RU2748772C1 - Endocuff vision handpiece finger control - Google Patents

Abstract

FIELD: medical equipment.SUBSTANCE: invention relates to medical equipment and can be used in colonoscopy. A colonoscope with a viewing angle of up to 180° has a distal end intended for insertion into the patient's body, and a proximal end held outside the patient's body, on the distal end of which a nozzle is installed, consisting of an anterior ring located at the distal end, a posterior ring remote from the distal end, intersections connecting the front and rear rings, and independent elastic fingers located in the intervals between adjacent jumpers, fixed to these intersections by two short torsion bars at the front ring of the nozzle and constantly raised to the working position. A bushing is installed on the nozzle, consisting of the front and rear rings and jumpers connecting the front and rear rings.EFFECT: application of the invention will allow minimizing trauma to the mucous membrane.15 cl, 23 dwg

Description

The invention relates to medical equipment and can be used for colonoscopy in studies of the rectum, all subsections of the colon, cecum and distal ileum.

It is known to use a colonoscope with a viewing angle of up to 180 ° for examining the colon, including diagnosing benign and malignant tumors, determining the source of bleeding, examining areas of the colon mucosa with inflammatory changes, removing polyps, diagnosing intestinal obstruction and other pathologies (see "Colonoscopy in diagnosis diseases of the colon "Sotnikov V.N., Razzhivina A.A., Veselov V.V., Kuzmin A.I. et al. - M .: Extraprint, 2006.-280s .;" Colonoscopy. Illustrated guide "edited by Douglas G. Adler, translated from English under the editorship of Doctor of Medical Sciences, Prof. V.V. Veselov - M: GEOTAR-Media, 2016.)

The length of the large intestine is about 1.5 m, and in the abdominal cavity it is gathered together, forming folds and bends. To ensure adequate visualization of the intestinal wall, it is necessary to straighten the folds. For this, air and / or carbon dioxide insufflation and water immersion are used.

The use of air in colonoscopy has several disadvantages. When the colonoscope is inserted and removed, air accumulates in the lumen of the large intestine, mainly in its right sections, which causes significant discomfort for the patient during and after the procedure. In this case, the stretching of the colon causes its elongation, which complicates the intubation of the cecum and the distal part of the colon. The discomfort caused by the dilated bowel forces the patient to strain the abdominal wall, making it difficult to provide manual assistance to patients undergoing colonoscopy without anesthesia. When carbon dioxide is used, the intestines expand in the same way as when using air, which creates conditions for visualization of the mucosa. However, in comparison with air, carbon dioxide is quickly removed from the intestinal lumen, absorbed into the blood without accumulating in the lumen of the colon, which significantly reduces the patient's discomfort during and after colonoscopy. But the use of carbon dioxide requires additional costs for equipment, refueling cylinders, delivery, storage, and compliance with safety requirements at all these stages and during colonoscopy. While room air is freely available, it is safe and does not require additional costs.

Water also dilates the intestines, reduces pain and enhances visualization by straightening collapsed folds of the mucous membrane. But in poorly prepared patients, water mixes with the remnants of intestinal contents, contaminates the colonoscope lens, which makes visualization difficult and requires additional time to clean the lens.

All the considered methods of improving visualization of the colon mucosa do not allow opening deep folds, since this would require an increase in the pressure of the listed media: air, carbon dioxide, water, which in turn will lead to increased pain in the patient and additional trauma to the mucous membrane.

Known device (attachment) Endocuff Vision, which is fixedly attached to the distal end of the colonoscope with a viewing angle of up to 180 °, and promotes the disclosure of previously inaccessible areas of examination by straightening deep folds of the colon, thereby reducing the time of the study, and increasing the likelihood of detecting colon pathologies. A row of elastic fingers of the nozzle straightens the folds, providing a better view and the ability to examine each area of the colon mucosa, which allows you to identify even the smallest polyps located behind deep folds, and to increase the examination speed (see Medical technologies guidance, NICE (2019) "ENDOCUFF VISION for assisting visualization during colonoscopy "; Experimental and clinical gastroenterology No. 4 (2019)" Modern endoscopic technologies in the diagnosis of colon neoplasia "V.A. Duvansky, Y.O. Chesalina).

Structurally, the nozzle is made in the form of a lattice sleeve, consisting of ( see Fig. 1; Fig. 2; Fig. 3; Fig. 4 ):

- anterior ring located near the distal end

colonoscope pos. 1 ;

- the back ring, remote from the distal end, pos . 2;

- jumpers connecting the front and rear rings, pos . 3;

- independent from each other elastic fingers position 4 , located

in the intervals between adjacent jumpers fixed to

these jumpers with two short torsion bars, pos. 5, see fig. 4;

Fig. 9; Fig. 15 at the front ring of the nozzle and constantly raised in

working position.

A notch in the grate of the nozzle, formed by two adjacent webs, the front and rear rings, allows the finger to be immersed in the grate flush with the outer surface of the nozzle. The nozzle is made of durable and resilient plastic, which allows:

- securely, with an interference fit, install the nozzle on the distal end

colonoscope, excluding axial and circular displacements;

- bend the free ends of the fingers repeatedly from 0 ° -fingers

recessed into the cutouts of the nozzle, up to 180 ° - the fingers are bent forward

relative to the distal end.

Each time after the load is removed, the fingers, under the action of the elastic forces of the torsion bars, return to the working position, in which the free end of the fingers is raised above the surface of the nozzle at an angle of approximately 45 °.

With the introduction of a colonoscope with a nozzle into the large intestine, the volume of research is insignificant. At this stage, the main task of the endoscopist doctor is to perform with a minimum amount of time:

- gathering (shortening) of the large intestine by movements of the colonoscope

back and forth;

- pass the colonoscope through all turns of the colon;

- insert the colonoscope into the dome of the large intestine and intubate the distal

ileum section by 10-15cm.

In this regard, the fingers of the nozzle, constantly raised to the working position, will either touch - when the colonoscope moves forward, or cling to the walls of the large intestine, turning up to 180 ° - when the colonoscope moves backward. Thus, when moving the colonoscope forward along the large intestine, the nozzle practically does not fulfill its main purpose, declared by the developer of Endocuff Vision, but unnecessarily injures the mucous membrane.

The endoscopist begins the main examination of the large intestine during the withdrawal of the colonoscope:

- assesses the condition of the mucous membrane;

- detects benign (polyps) and malignant (cancer) formations.

And from that moment on, the fingers of the nozzle, raised to the working position, allow the endoscopist to expand the field of vision in certain areas of the colon, including between deep folds, and increase the possibility of detecting pathological changes and small formations (less than 5 mm) at an early stage.

It should be borne in mind that not all areas of the colon surface are inaccessible for examination when the colonoscope is removed. Therefore, even at the stage of removing the colonoscope, the endoscopist doctor does not always need the fingers raised to the working position. It follows that the position of the nozzle fingers should be controlled by an endoscopist as needed.

The objective of the invention is to improve the nozzle, which allows the endoscopist to control the position of the fingers of the nozzle during the examination of the large intestine in order to minimize trauma to the colon mucosa.

This goal can be achieved by the fact that a lattice sleeve is installed on the nozzle with the ability to move along the surface of the nozzle along the axis of the colonoscope. For this, the surface of the nozzle must be cylindrical. In design, the sleeve is similar to the design of the nozzle and contains:

- front ring at the distal end of the colonoscope, pos . 7;

- back ring, remote from the distal end of pos. 8 ;

- jumpers connecting the front and rear rings, pos . 9;

See figure 1; figure 2; Fig. 3.

The sleeve is made of the same material as the nozzle. Unlike the nozzle, there are no fingers on the sleeve. Both the nozzle and the sleeve are missing two diametrically located bridges. Moreover, on the nozzle, part of the jumpers position 6 at the front ring is retained for attaching adjacent fingers, see Fig. 5; Fig. 6; Fig. 7 and Fig. 15 . In place of the missing bridges, two double-acting hydraulic cylinders, pos. 13, are installed; fourteen; 15, see figure 3; Fig. 9; Fig. 5; Fig. 6; Fig . 7. Cases of hydraulic cylinders fixedly secured between pos.13 pos.6 webs residue at position 1 of the front ring and the rear ring packing item 2 with the possibility of dismantling for replacement sm.fig.5; 6 and 7 . The piston of the hydraulic cylinder, pos. 14, has a double-sided rod, pos. 15 , made of high-strength, corrosion-resistant steel, see Fig. 5; 6 and 7 . The ends of the rod is pivotally connected with the front and rear pos.7 pos.8 sleeve rings, see Figure 5.; Fig. 6; Fig. 7; Fig . 8. For this purpose, the front and rear pos.7 pos.8 ring reinforced sleeve two rows of wire position 10, which is fastened to docking units item 11 for connection with the ends of the rods of hydraulic cylinders poz.15 sm.fig.5; Fig. 6; Fig. 7; Fig . 8. Reinforcing wire, pos. 10 , docking assemblies, pos. 11, and pivot axes, pos. 12, are made of high-strength, corrosion-resistant steel.

When fluid is supplied to the rear cavities of the hydraulic cylinders, the sleeve moves to the distal end of the colonoscope. In this case, the front sleeve ring pos.7 drives off the tips of fingers and they pos.4 under the influence of elastic forces are raised to the operating position sm.fig.1.

When fluid is supplied to the anterior cavities of the hydraulic cylinders, the sleeve moves towards the proximal end of the colonoscope. In this front hub ring pos.7 runs into the nozzle pos.4 fingers and pushes them into the nozzle recesses, returning the fingers to the initial position sm.fig.2.

To transfer the fingers from the working position to the initial position, it is sufficient to push the front ring of the bushing approximately 1/3 of the length of the fingers of the nozzle.

The use of two hydraulic cylinders located in the diametrical plane eliminates the skew of the sleeve when moving along the nozzle.

To supply fluid to each cavity of the hydraulic cylinder in the body of pos. 13 , two channels are made, pos. 16 and pos. 17, see Fig. 11 and Fig. 12 , one of which enters the front cavity of the hydraulic cylinder, pos. 18, see Fig. 13 , and the second channel enters the rear cavity of the hydraulic cylinder, pos. 19, see Fig. 14. Both inlets to the hydraulic cylinders are made near the end walls of the cylinder, see Fig . 15. In this case, the rear end wall, pos. 20, has a constructive sealed connector with the body, pos. 13, see Fig. 5; Fig. 6; Fig. 7; Fig . 15. In the end walls of the hydraulic cylinder, rod seals are installed, pos. 21 , and on the piston, there is a seal with the cylinder wall, pos. 22, see Fig. 5; Fig. 6; Fig. 7.

The channels for the fluid supply in the housings of the two hydraulic cylinders, pos. 16 and pos. 17, have their continuation in the rear ring of the nozzle, see Fig. 15 and Fig. 16. The joints of the channels of the hydraulic cylinders and the rear ring of the nozzle are made with a seal, pos. 23, see Fig. 16. The joints are kept from opening by the elastic forces of the nozzle jumpers when the hydraulic cylinders are installed in the spindle between the front and rear nozzle rings. And from the displacement of the bodies of the hydraulic cylinders relative to the nozzle, the protrusions and the corresponding depressions on the body of the hydraulic cylinder and on the remainder of the jumper at the front ring of pos. 24 and the rear ring of pos. 25 of the nozzle, see Fig. 16; Fig. 17 and Fig. 18.

The length of the proposed device, containing the nozzle, the sleeve in all its positions and two hydraulic cylinders, is not more than the length of the straight part remaining from the curved distal end of the colonoscope.

The proposed device includes a thin-walled five-channel hose, pos. 26, see Fig. 19. The diameter of the central channel of the hose is made with a small gap from the outer surface of the colonoscope tube for installation and removal for sterilization. Four other channels located along the periphery of the hose are grouped in 2 pieces. in the diametrical plane and serve to supply fluid in the cavity of two hydraulic cylinders. The hose is made of highly elastic, durable, medical grade plastic that can withstand fluid pressure and has a low coefficient of friction outside and inside the hose passages. Structurally, the hose consists of three one-piece sections:

- I section at the distal end of the colonoscope;

- II area at the proximal end of the colonoscope;

- III area between distal I and proximal II areas

colonoscope.

The rear ring of the nozzle and the I section of the hose are joined by channels for liquid, see Fig. 15 and Fig. 20. The joints are split and made with seals pos. 28, see fig. 22. The joints are kept from opening by two diametrically located latches pos. 27, see Fig. 23 mounted at 90 ° to the fluid passages, see Fig. 20 , and pressing the hose against the back ring of the nozzle.

In section I of the hose, the diameter of the holes of the channels for the liquid entering from the rear ring of the nozzle is slightly increased. For this, a small length transition zone is made in the channels, pos. 29, see Fig. 24. The goal of increasing canal diameters is to reduce resistance when moving fluid from the proximal to the distal end of the colonoscope and vice versa.

In section II of the hose, in order to synchronize the movement of the pistons in the hydraulic cylinders at the distal end, the channels supplying liquid to the front cavities of the hydraulic cylinders and the channels supplying liquid to the rear cavities of the hydraulic cylinders are combined in pairs into two independent channels, pos. 30 with a corresponding increase in the cross-sectional area of the holes in the combined channels see Fig . 19.

At the end of the II section of the hose, a double-acting hydraulic cylinder, pos. 31 , is installed, the piston of which, pos. 32, has a one-way rod, pos. 33 , driven by an endoscopist, for example, using a lever, pos. 34, see Fig. 19.

When moving the piston in the cylinder from one extreme position to another:

- in one cavity, a vacuum occurs, and the liquid from

hydraulic cylinders at the distal end moves along the hose channels

into the hydraulic cylinder at the proximal end;

- simultaneously in another cavity of the hydraulic cylinder on the proximal

at the end, the pressure rises, and the liquid through the channels of the hose

moves into hydraulic cylinders at the distal end.

Thus, in the hydraulic cylinders at the distal end, simultaneous depression in some cavities and an increase in pressure in other cavities leads to synchronous movement of the pistons and sleeve along the nozzle, opening the fingers to the working position or closing them to the initial position.

The design of the hydraulic cylinder in the II section is similar to the hydraulic cylinders at the distal end of the colonoscope. The volume of the working cavities of the hydraulic cylinder at the proximal end with a margin is equal to the sum of the volumes of the working cavities of the hydraulic cylinders at the distal end. The hydraulic cylinder at the proximal end of the colonoscope is fixed on the tube in a position convenient for the endoscopist doctor.

Section III of the hose has a constant cross-section extending from section I at the distal end to section II at the proximal end of the colonoscope.

Using the handpiece fingers will require additional time and effort on the part of the endoscopist. However, given the small stroke of the sleeve and the elasticity of the nozzle fingers, the burden on the doctor will be insignificant.

The above example of the implementation of the present invention is given as a version and does not exclude other possible options for solving the problem, allowing the endoscopist to control the position of the nozzle fingers from the proximal end of the colonoscope in order to minimize trauma to the colon mucosa during the study.

Brief description of the drawings.

- figure 1 shows a section along the axis of the device with the sleeve displaced to the distal end of the colonoscope, and the nozzle fingers raised to the working position;

- figure 2 shows a section of the device along the axis with the sleeve displaced to the proximal end of the colonoscope, and the fingers of the nozzle lowered to the initial position;

- figure 3 shows a section A-A of the device with the fingers raised to the working position;

- Fig. 4 shows a section BB of the device with the fingers lowered in the initial position into the cutouts of the nozzle, and showing the torsion bars with which the fingers are fixed to the jumper of the nozzle;

- figure 5 shows a section B-B of the device in the axial plane of two hydraulic cylinders with a sleeve displaced to the distal end of the colonoscope;

- Fig. 6 shows a unit L, showing the installation of the hydraulic cylinder body in the spacer between the remainder of the bridge at the front ring of the nozzle and the rear ring of the nozzle;

- Fig. 7 shows a section G-G of the device in the axial plane of two hydraulic cylinders with a sleeve displaced to the proximal end of the colonoscope;

- figure 8 shows a section T-T, showing the articulated connection of the hydraulic cylinder rod with the joint of the rear ring of the sleeve, reinforced with wire;

- Fig. 9 shows a section U-U, showing the nozzle pins in the closed position, nozzle jumpers, bushing jumpers, two hydraulic cylinder bodies and torsion bars securing the fingers to the nozzle jumpers;

- figure 10 shows a section Ш-Ш, showing the hinge between the hydraulic cylinder rod and the joint unit of the rear ring of the sleeve;

- figure 11 shows a section II, showing the design of the hydraulic cylinder body under the rod and the rod docking unit with the rear ring of the sleeve, as well as two channels for fluid in the body of the hydraulic cylinder;

- Fig. 12 shows a section З-З, showing the rear end wall having a structural connection with the body of the hydraulic cylinder and channels for fluid in the body of the hydraulic cylinder;

- figure 13 shows a section D-D, showing the entrance of the channel under the fluid into the front cavity of the hydraulic cylinder;

- Fig. 14 shows a section Zh-Zh, showing the entrance of the channel under the fluid into the rear cavity of the hydraulic cylinder;

- Fig. 15 shows a section E-E showing the unfolding of the nozzle surface, including the sole of the cylinder body and the hose;

- Fig. 16 shows a section K-K, showing the joint of the hydraulic cylinder body and the rear ring of the nozzle with the seal of the annular protrusion and the annular cavity of the channel for the liquid;

- Fig. 17 shows a node C, showing the vertical joint and fixation of the cylinder body with the remainder of the bridge at the front ring of the nozzle;

- Fig. 18 shows a section MM, showing the horizontal joint and fixation of the cylinder body with the remainder of the bridge at the front ring of the nozzle;

- Fig. 19 shows a section F-F, showing a five-channel hose, schematic images of two hydraulic cylinders at the distal end, a hydraulic cylinder at the proximal end of the colonoscope and hydraulic channels connecting the hydraulic cylinders;

- Fig. 20 shows a section H-H at the junction of the rear ring of the nozzle and the hose with four holes for the liquid, grouped by two in the diametrical plane and two latches set at an angle of 90 ° relative to the channels for the liquid;

- Fig. 21 shows a section P-P showing a change in the thickness of the hose wall above the channels after an increase in their diameters in the I section;

- Fig. 22 shows a section C-C, showing the joint of the channels for the liquid of the rear ring of the nozzle and the hose with the seal of the annular protrusion and the annular cavity;

- Fig. 23 is a view P showing the latches between the rear ring of the nozzle and the hose;

- Fig. 24 shows a section X-X, showing the transition zone of the channel diameters for the liquid from the rear ring of the nozzle to the hose.

Claims (15)

1. A colonoscope with a viewing angle of up to 180 °, having a distal end intended for introduction into the patient's body, and a proximal end held outside the patient's body, on the distal end of which a nozzle is installed, consisting of an anterior ring located at the distal end, a posterior ring, remote from the distal end, the bridges connecting the front and rear rings, and independent from each other elastic fingers located in the intervals between adjacent bridges, fixed to these bridges by two short torsion bars at the front ring of the nozzle and constantly raised to the working position, characterized in that a bushing is installed on the nozzle, consisting of the front and rear rings and jumpers connecting the front and rear rings. 2. Colonoscope according to claim 1, characterized in that the outer surface of the nozzle, including rings, webs and fingers, is cylindrical. 3. Colonoscope according to claim 1, characterized in that there are no two diametrically located bridges on the nozzle and on the sleeve, while on the nozzle a part of the bridges at the front ring is retained for attaching adjacent fingers. 4. The colonoscope according to claim 3, characterized in that in place of the missing bridges, two double-acting hydraulic cylinders are installed, the bodies of which are fixedly fixed between the rest of the bridges at the front ring of the nozzle and the rear ring of the nozzle with the possibility of dismantling. 5. Colonoscope according to claim 4, characterized in that the double-sided rods of the hydraulic cylinders are pivotally connected to the front and rear rings of the sleeve. 6. Colonoscope according to claim 1, characterized in that in the bodies of the hydraulic cylinders according to claim 4 there are two channels, one of which enters the front cavity of the hydraulic cylinder, and the second enters the rear cavity of the hydraulic cylinder. 7. Colonoscope according to claim 4, characterized in that the channels in the housings of the two hydraulic cylinders have their continuation in the rear ring of the nozzle, and the joints of the channels in the housing of the hydraulic cylinders and the rear ring of the nozzle have seals. 8. The colonoscope according to claim 1, characterized in that the proposed device includes a five-channel hose installed by the central channel on the tube of the colonoscope with the possibility of installation and removal, four other channels located along the periphery of the hose are grouped in two in the diametrical plane, serve to supply fluid in the cavity of two hydraulic cylinders according to claim 4. 9. Colonoscope according to claim 8, characterized in that the section of the hose at the distal end of the colonoscope is docked by four channels with the rear ring of the nozzle with a joint seal, while the joints are kept from opening by two diametrically located latches installed at an angle of 900 relative to the fluid channels. 10. The colonoscope of claim 8, wherein the diameters of the openings of the four fluid channels in the hose are increased to reduce resistance to fluid movement from the distal end to the proximal end of the colonoscope and vice versa. 11. Colonoscope according to claim 8, characterized in that the hose channels at the proximal end, supplying fluid to the front cavities of the hydraulic cylinders, and the hose channels supplying fluid to the rear cavities of the hydraulic cylinders, are combined in pairs into two independent channels with a corresponding increase in the cross-sectional area of the holes in the channels ... 12. The colonoscope according to claim 1, characterized in that a double-acting hydraulic cylinder with a one-way rod is installed at the proximal end, the cavities of which are connected to the combined channels of the hose according to claim 11. 13. The colonoscope according to claims 4 and 8, characterized in that it is configured to move the piston in a cylinder at the proximal end of the colonoscope, while the liquid through a closed system of channels leads to synchronous movement of the pistons of two hydraulic cylinders at the distal end of the colonoscope, and is configured to move sleeve, which either runs over the fingers of the nozzle, closing them to their original position, or slides off the fingers, opening them to the working position. 14. The colonoscope according to claim 13, characterized in that it is configured to move the hydraulic cylinder piston at the proximal end of the colonoscope using a lever pivotally connected to the rod. 15. Colonoscope according to claim 14, characterized in that the hydraulic cylinder at the proximal end of the colonoscope is attached to the tube.

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