TWI726309B - Endocranial endoscope and method for using endocranial endoscope - Google Patents

Abstract

An endoscope particularly suited for endocranial procedures and a method of using the endoscope. In some examples the endoscope is rigid except for a bend/tilt portion near a distal end of a rigid tube that is inserted in a patient’ s cranium, which distal end is controlled in a degree and direction of tilt with a finger operated controller at the endoscope’ s handle. Some examples use telescoping tubes that allow customizing the endoscope size for specific procedures. A distal portion of the endoscope can be disposable, supplied in a sterile package for a single procedure, thus taking into account contamination dangers that are particularly high for intracranial and certain other interventions and the fact that it can be difficult or impossible to effectively autoclave heat-sensitive components of certain endoscopes or effectively sterilize them using other techniques.

Description

Intracranial endoscope and how to use intracranial endoscope

(Related Application Citation) This patent application is a partial continuation application of U.S. Application No. 15/364,952 filed on November 30, 2016 and allowed on January 26, 2018. The U.S. application (a) requires February 2016 The benefits of U.S. Provisional Application No. 62/299,307 filed on the 24th and (b) is a partial continuation application of the PCT application PCT/US2015/52152 filed on September 25, 2015, which requires September 29, 2016 Benefits of U.S. Provisional Application No. 62/056,617 filed, No. 62/063,114 filed on October 13, 2014, and U.S. Provisional Application No. 62/084,584 filed on November 26, 2014. This patent specification incorporates by reference the patent applications identified in this paragraph, as well as other publications identified in the rest of the patent specification, including patents and published patent applications and unpublished patent applications.

This patent specification is in the field of intracranial endoscopy, and in general, certain aspects of the disclosed devices and methods additionally involve otolaryngology surgery, skull base surgery, and neurosurgery.

Intracranial endoscopy was investigated in the following literature: Gaab MR, Instruments: Endoscopes and Equipment , World Neurosurgery 79[2s]: S14.E1-S14.E21, February 2013. Another example of intracranial endoscopy is discussed in the following document: Schroeder HWS, a new multi-purpose ventricular mirror , neurosurgery, Vol. 62 No. 2, February 2008, pp. 489-492. Other examples of endoscopes are discussed in the following documents: US 1010/0022824 A1, WO 2013/082497 A1, US 2012/0330196 A1, US 2009/0054733 A1, 2009/0198216 A1, WO 2010/126586 A1, US 2004/ 0167542, US 2008/0154181 A1, and US 2014/0148727 A1.

An endoscope that is particularly suitable for intracranial surgery is disclosed. Except for the inclined/curved portion near the distal end of a part, some of the disclosed examples are rigid, the inclined/curved portion is inserted into the patient’s skull and controlled by the controller at the handle of the endoscope to specify Perform two-way tilt within the degree. Some examples use telescopic tubes that allow customization of the size of the endoscope for a specific procedure. Some examples of the described endoscopes are disposable single-use devices, or at least have a disposable main part, to avoid a particularly high risk of contamination to the intracranial and certain other interventions. The portion of a traditional endoscope that enters the skull may be difficult to sterilize effectively and efficiently in an autoclave, especially when the endoscope contains heat-sensitive components.

One disclosed example is an intracranial endoscope, including: an internally threaded rigid outer tube (16), which has a proximal end and a distal part; an externally threaded intermediate rigid tube (14), which is screwed into the outer tube to be opposed to it Rotate, thereby telescoping between an extended position and a retracted position; an inner tube (10) having a proximal portion partially in the middle tube (14) and being shaped, sized and configured for insertion into the patient’s skull The distal portion of the middle; stopper (18, 618k), which is installed at the distal end of the intermediate tube to move axially relative to the intermediate tube, and a biasing element (20), which biases the stopper toward the distal direction ; Wherein the inner tube has an inclined/bent portion (10a) adjacent to its distal end and an extended position and a retracted position relative to the intermediate tube; suction/irrigation tube (8, 8a), which sucks/irrigates the tube Slide in the inner tube between the extended position protruding to the distal end of the inner tube and the retracted position; the lighting module (701, 702; at the distal end of the inner tube; 802, 803) and imaging modules (703, 801), wherein the lighting module is configured to illuminate the field of view within the patient's skull and the imaging module is configured to capture and supply images of the field of view for display to the user; The handle (100, 500, 600, 900), which is configured to be held by the user's hand and has a distal portion coupled to the proximal portion of the outer tube, and a proximal portion, the handle including a proximal portion of the handle The suction port coupler (100a) and irrigation port coupler (100b) at the end portion, and the following user-operated controllers: (i) One or more suction and irrigation controllers (100c, 100d, 410, 418a) , 418b, 418c, 502, 602, 900c, 900d), which are configured to control the flow between the suction/irrigation tube and the suction and irrigation ports, (ii) tilt/bend controllers (201, 301, 501) , 601, 901), which is operatively associated with the tilt/bend portion of the inner tube to control the direction and degree of its tilt/bend; and (iii) extension-retraction controllers (204, 208, 410, 412, 414, 416), which are operatively associated with the suction/irrigation tube to control the extent to which the distal end of the suction/irrigation tube protrudes from the inner tube to the distal end.

In some embodiments, the intracranial endoscope may also include a hollow tube (804a) that surrounds the distal portion of the suction/irrigation tube and has a distal end that extends from the inner tube to the distal end. The end protrudes and is inclined in the shape of a hypodermic needle. In some embodiments, the suction/irrigation tube has a distal end (8a) that is inclined in the shape of a hypodermic needle, and some embodiments include both the inclined distal end of the hollow tube and the inclined distal end of the suction and irrigation tube, The tip is in a radially opposite position.

In some embodiments, the stopper includes an edge configured to squeeze the patient's skull or other head surface, while the inner tube extends into the patient's skull a certain distance, the distance being at least partially opposed by the stopper It is limited by the position of the inner tube. In some embodiments, the stopper includes two or more fins extending radially from its central area, the fins being configured to press against the patient’s skull or other head surface while the inner tube Extends into the patient's skull for a distance that is at least partially limited by the position of the stopper relative to the inner tube. In some embodiments, the stopper includes an opening configured to allow cerebrospinal fluid to flow through the opening, while the stopper is pressed against the patient's skull or other head surface and the inner tube is inserted into the patient's skull in.

In some embodiments, the one or more suction and irrigation controllers include one or more user-operated buttons configured to control the flow into or out of the distal tip of the suction/irrigation tube. Move between. In some embodiments, one or more suction and irrigation controllers include a single switch that moves in one direction to connect the suction/irrigation tube to the suction source and moves in the other direction to switch the suction The suction/flush tube is connected to a source of flushing material.

In some embodiments, the tilt/bend controller includes a thumb-operated joystick. In some embodiments, the tilt/bend controller is configured to tilt the distal portion of the inner tube relative to the longitudinal axis of the outer tube in at least two directions, and in some embodiments in more than two directions. bending.

In some embodiments, the imaging module includes a control circuit housed in the handle, and in some embodiments, the endoscope includes a display that is operatively associated with the imaging module to display the cranial image taken therethrough. Inner image.

In some embodiments, the outer tube and the middle tube are configured to extend and retract the middle tube from the outer tube to the distal end within a first selected distance, and the inner tube is configured to extend a second selected distance from the middle tube to the distal end, This results in the distal end of the inner tube and the distal end of the outer tube being spaced up to a combination of the first and second selected distances.

In some embodiments of the endoscope, at least the portion of the endoscope extending from the handle to the distal end is a disposable single-use instrument supplied in a sterile package.

In some embodiments, the intracranial endoscope includes: an outer tube having a proximal portion and a distal portion; an intermediate rigid tube that telescopes within the outer tube between an extended position and a retracted position, and a sleeve (12 ), which extends from the intermediate tube to the distal end; the stopper at the distal portion of the sleeve and the biasing element that biases the stopper in the distal direction; the inner tube inside the sleeve, the inner tube Shaped, sized and configured for insertion into the skull of a patient; a suction/irrigation tube in the inner tube that is configured to move between an extended position and a retracted position relative to the inner tube; at the distal end of the inner tube The imaging module and the lighting module at the place where the lighting module is configured to illuminate the field of view within the patient’s skull and the imaging module is configured to capture and provide An image of the field of view to be displayed to the user while the inner tube is inserted into the patient's skull; a handle configured to be held by the user's hand and having a distal portion coupled to the proximal portion of the outer tube, and The proximal portion, the handle includes: a suction port coupler and an irrigation port coupler at the proximal portion of the handle; user-operated suction and irrigation control items, which are configured to control the suction/irrigation respectively The flow between the tube and the suction and irrigation ports; and the user-operated extension-retraction control item, which is operatively associated with the suction/irrigation tube to control the distal end of the suction/irrigation tube from the inner tube to The extent of the distal protrusion.

In some embodiments, the inner tube includes a tilt/bend portion adjacent to its distal end, and the handle includes a tilt/bend controller operably connected to the portion of the inner tube to control the distal end of the inner tube relative to The angle of the direction parallel to the axis of the outer tube. In some embodiments, the tilt/bend controller is configured to change the angle in a single plane, and in some embodiments, in two or more planes.

In some embodiments, the stopper includes a radially extending portion and space that allows flow through the stopper.

In some embodiments, the suction/irrigation catheter has a distal end that is inclined to form a tip.

The disclosed intracranial endoscope can be used in a method comprising: providing an outer tube, an intermediate rigid tube telescoping within the outer tube between an extended position and a retracted position, spaced apart from the intermediate tube at the distal end, and A stop biased in the distal direction, an inner tube in the middle tube and the stop, the inner tube being shaped, sized and configured for insertion into the patient’s skull, and suction within the inner tube / Irrigation tube, which is configured to move between an extended position and a retracted position relative to the inner tube; insert the distal portion of the inner tube into the patient's skull through the opening prepared therein until the stopper is pressed against the patient's The skull or the surface associated with the skull; the inner tube is selectively inserted further to prevent biasing of the stopper; the distal end of the suction/irrigation tube is selectively extended from the inner tube to the distal end; by being mechanically fixed to The user controller of the handle of the outer tube selectively applies suction and irrigation to the suction/irrigation tube at a selected varying angle; the light source used at the distal end of the inner tube selectively illuminates the field of view in the patient's skull And used at the distal end of the inner tube The miniature camera of the camera images the field of view; and displays the images taken by the camera.

8, 8a, 708, 500a2, 500b2, 600a1, 600b2: suction/irrigation tube/catheter

10.710: inner tube

10a: Inclined/curved part

10b: Depth indicator ruler

12: Casing

14: External thread intermediate pipe/intermediate pipe/telescopic pipe

16: Internal thread rigid outer tube/outer tube

18, 618k: stopper

20: Bias element

700a: Thumbwheel controller

701, 702; 802, 803: lighting module

703, 801: imaging module

100, 500, 600, 700, 900, 1102: handle

1104, 1106, and 1108: control items

100a: Suction port coupler

100b: flush port coupler

100a1, 100b1: corresponding source of suction and flushing material

100c, 100d, 410, 418a, 418b, 418c, 502, 602, 900b, 900c, 900d: suction and irrigation controller

110, 910: cable

112, 909: image display

114, 124: pipeline

116, 126, 418, 904: Valve

118: tube

120: main tube

122, 907, 908: spring

200: camera

202: light source

201, 301, 501, 601, 901: tilt/bend controller

204, 208, 410, 412, 414, 416: extend-retract controller

903: Finger-operated controller

905, 906: circuit board

300: suction source

310, 312: wire part

310a: wheels

902: Wheel/Brightness Control Item

804: protruding part

804a: hollow tube

600f: pipe containing wires

618a: Edge

618b: spokes

618d, 618e: wings

618f: central part

618l: Center opening

1A and 1B are a side view and a top view of an example of an endoscope, respectively.

1C to 1E illustrate schematic diagrams of an example of a valve that controls the suction/washing operation of the example of the endoscope.

2A to 2D are partial views of the distal end portion of the endoscope that can be used in the endoscope of FIGS. 1A and 1B or in other examples of the endoscope.

3A and 3B are schematic diagrams illustrating an example of a mechanism for tilting/bending the distal tip of the endoscope example.

4A, 4B, and 4C illustrate schematic diagrams of an example of a single button that controls both the extension/retraction of the suction/irrigation tube and the supply of suction/irrigation to the catheter according to the stroke of the finger-operated button.

4D and 4E illustrate schematic diagrams of examples of valve arrangements applicable to the mechanism of FIGS. 4A to 4C.

Fig. 5 is a perspective view of an example of a handle of an endoscope and a pipe for connection to a suction and irrigation source.

6A to 6C are perspective views of an example of an endoscope having a stopper having an opening for passing a material, such as cerebrospinal fluid, and FIGS. 6D and 6E illustrate schematic views of an alternative stopper.

7A to 7C are perspective views of one example of the distal tip of the endoscope.

Figure 8 is a perspective view of an alternative distal end of the endoscope.

8A to 8C illustrate schematic diagrams of an alternative distal end of the endoscope.

9A and 9B are schematic diagrams illustrating an example of the handle of the endoscope.

10A and 10B illustrate schematic diagrams of alternative embodiments of parts of the intracranial endoscope.

Figure 11 is a perspective view of an alternative embodiment of an intracranial endoscope.

Figures 1A and 1B illustrate an example of an endoscope, and Figures 2A to 2D illustrate a distal portion that can be part of the endoscope of Figures 1A and 1B or an alternative endoscope design. The inner tube 10 protrudes from the sleeve (12) in the distal direction, and further protrudes from the externally threaded intermediate tube 14 to the distal end. The externally threaded intermediate tube 14 in turn protrudes distally from the internally threaded rigid outer tube 16 and is screwed into the internally threaded rigid outer tube. The inner tube 10 has a bendable portion 10a near its distal end, so that the distal end of the inner tube 10 points within an angle range from the common axis or parallel axis of the sleeve 12 and the externally threaded intermediate tube 14 and the internally threaded rigid outer tube 16 Direction (and the associated opposite direction). The depth indicator ruler 10b (FIG. 2C) extends a designated distance from the distal tip of the inner tube 10 toward the proximal end. The stopper 18 slides on the sleeve 12 between a distal position (FIG. 2B) and a position closer to or opposite to the intermediate tube 14 (FIG. 2C), the stopper being biased by a spring or other biasing element 20 Set to the remote location. When the endoscope is used, the stopper 18 is usually pressed against the patient's skull, or scalp, or nostril, or outer ear, so as to provide stability and accuracy for the surgical procedure. The inner tube 10 surrounds the suction/irrigation tube 8, which slides in the inner tube 10 between an extended position (Figure 2D) and a retracted position (Figure 2C), in which the The suction/irrigation tube protrudes distally from the inner tube 10, and the suction/irrigation tube does not protrude from the inner tube 10 or minimally protrudes from the inner tube 10 in the retracted position. The movement distance can be 3 to 30mm, but other distances can be designed as needed. The inner tube 10 is usually made of metal, plastic, or a combination of metal and plastic and is rigid except for the bent or inclined portion 10a, and the conduit 8 is usually made of a plastic material with less rigidity.

The distance that the intermediate tube 14 extends distally from the outer tube 16 is adjusted by rotating the two threaded tubes relative to each other (usually by rotating the externally threaded intermediate tube 14 while holding the internally threaded rigid outer tube 16). The engagement thread operation is used to change the range from the maximum value (FIG. 1A) to the minimum value (FIG. 1B), for example, the distance within 70mm, but other ranges can be designed to meet specific endoscope requirements. In this example, the distance between the stopper 18 and the distal end of the outer tube 16 is a total of 100 mm (because the spiral penetrates 70 mm, the telescoping tube 14 enters the internally threaded rigid outer tube 16 plus 30 mm of the biasing element 20). Compression) and zero or close to zero range, but other ranges can be designed as needed. In fact, the externally threaded intermediate tube 14 protrudes from the internally threaded rigid outer tube 16 and the inner tube 10 protrudes from the sleeve 12.

The distal tip of the inner tube 10 surrounds the imaging module including the miniature camera 200 and the illumination light source including the LED lamp or the fiber end 202, which is indicated by the general position in FIG. 2D and examples of which are further described below in FIGS. 7A, 7B and This is explained in more detail in 8. The imaging and/or lighting module may be connected to the finger controller described below and the external display 112 via a cable 110 or wirelessly. The module can be powered from a power source that may be included in the display 112, and/or from an internal power source, such as a battery, through the cable 110.

1A and 1B also illustrate the handle 100, the handle has a distal end coupled to the proximal end of the outer tube 16 and has a tilt/bend controller 201, in this example, the tilt/bend controller is a roller, which is coupled The inclined/curved portion 10 a to the inner tube 10 so that the distal tip of the inner tube 10 and the distal end portion of the catheter 8 that can protrude from the inner tube 10 are inclined away from the axis of the inner tube 10. At the proximal end of the handle 100, the handle 100 has couplers or ports 100a and 100b to connect to respective sources 100a1 and 100b1 of suction and irrigation material through connecting tubes illustrated as dashed lines. The flushing material can be saline or other fluids, and can contain treatment substances, such as drugs that can be in fluid or solid form, for example, powders, gels, crystals, and other matrices that can be carried in the fluid stream. Under the control of a suction controller such as a button 100c and a flushing controller such as a button 100d, the couplers or ports 100a and 100b are connected to the pump through corresponding internal channels or pipes and valves (not shown in FIGS. 1A to 1E). Suck/ Flush tube 8. (In some other examples, a single controller for aspiration/irrigation can be used.) When the button 100c is gradually pushed down with respect to the bias (through the example illustrated in FIG. 1E), more aspiration is applied to the catheter 8. When the button 100c is released, the closing conduit 8 is connected to the fluid flow of the suction coupler or port 100a (through the example illustrated in FIG. 1D). When the flushing button 100d is pushed relative to the bias (by the example also illustrated in FIG. 1E), more flushing material is supplied to the catheter 8, and when the button 100d is released, the fluid between the catheter 8 and the flushing coupler 100b is closed Stream connection (via the example also illustrated in Figure ID). One or both of the couplers or ports 100a and 100b may contain wires and/or one or more optical fibers, which connect external electronic devices and/or light sources to an imaging module such as the camera 200 at the tip of the inner tube 10 As well as a lighting module such as the light source 202, or for the purpose described, the handle 100 may contain corresponding individual electrical and/or fiber optic connectors (not shown). The handle 100 usually surrounds the circuits involved in the operation of the camera 200 and/or the light source 202, such as a controller chip and other circuits for operating the camera and light source, and the handle may have one or both of the camera and light source for turning on and off , Or a controller used to select between video clips and photos and/or to additionally control the imaging and/or lighting module's hand or finger operation. In addition, in this example, the handle 100 includes a controller in the form of side sliders 204 and 208 that slide in the distal-proximal direction to extend the catheter 8 from the tip of the inner tube 10 to the distal end ( To the position seen in FIG. 2D) or retract the catheter into the inner tube 10. The extension range of the duct 8 can be 5 mm, but other ranges can be designed. In addition, the handle 100 may include a controller in the form of a joystick or other interface associated with the catheter 8 to control the tilt of the extension of the catheter 8 (FIG. 2D) relative to the axis of the inner tube 10, and the tip of the catheter 8 The tilt control and the tilt position are not shown in FIGS. 1A and 1B, but are further illustrated and discussed below in conjunction with other figures.

Figures 1C, 1D, and 1E illustrate examples of fluid flow connections and valves between the coupler/ports 100a and 100b and the distal portion of the catheter 8 for controlling fluid flow. As seen in the schematic diagram in FIG. 1C, the suction port 100a is connected to the pipe 124 controlled by the valve 126 operated by the button 100c, and the flushing coupler/port 100b is connected to the valve 116 operated by the flush button 100d 制的管114。 The pipe 114. The pipes 124 and 114 are merged into the distal portion of the catheter 8 (or in a pipe in fluid communication with the distal portion of the catheter 8), thereby realizing the connection between the distal portion of the catheter 8 and the couplers/ports 100a and 100b Fluid flow. FIGS. 1D and 1E illustrate examples of valves that can be used for valve 112 and/or valve 114. In this example, the valve includes a movable barrel 118 that slides within the main barrel 120 relative to the bias of the spring 122. Each barrel has a lateral opening through which a pipe 124 (or 114) passes. The pipes 124 and 114 are made of a material that is flexible enough to compress so as to reduce or stop the flow of fluid between the movable cylinder and the main cylinder when compressed, and open sufficiently elastically so that it is not compressed When allowing the flow between the two cylinders. The spring 122 pushes the two barrels to keep the valve closed, thereby preventing fluid from flowing through the pipe 124 (114). When the button 100a (100b) is pushed down by the button 100c (100d) to the position seen in FIG. 1E, for example by the force of the spring 122, the two barrels are separated sufficiently to allow fluid to flow through the eggs of the tube 124 (114)形SECTION. Pushing further down allows more flow until the duct assumes a circular cross-section, and the pressure on the release button 100c (100d) gradually reduces the flow until the pressure is sufficiently released to allow the spring 122 to push the barrel 118 upward enough from the main barrel 120, As seen in Figure 1D. Other examples of valves may be used to control fluid flow between the distal tip of the catheter 8 and the suction/irrigation port, some of which are discussed further below.

For example, by connecting wires to the diametrically opposite side of the tip of the inner tube 10 at the distal end of the inclined/bent portion 10a, the tip/bend control of the distal tip of the inner tube 10 and therefore the catheter 8 can be achieved. This can be controlled by twisting the knob 201, thereby shortening one of the two diametrically opposed wires, for example by a cam action. Another example is discussed in more detail below in conjunction with Figures 3A and 3B.

Some or all of the distal end of the handle of the endoscope described in this patent specification may be single-use disposable elements configured to be supplied in sterile packaging and preferably manually by using a mating mechanical/electrical coupler The ground and without tools are assembled with one of the described handles to establish the required mechanical/electrical connection for the operations described in this patent specification. Alternatively, some or all of the endoscopes described in this patent specification may be disposable single-use devices, the disposable The single-use device is only used once for the patient's surgery.

3A and 3B illustrate an example of controlling the distal tip of the inner tube 10 and therefore the tilt/bend of the catheter 8. The button 301 may be a sliding button or a joystick as schematically shown in FIGS. 3A and 3B. The button can extend upward from the wheel 310a installed for rotating in the handle 100 through the top of the handle 100 (not shown in the figure), and drive the wire portion 310 and the wire portion 312, the wire portions are respectively fixed to the tilt The top and bottom of the tip portion of the inner tube 10 at the distal end of the curved portion 10a, and are fixed to a wheel 310a operated by a switch or lever 301. Pulling the switch or joystick 301 backward relative to the handle 100 tilts/bends the tip of the inner tube 10 and therefore the catheter 8 upwards, as seen in Figure 3B, and pushing the switch/ joystick 301 forward makes the tips of the inner tubes 10 and 8 Tilt down/bend down. If another pair of wires (not shown) are used so that their distal ends are fixed to the tip of the inner tube 10, then a wire is fixed at each quarter of the tip of the inner tube 10, and a ball instead of the wheel 310a Fixed to the button/joystick 301, where the wires are connected at the four sides of the ball, then moving the button/joystick 301 sideways also tilts/bends the tips of the inner tube 10 and the catheter 8 to the left or right. Moving the middle direction of the button/joystick 301 relative to the handle 100 can achieve tilting/bending of the tips of the inner tube 10 and the catheter 8 in any desired direction.

4A, 4B, and 4C illustrate examples of a mechanism that uses a controller to control the catheter 8 extending from the inner tube 10 to the distal end and aspiration/irrigation. The mechanism may be one of the handles described in this specification or Multiple inner sides are used, the difference is that the button 410 can be accessed from the outside of the handle directly or through the middle button or lever. In this example, the button 410 drives the lever 412 which pivots at 414 inside the handle and has its other end (made of flexible material) fixed to the catheter 8. Figure 4A shows an intermediate position of the controller, where the catheter 8 is in a retracted position relative to the inner tube 10 and the spring 416 biases the lever 412 to that position (and bends upward along a portion of the catheter 8). When the button 410 is pushed into the handle with respect to the bias of the spring 416, the lever 412 begins to push the catheter 8 in the distal direction. For a certain distance of the initial stroke of the button relative to the handle, such as stroke The button 410 remains out of contact with the valve 418, so that the valve remains in its middle position until the catheter 8 extends from the inner tube 10 by a selected distance, for example, 1 mm. In this position, as illustrated in Figure 4B, the degree of curvature of the catheter 8 is slightly less than that of Figure 4A. While still pushing the button 410 further into the handle with respect to the bias of the spring 416, the button contacts the valve 418 and acts on the valve as described below in connection with Figures 4D and 4E, thereby reducing and eventually stopping the flushing and starting to increase suction . At the same time, the lever pushes the catheter 8 to extend more from the inner tube 10, up to 3mm or 5.5mm, and the catheter 8 straightens, as illustrated in Figure 4C. With the button 410 initially traveling downward, one benefit of the catheter 8 initially extending from the inner tube 10 is that the surgeon can use the extension of the catheter 8 to poke and destroy blood clots without applying suction, and then press it further down. Button 410 to apply suction and extract substances, which may contain destroyed and decomposed materials.

Figures 4D and 4E illustrate examples of valves 418 (also seen in Figures 4A to 4C) that control both suction and flushing. The valve 418 includes a movable cylinder 418a that slides within a main cylinder 418b. The suction tube 124 and the flushing tube 114 pass through the corresponding openings in the two barrels, but the openings are arranged so that when the opening of the suction tube is misaligned enough to compress the suction tube 124 and prevent the flow through the opening, the opening of the flushing tube Align so as not to compress the irrigation tube 114, thereby allowing the irrigation material to flow to the distal end of the catheter 8. Conversely, when the irrigation tube 114 is compressed to stop flow therethrough, the suction tube 124 is not compressed and allows suction from the distal end of the catheter 8. The spring 418c biases the two cartridges so that in the normal state of the valve 418, the irrigation tube 114 is opened (not compressed), but the suction tube 124 is compressed and blocked. When the button 410 comes into contact with the valve 418 and starts to move to the right in FIGS. 4D and 4E, as the suction tube 124 gradually opens more, the irrigation tube 114 gradually becomes tighter, so that the distal tip of the catheter 8 gradually changes from full Flushing and non-aspiration change to full aspiration and non-flushing. This arrangement helps flush the anatomical site when the catheter 8 is retracted, and then extends the catheter 8 distally while still flushing, to help remove the tissue that should be removed, and then switch to suction to remove the tissue. As an alternative, the openings in the cylinders 418a and 418b can be aligned so that there is neither suction nor flushing in the intermediate state of the valve 418, but when the button 410 contacts the valve 418 Flushing or aspiration starts, and when the button is pushed further, flushing or aspiration increases, and then switches from one of flushing and aspiration to the other.

Figure 5 illustrates an example of a handle 500 that can be used with any of the elements described herein that extend distally from the handle, such as 100. At least for the layer on or near the outer surface of the part of the handle 500 held by the user's hand, it may be made of a relatively soft material, such as rubber or rubber-like material, to increase user comfort and is unlikely to be Slide between the handle and the user's hand. The handle 500 as illustrated has a generally rectangular cross-section with arc-shaped edges, but the expected generally triangular cross-section with arc-shaped edges is an alternative. The handle 500 includes a suction/flushing controller 502 in the form of a slider that can operate a valve that gradually opens/closes the conduit 8 leading to the suction source 300 and the conduit 500a2 between the conduit 500b2 leading to the source of irrigation material Fluid flow path. For example, when the user's thumb gradually pushes the slider 502 forward in the distal direction, suction is applied to the catheter 8 and the degree of suction increases as the distance the slider 502 is pushed in the distal direction increases. When the user gradually pushes the slider 502 backward in the proximal direction, the irrigation is supplied to the catheter 8 and then the slider 502 is pushed more in the proximal direction, the irrigation flow gradually increases. In this example, the slider 502 is biased to the middle center position where neither suction nor irrigation is applied to the catheter 8, and returns to the position when the user does not push the slider 502 in either direction, And alternative arrangements of valve 418 described above may be used. The handle 500 also includes a joint controller 501 that is coupled to the inclined/curved portion 10a of the inner tube 10 to, for example, be in a left-right direction, an up-down direction, or any other direction relative to the externally threaded intermediate tube 14 and The axis of the internally threaded rigid outer tube 16 is hinged to the distal end of the inner tube 10.

6A, 6B, and 6C are perspective views illustrating a stopper 618 that is an important substitute for the stopper 18 of FIGS. 1A to 2D. The stopper 618 has an opening through which excessive cerebrospinal fluid can be drained, and the opening can also avoid an increase in intracranial pressure. In any of the endoscope examples discussed herein, the stopper 618 may be used instead of the stopper 18. The stopper 618 includes an arc-shaped or rounded edge 618a and three spokes 618b, which are fixed to the sleeve 12 from the sleeve 618c. Extend to the distal end when unfolded. In use, the stopper 618 is pressed against the patient's skull or other head surface, as in the case of the stopper 18, while the distal tip of the endoscope handles the contents of the skull. The stopper 618 can also provide a navigation function, for example by making one or more of the stopper’s spokes longer or shorter than another spoke or other spokes, which can help control and evaluate the endoscope relative to the stopper. The direction of insertion of the pressed surface of the device 618, or by including other navigation aids, helps to identify the position and/or direction of the portion of the inner tube 10 within the skull during surgery or exploratory procedures. The edge 618a and the spokes 618b can be made of the same material, which can be rigid enough to maintain shape during use of the endoscope, or the spokes and the edge 618a can be made of different stiffnesses as needed or suitable for different surgical or exploratory procedures. Or made of soft materials. 6B and 6C illustrate a stopper 618 as a part of the endoscope, the stopper has a handle 600 that can be the same as the handle 500 in FIG. 5, and has the same function as the pipes 500a2 and 500b2 in FIG. 5 Suction/flush pipes 600a1 and 600b2. Figures 6B and 6C additionally illustrate a conduit 600f that may contain wires that supply power and/or to and/or from the camera at the distal tip that contains the endoscope (not seen in Figures 6A to 6C) The imaging module carries control and image data, and/or power, light, or control signals to an illumination module containing a light source at the tip of the endoscope (also not seen in Figures 6A to 6C).

Figures 6D and 6E illustrate an alternative stopper 618k that can be used in place of the stopper described above in any of the endoscopes described herein. The stopper 618k includes a pair of fins 618d and 618e extending radially in opposite directions from the central portion 618f surrounding the duct 12. Each fin has a central opening 6181 that is configured to allow fluid to flow through it when the stopper is pressed against the patient's skull or other head surface. More than two fins can be used in the alternative stopper, preferably evenly distributed around the circumference of the stopper. The illustrated fin is triangular with a central opening and apex at the central area of the stopper, but other shapes are possible, to name a few, such as ribbons, rectangles, and oval shapes. Preferably, the flap is made of a relatively soft material so that it does not damage the patient's tissues, but is sufficiently rigid and elastic so that the flap is spring-like when pressed against the surface.

7A to 7B are perspective views of an example of the distal tip of the endoscope. Figures 7A and 7B illustrate the distal end that can be used in any of the endoscopes described above. The distal end includes the forward (in the distal direction) part of the imaging module and the illumination module, namely the light sources 701 and 702, which can be LED lights or fiber ends and a forward camera 703 such as a CMOS camera. The inner tube 10 surrounds the suction/irrigation tube 8 as well as the light source and the camera. In an example of an endoscope, the outer diameter of the camera 703 may be 1.4mm, the outer diameter of the suction/irrigation tube 8 may be 2.8mm, and the diameter of each of the optical fibers may be less than 0.4mm (or alternatively may be LEDs with comparable diameters are used), and the outer diameter of the inner tube 10 may be 5.3 mm.

Figure 7C illustrates an endoscope in which an inner tube 710 for inserting a patient's skull extends 180mm distally from the handle 700, and a suction/irrigation tube 708 can extend from the inner tube 710 distally up to 5mm, such as by thumb The wheel controller 700a is selected.

Figure 8 illustrates in a perspective view an example of a distal tip that can be used with any of the endoscopes described herein. This example has a lighting module with front-view LED lights 802 and 803 and an imaging module with a front-view camera 801, and a protrusion 804, which is preferably transparent to light from the lighting module and from the inside The tube 10 extends in the distal direction. In addition, the illustrated tip may comprise a suction/irrigation tube (not explicitly shown in Figure 8) with a front-view opening and/or a lateral opening. For example, the catheter 8 may extend in a channel in the inner tube 10 and protrude distally from the inner tube 10 as needed.

Figures 8A to 8C illustrate an alternative distal portion that can be used in place of the distal portion described above in any of the endoscopes described herein. 8A and 8B are side views showing the distal end of the inner tube 10 from which the hollow tube 804a protrudes in the distal direction. The catheter 804a is preferably inclined into the shape of a hypodermic needle and terminates at a sharp point. The side view of FIG. 8B shows the distal end portion 8a of the suction/irrigation tube 8 protruding distally from the hollow tube 804a. Preferably, the distal end of the catheter portion 8a is also inclined like a hypodermic needle, wherein the sharp point is preferably but not necessarily diametrically opposed to the sharp point of the catheter 804a. The positive of Figure 8C The view illustrates the arrangement of the components in the inner tube 10: the hollow tube 804a and the suction/irrigation tube portion 8a, the imaging module 801, and the light sources 802, 803 therein. In use, after inserting the inner tube into the patient’s skull, the inclined tip of the hollow tube 804a can help to penetrate and/or break tissue, such as coagulation of blood, and the inclined end of the suction/washing portion 8a can then be Extend distally to further compress coagulated blood or other materials and flush the sides or aspirate fluid or tissue.

FIG. 9A is a side view, and FIG. 9B is a side view of an example of a handle 900 that can be used in any of the endoscopes instead of the handle described above. The handle 900 includes a tilt/bend control item 901, and a flushing controller in the form of a button 900c and a suction controller in the form of a slider 900b, which controls the suction/flushing pipe 8 (not shown in FIGS. 9A and 9B). To) and the fluid flow between the flushing coupler 100b and the suction coupler 100a. In addition, the handle 900 includes a brightness controller in the form of a wheel 902. The user can rotate the brightness controller to increase or decrease the LED, such as 701 and 702 in FIGS. 7A and 7B, or 802 and 803 in FIG. Lightness. In addition, the handle 900 may include one or more finger-operated controllers 903 that control the camera, such as 703 in FIGS. 7A and 7B or 801 in FIG. 8, for example to turn the camera on and off, and / Or control other functions, for example, choose between video clips and photos, or choose between different camera operation modes, such as different resolutions, frames per second, etc.

Figure 9B illustrates some of the internal elements of the handle 900, which may be the same or similar to the internal elements of the other examples of the handle described above. Figure 9B illustrates that the valve 904 controls the fluid flow between the suction/irrigation tube 8 (not seen in Figure 9B) and the suction and irrigation couplers 100a and 100b, and the spring 907 biases the irrigation controller 900c into the irrigation controller The position where the fluid flow connection between the duct 8 and the pipe 100b is closed, and the spring 908 biases the suction control item 900b to the position where the suction control item closes the fluid flow connection between the duct 8 and the suction coupler 100a. In addition, FIG. 9B illustrates an internal circuit board 905 (connected to the LED 701, 702 or 802, 803 and the brightness control item 902) for providing power and control to the LEDs, for example, from an internal battery or from an external power source, the internal circuit board passing Cable, for example 600f in the example of FIGS. 6B and 6C is connected to an external power source. FIG. 9B also illustrates a circuit board 906 that is coupled to a camera at the distal tip of the endoscope, such as a camera 703 or 801, and is coupled to a controller 903 to provide power and control signals to the camera and through a cable 910 Or, the image captured by the camera is transferred to the external display 909 through a wireless connection.

10A and 10B illustrate in perspective views the distal end portion of the endoscope using the stopper illustrated in Figs. 6D and 6E, and the distal end portion illustrated in Figs. 8A to 8C. In Fig. 10A, the suction/irrigation tube 8 (and its distal portion 8a) is retracted and cannot be seen. In Fig. 10B, the distal end portion 8a of the suction/irrigation tube 8 is shown as projecting distally.

Fig. 11 shows an example of an endoscope in a perspective view, which uses the parts illustrated in Figs. 10A and 10B and can use any feature of other endoscope examples disclosed herein. Figure 11 further illustrates a handle 1102 that can be used in place of the other described handles for any of the endoscope examples disclosed herein. The handle contains controls that can take the form of sliding switches, buttons, joysticks (or other user-operated controls) 1104, 1106, and 1108, which can control the functions described above for other handles, for example, extension And retract the suction/irrigation tube 8, control the suction and irrigation flow through the catheter 8 and its distal end portion 8a, and make the distal end portion of the inner tube 10 tilt/bend, etc. Figure 11 further illustrates the two pipes coupled with the proximal portion of the handle 1102 and connected to the suction and irrigation source, and at least one cable for connecting the video module and the power source of the light source at the tip of the endoscope and connecting The video module is connected to the video display and/or memory or other device to which the photos or video clips from the video module should be supplied.

Although several embodiments are described, it should be understood that the new subject matter described in this patent specification is not limited to any one embodiment or a combination of the embodiments described herein, but instead covers a variety of alternatives, modifications, and equivalents. In addition, although many specific details are set forth in the following description to provide a thorough understanding, some embodiments may be practiced without some or all of these details. In addition, for the sake of clarity, some technical materials known in the related fields are not detailed in order. To avoid unnecessarily obscuring the new topics described in this article. It should be clear that the features of one or several specific embodiments described herein can be used in combination with features or other described embodiments. In addition, the same reference numeral names in the respective drawings indicate the same elements.

Various modifications can be made without departing from the spirit and scope of the new method and system described in this patent specification. Therefore, the scope of this patent specification is not limited to the above-mentioned embodiments, but instead is defined by the claims of the patent issued thereon based on the full scope of its equivalents.

10: inner tube

12: Casing

14: External thread intermediate pipe/intermediate pipe/telescopic pipe

16: Internal thread rigid outer tube/outer tube

18: Stopper

20: Bias element

100: handle

100a: Suction port coupler

100b: flush port coupler

100b1: Corresponding source of suction and flushing material

100c, 100d: suction and flushing controller

110: Cable

112: Image display

201: Tilt/Bend Controller

300: suction source

Claims (22)

An intracranial endoscope includes: an internally threaded rigid outer tube, which has a proximal part and a distal part; an externally threaded intermediate tube, which is a rigid tube, which is screwed into the outer tube for relative rotation therewith, This telescopes between an extended position and a retracted position; an inner tube having a proximal portion partially in the middle tube and a distal portion that is shaped, sized and configured for insertion into the patient's skull; stopper , Which is installed at the distal end of the intermediate tube to move axially relative to the intermediate tube; a biasing element that biases the stopper toward the distal direction; wherein the inner tube has a distal end adjacent to it The inclined and/or curved portion of the tube, and the extended position and the retracted position relative to the intermediate tube; the catheter, which is between the extended position and the retracted position where the catheter protrudes distally from the inner tube Sliding in the inner tube; an illumination module and an imaging module at the distal end of the inner tube, wherein the illumination module is configured to illuminate the field of view in the patient's skull, and the imaging module The group is configured to take and supply an image of the field of view for display to the user; and a handle that is configured to be held by the user's hand and has a distal portion coupled to the proximal portion of the outer tube , And a proximal portion, the handle includes a suction port coupler and an irrigation port coupler at the proximal portion of the handle, and the following user-operated controllers: (i) one or more suction and irrigation A controller configured to control the flow between the catheter and the suction and irrigation ports, (ii) a tilt and/or bend controller, and the tilt and/or bend part of the inner tube Be operatively associated to control the direction and degree of its tilt and/or bend; and (iii) An extension-retraction controller, which is operatively associated with the catheter to control the extent to which the distal end of the catheter protrudes from the inner tube to the distal end. The intracranial endoscope according to claim 1, further comprising a hollow tube surrounding the distal portion of the catheter and having a distal end, the distal end extending from the inner tube to the distal end It is protruding and inclined in the shape of a hypodermic needle. The intracranial endoscope according to claim 1, wherein the catheter has a distal end inclined in the shape of a hypodermic needle. The intracranial endoscope according to claim 1, further comprising a hollow protrusion from the distal end of the inner tube, the hollow protrusion having a tipped distal end inclined in the shape of a hypodermic injection needle, And wherein the catheter has a tipped distal end that is inclined in the shape of a hypodermic injection needle, and the two tips are diametrically opposed. The intracranial endoscope according to claim 1, wherein the stopper includes a rim configured to press against the patient’s skull or other head surface, while the inner tube extends to the A certain distance in the skull of the patient, the distance being at least partially limited by the position of the stopper relative to the inner tube. The intracranial endoscope according to claim 1, wherein the stopper includes two or more fins extending radially from a central area thereof, and the fins are configured to squeeze the The patient's skull or other head surface, while the inner tube extends a certain distance into the patient's skull, the distance being at least partially limited by the position of the stopper relative to the inner tube. The intracranial endoscope according to claim 1, wherein the stopper includes an opening configured to allow cerebrospinal fluid to flow through the opening, while the stopper tightly presses the patient's skull Or other head surface and the inner tube is inserted into the patient's skull. The intracranial endoscope according to claim 1, wherein the one or more suction and irrigation controllers include one or more user-operated buttons, and the buttons are configured to control the inflow Or move out between the positions of the distal tip of the catheter. The intracranial endoscope according to claim 1, wherein the one or more suction and irrigation controllers include a single switch that moves in one direction to connect the catheter to the suction source, And move in the other direction to connect the catheter to a source of irrigation material. The intracranial endoscope according to claim 1, wherein the tilt and/or bend controller includes a thumb-operated joystick. The intracranial endoscope according to claim 1, wherein the tilt and/or bend controller is configured to make the distal end portion of the inner tube relative to the longitudinal axis of the outer tube in at least two directions Tilting and/or bending. The intracranial endoscope according to claim 1, wherein the imaging module includes a control circuit housed in the handle. The intracranial endoscope according to claim 1, further comprising a display, and the display is operatively associated with the imaging module to display intracranial images taken therethrough. The intracranial endoscope according to claim 1, wherein the outer tube and the middle tube are configured to extend and retract the middle tube from the outer tube to the distal end within a first selected distance, and the inner tube The tube is configured to extend a second selected distance distally from the intermediate tube, thereby causing the distal end of the inner tube to be spaced apart from the distal end of the outer tube by up to the first and second The combination of selected distances. The intracranial endoscope according to claim 1, wherein at least a part of the intracranial endoscope extending from the handle to the distal end is a disposable single-use instrument supplied in a sterile package. An intracranial endoscope, comprising: an outer tube having a proximal part and a distal part; an intermediate tube, which is a rigid tube, which telescopes within the outer tube between an extended position and a retracted position; and a sleeve , The sleeve extends from the intermediate tube to the distal end; a stopper, which is located at the distal portion of the sleeve; A biasing element that biases the stopper in the distal direction; an inner tube within the sleeve, the inner tube being shaped, sized and configured for insertion into the skull of a patient; the inner tube The inner tube is configured to move between an extended position and a retracted position relative to the inner tube; an imaging module and an illumination module at the distal end of the inner tube, wherein the illumination module is Configured to illuminate the field of view within the skull of the patient, and the imaging module is configured to capture and supply images of the field of view for display to the user, while the inner tube is inserted into the skull of the patient; and A handle, which is configured to be held by a user's hand, and has a distal portion coupled to the proximal portion of the outer tube, and a proximal portion, the handle includes: (i) in the proximal portion of the handle The suction port coupler and the irrigation port coupler at the end portion, (ii) user-operated suction and irrigation control items, which are configured to control the flow between the catheter and the suction and irrigation ports, respectively , And (iii) a user-operated extension-retraction control item, which is operatively associated with the catheter to control the extent to which the distal end of the catheter protrudes from the inner tube to the distal end. The intracranial endoscope according to claim 16, wherein the inner tube includes an inclined and/or curved portion adjacent to its distal end, and the handle includes an inclined and/or curved controller, which is operably connected To the portion of the inner tube to control the angle of the distal end of the inner tube with respect to a direction parallel to the axis of the outer tube. The intracranial endoscope according to claim 17, wherein the tilt and/or bending controller is configured to change the angle in a single plane. The intracranial endoscope according to claim 17, wherein the tilt and/or bending controller is configured to change the angle in a plurality of planes. The intracranial endoscope according to claim 16, wherein the stopper includes permission The flow passes through the radially extending portion and the space of the stopper. The intracranial endoscope according to claim 16, wherein the catheter has a distal end that is inclined to form a tip. A method of using an intracranial endoscope includes: providing an outer tube; a middle tube, which is a rigid tube, which telescopes within the outer tube between an extended position and a retracted position; and a stopper, which is at the distal end Spaced from the intermediate tube and offset in the distal direction; the inner tube within the intermediate tube and the stopper, the inner tube being shaped, sized and configured for insertion into the patient's skull And a catheter in the inner tube, which is configured to move relative to the inner tube between an extended position and a retracted position; inserting the distal end portion of the inner tube into the patient through the opening prepared therein In the skull until the stopper presses against the patient’s skull or the surface associated with the skull; optionally further inserts the inner tube to prevent the bias of the stopper; from the inside The tube selectively extends the distal end of the catheter to the distal end; through a user controller mechanically fixed to the handle of the outer tube, suction and irrigation are selectively applied to the Catheter; a light source at the distal end of the inner tube is used to selectively illuminate the field of view in the patient's skull, and a miniature camera at the distal end of the inner tube is used to image the field of view; And displaying the image taken with the camera.

Images