KR20050059168A - Piston-actuated endoscopic tool - Google Patents

Abstract

Endoscopic apparatus (400) is provided, having a distal end (102) for insertion into a body of a patient and a proximal end (104) that is held outside the body of the patient. The apparatus (400) includes a proximal cylinder (404), disposed in a vicinity of the proximal end (104) of the endoscopic apparatus (400). A proximal piston (406) is slidably contained within the proximal cylinder (404). A distal cylinder (328) is disposed in a vicinity of the distal end (102) of the endoscopic apparatus (400), and a distal piston (310) is slidably contained within the distal cylinder (328). A tube (402) for containing a liquid is coupled between the proximal (404) and distal (328) cylinders. A tool (e.g., biopsy tool 412) is coupled to be actuated by displacement of the distal piston (310), so as to perform a mechanical action on tissue of the body or contents of the body, responsive to displacement of the distal piston (310).

Description

Piston type endoscope instrument {PISTON-ACTUATED ENDOSCOPIC TOOL}

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to the operation of instruments for flexible medical devices, and more particularly to an apparatus and method for operating an endoscope instrument during medical treatment.

It is well known in the art to use an endoscope to examine a body cavity. The diagnostic and therapeutic advantages of direct examination of the gastrointestinal tract with flexible endoscopy have made this treatment a standard treatment in modern medicine. The most common endoscopy treatment is colonoscopy, which can be used for a variety of purposes, including diagnosing cancer, determining gastrointestinal hemorrhages, locations affected by inflammatory bowel disease, removing polyps, eliminating volvulus and intussusception. Is executed.

Flexible endoscopes typically include an actuation channel operated through an endoscope length. These channels allow the instrument to pass through an endoscope that performs diagnostic and therapeutic procedures inside the body. Such instruments include, for example, small biopsy forceps that take a biopsy sample from the area under examination by extending through the channel and through the end of the endoscope. Such instruments are typically controlled by cables or wires passing through the sheath and through the distal end of the endoscope behind the instrument itself. Tension is applied to the cable or wire by the doctor at the center end to induce the required instrument operation at the distal end.

The extent to which the mechanism can be operated by this technique is limited by the friction between each wire and the sheath surrounding the wire. In particular, if the surgeon only needs to overcome one turn in the gastrointestinal tract, the force F1 that must be applied to the central end to generate a force F2 at the distal end becomes F1 = F2 * e ^μα , Is the coefficient of friction between the wire and the sheath, and α is the effective angle formed by rotation in the gastrointestinal tract. If the endoscope normally travels through numerous turns α _i in the gastrointestinal tract, the total force is Which is increased considerably (and sometimes absurdly).

Attempts have been made to introduce hydraulic pressure to the endoscope to overcome the frictional effects caused by using systems based on wires in the shell, but none of these attempts have been commercially successful. All of these hydraulic systems known to the inventors are not only very complicated, expensive and bulky, but also require an external power source or pressure source, as well as a facility for managing such a power source or pressure source. Because of this drawback, only wire-based techniques are currently used for endoscope manipulation and instrument control.

U.S. Pat.No.5.569.299, which is incorporated herein by reference and incorporated in a deal, discloses an endoscope forceps for urological biopsy equipped with one stationary jaw and one movable jaw. Is controlled by a wire acting into the hollow tube supporting the two jaws. These forceps are operated by a medical professional through the action of a wire at the central end.

U.S. Pat.No.5.431.645, which is incorporated herein by reference and assigned to Smith, provides for remote operation of the endoscope opening by various types of power sources, including electrical, mechanical, hydraulic, and pneumatic sources disposed near the central end of the endoscope. Techniques are disclosed.

US Patent No. 5.779.645, which is incorporated herein by reference and incorporated by Coblis, discloses a deflectable biopsy catheter; According to this a control wire is used which is operated from the central end to the distal end of the catheter to deflect the distal tip and / or to operate the biopsy jaws. The control wire is attached to a piston seated in a cylinder embedded in the handle at the central end of the catheter, so that the movement of the piston allows the operator to control the deflection of the distal tip and / or activate the biopsy jaw. .

U.S. Patent No. 5.574.205, which is incorporated herein by reference and is issued to Pelicia, discloses a device for dispensing a drug into an area within the human lumen. This device is similar to an elongated syringe with a built-in distal piston / needle device, where the end of the syringe operated by a doctor is used to operate the distal device through a fluid-filled tube connecting the distal and central ends. .

US Pat. No. 6.059.719 to Yamato et al., Which is incorporated herein by reference, discloses an endoscope system incorporating a plurality of endoscope modules equipped with different treatment instruments, the various treatment modules being freely replaceable. In some embodiments, an indispensable force is supplied to operate the treatment module via a delivery wire that traverses the endoscope length. Yet another embodiment includes a liquid-filled channel connecting the end piston / cylinder device to the central means for dispensing hydraulic fluid to move the end piston. In order to operate the treatment module in the movement of the distal piston, a delivery wire connects the distal piston to the treatment module.

Published in 1998, incorporated herein by reference by Fayer et al., "Microrobot Arm for Self-Propelled Colonoscopy", Proc Actuate 98, 6th International Conference, New Actuator, pp. 576-579 The published document discloses a self-propelled endoscope system for a colonoscopy which includes a flexible arm and is controlled by a shape memory alloy with an endoscope instrument attached thereto. This endoscope mechanism is controlled by heating / cooling of the shape memory alloy, or by hydraulic means via a distal piston / cylinder device. A simple piston / cylinder device with a single pressure port on the cylinder is used so that positive and negative pressures can be used to operate the attached instrument.

1 is a schematic cross-sectional view of an endoscope instrument including a hydraulic instrument in accordance with a preferred embodiment of the present invention.

2 is a schematic cross-sectional view of an endoscope instrument including a hydraulic instrument according to another preferred embodiment of the present invention.

3 is a schematic cross-sectional view of an endoscope instrument including a hydraulic instrument in accordance with another preferred embodiment of the present invention.

4 is a schematic cross-sectional view of an endoscope instrument including a hydraulic instrument in accordance with another preferred embodiment of the present invention.

5 is a schematic cross-sectional view of an endoscope instrument including a hydraulic instrument in accordance with another preferred embodiment of the present invention.

6 is a schematic cross-sectional view of an endoscope instrument including a hydraulic instrument in accordance with another preferred embodiment of the present invention.

It is an object of the present invention to provide an improved system and method capable of operating the instrument within the lumen.

Another object of the present invention is to provide an improved instrument capable of operating the instrument in the body cavity of a patient for examination, diagnosis, or treatment.

It is yet another object of the present invention to provide an improved instrument capable of operating the instrument within the body cavity of a patient to obtain biopsy tissue or to perform another treatment.

In a preferred embodiment of the present invention, an endoscope instrument for performing mechanical operations on the contents or tissues of the gastrointestinal tract or other body cavity of a patient is advanced through a channel of a flexible endoscope located in the body cavity. The endoscopic instrument is operated by an actuating instrument in close proximity to the target (eg, tissue, intestinal stones), connected to the instrument near the end of the channel, and performs mechanical operation on the target. The actuating mechanism includes one or more cylinders each containing a piston, the movement of which actuates the mechanism by operating a link connected to the instrument. The movement of the piston can be accomplished by introducing liquid or removing liquid from the corresponding cylinder. The liquid is dispensed from the central end of the endoscope through a closing system of one or more flexible tubes passing through the actuation channel to an actuator cylinder located near the distal end of the endoscope. This embodiment of the present invention eliminates the need to use instrument actuation wires operated through the length of the endoscope, thereby minimizing the friction and the like typically associated with wired actuation.

The mechanism is operated by pressurizing the piston in the actuating mechanism and driving the fluid under pressure into the piston, rather than withdrawing the fluid from the piston as in hydraulic mechanisms known in the art. "Operation" of an instrument in the specification and claims of the present invention means the execution of an operation that requires a force exerted by the instrument, such as closing the forceps for biopsy. In an actuating mechanism based on fluid withdrawal from a hydraulic instrument, only 1 atm of negative pressure can be applied, so that the force applied by the instrument is limited. When the liquid is driven into the piston under positive pressure, more force can be applied.

The means for providing liquid in the cylinder through the flexible tube in the implement is preferably arranged near the central end of the endoscope outside the patient. In a preferred embodiment of the present invention, a drive piston / cylinder system can be used to drive the actuator in order to provide pressure to the liquid in the flexible tube. By using hand and / or foot motion to displace one or more pistons in each cylinder, the operator can cause liquid motion into and out of the implement cylinder, thereby causing movement of the corresponding piece barrel near the end of the endoscope and The required operation of the mechanism can be obtained. Thus, the physical force applied by the operator can be applied directly or in proportion to actuate the endoscope instrument, thereby providing a feeling of feedback to the operator. Even after relatively short training periods and running cycles, the operator can recognize the amount of force required to apply a mechanical user-interface device, typically a joystick or the like, to operate the instrument during a particular procedure. Leveraging or the mechanical and / or hydraulic design of the implement may control the physical forces required to operate the instrument.

In a preferred embodiment of the present invention, each implement cylinder includes one port for liquid inlet or liquid retraction to actuate a corresponding piston. The piston comprises two actuator cylinders in two regions: (a) a liquid delivery region comprising a port into which the liquid is actively added or retracted, and (b) a fixed mounting portion of a compressive fluid, such as air, with one end open. Or into a passive area containing a spring. The actuator cylinder is aligned with the longitudinal axis of the endoscope, and the liquid delivery area is closer to the passive area than to the distal end of the endoscope. Thus, this arrangement is preferred because when liquid is added to one end of the implement cylinder, it develops tension on the member of the implement connecting the piston to the instrument and reduces the likelihood of bending the thin member due to the compressive load. It is becoming. When liquid is added to the liquid transfer area of one or more cylinders, mechanical connection is preferred between two or more actuator cylinders in order to maintain a tension load on this actuator member. Alternatively or additionally, one or more rods of stable shape may be connected to the actuator cylinder and disposed in a compressed state during the application or removal of liquid from the liquid delivery zone of the cylinder, thereby facilitating operation of the mechanism. It may be.

If the passive region of each implement cylinder includes a compressive fluid (eg air), the fluid typically acts essentially as a spring, returning the piston to its equilibrium position. Alternatively or additionally, this region includes a solid spring that helps to return the piston to its equilibrium position when no external pressure is applied to the cylinder.

In another preferred embodiment of the present invention, each implement cylinder comprises two ports, one on each side of the piston, each of which has two ports in the liquid delivery zone of the cylinder to which liquid is actively added or removed. Connected. The flexible tube transfers hydraulic pressure from the central end of the endoscope to each port. The movement of the set piston in the implement begins in response to the pressure deviation on the opposite side of the piston. By controlling the pressure on each side of the piston, accurate control of the force distributed to the implement by the piston can be achieved. The pressure is preferably positive on both sides of the piston during each operating cycle of the mechanism.

According to an embodiment of the present invention, an endoscope device having a distal end inserted into a patient's body and a central end supported on an outside of the patient's body, the endoscope device having a central cylinder disposed near the central end of the endoscope device and sliding in the central cylinder; A central piston possibly embedded, an end cylinder disposed near the end of the endoscope device, an end piston slidably embedded in the end cylinder, a liquid-containing tube connected between the center cylinder and the end cylinder, An endoscope device is provided that includes a mechanism coupled to be actuated by the displacement of the distal piston to perform a medical action on tissue or contents of a patient's body in response to the displacement.

In one embodiment, the instrument, the distal cylinder, the distal piston and the tube pass through an endoscope's actuation channel to access areas within the body during use of the endoscope.

In an embodiment, the instrument accesses a portion of the patient's gastrointestinal tract.

In some embodiments, the instrument comprises a biopsy instrument. Alternatively or in addition, the apparatus includes a therapeutic apparatus.

In one embodiment, (a) the end cylinder has two zones on each side of the end cylinder, (b) the tube is connected with the first zone of the zone, and (c) the second zone of the zone The movement of the distal piston in one direction is formed to change the fluid pressure in the second region, and (d) the distal piston is in a second direction opposite to the first direction in response to the pressure change of the fluid. It is connected to the end cylinder to receive the force of.

In some embodiments, the central piston is operated manually. In one embodiment, the device comprises a link portion connected to the central piston, which link portion facilitates hand movement of the central piston.

In some embodiments, the instrument is connected to the distal piston to be actuated by pressurization of the tube by liquid due to the operation of the central piston. For example, the instrument includes forceps and the forceps are closed when the instrument is operated by pressurization of the tube. Optionally, the device closes the noose.

According to an embodiment of the present invention, in an endoscope device having a distal end inserted into a patient's body and a central end supported outside the patient's body, the distal piston and the distal piston are slidably embedded near the distal end of the endoscope device. A distal end cylinder, a mechanism connected to be operated by displacement of the distal piston, a central piston, a central cylinder in which the central piston is slidably near the central end of the endoscope device, and a first tube and a second tube. ; The end cylinder includes a first end port adjacent the end piston and a second end port away from the end piston; The end cylinder comprises a first central port adjacent the central piston and a second central port remote from the central piston; The central motion of the central piston drives the liquid through one tube to apply positive pressure to the first side of the distal piston, thereby driving the distal piston in the first direction to place the instrument in the first state, and the distal motion of the central piston The first tube has one center port on the other side to drive the liquid through the other tube to apply a positive pressure to the second side of the end piston, thereby driving the end piston in the second direction to place the instrument in the second state. An endoscope device is provided which connects to the distal port and the second tube connects the other central port to the other distal port.

In one embodiment, the instrument, the distal cylinder, the distal piston, and the tube pass through an endoscope's actuation channel to access an area within the body using an endoscope.

In one embodiment, the instrument accesses a portion of the patient's gastrointestinal tract.

In some embodiments, the instrument comprises a biopsy instrument and / or a therapeutic instrument.

In one embodiment, the central piston is operated manually. For example, the device includes a link portion connected to the central piston, which links facilitate hand movement of the central piston.

Further, an endoscope device having a distal end inserted into a patient's body and a central end supported outside the patient's body, comprising: first and second central cylinders disposed near the central end of the endoscope device, and sliding in each central cylinder; First and second central pistons possibly embedded therein, at least one end cylinder disposed near the distal end of the endoscope device, at least one end piston slidably embedded in the at least one end cylinder, and the first central cylinder And a liquid-containing first tube connected between the at least one end cylinder and a liquid-containing second tube connected between the second central cylinder and the at least one end cylinder and a first when the mechanical link is displaced in the first direction. Move the central piston to create a positive pressure in the first tube, and move the second central piston when the mechanical link is displaced in the second direction A mechanical link connected to the first central cylinder and the second central cylinder to form a positive pressure in the second tube,

An endoscope device is provided that includes a mechanism coupled to be operated by displacement of at least one distal piston to perform mechanical motion on tissue or contents of a patient's body in response to displacement of the distal piston.

Other objects, features and advantages of the present invention will be more clearly understood by the following detailed description with reference to the accompanying drawings.

1 is a schematic partial cross-sectional view of a flexible endoscope device 100 including a hydraulic instrument in accordance with another preferred embodiment of the present invention. The endoscope device 100 includes a distal end 102 that advances through the actuation channel 82 of the endoscope 80 disposed in the gastrointestinal tract of the patient. The device 100 includes a central portion 104, some of which may be disposed outside of the patient to access the operator of the instrument. Typically, the instrument includes a biopsy instrument 115 equipped with two opposing biopsy jaws 114. The instrument 115 is positioned near the distal tip of the device 100 for cutting or sampling tissue inside the gastrointestinal tract.

Means for actuating the instrument 115 are disposed near the distal tip of the portion 102. In a preferred embodiment, the biopsy jaw 114 includes a spoon-shaped lever and rotates around a common pivot point 113 so that the spoon portion of each lever can gripping or cutting tissue. The pivot point 113 is connected to an end cap 112 that is connected to the distal tip of the device 100. Movement of the wedge-shaped member 110 actuates jaws 114; Distal motion of the member 110, i.e., in the distal direction (upward in the figure), closes the biopsy jaw; The central movement of the member 110, that is, the movement in the central direction (downward), opens the jaw for biopsy. In a preferred embodiment, the instrument 115 includes a spring 130 that opens the biopsy jaw 114 as the member 110 moves in the central direction.

In order to limit the movement of the piston when positive pressure is applied, a mechanical stop 118 is connected inside the portion 102 located at the distal end of the piston 108. Typically, when the device 100 advances through the operating channel 82, pressure is applied to the piston 108 to pressurize the piston 108 to the stop 118 to hold the jaw 114 in the closed position. Is approved.

Since member 110 is connected to distal piston 108 by rod 120, member 110 moves equally by the movement of piston 108. Since the rod 120 has a very small ratio of length to diameter (for example, 10 or less), the rod 120 may transmit a compressive load without bending or twisting. Optionally, the rod 120 may not be provided, so the piston 108 may be fixed directly to the member 110.

The operation of the instrument 115 is achieved by the movement of the central piston 106, which changes the pressure of the duct 116 filled with liquid in the middle of the piston 106 and the piston 108, and thus on the piston 108. You can control the force acting. The duct 116 is preferably filled with an incompressible biological liquid (eg water or saline solution). Pressurization of the duct 116 using the piston 106 drives the piston 108 in the distal direction, closing the jaw 114. The operator starts the movement of the piston 106 through the mechanical link 122, which can be connected to the piston 106 and approach near the distal end of the portion 104. In a preferred embodiment, the link 122 is a simple rod whose movement is imparted directly to the piston 106. Optionally, the link 122 includes a joystick, wheel, or other device that can facilitate the easy use of the device, for example by reducing the force required by the operator. It should be appreciated that the use of the central piston 106 can eliminate the complex central pressure device required for hydraulic endoscopy biopsies known in the art.

2 schematically illustrates a cross-sectional view of a flexible endoscope device 200 including a hydraulic instrument, in accordance with a preferred embodiment of the present invention. The device 200 operates in a similar manner as the device 100 described with reference to FIG. 1, but includes a different mechanism that transfers the movement of the piston 108 to the operation of the biopsy instrument 117.

Movement of the piston 108 due to the pressure in the duct 116 is transmitted to the rod 120, the link member 124, and the central end of the biopsy jaw 114. In this way, the distal motion of the piston 108 opens the jaw 114 to unfold the spring 130, and the central movement of the piston 108 attempts to close the jaw 114 with the help of the spring 130. . Closing the jaws 114 of the biopsy instrument 117 induces tension in the rod 120 and the link member 124 to minimize the possibility of twisting of these components. Also, by modifying the size of the elements in the link portion of the instrument 117, the force applied by the biopsy joule 114 can be controlled to be a multiple of the force applied to the piston 106.

It should be appreciated that the use of the central piston 106 can eliminate the complex central pressure device required by hydraulic endoscopy biopsy instruments known in the art.

3 is a schematic cross-sectional view of a flexible endoscope device 400 that includes a hydraulic instrument 412 in accordance with a preferred embodiment of the present invention. Means for facilitating operation of the instrument are disposed in the portion 102 and include a plurality of cylinders 328; Each cylinder is disposed in the piston 310. Multiple cylinders 328 provide the physician the ability to independently control jaws 114, such as to operate instrument 412 outside the centerline of endoscope device 400. Other endoscope instruments or sets of instruments (not shown) used for other purposes also increase the degrees of freedom provided by multiple cylinders 328.

Each piston 310 is connected to one end of each wire 302. Opposite ends of the wire 302 are connected to respective portions of the biopsy jaw 114. In a preferred embodiment, the cross member 304 connected to the portion 102 includes a plurality of pulleys 306 to allow the wire 302 to pass between the piston 310 and the jaws 114.

The movement of the piston 310 is driven by liquid retracted from or dispensed into the cylinder 328 through the flexible tube 402. Each cylinder 328 is aligned parallel to the longitudinal axis of the endoscope, and the liquid is dispensed or withdrawn from the port 414 near the distal end of the cylinder. Thus, each cylinder is close to two portions by the piston 310, namely (a) the liquid delivery portion 308 and (b) the portion 102 of which the liquid is dispensed or retracted close to the distal end of the portion 102. It is divided into a passive portion 312 near the central end.

The spring 326 is connected to the biopsy jig 114 to open the jaw. Accordingly, the suction force applied to the cylinder 328 is not used or the suction force is minimized to move the piston 310 to the end and open the jaw 114. This reduced use of suction forces reduces the potential problems associated with the collapse of the flexible tube 402. In addition, the suction force as a means of generating useful endoscopy motion is generally limited to 1 atmosphere, and the positive pressure may exceed 1 atmosphere. Experiments carried out using the principles of the present invention generate a positive pressure of 50 atm at the distal end using only a force easily generated by the hand and is applied to a simple and inexpensive device according to this embodiment of the present invention. Conventional systems for hydraulic endoscopy biopsy instruments generally require complex and expensive devices and should focus on the use of pumps and pressure controls or other power equipment.

In one embodiment, the passive portion 312 of each cylinder 328 includes an orifice 408 that introduces or discharges fluid (typically air) when the piston 310 is displaced. In a preferred embodiment of the present invention, the passive portion of the cylinder 328 includes an elastic element such as a spring, and optionally the spring 326 may be used to keep the piston 310 in its equilibrium position. Optionally, the passive portion of the cylinder 228 is sealed and encloses a compressive fluid, such as air, which acts like a spring that returns the piston to its equilibrium position when the piston 310 is displaced.

The liquid is dispensed to or withdrawn from each cylinder 328 in response to the operation of the corresponding drive piston 406 in the drive cylinder 404. Each drive piston 406 is preferably connected to each cylinder 328 by one flexible tube 402. Applying a distal force to the drive piston 406 pressurizes the liquid in the drive cylinder 404. This pressure is transmitted through the liquid in the tube 402 and the cylinder 328, acting on the piston 310, thereby operating the instrument 412 as described above. In particular, the distal motion of the piston 406 closes the jaws 114, and the expansion of the spring 3126 opens the jaws 114. The ratio of the force applied to the drive piston 406 and the pressure force received by the piston 310 is generally proportional to the area ratio of the two piston surfaces. Thus, by reducing the area of the piston 406 relative to the area of the piston 310, fine control of the instrument 412 can be achieved. In this manner, the movement of the piston 406 induced by the operator can be connected to produce a fine movement of the piston 310. The force required to operate the instrument can be selected by sizing the drive piston 406 and the piston 310.

In some preferred embodiments of the present invention, a mechanical link 410, such as a joystick mechanically connected to the piston 406, can be used to operate the drive piston 406 to operate the mechanism more economically. Appropriate link variations are provided in embodiments where more cylinders are used at the distal and / or central end of the endoscope to facilitate the operator's ease of use.

4 shows a schematic cross-sectional view of a flexible endoscope device 460 that includes a hydraulic instrument 450 in accordance with a preferred embodiment of the present invention. As described above with reference to FIG. 1, the movement of the wedge-shaped member 110 activates the biopsy jaw 114, and thus the distal movement of the member 110 closes the biopsy jaw, and the central movement. Opens the biopsy jaws. Unlike some known hydraulic biopsy instrument controls, the instrument 450 does not include a spring to open and close the biopsy jaw 114.

Operation of the instrument 450 is initiated by the movement of the drive piston 406 controlled by the operator. The movement of the drive piston 406 changes the pressure of the end flexible tube 316 and the center flexible tube 314, each of which (a) drives the end drive 322 of the drive cylinder 404 to the cylinder 328. ) And (b) the central drive 324 of the drive cylinder 404 to the central portion 313 of the cylinder 328. In this way, control of the force acting on the piston 310 can be achieved. Tubes 314 and 316 are preferably filled with an incompressible biological liquid (eg, water or saline solution).

The operator initiates movement of the piston 406 through a mechanical link 122 that is connected to the piston 406 and accessible near the central end of the portion 104. Movement of the piston 310 in the central and distal directions can be achieved by applying positive pressure to the tubes 316, 314, respectively. In particular, the central movement of the drive piston 406 closes the jaws 114, and the distal movement of the drive piston 406 opens the jaws 114. Thus, the embodiment of the present invention shown in FIG. 4 generally performs active operation in both directions in response to the application of positive pressure without the use of a spring. High levels of positive pressure are readily generated to open or close the biopsy jaw or otherwise properly operate the endoscope instrument.

 5 illustrates a schematic cross-sectional view of a flexible endoscope device 400 that includes a hydraulic instrument 412 in accordance with a preferred embodiment of the present invention. The embodiment shown in FIG. 5 is generally shown in FIG. 3, except that the mechanical link 410 (FIG. 3 is shown with two joysticks) is replaced with a single joystick 500 in FIG. 5. Similar to the embodiment shown. When the joystick 500 is moved in one direction by the user, the pressure in one drive cylinder is increased, creating a corresponding pressure increase in the flexible tube 402 connected thereto. When the joystick 500 is moved in the other direction, the pressure in the other drive cylinder is increased, creating a corresponding pressure increase in the flexible tube 402 connected to the drive cylinder.

6 shows a schematic cross-sectional view of a flexible endoscope device 600 including a hydraulic snare 602 according to a preferred embodiment of the present invention. The endoscope device 600 is the endoscope described with reference to FIG. 4, except that the biopsy jaw 114 and the associated device shown in FIG. 4 have been replaced with a noose 602 in the embodiment shown in FIG. Similar to device 460. Lasso 602 is typically used to enclose a polyp or other tissue part of a patient. As the snare is gradually retracted into the casing 604 mounted to the end member 612 of the endoscope device 600, tissue is removed.

Operation of the noose 602 is initiated by the movement of the drive piston 406. The movement of the drive piston 406 changes the pressure of the end flexible tube 316 and the center flexible tube 314 as described above. In this way, fine control of the force acting on the piston 310 can typically be achieved. The movement of the piston 310 is preferably translated directly into actuation (ie, open or closed) of the noose 602. Thus, opening and closing of the noose 602 can typically be accomplished by applying positive pressure to the tubes 314 and 316, respectively.

It should be appreciated that the snare 602 may be replaced with a receptacle forceps or other medical device known in the art.

In a preferred embodiment of the present invention, the technique disclosed herein is assigned to the applicant of the present invention and is incorporated by reference in the present invention, corresponding to the name of the invention "piston endoscope steering system" filed on July 11, 2002. It can be applied in conjunction with the apparatus and method disclosed in US Patent Application No. 60 / 395.694. This patent application is disclosed as follows.

"In a preferred embodiment of the present invention, the distal end of the flexible endoscope advances through the gastrointestinal tract with the aid of a steering mechanism near the distal end of the endoscope. The steering mechanism includes one or more cylinders each having a piston therein, The movement of the one or more pistons actuates rods, wires and / or cables in the adjustment mechanism to rotate the distal end of the endoscope The movement of the one or more pistons is achieved by the introduction or removal of fluid into the corresponding cylinder, Cause movement. The fluid is dispensed from the central end of the endoscope to the cylinder of the adjustment mechanism through the closing system of the flexible tube near the distal end of the endoscope. "

Alternatively or additionally, such a technique is described in WO 00/44275, entitled "Intracolonal Propulsion with a Flexible Sleeve," and US Patents assigned to and assigned to the assignee of the present invention. For use with the methods and apparatus disclosed in Application 09 / 646.941.

WO 00/44275 discloses the following.

"In a preferred embodiment of the present invention, a probe comprising an endoscope instrument is advanced through the patient's lower gastrointestinal tract by expansion of a flexible sleeve connected to the probe. One end of the sleeve is typically near the anus or anus of the intestine. As the sleeve is inflated using compressed gas, the probe is pushed forward and the sleeve is gradually supplied between the probe and the anus. It remains almost stationary with respect to the barrier The longitudinal movement of the sleeve relative to the wall typically occurs only in the probe adjacent to the probe itself, so that the probe is easily advanced and trauma to the gastrointestinal tract is minimized. To remove the probe, the sleeve is retracted and used to pull the probe through the anus All."

"In a preferred embodiment of the invention, the sleeve is stored in a compact form, typically in the folded or curled form, very close to the inside of the probe or the probe. The folded or curled probe is located in the center portion of the probe. Stored in the recess. As the probe advances, the sleeve gradually expands from its stored state and expands against the barrier. "

"In a preferred embodiment of the present invention, expanding the sleeve and advancing the probe through the gastrointestinal tract causes mechanical force at the central end of the probe (outside the patient's body) to insert the probe, as required when using conventional endoscopes. The present invention thus reduces or eliminates the need to apply concentrated localized pressure to any part of the patient's body and reduces friction between the device or a portion of such device and the patient's body. Can be removed or removed, and fluids or other substances can escape from the passage of the patient's body. "

According to a preferred embodiment of the present invention, combining the technique of the present invention with the technique of a "piston-type endoscope adjustment system" and the "intracolonal probe propulsion using a flexible sleeve" technique may apply unnecessary force to the gastrointestinal tract and / or An endoscope can be provided that can perform all operations (ie, instrument-operation, adjustment and propulsion) without the need for wires or other elements known to cause excessive friction during operation.

It is to be appreciated that the preferred embodiments as described above are merely exemplary, and the invention is not limited to those described and illustrated. The scope of the present invention includes not only various modifications and modifications possible to those skilled in the art having read the description disclosed herein, but also combinations and differences of features as described above. For example, while the preferred embodiment of the present invention describes a hydraulic mechanism for operation in the gastrointestinal tract, it should be appreciated that this technique can also be used in other air holes.

Claims (19)

An endoscope device having a distal end inserted into a patient's body and a central end supported outside the patient's body, A central cylinder disposed near the central end of the endoscope device, A central piston slidably embedded in the central cylinder, A distal cylinder disposed near the distal end of the endoscope device, An end piston slidably embedded in the end cylinder; A liquid-containing tube connected between the center cylinder and the end cylinder, And an instrument coupled to be actuated by the displacement of the distal piston to perform a medical action on tissue or contents of the patient's body in response to the displacement of the distal piston. The endoscope device of claim 1, wherein the instrument, the end cylinder, the end piston, and the tube pass through an operating channel of the endoscope to access an area within the body using the endoscope. The endoscope device of claim 1, wherein the instrument accesses a portion of the patient's gastrointestinal tract. The endoscope device of claim 1, wherein the instrument comprises a biopsy instrument. The endoscope device of claim 1, wherein the instrument comprises a treatment instrument. 2. The cylinder of claim 1, wherein: the end cylinder comprises two zones on each side of the end cylinder; The tube is connected with a first region of the region; A second zone of said zone wherein the distal piston movement in the first direction changes the fluid pressure in the second zone; And the end piston is connected to the end cylinder to receive a force in a second direction opposite to the first direction in response to the pressure change of the fluid. The endoscope device according to any one of claims 1 to 6, wherein the central piston is passive. 8. An endoscopic device according to claim 7, wherein said device comprises a link connected to said central piston, said link facilitating hand movement of said central piston. The endoscope device according to claim 1, wherein the mechanism is connected to the distal piston to be actuated by pressurization of the tube by liquid due to the operation of the central piston. 10. An endoscopy device according to claim 9, wherein the instrument comprises forceps and operation of the instrument by pressurization of the tube closes the forceps. 10. The endoscope device of claim 9, wherein the instrument comprises a noose, wherein actuation of the instrument by pressurization of the tube closes the noose. An endoscope device having a distal end inserted into a patient's body and a central end supported outside the patient's body, With end piston, An end cylinder in which the end piston is slidably embedded near the end of the endoscope device; A mechanism connected to be operated by displacement of the end piston, With central piston, A central cylinder slidably embedded near the central end of the endoscope device, A first tube and a second tube, The end cylinder includes a first end port adjacent the end piston and a second end port away from the end piston; The end cylinder comprises a first central port adjacent the central piston and a second central port remote from the central piston; The central motion of the central piston drives the liquid through one tube to apply positive pressure to the first side of the distal piston, thereby driving the distal piston in the first direction to place the instrument in the first state, and the distal motion of the central piston The first tube has one center port on the other side to drive the liquid through the other tube to apply a positive pressure to the second side of the end piston, thereby driving the end piston in the second direction to place the instrument in the second state. An end port, the second tube connecting the other central port to the other end port. 13. The endoscope device of claim 12, wherein the instrument, the end cylinder, the end piston, and the tube pass through an operating channel of the endoscope to access an area within the body using an endoscope. 13. The endoscope device of claim 12, wherein the instrument accesses a portion of the patient's gastrointestinal tract. 13. The endoscope device of claim 12, wherein the instrument comprises a biopsy instrument. 13. An endoscopy device according to claim 12, wherein the device comprises a treatment device. 17. The endoscope device according to any one of claims 12 to 16, wherein the central piston is operated by hand. 18. The endoscope device of claim 17, wherein the device is connected to the central piston to facilitate hand movement of the central piston. An endoscope device having a distal end inserted into a patient's body and a central end supported outside the patient's body, First and second central cylinders disposed near the central end of the endoscope device, First and second central pistons slidably embedded in each central cylinder, At least one end cylinder disposed near the distal end of the endoscope device, At least one end piston slidably embedded in the at least one end cylinder, A liquid-containing first tube connected between the first central cylinder and the at least one end cylinder, A liquid-containing second tube connected between the second central cylinder and the at least one end cylinder; To move the first central piston to form a positive pressure in the first tube when the mechanical link is displaced in the first direction, and to move the second central piston to positive pressure in the second tube when the mechanical link is displaced in the second direction. A mechanical link connected to the first central cylinder and the second central cylinder to form a; And an instrument coupled to be actuated by displacement of at least one distal piston to effect mechanical motion on the tissue or contents of the patient's body in response to displacement of the distal piston.