JP2000516112A - インビボでの組織の診断およびインビボでの組織への介入手順の実施 - Google Patents
インビボでの組織の診断およびインビボでの組織への介入手順の実施Info
- Publication number
- JP2000516112A JP2000516112A JP10505331A JP50533198A JP2000516112A JP 2000516112 A JP2000516112 A JP 2000516112A JP 10505331 A JP10505331 A JP 10505331A JP 50533198 A JP50533198 A JP 50533198A JP 2000516112 A JP2000516112 A JP 2000516112A
- Authority
- JP
- Japan
- Prior art keywords
- tissue
- catheter
- interventional
- endoscope
- light
- 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.)
- Granted
Links
Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00163—Optical arrangements
- A61B1/00165—Optical arrangements with light-conductive means, e.g. fibre optics
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/0059—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence
- A61B5/0075—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence by spectroscopy, i.e. measuring spectra, e.g. Raman spectroscopy, infrared absorption spectroscopy
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- A—HUMAN NECESSITIES
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- A61B5/0059—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence
- A61B5/0082—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes
- A61B5/0084—Measuring for diagnostic purposes; Identification of persons using light, e.g. diagnosis by transillumination, diascopy, fluorescence adapted for particular medical purposes for introduction into the body, e.g. by catheters
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- A61B8/12—Diagnosis using ultrasonic, sonic or infrasonic waves in body cavities or body tracts, e.g. by using catheters
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- A61B8/44—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device
- A61B8/4444—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device related to the probe
- A61B8/4461—Features of the scanning mechanism, e.g. for moving the transducer within the housing of the probe
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- A61B10/06—Biopsy forceps, e.g. with cup-shaped jaws
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- A61B17/29—Forceps for use in minimally invasive surgery
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- A—HUMAN NECESSITIES
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B17/3209—Incision instruments
- A61B17/3211—Surgical scalpels, knives; Accessories therefor
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00022—Sensing or detecting at the treatment site
- A61B2017/00057—Light
- A61B2017/00061—Light spectrum
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00022—Sensing or detecting at the treatment site
- A61B2017/00106—Sensing or detecting at the treatment site ultrasonic
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B2017/22072—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an instrument channel, e.g. for replacing one instrument by the other
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B2017/22072—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an instrument channel, e.g. for replacing one instrument by the other
- A61B2017/22074—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an instrument channel, e.g. for replacing one instrument by the other the instrument being only slidable in a channel, e.g. advancing optical fibre through a channel
- A61B2017/22077—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for with an instrument channel, e.g. for replacing one instrument by the other the instrument being only slidable in a channel, e.g. advancing optical fibre through a channel with a part piercing the tissue
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/22—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for
- A61B2017/22082—Implements for squeezing-off ulcers or the like on the inside of inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; Calculus removers; Calculus smashing apparatus; Apparatus for removing obstructions in blood vessels, not otherwise provided for after introduction of a substance
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
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- A61B90/30—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
- A61B2090/306—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure using optical fibres
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
- A61B90/361—Image-producing devices, e.g. surgical cameras
- A61B2090/3614—Image-producing devices, e.g. surgical cameras using optical fibre
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
- A61B90/37—Surgical systems with images on a monitor during operation
- A61B2090/378—Surgical systems with images on a monitor during operation using ultrasound
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
- A61B2090/3937—Visible markers
- A61B2090/395—Visible markers with marking agent for marking skin or other tissue
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- A—HUMAN NECESSITIES
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- A61B2217/00—General characteristics of surgical instruments
- A61B2217/002—Auxiliary appliance
- A61B2217/005—Auxiliary appliance with suction drainage system
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Physics & Mathematics (AREA)
- General Health & Medical Sciences (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Pathology (AREA)
- Biophysics (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Radiology & Medical Imaging (AREA)
- Optics & Photonics (AREA)
- Spectroscopy & Molecular Physics (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Vascular Medicine (AREA)
- Endoscopes (AREA)
- Investigating Or Analysing Materials By Optical Means (AREA)
- Measurement Of The Respiration, Hearing Ability, Form, And Blood Characteristics Of Living Organisms (AREA)
- Ultra Sonic Daignosis Equipment (AREA)
Abstract
Description
Claims (1)
- 【特許請求の範囲】 1.カテーテルであって、以下:細長いカテーテルシャフト;該カテーテルシ ャフトを貫通して延び、該カテーテルシャフトの遠位端に位置する組織へと光を 伝達するための光ファイバ;該カテーテルシャフトを貫通して延び、介入手順が 該組織に施されるべきかどうかを決定する分光学的診断システムによる分析のた めに該組織から光を逆搬送するための光ファイバ;および該カテーテルシャフト の遠位端に配置され、該組織に該介入手順を施すために、該分光学的診断システ ムにより診断される組織に係合するようにされた介入装置を備える、カテーテル 。 2.組織に光を伝達するための前記光ファイバが、該組織から光を逆搬送する ための前記光ファイバとは別個のものである、請求項1に記載のカテーテル。 3.前記介入装置が外科用メスを備える、請求項1に記載のカテーテル。 4.前記介入装置が鉗子顎を備える、請求項1に記載のカテーテル。 5.前記介入装置が係蹄を備える、請求項1に記載のカテーテル。 6.前記介入装置がはさみを備える、請求項1に記載のカテーテル。 7.前記介入装置がニードルを備える、請求項1に記載のカテーテル。 8.前記ニードルが、前記組織にマーキング液を注入するように構成される、 請求項7に記載のカテーテル。 9.前記ニードルが、前記組織に化学的剥離液を注入するように構成される、 請求項7に記載のカテーテル。 10.前記ニードルが前記組織を切断するように構成される、請求項7に記載 のカテーテル。 11.前記ニードルが前記組織に粘性材料を付与するように構成される、請求 項7に記載のカテーテル。 12.前記ニードルが、前記組織の目視観察を可能にするのに有用な液体を該 組織に搬送するように構成される、請求項7に記載のカテーテル。 13.前記ニードルが前記組織に真空を適用させるように構成される、請求項 7に記載のカテーテル。 14.前記カテーテルシャフトが内視鏡の作動チャンネルを通して挿入される ように構成される、請求項11に記載のカテーテル。 15.前記光ファイバのうち少なくとも一方が、更に、前記組織に視覚化光を 搬送するように構成される、請求項1に記載のカテーテル。 16.前記光ファイバのうち少なくとも一方が、更に、前記組織の目視観察の ために該組織から光を逆搬送するように構成される、請求項1に記載のカテーテ ル。 17.組織を診断しそして組織に介入手順を施す方法であって、以下の工程: カテーテルの遠位端に位置する組織へと光を伝達するための第1の光ファイバ、 分光学的診断システムによる分析のために該組織から光を逆搬送するための第2 の光ファイバ、および介入装置とを有する該カテーテルを生体の身体内の管腔に 挿入する工程;該カテーテルの遠位端に位置する組織に該第1の光ファイバを介 して光を伝達する工程;分光学的診断システムによる分析のために該第2の光フ ァイバを介して該組織から光を逆搬送する工程;該組織に介入手順が施されるべ きかどうかを決定するために該分光学的診断システムを用いて該組織を診断する 工程;および該組織に介入手順を施すために、該分光学的診断システムにより診 断される該組織を該介入装置と係合させる工程を包含する、方法。 18.前記介入手順が、前記介入装置を用いて前記組織にマーキング液を注入 することにより該組織をマーキングする工程を包含する、請求項17に記載の方 法。 19.前記マーキング液が墨である、請求項18に記載の方法。 20.前記光ファイバおよび前記介入装置を有する前記カテーテルを引き出す 工程;その遠位端に配置される第2の介入装置を有する第2のカテーテルを生体 の身体内に挿入する工程;および前記組織に別の介入手順を施すために、前記分 光学的診断システムにより診断される該組織を、該第2のカテーテルの該第2の 介入装置と係合させる工程とを更に包含する、請求項18に記載の方法。 21.前記分光学的診断システムを用いて上記組織を診断する工程が、該組織 に介入手順が施されるべきかどうかを決定することを包含する、請求項17に記 載の方法。 22.前記介入手順が生検分析用に組織を取り出す工程を包含する、請求項1 7に記載の方法。 23.前記介入手順が、前記分光学的診断システムにより健康でないと診断さ れた組織を除去する工程を包含する、請求項17に記載の方法。 24.前記管腔が消化管の管腔を含む、請求項17に記載の方法。 25.前記管腔が肺の管腔を含む、請求項17に記載の方法。 26.前記組織を診断する工程が、該組織が腫瘍であるかどうかを決定するこ とを更に含む、請求項17に記載の方法。 27.該組織を診断する工程が、腫瘍が癌性であるかどうかを決定することを 更に含む、請求項26に記載の方法。 28.作動チャンネルを有する内視鏡を前記生体の身体内の前記管腔を通して 挿入する工程を更に含み、そしてここで該生体の身体内に前記カテーテルを挿入 する工程が、該内視鏡の該作動チャンネルに該カテーテルを挿入することを含む 、請求項17に記載の方法。 29.前記光ファイバのうち少なくとも一方を介して前記組織に視覚化光を搬 送する工程を更に含む、請求項17に記載の方法。 30.前記組織の目視観察のために前記光ファイバのうち少なくとも一方を介 して該組織から光を逆搬送させる工程を更に含む、請求項17に記載の方法。 31.該組織の目視観察を可能にするのに有用な前記カテーテルシャフトを介 して該組織に液体を搬送する工程を更に含む、請求項17に記載の方法。 32.前記カテーテルシャフトを介して前記組織に真空を適用させる工程を更 に含む、請求項17に記載の方法。 33.アセンブリーであって、以下: 内視鏡; 該内視鏡の作動チャンネルを通して挿入されるように構成された細長いカテー テルシャフト; 該カテーテルシャフトを貫通して延び、該カテーテルシャフトの遠位端に配置 された組織に光を伝達するための光ファイバ; 該カテーテルシャフトを貫通して延び、介入手順が該組織に施されるべきかど うかを決定するために、分光学的診断システムによる分析のために該組織から光 を逆搬送するための光ファイバ;および 該内視鏡の作動チャンネルを通して挿入されるように構成され、該組織に該介 入手順を施すために、該分光学的診断システムにより診断される組織を係合させ るための介入装置 を備える、アセンブリー。 34.前記介入装置が、前記光ファイバを有する前記カテーテルシャフトの前 記遠位端に配置される、請求項33に記載のアセンブリー。 35.組織を診断しそして組織に介入手順を施す方法であって、以下の工程; 生体の身体内の管腔を通して内視鏡を挿入する工程;カテーテルの遠位端に位置 する組織へと光を伝達するための第1の光ファイバ、および分光学的診断システ ムによる分析のために該組織から光を逆搬送させるための第2の光ファイバを有 する該カテーテルを該内視鏡の作動チャンネルを通して挿入する工程;該カテー テルの遠位端に位置する組織に該第1の光ファイバを介して光を伝達させる工程 ;分光学的診断システムによる診断のために上記第2の光ファイバを介して該組 織から光を逆搬送させる工程;介入手順を該組織に施すべきかどうかを決定する ために該分光学的診断システムを用いて該組織を診断する工程;および該組織に 介入手順を施すために、該分光学的診断システムにより診断される該組織を、該 内視鏡の作動チャンネルを通して挿入された介入装置と係合させる工程 を包含する、方法。 36.組織を画像化しそして組織に介入手順を施す方法であって、以下の工程 : 生体の身体内の管腔を通して内視鏡を挿入する工程; その遠位端に配置された超音波画像化装置を有するカテーテルを該内視鏡の作 動チャンネルを通して挿入する工程; 該超音波画像化装置を用いて該内視鏡の遠位端に位置する組織構造を画像化し 、該生体の身体内への該組織構造の浸透の深さを示す様式で該組織構造を表示す る工程;および 該組織構造に介入治療を施すために、該超音波画像化装置により画像化される 該組織構造を、該内視鏡の作動チャンネルを通して挿入される介入装置と係合さ せる工程であって、該組織構造の浸透の表示された深さに応じる様式で該介入治 療は施される、工程 を包含する、方法。 37.前記介入装置が、前記超音波装置を有する前記カテーテルとは別個の介 入カテーテルの遠位端に配置され、前記内視鏡の少なくとも2個の作動チャンネ ルが存在し、そして該超音波装置を有する該カテーテルが該2個の作動チャンネ ルのうち第1の作動チャンネルを通して挿入され、そして該介入カテーテルは該 2個の作動チャンネルのうち第2の作動チャンネルを通して挿入される、請求項 36に記載の方法。 38.前記組織構造の浸透の表示された深さに応じる様式で前記介入治療を施 す工程が、該介入治療が正当と認められるように該組織構造の浸透の深さが十分 に限定されているかどうかを決定し、浸透の深さが十分に限定されている場合は 、該介入治療を実施することを含む、請求項36に記載の方法。 39.該組織構造の浸透の表示された深さに応じる様式で前記介入治療を施す 工程が、浸透の深さに対応する量の組織を除去することを含む、請求項36に記 載の方法。 40.前記画像化工程が前記介入治療を施す工程と同時に実施される、請求項 39に記載の方法。 41.前記介入装置が外科用メスを備える、請求項36に記載の方法。 42.前記介入装置が鉗子顎を備える、請求項36に記載の方法。 43.前記介入装置が係蹄を備える、請求項36に記載の方法。 44.前記介入装置がはさみを備える、請求項36に記載の方法。 45.前記介入装置がニードルを備える、請求項36に記載の方法。 46.前記組織構造を前記介入装置と係合させる工程が、前記ニードルを介し て前記組織に化学的剥離液を注入することを含む、請求項45に記載の方法。 47.前記組織構造を前記介入装置と係合させる工程が、前記ニードルを用い て前記組織を切断することを含む、請求項45に記載の方法。 48.前記組織構造を前記介入装置に係合させる工程が、前記ニードルを用い て前記組織に粘着性材料を塗布することを含む、請求項45に記載の方法。 49.前記組織構造に光を伝達する工程、分光学的診断システムによる分析の ために前記組織から光を逆搬送する工程、および該分光学的診断システムを用い て、介入手順が該組織に施されるべきかどうかを決定する工程を更に含む、請求 項36に記載の方法。 50.前記管腔が消化管の管腔を含む、請求項36に記載の方法。 51.前記管腔が肺の管腔を含む、請求項36に記載の方法。
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US08/679,425 US6296608B1 (en) | 1996-07-08 | 1996-07-08 | Diagnosing and performing interventional procedures on tissue in vivo |
PCT/US1997/011864 WO1998001074A1 (en) | 1996-07-08 | 1997-07-07 | Diagnosing and performing interventional procedures on tissue in vivo |
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JP2008049157A (ja) * | 2006-08-28 | 2008-03-06 | Olympus Medical Systems Corp | 超音波内視鏡、ろう孔に配設するバルーン付きカテーテル、他の磁石と生体組織の壁面を介して磁着する磁石を留置する磁石留置具、他の磁石と生体組織の壁面を介して磁着する磁石セット |
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Also Published As
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DE69728277T2 (de) | 2004-08-12 |
EP0925034B1 (en) | 2004-03-24 |
DE69728277D1 (de) | 2004-04-29 |
US6296608B1 (en) | 2001-10-02 |
US20010047135A1 (en) | 2001-11-29 |
US8135454B2 (en) | 2012-03-13 |
EP0925034A1 (en) | 1999-06-30 |
US20060036182A1 (en) | 2006-02-16 |
CA2260147A1 (en) | 1998-01-15 |
JP3943600B2 (ja) | 2007-07-11 |
WO1998001074A1 (en) | 1998-01-15 |
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