Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
  • A61B8/12—Diagnosis using ultrasonic, sonic or infrasonic waves in body cavities or body tracts, e.g. by using catheters
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
  • A61B1/00064—Constructional details of the endoscope body
  • A61B1/00071—Insertion part of the endoscope body
  • A61B1/0008—Insertion part of the endoscope body characterised by distal tip features
  • A61B1/00082—Balloons
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
  • A61B1/00131—Accessories for endoscopes
  • A61B1/00135—Oversleeves mounted on the endoscope prior to insertion
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
  • A61B1/00163—Optical arrangements
  • A61B1/00165—Optical arrangements with light-conductive means, e.g. fibre optics

Definitions

• Endoscopic device for observation and treatment.
• the present invention relates generally to the medical field of observation and treatment of the human body using endoscopic probes which are introduced through a natural or artificial internal conduit.
• Probes or endoscopes are already known which allow observations and / or certain treatments to be carried out in specific areas of a human body cavity.
• Such probes are commonly used, for example in urology and gastroenterology.
• they mainly comprise in a cylindrical sheath of synthetic or plastic material serving as catheter and extending between an observation and external control head operated by the surgeon and an internal intervention end a certain number of longitudinal hollow conduits intended to receive lighting means, observation means and treatment means.
• optical fibers The appearance for several years of optical fibers has led to a noteworthy improvement of these devices by allowing the lighting and easy observation of the work area; by the way, laser probes made of an optical fiber transmitting the radiation of a power laser are also very commonly used to obtain, depending on the wavelength of the laser light, either a local burning of a part of the undesirable body, that is to say a broken nephritic calculus.
• laser probes made of an optical fiber transmitting the radiation of a power laser are also very commonly used to obtain, depending on the wavelength of the laser light, either a local burning of a part of the undesirable body, that is to say a broken nephritic calculus.
• Such an endoscopic intervention probe is described for example in document GB-A 2 167 668 published on June 4, 1986.
• This document shows an endoscope comprising an external observation and control head and an intervention end connected to each other by a sheath made of plastic pierced with four holes referenced respectively 3, 7, 8 and 10 and used for Observation, Lighting, passage of an intervention instrument and Circulation of an Irrigation Liquid from The Work zone.
• This probe is supplemented at its intervention end by a balloon 12 which can be inflated from the external control head and which allows, after the introduction of the probe into the internal duct of the human body, to ensure relative fixation thereof. by clamping along the walls of this conduit.
• an endoscopic probe conforming to the British document GB-A 2 167 668 is practically not, at least in the state in which La describes this document, functioning Lely viable and this for the following reason.
• the intervention instrument that is introduced through the conduit 8 is a fiber supplied by a power laser, for example of the YAG type or dye laser, the distal end of this fiber heats up strongly during its operation. This phenomenon is reinforced, and makes the intervention instrument ineffective when organic deposits coming to agglutinate at the end of the laser fiber, it reaches temperatures ranging from 100 ° C (boiling of the water of the cells ) up to more than 1000 ° C.
• the thermal energy thus emitted risks destroying the entire internal intervention end of the sheath and in particular that of the scattering and observation fibers (the latter being already destroyed at 70 ° C) and La lenti lle, by thermal shock.
• a device in accordance with this document the sheath of which is produced by extrusion, leads for this sheath to diameters of the order of at least 4 mm, without it being possible to descend below this dimension.
• the veins or The introduction of a probe to break kidney stones, such a probe must in this case obligatorily cross the ureterovesical orifice located at the exit of the bladder and whose normal opening in adults is about 2.3 mm.
• the surgeon is then forced to have recourse to a progressive dilation of this opening, Which requires anesthesia general several hours.
• the subject of the present invention is a method of preparation for an endoscopic observation and treatment device intended to be introduced into the human body through an internal conduit, of a cylindrical sheath of synthetic material serving as a catheter, extending between an external observation and control head and an internal intervention end and comprising a certain number of longitudinal hollow conduits also cylindrical intended to receive lighting means, observation means and processing means , characterized in that it consists in molding the sheath by bringing the synthetic material in the pasty state around long tudinal mandrels whose positions and diameters correspond to the future hollow conduits of this sheath and of ultrafine lighting optical fibers, solidifying the synthetic material, then extracting the different mandrels.
• the invention also relates to an endoscopic observation and treatment device with multiple functions intended to be introduced into the human body through an internal, natural or ArtificieL, mainly comprising a cylindrical sheath of synthetic material serving as a catheter and extending between an observation and external control head and an internal intervention end provided with an inflatable fixing balloon, a certain number of hollow conduits also cylindrical longitudinal intended to receive lighting means, observation means and treatment means, characterized in that the sheath is obtained by molding, has an outside diameter less than 2 mm and in that the hollow conduits are separated from each other by walls which, at the place of their minimum thickness, have a dimension less than 0.10 mm, which may reach, if necessary, 0.05 mm, said sheath comprising:
• - lighting means consisting of a plurality of ultrafine optical fibers, with an individual diameter of the order of 50 ⁇ m, distributed and embedded in the synthetic material of the sheath during the previous molding operation ,
• an observation optical fiber the intervention side end of which is fitted with optical accommodation means and the observation side end of which is provided with a screw and creamer system allowing axial movement of the fiber to the inside the sheath,
• an intervention fiber also adjustable in axial translation inside the sheath using a screw and creamer system fixed on the observation head, sufficient radial clearance being provided between the sheath and this fiber to allow the circulation of a cooling liquid along this L,
• any means of intervention in particular and optionally, one of the intervention means chosen from Ultrasonic probes, Microstrips, biopsy probes, coagulation probes, spark probes, laser probes and fiber optic pressure measurement probes.
• the observation optical fiber and the intervention fiber are both adjustable in translation by means of a screw and creamer system which allows them to be displaced relative to the head. 'observation.
• the intervention fiber can be either a laser fiber or an ultrasonic fiber.
• the laser fibers can, depending on the wavelength that they transmit, be used either for the burning of an undesirable tissue or, in particular in uroLogy or in gastroenterology, to break a calculation by thermal shock.
• the miniaturization carried out using the means according to the invention and which leads to a sheath with an external diameter of less than 2 mm allows, in particular in uroLogy, very substantial progress since the device thus produced crosses, without any need for expansion, nor consequently of general anesthesia, the meatus ureterovési ca which allows to reach the kidney after the crossing of the bladder.
• this channel it is thus possible to use this channel either for a second laser fiber which would in this case have a different function from the first intervention fiber, either for an ultrasound probe, the apparatus according to the invention thus making it possible to use at will either two laser intervention fibers or two intervention fibers on ultrasound, either in combination a laser fiber with an ultrasonic fiber,
• the ultrasonic fiber can also be replaced in situ and during the intervention either by a micro-drill, or by a biopsy, coagulation or sparks, etc.
• a single ultrasound probe is used, it can be used as a scalpel for its destruction function; in the case where the object of the invention is carried out with the apparatus, the simultaneous introduction of two ultrasonic probes, it is possible for example to use one as a transmitting probe and the other as a receiving probe, which makes it possible to do local ultrasound and even, when one is in a blood vessel in the presence of blood flow, ultrasound by Doppler effect.
• Such ultrasound probes as well as micro-burs can be particularly interesting in cardiology where their introduction either in the coronaries presenting stenoses or in the cardiac cavities makes it possible to obtain invaluable information on (or to treat) the state of the wall of the vessel or internal cavities of the heart.
• the echograph technique that associated with the Doppler effect can even allow an in situ study of the movement of the valves of the heart.
• Spark probes are useful for breaking stones or mineral concretions.
• Biopsy probes are also of obvious interest; as for fiber optic pressure measurement probes, they can be very useful important in Logi traumato neurocurgie that for example to observe directly the pressure inside a cavity which is filled with cerebrospinal fluid. In an intervention like this.
• the device which is the subject of the invention is introduced directly into the skull using an orifice pierced in the cranial box. All the preceding examples illustrate the multi-functional nature of the device which is the subject of the invention which allows, using a single endoscope introduced into a duct of the body, the production of a sequence of successive interventions of different natures.
• FIG. 1 is an overall view of the device which is the subject of the invention.
• FIG. 2 is a folded sectional view of the intervention end of the device
• FIG. 3 is a section along a cross section of the sheath of FIG. 2, on which the respective dimensions of the various conduits and probes have been respected,
• FIG. 4 is a sectional view of the observation head and external control of the endoscopic device.
• the observation head 1 On the observation head 1 are fixed an ocular device 5 in correspondence as will see it later with the observation fiber, a screw and creamer device 11 making it possible to adjust, inside the sheath 2, the state of axial translation of this same observation fiber.
• the first intervention fiber is a laser fiber 7 adjustable in translation in the sheath 2 using the screw and creamer device 8. According to the invention, a radial clearance is left between this laser fiber 7 and the duct which it occupies inside the sheath 2, for the circulation of a cooling fluid which enters the system at 9.
• the > observation and control head 1 also comprises the pipe 10 for introducing and receiving the circulation of irrigation and / or suction liquid as well as, in the same internal hollow pipe, the ways of introducing an ultrasonic probe 11 or any intervention tool 12 chosen from those already mentioned above.
• this same external observation and control head 1 also includes an orifice 13 into which one can introduce
• FIG. 2 which is a cut down level of the intervention end on 3 of the sheath 2
• the observation fiber 14 the laser fiber 7 and the ultrasonic probe 11 are found in their respective longitudinal hollow conduits.
• the plastic sheath 2 proper is terminated at its internal intervention end 3 by a thermal coating 15 of protection against possible overheating brought to this place by the laser fiber 7. It is also noted that the end of the
• observation fiber 14 is provided with an accommodation lens 16 attached to the end of the fiber
• the hollow conduit 17 which is used both for irrigation and for the introduction of the ultrasound probe 11 can also be used to bring any other means of treatment to the place of intervention, by way of example in the case of Figure 2, a micro-mill 18 mounted at the end of a cable 19 operable from the external control head.
• the sheath 2 also includes, in suitable hollow conduits, at least one flexible rigid core 20 intended to give the probe the desirable profile during its introduction and its progression in the conduit. internal body.
• An inflatable balloon 4 is also provided at the end 3 of the sheath 2; this balloon is inflatable, in a known manner, using a flow of pressurized air introduced into the duct 13.
• the walls of this balloon are shown in solid lines in their rest position and in lines mixed in its inflated position where it allows the sheath to be fixed to a certain extent along the unrepresented wall of the internal conduit into which it is introduced.
• the means for adjusting the translation 6 and 8 of the observation fiber 14 and of the laser fiber 7 as well as the thermal coating 15 make it possible, by choosing the state of translation of the fibers 7 and 14 protect the end 16 of the observation fiber 14 from laser heating.
• Figure 3 shows a section along a cross section of the sheath 2 of Figure 2 and gives a more precise idea of the reciprocal dimensions of the three hollow conduits traversing this sheath as well as ultra-fine optical fibers 21 carrying the light intended to illuminate the treated area .
• the various ultrafine optical fibers 21, the diameter of which is close to 50 micrometers, are integrated into the mass of synthetic material 2 and embedded in it at the very moment of molding of this material synthetic 2.
• the channel 22 intended to receive the laser fiber 7 has a diameter of the order of 0.3 mm as well as the channel 23 intended to receive the observation fiber on 14.
• An annular space is however provided between the laser fiber 7 and the channel 22 to allow the circulation of the cooling fluid injected by the orifice 9, FIG. 1.
• the channel 17 used for the introduction of the ultrasonic probe 11 and the micro-drill 18 it has a diameter of the order of 1 mm sufficient to authorize at the same time the circulation of the irrigation liquid of the work area.
• the external dimensions of the sheath 2 of FIG. 3 are, in the example described, 2 mm in diameter.
• the intensity of the luminous luminous flux conveyed by the various ultrafine fibers 21 depends directly on the surface of the cross sections of these various fibers and that the fact of having distributed these in large numbers by drowning them in The mass of the synthetic material of the sheath 2 makes it possible to obtain an equal illumination for a smaller size than would be the size of a single circular fiber with a surface equal to the sum of the elementary surfaces of the fibers 21. Furthermore, the distribution of these lighting fibers 21 in a large number of ultrafine fibers provides more solidity and resistance to bending of the lighting device, compared to the solution of a single fiber.
• FIG. 4 there is shown in section the external observation and control head 1 and its junction with the sheath of synthetic material 2.
• This figure shows the various elements already cited provided with the same reference numbers with in addition the motor 24 for controlling the micro-mill 18 by the metal cable 19, the ultrasonic source 25 which the fiber 11 supplies with ultrasonic power and the Laser 26 which supplies light energy to the laser fiber 7.
• FIG. 4 also shows in more detail the arrangement of the screw and rack system 8 and of the system for introducing coolant 9 allowing '' inject a certain amount of this Liquid between the fiber 7 and the corresponding hollow conduit inside the plastic sheath 2.

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• Health & Medical Sciences (AREA)
• Life Sciences & Earth Sciences (AREA)
• Surgery (AREA)
• Physics & Mathematics (AREA)
• Biomedical Technology (AREA)
• Molecular Biology (AREA)
• Pathology (AREA)
• Radiology & Medical Imaging (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Engineering & Computer Science (AREA)
• Biophysics (AREA)
• Heart & Thoracic Surgery (AREA)
• Medical Informatics (AREA)
• Optics & Photonics (AREA)
• Animal Behavior & Ethology (AREA)
• General Health & Medical Sciences (AREA)
• Public Health (AREA)
• Veterinary Medicine (AREA)
• Laser Surgery Devices (AREA)
• Radiation-Therapy Devices (AREA)
• Endoscopes (AREA)

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• 1987
  • 1987-06-29 CH CH2453/87A patent/CH672255A5/fr not_active IP Right Cessation
• 1988
  • 1988-06-27 JP JP63505527A patent/JPH01503684A/ja active Pending
  • 1988-06-27 WO PCT/FR1988/000340 patent/WO1989000023A1/fr not_active Application Discontinuation
  • 1988-06-27 US US07/333,624 patent/US4984563A/en not_active Expired - Fee Related
  • 1988-06-27 EP EP88905888A patent/EP0321538A1/fr not_active Withdrawn

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