RU2792751C1 - Nozzle for opening the folds of the colon - Google Patents

Abstract

FIELD: medical devices.

SUBSTANCE: invention is intended to extract the individual components of a layer-by-layer separated liquid. The nozzle attached to the distal end of the colonoscope is designed to open the deep folds of the colon. An open tubular torus made of anisotropic material is used as a working body. The nozzle contains eight radial tubular spokes evenly placed around the circumference of the torus, an annular nozzle collector at the distal end of the colonoscope, an intermediate annular nozzle collector, eight longitudinal channels between the annular collectors at the distal end and the intermediate one, and eight longitudinal channels emerging from the intermediate annular collector.

EFFECT: use of this invention will improve visualization, open the folds of the colon, regardless of the degree of their mutual compression without injury to the mucous membrane.

17 cl, 15 dwg

Description

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

Known nozzle Endocuff Vision, which is fixedly attached to the distal end of the colonoscope with a viewing angle of up to 180° and contributes to the disclosure of previously inaccessible areas of inspection by straightening the deep folds of the colon, thereby reducing the time of the study, and increasing the likelihood of detecting pathology of the colon. A number of elastic fingers of the nozzle, straightening the folds, provide 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 increase the speed of the study (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, Ya.O. Chesalina).

Structurally, the nozzle is made in the form of a lattice sleeve, consisting of:

- an anterior ring located near the distal end of the colonoscope;

- rear ring, remote from the distal end;

- jumpers connecting the front and rear rings;

- elastic fingers independent from each other, located in the gaps between adjacent jumpers, fixed to these jumpers by two short torsion bars at the front ring of the nozzle.

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 about 45°.

In this regard, the fingers of the nozzle, constantly raised to the working position when the colonoscope is inserted into the colon, will touch, and when removed, they will cling to the walls of the colon, twisting at an angle of up to 180°, unnecessarily injuring the mucous membrane.

A device for controlling the fingers of the nozzle Endocuff Vision is known (see patent for invention No. 2748772, author Akopyan O.G.).

The known device allows the endoscopist to control the position of the nozzle fingers, opening them to the working position when examining deep folds of the colon that are difficult to visualize and closing them to their original position when the fingers are not needed.

To open the fingers to the working position and close them to their original position, a lattice sleeve is installed on the Endocuff Vision nozzle with the ability to move along the surface of the nozzle along the axis of the colonoscope. In its design, the sleeve is similar to the design of the nozzle and contains:

- anterior ring at the distal end of the colonoscope;

- back ring, remote from the distal end;

- jumpers connecting the front and rear rings.

Both on the nozzle and on the sleeve there are no two diametrically located jumpers. Moreover, on the nozzle, a part of the jumpers near the front ring is retained for attaching adjacent fingers. In place of the missing jumpers, two double-acting hydraulic cylinders are installed. The bodies of the hydraulic cylinders are fixedly fixed on the nozzle, and the double-sided piston rods of the hydraulic cylinders are pivotally connected to the front and rear rings of the movable bushing.

When fluid is supplied to the rear cavities of the hydraulic cylinders, the sleeve is shifted to the distal end of the colonoscope. In this case, the front ring of the bushing slides off the fingers of the nozzle and they, under the action of the elastic forces of the torsion bars, rise to the working position.

When fluid is supplied to the anterior cavities of the hydraulic cylinders, the sleeve moves towards the proximal end of the colonoscope. In this case, the front ring of the sleeve runs over the fingers of the nozzle and presses them into the cutouts of the nozzle, returning the fingers to their original position.

To supply liquid to each cavity of the hydraulic cylinder, two channels are made in the body, one of which enters the front cavity of the hydraulic cylinder, and the second channel enters the rear cavity of the hydraulic cylinder.

Channels for fluid supply in the housings of two hydraulic cylinders have their continuation in the rear ring of the nozzle. The joints of the channels of the hydraulic cylinders and the rear ring of the nozzle are made with a seal. The elastic forces of the nozzle jumpers keep the joints from opening when the hydraulic cylinders are installed wide apart between the front and rear rings of the nozzle.

To supply fluid from the proximal end of the colonoscope to the distal one, a five-channel hose is included in the known device. The central channel of the hose is installed on the tube of the colonoscope. Four other channels located along the periphery of the hose are grouped in 2 pcs. in the diametrical plane and serve to supply fluid to the cavities of two hydraulic cylinders. Structurally, the hose consists of three one-piece sections:

- I site at the distal end of the colonoscope;

- II site at the proximal end of the colonoscope;

- III section between the distal I and proximal II sections of the colonoscope.

The back ring of the nozzle and the I section of the hose are joined by fluid channels. The joints are detachable and made with seals. The joints are kept from opening by two diametrically located latches, installed at an angle of 90 ° relative to the fluid channels, and pressing the hose against the back ring of the nozzle.

On the II section of the hose, in order to synchronize the movement of the pistons in the hydraulic cylinders at the distal end, the channels supplying fluid to the front cavities of the hydraulic cylinders and the channels supplying fluid to the rear cavities of the hydraulic cylinders are combined in pairs into two independent channels.

At the end of the II section of the hose, on the tube of the colonoscope, there is a double-acting hydraulic cylinder, the piston of which has a one-sided rod, driven by the endoscopist using a lever.

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

- a vacuum occurs in one cavity, and the fluid from the hydraulic cylinders at the distal end moves through the hose channels to the hydraulic cylinder at the proximal end;

- at the same time, in another cavity of the hydraulic cylinder at the proximal end, the pressure rises, and the liquid moves through the hose channels to the hydraulic cylinders at the distal end.

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

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 a known device, the doctor can open the fingers of the nozzle in front of the examined fold and move the colonoscope towards the proximal end to bring the fingers to the fold. Then, with the same movement of the colonoscope towards the proximal end, with the fingers of the nozzle, pull and open the fold, providing access for examination of the mucosa in the former blind area.

After examining the mucosal surface behind this deep fold, the fingers of the nozzle can be closed and the diagnosis of those areas of the colon where it is not necessary to use the fingers of the nozzle can be continued.

In this way, the physician can minimize injury to the colonic mucosa.

The fingers of the Endocuff Vision handpiece are flexible and independent of each other, and if, when opening deep folds, the doctor applies a load that exceeds the rigidity of the fingers, then individual fingers will deform and the fold will not be opened.

The amount of force that must be applied to the fingers to open the folds depends on the force of mutual compression of these folds.

At the same time, if you abandon the elasticity of the fingers and increase their rigidity, then the ends of the fingers of the nozzle, discretely located around the circumference, will injure the mucous membrane of the folds.

The device for controlling the Endocuff Vision nozzle fingers uses a movable sleeve that, moving along the outer surface of the nozzle, either runs over the fingers, pressing them into the nozzle cutouts to their original position, or slides off the fingers, opening them to the working position. With insufficient preparation of the intestine for colonoscopy, the patient may remain in the colon with fecal particles of various densities. If these particles get caught between the fingers and the colonoscope, or between the rings of the sleeve and the handpiece surface, the sleeve will either be difficult to move or the sleeve will not budge at all.

The objective of the invention is a nozzle on the distal end of the colonoscope, which allows, in order to improve visualization, to open the folds of the colon, regardless of the degree of their mutual compression, without injuring the mucous membrane. The proposed nozzle does not have mutually movable, rubbing parts at the distal end of the colonoscope, which eliminates the failure to control the nozzle when moving its working part from its original position to the working one and vice versa in case of insufficient preparation of the patient's intestines.

Brief description of the drawings.

- in Fig. 1 shows: a longitudinal section of the hose and nozzle with the torus and spokes raised to the working position, the cross-sections of the annular collectors at the distal end and the intermediate one, the joint line of the hose nozzle;

- in Fig. 2 shows: a longitudinal section of the hose and nozzle with the torus and spokes lowered to their original position, the cross-sections of the annular collectors at the distal end and the intermediate one, the junction line of the hose nozzle;

- in Fig. 3 shows: a longitudinal section of the hose and nozzle with a torus and spokes bent beyond the distal end at the moment of pulling and opening the folds, cross-sections of the annular collectors at the distal end and the intermediate one, the junction line of the hose nozzle;

- in Fig. 4 shows a section A-A of the nozzle with the torus in the working position, showing the mating of the torus channel, eight spokes and the annular collector of the distal end;

- in Fig. 5 is a B-B section of the nozzle, showing cross sections of the eight longitudinal channels, the relative position of the eight raised spokes and the longitudinal channels, the annular collector at the distal ring, and the shell of the nozzle;

- in Fig. 6 shows a section B-B, showing the torus lowered to its original position until it comes into contact with the longitudinal channels, cross sections of the longitudinal channels and spokes;

- in Fig. 7 is a view D showing the extension of the nozzle from the annular manifold at the distal end with the torus and spokes lowered to their original position, and the extension of the hose to the annular manifold at the proximal end; longitudinal channels between the collectors at the distal end and the intermediate; longitudinal channels grouped in twos from the intermediate annular manifold and along the entire length of the hose to the proximal end; grouping two longitudinal channels into one before entering the annular manifold at the proximal end; joint of pairwise grouped longitudinal channels of nozzle and hose and latches connecting nozzles and hose; hose outlet from the proximal end ring manifold to a three-way L-cock;

- in Fig. 8 shows the section D-D, showing eight longitudinal channels of the nozzle and hose grouped in pairs in two mutually perpendicular planes before and after the junction of the nozzle and hose;

- in Fig. 9 shows the I-I section along the junction of eight longitudinal channels of the nozzle and hose grouped in pairs, as well as four latches connecting the nozzle and hose, located at an angle of 45 ° relative to the axes of the paired channels;

- in Fig. 10 shows a K-K section, showing a hose with eight pairwise grouped longitudinal channels of increased diameter from the junction with the nozzle to the annular manifold at the proximal annulus;

- in Fig. 11 is a PP section of the hose showing four enlarged diameter longitudinal passages in front of the annular manifold at the proximal end;

- in Fig. 12 shows the section L-L along the axis of the longitudinal channels of the nozzle and the hose, showing the change in the diameters of the longitudinal channels of the hose, as well as the cross sections of the torus in the initial position and the annular collectors: at the distal end, intermediate and proximal ends; seal at the junction of the nozzle and hose;

- in Fig. 13 shows the section M-M, showing the torus and spokes in the initial position, the shell of the nozzle and the hose, the latch in the longitudinal section and the cross sections of the annular collectors: at the distal end, intermediate and proximal end with the hose outlet to the three-way L-shaped valve from the annular a hose manifold at the proximal end;

- in Fig. 14 shows: torus and spokes in working position; cut along the axis of the longitudinal channels of the nozzle and hose; three-way L-shaped valve in the open position for the annular manifolds, and the longitudinal channels of the hose and nozzle and closed for the release of compressed air into the atmosphere through the silencer, as well as the compressor station;

- in Fig. 15 shows: the torus in its original position; cut along the axes of the longitudinal channels of the nozzle and hose; a three-way L-shaped valve in the position closed for the hose and nozzle and open to discharge compressed air through the silencer to the atmosphere, as well as a compressor station.

Implementation of the invention.

This goal can be achieved by the fact that in the nozzle proposed for consideration:

1. In contact with the fold of the colon are at the same time parts of the torus and one or two spokes, see Fig. 3, which significantly reduces the possibility of injury to the mucosa. And the fact that both the torus and the spokes have a circular section reinforces this assumption.

2. The relatively high rigidity of the system of a tubular torus connected to tubular spokes, see FIG. 4, allows a large axial load to be applied to the colonoscope as the colonic folds open.

3. To control the positions of the torus from the initial to the working one and vice versa, compressed air and the elastic properties of the materials of the torus and spokes are used, see Fig. 14 and FIG. 15, with the complete absence of mutually movable, rubbing parts in the design of the nozzle.

In its design, the nozzle consists of:

- open tubular torus pos. 1 see fig. 1 - fig. 7; fig. 12 - fig. 15, made of an anisotropic, elastic material, which allows, under compressed air pressure, to increase the diameter of the guide circle of the torus, raising it to the working position, while maintaining the diameter of the generatrix of the torus unchanged, and after relieving air pressure due to the elastic forces of the torus material, to reduce the diameter of the guide circle , lowering the torus to its original position;

- eight radial tubular spokes evenly spaced around the circumference of the torus pos. 2 see FIG. 1 - fig. 7; fig. 13; fig. 14; the channels of the spokes are connected to the annular channel of the torus; the spokes are made of a material that has elastic properties along the axis, but keeps the diameter of the spokes unchanged under compressed air pressure; in the manufacture of the spokes were molded in the working position of the torus;

- an annular collector of the nozzle at the distal end of the colonoscope pos. 4 see FIG. 1 - fig. 5; fig. 7; fig. 12 - fig. 15 connected to the channels of the spokes;

- eight longitudinal channels of the nozzle pos. 3 see FIG. 5 - fig. 7; fig. 12; fig. 14; fig. 15, evenly spaced around the circumference at an angle of 22.5° relative to the spokes, connected to the annular channel of the collector at the distal end of pos. 4;

- an intermediate annular collector of the nozzle pos. 7 see FIG. 1 - fig. 3; fig. 7; fig. 12 - fig. 15 connected to the longitudinal channels pos. 3;

- eight longitudinal channels of the nozzle grouped in pairs in two mutually perpendicular diametrical planes pos. 6 see FIG. 7; fig. 8; fig. 12; fig. 14; fig. 15 connected to the intermediate ring manifold pos. 7;

- covering hooks of four latches pos. 12 see fig. 7; fig. 9 located at an angle of 45° relative to the paired longitudinal channels;

- shells pos. 5 see FIG. 1 - fig. 3; fig. 5 - fig. 7; fig. 13, uniting the annular collectors at the distal end of pos. 4 and intermediate pos. 7 and longitudinal channels pos. 3;

A hose pos. 8 see FIG. 1 - fig. 3; fig. 8; fig. 9, which consists of:

- covered hook of four latches pos. 12 see fig. 7; fig. 9 located at an angle of 45° relative to the paired longitudinal channels;

- eight longitudinal channels grouped in pairs in two mutually perpendicular diametrical planes, similar to the nozzle channels pos. 9 see FIG. 7 - fig. 10; fig. 12; fig. 14; fig. 15; in order to reduce resistance when moving air, the diameters of the channels after the junction with the nozzle and up to the proximal end are increased;

- seals pos. 11 see FIG. 12 joints of eight longitudinal channels of the nozzle and hose;

- four longitudinal channels of increased diameter pos. 13 see FIG. 7; fig. eleven; fig. 12; fig. 14; fig. 15, grouped from eight longitudinal channels pos. 9 and located in two mutually perpendicular planes;

- an annular collector at the proximal end of pos. 14 see fig. 7; fig. 12 - fig. 15 connected to the longitudinal channels pos. 13;

- shells pos. 10 see fig. 7; fig. 10; fig. eleven; fig. 13, combining the longitudinal channels pos. 9; pos. 13 and an annular manifold at the proximal end of pos. 14;

- outlet of the hose pos. 15 see fig. 7; fig. 13 - fig. 15 from the annular manifold at the proximal end to a three-way L-cock;

- three-way L-shaped valve pos. 16 see fig. 14; fig. 15;

- compressor station pos. 19 see fig. 14; fig. 15;

- hose pos. 17 see FIG. 14; fig. 15, connecting the three-way L-shaped valve pos. 16 with compressor station pos. 19;

- silencer pos. 27 see fig. 14; fig. 15;

- hose pos. 18 see fig. 14; fig. 15, connecting the three-way L-shaped valve pos. 16 with silencer pos. 27;

Compressor station pos. 19 see fig. 14; fig. 15 consists of:

- compressor pos. 20;

- check valve pos. 21;

- particulate filter pos. 22;

- receiver pos. 23;

- electrocontact pressure gauge pos. 24, which controls turning on the compressor when the air pressure in the receiver drops below the set value and turning off the compressor when the set pressure in the receiver reaches the set value;

- water separator filter with automatic condensate drain pos. 25;

- pressure reducing valve without pressure release pos. 26, providing a constant pressure at the outlet of the valve; at the same time, the inlet pressure to the pressure reducing valve from the receiver, installed on the electrocontact pressure gauge, must always remain higher than the outlet pressure from the pressure reducing valve.

Thus, before the start of the working day, you must:

- set the three-way L-cock in position to bleed air through the silencer, see fig. 15;

- turn on the compressor and wait until the receiver is filled with compressed air to the upper pressure level set on the electronic contact manometer and then the compressor is turned off.

Then proceed to the study of the colon. Before examining the mucosa between deep folds, it is necessary to connect the compressor station with the nozzle by turning the handle of the three-way L-shaped valve, see Fig. 14, thus raising the torus to the working position in front of the examined fold and perform actions to open the folds of the colon mucosa.

After completing the examination of the mucosa in this blind area, it is necessary to return the torus to its original position; to do this, by turning the handle of the three-way L-shaped valve, connect the nozzle and hose to the silencer, see Fig. 15.

During the working day, as compressed air is consumed from the receiver and the pressure drops to the set low level, the compressor will periodically turn on to increase the pressure to the upper level set on the electrocontact pressure gauge. At the end of the working day, the compressor must be switched off.

The above example of the implementation of the present invention does not exclude other options for the design of the nozzle, the hose, the complete set of the compressor station with finished products, with the exception of using a tubular torus made of anisotropic, elastic material as the working body of the nozzle, tubular spokes made of an elastic material and compressed air for control torus positions.

Claims (18)

1. Nozzle fixed at the distal end of the colonoscope, designed to open deep folds of the colon, characterized in that the working body is an open tubular torus made of anisotropic material, containing eight radial tubular spokes evenly spaced around the circumference of the torus, an annular collector nozzles at the distal end of the colonoscope, intermediate annular manifold of the nozzle, eight longitudinal channels between the annular manifolds at the distal end and the intermediate one, eight longitudinal channels coming out of the intermediate annular manifold. 2. Nozzle according to claim. 1, characterized in that the annular channel of the torus is connected to eight channels of radial tubular spokes. 3. The nozzle according to claim 1, characterized in that compressed air and the elastic properties of the materials of the torus and spokes are used to control the working and initial positions of the torus. 4. Nozzle according to claim 2, characterized in that the channels of eight tubular spokes are connected to an annular collector at the distal end of the colonoscope. 5. Nozzle according to claim. 4, characterized in that the annular collector at the distal end is connected to eight longitudinal channels evenly distributed around the perimeter of the nozzle and offset by an angle of 22.5° relative to the spokes. 6. The nozzle according to claim. 4, characterized in that the longitudinal channels from the annular manifold at the distal end are connected to the intermediate annular manifold. 7. The nozzle according to claim 6, characterized in that eight longitudinal channels grouped in pairs in two mutually perpendicular diametrical planes are connected to an intermediate annular collector from the side opposite to the longitudinal channels according to claim 5. 8. Nozzle according to claim 7, characterized in that the proposed device includes a nine-channel hose installed by the central channel on the colonoscope tube with the possibility of installation - removal; eight other longitudinal channels are grouped in pairs in two mutually perpendicular diametrical planes, similarly to the nozzle channels according to item 7, they serve to move compressed air. 9. Nozzle according to claim 8, characterized in that eight longitudinal channels of the hose and nozzle are connected in pairs through seals using four diametrically located latches installed at an angle of 45 ° relative to the axes of the paired channels. 10. Nozzle according to claim 8, characterized in that eight pairwise paired longitudinal channels of the hose at the proximal end of the colonoscope are grouped into four longitudinal channels of increased diameter in two mutually perpendicular diametral planes. 11. Nozzle according to claim 8, characterized in that the four longitudinal channels of the hose are connected to an annular collector of increased diameter at the proximal end of the colonoscope. 12. Nozzle according to claim 8, characterized in that a hose outlet is made from the annular manifold at the proximal end. 13. Nozzle according to claim 1, characterized in that a three-way L-shaped valve is installed on the colonoscope tube at the proximal end of the colonoscope. 14. The nozzle according to claim 13, characterized in that the outlet of the hose from the annular manifold at the proximal end is connected to the first outlet of the three-way L-shaped cock. 15. Nozzle according to claim 13, characterized in that the inlet of the three-way L-shaped valve is connected to the compressor station. 16. Nozzle according to claim 13, characterized in that the second outlet of the three-way L-shaped valve is connected by a hose to a silencer. 17. Nozzle according to claim 13, characterized in that it is made with the possibility of raising the torus to the working position by turning the handle of a three-way L-shaped valve connecting the nozzle to the compressor station. 18. Nozzle according to claim. 13, characterized in that it is made with the possibility of lowering the torus to its original position by turning the handle of a three-way L-shaped valve, disconnecting the nozzle from the compressor station and connecting it to a silencer.

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