The invention relates to an endoscope with a catheter having a plurality of lumens according to the preamble of claim 1.
Such an endoscope is sold, for example, by the applicant under the trademark "PolyScope (R)" and is described in DE 10 2004 005 709. This controllable flexible endoscope has a multi-lumen catheter probe, in which at least one optical channel for receiving an optical system, a working channel, for example for receiving a surgical tool, a scavenging suction and a control channel for receiving a control element are provided.
This is, for example, a control wire or a guide cable, which - as in the case of the PolyScope (R) - is axially displaceably guided within the catheter probe or along the probe, wherein one end section acts on the distal end of the flexible catheter probe and the other end on one of the catheter probe attached handle is fixed, by the actuation or movement of a distal probe portion can be bent over with a certain length or rotated about the probe longitudinal axis, so that this therapeutic endoscope can be relatively easily brought into an optimal operative position during a surgical procedure. Such endoscopes are used, for example, in ureteroendoscopy, but can also be used interdisciplinarily for various applications.
At the proximal end portion of the catheter probe, a hub is set, from which protrude the proximal outputs of the optical channel, the flushing channel, the working channel and the control channel / control lumen. From the latter is the handle-side end portion of the control wire before, is attached to the means of a clamping screw handle. In the case of the PolyScope (R), this handle has a main body receiving the end section of the control wire, to which are laterally set, diametrically opposite, two annular grip parts for the ring and the middle finger.
At a proximal end portion of the base body, a further annular grip part for the thumb is centrally placed, so that the control wire can be actuated by moving the middle handle portion towards the two held by ring finger and middle finger grip parts to deflect the distal end of the probe. In this case, the control wire is biased in a basic position in which the rear side, provided for the thumb grip part is held at a distance from the two diametrical grip parts for ring and middle finger. This comparatively much space engaging handle is attached to the widening towards the handle stroke. In this area, a protective tube for a 6000-pixel optics is connected, which consists for example of a lighting optics and observation optics.
With a 10,000-pixel optics, the illumination optics and the observation optics are each guided in their own lumen. For working and flushing channel are formed by a common lumen.
In the known solution, the distal end of the optical channel is hermetically sealed by a translucent cover, so that the optics can not be contaminated.
The relative positioning of the optics with respect to this cover can take place via a so-called optical shifter, which is attached on the one hand to the proximal end portion of the optic and on the other hand to an optic base body, so that the distal end portion of the optic is displaceable by changing the length of the optic shifter.
Furthermore, in the region of the hub, the flushing / suction hose and the surgical tool are then attached, so that in this area a plurality of supply lines / hoses / functional elements are arranged, which are each designed to be flexible and movable relative to each other.
Prior to the procedure, it is necessary to adjust the handle with respect to the flexible end portion of the catheter probe so that, for example, with vertical alignment of the handle and handle provided for ring and middle fingers, the flexible probe end is upwardly controlled. For this adjustment, the handle is actuated and the catheter probe with the deflected end portion in the desired direction - for example, up-aligned.
Subsequently, a locking screw of the handle is released at the proximal end portion of the control wire and aligned by rotation in the desired relative position with respect to the deflected end portion of the catheter probe, so that the operator then control the probe end defined by operating the handle and by rotating in any desired direction can. In this case, the catheter probe is designed so that a rotation of the handle is transmitted torsion-resistant to the catheter probe end about its longitudinal axis.
In particular, in such a rotation, it may happen that in the area of the hub, the elastic tubes (optics, rinsing), the above-described handle and as rigid as possible attached to the working channel surgical tool "cross", so that the operator is irritated and more Time needed to position the catheter probe.
In contrast, the invention has for its object to provide an endoscope with improved handling.
This object is achieved by an endoscope with the features of claim 1.
According to the invention, the endoscope has a multi-lumen catheter probe, with a control lumen, in which a control element is guided, which is adjustable at its proximal end by means of a handle within the control lumen. According to the invention, the handle is designed with a guide body, in which an end portion of the control member dips. This is indirectly or directly connected to an adjusting sleeve, which is guided adjustably and fixable on or on the guide body.
According to the invention, the guide body of the handle is penetrated by at least one elastic probe element guided in a lumen of the catheter probe.
In such a construction, the handle fulfills a dual function: it serves for one for actuating the control wire; on the other hand it also serves to guide at least one elastic probe element, for example the optics, so that no irritation of the operator may occur when the handle is rotated for positioning the catheter probe end, since the probe element guided in the handle - preferably the optic - together with the handle is rotated and thus the "cross over" described above, the rigid and elastic catheter elements does not occur or only at least only to a greatly reduced extent.
According to the invention, it is preferred if the lumens of the catheter probe are an optical lumen, a light lumen, a working and / or flushing lumen, to which then optics, if necessary a light guide, a surgical tool and a flushing tube can be attached.
In a particularly preferred embodiment, a working and / or flushing channel opens laterally into the guide body of the handle. In the case in which the illumination optics and the observation optics are formed separately from one another, a combined working / flushing connection is provided on the guide body, which is formed for example via a Y-piece.
In an endoscope which can be used in particular for vascular endoscopy, the catheter probe is provided, in addition to the control lumen, with a flushing lumen and a guide wire channel along which, for example, a probe or a stent can be guided to an intervention site, for example into the region of a stenosis. In such a variant, the flushing hose could then be connected to the guide body, which is then penetrated by the guide wire, so that even with such a comparatively simple construction disability of the physician by collision of the flushing hose with the relatively rigid tool (guide wire) does not take place ,
According to the invention it is preferred if the adjusting sleeve is associated with a detent, by means of which it can be fixed in a predetermined axial and / or radial position with respect to the guide body, so that no force has to be applied to hold the distal end portion of the catheter probe in its deflected position.
This lock is particularly simple if, in order to guide the setting sleeve in a circumferential wall of the guide body, sliding through openings are provided, in which a guide projection projecting radially inwards is guided. It is preferred if this gate opening has at least one axial slot defining the axial adjustment of the adjusting sleeve and at least one radial slot into which the guide projection is moved for locking.
For fixing in several positions can branch off a plurality of radial slots from the axial slot.
To improve the handling, the adjusting sleeve can be designed with at least one radially projecting retaining collar, which facilitates the application of axial displacement forces.
In one embodiment, the control element is designed as a control wire, the proximal end portion of which is attached to a run in the guide body clamping piece, which in turn is connected to the adjusting sleeve.
According to the invention, it is preferred if the catheter probe is attached to the guide body in a detachable manner on the front side so that practically all functional elements of the endoscope open or run in the guide body.
In a further variant of the inventive endoscope, the catheter probe is surrounded by a rigid catheter tube, wherein preferably the axial position of the catheter probe with respect to the catheter tube is adjustable via a shifter. Thereby, the distal end portion of the catheter probe can be moved out of the catheter tube, so that the advantages of a flexible and a rigid endoscope are combined. Such an endoscope can be used particularly advantageously in ureteroendoscopy.
The distal end of the catheter tube may be designed as an atraumatic termination. It is preferred to skew this end portion. In the axially furthest projecting region of the catheter tube, a radially outwardly and / or inwardly projecting guide element can then be arranged, via which the catheter tube can be levered or screwed in, for example, in the removal of kidney stones into the ostia. According to the invention it is preferred if this guide element is designed as a ball, so that there is no risk of injury when pulling out the endoscope. The radially inwardly projecting part of this spherical guide element is visible through the optics, so that a simple directional orientation (top / bottom) is possible.
In the case in which the catheter probe - as in the vascular endoscopy - must be inserted into very narrow areas with opposing deflections, the catheter probe can be assigned to two controls over which the catheter probe retrograde - in other words - counter-deflected. Such a control unit is known, for example, from the postponed DE 2007 006 185 filed by the patent applicant.
It is preferred if two adjusting sleeves are guided in the axial direction spaced on or on the guide body.
The structure of the endoscope is particularly compact when the guide body is made approximately cylindrical, wherein the adjusting sleeves are preferably guided slidably and rotatably.
Advantageous developments of the invention are the subject of further subclaims.
In the following preferred embodiments of the invention will be explained in more detail with reference to schematic drawings. Show it:
1 shows a longitudinal section through a first embodiment of an inventive endoscope;
FIG. 2 shows a catheter tube for a probe according to FIG. 1 and FIG
FIG. 3 shows an exemplary embodiment of an endoscope for vascular endoscopy.
FIG. 1 shows an endoscope which can be used interdisciplinarily for various applications and whose functional elements essentially correspond to those of the aforementioned PolyScope, so that with regard to the applications and with regard to the basic functions reference is made to the relevant information retrievable at www.polydiagnost.com and here only the essential elements for understanding the invention will be explained. The flexible endoscope 1 shown in FIG. 1 essentially consists of a multi-lumen catheter probe 2, which is attached to a handle 4. The connection between catheter probe 2 and handle 4 via a conventional bayonet connection, such as a Luer-lock connector. 6
In the illustrated embodiment, the catheter probe 2 has a combined working / irrigation lumen, an optical lumen for the observation optics (image guide), a lighting lumen for the illumination optics (light guide) and a control lumen for receiving a control wire over which the catheter probe is deflectable.
The catheter probe 2 itself consists of a flexurally elastic material, preferably of a biocompatible plastic. The catheter probe 2 is delivered sterile packed and is designed as disposable (disposable), so that it is released after the surgical use of the handle 4 and then disposed of. As explained in the aforementioned patent application, the optics is not contaminated, so that it is reusable. With regard to further details on the structure of the optics and the associated advantages, reference is made to the aforementioned document.
The handle 4 shown in Figure 1 serves on the one hand - in the usual way - to control the distal end portion of the catheter probe 2 and the other as a lumen output for the above elements, that is, for the working / flushing lumen, the optical lumen and the light lumen. This dual function is unprecedented in the art. In the known solutions of the handle is only used to control the catheter probe - the lumen outputs are executed in all known solutions to separate components.
The inventive handle 4 consists essentially of a tubular guide body 8, on which an adjusting sleeve 10 in the axial direction and - to a certain extent - is also rotatably mounted about the longitudinal axis. The adjusting sleeve 10 has a guide bushing 12, which is slidably guided on the outer circumference of the tubular guide body 8. At the right in Figure 1 end portion of the guide bush 12, a radially projecting retaining collar 14 is formed, which facilitates the handling of the handle 4. This adjusting sleeve 10 is arranged in the central region of the guide body 8, so that in Figure 1 to the right a handle 16 of the guide tube protrudes and to the left in Figure 1, a connection portion 18 of the guide body 8 is formed.
The user grasps the handle 4 in the region of the handle 16, wherein his thumb engages behind the retaining collar 4, so that the adjusting sleeve 10 is displaceable in the axial direction and also about the longitudinal axis. In the illustrated embodiment, the adjusting sleeve 10 has a bearing on the guide bushing 12 and inwardly to the guide body 8 projecting guide projection 20, which is designed as a pencil in the illustrated embodiment. This guide projection 20 passes through a gate opening 22 in the shell of the guide body 8. This link opening 22 is executed in the illustrated embodiment as an axial slot whose slot width is designed according to the geometry of the pin-shaped guide projection 20.
In order to lock the adjusting sleeve 10 in one or more axial positions, the sliding block opening 22 can be provided with radial slots (perpendicular to the plane of the drawing in FIG. 1), into which the guide projection 20 is inserted by axial displacement and rotation of the adjusting sleeve 10 and thus into Axial direction can be set so that a predetermined deflection of the catheter probe is locked. Of course, the determination of the adjusting sleeve 10 in other ways, for example by clamping or by a screw or the like. The adjusting sleeve 10 is biased by a spring, not shown, in a basic position, so that the adjustment takes place against the force of the spring.
The distal end portion of the catheter probe 2 is made of a slightly more flexible material than the other catheter probe area, so that when a Zugkraftbeaufschlagung by means of the control wire 33 this flexurally softer area is deflected.
In an inner space 26 of the guide body 8, a clamping piece 28 is guided axially displaceably, which is connected to the guide projection 20, so that the adjustment of the adjusting sleeve 10 is transmitted to the clamping piece 28. In the illustrated embodiment, the clamping piece 28 is designed as a cylindrical element which is slidably guided in the cylindrical interior of the guide body 8. About a clamping device, not shown, a proximal end portion of a control wire 33 is clamped tensile on the clamping piece 28 which is slidably guided along the catheter probe or within the control lumen mentioned in the catheter probe to the distal end portion, so that by moving the adjusting sleeve 10, the distal end the catheter probe 2 can be deflected.
At the connection area 18 of the guide body 8, a working / flushing lumen outlet 30 is formed, to which a tool or a flushing hose can be connected via a working / flushing connection 32. In principle, it is also possible to perform this work / flushing port 32 as a Y-piece, wherein the respectively not required connection piece is tightly closed by a plug.
In the exemplary embodiment illustrated in FIG. 1, image guides 36 and optical fibers 34 of the optics are guided out of the corresponding lumens of the catheter probe 2 and extend through the interior 26 of the guide piece 8. The right in Figure 1 end portion of the guide body 8 is shut off via a connecting piece 38 which is penetrated by the light guide 34 and image conductor 36. At least the protruding from the connector 38 areas of the conductors 34, 26 are protected by protective tubes 40, 42, which are placed on the light guide 34, image conductor 36 and can be connected via suitable, not shown closures with the connector 38.
An optical base body 44 is formed on the end section of the image conductor 36 remote from the handle 4, and an optical waveguide connection 46 is formed on the corresponding end section of the optical waveguide 34. About these ports 44, 46, the optics can be connected to the eyepiece or the light source.
In the solution according to the invention, the distal end section of the light guide 26 is designed in such a way that diffuse light is radiated in the opening angle of the image optics.
The above-described endoscope with separate light guide and image guide lumen can be used, for example, with 10,000-pixel optics, where a lumen is used as the working and irrigation lumen. In low-vision optics (6,000-pixel optics), image and light guides can be accommodated in a single lumen so that irrigation lumens and working lumens can be separated. In this case, two connections (working connection / flushing connection) could then be made at the connection region 18, while at the rear only a protective tube 40 for the optics emerges via the connection piece 38.
Since the optics go off axially to the rear and the relatively heavy rinsing hose is attached directly to the handle on which the comparatively rigid tool is attached, can in controlling the distal
Katheter probe end portion - even when twisting about the longitudinal axis - take place virtually no collision between the attached to the handles hoses / tools, so that the initially described irritation of the operator is excluded. The handle 4 is further characterized by an extremely compact, simple structure, so that it can be produced with extremely low material costs. According to the invention, it is preferable to make this handle 4 disposable from plastic, so that it is thrown away together with the catheter probe (without optics) after the treatment.
In principle, it is also possible to perform the catheter probe 2 with a balloon, which is then expanded via a suitable dilation medium. In the above-described embodiment, it would be difficult to provide an additional connection for such a dilation medium. In principle, it is conceivable to use air as the dilating medium and to guide it via the annular space between the optical waveguide 34 and the optical waveguide protective tube 40, which, however, would then have to be made gas-tight to the catheter probe 2. In the area of the balloon, this fiber channel can be drilled to connect to the balloon volume. Since the entire optical fiber order is hermetically lockable, this Dilation of the balloon by air would be harmless.
An additional advantage is that the catheter probe 2 is disposable with this balloon and disposed of after use, so that decontamination of the balloon is not required.
In the illustrated embodiment, the connection portion 18 is attached as a separate component axially to the tubular guide body 8. The above-described Luer lock for the catheter probe 2 is also formed on this component. Axially to the Luer lock 6, a further Luer connection 50 is provided, via which a catheter tube arrangement 52 according to FIG. 2 can be attached to the handle 4. The basic structure of this catheter assembly 52 and the interaction with the PolyScope are extensively available under the product name "CHIRIFLEX (R)" at www.polvdiagnost.com, so that only the essential elements for understanding the invention are explained. Referring to Figure 2, the catheter tube assembly "CHIRIFLEX (R)" has a catheter tube 54 connected to a shifter 56 and a catheter tube handle 58.
In this case, the catheter tube 54 is screwed by means of a bayonet or - as in the illustrated embodiment - via a threaded connection 60 with the catheter tube handle 58. At the right in Figure 2 end portion of the catheter tube handle 58, a clamping screw 62 and a connecting thread are formed, via which a shifter tube 64 of the shifter 56 is fixed. In this case, a shifter-side cap nut 66 is screwed onto the connecting thread, so that the shifter tube 64 is sealingly attached to the catheter tube handle 58. By loosening the clamping screw 62, the shifter tube 64 and thus the total length of the catheter tube arrangement 52 can then be adjusted, so that a predetermined relative positioning to the catheter probe 2 is possible.
The determination of the catheter assembly 52 at the handle 4 described above via a connection 68 which cooperates with the Luer connector 50 on the handle 4. During use, the operator holds the catheter tube assembly 52 and catheter probe / handle assembly on the catheter tube handle 58 after the distal catheter probe end portion is positioned. The actual instrumentation can then be done so to speak "from behind" on the handle 4 by an assistant.
According to the detail X in FIG. 2, the distal end section of the catheter tube 54 is designed with an opening 70 inclined obliquely to the longitudinal axis. At the axially projecting end portion of the mouth 70, a guide member 72 is fixed, which protrudes in the radial direction both over the outer circumference 74 of the catheter tube and inwardly beyond the inner peripheral wall 76. In the solution shown, the guide element 72 is designed as a smooth-surfaced ball, so that, for example, ureteroscopy during removal of the endoscope no injuries occur in the ureter region.
The over the outer circumference 74 protruding portion of the guide member 72 makes it easier for the operator to "fog" the endoscope when inserted into the ostia. The regions protruding radially inward beyond the inner circumferential wall 76 facilitate orientation in which relative position the endoscope is arranged in the relevant organ, since these radially inwardly projecting regions of the guide element 72 are detected via the optics of the catheter probe 2. After the catheter tube 54 is then brought into its desired desired position by the operator, the elastic catheter probe 2 can be moved out of the mouth region of the catheter tube 54 via the shifter 56, so that the elastic end section of the catheter probe 2 is deflected by actuating the adjusting sleeve 10.
Wherein the deflection direction is adjustable by turning the endoscope 1 about its longitudinal axis. The deflection radius is determined essentially by the length of the end of the catheter tube 2 moved out of the catheter tube 54. If this end section of the catheter probe 2 projecting from the catheter tube 54 is relatively short, a comparatively large deflection radius is established accordingly. If the catheter probe 2 is pushed out by the entire adjustment range of the shifter (for example, about 7 cm), the catheter probe 2 can be deflected very closely, so that it forms almost a full circle. The mechanisms of bending and radius manipulation are described in detail in the instructions for use for the "CHIRIFLEX (R)" product.
The above described embodiment, that is, the combination of a catheter probe 2 with a rigid catheter tube assembly 52, can combine the advantages of both principles (high rigidity and stability upon insertion and withdrawal - maximum flexibility during surgery).
Simplified endoscopes may be used in vascular endoscopy applications, where usually the positioning of the endoscope is monitored by X-ray or ultrasound control, so these endoscopes need not be designed with optics. In many applications it is sufficient if these vascular endoscopes, which are used, for example, for percutaneous vascular intervention, in particular for stent implantation, are designed with an endoscope deflection control, a rinsing connection and a working connection for a guide wire. In such endoscopes, however, it is important to be able to deflect the catheter probe 2 very closely and in different directions in order, for example, to be able to reach vascular branches.
For this purpose, in the subsequently published patent application DE 10 2007 006 185 of the applicant an endoscope is described in which a guide catheter has two coaxially behind each other arranged catheter sections with different stiffness. Each of these catheter sections is assigned its own control, so that the guide catheter can follow even the most difficult deflections, since the second catheter section can be deflected retrograde to the first catheter section. With regard to the specific embodiment of such a control, reference is made to the aforementioned patent application.
This very precise control is implemented in FIG. 3 in the present inventive concept. Similar to the above-described embodiment, the endoscope 1 has a catheter probe 2, which is designed as a guide catheter. As mentioned above, this catheter probe 2 is embodied by two catheter sections 78, 80 arranged coaxially with each other, the proximal catheter section 78 having a higher flexural rigidity than the distal catheter section. Each of these catheter sections 78, 80 is associated with a control wire (not visible in FIG. 3) which is guided in one or two control lumens of the catheter probe 2 which are separated from one another and which can be adjusted by means of an adjusting sleeve 10, 82.
Both adjusting sleeves 10, 82 are guided in the manner explained in Figure 1 on the tubular guide body 8 of the handle axially adjustable and fixable, so that, for example, by adjusting the adjusting sleeve 2 in the direction of arrow first the proximal, relatively rigid catheter section 78 is deflected. By adjusting the front adjusting sleeve 10, the comparatively easily bendable distal catheter section 80 can then be actuated so that it is deflected in a counter-rotating (retrograde) manner to the catheter section 78 with a comparatively small bending radius. The respective deflection can be fixed by locking the associated adjusting sleeve 10, 82 on the guide body 4.
The connection and guidance of the adjusting sleeves 10, 82 to the respective control wires corresponds to the construction according to FIG. 1, although two spaced-apart retaining collars 14a, 14b are provided in the exemplary embodiment according to FIG. Each adjusting sleeve 20, 82 is a gate opening 22 (see Figure 1) associated with radial slots 24, in each of which a guide projection 20 dips, the end portion is respectively connected to a clamping piece 28, is fixed to the respectively associated control wire, so that the axial displacement of Adjusting sleeves 10, 82 is transmitted directly to the control wires and accordingly to the catheter sections 78, 80. In the illustrated embodiment, the arrangement of the control wires is selected so that an opposite bending of the two catheter sections 78, 80 sets.
In principle, other geometries, for example, a corotating bending of the catheter sections 78, 80 with different radii can be adjusted by suitable connection.
As in the above-described embodiment, the handle 4 has on the rear side a connection piece 38, from which approximately parallel a guide wire 84 and a proximal flushing lumen outlet 30 are led out. In principle, this flushing-lumen outlet 30 can also be designed as an oblique or radial connection in the distal connection region 18 of the handle 4.
Similar to the above-described embodiment, both the handle 4 and the associated catheter probe 2 are designed as disposable. Since in the solutions described both the catheter probe 2 and the handle 4 are designed disposable, they can in principle also be designed as a structural unit, in which case only the optics is used and are aligned by means of Optikshifters with respect to the translucent cover.
Disclosed is an endoscope with a multi-lumen catheter probe, at least one of which is a control lumen, in which a control is guided, which is adjustable at its proximal end by means of an actuating element of a handle. According to the invention, this handle is designed with a guide body in which an end portion of the control is immersed. This is indirectly or directly with a guided on or on the guide body adjusting sleeve in operative engagement, so that the control is adjustable by adjusting the adjusting sleeve with respect to the guide body. According to the invention it is provided that at least one further lumen exit is formed on the handle.
LIST OF REFERENCES
2 catheter probe
6 luer lock
8 guide body
10 adjusting sleeve
12 guide bush
14 retaining band
18 connection area
20 Leadership lead
22 Gate opening
24 radial slot
28 clamping piece
30 working / flushing volume output
32 working / rinsing connection
33 control wire
34 optical fiber
36 picture ladder
38 connection piece
40 protective hose
42 protective hose
44 optical body
46 fiber optic connection
50 luer connection
52 catheter tube assembly
54 catheter tube
58 Catheter tube handle
60 connection thread
62 clamping screw
64 Shifter tube Union nut
inner circumferential wall
The catheter section
The catheter section