JP2009056330A - Flexible endoscope - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a bladder-kidney endoscope configured so as to be inserted through a dissection of the renal pelvis of a patient. <P>SOLUTION: The flexible endoscope includes: a handle; a shaft which is extended from the handle and has a front end including a first active flexible part and a second active flexible part, wherein the first active flexible part is limited so as to be flexible in a first plane, and the second active flexible part is limited so as to be flexible in a second plane different from the first plane, wherein the first plane is tilted to the second plane, and the first active flexible part includes a shaft including a plurality of rings rotatably connected to adjacent rings by two ball parts at both sides; and a means to observe the inside of the almost spherical shape through a fixed entrance inside the almost spherical shape by an optical lens on the front end of the shaft, without performing axial rotation of the shaft. <P>COPYRIGHT: (C)2009,JPO&INPIT

Description

  The present invention relates to a medical device, and more particularly to an endoscope.

  U.S. Pat. No. 4,873,965 discloses a flexible endoscope having two articulated portions. British Patent Application No. 2130885 discloses a flexible tip for an endoscope. This tip portion is made of a plastic material and is connected to the vertebrae by elongated members and barbs. U.S. Pat. No. 5,938,588 discloses an endoscope having a wire sheath made as a hard tube with a superelastic alloy material. Endoscopes including an active deflection section and a passive deflection section are also known in the art.

U.S. Pat. No. 4,873,965 British Patent Application No. 2130885 US Pat. No. 5,938,588

  It is an object of the present invention to improve a cysto-nephroscope according to the prior art.

According to the invention, the cysto-nephroscope comprises a handle,
A shaft having a front end that extends from the handle and includes a first active flexure and a second active flexure, the first active flexure being limited to bend in a first plane. The second active flexure is limited to bend in a different second plane, the first plane is inclined with respect to the second plane, and the first active flexure is A shaft including a plurality of rings, each pivotally connected to an adjacent ring by two ball portions on each side;
Means for observing the substantially spherical interior through a substantially spherical interior fixed entrance by an optical lens at the front end of the shaft without rotating the shaft.

  According to a preferred embodiment, the cysto-nephroscope further includes a connecting member extending through the holes of all the ball portions on one side.

  According to one aspect of the present invention, an endoscope includes a handle and a shaft extending from the handle. The shaft has a front end including a first active flexure and a second active flexure. The first active flexure is limited to bend in the first plane and the second active flexure is limited to bend in the second different plane. The first plane is inclined with respect to the second plane.

  According to another aspect of the invention, the nephroscope is configured to be inserted through an incision in the patient's renal pelvis. The nephroscope includes a handle having a control portion and a shaft extending from the handle. The shaft includes a first active flexure connected in series with a second active flexure. The said control part is comprised so that the 1st and 2nd active bending part may be bent separately. The first and second active flexures do not cause the tip of the kidney mirror to passively flex the front end of the shaft relative to the patient's kidney tissue to reach the kidney pole at the lower pole of the kidney. It is configured to be placed on the kidney pole of the lower pole of the kidney. The first and second active flexures are each limited to bend in one common plane.

  According to one method of the present invention, a method for observing an internal region of a patient using an endoscope is provided. This method includes: a) moving a second user-operated actuator of the endoscope to move a second active flexure at the front end of the endoscope shaft that is limited to movement along a single plane. The second user operation actuator is moved without moving the first user operation actuator of the endoscope, and the tip of the shaft of the endoscope is along the first path limited to the plane. And b) moving the first user operation actuator to move the first active flexure at the front end of the shaft, without moving the second user operation actuator. Moving the tip along a second path orthogonal to c) and c) step a) to systematically scan the patient's internal region by a series of adjacent paths parallel to the first path Repeat b) It contains a degree.

  Referring to FIG. 1, a side view of an endoscope 10 incorporating features of the present invention is shown. Although the invention will be described with reference to the embodiments shown in these figures, it should be understood that the invention can be embodied in many other variations than those embodiments. is there. The features of the present invention can be embodied in a variety of different types of flexible and deflectable endoscopes. Furthermore, any element or material of an appropriate size, shape or type can be used.

  In this embodiment, the endoscope 10 is a flexible cystoscope. However, in other embodiments, the endoscope may be a nephroscope, a cysto-renalscope, or any other suitable type of endoscope. The endoscope 10 generally includes a handle 12, a flexible shaft 14 coupled to the handle 12, and a front end 18 of the shaft having active flexibility. In another embodiment, the shaft 14 is sturdy except for its front end.

  The handle 12 is part of the control system and controls the active flexibility of the front end 18. The control system generally includes the handle 12, two actuators 16 and 17, a brake or locking actuator 22, and four control wires 23, 24, 25, 26 (see FIGS. 3A-3F). Yes. However, in other embodiments, the control system may include auxiliary or other components.

  The three actuators 16, 17, and 22 are attached to the handle 12 so as to be movable. The proximal ends of the wires 23, 24, 25, 26 are connected to the two actuators 16, 17. The brake actuator 22 is connected to a brake mechanism that locks the second control actuator 17 in a fixed position. However, in other embodiments, any suitable type of brake or locking mechanism is provided. In another type of embodiment, the endoscope does not include a brake for the control actuator. In the illustrated embodiment, the first control actuator 16 does not include a brake. In another embodiment, the endoscope includes two brakes. However, one brake is for the first control actuator 16. In another embodiment, the control device is a joystick type control device.

  The handle 12 also includes a light source post 28, a connection 30 that connects the output to a display device (not shown), and a work equipment / cleaning fluid inlet 32. However, in other embodiments, the handle 12 can include auxiliary or other components. The instrument comprises two optical fiber bundles 86 extending through the shaft 14 between the light source 28 and the tip 20. In one embodiment, a fiber optic imaging bundle extends through the shaft 14 between the tip 20 and an eyepiece (not shown) instead of the output connection 30. A working channel 84 extends through the shaft 14 between the working device inlet 32 and the tip 20.

  The flexible shaft 14 behind the front end 18 may be any suitable, such as, for example, the shaft disclosed in US patent application Ser. No. 09 / 547,686, the entirety of which is incorporated herein by reference. It may be of a type. The front end 18 includes a first active bending portion 34 and a second active bending portion 36. Referring to FIG. 2, in this embodiment, the second active flexure 36 is limited to flex in a single plane with respect to the handle 12, and the first active flexure 34 is the second active flexure 34. It is limited to bend in a single plane different from that for the flexure 36. In particular, these two planes are substantially orthogonal to each other at an angle of about 75 ° to 85 °, but may be 90 °. The second active bending portion 36 can be bent in the left-right direction, and the first active bending portion 34 can be bent in the up-down direction. In another embodiment, the first and / or second active flexures can each bend in fewer or more directions than two directions.

  3-5, the front end 18 generally includes a tip member 38, two frames 40, 42 connected to each other by a fixture or connector 62, and an outer cover 41 (see FIG. 2). Yes. In the illustrated embodiment, the two frames 40 and 42 are similar to each other, but the fixture 62 is deflected about 75 degrees to 85 degrees about its axis. In another embodiment, the two frames 40 and 42 may be different from each other.

  The first frame 40 generally includes a ring member 44, a rotary bearing 46 (see FIG. 3F), and a connecting member 47 ′ (see FIG. 3F). Referring again to FIGS. 4A-4C, each ring member 44 is preferably made of stainless steel. However, any suitable material may be used. Each ring member 44 comprises a generally open central channel, two control wire channels 48 and two connecting member channels 50. The front side portion 52 and the rear side portion 53 of each ring member 44 are inclined inward so that the width of the side surface of the ring member is wider than the upper portion and the lower portion of the ring member. The two control wire channels 48 extend through upper and lower sides 54, 55. Two connecting member channels 50 extend through the lateral sides 56, 57. The front and rear sides of the connecting member channel 50 include sockets 58.

  As best seen in FIG. 3F, each pivot bearing 46 is substantially spherical and has a central channel 60 therethrough. The ring member 44 is aligned in series with two rotational bearings 46 located between each pair of adjacent ring members. These rotational bearings 46 are provided in a socket 58. Due to the shape of the inclined front and rear sides of the rotating bearing 46 and the ring member 44, the ring member 44 can be rotated in the vertical direction.

  The connecting member 47 extends through the channel 50 of the connecting member and the channel 60 of the rotary bearing 46. The connecting member 47 can include a wire or a cable. In a preferred embodiment, the first frame 40 includes two connecting members 47, one passing through the left side and the other passing through the right side. The end of the connection member 47 extends into the connection tool 62 and the tip member 38. In the preferred embodiment, the ends of the connecting member are free to move relative to the connector 62 and the tip member 38. However, in another embodiment, one of the ends of the connecting member 47 is fixed.

  The second frame 42 generally includes a ring member 64, a rotary bearing 46 (see FIG. 3F), and a connecting member 47 (see FIG. 3F). Referring also to FIGS. 5A-5C, each ring 64 is preferably made of stainless steel. However, any appropriate material may be used. Each ring member 64 includes a generally open central channel, a first set of control wire channels 68, a second set of control wire channels 69, and two connecting member channels 70. The front side 72 and the rear side 73 of each ring member 64 are inclined inward, and the width of the upper and lower sides of the ring member is larger than the middle part of the ring member. The two control wire channels 68 of the first set of control wire channels extend through the upper and lower sides 76, 78. The two control wire channels 69 of the second set of control wire channels extend through the lateral sides 74, 75. The two connecting member channels 70 extend through the upper and lower sides 76 and 78. The upper and lower sides of the connecting member channel 70 include a socket 80.

  The rotary bearing used in the second frame 42 is the same as the rotary bearing used in the first frame 40. As seen in FIG. 3F, each pivot bearing 46 has a central channel 60 and is generally spherical. The ring member 64 is aligned in series with the two rotational bearings 46 located between pairs of adjacent ring members 64. The rotary bearing 46 is provided in the socket 80. The ring members 64 can be rotated in the left-right direction by the inclined shape of the rotary bearing 46 and the front and rear side surfaces 72, 73 of the ring member 64.

  The connecting member used for the second frame 42 is the same as the connecting member 47 used for the first frame 40 (see FIG. 3F). The second frame 42 includes two connecting members 47. The connecting member 47 extends through the connecting member channel 70 and the channel 60 of the rotary bearing 46. The connecting member 47 may include a wire or a cable. In a preferred embodiment, the second frame includes two connecting members 47, one of which penetrates the upper part and the other of which penetrates the lower part. Each end of the connecting member 47 extends into the connecting tool 62 and the base end member 82, respectively. In the preferred embodiment, both ends of the connecting member 47 are free to move relative to the connecting tool 62 and the proximal member 82. However, in another embodiment, one end of the connecting member 47 is fixed.

  With particular reference to FIGS. 3A, 3B, 3C, and 3D, the shaft 14 includes various components therethrough and includes a working channel 84, two light transports 86, and an electrical cable 88. These four members extend through the central channel of the different ring members 44, 64 and extend from the handle 12 to the tip 20. As best shown in FIG. 3A, the electrical cable 88 is connected to a printed circuit board 90 inside the tip member 38. A video capture system 92 is attached to the sensor on the printed circuit board 90 and has an electrical cable 88 connected thereto. The user can view the video from the video capture system 92 on a video screen (not shown) when the cable 88 is connected to this display. In another embodiment, the electrical cable 88, the printed circuit board 90, and the image capture system 92 may be replaced with a fiber optic image bundle and an objective lens. In this embodiment, the user can view an image with an eyepiece or a snap camera at the end of the handle 12.

  The tips of the first set of two control wires 25 and 26 are connected to a tip member 38. With reference to FIG. 3E, one connection of the control wires 25, 26 to the tip member 38 will be described. The control wires 25 and 26 are inserted into the rear end of the tip member 38 through the hole 96. A sleeve 94 is fixed to each of the tips of the control wires 25 and 26. The control wires 25, 26 are then pulled and tensioned, and the wire tip and sleeve 94 are positioned in the pocket of the tip member 38. Thus, when the control wires 25, 26 are pulled rearward, they pull the tip member 38 rearward. One of the control wires 25, 26 is pulled backward by the actuator 16, and the other wire is loosened by the actuator. Thus, the first frame 40 can be bent up and down. However, the movement of the frame 40 is limited to only two directions within a single plane due to the coupling provided on the ring member 44 in the rotary bearing 46.

  With reference to FIGS. 3C and 3D, the ring member 64 and connector 62 include channels that allow the first set of control wires 25, 26 to penetrate with the outer cable sheath 27. The distal ends of the second set of two control wires 23 and 24 are connected to a connector 62. However, the control wires 23, 24 for the second active flexure 36 are offset by about 90 ° (eg, about 75-85 °) relative to the control wires 25, 26 for the first active flexure 34. ing. The connection between the second control wires 23 and 24 and the connector 62 is substantially the same as the connection between the first control wires 25 and 26 and the tip member 38 (see FIG. 3E, provided in the receiving pocket of the connector 62). By using a sleeve 94). Thus, when the second control wires 23, 24 are pulled rearward, they pull the connector 62 rearward. One of the control wires 23, 24 is pulled backward by the actuator 16, and the other control wire is loosened by the actuator. Thus, the second frame 42 curves to the left or right. However, the movement of the frame 42 is limited to only two directions in a single plane by the connecting member provided between the ring members 64 in the rotary bearing 46.

  In the cross-sectional views shown in FIGS. 3B, 3C, and 3D, the connection members 47 of the first control cables 25 and 26 and the second frame 42 are slightly shifted from each other. Thus, the two flexure planes created by the two frames 40, 42 are not exactly orthogonal to each other. However, in another embodiment, the connecting member 47 of the rear frame 42 may be generally tubular through which the control wires 25, 26 pass. Thus, a truly orthogonal configuration is provided.

  With reference to FIGS. 6A-6F, the movement of the first and second active flexures 34, 36 will be described. FIG. 6A shows a state in which the first and second active flexures 34 and 36 are arranged substantially linearly with respect to each other. This type of shape is used to insert the front end of the endoscope 10 into the patient's bladder 10 through the patient's urethra 102 (see FIG. 9). When inserted into the bladder 100, the user can manipulate the actuators 16, 17 to bend the first and second active flexures 34, 36 separately and independently.

  FIG. 6B shows a state in which the first active flexure 34 is curved upward and the second active flexure 36 is maintained in a linear direction. FIG. 6C shows a state in which the first active flexure 34 is maintained in a curved state upward and the second active flexure 36 is curved to the left. As can be seen, the distal end 20 of the endoscope 10 faces upward and rearward. FIG. 6D shows a state in which the second active bending portion 36 is maintained in a position curved leftward, and the first active bending portion 34 is bent from a position curved upward to a downward position. The distal end 20 of the endoscope 10 faces downward and forward. FIG. 6E shows a state in which the first active flexure 34 is maintained in a downward curved position, and the second active flexure 36 is curved from a left bent position to a right bent position. Therefore, the distal end 20 of the endoscope 10 faces downward and rearward. FIG. 6F shows a state where the second active flexure 36 is maintained in a position bent to the right and the first active flexure 34 is bent backward and occupies an upward position.

  As described above, in this embodiment, the first active flexure 34 and the second active flexure 36 are limited to flex in a single plane that is substantially orthogonal to each other, eg, substantially horizontal and vertical. ing. Referring to FIG. 9, a cross-sectional view of the bladder is shown. In this embodiment, the endoscope is a cystoscope intended to be inserted into the bladder 100 through the urethra 102. When the front end 18 of the endoscope is inserted into the bladder 100, the front end 18 will bend flexibly to observe the inside of the bladder and work inside the bladder.

  The interior of the bladder has a generally round oval or spherical shape. Therefore, the user of the endoscope needs to operate the endoscope and observe the spherical 360 ° region inside. In the past, cystoscopes were capable of bending in four directions with a multidirectional control mechanism. However, an attempt to systematically observe all spherical areas inside the bladder simply using a control mechanism (and confirm that the user has no mistakes in any of the areas) Due to the required memory, it was practically impossible. Thus, in the past, the user manually scans the internal spherical region in a systematic pattern by simply rotating the entire endoscope shaft and positively bending the front end in one plane. There were many things. However, because the cystoscope was rotated after each path of scanning, the user had to twist his body during this process.

  The present invention allows the user to perform a systematic scanning process, rotating the cystoscopic shaft relative to the urethra, or allowing the user to twist his body during this process Is unnecessary. Although the rear end of the second active flexure 36 is kept substantially stationary, the structure of the two active flexures 34 and 36 and the visual field of the image observation system at the tip 20 make it a substantially spherical interior. Observation of 360 ° (ie inside the bladder) is possible. The present invention demonstrates this capability by providing two independently movable active flexures at the front end of the cystoscope that move in a limited manner in a flexure plane that intersects at substantially orthogonal angles to each other. Is. That is, the front end of the tip member 38 moves in a first plane, for example, a horizontal plane without moving in the vertical direction to form a first scanning path. The front end of the tip member 38 can move in a second plane, such as a vertical plane, without moving in the horizontal direction. The front end is then moved in a third plane adjacent to the first scan path without moving vertically to form a second scan path adjacent to the first scan path.

  By physically constraining the leading end motion to two bendable or angled, independent, planar planes, the user is confused or moves the tip member 38 in an unintended direction. It is possible to control the actuators 16 and 17 very easily without any trouble. For example, the user does not need to move the actuator 17 by moving the tip member 38 up and down simply by moving the actuator 16. The user does not need to move the actuator 16 by moving the tip member 38 left and right simply by moving the actuator 17. In the prior art, the user had to move both actuators at the same time to obtain this single plane type of movement repeatedly and consistently. It is very complex and time consuming to move both actuators at the same time and repeat this single plane type of motion consistently, as described above, the user simply shafts the patient It was only repeating the rotation.

  One of the unique features of the present invention is that the user can observe the inner surface of the patient in a controlled and systematic manner. Specifically, referring to FIGS. 7A, 7B, 8A, and 8B, the front end of the endoscope 10 is shown inside the bladder 100. FIG. The user first uses the actuators 16 and 17 so that the second active flexure 36 bends left and the first active flexure 34 bend upward as shown in FIG. 7A. The tip 20 is positioned. Next, the user operates only one actuator 17 so that the second active bending portion 36 is bent from the left side to the right side as shown by the dotted line in FIG. 7A. Bend like so. The other actuator 16 is not moved by the user, and therefore the first active flexure 34 is the entire period during which the second active flexure 36 moves from its left curved position to its right curved position. Maintain a curved shape upward through. The camera at the tip 20 can scan the inside of the bladder 100 along the path 104. Referring to FIG. 8A, in a preferred embodiment, the path 104 is about 50% of the entire inner circumferential surface of the bladder 100 and occupies the upper half of the inner circumferential surface of the bladder.

  Next, a user returns the 2nd active bending part 36 to the position curved to the left shown by FIG. 7A. By operating only the first actuator 16, as shown in FIGS. 7B and 8B, the user flexes the first active flexure 34 from a position bent upward to a position bent downward. Can be made. Next, the user operates only the second actuator 17 to bend the second active bending portion 36 from the position bent to the left side to the position bent to the right side, as shown by the dotted line in FIG. 7B. Can be bent. The camera at the tip 20 can scan the inside of the bladder 100 along the path 105. In the preferred embodiment, this pathway 105 is about 50% of the entire inner peripheral surface of the bladder 100 and occupies the lower half thereof. However, in other embodiments, the scanning path may be greater than the two paths 104, 105, and the scanning paths are preferably adjacent to each other or partially overlapping. In another method, the user can scan by moving the first active flexure 34 and maintaining the second active flexure 36 stationary.

  According to the present invention, a user can systematically scan adjacent paths and observe a 360 ° entire circumference region inside the bladder. In this method, the second actuator for user operation of the endoscope is moved to move the second active bending portion at the front end of the endoscope shaft, and the second active bending portion is moved along a single plane. A first method in which the distal end of the endoscope shaft is limited to the plane by moving the second actuator for user operation without moving the first actuator for user operation without moving the first actuator for user operation. Moving along the path, and moving the first actuator for user operation without moving the second actuator for user operation to move the first active flexure at the front end of the shaft to the first path. Moving the substantially orthogonal second path and repeating the two steps in order to systematically scan the patient's internal region with a series of adjacent first paths.

  In one preferred embodiment, the first active flexure is configured to bend over an angular range of about 110-210 °, and the second active flexure is over an angular range of about 110-210 °. It is preferably configured to bendable, and both are preferably about 130 °. However, any appropriate angle may be used. The field of view of the optical lens at the front end of the endoscope can overlook 360 ° when moved over these angles. The endoscope includes only one brake for each actuator, eg, left and right actuators. However, in another embodiment, this single brake performs braking control of only vertical movement. The present invention forms a means for observing the substantially spherical interior through a fixed entrance into the substantially spherical interior by a camera or optical lens at the front end of the shaft without rotating the shaft.

  The present invention has the advantage of allowing an overall scan of the interior without requiring substantially any shaft rotation. According to the present invention having the bending portions only in two directions connected in series substantially orthogonal to each other, the user can better control the movement of the tip portion (and the path to be observed). In this way, the user can use a controlled systematic scan pattern method that ensures that the entire internal spherical region can be observed. The user can scan one path in only one direction and reposition in the orthogonal direction to take another adjacent scan path. Thus, using the scanning repositioning repetition method, the user can limit the method consisting of the two steps to move either one of the actuators 16 and 17 for each step. As a result, the scanning pattern and the process motion of the flexures 34 and 36 can be clearly defined.

  FIG. 10 shows a cross section of the bladder K, with the front end 518 of one embodiment of the present invention positioned there. In this embodiment, the endoscope 510 is a nephroscope (a device that is inserted into the incision IN the renal pelvis to observe the inside of the kidney) or a gallbladder-renal mirror that can be used for both gallbladder and kidney mirrors. is there. The two active flexures 534 and 536 are configured to allow the endoscope distal end 520 to enter the kidney cup LPC of the lower lobe or lower pole LP. More particularly, the two active flexures 534, 536 are configured such that the front end 518 can pierce the tip 520 into the renal cup LPC without passively flexing the patient's kidney tissue. ing. The front end 518 does not include a passive flexure. Instead, the front end 518 includes the two active flexures described above.

  FIG. 11 shows the components of the front end 518. The front end 518 includes a tip member, a first frame member 540, a second frame member 542, and a joint 544. The front end 518 also includes an elastic cover attached to a cover that extends over the entire length of the shaft 514 in a sealed joint. The tip member is connected to the front end of the first frame member 540. The front ends of the two first control wires are fixed to the tip member.

  The first frame member 540 is a substantially tubular member that is a single piece. However, in another embodiment, the first frame member 540 is composed of more than one tube in which a plurality of tubes are connected in series, and may include an auxiliary member. The first frame member 540 is preferably made of a shape memory alloy material such as Tinel or Nitinol. However, any suitable type of shape memory alloy material may be used. This engagement memory alloy material elastically returns to its natural or predetermined position even if the material is strained more than 4% or more than 0.4%, which is a typical strain in which normal metals undergo compositional deformation. Used because of the superelasticity exhibited by the material properties. Thus, the term “superelastic material” is used to describe this type of material.

  The first frame member 540 has a center channel in which front and rear ends 548 and 550 are opened, and a slot 552. The first frame member 540 forms a frame for the first active flexure 534. The slot 552 in the illustrated embodiment enters the first frame member 540 in two opposite directions. However, in other embodiments, these slots 552 may extend in more or less than two directions. The slot 552 extends into the first frame member 540 along most of the length of the first frame member and into the first frame member a distance of more than half of its diameter. However, in other embodiments, the slots 552 may be arranged in any suitable type or shape.

  A rear end 550 of the first frame member 540 is fixed to the fixture 544. The fixture 544 is formed of an integral member made of an appropriate material such as metal. However, in other embodiments, the fixture 544 may be composed of more than one member, or may be incorporated into one or two frame members, or may be composed of any suitable type of material. The rear end 550 of the first frame member 540 is fixed to the outside of the front portion of the fixture 544.

  The central portion 554 forms an annular ring that rises around the fixture 544. This raised ring forms a stop surface for the ends 550 and 570 of the two frame members. In another embodiment, an appropriate type of positioning system can be provided for positioning the frame member on the fixture.

  The interior of the fixture 544 includes two through holes and a mounting portion for mounting the end of the second control cable. These two through holes have sizes and shapes that allow the two first control cables to slide through. The fixture 544 includes a hole having a size and a shape for receiving the front end of the second control cable 524, and the front end is fixed to the hole. However, in other embodiments, any suitable means can be used to attach the front end of the second control cable to the fixture 544. Further, in another embodiment, the fixture 544 can be configured to secure more than one cable thereto. Further, in another embodiment, the fixture 544 can be configured to penetrate more or less than two control cables.

  The second frame member 542 is a single tubular member. However, in another embodiment, the second frame member 542 may include more than one tube, such as a plurality of tubes connected in series, and may include an auxiliary member. The second frame member 542 may include a front portion of a member that extends along the length of the shaft 514, similar to that disclosed in US patent application Ser. No. 09 / 427,164. The second frame member 542 is preferably made of a shape memory alloy material similar to that previously described with reference to the first frame member 540.

  The second frame member 542 includes a central channel having open front and rear ends 570, 572 and a slot 574. The second frame member 542 forms a frame for the second active flexure 536. In the illustrated embodiment, the slot 574 penetrates the second frame member 542 in only one direction. However, in another embodiment, the slot 574 may penetrate the second frame member in multiple directions, more than two directions. These slots 574 extend along the majority of the length of the second frame member to the second frame member 542 and penetrate at a distance corresponding to about 3/4 of the diameter of the second frame member. However, in other embodiments, the slots 574 are arranged to enter the sides of the frame member in any suitable type of row, shape or depth.

  In the illustrated embodiment, the second frame member 542 has a preshaped initial position that is curved as shown in FIG. However, in other embodiments, the second frame member 542 can have any suitable type of initial position, including a linear initial position similar to the first frame member 540. In another embodiment, the first frame member 540 may include a curved initial position. The front end 570 of the second frame member 542 is fixed to the rear portion of the fixture 544. The rear end 572 of the second frame member 542 is fixed to the frame of the shaft 514 behind the front end 518.

  In another embodiment, the first frame member 540 and / or the second frame member 542 may be composed of any suitable material and member. For example, these members may be metal rings connected by flexible members (for example, rods of superelastic materials or other flexible materials), or simply metal rings that are pivotally connected to each other. It may be configured. The features of the present invention need not be limited to the use of two tubular frame members composed solely of superelastic materials. For example, one type of another embodiment is shown in FIG. In this embodiment, the first and second active flexures include a ring member 580. These ring members 580 are connected to each other in series at a joint 582 so as to be rotatable. A first control wire 524 has a tip connected to one of these ring members 584. Other control wires 525, 526 pass through the ring member. These metal rings are made of stainless steel. Various different types of flexible and deflectable endoscope shafts are known in the art and can be configured or modified to implement the present invention. For example, these metal rings may be connected to each other by rivets, or hinged to each other so that they can be rotated.

  In the illustrated embodiment, the lateral side surface of the second frame member 542 into which the slot 574 enters is aligned with the mounting portion of the fixture 544. When set in place by the actuator 17, the second control cable tensions the fixture 544 and maintains the second frame member 542 in a substantially straight state. When the second control cable is pulled backward by the actuator 17, the second frame member 542 is configured to be bent inward along the opposite lateral side surface. When the second control cable is loosened, the second active bending portion 536 returns to its linear initial position due to internal stress from the second frame member 542 that has been given a curved shape in advance. In other embodiments, more or less than three control cables may be used.

  In FIG. 10, a control unit (not shown) of the endoscope 510 is configured to bend the first and second active bending portions separately. The first and second active flexures allow the kidney mirror tip 520 to bend the front end 518 of the shaft passively relative to the kidney tissue and not reach the kidney cup, thereby preventing the lower pole LP of the kidney K. It can be placed in the kidney cup LPC.

  Regardless of the size and shape of the kidney, the front end of the kidney mirror is positioned in the kidney cup at the lower pole of the kidney by providing two active flexures that can be bent independently of each other at the front end of the kidney mirror Can do. The nephroscope 510 does not passively flex the kidney tissue to position its tip 520 in the desired position. The size of the space or estate for manipulating the front end of the nephroscope 510 and the small turning radius into the renal cup of the lower pole inside the kidney are very limited. By using two separate shape memory frame members 540, 542, the present invention provides the ability to manipulate the front end 518 in this limited space and sharp rotational path environment. Shape memory frame members 540, 542 provide superelasticity, allowing the frame members to flex within this limited space and sharp rotational path environment and to return elastically to their initial position. The ability to flex the two active flexures 534, 536 separately, combined with the superelasticity of the shape memory frame member, allows the frame member to pass through a path through this limited space and a sharp rotational path environment. Can do. If only one active flexure is provided, longer distances may be required to successfully operate to reach the lower pole kidney cup.

  The first active flexure 534 can be flexed before the second active flexure 536, and the second active flexure 536 bends as it enters the incision IN. The ability of these active flexures 534, 536 to sequentially flex as they exit incision IN allows access to the lower pole renal cup LPC without applying passive flexion. The present invention provides the ability to reach areas of the kidney that were previously impossible.

  In another embodiment of the present invention, the front end 518 includes more than two active flexures. As described above, the first active bending portion 534 can be bent in two directions in one plane and in the same plane as one bending of the second active bending portion 546. In another embodiment, the first active flexure 534 can bend in more or less than two directions. In this embodiment, the control system includes more or fewer control cables. As described above, the second active bending portion 536 can be bent in one direction. In another embodiment, the second active flexure 536 can bend in more than one direction in substantially the same plane. In this embodiment, the control system may include more than one control cable for the second active flexure.

  It should be understood that the foregoing description is only illustrative of the invention. Those skilled in the art can make various changes and modifications without departing from the present invention. Accordingly, the present invention is intended to embrace all such alterations and modifications that fall within the scope of the appended claims.

It is a side view of an endoscope incorporating the features of the present invention. It is an expansion perspective view of the front end of the endoscope shown in FIG. FIG. 2 is an enlarged side view of the front end of the endoscope shown in FIG. 1 with an outer cover removed. FIG. 4 is a cross-sectional view taken along line 3A-3A in FIG. FIG. 4 is a cross-sectional view taken along line 3B-3B in FIG. 3. FIG. 4 is a cross-sectional view taken along line 3C-3C in FIG. FIG. 4 is a cross-sectional view taken along line 3D-3D in FIG. 3. FIG. 4 is an enlarged partial cross-sectional view of a region 3E shown in FIG. FIG. 4 is an enlarged partial sectional view of a region 3F shown in FIG. 3. 3B is an end view of the ring member shown in FIG. 3B. FIG. FIG. 4B is a cross-sectional view of the ring member shown in FIG. 4A along line 4B-4B. FIG. 4B is a side view of the ring member shown in FIG. 4A. 3D is an end view of the ring member shown in FIG. 3D. FIG. FIG. 5B is a cross-sectional view of the ring member shown in FIG. 5A along line 5B-5B. FIG. 5B is a plan view of the ring member shown in FIG. 5A. It is the schematic of the front end of the endoscope shown by FIG. 1, and the 1st and 2nd active bending part occupies the linear position. It is the schematic similar to FIG. 6A, and the 1st active bending part is curving upwards. It is the schematic similar to FIG. 6B, and the 2nd active bending part is curving to the left side. It is the schematic similar to FIG. 6C, and the 1st active bending part is curving below. It is the schematic similar to FIG. 6D, and the 2nd active bending part is curving to the right side. It is the schematic similar to FIG. 6E, and the 1st active bending part is curving upwards. FIG. 6 is a schematic cross-sectional view of the front end of the shaft shown in FIG. 1 with the front end of the endoscope positioned in the posture shown in FIG. 6C in the patient's bladder. FIG. 7B is a schematic cross-sectional view similar to FIG. 7A, with the front end of the shaft in the position shown in FIG. 6D. FIG. 7B is a schematic cross-sectional view of the front end of the endoscope shown in FIG. 1 with the front end of the endoscope positioned in the patient's bladder as shown in FIG. 7A. FIG. 8B is a schematic cross-sectional view similar to FIG. 8A, wherein the endoscope has the front end at the position shown in FIG. 7B. It is sectional drawing of a bladder. 2 is a cross-sectional view of a kidney mirror similar to the endoscope shown in FIG. 1 with its front end positioned in the kidney. FIG. FIG. 11 is a side view of the frame member and fixture used to form part of the front end of the nephroscope shown in FIG. 10. It is a schematic diagram of the frame part and control wire of another structure of the 1st and 2nd active bending part incorporating the feature of the present invention.

Claims (2)

A handle,
A shaft extending from the handle and having a front end including a first active flexure and a second active flexure, the first active flexure being limited to bend in a first plane. The second active flexure is limited to bend in a different second plane, the first plane is inclined with respect to the second plane, and the first active flexure is A shaft including a plurality of rings, each pivotally connected to an adjacent ring by two ball portions on each side;
Means for observing the substantially spherical interior through a substantially spherical interior fixed inlet by an optical lens at the front end of the shaft without rotating the shaft.   The cysto-renalscope according to claim 1, further comprising a connecting member extending through the holes of all the ball portions on one side.

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