WO2016037684A1

WO2016037684A1 - Medical endoscope having an angled tool guide

Info

Publication number: WO2016037684A1
Application number: PCT/EP2015/001712
Authority: WO
Inventors: Simon Vogt
Original assignee: Olympus Winter & Ibe Gmbh
Priority date: 2014-09-09
Filing date: 2015-08-21
Publication date: 2016-03-17
Also published as: DE102014013076A1

Abstract

The invention relates to a medical endoscope (10) having an elongated shaft (12) for introduction into a human or animal body and a tool (14) having a tool section (16) that extends between a distal region and a proximal region of the endoscope (10). At least part of the tool section (16) is guided in a curved channel (18) of a component (20) of the endoscope (10), said channel (18) being defined by a bent tube section (22) arranged in the component (20).

Description

Medical endoscope with angled tool guide Description

The invention relates to an endoscope referred to in the preamble of claim 1 Art.

Such endoscopes are preferably used for cutting resection in the area of the bladder, in particular in the area of the prostate. Endoscopes for resecting tissue in the bladder and prostate area are commonly known as resectoscopes. However, resectoscopes can also be used in other surgical fields, for example when working in the uterus. They typically have a light source, a surgeon's vision channel, a fluid supply, and a working channel. Resectoscopes are usually transurethral with their sheath, i. inserted through the urethra into the body.

For processing a treatment area located in the region of the distal end of the endoscope within the body, different tools may be provided on the endoscope. For high-frequency resectoscopy, a loop subjected to high-frequency alternating current is usually inserted at the distal end of the endoscope. The loop is contacted via at least one wire-like electrical conductor, the electrode carrier, at the proximal end of the endoscope at connection points with a high-frequency source. To perform a cutting movement of the electrode carrier is mounted longitudinally displaceable in a shaft of the endoscope. The longitudinal displacement of the electrode carrier is typically performed by the operation of a transporter in the proximal region of the endoscope.

CONFIRMATION COPY In laser resectoscopy, instead of an electrode, a laser fiber is guided in a longitudinally displaceable manner in the shaft of the resectoscope, the distal end of the fiber being exposed at the distal end of the endoscope in order to machine the operating area with a laser light emerging therefrom. For longitudinal displacement of a laser fiber or a high-frequency electrode, these tools are usually motion-coupled in the proximal region of the endoscope to a movable carriage, which can be moved back and forth relative to the shaft of the endoscope by finger movement of the surgeon. The tool shanks, ie, for example, the fiber body or the electrode carrier are guided over longer regions axially parallel to the endoscope shaft within an outer tube. In particular, in the proximal region of the endoscope, guidance of the tool shanks in angled channels is usually also provided. For example, a laser fiber is guided proximally outwardly in an angled passageway to connect to an external laser source. An unnecessary interruption of the fiber is avoided in order to prevent energy losses and to keep the component complexity of the endoscope as low as possible. A continuous straight guidance of the tools is often not possible because, for example, axially parallel an optic is guided in the endoscope, which opens into an eyepiece in the proximal region. Lateral or oblique feeds through curved channels are therefore already necessary for space-economic reasons.

Shafts of a high-frequency electrode or the proximal terminal areas of an electrode carrier are sometimes also guided in angled channels to be connected at suitable contact points via connecting lines to a high-frequency power source or the like. Angled channels are often also at the coupling points of Endoskopschäften, for example, between the main body of a conveyor and an outer shaft. In addition to the usual use of laser fibers or high-frequency electrodes for cutting resection, optical fibers or biopsy forceps are inserted into the endoscope for illumination or removal of tissue samples and guided with the forceps body or the fiber body to the distal end of the endoscope. Even such tools or aids are often performed by angled channels of the endoscope. The implementation or the introduction of elongated tool shanks in angled channels involves various risks. For example, upon insertion of the tool into the angled channel, shaft portions of the tool may scrape on the inner wall of the channel, thereby shedding material chips from the inner wall of the channel and transporting them into the patient's body. In addition, the tool shanks sometimes jam at kinks of the angled channel, which can lead to jerky movements of the instrument. Tool shafts, which crochet on the walls of the channel, complicate the operation of the endoscope and worn material flakes can present high health risks when introduced into the patient's body.

Against this background, the object of the present invention is to provide a medical endoscope of the type mentioned in the introduction, which allows improved operation and reduces the risk of material erosion in angled channels.

This object is achieved by an article having the features of claim 1. Advantageous embodiments are specified in the subclaims. According to the invention, a medical endoscope is provided with an elongate shaft for insertion into a human or animal body and a tool having a tool section extending between a distal section and a proximal section of the endoscope, at least a portion of the tool section being in a curved channel of a component of the endoscope is guided, and wherein the channel is formed by a bent pipe piece arranged in the component.

Tools that are guided through the curved channel, can be introduced into the endoscope with low friction and with the use of only low shear forces. This not only prevents the risk of material abrasion on the inner surfaces of the curved or angled channel, but also facilitates the operation of the endoscope.

In endoscopes of conventional design, curved channels are typically formed by two angularly aligned bores that meet in their end regions. In thus formed angled channels arise in the meeting of the holes kinks and irregularities in the Inner wall of the canal. These irregularities lead to blockages of tools. The tools must be pushed with excessive force and the risk of material abrasion on the inner wall of such channels increases. In the invention, it is contemplated that the curved channel in the component of the endoscope is a portion between two straight portions of a channel and that at least the portion with the curvature of a bent pipe piece is formed. Preferably, the entire channel of the component is formed by the pipe section. It is also conceivable that the channel is curved over its entire longitudinal extent. For the formation of the channel can be provided that the pipe piece is inserted into an angled extending bore of the component. The bend of the pipe section may be incorporated prior to insertion into the pipe section. Alternatively, it can be provided that the bend adjusts when inserting into the angled bore or that a preset bend continues to bend as a result of the insertion or changes approaching the course of the angled bore.

For fixing the pipe section can be provided that the pipe section is clamped in the angled bore. For this purpose, it is conceivable that the pipe section rests with its outer wall at least partially clamping on one or more areas of the bore inner wall. Alternatively or additionally, it can be provided that the pipe section is held outside the angled bore on the component. For this purpose, the pipe section may for example have a flange which can be fastened to the component, in particular can be screwed to the component. For fixing the pipe section can also be provided that the pipe piece is at least partially bonded to the component.

In a first conceivable variant it can be provided that the curved channel is formed as a blind hole. Blind holes are preferably used to contact pads of electrodes at junctions in the proximal region of the endoscope.

In a second variant, it is conceivable that the curved channel is formed as a continuous, open at two points of the component channel. Through-passages of this type are preferably used to introduce tools from the outside into the endoscope. Feedthroughs are used, for example, for laser electrodes, biopsy forceps, optical fibers, or the like. In a preferred embodiment it is provided that the pipe section consists of a metal. Due to good biocompatibility, the metal may in particular be a stainless steel. The stainless steels commonly used in medical endoscopes are durable and dimensionally stable and are well suited for forming a curved channel within the endoscope. If the component having the channel also consists of a metal or at least partially has metallic surfaces, the tube piece can be welded to the component and / or soldered. Alternatively, the pipe section can also be made of a suitable plastic, in particular a heat-resistant and / or an abrasion-resistant plastic. Preferably, the pipe section is made of an autoclavable material. The component having the channel is preferably made of a plastic.

A piece of tubing made of metal to form the channel helps prevent material abrasion. For this purpose, metals such as stainless steels with suitable hardness can be selected.

A particularly cost-effective and flexible production of the component is supported by the fact that the component is an injection molded part. Injection molded parts are particularly advantageous for the production of large quantities. Complicated or complex component shapes can be implemented quickly and easily with injection molding. Alternatively it can be provided to manufacture the component from a solid material. Regardless of the embodiment of the component made of a solid material or as an injection molded part, a passage or a recess for receiving the bent pipe section, for example, be machined by machining into the material of the component.

In the embodiment of the component as an injection molded part, a simple integration of the bent pipe section into the component is possible. For this purpose, it may be provided that holes are formed in the molded component, which form a curved bore channel and the pipe section is inserted into the drill channel. The pipe section may be held by clamping and / or by means of screwing and / or adhesive bonding in the bore of the component. Regardless of whether the component is manufactured as an injection molded part, it can also be provided that the curved pipe section traverses a cavity of the component and thus forms a defined channel within the cavity. The For this purpose, pipe piece can be fastened, for example, at one or more mouth points of the component

To reduce the component complexity and / or to reduce the work steps necessary when assembling the endoscope, it is envisaged that the tube piece is incorporated as an insert in the component embodied as an injection-molded part. In particular, in a piece of pipe made of metal, such as stainless steel, the piece of pipe in the manufacture of the component can be easily injected with injection molding compound. When using a pipe section of a metal or other suitable material deformations or material changes can be avoided by hot injection molding compound.

The formation of the pipe section as a depositor in the component designed as an injection molded part is advantageous because the pipe section is firmly connected to the component and no further fastening means for holding the pipe section must be provided on the component. For this purpose, the pipe section may have structured outer surfaces which allow a firm hold in the solidified injection molding compound. For example, at least in some areas elevations and / or depressions, corrugations, edges, webs or the like may be provided on the outer surface of the pipe section.

For a modular construction of the endoscope, to simplify maintenance work and to improve the cleanability of individual elements of the endoscope, it is proposed that the component be detachably fastened to the endoscope. A releasable attachment to the endoscope can be realized for example by clamping or screwing. Alternatively or additionally, it can also be provided that the component is latched on the endoscope. A detachable attachment facilitates the replacement or the maintenance or cleaning-related disassembly of such parts.

In the component additional channels can be provided for the passage of other tools or components without further notice. For example, the component may also include a straight channel for performing optics. Furthermore, it can be provided that in the component connection points and / or contact points for the introduction and forwarding of high-frequency current to high-frequency tools of the endoscope, such as cutting electrodes, are incorporated. In a preferred embodiment it is provided that the component for attachment to the endoscope has at least two holes for receiving fastening bolts. The holes can be designed as through holes or blind holes. In particular, in the execution of a blind bore, an internal thread may be provided in the holes for the positive retention of bolts.

In the drawings, embodiments of the invention are shown very schematically. Show it:

1 shows an inventive, in the distal end portion axially cut endoscope,

2 shows a component with a curved channel in a first variant, and FIG. 3 shows a component with a curved channel in a second variant.

Fig. 1 shows in its right part in section the distal end of a tubular shaft 12 in which an optic 36 is arranged axially parallel. The viewing direction of the optics 36 is slightly oblique to the axis of the shaft 12 is formed. The optic 36 is guided in an optical channel 34 extending from the proximal region to the distal end of the endoscope.

On the optical channel 34, a tube 42 is guided with a partially tubular guide piece 40, which serves to guide a shaft portion or a portion 16 of a tool 14. The tube 42 receives the tool 14 with the tool section 16 so as to be longitudinally displaceable and guides the shank region of the tool or the tool section 16 at least in regions parallel to the longitudinal axis of the shank 12. In conceivable variants, the tube 42 may be fastened non-displaceably to the optical channel 34 in the longitudinal direction.

As shown, the tool 14 may be an optical fiber for illuminating or processing an operating area (not shown). The tool 14 may at its distal end also readily pliers industries and / or cutting industries have (not shown). In particular, when using electrodes for a transurethral resection can at the distal end the tool 14 also be supplied with electric current bare wire loops (not shown).

On the left side, Fig. 1 shows the proximal end of the illustrated endoscope 10. The shaft 12 is fixed at its proximal end to a main body 44. Rinse water inlets and outlets may be provided at the attachment area of the stem 12 (not shown).

Proximally beyond the main body 44, a feed dog with a carriage 30 is disposed. The slide 30 is - as schematically indicated - preferably mounted slidably on the optical channel 34. As shown, an optic 36 is inserted into the optical channel 34 to observe the surgical field and / or to observe the distal end of the tool 14. The optic 36 opens proximally in an eyepiece 38.

To operate the transporter on the carriage 30, a thumb ring 28 and the main body 44, a pair of finger systems 26 is arranged. The thumb ring 28 and the main body 44 are spring biased spaced from each other by a spring bridge 32. By moving the thumb ring 28 in the direction of the finger systems 26 against the spring force applied by the spring bridge 32, the operator of the endoscope 10 can move the carriage 30 relative to the main body 44. The carriage 30 is preferably slidably displaced on the optical channel 34.

Upon displacement of the carriage 30 in the distal direction of the endoscope 10, the tool section 16 and the distal end of the tool 14 are moved longitudinally with respect to the shaft 12. For this, the tool 14 may be forcibly coupled to the carriage 30, for example by means of clamping (not shown).

In another embodiment (not shown) can be provided that the carriage 30 with the finger systems 26 is coupled to the endoscope 10, preferably on the optical channel 34, slidingly arranged. It can be provided that the carriage 30 by means of the spring bridge 32 against a, with the optical channel 34 in the longitudinal direction of the endoscope 10 motion-coupled thumb ring 28, is spring-biased. In the movement of the finger systems 26 in the direction of the thumb ring 28, the operator of the endoscope, the carriage 30 in the proximal Move the direction of the endoscope and thus at least partially draw the distal end portion of the tool 14 in the shaft 12.

In the variants described, in particular in the variant shown in FIG. 1, the component 20 with the channel 18 formed therein is arranged in a carriage 30 which can be displaced relative to the longitudinal axis of the endoscope. Instead of a longitudinally displaceably mounted on the endoscope 10 component 20 may also be provided to arrange the channel 18 in an immovable to the shaft 12 area. For example, the channel 18 may be disposed in the main body 44. It may also be provided to arrange the component 20 in intermediate pieces which can be coupled to the endoscope 10, for example in a so-called bridge (not shown). It is preferred to use channels arranged immovably with respect to the main body 44 for introducing biopsy forceps. As shown in highly schematic form in FIG. 1 and more precisely also schematically in FIGS. 2 and 3, a component 20 is provided in which an angled channel 18 is arranged. The tool 14 is guided with a portion 16 in the channel 18. As shown, the channel 18 may be formed as a passageway with two openings, wherein the tool 14 passes through the channel 18 with the portion 16. Alternatively it can be provided that the channel 18 is formed as a blind channel with at least one curvature (not shown), for example for receiving a proximal end of an electrode.

As illustrated in FIGS. 2 and 3, the channel 18 is formed by a tubular piece 22. FIG. 2 shows the component 20 in a first variant in which the tube piece 22 is inserted into an angled bore channel 23 of the component 20. The pipe section 22 may be inserted into the bore channel 23 for this purpose. As can be clearly seen, the pipe section 22 has a course following the course of the bore channel 23 in the component 20. The rounding of the pipe section 22 facilitates the insertion and pushing through a portion 16 of a tool 14. The risk of the formation of material chips removed by inserted tools and their entry into the human or animal body is thereby considerably reduced.

Fig. 3 shows a further variant of the embodiment of the channel 18. Here, the component 20 is made as an injection molded part, wherein the pipe section 22 as a depositor in the manufacture of the component 20 is injection molded with injection molding material. The component 20 can, as shown in FIGS. 1 to 3, have bores 24 which are designed to receive bolts in order to fasten the component to the endoscope. The holes 24 may be designed as through holes or blind hole. In particular, it can be provided that at least some of the holes 24 have an internal thread for screwing with a screw bolt (not shown).

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LIST OF REFERENCE NUMBERS

10 endoscope

12 endoscope shaft

14 tool

16 shank area of the tool

18 angled channel

20 Component with angled channel

22 pipe section

23 hole

24 mounting holes

26 finger systems

28 thumb ring

30 sleds

32 spring link bridge

34 optical channel

36 optics

38 eyepiece

40 guide piece

42 pipe

44 main body

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Claims

claims

A medical endoscope (10) having an elongated shaft (12) for insertion into a human or animal body and a tool (14) having a tool portion (16) extending between a distal portion and a proximal portion of the endoscope (10). wherein at least a part of the tool section (16) is guided in a curved channel (18) of a component (20) of the endoscope (10), characterized in that the channel (18) is guided by a curved pipe section (20) arranged in the component (20). 22) is formed.

2. Medical endoscope according to claim 1, characterized in that the pipe section (22) consists of a metal.

3. Medical endoscope according to one of claims 1 or 2, characterized in that the component (20) is an injection molded part.

4. Medical endoscope according to claim 3, characterized in that the pipe section (22) is incorporated as an insert in the executed as an injection molded part (20).

5. Medical endoscope according to one of the preceding claims, characterized in that the component (20) is releasably attached to the endoscope (20).

6. Medical endoscope according to claim 5, characterized in that the component (20) for attachment to the endoscope has at least two bores (24) for receiving bolts.

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