing angle e.g., as described in greater detail below. Articulation mechanisms of interest are further described in published PCT Application Publication Nos. WO 2009029639; WO 2008/094444; WO 2008/094439 and WO 2008/094436; the entire disclosures of which are herein incorporated by reference. Specific articulation configurations of interest are further described in connection with the figures, below.
In some embodiments, the distal end of the elongated body 1102 is rotatable about its longitudinal axis when a significant portion of the operating handle is maintained in a fixed position. As such, at least the distal end 1108 of the elongated body 1102 can turn by some degree while the handle attached to the proximal end of the elongated body 1102 stays in a fixed position. The degree of rotation in a given device may vary, and may range from 0 to 360, such as 0 to 270, including 0 to 180 degrees.
As described herein this section and elsewhere in the specification, in certain embodiments, the device may be disposable or reusable. As such, devices disclosed herein may be entirely reusable (e.g., be multi-use devices) or be entirely disposable (e.g., where all components of the device are single-use). In some instances, the device can be entirely reposable (e.g., where all components can be reused a limited number of times). Each of the components of the device may individually be single-use, of limited reusability, or indefinitely reusable, resulting in an overall device or system comprised of components having differing usability parameters.
As described herein this section and elsewhere in the specification, in certain embodiments, devices disclosed herein may be fabricated using any convenient materials or combination thereof, including but not limited to: metallic materials such as tungsten, stainless steel alloys, platinum or its alloys, titanium or its alloys, molybdenum or its alloys, and nickel or its alloys, etc.; polymeric materials, such as polytetrafluoroethylene, polyimide, PEEK, and the like; ceramics, such as alumina (e.g., STEATITE™ alumina, MAECOR™ alumina), etc. In some embodiments, materials that provide both structural as well as light piping properties may be used.
As summarized above, some embodiments of the device include visualization sensors and illumination elements. In certain embodiments these visualization sensors are positioned within a handle at the proximal end of the device. The system may include one or more visualization sensors at the proximal end of the device and one or more illumination elements that are located among the distal and/or proximal ends of the elongated body. In particular embodiments, one or more visualization sensors, such as those described in this section or elsewhere in the specification, may be located in the distal end of the device such as within the distal end of the elongated body. In some embodiments, one or more visualization sensors may be located at various locations within the elongated body, such as at approximately one-quarter the length of the elongated body from the distal end, one-half, or three quarters the length of the elongated body from the distal end. In certain embodiments, the visualization sensors may be miniaturized such that they do not substantially increase the outer diameter of the elongated body. In certain embodiments, the visualization sensors 1150 have built in fiber optic cords that provide additional illumination.
Similarly, in embodiments, one or more illumination elements may be located at the distal and/or proximal end of the elongated body. Embodiments of the systems also include those systems where one illumination element is located at the distal and/or proximal end of the elongated body and another illumination element is located at the distal and/or proximal end of the access device. Furthermore, embodiments of the systems include those systems where one or more illumination elements are located at the proximal end of the device and light is propagated via wave guides such as a fiber optic bundle towards the distal end of the device. A longest cross section dimension for the elongated body is generally 20 mm or less, 10 mm or less, 6 mm or less, such as 5 mm or less, including 4 mm or less, and even 3 mm or less.
The wavelength of light delivered via illumination fibers 1210 [which can be at least 4, 8, 12 or more fibers or bundles of fibers, and which may be arranged in an annular configuration surrounding the image guide 1202 as shown in
Another wavelength specific application involves directing a preselected wavelength to a target impregnated with a drug or drug precursor. Upon delivery of the preselected wavelength to the target, drug is released, or the precursor is converted into a drug which is then released. The target may be an implanted mass or device, or an infused carrier medium such as any or a combination of a liquid, gel, or beads.
The UV light may include Ultraviolet A, long wave, or black light, abbreviated “UVA” and having a wavelength of 400 nm-315 nm; Near UV light, abbreviated “NUV” and having a wavelength of 400 nm-300 nm; Ultraviolet B or medium wave, abbreviated “UVB” and having a wavelength of 315 nm-280 nm; Middle UV light, abbreviated “MUV” and having a wavelength of 300 nm-200 nm; Ultraviolet C, short wave, or germicidal, abbreviated “UVC” and having a wavelength of 280 nm-100 nm; Far UV light, abbreviated “FUV” and having a wavelength of 200 nm-122 nm; Vacuum UV light, abbreviated “VUV” and having a wavelength of 200 nm-400 nm; Low UV light, abbreviated “LUV” and having a wavelength of 100 nm-88 nm; Super UV light, abbreviated “SUV” and having a wavelength of 150 nm-10 nm; and Extreme UV light, abbreviated “EUV” and having a wavelength of 121 nm-10 nm. In some embodiments, the catheters may include an element that emits visible light. Visible light may include violet light having a wavelength of 380-450 nm; blue light having a wavelength of 450-475 nm; cyan light having a wavelength of 476-495 nm; green light having a wavelength of 495-570 nm; yellow light having a wavelength of 570-590 nm; orange light having a wavelength of 590-620 nm; and red light having a wavelength of 620-750 nm. In some embodiments, the catheter includes an element that emits light having a wavelength between about 300 nm and 500 nm. In particular, the catheter may include an element that emits light having a wavelength associated with blue light (e.g., light having a wavelength between about 450-475 nm). Wavelength selection information and characterization and other details related to infrared endoscopy are found in U.S. Pat. No. 6,178,346; US Patent Application Publication No. 2005/0014995, and US Patent Application Publication No. 2005/0020914, each of which is hereby incorporated by reference in its entirety.
In certain embodiments, the outer diameter of the hypotube 1204 may range from approximately 0.1 mm to 0.3 mm, approximately 0.5 mm to 2.5 mm, or approximately 1 mm to 2 mm. In certain embodiments, the outer diameter of the hypotube 1204 is approximately 1.73 mm. In some embodiments, the inner diameter of the outer tubular body 1208 ranges from approximately 0.1 mm to 10 mm, approximately 0.2 mm to 8 mm, approximately 0.5 mm to 6 mm, approximately 1 mm to 5 mm, approximately 1.2 mm to 4 mm, or approximately 1.4 mm to 3 mm. In certain embodiments, the inner diameter of the outer tubular body 1208 is approximately 1.8 mm.
In some embodiments, the image guide 1202 allows for the viewing of an image of the tissue site by the visualization sensor in the hand piece. In particular embodiments, the image guide may be a fiber optic or other suitable medium to allow for imaging of the tissue site by a visualization sensor as described herein this section or elsewhere in the specification. The fiber optic bundle may have at least about 6K, or at least about 10K or at least about 15K or at least about 30K fibers or more, depending upon the desired performance. In some embodiments, the image fiber may be a 6.6 k fiber bundle or a 10 k fiber bundle.
In certain embodiments, the visualization complex 1318 can comprise a first lens 1322, an optical aperture 1324, and a second lens 1326. In some embodiments, the aperture may have a diameter of at least about 0.1 mm, at least about 0.2 mm, at least about 0.3 mm, at least about 0.5 mm, or more than 0.5 mm. Preferably, the aperture may be approximately 0.222 mm. To support the lenses, the visualization complex 1318 may comprise a proximal lens housing 1308 as described previously, wherein the proximal lens housing 1308 may serve to secure the lenses 1322 and 1326 in the proper location and orientation. The visualization complex 1318 may further comprise an image guide 1328, similar to the image guide described previously in relation to
As illustrated in
This re-orientation may be accomplished by including one or more sensors or switches carried by the integrated hysteroscopy device 4, that are capable of generating a signal indicative of the rotational orientation of the visualization sensor 1132. The signal can be transmitted via wire or wireless protocol to the controller 6 for processing and correction of the rotational orientation of the image on screen 19 or other display, to stabilize the image.
Suitable sensors may include simple tilt or orientation sensors such as mercury switches, or other systems capable of determining rotational orientation relative to an absolute reference direction such as up and down. Alternatively, the rotational orientation image correction system may comprise a 3-axis accelerometer with associated circuitry such as a small accelerometer constructed with MEMS (micro-electro mechanical systems) technology using capacitance measurement to determine the amount of acceleration, available from Freescale Semiconductor, Inc., of Austin, Tex. and other companies.
As an alternative or in addition to the accelerometer, the visualization device may carry a gyroscope such as a three-axis gyroscope. The output of the gyroscope may be the rate of change of roll angle, pitch angle and yaw angle and rotational rate measurements provided by the gyroscope can be combined with measurements made by the accelerometer to provide a full six degree-of-freedom description of the sensor 1132's motion and position, although that may not be necessary to simply correct for rotational orientation. A control may be provided on the hand piece 4 or controller 6, allowing the clinician to select what reference orientation (e.g., patient superior, inferior, true up or down, etc. or true sensor view such that the image on the screen rotates with the sensor) they would like to have appearing at the top of the screen regardless of sensor orientation. In certain embodiments, markers such as an arrow or line may be projected onto the image to further identify different orientations and/or directions.
In some embodiments, the hypotube may be sheathed in heat shrink tubing. For example, the outer tubular body as described elsewhere in the specification, may be constructed from a heat-sensitive material. Thus, to construct the elongated body as described elsewhere in the specification, the hypotube and other components may be extended down an over-sized outer tubular body which is then shrunk down to the diameter of the hypotube via means such as heat, UV, chemical, or other means. In contrast, traditional endoscopes and some endoscopes described elsewhere in the specification house the optics in a rigid stainless steel tube. However, housing the optics within a stainless steel tube may require forcing many optical and illumination fibers down a very tight ID and then applying an adhesive such as epoxy. Such a process is difficult and costly.
In certain embodiments, a desired direction of view may be reached by positioning a prism at the distal end of the elongated body. Such a prism may provide a direction of view such as disclosed elsewhere in the specification, for example: providing a direction of view 30 degrees from the axis of the elongated body. In some embodiments, the angle may be much smaller, such as between 0-15 degrees. In further embodiments the angle may range from 15-45 degrees. In some embodiments, the angle may be at least 45 degrees, at least 60 degrees, at least 75 degrees or at least 90 degrees or more.
In some embodiments, the elongated body may be in a shape that is non-circular. For example, the entirety of the elongated body may be oval or elliptical in shape. In some embodiments, only the distal end of the elongated body is oval-shaped while the remainder of the elongated body is circular. An oval shaped elongated body advantageously allows for additional space for the deflected distal tip. In certain embodiments, the major axis of the ellipse is approximately 1.1 times as long as the minor axis. In some embodiments, the major axis is at least 1.2 times, 1.3 times, 1.5 times, 1.75 times, 2 times, 3 times, 4 times, 5 times, or more than 5 times as long as the minor axis.
In particular embodiments, the distal tip of the elongated body may be constructed from elastic material to allow the distal tip to flex distally. Further, the deflected portion of the distal tip may be very short, allowing the deflected portion to stay within the outer perimeter confines of the elongated body.
In certain embodiments, the distal end of the elongated body may be rotated with respect to the hypotube. For example, the elongated body may comprise a sharpened distal point which may be under the hypotube, over the top of the hypotube, or on a side of the hypotube. In certain embodiments, the hypotube may act as a shield to prevent the sharpened distal point from damaging the surrounding tissue in any orientation. In certain embodiments, the hypotube may comprise a shield at the distal tip, the shield acting to protect the surrounding tissue from the sharpened distal tip of the elongated body. Upon rotation of the hypotube, the shield may be moved from the sharpened distal tip of the elongated body, allowing for further penetration through tissue.
In certain embodiments, as depicted in
In embodiments, and as depicted in
The window 114 encompasses an area of the plate not covered by the mask 113, thereby allowing light to pass through the window 114. As described in more detail in relation to
In particular embodiments, the mask 113 acts to limit the transmission of light through the plate 112. For example, the mask may restrict the gathering of all the angles of light reflecting from the object being viewed (e.g. tissue site). The overlap of light rays on the image is therefore very small and the result is a sharper image over a wider depth of field. Although this may reduce the brightness of the image, the image is much sharper. In certain embodiments, the material of the mask allows at most about 0% transmission of light through the material, about 2%, about 4%, about 5% or about 10%. Further, the mask preferably absorbs light rather than reflects light to limit stray light from affecting the sharpness of the image. In embodiments, the material of the mask may reflect at most about 0% of the light impacting the surface, about 5%, about 10%, about 20%, about 25%, or about 30%. In certain embodiments, the reflectivity at 400 nm of light may be 12%, at 500 nm—20%, at 600 nm—27%, at 700 nm—33%.
The circular plate 112 may be sized to have the same diameter as the lens 102, however, in embodiments the plate 112 may be smaller than the lens 102, such as at least about: 10% of the size of the lens 102, 25%, 50%, 75%, or 90%. When the plate 112 is smaller than the lens 102, light may potentially leak through the plate 112 into the lens 102, thus in these scenarios an opaque adhesive or cover may be applied to the distal end of the lens 102 to limit the passage of light into the lens 102. In certain embodiments, the plate 112 may be non-circular such as rectangular or polygonal. As with the circular plate, the non-circular plate may be about: 10% of the size of the lens, 25%, 50%, 75%, or 90%. As with the smaller rounded plate, the non-covered regions of the lens 102 may be coated in an opaque adhesive to limit the transmission of light.
In certain embodiments, rather than using a transparent plate 112 with a mask 113, the plate 112 may be replaced with any suitable material comprising an aperture. For example a metal plate with a window may be used, or an opaque polymeric material.
Commonly in the field of imaging, when using a GRIN lenses such as those described herein this section or elsewhere in the specification, an optical mask such as described above in relation to the plate, would normally be placed between two GRIN lenses or at the focus point of the lens. However, here the mask is positioned between a non-powered plate and a powered lens. Further, although the mask may be placed in the focal point of the lens, here the mask need not be located at the focal point.
In certain embodiments, the ratio between the diameter of the active area of the imaging element/imaging fiber to the diameter of the window 2004 may be approximately at least: about 2×, about 3×, about 4×, about 5×, about 6×, about 8×, about 10×, or more than 10×. In certain embodiments where the window 2004 is non-circular, the ratio of the area of the window 2004 to the active area of the imaging element or imaging fiber may be at least about 5×, about 10×, about 15×, or about 20×.
In certain embodiments, the distal end of the hypotube may be flared to accommodate a larger sensor than would ideally fit into the diameter of a standard hypotube. This flare could simply be a larger diameter cross-section, a square cross section or something to match what is within. The axial length of this flare would be to accommodate the length of the sensor plus routing of illumination fiber around the sensor and would have a transition zone back to the circular cross section of the normal hypotube. In embodiments, such an arrangement provides a lumen between the inner diameter of the outer tubular body and the outer diameter of the inner hypotube that can provide an exit/entrance when the inner hypotube's flared section is distally extended past the end of the outer hypotube. In certain embodiments, this may be accomplished with a non-circular cross-section. The distal end of the outer tubular body may also be flared with or without a gap to provide a lumen between the hypotube's outer diameter and the elongate member's inner diameter such as described above. In some embodiments, dimples may be provided on the outer tubular body to direct the bias the inner hypotube. The inner hypotube may also be bent or biased against the outer tubular body. Biasing against the outer tubular body may also provide blunting of the edges of the outer tubular body.
In certain embodiments, similar to the above concept, the visualization components of the integrated hysteroscopy device may be integrated/bonded into the conical distal window of the transparent tip. In embodiments, the distal window may be configured to open like a petal and allow device components, such as the inner hypotube or outer tubular body to extend forward and/or retract. In some embodiments, as described above, the optical trocar may contain a separate hysteroscopy device such as described above, but with only visualization components, for visualization during insertion, that is then removed from the clear trocar once the targeted site is reached. The trocar would then be removed from the cannula/portal, leaving the portal intact to the target site. Next, a second or the same integrated hysteroscopy device (with integrated suction) would then be inserted down the inner diameter of the cannula for aspiration/visualization of the tissue. The trocar-with-visualization may also incorporate additional features such as: illumination fibers (visible light or UV or IR or some other useful wavelengths), an ultrasonic transducer (to “see” through the tissue), a glucose sensor, or some other kind of sensor that would have clinical benefit during the traversing tissue step.
In certain embodiments, visualization may be incorporated into the cross-section of a cannula/portal with optional enhancements such as those described above (extra illumination, extra sensors, etc.). The distal end of the cannula may be flat or angled. If angled, the bevel tipped “point” of the cannula could hold the visualization elements and provide better visualization during the traversing step as it would be the most distal element. In further embodiments, a second separate aspiration device could be used for removing the biopsy tissue or alternatively an integrated aspiration/visualization device could be used providing two different views of the biopsy site.
In certain embodiments, a navigation probe configured to be inserted within the conically-shaped transparent distal end. A locking member may also be provided operatively to retain the navigation probe within the tube. Further details regarding a navigation probe may be found in U.S. Pat. Pub. 2014/0171873, hereby incorporated by reference in its entirety.
As is known in the art, in embodiments such as
In embodiments such as depicted in
Once the distal end 402 is inserted to a length such that a proximal ledge of the moveable window portion 404 distally surpasses the distal end of the visualization channel 406, the moveable window portion 404 can be moved to the outward position. In some embodiments, the distal end 402 may not be insertable into the outer tubular body 408 with the window portion 404 in the outward position (i.e. the distal end 402 with moveable window 404 may not have sufficient clearance with respect to the visualization channel 406). When the window portion 404 is positioned in the outward position, the window portion 404 together with the rest of the distal end 402 may form a conically-shaped tip that closes off the open end of the outer tubular body 408, including the visualization channel 406. The window portion 404, when positioned in the outward position, may cover or shield the visualization channel 406, such that visualization elements within the visualization channel 406 may operate through a transparent portion of the moveable window portion 404 to provide visualization. The moveable window portion 404 may be returned to the inward position for removing the distal end 402 from the outer tubular body 408. The distal end 402 with window portion 404 may be removed by sliding the distal end 404 proximally through the lumen of the outer tubular body 408. Once removed, evacuation or tissue sampling operations may be performed through the lumen. In some embodiments, the moveable window portion 404 may be a separate component from the distal end 402. In other embodiments, the moveable window portion 404 may be attached to the distal end 402 in a manner that allows the moveable window portion 404 to move between inward and outward positions. The leading edges of the outer tubular body 408 may also be tapered so as to allow the biopsy device 400 to pass through tissue.
The hysteroscopy device may have different embodiments for the biopsy collection tool. In certain embodiments and as described in further detail below and throughout the specification, the biopsy collection tool or collection technique may be: a forceps, shaving tool, needle biopsy tool, incisional biopsy, punch biopsy, or excisional biopsy. described below. In some embodiments, the biopsy tool can travel through the inner hypotube 1128 working channel. In some embodiments, the biopsy tool can be housed within the working channel or a hypotube. In
Another alternative embodiment of the system is shown in
As shown in
Systems and Methods Utilizing an Optical Introducer and a Separate Hysteroscopy Device
The proximal end 1606 may be coupled to a hand piece 1604 by which the operator may use hold and/or control the optical introducer 1600. The shape of the hand piece 1604 may be similar to the shapes of other hand pieces described herein this section or elsewhere in the specification. For example, the hand piece 1604 may comprise a generally “clamshell” shape and may include a clamshell top and clamshell bottom connected at a seam. Some embodiments may comprise a clamshell left side and clam shell right side connected at a seam. The hand piece 1604 may include a cable 1605, such as a USB cable, extending from the hand piece 1604 for transferring data and/or for powering the device. In some embodiments, the optical introducer 1600 may comprise wireless capabilities. The optical introducer 1600 may be controllable from an operatively coupled external controller or processor, which may include software for interfacing with the optical introducer. The hand piece 1604 may comprise one or more buttons 1612 for controlling the functionality of the optical introducer 1600. For example, the hand piece 1604 may include a camera button, which may activate the system to collect and/or store a still or moving image or a power button for powering off and on the device.
The visualization element 1628 may be positioned centrally within the elongate body 1602 along its longitudinal axis, as shown in
In some embodiments, the distal end of the visualization element 1628 may be deflected at an angle from the longitudinal axis and/or may be enabled with a wide-field view (e.g., 120 degrees or 160 degrees), such as by a lens or prism. The direction of view of the visualization element may be centered, for example, 0 degrees, 3 degrees, 6 degrees, 12 degrees, 15 degrees, 20 degrees, 30 degrees, 45 degrees, or more than 45 degrees off the longitudinal axis of the elongate member 1602. The visualization element 1628 may achieve forward and side views relative to the longitudinal axis. In some embodiments where the direction of the view is off-center from the longitudinal axis, the field of view may be effectively expanded by rotating the visualization element 1628, the elongate body 1602, or the entire optical introducer 1600 by 360 degrees or less, as described elsewhere herein. In some embodiments, the depth of the field of view may be between about 5 mm and 35 mm.
Portions or the entirety of the outer sheath 1601 may be transparent or partially transparent, similar to the atraumatic tip 1640, so that the visualization element 1628 may visualize through the side of the outer sheath 1601 when the atraumatic tip 1640 is disposed partially or entirely within outer sheath 1601 and/or when side viewing is enabled by the visualization element 1628. Similarly, portions or the entirety of the outer tubular body 1626 may be transparent or partially transparent.
The optical introducer 1600 may be used according to any suitable method. By way of example, the optical introducer 1600 may be inserted through outer sheath 1601, such that at least the atraumatic tip 1640 extends beyond the distal end of the outer sheath 1601, and then inserted into the bodily tissue. The optical introducer 1600 may or may not pass through an access device and/or a trocar device, such as those described elsewhere herein. The optical introducer 1600 may comprise or may be operatively coupled to a navigation system, as described elsewhere herein, to assist in guiding the optical introducer down an appropriate path within the bodily tissue. The user may use the visualization element 1628 to visualize tissue positioned distally and/or along the sides of the distal end of the elongate member 1602 as the user inserts the optical introducer 1600 through the tissue. At any point in the procedure, the user may partially retract the optical introducer 1600 relative to the distal end of the outer sheath 1601, such that the visualization element 1628 is further separated from the bodily tissue disposed around the distal end of the outer sheath and viewed through a “tunnel.” Such “tunnel vision” may advantageously allow the user to better focus on the tissue distal to the visualization element 1628. The images may be displayed in real time on a separate display device and the optical introducer 1600 may include functionality for capturing and saving still images. The optical introducer 1600 may be especially useful for allowing the user to detect the transition between healthy and unhealthy uterine tissue, thus assisting the user in placing the outer sheath 1601 into proper position for subsequent biopsy collection procedures. Once the optical introducer 1600, and hence, the outer sheath 1601 are in proper position, the user may remove the optical introducer from the body and the outer sheath, leaving the outer sheath in place. Subsequently, the user may insert a separate surgical device, such as the hysteroscopy device disclosed elsewhere herein (or alternatively multiple devices, such as suction, irrigation, an endoscope, cutting tools, etc.) through the outer sheath 1601 such that it may be positioned at the distal end of the outer sheath 1601 to operate on the bodily tissue.
Systems and Methods Utilizing a Removable Atraumatic Tip
In another embodiment, a hysteroscopy device, for example, one which is the same as or similar to the hysteroscopy device 1650 shown in
The atraumatic tip component may be secured to the distal end of the outer tubular body 1651 of the hysteroscopy device 1650 by any suitable means such that it closes off and shields the open face of the outer tubular body and shields components disposed within the outer tubular body. The atraumatic tip component may be secured to the hysteroscopy device by any suitable means. In some embodiments, the inner surface of the proximal end of the atraumatic tip component will comprise an elongate projection. The elongate projection may be configured to extend down and frictionally mate with the internal diameter of a working channel, such as that of the tissue biopsy tool/evacuation hypotube 1653, so that the atraumatic tip component is held in place at the distal end of the outer tubular member. In some embodiments, the atraumatic tip component may be configured with an annular portion and/or one or more protrusions at its proximal end that are shaped to fit within the internal diameter of the device's outer tubular body and secure the atraumatic tip component via an interference fit or a snap fit. In some embodiments, the inner diameter of the atraumatic tip component may be configured to mate with the outer diameter of the hysteroscopy device's outer tubular body, such that the atraumatic tip component slides over the distal end of the outer tubular body. The atraumatic tip component may be removably secured to the hysteroscopy device by a friction fit. The atraumatic tip component may be formed of plastic, such as a transparent plastic, and may be fabricated by injection molding.
The visualization element of the hysteroscopy device may be located in the same or a different position within the outer tubular body as the visualization element 1654 of the hysteroscopy device 1659 depicted in
The atraumatic tip component may be secured to the distal end of the hysteroscopy device prior to its insertion into the body. The hysteroscopy device may then be inserted into the body with an outer sheath, such as outer sheath 1601, in the same manner as optical introducer 1600. Once the outer sheath is positioned, for example, adjacent a biopsy tissue site, the hysteroscopy device may be removed and the atraumatic tip component detached from the distal end of the device. The hysteroscopy device may subsequently be reinserted into the outer sheath with an exposed distal end and positioned at or near the distal end of the outer sheath, such as depicted in
Systems, Methods, and Devices Utilizing an Integrated Introducer/Hysteroscopy Device
The shielding member 1760 may be permanently or removably attached to the outer tubular body 1751. The shielding member 1760 may form part of an atraumatic surface disposed on the distal end of the hysteroscopy device 1750. It may substantially occupy the cross sectional space between the outer diameter of the optical introducer 1700 and the outer tubular body 1751. The shielding member 1760 comprises a proximal end and a distal end. The proximal end may comprise an inner surface disposed adjacent to the distal end of the outer tubular body 1751 and configured to face at least partially toward the internal lumen of the outer tubular body. The distal end may comprise an outer surface disposed distally of the distal end of the outer tubular body 1751 and configured to face away from the internal lumen of the outer tubular body. The inner and outer surfaces of the shielding member 1760 may be opposite sides of a uniformly thick piece of material or they may be distinct surfaces of a piece of material with a variable thickness profile, which may be a solid or may be hollow between the inner and outer surfaces.
The shielding member 1760 further comprises a hollow passage 1762 extending from its proximal end to its distal end. The hollow passage 1762 is generally parallel with the longitudinal axis of the outer tubular body 1751. The hollow passage 1762 may be a hole surrounded on all sides by portions of the shielding member 1760. The hollow passage 1762 may be positioned centrally along the longitudinal axis of the outer tubular body 1751 or may be positioned off-center as shown in
The hollow passage 1762 may be configured to removably receive the optical introducer 1700. The optical introducer 1700 comprises an elongate body having a proximal end and a distal end and further comprises an atraumatic tip 1740 positioned at the distal end of the elongate body. The atraumatic tip 1740 may be the same or similar to the atraumatic tip 1640 shown in
Like optical introducer 1600, the elongate body of optical introducer 1700 may be configured to removably receive a visualization element 1728 or a visualization element 1728 may be integrally affixed within the elongate body. The visualization element may be the same or similar to the visualization element 1628 or other visualization elements described elsewhere herein. For example, it may include an image sensor 1729 disposed at or near its distal end and illumination elements disposed within. The distal end of the visualization element 1728 may extend into the atraumatic tip 1740, which may or may not comprise a flattened surface 1742. The atraumatic tip 1740 and flattened surface 1742 may be made of an entirely or partially transparent material. The optical introducer 1700 may be sized and configured to slide through the hollow passage 1762 of hysteroscopy device 1700, such that at least a portion or the entirety of the atraumatic tip 1740 is positioned distally of the distal end of the shielding member 1760.
In some embodiments, such as shown in
During insertion of the combined optical introducer 1700 and hysteroscopy device 1750, visualization element 1728 of the optical introducer 1700 may be used to provide guidance to the user in the same manner or similar to the way visualization element 1628 of optical introducer 1600 provides guidance during insertion. In some embodiments, the visualization element 1754 of the hysteroscopy device 1750 may be used in addition to or alternatively to the visualization element 1728 to provide guidance. The view of visualization element 1754 may be directed through a transparent portion of the shielding member 1760.
In some embodiments, the hysteroscopy device 1750 may be used with an introducer 1710 which does not comprise its own visualization element, as shown in
The introducer 1800 comprises an elongate body 1802 with a proximal end and a distal end and further comprises an atraumatic tip 1840 positioned at the distal end of the elongate body. The atraumatic tip 1840 may have a rounded or curved shape, and in some embodiments may be bullet-shaped. As with the embodiment depicted in
Shielding member 1860 may be attached to the distal end of outer tubular body 1851 and extend distally therefrom. Shielding member 1860 is shaped in one embodiment with a somewhat pointed tip 1861 and an off-center hollow passage 1862 directly adjacent the pointed tip 1861. The shielding member 1860 comprises a tapered portion 1863, which contributes to forming an atraumatic surface along with the atraumatic tip 1840 of the introducer 1800, a cylindrical portion 1864 proximal to the tapered portion 1863, and a cylindrical sleeve 1865 with an expanded diameter relative to and proximal to the cylindrical portion 1864 for receiving the outer tubular body 1851. The cylindrical portion 1864 may smoothly transition into the cylindrical sleeve 1865 such that the outer surface remains atraumatic. In some embodiments, the outer diameter of the shielding member 1860 may be between about 4 mm and about 5 mm (e.g., 4 mm or 12 Fr, 4.6 mm or 14 Fr, 5 mm or 15 Fr) along either the cylindrical sleeve 1865 and/or the cylindrical portion 1864. In some instances, the outer diameter along the cylindrical sleeve 1865 may be about 5 mm and the outer diameter along the cylindrical portion 1864 may be about 4.6 mm. In some embodiments, the outer diameter along the cylindrical sleeve 1865 and the cylindrical portion 1864 may be approximately the same, such that there is no taper between them.
As shown in
Inserting the introducer through the tissue biopsy tool/evacuation hypotube of the hysteroscopy device, such as shown in the examples of
In some embodiments of the combined hysteroscopy device and introducer, the outer diameter of the introducer is approximately the same as the diameter of the hollow passage, for example as seen in
In another embodiment, as described elsewhere herein, the filler member may be a balloon attached to the introducer which may be inflated after being inserted and extended through the working channel and deflated prior to retraction. The introducer may further comprise a channel coupled to the balloon or other integrated means for inflating and deflating the balloon.
In another embodiment, the filler member may a semi-rigid/semi-flexible film which is affixed to the introducer, similar to the balloon. The film may form an annular ring around the introducer and may operate similarly to the balloon, except that it is neither inflated nor deflated. The outer diameter of the film may be larger than the diameter of the hollow passage and the film may be rigid enough such that it effectively seals the space between the outer diameter of the introducer and the hollow passage when pressed against the hollow passage. The film may flex to an extent like a tent over a tent pole. This flexing may allow the introducer to be extended an additional length beyond the hollow passage without compromising the seal between the introducer and the hollow passage. The flexible nature of the film may also allow the film to collapse along the circumference of the introducer as the introducer is inserted into or retracted from the working channel of the hysteroscopy device.
Embodiments where the hollow passage is larger than the diameter of the introducer may provide some advantages. A larger hollow passage may allow for direct visualization by the tissue biopsy tool/evacuation visualization element through the hollow passage rather than through the shielding member. In some instances this may provide better imaging. The larger opening may also allow for more operational procedures (e.g. irrigation) to occur through the hollow passage. Simultaneously, a smaller diameter working channel, through which the introducer passes (thereby limiting the size of the introducer), may provide more volume within the device to incorporate operational elements.
Systems and Methods Utilizing an Integrated Introducer/Hysteroscopy Device with an Inflatable Balloon
The hysteroscopy device 1950 may share similar features with the hysteroscopy device 1750 shown in
Unlike hysteroscopy device 1750, in which the shielding member 1760 is a shielding member affixed to the distal end of the outer tubular body 1751, the shielding member 1960 is a balloon affixed to the distal end of the elongate body of the optical introducer 1900. The balloon 1960 may be at least partially transparent to the visible light spectrum or select wavelengths such that visualization may be achieved through the balloon 1960. Similar to the shielding member shielding member 1760, the balloon shielding member 1960 may substantially occupy the cross-sectional space between the outer diameter of the optical introducer 1900 and the outer tubular body 1951 and in doing so shield the operational elements disposed within the outer tubular body from bodily tissue disposed distally to the outer tubular body 1951. The outer diameter of the balloon 1960 may extend to approximately the inner or outer diameter of the outer tubular body 1951 or it may extend somewhat beyond the outer diameter of the outer tubular body 1951, effectively increasing the outer diameter of the hysteroscopy device 1950.
In some embodiments, the combined hysteroscopy device 1950 and optical introducer 1900 may comprise both a shielding member and a balloon 1960, as described elsewhere herein. In such embodiments, the outer diameter of the balloon may extend to approximately the diameter of a hollow passage within the shielding member. In other embodiments, the hysteroscopy device 1950 may comprise a collar affixed to the distal end of the outer tubular body 1951. The collar may be flexible and may help form a seal between the outer tubular body 1951 and the outer diameter of the balloon 1960.
The balloon 1960 may be fabricated and attached to the optical introducer 1900 by any suitable means, including those known in the art for attaching balloons to introducers for expanding the anatomical working space within the body upon inflation. The balloon 1960 may be formed to be generally toroidal in shape such that it surrounds the entire circumference of the optical introducer 1900. The outer surface of the balloon 1960 may be generally rounded, which may contribute to an atraumatic surface disposed on the distal end of the combined hysteroscopy device 1950 and optical introducer 1900. In some embodiments, the balloon 1960 may comprise fiber reinforcements, which may alter the shape of the inflated balloon 1960. The fiber reinforcements may reduce the amount by which the balloon 1960 bulges and can allow the balloon 1960 to fully extend to the diameter of the outer tubular member 1951 without portions significantly bulging beyond the outer tubular body 1951. The balloon 1960 may be controllably inflatable and/or deflatable. The elongate body of the optical introducer 1900 may comprise an air lumen leading from the proximal end of the device to an inflation aperture 1903 in its sidewall. The inflation aperture 1903 may be in fluid communication with the interior of the balloon 1960 and an air-tight seal between the interior and exterior of the balloon 1960 may be formed around the inflation aperture on the surface of the elongate body of the optical introducer 1900. The user may alter the air pressure within the air lumen to either inflate or deflate the balloon 1960.
The operation of the combined hysteroscopy device 1950 and optical introducer 1900 may be similar to that of hysteroscopy device 1750 and optical introducer 1700. The optical introducer 1900 may be inserted into a working channel of the hysteroscopy device 1950 with the balloon 1960 deflated. The working channel of the hysteroscopy device 1950 shown in
After the balloon 1960 is inflated, the combined hysteroscopy device 1950 and optical introducer 1900 may be inserted into the body in the same manner as the combined hysteroscopy device 1750 and optical introducer 1700. The visualization element 1928 of the optical introducer 1900 may be used to guide insertion of the device as described elsewhere herein. If the balloon 1960 is at least partially transparent, the visualization element 1954 of the hysteroscopy device 1950 may be used in addition to or alternatively to visualization element 1928, by viewing through the balloon 1960. In some embodiments, a balloon 1960 and a shielding member may be provided, in which case the view of the visualization element 1954 may also be directed through a transparent portion of the shielding member. Once the hysteroscopy device 1950 is in proper position, the balloon 1960 may be deflated and the optical introducer 1900 retracted from the working channel, leaving the distal end of the outer tubular body 1951 open such that the operative elements may freely operate on a suitable bodily tissue. Upon completion of the procedure, the hysteroscopy device 1950 may be removed from the body.
In some embodiments, the hysteroscopy device 1950 may be used with an introducer 1910 which does not comprise its own visualization element, as shown in
Systems and Methods for Adapting an Endoscope to Receive an Introducer
In other embodiments, the device may not be a hysteroscopy device or other operational device but may be an adaptor kit for transforming standard endoscopes into optical introducers. The adaptor kit may include a shielding member and an introducer and may be configured to interface with specific models of endoscopes existing within the medical device industry. The introducer may be specifically configured to be removably inserted within an open working channel of a standard endoscope, similar to the way introducers are received within the working channel of biopsy evacuation devices described elsewhere herein. The shielding member may be configured to removably attach to the distal end of the standard endoscope (i.e. a shielding member). It may be secured to the standard endoscope by any suitable means. For example, the shielding member may comprise protrusions configured to wedge into a recess on the standard endoscope and/or the shielding member may be held in place by one or more thin tension cables that travel through the working channel (or another lumen) to the proximal end of the standard endoscope. The shielding member may have a hollow passage for allowing the introducer to extend through as described elsewhere herein. The atraumatic tip of the introducer and the outer surface of the shielding member may cooperate to form an atraumatic distal end to the adapted endoscope. The introducer may or may not comprise its own visualization element. If the introducer comprises a visualization element, the introducer may be an optical introducer as described elsewhere herein. The shielding member may be attached to the standard endoscope and the introducer inserted through the working channel prior to its insertion into the body. During insertion, the endoscope may provide direct visualization through a transparent portion of the shielding member so as to guide the introduction procedure. Upon proper positioning of the standard endoscope the introducer may be removed through the working channel. Various operational instruments may be subsequently inserted through the working channel of the standard endoscope to perform the appropriate operation through the hollow passage of the shielding member. The shielding member may remain in place during the operational procedure and the visualization components of the standard endoscope may continue to operate through the shielding member. The shielding member may be removed after the standard endoscope is retracted from the body. The adaptor kit may be for single use operations or may be reusable. There may be different configurations of the introducer and shielding member for adapting to different endoscopes.
Additional Examples of Tissue Biopsy Tools/Evacuation Devices
As shown in
The retraction and/or extension of the tissue biopsy tool/evacuation hypotube (and in some embodiments the outer tubular bodies) in the embodiments disclosed herein may be accomplished by any suitable means and are not limited to the examples provided. Means of actuating the retraction/extension can include electric motors, electromagnetic solenoids, pneumatic pistons, cable systems, mechanical assemblies, etc. In some embodiments, the tissue biopsy tool/evacuation hypotube may manually extended by the user from the proximal end. The hand piece may include a sealing member (e.g., an O-ring) surrounding the tissue biopsy tool/evacuation hypotube within the hand piece. The retraction/extension may be accomplished by a hybrid mode of actuation. For instance, the hysteroscopy device can include an automated actuation mechanism (e.g., a motor) for retracting/extending the evacuation hypotube a first larger distance (e.g., 10 mm) and also allow manual actuation of the tissue biopsy tool/evacuation hypotube, for example by the fingers of the user. The manual actuation may be limited to a smaller distance (e.g., 2 mm) for fine-tuning. The manual fine-tuning may allow the user to sense tactile feedback in touching tissue with the tissue biopsy tool/evacuation hypotube. The automated actuation may provide favorable ergonomics for moving the tissue biopsy tool/evacuation hypotube over larger distances. The actuation mechanism may be integrated into the hand piece or into an external component. For example, in some embodiments the retraction/extension may be operated by operation of a foot pedal operatively connected to the hysteroscopy device.
The hysteroscopy devices disclosed herein may also have several operable modes of retraction and/or extension. For example, the hysteroscopy device may be configured to retract or extend the tissue biopsy tool/evacuation hypotube a first distance (e.g. a maximal distance such as 10 mm) and to oscillate the evacuation hypotube over a shorter displacement back and forth along a longitudinal direction when in a maximally extended position. The shorter displacement may be less than the distance of full retraction/extension. The tissue biopsy tool/evacuation hypotube may be oscillated at various speeds. Small displacement oscillations (e.g., 3 mm) may create a “pecking” motion, which may be useful for removing a tissue biopsy sample. Even smaller displacement oscillations (e.g., 0.5 mm) may create a vibration effect, which also may be useful for removing a tissue biopsy sample. Other modes of operation are also contemplated. In some embodiments, the tissue biopsy tool/evacuation hypotube may be extended to about 2 mm beyond the distal end of the shielding member.
In many embodiments, the tissue biopsy tool/evacuation hypotube and/or tissue biopsy tool/evacuation lumens of the hysteroscopy evacuation devices disclosed herein may be used as working channels for additional instruments, similar to the way they may be used for the insertion of introducers and/or obturators. For example, biopsy punches, bipolar devices, ultrasonic transducers, graspers, and other surgical instruments which are smaller than the inner diameter of the evacuation hypotube (e.g., 1.65 mm) may be inserted through the working channel of a tissue biopsy tool/evacuation hypotube from the proximal end of the device. The length of the working channel may be about 280 mm long. These instruments, may be used, for instance, after the hysteroscopy device has been inserted into the body to perform additional operations in the body. In this manner, the hysteroscopy device can act as hysteroscopy device and/or introducer and/or trocar/portal. The hysteroscopy device can include a plug, cover, or seal located at the proximal entry point into the evacuation hypotube or lumen so that suction may be maintained in the evacuation hypotube or lumen during evacuation steps of a procedure (i.e. aspiration).
Sensors within the hysteroscopy device (e.g., cameras) can be shielded from electromagnetic/RF interference (e.g., from other surgical devices inserted through the evacuation hypotube) by any suitable means. For example, shielding material and/or additional ground wires can be included in the hysteroscopy evacuation device. The main data cable can be used to accommodate additional ground wires and shielding tubing. The shielding tubing and/or housing for various sensor components can comprise materials suitable for resisting electromagnetic interference, such as non-metallic materials (e.g., thin-walled plastics, polyamides) or appropriate metals (e.g., titanium). The circuit board in the hand piece can be protected from electromagnetic interference by a metallic box. Aspects of RF shielding are further described in one or more the following US patent applications, the disclosures of which are herein incorporated by reference in their entireties: US 2015/0112324, US 2015/0157387, US 2011/0276113, US 2012/0095458, and US 2010/0286477
Further examples of embodiments of the present disclosure may include:
1. A device or method for tissue biopsy evacuation, particularly for collecting biopsies from within the uterine cavity, using an integrated device that provides both visualization (e.g., imaging, video and illumination) with suction and irrigation.
2. A device or method for tissue biopsy evacuation, particularly for collecting biopsies from within the uterine cavity, that includes vibration or mechanical movement, such as rotational movement of a suction tube provided concentrically over a visualization element or vibration of a visualization element, to help clear the biopsy tissue from the evacuation pathway.
3. A device or method for tissue biopsy evacuation, particularly for collecting biopsies from within the uterine cavity, for maintaining good visualization of the sample so that a visualization element is not obstructed by bodily fluids or tissue. For example, the visualization element may be retractable within a suction channel. In other examples, irrigation can be used to clean the visualization element (such as optics) by utilizing particular arrangements of the optics and irrigation devices.
4. A device or method for tissue biopsy evacuation, particularly for collecting biopsies from within the uterine cavity, which uses a visualization device having a clear and conically shaped obturator distal end that enables surgeons to see tissue as the device is moved through the cervix into the uterine cavity and the tissue biopsy location. For example, a separate visualization device may be provided that is removable from a clear trocar, or an integrated visualization device may be provided with a clear, conical distal window. This may be used with a separate integrated visualization/suction/irrigation device to remove the tissue biopsy
5. A device or method for tissue biopsy evacuation, particularly for collecting biopsies from within the uterine cavity, wherein the obturator distal end described in feature 4 above is configured to open and allow the distal end of the hysteroscopy device to extend outward toward the tissue site
6. A device or method for tissue biopsy evacuation, particularly for collecting biopsies from within the uterine cavity, wherein an introducer is removably insertable within a working channel of the hysteroscopy device and may be used to atraumatically insert the hysteroscopy device into the body tissue. The introducer and/or the hysteroscopy device may comprise additional components for shielding the operational elements of the hysteroscopy device during insertion, yet allowing the operational elements to perform through the distal end of the hysteroscopy device during insertion and/or upon removal of the introducer.
7. A device or method for tissue biopsy evacuation, particularly for collecting biopsies from within the uterine cavity, that provides visualization and includes optical enhancements on the hysteroscopy device itself to help the surgeon see where the device is going before it gets there. For example, such enhancements could help the surgeon see through the tissue, to be able to see the transition in tissue from healthy to unhealthy uterine tissue. Various embodiments are contemplated, such as infrared illumination, ultrasonic transducers, and other sensors (such as glucose sensors).
Embodiments Shown in
Hysteroscopy can be used in abnormal ultrasound findings. Such findings may show enlarged endometrial stripe or suspected intracavitary pathologies. Hysteroscopy can also be used in cases of infertility and for procedures involving intrauterine devices (IUDs).
Hysteroscopy can also be used in evaluation of abnormal uterine bleeding (AUB). AUB is a common reason for women to be referred to gynecologists. AUB can have heavy menstrual or menopausal bleeding. 30% of reproductive age women experience some type of AUB. Over 18% of all gynecology outpatient visits in the US are for menorrhagia alone. AUB is indicated for up to 25% of all gynecologic surgeries.
Hysteroscopy can provide direct visualization, opportunity for directed biopsy, and histopathology. Hysteroscopy is the most accurate diagnostic technique for diagnosis of any endometrial pathology, can be used in diagnosis of endometrial diseases—hyperplasia or cancer, can be used to examine intracavitary masses—polyp or myomas, and can be used to examine structural abnormalities. Blind biopsy techniques demonstrate very low sensitivity and accuracy in the diagnosis of benign focal intracavitary lesions. Hysteroscopy is confirmed as the gold standard in the assessment of AUB in menopause. Hysteroscopy can eliminate false-negative results of blind biopsy through direct visualization of the uterine cavity and the performance of targeted biopsy in cases of doubt.
Current hysteroscopy technology involves capital equipment with a high cost. As such, the hysteroscopes are reusable and include a camera and light source, a monitor, a mobile cart, a printer and recorder, and disinfection station. However, there is a need for inexpensive hysteroscopy devices that are appropriate for in-office use, such as certain embodiments disclosed herein.
A current in-office technology is the Endosee by Cooper Surgical; however, it is only a diagnostic hysteroscope that does not include a working channel. The lack of a working channel prevents from having a directed biopsy. Further, the Endosee is flexible but not steerable, making it more difficult to insert into the cervix and the design may be prone to breakage during insertion.
As shown in
As shown in
In some embodiments, the instrument can be held with a pen style grip. In some embodiments, there can be a retractable shielding member. The retractable shielding member can be placed on the dilator tip and then retract to remove from the field of view. In some embodiments, the tube can be tipped to provide dilation tip for insertion. In some embodiments, relief cuts/slits may be added to the tip to allow it to retract and flex over the metal outer tube of the probe. In some embodiments, a tube can be extended during insertion for dilation and retracted behind camera and working channel once the instrument is fully inserted.
In some embodiments, a camera can be placed in front of the working channel. The shielding member hole can be behind the view angle of the camera. In some embodiments, there can be a rounded dilation tip. In some embodiments, the cutting edge/surface can be oriented to the side which allows cutting to be accomplished with side oriented sweeping motion. In some embodiments the shielding member can be optically clear. In some embodiments, the dilator can be opaque.
In some embodiments, a clear shielding member 3310, 3410 can be used as shown in
As shown in
As shown in
In some embodiments, the biopsy tool can collect enough tissue with each actuation of the device. The biopsy tool can be integrated into the probe to create a singular device. In some embodiments, the biopsy tool can be integrated and some embodiments there can be an open working channel.
In some embodiments, the stand-alone instrument can integrate some motor or electronics to automate tissue sampling motion. A guillotine articulating blade 3700 can be used as shown in
In some embodiments, a twist blade design can be used. The blade can rotate within sleeve to cut tissue. Blade movement can be controlled with a twist handle at proximal end of instrument.
As shown in
Features, materials, characteristics, or groups described in conjunction with a particular aspect, embodiment, or example are to be understood to be applicable to any other aspect, embodiment or example described in this section or elsewhere in this specification unless incompatible therewith. All of the features disclosed in this specification (including any accompanying claims, abstract and drawings), and/or all of the steps of any method or process so disclosed, may be combined in any combination, except combinations where at least some of such features and/or steps are mutually exclusive. The protection is not restricted to the details of any foregoing embodiments. The protection extends to any novel one, or any novel combination, of the features disclosed in this specification (including any accompanying claims, abstract and drawings), or to any novel one, or any novel combination, of the steps of any method or process so disclosed.
While certain embodiments have been described, these embodiments have been presented by way of example only, and are not intended to limit the scope of protection. Indeed, the novel methods and systems described in this section or elsewhere in this specification may be embodied in a variety of other forms. Furthermore, various omissions, substitutions and changes in the form of the methods and systems described in this section or elsewhere in this specification may be made. Those skilled in the art will appreciate that in some embodiments, the actual steps taken in the processes illustrated and/or disclosed may differ from those shown in the figures. Depending on the embodiment, certain of the steps described above may be removed, others may be added. Furthermore, the features and attributes of the specific embodiments disclosed above may be combined in different ways to form additional embodiments, all of which fall within the scope of the present disclosure.
Although the present disclosure includes certain embodiments, examples and applications, it will be understood by those skilled in the art that the present disclosure extends beyond the specifically disclosed embodiments to other alternative embodiments and/or uses and obvious modifications and equivalents thereof, including embodiments which do not provide all of the features and advantages set forth in this section or elsewhere in this specification. Accordingly, the scope of the present disclosure is not intended to be limited by the specific disclosures of preferred embodiments in this section or elsewhere in this specification, and may be defined by claims as presented in this section or elsewhere in this specification or as presented in the future.
Many other variations than those described herein will be apparent from this disclosure. For example, depending on the embodiment, certain acts, events, or functions of any of the steps described herein can be performed in a different sequence, can be added, merged, or left out altogether (e.g., not all described acts or events are necessary for the practice of the algorithms). Moreover, in certain embodiments, acts or events can be performed concurrently. In addition, different tasks or processes can be performed by different machines and/or computing systems that can function together.
Conditional language used herein, such as, among others, “can,” “might,” “may,” “e.g.,” and the like, unless specifically stated otherwise, or otherwise understood within the context as used, is generally intended to convey that certain embodiments include, while other embodiments do not include, certain features, elements and/or states. Thus, such conditional language is not generally intended to imply that features, elements and/or states are in any way required for one or more embodiments or that one or more embodiments necessarily include logic for deciding, with or without author input or prompting, whether these features, elements and/or states are included or are to be performed in any particular embodiment. The terms “comprising,” “including,” “having,” and the like are synonymous and are used inclusively, in an open-ended fashion, and do not exclude additional elements, features, acts, operations, and so forth. Also, the term “or” is used in its inclusive sense (and not in its exclusive sense) so that when used, for example, to connect a list of elements, the term “or” means one, some, or all of the elements in the list. Further, the term “each,” as used herein, in addition to having its ordinary meaning, can mean any subset of a set of elements to which the term “each” is applied.
Disjunctive language such as the phrase “at least one of X, Y and Z,” unless specifically stated otherwise, is to be understood with the context as used in general to convey that an item, term, etc. may be either X, Y, or Z, or a combination thereof. Thus, such conjunctive language is not generally intended to imply that certain embodiments require at least one of X, at least one of Y and at least one of Z to each be present.
Unless otherwise explicitly stated, articles such as “a” or “an” should generally be interpreted to include one or more described items. Accordingly, phrases such as “a device configured to” are intended to include one or more recited devices. Such one or more recited devices can also be collectively configured to carry out the stated recitations.
While the above detailed description has shown, described, and pointed out novel features as applied to various embodiments, it will be understood that various omissions, substitutions, and changes in the form and details of the apparatus or method illustrated can be made without departing from the spirit of the disclosure. As will be recognized, certain embodiments of the inventions described herein can be embodied within a form that does not provide all of the features and benefits set forth herein, as some features can be used or practiced separately from others.
This application claims priority under 35 USC 119(e) to U.S. Provisional Application No. 62/650,261, entitled FULLY INTEGRATED HYSTEROSCOPY DEVICES WITH BIOPSY CAPABILITIES AND METHODS OF USE, filed on Mar. 29, 2018; the disclosure of which is hereby incorporated by reference in its entirety.
| Number | Name | Date | Kind |
|---|---|---|---|
| 3797505 | Gilhaus | Mar 1974 | A |
| 3835842 | Iglesias | Sep 1974 | A |
| 3871358 | Fukuda et al. | Mar 1975 | A |
| 4069823 | Isakov et al. | Jan 1978 | A |
| 4519391 | Murakoshi | May 1985 | A |
| 4624243 | Lowery et al. | Nov 1986 | A |
| 4646738 | Trott | Mar 1987 | A |
| 4651201 | Schoolman | Mar 1987 | A |
| 4678459 | Onik et al. | Jul 1987 | A |
| 4697210 | Toyota et al. | Sep 1987 | A |
| 4700702 | Nilsson | Oct 1987 | A |
| 4750902 | Wuchinich et al. | Jun 1988 | A |
| 4845555 | Yabe et al. | Jul 1989 | A |
| 4919112 | Siegmund | Apr 1990 | A |
| 5088676 | Orchard et al. | Feb 1992 | A |
| 5131382 | Meyer | Jul 1992 | A |
| 5170775 | Tagami | Dec 1992 | A |
| 5178130 | Kaiya | Jan 1993 | A |
| 5188093 | Lafferty et al. | Feb 1993 | A |
| 5190028 | Lafferty et al. | Mar 1993 | A |
| 5195541 | Obenchain | Mar 1993 | A |
| 5228430 | Sakamoto | Jul 1993 | A |
| 5242441 | Avitall | Sep 1993 | A |
| 5269785 | Bonutti | Dec 1993 | A |
| 5291010 | Tsuji | Mar 1994 | A |
| 5312407 | Carter | May 1994 | A |
| 5313962 | Obenchain | May 1994 | A |
| 5318589 | Lichtman | Jun 1994 | A |
| 5373312 | Bala | Jun 1994 | A |
| 5334183 | Wuchinich | Aug 1994 | A |
| 5351678 | Clayton et al. | Oct 1994 | A |
| 5354302 | Ko | Oct 1994 | A |
| 5365267 | Edwards | Nov 1994 | A |
| 5368015 | Wilk | Nov 1994 | A |
| 5369525 | Bala et al. | Nov 1994 | A |
| 5373317 | Salavi et al. | Dec 1994 | A |
| 5373392 | Bala | Dec 1994 | A |
| 5383888 | Zvenyatsky et al. | Jan 1995 | A |
| 5395312 | Desai | Mar 1995 | A |
| 5395313 | Naves et al. | Mar 1995 | A |
| 5403276 | Schechter et al. | Apr 1995 | A |
| 5403342 | Tovey et al. | Apr 1995 | A |
| 5406940 | Melzer et al. | Apr 1995 | A |
| 5417203 | Tovey et al. | May 1995 | A |
| 5423312 | Siegmund et al. | Jun 1995 | A |
| 5425355 | Kulick | Jun 1995 | A |
| 5476473 | Heckele | Dec 1995 | A |
| 5478328 | Silverman et al. | Dec 1995 | A |
| 5484433 | Taylor et al. | Jan 1996 | A |
| 5494483 | Adair | Feb 1996 | A |
| 5500012 | Brucker et al. | Mar 1996 | A |
| 5512036 | Tamburrino et al. | Apr 1996 | A |
| 5518502 | Kaplan et al. | May 1996 | A |
| 5547455 | McKenna et al. | Aug 1996 | A |
| 5569158 | Suzuki et al. | Oct 1996 | A |
| 5577992 | Chiba et al. | Nov 1996 | A |
| 5582575 | Heckele et al. | Dec 1996 | A |
| 5591192 | Privitera et al. | Jan 1997 | A |
| 5601525 | Okada | Feb 1997 | A |
| 5630784 | Siegmund et al. | May 1997 | A |
| 5630837 | Crowley | May 1997 | A |
| 5643294 | Tovey et al. | Jul 1997 | A |
| 5647840 | D'Amelio et al. | Jul 1997 | A |
| 5674191 | Edwards et al. | Oct 1997 | A |
| 5695513 | Johnson et al. | Dec 1997 | A |
| 5704534 | Huitema et al. | Jan 1998 | A |
| 5707382 | Sierocuk et al. | Jan 1998 | A |
| 5766194 | Smith | Jan 1998 | A |
| 5713505 | Huitema | Feb 1998 | A |
| 5722403 | McGee et al. | Mar 1998 | A |
| 5735792 | Hoeck et al. | Apr 1998 | A |
| 5757458 | Miller et al. | May 1998 | A |
| 5766199 | Heisler et al. | Jun 1998 | A |
| 5766200 | Mazurek et al. | Jun 1998 | A |
| 5785647 | Tompkins et al. | Jul 1998 | A |
| 5788636 | Curley | Aug 1998 | A |
| 5807240 | Muller et al. | Sep 1998 | A |
| 5818527 | Yamaguchi et al. | Oct 1998 | A |
| 5836943 | Miller, III | Nov 1998 | A |
| 5857961 | Vanden Hoek et al. | Jan 1999 | A |
| 5864359 | Kazakevich | Jan 1999 | A |
| 5868664 | Speier et al. | Feb 1999 | A |
| 5873814 | Adair | Feb 1999 | A |
| 5873816 | Ishii | Feb 1999 | A |
| 5873817 | Adair | Feb 1999 | A |
| 5879285 | Ishii | Mar 1999 | A |
| 5888193 | Breidental et al. | Mar 1999 | A |
| 5902272 | Eggers et al. | May 1999 | A |
| 5916146 | Allotta et al. | Jun 1999 | A |
| 5928137 | Crawford | Jul 1999 | A |
| 5929901 | Adair et al. | Jul 1999 | A |
| 5941817 | Crawford | Aug 1999 | A |
| 5976075 | Beane et al. | Nov 1999 | A |
| 5976076 | Kolff et al. | Nov 1999 | A |
| 5976077 | Wittens et al. | Nov 1999 | A |
| 5986693 | Adair et al. | Nov 1999 | A |
| 6001084 | Riek et al. | Dec 1999 | A |
| 6007554 | Van Ess | Dec 1999 | A |
| 6043839 | Adair et al. | Mar 2000 | A |
| 6045549 | Smethers et al. | Apr 2000 | A |
| 6068603 | Suzuki | May 2000 | A |
| 6080101 | Tatsuno et al. | Jun 2000 | A |
| 6086528 | Adair | Jul 2000 | A |
| 6053923 | Veca et al. | Aug 2000 | A |
| 6099465 | Inoue | Aug 2000 | A |
| 6112123 | Kelleher et al. | Aug 2000 | A |
| 6110127 | Suzuki | Sep 2000 | A |
| 6113614 | Mears | Sep 2000 | A |
| 6126592 | Proch et al. | Oct 2000 | A |
| 6129662 | Li et al. | Oct 2000 | A |
| 6142957 | Diamond et al. | Nov 2000 | A |
| 6149646 | West, Jr. et al. | Nov 2000 | A |
| 6156033 | Tu et al. | Dec 2000 | A |
| 6211904 | Adair et al. | Apr 2001 | B1 |
| 6234955 | Silverman et al. | May 2001 | B1 |
| 6241727 | Tu et al. | Jun 2001 | B1 |
| 6251120 | Dorn | Jun 2001 | B1 |
| 6261226 | McKenna et al. | Jul 2001 | B1 |
| 6264670 | Chin | Jul 2001 | B1 |
| 6275255 | Adair et al. | Aug 2001 | B1 |
| 6277137 | Chin | Aug 2001 | B1 |
| 6310642 | Adair et al. | Oct 2001 | B1 |
| 6315712 | Rovegno | Nov 2001 | B1 |
| 6316215 | Adair et al. | Nov 2001 | B1 |
| 6322494 | Bullicant et al. | Nov 2001 | B1 |
| 6331165 | Turturro et al. | Dec 2001 | B1 |
| 6332881 | Carner et al. | Dec 2001 | B1 |
| 6371909 | Hoeg et al. | Apr 2002 | B1 |
| 6387043 | Yoon | May 2002 | B1 |
| 6390972 | Speier et al. | May 2002 | B1 |
| 6419626 | Yoon | Jul 2002 | B1 |
| 6419627 | Ben Nun | Jul 2002 | B1 |
| 6419654 | Kadan | Jul 2002 | B1 |
| 6424369 | Adair et al. | Jul 2002 | B1 |
| 6447445 | Hirano | Sep 2002 | B1 |
| 6452626 | Adair et al. | Sep 2002 | B1 |
| 6458140 | Akin et al. | Oct 2002 | B2 |
| 6459481 | Schaack | Oct 2002 | B1 |
| 6464633 | Hosoda et al. | Oct 2002 | B1 |
| 6464711 | Emans et al. | Oct 2002 | B1 |
| 6468274 | Alleynne et al. | Oct 2002 | B1 |
| 6478730 | Bala et al. | Nov 2002 | B1 |
| 6491690 | Goble et al. | Dec 2002 | B1 |
| 6572578 | Blanchard | Feb 2003 | B1 |
| 6527753 | Sekine et al. | Mar 2003 | B2 |
| 6533749 | Mitusina et al. | Mar 2003 | B1 |
| 6544194 | Kortenbach et al. | Apr 2003 | B1 |
| 6561973 | Bala | May 2003 | B1 |
| 6569085 | Kortenbach et al. | May 2003 | B2 |
| 6583240 | Wang et al. | Jun 2003 | B2 |
| 6585734 | Levinson | Jul 2003 | B2 |
| 6602247 | Lalonde | Aug 2003 | B2 |
| 6602248 | Sharps et al. | Aug 2003 | B1 |
| 6605087 | Swartz et al. | Aug 2003 | B2 |
| 6607529 | Jones et al. | Aug 2003 | B1 |
| 6623437 | Hinchliffe et al. | Sep 2003 | B2 |
| 6632227 | Adams | Oct 2003 | B2 |
| 6652522 | Cucin | Nov 2003 | B2 |
| 6656132 | Ouchi | Dec 2003 | B1 |
| 6656195 | Peters et al. | Dec 2003 | B2 |
| 6660011 | Levinson | Dec 2003 | B2 |
| 6675033 | Lardo et al. | Jan 2004 | B1 |
| 6679838 | Bala | Jan 2004 | B2 |
| 6682535 | Hoogland | Jan 2004 | B2 |
| 6689130 | Arai et al. | Feb 2004 | B2 |
| 6692432 | Yarush et al. | Feb 2004 | B1 |
| 6695772 | Bon et al. | Feb 2004 | B1 |
| 6726684 | Woloszko et al. | Apr 2004 | B1 |
| 6750037 | Adair et al. | Jun 2004 | B2 |
| 6764439 | Schaaf et al. | Jul 2004 | B2 |
| 6805715 | Reuter et al. | Oct 2004 | B2 |
| 6820791 | Adams | Nov 2004 | B2 |
| 6832984 | Stelzer et al. | Dec 2004 | B2 |
| 6833000 | Levinson | Dec 2004 | B2 |
| 6835198 | Bonutti | Dec 2004 | B2 |
| 6837887 | Woloszko et al. | Jan 2005 | B2 |
| 6862036 | Adair et al. | Mar 2005 | B2 |
| 6863651 | Remijan et al. | Mar 2005 | B2 |
| 6885801 | Shankar et al. | Mar 2005 | B1 |
| 6893436 | Woodard et al. | May 2005 | B2 |
| 6899672 | Chin et al. | May 2005 | B2 |
| 6902526 | Katzman | Jun 2005 | B2 |
| 6982740 | Adair et al. | Jan 2006 | B2 |
| 6982742 | Adair et al. | Jan 2006 | B2 |
| 6997941 | Sharkey et al. | Feb 2006 | B2 |
| 7002621 | Adair et al. | Feb 2006 | B2 |
| 7004938 | Ormsby et al. | Feb 2006 | B2 |
| 7030904 | Adair et al. | Apr 2006 | B2 |
| 7060028 | Luloh et al. | Jun 2006 | B2 |
| 7094200 | Katzman | Aug 2006 | B2 |
| 7108657 | Irion et al. | Sep 2006 | B2 |
| 7137981 | Long | Nov 2006 | B2 |
| 7156559 | Gauthier, Jr. et al. | Jan 2007 | B2 |
| 7160247 | Deppmeier et al. | Jan 2007 | B2 |
| 7160295 | Garito et al. | Jan 2007 | B1 |
| 7169147 | Nosel | Jan 2007 | B2 |
| 7179255 | Lettice et al. | Feb 2007 | B2 |
| 7198635 | Danek et al. | Apr 2007 | B2 |
| 7214183 | Miyake | May 2007 | B2 |
| 7258663 | Doguchi et al. | Aug 2007 | B2 |
| 7269344 | Nishioka et al. | Sep 2007 | B2 |
| 7270658 | Woloszko et al. | Sep 2007 | B2 |
| 7318823 | Sharps et al. | Jan 2008 | B2 |
| 7320688 | Foley et al. | Jan 2008 | B2 |
| RE40156 | Sharps et al. | Mar 2008 | E |
| 7435010 | Gauthier, Jr. et al. | Oct 2008 | B2 |
| 7453984 | Chen et al. | Nov 2008 | B2 |
| 7491168 | Raymond et al. | Feb 2009 | B2 |
| 7572578 | Blanchard | Feb 2009 | B2 |
| 7689268 | Marshik-Geurts et al. | Mar 2010 | B2 |
| 7699773 | Forkey et al. | Apr 2010 | B2 |
| 7708689 | Deppmeier et al. | May 2010 | B2 |
| 7857755 | Kupferschmid et al. | Dec 2010 | B2 |
| 7918787 | Saadat | Apr 2011 | B2 |
| 7942814 | Remijan et al. | May 2011 | B2 |
| 8016839 | Wilk | Sep 2011 | B2 |
| 8038602 | Gill et al. | Oct 2011 | B2 |
| 8046057 | Clarke | Oct 2011 | B2 |
| 8052609 | Harhen | Nov 2011 | B2 |
| 8142346 | Shoroji et al. | Mar 2012 | B2 |
| 8170319 | Shukla | May 2012 | B2 |
| 8277411 | Gellman | Oct 2012 | B2 |
| 8317689 | Remijan et al. | Nov 2012 | B1 |
| 8475361 | Barlow et al. | Jul 2013 | B2 |
| 8814781 | Avitsian | Aug 2014 | B2 |
| 8885034 | Adair et al. | Nov 2014 | B2 |
| 8951274 | Adams et al. | Feb 2015 | B2 |
| 10028763 | Kumar | Jul 2018 | B2 |
| 20010036015 | Eguchi | Nov 2001 | A1 |
| 20010053873 | Schaaf et al. | Dec 2001 | A1 |
| 20020007110 | Irion | Jan 2002 | A1 |
| 20020016583 | Cragg | Feb 2002 | A1 |
| 20020072651 | Vilos | Jun 2002 | A1 |
| 20020080248 | Adair et al. | Jun 2002 | A1 |
| 20020087047 | Remijan et al. | Jul 2002 | A1 |
| 20020177847 | Long | Nov 2002 | A1 |
| 20020183739 | Long | Dec 2002 | A1 |
| 20030040668 | Kaneko et al. | Feb 2003 | A1 |
| 20030120156 | Forrester et al. | Jun 2003 | A1 |
| 20030181905 | Long | Sep 2003 | A1 |
| 20030220574 | Markus et al. | Nov 2003 | A1 |
| 20030233024 | Ando | Dec 2003 | A1 |
| 20040102772 | Baxter et al. | May 2004 | A1 |
| 20040162554 | Lee et al. | Aug 2004 | A1 |
| 20040162572 | Sauer | Aug 2004 | A1 |
| 20040215061 | Kimmel et al. | Oct 2004 | A1 |
| 20050038317 | Ratnakar | Feb 2005 | A1 |
| 20050090762 | Burbank et al. | Apr 2005 | A1 |
| 20050096504 | Akiba | May 2005 | A1 |
| 20050113641 | Bala | May 2005 | A1 |
| 20050154262 | Banik et al. | Jul 2005 | A1 |
| 20050192532 | Kucklick et al. | Sep 2005 | A1 |
| 20050197536 | Banik et al. | Sep 2005 | A1 |
| 20050197658 | Platt | Sep 2005 | A1 |
| 20050213267 | Azrai et al. | Sep 2005 | A1 |
| 20050228228 | Boulais | Oct 2005 | A1 |
| 20050234296 | Saadat et al. | Oct 2005 | A1 |
| 20050240218 | Freed | Oct 2005 | A1 |
| 20050277808 | Sonnenschein et al. | Dec 2005 | A1 |
| 20060004258 | Sun et al. | Jan 2006 | A1 |
| 20060004354 | Suslov | Jan 2006 | A1 |
| 20060030861 | Simonson et al. | Feb 2006 | A1 |
| 20060063973 | Makower et al. | Mar 2006 | A1 |
| 20060069303 | Couvillon, Jr. | Mar 2006 | A1 |
| 20060069313 | Couvillon, Jr. | Mar 2006 | A1 |
| 20060084839 | Mourlas et al. | Apr 2006 | A1 |
| 20060089633 | L. Bleich et al. | Apr 2006 | A1 |
| 20060106282 | Bala | May 2006 | A1 |
| 20060111613 | Boutillette et al. | May 2006 | A1 |
| 20060149129 | Watts et al. | Jul 2006 | A1 |
| 20060167340 | Pease et al. | Jul 2006 | A1 |
| 20060173244 | Boulas et al. | Aug 2006 | A1 |
| 20060178560 | Saadat et al. | Aug 2006 | A1 |
| 20060183975 | Saadat et al. | Aug 2006 | A1 |
| 20060190063 | Kanzius | Aug 2006 | A1 |
| 20060206007 | Bala | Sep 2006 | A1 |
| 20060206118 | Kim et al. | Sep 2006 | A1 |
| 20060241648 | Bleich et al. | Oct 2006 | A1 |
| 20060241665 | Bosley et al. | Oct 2006 | A1 |
| 20060258951 | Bleich et al. | Nov 2006 | A1 |
| 20060270904 | Kepferschmid et al. | Nov 2006 | A1 |
| 20060276690 | Farris, III et al. | Dec 2006 | A1 |
| 20060281972 | Pease et al. | Dec 2006 | A1 |
| 20060287576 | Tsuji et al. | Dec 2006 | A1 |
| 20060293562 | Uchimura et al. | Dec 2006 | A1 |
| 20070038117 | Bala | Feb 2007 | A1 |
| 20070049794 | Glassenberg et al. | Mar 2007 | A1 |
| 20070060798 | Krupnik et al. | Mar 2007 | A1 |
| 20070071311 | Rovira-Mas et al. | Mar 2007 | A1 |
| 20070073109 | Irion | Mar 2007 | A1 |
| 20070075654 | Kishinevsky | Apr 2007 | A1 |
| 20070093689 | Steinberg | Apr 2007 | A1 |
| 20070115376 | Igarashi | May 2007 | A1 |
| 20070123888 | Bleich et al. | May 2007 | A1 |
| 20070129604 | Hatcher et al. | Jun 2007 | A1 |
| 20070129719 | Kendale et al. | Jun 2007 | A1 |
| 20070135874 | Bala | Jun 2007 | A1 |
| 20070161855 | Mikkaichi et al. | Jul 2007 | A1 |
| 20070167678 | Moskowitz et al. | Jul 2007 | A1 |
| 20070167681 | Gill et al. | Jul 2007 | A1 |
| 20070179340 | Jorgensen | Aug 2007 | A1 |
| 20070213733 | Bleich et al. | Sep 2007 | A1 |
| 20070213734 | Bleich et al. | Sep 2007 | A1 |
| 20070213735 | Bleich et al. | Sep 2007 | A1 |
| 20070219412 | DiGiovanni et al. | Sep 2007 | A1 |
| 20070225556 | Oritz et al. | Sep 2007 | A1 |
| 20070232850 | Stokes et al. | Oct 2007 | A1 |
| 20070249904 | Amano et al. | Oct 2007 | A1 |
| 20070276183 | Melder | Nov 2007 | A1 |
| 20070287886 | Saadat | Dec 2007 | A1 |
| 20070293853 | Truckai et al. | Dec 2007 | A1 |
| 20080009747 | Saadat et al. | Jan 2008 | A1 |
| 20080033465 | Schmitz et al. | Feb 2008 | A1 |
| 20080045924 | Cox et al. | Feb 2008 | A1 |
| 20080051629 | Sugiyama et al. | Feb 2008 | A1 |
| 20080062429 | Liang et al. | Mar 2008 | A1 |
| 20080064925 | Gill et al. | Mar 2008 | A1 |
| 20080091064 | Laser | Apr 2008 | A1 |
| 20080103504 | Schmitz et al. | May 2008 | A1 |
| 20080108869 | Sanders et al. | May 2008 | A1 |
| 20080147018 | Squilla et al. | Jun 2008 | A1 |
| 20080161809 | Schmitz et al. | Jul 2008 | A1 |
| 20080051812 | Schmitz et al. | Aug 2008 | A1 |
| 20080200758 | Orbay et al. | Aug 2008 | A1 |
| 20080207992 | Scheller et al. | Aug 2008 | A1 |
| 20080207996 | Tsai | Aug 2008 | A1 |
| 20080214896 | Krupa et al. | Sep 2008 | A1 |
| 20080262302 | Azarbarzin et al. | Oct 2008 | A1 |
| 20080287961 | Miyamoto et al. | Nov 2008 | A1 |
| 20080300456 | Irion et al. | Dec 2008 | A1 |
| 20080300462 | Intoccia et al. | Dec 2008 | A1 |
| 20090043165 | Kucklick et al. | Feb 2009 | A1 |
| 20090076329 | Su et al. | Mar 2009 | A1 |
| 20090225159 | Schneider | Sep 2009 | A1 |
| 20090253967 | Gill et al. | Oct 2009 | A1 |
| 20090264706 | Bala | Oct 2009 | A1 |
| 20100016855 | Ramstein et al. | Jan 2010 | A1 |
| 20100022824 | Cybulski et al. | Jan 2010 | A1 |
| 20100056862 | Bakos | Mar 2010 | A1 |
| 20100063352 | Matsuura | Mar 2010 | A1 |
| 20100063356 | Smith | Mar 2010 | A1 |
| 20100087798 | Adams et al. | Apr 2010 | A1 |
| 20100094231 | Bleich et al. | Apr 2010 | A1 |
| 20100121139 | OuYang et al. | May 2010 | A1 |
| 20100121155 | OuYang et al. | May 2010 | A1 |
| 20100165335 | Tearney | Jul 2010 | A1 |
| 20100165336 | Terney | Jul 2010 | A1 |
| 20100217080 | Cheung et al. | Aug 2010 | A1 |
| 20100256446 | Raju | Oct 2010 | A1 |
| 20100274081 | Okoniewski | Oct 2010 | A1 |
| 20100284580 | OuYang et al. | Nov 2010 | A1 |
| 20100286477 | OuYang et al. | Nov 2010 | A1 |
| 20110009694 | Schultz et al. | Jan 2011 | A1 |
| 20110034769 | Adair et al. | Feb 2011 | A1 |
| 20110046652 | Rehnke et al. | Feb 2011 | A1 |
| 20110160740 | Makower | Jun 2011 | A1 |
| 20110227509 | Saleh | Sep 2011 | A1 |
| 20110263933 | Schaaf | Oct 2011 | A1 |
| 20110263983 | Peszynski | Oct 2011 | A1 |
| 20110276113 | Cybulski | Nov 2011 | A1 |
| 20120016397 | Briganti et al. | Jan 2012 | A1 |
| 20120071721 | Remijan et al. | Mar 2012 | A1 |
| 20120088968 | Gambhir et al. | Apr 2012 | A1 |
| 20120095458 | Cybulski et al. | Apr 2012 | A1 |
| 20120206591 | Selby et al. | Aug 2012 | A1 |
| 20120220827 | Sargeant | Aug 2012 | A1 |
| 20120241188 | Power et al. | Sep 2012 | A1 |
| 20120265009 | OuYang et al. | Oct 2012 | A1 |
| 20130006144 | Clancy | Jan 2013 | A1 |
| 20130046142 | Remijan et al. | Feb 2013 | A1 |
| 20130144122 | Adair et al. | Jun 2013 | A1 |
| 20130296648 | OuYang et al. | Nov 2013 | A1 |
| 20130303846 | Cybulski et al. | Nov 2013 | A1 |
| 20140276472 | VanderStek et al. | Sep 2014 | A1 |
| 20150112324 | Cybulski | Apr 2015 | A1 |
| 20150157387 | OuYang et al. | Jun 2015 | A1 |
| 20150196193 | Kienzle et al. | Jul 2015 | A1 |
| 20150196197 | Kienzle et al. | Jul 2015 | A1 |
| 20150313634 | Gross et al. | Nov 2015 | A1 |
| 20160045224 | Hendershot, III | Feb 2016 | A1 |
| 20160296108 | Kienzle et al. | Oct 2016 | A1 |
| 20170042408 | Washburn et al. | Feb 2017 | A1 |
| 20170042573 | Savvouras et al. | Feb 2017 | A1 |
| 20170086666 | Kienzle et al. | Mar 2017 | A1 |
| 20170197028 | Goldsmith | Jul 2017 | A1 |
| 20170265879 | Washburn, II | Sep 2017 | A1 |
| 20190274702 | Sutliff, III | Sep 2019 | A1 |
| Number | Date | Country |
|---|---|---|
| 2015204444 | Jan 2018 | AU |
| 2557085 | Jun 2003 | CN |
| 1612708 | May 2005 | CN |
| 1779836 | May 2006 | CN |
| 101040775 | Sep 2007 | CN |
| 103961177 | Aug 2014 | CN |
| 104367296 | Feb 2015 | CN |
| 106455907 | Feb 2017 | CN |
| 1252859 | Oct 2002 | EP |
| 2317931 | May 2011 | EP |
| 2335550 | Jun 2011 | EP |
| 2451338 | May 2012 | EP |
| 3094231 | Nov 2016 | EP |
| 2431539 | Apr 2007 | GB |
| H 1033462 | Feb 1998 | JP |
| 2001-161630 | Jun 2001 | JP |
| WO 0009001 | Feb 2000 | WO |
| WO 2006107877 | Oct 2006 | WO |
| WO 2007106740 | Sep 2007 | WO |
| WO 2008016927 | Feb 2008 | WO |
| WO 2008094436 | Aug 2008 | WO |
| WO 2008094439 | Aug 2008 | WO |
| WO 2008094444 | Aug 2008 | WO |
| WO 2008098251 | Aug 2008 | WO |
| WO-2009048542 | Apr 2009 | WO |
| WO 2010011781 | Jan 2010 | WO |
| WO 2011006052 | Jan 2011 | WO |
| WO 2014137530 | Sep 2014 | WO |
| WO 2015106288 | Jul 2015 | WO |
| WO 2016130844 | Aug 2016 | WO |
| WO 2017027749 | Feb 2017 | WO |
| WO 2017161777 | Sep 2017 | WO |
| WO 2019191705 | Oct 2019 | WO |
| Entry |
|---|
| Communication Pursuant to Article 94(3) EPC, Application No. 16 757 416.9-1008, dated Jun. 17, 2019, 3 pages. |
| European Extended Search Report, Application No. 19171390.8-1008, dated Sep. 24, 2019, 6 pages. |
| Keller C.A., Hinerman, R., Singh, A., Alvarez, F., “The Use of Endoscopic Argon Plasma Coagulation in Airway Complications After Solid Organ Transplantation,” Chest, 2001, vol. 119, No. 6, pp. 1968-1975. |
| International Search Report and Written Opinion dated Jul. 12, 2019, received in International Patent Application No. PCT/US2019/025034, in 16 pages. |
| Number | Date | Country | |
|---|---|---|---|
| 20190298321 A1 | Oct 2019 | US |
| Number | Date | Country | |
|---|---|---|---|
| 62650261 | Mar 2018 | US |
