DE20003797U1 - Flexible encoscope with coupling device for a tube - Google Patents

Description

Applicant; .. 28 February 2000

4613G112 VH-km
Karl Storz GmbH & Co. KG
Mittelstrasse 8

D-78532 Tuttlingen

Flexible endoscope with coupling device for a tube

The invention relates to a flexible endoscope with an elongated flexible shaft, at the proximal end of which an endoscope housing is arranged.

Such a flexible endoscope is known, for example, from the DE company catalog of Karl Storz GmbH & Co., Tuttlingen, "STORZ, Karl Storz-Endoskope", volume "Endoskope und Instrumente für ENT", 5th edition, 1996, page LA-FIB 2. Other endoscopes of the type mentioned above are known from DE 39 2 8 532 Al and from DE 25 04 663 Al and generally from practice.

Flexible endoscopes differ from rigid endoscopes in that the shaft of a flexible endoscope is so flexible that it can take on a curved, strongly bent or even looped shape.

Such flexible endoscopes are therefore particularly suitable as medical surgical or examination endoscopes for internal body parts that have branched or convoluted structures, such as the respiratory tract including the lungs.

A special application of both flexible endoscopes and rigid endoscopes is the intubation of patients to insert a tracheal tube under visual control through the endoscope.

Intubation using an endoscope has the advantage that the tube can be advanced more precisely and thus with less trauma to the adjacent tissue because of the immediate visual control when inserting the tube into the trachea.

With rigid endoscopes, i.e. endoscopes that have a rigid shaft, the patient is intubated exclusively through the mouth. An intubation endoscope with a rigid shaft is known from the German company catalog of Karl Storz GmbH & Co., Tuttlingen, "STORZ, Karl Storz-Endoskope", volume "Anästhesie", issue 1/1999, page AN-DAMS 1. This well-known intubation endoscope has a rigid shaft onto which the tube, which is designed as a flexible hose, is pushed and attached to an adapter for tube fixation.

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The adapter is designed in the form of a short piece of pipe which is arranged so that it can be moved on the rigid shaft and can be clamped to any point on the shaft using a screw.

With such a rigid intubation endoscope, the tube pushed onto the rigid shaft is inserted through the oral cavity into the trachea, after which the tube can be detached from the adapter and the endoscope can be pulled out of the tube.

However, intubation through the oral cavity using a rigid endoscope may be impossible due to abnormal anatomical conditions, such as adhesions in the throat, or due to diseases in the oral cavity. Intubation through the oral cavity is also not possible if the patient has suffered injuries to the jaw that make it impossible to open the mouth or could make the injury worse.

In such cases, intubation through the nose is indicated. However, intubation through the nose under endoscopic visual control is not feasible with a rigid intubation endoscope such as the one mentioned above, since the rigid shaft cannot adapt to the more curved nasal airways.

For intubation through the nose, a flexible endoscope with a flexible shaft must be used. However, no flexible endoscope is known to date that has a means of attaching the tube to the endoscope. In order to attach the tube to the flexible shaft, doctors currently use a

plaster to the flexible shaft. However, this is extremely unsatisfactory in terms of handling and secure fixation.

The previously mentioned known adapter for tube fixation for rigid endoscopes cannot be used with flexible endoscopes, as this adapter would have to be clamped to the shaft of the flexible endoscope. However, this can damage the flexible shaft, which has a relatively soft outer shell, and thus damage the sensitive optical fibers running in the flexible shaft.

The invention is therefore based on the object of developing a flexible endoscope of the type mentioned at the outset in such a way that its properties are improved for use as an intubation endoscope.

According to the invention, this object is achieved with regard to the flexible endoscope mentioned at the outset in that a coupling device is arranged on the endoscope housing, which has a distal fastening section for fastening a flexible tube pushed onto the shaft to the endoscope.

The flexible endoscope according to the invention makes it possible for the first time to attach a tube to the flexible endoscope. Instead of arranging the coupling device on the shaft as in the case of rigid endoscopes, the invention provides for arranging the coupling device on the endoscope housing, whereby the sensitive flexible shaft of the endoscope is not damaged, in particular if the coupling device is designed as an adapter and the coupling device is accordingly attached to the endoscope.

The coupling device can, as already mentioned, be designed as a removable adapter or be designed as an integral construction with the endoscope housing.

Thus, the problem underlying the invention is completely solved.

In a preferred embodiment, the distal fastening section has a plug-in receptacle for a proximal end of the tube.

The advantage here is that the tube can be particularly easily connected to the coupling device and secured to it.

It is also preferred if the plug-in receptacle has a cone.

The tubes commonly used for ventilation have a coupling sleeve in the form of a cone at their proximal end, to which a tube is usually attached that is connected to a ventilation gas source. The design of the plug-in receptacle of the coupling device as a cone means that the plug-in receptacle is optimally adapted to a conventional tube and thus enables an easy-to-use and securely fixed connection of the tube to the endoscope.

In a further preferred embodiment, the coupling device is designed in the form of at least one pipe section, the

Tube wall is radially spaced from an outer wall of the endoscope housing and/or the flexible shaft.

This measure advantageously opens up the possibility of using the coupling device at the same time as introducing a ventilation gas into the tube, particularly when the tube has an inner diameter that is larger than the outer diameter of the flexible shaft. In this case, ventilation can already take place through the tube while the flexible endoscope is being inserted together with the tube.

It is preferred if there is an opening in the pipe wall for the introduction of a gas.

In a further preferred embodiment, the coupling device is variable in length.

This measure has the particular advantage that the tube can be pushed back and forth on the flexible shaft even when attached to the endoscope, for example to push the tube over the distal tip of the flexible shaft to protect the distal tip of the flexible endoscope, or to pull the tube back behind the distal end of the flexible shaft to enable a better view through the endoscope.

It is preferred if the coupling device has a plurality of telescopically movable tube pieces, one of which has the distal fastening section.

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The telescopic design of the coupling device has the further special advantage that it enables a change in length over a large travel range.

In a further preferred embodiment of the telescopic coupling device, the pipe section having the distal fastening section is the pipe section with the smallest diameter.

Since the endoscope housing of flexible endoscopes has a large diameter in relation to the diameter of the flexible shaft, and since the endoscope housing also serves as a handpiece for holding and operating the endoscope, this measure has the advantage that the coupling device is particularly well adapted to the structural conditions of flexible endoscopes.

In a further preferred embodiment, the coupling device is designed as an adapter that can be removably attached to the endoscope housing and has a proximal fastening section for fastening the adapter to the endoscope housing.

The design of the coupling device as a removable adapter has the particular advantage that an existing flexible endoscope, which is also used for purposes other than intubation, is given an additional function as an intubation endoscope by attaching the adapter. Furthermore, the design of the coupling device as a removable adapter has the advantage that the coupling device can be cleaned more easily.

In a first preferred embodiment, the proximal fastening section can be clamped to the endoscope housing.

This particularly simple design has the additional advantage that the adapter can be attached to an existing conventional flexible endoscope without any special adaptation of the endoscope in the area of the endoscope housing. A screw can be provided on the proximal attachment section to improve the clamping effect.

In alternative preferred embodiments, the proximal fastening section has a locking mechanism for locking the adapter to the endoscope housing, or the fastening section can be fastened to the endoscope housing by means of a union nut-threaded connection.

In the case that the fastening section has a locking mechanism for locking the adapter to the endoscope housing, it is further preferred if the locking mechanism has at least one ball catch, and if at least one recess is formed on the endoscope housing into which the ball catch engages.

Attaching the adapter using a ball catch that snaps into a recess on the endoscope housing has the particular advantage that the adapter can be quickly and securely attached to the endoscope housing and removed just as quickly.

It is further preferred if the recess is designed as a circumferential groove.

This has the advantage that when attaching the adapter to the endoscope housing, no particular rotational orientation of the adapter in relation to the endoscope housing axis has to be taken into account, because with this design the adapter can be attached to the endoscope housing in any rotational position about the longitudinal axis of the endoscope housing.

The same advantage exists with the previously mentioned union nut thread connection between the adapter and the endoscope housing.

As a further possibility for fastening the adapter to the endoscope housing, a bayonet lock of the fastening section of the adapter to the endoscope housing is also preferred.

As an alternative to designing the coupling device as a removable adapter, it is also preferred if the coupling device is formed integrally with the endoscope housing.

Since the coupling device does not affect the handling of the flexible endoscope, the flexible endoscope housing can be equipped with a coupling device for attaching a tube as a single piece during production, which has the advantage that the coupling device can be made even slimmer, i.e. without a radial enlargement of the endoscope housing.

The invention also relates to an adapter for coupling a tube to a flexible endoscope, wherein the adapter has a proximal fastening section for detachably fastening the adapter to an endoscope housing of the endoscope and a

a distal fastening section for securing the tube which is pushed onto a flexible shaft of the endoscope.

Such an adapter according to the invention preferably has the features described above in connection with the design of the coupling device as a removable adapter.

Further advantages are apparent from the following description and the attached drawing.

It is understood that the features mentioned above and those to be explained below can be used not only in the combination specified in each case, but also in other combinations or on their own, without departing from the scope of the present invention.

Embodiments of the invention are shown in the drawing and are explained in more detail in the following description. They show:

Fig. IA and IB

a flexible endoscope in an overall view with a tube attached to it in two partial images in side view, the scale in Fig. IB being enlarged compared to Fig. IA;

Fig. 2 the endoscope in Fig. 1, with the tube pushed onto the shaft but not yet attached to the endoscope;

Fig. 3 is a partial longitudinal section through the endoscope in Fig. 1 in the region of a coupling device for attaching the tube;

Fig. 4 is a representation corresponding to Fig. 3 of a further embodiment of a coupling device;

Fig. 5 is a representation of a further embodiment of a coupling device corresponding to Figs. 3 and 4;

Fig. 6 is a representation corresponding to Figs. 3 to 5 of yet another embodiment of a coupling device in a first operating position; and

Fig. 7 shows the coupling device in Fig. 6 in a second operating position.

In Fig. 1 to 3, a flexible endoscope provided with the general reference numeral 10 is shown, which is used for intubating a patient.

Fig. IA and IB show the endoscope 10 in two partial images, the scale in Fig. IB being enlarged compared to Fig. IA.

The endoscope 10 has an elongated flexible shaft 12 which has such flexibility that it can assume a curved, a highly curved and even a looped shape, wherein in Fig. 1B the shaft 12 is shown substantially straight with only a slight curvature.

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The shaft 12 is so flexible that it always adapts to the course of the corresponding body passage when inserted into the body. The shaft 12 can thus be inserted through the nose into the trachea to intubate a patient, although the endoscope 10 is of course also suitable for intubation through the mouth.

A distal tip 14 of the shaft 12 forms the light exit or light entry end of the shaft 12, in which optical fibers running in the flexible shaft 12 end distally.

At the proximal end of the shaft 12 there is an endoscope housing 16 which has a distal section 17 in which the endoscope housing 16 tapers from a large diameter to the diameter of the shaft 12.

The endoscope housing 16 serves as a handpiece when handling the endoscope 10.

The endoscope housing 16 has an eyepiece 18 at its proximal end, through which the insertion process can be observed when the endoscope 10 is inserted into a body passage.

The structure of the flexible endoscope 10 with regard to the flexible shaft 12 and the endoscope housing 16 as well as the optics accommodated in the endoscope corresponds to that of a conventional flexible endoscope. The endoscope housing 16 also has a flushing connection 19 to which a flushing line (not shown) can be connected in order to introduce a

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To introduce rinsing fluid, which then exits from the distal tip 14 of the shaft 12.

The endoscope 10 now has a coupling device 20 for attaching a flexible tube 22, in particular a tracheal tube, to the endoscope 10.

The coupling device 20 has a distal fastening section which serves to fasten a proximal end 26 of the tube 22.

The proximal end 2 6 of the tube 22 has, as is usual with tracheal tubes, a hollow plug designed as a cone 28, which usually serves as a connection for connecting a gas hose to connect the tube to a ventilation gas source.

The distal fastening section 24 of the coupling device 20 is now, as can be seen from Fig. 3, adapted to the cone 28 of the tube 22, i.e. is itself designed as a cone with a slope complementary to the cone 28 of the tube 22. In other words, the clear inner diameter of the distal fastening section 24 of the coupling device 20 widens slightly in the distal direction.

The distal fastening section 24 thus forms a plug-in receptacle for the proximal end 26, more precisely the cone 28.

The coupling device 20 is formed as a single piece in the form of a pipe section 30.

As can be seen from Fig. 3, a tube wall 32 is radially spaced from the outer wall of the endoscope housing 16, here from the tapering distal section 17 of the endoscope housing 16. In the area radially spaced from the endoscope housing 16, the coupling device 20 has an opening 34 for introducing a gas, in particular a ventilation gas. For this purpose, a connection 36 for connecting a hose (not shown) that is connected to an external ventilation gas source is provided in the opening 34.

Gas introduced through the opening 34 can then be introduced through the cone 28 into the tube 22, more precisely between the tube 22 and the flexible shaft 12, provided that the tube 22 has an inner diameter that is at least slightly larger than the outer diameter of the shaft 12.

The coupling device 20 further comprises a proximal fastening section 38 with which the coupling device 20 is fastened or can be fastened to the endoscope housing 16, wherein the coupling device 20 is removably fastened to the endoscope housing 16.

The coupling device 20 is therefore designed as an adapter for coupling the tube 22 to the endoscope 10. In the embodiment shown in Figs. 1 to 3, the coupling device 20 designed as an adapter is attached by a screw 40, with which the proximal attachment section 38 of the coupling device 20 is clamped to the endoscope housing 16.

If the flexible endoscope 10 is used to intubate a patient, at least the coupling device 20 is attached to the

Shaft 12 is placed from distally and pushed proximally to the endoscope housing 16, where the coupling device 20 is then fastened to the endoscope housing 16 by means of the screw 40. Next, the tube 22 is also pushed onto the shaft 12 from the distal tip 14 of the shaft 12 (cf. Fig. 2), the tube 22 being fastened to the coupling device 20 and thus to the endoscope 10 by inserting the cone 28 into the distal fastening section 24.

Now, with the aid of the endoscope 10, the tube 22 can be pushed through the nose, but also through the mouth, under visual control through the eyepiece 18 into the trachea. As soon as the tube 22 is correctly positioned in the trachea, the cone 28 is pulled out of the distal fastening section 24 of the coupling device 20, after which the flexible endoscope 10 is pulled out of the tube 22. A tube is now connected to the cone 28 of the tube 22, which is connected to a ventilation gas source, so that the patient can be ventilated through the tube 22.

Fig. 4 shows a further embodiment of a coupling device 50, wherein the coupling device 50 is also designed as a removable adapter. The coupling device 50 serves to attach the tube 22 to an endoscope 52.

The coupling device 50 differs from the coupling device 20 in the manner of attachment to an endoscope housing 54 of the endoscope 52.

A proximal fastening section 56 can be removably fastened to the endoscope housing 54 via a locking mechanism. The locking mechanism comprises one or more ball catches 58, two in the embodiment shown, which, when the coupling device 50 is plugged onto the endoscope housing 54, engage in a locking manner with a groove 60 formed in the endoscope housing 54, which is formed circumferentially on the endoscope housing 54.

Fig. 5 shows a further embodiment of a coupling device 70, wherein the coupling device 70 is formed in one piece with an endoscope housing 72 of a flexible endoscope 74. With this design of the flexible endoscope 74, the coupling device 70 is thus firmly integrated into the endoscope housing 72. Otherwise, the coupling device 70 corresponds to the designs of the coupling devices 20 and 50 according to Figs. 1 to 3 and 4, respectively.

Other alternative fastening options not shown in the drawing include a union nut thread connection or a bayonet lock.

In Fig. 6 and 7, a further coupling device 80 is shown, which can be used in the flexible endoscope 10 instead of the coupling device 20.

The coupling device 80 is designed to be variable in length. For this purpose, the coupling device 80 has a structure made up of at least two, in the embodiment shown three, tube sections 82, 84 and 86 that can be telescoped into one another.

The pipe section 82 with the largest diameter, i.e. the radially outermost pipe section 82, has a proximal fastening section 88 with which the coupling device 80 as a whole is removably fastened to the endoscope housing 16 by means of a screw 90.

The tube section 86 with the smallest diameter, i.e. the radially innermost tube section 86, has a distal fastening section 92 which is designed as a plug-in receptacle for the cone 28 of the tube 22.

The pipe sections 82, 84 and 86 are each axially displaceable relative to one another, but are secured to one another in a captive manner, for which purpose corresponding stops (not shown in detail) are provided at the distal ends of the pipe sections 82, 84 and 86 or at their proximal ends.

A handle 94 is also provided on the tube piece 86 having the distal fastening section 92 in order to telescopically pull the tube pieces 86, 84 and 82 apart or to push them into one another.

While Fig. 6 shows the coupling device 80 in its maximum telescopically pushed-together position, Fig. 7 shows the coupling device 80 in an exploded view, in which the tube 22 is pushed forward on the shaft 12 in the direction of the distal end. By pulling the coupling device 80 apart, it is thus possible to push the tube 22 out over the distal tip 14 when inserting it into the patient, or to push it proximally over the distal tip 14 to

backwards, depending on which position of the tube 22 is most suitable for the insertion procedure.

However, in any position of the coupling device 80, the tube 22 is securely attached to the endoscope 10.

Claims (30)

1. Flexible endoscope, with an elongated flexible shaft ( 12 ), at the proximal end of which an endoscope housing ( 16 ; 54 ; 72 ) is arranged, characterized in that a coupling device ( 20 ; 50 ; 70 ; 80 ) is arranged on the endoscope housing ( 16 ; 54 ; 72 ), which has a distal fastening section ( 24 ; 92 ) for fastening a flexible tube ( 22 ) pushed onto the shaft to the endoscope ( 10 ; 52 ; 74 ). 2. Endoscope according to claim 1, characterized in that the distal fastening section ( 24 ; 92 ) has a plug-in receptacle for a proximal end ( 26 ) of the tube ( 22 ). 3. Endoscope according to claim 2, characterized in that the plug-in receptacle has a cone ( 28 ). 4. Endoscope according to one of claims 1 to 3, characterized in that the coupling device ( 20 ; 50 ; 70 ; 80 ) is designed in the form of at least one tube piece ( 30 ; 82 ; 84 , 86 ), the tube wall ( 32 ) of which is radially spaced from an outer wall of the endoscope housing ( 16 ; 54 ; 72 ) and/or from the shaft ( 12 ). 5. Endoscope according to claim 4, characterized in that an opening ( 34 ) for introducing a gas is provided in the tube wall ( 32 ). 6. Endoscope according to one of claims 1 to 5, characterized in that the coupling device ( 80 ) is variable in length. 7. Endoscope according to claim 6, characterized in that the coupling device ( 80 ) has a plurality of telescopically movable tube pieces ( 82 , 84 , 86 ), one of which has the distal fastening section ( 92 ). 8. Endoscope according to claim 7, characterized in that the tube piece ( 86 ) having the distal fastening section ( 92 ) is the tube piece with the smallest diameter. 9. Endoscope according to one of claims 1 to 9, characterized in that the coupling device ( 20 ; 50 ; 80 ) is designed as an adapter which can be removably fastened to the endoscope housing ( 16 ; 54 ) and which has a proximal fastening section ( 38 ; 56 ; 88 ) for fastening the adapter to the endoscope housing ( 16 ; 54 ). 10. Endoscope according to claim 9, characterized in that the proximal fastening section ( 38 ; 88 ) can be clamped to the endoscope housing. 11. Endoscope according to claim 9, characterized in that the proximal fastening section ( 56 ) has a locking mechanism for locking the adapter to the endoscope housing ( 54 ). 12. Endoscope according to claim 11, characterized in that the locking mechanism has at least one ball catch ( 58 ), and that at least one recess is formed on the endoscope housing ( 54 ) into which the ball catch ( 58 ) engages. 13. Endoscope according to claim 12, characterized in that the recess is designed as a circumferential groove ( 60 ). 14. Endoscope according to claim 9, characterized in that the proximal fastening section can be fastened to the endoscope housing by means of a union nut-thread connection. 15. Endoscope according to claim 9, characterized in that the proximal fastening section can be fastened to the endoscope housing by means of a bayonet lock. 16. Endoscope according to one of claims 1 to 8, characterized in that the coupling device ( 70 ) is formed integrally with the endoscope housing ( 72 ). 17. Adapter for coupling a tube ( 22 ) to a flexible endoscope ( 10 ; 52 ), the adapter having a proximal fastening section ( 38 ; 56 ; 88 ) for removably fastening the adapter to an endoscope housing ( 16 , 54 ) of the endoscope ( 10 ; 52 ) and a distal fastening section ( 24 ; 92 ) for fastening the tube ( 22 ) pushed onto a flexible shaft ( 12 ) of the endoscope ( 10 ; 52 ). 18. Adapter according to claim 17, characterized in that the distal fastening section ( 24 ; 92 ) has a plug-in receptacle for a proximal end ( 26 ) of the tube ( 22 ). 19. Adapter according to claim 17 or 18, wherein the plug receptacle has a cone ( 28 ). 20. Adapter according to one of claims 17 to 19, wherein the adapter is designed in the form of at least one pipe section ( 30 ; 82 , 84 , 86 ), the pipe wall ( 32 ) of which is radially spaced from an outer wall of the endoscope housing ( 16 ; 54 ) and/or from the shaft ( 12 ). 21. Adapter according to claim 20, wherein an opening ( 34 ) for introducing a gas is present in the tube wall ( 32 ). 22. Adapter according to one of claims 17 to 21, wherein the adapter is variable in length. 23. Adapter according to claim 22, wherein the adapter comprises a plurality of telescopically movable tube pieces ( 82 , 84 , 86 ), one of which comprises the distal attachment portion ( 92 ). 24. The adapter of claim 23, wherein the tubing ( 86 ) having the distal attachment portion ( 92 ) is the tubing with the smallest diameter. 25. Adapter according to one of claims 17 to 24, wherein the proximal fastening section ( 38 ; 88 ) can be clamped to the endoscope housing ( 16 ). 26. Adapter according to one of claims 17 to 24, wherein the proximal fastening portion ( 56 ) has a locking mechanism for locking the adapter to the endoscope housing ( 54 ). 27. Adapter according to claim 26, wherein the locking mechanism has at least one ball catch ( 58 ), and wherein at least one recess is formed on the endoscope housing into which the ball catch ( 58 ) engages. 28. Adapter according to claim 27, wherein the recess is formed as a circumferential groove ( 60 ). 29. Adapter according to one of claims 17 to 24, wherein the proximal fastening section can be fastened to the endoscope housing by means of a union nut-thread connection. 30. Adapter according to one of claims 17 to 24, wherein the proximal fastening section can be fastened to the endoscope housing by means of a bayonet lock.