1. Technical Field
The present disclosure generally relates to an endoscopic-type instrument having disposable components and reusable components and methods to use the instrument. More particularly, but not exclusively, the present disclosure relates to a symmetric endoscopic-type instrument wherein the disposable components can be controlled with either a right hand or a left hand.
2. Description of the Related Art
In many medical procedures, a medical practitioner accesses an internal cavity of a patient. In some cases, the medical practitioner accesses the internal cavity for diagnostic purposes. In other cases, the practitioner accesses the cavity to provide treatment. In still other cases, different therapy is provided.
In one common procedure, a medical practitioner places a medical device (e.g., a medical tube) into the body of a patient. The medical device is conventionally passed into the body through the patient's mouth or nasal cavity, but the device can also be passed through a different orifice or another surgically made entry point (e.g., by incision or puncture).
The success of the medical procedure often depends on the proper placement of the medical device. In many cases, an endoscope can help to improve the chance for successful placement of the medical device. For example, in a percutaneous endoscopic gastrostomy (PEG) medical procedure, an endoscope is used to assist in the placement of the medical device (i.e., a medical tube) through the abdominal wall of the patient. When the medical device is a medical tube placed with a PEG procedure, the medical device may be broadly described as a “PEG tube.” One such PEG tube is a feeding tube, and the medical practitioner uses a PEG procedure to place the feeding tube (i.e., the PEG tube) into the stomach of a patient who cannot swallow liquids or solids. In some instances, a PEG tube is used to facilitate the placement of a feeding tube into the small bowel.
The endoscope 42 includes a flexible tube 44 having one or more pathways axially formed within the flexible tube 44. The pathways include one endpoint on the proximal end 46 of the flexible tube 42 and a second endpoint formed on the distal end 48 of the flexible tube 42. One of the pathways includes a fiber-optic or other image passing cable with a lens or lens system placed at the distal end 48 of the flexible tube 44. In the base of the endoscope 42 or coupled thereto, a camera captures still pictures or moving video of that which is in front of the lens at the distal end 48 of the flexible tube 44. Other pathways in the endoscope 42 may be used to pass water, air, suction, or certain medical tools. The base of the endoscope 42 conventionally includes controls to steer the distal end 48 of the endoscope 42 orto control the other functions of the endoscope 42.
When the PEG procedure to place a PEG tube 24 begins, the distal end 48 of the endoscope's flexible tube 44 is passed through the patient's mouth and throat and into the esophagus 16. Using the camera tools, the medical practitioner is able to observe that the patient's esophagus 16 is without obstruction, diverticula, or other medical concerns. The medical practitioner advances the distal end 48 into the patient's stomach 18. The medical practitioner can use the tools of the endoscope 42 to inspect the stomach 18 and locate a suitable area 50 for the gastrostomy. During the inspection, the stomach 18 may be inflated by passing air through a lumen in the flexible tube 44, which allows the medical practitioner to see that the selected area 50 can be distended and that a PEG tube 24 placed in the selected area 50 will avoid interference with the pylorus 20. In this manner, a medical practitioner uses an endoscope 42 to select an area 50 of the lower body of the stomach or antrum (the gastric wall) that is particularly suitable for the PEG tube 24 placement.
In another step of the traditional PEG tube 24 placement procedure, the medical practitioner shines light 52 out from endoscope 42. In a darkened room, the light 52 can be seen through the patient's skin by a second medical practitioner (who may be any person trained in such medical procedures). Based on where the light is seen, the second medical practitioner can determine that the selected area 50 is in a reasonable location of the patient's body, e.g., not above the ribs. If the second medical practitioner is unable to see the light 50, the first medical practitioner can move the distal end 48 of the endoscope 42. By advancing or withdrawing the flexible tube 44 while also manipulating the steering controls, the medical practitioner can orient the distal end 48 of the flexible tube 44 of the endoscope 42 in three dimensions. If necessary, the medical practitioner can use the endoscope's tools to direct a stream of water over the lens and a lighting element in the distal end 48. Having thereby “cleaned” the lens and light source, the medical practitioner can use the tools to select a more preferable area 50 for the gastrostomy.
In addition or alternatively, the second medical practitioner may push a finger or another object into the skin of the patient 10 in the area of the stomach 18. The first medical practitioner can watch the images produced by the endoscope's camera to see an indentation in the stomach wall where the second medical practitioner is pressing. In this way, the medical practitioners can also select an area 50 for the gastrostomy.
Upon selection of a preferable area 50, and confirmation from inside the stomach 18 and outside the patient 10 that the preferred area 50 is suitable, the second medical practitioner will then make a small incision in the skin of the patient 10. A needle is inserted into the patient 10 at the site of the incision, and the needle is advanced through the fat layer 28, muscle 30, and stomach wall 32 to penetrate the area 50 selected by the practitioners. Using the camera tools of the endoscope 42, the medical practitioner expects to see the needle enter the stomach 18 in the selected area 50.
In a subsequent step in the traditional placement of a PEG tube 24, a medical wire can be passed through a lumen in the needle. The medical practitioner will use a snare tool in the endoscope to grasp the wire firmly. The endoscope and snare are then withdrawn from the patient's mouth, thereby pulling the wire from the outside of the patient's abdomen, through the needle into the stomach 18, up through the esophagus 16, and out of the patient's mouth. The part of the wire that extends out from the patient's mouth is subsequently attached to the PEG tube 24.
In yet another step in the traditional placement of a PEG tube 24, once the wire is successfully passed through the patient 10, a PEG tube 24 is secured to the end of the wire extending from the patient's mouth. The PEG tube 24 is guided into the patient's mouth and pulled into the patient's stomach 18 as the wire is pulled from the end that passed through the needle. Once the PEG tube 24 is in the stomach 18, the tube is pulled partially through the gastric and abdominal walls until the internal bumper 36 of the PEG tube 24 is snug against the gastric mucosa of the stomach 18. The external bumper 38 is similarly pressed snug against the patient's skin and secured in place for example with a stitch.
Upon placement of the PEG tube 24, the flexible tube 44 of the endoscope 42 can be re-advanced into the stomach 18 of the patient 10 and used to verify effective placement of the PEG tube 24. In other traditional PEG tube placement procedures, endoscopy is not in the final step, or endoscopy may not be used at all. Instead, x-ray may be used to verify a proper placement of the PEG tube 24 or to select a particularly suitable location 50 in the patient's body (e.g., the stomach) for the introduction of the PEG tube 24.
The endoscope 42 includes a handle portion 56 coupled to the flexible tube 44. The handle 46 of endoscope 42 illustrated in
In the endoscope 42 of
The distal end 48 of the flexible tube 44 includes a flexible tip 54. The flexible tip 54 may be controlled in three dimensions using the first steering control wheel 68 and the second steering control wheel 70. Extending from inside the handle 56 of the endoscope 42, steering cables are coupled to the first and second control wheels 68, 70. The steering cables extend into the proximal end 46 of the flexible tube 44. The steering cables pass under a jacket in the flexible tube 44 to the distal end 48 of the flexible tube 44 where they are fastened to the flexible tip 54. One of the two steering wheels, when rotated, is arranged to move the flexible tip 54 in a left and right direction. The other of the two steering wheels, when rotated, is arranged to move the flexible tip 54 in an up and down direction. Accordingly, when the medical practitioner uses his left thumb to rotate the first and second steering wheels 68, 70, the flexible tip 54 of the endoscope 42 can be controlled in three dimensions. Furthermore, as the medical practitioner advances and withdraws the flexible tube 44 within a patient's body, the flexible tip 54 of the endoscope 42 can be “aimed” in any direction along the flexible tube's path of travel. A tension control knob 78 can provide further control for the medical practitioner to lock, unlock, or change the amount of force necessary to rotate the steering wheels 68, 70.
The flexible tip of the endoscope 42 includes a distal end assembly 80. The distal end assembly 80 is illustrated in detail A. The distal end assembly 80 includes a tool port orifice 82. The tool port orifice 82 is a termination point of a lumen that passes through the flexible tube 44 to an entry point of a tool port 74 in the handle portion 56 of the endoscope 42. A medical tool, for example a biopsy collection device, can be passed by the medical practitioner through the tool port 74. From outside of the patient, the medical practitioner cannot advance the medical tool into the body of the patient. The medical tool advances out of the tool port orifice 82 where it can be used in a medical procedure. In another example, the medical practitioner can pass a medical tool snare device through the tool port 74 to grab a guide wire used in a PEG tube placement procedure.
The distal end assembly 80 also illustrates the termination points of several other lumens that passed through the flexible tube 44. With his left hand, the medical practitioner can control the operational features of the end assembly 80. For example, in some cases, a water source, an air source, and a suction source are coupled to the second material port 72. A light source is coupled to the first material port 62. Using the trumpet controls 62, 64, 66, the medical practitioner can pass water or air out of the water and air nozzle, and the medical practitioner can engage or disengage a suction source to collect material through the suction inlet 90. Using the visualization control 60, the medical practitioner can enable a light source that supplies light passed from the light source aperture 86. Also using the visualization control 60, the medical practitioner can focus, collect, or pass still or moving images via the visualization port 76. In some cases, the endoscope 42 includes optical visualization components. In such cases, the visualization port 76 is generally an eyepiece that the medical practitioner can look through, and the visualization control 60 performs mechanical focusing control. In other cases, the endoscope 42 includes electronic visualization components, and in these cases, the visualization control 60 directs an electronic camera system.
The endoscope 42 of
In accordance with some embodiments described herein, an endoscopic device has an image sensor arranged in a functional module at the steerable tip portion of a flexible tube attached to the endoscopic device. The tip can be steered in a back and forth direction of a common plane. The steering mechanism is configured for one-handed, either-handed use. The flexible tube is torque stable. As the flexible tube is rotated and the tip portion is steered, the functional module can be aimed in any direction in three dimensions. The functional module may include various controllable nozzles, ports, and electronic features such as an image sensor and lights. The features of the functional module are directed by a control module located in the handle of the endoscopic device. The handle of the endoscopic device and the flexible tube are sterile and configured for use on a single patient. The handle of the endoscopic device and the flexible tube are disposed of after they are used in a single medical procedure. The control module that directs the operations of the functional module is reusable.
In a first embodiment, an endoscopic device includes a disposable control handle having a sealable recess therein, a disposable flexible tubular member coupled to the control handle, and a non-disposable electronics control module configured for removable placement within the sealable recess.
In a second embodiment, a method to use a partially disposable endoscopic device is disclosed. The method includes the act of arranging a sterile disposable control handle having a sealable recess therein in the vicinity of a patient's body, the sterile disposable control handle having a sterile disposable flexible tubular member coupled thereto. The method also includes the acts of opening the sealable recess in the disposable control handle and introducing a non-disposable electronics control module into the sealable recess. An act of performing a medical procedure that includes passing the sterile disposable flexible tubular member into the patient's body and controlling at least one feature of the disposable flexible tubular member with the disposable control handle is also included in the method. Acts of re-opening the sealable recess in the disposable control handle, removing the non-disposable electronics control module from sealable recess, and disposing of the sterile disposable control handle and the sterile disposable flexible tubular member are also included in the method.
In another embodiment, an endoscopic device includes a control handle configured for single-handed, either-handed operation, and a steering mechanism cooperatively assembled with the control handle, the steering mechanism arranged to steer at least one portion of a flexible tubular member attachable to the steering mechanism.
These features with other objects and advantages which will become subsequently apparent reside in the details of construction and operation as more fully described hereafter and claimed, reference being had to the accompanying drawings forming a part hereof.
Non-limiting and non-exhaustive embodiments are described with reference to the following drawings, wherein like labels refer to like parts throughout the various views unless otherwise specified. One or more embodiments are described hereinafter with reference to the accompanying drawings in which:
Broadly speaking, an endoscope is an instrument used to see inside the body of a patient. A conventional medical endoscope includes a flexible tube, a functional control mechanism to direct the position of a distal end of the flexible tube, and a camera. The camera provides images of the internal body cavity to help the medical practitioner position the distal end of the flexible tube and confirm that the end is positioned at an acceptable location. The endoscope may also include other features as heretofore described.
Endoscopes are useful in the diagnosis and treatment of many medical conditions. Some medical procedures and therapies can only be performed with an endoscope or endoscopic type tool. As it turns out, however, endoscopes can be traced as one cause of a high number of healthcare provider associated diseases.
When the endoscope is used in a medical procedure, the flexible tube of an endoscope is generally directed into an internal body cavity of a patient. During its use in the procedure by a medical practitioner, the endoscope may acquire high levels of microbial contamination. The microbial contamination may include infectious agents or any number of harmful bacterial and viral microorganisms. In some cases, an endoscope used in a medical procedure on one patient is contaminated, improperly or insufficiently disinfected, and used in a medical procedure on another patient. In such cases, the health of the second patient is put at risk of microbial transmission or disease.
Medical practitioners work to prevent the spread of nosocomial infection and disease by following strict procedures to clean and disinfect an endoscope. Unfortunately, most conventional endoscopes (e.g., bronchoscopes, colonoscopes, gastrointestinal endoscopes, nasopharyngoscopes, sigmoidoscopes, and the like) are heat sensitive and cannot be sterilized. Instead, the endoscopes are cleaned with other procedures and wiped or even bathed in high-level disinfectants.
In spite of rigid attempts to effectively clean endoscopes, some patients suffer injury, illness, and even death as a result of an endoscope that carries pathogens from one patient to another. In 2010, the ECRI Institute cited endoscopic contamination as one of the top 10 health risks in a document entitled “Top 10 Health Technology Hazards for 2011,” Reprinted from Volume 39, Issue 11, November 2012 by the ECRI Institute (www.ecri.org). A seminal work that studied and described the problem of improperly cleaned endoscopes is “Transmission of Infection by Gastrointestinal Endoscopy and Bronchoscopy,” from the Annals of Internal Medicine, 1993; 118:117-128 by the American College of Physicians, authored in part by one of the present inventors.
The symmetrical steering mechanism 108 is illustrated in
With respect to the embodiment of
The flexible tube 104 may be configured in many different ways. Flexible tubes 104 that are compatible with the handle body 102 may be formed having many different lengths and many different degrees of flexibility. In some cases, color coding or numerical marking is provided to help medical practitioners distinguish flexible tubes 104 of different lengths and flexibilities.
A flexible tube 104 generally exhibits properties of torque stability. The properties may be a function of the materials used to form the flexible tube 104. The properties may also be a function of structures embedded in the walls of the flexible tube 104. The torque stable nature of a flexible tube 104 permits a medical practitioner to rotate a proximal end of the flexible tube 104 with confidence that the distal end of the flexible tube 104 will rotate in a corresponding direction and to a corresponding degree. By way of example, a 24″ section of common copper plumbing pipe (standard K, nominal ½″ diameter, 0.625″ O.D., 0.049″ wall thickness) is considered torque stable, and a 24″ section of common rubber hose having the same dimensions is considered not torque stable.
Flexible tubes 104 may be formed of many different widths. In some cases, a control handle 102 will be arranged to receive a flexible tube having a single width throughout its length. Accordingly, as the width of a flexible tube increases, the entrance hole in the control handle 102 will also increase. In other embodiments, a flexible tube 104 may be formed with multiple widths. A first width at the proximal end of the flexible tube 104 will be formed to a standard size for compatibility with control handles 102 having an entrance hole of the standard size. At some point along the length of the tubular body 104, the width of the flexible tube 104 will change. The width may increase in some cases. The width may decrease in other cases. A small diameter flexible tube 104 may be suitable for a smaller patient and for passage in a smaller space, for example, an artery or a vein. A large diameter flexible tube 104 may be suitable for a larger patient and for passage in a larger space. Additionally, a larger diameter flexible tube 104 may accommodate more lumens and thereby more tools or lumens of a larger size and thereby larger tools.
In some cases, the steerable tip portion 106 of a flexible tube 104 may have a functional module 110 at the distal tip of the steerable tip portion 106. One non-limiting embodiment of a functional module 110 is illustrated in
The functional module 110 may be integrated in the steerable tip portion 106 of the flexible tube 104 of the endoscopic device 100. The functional module 110 itself may be flexible or rigid. In some embodiments, the steerable tip portion has flexible baffles to define a bending profile for the tip. In other embodiments, the flexible baffles are a sheath covering a bending mechanism (e.g., a spring).
The functional module 110 may include an imaging module 198 and a light source 202. The imaging module 198 can be a charge couple device (CCD) video camera integrated circuit (IC) or some other type of image sensor. The light source 202 may include one or more light emitting diodes (LEDs), which can shine light through an optional window. The imaging/illumination modules 198, 202 respectively will also include an electrical interface assembly to provide power and control signals to the light source 202 and image sensor 198. A control module 112 may include optional electronic camera features. The light source 202 in the endoscopic device 100 permits the medical practitioner to see inside the cavity where the endoscopic device 100 has been placed, and the image sensor 198, if included, can capture and pass individual picture images or a video stream of the area in front of the flexible tip assembly 106.
The steerable tip portion 106 and thereby the functional module 110 can be moved in a plurality of directions when the steering mechanism 108 is manipulated and the control handle 102 is rotated, advanced, or withdrawn.
As illustrated in
The handle body 102 of the endoscopic device 100 is arranged to receive the non-disposable control module 112 through an opening in the handle body 102. The opening in the handle body 102 is illustrated as being opposite the tube body 104 in
The endoscopic device 100 illustrated in
In some embodiments, a scale (e.g., a graduated scale) provides an indication of rotation of the steering mechanism 108. The graduated scale may have linear marks that provide a relative indication of motion. Alternatively, the scale may have actual measurement information that indicates how far the steerable tip portion 106 has moved. The scale may reflect millimeters, inches, fractions of inches, or some other unit of measure. In some cases, a vernier scale is also provided to more accurately indicate deflection. In yet other embodiments, no scales, arrows, needles, or reference marks of any kind are provided.
As illustrated in
In operation, the steering mechanism 108 is configured for one-handed, either-handed operation. That is, the steering mechanism 108 is symmetrically arranged in the endoscopic device 100 for use by either a right hand or a left hand. For example, when a medical practitioner grasps the handle body 102 of the endoscopic device 100 in his left hand, the medical practitioner can use his left thumb or left thumb and left index finger to rotate the steering mechanism 108. Alternatively, if the medical practitioner grasps the endoscopic device 100 in his right hand, he can use his right thumb or right thumb and right index finger to rotate the steering mechanism 108.
The steering mechanism 108 is not limited to one-handed operation. In still another alternative, the medical practitioner can grasp the handle body 102 of the endoscopic device 100 with one hand and operate the steering mechanism 108 with his other hand. Other orientations can also be used by the medical practitioner to manipulate the steering mechanism 108.
In
In
As illustrated in
In other cases, the rotation of steering mechanism 108 has a different relationship with the deflection of the steerable tip portion 106. In endoscopic devices where substantial accuracy in the deflection of the steerable tip portion 106 is desired, a greater rotation of the steering mechanism 108 will be necessary to deflect the steerable tip 106. In endoscopic devices where easy, one-handed operation may be desired, a smaller rotation of the steering mechanism 108 will cause a greater deflection of the steerable tip 106. In one embodiment, a one-to-one-point-five (1:1.5) relationship exists such that a 30 degree rotation of steering mechanism 108 causes a corresponding, proportional 45 degree deflection of the steerable tip 106. Other linear and even non-linear relationships between the steering mechanism 104 and the steerable tip 106 can also be provided.
The outer shell of the disposable handle body 102 includes a handle body upper housing 120 and handle body lower housing 122. In
The symmetrical steering mechanism 108 is distinguishable from and integrated with the handle body 102 structures and tube body 104 structures in the embodiment shown in
The symmetrical steering mechanism 108 is shown having a textured end cap (or cover) 124. The steering mechanism cover 124 is configured with a circular aperture (i.e., a hole) formed around a central axis of the frustum. The aperture may be circular, notched, toothed, hexagonal, or of some other shape. The aperture in the steering mechanism cover is arranged to receive a tube body outer guide flange 126, which cooperatively couples with a tube body inner guide flange 128.
In the endoscopic device 100 embodiment of
Along the same lines, in some cases, a tube body 104 and steering mechanism 108 are manufactured and distributed separately from another structure that includes the upper and lower handle body housings 120, 122 and internal structures such as the non-disposable control module 112. In these types of embodiments, a medical practitioner or other person can combine a preassembled tube body 104 and steering mechanism 108 having certain desirable properties with a handle shell 120, 122 and non-disposable control module 112 having standardized properties.
The tube body inner guide flange 128 also includes an integrated steering cable guide to direct a desirable coupling of first and second steering cables 116a, 116b into a steering cable drive pulley mounting chassis 130, which is configured to receive a pinion shaft/pinion gear structure 132.
The pinion gear and shaft 132 structure is arranged with an optional encoder 152 (e.g., a rotary encoder). When the encoder 152 is included, a position of the pinion gear shaft can be tracked to a known degree of precision. The tracking information may be electronically supplied to a control module for visual presentation to a medical practitioner, for electronic storage such that specific details of a medical procedure can be studied after the procedure is complete, or for other purposes.
When the partially disposable endoscopic device 100 is assembled, a ring gear 138 (
In the embodiment of
In some embodiments, the handle body housings 120, 122 and other structures of the partially disposable endoscopic device 100 are formed from a plastic material. In other embodiments, the structures are not formed of plastic. Generally speaking, the structures can be made from any of a wide variety of materials including moldable organic and inorganic materials that are pure or formed as a compound.
When the endoscopic device 100 is assembled, the internal components are hermetically sealed. The external housing features (e.g., upper housing 120, lower housing 122, front cover 124, hinged end cap 114) may optionally include rubber, silicon, or other sealing materials on their mating surfaces. Alternatively, the individual structures may have sufficiently acceptable tolerances such that a hermetic seal may be formed when the structures are assembled. In some cases, the assembled structures may be snap-fit with cooperative features on adjacent housings. In some cases, the structures are welded, glued, or otherwise permanently assembled. In still other cases, the housings may be screwed together or joined with some other distinct fastening mechanism.
The external housing features of the disposable control handle 102 (e.g., upper housing 120, lower housing 122, front cover 124, hinged end cap 114) are sterile before being used in a medical procedure. The disposable control handle 102 may be used only on a single patient. Accordingly, each patient that is exposed to a partially disposable endoscopic device 100 is assured that no contaminants from other patients are transferred.
The control handle features are typically sterilized at the time of manufacture. The sterilization procedure can be by heat, chemical, irradiation, or by some other means. In one embodiment, the sterilization procedure kills or otherwise eliminates all microbial matter present on the surface of the control handle features to a high sterility assurance level.
After sterilization, the sterile disposable control handle 102 can then be packaged in a manner that keeps the control handle free of pathogenic organisms until the control handle is to be used in a medical procedure.
In one method, a medical practitioner or other party prepares a partially disposable endoscopic device 100 for use in a medical procedure. Typically, the handler of sterile disposable control handle 102 has antiseptically washed and donned medically clean attire and sterile gloves. In an environment where the medical procedure is to take place, or optionally in a nearby antiseptic environment, the sterile disposable control handle 102 is removed from its packaging. Additionally, the non-disposable control module 112 is removed from its packaging. The control module 112 may be sterilized, disinfected, or sanitized. Subsequently, the access port of disposable control handle 102 (e.g., the hinged end cap 114) is opened to reveal a recess in the disposable control handle 102. As the control module 112 is inserted into the control handle 102, certain structural features of the control module 112 register with corresponding structural features in the recess of the control handle 102. In one embodiment, a set of spring-enabled electrical contacts (e.g., pogo pins) of one structure (e.g., the control module 112) engage into electro-mechanical contact with the other structure (e.g., the control handle 102). The handler of the endoscopic device 100 may then remove the present sterile gloves and replace them with new sterile gloves. The medical practitioner then performs the medical procedure.
Upon completion of the medical procedure, a handler of the partially disposable endoscopic device 100 may then prepare a sterile or other container to receive the control module 112. For example, the handler or some other person may open a plastic bag. Subsequently, the handler of the partially disposable endoscopic device 100 will access the recess in the control handle 102. For example, the handler depresses a locking tab of the control handle 102 or hinged end cap 114. The control module 112, via gravity, springed features, or other means, can be removed from the control handle 102 recess and deposited in the container arranged to receive it. In one example, the control module 112 is partially ejected via a spring-type mechanism when the hinged end cap 114 is open. In the example, the handler then “dumps” the control module 112 into a medically clean bag or other container, and the handler medically disposes of the control handle 102. The control module 112 is then sterilized, disinfected, or otherwise sanitized, upon which the control module can be used in another new, sterile control handle 102 for another patient's medical procedure. According to such a method, the partially disposable endoscopic device 100 includes a disposable control handle portion 102 and a reusable, non-disposable control module 112.
In the section view of
In
As illustrated in
The embodiment illustrated in
When the cover 124 is rotated clockwise (from the perspective of a medical practitioner holding the handle body 102), the ring gear 138 will also rotate clockwise, and the pinion gear and shaft 132 will rotate (from a perspective above the gear) counterclockwise. The counterclockwise rotation of the pinion gear and shaft 132 will draw the “left-side” steering cable 116a inward, which will cause a deflection of the steerable tip portion 106 to the left. When the cover 124 is rotated counter-clockwise, the ring gear 138 rotates counterclockwise, and the pinion gear 132 rotates clockwise. The “right-side” steering cable 116b will be drawn inward thus causing a deflection of the steerable tip portion 106 to the right. In other configurations and gearing arrangement, a clockwise rotation of the cover 124 will cause a rightward deflection of the steerable tip 106, and a counter-clockwise rotation of the cover 124 will cause a leftward deflection of the steerable tip 106.
In
The shaft of the pinion gear 132 in
In the embodiment of
Due to the relative sizes of the ring gear in the steering mechanism housing 124 and the pinion gear 132, a known rotation of the housing 124 is sufficient to rotate the drive pulley 140 by about one quarter turn. In one embodiment, a 30 degree rotation of the steering mechanism housing 124 (
The embodiment of
Turning to
When the control module 112 is fully inserted into the recess in the control handle 102, the control module 112 will cooperatively mate with the steering cable drive pulley mounting chassis 130 enclosed and retained within the handle shell. Certain non-limiting structural features are shown on the steering cable drive pulley mounting chassis 130. Different structural features could also be used.
Formed in the surface of the control module 112 are two exemplary mechanical registration features 160. In
An input/output feature 162 is shown on the control module 112. In the exemplary embodiment of
The control module 112 of
A substrate 172 (e.g., a circuit board or an integrated circuit) includes operative electronic circuitry. Detail A in
The power supply/power regulator circuits may include charge and/or discharge circuitry for a battery 174, which is also assembled in the control module 112. The power supply/power regulator may also include other circuits to provide or distribute power to modules on the substrate or modules controlled by a microprocessor.
A microprocessor mounted or formed on the substrate 172 may include a single central processing unit (CPU) or a plurality of CPU's. Each CPU may have one or more cores that execute software instructions. Various clocking circuits and devices such as system clocks may be used to operate a CPU, memory, and other circuits. Real-time clock devices can be used, for example, to set alarms or trigger events, time stamp and date stamp certain data, control battery recharging circuits, and for other purposes.
The memory on the substrate 172 may include volatile memory (e.g., RAM) and nonvolatile memory (e.g., ROM). Within the memory, one or more software programs may reside including, for example, an operating system, a presentation program, a user interface program, and one or more communications programs.
The memory on the substrate 172 may store instructions and data retrieved and acted on by the microprocessor. An operating system or another type of control loop may include application and driver programs that permit additional software to control the operations of the partially disposable endoscopic device 100. For example, particular programs can be used to accept user input and to provide system output through a variety of input/output structures.
In such cases, the memory is a non-transitory computer readable medium (CRM). The CRM is configured to store computing instructions executable by a CPU. The computing instructions may be stored individually or as groups of instructions in files. The files may include functions, services, libraries, and the like. The files may include one or more computer programs or may be part of a larger computer program. Alternatively or in addition, each file may include data or other computational support material useful to carry out the computing functions of a partially disposable endoscopic device 100.
Buttons, keypads, computer mice, memory cards, serial ports, bio-sensor readers, touch screens, and the like may individually or in cooperation be useful to an operator of the endoscopic device 100. The devices may, for example, input control information into the device 100. Displays, printers, memory cards, LED indicators, audio devices (e.g., speakers, piezo device, etc.), vibrators, and the like are all useful to present output information to the operator of the endoscopic device 100. In some cases, the input and output devices are directly coupled to the substrate 172 and electronically coupled to the CPU or other operative circuitry. In other cases, the input and output devices pass information via one or more communication ports (e.g., RS-232, RS-485, infrared, USB, etc.)
One or more transceivers may be arranged on the substrate 172. The transceivers provide unidirectional or bidirectional communications with the electronic circuits of the partially disposable endoscopic device 100. The transceivers may be arranged to communicate over short distances (e.g., personal area networks, direct device-to-device communications) or long distances (commercial cellular services such as GSM, CDMA, etc.). In some cases, a Bluetooth transceiver is provided. In some cases, an IEEE 802.11 WiFi transceiver is provided. In some cases, a cellular transceiver chipset is provided. Other wireless and wired communication transceivers may also be provided. The control module 112 of
The one or more transceivers of the endoscopic device 100 can be configured to communicate control information, multimedia (i.e., audio/video) information, a patient's personal healthcare information, or other information. In cases where a patient's personal healthcare information is communicated, an encryption module may obfuscate the data prior to communication.
In the section view A-A, two contacts of the configuration of electric contacts 164 are shown. In
To help facilitate the electrical coupling, section view A-A illustrates a contact surface of the mechanical registration features 178. The registration features 178 are also shown as identified in Detail B. In the embodiment, the registration feature is arranged with angle 8. When the control module 112 is assembled in the recess of a control handle 102, the registration features 178 cooperate with corresponding features in the control handle 102 to align and properly seat the control module 112 for reliable electrical coupling.
The battery 174 and substrate 172 are illustrated in the Section A-A view of
In one embodiment, two pins of the array 164 are arranged for each of several features of the endoscopic device 100. For example, two pins may be configured to supply power signals to the endoscopic device 100. Power may be used within the control handle 102 and in the alternative or in addition, power may be distributed through the flexible tubular member 104 to the steerable tip portion 106.
Two pins of the array 164 may be used to provide electronic control of a liquid (e.g., water) source. The two pins may, for example, control a solenoid, an electronic valve, or some other mechanism that turns on and off a water source in which the water is passed through a lumen in the flexible tubular member 104 to the steerable tip portion 106. Two other pins may control a similar mechanism that turns on and off a gas (e.g., air) source that provides gas to the steerable tip portion 106. Yet two more pins may control a similar mechanism that turns on and off a source of suction. When the suction source is turned on, an aperture at the steerable tip portion 106 draws liquids, gases, and other material from the space around the steerable tip portion 106. Two additional pins of the array 164 may turn on and off a light source provided at the steerable tip portion 106. Two or more pins may control and pass the data to and from an imaging device at the steerable tip portion 106. For example, the steerable tip portion 106 may include an electronic image sensor configured to capture still or moving images. In such cases, individual images or full motion video signals can be captured at the steerable tip portion 106 of the partially disposable endoscopic device 100 and communicated to a presentation device. Additional pins of the array 106 may be spare pins or pins configured for some other purpose.
As illustrated in the back view of the control module 112 (
Prior to beginning the medical procedure, the medical practitioner properly attires himself and prepares clean hands for the procedure. The medical practitioner removes a disposable portion of the endoscopic device 100 from sterile packaging.
In some cases, the disposable portion of the endoscopic device 100 includes a preassembled a control handle 102 and tubular body member 104. In other cases, the control handle 102 is separately packaged. A medical practitioner may choose a tubular body member 104 or preassembled endoscopic device based on certain features arranged within the tubular body 104. Some features that the medical practitioner may consider are the length of the tubular member, the diameter of the tubular member, the type of imaging device arranged in the flexible tip portion 106, the number or size of lumens, the type of tools included in the flexible tip portion 106, and many other things.
After releasing the disposable portion from its sterile packaging, the medical practitioner may remove and dispose of his gloves and don a new pair of sterile gloves.
If the disposable control handle 102 and the tubular body 104 are not preassembled, the medical practitioner will assemble the two components together to form the disposable portion of the partially disposable endoscopic device 100. When the disposable portions are assembled, the medical practitioner will expose a recess in the disposable control handle 102. The recess may be exposed, for example, by releasing a catch or interlock mechanism on the upper or lower housing 120, 122 of the control handle 102. Releasing the catch may open an access panel (e.g., hinged end cap 114), thus exposing the recess. Subsequently, the medical practitioner or another person may advance a medically clean, reusable control module 112 into the recess. The amount of pressure necessary to advance the control module 112 into the recess may be a function of springs or particular registration features molded or otherwise formed in the structures of the control handle 102 and the control module 112.
Upon closing the access panel, operation of the endoscopic device 100 may be verified after pressing a user interface input/output 136 in the control handle. Applying pressure to one or more of the user interface I/O 136 features will engage a power button on the control module 112, thereby turning on the endoscopic device 100. In some cases, lights, sounds, vibrations, or some other feedback will inform the medical practitioner that the device is operating. The medical practitioner may also operate other user interface I/O 136 features to test the various functions of the endoscopic device 100.
In some embodiments, the endoscopic device 100 includes a wireless 802.11 WiFi transceiver. When the endoscopic device 100 is powered, the transceiver provides signaling data to external computing devices 188. An external computing device 188 in the endoscopic device 100 may form a communicative coupling as a matched pair of devices. Information may be passed between the computing device 188 and the endoscopic device 100. A presentation device 190 attached to the computing device 188 informs the medical practitioner that a communication link has been established. Subsequently, information associated with the endoscopic device 100 can quickly and efficiently be passed to the computing device 188. The computing device 188 may be a computer and video display mounted or placed in a surgery suite, a portable tablet computing device, a smart phone, a medical device such as a fluoroscope or ultrasound machine, or any other type of computing device configured to receive wireless communication.
Prior to use in the medical procedure, the medical practitioner may test other features. For example, if the endoscopic device 100 includes a light output, the practitioner may manipulate user interface I/O structures 136 on the control handle 102 to turn on and off the light. If the endoscopic device 100 includes an image sensor, the practitioner may manipulate user interface I/O structures 136 on the control handle 102 to adjust brightness, contrast, color, or other features.
If the endoscopic device 100 includes an image sensor device, the medical practitioner may test the image sensor by turning it on via the user interface I/O 136. The image sensor device may be configured for image capture or video acquisition. Accordingly, the medical practitioner may aim the image sensor embedded in the steerable tip portion 106 toward any recognizable object. The medical practitioner may expect to see a representation of the object on a presentation device 190 coupled to the computing device 188. Still images or full or partial motion video may be presented. Images or video may be recorded and played back. The computing device may include other features to direct or control the information captured by the image sensor.
The medical practitioner may further test the endoscopic device 100. Water or other liquid sources may be coupled to the endoscopic device 100 such that the liquid is passed through a lumen in the tubular body 104. The function may be controllable via the user interface I/O 136. Similarly, the medical practitioner may test an air source or other gas source and a suction source. If the endoscopic device 100 includes other tools that perform functions in the steerable tip portion 106, the medical practitioner may test them. Alternatively, or in addition, the medical practitioner may pass other tools through a lumen in the tubular body 104, thereby testing the integrity of the lumen and the ability to control the tools.
The medical practitioner may test the single-handed, either-handed operation of the symmetrical steering mechanism 108 by rotating the symmetrical steering mechanism cover 124. To perform this test, the medical practitioner may place the control handle 102 in the palm of either his left hand or his right hand. Using his thumb and/or index finger of the hand that is holding the control handle 102, the practitioner may rotate the steering mechanism cover 124. Upon rotating the steering mechanism cover 124, the medical practitioner will see the flexible tip portion 106 deflect one direction (e.g., to the right) or an opposite direction (e.g., left). The steerable tip portion 106 will move in one direction or the other direction in a common plane. In some embodiments, the steerable tip portion 106 is permitted to move 270° in the common plane. In other embodiments, the steerable tip portion 106 may only move 180° in common plane.
The proper operation of the steering mechanism 108 can be confirmed by the medical practitioner in many ways. For example, the medical practitioner can visually inspect the motion of the flexible tip 106 when the steering mechanism cover 124 is rotated. The medical practitioner can observe the presentation device 190 when the image sensor 198 is enabled. As the flexible tip moves, the image or images represented on the presentation device 190 will change accordingly. The medical practitioner can also observe the data passing from an encoder 152 if such a device is included. Data from a rotary encoder 152 may be processed and presented as a degree of rotation and direction on the presentation device 190.
The medical practitioner may perform further testing of the symmetrical steering mechanism 108. The practitioner may switch hands that are holding the control handle 102. The practitioner may use one hand to hold the control handle 102 while using his other hand to turn the steering mechanism cover 124. During the testing, the medical practitioner may also be using the image sensing features, lights, water nozzles, air nozzles, suction sources, and other features of the endoscopic device 100 to facilitate testing.
In some cases, a medical practitioner prefers to hold the control handle 102 in his dominant hand. In this arrangement, the medical practitioner can easily control the symmetrical steering function and other user I/O functions of the control handle 102. Concurrently, the medical practitioner will use his subordinate hand to control the flexible tubular member 104 as it is advanced into a patient's body. In such an arrangement, the medical practitioner can rotate the torque stable tubular body 104 using his subordinate hand as he passes the tube body 104 into the patient. At the same time, the medical practitioner can steer the flexible tip 106 in a common plane using his dominant hand. As the medical practitioner's two hands cooperate to steer and rotate the flexible tip 106, the flexible tip 106 can be pointed in any direction in three-dimensional space.
After adequately testing the functions of the endoscopic device 100 to his satisfaction, the medical practitioner can begin the medical procedure. The patient has been properly prepared for the procedure.
The medical practitioner begins the procedure by lubricating the flexible tubular member 104. In the procedure, the tubular member will be passed down the patient's throat. As the medical practitioner advances the flexible tip 106 into the patient's mouth, he can confirm the direction and location of the flexible tip by viewing the presentation device 190. The practitioner may turn on a light 202 in the functional module 110 of the flexible tip 106 to illuminate the path in front of the tip 106. The medical practitioner may also choose to record the streaming video that is being presented.
The medical practitioner can steer the flexible tip 106 by cooperatively rotating the symmetrical steering mechanism cover 124 and by rotating the entire control handle 102. In some cases, the medical practitioner will desirably change which hand is holding the control handle 102 as he rotates the device. The symmetrical nature of the endoscopic device 100 allows the practitioner to switch hands as seldom or frequently as he chooses.
The flexible tube 104 is further steered and advanced past the patient's throat, through the esophagus, and into the patient's stomach. The medical practitioner may enable an air nozzle 196 to inflate the stomach 18. He may also apply water from the water nozzle 194 to clean the light source 202 and a lens or other surface in front of the image sensor 198.
In the medical procedure illustrated in
In some cases, the medical practitioner may pass a tool through a tool lumen 192 in the endoscopic device 100. The tool may be, for example, a forceps tool to sample or excise the area of interest 184. Alternatively, or in addition, the practitioner may apply a different therapy to the area of interest.
After completion of the medical procedure, the medical practitioner will withdraw the flexible tube 104 from the patient.
When the flexible tube 104 has been withdrawn, the medical practitioner will power down the endoscopic device 100. The practitioner will then find a clean receptacle. Upon locating a clean receptacle, the practitioner will again open the access port (e.g., hinged end cap 114) of the endoscopic device 100. When the access port is opened, the control module 112 is permitted to drop into the receptacle. The control module, which had previously been enveloped in the hermetically sealed recess of the control handle 102, has not been contaminated with any biological agents of the patient, medical practitioner, or anyone else. Out of an abundance of caution, the control module 112 will nevertheless be sealed in the receptacle to later be medically cleaned. The control module 112 is reusable and is not disposed of.
After the control module 112 has been released from the control handle 102, the medical practitioner will properly dispose of the control handle 102 and flexible tube 104. The assembly formed by the control handle 102 and the flexible tube 104 was sterile when the medical procedure began, and the assembly is disposed of after the medical procedure. The assembly will not be used on another patient. Accordingly, a patient can be given assurance that no infectious agents or other contaminants between this patient and another patient as a result of the medical procedure.
As described herein, for simplicity, a medical practitioner is in some case described in the context of the male gender. For example, the terms “his hand,” “his left thumb,” and the like are used. It is understood that a medical practitioner can be of any gender, and the terms “he,” “his,” and the like as used herein are to be interpreted broadly inclusive of all known gender definitions.
As described herein, the terms “rigid” and “semi-rigid” may be interchanged. Accordingly, “rigid” device is not necessarily completely unbendable. Instead, a rigid device or a rigid portion of a device has a desired degree of stiffness. That is, a device that is “rigid” or “semi-rigid” is a device that resists deformation to a desired degree. The desired degree of rigidity may be measured, for example, in units such as foot pounds per inch or some other units. One device may be more rigid than another device. The increased (or decreased) rigidity may be caused by the devices being formed from different materials, from materials having different physical or chemical properties, or for some other reason. Correspondingly, the terms “flexible,” “flexibility,” and the like impart a desired degree of flexibility to the device which the term modifies.
Where a range of values is provided, it is understood that each intervening value, to the tenth of the unit of the lower limit unless the context clearly dictates otherwise, between the upper and lower limit of that range and any other stated or intervening value in that stated range is encompassed within the invention. The upper and lower limits of these smaller ranges may independently be included in the smaller ranges is also encompassed within the invention, 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 invention.
Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. Although any methods and materials similar or equivalent to those described herein can also be used in the practice or testing of the present invention, a limited number of the exemplary methods and materials are described herein.
As used herein and in the appended claims, the singular forms “a”, “an”, and “the” include plural referents unless the context clearly dictates otherwise. It should also be noted that the term “or” is generally employed in its sense including “and/or” unless the content clearly dictates otherwise.
The terms “comprises” and “comprising” should be interpreted as referring to elements, components, or steps in a non-exclusive manner, indicating that the referenced elements, components, or steps may be present, or utilized, or combined with other elements, components, or steps that are not expressly referenced.
The various embodiments described above can be combined to provide further embodiments. These and other changes can be made to the embodiments in light of the above-detailed description. In general, in the following claims, the terms used should not be construed to limit the claims to the specific embodiments disclosed in the specification and the claims, but should be construed to include all possible embodiments along with the full scope of equivalents to which such claims are entitled. Accordingly, the claims are not limited by the disclosure.
The headings and Abstract of the Disclosure provided herein are for convenience only and do not interpret the scope or meaning of the embodiments.
Reference throughout this specification to “one embodiment” or “an embodiment” and variations thereof means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment. Thus, the appearances of the phrases “in one embodiment” or “in an embodiment” in various places throughout this specification are not necessarily all referring to the same embodiment. Furthermore, the particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments.