US20060079735A1 - Endoscope assemblies having working channels with reduced bending and stretching resistance - Google Patents
Endoscope assemblies having working channels with reduced bending and stretching resistance Download PDFInfo
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- US20060079735A1 US20060079735A1 US11/291,655 US29165505A US2006079735A1 US 20060079735 A1 US20060079735 A1 US 20060079735A1 US 29165505 A US29165505 A US 29165505A US 2006079735 A1 US2006079735 A1 US 2006079735A1
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- working channel
- body portion
- insertion tube
- working
- sheath
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00064—Constructional details of the endoscope body
- A61B1/00071—Insertion part of the endoscope body
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00131—Accessories for endoscopes
- A61B1/00135—Oversleeves mounted on the endoscope prior to insertion
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00131—Accessories for endoscopes
- A61B1/0014—Fastening element for attaching accessories to the outside of an endoscope, e.g. clips, clamps or bands
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/005—Flexible endoscopes
- A61B1/0051—Flexible endoscopes with controlled bending of insertion part
- A61B1/0055—Constructional details of insertion parts, e.g. vertebral elements
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
- A61B1/018—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor for receiving instruments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/00142—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor with means for preventing contamination, e.g. by using a sanitary sheath
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/005—Flexible endoscopes
- A61B1/0051—Flexible endoscopes with controlled bending of insertion part
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
- A61B10/02—Instruments for taking cell samples or for biopsy
- A61B10/04—Endoscopic instruments
Definitions
- the present invention is directed toward endoscopic apparatus and methods, and more specifically, to endoscope assemblies having working channels with reduced bending and stretching resistance.
- Endoscopes are widely used for a variety of medical procedures. To improve their performance, endoscopes have been optimized in various ways to best accomplish their purpose. Examples of specialized endoscopes include angioscopes, colonoscopes, bronchoscopes, and arthroscopes.
- FIG. 1 shows a conventional endoscope assembly 10 used for obtaining a biopsy sample.
- the endoscope assembly 10 includes an endoscope 20 having an elongated insertion tube 22 .
- the insertion tube 22 may be rigid, partially flexible, or entirely flexible.
- the insertion tube 22 includes a distal portion 24 that may be inserted into a body cavity of a patient (not shown), and a working end 26 .
- the endoscope 20 includes a headpiece 28 that remains external to the patient during a medical procedure.
- the headpiece 28 includes an eyepiece 30 for viewing the scene through a viewing lens 31 at the working end 26 of the insertion tube 22 , a pair of articulation control knobs 32 for manipulating the position of the distal portion 24 of the insertion tube 22 , and a pair of fluid control actuators 34 for controlling the flow of fluids through tubes 36 to (or from) the working end 26 .
- Endoscopes 20 of the type generally shown in FIG. 1 are described more fully, for example, in U.S. Pat. No. 5,931,833 issued to Silverstein, U.S. Pat. No.
- endoscopes include, for example, video or fiberoptically-equipped sigmoidoscopes, bronchoscopes, nasopharyngo-laryngoscopes, colonoscopes, and gastroscopes.
- the endoscope assembly 10 includes a sheath 40 that encapsulates the insertion tube 22 to prevent at least part of the insertion tube 22 from being soiled during the medical procedure.
- the sheath 40 may be flexible to allow unrestricted bending of the flexible portion of the insertion tube 22 , or may be relatively rigid.
- the sheath 40 includes an enlarged fitting portion 42 that fits over an engagement portion 44 of the headpiece 28 , and a working channel 46 having a proximal end 48 that projects outwardly from the sheath 40 proximate the headpiece 28 .
- FIG. 2 is an enlarged isometric view of the working end 26 of the endoscope assembly 10 of FIG. 1 .
- the sheath 40 surrounds the insertion tube 22 of the endoscope 20 , and the working channel 46 extends along an outer surface of the insertion tube 22 .
- the working channel 46 terminates in an open distal end 49 at the working end 26 of the insertion tube 22 .
- a medical instrument 50 including a biopsy sampling device 52 , extends through the working channel 46 (see FIG. 1 ) and projects from the open distal end 49 of the working channel 46 .
- Sheaths of the type shown in FIGS. 1 and 2 are described more fully, for example, in U.S. Pat. No.
- the medical instrument 50 is inserted into the proximal end 48 of the working channel 46 and slid through the working channel 46 until the biopsy sampling device 52 emerges from the open distal end 49 at the working end 26 .
- the physician observes the biopsy sampling device 52 through the viewing lens 31 and manipulates the medical instrument 50 into the desired position and collects the desired sample.
- the biopsy sampling device 52 containing the biopsy sample may be withdrawn through the working channel 46 , or alternately, the entire insertion tube 22 may be withdrawn from the patient's body with the biopsy sampling device 52 remaining in position near the working end 26 .
- the flexible insertion tube 22 is generally manipulated into various bending positions using the articulation control knobs 32 . It is therefore desirable for such endoscope assemblies that the sheath 40 , including the working channel 46 , be fabricated of a flexible material to allow for bending and articulation of the insertion tube 22 . Furthermore, it may be desirable to axially stretch the sheath and working channel when positioned on the insertion tube 22 to maintain a tight engagement between an enclosed, transparent end cap of the sheath and the viewing lens 31 of the insertion tube 22 , as described more fully, for example, in co-pending, commonly-owned U.S. patent application Ser. No. 09/235,355.
- sheaths are commonly constructed of a flexible elastomeric material.
- a variety of known flexible materials are used for this purpose.
- such known flexible materials have high coefficients of friction that inhibit the movement of medical instruments through the working channel.
- the medical instrument may be unable to progress through the working channel, or may even become stuck, necessitating the removal of the insertion tube.
- a variety of techniques have been employed.
- One approach has been to line the working channel with a relatively-hard corrugated material having a low coefficient of friction, such as materials sold under the trademark TEFLON®. Because the relatively-hard corrugated material has a lower coefficient of friction than the flexible material of the working channel, the medical instrument moves more easily through the working channel, and the corrugations allow the necessary bending and axial stretching of the working channel.
- the lining of relatively-hard corrugated material greatly increases the thickness of the wall of the working channel, and thus, the overall diameter of the endoscope assembly.
- the sheath having a working channel lined with a relatively-hard corrugated material may increase the discomfort or trauma experienced by the patient, or may not be practical for some medical procedures due to size constraints within the patient's body. Also, the cost of manufacturing the working channel lined with the relatively-hard corrugated material is undesirably high. Finally, although the corrugated channel does stretch axially, it does not do so easily.
- an endoscope assembly includes a sheath having a body portion adapted to at least partially encapsulate an endoscopic insertion tube, and a working channel attached to the body portion and extending along at least a portion of the body portion.
- the working channel has a cut disposed therein, the cut being at least partially transverse to a longitudinal axis of the working channel.
- the working channel is separable along at least a portion of the cut when the working channel is subjected to an axial tension force.
- the working channel has a gap disposed therein, the gap being at least partially transverse to a longitudinal axis of the working channel.
- the gap is adapted to widen along at least a portion thereof when the working channel is subjected to an axial tension force.
- the working channel is attached to the body portion proximate the distal end and has a sliding portion extending along at least a part of the body portion, the sliding portion being axially slideable along the body portion when the working channel is subjected to an axial force.
- the working channel further includes an expansion section coupled between the sliding portion and the second end, the expansion section including an expansion member that is axially expandable when the working channel is subjected to the axial force.
- Endoscope assemblies having a working channel in accordance with the invention advantageously reduce the bending and stretching resistance of the assembly during articulation of the endoscope assembly, thereby reducing the tension on the articulation control cables. Also, because the axial forces (tension and compression) within the working channel are reduced, the working channel can be fabricated out of a relatively hard, inelastic material, thereby reducing the friction within the working channel and improving the physician's ability to perform a medical procedure.
- FIG. 1 is an isometric view of an endoscope assembly in accordance with the prior art.
- FIG. 2 is a partial isometric view of a distal end of the endoscope assembly of FIG. 1 .
- FIG. 3 is a partial isometric view of an endoscope assembly including a sheath in accordance with an embodiment of the invention.
- FIG. 4 is a partial isometric view of the endoscope assembly of FIG. 3 in a first articulated position.
- FIG. 5 is a partial isometric view of the endoscope assembly of FIG. 3 in a second articulated position.
- FIG. 6 is an enlarged, partial cross-sectional view of the working channel of FIG. 5 .
- FIG. 7 is a partial isometric view of an endoscope assembly in accordance with an alternate embodiment of the invention.
- FIG. 8 is another partial isometric view of the endoscope assembly of FIG. 7 .
- FIG. 9 is a partial isometric view of an endoscope assembly in accordance with another embodiment of the invention.
- FIG. 10 is a partial isometric view of an endoscope assembly in accordance with another alternate embodiment of the invention.
- FIG. 11 is a partial isometric view of an endoscope assembly in accordance with yet another embodiment of the invention.
- FIG. 12 is a partial elevational view of the endoscope assembly of FIG. 11 .
- FIG. 13 is a partial isometric view of an endoscope assembly in accordance with a further embodiment of the invention.
- FIG. 14 is a partial isometric view of the endoscope assembly of FIG. 13 in a first articulated position.
- FIG. 15 is a partial isometric view of the endoscope assembly of FIG. 13 in a second articulated position.
- FIG. 16 is a partial isometric view of an endoscope assembly in accordance with another embodiment of the invention.
- FIG. 17 is a partial isometric view of the endoscope assembly of FIG. 16 in a first articulated position.
- FIG. 18 is a partial isometric view of the endoscope assembly of FIG. 16 in a second articulated position.
- FIG. 19 is a partial isometric view of an endoscope assembly in accordance with another embodiment of the invention.
- FIG. 20 is a partial isometric view of an endoscope assembly in accordance with still another embodiment of the invention.
- FIG. 21 is a partial elevational view of an endoscope assembly in accordance with a further embodiment of the invention.
- FIG. 22 is another partial elevational view of the endoscope assembly of FIG. 21 .
- FIG. 23 is a partial elevational view of an endoscope assembly in accordance with yet another embodiment of the invention.
- FIG. 24 is another partial elevational view of the endoscope assembly of FIG. 23 .
- the present invention is directed toward endoscopic sheath apparatus and methods, and more specifically, to sheath assemblies having working channels with reduced bending and stretching resistance.
- Many specific details of certain embodiments of the invention are set forth in the following description and in FIGS. 3-24 to provide a thorough understanding of such embodiments.
- One skilled in the art, however, will understand that the present invention may have additional embodiments, or that the invention may be practiced without several of the details described in the following description.
- FIG. 3 is a partial isometric view of an endoscope assembly 100 in accordance with an embodiment of the invention.
- the endoscope assembly 100 includes a sheath 110 having a tubular body portion 112 that at least partially encapsulates the insertion tube 22 of the endoscope 10 ( FIG. 1 ), and a working channel 120 attached to an outer surface of the tubular body portion 112 at a plurality of attachment points 122 .
- the working channel 120 is cut with a spiral (or helical) cut 124 through an outer wall of the working channel 120 .
- the spiral cut 124 may extend along the entire length of the working channel 120 , or may extend along only a portion of the working channel 120 , such as along a bending section 126 of the insertion tube 22 ( FIG. 3 ).
- the working channel 120 may be fabricated from a relatively stiff material having a coefficient of friction that is relatively lower than that of the elastomeric materials commonly used in the prior art, including, for example, materials sold under the trademark TEFLON®, or a variety of relatively hard, relatively inelastic, relatively high durometer polymers, such as urethane, polyvinyl chloride (PVC), acrylic, polycarbonate, polyethylene terephthalate, or other thermoplastic polyesters.
- the working channel 120 may be fabricated from the same elastomeric materials commonly used to fabricate sheaths in the prior art.
- the body portion 112 of the sheath 110 is fabricated from an elastomeric material and the working channel 120 is fabricated from a relatively stiff urethane material having a lower coefficient of friction than the elastomeric material of the body portion 112 .
- the urethane working channel 120 may be bonded to the body portion 112 at one or more attachment points 122 using known bonding techniques, such as, for example, an ultra-violet (UV) bonding process or the like.
- FIG. 4 is a partial isometric view of the endoscope assembly 100 of FIG. 3 with the bending section 126 of the insertion tube 22 articulated (or bent) into a first articulated position 128 .
- the working channel 120 is stretched or extended, causing the spiral cut 124 to separate at one or more locations to form a plurality of gaps 130 between a plurality of channel segments 132 .
- the widths of the gaps 130 increase, particularly at the outermost portion of each gap (i.e. the portion of each gap 130 that is furthest from the tubular body portion 112 of the sheath 110 ).
- FIG. 5 is a partial isometric view of the endoscope assembly 100 of FIG. 3 in a second articulated position 134 .
- the working channel 120 is compressed.
- one or more overlaps 136 are formed between at least some of the plurality of channel segments 132 .
- the amount of overlap between adjacent channel segments 132 increases, and the number of overlaps 136 formed between channel segments 132 may also increase.
- FIG. 6 is an enlarged, partial cross-sectional view of the endoscope assembly 100 of FIG. 5 .
- the channel segments 132 may become compressed to form overlaps 136 .
- the spiral cut 124 is not perpendicular to a longitudinal axis 138 of the working channel 120 , but rather, is angled (as shown in FIG. 6 ) so that the ends of the channel segments 132 may more readily slide over each other during compression of the working channel 120 .
- the working channel 120 having the spiral cut 124 advantageously reduces the bending and stretching resistance of the sheath 110 during articulation of the endoscope assembly 100 .
- the working channel 120 stretches to form the plurality of gaps 130 between the plurality of channel segments 132 .
- the gaps 130 relieve the axial tension forces that would otherwise exist within a stretched prior art working channel, thereby reducing the resistance of the sheath 110 to bending and reducing the amount of force required to articulate and maintain the insertion tube 22 into the first articulated position 126 .
- the working channel 120 is compressed so that the plurality of channel segments 132 move together to form one or more overlaps 136 .
- the overlaps 136 relieve the axial compression forces that would otherwise exist within the prior art working channels, which in turn reduces the resistance of the sheath 110 to bending, and reduces the amount of force required to articulate and maintain the insertion tube 22 into the second articulated position 134 .
- the working channel 120 can be fabricated out of a relatively hard, inelastic material.
- the spiral cut 124 advantageously permits the working channel 120 to be fabricated from a relatively hard material having a lower coefficient of friction than the elastomeric materials commonly used in the prior art. Because the friction between the working channel 120 and the medical device 50 is reduced, the physician's ability to perform a medical procedure may be improved.
- the pitch or frequency of the spiral cut 124 may be varied to create a greater or fewer number of channel segments 132 .
- the angle of the spiral cut 124 may be varied to be more or less oblique to the longitudinal axis 138 of the working channel 120 .
- the spiral cut 124 may extend the entire length of the working channel 120 , or may be limited to one or more portions of the working channel 120 as desired, such as, for example, to be adjacent to the portions of greatest bending of the insertion tube 22 .
- the channel 120 can also be installed such that it is in a slightly stretched condition causing gaps to exist when the articulation section is in the neutral position.
- FIG. 7 is a partial isometric view of an endoscope assembly 150 in accordance with an alternate embodiment of the invention.
- FIG. 8 is another partial isometric view of the endoscope assembly 150 of FIG. 7 .
- the endoscope assembly 150 includes a sheath 160 having a tubular body portion 162 , and a working channel 170 attached thereto.
- a plurality of partial cuts 172 are disposed through the working channel 170 .
- the partial cuts 172 extend approximately half-way through the working channel 170 to form approximately semi-circular cuts.
- the partial cuts 172 may extend a greater or lesser amount through the working channel 170 .
- the working channel 170 has first and second portions 173 , 175 having partial cuts 172 disposed therein.
- the first and second portions 173 , 175 are positioned proximate first and second bending portions 126 , 127 of the insertion tube 22 , respectively.
- the partial cuts 172 are stretched open to form one or more open notches 174 in the working channel 170 .
- the insertion tube 22 is articulated into a position that compresses the working channel 170 , such as a second articulated position 178 , the partial cuts 172 are compressed together to form overlaps 180 , in the manner described above and shown in FIGS. 5 and 6 .
- the open notches 174 serve to relieve the tension forces within the working channel 170 when the working channel 170 is stretched into the first articulated position 176 , and the overlaps 180 relieve the compression forces within the working channel 170 when the working channel 170 is compressed. Therefore, the partial cuts 172 advantageously reduce the resistance of the sheath 110 to bending and articulation of the insertion tube 22 , and also reduce the amount of force required to articulate and maintain the insertion tube 22 into an articulated position.
- the working channel 120 can be fabricated out of a relatively hard, inelastic material.
- the partial cuts 172 advantageously permit the working channel 170 to be fabricated from a relatively hard material having a lower coefficient of friction than the elastomeric materials commonly used in the prior art.
- FIG. 9 is a partial isometric view of an endoscope assembly 200 in accordance with another embodiment of the invention.
- the endoscope assembly 200 includes a sheath 210 having a tubular body portion 212 that partially encapsulates the insertion tube 22 , and a working channel 220 extending along the insertion tube 22 within the body portion 212 of the sheath 210 .
- the working channel 220 is cut with a spiral cut 224 .
- the spiral cut 224 causes the working channel to form gaps 130 or overlaps 136 , respectively, thereby relieving the tension or compression stresses that would otherwise form in the working channel 220 .
- the resistance of the sheath 210 to bending of the insertion tube 22 is reduced.
- the sheath 210 of the endoscope assembly 200 advantageously provides the reduced resistance to articulation of the insertion tube 22 as described above, and allows the working channel 220 to be fabricated from a relatively hard material having a lower coefficient of friction than the elastomeric materials commonly used in the prior art. Furthermore, because the working channel 210 is located within the tubular body portion 212 , the working channel 210 may be less likely to accumulate foreign matter that may otherwise enter the working channel 210 through the spiral cut 224 during a medical procedure. As a result, the sheath 210 may improve the physician's ability to operate the medical device 50 to perform the desired medical procedure.
- FIG. 10 is a partial isometric view of an endoscope assembly 300 in accordance with another alternate embodiment of the invention.
- the endoscope assembly 300 includes a sheath 310 having a tubular body portion 312 that at least partially encapsulates the insertion tube 22 of the endoscope 10 ( FIG. 1 ), and an end cap 313 that encapsulates the working end 26 of the insertion tube 22 .
- the end cap 313 may be transparent to permit the physician to view a location within the patient's body through the eyepiece 30 and viewing lens 31 .
- a working channel 320 is attached to an outer surface of the tubular body portion 312 at a plurality of attachment points 322 . As shown in FIG.
- a continuous spiral gap 324 is disposed through the outer wall of the working channel 320 .
- the spiral gap 324 has a nominal width w.
- the spiral gap 324 may extend along the entire length of the working channel 320 , or may extend along only a portion of the working channel 320 .
- the medical device 50 is visible through the spiral gap 324 .
- the nominal width w represents the width of the spiral gap 324 when the sheath 310 is in a relaxed, unstretched position.
- the nominal width w may represent the width of the spiral gap 324 when the sheath 310 is in an axially-stretched position, and therefore, in a relaxed, unstretched position, the spiral gap 324 may have a width that is less than the nominal width w.
- the width of the spiral gap 324 when the sheath 310 is in a relaxed, unstretched position is zero, wherein the spiral gap 324 resembles a spiral cut 124 as shown in FIG. 3 .
- the width of the spiral gap 324 may increase over the nominal width w at axial stations proximate to the bending region of the insertion tube 22 , thereby reducing the tension forces that would otherwise exist within the working channel 320 .
- the width of the spiral gap 324 may decrease from the nominal width w at axial stations proximate to the bending region.
- the sheath 310 having the working channel 320 with the spiral gap 324 disposed therethrough may advantageously reduce the bending and stretching resistance of the sheath 310 during articulation of the endoscope assembly 300 .
- the spiral gap 324 relieves the axial tension and compression forces that would otherwise exist within the working channel, thereby reducing the resistance of the sheath 310 to bending, as well as the amount of force required to articulate and maintain the insertion tube 22 in an articulated position.
- the spiral gap 324 also allows the working channel 320 to be fabricated from a relatively hard material having a lower coefficient of friction than the elastomeric materials commonly used in the prior art.
- FIG. 11 is a partial isometric view of an endoscope assembly 400 in accordance with yet another embodiment of the invention.
- FIG. 12 is a partial elevational view of the endoscope assembly 400 of FIG. 11 .
- the endoscope assembly 400 includes a sheath 410 having a tubular body portion 412 , a proximal fitting 442 engageable with the engagement portion 44 of the endoscope 20 ( FIG. 1 ), and an end cap 413 attached to a distal end of the body portion 412 .
- the end cap 413 includes a substantially transparent distal end 415 to enable viewing through the viewing lens 31 of the endoscope 20 .
- the endoscope assembly 400 further includes a working channel 420 having a spiral cut 424 therethrough, and an enlarged end portion 425 proximate the working end 26 of the insertion tube 22 .
- the enlarged end portion 425 may be sized to receive an operating end 451 of a medical device 450 .
- the working channel 420 further includes an open, proximal end 448 near the endoscope 20 .
- the proximal end 448 includes an enlarged fitting, such as a well-known Luer lock fitting, to improve the operator's ability to handle the working channel 420 during a medical procedure.
- a control end 453 of the medical device 450 extends from the proximal end 448 of the working channel 420 .
- the medical device 450 may comprise a biopsy sampling device and the operating end 451 may include a biopsy collection brush of the type described in co-pending, commonly owned U.S. patent application No. ______, filed concurrently herewith under Attorney Docket No. 501060.01.
- a variety of alternate biopsy sampling devices may be used, including, for example, needles, forceps (e.g. U.S. Pat. No. 5,820,630 issued to Lind), loop and cup devices (e.g. U.S. Pat. No. 5,417,697 issued to Wilk et al., U.S. Pat. No. 5,741,271 issued to Nakao et al.), and cylindrical cutting devices (e.g. U.S. Pat. No. 4,651,753 issued to Lifton).
- the working channel 420 is bonded to the body portion 412 of the sheath 410 at a plurality of attachment points 422 .
- the working channel 420 may be fabricated from a urethane tubing material and the body portion 412 may be fabricated of a commonly used elastomeric material.
- the enlarged end portion 425 may be fabricated by splitting the urethane tubing along a lengthwise portion thereof, and the urethane tubing may be bonded to the body portion 412 at the attachment points 422 using a well-known UV bonding process.
- the body portion 412 may be engaged into position onto the insertion tube 22 of the endoscope 20 in an axially-stretched or pre-loaded position. In one preferred embodiment, the body portion 412 is axially stretched between approximately 0.4 inches and approximately 0.6 inches.
- the operating end 451 e.g. biopsy collection brush
- the medical device 450 may be withdrawn into a retracted or non-operational position 460 as shown in FIG. 12 , with the operating end 451 disposed within the enlarged end portion 425 of the working channel 420 .
- the physician may then insert the working end 26 of the endoscope assembly 400 into a patient's body to perform a desired medical procedure.
- the insertion tube 22 may be articulated into various bending positions using the control knobs 32 ( FIG. 1 ) as described above.
- the medical device 450 may be moved within the working channel 420 to a second or operational position 462 , as shown in FIG. 11 .
- the operational position 462 the operating end 451 is at least partially removed from the enlarged end portion 425 of the working channel 420 .
- the physician may then manipulate the control end 453 of the medical device 450 which extends from the proximal end 448 of the working channel 420 ( FIG. 11 ) to perform the desired medical procedure (e.g. to collect a biopsy sample).
- the medical device 450 may be retracted into the first or non-operational position 460 ( FIG. 12 ), and subsequently withdrawn from the patient's body.
- the working channel 420 having the spiral cut 424 provides the advantages of reducing the working channel's resistance to bending and articulation of the insertion tube 22 , and to axial stretching of the sheath 410 , as described above. Furthermore, the enlarged end portion 425 of the working channel 420 may improve the ease of inserting and removing the endoscope assembly 400 from the patient. Because the enlarged end portion 425 at least partially surrounds and covers the operating end 451 in the non-operating position 460 , the enlarged end portion 425 may ease the task of inserting (and removing) the endoscope assembly 400 into the patient's body cavity, thereby reducing the trauma to the surrounding tissues and ultimately the discomfort experienced by the patient. The enlarged end portion 425 may also ensure that the operating end 451 does not become occluded with unwanted or undesirable foreign matter during insertion of the endoscope assembly 400 which might inhibit the physician's ability to perform the desired medical procedure.
- FIG. 13 is a partial isometric view of an endoscope assembly 500 in accordance with a further embodiment of the invention.
- a sheath 510 having a tubular body 512 is positioned on the insertion tube 22 of the endoscope 20 ( FIG. 1 ), and a collapsible working channel 520 is attached to the body 512 of the sheath 510 .
- the sheath 510 includes an end cap 513 that encloses the working end 26 of the insertion tube 22 , and a proximal fitting 548 that fittingly engages the engagement portion 44 of the endoscope 20 .
- the collapsible working channel 520 is shown in a collapsed position 562 .
- the collapsible working channel 520 is a continuous channel that remains collapsed until a medical device 50 is inserted therethrough.
- the collapsible working channel 520 may be constructed from collapsible tubing, or any other known collapsible channel structure, including, for example, the collapsible structures disclosed in U.S. Pat. No. 5,025,778 issued to Silverstein et al., incorporated herein by reference.
- the collapsible working channel 520 is attached to the end cap 513 of the sheath 510 at an attachment point 522 .
- a sleeve support 523 is attached to the body 512 of the sheath 510 along an intermediate portion of the body 512 , and the collapsible working channel 520 is slideably engaged within the sleeve support 523 .
- a fitting 548 is attached to a proximal end of the collapsible working channel 520 .
- the fitting 548 In the collapsed position 562 , the fitting 548 is partially engaged into a receiver 560 that is attached to the proximal fitting 542 of the sheath 310 .
- the fitting 548 includes at least one tab 550 projecting outwardly therefrom that is slideably engaged in a slot 552 disposed in the receiver 560 .
- FIG. 14 is a partial isometric view of the endoscope assembly 500 in a first articulated position 528 with the collapsible working channel 520 in a non-collapsed position 564 .
- FIG. 15 is a partial isometric view of the endoscope assembly 500 in a second articulated position 530 .
- a medical device 50 may be inserted through the working channel 520 such that a working portion 52 (e.g. a biopsy sampling device) extends from a distal end of the collapsible working channel 520 and a control end 553 extends from a proximal end of the collapsible working channel 520 .
- a working portion 52 e.g. a biopsy sampling device
- the collapsible working channel 520 is pushed, causing the collapsible working channel 520 to slide through the sleeve support 523 , and the fitting 553 to slide in a second direction 557 out of the receiver 560 .
- the collapsible working channel 520 may be replaced with a regular, non-collapsible working channel (e.g. a flexible tube).
- the collapsible working channel 520 may be replaced in whole or in part with any of the working channel embodiments described above and shown in FIGS. 3-12 , except that such alternate embodiments of working channels would only be fixedly attached to the sheath 510 at the attachment point 522 proximate the working end 26 .
- the attachment point 522 may be located on the body of the sheath rather than on the end cap 513 , or multiple attachment points may be used, or the attachment point may be extended to an attachment area extending from the working end 26 to the bending section 526 of the insertion tube 22 .
- additional sleeve supports 523 may be added to ensure that the working channel 520 remains in proximity to the body 512 of the sheath 510 .
- the endoscope assembly 500 advantageously provides reduced resistance to articulation of the endoscope 20 over prior art assemblies. Because the collapsible working channel 520 is allowed to slide along the body 512 of the sheath 510 , the collapsible working channel 520 may exert little or no resistance to the articulation of the insertion tube 22 . Furthermore, the sheath 210 may be axially stretched onto the insertion tube 22 without a corresponding stretching of the collapsible working channel 520 .
- the working channel may be fabricated out of a relatively hard material having a relatively lower coefficient of friction compared with commonly used elastic sheath materials. Because the working channel is allowed to slide along the body of the sheath, the working channel is not required to stretch appreciably in the axial direction. Although the working channel may still be somewhat flexible to permit bending during articulation of the insertion tube, because the working channel is not appreciably stretched, the working channel may be fabricated from a relatively hard material having a low coefficient of friction, thereby reducing the friction within the working channel and improving the ability of the operator to articulate the medical device to perform the desired medical procedure.
- Yet another advantage of the endoscope assembly 500 is that the proximate end of the collapsible working channel 520 is permitted to move in the first and second directions 555 , 557 without the operator's assistance or handling. Because the fitting 548 slideably moves within the receiver 560 , the fitting 548 advantageously permits the collapsible working channel 520 to slide along the body 512 of the sheath 510 without the operator's assistance. The operator's hands are thereby freed for other purposes, allowing the operator to concentrate on proper performance of the medical procedure.
- FIG. 16 is a partial isometric view of an endoscope assembly 600 in accordance with still another embodiment of the invention.
- the endoscope assembly 600 includes a working channel 620 having an expansion section 670 .
- the expansion section 670 is shown in cut-away, cross-sectional view in FIG. 16 (with a portion of the medical device 50 omitted) so that the internal components of the expansion section 670 are visible.
- the expansion section 670 includes a flexible outer covering 672 and a corrugated inner member 674 .
- the flexible outer cover 672 is bonded to the adjacent portions of the working channel 620 at bond points 673 .
- the accordian-like inner member 674 has a plurality of corrugations (or pleats) 676 that permit the inner member 674 to be elongated in a lengthwise or axial direction along the length of the working channel 620 .
- the corrugated inner member 674 is shown in an unstretched or relaxed position.
- the proximal end of the working channel 620 includes a fitting 648 (e.g. a Luer lock fitting) fixedly attached to the proximal fitting 642 of the sheath 610 by a fixed collar 660 .
- a fitting 648 e.g. a Luer lock fitting
- the fixed collar 600 may be eliminated, and the fitting 648 may be directly attached to the sheath 610 or to the endoscope 20 .
- the distal end of the working channel 620 is fixedly attached at an attachment area 622 proximate the working end 26 , and is slideably coupled to the body 612 of the sheath 610 by the sleeve support 623 .
- the working channel 620 is free to axially slide along the tubular body 612 of the sheath 610 along most of the length of the working channel 620 .
- FIGS. 17 and 18 show partial isometric views of the endoscope assembly 600 in first and second articulated positions 628 , 630 , respectively.
- the insertion tube 22 pulls (or tensions) the working channel 620 , thereby applying an axial tension force on the expansion section 670 .
- the flexible outer cover 672 stretches and the corrugated inner member 674 elongates in the axial direction.
- the axial tension force causes the corrugations 676 of the inner member 674 expand or flatten, and the bond points 673 becoming spaced farther apart.
- the insertion tube 22 pushes (or compresses) the working channel 620 , thereby applying an axial compression force on the expansion section 670 .
- the axial compression force causes the flexible outer cover 672 to slacken, and may even bow outwardly from the corrugated inner member 674 .
- the corrugated inner member 674 compresses in the axial direction, with the corrugations 676 become more pronounced and/or greater in number.
- the inner member 674 may also begin to bow outwardly.
- the axial compression force causes the bond points 673 to become spaced more closely together.
- the endoscope assembly 600 advantageously provides reduced resistance to articulation of the endoscope 20 over prior art assemblies. Because the working channel 620 includes the expansion section 670 , the working channel 620 may exert little or no resistance to the articulation of the insertion tube 22 . Furthermore, the sheath 610 may be axially stretched or pre-loaded onto the insertion tube 22 without a corresponding loading of the working channel 620 . The working channel 620 may be beneficial during installation of the assembly 600 when the sheath 610 is being stretched.
- the working channel 620 is not required to stretch appreciably in the axial direction during articulation of the endoscope assembly 600 , the working channel may be fabricated out of a relatively hard material having a relatively lower coefficient of friction. Although the working channel may still be flexible enough to permit bending during articulation of the insertion tube, the working channel fabricated from a relatively hard material having a low coefficient of friction may advantageously reduce the friction within the working channel and improve the operator's ability to articulate the medical device to perform the desired medical procedure.
- FIG. 19 is a partial isometric view of an endoscope assembly 680 in accordance with another embodiment of the invention. Similar to the previously-described embodiment, the endoscope assembly 680 shown in FIG. 19 includes a working channel 620 having an expansion section 682 , shown in cut-away, cross-sectional view (with a portion of the medical device 50 omitted).
- the expansion section 682 includes an outer sleeve 684 and a corrugated inner member 686 .
- the inner member 686 is bonded to the adjacent portions of the working channel 620 at bond point 685 and to the fitting 648 .
- the outer sleeve 684 is attached to the fitting 648 but is not bonded to the working channel 620 .
- the accordian-like inner member 686 has a plurality of corrugations (or pleats) 688 that permit the inner member 686 to be elongated in a lengthwise or axial direction along the length of the working channel 620 .
- the fitting 648 is attached to the proximal fitting 642 of the sheath 610 .
- the working channel 620 is free to axially slide along the tubular body 612 of the sheath 610 along most of the length of the working channel 620 .
- the bond point 685 between the working channel 620 and the inner member 686 is free to axially slide within the outer sleeve 684 .
- the corrugated inner member 686 is elongated in the axial direction, causing the corrugations 688 of the inner member 686 to expand or flatten and drawing the bond point 685 toward the working end 26 of the insertion tube 22 . Because the outer sleeve 684 is not attached to the working channel 620 , the bond point 685 moves inside the outer sleeve 684 toward the working end 26 , and the outer sleeve 684 is not tensioned or stretched during this movement. As the endoscope assembly 680 is positioned in the second articulated position 630 ( FIG.
- the insertion tube 22 pushes (or compresses) the corrugated inner member 686 in the axial direction, with the corrugations 688 becoming more pronounced and/or greater in number.
- the bond point 685 moves within the outer sleeve 684 away from the working end 26 of the insertion tube 22 . Because the outer sleeve 684 is not attached to the working channel 620 , the working channel 620 and the bond point 685 slide within the outer sleeve 684 . Consequently, the outer sleeve 684 is not compressed and does not bow outwardly during articulation of the insertion tube 22 into the second articulated position 630 .
- the endoscope assembly 680 provides the above-noted advantages of reducing the resistance of the working channel 620 to articulation of the endoscope 20 , and also allowing the working channel 620 to be fabricated out of a relatively hard material having a relatively lower coefficient of friction. Furthermore, because the outer sleeve 684 of the expansion section 682 maintains a constant diameter and does not bow outwardly during articulation of the insertion tube 22 , the expansion section 682 may advantageously be positioned within the patient's body during a medical procedure without causing undue expansion of or trauma to the surrounding tissues during articulation of the insertion tube 22 .
- FIG. 20 is a partial isometric view of an endoscope assembly in accordance with still another embodiment of the invention.
- the endoscope assembly 690 includes an expansion section 692 that includes a flexible resilient portion 694 coupled at bond points 695 between the working channel 620 and the fitting 648 .
- the working channel 620 may be fabricated from a relatively hard material having a relatively lower coefficient of friction.
- the flexible resilient portion 694 is fabricated from a flexible material, allowing the flexible resilient portion 694 to axially stretch and contract during articulation of the insertion tube 22 .
- the flexible resilient portion 694 may be positioned at a variety of axial stations along the insertion tube 22 , preferably the flexible resilient portion 694 is positioned adjacent a non-bending portion of the insertion tube 22 .
- the flexible resilient portion 694 In operation, as the endoscope assembly 690 is positioned in the first articulated position 628 ( FIG. 17 ), the flexible resilient portion 694 is stretched in the axial direction. Conversely, as the endoscope assembly 690 is positioned in the second articulated position 630 ( FIG. 18 ), the flexible resilient portion 694 axially contracts.
- the inner diameter of the flexible resilient portion 694 is sized so that as the flexible resilient portion 694 is stretched, the inner diameter remains large enough for the medical device 50 to continue to move reasonably freely within the flexible resilient portion 694 , thereby allowing the physician to conduct the desired medical procedure.
- the flexible resilient portion 694 may be axially stretched or pre-loaded when the insertion tube 22 is in a relatively straight position, as shown in FIG. 20 .
- the flexible resilient portion 694 By pre-loading the flexible resilient portion 694 , when the insertion tube 22 is articulated into the second articulated portion 630 ( FIG. 18 ), the flexible resilient portion 694 does not go slack, but rather, simply becomes less stretched but remains under axial tension. Such pre-loading may reduce the possibility of binding or unwanted friction on the medical device 50 due to an overly-relaxed flexible resilient portion 694 .
- the endoscope assembly 692 provides the above-noted advantages of reducing the resistance of the working channel 620 to articulation of the endoscope 20 , and also allowing the working channel 620 to be fabricated out of a relatively hard material having a relatively lower coefficient of friction. Furthermore, the expansion section 692 having a relatively simple flexible resilient portion 694 may be more easily fabricated than alternate expansion section embodiments, thereby reducing the cost of the assembly 692 .
- FIGS. 21 and 22 are partial elevational views of an endoscope assembly 700 in accordance with a further embodiment of the invention.
- the endoscope assembly 700 includes a sheath 760 having a channel 770 attached to a body portion 762 that at least partially encapsulates the insertion tube 22 of an endoscope 20 .
- a plurality of partial cuts 772 are disposed through the channel 770 .
- the partial cuts 772 extend into the channel 770 from two sides, that is, from both the inner side (proximate the body portion 762 ) and the outer side (away from the body portion 762 ).
- the partial cuts 772 are approximately uniformly staggered and extend more than half way through the channel 770 .
- the cuts 772 may be non-uniformly staggered, and may extend a greater or lesser amount through the channel 770 than the embodiment shown in FIGS. 21 and 22 .
- FIG. 21 shows the endoscope assembly 700 in an unstretched position 775 .
- the channel 770 is unstretched and the cuts 772 are substantially closed.
- FIG. 22 shows the channel 770 in a stretched position 777 wherein the cuts 772 are widened to form a plurality of gaps 774 . Portions of the medical device 50 are visible through the gaps 774 in FIG. 22 .
- the cuts 772 and gaps 774 serve to relieve the axial forces (tension or compression) that would otherwise develop in the channel 770 when the endoscope assembly 700 is articulated during operation, or when the sheath 760 is installed onto the insertion tube 22 in a pre-loaded or stretched position.
- the cuts 772 and gaps 774 advantageously reduce the resistance of the endoscope assembly 700 to bending and articulation, and also reduce the amount of force required to maintain the endoscope assembly 700 in an articulated position.
- FIGS. 23 and 24 are partial elevational views of an endoscope assembly 800 in accordance with yet another embodiment of the invention.
- the endoscope assembly 800 is similar to the previously described embodiment, except that the cuts 872 in the channel 870 are non-uniformly distributed.
- the endoscope assembly 800 includes a sheath 860 having a channel 870 attached to a body portion 862 that at least partially encapsulates the insertion tube 22 of an endoscope 20 .
- the cuts 872 extend into the channel 870 from two sides.
- FIG. 23 shows the endoscope assembly 800 in an unstretched position 875 , in which the channel 870 is unstretched and the cuts 872 are substantially closed.
- FIG. 24 shows the channel 870 in a stretched position 877 wherein the cuts 872 are widened to form a plurality of gaps 874 . Again, portions of the medical device 50 are visible through the gaps 874 in FIG. 24 .
- the cuts 872 and gaps 874 advantageously serve to relieve the axial forces that would otherwise develop in the channel 870 when the endoscope assembly 800 is articulated during operation, or when the sheath 860 is installed onto the insertion tube 22 in a pre-loaded or stretched position.
- the endoscope assembly 800 exhibits reduced resistance to bending and articulation.
Abstract
Apparatus and methods for endoscope assemblies having working channels with reduced bending and stretching resistance are disclosed. In one embodiment, an endoscope assembly includes a sheath having a body portion adapted to at least partially encapsulate an endoscopic insertion tube, and a working channel attached to the body portion and extending along at least a portion of the body portion. The working channel includes a component for reducing the resistance of the assembly to bending and stretching. In alternate aspects, the working channel may include a cut, a gap, a sliding portion, or an expansion section. Endoscope assemblies having a working channel in accordance with the invention advantageously reduce the articulation and stretching resistance of the assembly during articulation of the endoscope assembly. Also, because the axial forces (tension and compression) within the working channel are reduced, the working channel can be fabricated out of a relatively hard, inelastic material, thereby reducing the friction within the working channel and improving the physician's ability to perform a medical procedure.
Description
- The present invention is directed toward endoscopic apparatus and methods, and more specifically, to endoscope assemblies having working channels with reduced bending and stretching resistance.
- Endoscopes are widely used for a variety of medical procedures. To improve their performance, endoscopes have been optimized in various ways to best accomplish their purpose. Examples of specialized endoscopes include angioscopes, colonoscopes, bronchoscopes, and arthroscopes.
- One of the medical procedures that may be performed using an endoscope is obtaining a biopsy sample.
FIG. 1 shows aconventional endoscope assembly 10 used for obtaining a biopsy sample. Theendoscope assembly 10 includes anendoscope 20 having anelongated insertion tube 22. Theinsertion tube 22 may be rigid, partially flexible, or entirely flexible. Theinsertion tube 22 includes a distal portion 24 that may be inserted into a body cavity of a patient (not shown), and a workingend 26. - The
endoscope 20 includes aheadpiece 28 that remains external to the patient during a medical procedure. In the embodiment shown inFIG. 1 , theheadpiece 28 includes aneyepiece 30 for viewing the scene through aviewing lens 31 at the workingend 26 of theinsertion tube 22, a pair ofarticulation control knobs 32 for manipulating the position of the distal portion 24 of theinsertion tube 22, and a pair offluid control actuators 34 for controlling the flow of fluids throughtubes 36 to (or from) the workingend 26.Endoscopes 20 of the type generally shown inFIG. 1 are described more fully, for example, in U.S. Pat. No. 5,931,833 issued to Silverstein, U.S. Pat. No. 5,483,951 issued to Frassica and Ailinger, and U.S. Pat. No. 4,714,075 issued to Krauter and Vivenzio, which patents are incorporated herein by reference. Representative commercially-available endoscopes include, for example, video or fiberoptically-equipped sigmoidoscopes, bronchoscopes, nasopharyngo-laryngoscopes, colonoscopes, and gastroscopes. - As further shown in
FIG. 1 , theendoscope assembly 10 includes asheath 40 that encapsulates theinsertion tube 22 to prevent at least part of theinsertion tube 22 from being soiled during the medical procedure. Thesheath 40 may be flexible to allow unrestricted bending of the flexible portion of theinsertion tube 22, or may be relatively rigid. In the depicted embodiment, thesheath 40 includes an enlargedfitting portion 42 that fits over anengagement portion 44 of theheadpiece 28, and a workingchannel 46 having aproximal end 48 that projects outwardly from thesheath 40 proximate theheadpiece 28. -
FIG. 2 is an enlarged isometric view of the workingend 26 of theendoscope assembly 10 ofFIG. 1 . As shown inFIG. 2 , thesheath 40 surrounds theinsertion tube 22 of theendoscope 20, and theworking channel 46 extends along an outer surface of theinsertion tube 22. The workingchannel 46 terminates in an opendistal end 49 at the workingend 26 of theinsertion tube 22. Amedical instrument 50, including abiopsy sampling device 52, extends through the working channel 46 (seeFIG. 1 ) and projects from the opendistal end 49 of the workingchannel 46. Sheaths of the type shown inFIGS. 1 and 2 are described more fully, for example, in U.S. Pat. No. 5,025,778 issued to Silverstein et al., U.S. Pat. No. 5,483,951 issued to Frassica et al., and U.S. Pat. No. 5,827,177 issued to Oneda et al. - During a medical procedure, the
medical instrument 50 is inserted into theproximal end 48 of the workingchannel 46 and slid through the workingchannel 46 until thebiopsy sampling device 52 emerges from the opendistal end 49 at the workingend 26. Through theeyepiece 30, the physician observes thebiopsy sampling device 52 through theviewing lens 31 and manipulates themedical instrument 50 into the desired position and collects the desired sample. After a biopsy sample is obtained, thebiopsy sampling device 52 containing the biopsy sample may be withdrawn through the workingchannel 46, or alternately, theentire insertion tube 22 may be withdrawn from the patient's body with thebiopsy sampling device 52 remaining in position near the workingend 26. - Although desirable results have been achieved using the conventional devices described above, some drawbacks do exist. For example, during a medical procedure, the
flexible insertion tube 22 is generally manipulated into various bending positions using thearticulation control knobs 32. It is therefore desirable for such endoscope assemblies that thesheath 40, including the workingchannel 46, be fabricated of a flexible material to allow for bending and articulation of theinsertion tube 22. Furthermore, it may be desirable to axially stretch the sheath and working channel when positioned on theinsertion tube 22 to maintain a tight engagement between an enclosed, transparent end cap of the sheath and theviewing lens 31 of theinsertion tube 22, as described more fully, for example, in co-pending, commonly-owned U.S. patent application Ser. No. 09/235,355. - For these reasons, sheaths are commonly constructed of a flexible elastomeric material. A variety of known flexible materials are used for this purpose. Generally speaking, however, such known flexible materials have high coefficients of friction that inhibit the movement of medical instruments through the working channel. In some situations, such as at a sharp bending corner along the insertion tube, the medical instrument may be unable to progress through the working channel, or may even become stuck, necessitating the removal of the insertion tube.
- To reduce the coefficient of friction of the internal surface of the working channel, a variety of techniques have been employed. One approach has been to line the working channel with a relatively-hard corrugated material having a low coefficient of friction, such as materials sold under the trademark TEFLON®. Because the relatively-hard corrugated material has a lower coefficient of friction than the flexible material of the working channel, the medical instrument moves more easily through the working channel, and the corrugations allow the necessary bending and axial stretching of the working channel. Unfortunately, the lining of relatively-hard corrugated material greatly increases the thickness of the wall of the working channel, and thus, the overall diameter of the endoscope assembly. Thus, the sheath having a working channel lined with a relatively-hard corrugated material may increase the discomfort or trauma experienced by the patient, or may not be practical for some medical procedures due to size constraints within the patient's body. Also, the cost of manufacturing the working channel lined with the relatively-hard corrugated material is undesirably high. Finally, although the corrugated channel does stretch axially, it does not do so easily.
- The present invention is directed to endoscope assemblies having working channels with reduced bending and stretching resistance. In one embodiment, an endoscope assembly includes a sheath having a body portion adapted to at least partially encapsulate an endoscopic insertion tube, and a working channel attached to the body portion and extending along at least a portion of the body portion. The working channel has a cut disposed therein, the cut being at least partially transverse to a longitudinal axis of the working channel. The working channel is separable along at least a portion of the cut when the working channel is subjected to an axial tension force.
- In an alternate embodiment, the working channel has a gap disposed therein, the gap being at least partially transverse to a longitudinal axis of the working channel. The gap is adapted to widen along at least a portion thereof when the working channel is subjected to an axial tension force.
- In another embodiment, the working channel is attached to the body portion proximate the distal end and has a sliding portion extending along at least a part of the body portion, the sliding portion being axially slideable along the body portion when the working channel is subjected to an axial force. Alternately, the working channel further includes an expansion section coupled between the sliding portion and the second end, the expansion section including an expansion member that is axially expandable when the working channel is subjected to the axial force.
- Endoscope assemblies having a working channel in accordance with the invention advantageously reduce the bending and stretching resistance of the assembly during articulation of the endoscope assembly, thereby reducing the tension on the articulation control cables. Also, because the axial forces (tension and compression) within the working channel are reduced, the working channel can be fabricated out of a relatively hard, inelastic material, thereby reducing the friction within the working channel and improving the physician's ability to perform a medical procedure.
-
FIG. 1 is an isometric view of an endoscope assembly in accordance with the prior art. -
FIG. 2 is a partial isometric view of a distal end of the endoscope assembly ofFIG. 1 . -
FIG. 3 is a partial isometric view of an endoscope assembly including a sheath in accordance with an embodiment of the invention. -
FIG. 4 is a partial isometric view of the endoscope assembly ofFIG. 3 in a first articulated position. -
FIG. 5 is a partial isometric view of the endoscope assembly ofFIG. 3 in a second articulated position. -
FIG. 6 is an enlarged, partial cross-sectional view of the working channel ofFIG. 5 . -
FIG. 7 is a partial isometric view of an endoscope assembly in accordance with an alternate embodiment of the invention. -
FIG. 8 is another partial isometric view of the endoscope assembly ofFIG. 7 . -
FIG. 9 is a partial isometric view of an endoscope assembly in accordance with another embodiment of the invention. -
FIG. 10 is a partial isometric view of an endoscope assembly in accordance with another alternate embodiment of the invention. -
FIG. 11 is a partial isometric view of an endoscope assembly in accordance with yet another embodiment of the invention. -
FIG. 12 is a partial elevational view of the endoscope assembly ofFIG. 11 . -
FIG. 13 is a partial isometric view of an endoscope assembly in accordance with a further embodiment of the invention. -
FIG. 14 is a partial isometric view of the endoscope assembly ofFIG. 13 in a first articulated position. -
FIG. 15 is a partial isometric view of the endoscope assembly ofFIG. 13 in a second articulated position. -
FIG. 16 is a partial isometric view of an endoscope assembly in accordance with another embodiment of the invention. -
FIG. 17 is a partial isometric view of the endoscope assembly ofFIG. 16 in a first articulated position. -
FIG. 18 is a partial isometric view of the endoscope assembly ofFIG. 16 in a second articulated position. -
FIG. 19 is a partial isometric view of an endoscope assembly in accordance with another embodiment of the invention. -
FIG. 20 is a partial isometric view of an endoscope assembly in accordance with still another embodiment of the invention. -
FIG. 21 is a partial elevational view of an endoscope assembly in accordance with a further embodiment of the invention. -
FIG. 22 is another partial elevational view of the endoscope assembly ofFIG. 21 . -
FIG. 23 is a partial elevational view of an endoscope assembly in accordance with yet another embodiment of the invention. -
FIG. 24 is another partial elevational view of the endoscope assembly ofFIG. 23 . - The present invention is directed toward endoscopic sheath apparatus and methods, and more specifically, to sheath assemblies having working channels with reduced bending and stretching resistance. Many specific details of certain embodiments of the invention are set forth in the following description and in
FIGS. 3-24 to provide a thorough understanding of such embodiments. One skilled in the art, however, will understand that the present invention may have additional embodiments, or that the invention may be practiced without several of the details described in the following description. -
FIG. 3 is a partial isometric view of anendoscope assembly 100 in accordance with an embodiment of the invention. In this embodiment, theendoscope assembly 100 includes asheath 110 having atubular body portion 112 that at least partially encapsulates theinsertion tube 22 of the endoscope 10 (FIG. 1 ), and a workingchannel 120 attached to an outer surface of thetubular body portion 112 at a plurality of attachment points 122. As shown inFIG. 3 , the workingchannel 120 is cut with a spiral (or helical) cut 124 through an outer wall of the workingchannel 120. The spiral cut 124 may extend along the entire length of the workingchannel 120, or may extend along only a portion of the workingchannel 120, such as along abending section 126 of the insertion tube 22 (FIG. 3 ). - The working
channel 120 may be fabricated from a relatively stiff material having a coefficient of friction that is relatively lower than that of the elastomeric materials commonly used in the prior art, including, for example, materials sold under the trademark TEFLON®, or a variety of relatively hard, relatively inelastic, relatively high durometer polymers, such as urethane, polyvinyl chloride (PVC), acrylic, polycarbonate, polyethylene terephthalate, or other thermoplastic polyesters. Alternately, the workingchannel 120 may be fabricated from the same elastomeric materials commonly used to fabricate sheaths in the prior art. In a preferred embodiment, thebody portion 112 of thesheath 110 is fabricated from an elastomeric material and the workingchannel 120 is fabricated from a relatively stiff urethane material having a lower coefficient of friction than the elastomeric material of thebody portion 112. Theurethane working channel 120 may be bonded to thebody portion 112 at one or more attachment points 122 using known bonding techniques, such as, for example, an ultra-violet (UV) bonding process or the like. -
FIG. 4 is a partial isometric view of theendoscope assembly 100 ofFIG. 3 with thebending section 126 of theinsertion tube 22 articulated (or bent) into a first articulatedposition 128. In the first articulatedposition 128, the workingchannel 120 is stretched or extended, causing the spiral cut 124 to separate at one or more locations to form a plurality ofgaps 130 between a plurality ofchannel segments 132. As thebending section 126 of theinsertion tube 22 is articulated from a relatively straight position to the first articulatedposition 128, the widths of thegaps 130 increase, particularly at the outermost portion of each gap (i.e. the portion of eachgap 130 that is furthest from thetubular body portion 112 of the sheath 110). -
FIG. 5 is a partial isometric view of theendoscope assembly 100 ofFIG. 3 in a second articulatedposition 134. In the second articulatedposition 134, the workingchannel 120 is compressed. In turn, one ormore overlaps 136 are formed between at least some of the plurality ofchannel segments 132. As thebending section 126 of theinsertion tube 22 is articulated from a relatively straight position to the second articulatedposition 134, the amount of overlap betweenadjacent channel segments 132 increases, and the number ofoverlaps 136 formed betweenchannel segments 132 may also increase. -
FIG. 6 is an enlarged, partial cross-sectional view of theendoscope assembly 100 ofFIG. 5 . As shown inFIG. 6 , in the second articulatedposition 134, thechannel segments 132 may become compressed to formoverlaps 136. In one embodiment, the spiral cut 124 is not perpendicular to alongitudinal axis 138 of the workingchannel 120, but rather, is angled (as shown inFIG. 6 ) so that the ends of thechannel segments 132 may more readily slide over each other during compression of the workingchannel 120. - The working
channel 120 having the spiral cut 124 advantageously reduces the bending and stretching resistance of thesheath 110 during articulation of theendoscope assembly 100. As theinsertion tube 22 is articulated into the first articulatedposition 126, the workingchannel 120 stretches to form the plurality ofgaps 130 between the plurality ofchannel segments 132. Thegaps 130 relieve the axial tension forces that would otherwise exist within a stretched prior art working channel, thereby reducing the resistance of thesheath 110 to bending and reducing the amount of force required to articulate and maintain theinsertion tube 22 into the first articulatedposition 126. - Similarly, as the
insertion tube 22 is articulated into the second articulatedposition 134, the workingchannel 120 is compressed so that the plurality ofchannel segments 132 move together to form one ormore overlaps 136. Theoverlaps 136 relieve the axial compression forces that would otherwise exist within the prior art working channels, which in turn reduces the resistance of thesheath 110 to bending, and reduces the amount of force required to articulate and maintain theinsertion tube 22 into the second articulatedposition 134. - Furthermore, because the axial forces (tension and compression) within the working
channel 120 are reduced by the spiral cut 124, the workingchannel 120 can be fabricated out of a relatively hard, inelastic material. Thus, the spiral cut 124 advantageously permits the workingchannel 120 to be fabricated from a relatively hard material having a lower coefficient of friction than the elastomeric materials commonly used in the prior art. Because the friction between the workingchannel 120 and themedical device 50 is reduced, the physician's ability to perform a medical procedure may be improved. - One may note that several of the specific features of the
endoscope assembly 100 may be varied from the embodiment shown inFIGS. 3-6 and still remain within the scope of the invention. For example, the pitch or frequency of the spiral cut 124 may be varied to create a greater or fewer number ofchannel segments 132. Similarly, the angle of the spiral cut 124 may be varied to be more or less oblique to thelongitudinal axis 138 of the workingchannel 120. In alternate embodiments, the spiral cut 124 may extend the entire length of the workingchannel 120, or may be limited to one or more portions of the workingchannel 120 as desired, such as, for example, to be adjacent to the portions of greatest bending of theinsertion tube 22. Thechannel 120 can also be installed such that it is in a slightly stretched condition causing gaps to exist when the articulation section is in the neutral position. - Several alternate embodiments of the invention will now be described. In general, the following descriptions of alternate embodiments should not be viewed as an exhaustive list of all possible embodiments contemplated by the inventors to be within the scope of the invention. In the following descriptions, common elements are identified by the same reference numbers as the previously described embodiments. For the sake of brevity, only some of the more significant differences in construction or operation of each embodiment are described in detail.
-
FIG. 7 is a partial isometric view of anendoscope assembly 150 in accordance with an alternate embodiment of the invention.FIG. 8 is another partial isometric view of theendoscope assembly 150 ofFIG. 7 . In this embodiment, theendoscope assembly 150 includes asheath 160 having atubular body portion 162, and a workingchannel 170 attached thereto. A plurality ofpartial cuts 172 are disposed through the workingchannel 170. In the embodiment depicted inFIG. 7 , thepartial cuts 172 extend approximately half-way through the workingchannel 170 to form approximately semi-circular cuts. In alternate embodiments, thepartial cuts 172 may extend a greater or lesser amount through the workingchannel 170. - As best shown in
FIG. 8 , in this embodiment, the workingchannel 170 has first andsecond portions partial cuts 172 disposed therein. The first andsecond portions second bending portions insertion tube 22, respectively. - In operation, when the
endoscope assembly 150 is articulated into a first articulatedposition 176 as shown inFIG. 7 , thepartial cuts 172 are stretched open to form one or moreopen notches 174 in the workingchannel 170. Similarly, when theinsertion tube 22 is articulated into a position that compresses the workingchannel 170, such as a second articulated position 178, thepartial cuts 172 are compressed together to formoverlaps 180, in the manner described above and shown inFIGS. 5 and 6 . - As described above, the
open notches 174 serve to relieve the tension forces within the workingchannel 170 when the workingchannel 170 is stretched into the first articulatedposition 176, and theoverlaps 180 relieve the compression forces within the workingchannel 170 when the workingchannel 170 is compressed. Therefore, thepartial cuts 172 advantageously reduce the resistance of thesheath 110 to bending and articulation of theinsertion tube 22, and also reduce the amount of force required to articulate and maintain theinsertion tube 22 into an articulated position. - Furthermore, because the axial forces (tension and compression) within the working
channel 170 are reduced by thepartial cuts 172, the workingchannel 120 can be fabricated out of a relatively hard, inelastic material. Thus, thepartial cuts 172 advantageously permit the workingchannel 170 to be fabricated from a relatively hard material having a lower coefficient of friction than the elastomeric materials commonly used in the prior art. -
FIG. 9 is a partial isometric view of anendoscope assembly 200 in accordance with another embodiment of the invention. Theendoscope assembly 200 includes asheath 210 having atubular body portion 212 that partially encapsulates theinsertion tube 22, and a workingchannel 220 extending along theinsertion tube 22 within thebody portion 212 of thesheath 210. The workingchannel 220 is cut with aspiral cut 224. As described above with respect to theendoscope assembly 100 shown inFIGS. 3-5 , when theinsertion tube 22 is articulated into positions which stretch or compress the workingchannel 220, the spiral cut 224 causes the working channel to formgaps 130 or overlaps 136, respectively, thereby relieving the tension or compression stresses that would otherwise form in the workingchannel 220. In turn, the resistance of thesheath 210 to bending of theinsertion tube 22 is reduced. - The
sheath 210 of theendoscope assembly 200 advantageously provides the reduced resistance to articulation of theinsertion tube 22 as described above, and allows the workingchannel 220 to be fabricated from a relatively hard material having a lower coefficient of friction than the elastomeric materials commonly used in the prior art. Furthermore, because the workingchannel 210 is located within thetubular body portion 212, the workingchannel 210 may be less likely to accumulate foreign matter that may otherwise enter the workingchannel 210 through the spiral cut 224 during a medical procedure. As a result, thesheath 210 may improve the physician's ability to operate themedical device 50 to perform the desired medical procedure. -
FIG. 10 is a partial isometric view of anendoscope assembly 300 in accordance with another alternate embodiment of the invention. In this embodiment, theendoscope assembly 300 includes asheath 310 having atubular body portion 312 that at least partially encapsulates theinsertion tube 22 of the endoscope 10 (FIG. 1 ), and anend cap 313 that encapsulates the workingend 26 of theinsertion tube 22. Theend cap 313 may be transparent to permit the physician to view a location within the patient's body through theeyepiece 30 andviewing lens 31. A workingchannel 320 is attached to an outer surface of thetubular body portion 312 at a plurality of attachment points 322. As shown inFIG. 10 , acontinuous spiral gap 324 is disposed through the outer wall of the workingchannel 320. Thespiral gap 324 has a nominal width w. Thespiral gap 324 may extend along the entire length of the workingchannel 320, or may extend along only a portion of the workingchannel 320. Themedical device 50 is visible through thespiral gap 324. - In one aspect of the above-described embodiment, the nominal width w represents the width of the
spiral gap 324 when thesheath 310 is in a relaxed, unstretched position. Alternately, it may be desirable to maintain an axial stretching of thesheath 310 in order to ensure that theend cap 313 is securely engaged against the workingend 26 of theinsertion tube 22, such as, for example, to permit optimal viewing through theviewing lens 31. In such alternate embodiments, the nominal width w may represent the width of thespiral gap 324 when thesheath 310 is in an axially-stretched position, and therefore, in a relaxed, unstretched position, thespiral gap 324 may have a width that is less than the nominal width w. In one embodiment, the width of thespiral gap 324 when thesheath 310 is in a relaxed, unstretched position is zero, wherein thespiral gap 324 resembles aspiral cut 124 as shown inFIG. 3 . - In operation, when the
insertion tube 22 is articulated into a position that stretches the working channel 320 (e.g. the first articulatedposition 128 shown inFIG. 4 ), the width of thespiral gap 324 may increase over the nominal width w at axial stations proximate to the bending region of theinsertion tube 22, thereby reducing the tension forces that would otherwise exist within the workingchannel 320. Similarly, when theinsertion tube 22 is articulated into a position that compresses the working channel 320 (e.g. the second articulatedposition 134 shown inFIG. 5 ), the width of thespiral gap 324 may decrease from the nominal width w at axial stations proximate to the bending region. - Overall, the
sheath 310 having the workingchannel 320 with thespiral gap 324 disposed therethrough may advantageously reduce the bending and stretching resistance of thesheath 310 during articulation of theendoscope assembly 300. As theinsertion tube 22 is articulated, thespiral gap 324 relieves the axial tension and compression forces that would otherwise exist within the working channel, thereby reducing the resistance of thesheath 310 to bending, as well as the amount of force required to articulate and maintain theinsertion tube 22 in an articulated position. Thespiral gap 324 also allows the workingchannel 320 to be fabricated from a relatively hard material having a lower coefficient of friction than the elastomeric materials commonly used in the prior art. -
FIG. 11 is a partial isometric view of anendoscope assembly 400 in accordance with yet another embodiment of the invention.FIG. 12 is a partial elevational view of theendoscope assembly 400 ofFIG. 11 . In this embodiment, theendoscope assembly 400 includes asheath 410 having atubular body portion 412, aproximal fitting 442 engageable with theengagement portion 44 of the endoscope 20 (FIG. 1 ), and anend cap 413 attached to a distal end of thebody portion 412. Theend cap 413 includes a substantially transparentdistal end 415 to enable viewing through theviewing lens 31 of theendoscope 20. - The
endoscope assembly 400 further includes a workingchannel 420 having aspiral cut 424 therethrough, and anenlarged end portion 425 proximate the workingend 26 of theinsertion tube 22. Theenlarged end portion 425 may be sized to receive an operatingend 451 of amedical device 450. The workingchannel 420 further includes an open,proximal end 448 near theendoscope 20. In the embodiment shown inFIG. 11 , theproximal end 448 includes an enlarged fitting, such as a well-known Luer lock fitting, to improve the operator's ability to handle the workingchannel 420 during a medical procedure. Acontrol end 453 of themedical device 450 extends from theproximal end 448 of the workingchannel 420. - In one embodiment, as shown in
FIGS. 11 and 12 , themedical device 450 may comprise a biopsy sampling device and the operatingend 451 may include a biopsy collection brush of the type described in co-pending, commonly owned U.S. patent application No. ______, filed concurrently herewith under Attorney Docket No. 501060.01. A variety of alternate biopsy sampling devices may be used, including, for example, needles, forceps (e.g. U.S. Pat. No. 5,820,630 issued to Lind), loop and cup devices (e.g. U.S. Pat. No. 5,417,697 issued to Wilk et al., U.S. Pat. No. 5,741,271 issued to Nakao et al.), and cylindrical cutting devices (e.g. U.S. Pat. No. 4,651,753 issued to Lifton). - As shown in
FIGS. 11 and 12 , the workingchannel 420 is bonded to thebody portion 412 of thesheath 410 at a plurality of attachment points 422. In one embodiment, the workingchannel 420 may be fabricated from a urethane tubing material and thebody portion 412 may be fabricated of a commonly used elastomeric material. Theenlarged end portion 425 may be fabricated by splitting the urethane tubing along a lengthwise portion thereof, and the urethane tubing may be bonded to thebody portion 412 at the attachment points 422 using a well-known UV bonding process. In another aspect, thebody portion 412 may be engaged into position onto theinsertion tube 22 of theendoscope 20 in an axially-stretched or pre-loaded position. In one preferred embodiment, thebody portion 412 is axially stretched between approximately 0.4 inches and approximately 0.6 inches. - In operation, the operating end 451 (e.g. biopsy collection brush) of the
medical device 450 may be withdrawn into a retracted or non-operational position 460 as shown inFIG. 12 , with the operatingend 451 disposed within theenlarged end portion 425 of the workingchannel 420. The physician may then insert the workingend 26 of theendoscope assembly 400 into a patient's body to perform a desired medical procedure. During insertion, as well as during the medical procedure itself, theinsertion tube 22 may be articulated into various bending positions using the control knobs 32 (FIG. 1 ) as described above. - Once the working
end 26 is located at the desired position within the patient's body, themedical device 450 may be moved within the workingchannel 420 to a second oroperational position 462, as shown inFIG. 11 . In theoperational position 462, the operatingend 451 is at least partially removed from theenlarged end portion 425 of the workingchannel 420. The physician may then manipulate thecontrol end 453 of themedical device 450 which extends from theproximal end 448 of the working channel 420 (FIG. 11 ) to perform the desired medical procedure (e.g. to collect a biopsy sample). After accomplishing the desired procedure, themedical device 450 may be retracted into the first or non-operational position 460 (FIG. 12 ), and subsequently withdrawn from the patient's body. - The working
channel 420 having the spiral cut 424 provides the advantages of reducing the working channel's resistance to bending and articulation of theinsertion tube 22, and to axial stretching of thesheath 410, as described above. Furthermore, theenlarged end portion 425 of the workingchannel 420 may improve the ease of inserting and removing theendoscope assembly 400 from the patient. Because theenlarged end portion 425 at least partially surrounds and covers the operatingend 451 in the non-operating position 460, theenlarged end portion 425 may ease the task of inserting (and removing) theendoscope assembly 400 into the patient's body cavity, thereby reducing the trauma to the surrounding tissues and ultimately the discomfort experienced by the patient. Theenlarged end portion 425 may also ensure that the operatingend 451 does not become occluded with unwanted or undesirable foreign matter during insertion of theendoscope assembly 400 which might inhibit the physician's ability to perform the desired medical procedure. -
FIG. 13 is a partial isometric view of anendoscope assembly 500 in accordance with a further embodiment of the invention. In this embodiment, asheath 510 having atubular body 512 is positioned on theinsertion tube 22 of the endoscope 20 (FIG. 1 ), and acollapsible working channel 520 is attached to thebody 512 of thesheath 510. Thesheath 510 includes anend cap 513 that encloses the workingend 26 of theinsertion tube 22, and aproximal fitting 548 that fittingly engages theengagement portion 44 of theendoscope 20. - In
FIG. 13 , the collapsible workingchannel 520 is shown in acollapsed position 562. In this embodiment, the collapsible workingchannel 520 is a continuous channel that remains collapsed until amedical device 50 is inserted therethrough. Thecollapsible working channel 520 may be constructed from collapsible tubing, or any other known collapsible channel structure, including, for example, the collapsible structures disclosed in U.S. Pat. No. 5,025,778 issued to Silverstein et al., incorporated herein by reference. Thecollapsible working channel 520 is attached to theend cap 513 of thesheath 510 at anattachment point 522. Asleeve support 523 is attached to thebody 512 of thesheath 510 along an intermediate portion of thebody 512, and the collapsible workingchannel 520 is slideably engaged within thesleeve support 523. - As further shown if
FIG. 13 , a fitting 548 is attached to a proximal end of the collapsible workingchannel 520. In thecollapsed position 562, the fitting 548 is partially engaged into areceiver 560 that is attached to theproximal fitting 542 of thesheath 310. The fitting 548 includes at least onetab 550 projecting outwardly therefrom that is slideably engaged in aslot 552 disposed in thereceiver 560. -
FIG. 14 is a partial isometric view of theendoscope assembly 500 in a first articulatedposition 528 with the collapsible workingchannel 520 in anon-collapsed position 564.FIG. 15 is a partial isometric view of theendoscope assembly 500 in a second articulatedposition 530. As shown inFIGS. 14 and 15 , amedical device 50 may be inserted through the workingchannel 520 such that a working portion 52 (e.g. a biopsy sampling device) extends from a distal end of the collapsible workingchannel 520 and acontrol end 553 extends from a proximal end of the collapsible workingchannel 520. - In operation, when a bending
portion 526 of theinsertion tube 22 is articulated into the first articulated position 528 (FIG. 14 ), the collapsible workingchannel 520 is pulled by theinsertion tube 22 via theattachment point 522, causing the collapsible workingchannel 520 to slide through thesleeve support 523, and the fitting 553 to slide in afirst direction 555 into thereceiver 560. Similarly, when the bendingportion 526 is articulated into the second articulated position 530 (FIG. 15 ), the collapsible workingchannel 520 is pushed, causing the collapsible workingchannel 520 to slide through thesleeve support 523, and the fitting 553 to slide in asecond direction 557 out of thereceiver 560. - One may note that several of the details of the
endoscope assembly 500 may be varied from the specific embodiment shown inFIGS. 13-15 . For example, the collapsible workingchannel 520 may be replaced with a regular, non-collapsible working channel (e.g. a flexible tube). Alternately, the collapsible workingchannel 520 may be replaced in whole or in part with any of the working channel embodiments described above and shown inFIGS. 3-12 , except that such alternate embodiments of working channels would only be fixedly attached to thesheath 510 at theattachment point 522 proximate the workingend 26. In further embodiments, theattachment point 522 may be located on the body of the sheath rather than on theend cap 513, or multiple attachment points may be used, or the attachment point may be extended to an attachment area extending from the workingend 26 to thebending section 526 of theinsertion tube 22. In other embodiments, additional sleeve supports 523 may be added to ensure that the workingchannel 520 remains in proximity to thebody 512 of thesheath 510. - The
endoscope assembly 500 advantageously provides reduced resistance to articulation of theendoscope 20 over prior art assemblies. Because the collapsible workingchannel 520 is allowed to slide along thebody 512 of thesheath 510, the collapsible workingchannel 520 may exert little or no resistance to the articulation of theinsertion tube 22. Furthermore, thesheath 210 may be axially stretched onto theinsertion tube 22 without a corresponding stretching of the collapsible workingchannel 520. - Another advantage of the
endoscope assembly 500 is that the working channel may be fabricated out of a relatively hard material having a relatively lower coefficient of friction compared with commonly used elastic sheath materials. Because the working channel is allowed to slide along the body of the sheath, the working channel is not required to stretch appreciably in the axial direction. Although the working channel may still be somewhat flexible to permit bending during articulation of the insertion tube, because the working channel is not appreciably stretched, the working channel may be fabricated from a relatively hard material having a low coefficient of friction, thereby reducing the friction within the working channel and improving the ability of the operator to articulate the medical device to perform the desired medical procedure. - Yet another advantage of the
endoscope assembly 500 is that the proximate end of the collapsible workingchannel 520 is permitted to move in the first andsecond directions receiver 560, the fitting 548 advantageously permits the collapsible workingchannel 520 to slide along thebody 512 of thesheath 510 without the operator's assistance. The operator's hands are thereby freed for other purposes, allowing the operator to concentrate on proper performance of the medical procedure. -
FIG. 16 is a partial isometric view of anendoscope assembly 600 in accordance with still another embodiment of the invention. In this embodiment, theendoscope assembly 600 includes a workingchannel 620 having anexpansion section 670. For clarity, theexpansion section 670 is shown in cut-away, cross-sectional view inFIG. 16 (with a portion of themedical device 50 omitted) so that the internal components of theexpansion section 670 are visible. Theexpansion section 670 includes a flexibleouter covering 672 and a corrugatedinner member 674. The flexibleouter cover 672 is bonded to the adjacent portions of the workingchannel 620 at bond points 673. The accordian-likeinner member 674 has a plurality of corrugations (or pleats) 676 that permit theinner member 674 to be elongated in a lengthwise or axial direction along the length of the workingchannel 620. InFIG. 16 , the corrugatedinner member 674 is shown in an unstretched or relaxed position. - The proximal end of the working
channel 620 includes a fitting 648 (e.g. a Luer lock fitting) fixedly attached to theproximal fitting 642 of thesheath 610 by a fixedcollar 660. In an alternate embodiment, the fixedcollar 600 may be eliminated, and the fitting 648 may be directly attached to thesheath 610 or to theendoscope 20. The distal end of the workingchannel 620 is fixedly attached at anattachment area 622 proximate the workingend 26, and is slideably coupled to thebody 612 of thesheath 610 by thesleeve support 623. As in the previously described embodiment, the workingchannel 620 is free to axially slide along thetubular body 612 of thesheath 610 along most of the length of the workingchannel 620. -
FIGS. 17 and 18 show partial isometric views of theendoscope assembly 600 in first and second articulatedpositions endoscope assembly 600 is positioned in the first articulated position 628 (FIG. 17 ), theinsertion tube 22 pulls (or tensions) the workingchannel 620, thereby applying an axial tension force on theexpansion section 670. When subjected to the axial tension force, the flexibleouter cover 672 stretches and the corrugatedinner member 674 elongates in the axial direction. Also, as shown inFIG. 17 , the axial tension force causes thecorrugations 676 of theinner member 674 expand or flatten, and the bond points 673 becoming spaced farther apart. - As the
endoscope assembly 600 is positioned in the second articulated position 630 (FIG. 18 ), theinsertion tube 22 pushes (or compresses) the workingchannel 620, thereby applying an axial compression force on theexpansion section 670. The axial compression force causes the flexibleouter cover 672 to slacken, and may even bow outwardly from the corrugatedinner member 674. Similarly, the corrugatedinner member 674 compresses in the axial direction, with thecorrugations 676 become more pronounced and/or greater in number. Theinner member 674 may also begin to bow outwardly. As shown inFIG. 18 , the axial compression force causes the bond points 673 to become spaced more closely together. - The
endoscope assembly 600 advantageously provides reduced resistance to articulation of theendoscope 20 over prior art assemblies. Because the workingchannel 620 includes theexpansion section 670, the workingchannel 620 may exert little or no resistance to the articulation of theinsertion tube 22. Furthermore, thesheath 610 may be axially stretched or pre-loaded onto theinsertion tube 22 without a corresponding loading of the workingchannel 620. The workingchannel 620 may be beneficial during installation of theassembly 600 when thesheath 610 is being stretched. - Also, because the working
channel 620 is not required to stretch appreciably in the axial direction during articulation of theendoscope assembly 600, the working channel may be fabricated out of a relatively hard material having a relatively lower coefficient of friction. Although the working channel may still be flexible enough to permit bending during articulation of the insertion tube, the working channel fabricated from a relatively hard material having a low coefficient of friction may advantageously reduce the friction within the working channel and improve the operator's ability to articulate the medical device to perform the desired medical procedure. -
FIG. 19 is a partial isometric view of anendoscope assembly 680 in accordance with another embodiment of the invention. Similar to the previously-described embodiment, theendoscope assembly 680 shown inFIG. 19 includes a workingchannel 620 having anexpansion section 682, shown in cut-away, cross-sectional view (with a portion of themedical device 50 omitted). Theexpansion section 682 includes anouter sleeve 684 and a corrugatedinner member 686. Theinner member 686 is bonded to the adjacent portions of the workingchannel 620 atbond point 685 and to the fitting 648. Theouter sleeve 684 is attached to the fitting 648 but is not bonded to the workingchannel 620. Again, the accordian-likeinner member 686 has a plurality of corrugations (or pleats) 688 that permit theinner member 686 to be elongated in a lengthwise or axial direction along the length of the workingchannel 620. The fitting 648 is attached to theproximal fitting 642 of thesheath 610. The workingchannel 620 is free to axially slide along thetubular body 612 of thesheath 610 along most of the length of the workingchannel 620. Thebond point 685 between the workingchannel 620 and theinner member 686 is free to axially slide within theouter sleeve 684. - In operation, as the
endoscope assembly 682 is positioned in the first articulated position 628 (FIG. 17 ), the corrugatedinner member 686 is elongated in the axial direction, causing thecorrugations 688 of theinner member 686 to expand or flatten and drawing thebond point 685 toward the workingend 26 of theinsertion tube 22. Because theouter sleeve 684 is not attached to the workingchannel 620, thebond point 685 moves inside theouter sleeve 684 toward the workingend 26, and theouter sleeve 684 is not tensioned or stretched during this movement. As theendoscope assembly 680 is positioned in the second articulated position 630 (FIG. 18 ), theinsertion tube 22 pushes (or compresses) the corrugatedinner member 686 in the axial direction, with thecorrugations 688 becoming more pronounced and/or greater in number. In turn, thebond point 685 moves within theouter sleeve 684 away from the workingend 26 of theinsertion tube 22. Because theouter sleeve 684 is not attached to the workingchannel 620, the workingchannel 620 and thebond point 685 slide within theouter sleeve 684. Consequently, theouter sleeve 684 is not compressed and does not bow outwardly during articulation of theinsertion tube 22 into the second articulatedposition 630. - The
endoscope assembly 680 provides the above-noted advantages of reducing the resistance of the workingchannel 620 to articulation of theendoscope 20, and also allowing the workingchannel 620 to be fabricated out of a relatively hard material having a relatively lower coefficient of friction. Furthermore, because theouter sleeve 684 of theexpansion section 682 maintains a constant diameter and does not bow outwardly during articulation of theinsertion tube 22, theexpansion section 682 may advantageously be positioned within the patient's body during a medical procedure without causing undue expansion of or trauma to the surrounding tissues during articulation of theinsertion tube 22. -
FIG. 20 is a partial isometric view of an endoscope assembly in accordance with still another embodiment of the invention. In this embodiment, theendoscope assembly 690 includes anexpansion section 692 that includes a flexibleresilient portion 694 coupled atbond points 695 between the workingchannel 620 and the fitting 648. The workingchannel 620 may be fabricated from a relatively hard material having a relatively lower coefficient of friction. The flexibleresilient portion 694 is fabricated from a flexible material, allowing the flexibleresilient portion 694 to axially stretch and contract during articulation of theinsertion tube 22. Although the flexibleresilient portion 694 may be positioned at a variety of axial stations along theinsertion tube 22, preferably the flexibleresilient portion 694 is positioned adjacent a non-bending portion of theinsertion tube 22. - In operation, as the
endoscope assembly 690 is positioned in the first articulated position 628 (FIG. 17 ), the flexibleresilient portion 694 is stretched in the axial direction. Conversely, as theendoscope assembly 690 is positioned in the second articulated position 630 (FIG. 18 ), the flexibleresilient portion 694 axially contracts. Preferably, the inner diameter of the flexibleresilient portion 694 is sized so that as the flexibleresilient portion 694 is stretched, the inner diameter remains large enough for themedical device 50 to continue to move reasonably freely within the flexibleresilient portion 694, thereby allowing the physician to conduct the desired medical procedure. In another preferred aspect, the flexibleresilient portion 694 may be axially stretched or pre-loaded when theinsertion tube 22 is in a relatively straight position, as shown inFIG. 20 . By pre-loading the flexibleresilient portion 694, when theinsertion tube 22 is articulated into the second articulated portion 630 (FIG. 18 ), the flexibleresilient portion 694 does not go slack, but rather, simply becomes less stretched but remains under axial tension. Such pre-loading may reduce the possibility of binding or unwanted friction on themedical device 50 due to an overly-relaxed flexibleresilient portion 694. - Again, the
endoscope assembly 692 provides the above-noted advantages of reducing the resistance of the workingchannel 620 to articulation of theendoscope 20, and also allowing the workingchannel 620 to be fabricated out of a relatively hard material having a relatively lower coefficient of friction. Furthermore, theexpansion section 692 having a relatively simple flexibleresilient portion 694 may be more easily fabricated than alternate expansion section embodiments, thereby reducing the cost of theassembly 692. -
FIGS. 21 and 22 are partial elevational views of anendoscope assembly 700 in accordance with a further embodiment of the invention. In this embodiment, theendoscope assembly 700 includes asheath 760 having achannel 770 attached to abody portion 762 that at least partially encapsulates theinsertion tube 22 of anendoscope 20. A plurality ofpartial cuts 772 are disposed through thechannel 770. In this embodiment, thepartial cuts 772 extend into thechannel 770 from two sides, that is, from both the inner side (proximate the body portion 762) and the outer side (away from the body portion 762). As best shown inFIG. 21 , in this embodiment, thepartial cuts 772 are approximately uniformly staggered and extend more than half way through thechannel 770. In alternate embodiments, thecuts 772 may be non-uniformly staggered, and may extend a greater or lesser amount through thechannel 770 than the embodiment shown inFIGS. 21 and 22 . -
FIG. 21 shows theendoscope assembly 700 in anunstretched position 775. In this position, thechannel 770 is unstretched and thecuts 772 are substantially closed.FIG. 22 shows thechannel 770 in astretched position 777 wherein thecuts 772 are widened to form a plurality ofgaps 774. Portions of themedical device 50 are visible through thegaps 774 inFIG. 22 . - As described above, the
cuts 772 andgaps 774 serve to relieve the axial forces (tension or compression) that would otherwise develop in thechannel 770 when theendoscope assembly 700 is articulated during operation, or when thesheath 760 is installed onto theinsertion tube 22 in a pre-loaded or stretched position. Thus, thecuts 772 andgaps 774 advantageously reduce the resistance of theendoscope assembly 700 to bending and articulation, and also reduce the amount of force required to maintain theendoscope assembly 700 in an articulated position. -
FIGS. 23 and 24 are partial elevational views of anendoscope assembly 800 in accordance with yet another embodiment of the invention. Theendoscope assembly 800 is similar to the previously described embodiment, except that thecuts 872 in thechannel 870 are non-uniformly distributed. Again, in this embodiment, theendoscope assembly 800 includes asheath 860 having achannel 870 attached to abody portion 862 that at least partially encapsulates theinsertion tube 22 of anendoscope 20. Thecuts 872 extend into thechannel 870 from two sides. -
FIG. 23 shows theendoscope assembly 800 in anunstretched position 875, in which thechannel 870 is unstretched and thecuts 872 are substantially closed. On the other hand,FIG. 24 shows thechannel 870 in astretched position 877 wherein thecuts 872 are widened to form a plurality ofgaps 874. Again, portions of themedical device 50 are visible through thegaps 874 inFIG. 24 . - The
cuts 872 andgaps 874 advantageously serve to relieve the axial forces that would otherwise develop in thechannel 870 when theendoscope assembly 800 is articulated during operation, or when thesheath 860 is installed onto theinsertion tube 22 in a pre-loaded or stretched position. Thus, theendoscope assembly 800 exhibits reduced resistance to bending and articulation. - The detailed descriptions of the above embodiments are not exhaustive descriptions of all embodiments contemplated by the inventors to be within the scope of the invention. Indeed, persons skilled in the art will recognize that certain elements of the above-described embodiments may variously be combined or eliminated to create further embodiments, and such further embodiments fall within the scope and teachings of the invention. It will also be apparent to those of ordinary skill in the art that the above-described embodiments may be combined in whole or in part to create additional embodiments within the scope and teachings of the invention.
- Thus, although specific embodiments of, and examples for, the invention are described herein for illustrative purposes, various equivalent modifications are possible within the scope of the invention, as those skilled in the relevant art will recognize. The teachings provided herein can be applied to other apparatus and methods for endoscope assemblies having working channels with reduced bending and stretching resistance, and not just to the embodiments described above and shown in the accompanying figures. Accordingly, the scope of the invention should be determined from the following claims.
Claims (13)
1-138. (canceled)
139. A method of performing a procedure using an endoscopic insertion tube having a working end adapted to be insertable into a patient, comprising:
providing a sheath assembly having a body portion that at least partially encapsulates the endoscopic insertion tube, the body portion having a distal end proximate the working end of the insertion tube;
providing a working channel attached to the body portion proximate the distal end and having a sliding portion extending along at least part of the body portion, the sliding portion being axially slideable along the body portion when the working channel is subjected to an axial force; and
exerting an axial force on the working channel to axially slide the sliding portion of the working channel along the body portion.
140. The method of claim 139 wherein providing a working channel attached to the body portion comprises providing a working channel having a sliding portion coupled to the body portion by a sleeve support.
141. The method of claim 139 wherein providing a working channel attached to the body portion comprises providing a collapsible channel attached to the body portion.
142. The method of claim 139 wherein providing a working channel attached to the body portion comprises providing a working channel having a first end proximate the distal end and a second end opposite from the first end, the working channel including a fitting attached to the second end.
143. The method of claim 139 wherein providing a working channel attached to the body portion comprises providing a working channel having a first end proximate the distal end and a second end opposite from the first end, the working channel including a fitting attached to the second end, the method further comprising slideably receiving and guiding the fitting when the working channel is subjected to the axial force.
144. The method of claim 143 wherein slideably receiving and guiding the fitting comprises slideably receiving and guiding the fitting within a collar attached to the body portion of the sheath.
145. The method of claim 139 wherein exerting an axial force on the working channel comprises articulating a bending section of the insertion tube to apply the axial force on the working channel.
146. The method of claim 139 wherein exerting an axial force on the working channel comprises stretching the body portion of the sheath assembly onto the insertion tube to apply an axial tension force on the working channel.
147. The method of claim 139 , further comprising inserting a medical device through the working channel.
148. The method of claim 139 wherein providing a working channel includes providing a working channel having an enlarged end portion, further comprising drawing a medical device into the enlarged end portion of working channel.
149. The method of claim 139 , further comprising inserting working end of the insertion tube into a patient.
150-163. (canceled)
Priority Applications (1)
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US11/291,655 US20060079735A1 (en) | 2002-01-04 | 2005-11-30 | Endoscope assemblies having working channels with reduced bending and stretching resistance |
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US10/040,972 US6740030B2 (en) | 2002-01-04 | 2002-01-04 | Endoscope assemblies having working channels with reduced bending and stretching resistance |
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US11/291,655 US20060079735A1 (en) | 2002-01-04 | 2005-11-30 | Endoscope assemblies having working channels with reduced bending and stretching resistance |
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US10/821,036 Division US7056284B2 (en) | 2002-01-04 | 2004-04-07 | Endoscope assemblies having working channels with reduced bending and stretching resistance |
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US10/821,036 Expired - Lifetime US7056284B2 (en) | 2002-01-04 | 2004-04-07 | Endoscope assemblies having working channels with reduced bending and stretching resistance |
US11/291,655 Abandoned US20060079735A1 (en) | 2002-01-04 | 2005-11-30 | Endoscope assemblies having working channels with reduced bending and stretching resistance |
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US10/821,036 Expired - Lifetime US7056284B2 (en) | 2002-01-04 | 2004-04-07 | Endoscope assemblies having working channels with reduced bending and stretching resistance |
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US20050177168A1 (en) * | 2004-02-11 | 2005-08-11 | Medtronic, Inc. | High speed surgical cutting instrument |
US20070175947A1 (en) * | 2006-01-31 | 2007-08-02 | Ethicon Endo-Surgery, Inc. | Surgical fastener and cutter with single cable actuator |
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Also Published As
Publication number | Publication date |
---|---|
US20030130564A1 (en) | 2003-07-10 |
AU2003202866C1 (en) | 2009-02-19 |
AU2003202866A1 (en) | 2003-07-24 |
EP1471820A4 (en) | 2010-08-25 |
WO2003057019A1 (en) | 2003-07-17 |
US6740030B2 (en) | 2004-05-25 |
AU2003202866B2 (en) | 2008-10-09 |
US7056284B2 (en) | 2006-06-06 |
EP1471820A1 (en) | 2004-11-03 |
US20040193007A1 (en) | 2004-09-30 |
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