CN114246539A

CN114246539A - Hand-held surgical endoscope

Info

Publication number: CN114246539A
Application number: CN202111328490.4A
Authority: CN
Inventors: 欧阳晓龙; 廷志宇; 王士平; 罗伯特·K·德克曼
Original assignee: Uroviu Corp
Current assignee: Uroviu Corp
Priority date: 2017-01-23
Filing date: 2018-01-23
Publication date: 2022-03-29
Also published as: CN110234265B; EP3570723A1; CN114271761A; CN114305290A; EP3570723A4; WO2018136950A1; CN110234265A

Abstract

A handheld surgical endoscope has a reusable portion and a disposable single-use portion including a fluid hub, a cannula, a distal tip, and an integrated, internally mounted needle that moves with a finger actuation tab between a retracted position and an extended position. The distal tip includes an LED illumination and imaging module, which may be digital and feeds real-time video to a display module that can be rotated for viewing by the operator and others. The imaging module may have a wide field of view (FOV), e.g. 140 °, using no more than 2 lenses, and the LEDs are arranged to have an illumination Field (FOI) matching the FOV. When the imaging surface is not uniformly illuminated, provisions may be included to equalize the brightness of the image. The single-use and reusable portions mate and un-mate via physically separate well-separated mechanical and electrical connectors. The needle delivers liquid from a syringe that may be attached to the handle for movement therewith or simply connected to the endoscope by a flexible conduit. The surgical endoscope is configured for operation by a single clinician in multiple procedures.

Description

Hand-held surgical endoscope

The present application is a divisional application of chinese patent application No. 201880007960.7, entitled "hand-held surgical endoscope", filed on 22/7/2019.

Cross Reference to Related Applications

The present patent application claims the benefit of and is incorporated by reference into each of the following provisional applications:

us temporary serial No. 62/449,257 filed on 23/1/2017;

us temporary serial No. 62/452,883 filed on 31/1/2017;

us temporary serial No. 62/513,386 filed on 31/5/2017;

us temporary serial No. 62/530,238 filed on 7, 9, 2017;

us temporary serial No. 62/531,212 filed on 11/7/2017;

us temporary serial No. 62/573,380 filed on day 17 of month 10 in 2017;

us temporary serial No. 62/578,407 filed on 28/10/2017; and

us temporary serial No. 62/594,013 filed on 3.12.2017.

This patent application also claims the benefit of and is incorporated by reference with each of the following U.S. patent applications:

us serial No. 15/462,331 filed on day 17 of 3 months in 2017;

us serial No. 15/651,526 filed on day 17 of 7 months in 2017; and

us serial No. 15/855,532 filed on 12/27/2017.

Technical Field

This patent specification relates generally to medical devices for use in histological examination and endoscopic surgery (e.g., urology). More particularly, some embodiments relate to an integrated, hand-held, low-cost surgical endoscopic device having a disposable, single-use portion and a reusable, multi-use portion.

Background

Conventional endoscopy or direct-view endoscopes, which are used to examine the interior of a hollow organ or cavity of the body, typically use complex lens systems to convey images from the distal tip of the endoscope to the viewer. The lens system is typically a relay lens system in a rigid endoscope or a bundle of optical fibers or an objective lens system in a flexible endoscope. In both rigid and flexible conventional endoscopes, the lens or fiber optic system is relatively expensive and is intended to be reused multiple times. Therefore, strict decontamination and disinfection procedures are required after each use.

In a surgical procedure where a needle is used to inject a fluid, such as a drug, into the tissue of a patient, a long injection needle is inserted into the working channel of an endoscope. In such procedures, surgery is typically performed using two or more operators: one to operate the endoscope and the other to operate the needle assembly and the syringe. There is typically a physical separation between the display screen (e.g., mounted overhead), the endoscope (within the patient), and/or the syringe used to administer the drug. In this case, the operator or clinician has to look at the display screen and cannot view the scope handle and the syringe simultaneously. In addition, a separate needle assembly, which is often long and somewhat cumbersome, requires a working channel through the endoscope and may require a great deal of manual dexterity to control the lancing and injection process.

Disposable endoscopes are an emerging class of endoscopic instruments. In some cases, the manufacture of the endoscope can be made inexpensive enough to be used for only a single patient. A disposable or single use endoscope may reduce the risk of cross contamination and hospital acquired diseases. A partially disposable endoscopy system for hysteroscopy is discussed in U.S. patent No. 8,460,182, which is hereby incorporated by reference. Hysteroscopes with a one-time probe are available from Endosee Corporation of Los Altos, california, and are now available from courbatersurgical, inc.

Known part disposable hysteroscopes have a miniature camera at the end of the disposable part thereof. The tip has a small diameter, which makes it difficult to incorporate a lens system therein. In known disposable endoscopes, the camera field of view (FOV) is no greater than about 120 °, so the user may need to frequently reposition the tip to include a different region of the uterus in the camera FOV. For endoscopes that are suitable for larger or differently shaped organs (e.g., the bladder), viewing different areas inside the bladder may require more frequent repositioning of the camera tip with such a FOV. This is undesirable because it makes the examination longer, and also because it prevents a larger area in the organ from being viewed at the same time.

The tip of some known endoscopes includes a light source, such as an LED, to illuminate the object or surface being viewed. The illumination field may be different from the camera FOV so that some objects or surfaces in the camera FOV are not illuminated and therefore do not image well and/or some illumination is wasted because it does not contribute to the imaging because it illuminates areas not currently seen by the camera.

Additionally, in some known endoscopes, illumination may impair imaging depending on the position and orientation of the camera relative to the organ being imaged. For example, if one set of LEDs is closer to the organ wall than another set of LEDs, one area of the wall may be illuminated more and may appear brighter and even saturate that area of the image, making image evaluation more difficult.

The subject matter described or claimed in this patent specification is not limited to implementations that solve any particular disadvantages or that operate only in environments such as those described above. Rather, the foregoing background is provided merely to illustrate one exemplary technology area in which some embodiments described herein may be practiced.

Disclosure of Invention

Some embodiments include an endoscope having a multi-use reusable proximal portion and a single-use disposable distal portion that carries a needle entirely internally movable between a retracted position in which the needle is within the disposable portion and an extended position in which a distal end of the needle protrudes from a distal tip of the disposable portion. The endoscope may include: a handle configured to be grasped by a hand of a user and having at least one button to control a function of the endoscope, wherein the handle and the screen form part of a reusable portion of the endoscope; a sleeve forming part of a disposable part of an endoscope; a connector at a proximal portion of the disposable portion of the endoscope configured to releasably tool-lessly mate with the connector at the reusable portion of the endoscope, thereby releasably integrating (integrating) the reusable portion and the disposable portion; a needle actuation tab mounted to the endoscope and positioned and configured to be moved between a retracted position and an extended position by a user grasping the handle; a needle actuation tab is coupled to the needle to drive the needle between the retracted and extended positions of the needle as a user moves the tab between the retracted and extended positions of the tab; an injection fluid port at a proximal portion of the disposable portion, the port in fluid communication with the injection needle through the cannula such that fluid introduced into the port is injected through the needle; and an imaging module having a video camera at the end of the cannula and a light source at the end of the cannula, the video camera coupled with the screen to provide images to the screen, and the light source at the end of the cannula configured to illuminate a region viewed by the camera under control of a button on the handle.

In some embodiments, the endoscope may further include one or more of the following characteristic elements: (1) a fluid source and a flexible conduit from the source to the injection fluid port, wherein the flexible conduit is the only connection between the fluid source and the endoscope; (2) a syringe releasably secured to the handle and coupled with the fluid port to enable an operator to operate the endoscope with a single hand to visualize a region of the patient, to move the needle between its retracted and extended positions and to penetrate the needle into tissue, and to inject fluid into the tissue; (3) a field of view (FOV) of the imaging module including a central region of the FOV with the distal tip of the needle when the needle is in its extended position; (4) a direction of field of view (DOV) of the video camera, which is angled relative to a direction in which the cannula tip extends; (5) the needle actuation tab has a projection that moves with the tab, and the endoscope has a stopper configured to releasably engage the projection at each of the retracted and extended positions of the needle actuation tab and thereby at least releasably lock the tab in the extended position of the needle actuation tab, and the endoscope further includes a manual release button that acts on the projection to selectively release the tab and thereby the needle from the locked position; (6) the cannula is secured to the disposable portion to selectively rotate the cannula about its long axis; (7) the needle is no longer than the distance from the fluid port to the distal end of the cannula; (8) the connector comprises a mechanical connector at each of the reusable portion and the disposable portion, and an electrical connector at the reusable portion and the disposable portion, wherein the electrical connector is proximally spaced from the mechanical connector by a distance of 2cm or more, and the connector releasably integrates the reusable portion and the disposable portion tool-lessly into the endoscope; (9) the video camera in the imaging module is a digital camera that transmits digital video images from the cannula distal end to the electrical connector; (10) the cannula end at the video camera has an outer diameter of 4mm or less or 3mm or less; (11) the imaging module in the disposable portion has a field of view (FOV) of 140 ° or greater or 130 ° or greater; (12) the imaging module comprises an image sensor array and no more than two lenses providing a field of view (FOV) of the imaging module of no less than 130 °; (13) the lens extends no more than 4mm from the image plane; (14) each of the lenses is made of a molded polymer material; (15) the light source comprises a plurality of LEDs arranged symmetrically about the long axis of the cannula and having an illumination Field (FOI) matching the field of view (FOV) of the imaging module, thereby avoiding a blind spot or an unevenly illuminated FOV; (16) the endoscope further includes circuitry to control the distribution of the area of illumination from the light source to reduce brightness imbalance between the image portions provided by the imaging module; (17) the circuit control area distribution includes a manual controller on the reusable portion and a circuit responsive to the manual controller to change an illumination distribution from the light source to reduce a brightness imbalance between portions of the image provided by the imaging module; (18) the endoscope further comprises: circuitry responsive to illumination imbalances between regions of an image provided by the imaging module to automatically reduce the imbalance by changing a distribution of the regions of illumination from the light source; (19) the imaging module has a field of view including a distal length of the needle, and the display has indicia visible on the length of the needle on the display showing a depth of insertion of the needle into tissue; (20) the distal length of the needle has indicia on the display showing the extent to which the needle has been inserted into tissue; (21) both the display and the needle have indicia on the display showing the depth of penetration of the needle into the tissue using the endoscope.

In some embodiments, an endoscope having a multi-use reusable proximal portion and a single-use disposable distal portion comprises: a handle configured to be grasped by a hand of a user and having at least one button to control a function of the endoscope, wherein the handle and the screen form part of a reusable portion of the endoscope; the sleeve forms part of a disposable portion of the endoscope; a connector at a proximal portion of the disposable portion of the endoscope configured to releasably mate tool-lessly with the connector at the reusable portion of the endoscope, thereby releasably integrating the reusable portion and the disposable portion; and an imaging module having a video camera at the end of the cannula and a light source at the end of the cannula, the video camera being coupled to the screen to provide images to the screen and the light source at the end of the cannula illuminating a region viewed by the camera under control of a button on the handle; wherein the video camera is a digital video camera providing digital image output delivered to a video display screen; and wherein the distal end of the cannula has an outer diameter of no more than 4.2mm and the imaging module comprises an image sensor having an image plane no wider or no higher than 3 mm. The endoscope may also include one or more of the following elements or features: (1) the digital video camera comprises an image sensor having an image plane with a linear dimension not greater than 3 mm; (2) the imaging module includes a lens system providing a field of view of not less than 130 °; (3) the lens system uses no more than two lenses; (4) the lens extends no more than 4mm from the image plane; (5) the endoscope further includes a needle fully contained within the disposable portion of the endoscope and having an extended position in which the needle protrudes distally from the cannula, wherein the imaging module has a field of view that includes the distal length of the needle, and further including indicia on one or both of the display and the needle that show on the display a depth of penetration of the needle into tissue using the endoscope.

In some embodiments, an endoscope having a multi-use reusable proximal portion and a single-use disposable distal portion comprises: a handle configured to be grasped by a user's hand and having at least one button to control an endoscope function, wherein the handle and screen form part of an endoscope reusable portion; the sleeve forms part of a disposable portion of the endoscope; a connector at a proximal portion of the disposable portion of the endoscope configured to releasably mate tool-lessly with the connector at the reusable portion of the endoscope, thereby releasably integrating the reusable portion and the disposable portion; an imaging module having a video camera at the end of the cannula and a light source at the end of the cannula, the video camera coupled with the screen to provide an image to the screen, and the light source at the end of the cannula illuminating a region viewed by the camera under control of the button of the handle; and a circuit coupled with the light source and configured to control a distribution of areas of illumination from the light source to reduce a brightness imbalance between portions of the image. The endoscope may also include one or more of the following elements or features: (1) a manual controller on the reusable portion, wherein the circuitry is responsive to the manual controller to change an illumination profile from the light source to thereby reduce a brightness imbalance between portions of the image shown on the screen; (2) the circuitry automatically reduces the imbalance by changing a regional distribution of illumination from the light source in response to a luminance imbalance between regions of an image provided by the imaging module; (3) the light source includes a plurality of LEDs at each of two sides of a long axis of the cannula, and the circuitry is configured to vary illumination from the LEDs on one side relative to illumination from the other side.

In some embodiments, a single-use, disposable distal portion is configured to releasably mate with a multi-use, reusable proximal portion to form an endoscope, the disposable portion comprising: a cannula having a connector at a proximal portion thereof, the connector configured to releasably tool-less mate with the reusable portion to thereby releasably integrate the reusable portion and the disposable portion; and an imaging module having a video camera at the distal end of the cannula and a light source at the distal end of the cannula, the video camera configured to provide an image of the region and the light source at the distal end of the cannula illuminating the region viewed by the camera; wherein the video camera is a digital camera providing digital image output for delivery to the reusable portion; and wherein the distal end of the cannula has an outer diameter of no more than 4.2mm and the imaging module comprises an image sensor having an image plane no wider or no higher than 3 mm. The endoscope may also include one or more of the following elements or features: (1) an injection needle carried entirely within the disposable part and movable between a retracted position, wherein the needle is within the disposable part, and an extended position, wherein a distal end of the needle protrudes from a distal tip of the disposable part; (2) the imaging module has a field of view of at least 130 ° including the distal length of the needle, and further includes indicia on one or both of the display and the needle showing on the display the depth of penetration of the needle in tissue using the endoscope; (3) the imaging module includes a lens system providing a field of view of not less than 130 °; (4) the lens system uses no more than two lenses; (5) the lens extends no more than 4mm from the image plane.

As used herein, the grammatical conjunctions "and", "or" and/or "are intended to indicate that one or more of the cases, objects or topics to which they connect may appear or exist. In this manner, the term "or" as used herein is in all instances indicative of the meaning of "an inclusive or" rather than the meaning of "an exclusive or".

As used herein, the term "surgical" or "surgery" refers to any physical intervention on a patient's tissue, and does not necessarily involve cutting the patient's tissue or closing a previously sustained wound.

Drawings

To further clarify the above and other advantages and features of the subject matter of this patent specification, there is shown in the drawings specific examples of embodiments thereof. It should be understood that elements or components shown in one figure may be used in place of comparable or similar elements or components shown in another figure, and that these figures depict only illustrative embodiments and are therefore not to be considered limiting of the scope of this patent specification or the appended claims. The subject matter of this patent will be described and explained with additional specificity and detail through the use of the accompanying drawings in which:

FIGS. 1 and 2 are right side and top views, respectively, of a handheld surgical endoscope according to some embodiments;

FIG. 3 is a perspective view showing aspects of attachment and detachment of a single use section and a reusable section of a handheld surgical endoscope according to some embodiments;

FIGS. 4A, 4B, and 4C are side, perspective, and cross-sectional views of a sleeve of a handheld surgical endoscope according to some embodiments;

FIGS. 5A and 5B are perspective views illustrating aspects of needle actuation for a handheld surgical endoscope, according to some embodiments;

fig. 6A and 6B are perspective views of the distal tip of a cannula according to some embodiments and illustrate aspects of needle actuation;

FIGS. 7A and 7B are perspective views of a portion of a single-use portion of a handheld surgical endoscope according to some embodiments;

FIGS. 8A and 8B are side and cross-sectional views of a distal tip of a handheld surgical endoscope according to some embodiments;

FIG. 9 is a perspective view of a hand-held surgical endoscope for performing a surgical procedure by a single operator, according to some embodiments;

10A and 10B are further perspective views of a hand-held surgical endoscope for performing a surgical procedure by a single operator, according to some embodiments;

FIG. 11 is a perspective view of a handheld surgical endoscope according to some embodiments;

FIG. 12 is a block diagram illustrating aspects of a single operator performing a surgical procedure with a hand-held surgical endoscope, according to some embodiments;

fig. 13 and 14 are perspective views of a handheld surgical endoscope having a clip for attaching a syringe to a handle, according to some embodiments;

FIG. 15 is a block diagram of electronics in the single use and reusable portions of an endoscope according to some embodiments;

FIG. 16 is a system block diagram of signal flow through a digital signal processor in an endoscope according to some embodiments;

FIG. 17 is a perspective illustration of an example of an endoscope with indications that the working length of the cannula may be different for different cannulas, in accordance with some embodiments;

FIG. 18 illustrates an endoscope having a rigid or semi-rigid sleeve according to some embodiments;

19A-19E illustrate an endoscope also having a rigid or semi-rigid cannula but which may be configured with different direction of field of view (DOV) cameras at the cannula tip, according to some embodiments;

FIG. 20 illustrates an endoscope that may be configured with a camera at the cannula tip beyond the direction of field of view (DOV) at right angles to the length of the cannula and may even operate the camera looking backwards, according to some embodiments;

FIG. 21 is an exploded view of a distal portion of a single use portion of an endoscope according to some embodiments;

FIG. 22A shows a detail of FIG. 21 in enlargement, and FIGS. 22B, 22C and 22D are front, side and cross-sectional views, respectively, of a distal portion of a single-use section of an endoscope, according to some embodiments;

FIG. 23 is a cross-sectional view showing a lens barrel housing a lens system providing a wide field of view at a sensor plane of an imaging sensor in a single use portion of an endoscope, according to some embodiments;

fig. 24A is a schematic diagram of matching field of illumination (FOI) to field of view (FOV) according to some embodiments of an endoscope; FIG. 24B illustrates the mismatch between FOI and FOV in a prior art endoscope; and fig. 24C is a schematic illustration of an image with image brightness imbalance between regions of the image due to a mismatch of FOI and FOV and/or different distances of the LEDs from the surface being imaged, according to some embodiments.

FIG. 25 illustrates an example of a control circuit for equalizing illumination and image brightness balance under manual control, according to some embodiments;

FIG. 26 illustrates an example of an automatic control circuit for equalizing illumination and image brightness balance, according to some embodiments;

FIG. 27 shows a screen image in a system that provides visual control of the insertion depth of a needle at the end of a cannula according to some embodiments;

28A, 28B and 28C show screen images at three different needle insertion depths according to some embodiments; and

fig. 29 illustrates a needle with markings that facilitate visual control of insertion depth, according to some embodiments.

Detailed Description

A detailed description of examples of preferred embodiments is provided below. While several embodiments have been described, it should be understood that the novel subject matter described in this patent specification is not limited to any one embodiment or combination of embodiments described herein, but embraces many alternatives, modifications, and equivalents. In addition, while numerous specific details are set forth in the following description in order to provide a thorough understanding, some embodiments may be practiced without some or all of these details. Moreover, for the purpose of clarity, certain technical material that is known in the related art has not been described in detail in order to avoid unnecessarily obscuring the new subject matter described herein. It is to be understood that each feature of one or more specific embodiments described herein may be used in combination with features of other described embodiments, or other features. Further, like reference numbers and designations in the various drawings indicate like elements.

Fig. 1 and 2 are right side and top views, respectively, of a handheld surgical endoscope, according to some embodiments. The surgical endoscope 100 includes an elongate cannula 120, the elongate cannula 120 having a distal tip 112 for insertion into a hollow organ or cavity of the body. The needle 114 passes through a dedicated lumen in the cannula 120. As shown, the tip of needle 114 may extend to protrude distally from distal tip 112. The needle 114 is hollow and is in fluid communication with a fluid line 172 at the needle actuation hub 170, the fluid line 172 in turn being connected to a syringe 180 (or other fluid dispensing device).

According to some embodiments, the separate terminal sub-assembly 110 is attached to a sleeve 120, which may be made of an extruded material. For further details regarding a separate tip subassembly for a handheld endoscope, see U.S. patent application Ser. No. 15/371,858, filed 2016, 12, 7, and published as US 2017 and 0188795A 1. Subassembly 110 includes an imaging module and one or more LED light sources for viewing the organ or cavity into which tip assembly 110 is inserted. Tip assembly 110 also includes one or more fluid ports. The distal end of the sleeve 120 may be bent in the region 122, for example to the position shown in fig. 1. According to some embodiments, a bend of about 15 degrees in region 122 has been found suitable for many applications, but other angles are not excluded from use in alternative embodiments.

According to some embodiments, the sleeve 120 includes one or more fluid channels fluidly connected to the fluid port 132 at the fluid hub and the connection assembly 130. Port 132 includes a luer fitting to facilitate leak-free connection of port 132 to various medical fluid components. The fluid channel or lumen in the cannula 120 is also connected to the distal side of the tip assembly 110 facing the fluid ports (holes or

ports

616 and 618 shown in fig. 6A and 6B). According to some embodiments, wires extending from the LED light source and camera module in the tip assembly 110 pass through separate channels in the sleeve 120.

The endoscope 100 includes a pistol-like handle portion 140 sized and shaped for easy grasping by an endoscope operator (e.g., a physician or other medical professional). The display module 150 is rotatably mounted to the handle 140 via a bearing, which may be a planar bearing made of plastic, and a rubber-coated hinge. Also visible on handle 140 are an image capture button 160 and a power button 162. (the function of button 2512 is described below in conjunction with FIG. 25). According to some embodiments, handle 140 and display module 150 are configured to be reusable and constitute reusable portion 102. According to some embodiments, the handle 140 is similar to or identical to the handle 140 shown and described in the application published as US 2017-.

Single-use portion 104 includes needle actuation hub 170, fluid hub and connection assembly 130, cannula 120, and tip assembly 110. The single-use portion 104 is manufactured at a relatively low cost and is intended to be disposed of after a single use. By having a single use for all of the tip, cannula, fluid hub, the risks of rigorous decontamination and disinfection procedures, as well as cross-contamination and hospital acquired diseases, can be significantly reduced or avoided. According to some embodiments, the disposable single-use portion (portion 104 shown in fig. 1 and 3) is sterilized, for example, during manufacture, and provided to the user in a sealed sterile bag for storage and handling. The camera module in the tip assembly may have a wide viewing angle, for example 140 ° in this example, and may be implemented in some embodiments by using no more than two lenses, as described in more detail below. According to some embodiments, a fluid line 172 is also included in the single-use portion 104, and may be attached to the hub 170 and included in the same sterile pouch.

According to some embodiments, the length of needle 114 (including the fluid path within needle actuation hub 170) (i.e., from the distal tip of needle 114 to needle fluid port 174) is less than 50cm, and according to some embodiments is about 37 cm. This is in contrast to surgical procedures performed using conventional endoscopes having a working channel through which a separate needle assembly is passed. In those cases, the individual needle assemblies are typically handled by a second clinician, which requires a longer needle (e.g., between 70cm and 100 cm) to allow each clinician sufficient working space. According to embodiments described herein, the use of a shorter needle enables less waste of medical fluid remaining within the needle and easier handling during patient surgery.

According to some embodiments, the surgical endoscope is configured to allow the sleeve 120 to rotate about its longitudinal axis, as indicated by the arrow in fig. 1. For further details on how the hub 130 is configured to allow rotation of the cannula, see said application published as US 2017 and 0188795 a 1. According to some embodiments, the sleeve rotation may include a certain amount of friction (e.g., friction overcome by a torque in the range of 0.04N · m to 0.2N · m). This enables the cannula to be "rotated and held", which is desirable for some procedures. See said application published as US 2017-0188795 a1 for further details on how to configure such a "friction fit". According to some embodiments, the endoscope may be configured to detect the rotational position of the cannula 120 relative to the handle 140. The detected rotational position is then input to a software algorithm configured to reorient the image displayed on the display module 150 so that the correctly oriented image is displayed to the operator. For further details on such rotational position detection see said application published as US 2017 and 0188795 a 1.

Fig. 3 is a perspective view illustrating aspects of attachment and detachment of a single use section and a reusable section of a handheld surgical endoscope according to some embodiments. Single-use portion 104 and reusable portion 102 are primarily mechanically attached by mating

mechanical connectors

320 and 322. Electrical connection is made through separate mating

electrical connectors

310 and 312. In this example, the two

portions

102 and 104 are mechanically attached by translating vertically with respect to each other. Note that electrical connector 310 and mechanical connector 320 are both separate from fluid hub 130 and needle actuation hub 170. This separation allows for an easy and effective, but simple and inexpensive, fluid seal to prevent fluid from

hubs

170 and 130 from permeating internally towards

connectors

310 and 320, and also enables some protection from any external fluid, such as fluid from fluid port 132, from reaching and possibly damaging

electrical connectors

310 and 312. In addition, the separation between the mechanical connector 320 and the hub 130 allows the sleeve bearing to rotate the sleeve 120 relative to the proximal portion of the hub 130. For further details of this rotation mechanism, see the said application published as US 2017-. The physical separation of the fluid hub 130 from the mechanical connector 320 and the electrical connector 310 also provides additional assurance against accidental contamination from the fluid hub 130 to the reusable portion 102. For further details on physical separation and related benefits see said application published as US 2017-.

Fig. 4A, 4B, and 4C are side, perspective, and cross-sectional views of a cannula for use on a handheld surgical endoscope, according to some embodiments. The sleeve 120 may be extruded and formed from a nylon material such as nylon 12 (e.g., nylon 12)

) And (4) preparing. The distal end of the sleeve 120 may include a curved region 122, which curved region 122 may be beneficial for certain applications and may effectively increase the field of view of a camera secured to the distal tip as the endoscope is rotated about its central longitudinal axis. Fig. 4B and 4C show further details of the inner lumen of the cannula 120. An insulated cable (not shown in fig. 4A-4C) passes through the upper lumen 430. Further details regarding insulated cables including for sending power and signaling back to the camera and LED in the distal tipThe conductors leading back to the electronics in the handle are described in said application published as US 2017 and 0188795 a1, for example in fig. 8A and 8B thereof.

Fluid lumens

416 and 418 are used to carry fluid between fluid port 132 (shown in fig. 1-3) and the distal fluid port (see

ports

616 and 618 shown in fig. 6A). In this example,

lumens

416 and 418 each have approximately 1.33mm²Cross-sectional area of (a). The needle 114 (shown in fig. 1-3, 6A-6B, and 8A-8B) passes through the lumen 470. Dimensions for an example device are shown in fig. 4C. Generally, the lumen 470 should be sized to allow passage of the needle 114, the needle 114 being between 26 gauge (0.4636mm) and 21 gauge (0.8192mm) according to some embodiments. According to some embodiments, the needle 114 is 23 gauge (0.6414mm) or 22 gauge (0.7176 mm). According to some embodiments, the sleeve 120 may be manufactured such that its stiffness is not constant along its length. For example, providing a cannula that is more flexible toward the distal tip and stiffer toward the handle may be useful in some clinical applications. In such a case, the sleeve 120 may be formed of a multi-durometer tube, e.g., multi-durometer

Or

And (4) preparing.

According to some embodiments, the cannula 120 is rotatable relative to the handle. The rotation mechanism may be disposed in the hub 130; further details of the rotation mechanism are shown and described in said application published as US 2017-.

Fig. 5A and 5B are perspective views illustrating aspects of needle actuation for a handheld surgical endoscope, according to some embodiments. Fig. 5A shows the needle actuation hub 170 when the needle is in the retracted position, while fig. 5B shows the hub 170 when the needle is in the extended position. Hub 170 includes a housing 500 through which two windows, a proximal window 532 and a distal window 534, are formed. The lock release button 530 extends from the housing 500 and includes an inwardly projecting tab aligned with the distal window 534. The actuation plate 510 is movable relative to the hub shell 500. Fluid port 512 moves with plate 510, and fluid port 512 is in fluid communication with fluid line 172 (not shown), spring plate 520, and needle 114 (not shown). Further details of the movable portion of the hub 170 are shown in fig. 7B.

Fig. 6A and 6B are perspective views of distal tip 112 according to some embodiments and illustrate aspects of needle actuation. Fig. 6A shows tip 112 when needle 114 is in a retracted position and fig. 6B shows tip 112 when needle 114 is in an extended position. Note that when in the retracted position, the sharp tip of the needle 114 is fully recessed within the needle port 614 of the tip assembly 110 and there is no risk of sharp injury to the tip of the needle 114. Also visible in fig. 6A and 6B are camera lens dust cover 612, two light guide lenses 662 and 664 (for LED light sources), and

distal fluid ports

616 and 618.

Distal fluid ports

616 and 618 are provided to allow fluid communication with the

fluid lumens

410 and 412 of the cannula 120 (as shown in fig. 4B and 4C). In this example, each of the

fluid ports

616 and 618 has about 1.6mm²Cross-sectional area of (a). Note that port 132,

lumens

410 and 412, and

distal fluid ports

616 and 618 may be configured to provide in-flow (i.e., fluid flows out of the endoscope and into a patient's organ or cavity) and/or fluid outflow (i.e., fluid flows out of a patient's organ or cavity and into the endoscope).

Fig. 7A and 7B are perspective views of a portion of a single-use portion of a handheld surgical endoscope, according to some embodiments. Fig. 7A shows needle actuation hub 170 at another angle from which needle

extension indicia

710 and 712 are visible. In this example, indicia 710 is "0", indicia 710 indicates to the operator that the needle is fully retracted when spring tab (tap)520 protrudes through proximal window 532, and indicia 712 is "15", indicia 712 indicates that the needle is extended 15mm when tab 520 protrudes through distal window 534. According to some embodiments, the full extension of the needle may be an amount other than 15mm (e.g., a value between 10mm and 20 mm), and the indicia 712 will reflect that value. Fig. 7B shows a carrier 720 fixedly attached to the actuator plate 510, the spring plate 510, and the needle 114. According to some embodiments, carrier 720, spring plate 520, and/or actuator plate 510 are molded from a single piece of polymeric material. As shown, the spring leaf 520 has a ramp-shaped distal edge and a square-shaped proximal edge. This shape allows it to move freely distally, but will "lock" when it reaches a distal window that is fully extended and protrudes through housing 500. The pins 114 are glued or bonded into the openings of the carrier 720. A fluid-tight path is provided through the carrier 720 between the fluid port 512 and the interior lumen of the needle 114.

Referring back to FIG. 5A, the actuation tab 510 is shown in a retracted position, wherein the tab 510 is in its rearmost or proximal position relative to the hub shell 500. In this position, spring leaf 520 protrudes through proximal window 532 of housing 500 and the tip of needle 114 is recessed within needle port 614, as shown in fig. 6A. To extend the tip of needle 114 to penetrate the tissue of the patient, the operator moves actuation tab 510 forward (distally) relative to housing 500 as indicated by the dashed arrow in fig. 5A. This causes carrier 720 (shown in fig. 7B) to move distally relative to housing 500 and needle 114 to translate distally within lumen 470 (shown in fig. 4B and 4C) of cannula 120 and distally relative to tip assembly 110. As shown in fig. 7B, the spring leaf 520 is radially movable and has a ramp-shaped distal edge and a square proximal edge. Accordingly, the spring leaf 520 is urged radially inward by the proximal edge of the proximal window 532. As the actuation tab 510 is pushed further distally, the top surface of the tab 520 moves over the inner surface of the housing 500 and toward the distal window 534. When the spring leaf 520 reaches the distal window 534, the radial spring force pushes the tip of the leaf 520 through the distal window 534. The square proximal edge of spring plate 520 engages the square proximal edge of window 534, which effectively "locks" or prevents retraction or proximal movement of needle 114, carrier 720, and actuation plate 510. This locking mechanism is useful when a needle is used to inject a desired fluid (e.g., medication) into a patient's tissue, because the entire endoscope can be used to push the needle without retracting the needle into the cannula. The needle of the surgical endoscope is depicted in a fully extended state in fig. 5B and 6B.

When the operator wishes to retract the needle, the lock release button 530 is depressed, which forces the spring leaf 520 inwardly through the window 534. In the depressed state, spring leaf 520 is no longer "locked" by distal window 534, and then actuation tab 510 can be moved rearwardly or proximally relative to housing 500, which causes the needle to retract into tip assembly 110, as shown in fig. 6A. According to some embodiments, spring leaf 520 may be shaped with square edges on both the proximal and distal sides, which will allow the needle to be releasably locked in the retracted and protruding positions. In such a case, the lock release button 530 is used to unlock the tab 520 in either position to allow actuation of the needle.

Fig. 8A and 8B are side and cross-sectional views of a distal tip of a handheld surgical endoscope according to some embodiments. The cannula 120 and the housing 811 of the cannula tip 110 are held together using a sleeve 820, the sleeve 820 being sized to fit around the outer surface of the distal end of the cannula 120 and the proximal end 816 of the tip housing 811. End housing 811 includes an upper chamber 830 that houses a camera assembly 854 and an LED 860. A separate needle lumen 870 is included in tip housing 811 to allow passage of needle 114. In the example shown, the needle 114 protrudes 15mm when fully extended, which has been found to be a suitable amount of extension for many surgical urology applications. According to some other embodiments, other extensions, such as between 10mm and 20mm, may be achieved. According to some embodiments, needle 114 is not parallel to the central axis of distal tip assembly 110 and housing 811. Instead, the needle 114 is angled upward (toward the camera) approximately 2 to 5 degrees so that when the needle 114 is in the fully extended position (10mm to 20mm, preferably 15mm), its distal tip will approximately reach the center of the FOV of the camera. This may be accomplished by appropriately shaping needle lumen 870 in housing 811. According to some embodiments, the sleeve 820 is made of stainless steel, although other materials may be used. Three pieces of sleeve 120, sleeve 820 and end housing 811 may be glued together using, for example, a U-V cured adhesive glue. For further details regarding tip assembly 110, including suitable sensor, lens and LED assemblies, as well as suitable assembly and bonding techniques, see the co-pending' 858 application. According to some embodiments, the field of view (FOV) of the camera is configured such that, when extended, the tip of the needle 114 is clearly visible by the sensor and may be so displayed to the operator. According to some embodiments, the maximum outer diameter of the tip housing 811 is about 15fr (or 5mm) or less and the other diameter of the cannula 120 is about 4.8mm or less. This is in contrast to conventional rigid endoscopes, which typically have an outer diameter of about 7 mm. According to some embodiments, the distal outer edge of tip housing 811 is rounded to facilitate insertion/passage through tissue passageways and mitigate tissue contact issues. For further details on suitable circle dimensions and standards, see said application published as US 2017 and 0188795 a 1.

Fig. 9 is a perspective view of a hand-held surgical endoscope for performing a surgical procedure by a single operator, according to some embodiments. Unlike conventional endoscopic surgical procedures performed using at least two skilled operators or clinicians, according to some embodiments, the surgical endoscope 100 with an integrated needle is configured for a single operator to perform many surgical procedures. Shown in fig. 9 is a single operator, with his/her left hand 910 gripping the handle 140 (and optionally pressing the image capture button 160) and his/her right hand 912 operating the syringe 180 to dispense medication (or other fluid) via the extended needle 114. For clarity purposes, the patient and the patient's tissue are not shown. By integrating the needle assembly with a handheld endoscope having an attached display as described and illustrated herein, it has been found that a single operator can both control the endoscope and (using the entire endoscope) prick with the needle and deliver the drug fluid in the syringe. Although fig. 9 shows the handle of the left-handed operation endoscope 100 and the right-handed operation injector, the operator can easily perform the operation with his/her hands switched, i.e., the right-handed operation handle and the left-handed operation injector, if necessary.

Fig. 10A and 10B are further perspective views of a hand-held surgical endoscope for performing a surgical procedure by a single operator, according to some embodiments. It has been found that for some procedures, an operator may prefer to manipulate cannula 120 with one hand while grasping the handle with the other hand. Fig. 10A and 10B illustrate how surgery may be performed by a single operator to manipulate an endoscope and control a syringe to administer a drug. In particular, the operator grasps the handle using his/her left hand 910 and optionally depresses the capture button 160, and manipulates the cannula 120 (shown in fig. 10A) and dispenses medication from the syringe 180 (shown in fig. 10B) using his/her right hand 912.

FIG. 11 is a perspective view of a handheld surgical endoscope according to some embodiments. As shown, when the needle 1114 is in the extended position, the camera sensor captures a distal portion of the needle, and the display 150 clearly shows the needle tip at a generally central portion of the display screen. As can also be appreciated in fig. 11, the hand-held surgical endoscope 100 is economically configured for a single operator to view the endoscope, display screen, and syringe, which further facilitates the performance of a surgical procedure by a single operator.

Fig. 12 is a block diagram illustrating aspects of a single operator performing a surgical procedure with a hand-held surgical endoscope, according to some embodiments. In block 1210, a sterile package containing a single-use portion of an endoscope is opened. As shown in fig. 1-3, single-use portion 104 includes a fluid hub 130, a cannula 120, a tip assembly 110, a needle actuation hub 170, and a fluid line 172. The needle 114 is pre-installed in a dedicated lumen in the cannula 120 in a recessed (non-extended) position to reduce the risk of a sharp injury. In block 1212, a single-use portion from the sterilized packaging is mated with a multiple-use portion. As shown in fig. 1-3, multi-use portion 102 includes a handle 140 and a display module 150. In block 1214, saline solution, for example from a syringe, is supplied to the fluid port 132, and a syringe 180 containing a drug is connected to the fluid line 172.

In block 1216, the single operator inserts the distal tip 112 and the cannula 120 through the patient's urethra such that the distal tip 112 is deployed in the patient's bladder. Note that a supply of saline (or other fluid) to the fluid port 132 may be used to facilitate insertion of the distal tip, as is known. Once the cannula tip 112 is in the bladder, the operator can view the bladder cavity and associated tissue on the display module 150 using the camera and LED light source in the tip 112. At 1218, the needle is actuated from the "retracted" position to the "extended" position (shown in fig. 5A and 5B) by manipulating the actuation tab 510 until the slide mechanism is distally locked. The extended distal tip of the needle 114 is located at or near the center of the field of view of the camera module and the operator can clearly see a view of the needle head on the display module, as shown in fig. 11. In block 1220, the distal end of the needle 114 is inserted or pierced into the bladder tissue by distal movement or poking of the entire endoscope 100. This is in contrast to procedures using conventional rigid or flexible endoscopes, in which the needle assembly is moved relative to the endoscope for each puncture. The medical fluid in the syringe 180 is dispensed into the tissue. According to some embodiments, the medical fluid is or contains botulinum toxin (Botox). In block 1222, the process of lancing and dispensing is repeated to treat as much bladder tissue as desired by the operator. In block 1224, the needle is retracted by depressing the lock release button 530 and moving the actuation tab 510 proximally. Whereby the needle is retracted to a recessed position within tip assembly 110 of tip 112. In block 1226, the cannula and distal tip are withdrawn from the bladder and urethra of the patient. In block 1228, the single-use and multi-use portions of the endoscope 100 are separated from one another. The single-use portion may be discarded and the multiple-use portion may be sterilized.

According to some embodiments, portions of the endoscope that may contact patient tissue, such as the distal portion of cannula 120 and tip assembly 110, are hydrophilic. For further details on the hydrophilic treatment see said application published as US 2017-.

Fig. 13 and 14 are perspective views of a handheld surgical endoscope having a clip or similar arrangement for attaching a syringe to a handle, according to some embodiments. In these examples, syringe 180 may be temporarily attached to handle 140 using a clamp or strap, which has been found to facilitate a single operator performing a surgical procedure in some applications. In the case of fig. 13, a clip system 1300 is provided, the clip system 1300 including a strap 1310 for holding the syringe 180 and a strap 1312 attached to the body of the handle 140. The two

bands

1310 and 1312 can be secured to each other in the orientation shown so that the syringe 180 is securely secured to the handle. With the clamp system 1300 installed, an operator can easily grasp the handle 140 and operate its controls (e.g., the image capture button 160) and push the plunger of the syringe 180 using a single hand 912. According to some embodiments, the

bands

1310 and 1312 are made of a plastic material, and according to other embodiments, one or both bands are made of an elastic or rubber-like material. Where one or both of 1310 and 1312 are made of a hard or semi-hard plastic, one or both of the clamps may have an opening to facilitate attachment to the handle and/or syringe. The

bands

1310 and 1312 may be attached to the handle 140 as a unit such that the syringe 180 may be slid within the band 1310 and coupled with the fluid port 174 via the conduit 172 (see fig. 1). As an alternative, the strap 1312 may be wrapped around or otherwise attached to the handle 140, the strap 1310 may be wrapped around or otherwise attached to the injector 180, or the injector 180 may be slid in the strap 1310, and then the

straps

1310 and 1312 may be secured to each other, such as by one or more buttons snapping one protruding into a recess in the other —, or by mating a hook and loop (e.g., Velcro) patch secured to each strap at an appropriate location, such as by gluing. As yet another alternative, a hook and loop strap may be wrapped around each of the syringe 180 and the handle 140, and then the two straps may be pressed against each other for hook and loop connection. In this way, a new syringe may be used for each new patient, or two or more syringes may be used in series for a single patient, and the syringes may be securely attached to the handle so that the user may operate the syringe and handle with one hand (and still choose to push the syringe plunger with the other hand as needed or desired). The syringe 180 may be attached to the left or right side of the handle 140 and may be tilted at a desired angle relative to the long axis of the cannula 120.

Fig. 14 shows another example of a clip system or similar arrangement for attaching a syringe 180 to a handle 140. In this case, the attachment system 1400 includes straps 1410 and 1412 (similar to straps 1310 and 1312) to attach the syringe 180 to the handle 140. In the example shown, the system 1400 is configured to position the syringe 180 on the right side of the handle 140 and also to tilt the plunger of the syringe 180 slightly upward as shown. Various other configurations and relative orientations of the positioning of the syringe 180 and handle 140 are possible and should be accomplished according to the operator's ergonomics and preferences to facilitate a particular surgical procedure by a single operator.

FIG. 15 is a block diagram of the electronic components in the single use and reusable portions of an endoscope, which may be any of the endoscope embodiments discussed in this patent specification. The components in one embodiment are divided into three groups: (1) the first group is located at the end of the cannula 120; (2) the second set is located in the main plate 1500, which is generally in the handle portion 140; (3) the third group is located in the display module 150.

The set of components at the distal end of the cannula 120 includes a camera module 854, the camera module 854 preferably being small enough to fit within a portion of a lumen, such as the upper lumen 430, which in one example of the cannula 120 is 2.8mm in its largest dimension. Preferably, the maximum dimension of the camera module across the length of the sleeve 120 is less than 2.8mm, and preferably even smaller. The camera module 854 may be, for example, a camera module provided by taiwan OPCOM group under the designation CI 362. Notably, the camera module 854 preferably includes a digital camera with on-board analog-to-digital conversion rather than an analog camera, such that its output is a digital signal in a selected format, such as a format conforming to the MIPI format specified by the MIPI alliance. An example of a suitable format is MIPI camera serial interface 2(MIPI CSI-2), which is a widely adopted high-speed protocol useful for point-to-point image and video transmission between a camera and a host device. Wires in the sleeve 120 provide the MIDI format output of the camera module 854 to the

electrical connectors

310, 312 and thus to the motherboard 1500. One or more LED light sources are also included at the end of the sleeve 120.

The motherboard 1500 is used to provide an interface, process data, and control components at the end of the cannula 120 and the display module 150. Broadly, the motherboard 1500 provides power and control signals to the camera module 854 and LEDs 860 and the display module 150 and converts the camera MIDI format output to an image signal for display on the display module 150. In the motherboard 1500, a Digital Signal Processor (DSP) is the main processor that controls the components at the end of the cannula 120 and the operation in the display module 150 and processes all captured data. Communicating through field programmable gate array 1(FPGA1)1504, DSP 1502 sends control signals ALC to LED driver 1506 to turn LEDs 860 on and off and adjust to the desired illumination level as needed, and receives the output of camera module 854 after the output of camera module 854 has been converted from serial to parallel by STMIPI interface 1508. The DSP 1502 exchanges information with information storage devices, such as DDR2 memory 1510, SD card memory 1512, and SPI flash memory 1514, as needed. The DSP 1502 may provide an output to the HDMI connector 1516 and may receive a key actuation signal or interrupt signal from the touch key 1518, which touch key 1518 may be a button on the handle 140, such as

buttons

160 and 162. The DSP 1502 also receives touch or slide information from the touch pad 1520 in the display panel 150. The DSP 1500 provides control signals to the camera module 854, touchpad 1520, and FPGA 11504 via I2C line 1522. The DSP 1502 converts the parallel signals from the FPAG 11504 into serial RGB signals and provides the serial RGB signals to the display module 150.

The display module 150 displays an image from the camera module 854 and transmits a control signal to the DSP 1502 in response to a touch. The display module 150 includes a field programmable gate array (FPGA2)1522, the field programmable gate array (FPGA2)1522 receiving images from the camera module 854 and providing images from the DSP 1502 in serial RGB format. The FPGA 21522 sends images to the LCD display 1526 in a parallel RGB format, and can store the selected images in the memory SRAM 1524 and recall the images for display or storage in the SD card 1512 and/or the SPI flash 1514, in response to commands from the touch pad 1520 or preprogrammed instructions from the DSP 1502 or FPGA 21522 or other processor or memory component. The touchpad 1520 communicates with the DSP 1502 through a signal bus I2C, and may also send commands to the DSP 1502 through a direct connection bus INT. The microcontroller unit MCU 1528 initializes the LCD display 1526 as needed and as specified. Power supply facilities such as connections to rechargeable batteries removably secured to or in the handle 140, connections to manual on/off switches on the handle 140, and connections to camera control buttons on the handle 140 may also be on the motherboard 1500.

Fig. 16 shows the overall system flow through the electronic device shown in fig. 15. The user interface module 1602 interacts with the user through the touch pad 1520, the LCD display 1526 and manual buttons on the handle 140 and interacts with the application programming interface 1604. When power is supplied to the endoscope by operating the off/on switch 162, the DSP 1502 reads firmware in the SPI flash 1514 and activates the STMIPI interface 1508, the camera module 854, the touch pad 1520, and other components of fig. 15 as needed. After startup, application programming interface 1604 points to the indicated task (global, capture, playback, and encode/decode) in response to commands entered through touch pad 1520 and control buttons 160 on handle 140, with indicated subsystem library module 1606 and driver library module 1608 in turn interacting with the same electronic components 1610 as the identically named components in FIG. 15.

Fig. 17 shows an endoscope that may otherwise be the same as the endoscope shown in other embodiments described in this patent specification, e.g., as shown in fig. 9, but provided with a plurality of cannulae 120 that differ in Cannula Working Length (CWL). In one example, a casing with two CWLs may be provided: a shorter cannula with a CWL of 8 inches or less suitable for bladder examinations primarily for female patients, and a longer cannula with a CWL of 13 inches or more suitable for bladder examinations primarily for male patients. Of course, these lengths are merely examples, and different lengths may be provided for different medical applications, and three or more different CWLs may be provided. An important benefit of providing a cannula with multiple CWLs is that each CWL can be optimized for the respective medical application and that a medical facility such as an office, clinic or hospital can store many different CWL cannulas suitable for its practice and can use the cannula best suited for a given patient procedure. For example, in cystoscopy, the optimal CWL may be about 8 inches for most female patients, while larger CWLs may present problems such as undesirable bending and twisting of the cannula during insertion and during bladder visualization. As another example, for a male patient cystoscopy, a CWL that is too small may not be sufficient to reach the bladder. For medical applications other than cystoscopy, other CWLs may be suitable, such as in the range of 8 to 13 inches, more specifically in the range of 10 to 12 inches, 11 to 12 inches, or about 11 inches. As shown, the CWL is measured through the cannula 120 from where the fluid hub and connection assembly 130 emerges to the distal tip of the cannula 120. In the case of larger CWLs, the guide wire may be inserted or added to the cannula 120, for example in the fluid channel(s) or lumen(s) in the cannula 120, or through a dedicated additional channel or lumen, or may be integrated or attached to the wall of the cannula 120.

Fig. 18 shows an endoscope that may be otherwise identical to that shown in other embodiments described in this patent specification, such as that shown in fig. 9, but having a rigid or semi-rigid sleeve 120 a. In this context, the term "rigid" refers to a rigidity that does not allow the cannula 120a to bend significantly when inserted and used within a patient's body, and the term "semi-rigid" refers to a lesser rigidity that allows some bending to help avoid injury or perforation but is not sufficient to interfere with medical procedures using an endoscope. Cannula 120a may be straight, as shown in fig. 18, or it may be provided with a curved tip or curvature along some or all of its length, as desired for a corresponding medical procedure.

Fig. 19A-19E illustrate an endoscope that may be otherwise identical to other embodiments described in this patent specification, but which may be configured with a selected direction of field of view (DOV) camera module 854. For example, fig. 19B shows a DOV of zero degrees, i.e., if the cannula tip is not angled relative to the rest of the cannula 120, the direction of the field of view is along the long axis 1910 of the cannula tip 110 or the entire cannula. The illustrated DOV may be used with a semi-rigid or more flexible cannula. Fig. 19A-19E also illustrate that different DOVs, e.g., angles of 30 degrees (fig. 19C), 45 degrees (fig. 19D), or 70 degrees (fig. 19E), may be selected for

different cannulae

120, 120 a. Where the DOV is at a greater angle to the length of the cannula tip, the camera may be located to one side of the cannula tip, such as shown by camera module 854 in FIG. 19E. The angles shown are examples only, and different angles may be selected for each cannula depending on the medical procedure to be performed or the preference of the health professional performing the medical procedure. The desired DOV may be selected when manufacturing the cannula tip, for example by fixing the camera module in the desired orientation of its viewing plane relative to the tip axis, for example at the side or inclined face of the camera tip, or by bending the cannula so that its tip points in the desired direction, for example as shown in fig. 17. As an alternative, the cannula bend portion 122 (FIG. 1) may be made of a known type of material that can be bent by hand to a desired angle and retains its shape once bent.

Fig. 20 shows an endoscope that may be otherwise identical to the other embodiments described in this patent specification, but which may be configured with a direction of field of view (DOV) camera module 854 capable of imaging tissue behind (proximal to) the cannula tip 110. According to some embodiments, the camera module 854 may be mounted on the side of the sleeve tip 110 and may be tilted to have a DOV greater than 90 ° relative to the tip axis 1910. Generally, the camera module 854 may be mounted such that a camera field of view (FOV) and an LED field of illumination (FOI) may at least partially encompass the proximal direction of the endoscope 100 and the cannula 120. Note that in the case of fig. 20, tip 110 is angled relative to main cannula axis 2010, and that camera FOV and LED FOI partially comprise the direction proximal of cannula 120. Again, while fig. 20 shows the case of a rigid or semi-rigid cannula (but with angled ends), the cannula may be more flexible and may include wires if desired.

The field of view (FOV) of the camera module 854 may be a particularly important factor in endoscopes having disposable distal portions. A wide FOV (greater than 120 °) is desirable because it allows a larger area of the internal organ to be viewed at one time and thus requires less cannula movement during the patient examination and thus can reduce patient discomfort and examination time. In addition, a wider FOV may enhance the medical benefit of the examination, as it may help to easily compare suspected abnormalities to more surrounding tissue in the same image. However, a small diameter cannula and its tip are also important, particularly for cystoscopes but also for some other medical procedures, and achieving a wider FOV is usually reserved for non-disposable cameras, where larger manufacturing costs and possibly larger cannula and tip diameters are justified. According to some embodiments, a wide FOV using a lens system with no more than two lenses having a small overall diameter is achieved as discussed below.

Fig. 21 is a cross-sectional view showing various components of a distal tip 110 for use on a handheld endoscope, according to some embodiments. A cannula 120, which may otherwise be like the cannulae seen in fig. 4A-4C, is shown in fig. 21, with an upper lumen 430 of the cannula 120 for carrying the cable 410. In the example of fig. 21, a single lower lumen 420 may deliver fluid, rather than having two fluid lumens as in the example of fig. 4C. The cable 410 emerges from the upper lumen 430 and includes an outer insulation 431 surrounding the plurality of inner conductors 412. Each of the inner conductors 412 has their own insulation. Although 6 conductors 412 are depicted in this example, other numbers of conductors may be used depending on the requirements of the camera module and the LEDs. The cannula 120 and tip housing 440 are held together using a sleeve 442, the sleeve 442 being sized to surround the outer surface of the distal end of the cannula 120 and the proximal end 444 of the tip housing 440. According to some embodiments, the sleeve 442 is made of stainless steel, although other materials may be used. The three pieces of sleeve 120, sleeve 442 and tip housing 440 may be glued together using, for example, a U-V cured adhesive glue. Some or all of the conductors 412 are bonded to a Printed Circuit Board (PCB) 450. According to some embodiments, the conductors 412 are attached to the PCB 450 using a relatively strong bonding technique (e.g., solder). Such a strong bond has the benefit of further reducing the risk of portions of tip assembly 110 becoming detached from the cannula during surgery. The sensor 452 is mounted on the PCB 450. A support 454 is located around the sensor 452 and a light shield or collar 456 also surrounds the lens system and dust shield 458.

According to some embodiments, a plurality of LEDs 460 are mounted to a horseshoe (C-clip) LED plate 461 surrounding the distal end of the lens system 458. According to some embodiments,

light guide lenses

462 and 464 are inserted into and bonded to a recess in the distal end of tip housing 440. Although 4 LEDs 460 are shown in fig. 21, other numbers of LEDs, such as 1,2, 3, 4, 5, 6, or more LEDs, may be used around the perimeter of the lens system 458. By using 4 LEDs it has been found that a relatively uniform beam pattern can be produced.

By positioning the LEDs within the housing 440 rather than flush with the distal surface, the LEDs are "potted" in the sense that they do not contact patient tissue and seal well against fluids such as saline. It has also been found that the translucent shell provides some useful light scattering for a wide range of illumination, with or without the use of

lenses

462 and 464. In addition, recessing the LEDs as shown may free up some space on the distal surface. Finally, when the LEDs are positioned within the housing 440, the assembly process is simplified.

The components 480 within the upper cavity of the tip housing 440 form a camera or imaging module 480. The tip housing 440 may be molded from a transparent material such as polycarbonate, but other materials that are easily molded may also be used. When assembled, the front of the lens system 458 is flush with the distal end of the tip housing 440 at the lens aperture 441. A lower aperture 443 is provided to allow fluid communication with the lower lumen 420 of the cannula 120. Note that port 132 (fig. 1), lumen 420, and orifice 443 may provide fluid inflow (i.e., flow of fluid out of the endoscope and into a patient's organ or cavity) and/or fluid outflow (i.e., flow of fluid out of a patient's organ or cavity and into the endoscope).

Fig. 22A is an enlarged perspective view of a portion of the components of the camera module 480 shown in fig. 21. The LED panel 461 is horseshoe shaped, or shaped as a C-clip, and is mounted by snapping over the proximal end of the light shield 456, or may be a ring mount that slides over the light barrier 456. Light shield 456 extends distally from the LED and thus serves as a light shield or collar that prevents direct light from the LED from reaching the lens system and sensor 452 within the cradle 454. Preferably, the LEDs 460 are coplanar or nearly coplanar with the distal end of the lens assembly and include a pair of LEDs 460a on one side (left side) and a pair of LEDs 460b on the other side (right side) of the light barrier ring or sleeve 466.

Fig. 22B is a front view, fig. 22C is a side view, and fig. 22D is a cross-sectional view of an example of the distal tip 110 of the cannula 120, of an example of the distal tip 110 of the cannula 120. Some dimensions are shown, but alternative dimensions are possible and contemplated within the scope of this patent specification. Fig. 22B-22D illustrate the lens aperture 441, the

recesses

468 and 470 into which the

lenses

462 and 464 are inserted, and the lower aperture 474 through which fluid may enter or exit the patient or through which a guide wire may pass. As can be seen in fig. 22D, the interior of the tip 110 of the cannula 120 has two

lumens

472 and 474 separated by a wall 476. Fig. 22C and 22D illustrate that the distal outer edge 478 is rounded to facilitate insertion/passage through a tissue tract and mitigate tissue contact issues, according to some embodiments. When inserting an endoscope through a channel such as a urethra, trachea, or blood vessel, it is desirable that the outer distal edge 478 of the distal tip should be rounded because this area of the distal tip both contacts and dilates the tissue channel. In such a case, the central portion 480 of the distal tip may be made smaller rounded or flat. It has been found that making the central portion 480 less rounded or flat over the more spherical end enhances imaging properties because the camera and illumination are not damaged or are significantly less damaged. In the case shown, the aperture 472 may be covered with a flat glass dust cover flush with the rest of the central portion 480. Fig. 22C and 22D show that the outer surface of the housing 482 surrounding the fluid or guidewire opening 466 can be tapered. In the example shown, a taper of about 1 degree has been found to be useful for insertion into urological shell applications. The end surfaces surrounding the fluid or wire ports are beveled as best shown in fig. 8A and 8B.

In one embodiment, the endoscope described in this patent specification achieves low FOV and low cost for small cannula tips (less than 5mm cannula tip diameter) by special techniques using a lens system of no more than two microlenses, preferably molded using plastic material.

Fig. 23 shows a cross-sectional view of a lens system 2300, the lens system 2300 being located within a lens barrel 2310, the lens barrel 2310 fitting into the lens holder 454 shown in fig. 22C and preferably being coaxial with a light shield or ferrule 456. The lens barrel 2310 holds two

lenses

2312 and 2314, labeled as a first (top) element 2312 and a second element 2314. The second lens element 2314 may be retained in the barrel 2310 by a mounting ring or spacer 2316. The first lens element 2312 may be held in the barrel 2310 by an annular aperture 2318. An Infrared (IR) filter 2316 may be positioned just proximal to the second element 2314. If a sufficiently wide FOV can be provided for the camera module, a single lens can be used instead of

lenses

2312 and 2314.

An important characteristic of the lens system 2300 is that it provides a field of view (FOV) for the sensor 452 that is particularly wide for single use disposable endoscope portions having a small outer diameter, e.g., less than 5mm, preferably 4.2mm or 4mm or less. In some embodiments, the FOV is greater than 120 °, preferably 130 ° or greater, and most preferably 140 ° or greater at the diagonal of the rectangular or square sensor 452 at the sensor plane 2320 of the sensor. In a specific example of a lens system 2300 according to some embodiments, for the rectangular sensor 452, the FOV parameters are: diagonal FOV-140 ° ± 3 °; horizontal FOV-106 ° ± 3 °; and a vertical FOV-82 ° ± 3 °. In this example, the total track length of the lens assembly 2300, i.e. the distance from the distal end of the first lens element 2312 to the sensor plane 2320 of the sensor 452, is 4 mm; the distance from the proximal end of the IR filter 2316 to the sensor plane 2320 of the sensor 452 is 1.56 mm; the distance from the proximal end of barrel 2310 to sensor plane 2320 is 1.2 mm. In this example, the outer diameter of the lens barrel 2310 is 2 mm. In terms of MTF (modulation transfer function), the resolution of the combination of lens system 2300 and sensor 452 (in the example of a sensor with 640 x 480 pixels) is (1) 50% of-200 Ip/mm (per mm line pair) on the axis, 76% of 100 Ip/mm; and (2) 80% -39% (t) and 52%(s) of 100Ip/mm, and 66% (t) and 74%(s) of 60Ip/mm in the same example. In the same example, the distortion does not exceed 15%. Of course, these parameters are specific examples for some embodiments, and different parameters may be used and envisaged in this patent specification as long as they achieve a desired FOV of greater than 120 °, preferably 130 ° or greater, and most preferably 140 ° or greater.

The wide field of view of the lens system 2310 allows a larger area of the organ to be seen in a single image than is imaged in known prior art disposable endoscopes. This is particularly important when observing organs such as the bladder (the inner region of the bladder is several times that of the uterus). If the bladder is viewed using a known prior art disposable endoscope having a 120 ° FOV, significantly more repositioning will be required to examine the same internal region than would be required for an endoscope having a wider FOV. In addition, a wider FOV allows a larger area of the organ to be seen in a single image, which may facilitate accurate assessment by allowing one area of the organ to be compared relative to other areas in the same image.

As shown in fig. 22A and discussed above, according to some embodiments, LEDs 460 are symmetrically arranged around light-blocking ring 456 in a manner that allows illumination from one side of ring 456 to overlap with illumination from the other side, and thereby provide a wide field of illumination (FOI) that substantially matches the FOV of sensor 452.

This overlap is illustrated in fig. 24A, where light from an LED 460 located on one side of the ring 458 provides an illumination field labeled LED FOI 1, light from an LED 460 located on the opposite side of the ring 458 provides an illumination field labeled LED FOI 2, and the two FOIs overlap each other and otherwise match the FOV of the lens system 2300. Although the outer edges of the FOI and FOV may be slightly offset as shown, they still match to make full use of the available light and avoid blind spots.

In contrast, in known endoscopes, the LED light sources are arranged asymmetrically with respect to the lens system and there is a significant mismatch, as shown in fig. 24B, where a large portion of the lens FOV is not illuminated and thus there are blind spots in the image that are not well shown due to insufficient light. When referring to a symmetrical arrangement of the LEDs, this patent specification refers to a substantially, but not completely, symmetrical arrangement, for example as shown in fig. 22A, wherein the LEDs are symmetrical with respect to a vertical cross-section through a central axis of the light shield 456, and are almost, but not necessarily, completely symmetrical with respect to a horizontal cross-section through the central axis.

According to some embodiments, the image is improved by providing the endoscope with a facility to make the illumination of the camera FOV more uniform. This is particularly beneficial for examining organs such as the inner wall of the bladder, where the cannula tip 110 can be in a position where one pair of adjacent LEDs is closer to the bladder wall than the other pair. In that case, one side of the sensor 452 may receive significantly more light than the other side, and the brightness of the image may not be balanced. This may make image interpretation more difficult, as some imaged portions of the bladder wall may appear darker than another, or one portion may appear brighter or even washed away. Fig. 24C shows an image in which the field of view of the camera is not uniformly illuminated, and thus image area 2410 is entirely darker because it receives less light than image area 2412. This may occur due to a significant mismatch between the FOI and the FOV caused by an arrangement such as that shown in fig. 24B. It has been found that for different reasons, non-uniform overall brightness of regions within an image can occur to a lesser extent, because some LEDs are significantly closer to the imaged organ surface than others, even when the LEDs are symmetrically arranged around the optical axis of the lens system. Therefore, the control of the brightness as discussed below is helpful even in the case of a symmetrical arrangement of the LEDs.

Fig. 25 illustrates, in block diagram form, an example of a control circuit or system that can improve brightness balance in an image when different regions of an imaged organ receive different levels of illumination. The control circuit may be used in any of the endoscopes described in this patent specification. Fig. 25 is similar to fig. 15 in U.S. patent application SN 15/651,526, which is incorporated herein by reference (except for the addition and modification to improve brightness balance). Specifically, the LEDs 460a on one side of the light-blocking ring 456 of the camera module 480 have their own LED drivers 2506a, and the LEDs 460b on the other side of the light-blocking ring have their own LED drivers 2506 b. The field programmable gate array 2508 provides corresponding control signals ALCa and ALCb to the

LED drivers

2506a and 2506b that vary the intensity of light emitted by the LEDs. A three-position, manually operated switch or button 2512 provides an input to the processor ISP 2510, and the processor ISP 2510 varies the control signals ALCa and ALCb, and thus the light intensity from the

LEDs

460a and 460b, through the FPGA 708. As one example, (i) switch 2512 is in position 1 (which may be a default position) with

LEDs

460a and 460b providing approximately equal light intensity, e.g., each operating at 100% of their rated brightness; (ii) at position 2, LED 460a operates at 50% of its rated brightness and LED 460b operates at 100% brightness, and (ii) at position 3, LED 460a operates at 100% brightness and LED 460b operates at 50% brightness. Of course, different brightness levels, e.g. 40%, 60%, 70%, etc., may be achieved for the dimmed LEDs. Also, there may be more than two separately controlled groups of LEDs, e.g. 3 or 4 groups, with the corresponding switch having more positions to change the light output of the LEDs. A potentiometer may be used instead of a three-position switch to refine the steps in the relative light output of the LED. The switch or button 712 may be mounted at a convenient location on the handle 140 for operation by a user, such as shown in FIG. 1. While the display 150 displays images and the user is manipulating the handle 140 to point the cannula 120 at different regions of the organ under examination, the user may operate the switch 2512 according to a balance of brightness seen on the display 150.

Otherwise, fig. 25 is like fig. 15 in said application SN 15/651,526 and will be similar to what is described below except for the use of different reference numerals. The motherboard 2516 is used to provide the interface, components to process data and control the end of the cannula 120 and the display module 150. Broadly speaking, the main board 2516 supplies power and control signals to the camera module 480 and the LEDs 460 and to the display module 150, and converts the camera output into an image signal to be displayed on the display module 150. In the main board 2516, the processor 2510 (which may be a DSP or ISP) is a digital signal processor that controls the components at the tip of the cannula 120 and the operation in the display module 150, and processes captured image data. Communicating through a field programmable gate array (FPGA1)2508, the processor 2510 sends control signals ALCa and ALCb to the

LED drivers

2506a and 2506b, respectively, to turn the

LEDs

460a and 460b on and off as needed and adjust their outputs to desired brightness levels. After converting the output of the camera module 480 from serial to parallel through the STMIPI interface 2518, the processor 2510 receives the output of the camera module 480. Processor 2510 exchanges information with information storage devices such as DDR2 memory 2520, SD card memory 2522, and SPI flash memory 2524 as necessary. In one illustrative example, the position of switch 2512 results in illumination as set forth in fig. 25: the default brightness may be equal or normal illumination from both pairs of LEDs; the left LED is in 50% illumination and the right LED is in normal illumination; and the right LED is at 50% illumination and the LED is at normal illumination. Processor 2510 can provide an output to HDMI connector 2514 and can receive a key actuation signal or interrupt signal from touch key 2526, which can be a button on handle 140, such as

buttons

160 and 162. Processor 2510 also receives touch or slide information from touchpad 2528 in display 150. The processor 2510 provides control signals to the camera module 480, touchpad 2528 and FPGA 12508 via I2C line 2530. The processor 2510 converts the parallel signal from the FPAG 12508 into a serial RGB signal and provides the serial RGB signal to the display module 150.

The display module 150 displays images from the camera module 480 and responds to touches to send control signals to the processor 2510. The display module 150 includes a field programmable gate array (FPGA2)2532, the field programmable gate array (FPGA2)2532 receiving images from the camera module 480 provided in a serial RGB format by the processor 2510. The FPGA 22532 sends images in a parallel RGB format to the LCD display 2534 and may store selected images in the memory SRAM 2536 and call them for display or storage in the SD card 2522 and/or SPI flash 2524, in response to commands from the touch pad 2528 or preprogrammed instructions from the processor 2510 or FPGA 22532 or other processor or memory component. The touchpad 2528 communicates with the processor 2510 over a signal bus I2C 2530 and may send commands to the processor 2510 over a direct bus INT 2538. Power supply facilities such as connections to rechargeable batteries removably secured to the handle 140, connections to manual off/on switches on the handle 140, and camera control buttons on the handle 140 may also be on the main board 2516.

Thus, in the example of fig. 25, the user may select one of three positions of the switch or button 2512 as desired to reduce the brightness imbalance in the image.

According to some embodiments, an automated system may be implemented in any of the described endoscopes to improve brightness balance in images in smoother steps when needed. Fig. 26 illustrates such an automated system and is otherwise similar to fig. 25 except that it omits switch 2512 and includes an algorithm in processor 2510 that responds to the overall brightness level in a selected region of the image information from sensor 452 (or from LCD display 2534) to vary the light output of LED 460 to equalize the overall brightness of the entire image on LCD display 2534. In this example, processor 2510 is programmed with an algorithm 2510a, where algorithm 2510a is responsive to a difference in overall brightness of two different regions of the current image frame from sensor 452, for example, between the left and right halves of the image frame. The algorithm may be relatively simple, for example, when either the left half or the right half of the image frame exceeds a selected overall brightness threshold, the processor 2510 calculates a balance signal indication or difference and issues a command to the LED drivers 2506a and/or 2506b to decrease the intensity of the LED corresponding to the side of the image whose overall brightness has exceeded the threshold. In a simple implementation, algorithm 2510a may mimic the effect of switch 2512 of fig. 25, i.e., (i) when the left side of the image frame, which is brighter than the right side, is greater than a threshold, the light output of left LED 460a is reduced by 50% (or some other selected percentage (%) reduction), (i i) if the right side of the image has an overall brightness that exceeds the threshold, do the other way around, and (iii) the difference in overall brightness for the left and right sides of the image frame does not change the relative output of the LEDs within a selected threshold. Alternatively, the algorithm 2510a may provide control in finer steps, e.g., if the overall brightness difference between the two halves of an image frame is greater than a first threshold but less than a second threshold, then the light output of the associated LED is reduced by a first amount; but if the difference exceeds a second, greater threshold, then a second, greater amount is decreased. There may even be more steps, i.e. three or more thresholds and three or more corresponding reductions in the light output of the associated LEDs. As an alternative, the algorithm may increase the light output of the LEDs corresponding to less bright image areas, while or not simultaneously decreasing the light output of the LEDs corresponding to brighter areas in the image. The algorithm may be implemented by one of ordinary skill in the programming arts in view of the teachings of this patent specification. Algorithm 2510a can be configured to respond to two or more smaller regions of the image, such as two strips of image frames or two groups of pixels spread out in each half of the image frame, or several groups of pixels in each half of the image, rather than to the overall brightness or each half of the image frame.

The depth of penetration of the injection needle protruding from the end of the endoscope cannula into the tissue is important for the medical professional and the patient. Controlling the insertion depth by feel may not be accurate and reproducible enough. For example, where an endoscope is used to inject some type of drug into the bladder, there may be multiple injection sites, and it may be important to ensure that the depth of insertion is as necessary, e.g., the same for all sites but not deeper or shallower than desired, as opposed to requiring different depths at different sites as required by medical requirements. In the endoscope described in this patent specification, according to some embodiments, the insertion depth can be controlled accurately and reproducibly.

Fig. 27 shows the image seen on the display 150 when the injection needle 1114 is in its fully extended position, such as the position seen in fig. 6B. As previously mentioned, for example, in connection with fig. 11, in some embodiments, the endoscope is configured such that the needle is seen on the display 150 and the needle tip is located in the central region of the image. In the example of fig. 27, the display 150 is provided with scale markings 2710, each scale marking 2710 representing a respective depth of insertion of the needle 1114 into the tissue. The tick marks may be engraved or otherwise placed on the screen of the display 150, or they may be part of the displayed image, and the controls on the display may be programmed so that the marks are always shown or only shown when the user desires to turn them on or choose not to turn them off. The depth of insertion can be seen on the screen 150, which overlays an image of the tissue, such as the inside of the patient's bladder, and on the scale markings. For certain embodiments of the endoscope, the units of the scale markings, e.g., the distance between two adjacent markings 2710, may be fixed — for example, the units of the scale markings correspond to a needle length or insertion depth of 2 mm. Of course, different relationships may be established, for example, scale mark units corresponding to 1mm or 3mm, etc. In the example of fig. 27, the distal 6mm needle length is seen in the image on the display 150.

Fig. 28A-28C show images on the display 150 at three different depths of insertion of the needle 114 into tissue for some embodiments (images of tissue such as the inner bladder wall are omitted from these figures for clarity, but in actual practice will be seen under superposition of the needle image and the scale markings). Fig. 28A shows the needle 1114 at zero insertion depth, i.e., the entire distal portion of the needle is considered to have not been inserted into tissue. Fig. 28B shows the portion of the needle that has not penetrated into the tissue at 2814, and the portion of the needle that has entered the tissue and is therefore not visible in the image in dashed lines at 2916. Thus, the endoscope user can visually verify how much the needle has been inserted, and can determine whether the desired insertion depth has been reached and/or maintained for a given injection site, and if not, how deep the needle is inserted or how much the injection needle is pulled back. Fig. 28C shows a display 150 for a deeper insertion. In this case, the portion 2814 of the needle seen in the image only rises up to the first tick mark 2710, which means that the needle length corresponding to the distance between two pairs of adjacent marks has been inserted into the tissue. Portion 2016 is not visible in the image because it is inside the tissue, and is shown in dashed lines in fig. 28C. For example, if the distance between the two markers 2710 corresponds to a needle length of 2mm, fig. 28B shows that a needle length of 2mm has been inserted into tissue, and fig. 28C shows that a needle length of 4mm has been inserted into tissue. At each injection site, the display 150 dynamically displays the actual insertion depth as the needle is inserted. Thus, the endoscope user can use the images on the display 150 to reliably and reproducibly insert the needle at the desired depth at each injection site.

Fig. 29 illustrates an example of markings on an injection needle 114 that may facilitate control of needle insertion depth in some embodiments of the endoscope described in this patent specification. In this example, the indicia includes three portions of the injection needle 114 colored in respective different colors, e.g., red at a portion 2912 immediately behind the needle 2910, blue at a next portion 2914, and green for a remaining portion 2916. In this example each section is 2mm long, but of course different lengths in mm may be marked with colour, and the sections may all be the same length or different lengths from each other. The color on the needle is highly visible in the image on the display 150 and can speed up the injection process while providing immediate guidance of the current insertion depth and confirming that the desired injection depth has been achieved and maintained during the injection or changed as needed during the injection. Different colors or different numbers of colors may be used or different colored indicia may be used in place of the colors shown.

Although the foregoing has been described in some detail for purposes of clarity of understanding, it will be apparent that certain changes and modifications may be made without departing from the principles thereof. It should be noted that there are many alternative ways of implementing the processes and apparatuses described herein. Accordingly, the present embodiments are to be considered as illustrative and not restrictive, and the subject matter described herein is not to be limited to the details given herein, but may be modified within the scope and equivalents of the appended claims.

Claims

1. An endoscope having a multi-use reusable proximal portion and a single-use disposable distal portion, said endoscope comprising:

a handle configured to be grasped by a user's hand and having at least one button to control endoscope functions, and a video display screen mounted to the handle, wherein the handle and screen form part of a reusable portion of the endoscope;

a sleeve forming part of a disposable part of the endoscope;

a connector at a proximal portion of the disposable portion of the endoscope configured to releasably mate tool-lessly with a connector at the reusable portion of the endoscope to releasably integrate the reusable portion and the disposable portion; and

an imaging module having a video camera at a distal end of the cannula and a light source at the distal end of the cannula, the video camera coupled with the screen to provide images to the screen, and the light source illuminating a region viewed by the camera under control of the button on the handle;

wherein the video camera is a digital video camera providing digital image output delivered to the video display screen; and is

Wherein the distal end of the cannula has an outer diameter of no greater than 4.2mm and the imaging module includes an image sensor having an image plane no wider or no higher than 3 mm.

2. The endoscope of claim 1, wherein the digital video camera comprises an image sensor having an image plane with a linear dimension of no more than 3 mm.

3. The endoscope of claim 1, wherein the imaging module comprises a lens system providing a field of view of no less than 130 °.

4. The endoscope of claim 3, wherein the lens system uses no more than two lenses.

5. The endoscope of claim 4, wherein the lens extends no more than 4mm from the image plane.

6. The endoscope of claim 1, further comprising a needle fully contained in the disposable portion of the endoscope and having an extended position in which the needle protrudes distally from the cannula, wherein the imaging module has a field of view that includes a distal length of the needle, and further comprising indicia on one or both of the display and the needle showing a depth of penetration of the needle in tissue when the endoscope is used on the display.