EP4326136A1 - Procédé et appareil pour manipuler la paroi latérale d'une lumière corporelle ou d'une cavité corporelle - Google Patents

Procédé et appareil pour manipuler la paroi latérale d'une lumière corporelle ou d'une cavité corporelle

Info

Publication number
EP4326136A1
EP4326136A1 EP22763991.1A EP22763991A EP4326136A1 EP 4326136 A1 EP4326136 A1 EP 4326136A1 EP 22763991 A EP22763991 A EP 22763991A EP 4326136 A1 EP4326136 A1 EP 4326136A1
Authority
EP
European Patent Office
Prior art keywords
sleeve
balloon
endoscope
distal end
lumen
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Pending
Application number
EP22763991.1A
Other languages
German (de)
English (en)
Inventor
Peter Johann
Amos Cruz
David GADDY
Robert Lulo
Eric Coolidge
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Lumendi LLC
Original Assignee
Lumendi LLC
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Lumendi LLC filed Critical Lumendi LLC
Publication of EP4326136A1 publication Critical patent/EP4326136A1/fr
Pending legal-status Critical Current

Links

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00Instruments 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
    • A61B1/31Instruments 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 for the rectum, e.g. proctoscopes, sigmoidoscopes, colonoscopes
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00Instruments 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
    • A61B1/00064Constructional details of the endoscope body
    • A61B1/00071Insertion part of the endoscope body
    • A61B1/0008Insertion part of the endoscope body characterised by distal tip features
    • A61B1/00082Balloons
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00Instruments 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
    • A61B1/00131Accessories for endoscopes
    • A61B1/00135Oversleeves mounted on the endoscope prior to insertion
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00Catheters; Hollow probes
    • A61M25/10Balloon catheters
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00Catheters; Hollow probes
    • A61M25/01Introducing, guiding, advancing, emplacing or holding catheters
    • A61M2025/0175Introducing, guiding, advancing, emplacing or holding catheters having telescopic features, interengaging nestable members movable in relations to one another
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00Catheters; Hollow probes
    • A61M25/01Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/06Body-piercing guide needles or the like
    • A61M25/0662Guide tubes
    • A61M2025/0681Systems with catheter and outer tubing, e.g. sheath, sleeve or guide tube
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00Catheters; Hollow probes
    • A61M25/01Introducing, guiding, advancing, emplacing or holding catheters
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00Catheters; Hollow probes
    • A61M25/01Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/02Holding devices, e.g. on the body
    • A61M25/04Holding devices, e.g. on the body in the body, e.g. expansible

Definitions

  • This invention relates to surgical methods and apparatus in general, and more particularly to surgical methods and apparatus for manipulating the side wall of a body lumen and/or body cavity so as to provide increased visualization of the same and/or increased access to the same, and/or for stabilizing instruments relative to the same.
  • the human body comprises many different body lumens and body cavities.
  • the human body comprises body lumens such as the gastrointestinal (GI) tract, blood vessels, lymphatic vessels, the urinary tract, fallopian tubes, bronchi, bile ducts, etc.
  • the human body comprises body cavities such as the head, chest, abdomen, nasal sinuses, bladder, cavities within organs, etc.
  • GI gastrointestinal
  • the human body comprises body cavities such as the head, chest, abdomen, nasal sinuses, bladder, cavities within organs, etc.
  • the endoscopic examination and/or treatment of the side wall of a body lumen and/or body cavity can be complicated by the anatomic configuration (both regional and local) of the side wall of the body lumen and/or body cavity, and/or by the consistency of the tissue making up the side wall of the body lumen and/or body cavity, and/or by the tethering of the side wall of the body lumen and/or body cavity to other anatomical structures.
  • the intestine is an elongated tubular organ having an inner lumen and is characterized by frequent turns (i.e., the regional anatomic configuration of the intestine), and comprises a side wall characterized by numerous folds (i.e., the local anatomic configuration of the intestine), with the side wall tissue having a relatively soft, pliable consistency, and with the colon in particular being tethered to the abdomen and/or other abdominal structures via soft tissue.
  • some body lumens and/or body cavities can spasm and/or contract.
  • This spasming and/or contraction can occur spontaneously, but it is particularly common when an endoscope or other instrument is inserted into the body lumen and/or body cavity.
  • This spasming and/or contraction can cause the body lumen and/or body cavity to constrict and/or otherwise move and/or change its configuration, which can further complicate and/or compromise endoscopic visualization of the anatomy, and/or further complicate and/or compromise access to the anatomy using instruments introduced through conventional, flexible endoscopes.
  • the endoscope may grip and/or otherwise gather the colon during advancement and/or withdrawal and then suddenly slip and release the colon. This gripping and then sudden release of the colon can result in the endoscope moving quickly past significant lengths of the colon, thereby making accurate examination of the colon challenging.
  • the present invention comprises the provision and use of novel apparatus for manipulating the side wall of a body lumen and/or body cavity so as to better present the side wall tissue (including visualization of areas which may be initially hidden from view or outside the field of view) for examination and/or treatment during an endoscopic procedure.
  • the present invention also comprises the provision and use of novel apparatus capable of steadying and/or stabilizing the distal tips and/or working ends of instruments (e.g., endoscopes, articulating and/or non-articulating devices such as graspers, cutters or dissectors, cauterizing tools, ultrasound probes, etc.) inserted into a body lumen and/or body cavity with respect to the side wall of the body lumen and/or body cavity, whereby to facilitate the precision use of those instruments.
  • instruments e.g., endoscopes, articulating and/or non-articulating devices such as graspers, cutters or dissectors, cauterizing tools, ultrasound probes, etc.
  • the present invention comprises the provision and use of novel apparatus capable of steadying and/or stabilizing the distal tips and/or working ends of endoscopes (and hence also steadying and/or stabilizing the distal tips and/or working ends of other instruments inserted through the working channels of those endoscopes, such as graspers, cutters or dissectors, cauterizing tools, ultrasound probes, etc.).
  • the present invention comprises the provision and use of novel apparatus capable of steadying and/or stabilizing the distal tips and/or working ends of instruments (such as graspers, cutters or dissectors, cauterizing tools, ultrasound probes, etc.) advanced to the surgical site by means other than through the working channels of endoscopes.
  • instruments such as graspers, cutters or dissectors, cauterizing tools, ultrasound probes, etc.
  • the present invention comprises the provision and use of novel apparatus capable of straightening bends, “ironing out” folds and creating a substantially static or stable side wall of the body lumen and/or body cavity which enables more precise visual examination (including visualization of areas which may be initially hidden from view or outside the field of view) and/or therapeutic intervention.
  • apparatus comprising: a sleeve adapted to be slid over the exterior of an endoscope; an aft balloon secured to the sleeve; an inflation/deflation tube carried by the sleeve and in fluid communication with the interior of the aft balloon; a pair of hollow push tubes slidably mounted to the sleeve, the pair of hollow push tubes being connected to one another at their distal ends with a raised push tube bridge, the raised push tube bridge being configured to nest an endoscope therein; and a fore balloon secured to the distal ends of the pair of hollow push tubes, the interior of the fore balloon being in fluid communication with the interiors of the pair of hollow push tubes, wherein the fore balloon is capable of assuming a deflated condition and an inflated condition, and further wherein (i) when the fore balloon is in its deflated condition, an axial opening extends therethrough, the axial opening being sized to receive the endoscope there
  • a method for performing a procedure in a body lumen and/or body cavity comprising: providing apparatus comprising: a sleeve adapted to be slid over the exterior of an endoscope; an aft balloon secured to the sleeve; an inflation/deflation tube carried by the sleeve and in fluid communication with the interior of the aft balloon; a pair of hollow push tubes slidably mounted to the sleeve, the pair of hollow push tubes being connected to one another at their distal ends with a raised push tube bridge, the raised push tube bridge being configured to nest an endoscope therein; and a fore balloon secured to the distal ends of the pair of hollow push tubes, the interior of the fore balloon being in fluid communication with the interiors of the pair of hollow push tubes, wherein the fore balloon is capable of assuming a deflated condition and an inflated condition, and further wherein (i) when the fore balloon is in its deflate
  • a new and improved apparatus for steadying and/or stabilizing the distal tips and/or working ends of instruments (e.g., endoscopes, articulating and/or non-articulating devices such as graspers, cutters or dissectors, cauterizing tools, ultrasound probes, etc.) relative to the side wall of a body lumen and/or body cavity when such instruments are inserted into the body lumen and/or body cavity, whereby to facilitate the precision use of those instruments.
  • instruments e.g., endoscopes, articulating and/or non-articulating devices such as graspers, cutters or dissectors, cauterizing tools, ultrasound probes, etc.
  • an apparatus comprising: a flexible sleeve adapted to be slid over the exterior of an endoscope, wherein the endoscope comprises a proximal end and a distal end, and a handle disposed at the proximal end of the endoscope, and wherein the sleeve comprises a proximal end, a distal end and a sleeve lumen extending therebetween, and further wherein the sleeve is configured to be slid over the exterior of the endoscope so as to substantially cover the exterior of the endoscope from a point adjacent to the distal end of the endoscope to a point adjacent to the handle of the endoscope; a balloon secured to the distal end of the sleeve; an inflation/deflation tube carried by the sleeve and in fluid communication with an interior of the balloon; and a pair of push tubes mounted to the sleeve.
  • a method for performing a procedure in a body lumen and/or body cavity comprising: providing an apparatus comprising: a flexible sleeve adapted to be slid over the exterior of an endoscope, wherein the endoscope comprises a proximal end and a distal end, and a handle disposed at the proximal end of the endoscope, and wherein the sleeve comprises a proximal end, a distal end and a sleeve lumen extending therebetween, and further wherein the sleeve is configured to be slid over the exterior of the endoscope so as to substantially cover the exterior of the endoscope from a point adjacent to the distal end of the endoscope to a point adjacent to the handle of the endoscope; a balloon secured to the distal end of the sleeve; an inflation/deflation tube carried by the sleeve and in fluid communication with an interior of the balloon;
  • an apparatus comprising: a flexible sleeve adapted to be slid over the exterior of an endoscope, wherein the endoscope comprises a proximal end and a distal end, and a handle disposed at the proximal end of the endoscope, and wherein the sleeve comprises a proximal end, a distal end and a sleeve lumen extending therebetween, and further wherein the sleeve is configured to be slid over the exterior of the endoscope so as to substantially cover the exterior of the endoscope from a point adjacent to the distal end of the endoscope to a point adjacent to the handle of the endoscope; a balloon secured to the distal end of the sleeve; an inflation/deflation tube carried by the sleeve and in fluid communication with an interior of the balloon; a pair of push tubes mounted to the sleeve; and a pair of instrument lumens mounted to
  • an apparatus comprising: a flexible sleeve adapted to be slid over the exterior of an endoscope, wherein the endoscope comprises a proximal end and a distal end, and a handle disposed at the proximal end of the endoscope, and wherein the sleeve comprises a proximal end, a distal end and a sleeve lumen extending therebetween, and further wherein the sleeve is configured to be slid over the exterior of the endoscope so as to substantially cover the exterior of the endoscope from a point adjacent to the distal end of the endoscope to a point adjacent to the handle of the endoscope; a balloon secured to the distal end of the sleeve; an inflation/deflation tube carried by the sleeve and in fluid communication with an interior of the balloon; a pair of push tubes mounted to the sleeve; and an instrument lumen mounted to the sle
  • an apparatus comprising: a flexible sleeve adapted to be slid over the exterior of an endoscope, wherein the endoscope comprises a proximal end and a distal end, and a handle disposed at the proximal end of the endoscope, and wherein the sleeve comprises a proximal end, a distal end and a sleeve lumen extending therebetween, and further wherein the sleeve is configured to be slid over the exterior of the endoscope so as to substantially cover the exterior of the endoscope from a point adjacent to the distal end of the endoscope to a point adjacent to the handle of the endoscope, wherein the sleeve comprises an atraumatic tip; a balloon secured to the distal end of the sleeve, wherein (i) when the balloon is in its deflated condition, an axial opening extends therethrough, the axial opening being sized to receive the end
  • Fig. l is a schematic view showing novel apparatus formed in accordance with the present invention, wherein the novel apparatus comprises, among other things, a sleeve for disposition over the end of an endoscope, an aft balloon mounted to the sleeve, a pair of hollow push tubes slidably mounted to the sleeve, the pair of hollow push tubes being connected to one another at their distal ends with a raised push tube bridge, the raised push tube bridge being configured to nest an endoscope therein, a fore balloon mounted to the distal end of the hollow push tubes, and a push tube handle mounted to the proximal ends of the hollow push tubes;
  • Figs. 2-4 are schematic views showing various dispositions of the fore balloon relative to the aft balloon
  • Fig. 5 is a schematic view showing further details of the distal end of the apparatus shown in Fig. 1;
  • Fig. 6 is a section view taken along line 6-6 of Fig. 5;
  • Figs. 7 and 8 are schematic views showing a pair of hollow push tubes, a raised push tube bridge, and the fore balloon;
  • Figs. 9-11 are schematic views showing a pair of hollow push tubes and a raised push tube bridge formed in accordance with the present invention.
  • Fig. 12 is a schematic view showing another pair of hollow push tubes and a raised push tube bridge formed in accordance with the present invention.
  • Fig. 13 is a schematic view showing another pair of hollow push tubes and a raised push tube bridge formed in accordance with the present invention.
  • Fig. 14 is a schematic view showing another pair of hollow push tubes and a raised push tube bridge formed in accordance with the present invention.
  • Figs. 15 and 16 are schematic views showing further details of the fore balloon
  • Fig. 17 is a schematic view showing the push tube handle
  • Figs. 18 and 19 are schematic views showing construction details of the fore balloon
  • Figs. 20-34 are schematic views showing another form of the handle mechanism for the novel apparatus of the present invention.
  • Fig. 35 is a schematic view showing one form of inflation mechanism provided in accordance with the present invention.
  • Fig. 36 is a schematic view showing another form of inflation mechanism provided in accordance with the present invention
  • Figs. 37 and 38 are schematic views showing another form of inflation mechanism provided in accordance with the present invention
  • Figs. 39-58 are schematic views showing another form of inflation mechanism provided in accordance with the present invention.
  • Fig. 59 is a schematic view showing relief valves which may be used to ensure that the pressure within the fore balloon and/or aft balloon does not exceed a predetermined level;
  • Fig. 60 is a schematic view showing a retraction system which may be used to take up slack in a flexible tube of the apparatus shown in Fig. 1;
  • Figs. 61-82 are schematic views showing novel apparatus for inflating and deflating balloons
  • Fig. 83 is a schematic view showing the novel apparatus of the present invention sealed within a novel package formed in accordance with the present invention
  • Fig. 84 is a schematic view showing details of a novel inflation mechanism formed in accordance with the present invention.
  • Fig. 85-88 are schematic views showing further details of the novel package of Fig. 83 and further details of the novel inflation mechanism of Fig. 84;
  • Figs. 89-107 are schematic views showing preferred ways of using the apparatus of Fig. 1;
  • Fig. 108 is a cross-sectional schematic view showing how gaps are created between (i) the sleeve, (ii) the push rod lumens, and (iii) the aft balloon inflation lumen of the apparatus of Figs. 1-106;
  • Fig. 109 is a cross-sectional schematic view similar to Fig. 108, showing a plurality of novel extruded inserts filling the aforementioned gaps between the sleeve, the push rod lumens and the aft balloon inflation lumen, whereby to facilitate airtight bonding of the aft balloon to the assembly;
  • Figs. 110, 111 and 112 are schematic views showing novel extruded inserts formed in accordance with the present invention;
  • Figs. 113 and 114 are schematic views showing the novel extruded inserts of Figs. 110, 111 and 112 disposed along the sheath of the apparatus of Figs. 1- 106 so as to fill the gaps between the sleeve, the push rod lumens and aft balloon inflation lumen;
  • Figs. 115-122 are schematic views showing an alternative construction for the fore balloon
  • Fig. 123 is a schematic view showing another alternative construction for the fore balloon
  • Figs. 124 and 125 are schematic views showing an alternative construction for the aft balloon
  • Fig. 126 is a schematic view showing an alternative construction for the hollow push tubes and push tube handle of the present invention.
  • Fig. 127 is a schematic view showing another form of the sleeve, wherein the sleeve comprises additional lumens for receiving instruments;
  • Figs. 128-131 are schematic views showing how instruments may be advanced through the additional lumens of the sleeve
  • Fig. 132 is a schematic view showing instrument guide tubes which may be disposed in the additional lumens of the sleeve, wherein instruments may be advanced through the instrument guide tubes;
  • Figs. 133, 133A, 134 and 134A are schematic views showing a novel apparatus formed in accordance with the present invention, wherein the novel apparatus comprises, among other things, a sleeve for disposition over the end of an endoscope, an aft balloon mounted to the sleeve, an inflation line for inflating the aft balloon, a pair of instrument lumens mounted to the sleeve, and a pair of support tubes mounted to the sleeve; Figs.
  • FIG. 135 and 136 are schematic views showing a novel apparatus formed in accordance with the present invention, wherein the novel apparatus comprises, among other things, a sleeve for disposition over the end of an endoscope, an aft balloon mounted to the sleeve, an inflation line for inflating the aft balloon, a pair of instrument lumens mounted to the sleeve, a pair of support tubes mounted to the sleeve, and a pair of push tubes movably disposed within the pair of support tubes;
  • Figs. 137-140 are schematic views showing a novel apparatus formed in accordance with the present invention, wherein the novel apparatus comprises, among other things, a sleeve for disposition over the end of an endoscope, an aft balloon mounted to the sleeve, an inflation line for inflating the aft balloon, a pair of instrument lumens mounted to the sleeve, a pair of support tubes mounted to the sleeve, and a pair of push tubes movably disposed within the pair of support tubes, the pair of push tubes being connected to one another at their distal ends with a raised push tube bridge, the raised push tube bridge being configured to nest an endoscope therein;
  • Figs. 141 and 142 are schematic views showing a novel apparatus formed in accordance with the present invention, wherein the novel apparatus comprises, among other things, a sleeve for disposition over the end of an endoscope, a first aft balloon mounted to the sleeve, a second aft balloon mounted to the sleeve, an inflation line for inflating the first and second aft balloons, a pair of instrument lumens mounted to the sleeve, and a pair of support tubes mounted to the sleeve;
  • Figs. 143 and 144 are schematic views showing a novel apparatus formed in accordance with the present invention, wherein the novel apparatus comprises, among other things, a sleeve for disposition over the end of an endoscope, a first aft balloon mounted to the sleeve, a second aft balloon mounted to the sleeve, an inflation line for inflating the first and second aft balloons, a pair of instrument lumens mounted to the sleeve, a pair of support tubes mounted to the sleeve, and a pair of push tubes movably disposed within the pair of support tubes;
  • Figs. 145 and 146 are schematic views showing a novel apparatus formed in accordance with the present invention, wherein the novel apparatus comprises, among other things, a sleeve for disposition over the end of an endoscope, a first aft balloon mounted to the sleeve, a second aft balloon mounted to the sleeve, an inflation line for inflating the first and second aft balloons, a pair of instrument lumens mounted to the sleeve, a pair of support tubes mounted to the sleeve, and a pair of push tubes movably disposed within the pair of support tubes, the pair of push tubes being connected to one another at their distal ends with a raised push tube bridge, the raised push tube bridge being configured to nest an endoscope therein;
  • Figs. 146A, 146B, 147 and 148 are schematic views showing a novel apparatus formed in accordance with the present invention, wherein the novel apparatus comprises, among other things, a sleeve for disposition over the end of an endoscope, an aft balloon mounted to the sleeve, an inflation line for inflating the aft balloon, and a pair of support tubes mounted to the sleeve;
  • Figs. 149 and 150 are schematic views showing a novel apparatus formed in accordance with the present invention, wherein the novel apparatus comprises, among other things, a sleeve for disposition over the end of an endoscope, an aft balloon mounted to the sleeve, an inflation line for inflating the aft balloon, a pair of support tubes mounted to the sleeve, and a pair of push rods movably disposed within the pair of support tubes;
  • Figs. 151 and 152 are schematic views showing a novel apparatus formed in accordance with the present invention, wherein the novel apparatus comprises, among other things, a sleeve for disposition over the end of an endoscope, an aft balloon mounted to the sleeve, an inflation line for inflating the aft balloon, a pair of support tubes mounted to the sleeve, and a pair of push tubes movably disposed within the pair of support tubes, the pair of push tubes being connected to one another at their distal ends with a raised push tube bridge, the raised push tube bridge being configured to nest an endoscope therein;
  • Figs. 153 and 154 are schematic views showing a novel apparatus formed in accordance with the present invention, wherein the novel apparatus comprises, among other things, a sleeve for disposition over the end of an endoscope, a first aft balloon mounted to the sleeve, a second aft balloon mounted to the sleeve, an inflation line for inflating the first and second aft balloons, and a pair of support tubes mounted to the sleeve;
  • Figs. 155 and 156 are schematic views showing a novel apparatus formed in accordance with the present invention, wherein the novel apparatus comprises, among other things, a sleeve for disposition over the end of an endoscope, a first aft balloon mounted to the sleeve, a second aft balloon mounted to the sleeve, an inflation line for inflating the first and second aft balloons, a pair of support tubes mounted to the sleeve, and a pair of push tubes movably disposed within the pair of support tubes;
  • Figs. 157 and 158 are schematic views showing a novel apparatus formed in accordance with the present invention, wherein the novel apparatus comprises, among other things, a sleeve for disposition over the end of an endoscope, a first aft balloon mounted to the sleeve, a second aft balloon mounted to the sleeve, an inflation line for inflating the first and second aft balloons, a pair of support tubes mounted to the sleeve, and a pair of push tubes movably disposed within the pair of support tubes, the pair of push tubes being connected to one another at their distal ends with a raised push tube bridge, the raised push tube bridge being configured to nest an endoscope therein;
  • Figs. 159-162, 162A and 163 are schematic views showing a novel apparatus formed in accordance with the present invention, wherein the novel apparatus comprises, among other things, a sleeve for disposition over the end of an endoscope, an aft balloon mounted to the sleeve, an inflation line for inflating the aft balloon, a single instrument lumen mounted to the sleeve, a pair of support tubes mounted to the sleeve, and a pair of push tubes fixed within the pair of support tubes, wherein the distal end of the sleeve is formed with a nose cone;
  • Figs. 164-166 are schematic views showing a novel apparatus formed in accordance with the present invention, wherein the novel apparatus comprises, among other things, a sleeve for disposition over the end of an endoscope, an aft balloon mounted to the sleeve, an inflation line for inflating the aft balloon, a single instrument lumen mounted to the sleeve, a pair of support tubes mounted to the sleeve, and a pair of push tubes fixed within the pair of support tubes, wherein the distal end of the sleeve is formed with a nose cone, and wherein the distal end of the instrument lumen is collapsible;
  • Fig. 166A is a schematic view showing a sleeve for disposition over the end of an endoscope, wherein instrument lumens are formed on the interior surface of the sleeve;
  • Fig. 167 is a schematic view showing a novel apparatus formed in accordance with the present invention, wherein the novel apparatus comprises, among other things, a sleeve for disposition over the end of an endoscope, an aft balloon mounted to the sleeve, an inflation line for inflating the aft balloon, a pair of support tubes mounted to the sleeve, and a pair of push tubes fixed within the pair of support tubes, wherein the distal end of the sleeve is formed with a nose cone; and
  • Figs. 168-170 are schematic views showing a novel apparatus formed in accordance with the present invention, wherein the aft balloon is formed with a toroidal construction.
  • the present invention comprises the provision and use of novel apparatus for manipulating the side wall of a body lumen and/or body cavity so as to better present the side wall tissue (including visualization of areas initially hidden or outside the field of view) for examination and/or treatment during an endoscopic procedure.
  • endoscopic procedure is intended to mean substantially any minimally-invasive or limited access procedure, diagnostic and/or therapeutic and/or surgical, for accessing, endoluminally or transluminally or otherwise, the interior of a body lumen and/or body cavity for the purposes of viewing, biopsying and/or treating tissue, including removing a lesion and/or resecting tissue, etc.
  • the present invention also comprises the provision and use of novel apparatus capable of steadying and/or stabilizing the distal tips and/or working ends of instruments (e.g., endoscopes, articulating and/or non-articulating devices such as graspers, cutters or dissectors, cauterizing tools, ultrasound probes, etc.) inserted into a body lumen and/or body cavity with respect to the side wall of the body lumen and/or body cavity, whereby to facilitate the precision use of those instruments.
  • instruments e.g., endoscopes, articulating and/or non-articulating devices such as graspers, cutters or dissectors, cauterizing tools, ultrasound probes, etc.
  • the present invention comprises the provision and use of novel apparatus capable of steadying and/or stabilizing the distal tips and/or working ends of endoscopes (and hence also steadying and/or stabilizing the distal tips and/or working ends of other instruments inserted through the working channels of those endoscopes, such as graspers, cutters or dissectors, cauterizing tools, ultrasound probes, etc.).
  • the present invention comprises the provision and use of novel apparatus capable of steadying and/or stabilizing the distal tips and/or working ends of instruments (such as graspers, cutters or dissectors, cauterizing tools, ultrasound probes, etc.) advanced to the surgical site by means other than through the working channels of endoscopes.
  • instruments such as graspers, cutters or dissectors, cauterizing tools, ultrasound probes, etc.
  • the present invention comprises the provision and use of novel apparatus capable of straightening bends, “ironing out” folds and creating a substantially static or stable side wall of the body lumen and/or body cavity which enables more precise visual examination (including visualization of areas which may be initially hidden from view or outside the field of view) and/or therapeutic intervention.
  • novel apparatus 5 which is capable of manipulating (e.g., stabilizing, straightening, expanding and/or flattening, etc.) the side wall of a body lumen and/or body cavity so as to better present the side wall tissue (including visualization of areas which may be initially hidden from view or outside the field of view) for examination and/or treatment during an endoscopic procedure using an endoscope 10 (e.g., an articulating endoscope), and/or for stabilizing the distal end of endoscope 10 and/or the distal tips and/or working ends of other instruments (e.g., graspers, cutters or dissectors, cauterizing tools, ultrasound probes, etc., not shown in Fig. 1).
  • endoscope 10 e.g., an articulating endoscope
  • other instruments e.g., graspers, cutters or dissectors, cauterizing tools, ultrasound probes, etc., not shown in Fig.
  • apparatus 5 generally comprises a sleeve 15 adapted to be slid over the exterior of the shaft of endoscope 10, a proximal (or “aft”) balloon 20 (the terms “proximal” and “aft” will hereinafter be used interchangeably) secured to sleeve 15 near the distal end of the sleeve, and a base 25 secured to sleeve 15 at the proximal end of the sleeve.
  • a proximal balloon 20 the terms “proximal” and “aft” will hereinafter be used interchangeably
  • Apparatus 5 also comprises a pair of hollow push tubes 30 slidably mounted to sleeve 15 as will hereinafter be discussed, the pair of hollow push tubes being connected to one another at their distal ends with a raised push tube bridge 31, the raised push tube bridge 31 being configured to nest an endoscope therein, and a distal (or “fore”) balloon 35 (the terms “distal” and “fore” will hereinafter be used interchangeably) secured to the distal ends of hollow push tubes 30, such that the spacing between aft balloon 20 and fore balloon 35 can be adjusted by the physician (or other operator or user) by moving hollow push tubes 30 relative to sleeve 15 (e.g., by advancing the two hollow push tubes simultaneously at push tube handle 37, see below). See Figs. 1 and 2-4.
  • Apparatus 5 also comprises an associated inflation mechanism 40 (Fig. 1) for enabling selective inflation/deflation of one or both of aft balloon 20 and fore balloon 35 by the physician (or other operator or user).
  • sleeve 15 generally comprises an elongated, thin-walled tube configured to be slid over the exterior of the shaft of endoscope 10 (e.g., retrograde from the distal tip of the endoscope) so as to make a close fit therewith, with the sleeve being sized and constructed so that it will slide easily back over the endoscope during mounting thereon (preferably with the scope “dry”) but will have sufficient residual friction (when gripped by the hand of the physician or other operator or user) with the outer surface of the endoscope such that the sleeve will remain in place to allow torqueing (i.e., rotational turning) and pushing/pulling of the endoscope during use (e.g., within the colon of a patient).
  • torqueing i.e., rotational turning
  • pushing/pulling of the endoscope during use e.g., within the colon of a patient.
  • sleeve 15 can move circumferentially to some extent about endoscope 10 (and when gripped securely by the hand of the physician or other operator or user, can rotate in conjunction with the shaft of the endoscope); but sleeve 15 can only move nominally in an axial direction relative to endoscope 10.
  • Sleeve 15 is sized so that when its distal end is substantially aligned with the distal end of endoscope 10, sleeve 15 (in conjunction with base 25) will substantially cover the shaft of the endoscope.
  • sleeve 15 is sized so that when it is mounted to endoscope 10 and endoscope 10 is inserted into a patient, sleeve 15 extends out of the body of the patient.
  • apparatus 5 is provided according to the particular endoscope with which it is intended to be used, with apparatus 5 being sized so that when base 25 is in engagement with the handle of the endoscope, the distal end of sleeve 15 will be appropriately positioned at the distal end of the endoscope, i.e., substantially aligned with the distal end of the endoscope or slightly proximal to the distal end of the endoscope.
  • the distal end of sleeve 15 may be provided with a radially- inwardly-extending stop (not shown) to positively engage the distal end surface of endoscope 10, whereby to prevent the distal end of sleeve 15 from moving proximally beyond the distal end surface of endoscope 10.
  • a radially- inwardly-extending stop can also assist in preventing “torque slip” of sleeve 15 relative to endoscope 10 during torqueing (i.e., rotational turning) of the endoscope while within the colon, and/or “thrust slip” of sleeve 15 relative to endoscope 10 during forward pushing of the endoscope while within the colon.
  • Sleeve 15 preferably has a smooth outer surface so as to be non-traumatic to tissue, and is preferably made of a highly flexible material such that the sleeve will not inhibit bending of the endoscope during use.
  • sleeve 15 comprises polyurethane, polyethylene, poly(vinyl chloride) (PVC), polytetrafluoroethylene (PTFE), etc., and is preferably transparent (or at least translucent) so as to allow distance markings on endoscope 10 to be visualized through sleeve 15.
  • sleeve 15 preferably has nominal hoop strength, so that the physician (or other operator or user) can grip endoscope 10 through sleeve 15, e.g., so as to torque the scope.
  • sleeve 15 can include a lubricious coating (e.g., a liquid such as perfluoropolyether synthetic oil, a powder, etc.) on some or all of its interior and/or exterior surfaces, so as to facilitate disposition of the sleeve over the endoscope and/or movement of apparatus 5 through a body lumen and/or body cavity.
  • a lubricious coating e.g., a liquid such as perfluoropolyether synthetic oil, a powder, etc.
  • sleeve 15 may be formed of a material which is itself lubricious, e.g., polytetrafluoroethylene (PTFE), etc.
  • PTFE polytetrafluoroethylene
  • the inside surface of sleeve 15 may include features (e.g., ribs) to prevent the sleeve from rotating relative to the endoscope during use.
  • a vacuum may be “pulled” between sleeve 15 and endoscope 10, whereby to secure sleeve 15 to endoscope 10 and minimize the profile of sleeve 15.
  • a vacuum may be introduced at the proximal end of sleeve 15 (i.e., at base 25) or a vacuum may be introduced at a point intermediate sleeve 15.
  • removal of sleeve 15 from endoscope 10 may be facilitated by introducing a fluid (e.g., air or a liquid lubricant) into the space between sleeve 15 and endoscope 10, e.g., at the proximal end of sleeve 15 (i.e., at base 25) or intermediate sleeve 15.
  • a fluid e.g., air or a liquid lubricant
  • aft balloon 20 is secured to sleeve 15 just proximal to the articulating joint of the endoscope near to, but spaced from, the distal end of the sleeve.
  • Aft balloon 20 is disposed concentrically about sleeve 15, and hence concentrically about an endoscope 10 disposed within sleeve 15.
  • aft balloon 20 has a generally toroidal shape.
  • Aft balloon 20 may be selectively inflated/deflated by means of a proximal inflation/deflation tube 45 which has its distal end in fluid communication with the interior of aft balloon 20, and which has its proximal end in fluid communication with a fitting 46 mounted to base 25.
  • Fitting 46 is configured for connection to the aforementioned associated inflation mechanism 40.
  • Fitting 46 is preferably a luer-activated valve, allowing inflation mechanism 40 to be disconnected from fitting 46 without losing pressure in aft balloon 20.
  • Inflation/deflation tube 45 may be secured to the exterior surface of sleeve 15 or, more preferably, inflation/deflation tube 45 may be contained within a lumen 47 formed within sleeve 15.
  • aft balloon 20 is disposed a short distance back from the distal end of sleeve 15, i.e., by a distance which is approximately the same as the length of the articulating portion of a steerable endoscope 10, such that the articulating portion of the steerable endoscope will be disposed distal to aft balloon 20 when the steerable endoscope is disposed in sleeve 15.
  • This construction allows the flexible portion of the steerable endoscope to be articulated even when aft balloon 20 has been inflated in the anatomy so as to stabilize the adjacent non-articulating portion of the endoscope relative to the anatomy, as will hereinafter be discussed in further detail.
  • aft balloon 20 when inflated, provides a secure platform within the anatomy for maintaining endoscope 10 in a stable position within a body lumen or body cavity, with endoscope 10 centered within the body lumen or body cavity.
  • endoscope 10 can provide improved visualization of the anatomy.
  • instruments advanced through the internal lumens (sometimes referred to as the “working channel” or “working channels”) of endoscope 10 will also be provided with a secure platform for supporting those instruments within the body lumen or body cavity.
  • aft balloon 20 When aft balloon 20 is appropriately inflated, the aft balloon can atraumatically engage and form a sealing relationship with the side wall of a body lumen within which apparatus 5 is disposed.
  • aft balloon 20 is formed out of polyurethane.
  • Base Base 25 is secured to the proximal end of sleeve 15.
  • Base 25 engages endoscope 10 and helps secure the entire assembly (i.e., apparatus 5) to endoscope 10.
  • Base 25 preferably comprises a substantially rigid or semi-rigid structure which may be gripped by the physician (or other operator or user) and pulled proximally, whereby to allow the physician (or other operator or user) to pull sleeve 15 over the distal end of endoscope 10 and then proximally back along the length of endoscope 10, whereby to mount sleeve 15 to the outer surface of the shaft of the endoscope.
  • base 25 is pulled proximally along the endoscope until base 25 seats against the handle of the endoscope, thereby prohibiting further proximal movement of base 25 (and hence thereby prohibiting further proximal movement of sleeve 15).
  • base 25 makes a sealing engagement with endoscope 10.
  • the pair of hollow push tubes 30 are slidably mounted to sleeve 15, whereby the distal ends of the hollow push tubes (and the raised push tube bridge 31 connecting the distal ends of the pair of hollow push tubes 30) can be extended and/or retracted relative to sleeve 15 (e.g., by advancing or withdrawing the hollow push tubes via push tube handle 37, see below), and hence extended and/or retracted relative to the distal end of endoscope 10 which is disposed in sleeve 15.
  • hollow push tubes 30 are slidably disposed in support tubes 50 which are secured to the outer surface of sleeve 15 or, more preferably, are contained within lumens 52 formed within sleeve 15.
  • Support tubes 50 are preferably formed out of a low friction material (e.g., polytetrafluoroethylene, also known as “PTFE”) so as to minimize resistance to movement of hollow push tubes 30 relative to support tubes 50 (and hence minimize resistance to movement of hollow push tubes 30 relative to sleeve 15).
  • PTFE polytetrafluoroethylene
  • support tubes 50 are flexible (so as to permit endoscope 10, and particularly the articulating portion of steerable endoscope 10, to flex as needed during the procedure); however, support tubes 50 also provide some column strength.
  • support tubes 50 when support tubes 50 are mounted within lumens 52 formed in sleeve 15, the assembly of sleeve 15 and hollow support tubes 50 is flexible yet has a degree of column strength (whereas sleeve 15 alone is flexible but has substantially no column strength).
  • lumens 52 are preferably lubricated so as to minimize friction between hollow push tubes 30 and lumens 52.
  • Raised push tube bridge 31 provides a rounded structure at the distal ends of hollow push tubes 30 which simultaneously serves to (i) connect the distal ends of hollow push tubes 30 together, and (ii) eliminate abrupt ends at the distal end of hollow push tubes 30 which could cause trauma to tissue, e.g., during distal advancement of hollow push tubes 30.
  • Raised push tube bridge 31 is configured to nest an endoscope therein (Fig. 8).
  • raised push tube bridge 31 is also hollow.
  • the hollow raised push tube bridge 31 may be formed integral with hollow push tubes 30, i.e., the hollow push tubes 30 and the hollow raised push tube bridge 31 may form one continuous tube (Figs. 9-11).
  • the hollow raised push tube bridge 31 may be formed separately from hollow push tubes 30 and the hollow raised push tube bridge 31 may be joined to hollow push tubes 30 during manufacturing (Fig. 12).
  • raised push tube bridge 31 may be substantially solid and is connected with hollow push tubes 30 during manufacture.
  • raised push tube bridge 31 may be inclined distally, e.g., in the manner shown in Figs. 7-12.
  • raised push tube bridge 31 may be set substantially perpendicular to the longitudinal axes of hollow push tubes 30, e.g., in the manner shown in Fig. 13.
  • raised push tube bridge 31 may be in the form of a ring, with endoscope 10 nesting within the interior of the ring, e.g., in the manner shown in Fig. 14.
  • hollow push tubes 30 are connected to push tube handle 37.
  • pushing distally on push tube handle 37 causes the distal ends of hollow push tubes 30 to move distally (at the same rate) relative to sleeve 15 (whereby to move fore balloon 35 distally relative to aft balloon 20) and pulling proximally on push tube handle 37 causes the distal ends of hollow push tubes 30 to retract proximally (at the same rate) relative to sleeve 15 (whereby to move fore balloon 35 proximally relative to aft balloon 20).
  • a clamp 53 (Figs. 37 and 60) is provided at base 25 for holding hollow push tubes 30 in a selected disposition relative to base 25 (and hence in a selected disposition relative to sleeve 15).
  • Hollow push tubes 30 and raised push tube bridge 31 are preferably formed out of a relatively flexible material which provides good column strength, e.g., a thermoplastic polyethylene resin such as IsoplastTM (available from The Lubrizol Corporation of Wickliffe, Ohio), polyethylene, polypropylene, nylon, etc. It should be appreciated that hollow push tubes 30 and raised push tube bridge 31 can comprise a single material or a plurality of materials, and that the stiffness of hollow push tubes 30 and raised push tube bridge 31 can vary along their length.
  • the distal-most portion of hollow push tubes 30 and raised push tube bridge 31 can be formed of the same material as the remainder of the hollow push tubes but have a lower modulus so as to be more flexible than the remainder of the hollow push tubes, or the distal- most portion of hollow push tubes 30 and raised push tube bridge 31 can comprise a different, more resilient flexible material.
  • the distal-most portion of hollow push tubes 30 and raised push tube bridge 31 can comprise Nitinol.
  • the distal- most portion of hollow push tubes 30 and raised push tube bridge 31 can comprise a stainless steel coil covered with an outer jacket of polytetrafluoroethylene (PTFE), with the distal-most jacket/more-proximal tubing together providing a sealed lumen for inflating/deflating fore balloon 35.
  • PTFE polytetrafluoroethylene
  • the hollow push tubes 30, raised push tube bridge 31 and fore balloon 35 can together function as a lead (with a soft atraumatic tip) for apparatus 5 and endoscope 10, as discussed further below.
  • hollow push tubes 30 are configured to maintain a parallel disposition when they are in an unbiased state, i.e., when no force is being applied to hollow push tubes 30. This is true regardless of the state of inflation or deflation of fore balloon 35.
  • the provision of raised push tube bridge 31 can help maintain the parallel disposition of hollow push tubes 30.
  • the distal-most portion of hollow push tubes 30 can be configured to bend inwardly or outwardly if desired e.g., via their connection to raised push tube bridge 31.
  • the middle portions of hollow push tubes 30 i.e., the portions between the inflated fore balloon 35 and sleeve 15
  • This “tenting” effect can significantly enhance visibility and/or tissue stability in the area distal to endoscope 10, by pushing outwardly on the side wall of the body lumen and/or body cavity in which apparatus 5 is
  • hollow push tubes 30 out of a flexible material, it is possible to manually adjust their position during use (e.g., by using a separate tool, by torqueing the apparatus, etc.) so as to prevent the hollow push tubes 30 from interfering with visualization of the patient’s anatomy and/or interfering with diagnostic or therapeutic tools introduced into the space between the fore and aft balloons 35, 20.
  • the flexible hollow push tube(s) may be moved out of the way by using a separate tool or instrument, or by rotating the apparatus with a torqueing motion so as to move the flexible hollow push tube(s) out of the way, etc.
  • hollow push tubes 30 so that they are circular and flexible and of a diameter significantly smaller than the round circumference of endoscope 10, the movement of the round endoscope, when articulated, can simply push the hollow push tubes out of the way and provides an unobstructed visual path to the tissue of interest.
  • hollow push tubes 30 can be marked with an indicator including distance markers (not shown in the figures), e.g., colored indicators or radiopaque indicators, so that a physician (or other operator or user) observing the surgical site via endoscope 10 or by radiological guidance (e.g., X-ray fluoroscopy) can ascertain the relative disposition of hollow push tubes 30 at the surgical site both longitudinally and/or circumferentially with respect to the side wall of the body lumen and/or other body cavity.
  • distance markers e.g., colored indicators or radiopaque indicators
  • Hollow push tubes 30 have their internal lumens (i) in fluid communication with the interior of fore balloon 35 (Figs. 1-5, 15 and 16), e.g., via a plurality of openings 32, and (ii) in fluid communication with a fitting 56 mounted to base 25.
  • Fitting 56 is configured for connection to the aforementioned associated inflation mechanism 40, in order that fore balloon 35 may be selectively inflated/deflated with air or other fluids (including liquids).
  • Fitting 56 is preferably a luer-activated valve, allowing inflation mechanism 40 to be disconnected from fitting 56 without losing pressure in fore balloon 35.
  • push tube handle 37 comprises a hollow interior 57.
  • Hollow push tubes 30 are mounted to push tube handle 37 so that hollow push tubes 30 will move in conjunction with push tube handle 37, and so that the hollow interiors of hollow push tubes 30 are in fluid communication with the hollow interior 57 of push tube handle 37.
  • Push tube handle 37 also comprises a fitting 58 which is in fluid communication with hollow interior 57 of push tube handle 37.
  • a flexible tube 59 connects fitting 58 with an internal chamber (not shown) in base 25, with this internal chamber in base 25 being in fluid communication with the aforementioned fitting 56.
  • a pair of hollow push tubes 30, connected together at their distal ends by a raised push tube bridge 31 provides numerous advantages.
  • the provision of a pair of hollow push tubes 30, connected together at their distal ends by a raised push tube bridge 31, provides a symmetric force to fore balloon 35 when the fore balloon is advanced distally into a body lumen, as will hereinafter be discussed.
  • a pair of hollow push tubes 30, connected together at their distal ends by a raised push tube bridge 31 provides equal outward forces against the adjacent anatomy when the pair of hollow push tubes are employed to straighten out the anatomy in the area proximate the distal end of endoscope 10, thereby enhancing visualization of, and/or access to, the anatomy, as will hereinafter be discussed.
  • the provision of a pair of hollow push tubes 30, connected together at their distal ends by a raised push tube bridge 31, ensures that fore balloon 35 remains centered on endoscope 10, thereby facilitating un-docking of fore balloon 35 from endoscope 10 and re-docking of fore balloon 35 over endoscope 10, as will hereinafter be discussed.
  • a pair of hollow push tubes 30, connected together at their distal ends by a raised push tube bridge 31 helps ensure that fore balloon 35 is stable relative to the tip of the endoscope, minimizing rotational movement of the fore balloon when inflated.
  • the provision of a pair of hollow push tubes, connected together at their distal ends by a raised push tube bridge 31, provides a redundant air transfer system for inflating or deflating fore balloon 35.
  • the provision of a pair of hollow push tubes 30, connected together a their distal ends by a raised push tube bridge 31, presents a rounded, blunt distal end for hollow push tubes 30, thereby ensuring atraumatic advancement of fore balloon 35 within the anatomy.
  • Fore balloon 35 is secured to the distal ends of hollow push tubes 30, with raised push tube bridge 31 being disposed within the interior of fore balloon 35, whereby the spacing between aft balloon 20 and fore balloon 35 can be adjusted by moving hollow push tubes 30 relative to sleeve 15, i.e., by moving push tube handle 37 relative to sleeve 15.
  • hollow push tubes 30 provide a conduit between the interior of fore balloon 35 and fitting 56, whereby to permit selective inflation/deflation of fore balloon 35 via fitting 56.
  • balloon 35 is configured so that (i) when it is deflated (or partially deflated) and it is in its “retracted” position relative to sleeve 15 (Fig. 2), fore balloon 35 provides an axial opening 63 (Figs. 15, 16 and 19) sufficient to accommodate sleeve 15 and the shaft of endoscope 10 therein, with raised push tube bridge 31 extending concentrically about axial opening 63, whereby fore balloon 35 can be “docked” over sleeve 15 and endoscope 10, and (ii) when fore balloon 35 is in its “extended” position relative to sleeve 15 and is appropriately inflated (Fig. 4), axial opening 63 is closed down (and preferably completely closed off).
  • the fore balloon when appropriately inflated, can atraumatically engage and form a sealing relationship with the side wall of a body lumen and/or body cavity within which apparatus 5 is disposed.
  • the fore balloon when fore balloon 35 is appropriately inflated, can effectively seal the body lumen and/or body cavity distal to fore balloon 35, by closing down axial opening 63 and forming a sealing relationship with the side wall of the body lumen and/or body cavity within which apparatus 5 is disposed.
  • the two balloons will create a sealed zone therebetween (sometimes hereinafter referred to as “the therapeutic zone”).
  • hollow push tubes 30 and raised push tube bridge 31 are disposed within fore balloon 35 in such a way that their presence within the fore balloon does not physically interfere with inflation or deflation of fore balloon 35.
  • balloon 35 has a “torus” shape when deflated (to allow it to seat over the distal end of the endoscope) and a substantially “solid” shape when inflated (to allow it to close off a body lumen or body cavity).
  • balloon 35 is preferably manufactured as a single construct comprising a body 67 having a proximal opening 69 and a distal opening 71, a proximal extension 73 having a “key-shaped” cross-section comprising lobes 74, and a distal extension 76 having a circular cross-section.
  • lobes 74 are disposed on proximal extension 73 with a configuration which matches the configuration of hollow push tubes 30 (i.e., where apparatus 5 comprises two hollow push tubes 30 diametrically opposed to one another, proximal extension 73 will comprise two lobes 74 diametrically opposed to one another - for the purposes of the present invention, proximal extension 73 and lobe(s) 74 may be collectively referred to as having a “key-shaped” cross-section).
  • proximal extension 73 is everted into the interior of body 67, hollow push tubes 30 are seated in lobes 74 of proximal extension 73, (with the interiors of hollow push tubes 30 being in fluid communication with the interior of body 67 and with raised push tube bridge 31 disposed within the interior of body 67), and then distal extension 76 is everted into the interior of proximal extension 73, whereby to provide a fore balloon 35 having axial opening 63 extending therethrough, with hollow push tubes 30 being secured to fore balloon 35 and communicating with the interior of fore balloon 35, and with raised push tube bridge 31 being disposed concentrically about axial opening 63.
  • axial opening 63 is sized to receive the distal end of endoscope 10 therein, and raised push tube bridge 31 is sized to nest endoscope 10 in the area beneath the raised push tube bridge 31.
  • formation of fore balloon 35 by the aforementioned process of everting proximal extension 73 into the interior of body 67, and then everting distal extension 76 into the interior of proximal extension 73, provides multiple layers of balloon material around hollow push tubes 30, thereby providing a more robust balloon construction.
  • providing multiple layers of balloon material around hollow push tubes 30 adds cushioning to the distal ends of hollow push tubes 30, thereby providing an even more atraumatic distal tip to hollow push tubes 30 and further ensuring that the distal tips of hollow push tubes 30 do not damage the adjacent tissue.
  • fore balloon 35 is formed out of polyurethane.
  • hollow push tubes 30, raised push tube bridge 31 and the deflated fore balloon 35 can, together, essentially function as a soft-tipped lead for apparatus 5 and endoscope 10, as discussed further below (Fig. 93).
  • one or both of aft balloon 20 and fore balloon 35 can be marked with an indicator (e.g., a color indicator or a radiopaque indicator) so that a physician (or other operator or user) observing the surgical site via endoscope 10 or radiological guidance (e.g., X-ray fluoroscopy) can ascertain the disposition of one or both of the balloons at the surgical site.
  • an indicator e.g., a color indicator or a radiopaque indicator
  • apparatus 5 comprises a base 25 which is secured to sleeve 15 at the proximal end of the sleeve and which carries fittings 46, 56 for inflating/deflating aft balloon 20 and/or fore balloon 35, respectively.
  • Apparatus 5 also comprises a push tube handle 37 which has hollow push tubes 30 mounted thereto, with hollow push tubes 30 physically supporting (and providing fluid communication to) the interior of fore balloon 35.
  • proximal inflation/deflation tube 45 provides fluid communication between fitting 46 of base 25 and the interior of aft balloon 20; and a flexible tube 59 provides (with other elements) fluid communication between fitting 56 of base 25 and the interior of hollow push tubes 30 (and hence the interior of fore balloon 35).
  • base 25 supports and guides hollow push tubes 30 as they are advanced distally or retracted proximally, but base 25 does not directly support and guide push tube handle 37 as it is advanced distally or retracted proximally.
  • apparatus 5 may comprise a similar but somewhat different base (i.e., the base 25A) and a similar but somewhat different push tube handle (i.e., the push tube handle 37A).
  • Base 25A comprises an extension 205 which has the aforementioned fittings 46, 56 mounted thereto.
  • Extension 205 comprises a center slot 210 and a pair of side slots 215.
  • Push tube handle 37A comprises a C-shaped body 220 having hollow push tubes 30 mounted thereto, and having a center locking element 225 and a pair of finger grips 230 mounted thereto.
  • Locking element 225 preferably comprises a screw shaft 235 and a screw knob 240, such that screw knob 240 can be advanced towards or away from body 220 by turning the screw knob.
  • Push tube handle 37A is mounted within extension 205 of base 25A so that screw shaft 235 is slidably received in center slot 210 and so that finger grips 230 are slidably received in side slots 215, whereby to provide support and guidance to push tube handle 37 A.
  • push tube handle 37A can be moved distally or proximally by moving screw shaft 235 and finger grips 230 distally or proximally, whereby to move fore balloon 35 distally or proximally; and push tube handle 37A can be locked in position relative to body 25 A by turning screw knob 240 so that it securely engages the outer surface of extension 205, whereby to lock fore balloon 35 in position relative to body 25 A.
  • torsion can be applied to fore balloon 35 by applying torsion to finger grips 230, e.g., by moving one side wing 230 distally while pulling the other side wing 230 proximally.
  • Figs. 26-30 show different configurations for screw knob 240.
  • lubricious washers 245 may be added to the assembly to reduce friction (Fig. 31), or texture may be added to surfaces (e.g., the underside of screw knob 240 as shown in Fig. 32) so as to increase friction.
  • finger grips 230 may be shaped differently than those illustrated in Figs. 20-30, or moved to a different portion of the assembly. See, for example, Fig. 33, which shows finger grips 230 formed as part of a second knob 250 which keys to the slider assembly.
  • push tube handle 37A may comprise a generally C-shaped body having a different configuration from the C- shaped body 220 shown in Figs. 23, 25, 31 and 33.
  • C-shaped body 220 may comprise a pair of downwardly extending legs 255 connected by a linkage 260.
  • the Inflation Mechanism Inflation mechanism 40 provides a means to selectively inflate aft balloon 20 and/or fore balloon 35.
  • inflation mechanism 40 comprises a single-line syringe inserter 140 comprising a body 145 and a plunger 150.
  • a spring 153 is provided in body 145 to automatically return plunger 150 at the end of its stroke.
  • Syringe inserter 140 is connected to one or the other of fittings 46, 56 via a line 155.
  • syringe inserter 140 when single-line syringe inserter 140 is to be used to inflate aft balloon 20, syringe inserter 140 is connected to fitting 46 via line 155 so that the output of single-line syringe inserter 140 is directed to aft balloon 20 (i.e., via proximal inflation/deflation tube 45).
  • syringe inserter 140 when single-line syringe inserter 140 is to be used to inflate fore balloon 35, syringe inserter 140 is connected to fitting 56 via line 155 so that the output of single-line syringe inserter 140 is directed to fore balloon 35 (i.e., via flexible tube 59 and the interiors of hollow push tubes 30 and out of openings 32).
  • inflation mechanism 40 comprises an elastic bulb 156 having a first port 157 and a second port 158.
  • a one-way valve 159 e.g., a check valve
  • Another one-way valve 159 is disposed in second port 158 so that air can only pass through second port 158 when traveling in an inward direction.
  • elastic bulb 156 is compressed (e.g., by hand), air within the interior of elastic bulb 156 is forced out first port 157; and when elastic bulb 156 is thereafter released, air is drawn back into the interior of elastic bulb 156 through second port 158.
  • first port 157 is connected to fitting 46 via line 155 so that the positive pressure output of elastic bulb 156 is directed to aft balloon 20.
  • Elastic bulb 156 may thereafter be used to deflate aft balloon 20, i.e., by connecting second port 158 to fitting 46 via line 155 so that the suction of elastic bulb 156 is directed to aft balloon 20.
  • first port 157 is connected to fitting 56 via line 155 so that the positive pressure output of elastic bulb 156 is directed to fore balloon 35.
  • Elastic bulb 156 may thereafter be used to deflate fore balloon 35, i.e., by connecting second port 158 to fitting 56 via line 155 so that the suction of elastic bulb 156 is directed to fore balloon 35.
  • a syringe 160 may be used to inflate aft balloon 20 and/or fore balloon 35.
  • Inflation mechanism 160 comprises a body 161 and a plunger 162.
  • a spring (not shown) is provided in body 161 to automatically return plunger 162 at the end of its power stroke.
  • Syringe 160 is connected to fittings 46, 56 via a line 163.
  • syringe 160 comprises a valve 165 for connecting syringe 160 to fore balloon 35 or aft balloon 20, and a valve 170 for selecting inflation or deflation of the connected-to balloon.
  • valve 165 (a two-position valve that connects valve 170 to either the fore balloon or the aft balloon) is set so that the syringe 160 is connected through fitting 46 to aft balloon 20, and valve 170 (a 2-way crossover valve which allows the one-way valves to be arranged to inflate in one configuration and deflate in the other configuration) is set so that syringe 160 is providing inflation pressure. Thereafter, when aft balloon 20 is to be deflated, valve 170 is set to its deflate position.
  • valve 165 is set so that syringe 160 is connected through fitting 56 to fore balloon 35
  • valve 170 is set so that syringe 160 is providing inflation pressure.
  • valve 170 is set to its deflate position.
  • inflation mechanism 40 comprises a hand inflator 300 also formed in accordance with the present invention.
  • Hand inflator 300 generally comprises a housing 305 carrying a bulb or “pump” 310, an aft balloon inflation line 315 (for connection to fitting 46 of apparatus 5, see Fig. 1), a fore balloon inflation line 320 (for connection to fitting 56 of apparatus 5, see Fig. 1), and internal pneumatic apparatus 325 (Fig. 42) for directing air between pump 310 and aft balloon inflation line 315 and fore balloon inflation line 320 (and for venting air from aft balloon inflation line 315 and fore balloon inflation line 320), all as will hereinafter be discussed.
  • internal pneumatic apparatus 325 comprises a check valve 330, a check valve 335, a check valve 340, a multi-way valve 345, a fore balloon indicator 350, an aft balloon indicator 355, a check valve 360, a check valve 365, an “air in” port 367 and an “air out” port 368.
  • a selector knob 370 (Figs. 39, 40 and 41) is attached to multi-way valve 345 so as to allow the user to set multi-way valve 345 as desired, and openings 375, 380 (Fig. 40) are formed in housing 305 so as to expose fore balloon indicator 350 and aft balloon indicator 355, respectively, to the view of the user.
  • internal pneumatic apparatus 325 is configured so that (i) aft balloon 20 can be selectively inflated by pump 310, (ii) aft balloon 20 can be selectively deflated by pump 310, (iii) fore balloon 35 can be selectively inflated by pump 310, and (iv) fore balloon 35 can be selectively deflated by pump 310.
  • selector knob 370 is set so that multi-way valve 345 creates a fluid line connecting “air in” port 367, check valve 340, check valve 335, pump 310, check valve 330, aft balloon indicator 355, check valve 365, aft balloon inflation line 315 and aft balloon 20, so that repeated compressions of pump 310 inflates aft balloon 20, with the pressure within aft balloon 20 being indicated by aft balloon indicator 355.
  • selector knob 370 is set so that multi-way valve 345 creates a fluid line connecting aft balloon 20, aft balloon inflation line 315, check valve 365, aft balloon indicator 355, check valve 340, check valve 335, pump 310, check valve 330 and “air out” port 368, so that repeated compressions of pump 310 deflates aft balloon 20, with the pressure within aft balloon 20 being indicated by aft balloon indicator 355.
  • selector knob 370 When fore balloon 35 is to be inflated, and looking now at Fig. 46, selector knob 370 is set so that multi-way valve 345 creates a fluid line connecting “air in” port 367, check valve 340, check valve 335, pump 310, check valve 330, fore balloon indicator 350, check valve 360, fore balloon inflation line 320 and fore balloon 35, so that repeated compressions of pump 310 inflates fore balloon 35, with the pressure within fore balloon 35 being indicated by fore balloon indicator 350.
  • selector knob 370 When fore balloon 35 is to be deflated, and looking now at Fig. 47, selector knob 370 is set so that multi-way valve 345 creates a fluid line connecting fore balloon 35, fore balloon inflation line 320, check valve 360, fore balloon indicator 350, check valve 340, check valve 335, pump 310, check valve 330 and “air out” port 368, so that repeated compressions of pump 310 deflates fore balloon 35, with the pressure within fore balloon 35 being indicated by fore balloon indicator 350.
  • fore balloon indicator 350 and aft balloon indicator 355 each comprise a piston 385.
  • Piston 385 is created by attaching two end caps 390, 395 together with a pliable extrusion 400.
  • End cap 390 is securely mounted to housing 305 and is pneumatically connected by a tube 405 to the system pressure which is to be measured (i.e., to a balloon, either the fore balloon 35 or the aft balloon 20, depending on whether piston 385 is employed in fore balloon indicator 350 or aft balloon indicator 355).
  • End cap 395 rides along tube 405 and abuts a spring 410 which engages a wall 415 of housing 305.
  • End cap 395 includes an alignment feature 420 which is slidably disposed in a guide (not shown) in housing 305, and a color pressure indicator 425 which is visible through one or the other of the aforementioned openings 375, 380 (depending on whether piston 385 is employed in fore balloon indicator 350 or aft balloon indicator 355).
  • End cap 395 acts as the pressure indicator, inasmuch as the longitudinal position of second end cap 395 along tube 405 (relative to wall 415) is an indicator of system pressure.
  • the two end caps 390, 395 and extrusion 400 effectively constitute a piston (i.e., piston 385) which expands and contracts as the system pressure changes, with system pressure being reflected by the disposition of color pressure indicator 425 relative to one or the other of the aforementioned openings 375,
  • the indicator When there is no pressure in the system (i.e., when the fore balloon or the aft balloon is entirely deflated), the indicator remains in the position shown in Fig. 50. In this position, extrusion 400 is collapsed and folded upon itself.
  • a balloon i.e., fore balloon 35 or aft balloon 20
  • end cap 395 begins to move relative to tube 405, compressing spring 410. The distance that end cap 395 moves depends on the pressure in the system (i.e., the pressure within tube 405), the diameter of the extrusion, and the bias force of the spring.
  • a color pressure indicator 425 is reflective of the pressure within the system (i.e., the pressure within either fore balloon 35 or aft balloon 20), in one preferred form of the present invention, various colors (e.g., green, yellow and red) are used to correspond to various predetermined pressures within the system.
  • the design shown in Figs. 48-53 comprises a colored indicator (i.e., color pressure indicator 425) attached to the “dynamic” (i.e., moving) end cap 395 of piston 385.
  • the color scheme on each indicator alerts the user as to how “full” (i.e., how inflated) each of the balloons (i.e., fore balloon 35 or aft balloon 20) is.
  • the indicator could comprise numeric pressure values instead of colors.
  • the pressure level could be indicated by a strip of colors (or numbers) fixed to the housing (i.e., adjacent openings 375, 380 in housing 305).
  • the end cap 395 comprises a pointer which extends out of opening 375 or 380 and, as the piston expands (i.e., as pliable extrusion 400 expands and end cap 395 moves toward wall 415 against the power of spring 410) and contracts (i.e., as pliable extrusion 400 contracts and end cap 395 moves away from wall 415 under the power of spring 410), the pointer points to the appropriate pressure indication mark on housing 305.
  • pliable extrusion 400 may be replaced by a balloon 430 (Fig. 54).
  • Balloon 430 is preferably spherical (Fig. 54), although it may also comprise other shapes if desired (see, for example, Fig. 55, which shows a generally diamond-shaped balloon 430, and Fig. 56 which shows a generally tubular balloon 430).
  • balloon 430 may be used to push a flag upward, i.e., perpendicular to the axis of the balloon, instead of expanding a piston along its axis. See Figs. 57 and 58.
  • inflation mechanism 40 may comprise an automated source of fluid pressure (either positive or negative), e.g., an electric pump.
  • a relief valve 175 can be connected to the inflation/deflation line which connects to fore balloon 35 so as to ensure that the pressure within fore balloon 35 does not exceed a predetermined level.
  • a relief valve 180 can be connected to the inflation/deflation line which connects to aft balloon 20 so as to ensure that the pressure within aft balloon 20 does not exceed a predetermined level.
  • one or more pressure gauges 182 may be incorporated into the fluid line connected to aft balloon 20, and/or the fluid line connected to fore balloon 35, whereby to provide the physician (or other operator or user) with information relating to the pressure inside aft balloon 20 and/or fore balloon 35 so as to avoid over inflation and/or to help the physician (or other operator or user) ascertain the inflation state of a balloon during a procedure.
  • a flexible tube retraction system 185 may be provided (e.g., within base 25) to take up slack in flexible tube 59 when fore balloon 35 is extended.
  • inflation mechanism 40 comprises a hand inflator 300 (Figs. 39-58) for selectively inflating/deflating a selected one of fore balloon 35 and aft balloon 20.
  • Hand inflator 300 generally comprises a manual pump (e.g., bulb 310) for providing an air pressure/suction source, and a multi-way valve 345 for directing the flow of air from/to bulb 310 to/from a selected one of fore balloon 35 and aft balloon 20.
  • multi-way valve 345 preferably takes the form of a novel manifold 500 disposed within housing 305 of hand inflator 300.
  • Manifold 500 generally comprises a bottom plate 505 fluidically connected to bulb 310, a rotatable middle plate 510, and a top plate 515 fluidically connected to fore balloon 35, aft balloon 20, fore balloon indicator 350 and aft balloon indicator 355.
  • a shaft 520 passes through, and connects together, top plate 515, middle plate 510 and bottom plate 505, as will hereinafter be discussed in further detail.
  • bottom plate 505 generally comprises a body 525 having a cavity 530 formed therein.
  • Bottom plate 505 also comprises an inflation port 535 configured to be fluidically connected to an air pressure source (e.g., bulb 310) and a deflation port 540 configured to be fluidically connected to an air suction source (e.g., bulb 310).
  • Inflation port 535 and deflation port 540 are fluidically connected to cavity 530, as will hereinafter be discussed in further detail.
  • Cavity 530 of bottom plate 505 comprises (i) a central opening 545 which passes through body 525 of bottom plate 505 for rotatably receiving shaft 520 therein, and (ii) a plurality of O-rings 550 which are disposed in cavity 530 and arranged concentrically about central opening 545.
  • O-rings 550 define two ring- shaped zones which are disposed coaxially relative to one another and which can be fluidically isolated from one another (i.e., when middle plate 510 is mounted on top of bottom plate 505 and covers cavity 530, as will hereinafter be discussed). More particularly, O-rings 550 define an inner deflation zone 555 and an outer inflation zone 560 disposed coaxially about inner deflation zone 555.
  • Inner deflation zone 555 comprises an opening 565 which is fluidically connected to deflation port 540
  • outer inflation zone 560 comprises an opening 570 which is fluidically connected to inflation port 535.
  • bottom plate 505 also comprises a check valve 575 fluidically connected to deflation port 540 for allowing bulb 310 to “re-form” (i.e., draw air through check valve 575) when it is not possible to draw air from atmosphere through inner deflation zone 555 (it will be appreciated that check valve 575 is functionally equivalent to the check valve 340 shown in Fig. 65).
  • middle plate 510 comprises a body 580 having a smooth bottom surface 585 for sealingly engaging O-rings 550 disposed in cavity 530 of bottom plate 505 (whereby to fluidically seal inner deflation zone 555 and outer inflation zone 560), and a smooth top surface 590 for sealingly engaging top plate 515, as will hereinafter be discussed in further detail.
  • Body 580 of middle plate 510 comprises a central opening 595 which passes through body 580 of middle plate 510 and is configured to engage shaft 520 (e.g., central opening 595 may comprise a non-circular cross-section which mates with a portion of shaft 520 having a corresponding non-circular cross-section) such that rotation of shaft 520 causes corresponding rotation of middle plate 510.
  • Middle plate 510 also comprises an inner hole 600 and an outer hole 605 which are disposed on a common radius and which pass through body 580 of middle plate 510.
  • Inner hole 600 is disposed so as to be in common orbit with, and fluidically connected to, inner deflation zone 555 of bottom plate 505 when middle plate 510 is mounted over bottom plate 505.
  • Outer hole 605 is disposed so as to be in common orbit with, and fluidically connected to, outer inflation zone 560 of bottom plate 505 when middle plate 510 is mounted over bottom plate 505.
  • top plate 515 comprises a body 610 having a bottom surface 615, a top surface 620 and a central opening 625 passing through body 610 for rotatably receiving shaft 520.
  • Top plate 515 also comprises an aft balloon connection port 630 for fluidically connecting aft balloon 20 to manifold 500, an aft balloon indicator port 635 for fluidically connecting aft balloon indicator 355 to manifold 500, an aft balloon channel 640 extending between aft balloon connection port 630 and aft balloon indicator port 635, a fore balloon connection port 645 for fluidically connecting fore balloon 35 to manifold 500, a fore balloon indicator port 650 for fluidically connecting fore balloon indicator 350 to manifold 500 and a fore balloon channel 655 extending between fore balloon connection port 645 and fore balloon indicator port 650.
  • Bottom surface 615 of body 610 comprises an aft balloon inflation port 660 and an aft balloon deflation port 665 which open on bottom surface 615 and which are fluidically connected to aft balloon channel 640.
  • Bottom surface 615 of body 610 also comprises a fore balloon inflation port 670 and a fore balloon deflation port 675 which open on bottom surface 615 and which are fluidically connected to fore balloon channel 655.
  • a plurality of O-rings 680 are disposed about ports 660, 665, 670, 675 for effecting sealing engagement of ports 660, 665, 670, 675 with top surface 590 of middle plate 510 as will hereinafter be discussed in further detail.
  • bottom surface 615 of body 610 also comprises a balance O-ring 685 for helping to maintain sealing engagement of O-rings 680 with top surface 590 of middle plate 510, as will hereinafter be discussed in further detail.
  • top plate 515 also comprises an aft balloon channel check valve 690 disposed in top plate 515 (it will be appreciated that check valve 690 is functionally equivalent to the check valve 365 shown in Fig. 65).
  • Aft balloon check valve 690 is in fluid communication with aft balloon channel 640 and prevents over-inflation of aft balloon 20 by releasing air to atmosphere when the air pressure within aft balloon channel 640 (which is the same as the air pressure within aft balloon 20) exceeds a predetermined threshold.
  • top plate 515 also comprises a fore balloon channel check valve 695 disposed in top plate 515 (it will be appreciated that check valve 695 is functionally equivalent to the check valve 360 shown in Fig. 43).
  • Fore balloon check channel valve 695 is in fluid communication with fore balloon channel 655 and prevents over-inflation of fore balloon 35 by releasing air to atmosphere when the air pressure within fore balloon channel 655 (which is the same as the air pressure within fore balloon 35) exceeds a predetermined threshold.
  • manifold 500 is assembled such that middle plate 510 is rotatably disposed between bottom plate 505 and top plate 515, with shaft 520 passing through central opening 625 of top plate 515, through central opening 595 of middle plate 510 and through central opening 545 of bottom plate 505.
  • the distal end of shaft 520 comprises a distal bearing 700 which is secured to shaft 520 by a retainer clip 705.
  • the proximal end of shaft 520 comprises a proximal bearing 710 which is secured to the proximal end of shaft 520, with a spring 715 being disposed between proximal bearing 710 and top surface 620 of top plate 515.
  • a selector knob 720 is fixedly mounted to the proximal end of shaft 520 such that rotation of selector knob 720 causes corresponding rotation of shaft 520 (and hence corresponding rotation of middle plate 510).
  • Shaft 520 is able to rotate freely within central opening 625 of top plate 515 and central opening 545 of bottom plate 505, and to also rotate freely within proximal bearing 710 and distal bearing 700.
  • shaft 520 engages central opening 595 of middle plate 510 such that rotation of shaft 520 causes corresponding rotation of middle plate 510, whereby to permit a user to selectively rotate middle plate 510 (i.e., by rotating selector knob 720, which, in turn, rotates middle plate 510).
  • bottom plate 505, middle plate 510 and top plate 515 are “sandwiched” between distal bearing 700 and proximal bearing 710 under compression provided by spring 715, whereby to maintain constant contact (i) between bottom surface 585 of middle plate 510 and O-rings 550 of bottom plate 505, (ii) between top surface 590 of middle plate 510 and O-rings 680 of top plate 515 (i.e., between top surface 590 of middle plate 510 and aft balloon inflation port 660, aft balloon deflation port 665, fore balloon inflation port 670 and fore balloon deflation port 675), and (iii) between top surface 590 of middle plate 510 and balance O-ring 685 of top plate 515.
  • an air-tight air pathway is maintained through manifold 500 between a selected one of (i) inflation port 535 or deflation port 540, and (ii) a selected one of fore balloon 35 or aft balloon 20, such that bulb 310 may be used to selectively inflate or deflate a selected one of fore balloon 35 or aft balloon 20, as will hereinafter be discussed in further detail.
  • rotating selector knob 720 causes shaft 520 to rotate, thereby causing middle plate 510 to rotate.
  • inner hole 600 and outer hole 605 of middle plate 510 also rotate relative to bottom plate 505 and top plate 515. Since inner hole 600 of middle plate 510 is aligned in common orbit with inner deflation zone 555 of bottom plate 505, inner hole 600 is always aligned with inner deflation zone 555, regardless of the rotational position of middle plate 510 (and hence, inner hole 600 is always fluidically connected to deflation port 540, i.e., vis-a-vis opening 565 in inner deflation zone 555).
  • middle plate 510 since outer hole 605 of middle plate 510 is aligned in common orbit with outer inflation zone 560 of bottom plate 505, outer hole 605 is always aligned with outer inflation zone 560 (and hence, outer hole 605 is always fluidically connected to inflation port 535 vis-a-vis opening 570 in outer inflation zone 560). It will also be appreciated that when middle plate 510 is rotated (i.e., by rotating selector knob 720), inner hole 600 of middle plate 510 may be positioned so that it is (i) aligned with aft balloon deflation port 665, or (ii) aligned with fore balloon deflation port 675, or (iii) unaligned with a port 665, 675 (and hence open to atmosphere).
  • outer hole 605 of middle plate 510 may be positioned so that it is (i) aligned with aft balloon inflation port 660, or (ii) aligned with fore balloon inflation port 670, or (iii) unaligned with a port 660, 670 (and hence open to atmosphere).
  • O-rings 680 and balance O-ring 685 creates a small gap between bottom surface 615 of top plate 515 and top surface 590 of middle plate 510, such that when either (or both) of inner hole 600 and/or outer hole 605 of middle plate 510 are unaligned with a port 665, 675, 660, 670, inner hole 600 and/or outer hole 605 are connected with atmosphere.
  • middle plate 510 can be selectively rotated so as to occupy one of five states: (1) an aft balloon inflation state, wherein outer hole 605 of middle plate 510 is aligned with aft balloon inflation port 660 of top plate 515 and inner hole 600 of middle plate 510 is open to atmosphere (“State 1”); (2) an aft balloon deflation state wherein outer hole 605 of middle plate 510 is open to atmosphere and inner hole 600 of middle plate 510 is aligned with aft balloon deflation port 665 of top plate 515 (“State 2”); (3) a fore balloon inflation state wherein outer hole 605 of middle plate 510 is aligned with fore balloon inflation port 670 of top plate 515 and inner hole 600 of middle plate 510 is open to atmosphere (“State 3”); (4) a fore balloon deflation state wherein outer hole 605 of middle plate 510 is open to atmosphere and inner hole 600 of middle plate 510 is aligned with fore balloon deflation
  • aft balloon inflation port 660, aft balloon deflation port 665, fore balloon inflation port 670 and fore balloon deflation port 675 within bottom surface 615 of top plate 515 can be arranged such that rotation of middle plate 510 causes selective switching between the States 1, 2, 3, 4 and 5 discussed above.
  • State 1 is effected when knob 720 is in the “8 o’clock” position
  • State 2 is effected when knob 720 is in the “4 o’clock” position
  • State 3 is effected when knob 720 is in the “10 o’clock” position
  • State 4 is effected when knob 720 is in the “2 o’clock” position.
  • State 5 is effected whenever knob 720 is rotated to a position intermediate the aforementioned positions.
  • Figs. 70-72 there is shown the path that air travels through manifold 500 when middle plate 510 is in State 1 discussed above for effecting aft balloon inflation (i.e., when middle plate 510 is rotated such that outer hole 605 of middle plate 510 is aligned with aft balloon inflation port 660 of top plate 515 and inner hole 600 of middle plate 510 is open to atmosphere).
  • aft balloon deflation port 665, fore balloon inflation port 670 and fore balloon deflation port 675 are all fluidically sealed against top surface 590 of middle plate 510 so that air cannot enter or leave via ports 665, 670, 675, and hence, when manifold 500 is in State 1, inflation of aft balloon 20 does not have any effect on fore balloon 35.
  • FIGs. 73 and 74 there is shown the path that air travels through manifold 500 when middle plate 510 is in State 2 discussed above for effecting aft balloon deflation (i.e., when middle plate 510 is rotated such that outer hole 605 of middle plate 510 is open to atmosphere and inner hole 600 of middle plate 510 is aligned with aft balloon deflation port 665).
  • aft balloon inflation port 660, fore balloon inflation port 670 and fore balloon deflation port 675 are all fluidically sealed against top surface 620 of middle plate 510 so that air cannot enter or leave via ports 660, 670, 675, and hence, when manifold 500 is in State 2, deflation of aft balloon 20 does not have any effect on fore balloon 35.
  • Figs. 75 and 76 there is shown the path that air travels through manifold 500 when middle plate 510 is in State 3 discussed above for effecting fore balloon inflation (i.e., when middle plate 510 is rotated such that outer hole 605 of middle plate 510 is aligned with fore balloon inflation port 670 of top plate 515 and inner hole 600 of middle plate 510 is open to atmosphere).
  • aft balloon deflation port 665, aft balloon inflation port 660 and fore balloon deflation port 675 are all fluidically sealed against top surface 590 of middle plate 510 so that air cannot enter or leave via ports 665, 660, 675, and hence, when manifold 500 is in State 3, inflation of fore balloon 35 does not have any effect on aft balloon 20.
  • Figs. 77 and 78 there is shown the path that air travels through manifold 500 when middle plate 510 is in State 4 discussed above for effecting fore balloon deflation (i.e., when middle plate 510 is rotated such that outer hole 605 of middle plate 510 is open to atmosphere and inner hole 600 of middle plate 510 is aligned with fore balloon deflation port 675).
  • aft balloon inflation port 660, aft balloon deflation port 665 and fore balloon inflation port 670 are all fluidically sealed against top surface 590 of middle plate 510 so that air cannot enter or leave ports 660, 665, 670, and hence, when manifold 500 is in State 4, deflation of fore balloon 35 does not have any effect on aft balloon 20. 5 Fore Balloon And Aft Balloon Sealed against Inflation/Deflation.
  • middle plate 510 When middle plate 510 is disposed in State 5 discussed above (i.e., when middle plate 510 is rotated such that inner hole 600 and outer hole 605 are both open to atmosphere), aft balloon inflation port 660, aft balloon deflation port 665, fore balloon inflation port 670 and fore balloon deflation port 675 are all sealed against top surface 590 of middle plate 510.
  • Manifold 500A for selectively inflating or deflating a selected one of aft balloon 20 and fore balloon 35.
  • Manifold 500A serves the same function as manifold 500 discussed above (i.e., manifold 500A selectively controls a plurality of airway paths in order to permit a user to selectively inflate or deflate a selected one of aft balloon 20 and fore balloon 35 using a single user interface), however, manifold 500A employs a somewhat different construction than manifold 500.
  • manifold 500A generally comprises a rotatable control dial and a plurality of tubes (labelled 1-6 in Fig. 80), with the control dial being configured to selectively close-off one or more of the plurality of tubes and to selectively open one or more of the plurality of tubes as the rotatable control dial is rotated. More particularly, and still looking at Fig. 80, there is shown a rotatable control dial 800 comprising a body 805.
  • Body 805 comprises a first groove 810 having a first cutout section 815 and a second cutout section 820, a second groove 825 having a first cutout section 830 and a second cutout section 835, a third groove 840 having a cutout section 845, a fourth groove 850 having a cutout section 855, a fifth groove 860 having a cutout section 865 and a sixth groove 870 having a cutout section 875.
  • the plurality of tubes discussed above are fixed in place relative to rotatable control dial 800 and each of the plurality of tubes passes through one of first groove 810, second groove 825, third groove 840, fourth groove 850, fifth groove 860 and sixth groove 870. More particularly, a first tube 880 in fluid connection with bulb 310 and atmosphere passes through first groove 810, a second tube 885 in fluid connection with bulb 310 and atmosphere passes through second groove 825, a third tube 890 in fluid connection with aft balloon 20 and bulb 310 passes through third groove 840, a fourth tube 895 in fluid connection with aft balloon 20 and bulb 310 passes through fourth groove 850, a fifth tube 900 in fluid connection with fore balloon 35 and bulb 310 passes through fifth groove 860, and a sixth tube 905 in fluid connection with fore balloon 35 and bulb 310 passes through sixth groove 870.
  • First groove 810, second groove 825, third groove 840, fourth groove 850, fifth groove 860 and sixth groove 870 are sized such that first tube 880, second tube 885, third tube 890, fourth tube 895, fifth tube 900 and sixth tube 905 are “pinched off’ such that air cannot flow throw the tube whenever the tube is disposed in a section of its respective groove 810, 825, 840, 860, 870 which is not a cutout section. As a result, air can only flow through a given tube 880, 885,
  • first tube 880 only permits passage of air through the tube when it is disposed in either cutout section 815 or cutout section 820 of first groove 810
  • second tube 885 only permits passage of air through the tube when it is disposed in either cutout section 830 or cutout section 835
  • third tube 890 only permits passage of air through the tube when it is disposed in cutout section 845, etc.
  • tubes 880, 885, 890, 895, 900 and 905 are fixed in location relative to control dial 800, when control dial 800 is selectively rotated by a user, cutout sections 815, 820, 830, 835, 845, 855, 865 and 875 move relative to tubes 880, 885, 890, 895, 900 and 905.
  • control dial 800 By controlling where the cutout sections 815, 820, 830, 835, 845, 855, 865 and 875 are formed in body 805 of control dial 800, it is possible to control which of the tubes 880, 885, 890, 895, 900 and 905 will be “pinched off’ and which will reside in a cutout section 815, 820, 830, 835, 845, 855, 865 and 875 when control dial 800 is rotated to a given position. Thus it is possible to control the flow of air to and from bulb 310, and to simultaneously control the flow of air to and from a selected one of aft balloon 20 and fore balloon 35, by selectively moving control dial 800 to a specific position. Further details regarding the flow of air through manifold 500A are provided in Figs. 81 and 82.
  • novel apparatus 5 is sealed within a sterile package 1000 until novel apparatus 5 is to be used.
  • Package 1000 is typically provided in the form of a bottom tray 1005 which is sized to hold novel apparatus 5, and a cover 1010 for mating to, and sealing off, bottom tray 1005.
  • Fore balloon 35 and aft balloon 20 are in their deflated condition when novel apparatus 5 is sealed within sterile package 1000.
  • novel apparatus 5 (sealed within package 1000) is thereafter shipped to a recipient via a means of transportation where package 1000 is exposed to a substantial change in air pressure (e.g., when novel apparatus 5 is shipped to a recipient via an airplane), the change in air pressure can cause the residual air remaining within fore balloon 35 and/or aft balloon 20 (and/or the various fluid pathways leading to fore balloon 35 and/or aft balloon 20) to expand.
  • a substantial change in air pressure can cause the residual air remaining within fore balloon 35 and/or aft balloon 20 (and/or the various fluid pathways leading to fore balloon 35 and/or aft balloon 20) to expand.
  • Such expansion while novel apparatus 5 is sealed within package 1000 can cause damage to fore balloon 35, aft balloon 20 and/or other components of novel apparatus 5.
  • One possible solution to the foregoing problem is to fully evacuate all of the air from fore balloon 35, aft balloon 20 and all of the pathways, leading to fore balloon 35 and aft balloon 20 before novel apparatus 5 is sealed within package 1000.
  • a fore balloon venting check valve 1015 and an aft balloon venting check valve 1015 A are provided in hand inflator 300, with fore balloon venting check valve 1015 being disposed in fore balloon inflation line 320 and with aft balloon venting check valve 1015 A being disposed in aft balloon inflation line 315.
  • fore balloon venting check valve 1015 is shown in Figs.
  • aft balloon venting check valve 1015 A is identical in construction and function to fore balloon venting check valve 1015 (although aft balloon venting check valve 1015 A is disposed in aft balloon inflation line 315 rather than in fore balloon inflation line 320).
  • fore balloon venting check valve 1015 and aft balloon venting check valve 1015 A are disposed in the bottom surface of housing 305 of hand inflator 300, such that they are in fluid communication with fore balloon inflation line 320 and aft balloon inflation line 315, respectively, and hence in fluid communication with fore balloon 35 and aft balloon 20, respectively.
  • fore balloon venting check valve 1015 comprises a lumen 1020 having a first end in fluid communication with fore balloon inflation line 320 and a second end having an opening 1025 formed in the outer surface of housing 305.
  • a ball (e.g., a rubber ball) 1030 is movably disposed within lumen 1020 and is biased against opening 1025 by a spring 1035.
  • Ball 1030 is biased against opening 1025, air cannot pass through opening 1025 and into (or out of) fore balloon inflation line 320, i.e., fore balloon 35 is sealed off against the free passage of air into (or out of) fore balloon 35.
  • Bottom tray 505 comprises an upwardly-extending finger 1040 which is sized and positioned such that finger 1040 is received within opening 1025 of housing 305 when novel apparatus 5 (and, more specifically, hand inflator 300) is disposed within bottom tray 1005 of package 1000.
  • Finger 1040 is sized such that when it is received within opening 1025, a finger 1040 engages ball 1030 and drives ball 1030 against the power of spring 1035, whereby to unseat ball 1030 from opening 1025. At the same time, a gap remains between finger 1040 and the sides of opening 1025, whereby to allow air to pass from the interior of package 1000 through fore balloon venting check valve 1015, through fore balloon inflation line 320 and into fore balloon 35, and vice versa (Fig. 87).
  • Bottom tray 1005 comprises a similar finger 1040A for forcing check valve 1015A open when hand inflator 300 is seated in bottom tray 1005 of package 1000.
  • an upwardly-extending stop may also be provided on bottom tray 1005 of package 1000 for engaging the bottom surface of housing 305 of hand inflator 300 when hand inflator 300 is disposed within bottom tray 1005 of package 1000, whereby to ensure that an air gap is maintained between the bottom surface of hand inflator 300 and the bottom surface of bottom tray 1005, and hence ensure that air is free to flow through check valves 1015, 1015 A when hand inflator 300 is seated in bottom tray 1005 of package 1000.
  • fore balloon venting check valve 1015 and aft balloon venting check valve 1015 A act to protect novel apparatus 5 from exposure to air pressure differentials during shipping/storage and does so in a passive fashion that does not require the recipient to close any valves.
  • Apparatus 5 may be used to manipulate, (e.g., stabilize, straighten, expand and/or flatten, etc.) the side wall of a body lumen and/or body cavity so as to better present the side wall tissue (including visualization of areas which may be initially hidden from view or outside the field of view) for examination and/or treatment during an endoscopic procedure using endoscope 10, and/or to stabilize the distal tips and/or working ends of instruments (e.g., graspers, cutters or dissectors, cauterizing tools, ultrasound probes, etc.), e.g., advanced into the therapeutic zone.
  • instruments e.g., graspers, cutters or dissectors, cauterizing tools, ultrasound probes, etc.
  • sleeve 15 is first mounted to endoscope 10 (Fig. 1). This may be accomplished by pulling base 25 proximally over the distal end of endoscope 10 and then pulling proximally along the length of endoscope 10 until the distal end of sleeve 15 is substantially aligned with the distal tip of endoscope 10. At this point, aft balloon 20 is deflated, fore balloon 35 is deflated, and fore balloon 35 is docked over the distal end of endoscope 10, with endoscope 10 nesting in the area beneath raised push tube bridge 31. Endoscope 10 and apparatus 5 are ready to be inserted as a unit into the patient. Looking next at Fig.
  • endoscope 10 and apparatus 5 are inserted as a unit into a body lumen and/or body cavity of the patient.
  • endoscope 10 and apparatus 5 are inserted as a unit into the gastrointestinal (GI) tract of the patient. Endoscope 10 and apparatus 5 are advanced along the body lumen and/or body cavity to a desired location within the patient (Figs. 90 and 91).
  • GI gastrointestinal
  • aft balloon 20 is inflated so as to stabilize apparatus 5 (and hence endoscope 10) within the body lumen and/or body cavity. See Fig. 92. This may be done using the aforementioned associated inflation mechanism 40.
  • the endoscope inasmuch as the articulating portion of the endoscope resides distal to aft balloon 20, the endoscope will be able to articulate distal to aft balloon 20 so as to facilitate visualization of the anatomy even after aft balloon 20 is inflated.
  • aft balloon 20 stabilizes endoscope 10 within the gastrointestinal tract and distends the colon and increases the colon to a fixed diameter directly adjacent to aft balloon 20.
  • hollow push tubes 30 are advanced distally in the body lumen and/or body cavity (i.e., so as to move fore balloon 35 further ahead of aft balloon 20) by pushing distally on push tube handle 37.
  • hollow push tubes 30, and hence fore balloon 35 move distally relative to endoscope 10 (which is stabilized in position within the gastrointestinal tract by the inflated aft balloon 20).
  • raised push tube bridge 31 provides an atraumatic tip for the distal ends of hollow push tubes 30, thereby ensuring atraumatic advancement of fore balloon 35.
  • the deflated fore balloon 35 covers the distal ends of hollow push tubes 30 and raised push tube bridge 31 during such distal advancement of fore balloon 35, thereby ensuring atraumatic advancement of fore balloon 35.
  • atraumatic advancement of fore balloon 35 may be further enhanced by forming the distal ends of hollow push tubes 30 and raised push tube bridge 31 out of a more resilient material.
  • hollow push tubes 30 When hollow push tubes 30 have advanced fore balloon 35 to the desired position distal to endoscope 10, fore balloon 35 is inflated (Fig. 93) so as to secure fore balloon 35 to the anatomy. Again, this may be done using the aforementioned associated inflation mechanism 40. As fore balloon 35 is inflated, the inflated fore balloon 35, the inflated aft balloon 20, and hollow push tubes 30 will all complement one another so as to stabilize, straighten, expand and/or flatten the side wall of the body lumen and/or body cavity so as to better present the side wall tissue (including visualization of areas which may be initially hidden from view or outside the field of view) for examination and/or treatment during an endoscopic procedure using endoscope 10.
  • the inflated fore balloon 35 and the inflated aft balloon 20 will together expand and tension the side wall of the body lumen and/or body cavity, and hollow push tubes 30 will tend to straighten the anatomy between the two inflated balloons when the fore balloon is extended distally from the aft balloon.
  • the inflated fore balloon 35 and the inflated aft balloon 20 will together define a substantially closed region along the body lumen and/or body cavity (i.e., an isolated therapeutic zone which prevents the passage of fluid and/or other liquids by virtue of the air-tight seals established by the inflated fore balloon 35 and aft balloon 20).
  • the side wall of the body lumen and/or body cavity will be tensioned by inflation of fore balloon 35 and aft balloon 20, whereby to better present the side wall of the body lumen and/or body cavity for viewing through endoscope 10.
  • the expansion and tensioning of the side wall of the body lumen and/or body cavity effected by the inflated fore balloon 35, the inflated aft balloon 20, and hollow push tubes 30, can be further enhanced by advancing the fore balloon when it is inflated and gripping the side wall of the body lumen and/or body cavity, whereby to further tension the side wall of the body lumen and/or body cavity.
  • this region can then be inflated (Fig. 24) with a fluid (e.g., air, CO2, etc.) so as to further tension the side wall of the body lumen and/or body cavity, whereby to better present the side wall of the body lumen and/or body cavity for viewing through endoscope 10 and stabilize the side wall so as to facilitate more precise therapeutic interventions.
  • a fluid e.g., air, CO2, etc.
  • fore balloon 35 can be retracted toward aft balloon 20 (i.e., by pulling push tube handle 37 proximally), while remaining inflated (and hence maintaining a grip on the side wall of the body lumen and/or body cavity), so as to move the visible mucosa and further improve visualization and access (see Fig. 95), e.g., so as to position a particular target area on the side wall of the body lumen and/or body cavity at a convenient angle relative to the endoscope and endoscopic tools.
  • hollow push tubes 30 may be advanced distally a portion - but only a portion - of their full distal stroke, then fore balloon 35 may be inflated so as to grip the side wall of the body lumen and/or body cavity, and then hollow push tubes 30 may be further advanced distally.
  • This action will cause flexible hollow push tubes 30 to bow outwardly (see Figs. 96-99), contacting the side wall of the body lumen and/or body cavity and pushing the side wall of the body lumen and/or body cavity outwardly, e.g., in a “tenting” fashion, whereby to further enhance visualization of the side wall of the body lumen and/or body cavity by endoscope 10
  • instruments 190 may be advanced through working channels of endoscope 10 so as to biopsy and/or treat pathologic conditions (e.g., excise pathological anatomy). It will be appreciated that such instruments will extend through the distal end of the endoscope, which is effectively stabilized relative to the anatomy via aft balloon 20, so that the working ends of instruments 190 will also be highly stabilized relative to the anatomy. This is a significant advantage over the prior art practice of advancing instruments out of the non- stabilized end of an endoscope.
  • instruments 190 include articulating instruments having a full range of motion, whereby to better access target anatomy.
  • the isolated therapeutic zone permits rapid flushing of the anatomic segment in which the therapeutic zone lies (e.g., with a liquid such as saline) with rapid subsequent removal of the flushing liquid (see Figs. 101-103).
  • fore balloon 35 can be directed with high precision to a bleeding site, whereupon fore balloon 35 may be used (e.g., inflated) to apply local pressure to the bleeding site in order to enhance bleeding control (see Fig. 104). This can be done under the visualization provided by endoscope 10.
  • endoscope 10 is repositioned within the anatomy with minimal interference from apparatus 5
  • fore balloon 35 is returned to its torus configuration (i.e., partially deflated)
  • the fore balloon is retracted proximally and “re-docked” on the distal end of endoscope 10 (with endoscope 10 nesting in the area beneath raised push tube bridge 31)
  • aft balloon 20 is deflated, and then endoscope 10 (with apparatus 5 carried thereon) is repositioned within the anatomy.
  • fore balloon 35 is to be re-docked on the distal end of endoscope 10
  • fore balloon 35 is preferably only partially deflated until fore balloon 35 is re-docked on the distal end of the endoscope, since partial inflation of fore balloon 35 can leave fore balloon 35 with enough “body” to facilitate the re-docking process. Thereafter, fore balloon 35 may be fully deflated if desired, e.g., so as to positively grip the distal end of endoscope 10.
  • fore balloon 35 may be used as a drag brake to control retrograde motion of the endoscope. More particularly, in this form of the invention, endoscope 10 and apparatus 5 are first advanced as a unit into the body lumen and/or body cavity until the tip of the endoscope is at the proper location. Next, aft balloon 20 is inflated, hollow push tubes 30 are advanced distally, and then fore balloon 35 is inflated (Fig. 105). Visualization and, optionally, therapeutic treatment may then be effected at that location.
  • aft balloon 20 When the apparatus is to be moved retrograde, aft balloon 20 is deflated, fore balloon 35 is partially deflated, and then the endoscope is withdrawn proximally, dragging the semi- inflated fore balloon 35 along the body lumen and/or body cavity (Fig. 106), with fore balloon 35 acting as something of a brake as the endoscope is pulled proximally, thereby enabling more controlled retrograde movement of the endoscope and hence better visualization of the anatomy. If at some point it is desired, aft balloon 20 and fore balloon 35 can be re-inflated, as shown in Fig.
  • aft balloon 20 as a brake when withdrawing the endoscope (and hence apparatus 5) from the anatomy, either alone or in combination with the aforementioned braking action from fore balloon 35.
  • endoscope 10 and apparatus 5 are withdrawn from the anatomy.
  • this is done by deflating (or partially deflating) fore balloon 35, retracting hollow push tubes 30 so that fore balloon 35 is “re-docked” onto the distal end of endoscope 10 (with endoscope 10 nesting in the area beneath raised push tube bridge 31), fully deflating fore balloon 35 so that it grips the distal end of the endoscope, deflating aft balloon 20 (if it is not yet deflated), and then withdrawing endoscope 10 and apparatus 5 as a unit from the anatomy.
  • apparatus 5 may also be used advantageously in various ways other than those disclosed above.
  • endoscope 10 and apparatus 5
  • the fore balloon and flexible hollow push tubes 30 and raised push tube bridge 31
  • the endoscope may act as an atraumatic lead (guiding structure) for the endoscope as the endoscope advances through the colon.
  • hollow push tubes 30 are preferably highly flexible, as the advancing fore balloon 35 encounters the colon wall (e.g., at a turn of the colon), the flexible hollow push tubes can deflect so that the fore balloon tracks the path of the colon, thereby aiding atraumatic advancement of the endoscope along the colon.
  • apparatus 5 may also be used advantageously in other ways to facilitate further examinations of the luminal surface otherwise difficult to be performed currently. Such an example is endoscopic ultrasound examination of the lumen which would be facilitated by the fluid-filled inflated fore balloon and ultrasound probe examination.
  • Aft balloon 20 is bonded to sleeve 15 along at least the distal edge of aft balloon 20 and the proximal edge of aft balloon 20 (i.e., the distal and proximal edges where aft balloon 20 meets sleeve 15), such that an airtight seal is created between aft balloon 20 and sleeve 15.
  • Pushrod lumens 52 and aft balloon inflation lumen 47 are disposed in contact with, and parallel to, sleeve 15, with pushrod lumens 52 passing entirely through aft balloon 20 (i.e., through both the proximal and distal edges of aft balloon 20 where aft balloon 20 meets sleeve 15) and with aft balloon inflation lumen 47 passing through the proximal edge of aft balloon 20 and extending into the interior of aft balloon 20.
  • aft balloon 20 must be sealingly bonded to sleeve 15 about a series of components (i.e., pushrod lumens 52 and aft balloon inflation lumen 47) which collectively present a non-circular cross-sectional profile at the bonding sites.
  • gaps 1100 exist in the space between pushrod lumens 52 and sleeve 15, gap 1105 exists in the space between aft balloon inflation lumen 47 and sleeve 15, and gaps 1110 exist in the space between a pushrod lumen 52 and aft balloon inflation lumen 47.
  • gaps 1100, 1105 and 1110 at the proximal edge of aft balloon 20, and the presence of gaps 1100 at the distal edge of aft balloon 20 compromise the airtight sealing of aft balloon 20 to sleeve 15, since it is difficult to make the material of aft balloon 20 adhere to the irregular perimeter defined by pushrod lumens 52 and aft balloon inflation lumen 47. Stated another way, it can be challenging to make the material of aft balloon 20 enter into gaps 1100, 1105 and 1110
  • novel extruded inserts 1115 which have a cross-sectional profile matching the aforementioned gaps 1100. Extruded inserts 1115 are sized to fill gaps 1100 at the location where the proximal edge of aft balloon 20 and the distal edge of aft balloon 20 are bonded to sleeve 15 around pushrod lumens 52.
  • Extruded inserts 1110 are preferably flexible and may be of any desired length (e.g., extruded inserts 1115 may extend along substantially the entire length of sleeve 15, or extruded inserts 1115 may extend only along a portion of sleeve 15 where aft balloon 20 is bonded to sleeve 15, or a plurality of extruded inserts 1115 may extend along a plurality of interrupted sections of sleeve 15, etc.). In one preferred form of the invention, extruded inserts 1115 extend from a location just distal to aft balloon 20 to a location just proximal to aft balloon 20.
  • Extruded insert 1120 having a cross- sectional profile matching the aforementioned gap 1105. Extruded insert 1120 is sized to fill gap 1105 at the location where the proximal edge of aft balloon 20 and the distal edge of aft balloon 20 are bonded to sleeve 15 around aft balloon inflation lumen 47.
  • Extruded insert 1120 is preferably flexible and may be of any desired length (e.g., extruded inserts 1120 may extend along substantially the entire length of sleeve 15, or extruded inserts 1120 may extend only along a portion of sleeve 15 where aft balloon 20 is bonded to sleeve 15, or a plurality of extruded inserts 1120 may extend along a plurality of interrupted sections of sleeve 15, etc.). In one preferred form of the invention, extruded insert 1120 extends from a location at the distal end of aft balloon inflation lumen 47 to a location just proximal to aft balloon 20.
  • Extruded inserts 1125 having a cross- sectional profile matching the aforementioned gaps 1110. Extruded inserts 1125 are sized to fill gaps 1110 at the location where the proximal edge of aft balloon 20 and the distal edge of aft balloon 20 are bonded to sleeve 15 around aft balloon inflation lumen 47 and a pushrod lumen 52.
  • Extruded inserts 1125 are preferably flexible and may be of any desired length (e.g., extruded inserts 1125 may extend along substantially the entire length of sleeve 15, or extruded inserts 1125 may extend only along a portion of sleeve 15 where aft balloon 20 is bonded to sleeve 15, or a plurality of extruded inserts 1125 may extend along a plurality of interrupted sections of sleeve 15, etc.). In one preferred form of the invention, extruded insert 1125 extends from a location at the distal end of aft balloon inflation lumen 47 to a location just proximal to aft balloon 20.
  • Inserts 1115, 1120 and 1125 are preferably formed out of a material which will thermally bond with the material(s) of (i) sleeve 15, (ii) pushrod lumens 52, (iii) aft balloon inflation lumen 47, and (iv) aft balloon 20, whereby to facilitate the airtight bonding of aft balloon 20 to sleeve 15, pushrod lumen 52 and aft balloon inflation lumen 47.
  • fore balloon 35 is formed as a hollow balloon body 67 having two extensions (i.e., proximal extension 73 and distal extension 76) which are both everted inwardly (i.e., the proximal extension is everted first, the distal extension is everted second) into the interior of body 67 and thermally bonded together to form fore balloon 35.
  • fore balloon 35 comprises a torus, whereby to facilitate docking of fore balloon 35 over the distal end of sleeve 15 (i.e., the distal end of endoscope 10) when fore balloon 35 is in its deflated condition.
  • fore balloon 35 can provide a full-diameter barrier across an anatomical passageway when fore balloon 35 is in its inflated condition.
  • Fore balloon 35A is manufactured as a single construct comprising a body 67A having a proximal opening 69A and a distal opening 71A, a proximal extension 73A having a “key-shaped” cross- section comprising lobes 74A, and a distal extension 76A having a circular cross- section.
  • lobes 74A of proximal extension 73 A have a configuration that matches the configuration of hollow push tubes 30 (i.e., where apparatus 5 comprises two hollow push tubes 30 diametrically opposed to one another, proximal extension 73 A comprises two lobes 74A diametrically opposed to one another - for the purposes of the present invention, proximal extension 73 A and lobe(s) 74A may be collectively referred to as having a “key-shaped” cross- section).
  • Proximal extension 73 A is relatively short and is preferably flared outwardly at its proximal end, whereby to facilitate docking of fore balloon 35 A over sleeve 15 and/or endoscope 10 as will hereinafter be discussed in greater detail. Furthermore, proximal extension 73A preferably comprises a proximally- extending tongue 77 for facilitating docking of fore balloon 35 A over the proximal end of sleeve 15 (and/or the proximal end of endoscope 10).
  • proximal extension 73 A of fore balloon 35 A differs from the aforementioned proximal extension 73 of fore balloon 73 (i.e., by being formed with a shorter length, a flared proximal end and a tongue 77).
  • Fore balloon 35A is also assembled in a somewhat different manner than the aforementioned fore balloon 35, as will hereinafter be discussed in greater detail. More particularly, and looking now at Figs. 120-122, hollow push tubes 30 are seated in lobes 74A of proximal extension 73 A, with proximal extension 73 A extending proximally away from fore balloon 35 A and with distal extension 76 extending distally away from fore balloon 35A. Hollow push tubes 30 are advanced distally into the interior of body 67A of fore balloon 35 A such that the interiors of hollow push tubes 30 are in fluid communication with the interior of body 67A and with raised push tube bridge 31 disposed within the interior of body 67A. If desired, an assembly mandrel M may be used during assembly in order to provide support for the components during insertion of hollow push tubes 30 into fore balloon 35A of fore balloon 35A (see Fig. 120).
  • processing mandrel M is removed (if one is used), and distal extension 76A is everted into the interior of body 67A of fore balloon 35 A and passed proximally through body 67A, and through the interior of proximal extension 73 A, until distal extension 76A extends to the proximal opening of proximal extension 73 A.
  • proximal extension 76A extends through body 67A, and both proximal extension 73 A and distal extension 76A extend proximally away from body 67A of fore balloon 35 A, and push tubes 30 are disposed between proximal extension 73A and distal extension 76A proximal to body 67A of fore balloon 35 A.
  • proximal extension 73 A is not everted into the interior of fore balloon 35 A, rather, proximal extension 73 A remains extending proximally away from fore balloon 35.
  • Proximal extension 73 A and distal extension 76A are then bonded together at their proximal ends, with push tubes 30 being sealed therebetween, such that airtight thermal bonding is effected.
  • fore balloon 35 A has a toroidal configuration, comprising a boy 67 having a center opening formed by (i) proximal extension 73 A/everted distal extension 76A on the proximal side of body 67A, and (ii) everted distal extension 76A within the interior of body 67A.
  • proximal extension 73 A as a relatively short structure having an outwardly flared proximal end, and by providing tongue 77 on the proximal edge of proximal extension 73 A, proximal extension 73 A can facilitate docking of fore balloon 35 A over sleeve 15 and/or endoscope 10.
  • novel extruded inserts 1130 may be provided alongside hollow push tubes 30 so as to facilitate bonding hollow push tubes 30 to proximal extension 73A and to the everted distal extension 76A.
  • proximal extension 73 A and distal extension 76A may be provided along either (or both of) proximal extension 73 A and distal extension 76A, and/or around the proximal opening of proximal extension 73 A, so as to provide increased rigidity to those portions of fore balloon 35 A.
  • aft balloon 20 may be formed with an everted construction. More particularly, and looking now at Figs. 124 and 125, there is shown an aft balloon 20A which generally comprises a distal extension 1135 and a proximal extension 1140. During construction, distal extension 1135 is everted back through the center of aft balloon 20A so as to form a generally toroidal balloon structure which is secured to sleeve 15.
  • a tube 1145 has its distal end 1150 disposed exterior to the everted distal extension 1135, and interior to the outside wall of aft balloon 20A, and its proximal end 1155 connected to the aforementioned proximal inflation/deflation tube 45, so that air (or another fluid) can be introduced into aft balloon 20A and removed from aft balloon 20A.
  • apparatus 5 may be constructed so that hollow push tubes 30 may be advanced or retracted, to a limited extent, independently of one another, as well as in conjunction with one another - such limited independent advancement or retraction of hollow push tubes 30 can aid in steering the partially- or fully-deflated fore balloon 35 through the body lumen and/or body cavity, whereby to facilitate advancement or retraction of endoscope 10 through the body lumen and/or body cavity, and/or such independent advancement or retraction of hollow push tubes 30 can facilitate applying a “turning force” to the anatomy with an inflated fore balloon 35, whereby to better present the anatomy for visualization and/or treatment.
  • hollow push tubes 30 are each independently slidably mounted to push tube handle 37 so that hollow push tubes 30 can move, to some extent, independently of push tube handle 37 and each other. Stops 191 limit distal movement of hollow push tubes 30 relative to push tube handle 37 so that a hollow push tube cannot be moved completely out of push tube handle 37. As a result of this construction, when fore balloon 35 is to be moved distally, hollow push tubes 30 are moved distally, either together or, to the extent allowed by raised push tube bridge 31, independently of one another.
  • hollow push tubes 30 are moved proximally, either together or independently of one another, to the extent allowed by raised push tube bridge 31.
  • hollow push tubes 30 can be moved, to the extent allowed by raised push tube bridge 31, independently of one another so as to “turn” the fore balloon, e.g., such as when fore balloon 35 is inflated and engaging the anatomy, whereby to apply a “turning force” to the anatomy, or where fore balloon 35 is partially inflated and is being used as an atraumatic tip for the advancing assembly, whereby to help “steer” the assembly through the anatomy.
  • raised push tube bridge 31 at the distal ends of hollow push tubes 30 provides a limiting mechanism to limit the extent to which hollow push tubes 30 may be moved, longitudinally, independently of one another, in order to prevent excessive turning of fore balloon 35, and/or hollow push tube cross-over, and/or hollow push tube entanglement, and/or hollow push tube misalignment, etc.
  • hollow push tubes 30 may be held in a particular disposition by mounting hollow push tubes 30 in the aforementioned clamp 53 (Figs. 37 and 60).
  • sleeve 15 so as to support instruments (or hollow instrument guide tubes) external to endoscope 10. More particularly, looking again at Figs. 5 and 6, it will be seen that in the construction shown in Figs. 5 and 6, sleeve 15 comprises a lumen 47 for receiving inflation/deflation tube 45 for inflating/deflating aft balloon 20, and a pair of lumens 52 for receiving support tubes 50 which receive push tubes 30 for manipulating and inflating/deflating fore balloon 35. However, if desired, sleeve 15 may include additional lumens for supporting instruments (or hollow instrument guide tubes) external to endoscope 10.
  • sleeve 15 which includes a plurality of lumens 195 for slidably receiving instruments 190 therein.
  • aft balloon 20 when inflated, aft balloon 20 provides a secure platform for maintaining endoscope 10 and sleeve 15 within a body lumen or body cavity, with endoscope 10 and sleeve 15 centered within the body lumen or body cavity.
  • the distal ends of lumens 195 of sleeve 15 will also be securely maintained within the body lumen or body cavity so as to provide a secure support for instruments advanced through lumens 195 of sleeve 15.
  • the proximal ends of lumens 195 may extend to, and through, base 25, in which case instruments may be inserted into lumens 195 at base 25, or the proximal ends of lumens 195 may terminate proximal to base 25 (but still outside the body of the patient), in which case instruments may be inserted into lumens 195 intermediate sleeve 15.
  • endoscope 10 is 180 cm in length and instruments 190 are 60 cm in length, it can be advantageous to insert instruments 190 into lumens 195 at a point closer to balloons 20, 35 (rather than at base 25). Note that in Fig.
  • the lumen 47 for receiving inflation/deflation tube 45 and inflation/deflation tube 45 for inflating/deflating aft balloon 20 are not visible, since the view is distal-facing and is taken at a location distal to where lumen 47 and inflation/deflation tube 45 terminate on sleeve 15.
  • Figs. 128-131 show various instruments 190 extending out of lumens 195.
  • instruments 190 preferably comprise articulating instruments, e.g., graspers 190A in Figs 128-131, a cauterizing device 190B in Figs. 128-129, scissors 190C in Figs. 130 and 131, and a suction device 190D in Figs. 128-131.
  • sleeve 15 comprises its central passageway for receiving endoscope 10, lumen 47 for receiving inflation/deflation tube 45, lumens 52 for receiving support tubes 50 which receive hollow push tubes 30, and/or lumens 195 for slidably receiving instruments 190 therein, sleeve 15 is preferably formed by an extrusion process.
  • lumen 47 for receiving inflation/deflation tube 45, lumens 52 for receiving support tubes 50 which receive hollow push tubes 30, and/or lumens 195 for slidably receiving instruments 190 may have a fixed configuration (i.e., a fixed diameter), so that sleeve 15 has a fixed outer profile.
  • lumen 47 for receiving inflation/deflation tube 45, lumens 52 for receiving support tubes 50 which receive hollow push tubes 30, and/or lumens 195 for slidably receiving instruments 190 may have an expandable configuration (i.e., they may have a minimal profile when empty and expand diametrically as needed when filled with an instrument or other filling material), so that the overall profile of sleeve 15 is minimized. If desired, lumen 47 for receiving inflation/deflation tube 45, lumens 52 for receiving support tubes 50 which receive hollow push tubes 30, and/or lumens 195 for slidably receiving instruments 190 may be expandable only at their distal ends (i.e., not along the entire length of the instrument lumen).
  • sleeve 15 comprises a plurality of lumens 195 for slidably receiving instruments 190 therein, it can be desirable to provide greater structural integrity to the distal ends of lumens 195 so as to provide improved support for the instruments 190 received within lumens 195.
  • a support ring may be provided at the distal end of sleeve 15, wherein the support ring provides openings for the passage of hollow push tubes 30 and openings for the passage of instruments 190.
  • the openings in such a support ring for the passage of instruments 190 preferably make a close fit with the instalments so as to provide excellent instrument support at the distal end of sleeve 15.
  • lumens 195 may accommodate hollow instrument guide tubes which themselves accommodate instruments therein.
  • Such hollow instrument guide tubes can provide greater structural integrity to the distal ends of lumens 195 so as to provide improved support for the instruments 190 received within lumens 195.
  • hollow instrument guide tubes may be of fixed geometry or of bendable or articulating geometry. See, for example, Fig. 132, which shows hollow instrument guide tubes 200 extending out of lumens 195 and receiving instruments 190 therein. Note that hollow instrument guide tubes 200 may be independently movable relative to one another (and independently movable relative to sleeve 15). Note also that instruments 190 preferably make a close fit with hollow instrument guide tubes 200 so as to provide excellent instrument support at the distal end of sleeve 15.
  • the toroidal construction of fore balloon 35 may be replaced by a “conventional” balloon construction, i.e., by a balloon having a substantially uniform, full-diameter cross-section.
  • the deflated fore balloon is not “docked” over the endoscope during insertion - instead, the deflated fore balloon resides alongside the endoscope during insertion; and in this form of the invention, the fore balloon is not “re-docked” back over the endoscope during withdrawal - instead, the balloon resides distal to the endoscope (or alongside the endoscope) during withdrawal.
  • the raised push tube bridge 31 can help retain the deflated fore balloon alongside the endoscope.
  • apparatus 5 generally comprises a sleeve 15 for accommodating an endoscope 10, an aft balloon 20, an inflation line 45 for inflating aft balloon 20, hollow push tubes (or rods) 30, a fore balloon 35, and preferably, one or more instrument lumens 195 for receiving instruments therein.
  • apparatus 5 may omit certain features if their functionality is not required.
  • apparatus 5 may be simplified by omitting the aforementioned fore balloon 35.
  • the aforementioned hollow push tubes 30 may be retained without the use of fore balloon 35 in order to provide a desired function (as shown in Figs. 133, 133A, 134, 134A and 135-140, and as will be discussed in further detail below) or hollow push tubes 30 (and/or hollow support tubes 50) may be omitted from sleeve 15 (not shown).
  • hollow push tubes 30 and/or hollow support tubes 50 may be retained without the use of fore balloon 35 in order to provide a desired function.
  • hollow push tubes 30 and/or hollow support tubes 50 may be retained for (i) providing column strength to sleeve 15 (Figs. 133, 133A, 134 and 134A), (ii) use in a procedure within a body lumen of a patient (Figs. 135-140), (iii) passing instruments through hollow push tubes 30, and/or (iv) passing instruments through hollow support tubes 50, etc.
  • apparatus 5 comprises a sleeve 15 for accommodating an endoscope 10, an aft balloon 20 for stabilizing sleeve 15 (and an endoscope disposed therein) within a body cavity or body lumen, inflation line 45 for inflating aft balloon 20, hollow push tubes 30, hollow support tubes 50 for receiving hollow push tubes 30 and instrument lumens 195 for receiving an instrument therein.
  • sleeve 15 of apparatus 5 is formed out of a flexible material with substantially no column strength, and push tubes 30 and/or support tubes 50 provide the column strength needed to prevent sleeve 15 from collapsing upon endoscope 10 (e.g., kinking) as apparatus 5 and endoscope 10 are positioned within, or withdrawn from, the anatomy of a patient. Therefore, when fore balloon 35 is omitted from apparatus 5, it is desirable to retain push tubes 30 and/or support tubes 50 along the length of sleeve 15 in order to retain the column strength typically provided by push tubes 30 and/or support tubes 50.
  • push tubes 30 and/or support tubes 50 are retained solely to provide column strength to sleeve 15, push tubes 30 are no longer required to be movable (i.e., slidable in the distal and proximal directions) with respect to sleeve 15.
  • the portions of the push tubes 30 and/or the support tubes 50 extending distally beyond aft balloon 20 may be omitted so that push tubes 30 and/or support tubes 50 terminate within aft balloon 20 (Figs. 133, 133A, 134 and 134A) or just proximal to aft balloon 20 (if it is desirable for the distal end of sleeve 15 to be provided with more flexibility than the remainder of sleeve 15).
  • sleeve 15 could be formed out of a material having sufficient column strength to prevent sleeve 15 from collapsing upon endoscope 10 (e.g., kinking) as apparatus 5 and endoscope 10 are positioned within, or withdrawn from, the anatomy of a patient.
  • endoscope 10 e.g., kinking
  • push tubes 30 and support tubes 50 could be omitted entirely from apparatus 5.
  • apparatus 5 comprises a sleeve 15 for accommodating an endoscope 10, an aft balloon 20 for stabilizing sleeve 15 (and an endoscope disposed therein) within a body cavity or body lumen, inflation line 45 for inflating aft balloon 20, hollow push tubes 30, hollow support tubes 50 for receiving hollow push tubes 30 and instrument lumens 195 for receiving an instrument therein.
  • push tubes 30 are configured to move between a retracted position (Figs. 135) and an extended, distally-advanced position (Fig. 136).
  • the distal ends of the push tubes 30 are formed with atraumatic (e.g., “blunt”) tips so that the distal ends of push tubes 30 do not cause trauma to tissue as the push tubes 30 are moved distally within the anatomy.
  • atraumatic e.g., “blunt”
  • fore balloon 35 is not disposed at the distal ends of push tubes 30, inasmuch as fore balloon 35 may otherwise act to shield the anatomy from trauma resulting from distal movement of push tubes 30.
  • the distal ends of the pair of hollow push tubes 30 may be connected together with a raised push tube bridge 31 (e.g., the “saddle” push tubes shown in Figs. 7-13).
  • Raised push tube bridge 31 provides a rounded structure at the distal ends of hollow push tubes 30 which, among other things, simultaneously serves to (i) connect the distal ends of hollow push tubes 30 together, and (ii) eliminate abrupt ends at the distal end of hollow push tubes 30 which could cause trauma to tissue, e.g., during distal advancement of hollow push tubes 30.
  • raised push tube bridge 31 may be inclined distally, e.g., in the manner shown in Figs. 7-12.
  • raised push tube bridge 31 may be set substantially perpendicular to the longitudinal axes of hollow push tubes 30, e.g., in the manner shown in Fig. 13.
  • raised push tube bridge 31 may be in the form of a ring, e.g., in the manner shown in Fig. 14. See, for example, Figs. 137-140, which show push tubes 30 having a raised push tube bridge 31 in the form of a ring, with Figs. 137 and 138 showing push tubes 30 in a retracted position, and with Figs. 139 and 140 showing push tubes 30 in an extended, distally-advanced position.
  • raised push tube bridge 31 is preferably configured to rest adjacent to aft balloon 20 and the distal end of endoscope 10 when raised push tube bridge 31 is in its retracted position. See, for example, Fig. 8, which shows the distal end of endoscope 10 nesting within raised push tube bridge 31 and fore balloon 35 when fore balloon 35 is disposed at the distal end of endoscope 10, and Fig. 14 which shows the distal end of endoscope 10 nesting within the interior of the ring. See also, for example, Figs. 137 and 138 which show apparatus 5 (with fore balloon 35 omitted), with the distal end of endoscope 10 nesting within the interior of the ring.
  • the ring serves to provide the distal end of sleeve 15 and the distal ends of support tubes 50 with an atraumatic tip which makes apparatus 5 (with the fore balloon omitted) less traumatic and easier to pass through a body lumen or body cavity.
  • simplified apparatus 5 may be used to perform a procedure in a body lumen without creating a sealed therapeutic zone between two inflated balloons.
  • push tubes 30 may be used to tension a lesion which is to be excised from a body lumen, as described in U.S. Patent Application Serial No. 16/513,388, filed July 16, 2019 by Lumendi Ltd. and Peter Johann et al.
  • the distal ends of push tubes 30 of sleeve 15 may be connected to one another by a bridge 31, and a connector (e.g., a strand of suture) may be attached to bridge 31 (either prior to, or during, the procedure) and connected to a lesion (e.g., using a clip).
  • a connector e.g., a strand of suture
  • This simplified form of apparatus 5 is pulled over endoscope 10, the combination of endoscope 10 and simplified apparatus 5 is advanced into a body lumen or body cavity (e.g., an intestine) so that endoscope 10 sits just proximal to a lesion, aft balloon 20 is inflated so as to stabilize the endoscope relative to the lesion, the connector is attached to bridge 31 of push tubes 30 and connected to the lesion by a clip, and push tubes 30 are moved distally to tension the lesion away from endoscope 10.
  • a body lumen or body cavity e.g., an intestine
  • a cutting tool which has been advanced through a working lumen of endoscope 10 (or an instrument lumen 195), is used to dissect the lesion from the body lumen or body cavity (e.g., the submucosal layer of the intestine).
  • push tubes 30 without fore balloon 35 is not limited to tensioning a lesion.
  • push tubes 30 could be retained without fore balloon 35 for use in passing instruments through one or both of the hollow push tubes 30 or through one or both of support tubes 50.
  • push tubes 30 may be used to manipulate (e.g., straighten) the side of a body lumen and/or body cavity so as to better present the side wall tissue for examination and/or treatment.
  • sleeve 15 may comprise one or more additional aft balloons 20B for use in stabilizing sleeve 15 (and an endoscope disposed therein) within the anatomy.
  • apparatus 5 comprises a sleeve 15 for accommodating an endoscope 10, a first aft balloon 20 disposed at approximately the distal end of sleeve 15 (e.g., just proximal to the distal end of sleeve 15, or on the portion of sleeve 15 that is adjacent to the bending section of an endoscope, etc.), a second aft balloon 20B disposed proximal to aft balloon 20, inflation line 45 for inflating aft balloon 20 and aft balloon 20B (either simultaneously or independent from one another), hollow push tubes 30, hollow support tubes 50 for receiving hollow push tubes 30 and instrument lumens 195 for receiving an instrument therein.
  • a sleeve 15 for accommodating an endoscope 10
  • a first aft balloon 20 disposed at approximately the distal end of sleeve 15 (e.g., just proximal to the distal end of sleeve 15, or on the portion of sleeve 15 that is
  • sleeve 15 comprises an additional aft balloon 20B
  • the additional aft balloon 20B may be positioned directly adjacent to, and contacting, aft balloon 20 (Fig. 141), or the additional aft balloon 20B may be spaced proximally from aft balloon 20 (Fig. 142).
  • the additional aft balloon 20B may be movably disposed on sleeve 15 so that the position of aft balloon 20B may be adjusted relative to aft balloon 20, whereby to provide the desired stability within the anatomy.
  • push tubes 30 may be retained for a desired function, e.g., providing column strength to sleeve 15 (as shown in Figs. 141 and 142) or for use in a procedure within a body lumen of a patient (as shown in Figs. 143-146).
  • instrument lumens 195 may be omitted from apparatus 5.
  • the aforementioned hollow push tubes 30 may be retained without the use of fore balloon 35 in order to provide a desired function (as shown in Figs. 146A, 146B and 147-152, and as will be discussed in further detail below) or hollow push tubes 30 (and/or hollow support tubes 50) may be omitted from sleeve 15 (not shown), provided that sleeve 15 is formed with the appropriate column strength.
  • apparatus 5 comprises a sleeve 15 for accommodating an endoscope 10, an aft balloon 20 for stabilizing sleeve 15 (and an endoscope disposed therein) within a body cavity or body lumen, inflation line 45 for inflating aft balloon 20, hollow push tubes 30 and hollow support tubes 50 for receiving hollow push tubes 30.
  • instruments when it is desirable to pass instruments along the path followed by endoscope 10, instruments may be passed through the endoscope itself, e.g., instruments can be passed down a working lumen of the endoscope.
  • an endoscope having a smaller diameter than the diameter of the lumen of sleeve 15 can be used such that a gap exists between the inner wall of the lumen of sleeve 15 and the exterior of the endoscope.
  • Instruments can then be passed through the gap between sleeve 15 and endoscope 10. If desired, and as will be discussed in further detail below, one or more channels could be formed on the interior of sleeve 15 to provide support for an instrument passing through the gap between sleeve 15 and endoscope 10.
  • hollow push tubes 30 and/or hollow support tubes 50 may be retained without the use of fore balloon 35 in order to provide a desired function.
  • hollow push tubes 30 and/or hollow support tubes 50 may be retained for (i) providing column strength to sleeve 15 (Figs. 146A, 146B, 147 and 148), (ii) use in a procedure within a body lumen of a patient (Figs. 149-152), (iii) passing instruments through hollow push tubes 30, and/or (iv) passing instruments through hollow support tubes 50, etc.
  • push tubes 30 are configured to move between a retracted position (Figs. 149 and 151) and an extended, distally-advanced position (Figs. 150 and 152).
  • atraumatic (e.g., “blunt”) tips so that the distal ends of push tubes 30 do not cause trauma to tissue as the push tubes 30 are moved distally within the anatomy. This is particularly important where fore balloon 35 is not disposed at the distal ends of push tubes 30, inasmuch as fore balloon 35 may otherwise act to shield the anatomy from trauma resulting from distal movement of push tubes 30.
  • the distal ends of the pair of hollow push tubes 30 may be connected together with a raised push tube bridge 31 (e.g., the “saddle” push tubes shown in Figs. 7-13).
  • Raised push tube bridge 31 provides a rounded structure at the distal ends of hollow push tubes 30 which, among other things, simultaneously serves to (i) connect the distal ends of hollow push tubes 30 together, and (ii) eliminate abrupt ends at the distal end of hollow push tubes 30 which could cause trauma to tissue, e.g., during distal advancement of hollow push tubes 30.
  • raised push tube bridge 31 provides a rounded structure at the distal ends of hollow push tubes 30 which, among other things, simultaneously serves to (i) connect the distal ends of hollow push tubes 30 together, and (ii) eliminate abrupt ends at the distal end of hollow push tubes 30 which could cause trauma to tissue, e.g., during distal advancement of hollow push tubes 30.
  • raised push tube bridge 31 provides a rounded structure at the distal ends of hollow push tubes 30 which, among other things, simultaneously
  • Figs. 7-12 may be inclined distally, e.g., in the manner shown in Figs. 7-12.
  • raised push tube bridge 31 may be set substantially perpendicular to the longitudinal axes of hollow push tubes 30, e.g., in the manner shown in Fig. 13.
  • raised push tube bridge 31 may be in the form of a ring, e.g., in the manner shown in Fig. 14. See, for example, Fig. 151, which shows push tubes 30 having a raised push tube bridge 31 in the form of a ring, with Fig. 151 showing push tubes 30 in a retracted position, and Fig. 152 showing push tubes 30 in an extended, distally-advanced position.
  • raised push tube bridge 31 is preferably configured to rest adjacent to aft balloon 20 and the distal end of endoscope 10 when raised push tube bridge 31 is in its retracted position. See, for example, Fig. 8, which shows the distal end of endoscope 10 nesting within raised push tube bridge 31 and fore balloon 35 when fore balloon 35 is disposed at the distal end of endoscope 10, and Fig. 14 which shows the distal end of endoscope 10 nesting within the interior of the ring. See also, for example, Fig. 151 which shows apparatus 5 (with fore balloon 35 and instrument lumens 195 omitted), with the distal end of endoscope 10 nesting within the interior of the ring.
  • raised push tube bridge 31 is in the form of a ring
  • the retracted ring also serves to provide the distal end of sleeve 15 and the distal ends of support tubes 50 with an atraumatic tip so that apparatus 5 (with fore balloon 35 and instrument lumens 195 omitted) does not cause trauma as apparatus 5 is moved distally through a body lumen or body cavity.
  • apparatus 5 with fore balloon 35 and instrument lumens 195 omitted
  • the gap between the inner wall of the lumen of sleeve 15 and the exterior of the endoscope having a smaller diameter than the diameter of the lumen of sleeve 15 creates a “step” between the exterior of the endoscope and the inner wall of the lumen of the sleeve 15 which may be traumatic or may make it difficult to advance apparatus 5 through a body lumen (e.g., the colon).
  • the ring when the ring is in its retracted position, the ring can fill the gap between the inner wall of the lumen of sleeve 15 and the exterior of the endoscope, whereby to provide a more gradual “step” between the exterior of the endoscope and the inner wall of the lumen of sleeve 15 which would make it less traumatic and easier to pass apparatus 5 through a body lumen.
  • simplified apparatus 5 may be used to perform a procedure in a body lumen without creating a sealed therapeutic zone between two inflated balloons.
  • push tubes 30 may be used to tension a lesion which is to be excised from a body lumen, as described in U.S. Patent Application Serial No. 16/513,388, filed July 16, 2019 by Lumendi Ltd. and Peter Johann et al.
  • the distal ends of push tubes 30 of sleeve 15 may be connected to one another by a bridge 31, and a connector (e.g., a strand of suture) may be attached to bridge 31 (either prior to, or during, the procedure) and connected to a lesion (e.g., using a clip).
  • a connector e.g., a strand of suture
  • This simplified form of apparatus 5 is pulled over endoscope 10, the combination of endoscope 10 and simplified apparatus 5 is advanced into a body lumen or body cavity (e.g., an intestine) so that endoscope 10 sits just proximal to a lesion, aft balloon is inflated so as to stabilize the endoscope relative to the lesion, the connector is attached to bridge 31 of push tubes 30 and connected to the lesion by a clip, and push tubes 30 are moved distally to tension the lesion away from endoscope 10. Then a cutting tool, which has been advanced through a working lumen of endoscope 10, is used to dissect the lesion from the body lumen or body cavity (e.g., the submucosal layer of the intestine).
  • a body lumen or body cavity e.g., an intestine
  • push tubes 30 without fore balloon 35 and without instrument lumens 195 is not limited to tensioning a lesion.
  • push tubes 30 could be retained without fore balloon 35 and without instrument lumens 195 for use in passing instruments through one or both of the hollow push tubes 30 or through one or both of support tubes 50.
  • push tubes 30 may be used to manipulate (e.g., straighten) the side of a body lumen and/or body cavity so as to better present the side wall tissue for examination and/or treatment.
  • sleeve 15 may comprise one or more additional aft balloons 20B for use in stabilizing sleeve 15 (and an endoscope disposed therein) within the anatomy.
  • apparatus 5 comprises a sleeve 15 for accommodating an endoscope 10, a first aft balloon 20 disposed at approximately the distal end of sleeve 15 (e.g., just proximal to the distal end of sleeve 15, or on the portion of sleeve 15 that is adjacent to the bending section of an endoscope, etc.), a second aft balloon 20B disposed proximal to aft balloon 20, inflation line 45 for inflating aft balloon 20 and aft balloon 20B (either simultaneously or independent from one another), hollow push tubes 30 and hollow support tubes 50 for receiving hollow push tubes 30.
  • a sleeve 15 for accommodating an endoscope 10
  • a first aft balloon 20 disposed at approximately the distal end of sleeve 15 (e.g., just proximal to the distal end of sleeve 15, or on the portion of sleeve 15 that is adjacent to the bending section of an endoscope,
  • sleeve 15 comprises an additional aft balloon 20B
  • the additional aft balloon 20B may be positioned directly adjacent to, and contacting, aft balloon 20 (Fig. 153), or the additional aft balloon 20B may be spaced proximally from aft balloon 20 (Fig. 154).
  • the additional aft balloon 20B may be movably disposed on sleeve 15 so that the position of aft balloon 20B may be adjusted relative to aft balloon 20, whereby to provide the desired stability within the anatomy.
  • push tubes 30 may be retained for a desired function, e.g., providing column strength to sleeve 15 (as shown in Figs. 153 and 154) or for use in a procedure within a body lumen of a patient (as shown in Figs. 155-158).
  • a sleeve with only one instrument lumen 195 for accommodating an instrument in addition to removing the aforementioned fore balloon 35, it may be desirable to provide a sleeve with only one instrument lumen 195 for accommodating an instrument and the other instrument lumen 195 may be omitted from apparatus 5.
  • Providing sleeve 15 with only one instrument lumen has the benefit of providing an instrument channel for supporting an instrument passing therethrough while also reducing the outer diameter of sleeve 15.
  • apparatus 5 (with fore balloon 35 and one instrument lumen 195 removed) comprises a sleeve 15 for accommodating an endoscope 10, an aft balloon 20 for stabilizing sleeve 15 (and an endoscope disposed therein) within a body cavity or body lumen, inflation line 45 for inflating aft balloon 20, hollow push tubes 30, hollow support tubes 50 for receiving hollow push tubes 30 and a single instrument lumen 195 for receiving an instrument therein.
  • hollow push tubes 30 remain fixed within hollow support tubes 50 to provide the necessary column strength to sleeve 15, with the distal ends of push tubes 30 and/or support tubes 50 terminating at aft balloon 20 (either within aft balloon 20 or just proximal to aft balloon 20, if it is desirable for the distal end of sleeve 15 to be provided with more flexibility than the remainder of sleeve 15).
  • sleeve 15 is formed out of a material having sufficient column strength to prevent sleeve 15 from collapsing upon endoscope 10 (e.g., kinking) as apparatus 5 and endoscope 10 are positioned within, or withdrawn from, the anatomy of a patient, push tubes 30 and/or support tubes 50 could be omitted entirely from apparatus 5.
  • apparatus 5 may be further simplified by omitting the aforementioned aft balloon 20.
  • sleeve 15 may or may not include push tubes 30 and/or support tubes 50 and sleeve 15 may or may not include instrument lumens 195.
  • Omitting certain features (e.g., fore balloon 35, push tubes 30, support tubes 50 and/or instrument lumen(s) 195) to provide a simplified apparatus 5 has the benefit of providing an endoscope sleeve with a reduced outer diameter.
  • instrument lumens 195 may be formed with a collapsible material so that the overall profile of sleeve 15 is minimized prior to insertion of an instrument, whereby sleeve 15 can have a reduced profile during navigation of sleeve 15 through a body lumen or body cavity.
  • instrument lumens 195 have a minimal profile when empty and expand diametrically when filled with an instrument or other filling material. If desired, instrument lumens 195 may be expandable only at their distal ends (i.e., not along the entire length of the instrument lumen).
  • one or more instrument lumens 195 could be formed on the interior of sleeve 15 (instead of the exterior of sleeve 15), whereby to reduce the outer diameter of sleeve 15 while still providing support for an instrument.
  • instrument lumens 195 are typically formed out of a material that is sufficient to prevent an instrument passing through the instrument lumen from piercing the side wall of the instrument lumen and entering the body lumen or body cavity of the patient, where it could cause trauma to the anatomy.
  • instrument lumens 195 when instrument lumens 195 are disposed on the interior of sleeve 15, and an instrument pierces the instrument lumen, the instrument would pass into the interior of sleeve 15 (and not into the body lumen or body cavity of the patient). Therefore, when instrument lumens 195 are disposed within the interior of sleeve 15, instrument lumens 195 may be formed out of a softer material (e.g., Teflon) than instrument lumens 195 formed on the exterior of sleeve 15.
  • a softer material e.g., Teflon
  • raised push tube bridge 31 and/or fore balloon 35 can together function as a lead for apparatus 5 and endoscope 10, thereby providing a soft atraumatic tip as apparatus 5 is advanced within a body lumen or body cavity of a patient.
  • fore balloon 35 is omitted and/or push tubes 30 are fixed within support tubes 50, it is desirable to form sleeve 15 with an atraumatic tip so that sleeve 15 does not cause trauma to the anatomy as apparatus 5 is moved through a body lumen or body cavity.
  • the distal end of sleeve 15 can be formed with a conical tip 1500.
  • Conical tip 1500 comprises a lumen 1505 which is sized to receive endoscope 10.
  • conical tip 1500 is formed out of a medical grade elastomer (e.g., PEBAX ® ) that is secured (e.g., glued) to the distal end of sleeve 15.
  • a medical grade elastomer e.g., PEBAX ®
  • the blunt distal end of sleeve 15 may be provided with a conical tip 1500, whereby to provide sleeve 15 with an atraumatic tip.
  • conical tip 1500 may be formed out of a flexible material so that conical tip 1500 can be configured between a “collapsed” configuration and an “expanded” configuration. In this way, conical tip 1500 provides the distal end of sleeve 15 with an atraumatic tip which can also be configured into a reduced profile during navigation of sleeve 15 through a body lumen or body cavity.
  • conical tip 1500 is moved from its “collapsed” configuration to its “expanded” configuration when endoscope 10 is passed through lumen 1505 of conical tip 1500.
  • a pull wire (not shown) extends between conical tip 1500 and base 25, and the pull wire can be tensioned to widen or close conical tip 1500.
  • instrument lumens 195 may be formed with atraumatic tips so that instrument lumens 195 do not cause trauma to the anatomy as apparatus 5 is moved through a body lumen or body cavity. See, for example, Fig. 163, which shows an instrument lumen 195 with a canted distal end.
  • aft balloon 20 is shown as a “conventional” balloon construction (i.e., a balloon having a substantially uniform, full-diameter cross-section).
  • the “conventional” balloon construction may be replaced with the toroidal construction of fore balloon 35. See Figs. 168-170 which show aft balloon 20 with the toroidal construction of fore balloon 35.
  • aft balloon 20 is configured so that (i) when it is deflated (or partially deflated), aft balloon 20 provides an axial opening 63 (Figs. 15, 16 and 19) sufficient to accommodate sleeve 15 therein, and (ii) when aft balloon 20 is appropriately inflated, axial opening 63 is closed down (and preferably completely closed off).
  • aft balloon 20 can atraumatically engage and form a sealing relationship with the side wall of a body lumen and/or body cavity within which apparatus 5 is disposed.
  • aft balloon 20 when aft balloon 20 is appropriately inflated, aft balloon 20 can effectively seal the body lumen and/or body cavity distal to aft balloon 20, by closing down axial opening 63 and forming a sealing relationship with the side wall of the body lumen and/or body cavity within which apparatus 5 is disposed. It will be appreciated that, when aft balloon 20 is reconfigured from its deflated condition to its inflated condition, aft balloon 20 expands radially inwardly (so as to close down axial opening 63) as well as radially outwardly (so as to engage the surrounding tissue).
  • hollow push tubes 30 and/or instrument lumens 195 are disposed within aft balloon 20 in such a way that their presence within the aft balloon does not physically interfere with inflation or deflation of aft balloon 20.
  • aft balloon 20 has a “torus” shape when deflated (to allow it to seat over sleeve 15) and a substantially “solid” shape when inflated (to allow it to close off a body lumen or body cavity).
  • the present invention comprises the provision and use of novel apparatus for manipulating the side wall of a body lumen and/or body cavity so as to better present the side wall tissue (including visualization of areas which may be initially hidden from view or outside the field of view) for examination and/or treatment during an endoscopic procedure, e.g., to straighten bends, “iron out” inner luminal surface folds and create a substantially static or stable side wall of the body lumen and/or body cavity which enables more precise visual examination (including visualization of areas which may be initially hidden from view or outside the field of view) and/or therapeutic intervention.
  • the novel apparatus can be used to stabilize, straighten, expand and/or flatten bends and/or curves and/or folds in the side wall of the intestine so as to better present the side wall tissue (including visualization of areas which may be initially hidden from view or outside the field of view) for examination and/or treatment during an endoscopic procedure.
  • the present invention also comprises the provision and use of novel apparatus capable of steadying and/or stabilizing the distal tips and/or working ends of instalments (e.g., endoscopes, articulating and/or non-articulating devices such as graspers, cutters or dissectors, cauterizing tools, ultrasound probes, etc.) inserted into a body lumen and/or body cavity during an endoscopic procedure with respect to the side wall of the body lumen and/or body cavity, whereby to facilitate the precision use of those instruments.
  • instalments e.g., endoscopes, articulating and/or non-articulating devices such as graspers, cutters or dissectors, cauterizing tools, ultrasound probes, etc.
  • the present apparatus can provide a stable platform (i.e., a stable endoscope, stable therapeutic tools and a stable colon wall, all stable with respect to one another) for the performance of numerous minimally-invasive procedures within a body lumen and/or body cavity, including the stabilization of an endoscope and/or other surgical instruments (e.g., graspers, cutters or dissectors, cauterizing tools, ultrasound probes, etc.) within the body lumen and/or body cavity, e.g., during a lesion biopsy and/or lesion removal procedure, an organ resection procedure, endoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), etc., while at the same time stabilizing the colon (including decreasing deformation of the colon wall) so as to enable more precise visualization, intervention and/or surgery.
  • a stable platform i.e., a stable endoscope, stable therapeutic tools and a stable colon wall, all stable with respect to one another
  • an endoscope and/or other surgical instruments
  • the present invention provides novel apparatus capable of steadying and/or stabilizing the distal tips and/or working ends of endoscopes (and hence also steadying and/or stabilizing the distal tips and/or working ends of other instruments inserted through the working channels of those endoscopes, such as graspers, cutters or dissectors, cauterizing tools, ultrasound probes, etc.) with respect to the side wall of the body lumen and/or body cavity, and stabilizing the side wall of the body lumen and/or body cavity relative to these instruments.
  • endoscopes such as graspers, cutters or dissectors, cauterizing tools, ultrasound probes, etc.
  • the present invention provides novel apparatus capable of steadying and/or stabilizing the distal tips and/or working ends of instruments (such as graspers, cutters or dissectors, cauterizing tools, ultrasound probes, etc.) advanced to the surgical site by means other than through the working channels of endoscopes.
  • the novel apparatus of the present invention can be used in substantially any endoscopic procedure to facilitate the alignment and presentation of tissue during an endoscopic procedure and/or to stabilize the working end of an endoscope (and/or other instruments advanced through the endoscope) relative to tissue or to assist in the advancement of the endoscope during such a procedure.
  • the present invention is believed to have widest applications with respect to the gastrointestinal (GI) tract (e.g., large and small intestines, esophagus, stomach, etc.), which is generally characterized by frequent turns and which has a side wall characterized by numerous folds and disease processes located on and between these folds.
  • GI gastrointestinal
  • the methods and apparatus of the present invention may also be used inside other body lumens (e.g., blood vessels, lymphatic vessels, the urinary tract, fallopian tubes, bronchi, bile ducts, etc.) and/or inside other body cavities (e.g., the head, chest, abdomen, nasal sinuses, bladder, cavities within organs, etc.).

Abstract

L'invention concerne un appareil comprenant : un manchon flexible conçu pour être glissé sur l'extérieur d'un endoscope, l'endoscope comprenant une extrémité proximale et une extrémité distale, et une poignée disposée à l'extrémité proximale de l'endoscope, et le manchon comprenant une extrémité proximale, une extrémité distale et une lumière de manchon s'étendant entre celles-ci, et le manchon étant en outre conçu pour être glissé sur l'extérieur de l'endoscope de façon à recouvrir sensiblement l'extérieur de l'endoscope depuis un point adjacent à l'extrémité distale de l'endoscope vers un point adjacent à la poignée de l'endoscope ; un ballonnet fixé à l'extrémité distale du manchon ; un tube de gonflage/dégonflage porté par le manchon et en communication fluidique avec l'intérieur du ballonnet ; et une paire de tubes de poussée montés sur le manchon.
EP22763991.1A 2021-03-02 2022-03-02 Procédé et appareil pour manipuler la paroi latérale d'une lumière corporelle ou d'une cavité corporelle Pending EP4326136A1 (fr)

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US202163155627P 2021-03-02 2021-03-02
PCT/US2022/018553 WO2022187384A1 (fr) 2021-03-02 2022-03-02 Procédé et appareil pour manipuler la paroi latérale d'une lumière corporelle ou d'une cavité corporelle

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Publication number Priority date Publication date Assignee Title
US6740030B2 (en) * 2002-01-04 2004-05-25 Vision Sciences, Inc. Endoscope assemblies having working channels with reduced bending and stretching resistance
US7798992B2 (en) * 2005-11-04 2010-09-21 Ethicon Endo-Surgery, Inc. Lumen traversing device
US10149601B2 (en) * 2009-12-15 2018-12-11 Lumendi Ltd. Method and apparatus for manipulating the side wall of a body lumen or body cavity so as to provide increased visualization of the same and/or increased access to the same, and/or for stabilizing instruments relative to the same
US8979884B2 (en) * 2009-12-15 2015-03-17 Cornell University Method and apparatus for stabilizing, straightening, expanding and/or flattening the side wall of a body lumen and/or body cavity so as to provide increased visualization of the same and/or increased access to the same, and/or for stabilizing instruments relative to the same

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