BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a perspective view of one aspect of the disclosed lumen stabilizer device;
FIG. 2(
a) is a perspective view of a portion of the lumen stabilizer device shown in FIG. 1, in a first configuration;
FIG. 2(
b) is a perspective view of a portion of the lumen stabilizer device shown in FIG. 1, in a second configuration;
FIG. 2(
c) is a perspective view, partially in section, of the portion of the lumen stabilizer device shown in FIG. 2(a);
FIG. 3 is a perspective side of a second aspect of the disclosed lumen stabilizer device;
FIG. 4(
a) is a perspective view of a portion of the lumen stabilizer device shown in FIG. 3, in a first configuration;
FIG. 4(
b) is a perspective view of a portion of the lumen stabilizer device shown in FIG. 3, in a second configuration;
FIG. 4(
c) is a perspective view, partially in section, of the portion of the lumen stabilizer device shown in FIG. 4(a);
FIG. 5 is a side elevational view, in section, of a third aspect of the disclosed lumen stabilizer device; and
FIG. 6 is a side elevational view, in section, of a portion of the lumen stabilizer accessory shown in FIG. 5.
DETAILED DESCRIPTION OF THE INVENTION
Referring to FIG. 1, a first aspect of an endoscopic instrument is shown and may include a flexible shaft 100 having a distal end 102 for insertion into the gastrointestinal tract 10 of a patient and a proximal end 104 for the connection of light sources, fiberscopic eyepieces, camera displays, irrigation lines, vacuum sources, actuator controls and the like. The shaft 100 may be sized and shaped to received a flexible endoscope therein and may define an elongated axis A, which may be linear or curvilinear. The distal end 102 of flexible shaft 100 may include a plurality of arms 110 that may be extended from and retracted into a plurality of arm housings 128 disposed about the periphery of distal end 102.
The flexible shaft 100 may also include a working channel 150 and a plurality of auxiliary channels 160. The channels 150, 160 may be either internal or external of the shaft 100. Working channel 150 may be used during surgical procedures to deploy endoscopic devices such as needles, forceps, snares, knives, and other such devices known in the art. An auxiliary channel 160 may house an arm actuator 130 that provides a means for extending and retracting an arm 110 in relation to protective sleeve 128. Arm actuator 130 may be connected to arm 110 by gluing, welding, or other methods known in the art. Arm actuator 130 may also coaxially house a finger actuator 132 (e.g., an actuation cable). In such case, arm actuator 130 may be provided as a helically wound stainless steel wire sheath, and finger actuator 132 may be provided as a stainless steel wire slidingly movable within that sheath. Arm actuator 130 and finger actuator 132 may be independently manipulated by various trigger controls, plunger controls, slider controls or other control means attached to proximal end 104 of flexible shaft 100.
With reference to FIGS. 2(a), 2(b) and 2(c), each arm 110 may include a finger actuator channel 118 and a distal fork 112, which may further include a pivot pin 114 and a pair of pivot pin receivers 116. Finger actuator channel 118 may house a portion of finger actuator 132 extending distally from arm actuator 130. Finger actuator 132 may terminate in a Y-shaped head 134 providing offset and diverging actuator pins 136. When finger actuator 132 is fully extended distally from finger actuator channel 118, head 134 may abut pivot pin 114, and when finger actuator 132 is fully retracted proximally into finger actuator channel 118, head 134 may abut arm 110. A pivoting finger 120 may be provided which may include a hub 122 that encircles pivot pin 114 and an offset actuator pin receiver 124 that receives and interlocks with an actuator pin 136 on head 134. A pair of fingers 120 may be anchored within distal fork 112 on either side of head 134 by inserting pivot pin 114 between pivot pin receivers 116 and through hub 122. The actuator pin receivers 124 and actuator pins 136 may drive fingers 120 to rotate around pivot pin 114, such that when finger actuator 132 is extended distally, fingers 120 may close together and become aligned with arm 110 (FIG. 2(a)), and when finger actuator 132 is retracted proximally, fingers 120 may spread apart with respect to the arm 110 (FIG. 2(B)).
Accordingly, arms 110 and fingers 120 may be operated to apply localized tension to the tissues of a tubular structure such as the esophagus or colon. Arm actuators 130 may be extended distally to deploy arms 110 from arm housings 128 arrayed around distal end 102 of a flexible endoscope, which may part some of the tissue adjacent to distal end 102 of the instrument, and finger actuators 132 may be retracted proximally to spread apart fingers 120 to the deployed configuration, creating a perimeter that may approximate the distended perimeter of a tubular tissue such as an esophagus or colon. Such distension may place the tissues under a moderate degree of tension, such that the mucosa, submucosa and muscularis adjacent to arms 110 and distal end 102 are presented as a set of substantially smooth and non-convoluted layers. When a surgeon desires to reposition or remove the flexible endoscope, finger actuators 132 may be extended distally to close fingers 120, and arm actuators 130 may be retracted proximally to withdraw arms 110 within arm housings 128, releasing the tissues and readying the instrument for movement within the patient.
Referring to FIG. 3, a first aspect of an endoscopic accessory is shown for use with a flexible endoscopic instrument having a plurality of peripheral auxiliary channels (not shown), such as a flexible endoscope. Such endoscopic devices may include conventional flexible endoscopes combined with “overtubes” that add peripheral auxiliary channels to instruments that otherwise lack them. The accessory 200 may include a plurality of arms 210 that may be extended from and retracted into the distal openings of the auxiliary channels of the instrument. Each arm 210 may be connected to a control handle 202 by way of an arm actuator 230 that provides a means for extending and retracting arms 210 in relation to the auxiliary channels of the endoscope. Arm actuator 230 may be connected to arm 210 by gluing, welding, or other methods known in the art. Arm actuator 230 may also coaxially house a finger actuator 232. In such case, arm actuator 230 may be provided as a helically wound stainless steel wire sheath, and finger actuator 232 may be provided as a stainless steel wire slidingly movable within that sheath. The actuators 230 and 232 may be routed through the aforementioned auxiliary channels and connected to a control handle 202 disposed outside the proximal auxiliary channel openings in the instrument. A surgeon or surgical assistant may move control handle 202 towards the proximal auxiliary channel openings to extend arm actuators 230 from the distal auxiliary channel openings of the instrument, and away from the proximal auxiliary channel openings to retract arm actuators 230 into the distal auxiliary channel openings of the instrument.
With reference to FIGS. 4(a), 4(b) and 4(c), each arm 210 may include a finger actuator channel 218 extending therethrough and a distal fork 212. The distal fork 212 may include a pivot pin 214 and a pair of pivot pin receivers 216. Finger actuator channel 218 may house a portion of finger actuator 232 extending distally from arm actuator 230. Finger actuator 232 may terminate in a Y-shaped head 234 providing offset and diverging actuator pins 236. When finger actuator 232 is fully extended distally from finger actuator channel 218, head 234 may abut pivot pin 214, and when finger actuator 232 is fully retracted proximally into finger actuator channel 218, head 234 may abut arm 210. A pivoting finger 220 may be provided which may include a hub 222 that encircles pivot pin 214 and an offset actuator pin receiver 224 that receives and substantially encloses an actuator pin 236 on head 234. A pair of fingers 220 may be anchored within distal fork 212 on either side of head 234 by inserting pivot pin 214 between pivot pin receivers 216 and through hub 222. The actuator pin receivers 224 and actuator pins 236 drive fingers 220 to rotate around pivot pin 214, such that when finger actuator 232 is extended distally, fingers 220 may close together and become aligned with arm 210, and when finger actuator 232 is retracted proximally, fingers 120 may spread apart with respect to arm 210. The surgeon or surgical assistant may manipulate a slider control 204 in control handle 202 (FIG. 3) to operate fingers 220, sliding the control 204 towards the distal end of the control handle 202 to distally extend finger actuators 232 and close fingers 220, aligning fingers 220 with arms 210, and sliding control 204 towards the proximal end of the control handle 202 to proximally retract finger actuators 232, spreading fingers 220 with respect to arms 110.
Accordingly, arms 210 and fingers 220 may be operated to apply localized tension to the tissues of a tubular structure such as the esophagus or colon. Control handle 202 may be manipulated to distally extend arms 210 from the distal auxiliary channel openings in a flexible endoscopic instrument, which may part some of the tissue adjacent to the distal end of the instrument, and sliding control 204 may be manipulated to spread fingers 120. The extension of arms 210 and spreading of fingers 220 may create a perimeter that may approximate the distended perimeter of a tubular tissue such as an esophagus or colon. Such distension may place the tissues under a moderate degree of tension, such that the mucosa, submucosa and muscularis adjacent to arms the distal end of the flexible endoscopic instrument are presented as a set of substantially smooth and non-convoluted layers. When a surgeon desires to reposition or remove the flexible endoscope, sliding control 204 may be manipulated to close fingers 220, aligning fingers 220 with arms 210, and control handle 202 may be manipulated to retract arms 210 within the distal auxiliary channel openings of the flexible endoscopic instrument.
With reference to FIG. 5, another aspect of a lumen stabilizer adapted for use with a flexible endoscopic instrument, such as a gastroscope or a colonoscope, is shown. The device 300 may include a mounting sheath 310, a stent stabilizer 320 and constraining sheath 330. Mounting sheath 310 may be configured as a hollow tube having a generally annular cross section adapted to interlock with the distal end of a flexible endoscopic instrument. Such an interlocking relationship may be established by configuring the inner surface of mounting sheath 310 to conform to the ridged outer surface of a flexible endoscope, by affixing a portion of mounting sheath 310 to the outer surface of a flexible endoscope using a clamp, or by other means that will be apparent to those having skill in the art. A proximal end of stent stabilizer 320 may be affixed to the distal end of mounting sheath 310, such that a substantial portion of stent stabilizer 320 extends beyond the distal end of mounting sheath 310. Stent stabilizer may be affixed to mounting sheath 310 by welding, gluing, clamping or other means known in the art. Constraining sheath 330 may be configured as a hollow tube adapted to conform to the shape of mounting sheath 310 and to be slidably operable with respect to mounting sheath 310. The distal end of constraining sheath 330 may be further adapted to define a gap between the inner wall of constraining sheath 330 and the outer wall of mounting sheath 310, the gap providing an annular volume that may receive the proximal end of stent stabilizer 320.
Stent stabilizer 320 may be both expandable and collapsible and may be adapted or otherwise pre-stressed such that the stent may assume an expanded configuration when it is neither compressed nor constrained by adjacent structures. Stent stabilizer may be designed to have an expanded diameter that is greater than the diameter of the distal end of the flexible endoscopic instrument, and to have an collapsed diameter that is approximately equal to the diameter of the mounting sheath 310. The stent stabilizer 320 may be manufactured from a cylindrical mesh of resilient material such as nylon or, optionally, from a highly resilient material exhibiting a shape-memory effect, such as nickel-titanium alloy (nitinol). The mesh of stent stabilizer 320 may optionally be modified to provide an operative window 322 within the weave of the mesh, which may provide devices operated from the distal end of an endoscopic instrument with access to tissues abutting the outer surface of the stent.
Constraining tube 330 may be slidably operated with respect to the mounting sheath 310 to collapse or release stent stabilizer 320. If constraining tube 330 is configured as an overtube extending proximally along the shaft of a flexible endoscopic instrument, constraining tube 330 may be manipulated by a control mounted at the proximal end of the instrument. Alternately, if constraining tube 330 is configured as a comparatively short sheath, constraining tube 330 may be connected to an actuator cable extending alongside the shaft of the flexible endoscopic instrument. Constraining tube 330 may be advanced distally past the distal end of mounting sheath 310, whereby interference between constraining tube 330 and stent stabilizer 320 will tend to cause stent stabilizer 320 to collapse to a diameter that is approximately equal to the diameter of mounting sheath 310. Constraining tube 330 may also be retracted proximally along mounting sheath 310 and the distal end of the flexible endoscopic instrument, whereby the distal end of stabilizing stent 320 may be released and may expand to a diameter that is substantially greater than the diameter of the distal end of the flexible endoscopic instrument. The expansion of a distal portion of stabilizing stent 320 may create a perimeter barrier that may approximate the distended perimeter of a tubular tissue such as an esophagus or colon. Such distension may place the tissues under a moderate degree of tension, such that the mucosa, submucosa and muscularis adjacent to the distal end of the stabilizing stent 320 and, optionally, within operative window 322, are presented as a set of substantially smooth and non-convoluted layers.
Although various aspects of the disclosed device have been shown and described herein, modifications may occur to those skilled in the art upon reading this specification. The present application includes such modifications as are within the spirit of the invention, and is to be limited only by the scope of the appended claims.
Patent Application
20070270643
