Classifications

• • 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
  • A61B1/012—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 characterised by internal passages or accessories therefor
  • A61B1/018—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 characterised by internal passages or accessories therefor for receiving instruments
• • 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
  • A61B1/005—Flexible endoscopes
  • A61B1/0051—Flexible endoscopes with controlled bending of insertion part
  • A61B1/0052—Constructional details of control elements, e.g. handles

Definitions

• the invention relates to an endoscope with a flexible and multiple lumen catheter probe according to the preamble of claim 1.
• Such an endoscope is known from DE 100 45 036 CI.
• the known endoscope has a multi-lumen probe and a handle, which is provided at the proximal end of the probe.
• An optic extends in at least one of the probe lumens.
• a working lumen for a surgical tool is also provided.
• a control element for example in the form of a puller wire or a pulling cable, is connected to the distal end of the probe and is movably guided on the probe in the axial direction. As a result, a distal probe part with a certain length can be bent over and also rotated. In this way, a therapeutic endoscope can be reached, which can be easily operated during the surgical procedure.
• an endoscope with a handle and a catheter arrangement in which the catheter arrangement is rotatably and detachably attached to the handle.
• the fiber optics provided in the catheter probe are aligned with the eyepiece optics provided in the handle.
• an optical output provided on the catheter arrangement is detachably connected to the handle.
• the catheter probe has additional lumens, the outputs of which are located outside the handle at the proximal end.
• a control element for guiding the probe to the target location is not provided in this endoscope. Maintenance, especially decontamination, is extremely difficult with endoscopes with multi-lumen probes. This results in high service costs and there are long downtimes between the respective missions in order to achieve safe decontamination.
• the object of the invention is therefore to provide an endoscope with a controllable and flexible multi-lumen probe, in which simple maintenance is achieved and problems which occur in particular during decontamination are eliminated.
• the proximal end piece of the optics which protrudes beyond the proximal end of the catheter probe, is guided in a flexible tube.
• the optics which are designed in particular as fiber optics, preferably include the observation optics and the illumination optics.
• the bendable hose is elastic in its longitudinal direction and can be made of silicone rubber, for example.
• the tube is firmly connected to the optics at an attachment point which is distant from the proximal end of the catheter probe.
• the attachment point of the tube with the optics is preferably located at the proximal end of the optics.
• the resiliently elastic tube is between its distal tube end, which is releasably attached in the area of the proximal end of the probe, and the attachment point is clamped with the optics.
• the translucent seal or cover for example in the form of a glass or plastic pane, is inserted tightly into the lumen material.
• the optic lumen is hermetically sealed at the distal end opposite the destination.
• the translucent cover can also have optical properties, in particular design properties, and can be designed, for example, as a lens.
• the translucent cover in the form of a disc or lens can be inserted hermetically sealed into the distal opening of the optic lumen, for example by gluing, welding into the probe material, which is made in particular of plastic, or by shaping the probe by extrusion, injection molding or the like.
• the optics in particular lighting and observation optics, can be moved in the optics lumen and in the tube and can be removed from the optics lumen and tube.
• a connector can be provided, to which an illumination device and / or an eyepiece can be connected.
• the connection piece has suitable adapter devices for connecting the lighting device and the eyepiece.
• Emergency lighting which may be battery-operated, can also be connected to the connector and thus to the optical lighting fibers of the optics as the lighting device.
• the eyepiece is connected to the observation fiber strand of the optics via the connector.
• the fastening point in which the proximal end of the tube is connected to the optics, can be provided on the connector and is preferably designed as a Luer lock connection. Due to the detachability of the connection between the optics and the tube, the optics can be removed from the optic lumen of the catheter probe and the tube. In addition to the prestressing effect on the optics, the tube offers protection of the optics between the proximal end of the catheter probe and the connector.
• the tube Due to its elasticity, the tube forms a length compensation device, which acts with a certain pretensioning force like a spring on the optical fiber / fiber bundle of the optics.
• the distal end of the optic is pressed against the translucent cover at the distal end of the optic lumen and when the distal probe part is bent, the change in length is compensated by the resilient biasing force.
• the optics remain in contact with the cover with a certain pressure.
• the catheter probe is preferably rotatably mounted on the handle.
• the proximal end of the catheter probe can be mounted in a pivot bearing on the handle.
• the pivot bearing preferably has a longitudinal bore which is aligned with a control lumen of the catheter probe in which the control element is arranged.
• the control element can thus be guided through the pivot bearing to a slide in or on the handle.
• the control is firmly connected to the slider.
• the slider allows the control element to bend the distal one in the axial direction Probe part to be moved. By turning the catheter probe in relation to the handle, the bent probe end can also be controlled.
• the pivot bearing enables the catheter probe to be rotated 360 ° relative to the handle.
• the catheter probe is fastened to the rotary bearing by means of a releasable fastening device, in particular a Luer lock connection.
• the control element is also fastened to the slide by means of a releasable fastening device, for example using a clamping screw.
• the catheter probe is preferably detachably connected to the pivot bearing on the handle only in the area of the guide wire lumen.
• the proximal outlets for the other probe lumens are not connected to the handle.
• These probe lumen outputs can be connected to assigned end devices independently of the handle and outside the handle.
• the optics guided through the hose are attached to the lighting system outside the handle, e.g. Emergency lighting, and connected to the eyepiece, which can preferably be attached to the handle, as already explained above.
• the observation optics can also be connected via the eyepiece to a camera / monitor system or a suitable observation device in a known manner.
• a flushing outlet at the proximal end of a flushing lumen of the probe can be connected to a flushing / suction system.
• a working lumen or a plurality of working lumens for a surgical tool or for several surgical tools can be connected to actuating elements with which the respective surgical element is actuated.
• the respective surgical element is removably guided in the assigned working lumen.
• the multi-lumen catheter probe is preferably designed as a single part.
• the probe can be manufactured by injection molding or extrusion technology or by another suitable shaping technology and consist of plastic.
• an attachment piece made of a solid material, for example plastic can be provided at the proximal end of the probe, on which the lumen outputs for the plurality of probe lumens and the guide outlet for the control element that can be connected to the pivot bearing on the handle are provided.
• the lumen outputs and the guide output can preferably have connection elements for luer locks, bayonet locks or the like or be designed as coupling parts of such locks and likewise consist of the solid material of the proximal attachment piece.
• the proximal extension piece can also preferably be designed as an injection molding or extruder part, which together with the flexible probe forms a single part.
• the decontamination of the surgical tool that can be removed from the working lumen can be carried out in a simple manner.
• the optics removed from the optic lumen have not been contaminated during the surgical procedure because the distal end of the optics volume is protected from the target location by the translucent seal at the distal end and the surrounding probe material protects the optics in their longitudinal extent. Since the catheter probe is preferably designed as a single-use part, a new, not yet used probe is connected to the handle as described above, so that the optics can be re-used in the optics lumen.
• the catheter probe can have a balloon which is inserted into the catheter probe via a balloon lumen Dilation medium, for example a gas or a liquid, can be supplied for balloon expansion.
• Dilation medium for example a gas or a liquid
• the catheter probe can have a guide wire lumen through which a guide wire can be guided from the distal end of the probe to an exit opening in the catheter wall behind the balloon.
• the guide wire can then be used to guide the catheter probe, in particular with the probe part which has the balloon, or with the bendable probe part to a target location in the patient's body.
• the control element can be guided in a flexible support tube in the catheter probe.
• the support tube ends a distance from the distal end of the catheter probe. As a result, the flexibility and bendability of the probe part to be bent is not impaired by the support tube.
• the distance to the distal end corresponds approximately to the length of the distal probe part to be bent over by the control element.
• the handle, the optics and the eyepiece form reusable modular components, which can be assembled with catheters of different lengths, outer diameters and different numbers of lumens and different dimensions of the lumens, especially working lumens, to form a multi-purpose endoscope (multitasking endoscope) ,
• a multi-purpose endoscope multitasking endoscope
• a wide variety of instruments can also be directly incorporated into the working channel, in particular mounted, so that an endoscope catheter with instrument forms a disposable system that does not cause any decontamination problems.
• a controllable and rotatable endoscopic cutlery (Visio Instrument).
• a balloon catheter can be realized as a single part with reusable, uncontaminated optics that can be removed from the balloon catheter.
• FIG. 1 shows an embodiment of the invention in a schematic representation
• Fig. 2 shows an embodiment for the rotatable attachment of the catheter probe to the handle, which can be used in the embodiment of Fig. 1;
• FIG. 3 shows a section through a multi-lumen catheter probe, which can be used in the embodiment of FIG. 1;
• FIG. 4 shows part of a probe designed as a balloon catheter, which can be used in the embodiment of FIG. 1;
• FIG. 5 shows an embodiment for a bendable distal probe part of a catheter probe, which can be used in the invention.
• FIG. 6 shows a further embodiment of a bendable distal probe part of a catheter probe which can be used in the invention.
• the embodiment of an endoscope shown in FIG. 1 has a handle 12 and a catheter probe 1 that can be detachably attached to it.
• the probe 1 is designed as a multi-lumen probe (FIG. 3) and can be, for example, one working lumen or several working lumens 29 for surgical tools and have at least one optical lumen 5 for an optical system 6.
• a balloon lumen 18 can be provided for dilating a balloon 17 (FIG. 4).
• Separate optical lumens can also be provided for the optical system 6 consisting of lighting optics and observation optics.
• separate lumens can be provided in the probe 1 for rinsing and aspiration.
• the catheter probe 1 contains a control element 13, for example in the form of a pull rope or pull wire.
• a control element 13 for example in the form of a pull rope or pull wire.
• the elongate control element is fixedly connected to a distal probe end 20 or is fastened in the vicinity thereof and extends in the axial direction along the probe and is movably guided thereon.
• the distal end piece of the catheter probe 1 can be bent by the control element 13.
• the control element 13 extends through a support tube 23 which is arranged in a control lumen 25 of the catheter probe.
• Support tube 23 is also flexible.
• the support tube 23 ends at a certain distance from the distal probe end 20. This distance corresponds approximately to the length of a probe part 24 to be bent by the control element 13.
• the distal probe part 24 to be bent has a greater flexibility than the probe part of the catheter probe, in which the support tube 23 extends ,
• the support tube 23 is in the region of its distal end on the catheter probe 1, for example with the aid of an adhesive in a fastening place 28 fixed.
• the attachment point 28 extends only over a small axial distance of the support tube 23.
• the support tube 23 With its remaining length, the support tube 23 is arranged movably in the control lumen 25 of the catheter probe. The flexibility of the catheter probe is thus maintained over most of its length.
• the catheter probe In the area of the distal probe part 24 to be bent, the catheter probe has greater flexibility and flexibility than in the rest of the probe part, in which the support tube 23 runs.
• the control element 13, which is preferably designed as a pull wire, is fastened to the distal probe end 2.
• the fixation is carried out with the aid of an adhesive 27.
• the fixation is carried out with the aid of a shrink tube 26.
• Shrink tube 26 presses the pull wire end 31, which is guided from the inside through an opening 30 in the probe wall, onto the outside of the distal end of the probe.
• the distal end of the continuous control lumen 25 is closed with a closure element 32.
• the distal probe part 24 which can be bent by means of the control element 13 can also be designed in the manner known from DE 201 18 886 U or from DE 199 28 272 AI.
• the catheter probe 1 consists of a bendable material, in particular biocompatible plastic. It is preferably designed as a disposable part, which is released from the handle 12 and disposed of after a surgical operation. In the event of a new surgical intervention, a new catheter probe is attached to the handle 12 and is kept sterile as a single part.
• the catheter probe 1 has a probe attachment piece 33 made of a rigid, solid material. This measure material can also be a plastic material.
• Proximal lumen outputs 34, 35, 36 and 37 are located on probe attachment piece 33. Control element 13 is guided through lumen output 34.
• the lumen outlet 35 is, for example, the balloon lumen 18, the lumen outlet 36 is, for example, the working lumen 29 and the lumen outlet 37 is, for example, the optical lumen 5.
• the outputs are equipped with coupling elements, for example for a bayonet lock, Luer lock or with similar coupling and connecting pieces.
• the catheter probe 1 is connected in a rotationally fixed manner to a rotary bearing 14 on the handle 12, in particular on the handle housing, via the rigid, tubular lumen outlet 34 for the control element 13 (FIG. 2).
• the handle 12 has at its front end the rotary bearing 14, which can be connected to the lumen outlet 34 provided on the probe attachment piece 33 by means of a releasable fastening device 15.
• the releasable fastening device 15 can be designed as a bayonet lock or Luer lock or the like.
• a detachable connection between the rotary bearing 14 on the handle 12 and the catheter probe 1 is formed by the releasable fastening device 15. In this way, rotary movements of, for example, a manually operated rotary part 38 of the
• Rotary bearings 14 are transferred to the catheter probe 1 and in particular to the distal probe part 24 with the distal probe end 20 possibly bent. Based on the shape, for example of the probe attachment piece 33 or on the basis of a marking on the catheter probe 1 or on the probe attachment piece 33, the angular position of the catheter probe, in particular the position of the distal probe end 20 and the angular position of the optics 6 about the probe axis, can be recognized.
• the catheter probe 1 can be at an angle can be rotated from 360 ° relative to the handle 12.
• the releasable fastening device 15 has a coupling element 40 which is fastened to the rotating part 38 and a coupling element 39 fastened to the lumen outlet 34.
• the detachable fastening device 15 created in this way has a continuous axial bore which also passes through the pivot bearing 14.
• the control element 13 extends through this axially extending bore.
• the slider 16 is guided in the housing of the handle 12 so that it can move axially against a biasing force, for example a biasing spring 42, in the axial direction.
• the biasing force acts in the direction of the front (distal) end of the handle 12.
• the distal probe end 20 is not bent relative to the rest of the probe area.
• the slide 16 can be actuated, for example, by means of an actuating element connected to the fastening means 41.
• the head of the clamping screw can be designed as an actuating element. It however, an additional actuating element can also be provided.
• the actuating element can protrude through a longitudinal slot 43 running in the axial direction of the handle 12 in the handle housing, as is shown in FIG. 2 for the clamping screw acting as a releasable fastening means 41.
• the longitudinal slot 43 can form stops at both ends to limit the movement of the slide 16 and the axial control movement of the control element 13.
• a crank mechanism can also be provided, with which a swivel movement or rotary movement generated on the outside of the handle is converted into the axial, linear slide movement.
• a handle with such a crank mechanism is described in DE 103 51 013 AI (PCT / EP03 / 12897) and can be used in the embodiment of FIG. 1.
• an eyepiece holder (not shown in detail) can preferably be pivotably arranged on the handle 12, in particular at the rear (proximal) end.
• the catheter probe 1 is connected to the handle 12 only via the proximal probe outlet 34 for the control element 13 by means of the releasable fastening device 15.
• the remaining lumen outputs 35, 36 and 37 are independent of the handle 12 and can be connected directly to associated end devices via suitable connecting means.
• the proximal lumen outlet 35 for the balloon lumen 18 can be connected to a dilation device (not shown in more detail), which supplies a liquid or gaseous dilation medium, by means of a corresponding connector.
• Surgical tool for example a drill with a flexible shaft, as known for example from DE 101 078 156 AI, or a tool for removing foreign bodies and comminuting foreign bodies, in particular for use in mechanical lithotripsy, can be removed.
• a flushing or suction device can be connected to the working lumen 19 via the lumen outlet 36.
• the respective distal end of the optical lumen 5 is hermetically sealed with a translucent cover 7. In this way, contamination of the optics 6 at the destination is prevented. The remaining part of the optics 6 is protected against contamination by the sheath formed by the catheter probe 1.
• the optics 6 can for example be moved forward in the optics channel 4 with the aid of an optics slide 26 placed on the optics output 11 up to the translucent cover 5, which can be designed as a glass pane.
• the optical fiber strand of the optics 6 projecting beyond the proximal end of the catheter probe 1 and the lumen outlet 37 is guided in a flexible tube 2 in the axial direction.
• the tube 2 forms a protection for the optics 6 against external influences, and the tube 2 is also designed to be elastically resilient in its longitudinal direction.
• the tube 2 has at its front (distal) end a coupling piece which, for example, has a detachable fastening device 46 with the proximal lumen outlet 37 Luer lock, forms.
• the rear (proximal) hose end 8 is also equipped with a coupling element which can be releasably connected to a connector 10 to form a releasable fastening point 3.
• the releasable fastening point 3 can be designed as a Luer lock connection.
• a bayonet connection can also be provided.
• the connector 10 is located at the proximal end of the optical fiber strand of the optics 6.
• the tube 2 When connecting the distal end of the tube to the lumen outlet 37 and the proximal tube end 8 to the connector 10, the tube 2 is stretched so that a prestress is exerted on the optics 6 in its longitudinal direction. As a result of this prestressing, the distal end 4 of the optics is pressed against the cover 7 at the end of the optic lumen. This pretensioning ensures that even when the distal probe part 24 is bent, the distal optic end 4 is always pressed against the translucent cover 7, so that a perfect observation of the target location is ensured.
• the resilient biasing force imparted by the tube 2 ensures that the optics are automatically advanced when the distal probe end 20 is bent. When returning the probe end 20 to its straight position, the optics 6 are pushed back against the biasing force. This ensures that the optic 6 always lies with its distal end on the cover 7 with a certain pressing force.
• the proximal end of the lighting optics line can be connected to a lighting device, for example emergency lighting, via the connector 10.
• the extension piece 10 has a corresponding adapter device 44.
• the proximal end of the observation optics line of optics 6 can be connected to an observation device his.
• the observation device contains an eyepiece which can be connected to the observation optical line of the optics 6 via the connection piece 10 by means of a suitable adapter device 45, for example a bayonet lock.
• the observation device can be designed as a camera / monitor system.
• the catheter probe 1 can have a balloon 17 at a specific distance from the distal probe end 20.
• a liquid or gaseous dilation medium is supplied to it via the balloon lumen 18.
• the balloon 17 can be expanded in diameter by approximately 1.0 to 1.5 mm compared to the probe diameter.
• the outside diameter of the catheter probe can be 1.8 mm, the balloon being expandable to about 3.0 mm.
• the balloon 17 can have a length of approximately 20 mm.
• the distance of the balloon 17 to the distal end of the probe can be approximately 25 mm to 35 mm, in particular 30 mm.
• a guide wire 11 can be guided through a guide wire lumen 19 which is open at the distal probe end 20. This makes it possible to insert the distal region of the catheter probe 1 and in particular the region of the distal probe part 24 to be bent over and the balloon 17 into the body of a patient with the aid of the guide wire 11.
• the guidewire lumen 19 ends, seen from the distal probe end 20, behind the balloon 17 and exits via an exit opening 21 in the catheter wall 22.
• the exit opening can be predetermined in the vicinity of the proximal end of the probe.
• the distance from the distal end of the probe 20 to the outlet opening 21 can be, for example, 230 mm.
• the catheter probe 1 and the proximal probe attachment piece 33 with the associated lumen outputs 34 to 37 can be produced as a single part, for example using injection molding technology, only the surgical tool used in each case remains for the decontamination treatment. If the tool is integrated or integrated, the decontamination treatment is also omitted.
• the handle 12 is designed such that it can be used with various catheter probes which have a control element in the manner of the control element 13.
• a catheter probe 1 with the cross-sectional shape shown in FIG. 3 can have an outer diameter of 1.8 mm ⁇ 0.05 mm, for example.
• the inner diameter of the optical channel 5 can be, for example, 0.85 ⁇ 0.02 mm.
• the diameter for the balloon channel 18 can be, for example, 0.22 ⁇ 0.02 mm.
• the inner diameter of the guide wire lumen 19 can be, for example, 0.47 ⁇ 0.02 mm.
• the inner diameter of the working lumen 29, which can also be used as a flushing lumen, can be, for example, 0.6 ⁇ 0.02 mm.
• the inner diameter of the control lumen 25 can be, for example, 0.47 ⁇ 0.02 mm.
• the specified diameter dimensions can vary for catheter probes for different purposes.
• the handle, the optics and the eyepiece can be used uniformly for the different catheter probes.
• these lengths can be compensated for by different tubes 2 with corresponding length dimensions, so that a single optic 6 with the associated connecting piece can also be used for catheter probes of different lengths.
• the endoscope described can be used, for example, for coronary artery endoscopy, it being possible for the catheter probe 1 to be equipped with the balloon 17 in its distal probe region.
• the handle 12 can be used with different catheter probes for use in cholangioscopy and mechanical lithotripsy, in particular percutaneous mechanical lithotripsy and other endoscopic interventions.
• Catheter probe resilient, elastic, stretchable tube, attachment point, distal end of the optical lumen, optical lumen
• control element e.g. pull wire

Landscapes

• Health & Medical Sciences (AREA)
• Life Sciences & Earth Sciences (AREA)
• Surgery (AREA)
• Biomedical Technology (AREA)
• Medical Informatics (AREA)
• Optics & Photonics (AREA)
• Pathology (AREA)
• Radiology & Medical Imaging (AREA)
• Biophysics (AREA)
• Engineering & Computer Science (AREA)
• Physics & Mathematics (AREA)
• Heart & Thoracic Surgery (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Molecular Biology (AREA)
• Animal Behavior & Ethology (AREA)
• General Health & Medical Sciences (AREA)
• Public Health (AREA)
• Veterinary Medicine (AREA)
• Endoscopes (AREA)
• Instruments For Viewing The Inside Of Hollow Bodies (AREA)

Applications Claiming Priority (2)

Publications (1)

Family

ID=34801622

Family Applications (1)

Country Status (8)

Families Citing this family (588)

Family Cites Families (23)

• 2004
  • 2004-02-05 DE DE102004005709A patent/DE102004005709A1/de not_active Withdrawn
  • 2004-10-01 JP JP2006551725A patent/JP2007520287A/ja not_active Ceased
  • 2004-10-01 US US10/587,981 patent/US8333691B2/en not_active Expired - Fee Related
  • 2004-10-01 CN CNB2004800410142A patent/CN100407982C/zh not_active Expired - Fee Related
  • 2004-10-01 AU AU2004315387A patent/AU2004315387A1/en not_active Abandoned
  • 2004-10-01 EP EP04765788A patent/EP1713376A1/de not_active Withdrawn
  • 2004-10-01 WO PCT/EP2004/011050 patent/WO2005074787A1/de not_active Application Discontinuation
• 2007
  • 2007-04-12 HK HK07103833A patent/HK1096834A1/xx unknown

Non-Patent Citations (1)

Also Published As

Similar Documents

Legal Events