WO1996000517A1 - Video bug for endoscopy - Google Patents

Video bug for endoscopy Download PDF

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Publication number
WO1996000517A1
WO1996000517A1 PCT/US1995/008218 US9508218W WO9600517A1 WO 1996000517 A1 WO1996000517 A1 WO 1996000517A1 US 9508218 W US9508218 W US 9508218W WO 9600517 A1 WO9600517 A1 WO 9600517A1
Authority
WO
WIPO (PCT)
Prior art keywords
pressure
chassis
linear actuators
endoscope
articulated endoscope
Prior art date
Application number
PCT/US1995/008218
Other languages
French (fr)
Inventor
Michael R. Treat
William S. Trimmer
Original Assignee
The Trustees Of Columbia University In The City Of New York
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by The Trustees Of Columbia University In The City Of New York filed Critical The Trustees Of Columbia University In The City Of New York
Priority to AU29535/95A priority Critical patent/AU2953595A/en
Publication of WO1996000517A1 publication Critical patent/WO1996000517A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/0105—Steering means as part of the catheter or advancing means; Markers for positioning
    • A61M25/0133—Tip steering devices
    • 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
    • A61B1/00147—Holding or positioning arrangements
    • A61B1/00156—Holding or positioning arrangements using self propulsion
    • 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
    • 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
    • A61B1/04—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 combined with photographic or television appliances
    • A61B1/05—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 combined with photographic or television appliances characterised by the image sensor, e.g. camera, being in the distal end portion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/0105—Steering means as part of the catheter or advancing means; Markers for positioning
    • A61M25/0116—Steering means as part of the catheter or advancing means; Markers for positioning self-propelled, e.g. autonomous robots
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/361—Image-producing devices, e.g. surgical cameras
    • A61B2090/3614—Image-producing devices, e.g. surgical cameras using optical fibre
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/0105—Steering means as part of the catheter or advancing means; Markers for positioning

Definitions

  • the present invention relates to a self-propelled endoscope apparatus for performing endoscopic procedures in which many of the hazards posed by conventional endoscopes are eliminated.
  • colon cancer is a major health problem (1) .
  • This precursor lesion is the polyp.
  • neoplastic transformation i.e. clones of the cells which have undergone a genetic change enabling them to escape the regulatory systems controlling normal cell growth.
  • a polyp is neoplastic, it is still benign, since it is not capable of invading other structures or of metastasizing to other locations.
  • Endoscopic technology permits the detection and removal of polyps from the gastrointestinal tract without resorting to major invasive surgery.
  • polyps When polyps are endoscopically removed, they generally do not recur. However, if polyps are not removed, some of them will undergo malignant transformation and become cancers.
  • a cancer is capable of infiltrating its cells into normal tissues, and is also capable of metastasizing. Unlike polyps, a cancer will recur unless a fairly radical operation is done. Unfortunately, the overall cure rate for colon cancers is less than 50 % even if extensive surgery is done.
  • colon cancer if one could detect and remove all colon polyps, the incidence of colon cancer would be very low (there are probably some cancers that arise de novo, without a preceding benign polyp precursor) (2) .
  • Flexible endoscopes e.g. colonoscopes
  • Conventional endoscopes are constructed as follows: there is a long flexible shaft, with a diameter suitable to the organ for which it is intended.
  • a flexible colonoscope is about 14 mm in diameter and 180 cm in length.
  • the shaft is encased with a metallic double helical spiral that resists torsional deformation while permitting axial flexibility.
  • the distal 8 cm of the endoscope, the bending section is a stacked series of universal joints. Wires operated by controls at the proximal end of the endoscope cause the bending section to bend in whatever direction is desired.
  • the shaft also contains fiberoptic bundles to bring light to the scene at the tip of the endoscope.
  • a video chip with appropriate optics and video electronics is mounted at the tip of the endoscope and the image is conveyed by wires back to the operator.
  • the shaft of the endoscope also incorporates small tubes to bring air and water into the field. The air is used to open up the bowel to obtain a clear view. The water is used to clean the endoscope's optics.
  • the shaft also contains a channel to pass instruments such as biopsy forceps or snares to remove polyps.
  • the operator of the endoscope pushes it into the bowel.
  • the scope is of necessity flexible so that it can fit around the curvatures of the bowel.
  • the bowel itself is not only curved but also is capable of stretching or being looped into curves which are exaggerations of the normal anatomic position. Therefore, as the endoscope is pushed into the bowel, it stretches the bowel. When the bowel is forced into these stretched loops by the insertion of the endoscope, the patient is made uncomfortable. If the doctor does not recognize that the bowel is being unduly stretched, the bowel wall will tear and a perforation occurs, requiring an emergency operation to repair (3) .
  • a skilled operator of the endoscope can avoid excessive stretching or looping, but even a skilled operator cannot avoid causing some discomfort to the patient and very occasionally even serious harmful effects.
  • Manipulating the shaft of the endoscope so that excessive looping does not occur is a blind process.
  • the operator is aware by direct endoscopic vision of what lies ahead of the endoscope, but he is only indirectly aware of how the shaft is interacting with the bowel to form loops. Thus, even a skilled operator may not be aware of the formation of an excessive loop and a serious complication may ensue (4) .
  • a conventional endoscope cannot be sterilized in the same way as a simple stainless steel surgical instrument. This lack of absolute sterilizability results from the conventional endoscope's complex hybrid construction of metallic parts, plastic parts, electronics and optics which would be destroyed by the high temperatures used in steam autoclaves. These instruments can be sterilized by use of an ethylene oxide gas process ("gas sterilization”) , but this procedure requires approximately six to eight hours. Since endoscopes are expensive, it is not practical to have enough endoscopes in reserve to do all the procedures that one might do in one day. Therefore, what is conventionally done is "cold soaking", which refers to the use of a bactericidal/viricidal liquid such as glutaraldehyde to achieve a high degree of disinfection.
  • the present invention also provides an articulated endoscope for performing endoscopic procedures in a tubular organ of a patient comprising a chassis, a plurality of pressure driven linear actuators, the plurality of pressure driven linear actuators being pivotally mounted on the chassis at their proximal ends, in oppositely facing pairs, pressure driven pivoting means for pivoting respective ones of the oppositely facing pressure driven linear actuators, a plurality of rods mounted at distal ends of respective ones of the plurality of pressure driven linear actuators, control means mounted on the chassis for storing a predetermined pressure distribution sequence therein and for outputing the predetermined sequence in response to a directional input from a user, means for receiving and distributing pressure to the plurality of pressure driven linear actuators and the pressure driven pivoting means in the predetermined pressure distribution sequence, and a tail with at least one tube for delivering pressure to the means for receiving and distributing, the means for receiving and distributing being mounted on the chassis and self-propelled motive force being produced by pushing against interior surfaces of the tubular organ with distal ends of the plurality of rod
  • the present invention also provides a self-propelling device for insertion and longitudinal movement within an elongated passage having a tubular wall, the device comprising a rigid chassis insertable in the elongated passage for carrying a payload for performing a procedure within the passage, a plurality of rigid legs carried by the chassis and movable relative thereto, each of the legs having a distal end, the legs projecting laterally from the chassis such that their distal ends are respectively disposed for engagement with spaced-apart portions of the tubular wall, means, carried by the chassis and connected to the legs, for actuating the legs to move for propelling the chassis along the passage, means carried by the chassis for controlling the actuating means to effect movement of the legs, and a thin elongated flexible tail extending from the chassis for transmitting motive power to the actuating means and control signals to the controlling means from a locality external to the passage when the chassis is inserted within the passage.
  • Fig. 1 is an articulated endoscope apparatus according to a first embodiment of the present invention
  • Fig. 2 is an articulated endoscope apparatus according to a second embodiment of the present invention.
  • Fig. 3 is an articulated endoscope apparatus according to a first embodiment of the present invention that is covered by a removable sheath;
  • Fig. 4 is an articulated endoscope apparatus according to a third embodiment of the present invention.
  • Fig. 5 is an embodiment of a linear actuator or pivoting means of the instant invention
  • Fig. 6 depicts an imaging system incorporated into the third embodiment of the instant invention.
  • Fig. 7 is a cross-section of a tail of an embodiment of the instant invention.
  • Fig. 8 is an embodiment of driver circuitry for driving the instant invention.
  • Fig. 9 is a schematic diagram of an embodiment of a valve system for the instant invention.
  • the plurality of pressure driven linear actuators are pneumatically driven.
  • the plurality of pressure driven linear actuators are hydraulically driven.
  • the predetermined pressure distribution sequence causes the endoscope to move forward through the tubular organ.
  • a plurality of rods may be mounted to distal ends of respective ones of the plurality of pressure driven linear actuators.
  • a removable sheath may be mounted over the plurality of pressure driven linear actuators, the plurality of rods, the chassis, and the means for receiving and distributing pressure.
  • the means for receiving and distributing the pressure further comprises a valve.
  • the valve further comprises a shape metal alloy valve which employs shape metal alloys as pressure regulation means.
  • control means responds to electronic signals transmitted by a user through electronic signal transmitting means connected to the control means.
  • control means responds to light signals transmitted by a user through fiber-optic signal transmitting means connected to the control means.
  • the present invention also provides an articulated endoscope for performing endoscopic procedures in a tubular organ of a patient comprising a chassis, a plurality of pressure driven linear actuators, the plurality of pressure driven linear actuators being pivotally mounted, by proximal ends, in oppositely facing pairs to the chassis, pressure driven pivoting means for pivoting respective ones of the oppositely facing pressure driven linear actuators, a plurality of rods mounted to distal ends of respective ones of the plurality of pressure driven linear actuators, control means mounted to the chassis for storing a predetermined pressure distribution sequence therein and for outputing the predetermined sequence in response to a directional input from a user, means for receiving and distributing pressure to the plurality of pressure driven linear actuators and the pressure driven pivoting means in the predetermined pressure distribution sequence, and a tail with at least one tube for delivering pressure to the means for receiving and distributing, whereby the means for receiving and distributing is mounted to the chassis and self-propelled motive force is produced by pushing against interior surfaces of the tubular organ with distal ends of the plurality
  • the pressure driven pivoting means are pneumatically driven.
  • the pressure driven pivoting means are hydraulically driven.
  • the tail is removable.
  • the predetermined pressure distribution sequence causes the chassis to move backward through the tubular organ.
  • a removable sheath is provided for covering the chassis, the plurality of pressure driven linear actuators, the plurality of rods, the pressure driven pivoting means, the means for receiving and distributing, and the tail.
  • a plurality of load spreading members mounted on respective ones of the plurality of rods are provided to spread the force produced by the distal ends of the rods as they push against the interior surface of the tubular organ over a larger surface area, the plurality of load spreading members being covered by the removable sheath.
  • the plurality of load spreading members are beads.
  • the plurality of beads are compressible.
  • an imaging means mounted on the chassis is provided, the imaging means being covered by the removable sheath.
  • the removable sheath includes a transparent window in register with the imaging means.
  • the tail further comprises at least one tube for carrying fluid to the exterior of the sheath, whereby the fluid cleans the transparent window.
  • the tail further comprises at least one conduit terminating outside the sheath for guiding surgical instruments.
  • the pressure applied to the interior surface of the tubular organ by the load spreading members is less than the pressure necessary to puncture a gastrointestinal tract.
  • the pressure applied to the interior surface of the tubular organ by the load spreading members is less than the pressure necessary to puncture a urinary tract.
  • the pressure applied to the interior surface of the tubular organ by the load spreading members is less than the pressure necessary to puncture a member of the vascular system.
  • the imaging means further comprises a charge coupled device.
  • the imaging means further comprises a video driver.
  • Fig. 1 shows an articulated endoscope apparatus according to a first embodiment of the present invention.
  • the apparatus is particularly suited for endoscopic procedures in the gastrointestinal tract, urinary tract, or vascular system.
  • the preferred embodiment will be described with reference to the gastrointestinal tract, but this is by way of example and not by way of limitation.
  • the apparatus comprises a rigid chassis 1, supporting, by their proximal ends, a plurality of linear actuators 3a, 3b, 3c, and 3d arranged in oppositely facing pairs.
  • the linear actuators may be pressure driven actuators, such as pneumatically or hydraulically driven actuators, for example.
  • the two pressure driven linear actuators comprising each pair are mounted at a fixed angular relationship to one another, each actuator extending outwardly and obliquely rearwardly from the chassis.
  • Rigid leg members 5a, 5b, 5c, and 5d are mounted on distal ends of respective ones of the pneumatic linear actuators 3a, 3b, 3c, and 3d.
  • the leg members may be, for example, metal or plastic rods.
  • Load spreading members 6a, 6b, 6c, and 6d are mounted on distal ends of respective leg members 5a, 5b, 5c, 5d.
  • the load spreading members may be in the form of pads or beads, and may be either rigid or compressible.
  • Means for receiving and distributing pressure 7 to the plurality of linear actuators 3a, 3b, 3c, and 3d is mounted to chassis 1.
  • the means for receiving and distributing pressure 7, which may (for example) be a pneumatic mini-value, receives pressure from a supply means (not shown) through tube 10a within tail 10 and distributes the pressure to respective ones of the linear actuators 3a, 3b, 3c, and 3d through tubes 12a, 12b, 12c, and 12d.
  • Control electronics 8 also mounted on the chassis, has a predetermined pressure distribution sequence stored therein and the means for receiving and distributing pressure 7 distributes the pressure in the predetermined sequence in response to control signals carried by signal carrying means 9a (such as a wire or fiber-optic cable) from control electronics 8, which receives directional input from a user, such as a forward or backward command, and sends the predetermined sequence of control signals to the means for receiving and distributing pressure 7 in response to the directional input.
  • the control means 8 receives directional input from a user via a signal transmitting means 9 within tail 10.
  • the signal transmitting means 9 may be, for example, a wire or a fiber-optic cable.
  • Imaging means 11 is mounted to chassis 1 and is connected by a wire or fiber ⁇ optic cable to video electronics 11a.
  • Video electronics 11a are connected through a wire or fiber-optic cable running through tail 10 to an external video system (not shown) .
  • Tube 10b, within tail 10 carries air or water for cleaning purposes.
  • the operation of an articulated endoscope according to a first embodiment of the present invention is as follows.
  • the chassis is inserted into a patient's gastrointestinal tract (not shown) .
  • the means for receiving and distributing pressure 7 receives pressure from the supply means (not shown) through tube 10a and distributes the pressure to the plurality of linear actuators 3a, 3b, 3c, and 3d in the predetermined sequence, under control of control electronics 8, which is receiving directional input from the user.
  • the predetermined sequence could be, for example, the retraction of the forward legs coupled with extension of the rear legs followed by the extension of the forward legs coupled with retraction of the rear legs, thus propelling the chassis forward.
  • the chassis may be removed from the patient by retracting all of the legs and pulling the chassis out of the patient's body by the tail 10.
  • FIG. 2 wherein the same reference numerals of Fig. 1 are applied to the same parts and therefore do not require detailed description, an articulated endoscope apparatus according to a second embodiment of the present invention is shown.
  • the plurality of linear actuators 3a, 3b, 3c, and 3d are pivotally mounted to the chassis 1 and are pivoted by pressure driven pivoting means 15a, 15b, 15c, and 15d, mounted to chassis 1 and respective ones of the plurality of linear actuators 3a, 3b, 3c, and 3d.
  • the pressure driven linear actuators may be pneumatically or hydraulically driven, as may be the pressure driven pivoting means.
  • an articulated endoscope according to the second embodiment of the present invention is as follows.
  • the chassis is inserted into a patient's gastrointestinal tract (not shown) .
  • a means for receiving and distributing pressure 14 receives pressure from the supply means (not shown) through tube 10a and distributes the pressure to the plurality of linear actuators 3a, 3b, 3c, and 3d and the pivoting means 15a, 15b, 15c, and 15d through tubes 12a, 12b, 12c, 12d, 12e, 12f, 12g, and 12h.
  • Control electronics 8 has a predetermined pressure distribution sequence stored therein and the means for receiving and distributing pressure 14 distributes the pressure in the predetermined sequence in response to control signals from control electronics 8, which receives directional input from a user, such as a forward or backward command, and sends the predetermined sequence of control signals to the means for receiving and distributing pressure 14 in response to the directional input.
  • the control means 8 receives directional input from a user via a signal transmitting means 9 within tail 10.
  • the signal transmitting means may be, for example, a wire or a fiber-optic cable.
  • Imaging means 11 is mounted to chassis 1 and is connected by a wire or fiber-optic cable to video electronics 11a.
  • Video electronics 11a are connected through a wire or fiber-optic cable running through tail 10 to an external video system (not shown) .
  • forward is taken to mean further into the patient and backward is take to mean out of the patient.
  • the predetermined sequence could be, for example, the retraction of the legs 5a, 5b, 5c, and 5d coupled with forward pivoting of the linear actuators 3a, 3b, 3c, and 3d by respective pivoting means 15a, 15b, 15c, and 15d followed by the extension of legs 5a, 5b, 5c, and 5d and the backward pivoting of the linear actuators 3a, 3b, 3c, and 3d by respective pivoting means 15a, 15b, 15c, and 15d, thus propelling the chassis forward.
  • the direction of travel may also, of course, be reversed by reversing the above sequence.
  • the plurality of linear actuators 3a, 3b, 3c, and 3d are first pivoted by respective pivoting means 15a, 15b, 15c, and 15d so that their distal ends face the forward end of the chassis. Then, the retraction of the legs 5a, 5b, 5c, and 5d coupled with backward pivoting of the linear actuators 3a, 3b, 3c, and 3d by pivoting means 15a, 15b, 15c, and 15d followed by the extension of legs 5a, 5b, 5c, and 5d and the forward pivoting of the pivoting means 15a, 15b, 15c, and 15d, propels the chassis backward.
  • the chassis may be removed from the patient by retracting all of the legs 5a, 5b, 5c, and 5d and pulling the chassis out of the patient's body by the tube 10.
  • FIG. 4 wherein the same reference numerals of Fig. 2 are applied to the same parts and therefore do not require detailed description, an articulated endoscope apparatus according to a third embodiment of the present invention is shown.
  • two linear actuators 3a and 3b are pivotally mounted to the chassis 1 and are pivoted by pressure driven pivoting means 15a and 15b, mounted to chassis 1 and respective ones of the plurality of linear actuators 3a and 3b.
  • the pressure driven linear actuators may be pneumatically or hydraulically driven, as may be the pressure driven pivoting means.
  • the pressure driven pivoting means may be pivotally mounted, as the linear actuators are, or they may be fixed.
  • Fig. 4 depicts only the two linear actuator design of this embodiment and the driving elements are not shown in this Fig. , although they are similar to the elements used to drive the moving parts of the first two embodiments.
  • the chassis of all of the embodiments of the instant invention must be light, strong, and rigid. Plastic from Plastruct Inc. , City of Industry, CA may be used for this purpose.
  • the chassis may be a solid plate with appropriate holes for mounting the various elements thereto.
  • the chassis may incorporate struts and formers to support and shape the outer sheath, described below.
  • the chassis may be molded and incorporate honey-comb type construction in order to decrease weight and maintain or increase rigidity.
  • Fig. 5 shows a diagram of an embodiment of the linear actuators and/or the pivoting means.
  • These elements may be constructed from brass, plastic, or other appropriate material. As seen in this Fig., these elements may incorporate a pivot pin 50, a piston 52, a cylinder 54, a seal/bearing 56, input air port 58a, and output air port 58b.
  • the linear actuators and pivoting means may, of course, be mounted on either the top or the bottom of the chassis.
  • a viewing system may be utilized and may consist of two small diameter fiberoptic imaging bundles along with associated focusing lenses.
  • the dual optical path may provide the operator with a simultaneous forward and rear view, to be displayed on the operator's monitor in a "split screen" fashion. Alternatively, the views may, of course, be viewed on separate monitors.
  • most of the optical path components may be mounted on the bottom of the chassis. The remaining elements depicted in this Fig. refer to the same elements of Fig. 4, and do not require further description.
  • the forward-view fiberoptic bundle 64 may be used (as in the case of a standard endoscope) to guide the steering of the apparatus.
  • the rear-view may be used to permit visual monitoring of the position of the linear actuators and the pivoting means.
  • the rear-view as well as the forward-view may also be used to provide diagnostic information.
  • Fiberoptic light providing bundles (not shown) associated with the forward-view fiberoptic bundle and the rear-view fiberoptic bundle may also be provided to illuminate the front and rear views.
  • the fiberoptic bundle viewing system described above has the advantage that many (up to 16) connecting wires may be required to interface a video chip to its driver circuitry. These connecting wires and necessary shielding may increase the bulk and weight of the tail of the instant apparatus and thus increase the traction requirements.
  • Miniature fiberoptic bundles which convey a very adequate image are available in the 1mm diameter size range and may provide a lighter, less bulky, alternative to currently available video chips.
  • video chips with integral driver circuitry which require fewer wires to convey a video signal to an operator may be developed to bring this type of video system into the size and weight range of the fiberoptic bundle type video system.
  • Fig. 7 shows a cross-section of a tail 71 of the instant apparatus used in an embodiment of the invention.
  • the tail may contain air tubes for the linear actuators and pivoting means, shown here as 70a, 70b, 70c, and 70d, as well as forward-view and rear-view fiberoptic bundles (72a and 72b, respectively) , and light providing fiberoptic bundles 74a, 74b, 74c, and 74d.
  • the tail 71 may be surrounded by sheath 76 (which may also cover the chassis and other components as described below) and the sheath 76 may include suction tube 78a and air insufflation tube 78b.
  • the air insufflation tube 78b is for opening up the bowel ahead of the bug as it travels along the colon.
  • the suction tube 78a is for removing fluid.
  • the sheath 76 may include suction elements (not shown) to grip the bowel wall between thrusts and thus prevent backsliding, especially on an inclined course.
  • valves may preferably be medical grade, computer interfacable, and capable of the fast response time (pulsing) required by control software, which may be used to control the valves through a computer or microprocessor.
  • control software which may be used to control the valves through a computer or microprocessor.
  • Very small valves may be placed directly on the chassis to reduce the size and weight of the tail by reducing or eliminating the number of tubes required to carry the valve regulated pressure from outside the patient when the valves are externally located.
  • Fig. 8 depicts a schematic diagram of an embodiment of valve driver/computer interface circuitry for interfacing the parallel, or printer, port of an IBM type computer with the valves of the instant apparatus.
  • the parallel port can support up to twelve data lines and can easily be manipulated by software routines.
  • the circuit depicted in this Fig. handles only two valves, but can easily be expanded to handle four or more. Where pulsed signals are provided to the interface circuit a very fine level of valve control may be achieved. Linear actuator and pivoting means position may be controlled via an operator manipulating a joystick, for example, via the disclosed valve driver/computer interface circuitry.
  • FIG. 9 a schematic diagram of a valving system according to an embodiment of the instant invention is shown.
  • the linear actuator (or pivoting means) 90 may be controlled by two three-way valves per cylinder (92a and 92b) .
  • the valves 92a and 92b may be computer driven and may be synchronized so that when one valve is being used as an inlet valve, the other valve will be pulsed open and shut to provide a counter force by regulating the rate at which pressure can exhaust from the cylinder.
  • a sheath 16 is shown covering the chassis l, the plurality of linear actuators 3a, 3b, 3c, and 3d, the leg members 5a, 5b, 5c, and 5d, the load spreading members 6a, 6b, 6c, and 6d, the means for receiving and distributing pneumatic pressure 7, the imaging means 11, and at least part of the tail 10.
  • the sheath includes a transparent portion 20 in register with the imaging means so as to allow light to pass through the sheath onto the imaging means.
  • a port 25 gives tube 10b access to the exterior of the sheath for expelling air or water or for extending surgical instruments such as snares therethrough.
  • the sheath is discarded and a new one is installed over the chassis 1, the plurality of linear actuators 3a, 3b, 3c, and 3d, the leg members 5a, 5b, 5c, and 5d, the load spreading members 6a, 6b, 6c, and 6d, the means for receiving and distributing pressure 7, the imaging means 8, and at least part of the tube 10 in order to reduce the risk of cross-contamination between patients.
  • Fenoglio-Preiser CM Lantz PE, Listrom MB, Davis, M, Rilke FO, The Neoplastic Large Intestine. Gastrointestinal Pathology, An Atlas and Text, Raven Press, New York, New York 1989.

Abstract

An articulated endoscope for performing endoscopic procedures in a tubular organ of a patient is provided, comprising a chassis (1), a plurality of pressure driven linear actuators (3a)-(3d) mounted, by proximal ends, in oppositely facing pairs to the chassis (1), control means (8) mounted to the chassis for storing a predetermined pressure distribution sequence therein and for out-putting the predetermined sequence in response to a directional input from the user, means for receiving and distributing pressure (7) to a plurality of pressure driven linear actuators (3a)-(3d) in the predetermined pressure distribution sequence in response to control signals from the control means (8), the means for receiving and distributing (7) being mounted to the chassis (1), and a tube (10a) delivering pressure to the means for receiving and distributing pressure (7), whereby self-propelled motive force is produced by pushing against interior surfaces of the tubular organ with distal ends of the plurality of pressure driven linear actuators (3a)-(3d) as pressure is applied to the plurality of pressure driven linear actuators (3a)-(3d) in the predetermined pressure distribution sequence.

Description

"VIDEO BUG" FOR ENDOSCOPY
BACKGROUND OF THE INVENTION
The present invention relates to a self-propelled endoscope apparatus for performing endoscopic procedures in which many of the hazards posed by conventional endoscopes are eliminated.
Within this application several publications are referenced by arabic numerals within parentheses. Full citations for these and other references may be found at the end of the specification immediately preceding the claims. The disclosures of all of these publications in their entireties are hereby incorporated by reference into this application in order to more fully describe the state of the art to which this invention pertains.
One of the major applications of gastrointestinal endoscopy is the detection of pre-malignant and malignant lesions of the gastrointestinal tract. There are approximately 250,000 new cases of colon cancer diagnosed in the United States every year. Approximately 50,000 of these people die of colon cancer every year. Colon cancer represents the number one killing cancer affecting both sexes nearly equally (breast cancer is much more common in women than in men) . Not only in the United States, but in Western societies in general, colon cancer is a major health problem (1) .
Despite the lethality of colon cancer, there exists an opportunity for its prevention by detecting and removing the precursor of the actual cancer. This precursor lesion is the polyp. This is a small (generally less than 1 cm diameter) growth on the lining of the bowel. It represents an area of the lining of the bowel which has undergone neoplastic transformation — i.e. clones of the cells which have undergone a genetic change enabling them to escape the regulatory systems controlling normal cell growth. While a polyp is neoplastic, it is still benign, since it is not capable of invading other structures or of metastasizing to other locations.
Endoscopic technology permits the detection and removal of polyps from the gastrointestinal tract without resorting to major invasive surgery. When polyps are endoscopically removed, they generally do not recur. However, if polyps are not removed, some of them will undergo malignant transformation and become cancers. A cancer is capable of infiltrating its cells into normal tissues, and is also capable of metastasizing. Unlike polyps, a cancer will recur unless a fairly radical operation is done. Unfortunately, the overall cure rate for colon cancers is less than 50 % even if extensive surgery is done.
Theoretically, if one could detect and remove all colon polyps, the incidence of colon cancer would be very low (there are probably some cancers that arise de novo, without a preceding benign polyp precursor) (2) . Flexible endoscopes (e.g. colonoscopes) make this possible.
Conventional endoscopes are constructed as follows: there is a long flexible shaft, with a diameter suitable to the organ for which it is intended. A flexible colonoscope is about 14 mm in diameter and 180 cm in length. The shaft is encased with a metallic double helical spiral that resists torsional deformation while permitting axial flexibility. The distal 8 cm of the endoscope, the bending section, is a stacked series of universal joints. Wires operated by controls at the proximal end of the endoscope cause the bending section to bend in whatever direction is desired. The shaft also contains fiberoptic bundles to bring light to the scene at the tip of the endoscope. A video chip with appropriate optics and video electronics is mounted at the tip of the endoscope and the image is conveyed by wires back to the operator. The shaft of the endoscope also incorporates small tubes to bring air and water into the field. The air is used to open up the bowel to obtain a clear view. The water is used to clean the endoscope's optics. The shaft also contains a channel to pass instruments such as biopsy forceps or snares to remove polyps.
Essentially, the operator of the endoscope pushes it into the bowel. The scope is of necessity flexible so that it can fit around the curvatures of the bowel. The bowel itself is not only curved but also is capable of stretching or being looped into curves which are exaggerations of the normal anatomic position. Therefore, as the endoscope is pushed into the bowel, it stretches the bowel. When the bowel is forced into these stretched loops by the insertion of the endoscope, the patient is made uncomfortable. If the doctor does not recognize that the bowel is being unduly stretched, the bowel wall will tear and a perforation occurs, requiring an emergency operation to repair (3) . A skilled operator of the endoscope can avoid excessive stretching or looping, but even a skilled operator cannot avoid causing some discomfort to the patient and very occasionally even serious harmful effects. Manipulating the shaft of the endoscope so that excessive looping does not occur is a blind process. The operator is aware by direct endoscopic vision of what lies ahead of the endoscope, but he is only indirectly aware of how the shaft is interacting with the bowel to form loops. Thus, even a skilled operator may not be aware of the formation of an excessive loop and a serious complication may ensue (4) .
Additionally, a conventional endoscope cannot be sterilized in the same way as a simple stainless steel surgical instrument. This lack of absolute sterilizability results from the conventional endoscope's complex hybrid construction of metallic parts, plastic parts, electronics and optics which would be destroyed by the high temperatures used in steam autoclaves. These instruments can be sterilized by use of an ethylene oxide gas process ("gas sterilization") , but this procedure requires approximately six to eight hours. Since endoscopes are expensive, it is not practical to have enough endoscopes in reserve to do all the procedures that one might do in one day. Therefore, what is conventionally done is "cold soaking", which refers to the use of a bactericidal/viricidal liquid such as glutaraldehyde to achieve a high degree of disinfection. This process takes about a half hour to perform, which is compatible with the turn-over requirements of an endoscopy unit. However, a high level of disinfection is not the same as absolute sterilization by autoclave. In addition, the actual ability of the glutaraldehyde to achieve high disinfection is dependent on diligent pre- cleaning of mucus and other substances from the numerous channels and crevices which exist in the endoscope. If this tenacious debris is not removed, the glutaraldehyde will not be able to penetrate to achieve killing of micro-organisms (5,6).
SUMMARY OF THE INVENTION
It is an object of the present invention to provide an arrangement for performing endoscopic procedures in which many of the hazards posed by conventional endoscopes are eliminated.
It is a further object of the present invention to provide an arrangement in which endoscopic procedures may be safely and comfortably carried out in various tubular organs of a patient.
It is yet a further object of the present invention to provide an arrangement in which endoscopic procedures may be carried out without looping the gastrointestinal tract of a patient.
It is yet a further object of the present invention to provide an arrangement in which endoscopic procedures may be carried out without puncturing the wall of a patent's gastrointestinal tract.
It is yet a further object of the present invention to provide an arrangement in which endoscopic procedures may be carried out that would be difficult to perform with a conventional endoscope because of the finite bending radius imposed by the shaft.
It is yet a further object of the present invention to provide an arrangement in which endoscopic procedures may be carried out free from the risk of cross-contamination between patients.
It is yet a further object of the present invention to provide an arrangement in which an articulated endoscope includes reusable components encased in an inexpensive disposable outer sheath, thus allowing the patient to benefit from advanced technology which itself is too costly to be disposable, while maintaining the advantage of freedom from risk of cross contamination from another patient.
According to one aspect of the present invention, an articulated endoscope for performing endoscopic procedures in a tubular organ of a patient is provided, comprising a chassis, a plurality of pressure driven linear actuators mounted at their proximal ends, in oppositely facing pairs on the chassis, control means mounted on the chassis for storing a predetermined pressure distribution sequence therein and for outputing the predetermined sequence in response to a directional input from a user, means for receiving and distributing pressure to the plurality of pressure driven linear actuators in the predetermined pressure distribution sequence in response to control signals from the control means, the means for receiving and distributing being mounted on the chassis, and a tube delivering pressure to the means for receiving and distributing pressure, whereby self-propelled motive force is produced by pushing against interior surfaces of the tubular organ with distal ends of the plurality of pressure driven linear actuators as pressure is applied to the plurality of pressure driven linear actuators in the predetermined pressure distribution sequence.
The present invention also provides an articulated endoscope for performing endoscopic procedures in a tubular organ of a patient comprising a chassis, a plurality of pressure driven linear actuators, the plurality of pressure driven linear actuators being pivotally mounted on the chassis at their proximal ends, in oppositely facing pairs, pressure driven pivoting means for pivoting respective ones of the oppositely facing pressure driven linear actuators, a plurality of rods mounted at distal ends of respective ones of the plurality of pressure driven linear actuators, control means mounted on the chassis for storing a predetermined pressure distribution sequence therein and for outputing the predetermined sequence in response to a directional input from a user, means for receiving and distributing pressure to the plurality of pressure driven linear actuators and the pressure driven pivoting means in the predetermined pressure distribution sequence, and a tail with at least one tube for delivering pressure to the means for receiving and distributing, the means for receiving and distributing being mounted on the chassis and self-propelled motive force being produced by pushing against interior surfaces of the tubular organ with distal ends of the plurality of rods as pressure is applied to the plurality of pressure driven linear actuators and the pressure driven pivoting means in the predetermined pressure distribution sequence.
The present invention also provides a self-propelling device for insertion and longitudinal movement within an elongated passage having a tubular wall, the device comprising a rigid chassis insertable in the elongated passage for carrying a payload for performing a procedure within the passage, a plurality of rigid legs carried by the chassis and movable relative thereto, each of the legs having a distal end, the legs projecting laterally from the chassis such that their distal ends are respectively disposed for engagement with spaced-apart portions of the tubular wall, means, carried by the chassis and connected to the legs, for actuating the legs to move for propelling the chassis along the passage, means carried by the chassis for controlling the actuating means to effect movement of the legs, and a thin elongated flexible tail extending from the chassis for transmitting motive power to the actuating means and control signals to the controlling means from a locality external to the passage when the chassis is inserted within the passage.
These and other advantages will become apparent from the detailed description accompanying the claims and attached drawing figures.
DESCRIPTION OF THE DRAWINGS
Fig. 1 is an articulated endoscope apparatus according to a first embodiment of the present invention;
Fig. 2 is an articulated endoscope apparatus according to a second embodiment of the present invention;
Fig. 3 is an articulated endoscope apparatus according to a first embodiment of the present invention that is covered by a removable sheath;
Fig. 4 is an articulated endoscope apparatus according to a third embodiment of the present invention;
Fig. 5 is an embodiment of a linear actuator or pivoting means of the instant invention;
Fig. 6 depicts an imaging system incorporated into the third embodiment of the instant invention;
Fig. 7 is a cross-section of a tail of an embodiment of the instant invention;
Fig. 8 is an embodiment of driver circuitry for driving the instant invention; and
Fig. 9 is a schematic diagram of an embodiment of a valve system for the instant invention. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS According to one aspect of the present invention, an articulated endoscope for performing endoscopic procedures in a tubular organ of a patient is provided, comprising a chassis, a plurality of pressure driven linear actuators mounted, by proximal ends, in oppositely facing pairs to the chassis, control means mounted to the chassis for storing a predetermined pressure distribution sequence therein and for outputing the predetermined sequence in response to a directional input from a user, means for receiving and distributing pressure to the plurality of pressure driven linear actuators in the predetermined pressure distribution sequence in response to control signals from the control means, the means for receiving and distributing being mounted to the chassis, and a tube delivering pressure to the means for receiving and distributing pressure, whereby self-propelled motive force is produced by pushing against interior surfaces of the tubular organ with distal ends of the plurality of pressure driven linear actuators as pressure is applied to the plurality of pressure driven linear actuators in the predetermined pressure distribution sequence.
According to another aspect of the present invention, the plurality of pressure driven linear actuators are pneumatically driven.
According to another aspect of the present invention, the plurality of pressure driven linear actuators are hydraulically driven.
According to another aspect of the present invention, the predetermined pressure distribution sequence causes the endoscope to move forward through the tubular organ.
According to another aspect of the present invention, a plurality of rods may be mounted to distal ends of respective ones of the plurality of pressure driven linear actuators.
According to another aspect of the present invention, a removable sheath may be mounted over the plurality of pressure driven linear actuators, the plurality of rods, the chassis, and the means for receiving and distributing pressure.
According to another aspect of the present invention, the means for receiving and distributing the pressure further comprises a valve.
According to another aspect of the present invention, the valve further comprises a shape metal alloy valve which employs shape metal alloys as pressure regulation means.
According to another aspect of the present invention, the control means responds to electronic signals transmitted by a user through electronic signal transmitting means connected to the control means.
According to another aspect of the present invention, the control means responds to light signals transmitted by a user through fiber-optic signal transmitting means connected to the control means.
The present invention also provides an articulated endoscope for performing endoscopic procedures in a tubular organ of a patient comprising a chassis, a plurality of pressure driven linear actuators, the plurality of pressure driven linear actuators being pivotally mounted, by proximal ends, in oppositely facing pairs to the chassis, pressure driven pivoting means for pivoting respective ones of the oppositely facing pressure driven linear actuators, a plurality of rods mounted to distal ends of respective ones of the plurality of pressure driven linear actuators, control means mounted to the chassis for storing a predetermined pressure distribution sequence therein and for outputing the predetermined sequence in response to a directional input from a user, means for receiving and distributing pressure to the plurality of pressure driven linear actuators and the pressure driven pivoting means in the predetermined pressure distribution sequence, and a tail with at least one tube for delivering pressure to the means for receiving and distributing, whereby the means for receiving and distributing is mounted to the chassis and self-propelled motive force is produced by pushing against interior surfaces of the tubular organ with distal ends of the plurality of rods as pressure is applied to the plurality of pressure driven linear actuators and the pressure driven pivoting means in the predetermined pressure distribution sequence.
According to another aspect of the present invention, the pressure driven pivoting means are pneumatically driven.
According to another aspect of the present invention, the pressure driven pivoting means are hydraulically driven.
According to another aspect of the present invention, the tail is removable.
According to another aspect of the present invention, the predetermined pressure distribution sequence causes the chassis to move backward through the tubular organ.
According to another aspect of the present invention, a removable sheath is provided for covering the chassis, the plurality of pressure driven linear actuators, the plurality of rods, the pressure driven pivoting means, the means for receiving and distributing, and the tail.
According to another aspect of the present invention, a plurality of load spreading members mounted on respective ones of the plurality of rods are provided to spread the force produced by the distal ends of the rods as they push against the interior surface of the tubular organ over a larger surface area, the plurality of load spreading members being covered by the removable sheath.
According to another aspect of the present invention, the plurality of load spreading members are beads.
According to another aspect of the present invention, the plurality of beads are compressible.
According to another aspect of the present invention, an imaging means mounted on the chassis is provided, the imaging means being covered by the removable sheath.
According to another aspect of the present invention, the removable sheath includes a transparent window in register with the imaging means.
According to another aspect of the present invention, the tail further comprises at least one tube for carrying fluid to the exterior of the sheath, whereby the fluid cleans the transparent window.
According to another aspect of the present invention, the tail further comprises at least one conduit terminating outside the sheath for guiding surgical instruments.
According to another aspect of the present invention. the pressure applied to the interior surface of the tubular organ by the load spreading members is less than the pressure necessary to puncture a gastrointestinal tract.
According to another aspect of the present invention, the pressure applied to the interior surface of the tubular organ by the load spreading members is less than the pressure necessary to puncture a urinary tract.
According to another aspect of the present invention, the pressure applied to the interior surface of the tubular organ by the load spreading members is less than the pressure necessary to puncture a member of the vascular system.
According to another aspect of the present invention, the imaging means further comprises a charge coupled device.
According to another aspect of the present invention, the imaging means further comprises a video driver.
Referring now to the drawings, Fig. 1 shows an articulated endoscope apparatus according to a first embodiment of the present invention. The apparatus is particularly suited for endoscopic procedures in the gastrointestinal tract, urinary tract, or vascular system. The preferred embodiment will be described with reference to the gastrointestinal tract, but this is by way of example and not by way of limitation.
The apparatus comprises a rigid chassis 1, supporting, by their proximal ends, a plurality of linear actuators 3a, 3b, 3c, and 3d arranged in oppositely facing pairs. The linear actuators may be pressure driven actuators, such as pneumatically or hydraulically driven actuators, for example. In this embodiment, the two pressure driven linear actuators comprising each pair are mounted at a fixed angular relationship to one another, each actuator extending outwardly and obliquely rearwardly from the chassis. Rigid leg members 5a, 5b, 5c, and 5d are mounted on distal ends of respective ones of the pneumatic linear actuators 3a, 3b, 3c, and 3d. The leg members may be, for example, metal or plastic rods. Load spreading members 6a, 6b, 6c, and 6d are mounted on distal ends of respective leg members 5a, 5b, 5c, 5d. The load spreading members may be in the form of pads or beads, and may be either rigid or compressible. Means for receiving and distributing pressure 7 to the plurality of linear actuators 3a, 3b, 3c, and 3d is mounted to chassis 1. The means for receiving and distributing pressure 7, which may (for example) be a pneumatic mini-value, receives pressure from a supply means (not shown) through tube 10a within tail 10 and distributes the pressure to respective ones of the linear actuators 3a, 3b, 3c, and 3d through tubes 12a, 12b, 12c, and 12d. Control electronics 8, also mounted on the chassis, has a predetermined pressure distribution sequence stored therein and the means for receiving and distributing pressure 7 distributes the pressure in the predetermined sequence in response to control signals carried by signal carrying means 9a (such as a wire or fiber-optic cable) from control electronics 8, which receives directional input from a user, such as a forward or backward command, and sends the predetermined sequence of control signals to the means for receiving and distributing pressure 7 in response to the directional input. The control means 8 receives directional input from a user via a signal transmitting means 9 within tail 10. The signal transmitting means 9 may be, for example, a wire or a fiber-optic cable. Imaging means 11 is mounted to chassis 1 and is connected by a wire or fiber¬ optic cable to video electronics 11a. Video electronics 11a are connected through a wire or fiber-optic cable running through tail 10 to an external video system (not shown) . Tube 10b, within tail 10, carries air or water for cleaning purposes.
The operation of an articulated endoscope according to a first embodiment of the present invention is as follows. The chassis is inserted into a patient's gastrointestinal tract (not shown) . The means for receiving and distributing pressure 7 receives pressure from the supply means (not shown) through tube 10a and distributes the pressure to the plurality of linear actuators 3a, 3b, 3c, and 3d in the predetermined sequence, under control of control electronics 8, which is receiving directional input from the user. The predetermined sequence could be, for example, the retraction of the forward legs coupled with extension of the rear legs followed by the extension of the forward legs coupled with retraction of the rear legs, thus propelling the chassis forward. After reaching a given site within the gastrointestinal tract, the chassis may be removed from the patient by retracting all of the legs and pulling the chassis out of the patient's body by the tail 10.
Referring now to Fig. 2, wherein the same reference numerals of Fig. 1 are applied to the same parts and therefore do not require detailed description, an articulated endoscope apparatus according to a second embodiment of the present invention is shown. In this Fig., the plurality of linear actuators 3a, 3b, 3c, and 3d are pivotally mounted to the chassis 1 and are pivoted by pressure driven pivoting means 15a, 15b, 15c, and 15d, mounted to chassis 1 and respective ones of the plurality of linear actuators 3a, 3b, 3c, and 3d. As in the case of the first embodiment, the pressure driven linear actuators may be pneumatically or hydraulically driven, as may be the pressure driven pivoting means. The operation of an articulated endoscope according to the second embodiment of the present invention is as follows. The chassis is inserted into a patient's gastrointestinal tract (not shown) . A means for receiving and distributing pressure 14 receives pressure from the supply means (not shown) through tube 10a and distributes the pressure to the plurality of linear actuators 3a, 3b, 3c, and 3d and the pivoting means 15a, 15b, 15c, and 15d through tubes 12a, 12b, 12c, 12d, 12e, 12f, 12g, and 12h. Control electronics 8 has a predetermined pressure distribution sequence stored therein and the means for receiving and distributing pressure 14 distributes the pressure in the predetermined sequence in response to control signals from control electronics 8, which receives directional input from a user, such as a forward or backward command, and sends the predetermined sequence of control signals to the means for receiving and distributing pressure 14 in response to the directional input. The control means 8 receives directional input from a user via a signal transmitting means 9 within tail 10. The signal transmitting means may be, for example, a wire or a fiber-optic cable. Imaging means 11 is mounted to chassis 1 and is connected by a wire or fiber-optic cable to video electronics 11a. Video electronics 11a are connected through a wire or fiber-optic cable running through tail 10 to an external video system (not shown) .
For the purposes of this explanation, forward is taken to mean further into the patient and backward is take to mean out of the patient. The predetermined sequence could be, for example, the retraction of the legs 5a, 5b, 5c, and 5d coupled with forward pivoting of the linear actuators 3a, 3b, 3c, and 3d by respective pivoting means 15a, 15b, 15c, and 15d followed by the extension of legs 5a, 5b, 5c, and 5d and the backward pivoting of the linear actuators 3a, 3b, 3c, and 3d by respective pivoting means 15a, 15b, 15c, and 15d, thus propelling the chassis forward.
The direction of travel may also, of course, be reversed by reversing the above sequence. In this case, the plurality of linear actuators 3a, 3b, 3c, and 3d are first pivoted by respective pivoting means 15a, 15b, 15c, and 15d so that their distal ends face the forward end of the chassis. Then, the retraction of the legs 5a, 5b, 5c, and 5d coupled with backward pivoting of the linear actuators 3a, 3b, 3c, and 3d by pivoting means 15a, 15b, 15c, and 15d followed by the extension of legs 5a, 5b, 5c, and 5d and the forward pivoting of the pivoting means 15a, 15b, 15c, and 15d, propels the chassis backward. In addition, as in the first embodiment, the chassis may be removed from the patient by retracting all of the legs 5a, 5b, 5c, and 5d and pulling the chassis out of the patient's body by the tube 10.
Referring now to Fig. 4, wherein the same reference numerals of Fig. 2 are applied to the same parts and therefore do not require detailed description, an articulated endoscope apparatus according to a third embodiment of the present invention is shown. In this Fig. , two linear actuators 3a and 3b are pivotally mounted to the chassis 1 and are pivoted by pressure driven pivoting means 15a and 15b, mounted to chassis 1 and respective ones of the plurality of linear actuators 3a and 3b. As in the case of the first embodiment, the pressure driven linear actuators may be pneumatically or hydraulically driven, as may be the pressure driven pivoting means. The pressure driven pivoting means may be pivotally mounted, as the linear actuators are, or they may be fixed.
The operation of an articulated endoscope according to the third embodiment of the present invention is similar to the first two embodiments. Fig. 4 depicts only the two linear actuator design of this embodiment and the driving elements are not shown in this Fig. , although they are similar to the elements used to drive the moving parts of the first two embodiments.
The chassis of all of the embodiments of the instant invention must be light, strong, and rigid. Plastic from Plastruct Inc. , City of Industry, CA may be used for this purpose. The chassis may be a solid plate with appropriate holes for mounting the various elements thereto. Alternatively, the chassis may incorporate struts and formers to support and shape the outer sheath, described below. Further, the chassis may be molded and incorporate honey-comb type construction in order to decrease weight and maintain or increase rigidity.
Fig. 5 shows a diagram of an embodiment of the linear actuators and/or the pivoting means. These elements may be constructed from brass, plastic, or other appropriate material. As seen in this Fig., these elements may incorporate a pivot pin 50, a piston 52, a cylinder 54, a seal/bearing 56, input air port 58a, and output air port 58b. The linear actuators and pivoting means may, of course, be mounted on either the top or the bottom of the chassis.
As seen in Fig. 6, a viewing system, or optical path, may be utilized and may consist of two small diameter fiberoptic imaging bundles along with associated focusing lenses. The dual optical path may provide the operator with a simultaneous forward and rear view, to be displayed on the operator's monitor in a "split screen" fashion. Alternatively, the views may, of course, be viewed on separate monitors. In any case, as seen in this Fig. , most of the optical path components (except for the rear-view focusing lens and the end of the rear- view fiberoptic bundle) may be mounted on the bottom of the chassis. The remaining elements depicted in this Fig. refer to the same elements of Fig. 4, and do not require further description.
The forward-view fiberoptic bundle 64 may be used (as in the case of a standard endoscope) to guide the steering of the apparatus. The rear-view may be used to permit visual monitoring of the position of the linear actuators and the pivoting means. The rear-view as well as the forward-view may also be used to provide diagnostic information. Fiberoptic light providing bundles (not shown) associated with the forward-view fiberoptic bundle and the rear-view fiberoptic bundle may also be provided to illuminate the front and rear views.
While different viewing systems may be employed in the instant apparatus, including a video chip, or sensor, the fiberoptic bundle viewing system described above has the advantage that many (up to 16) connecting wires may be required to interface a video chip to its driver circuitry. These connecting wires and necessary shielding may increase the bulk and weight of the tail of the instant apparatus and thus increase the traction requirements. Miniature fiberoptic bundles which convey a very adequate image are available in the 1mm diameter size range and may provide a lighter, less bulky, alternative to currently available video chips. In the future, of course, video chips with integral driver circuitry which require fewer wires to convey a video signal to an operator may be developed to bring this type of video system into the size and weight range of the fiberoptic bundle type video system.
Fig. 7 shows a cross-section of a tail 71 of the instant apparatus used in an embodiment of the invention. The tail may contain air tubes for the linear actuators and pivoting means, shown here as 70a, 70b, 70c, and 70d, as well as forward-view and rear-view fiberoptic bundles (72a and 72b, respectively) , and light providing fiberoptic bundles 74a, 74b, 74c, and 74d. Moreover, the tail 71 may be surrounded by sheath 76 (which may also cover the chassis and other components as described below) and the sheath 76 may include suction tube 78a and air insufflation tube 78b. The air insufflation tube 78b is for opening up the bowel ahead of the bug as it travels along the colon. The suction tube 78a is for removing fluid. These two tubes 78a and 78b, which will come in direct contact with the patient's fluids, may be molded into the sheath 76, which may be disposable.
Moreover, the sheath 76 may include suction elements (not shown) to grip the bowel wall between thrusts and thus prevent backsliding, especially on an inclined course.
The valves used in the various embodiments of the invention may be miniature valves available from the Lee
Company, Westbrook, CT. The valves may preferably be medical grade, computer interfacable, and capable of the fast response time (pulsing) required by control software, which may be used to control the valves through a computer or microprocessor. Very small valves may be placed directly on the chassis to reduce the size and weight of the tail by reducing or eliminating the number of tubes required to carry the valve regulated pressure from outside the patient when the valves are externally located.
Fig. 8 depicts a schematic diagram of an embodiment of valve driver/computer interface circuitry for interfacing the parallel, or printer, port of an IBM type computer with the valves of the instant apparatus. The parallel port can support up to twelve data lines and can easily be manipulated by software routines. The circuit depicted in this Fig. handles only two valves, but can easily be expanded to handle four or more. Where pulsed signals are provided to the interface circuit a very fine level of valve control may be achieved. Linear actuator and pivoting means position may be controlled via an operator manipulating a joystick, for example, via the disclosed valve driver/computer interface circuitry.
Regarding Fig. 9, a schematic diagram of a valving system according to an embodiment of the instant invention is shown. The linear actuator (or pivoting means) 90 may be controlled by two three-way valves per cylinder (92a and 92b) . The valves 92a and 92b may be computer driven and may be synchronized so that when one valve is being used as an inlet valve, the other valve will be pulsed open and shut to provide a counter force by regulating the rate at which pressure can exhaust from the cylinder.
Referring now to Fig. 3, wherein the same reference numerals of Fig. 1 are applied to the same parts and therefore do not require detailed description, an articulated endoscope apparatus according to the first embodiment of the present invention is shown covered by a removable sheath. In this Figure, a sheath 16 is shown covering the chassis l, the plurality of linear actuators 3a, 3b, 3c, and 3d, the leg members 5a, 5b, 5c, and 5d, the load spreading members 6a, 6b, 6c, and 6d, the means for receiving and distributing pneumatic pressure 7, the imaging means 11, and at least part of the tail 10. The sheath includes a transparent portion 20 in register with the imaging means so as to allow light to pass through the sheath onto the imaging means. A port 25 gives tube 10b access to the exterior of the sheath for expelling air or water or for extending surgical instruments such as snares therethrough. After removal from the patient, the sheath is discarded and a new one is installed over the chassis 1, the plurality of linear actuators 3a, 3b, 3c, and 3d, the leg members 5a, 5b, 5c, and 5d, the load spreading members 6a, 6b, 6c, and 6d, the means for receiving and distributing pressure 7, the imaging means 8, and at least part of the tube 10 in order to reduce the risk of cross-contamination between patients.
It must be noted that although the present invention is described by reference to particular embodiments thereof, many changes and modifications of the invention may become apparent to those skilled in the art without departing from the spirit and scope of the invention, which is only limited by the appended claims. Therefore, the embodiments shown and described are only illustrative, not restrictive.
REFERENCES
1. Fenoglio-Preiser CM, Lantz PE, Listrom MB, Davis, M, Rilke FO, The Neoplastic Large Intestine. Gastrointestinal Pathology, An Atlas and Text, Raven Press, New York, New York 1989.
2. Guillem JG, Forde KA, Treat MR, Neugut Al, O'Toole KM, Diamond BE, Colonoscopic screening for neoplasms in asymptomatic first-degree relatives of colon cancer patients. A controlled, prospective study, Dis Colon Rectum. 35(6):523-9, 1992.
3. Complications of colonoscopy, Colonoscopy (Eds. Hunt and Way JG) , 1989.
4. Gores PF, Simso LA., Splenic injury during colonoscopy. Arch Surg 124:1342, 1989.
5. Porter JV, Connell PA, Crow S, Reichert M. , Endoscope disinfection and sterilization: not a black- and-white issue. Todays OR Nurse 15(3):27-30, 1993.
6. Kaczmarek, RG, Moore RM Jr, McCrohan J, Goldmann DA, Reynolds C, Caquelin C, Israel E., Multi-state investigation of the actual disinfection/sterilization of endoscopies in health care facilities. Am J Med 92(3)L257-261, 1992.

Claims

WHAT IS CLAIMED IS:
1. An articulated endoscope for performing endoscopic procedures in a tubular organ of a patient comprising: a chassis; a plurality of pressure driven linear actuators mounted, by proximal ends, in oppositely facing pairs to the chassis; control means mounted to the chassis for storing a predetermined pressure distribution sequence therein and for outputing the predetermined sequence in response to a directional input from a user; means for receiving and distributing pressure to the plurality of pressure driven linear actuators in the predetermined pressure distribution sequence in response to control signals from the control means, the means for receiving and distributing being mounted to the chassis; and a tube delivering pressure to the means for receiving and distributing pressure, whereby self- propelled motive force is produced by pushing against interior surfaces of the tubular organ with distal ends of the plurality of pressure driven linear actuators as pressure is applied to the plurality of pressure driven linear actuators in the predetermined pressure distribution sequence.
2. The articulated endoscope of claim 1, wherein the plurality of pressure driven linear actuators are pneumatically driven.
3. The articulated endoscope of claim 1, wherein the plurality of pressure driven linear actuators are hydraulically driven.
4. The articulated endoscope of claim 1, wherein the predetermined pressure distribution sequence causes the endoscope to move forward through the tubular organ.
5. The articulated endoscope of claim l, further comprising a plurality of rods mounted to distal ends of respective ones of the plurality of pressure driven linear actuators.
6. The articulated endoscope of claim 5, further comprising a removable sheath mounted over the plurality of pressure driven linear actuators, the plurality of rods, the chassis, and the means for receiving and distributing pressure.
7. The articulated endoscope of claim 6, wherein the means for receiving and distributing the pressure further comprises a valve.
8. The articulated endoscope of claim 7, wherein the valve further comprises a shape metal alloy valve which employs shape metal alloys as pressure regulation means.
9. The articulated endoscope of claim 7, wherein the control means responds to electronic signals transmitted by a user through electronic signal transmitting means connected to the control means.
10. The articulated endoscope of claim 7, wherein the control means responds to light signals transmitted by a user through fiber-optic signal transmitting means connected to the control means.
11. An articulated endoscope for performing endoscopic procedures in a tubular organ of a patient comprising: a chassis; a plurality of pressure driven linear actuators, the plurality of pressure driven linear actuators being pivotally mounted, by proximal ends, in oppositely facing pairs to the chassis; pressure driven pivoting means for pivoting respective ones of the oppositely facing pressure driven linear actuators; a plurality of rods mounted to distal ends of respective ones of the plurality of pressure driven linear actuators; control means mounted to the chassis for storing a predetermined pressure distribution sequence therein and for outputing the predetermined sequence in response to a directional input from a user; means for receiving and distributing pressure to the plurality of pressure driven linear actuators and the pressure driven pivoting means in the predetermined pressure distribution sequence; and a tail with at least one tube for delivering pressure to the means for receiving and distributing; whereby the means for receiving and distributing is mounted to the chassis and self-propelled motive force is produced by pushing against interior surfaces of the tubular organ with distal ends of the plurality of rods as pressure is applied to the plurality of pressure driven linear actuators and the pressure driven pivoting means in the predetermined pressure distribution sequence.
12. The articulated endoscope of claim 11, wherein the plurality of pressure driven linear actuators and pressure driven pivoting means are pneumatically driven.
13. The articulated endoscope of claim 11, wherein the plurality of pressure driven linear actuators and pressure driven pivoting means are hydraulically driven.
14. The articulated endoscope of claim 11, wherein the predetermined pressure distribution sequence causes the chassis to move forward through the tubular organ.
15. The articulated endoscope of claim 11, wherein the predetermined pressure distribution sequence causes the chassis to move backward through the tubular organ.
16. The articulated endoscope of claim 11, wherein the tail is removable.
17. The articulated endoscope of claim 16, further comprising a removable sheath for covering the chassis, the plurality of pressure driven linear actuators, the plurality of rods, the pressure driven pivoting means, the means for receiving and distributing, and the tail.
18. The articulated endoscope of claim 17, further comprising a plurality of load spreading members mounted on respective ones of the plurality of rods to spread the force produced by the distal ends of the rods as they push against the interior surface of the tubular organ over a larger surface area, the plurality of load spreading members being covered by the removable sheath.
19. The articulated endoscope of claim 18, wherein the plurality of load spreading members are beads.
20. The articulated endoscope of claim 19, wherein the plurality of beads are compressible.
21. The articulated endoscope of claim 18, further comprising an imaging means mounted on the chassis, the imaging means being covered by the removable sheath.
22. The articulated endoscope of claim 21, wherein the removable sheath includes a transparent window in register with the imaging means.
23. The articulated endoscope of claim 22, wherein the tail further comprises at least one tube for carrying fluid to the exterior of the sheath, whereby the fluid cleans the transparent window.
24. The articulated endoscope of claim 23, wherein the tail further comprises at least one conduit terminating outside the sheath for guiding surgical instruments.
25. The articulated endoscope of claim 11, wherein the means for receiving and distributing the pressure further comprises a valve.
26. The articulated endoscope of claim 25, wherein the control means responds to electronic signals transmitted by a user through electronic signal transmitting means within the tail.
27. The articulated endoscope of claim 25, wherein the control means responds to light signals transmitted by a user through fiber-optic transmitting means within the tail.
28. The articulated endoscope of claim 25, wherein the valve further comprises a shape metal alloy valve which employs shape metal alloys as pressure regulation means.
29. The articulated endoscope of claim 18, wherein the pressure applied to the interior surface of the tubular organ by the load spreading members is less than the pressure necessary to puncture a gastrointestinal tract.
30. The articulated endoscope of claim 18, wherein the pressure applied to the interior surface of the tubular organ by the load spreading members is less than the pressure necessary to puncture a urinary tract.
31. The articulated endoscope of claim 18, wherein the pressure applied to the interior surface of the tubular organ by the load spreading members is less than the pressure necessary to puncture a member of the vascular system.
32. The articulated endoscope of claim 21, wherein the imaging means further comprises a charge coupled device.
33. The articulated endoscope of claim 21, wherein the imaging means further comprises a video driver.
34. A self-propelling device for insertion and longitudinal movement within an elongated passage having a tubular wall, said device comprising: a rigid chassis insertable in the elongated passage for carrying a payload for performing a procedure within the passage; a plurality of rigid legs carried by the chassis and movable relative thereto, each of said legs having a distal end, said legs projecting laterally from said chassis such that their distal ends are respectively disposed for engagement with spaced-apart portions of the tubular wall; means, carried by the chassis and connected to the legs, for actuating the legs to move for propelling the chassis along the passage; means carried by the chassis for controlling the actuating means to effect movement of said legs; and a thin elongated flexible tail extending from said chassis for transmitting motive power to said actuating means and control signals to said controlling means from a locality external to the passage when said chassis is inserted within the passage.
35. A device as defined in claim 34, wherein each of said legs is movable by longitudinal extension and retraction with respect to said chassis.
36. A device as defined in claim 34, wherein each of said legs is movable angularly with respect to said chassis.
37. A device as defined in claim 34, wherein said actuating means comprises a plurality of actuators, one for each leg, each of said actuators being connected to one of said legs and operable by fluid pressure to move the leg to which it is connected; wherein said controlling means comprises a fluid pressure distributor for controllably transmitting fluid pressure to said actuators in response to control signals; and wherein said tail includes a conduit for transmitting fluid pressure to said distributor.
38. A device as defined in claim 37, wherein said fluid pressure is gas pressure and said actuators are pneumatic actuators.
39. A device as defined in claim 34, wherein said distal ends of said legs are enlarged and smooth-surfaced terminal portions of said legs for distributing pressure, exerted by said legs, over extended surface areas of said wall.
40. A device as defined in claim 34, further including disposable flexible sheath means enclosing the chassis, payload, legs, actuating means, controlling means and tail, for shielding the chassis, legs, actuating means, controlling means and tail from contamination.
41. A device as defined in claim 34, further including a payload for performing a viewing procedure within the passage, said payload comprising viewing means carried by said chassis for obtaining visual image information, said tail including means for transmitting the visual image information to the exterior of the passage.
42. A device as defined in claim 34, wherein said legs are arranged on said chassis in pairs such that the distal ends of the legs of each pair are respectively disposed for engagement with opposite portions of the wall.
43. A device as defined in claim 34, dimensioned for insertion in a human intestinal tract.
44. A self-propelling endoscopic device for insertion and longitudinal movement within a portion of a human intestinal tract having a wall, said device comprising: a rigid chassis insertable in the tract; a plurality of pairs of rigid legs carried by the chassis and movable relative thereto, each of said legs having an enlarged distal end, the legs of each pair projecting generally laterally from said chassis such that their distal ends are respectively disposed for engagement with opposite portions of the wall; a plurality of actuators, one for each leg, carried by the chassis, for actuating the legs to move relative to the chassis for propelling the chassis along the tract when the chassis is inserted in the tract and the leg distal ends engage the wall, each of said actuators being connected to one of said legs and operable by fluid pressure to move the leg to which it is connected; a fluid pressure distributor carried by the chassis for controllably transmitting fluid pressure to said actuators, to effect movement of said legs, in response to control signals; a thin elongated flexible tail extending from said chassis for transmitting fluid pressure and control signals to said distributor from a locality external to the tract when said chassis is inserted within the passage; viewing means carried by said chassis for obtaining visual image information, said tail including means for transmitting the visual image information to the exterior of the tract; and disposable flexible sheath means enclosing said chassis, said legs, said actuating means, said controlling means and said tail, for shielding the chassis, legs, actuating means and tail from contamination.
45. An articulated endoscope for performing endoscopic procedures in a tubular organ of a patient comprising: a chassis; a plurality of pressure driven linear actuators, the plurality of pressure driven linear actuators being pivotally mounted, by proximal ends, to the chassis; pressure driven pivoting means for pivoting respective ones of the pressure driven linear actuators; control means for outputting a pressure distribution sequence in response to a directional input from a user; means for receiving and distributing pressure to the plurality of pressure driven linear actuators and the pressure driven pivoting means in the pressure distribution sequence; and a tail with at least one tube for delivering the pressure distribution sequence to the means for receiving and distributing; whereby self-propelled motive force is produced by the endoscope by pushing against interior surfaces of the tubular organ with distal ends of the plurality of pressure driven linear actuators as pressure is applied to the pressure driven linear actuators and the pressure driven pivoting means in the pressure distribution sequence.
46. The articulated endoscope of claim 45, wherein the plurality of pressure driven linear actuators and pressure driven pivoting means are pneumatically driven.
47. The articulated endoscope of claim 45, wherein the plurality of pressure driven linear actuators and pressure driven pivoting means are hydraulically driven.
48. The articulated endoscope of claim 45, wherein the tail is removable.
49. The articulated endoscope of claim 45, further comprising a removable sheath for covering the chassis, the plurality of pressure driven linear actuators, the pressure driven pivoting means, and the tail.
50. The articulated endoscope of claim 49, further comprising imaging means mounted on the chassis, the imaging means being covered by the removable sheath.
51. The articulated endoscope of claim 50, wherein the imaging means comprises at least one fiberoptic bundle and at least one focusing lens operatively associated with said fiberoptic bundle.
52. The articulated endoscope of claim 51, wherein a first fiberoptic bundle and first associated focusing lens are mounted to the chassis to provide a forward view and a second fiberoptic bundle and second associated focusing lens are mounted to the chassis to provide a rear view.
53. The articulated endoscope of claim 52, wherein the removable sheath includes a transparent window in register with the first associated focusing lens and a transparent window in register with the second associated focusing lens.
54. The articulated endoscope of claim 45, wherein the tail further comprises surface mounted suction producing means on an exterior surface for rendering the tail substantially stationary relative to the tubular organ of the patient when suction is produced by the surface mounted suction producing means.
55. The articulated endoscope of claim 54, wherein the surface mounted suction producing means comprise holes in the exterior surface of the tail in communication with a suction pump.
56. The articulated endoscope of claim 45, wherein the plurality of pressure driven linear actuators are mounted to a rear end of the chassis and the pressure driven pivoting means is mounted to a front end of the chassis.
PCT/US1995/008218 1994-06-30 1995-06-30 Video bug for endoscopy WO1996000517A1 (en)

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