CA2512905C - Endoscopic ligating instrument - Google Patents
Endoscopic ligating instrument Download PDFInfo
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- CA2512905C CA2512905C CA002512905A CA2512905A CA2512905C CA 2512905 C CA2512905 C CA 2512905C CA 002512905 A CA002512905 A CA 002512905A CA 2512905 A CA2512905 A CA 2512905A CA 2512905 C CA2512905 C CA 2512905C
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- distal end
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- endoscope
- ligating
- support member
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Abstract
An endoscopic instrument for ligating multiple lesions within a hollow body organ. A plurality of cords (103) are laid over the tube (101) to extend longitudinally thereon and be folded over the distal end of the tube. A plurality of elastic rings (50) are mounted on the tube (101) in stretched condition and overlaying the cords (103). The segment of each cord (103) between each pair of adjacent rings (50) is in slack condition and of a length which equals or exceeds the distance of the tube's distal end to the furthest ring of the pair. By a trip cord (105) threaded through a working channel (19) of the endoscope and connected to the cords (103), a pull can be exerted thereon to simultaneously retract the cords (103) and dislodge each of the rings in controlled stepped sequence in a procedure wherein only one elastic ring at a time moves over the tube in the process of its dislodgement to ligate a lesion which has been suctioned part way into the tube (101).
Description
ENDOSCOPIC LIGATING INS1'RUMENT
FIELD OF INVENTION
The invention relates to an instruinent for ligating lesions, and more particularly to an endoscopic instrumeiit for,ligating mucosal and subinucosal lesions within a hollow organ of the body, sucli as the alimentary tract.
BACKGROUND OF THE INVENTION
The endoscopic treatmeiit of lesions presently encompasses a variety of techniques such as electrocauterization, leser photocoagulation, heat therapy by the application of heat probes, aricl scierotherapy which involves the iiijection of iuedicine into a target varix by a needle passed i:lirough tlie working channel of the endoscope. A further, widely used and increasingly promising technique involves the ligation of lesions, wherein mucosal and submucosal tissue is strangulated by an elastic ligature.
A variety of instrtiments for effecting the ligation of body tissue by the application of an elastic.ring are well known in the prior art. Some of these instruments, because of their rigidity and size are suited only for treatment of lesioiis that are in the external regions of the body or in the shallow body cavities. Others are particularly suited for ttie ligation of tissue in the abclomitial cavity, such as for tubal ligation, when the abdominal cavity has been opened surgically.
U.S. Patent No. 3,760,810 to Van Hoorn discloses an endoscope-equipped iristrument comprising a device witli two tubes mounted one insid- the other, with the inner tube protruding at the front of the outer tube. Means are included to move the outer tube forwardly relative to the inrier tube and cause an elastic cord to be disloclged arid placed about the tissue to be ligated. In U.S. Patent No..
4,257,419, there is disclosed an instrument for ligating hemorrhoids wherein a suction tube fitted inside a proctoscope provides means for sucking the hemorrhoid into a suction cavity where a ligating ring is applied. Both of these instriiments are rigid devices suited for treating lesions close to the external regions, and both are equipped with only a single elastic ring for treating a single lesion.
There are also instruments in the prior art which employ laparoscope-assisted means for ring ligation such as shown in U.S. Patent No. 4,257,420 an 4,471,766, wherei.n the instruments are eacti equipped with a single elastic band and utilize forceps to position the tissue for ring ligation.
In U.S. Paterit No. 3,870,048, there is disclosed a ring applicator device having forceps slidably mounted in a cylinder for grasping the fallopian tube and including means for displacing an elastic ring to effect a ligation of tissue. While this device can be eqiii.pped with a plurality of elastic rings, its rigidity precludes its use with a flexible endoscope for treating the deeper regions of an internal orgaii, such as the alimentary tract.
A flexible endoscopic instrument used for ligation pur2.ioses and disclosed in U.S. Patent No. 4,735,194 comprises a floxible fiber optic endoscope on the end of which is secured ari outer tube and aii inner tube reciprocally movable therein. A trip wire is fastened to the inner tube to provide rearward motion to the inner tube to cause an elastic ririg fitted about the inner tube to slide off and effect ligation. While this instrument is suitable for ligating ).esions c7eep within the alimentary tract, it can only be used to treat but one lesion during a sirigle irisertion of the instruinent.
In many instances, liuwever, there are a nuniber of lesions present in the organ being treated, such as the esopliagtis, stomach or colon. If an endoscopic instrument equipped with on?y one elastic ring is used, the treatment of multiple lesioris in the sarne orgaii requires the extraction of the endoscope after the placing of each elastic ring about a lesion and reinsertion of tlre endoscope into the organ to repeat the procedure for placing an elastic ligating ring about each of the lesions. In addition to being tirne cons>>ming and an associated concern for blood loss when there are bleeding lesions, ttiere are other disadvantages associated with ttie repetitions of this procedure. The instrument, when withdrawn from the body, is usually covered witli blood and mucous. Furthermore, each time the instrument is reinserted into the organ, it becomes necessary to relocate a lesion to be treated and to orient the instrunient with respect thereto. In some cases wtiere considerable blood and mucous are present, the relocating of ttie instrument is a tedious and difficult task.
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FIELD OF INVENTION
The invention relates to an instruinent for ligating lesions, and more particularly to an endoscopic instrumeiit for,ligating mucosal and subinucosal lesions within a hollow organ of the body, sucli as the alimentary tract.
BACKGROUND OF THE INVENTION
The endoscopic treatmeiit of lesions presently encompasses a variety of techniques such as electrocauterization, leser photocoagulation, heat therapy by the application of heat probes, aricl scierotherapy which involves the iiijection of iuedicine into a target varix by a needle passed i:lirough tlie working channel of the endoscope. A further, widely used and increasingly promising technique involves the ligation of lesions, wherein mucosal and submucosal tissue is strangulated by an elastic ligature.
A variety of instrtiments for effecting the ligation of body tissue by the application of an elastic.ring are well known in the prior art. Some of these instruments, because of their rigidity and size are suited only for treatment of lesioiis that are in the external regions of the body or in the shallow body cavities. Others are particularly suited for ttie ligation of tissue in the abclomitial cavity, such as for tubal ligation, when the abdominal cavity has been opened surgically.
U.S. Patent No. 3,760,810 to Van Hoorn discloses an endoscope-equipped iristrument comprising a device witli two tubes mounted one insid- the other, with the inner tube protruding at the front of the outer tube. Means are included to move the outer tube forwardly relative to the inrier tube and cause an elastic cord to be disloclged arid placed about the tissue to be ligated. In U.S. Patent No..
4,257,419, there is disclosed an instrument for ligating hemorrhoids wherein a suction tube fitted inside a proctoscope provides means for sucking the hemorrhoid into a suction cavity where a ligating ring is applied. Both of these instriiments are rigid devices suited for treating lesions close to the external regions, and both are equipped with only a single elastic ring for treating a single lesion.
There are also instruments in the prior art which employ laparoscope-assisted means for ring ligation such as shown in U.S. Patent No. 4,257,420 an 4,471,766, wherei.n the instruments are eacti equipped with a single elastic band and utilize forceps to position the tissue for ring ligation.
In U.S. Paterit No. 3,870,048, there is disclosed a ring applicator device having forceps slidably mounted in a cylinder for grasping the fallopian tube and including means for displacing an elastic ring to effect a ligation of tissue. While this device can be eqiii.pped with a plurality of elastic rings, its rigidity precludes its use with a flexible endoscope for treating the deeper regions of an internal orgaii, such as the alimentary tract.
A flexible endoscopic instrument used for ligation pur2.ioses and disclosed in U.S. Patent No. 4,735,194 comprises a floxible fiber optic endoscope on the end of which is secured ari outer tube and aii inner tube reciprocally movable therein. A trip wire is fastened to the inner tube to provide rearward motion to the inner tube to cause an elastic ririg fitted about the inner tube to slide off and effect ligation. While this instrument is suitable for ligating ).esions c7eep within the alimentary tract, it can only be used to treat but one lesion during a sirigle irisertion of the instruinent.
In many instances, liuwever, there are a nuniber of lesions present in the organ being treated, such as the esopliagtis, stomach or colon. If an endoscopic instrument equipped with on?y one elastic ring is used, the treatment of multiple lesioris in the sarne orgaii requires the extraction of the endoscope after the placing of each elastic ring about a lesion and reinsertion of tlre endoscope into the organ to repeat the procedure for placing an elastic ligating ring about each of the lesions. In addition to being tirne cons>>ming and an associated concern for blood loss when there are bleeding lesions, ttiere are other disadvantages associated with ttie repetitions of this procedure. The instrument, when withdrawn from the body, is usually covered witli blood and mucous. Furthermore, each time the instrument is reinserted into the organ, it becomes necessary to relocate a lesion to be treated and to orient the instrunient with respect thereto. In some cases wtiere considerable blood and mucous are present, the relocating of ttie instrument is a tedious and difficult task.
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SUMMARY OF TIIE INVENTION
A flexible endoscopic instrument is provided with a plurality of elastic ligating rings mounted on one tube of a pair of tubular mernbers which are affixed in coaxial relation to the insertion end of an endoscope. The rings are adapted to be dislodged therefrom in sequence at selectively controlled times for treating niultiple lesions during a single insertion of the endoscope into a body organ. The endoscope is equipped wit-h illuinination and viewing means to io facilitate orientation of the instrument in the body organ, and longitudinally extending tubular passages.comprising a channel through whiclr objects rnay be passed and suction applied for drawing the lesion tissue into the tubular end of the endoscope to facilitate ligation of a lesion, and a working channel through which a flexible actuating cable is inserted. The cable is connected to one of the tubular members and serves as a means for imparting relative motion between the pair of tubular members to sequentially dislodge the elastic rings frorn the endoscope at controlled times.
Eactr of the elastic rings can be dislodged from the endoscope and placed in ligating relation to a lesion when lesion tissue is drawn irito the innermost of the tubular mernbers by a suction force applied ttirough the suction channel and each of Lhe rings can be applied to a different one of the multiple lesions in tiie body organ during a single insertion of the eridoscope.
In one embodiment of the invention, a tubular member is provided with a lielical groove in its inner wall and with mearis at one end for fitting the tubular meinber orito the insertion end of the endoscope. A plurality of elastic ligaLing rings are mounted in stretched condition about the periphery of a second tubular mernber which, when inserted into the first tubular member with a twisting motion, causes tlie greater part of each of the elastic riiigs to be placed iri a different one of the coils of the helical groove. By a drive gear connection between the flexible cable and the inner tubular ineinber, rotary niotion of ttie cable is imparted to the inner tubular member whereby the elastic rings are adapted to be dislodgec] one at a time to effect ttie ligaL-ion of nrultiple lesions during a single insertion of the endoscope.
In a second embodiment, a first rigid tubular meniber is fitted to the insertion eiid of the endoscope in coaxial relation thereto. A second tubular member of flexible material is placed on the rigid tubular member with a first outer portion tliereof sleeved over the rigid tubular merriber and a second portion inserted within the first tubular member by folding over the free end of the rigid tubular member.
The elastic rings are placed in stretched condition about the outer portion of the flexible tubular member in side-by-side spaced relation to one another. By direct connection of the flexible cable to tiie inner second portion of the flexible tubular inember, the cable can be retracted to pull most of the outer sleeve portion over the free end of the rigid tube arid into the interior of the rigid tubular member thereby causing the elastic rings to be dislodged from the endoscope one at a time as they pass over the end of the rigid tubular member at times controlled by the ret-ractiozi of tlre flexible cable.
In a third embodiment, a rigid tubular member is fitted to the insertion end of the endoscope and a plurality of cords connected together at the saine point inside the tube, are each folded over its distal end with the free end portion thereof extending in the longitudinal direction of the tube arrd aiigularly spaced relative to one another witli respect to tlie axis of tlie tube. A plurality of elastic riligs are placed in stretched conditiori about the tube at longiLudinally spaced locations thereori and also over the cords which lay over the tube. Each cord is provided with knots at predetermined spaced locations thereon against each of which an elastic ring is placed. By means of a trip wire or trip line threaded through a working channel of the endoscope and connecting to the cords at this mutual connecting point, the cords can be simultaneously retracted to pull the rings over the distal end of the tube in controlled sequence. By also providing a slack length of the cord between each pair of adjacent elastic rings, which slack length equals or exceeds the distance of the tube's distal end to the furthermost ring of the pair a small pulling force is required to dislodge a ring from the tube.
Thus, in a broad aspect the invention provides a flexible endoscopic instrument for ligating a multiplicity of lesions within a hollow body organ, such as the alimentary tract, said instrument comprising: (a) a flexible fiber optic endoscope having a forward insertion end and a rearward end, said endoscope including means for illumination and viewing through said endoscope, means for providing a suction force at said insertion end, and a working channel; (b) a tubular member having a forward distal end, a rearward end and a longitudinal axis, said rearward end having means for providing attachment to the insertion end of the endoscope; (c) a plurality of string-like cords of flexible substantially inelastic material, each said cord being folded over the distal end of the tubular member with a first portion of each said cord overlaying a part of the exterior of said tubular member and a second portion thereof being disposed internally of said tubular member, said cords being oriented in angular spacing about the longitudinal axis of said tubular member; (d) a plurality of elastic ligating rings removably mounted in stretched condition on said tubular member in coaxial - 6a -relation thereto and in overlying relation to said cords, said rings being spaced from one another in the longitudinal direction of the tubular member at successively greater different distances from the distal end of the tubular member; and (e) means for imparting relative sliding motion between said cords and said tubular member to dislodge each of the elastic rings in controlled sequence during a single insertion of the endoscope into the body organ whereby each of the elastic rings can be dislodged from the endoscope and placed in ligating relation to a lesion when lesion tissue is drawn into the tubular member by said suction means with each ring being applied to a different one of multiple lesions present in the body organ, said means comprising a flexible line element threaded through the working channel of the endoscope and connecting at one end to said cords disposed within said tubular member and exiting the endoscope at the rearward end thereof whereby a pulling force may be exerted on the other end of the line element to cause sliding movement of the cords over said tubular member, each said cord being arranged in slack condition between each pair of adjacent elastic rings.
In another aspect the invention provides a flexible endoscopic instrument for ligating a multiplicity of lesions within a hollow body organ, such as the alimentary tract, said instrument comprising: (a) a flexible fiber optic endoscope having a forward insertion end and a rearward end, said endoscope including means for illumination and viewing through said endoscope, means for providing a suction force at said insertion end, and a working channel; (b) a tubular member having a forward distal end, a rearward end and a longitudinal axis, said rearward end having means for providing attachment to the insertion end of the endoscope; (c) a plurality of string-- 6b -like cords of flexible substantially inelastic material, each said cord being folded over the distal end of the tubular member with a first portion of each said cord overlaying a part of the exterior of said tubular member and a second portion thereof being disposed internally of said tubular member, said cords being oriented in angular spacing about the longitudinal axis of said tubular member; (d) a plurality of elastic ligating rings removably mounted in stretched condition on said tubular member in coaxial relation thereto and in overlying relation to said cords, said rings being spaced from one another in the longitudinal direction of the tubular member and between at least one pair of adjacent elastic rings each of said cords having a slack segment of cord of a length which is at least equal to the distance between the distal end of the tubular member and the ring of said pair which is furthest from said distal end; and (e) means for imparting relative sliding motion between said cords and said tubular member to dislodge each of the elastic rings in controlled sequence during a single insertion of the endoscope into the body organ whereby each of the elastic rings can be dislodged from the endoscope and placed in ligating relation to a lesion when lesion tissue is drawn into the tubular member by said suction means with each ring being applied to a different one of multiple lesions present in the body organ, said means comprising a flexible line element threaded through the working channel of the endoscope and connecting at one end to said cords disposed within said tubular member and exiting the endoscope at the rearward end thereof whereby a pulling force may be exerted on the other end of the line element to cause sliding movement of the cords over said tubular member, each said cord being arranged in slack condition between each pair of adjacent elastic rings.
- 6c -In another aspect the invention provides a flexible endoscopic instrument for multiple ligation, said instrument comprising: (a) a flexible endoscope having a forward insertion portion, said endoscope including means for illumination and viewing through said endoscope, means for providing a suction force at said insertion portion, and a working channel; (b) a hollow support member having a forward distal end and a rearward portion, said rearward portion being connectable to the insertion portion of the endoscope; (c) at least two string-like cords of flexible substantially inelastic material, each of said cords having a first portion overlaying a part of the exterior of said support member and a second portion disposed internally of said support member; and (d) a plurality of elastic ligating rings removably mounted in stretched condition on said support member and each of said rings being in overlying contacting relation to each of said cords, said rings being spaced from one another along said support member at successively greater different distances from said distal end of said support member; wherein a pulling force may be exerted on each of said cords to cause movement of each of said cords relative to said support member to dislodge one or more of said rings in controlled sequence from said support member, each of said cords being arranged in slack condition between each pair of adjacent elastic rings.
In another aspect the invention provides use of a ligation apparatus for ligating tissue, said ligation apparatus including: a hollow support member having a forward distal end and a rearward portion; at least two string-like cords of flexible substantially inelastic material, each of said cords having a first portion overlaying a part of the exterior of said support member and a second portion disposed internally of said support member;
- 6d -and a plurality of elastic ligating rings removably mounted in stretched condition on said support member and each of said rings being in overlying contacting relation to each of said cords, each of said cords being arranged in slack condition between each pair of adjacent elastic rings, wherein: said rearward portion of said support member is capable of connection to a forward insertion end of an endoscope; said forward end of said support member is capable of insertion into a body organ and placement adjacent tissue to be ligated; said ligation apparatus is capable of drawing tissue within said support member; and said ligation apparatus is capable of dislodging one of said rings from said support member to ligate tissue drawn within said support member upon exertion of a pulling force on each of said cords.
In another aspect the invention provides a flexible endoscopic instrument for multiple ligation, said instrument comprising: (a) a flexible endoscope having a forward insertion portion, said endoscope including means for illumination and viewing through said endoscope, means for providing a suction force at said insertion portion, and a working channel; (b) a hollow support member having a forward distal end and a rearward portion, said rearward portion being connectable to the insertion portion of the endoscope; (c) at least two string-like cords of flexible substantially inelastic material, each of said cords having a first portion overlaying a part of the exterior of said support member and a second portion disposed internally of said support member; and (d) a plurality of elastic ligating rings removably mounted in stretched condition on said support member and each of said rings being in contacting relation to each of said cords, said rings being spaced from one another along said support member at successively s - 6e -greater different distances from said distal end of said support member; wherein a pulling force may be exerted on each of said cords to cause movement of each of said cords relative to said support member to dislodge one or more of said rings in controlled sequence from said support member, each of said cords being arranged in slack condition between each pair of adjacent elastic rings.
In another aspect the invention provides a flexible endoscopic instrument for multiple ligation, said instrument comprising: (a) a flexible endoscope having a forward insertion portion, said endoscope including means for illumination and viewing through said endoscope, means for providing a suction force at said insertion portion, and a working channel; (b) a hollow support member having a forward distal end and a rearward portion, said rearward portion being connectable to the insertion portion of the endoscope; (c) at least one string-like cord of flexible substantially inelastic material, each said cord having a first portion overlaying a part of the exterior of said support member and a second portion disposed internally of said support member; and (d) a plurality of elastic ligating rings removably mounted in stretched condition on said support member and each of said rings being in overlying contacting relation to each said cord, said rings being spaced from one another along said support member at successively greater different distances from said distal end of said support member; wherein a pulling force may be exerted on each said cord to cause movement of each said cord relative to said support member to dislodge one or more of said rings in controlled sequence from said support member, each said cord being arranged in slack condition between each pair of adjacent elastic rings.
- 6f -In another aspect the invention provides use of a ligation apparatus for ligating tissue, said ligation apparatus including: a hollow support member having a forward distal end and a rearward portion; at least one string-like cord of flexible substantially inelastic material, each said cord having a first portion overlaying a part of the exterior of said support member and a second portion disposed internally of said support member; and a plurality of elastic ligating rings removably mounted in stretched condition on said support member and each of said rings being in overlying contacting relation to each said cord, each said cord being arranged in slack condition between each pair of adjacent elastic rings, wherein: said rearward portion of said support member is capable of connection to a forward insertion end of an endoscope; said forward end of said support member is capable of insertion into a body organ and placement adjacent tissue to be ligated; said ligation apparatus is capable of drawing tissue adjacent to said forward end, within said support member; and said ligation apparatus is capable of dislodging one of said rings from said support member to ligate tissue drawn within said support member upon exertion of a pulling force on each said cord.
In another aspect the invention provides a flexible endoscopic instrument for multiple ligation, said instrument comprising: (a) a flexible endoscope having a forward insertion portion, said endoscope including means for illumination and viewing through said endoscope, means for providing a suction force at said insertion portion, and a working channel; (b) a hollow support member having a forward distal end and a rearward portion, said rearward portion being connectable to the insertion portion of the endoscope; (c) at least one string-like cord of flexible ~ ~.
- 6g -substantially inelastic material, each said cord having a first portion overlaying a part of the exterior of said support member and a second portion disposed internally of said support member; and (d) a plurality of elastic ligating rings removably mounted in stretched condition on said support member and each of said rings being in contacting relation to each said cord, said rings being spaced from one another along said support member at successively greater different distances from said distal end of said support member; wherein a pulling force may be exerted on each said cord to cause movement of each said cord relative to said support member to dislodge one or more of said rings in controlled sequence from said support member, each said cord being arranged in slack condition between each pair of adjacent elastic rings.
In another aspect the invention provides an endoscopic ligating apparatus, comprising: a hollow barrel defining a barrel proximal end, a barrel distal end, a hollow interior and an outer surface; at least one elastic ligating band stretched around said barrel outer surface;
and at least one piece of flexible material having a material proximal end and a material distal end, said at least one piece of flexible material extending through said hollow interi'or, folding over said barrel distal end, and lying between at least a portion of said at least one ligating band and said outer surface; wherein pulling said material proximal end in a proximal direction is operative to pull said material distal end toward said barrel distal end, thereby pulling said at least one ligating band off of said barrel distal end.
In another aspect the invention provides an endoscopic ligating apparatus, comprising: a hollow barrel defining a barrel proximal end, a barrel distal end, a (' \
- 6h -hollow interior and an outer surface; at least one elastic ligating band stretched around said barrel outer surface;
and at least one piece of flexible material having a material proximal end and a material distal end, said at least one piece of flexible material extending through said hollow interior, folding over said barrel distal end, and lying between at least a portion of said at least one ligating band and said outer surface; wherein pulling said material proximal end in a proximal direction is operative to pull said at least one ligating band off of said barrel distal end.
In another aspect the invention provides an endoscopic ligating apparatus for use with a flexible endoscope, said endoscope having an endoscope distal end, said endoscopic ligating apparatus comprising: a hollow barrel defining a barrel proximal end, a barrel distal end, a hollow interior having an annular shoulder formed therein, and an outer surface; at least one elastic ligating band stretched around said barrel outer surface; and at least one piece of flexible material having a material proximal end and a material distal end, said at least one piece of flexible material extending through said hollow interior, folding over said barrel distal end, and lying between at least a portion of said at least one ligating band and said outer surface; wherein said hollow interior at said barrel proximal end is sized to mount over said endoscope distal end such that said endoscope distal end abuts said annular shoulder; and wherein pulling said material proximal end in a proximal direction is operative to pull said material distal end toward said barrel distal end, thereby pulling said at least one ligating band off of said barrel distal end.
- 6i -In another aspect the invention provides an endoscopic ligating apparatus, comprising: a hollow barrel defining a barrel proximal end, a barrel distal end, a hollow interior having an annular shoulder formed therein, and an outer surface; at least one elastic ligating band stretched around said barrel outer surface; and at least one piece of flexible material having a material proximal end and a material distal end, said at least one piece of flexible material extending through said hollow interior, folding over said barrel distal end, and lying between at least a portion of said at least one ligating band and said outer surface; wherein said hollow interior at said barrel proximal end is sized to mount over said endoscope distal end such that said endoscope distal end abuts said annular shoulder; and wherein pulling said material proximal end in a proximal direction is operative to pull said at least one ligating band off of said barrel distal end.
In another aspect the invention provides an endoscopic ligating apparatus, comprising: a support member defining a support member proximal end, a support member distal end, a hollow interior and an outer surface; at least one elastic ligating band stretched around said support member outer surface; and at least one piece of flexible material having a material proximal end and a material distal end, said at least one piece of flexible material lying between at least a portion of said at least one ligating band and said outer surface, wherein pulling said material proximal end in a proximal direction is operative to pull said at least one ligating band distally off of said support member distal end.
In another aspect the invention provides an endoscopic ligating apparatus for use with a flexible endoscope having an endoscope distal end, said endoscopic ( (, - 6j -ligating apparatus comprising: a support member defining a support member proximal end, a support member distal end, a hollow interior, and an outer surface; at least one elastic ligating band stretched around said support member outer surface; and at least one piece of flexible material having a material proximal end and a material distal end, said at least one piece of flexible material lying between at least a portion of said at least one ligating band and said outer surface; wherein said support member proximal end is adapted to contact a portion of said endoscope distal end; and wherein pulling said at least one piece of flexible material is operative to pull said at least one ligating band distally off of said support member distal end.
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A flexible endoscopic instrument is provided with a plurality of elastic ligating rings mounted on one tube of a pair of tubular mernbers which are affixed in coaxial relation to the insertion end of an endoscope. The rings are adapted to be dislodged therefrom in sequence at selectively controlled times for treating niultiple lesions during a single insertion of the endoscope into a body organ. The endoscope is equipped wit-h illuinination and viewing means to io facilitate orientation of the instrument in the body organ, and longitudinally extending tubular passages.comprising a channel through whiclr objects rnay be passed and suction applied for drawing the lesion tissue into the tubular end of the endoscope to facilitate ligation of a lesion, and a working channel through which a flexible actuating cable is inserted. The cable is connected to one of the tubular members and serves as a means for imparting relative motion between the pair of tubular members to sequentially dislodge the elastic rings frorn the endoscope at controlled times.
Eactr of the elastic rings can be dislodged from the endoscope and placed in ligating relation to a lesion when lesion tissue is drawn irito the innermost of the tubular mernbers by a suction force applied ttirough the suction channel and each of Lhe rings can be applied to a different one of the multiple lesions in tiie body organ during a single insertion of the eridoscope.
In one embodiment of the invention, a tubular member is provided with a lielical groove in its inner wall and with mearis at one end for fitting the tubular meinber orito the insertion end of the endoscope. A plurality of elastic ligaLing rings are mounted in stretched condition about the periphery of a second tubular mernber which, when inserted into the first tubular member with a twisting motion, causes tlie greater part of each of the elastic riiigs to be placed iri a different one of the coils of the helical groove. By a drive gear connection between the flexible cable and the inner tubular ineinber, rotary niotion of ttie cable is imparted to the inner tubular member whereby the elastic rings are adapted to be dislodgec] one at a time to effect ttie ligaL-ion of nrultiple lesions during a single insertion of the endoscope.
In a second embodiment, a first rigid tubular meniber is fitted to the insertion eiid of the endoscope in coaxial relation thereto. A second tubular member of flexible material is placed on the rigid tubular member with a first outer portion tliereof sleeved over the rigid tubular merriber and a second portion inserted within the first tubular member by folding over the free end of the rigid tubular member.
The elastic rings are placed in stretched condition about the outer portion of the flexible tubular member in side-by-side spaced relation to one another. By direct connection of the flexible cable to tiie inner second portion of the flexible tubular inember, the cable can be retracted to pull most of the outer sleeve portion over the free end of the rigid tube arid into the interior of the rigid tubular member thereby causing the elastic rings to be dislodged from the endoscope one at a time as they pass over the end of the rigid tubular member at times controlled by the ret-ractiozi of tlre flexible cable.
In a third embodiment, a rigid tubular member is fitted to the insertion end of the endoscope and a plurality of cords connected together at the saine point inside the tube, are each folded over its distal end with the free end portion thereof extending in the longitudinal direction of the tube arrd aiigularly spaced relative to one another witli respect to tlie axis of tlie tube. A plurality of elastic riligs are placed in stretched conditiori about the tube at longiLudinally spaced locations thereori and also over the cords which lay over the tube. Each cord is provided with knots at predetermined spaced locations thereon against each of which an elastic ring is placed. By means of a trip wire or trip line threaded through a working channel of the endoscope and connecting to the cords at this mutual connecting point, the cords can be simultaneously retracted to pull the rings over the distal end of the tube in controlled sequence. By also providing a slack length of the cord between each pair of adjacent elastic rings, which slack length equals or exceeds the distance of the tube's distal end to the furthermost ring of the pair a small pulling force is required to dislodge a ring from the tube.
Thus, in a broad aspect the invention provides a flexible endoscopic instrument for ligating a multiplicity of lesions within a hollow body organ, such as the alimentary tract, said instrument comprising: (a) a flexible fiber optic endoscope having a forward insertion end and a rearward end, said endoscope including means for illumination and viewing through said endoscope, means for providing a suction force at said insertion end, and a working channel; (b) a tubular member having a forward distal end, a rearward end and a longitudinal axis, said rearward end having means for providing attachment to the insertion end of the endoscope; (c) a plurality of string-like cords of flexible substantially inelastic material, each said cord being folded over the distal end of the tubular member with a first portion of each said cord overlaying a part of the exterior of said tubular member and a second portion thereof being disposed internally of said tubular member, said cords being oriented in angular spacing about the longitudinal axis of said tubular member; (d) a plurality of elastic ligating rings removably mounted in stretched condition on said tubular member in coaxial - 6a -relation thereto and in overlying relation to said cords, said rings being spaced from one another in the longitudinal direction of the tubular member at successively greater different distances from the distal end of the tubular member; and (e) means for imparting relative sliding motion between said cords and said tubular member to dislodge each of the elastic rings in controlled sequence during a single insertion of the endoscope into the body organ whereby each of the elastic rings can be dislodged from the endoscope and placed in ligating relation to a lesion when lesion tissue is drawn into the tubular member by said suction means with each ring being applied to a different one of multiple lesions present in the body organ, said means comprising a flexible line element threaded through the working channel of the endoscope and connecting at one end to said cords disposed within said tubular member and exiting the endoscope at the rearward end thereof whereby a pulling force may be exerted on the other end of the line element to cause sliding movement of the cords over said tubular member, each said cord being arranged in slack condition between each pair of adjacent elastic rings.
In another aspect the invention provides a flexible endoscopic instrument for ligating a multiplicity of lesions within a hollow body organ, such as the alimentary tract, said instrument comprising: (a) a flexible fiber optic endoscope having a forward insertion end and a rearward end, said endoscope including means for illumination and viewing through said endoscope, means for providing a suction force at said insertion end, and a working channel; (b) a tubular member having a forward distal end, a rearward end and a longitudinal axis, said rearward end having means for providing attachment to the insertion end of the endoscope; (c) a plurality of string-- 6b -like cords of flexible substantially inelastic material, each said cord being folded over the distal end of the tubular member with a first portion of each said cord overlaying a part of the exterior of said tubular member and a second portion thereof being disposed internally of said tubular member, said cords being oriented in angular spacing about the longitudinal axis of said tubular member; (d) a plurality of elastic ligating rings removably mounted in stretched condition on said tubular member in coaxial relation thereto and in overlying relation to said cords, said rings being spaced from one another in the longitudinal direction of the tubular member and between at least one pair of adjacent elastic rings each of said cords having a slack segment of cord of a length which is at least equal to the distance between the distal end of the tubular member and the ring of said pair which is furthest from said distal end; and (e) means for imparting relative sliding motion between said cords and said tubular member to dislodge each of the elastic rings in controlled sequence during a single insertion of the endoscope into the body organ whereby each of the elastic rings can be dislodged from the endoscope and placed in ligating relation to a lesion when lesion tissue is drawn into the tubular member by said suction means with each ring being applied to a different one of multiple lesions present in the body organ, said means comprising a flexible line element threaded through the working channel of the endoscope and connecting at one end to said cords disposed within said tubular member and exiting the endoscope at the rearward end thereof whereby a pulling force may be exerted on the other end of the line element to cause sliding movement of the cords over said tubular member, each said cord being arranged in slack condition between each pair of adjacent elastic rings.
- 6c -In another aspect the invention provides a flexible endoscopic instrument for multiple ligation, said instrument comprising: (a) a flexible endoscope having a forward insertion portion, said endoscope including means for illumination and viewing through said endoscope, means for providing a suction force at said insertion portion, and a working channel; (b) a hollow support member having a forward distal end and a rearward portion, said rearward portion being connectable to the insertion portion of the endoscope; (c) at least two string-like cords of flexible substantially inelastic material, each of said cords having a first portion overlaying a part of the exterior of said support member and a second portion disposed internally of said support member; and (d) a plurality of elastic ligating rings removably mounted in stretched condition on said support member and each of said rings being in overlying contacting relation to each of said cords, said rings being spaced from one another along said support member at successively greater different distances from said distal end of said support member; wherein a pulling force may be exerted on each of said cords to cause movement of each of said cords relative to said support member to dislodge one or more of said rings in controlled sequence from said support member, each of said cords being arranged in slack condition between each pair of adjacent elastic rings.
In another aspect the invention provides use of a ligation apparatus for ligating tissue, said ligation apparatus including: a hollow support member having a forward distal end and a rearward portion; at least two string-like cords of flexible substantially inelastic material, each of said cords having a first portion overlaying a part of the exterior of said support member and a second portion disposed internally of said support member;
- 6d -and a plurality of elastic ligating rings removably mounted in stretched condition on said support member and each of said rings being in overlying contacting relation to each of said cords, each of said cords being arranged in slack condition between each pair of adjacent elastic rings, wherein: said rearward portion of said support member is capable of connection to a forward insertion end of an endoscope; said forward end of said support member is capable of insertion into a body organ and placement adjacent tissue to be ligated; said ligation apparatus is capable of drawing tissue within said support member; and said ligation apparatus is capable of dislodging one of said rings from said support member to ligate tissue drawn within said support member upon exertion of a pulling force on each of said cords.
In another aspect the invention provides a flexible endoscopic instrument for multiple ligation, said instrument comprising: (a) a flexible endoscope having a forward insertion portion, said endoscope including means for illumination and viewing through said endoscope, means for providing a suction force at said insertion portion, and a working channel; (b) a hollow support member having a forward distal end and a rearward portion, said rearward portion being connectable to the insertion portion of the endoscope; (c) at least two string-like cords of flexible substantially inelastic material, each of said cords having a first portion overlaying a part of the exterior of said support member and a second portion disposed internally of said support member; and (d) a plurality of elastic ligating rings removably mounted in stretched condition on said support member and each of said rings being in contacting relation to each of said cords, said rings being spaced from one another along said support member at successively s - 6e -greater different distances from said distal end of said support member; wherein a pulling force may be exerted on each of said cords to cause movement of each of said cords relative to said support member to dislodge one or more of said rings in controlled sequence from said support member, each of said cords being arranged in slack condition between each pair of adjacent elastic rings.
In another aspect the invention provides a flexible endoscopic instrument for multiple ligation, said instrument comprising: (a) a flexible endoscope having a forward insertion portion, said endoscope including means for illumination and viewing through said endoscope, means for providing a suction force at said insertion portion, and a working channel; (b) a hollow support member having a forward distal end and a rearward portion, said rearward portion being connectable to the insertion portion of the endoscope; (c) at least one string-like cord of flexible substantially inelastic material, each said cord having a first portion overlaying a part of the exterior of said support member and a second portion disposed internally of said support member; and (d) a plurality of elastic ligating rings removably mounted in stretched condition on said support member and each of said rings being in overlying contacting relation to each said cord, said rings being spaced from one another along said support member at successively greater different distances from said distal end of said support member; wherein a pulling force may be exerted on each said cord to cause movement of each said cord relative to said support member to dislodge one or more of said rings in controlled sequence from said support member, each said cord being arranged in slack condition between each pair of adjacent elastic rings.
- 6f -In another aspect the invention provides use of a ligation apparatus for ligating tissue, said ligation apparatus including: a hollow support member having a forward distal end and a rearward portion; at least one string-like cord of flexible substantially inelastic material, each said cord having a first portion overlaying a part of the exterior of said support member and a second portion disposed internally of said support member; and a plurality of elastic ligating rings removably mounted in stretched condition on said support member and each of said rings being in overlying contacting relation to each said cord, each said cord being arranged in slack condition between each pair of adjacent elastic rings, wherein: said rearward portion of said support member is capable of connection to a forward insertion end of an endoscope; said forward end of said support member is capable of insertion into a body organ and placement adjacent tissue to be ligated; said ligation apparatus is capable of drawing tissue adjacent to said forward end, within said support member; and said ligation apparatus is capable of dislodging one of said rings from said support member to ligate tissue drawn within said support member upon exertion of a pulling force on each said cord.
In another aspect the invention provides a flexible endoscopic instrument for multiple ligation, said instrument comprising: (a) a flexible endoscope having a forward insertion portion, said endoscope including means for illumination and viewing through said endoscope, means for providing a suction force at said insertion portion, and a working channel; (b) a hollow support member having a forward distal end and a rearward portion, said rearward portion being connectable to the insertion portion of the endoscope; (c) at least one string-like cord of flexible ~ ~.
- 6g -substantially inelastic material, each said cord having a first portion overlaying a part of the exterior of said support member and a second portion disposed internally of said support member; and (d) a plurality of elastic ligating rings removably mounted in stretched condition on said support member and each of said rings being in contacting relation to each said cord, said rings being spaced from one another along said support member at successively greater different distances from said distal end of said support member; wherein a pulling force may be exerted on each said cord to cause movement of each said cord relative to said support member to dislodge one or more of said rings in controlled sequence from said support member, each said cord being arranged in slack condition between each pair of adjacent elastic rings.
In another aspect the invention provides an endoscopic ligating apparatus, comprising: a hollow barrel defining a barrel proximal end, a barrel distal end, a hollow interior and an outer surface; at least one elastic ligating band stretched around said barrel outer surface;
and at least one piece of flexible material having a material proximal end and a material distal end, said at least one piece of flexible material extending through said hollow interi'or, folding over said barrel distal end, and lying between at least a portion of said at least one ligating band and said outer surface; wherein pulling said material proximal end in a proximal direction is operative to pull said material distal end toward said barrel distal end, thereby pulling said at least one ligating band off of said barrel distal end.
In another aspect the invention provides an endoscopic ligating apparatus, comprising: a hollow barrel defining a barrel proximal end, a barrel distal end, a (' \
- 6h -hollow interior and an outer surface; at least one elastic ligating band stretched around said barrel outer surface;
and at least one piece of flexible material having a material proximal end and a material distal end, said at least one piece of flexible material extending through said hollow interior, folding over said barrel distal end, and lying between at least a portion of said at least one ligating band and said outer surface; wherein pulling said material proximal end in a proximal direction is operative to pull said at least one ligating band off of said barrel distal end.
In another aspect the invention provides an endoscopic ligating apparatus for use with a flexible endoscope, said endoscope having an endoscope distal end, said endoscopic ligating apparatus comprising: a hollow barrel defining a barrel proximal end, a barrel distal end, a hollow interior having an annular shoulder formed therein, and an outer surface; at least one elastic ligating band stretched around said barrel outer surface; and at least one piece of flexible material having a material proximal end and a material distal end, said at least one piece of flexible material extending through said hollow interior, folding over said barrel distal end, and lying between at least a portion of said at least one ligating band and said outer surface; wherein said hollow interior at said barrel proximal end is sized to mount over said endoscope distal end such that said endoscope distal end abuts said annular shoulder; and wherein pulling said material proximal end in a proximal direction is operative to pull said material distal end toward said barrel distal end, thereby pulling said at least one ligating band off of said barrel distal end.
- 6i -In another aspect the invention provides an endoscopic ligating apparatus, comprising: a hollow barrel defining a barrel proximal end, a barrel distal end, a hollow interior having an annular shoulder formed therein, and an outer surface; at least one elastic ligating band stretched around said barrel outer surface; and at least one piece of flexible material having a material proximal end and a material distal end, said at least one piece of flexible material extending through said hollow interior, folding over said barrel distal end, and lying between at least a portion of said at least one ligating band and said outer surface; wherein said hollow interior at said barrel proximal end is sized to mount over said endoscope distal end such that said endoscope distal end abuts said annular shoulder; and wherein pulling said material proximal end in a proximal direction is operative to pull said at least one ligating band off of said barrel distal end.
In another aspect the invention provides an endoscopic ligating apparatus, comprising: a support member defining a support member proximal end, a support member distal end, a hollow interior and an outer surface; at least one elastic ligating band stretched around said support member outer surface; and at least one piece of flexible material having a material proximal end and a material distal end, said at least one piece of flexible material lying between at least a portion of said at least one ligating band and said outer surface, wherein pulling said material proximal end in a proximal direction is operative to pull said at least one ligating band distally off of said support member distal end.
In another aspect the invention provides an endoscopic ligating apparatus for use with a flexible endoscope having an endoscope distal end, said endoscopic ( (, - 6j -ligating apparatus comprising: a support member defining a support member proximal end, a support member distal end, a hollow interior, and an outer surface; at least one elastic ligating band stretched around said support member outer surface; and at least one piece of flexible material having a material proximal end and a material distal end, said at least one piece of flexible material lying between at least a portion of said at least one ligating band and said outer surface; wherein said support member proximal end is adapted to contact a portion of said endoscope distal end; and wherein pulling said at least one piece of flexible material is operative to pull said at least one ligating band distally off of said support member distal end.
f ~' 1\
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a longitudinal view, partly in section of an endoscopic ligating instrument representing a preferred embodiment of the invention;
FIG. 2 is a frontal plan view of the insertion end of the endoscopic ligating instrument of FIG. 1;
FIG. 3 is a section view through the end portion of the instrtrment as taken along the section line 3-3 in FIG. 2;
FIG. 4 is a fragmentary view in cross-section showing details of the end portion of the flexible actuating cable at its connection with a planetary gear in a tubular niember in an assembly of tubular members affixed to the insertion end of the endoscope;
FIG. 5 is a section view throuyh the iiisertion end of the endoscope as taken along the section line 5-5 in FIG. 3;
FIG. 6 is an exploded view of a tubular assembly wlrich is affixed to the inserLion end of the endoscope;
FIG. 7 is a fragmentary view, partly in section, showing the insertion end of the instrument of the invention applied to a lesion witti lesion tissue drawn by suction into arr inner tubular nrenrber on the end of the instrument;
FIG. 8 is a view similar to FIG. 7, but showing an elastic ligating ring applied about a lesion after its dislodgement front lie end of the endoscopic instrument of the invention;
FIG. 9 shows a lesion witfi an elastic ligating ring applied in strangulatirrg relaLionship hereto;
FIG. 10 is a block plan view showing an endoscopic instrument as shown in FIG. 1 which is provided with a step-niotor for selecLively and automatically controlling the rotation of the flexible cable;
FIG. 11 is a fragmentary view in longitudinal cross-section of a modified form of tubular assembly wlricli is connectable to the insertion end of the endoscope of the invention;
FIG. 12 is a sectional view as taken along the sectiori line 12-12 in FIG. 11;
FIG. 13 is an enlarged fragmentary view of the tubular assembly of FIG. 11 which shows the nature and direction of the relative movemerit wliich is imposed between the paired tubular meniber of the assembly for effecting the discharge of an elastic ligating ring;
FIG. 14 is a view siinilar to FIG. 13 but sliowing a modified form of ribbing which is provided on the exterior of a LexLile mernber of the Luvular assenibly of FIG. 11; arrd FIG. 15 is a plan view of an embodiment of the inverlL-ior-as illustrated in FIGS. 11 - 14.
FIG. 16 is a perspective fragmentary view of a furtlier embodiment of the invention showing the insertiori end of an endoscope witti elastic rings displaceably mounted on a rigid tube affixed tlieret-o;
FIG. 17 is a frorit view of the apparatus attaclied to the insertion end of the endoscope of FIG. 16;
FIG. 18 is a longitudinal sectional view of the endoscope apparatus as taken along the sectzori line 18-18 in FIG. 17 showing the arrarigement of elastic rings on the rigid tube connected to the end of the endoscope;
FIG. 19 is an erilarged fragmentary view showing the distal end of the tubular meinber fitted to the end of the endoscope in FIG. 16; and FIG. 20 is a longiLuclinal sectiorial view similar to FIG.
18 but showing a suctioned lesion ligated by an elastic ring which has been dislodged from the tube.
FIG. 1 is a longitudinal view, partly in section of an endoscopic ligating instrument representing a preferred embodiment of the invention;
FIG. 2 is a frontal plan view of the insertion end of the endoscopic ligating instrument of FIG. 1;
FIG. 3 is a section view through the end portion of the instrtrment as taken along the section line 3-3 in FIG. 2;
FIG. 4 is a fragmentary view in cross-section showing details of the end portion of the flexible actuating cable at its connection with a planetary gear in a tubular niember in an assembly of tubular members affixed to the insertion end of the endoscope;
FIG. 5 is a section view throuyh the iiisertion end of the endoscope as taken along the section line 5-5 in FIG. 3;
FIG. 6 is an exploded view of a tubular assembly wlrich is affixed to the inserLion end of the endoscope;
FIG. 7 is a fragmentary view, partly in section, showing the insertion end of the instrument of the invention applied to a lesion witti lesion tissue drawn by suction into arr inner tubular nrenrber on the end of the instrument;
FIG. 8 is a view similar to FIG. 7, but showing an elastic ligating ring applied about a lesion after its dislodgement front lie end of the endoscopic instrument of the invention;
FIG. 9 shows a lesion witfi an elastic ligating ring applied in strangulatirrg relaLionship hereto;
FIG. 10 is a block plan view showing an endoscopic instrument as shown in FIG. 1 which is provided with a step-niotor for selecLively and automatically controlling the rotation of the flexible cable;
FIG. 11 is a fragmentary view in longitudinal cross-section of a modified form of tubular assembly wlricli is connectable to the insertion end of the endoscope of the invention;
FIG. 12 is a sectional view as taken along the sectiori line 12-12 in FIG. 11;
FIG. 13 is an enlarged fragmentary view of the tubular assembly of FIG. 11 which shows the nature and direction of the relative movemerit wliich is imposed between the paired tubular meniber of the assembly for effecting the discharge of an elastic ligating ring;
FIG. 14 is a view siinilar to FIG. 13 but sliowing a modified form of ribbing which is provided on the exterior of a LexLile mernber of the Luvular assenibly of FIG. 11; arrd FIG. 15 is a plan view of an embodiment of the inverlL-ior-as illustrated in FIGS. 11 - 14.
FIG. 16 is a perspective fragmentary view of a furtlier embodiment of the invention showing the insertiori end of an endoscope witti elastic rings displaceably mounted on a rigid tube affixed tlieret-o;
FIG. 17 is a frorit view of the apparatus attaclied to the insertion end of the endoscope of FIG. 16;
FIG. 18 is a longitudinal sectional view of the endoscope apparatus as taken along the sectzori line 18-18 in FIG. 17 showing the arrarigement of elastic rings on the rigid tube connected to the end of the endoscope;
FIG. 19 is an erilarged fragmentary view showing the distal end of the tubular meinber fitted to the end of the endoscope in FIG. 16; and FIG. 20 is a longiLuclinal sectiorial view similar to FIG.
18 but showing a suctioned lesion ligated by an elastic ring which has been dislodged from the tube.
DETAILED DESCRIPTION OF THE INVENTION
Referring more particularly to the drawings, there is shown in FIG. 1 a flexible endoscopic instrument 10 of a lengtli which perniits access to the deeper regions of a hollow body organ, such as the alimentary tract. The instrument 10 comprises a conventional endoscope with an operating controls section 11 of rigid coristructioii and a flexible sectiori 12 wliich extends therefrom and is a length sufficient to reach the deeper regions of the alimentary tract. The distal end of the flexible sectiozr 12 is the iiisertion end 13 of the endoscope and the viewing end 14 of the endoscope is at the erid of the rigid operating controls section 11 remote from the end tlsereof which connects to the flexible section 12.
Ttie endoscope is provided with passages 16-21 which extend longitudinally therein from its insertion end 13 to exit ports near the viewing end of ttie endoscope. The passages comprise an illumiriation channel 16 through which is inserted a fiber optic cable for the transmission of light from a light source, a viewing channel 17 whicli is also provided with a fiber optic cable for viewing purposes, and a channel through which objects may be passed or suction applied 18. The illuniiriation channel and suction channel exit laterally througli a lateral extension 22 of tiie side wall of the endoscope at a location on the operating controls section 11 near the viewing end 14. At their exit location, the fiber optic cable f-rom channel 16 and the channel 18 are connectable through an.umbilical cable 23 to a control device (riot shown) wliicli is adaptable for supplying illumination to ttie transinission optic cable and for connecting the channel 18 to an appropriate means for applying a suction therelhrougli. The fiber optic viewing channel 17 extends to the viewing ericl 14 of the eric]oscope which may lie p.iovidecl witti a viewing lens aiid an adapter for mounting a caniera tliereon, if desired.
WO 95/34244 PCT/US95/0f.' J' The endoscope is also provided with a working channel 19 which extends througli the endoscope from its inserl=ion end 11 to an exit in the lateral extension 22. The working cliannel 19 includes a branch 19a which extends i:lirough an angularly exteiiding protuberance 24 to a second exit near the viewing end of the endoscope.
Additional channels 20 ancl 21, shown in FIG. 2, may be utilized for delivering pressurized air or a jet stream of water for cleanirig the lens.
In the ecubodiment of the iriverition sliown in FIGS. 1-6, the insertion end of the ericioscope is fitted with an assembly of coaxially arranged tubes 25, 26, the outer tube 26 of wLich is secured in coaxial relation thereto preferably by a tubular adapter 27 which provides a friction fit as shown in FIG. 3 although other fastening means such as a threaded connection niiglit be suitably employed. The tube 26 is preferably of transparent plastic material for enhancing the illumination and field of vision from the insertion end of the endoscope, altliougli otlier inert material miglit also be suitable includirig stainless steel. The tube 26 is provided at its attaching end with an external frusto-conical bevel surface 28 to facilitate the placement of the tubular adapter 27 thereover. The adapter 27 is preferably of a flexible material such as plastic and is provided with an internal diameter which allows it to be sleeved tightly over the tube 26. For furtlier en}rancirig the connecLion, the adapter 27 is provided witli an internal annular flange 31 which is adapted to seat in an accommodating annular groove 32 from externally about the surface of the tube 26, tliereby locking the adapter 27 to the tube 26.
At its otlier end, the inner wall of the adapter 27 is fornied with a succession of outwardly diverging frusto-conical grooved surfaces 34 wliich provide teeth-like edges for enhancing its grip on the endoscope when sleeved over the end thereof. In addition, it is provided with an WO 95/34244 PC'T/US95/01305 internal annular latchiiig flange 36 which is adapted to seat in a latcliing groove 37 formed about the exterior of the endoscope.
The inner wall of outer tube 26 is formed with a lielical groove 40 which extends from its distal end for the greater part of its lengt-li. Near its attacliing end, the inner wall of outer tube 26 is formed with an internal annular flange 41.
The inner tubular member 25 has a forward end 42 and a rearward erid 43 and comprises a first elongate section 44 and an adjoining shorter section 45 of circular cylinder configuration and larger radial dimensions. Tl-e tubular u-ember 25 llas an external annular shoulder 46 formea at the jiinction of the elongate tubular section 44 with the larger diameter section 45. The tubular member 25 is also provided an i,iternal annular radial slioulder 47, wliich is forined at the juriction of the bore of section 45 with the smaller bore of the elongate section 44.
Ttie elongate section 44 lias a radial cross section in the configuration of a segntented circle and an external cylindrical surface characterized by an elongate planar surface section 48 which exteiids froin the forward end 42 of ttie tubular member 25 to the radial shoulder 46.
The inner tubular member 25 serves as a carrier for a plurality of elastic ligating rings 50 wliich are placed in stretclied coridition about the elongate section 44 and mounted thereon in side-by-side relation to one another and in sleeved relation to the section 44. Z'he elastic rings 50 are typically of rubber rnaterial or an inert non-toxic plastic composition.
The tubular mernber 25 is also provided with a circular plarietary gear 52 wliicli is seated in the bore of the circular section 45 in the coaxial reaction therewith. The gear 52 may be fabricated as an integral part of the tubular meniber 25 or it could be separately formed and bonded to the radial shoulder 47 and the inner cylindrical wall of circular WO 95/34244 PCT/US95/iso5 section 45 by an appropriate adhesive although other fastening means could also be used. An opening 49 is also provided in the radial shoulcler 47 to insure full communication of the interiors of the tubular members 25 and 26 with the suction channel 18.
When completely assembled as shown in FIG. 3, the gear teeth of planetary gear 52 are in meshing engagement with a drive gear 53 which is mounted by a connecting adapter 54 on the enc] of a flexible steel cable 55, preferably a single wire, which is inserted through the working clianriel 19 of the eridoscope. The cable 55 extends through the working channel section 19a where it is fitted with a rotary control mearis sucli as knob 56 for manually effecting axial rotation of the cable 55.
The adapter 54 cotnprises a shaf t 57 enlarged at one erid which is provided with a socket 58 characterized by a socket cavity of rectangular transverse cross-section which receives the squared erid of the cable 55. At its otlier end, the shaf t 57 is journaled for rotation on a transverse support 60 fitted internally of tube 25. Ttie shaft 57 is also fitted with a drive gear 53 which is fixed on the shaft 57 in coaxial relation thereL-o by a press fit or any suitable bonding means. Also sleeved about the shaft 57 is a plastic spacer 59 which is in abutting engagement with the drive gear 53 and one end of the socket 58.
Also sliown in FIG. 3, a retaining riilg 61 is also fitted irrto the end of the inner tubular nieiiiber 25 in coaxial relation therewith and in abutting engagement with both ttie rearward end of the tubular member 25 and the planetary gear 52. The retaining ring 61 is provided in its outer surface with a circumferential groove 62 whicli receives the annular flange 41 of the tubular member 25 and latches the retaining iing 61 iri position.
In assembly of the instrurnent 10 of tlie elastic ligatiiig rings 50 must be placed onto tlie inner tubular mernber 25 before it is inserted in the outer tubular member 26. This is also done before the i.ubular members 25, 26 are fitted onto the endoscope. The elastic ligating rings 50, when iri the relaxed state are of a diameter less than that of the inserLion end of the endoscope, wliicli for representative endoscopes, is in the range of approximately 9mm to 13mm.
The rings 50 are placed in stretched condition onto the elongate section 44 of the tubular member 25 in side-by-side relation to one another and in sleeved relation to the section 44. The tubular member 25 is then inserted with an axially twisting motion tlirough the attaching end of the otiter tubular meniber 26 whereby each elastic ring, except for the portion thereof which rests atop the planar surface of the inner tubular member 25, is placed in a coil of the helical groove 40 in spaced relation to the adjacent elastic ring in the next adjacent coil of the helical groove.
The tubular assembly, coniprising tubular member 25 and 26 witli tubular adapter 27 secured to the member 26, is then sleeved onto the insertion end of the endoscope such that the planetary gear 52 and drive gear 53 are in meshed driving engagement witli orie another and the attaching end of the tubular member 26 abuts the insertion end of the endoscope.
When treating a paL-ient, the endoscopic instrument of the inverltion is first iiiserted into the affected orgarr, such as the alimentary tract, to place the insertion end of the endoscope in the vicinity of lesions in the alimentary tract. In some iilstances, liowever, it rnay be preferred that insertioii of the instrurnent be preceded by the insertion of an encloscopic overtube (not shown) into the alimentary tract atid the instrumerit then be inserted through the overtube. In either case, the instrument is then oriented for sighting of a target lesion, such as lesion 77 shown in FIG. 7, and the instrument advanced tiiider the control of a liuman operator until the distal end of the tubular rnember 25 contacts the lesion area and is placed in surrounding relation to the target lesion.
WO 95134244 PCTlUS95/01305 A suction force is Llien applied through the suction chazinel 18 to conrpletely draw the lesion tissue into the inner tubular meinber 25 as shown in FIG. 7. The operator then manually initiaLes axial rotation of the cable 55 and the inner tubular member 25 in the spirally forward direction of the helical groove 40 whereby the elastic rings 50 are driven along Llie surface of the tubular merrrber 25 by the walls of the helical groove 40 until one of the elastic ririgs is dislodged from ttie instrurnent and placed in ligating relation about Llie base of Llie target lesion as shown in FIG.
8. Tlte end of the instrunient 10 is then withdrawn from around the lesion tissue, as shown in FIG. 9.
It is to be appreciated that by continuing the axial rotation of the tubular rrteniber 25, more of the elastic rings can be dislodged from the instrurnent. Accordingly, the enc7oscopic iristrument of the invention permits the successive ligation of rnult=iple lesions during a single insertion of the instrurnent. With patienL-s who are not bleeding, the ligation treatrnent is started at the niost distal point in the aliiiientary tract and then continued proxirnally so that elastic bands wliich are placed about the lesioii tissue are not disturbed by movement of the instrument. The instrument ttierefore facilitates the treatment of multiple lesions and alleviates the need for repeated removal and reinsertion of the instrument and reloading of an elastic ring for treating each lesion.
In sorne instances, particularly where vision is oLscured, the instrument operator may liave diffictilty in ascertaining the precise amouiit of rotation of the flexible cable 55 tliat is iiecessary for dislodging one and only one elastic ring 50 when ligating a single target lesioii. In this respect, a rnodified form of Llie inveriLion, which enables the axial rotation of the cable 55 in steps of precise amounts, is represented by ttie endoscopic instrurnent 7U as shown in scliematic form in FIG. 10. The instrument 70 is ideiitical in WO 9S/34244 PCT![JS95/01305 all respects to the irrstrumenl 10 except for the means of iinparting axial rotation to the flexible cable 55 and identical components are identically numbered. in lieu of a knob 56 which enables the manual rotation of the cable 55, the instrument 70 is provided with automatic means represented by a stepping motor 72 and a controller 74 for rotation of the cable 55 in precisely controlled amounts.
The controller 74 and inotor 72 are connected to receive power from ari electrical power source 76. A foot pedal triyger switclr 75 is used by tlre operator to energize the steppiny motor 72 for a precise time interval during which time the flexible cable 55 is axially rotated by an amourit which moves the elastic rings a precise distance along the tubular rnember 25 such that the most distal elastic ring 50 is forced off the end of the tubular niember 25 and the remainirig ring 50 is forced off ttie end of the tubular niember 25 and the remaining rings 50 are retained thereon. In effect, the precise time interval of motor operation moves the elastic rings a distance wtiich corresponds to the distance between adjacent coils of the helical groove 40.
It is to be appreciated therefore that the endoscopic instrument 70 provides tlre operator with means for precisely controlling wtieri an elastic ring 50 is dislodged from the instrument and for insuring that oiily one elastic ring is dislodge when ligating a target lesion. It is therefore possible for the operator to dislodged additiorral elastic rings in sequence and at tiines controlled by the operator so tlrat multiple lesions can be ligated during a single insertion of the instrument.
A further embodiment of the invention represented by the eridoscopic instrument 80 is disclosed in FIGS. 11-15. The endoscopic instrument 80 differs from t.tie instruments 10 and 70 in the nature and operation of the tubular assembly which is affixed to the irisertion end of ttie endoscope, but is otlierwise iderrtical thereto. As si-iown in FIG. 11, a rigid vVO 95/34244 PCT/US95/013ft tube 81 is fixed in coaxial relation to the insertion encl of the endoscope, preferably by a sleeve adapter 82. A tubular textile rneniber 83 of an inelastic material, such as the conunercial product Kevlar or other inelastic flexible material, is mounted onto the rigid tube 81 such that the member 83 is folded over the distal end of the tube 81 with a first portion 83a thereof being sleeved over the tube 81 and a second portion 83b thereof disposed internally of the tube 81 and substantially coaxial thereto.
As sliown in FIG. 11, a plurality of elasl:ic ligating rings 50a are placed in stretched condition in encircling relation about the portion 83a of the tubular mernber 83. The textile material of portion 83a is provided with an external surface 1-iaving a plurality of annular ridges 84 in the encirclirrg r.elation thereto and preferably arranged in pairs wiricly define a plurality of urriforrnly spaced annular recesses or grooves 85, each of whiclr is adapted to receive an elastic ring 50a ttierein. The elastic rings 50a are therefore maintained in uniform side-by-side spacing on the tubular portion 83a.
The end of the second portion 83b of the textile tubular member 83 is fitted with a rigid aiiiiular ring clamping assembly 86 to which the textile fabric of the tubular meniber 83 is attached. The clamping assernbly 86 comprises an outer retaining ring 86a and an inner clamping ring 86b whicli is of a smaller external diarneter tlrarr the internal diarneter of the outer ring 86a and is irisertable therein from the distal end of the t-ube 81 to clamp tlie portion 83b of the textile tubular member 83 tlrerebetween. Preferably, the inner wall of the outer ring 86a is forrned with an annular coaxial groove 87 and the outer wall of the inner ring 86b is formed with an annular ridge 88 of conforrrring configuration and location such as to serve in retaining the textile mernber 83 therebetween. The outer ring 86a is also provided with at least tliree cenL-ering protuberances 90 wliich are in uniforrn WO 95/34244 ( PCT/US95/01305 angular spacing and serve to maintain the ring 86a in coaxial relation to the tube 81 and in a tight friction fit therein.
As best seen in FIG. 11, the adapter 82 is sleeved over an annular bevel surface 89 oiz the attaching end of the tube 81 and is provided with an internal annular flange 91 which latches in an anriular groove 92 formed about the external surface of the rigid tube 81. At its other end, the adapter is designed for a press fit connection with the insertion end oi ttie endoscope as provided for the adapter 27 in the embodimerit of FIG. 1 or could be provided with threads, if desired.
A flexible cable 55a, similar to the cable 55 sliown in the embodiment of FIG. 1, and similarly tlireaded througli the working channel of the endoscope is attached to an internal flange 93 on the inner wall of the clainping ring 86b. As best seeri iri FIGS. 11 and 12, one end of the cable 55a is placed in an axial blind bore formed inwardly from one end of a sleeve inernber 94 wlriclr is swayed in engagement tlierewith.
The sleeve member 94 which is externally tllreaded at its other end, is inserted through an opening in the flange 93 and secured by a nut 95 on its threaded end. It is thus to be seen that by a pull on the cable 55a to the right as sliown in FIG. 11, the portion 83b of textile tubular nieniber 83 which is ir_terior of the rigid tube 81 is increased and the portion 83a whicli is exterior of the tube 81 is decreased.
The relative movernent of the flexible tube 83 with respect to the rigid tube 81 is illustrated by arrows in FIG
13 whicli show the textile tubular meiuber 83 sliding over the distal errd of the tube 81. As this movenient increases, the most distal of the elastic ligating rings 50a passes over the distal etid of the tube 81 and is discharged ttierefrarn. When the assen-bly of tubes 81, 83 are placed in surrounding relation to a target lesion, and lesion tissue is drawn into tlre tube 83 by suction iri a inanner as previously described, it is to be appreciated that ligation of a lesion as shown in FIG. 9 can be readily acliieved.
It is irnportanL that only a single ligat-irig ring 50a be discharged frorn the instrument 80 for treating each lesion and the movemerit of the cable 50a must be determined accordingly. AFter treating one lesion, the instrument can be reoriented in surroiinding relation to another lesion and the proceclure repeated. Accordingly, multiple lesions can be ligated during a single insertion of the instrument. For most applications, the instrument shotild be provided with at least six elastic rings 50a.
In FIG. 15, the cable 55a is shown attached to a reel 96 whereby an indexed rotatioii thereof is designed to move the cable 55a a predeterniined distance to cause the discharge of only a single ligating ring 50a. Obviously, the inovemerit --could be coritrolled manually or other techniques eiiiployed for controlling a precise axial movement of the cable 55a.
A variation in the arrangement of ridges 84 on the external surface of the textile tubular member 83 is shown in FIG. 14. In this modified form of the member 83, only a single ridge 84 is used for aligning the elastic rizigs 50a in uniform spacing ori the member 83. The rings 50a are installed wliereby each is in abutting engagement with the side of a ridge 84 which faces toward the distal end of the tubular assembly so as to preveiit their being moved or disturbed as tlie instriimerit is inserted into a body organ.
It is to be noled tliat iii tlie einbodiment of ttie invention disclosed in FIGS. 11-15, the force required to pull the sleeve inember 83 over the distal end of the tube 81 iilcreases proportionately witli the number of elastic rings, such that a strong aricl sturdy construction must be used for the parts mounted on ttre insertion end of the endoscope and the coinponent parl-s for imparting sliding movement beL-weer- tlie sleeve 83 and the tube 81 and for a precise ainouiit of slidlSlg to ensure that orily orie ring is dislodged at a time. The force to dislodge the first riiig, which must be strong enough i ~.
Referring more particularly to the drawings, there is shown in FIG. 1 a flexible endoscopic instrument 10 of a lengtli which perniits access to the deeper regions of a hollow body organ, such as the alimentary tract. The instrument 10 comprises a conventional endoscope with an operating controls section 11 of rigid coristructioii and a flexible sectiori 12 wliich extends therefrom and is a length sufficient to reach the deeper regions of the alimentary tract. The distal end of the flexible sectiozr 12 is the iiisertion end 13 of the endoscope and the viewing end 14 of the endoscope is at the erid of the rigid operating controls section 11 remote from the end tlsereof which connects to the flexible section 12.
Ttie endoscope is provided with passages 16-21 which extend longitudinally therein from its insertion end 13 to exit ports near the viewing end of ttie endoscope. The passages comprise an illumiriation channel 16 through which is inserted a fiber optic cable for the transmission of light from a light source, a viewing channel 17 whicli is also provided with a fiber optic cable for viewing purposes, and a channel through which objects may be passed or suction applied 18. The illuniiriation channel and suction channel exit laterally througli a lateral extension 22 of tiie side wall of the endoscope at a location on the operating controls section 11 near the viewing end 14. At their exit location, the fiber optic cable f-rom channel 16 and the channel 18 are connectable through an.umbilical cable 23 to a control device (riot shown) wliicli is adaptable for supplying illumination to ttie transinission optic cable and for connecting the channel 18 to an appropriate means for applying a suction therelhrougli. The fiber optic viewing channel 17 extends to the viewing ericl 14 of the eric]oscope which may lie p.iovidecl witti a viewing lens aiid an adapter for mounting a caniera tliereon, if desired.
WO 95/34244 PCT/US95/0f.' J' The endoscope is also provided with a working channel 19 which extends througli the endoscope from its inserl=ion end 11 to an exit in the lateral extension 22. The working cliannel 19 includes a branch 19a which extends i:lirough an angularly exteiiding protuberance 24 to a second exit near the viewing end of the endoscope.
Additional channels 20 ancl 21, shown in FIG. 2, may be utilized for delivering pressurized air or a jet stream of water for cleanirig the lens.
In the ecubodiment of the iriverition sliown in FIGS. 1-6, the insertion end of the ericioscope is fitted with an assembly of coaxially arranged tubes 25, 26, the outer tube 26 of wLich is secured in coaxial relation thereto preferably by a tubular adapter 27 which provides a friction fit as shown in FIG. 3 although other fastening means such as a threaded connection niiglit be suitably employed. The tube 26 is preferably of transparent plastic material for enhancing the illumination and field of vision from the insertion end of the endoscope, altliougli otlier inert material miglit also be suitable includirig stainless steel. The tube 26 is provided at its attaching end with an external frusto-conical bevel surface 28 to facilitate the placement of the tubular adapter 27 thereover. The adapter 27 is preferably of a flexible material such as plastic and is provided with an internal diameter which allows it to be sleeved tightly over the tube 26. For furtlier en}rancirig the connecLion, the adapter 27 is provided witli an internal annular flange 31 which is adapted to seat in an accommodating annular groove 32 from externally about the surface of the tube 26, tliereby locking the adapter 27 to the tube 26.
At its otlier end, the inner wall of the adapter 27 is fornied with a succession of outwardly diverging frusto-conical grooved surfaces 34 wliich provide teeth-like edges for enhancing its grip on the endoscope when sleeved over the end thereof. In addition, it is provided with an WO 95/34244 PC'T/US95/01305 internal annular latchiiig flange 36 which is adapted to seat in a latcliing groove 37 formed about the exterior of the endoscope.
The inner wall of outer tube 26 is formed with a lielical groove 40 which extends from its distal end for the greater part of its lengt-li. Near its attacliing end, the inner wall of outer tube 26 is formed with an internal annular flange 41.
The inner tubular member 25 has a forward end 42 and a rearward erid 43 and comprises a first elongate section 44 and an adjoining shorter section 45 of circular cylinder configuration and larger radial dimensions. Tl-e tubular u-ember 25 llas an external annular shoulder 46 formea at the jiinction of the elongate tubular section 44 with the larger diameter section 45. The tubular member 25 is also provided an i,iternal annular radial slioulder 47, wliich is forined at the juriction of the bore of section 45 with the smaller bore of the elongate section 44.
Ttie elongate section 44 lias a radial cross section in the configuration of a segntented circle and an external cylindrical surface characterized by an elongate planar surface section 48 which exteiids froin the forward end 42 of ttie tubular member 25 to the radial shoulder 46.
The inner tubular member 25 serves as a carrier for a plurality of elastic ligating rings 50 wliich are placed in stretclied coridition about the elongate section 44 and mounted thereon in side-by-side relation to one another and in sleeved relation to the section 44. Z'he elastic rings 50 are typically of rubber rnaterial or an inert non-toxic plastic composition.
The tubular mernber 25 is also provided with a circular plarietary gear 52 wliicli is seated in the bore of the circular section 45 in the coaxial reaction therewith. The gear 52 may be fabricated as an integral part of the tubular meniber 25 or it could be separately formed and bonded to the radial shoulder 47 and the inner cylindrical wall of circular WO 95/34244 PCT/US95/iso5 section 45 by an appropriate adhesive although other fastening means could also be used. An opening 49 is also provided in the radial shoulcler 47 to insure full communication of the interiors of the tubular members 25 and 26 with the suction channel 18.
When completely assembled as shown in FIG. 3, the gear teeth of planetary gear 52 are in meshing engagement with a drive gear 53 which is mounted by a connecting adapter 54 on the enc] of a flexible steel cable 55, preferably a single wire, which is inserted through the working clianriel 19 of the eridoscope. The cable 55 extends through the working channel section 19a where it is fitted with a rotary control mearis sucli as knob 56 for manually effecting axial rotation of the cable 55.
The adapter 54 cotnprises a shaf t 57 enlarged at one erid which is provided with a socket 58 characterized by a socket cavity of rectangular transverse cross-section which receives the squared erid of the cable 55. At its otlier end, the shaf t 57 is journaled for rotation on a transverse support 60 fitted internally of tube 25. Ttie shaft 57 is also fitted with a drive gear 53 which is fixed on the shaft 57 in coaxial relation thereL-o by a press fit or any suitable bonding means. Also sleeved about the shaft 57 is a plastic spacer 59 which is in abutting engagement with the drive gear 53 and one end of the socket 58.
Also sliown in FIG. 3, a retaining riilg 61 is also fitted irrto the end of the inner tubular nieiiiber 25 in coaxial relation therewith and in abutting engagement with both ttie rearward end of the tubular member 25 and the planetary gear 52. The retaining ring 61 is provided in its outer surface with a circumferential groove 62 whicli receives the annular flange 41 of the tubular member 25 and latches the retaining iing 61 iri position.
In assembly of the instrurnent 10 of tlie elastic ligatiiig rings 50 must be placed onto tlie inner tubular mernber 25 before it is inserted in the outer tubular member 26. This is also done before the i.ubular members 25, 26 are fitted onto the endoscope. The elastic ligating rings 50, when iri the relaxed state are of a diameter less than that of the inserLion end of the endoscope, wliicli for representative endoscopes, is in the range of approximately 9mm to 13mm.
The rings 50 are placed in stretched condition onto the elongate section 44 of the tubular member 25 in side-by-side relation to one another and in sleeved relation to the section 44. The tubular member 25 is then inserted with an axially twisting motion tlirough the attaching end of the otiter tubular meniber 26 whereby each elastic ring, except for the portion thereof which rests atop the planar surface of the inner tubular member 25, is placed in a coil of the helical groove 40 in spaced relation to the adjacent elastic ring in the next adjacent coil of the helical groove.
The tubular assembly, coniprising tubular member 25 and 26 witli tubular adapter 27 secured to the member 26, is then sleeved onto the insertion end of the endoscope such that the planetary gear 52 and drive gear 53 are in meshed driving engagement witli orie another and the attaching end of the tubular member 26 abuts the insertion end of the endoscope.
When treating a paL-ient, the endoscopic instrument of the inverltion is first iiiserted into the affected orgarr, such as the alimentary tract, to place the insertion end of the endoscope in the vicinity of lesions in the alimentary tract. In some iilstances, liowever, it rnay be preferred that insertioii of the instrurnent be preceded by the insertion of an encloscopic overtube (not shown) into the alimentary tract atid the instrumerit then be inserted through the overtube. In either case, the instrument is then oriented for sighting of a target lesion, such as lesion 77 shown in FIG. 7, and the instrument advanced tiiider the control of a liuman operator until the distal end of the tubular rnember 25 contacts the lesion area and is placed in surrounding relation to the target lesion.
WO 95134244 PCTlUS95/01305 A suction force is Llien applied through the suction chazinel 18 to conrpletely draw the lesion tissue into the inner tubular meinber 25 as shown in FIG. 7. The operator then manually initiaLes axial rotation of the cable 55 and the inner tubular member 25 in the spirally forward direction of the helical groove 40 whereby the elastic rings 50 are driven along Llie surface of the tubular merrrber 25 by the walls of the helical groove 40 until one of the elastic ririgs is dislodged from ttie instrurnent and placed in ligating relation about Llie base of Llie target lesion as shown in FIG.
8. Tlte end of the instrunient 10 is then withdrawn from around the lesion tissue, as shown in FIG. 9.
It is to be appreciated that by continuing the axial rotation of the tubular rrteniber 25, more of the elastic rings can be dislodged from the instrurnent. Accordingly, the enc7oscopic iristrument of the invention permits the successive ligation of rnult=iple lesions during a single insertion of the instrurnent. With patienL-s who are not bleeding, the ligation treatrnent is started at the niost distal point in the aliiiientary tract and then continued proxirnally so that elastic bands wliich are placed about the lesioii tissue are not disturbed by movement of the instrument. The instrument ttierefore facilitates the treatment of multiple lesions and alleviates the need for repeated removal and reinsertion of the instrument and reloading of an elastic ring for treating each lesion.
In sorne instances, particularly where vision is oLscured, the instrument operator may liave diffictilty in ascertaining the precise amouiit of rotation of the flexible cable 55 tliat is iiecessary for dislodging one and only one elastic ring 50 when ligating a single target lesioii. In this respect, a rnodified form of Llie inveriLion, which enables the axial rotation of the cable 55 in steps of precise amounts, is represented by ttie endoscopic instrurnent 7U as shown in scliematic form in FIG. 10. The instrument 70 is ideiitical in WO 9S/34244 PCT![JS95/01305 all respects to the irrstrumenl 10 except for the means of iinparting axial rotation to the flexible cable 55 and identical components are identically numbered. in lieu of a knob 56 which enables the manual rotation of the cable 55, the instrument 70 is provided with automatic means represented by a stepping motor 72 and a controller 74 for rotation of the cable 55 in precisely controlled amounts.
The controller 74 and inotor 72 are connected to receive power from ari electrical power source 76. A foot pedal triyger switclr 75 is used by tlre operator to energize the steppiny motor 72 for a precise time interval during which time the flexible cable 55 is axially rotated by an amourit which moves the elastic rings a precise distance along the tubular rnember 25 such that the most distal elastic ring 50 is forced off the end of the tubular niember 25 and the remainirig ring 50 is forced off ttie end of the tubular niember 25 and the remaining rings 50 are retained thereon. In effect, the precise time interval of motor operation moves the elastic rings a distance wtiich corresponds to the distance between adjacent coils of the helical groove 40.
It is to be appreciated therefore that the endoscopic instrument 70 provides tlre operator with means for precisely controlling wtieri an elastic ring 50 is dislodged from the instrument and for insuring that oiily one elastic ring is dislodge when ligating a target lesion. It is therefore possible for the operator to dislodged additiorral elastic rings in sequence and at tiines controlled by the operator so tlrat multiple lesions can be ligated during a single insertion of the instrument.
A further embodiment of the invention represented by the eridoscopic instrument 80 is disclosed in FIGS. 11-15. The endoscopic instrument 80 differs from t.tie instruments 10 and 70 in the nature and operation of the tubular assembly which is affixed to the irisertion end of ttie endoscope, but is otlierwise iderrtical thereto. As si-iown in FIG. 11, a rigid vVO 95/34244 PCT/US95/013ft tube 81 is fixed in coaxial relation to the insertion encl of the endoscope, preferably by a sleeve adapter 82. A tubular textile rneniber 83 of an inelastic material, such as the conunercial product Kevlar or other inelastic flexible material, is mounted onto the rigid tube 81 such that the member 83 is folded over the distal end of the tube 81 with a first portion 83a thereof being sleeved over the tube 81 and a second portion 83b thereof disposed internally of the tube 81 and substantially coaxial thereto.
As sliown in FIG. 11, a plurality of elasl:ic ligating rings 50a are placed in stretched condition in encircling relation about the portion 83a of the tubular mernber 83. The textile material of portion 83a is provided with an external surface 1-iaving a plurality of annular ridges 84 in the encirclirrg r.elation thereto and preferably arranged in pairs wiricly define a plurality of urriforrnly spaced annular recesses or grooves 85, each of whiclr is adapted to receive an elastic ring 50a ttierein. The elastic rings 50a are therefore maintained in uniform side-by-side spacing on the tubular portion 83a.
The end of the second portion 83b of the textile tubular member 83 is fitted with a rigid aiiiiular ring clamping assembly 86 to which the textile fabric of the tubular meniber 83 is attached. The clamping assernbly 86 comprises an outer retaining ring 86a and an inner clamping ring 86b whicli is of a smaller external diarneter tlrarr the internal diarneter of the outer ring 86a and is irisertable therein from the distal end of the t-ube 81 to clamp tlie portion 83b of the textile tubular member 83 tlrerebetween. Preferably, the inner wall of the outer ring 86a is forrned with an annular coaxial groove 87 and the outer wall of the inner ring 86b is formed with an annular ridge 88 of conforrrring configuration and location such as to serve in retaining the textile mernber 83 therebetween. The outer ring 86a is also provided with at least tliree cenL-ering protuberances 90 wliich are in uniforrn WO 95/34244 ( PCT/US95/01305 angular spacing and serve to maintain the ring 86a in coaxial relation to the tube 81 and in a tight friction fit therein.
As best seen in FIG. 11, the adapter 82 is sleeved over an annular bevel surface 89 oiz the attaching end of the tube 81 and is provided with an internal annular flange 91 which latches in an anriular groove 92 formed about the external surface of the rigid tube 81. At its other end, the adapter is designed for a press fit connection with the insertion end oi ttie endoscope as provided for the adapter 27 in the embodimerit of FIG. 1 or could be provided with threads, if desired.
A flexible cable 55a, similar to the cable 55 sliown in the embodiment of FIG. 1, and similarly tlireaded througli the working channel of the endoscope is attached to an internal flange 93 on the inner wall of the clainping ring 86b. As best seeri iri FIGS. 11 and 12, one end of the cable 55a is placed in an axial blind bore formed inwardly from one end of a sleeve inernber 94 wlriclr is swayed in engagement tlierewith.
The sleeve member 94 which is externally tllreaded at its other end, is inserted through an opening in the flange 93 and secured by a nut 95 on its threaded end. It is thus to be seen that by a pull on the cable 55a to the right as sliown in FIG. 11, the portion 83b of textile tubular nieniber 83 which is ir_terior of the rigid tube 81 is increased and the portion 83a whicli is exterior of the tube 81 is decreased.
The relative movernent of the flexible tube 83 with respect to the rigid tube 81 is illustrated by arrows in FIG
13 whicli show the textile tubular meiuber 83 sliding over the distal errd of the tube 81. As this movenient increases, the most distal of the elastic ligating rings 50a passes over the distal etid of the tube 81 and is discharged ttierefrarn. When the assen-bly of tubes 81, 83 are placed in surrounding relation to a target lesion, and lesion tissue is drawn into tlre tube 83 by suction iri a inanner as previously described, it is to be appreciated that ligation of a lesion as shown in FIG. 9 can be readily acliieved.
It is irnportanL that only a single ligat-irig ring 50a be discharged frorn the instrument 80 for treating each lesion and the movemerit of the cable 50a must be determined accordingly. AFter treating one lesion, the instrument can be reoriented in surroiinding relation to another lesion and the proceclure repeated. Accordingly, multiple lesions can be ligated during a single insertion of the instrument. For most applications, the instrument shotild be provided with at least six elastic rings 50a.
In FIG. 15, the cable 55a is shown attached to a reel 96 whereby an indexed rotatioii thereof is designed to move the cable 55a a predeterniined distance to cause the discharge of only a single ligating ring 50a. Obviously, the inovemerit --could be coritrolled manually or other techniques eiiiployed for controlling a precise axial movement of the cable 55a.
A variation in the arrangement of ridges 84 on the external surface of the textile tubular member 83 is shown in FIG. 14. In this modified form of the member 83, only a single ridge 84 is used for aligning the elastic rizigs 50a in uniform spacing ori the member 83. The rings 50a are installed wliereby each is in abutting engagement with the side of a ridge 84 which faces toward the distal end of the tubular assembly so as to preveiit their being moved or disturbed as tlie instriimerit is inserted into a body organ.
It is to be noled tliat iii tlie einbodiment of ttie invention disclosed in FIGS. 11-15, the force required to pull the sleeve inember 83 over the distal end of the tube 81 iilcreases proportionately witli the number of elastic rings, such that a strong aricl sturdy construction must be used for the parts mounted on ttre insertion end of the endoscope and the coinponent parl-s for imparting sliding movement beL-weer- tlie sleeve 83 and the tube 81 and for a precise ainouiit of slidlSlg to ensure that orily orie ring is dislodged at a time. The force to dislodge the first riiig, which must be strong enough i ~.
-to pull the sleeve and all the elastic rings towards the distal end of the tube, is considerably greater than the force required to dislodge the last remaining elastic ring from the tube.
A third embodimerit of the invention represerited by the endoscopic instrument 100 disclosed iri FIGS. 16-19 requires a pulliilg force to dislodge an elastic ring which is comparable to that required for dislodging the last ring of the sleeve version disclosed in FIGS. 11-15. As best seen in FIG. 16, a transparent rigid tube 101 is fitted to the insertion end of the endoscope 100 by an adapter section 102 whicli provides a friction fit witli the iiisertiozi end of the endoscope. The endoscope 100 is provided with a plurality of flexible and substantially in elastic cords 103, each of which is folded over the distal end of tiie tube 101 and includes a first portion which is laid over the exterior surface of the tube and a secorid portion wliich is disposed iiiternally of the tube. The ends of the cords 103 iiiside the tube are fastened to oiie end of a flexible line 105 as by tying thereto or the use of an adapter connector 106. From its connection with cords 103, the flexible line 105 is threaded through the working channel 19 of the endoscope and exits near the rearward end of the endoscope sucli that L-he exiting end portion of the line 105 may be fitted witti a handle.
As best seen in FIG. 17, the cords 103 are disposed in preferably uniforin angular spacing about the longitudinal axis 107 of the tube 101. A plurality of elastic ligating rings 50 are=each placed in stretclied condition in sleeved relationship about the tube 101 and in overlying relation to the plurality of cords 103 to thereby hold the cords against the tube 101.
It is to be noted in FIGS. 16, 18 and 20 LhaL the rings 50 are spaced from one another in the longitudinal direction of the tubular meniber at successingly greater distances from L-he distal end 108. Each cord 103 is also provided witli a t . .
.#10 95/34244 PCTIUS95/01303' - 20 -series of longitudinally spaced knots 109 agaiilst eacli of which an elastic ring 50 is placed on the forward side of the knot. A means for iinparting sliding motion betweeri said cords and the tubular member is provided by the flexible line element 105 by which because of its connection to the ends of the words 103 williin the tubular member 101, a pulliilg force niay be exerted at its outer end to cause sliding movement between the cords and the tubular member so as to dislodge eacli of the elastic rings in desirably controlled sequence.
When tiie pull is applied, a knot 109 acts as a shoulder which precludes relative movement between the elastic ring and the cord until the ring is dislodged at the distal end of the tubular member.
As is best shown in FIG. 16, each cord 103 inclucles a seginenL- of cord between eacli pair of adjacent elastic rings wliich his in slack condition and of a length which is equal to the distance between said pair plus ttie distance from the distal end of the tube 101 to the ring of the pair whicli is riearest the distal end 108. It will therefore be seen ttiat when the cords are pulled a ciistarice which moves ttie forward ring of the pair to the distal end of the tube and off the tube, the slack lengt-li of cord suffices to preclude any movement of the remaining elastic rings. lt is therefore to be noted that the required pulling force to dislodge a ring is L-l-iat wliicli is necessary to move a single ring and the required force does not increase as additional rings are dislodged.
After tiie cords 103 aiid elastic rings 50 have been loaded on the rigid tube 101 and positioned thereon as shown in FIG.
16 and 18, it may be a desirable option to place a flexible sleeve of plastic or a Lextile niaterial L-o fit loosely over Ltie cords 103 and llie tube 101. Suci- a sleeve, wlien attaclied at one end to the flexible sectiozi 12 of the endoscope and extendirig over the cords 103 and elastic rings 50 to approximately ttie distal eirci of the tube 101, would serve to protect against "sriagging" of the slack segments or loop of cords beLween Lhe ririgs when the endoscope is in use or prepared for use.
It is to be uriderstood that the foregoing descriptions of a preferred embodiment of the itivention has been preserited for purposes of illustration and explanation and are not intended to limit the invention to the precise forms disclosed. For example, a motor coiitrol could be provided for controlling the movement of the cable 55a in precise steps. Also, the riurnber of elastic ligating rings 50 or 50a could be greater or less Llian those illustrated lierein. In some instances the rings 50a cari be aligned on the textile tubular member 83 without ridges 84. It is to be appreciated therefore, that various material and structural changes may be macle by those skilled in ttie art without departing from the spirit of the invention.
A third embodimerit of the invention represerited by the endoscopic instrument 100 disclosed iri FIGS. 16-19 requires a pulliilg force to dislodge an elastic ring which is comparable to that required for dislodging the last ring of the sleeve version disclosed in FIGS. 11-15. As best seen in FIG. 16, a transparent rigid tube 101 is fitted to the insertion end of the endoscope 100 by an adapter section 102 whicli provides a friction fit witli the iiisertiozi end of the endoscope. The endoscope 100 is provided with a plurality of flexible and substantially in elastic cords 103, each of which is folded over the distal end of tiie tube 101 and includes a first portion which is laid over the exterior surface of the tube and a secorid portion wliich is disposed iiiternally of the tube. The ends of the cords 103 iiiside the tube are fastened to oiie end of a flexible line 105 as by tying thereto or the use of an adapter connector 106. From its connection with cords 103, the flexible line 105 is threaded through the working channel 19 of the endoscope and exits near the rearward end of the endoscope sucli that L-he exiting end portion of the line 105 may be fitted witti a handle.
As best seen in FIG. 17, the cords 103 are disposed in preferably uniforin angular spacing about the longitudinal axis 107 of the tube 101. A plurality of elastic ligating rings 50 are=each placed in stretclied condition in sleeved relationship about the tube 101 and in overlying relation to the plurality of cords 103 to thereby hold the cords against the tube 101.
It is to be noted in FIGS. 16, 18 and 20 LhaL the rings 50 are spaced from one another in the longitudinal direction of the tubular meniber at successingly greater distances from L-he distal end 108. Each cord 103 is also provided witli a t . .
.#10 95/34244 PCTIUS95/01303' - 20 -series of longitudinally spaced knots 109 agaiilst eacli of which an elastic ring 50 is placed on the forward side of the knot. A means for iinparting sliding motion betweeri said cords and the tubular member is provided by the flexible line element 105 by which because of its connection to the ends of the words 103 williin the tubular member 101, a pulliilg force niay be exerted at its outer end to cause sliding movement between the cords and the tubular member so as to dislodge eacli of the elastic rings in desirably controlled sequence.
When tiie pull is applied, a knot 109 acts as a shoulder which precludes relative movement between the elastic ring and the cord until the ring is dislodged at the distal end of the tubular member.
As is best shown in FIG. 16, each cord 103 inclucles a seginenL- of cord between eacli pair of adjacent elastic rings wliich his in slack condition and of a length which is equal to the distance between said pair plus ttie distance from the distal end of the tube 101 to the ring of the pair whicli is riearest the distal end 108. It will therefore be seen ttiat when the cords are pulled a ciistarice which moves ttie forward ring of the pair to the distal end of the tube and off the tube, the slack lengt-li of cord suffices to preclude any movement of the remaining elastic rings. lt is therefore to be noted that the required pulling force to dislodge a ring is L-l-iat wliicli is necessary to move a single ring and the required force does not increase as additional rings are dislodged.
After tiie cords 103 aiid elastic rings 50 have been loaded on the rigid tube 101 and positioned thereon as shown in FIG.
16 and 18, it may be a desirable option to place a flexible sleeve of plastic or a Lextile niaterial L-o fit loosely over Ltie cords 103 and llie tube 101. Suci- a sleeve, wlien attaclied at one end to the flexible sectiozi 12 of the endoscope and extendirig over the cords 103 and elastic rings 50 to approximately ttie distal eirci of the tube 101, would serve to protect against "sriagging" of the slack segments or loop of cords beLween Lhe ririgs when the endoscope is in use or prepared for use.
It is to be uriderstood that the foregoing descriptions of a preferred embodiment of the itivention has been preserited for purposes of illustration and explanation and are not intended to limit the invention to the precise forms disclosed. For example, a motor coiitrol could be provided for controlling the movement of the cable 55a in precise steps. Also, the riurnber of elastic ligating rings 50 or 50a could be greater or less Llian those illustrated lierein. In some instances the rings 50a cari be aligned on the textile tubular member 83 without ridges 84. It is to be appreciated therefore, that various material and structural changes may be macle by those skilled in ttie art without departing from the spirit of the invention.
Claims (6)
1. An endoscopic ligating apparatus, comprising:
a hollow barrel defining a barrel proximal end, a barrel distal end, a hollow interior and an outer surface;
at least one elastic ligating band stretched around said barrel outer surface; and at least one piece of flexible material having a material proximal end and a material distal end, said at least one piece of flexible material extending through said hollow interior, folding over said barrel distal end, and lying between at least a portion of said at least one ligating band and said outer surface;
wherein pulling said material proximal end in a proximal direction is operative to pull said material distal end toward said barrel distal end, thereby pulling said at least one ligating band off of said barrel distal end.
a hollow barrel defining a barrel proximal end, a barrel distal end, a hollow interior and an outer surface;
at least one elastic ligating band stretched around said barrel outer surface; and at least one piece of flexible material having a material proximal end and a material distal end, said at least one piece of flexible material extending through said hollow interior, folding over said barrel distal end, and lying between at least a portion of said at least one ligating band and said outer surface;
wherein pulling said material proximal end in a proximal direction is operative to pull said material distal end toward said barrel distal end, thereby pulling said at least one ligating band off of said barrel distal end.
2. An endoscopic ligating apparatus, comprising:
a hollow barrel defining a barrel proximal end, a barrel distal end, a hollow interior and an outer surface;
at least one elastic ligating band stretched around said barrel outer surface; and at least one piece of flexible material having a material proximal end and a material distal end, said at least one piece of flexible material extending through said hollow interior, folding over said barrel distal end, and lying between at least a portion of said at least one ligating band and said outer surface;
wherein pulling said material proximal end in a proximal direction is operative to pull said at least one ligating band off of said barrel distal end.
a hollow barrel defining a barrel proximal end, a barrel distal end, a hollow interior and an outer surface;
at least one elastic ligating band stretched around said barrel outer surface; and at least one piece of flexible material having a material proximal end and a material distal end, said at least one piece of flexible material extending through said hollow interior, folding over said barrel distal end, and lying between at least a portion of said at least one ligating band and said outer surface;
wherein pulling said material proximal end in a proximal direction is operative to pull said at least one ligating band off of said barrel distal end.
3. An endoscopic ligating apparatus for use with a flexible endoscope, said endoscope having an endoscope distal end, said endoscopic ligating apparatus comprising:
a hollow barrel defining a barrel proximal end, a barrel distal end, a hollow interior having an annular shoulder formed therein, and an outer surface;
at least one elastic ligating band stretched around said barrel outer surface; and at least one piece of flexible material having a material proximal end and a material distal end, said at least one piece of flexible material extending through said hollow interior, folding over said barrel distal end, and lying between at least a portion of said at least one ligating band and said outer surface;
wherein said hollow interior at said barrel proximal end is sized to mount over said endoscope distal end such that said endoscope distal end abuts said annular shoulder; and wherein pulling said material proximal end in a proximal direction is operative to pull said material distal end toward said barrel distal end, thereby pulling said at least one ligating band off of said barrel distal end.
a hollow barrel defining a barrel proximal end, a barrel distal end, a hollow interior having an annular shoulder formed therein, and an outer surface;
at least one elastic ligating band stretched around said barrel outer surface; and at least one piece of flexible material having a material proximal end and a material distal end, said at least one piece of flexible material extending through said hollow interior, folding over said barrel distal end, and lying between at least a portion of said at least one ligating band and said outer surface;
wherein said hollow interior at said barrel proximal end is sized to mount over said endoscope distal end such that said endoscope distal end abuts said annular shoulder; and wherein pulling said material proximal end in a proximal direction is operative to pull said material distal end toward said barrel distal end, thereby pulling said at least one ligating band off of said barrel distal end.
4. An endoscopic ligating apparatus, comprising:
a hollow barrel defining a barrel proximal end, a barrel distal end, a hollow interior having an annular shoulder formed therein, and an outer surface;
at least one elastic ligating band stretched around said barrel outer surface; and at least one piece of flexible material having a material proximal end and a material distal end, said at least one piece of flexible material extending through said hollow interior, folding over said barrel distal end, and lying between at least a portion of said at least one ligating band and said outer surface;
wherein said hollow interior at said barrel proximal end is sized to mount over said endoscope distal end such that said endoscope distal end abuts said annular shoulder; and wherein pulling said material proximal end in a proximal direction is operative to pull said at least one ligating band off of said barrel distal end.
a hollow barrel defining a barrel proximal end, a barrel distal end, a hollow interior having an annular shoulder formed therein, and an outer surface;
at least one elastic ligating band stretched around said barrel outer surface; and at least one piece of flexible material having a material proximal end and a material distal end, said at least one piece of flexible material extending through said hollow interior, folding over said barrel distal end, and lying between at least a portion of said at least one ligating band and said outer surface;
wherein said hollow interior at said barrel proximal end is sized to mount over said endoscope distal end such that said endoscope distal end abuts said annular shoulder; and wherein pulling said material proximal end in a proximal direction is operative to pull said at least one ligating band off of said barrel distal end.
5. An endoscopic ligating apparatus, comprising:
a support member defining a support member proximal end, a support member distal end, a hollow interior and an outer surface;
at least one elastic ligating band stretched around said support member outer surface; and at least one piece of flexible material having a material proximal end and a material distal end, said at least one piece of flexible material lying between at least a portion of said at least one ligating band and said outer surface, wherein pulling said material proximal end in a proximal direction is operative to pull said at least one ligating band distally off of said support member distal end.
a support member defining a support member proximal end, a support member distal end, a hollow interior and an outer surface;
at least one elastic ligating band stretched around said support member outer surface; and at least one piece of flexible material having a material proximal end and a material distal end, said at least one piece of flexible material lying between at least a portion of said at least one ligating band and said outer surface, wherein pulling said material proximal end in a proximal direction is operative to pull said at least one ligating band distally off of said support member distal end.
6. An endoscopic ligating apparatus for use with a flexible endoscope having an endoscope distal end, said endoscopic ligating apparatus comprising:
a support member defining a support member proximal end, a support member distal end, a hollow interior, and an outer surface;
at least one elastic ligating band stretched around said support member outer surface; and at least one piece of flexible material having a material proximal end and a material distal end, said at least one piece of flexible material lying between at least a portion of said at least one ligating band and said outer surface;
wherein said support member proximal end is adapted to contact a portion of said endoscope distal end;
and wherein pulling said at least one piece of flexible material is operative to pull said at least one ligating band distally off of said support member distal end.
a support member defining a support member proximal end, a support member distal end, a hollow interior, and an outer surface;
at least one elastic ligating band stretched around said support member outer surface; and at least one piece of flexible material having a material proximal end and a material distal end, said at least one piece of flexible material lying between at least a portion of said at least one ligating band and said outer surface;
wherein said support member proximal end is adapted to contact a portion of said endoscope distal end;
and wherein pulling said at least one piece of flexible material is operative to pull said at least one ligating band distally off of said support member distal end.
Applications Claiming Priority (3)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US08/260,380 | 1994-06-14 | ||
| US08/260,380 US5462559A (en) | 1993-02-23 | 1994-06-14 | Endoscopic ligating instrument |
| CA002192471A CA2192471C (en) | 1994-06-14 | 1995-01-31 | Endoscopic ligating instrument |
Related Parent Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA002192471A Division CA2192471C (en) | 1994-06-14 | 1995-01-31 | Endoscopic ligating instrument |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| CA2512905A1 CA2512905A1 (en) | 1995-12-21 |
| CA2512905C true CA2512905C (en) | 2008-10-07 |
Family
ID=35005629
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA002512905A Expired - Fee Related CA2512905C (en) | 1994-06-14 | 1995-01-31 | Endoscopic ligating instrument |
Country Status (1)
| Country | Link |
|---|---|
| CA (1) | CA2512905C (en) |
-
1995
- 1995-01-31 CA CA002512905A patent/CA2512905C/en not_active Expired - Fee Related
Also Published As
| Publication number | Publication date |
|---|---|
| CA2512905A1 (en) | 1995-12-21 |
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| EEER | Examination request | ||
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