TW201944956A - Endocranial endoscope - Google Patents

Abstract

An endoscope particularly suited for endocranial procedures and a method of using the endoscope. In some examples the endoscope is rigid except for a bend/tilt portion near a distal end of a rigid tube that is inserted in a patient's cranium, which distal end is controlled in a degree and direction of tilt with a finger operated controller at the endoscope's handle. Some examples use telescoping tubes that allow customizing the endoscope size for specific procedures. A distal portion of the endoscope can be disposable, supplied in a sterile package for a single procedure, thus taking into account contamination dangers that are particularly high for intracranial and certain other interventions and the fact that it can be difficult or impossible to effectively autoclave heat-sensitive components of certain endoscopes or effectively sterilize them using other techniques.

Description

Intracranial endoscope

(References to related applications) This patent application is a continuation of a portion of U.S. Application No. 15 / 364,952, filed on November 30, 2016 and allowed on January 26, 2018, which states that (a) requires February 2016 Interests in U.S. Provisional Application No. 62 / 299,307 filed on the 24th and (b) is part of the PCT application PCT / US2015 / 52152 continued application filed on September 25, 2015 which requires September 29, 2016 Benefits filed 62 / 056,617, 62 / 063,114 filed October 13, 2014, and 62 / 084,584 US provisional application filed November 26, 2014. This patent specification incorporates, by reference, the patent applications identified in this paragraph, and other publications identified in the remainder of this patent specification, including patents as well as published patent applications and unpublished patent applications.

This patent specification is in the field of intracranial endoscopy, and in general, certain aspects of the disclosed devices and methods additionally relate to ENT surgery, skull base surgery, and neurosurgery.

Intracranial endoscopes were investigated in the following literatures: Gaab MR, Instruments : Endoscopes and equipment , World Neurosurgery 79 [2s]: S14.E1-S14.E21, February 2013. Another example of intracranial endoscopes is discussed in the following literature: Schroeder HWS, New Multipurpose Ventriculoscopy , Neurosurgery, Volume 62 Number 2, February 2008, pages 489-492. Other examples of endoscopes are discussed in the following documents: US 1010/0022824 A1, WO 2013/082497 A1, US 2012/0330196 A1, US 2009/0054733 A1, 2009/0198216 A1, WO 2010/126586 A1, US 2004 / 0167542, US 2008/0154181 A1, and US 2014/0148727 A1.

An endoscope particularly suitable for intracranial surgery is disclosed. In addition to the inclined / curved portion near the distal end of a portion, some disclosed examples are rigid, which is inserted into the patient's skull and controlled using a controller at the handle of the endoscope to Perform a two-way tilt to the extent possible. Some examples use a telescoping tube that allows customizing the endoscope size for a particular procedure. Some examples of the described endoscopes are single-use, single-use devices, or at least with a disposable part, to avoid a particularly high risk of contamination of the intracranial and certain other interventions. Portions of conventional endoscopes that enter the skull may be difficult to effectively and efficiently sterilize in an autoclave, especially when the endoscope contains a heat-sensitive component.

One disclosed example is an intracranial endoscope including: an internally threaded rigid outer tube (16) having proximal and distal portions; an externally threaded intermediate rigid tube (14) that is screwed into the external tube to oppose it Rotate, thereby telescoping between an extended position and a retracted position; an inner tube (10) having a proximal portion partially in an intermediate tube (14) and a shaped, sized and configured for insertion into a patient's skull The distal portion of the middle; a stopper (18, 618k) that is mounted on the distal end of the intermediate tube to move axially relative to the intermediate tube, and a biasing element (20) that biases the stopper toward the distal direction ; Wherein the inner tube has an inclined / curved portion (10a) adjacent to its distal end and an extended position and a retracted position relative to the middle tube; an aspiration / irrigation tube (8, 8a) in which the aspiration / irrigation tube is Slide between the extended position and the retracted position protruding from the inner tube in the inner tube; the lighting module (701, 702; 802, 803) and the imaging module (703, 801) at the distal end of the inner tube ), Wherein the illumination module is configured to illuminate the field of view within the skull of the patient and The imaging module is configured to capture and supply an image of the field of view for display to a user; a handle (100, 500, 600, 900) configured to be held by the user's hand and has a near coupling to an outer tube The distal portion of the end portion, and the proximal portion, the handle includes a suction port coupler (100a) and an irrigation port coupler (100b) at the proximal portion of the handle, and the following user-operated controls: ( i) one or more aspiration and irrigation controllers (100c, 100d, 410, 418a, 418b, 418c, 502, 602, 900c, 900d) configured to control the aspiration / irrigation tube and aspiration and irrigation ports Flow between ports, (ii) tilt / bend controller (201, 301, 501, 601, 901) which is operatively associated with the tilt / bend portion of the inner tube to control the direction and degree of its tilt / bend ; And (iii) an extension-retraction controller (204, 208, 410, 412, 414, 416) that is operatively associated with the suction / irrigation tube to control the distal end of the suction / irrigation tube from the inner tube Extent to the distal end.

In some embodiments, the intracranial endoscope may further include a hollow tube (804a) that surrounds the distal portion of the suction / irrigation tube and has a distal end that is distal from the inner tube The end protrudes and is inclined in the shape of a hypodermic needle. In some embodiments, the suction / irrigation tube has a distal end (8a) inclined in the shape of a hypodermic needle, and some embodiments include both the inclined distal end of the hollow tube and the inclined distal end of the suction irrigation tube, Wherein its tips are in a radially opposed position.

In some embodiments, the stopper includes an edge configured to squeeze the patient's skull or other head surface while the inner tube extends into the patient's skull a distance that is at least partially opposed by the stopper Limitations on the position of the inner tube. In some embodiments, the stopper includes two or more fins extending radially from its central region, the fins being configured to compress the patient's skull or other head surface while the inner tube Extend into the patient's skull a distance that is at least partially limited by the position of the stopper relative to the inner tube. In some embodiments, the stopper includes an opening configured to allow cerebrospinal fluid to flow through the opening while the stopper is pressed against the patient's skull or other head surface and the inner tube is inserted into the patient's skull in.

In some embodiments, the one or more aspiration and irrigation controllers include one or more user-operated buttons configured to control the position of the distal tip of the aspiration / irrigation tube in or out of the aspiration tube. Between moves. In some embodiments, the one or more suction and irrigation controllers include a single switch that moves in one direction to connect the suction / irrigation tube to the suction source and moves in the other direction to move the suction The suction / rinsing tube is connected to a source of rinsing material.

In some embodiments, the tilt / bend controller includes a thumb-operated joystick. In some embodiments, the tilt / bend controller is configured to tilt the distal portion of the inner tube in at least two directions relative to the longitudinal axis of the outer tube, and in some embodiments tilt / bending.

In some embodiments, the imaging module includes a control circuit housed in a handle, and in some embodiments, the endoscope includes a display operatively associated with the imaging module to display a skull photographed therethrough. Within the image.

In some embodiments, the outer tube and the middle tube are configured to retract the middle tube from the outer tube to the distal end within a first selected distance range, and the inner tube is configured to extend from the middle tube to the distal end a second selected distance, This results in a combination of the distal end of the inner tube and the distal end of the outer tube separated by up to a first and second selected distance.

In some embodiments of the endoscope, at least a portion of the endoscope extending distally from the handle is a disposable single-use instrument supplied in a sterile package.

In some embodiments, an intracranial endoscope includes: an outer tube having a proximal portion and a distal portion; an intermediate rigid tube that retracts and retracts within the outer tube between an extended position and a retracted position; and a cannula (12 ), Which extends distally from the intermediate tube; a stopper at the distal portion of the sleeve and a biasing element that biases the stopper in the distal direction; an inner tube within the sleeve, said inner tube Shaped, sized and configured for insertion into a patient's skull; suction / irrigation tube within the inner tube configured to move relative to the inner tube between an extended position and a retracted position; at the distal end of the inner tube An imaging module and a lighting module, wherein the lighting module is configured to illuminate a field of view in a patient's skull and the imaging module is configured to capture and supply an image of the field of view for display to a user while the inner tube is inserted In the skull of a patient; a handle configured to be held by a user's hand and having a distal portion coupled to a proximal portion of the outer tube, and a proximal portion, the handle comprising: at the proximal portion of the handle Suction port coupler and flush port coupler; User-operated suction and irrigation controls configured to control the flow between the suction / irrigation tube and suction and irrigation port, respectively; and user-operated extension-retraction controls The irrigation tube is operatively associated to control the extent to which the distal end of the suction / irrigation tube projects from the inner tube to the distal end.

In some embodiments, the inner tube includes a sloped / curved portion adjacent to its distal end, and the handle includes a tilt / bend controller operatively connected to the portion of the inner tube to control the distal end of the inner tube relative to An angle in a direction parallel to the axis of the outer tube. In some embodiments, the tilt / bend controller is configured to change the angle in a single plane, and in some embodiments in two or more planes.

In some embodiments, the stopper includes a radially extending portion and space that allows flow through the stopper.

In some embodiments, the suction / irrigation catheter has a distal end that is angled to form a tip.

The disclosed intracranial endoscope can be used in a method including providing an outer tube, an intermediate rigid tube retractable within the outer tube between an extended position and a retracted position, spaced apart from the intermediate tube at the distal end, and Stopper biased in the distal direction, inner tube within the stopper, the inner tube being shaped, sized and configured for insertion into the skull of a patient, and suction in the inner tube / Irrigation tube configured to move relative to the inner tube between an extended position and a retracted position; inserting a distal portion of the inner tube into a patient's skull through an opening prepared therein until the stopper presses the patient's Skull or associated surface of the skull; selective further insertion of the inner tube to prevent biasing of the stopper; selective extension of the distal end of the suction / irrigation tube from the inner tube to the distal end; by mechanically fixing to User controller of the handle of the outer tube to selectively apply suction and irrigation to the suction / irrigation tube at a selected angle of change; a light source at the distal end of the inner tube to selectively illuminate the field of view in the skull of the patient And used at the distal end of the inner tube Miniature camera for imaging a field of view; and displaying images captured by a camera.

1A and 1B illustrate one example of an endoscope, and FIGS. 2A to 2D illustrate a distal portion that may be the endoscope of FIG. 1A and 1B or a part of an alternative endoscope design. The inner tube 10 projects from the cannula (12) in the distal direction, and then projects distally from the externally threaded middle tube 14. The catheter 14 further projects distally from the internally threaded rigid outer tube 16 and is screwed into the internally threaded rigid outer tube. The inner tube 10 has a bendable portion 10a near its distal end such that the distal end of the inner tube 10 points in a direction (and associated opposite directions) within an angular range from the common or parallel axis of the cannula 12 and the catheters 14 and 16 ). The depth indicator ruler 10b (FIG. 2C) extends a specified distance from the distal tip of the catheter 10 to the proximal end. The stopper 18 slides on the sleeve 12 between a distal position (FIG. 2B) and a position closer to or opposite the intermediate tube 14 (FIG. 2C), said stopper being biased by a spring or other biasing element 20 To the remote position. When using an endoscope, stopping it 18 usually squeezes the patient's skull, or scalp, or nostril, or outer ear, thereby providing stability and accuracy for the surgical procedure. The inner tube 10 surrounds a suction / irrigation tube 8 which slides between the extended position (FIG. 2D) and the retracted position (FIG. 2C) within the catheter 10, in which the suction The suction / irrigation tube protrudes distally from the inner tube 10 and in the retracted position the suction / irrigation tube does not protrude from the catheter 10 or minimally protrudes from the catheter 10. The movement distance can be 3 to 30 mm, but other distances can be designed as required. The catheter 10 is usually made of metal, plastic, or a combination of metal and plastic and is rigid except for its curved or inclined portion 10a, and the catheter 8 is usually made of a plastic material with less rigidity.

The distance that the middle tube 14 extends from the outer tube 16 to the distal end is adjusted by rotating the two threaded tubes relative to each other (typically by rotating the tube 14 while holding the tube 16). The engagement thread operation is used to change the range from the maximum (Figure 1A) to the minimum (Figure 1B), such as a distance within 70 mm, but other ranges can be designed to meet specific endoscope requirements. In this example, the distance between the stopper 18 and the distal end of the outer tube 16 is between a total of 100 mm (due to a screw penetration of 70 mm, the telescopic tube 14 enters the catheter 16 plus a 30 mm compression of the biasing element 20 ) And zero or near zero, but other ranges can be designed as needed. In practice, the catheter 14 projects from the catheter 16 and the catheter 10 projects from the cannula 12.

The distal tip of the catheter 10 surrounds an imaging module including a miniature camera 200 and an illumination light source including an LED light or fiber optic end 202, which is indicated by the general position in FIG. 2D and examples of which are further described below in FIGS. 7A, 7B, and 8 Explained in more detail. The imaging and / or lighting module may be connected to the finger controller and the external display 112 described below via a cable 110 or wirelessly. The module may be powered through the cable 110 from a power source that may be included in the display 112 and / or from an internal power source such as a battery.

1A and 1B also illustrate a handle 100 having a distal end coupled to the proximal end of the outer tube 16 and having a tilt / bend controller 201, which in this example is a roller, which is coupled To the inclined / curved portion 10 a of the catheter 10 such that the distal tip of the catheter 10 and the distal portion of the catheter 8 that can protrude from the catheter 10 are inclined away from the axis of the catheter 10. At the proximal end of the handle 100, the handle 100 has couplers or ports 100a and 100b to connect to the respective sources 100a1 and 100b1 of the suction and irrigation material through connecting tubes illustrated as dashed lines. The irrigating material may be saline or other fluids, and may contain treatment substances, such as drugs that may be in fluid or solid form, such as powders, gels, crystals, and other matrices that may be carried in a fluid stream. Under the control of a suction controller such as button 100c and a flushing controller such as button 100d, the couplers or ports 100a and 100b are connected to the suction through corresponding internal channels or pipes and valves (not shown in Figures 1A to 1E). Suction / rinse tube 8. (In some other examples, a single controller for suction / irrigation can be used.) As push button 100c is pushed down gradually relative to the bias (through the example illustrated in Figure 1E), more suction is applied to the catheter 8. When the button 100c is released, the closing catheter 8 is connected to the fluid flow of the suction coupler or port 100a (through the example illustrated in FIG. 1D). When the flush button 100d is pushed relative to the bias (via the example also illustrated in FIG. 1E), more flush material is supplied to the catheter 8, and when the button 100d is released, the fluid between the catheter 8 and the flush coupler 100b is closed Stream connection (via the example also illustrated in Figure 1D). One or both of the couplers or ports 100a and 100b may contain wires and / or one or more optical fibers that connect external electronics and / or light sources at the tip of the catheter 10 to an imaging module such as the camera 200 and A lighting module such as the light source 202, or for the purpose described, the handle 100 may include a corresponding separate electrical and / or fiber optic connector (not shown). The handle 100 typically surrounds circuits that participate in the operation of the camera 200 and / or the light source 202, such as a controller chip and other circuits for operating the camera and light source, and the handle may have one or both of the camera and light source on and off , Or a controller for selecting between video clips and photos and / or for additional hand or finger operation of the imaging and / or lighting module. In addition, in this example, the handle 100 includes a controller in the form of side sliders 204 and 208 that slide in the distal-proximal direction to extend the catheter 8 from the tip of the catheter 10 to the distal end (to 2D) or retract the catheter into the catheter 10. The extension range of the catheter 8 can be 5 mm, but other ranges can be designed. Still further, the handle 100 may include a controller in the form of a joystick or other interface associated with the catheter 8 to control the inclination of the extension of the catheter 8 (FIG. 2D) relative to the axis of the catheter 10, and the inclination of the tip of the catheter The control and tilt positions are not shown in Figures 1A and 1B, but are explained and discussed further below in conjunction with other figures.

1C, 1D, and 1E illustrate examples of fluid flow connections between couplers / ports 100a and 100b and the distal portion of the catheter 8 and valves for controlling fluid flow. As seen in the schematic diagram in FIG. 1C, the suction port 100a is connected to a pipe 124 controlled by a valve 126 operated by a button 100c, and the flushing coupler / port 100b is connected to a valve 116 controlled by a valve 116 operated by a flush button 100d. Pipeline 114. The tubes 124 and 114 are merged into the distal portion of the catheter 8 (or in a tube in fluid communication with the distal portion of the catheter 8), thereby realizing a gap between the distal portion of the catheter 8 and the couplers / ports 100a and 100b. Fluid flow. 1D and 1E illustrate examples of valves that may be used for the valve 112 and / or the valve 114. In this example, the valve includes a movable barrel 118 that is biased relative to the spring 122 to slide within the main barrel 120. Each cartridge has a lateral opening through which a tube 124 (or 114) passes. The pipes 124 and 114 are made of a material that is sufficiently flexible to compress, so that the fluid flow between the movable cylinder and the main cylinder is reduced or stopped when compressed, and opens sufficiently elastically, so that when there is no compression Allows flow between the two cylinders. The spring 122 pushes the two barrels to keep the valve closed, preventing fluid from flowing through the pipe 124 (114). When the button 100a (100b) is pushed down by the button 100c (100d) to the position seen in FIG. Shaped cross section. Pushing further down allows more flow until the catheter assumes a circular cross section and the pressure on the release button 100c (100d) gradually decreases the flow until the pressure is sufficiently released to allow the spring 122 to push the barrel 118 upwards from the main barrel 120 sufficiently, See Figure 1D. Other examples of valves can be used to control the fluid flow between the distal tip of the catheter 8 and the suction / irrigation port, some of which are discussed further below.

For example, tilt / bend control of the distal tip of the catheter 10 and thus the catheter 8 can be achieved by a wire connected to the radially opposite side of the tip of the catheter 10 at the distal end of the inclined / curved portion 10a. This can be controlled by turning the knob 201, thereby shortening one of the two radially opposing wires, for example by a cam action. Another example is discussed in more detail below in connection with FIGS. 3A and 3B.

Some or all of the distal end of the handle of the endoscope described in this patent specification may be a single-use disposable element configured to be supplied in a sterile package and preferably by using a mating mechanical / electrical coupler, preferably manually The ground and without a tool are assembled with one of the described handles to establish the required mechanical / electrical connections for the operation described in this patent specification. Alternatively, some or all of the endoscopes described in this patent specification may be disposable single-use devices that are used only once for a patient's surgery.

3A and 3B illustrate examples of controlling the tip / bend of the distal end of the catheter 10 and therefore the catheter 8. The button 301 may be a slide button or a joystick as schematically shown in Figs. 3A and 3B. The button may extend upward from a wheel 310a installed for rotation in the handle 100 through the top of the handle 100 (not shown in the figure), and drive the lead portion 310 and the lead portion 312, which are respectively fixed to the inclined The top / bottom of the tip portion of the catheter 10 at the distal end of the / curved portion 10a, and fixed to a wheel 310a operated by a switch or a joystick 301. Pulling the switch or lever 301 backward relative to the handle 100 tilts / bends the catheter 10 and thus the tip of the catheter 8 as seen in FIG. 3B, and pushing the switch / joystick 301 forward causes the tips of the catheters 10 and 8 to go down Tilt / bend. If another pair of wires (not shown) is used so that its distal end is fixed to the tip of the catheter 10, then the wire is fixed at each quarter of the tip of the catheter 10 and the ball instead of the wheel 310a is fixed to Buttons / joysticks 301, where the wires are connected at the four sides of the ball, then moving the buttons / joysticks 301 laterally also tilts / bends the tips of the catheters 10 and 8. Moving the middle direction of the button / joystick 301 relative to the handle 100 allows the tips of the catheters 10 and 8 to tilt / bend in any desired direction.

Figures 4A, 4B, and 4C illustrate examples of mechanisms that use a controller to control both the catheter 8 extending distally from the catheter 10 and the suction / irrigation mechanism, which may be one or more of the handles described in this specification The inside is used, except that the button 410 can be accessed directly from the outside of the handle or through the middle button or lever. In this example, the button 410 drives a lever 412 which pivots inside the handle at 414 and has its other end (made of a flexible material) fixed to the catheter 8. FIG. 4A shows the intermediate position of the controller in which the catheter 8 is in a retracted position relative to the catheter 10 and the spring 416 biases the lever 412 to said position (and bends upward along a portion of the catheter 8). When the button 410 is pushed into the handle by the bias relative to the spring 416, the lever 412 starts to push the catheter 8 in the distal direction. For a certain distance of the initial stroke of the button relative to the handle, such as the first 1.8 mm of the stroke, the button 410 remains out of contact with the valve 418 so that the valve remains in its neutral position until the catheter 8 extends a selected distance from the catheter 10, such as 1 mm. In this position, as illustrated in FIG. 4B, the degree of bending of the catheter 8 is slightly smaller than that of FIG. 4A. While the push button 410 is further pushed into the handle while still being biased relative to the spring 416, the push button contacts the valve 418 and acts on the valve as described below in conjunction with FIGS. 4D and 4E, thereby reducing and eventually stopping flushing and beginning to increase suction . At the same time, the lever pushes the catheter 8 to extend more from the catheter 10, up to 3 mm or 5.5 mm, and the catheter 8 straightens, as illustrated in Figure 4C. With the button 410 initially descending, one benefit of the catheter 8 initially extending from the catheter 10 is that the surgeon can use the extension of the catheter 8 to poke and destroy the blood clot without applying suction, and then press the button further down 410 to apply suction and extract a substance, which may contain material that has been destroyed and broken down.

4D and 4E illustrate examples of a valve 418 (also seen in FIGS. 4A to 4C) that controls both suction and irrigation. The valve 418 includes a movable cartridge 418a that slides within the main cartridge 418b. The suction tube 124 and the irrigation tube 114 pass through the corresponding openings in the two cylinders, but the openings are provided so that when the opening of the suction tube is sufficiently misaligned to compress the suction tube 124 and prevent the flow through the opening, the opening of the irrigation tube Align so as not to compress the irrigation tube 114, thereby allowing irrigation material to flow to the distal end of the catheter 8. In contrast, when the irrigation tube 114 is compressed to stop the flow therethrough, the suction tube 124 is not compressed and allows suction from the distal end of the catheter 8. The spring 418c biases the two cylinders so that in the normal state of the valve 418, the flushing tube 114 is opened (not compressed), but the suction tube 124 is compressed and blocked. When the button 410 is in contact with the valve 418 and begins to move to the right in FIGS. 4D and 4E, as the suction tube 124 gradually opens more, the irrigation tube 114 gradually tightens, so that the distal tip of the catheter 8 gradually moves from fully Irrigation and non-suction are changed to full aspiration and non-suction. This arrangement helps to irrigate the anatomical site when the catheter 8 is retracted, and then to extend the catheter 8 distally while still irrigating, to help remove the tissue that should be removed, and then switch to suction to clear the tissue. As an alternative, the openings in the barrels 418a and 418b may be aligned so that there is neither suction nor flushing in the middle state of the valve 418, but flushing or suctioning starts when the button 410 contacts the valve 418, and the button is pushed further Rinse or aspirate as time increases, and then switch from one of the flushes and aspirate to the other.

FIG. 5 illustrates an example of a handle 500 that can be used with any of the elements described herein extending distally from the handle, such as 100. At least for a layer on or near the outer surface of a portion of the handle 500 held by a user's hand, it may be made of a relatively soft material, such as rubber or a rubber-like material, to increase user comfort and is unlikely to be Slide between the handle and the user's hand. The handle 500 as illustrated has a generally rectangular cross section with curved edges, but a generally triangular cross section with curved edges is contemplated as an alternative. The handle 500 includes a suction / irrigation controller 502 that can take the form of a slider that operates a valve that gradually opens / closes between the conduit 8 and 500a2 to the suction source 300 and the conduit 500b2 to the source of irrigation material Fluid flow path. For example, when the user's thumb gradually pushes the slider 502 forward in the distal direction, suction is applied to the catheter 8 and the degree of suction increases as the distance the slider 502 is pushed in the distal direction increases. When the user gradually pushes the slider 502 backward in the proximal direction, the irrigation is supplied to the catheter 8 and then the slider 502 is pushed more in the proximal direction, and the irrigation flow gradually increases. In this example, the slider 502 is biased to an intermediate center position at which neither suction nor irrigation is applied to the catheter 8 and returns to the position when the user does not push the slider 502 in either direction, And alternative arrangements of the valve 418 described above can be used. The handle 500 also includes a joint controller 501 that is coupled to the inclined / curved portion 10a of the catheter 10 to articulate, for example, in a left-right direction, an up-down direction, or any other direction relative to the axes of the catheters 14 and 16 The distal end of the catheter 10.

6A, 6B, and 6C illustrate perspective views of a stopper 618 as an important alternative to the stopper 18 of FIGS. 1A to 2D. The stopper 618 has an opening through which excessive cerebrospinal fluid can be drained, and the opening can also avoid increasing intracranial pressure. In any of the examples of endoscopes discussed herein, a stopper 618 may be used instead of the stopper 18. The stopper 618 includes an arcuate or rounded edge 618a and three spokes 618b that extend distally when deployed from a cannula 618c fixed to the cannula 12. In use, the stopper 618 squeezes the patient's skull or other head surface, as in the case of the stopper 18, while the distal tip of the endoscope handles the contents of the skull. The stopper 618 may also provide navigation functions, such as by making one or more of the spokes of the stopper longer or shorter than the other spoke or other spokes, which may help control and evaluate the endoscope relative to the stop Orientation of the pressing surface of the device 618, or by including other navigation aids, which helps identify the position and / or orientation of the portion of the catheter 10 within the skull during a surgical or exploratory procedure. The edges 618a and spokes 618b may be made of the same material, which may be sufficiently rigid to maintain the shape during use of the endoscope, or the spokes and edges 618a may be made of different stiffnesses as needed or suitable for different surgical or exploratory procedures Or soft materials. 6B and 6C illustrate a stopper 618 as a part of the endoscope, the stopper having a handle 600 that may be the same as the handle 500 in FIG. 5 and a same function as the pipes 500a2 and 500b2 in FIG. 5 Suction / flushing pipes 600a1 and 600b2. 6B and 6C additionally illustrate a duct 600f that may contain a lead that supplies power and / or to and / or from a camera at a distal tip containing an endoscope (not seen in FIGS. 6A to 6C) The imaging module carries control and image data, and / or carries power, light, or control signals to a lighting module containing a light source at the tip of an endoscope (also not seen in Figures 6A to 6C).

6D and 6E illustrate alternative stoppers 618k that can be used in place of the stoppers described above in any of the endoscopes described herein. The stopper 618k includes a pair of fins 618d and 618e extending radially in opposite directions from the central portion 618f surrounding the catheter 12. Each flap has a central opening 6181 configured to allow fluid to flow through the stopper when it is pressed against the skull or other head surface of the patient. More than two fins can be used in place of the stopper, preferably evenly distributed around the circumference of the stopper. The illustrated fins are triangular with central openings and vertices at the central area of the stopper, but other shapes are possible, to name a few, such as bands, rectangles, and ovals. Preferably, the flap is made of a relatively soft material so that it does not damage the patient's tissue, but is sufficiently rigid and resilient so that the flap is spring-like when pressed against the surface.

7A to 7B are perspective views of an example of a distal tip of an endoscope. 7A and 7B illustrate distal ends that can be used in any of the endoscopes described above. The distal end contains the forward (in the distal direction) part of the imaging module and the lighting module, namely the light sources 701 and 702, which may be LED lights or fiber ends and a forward camera 703 such as a CMOS camera. The inner tube 10 surrounds the suction / irrigation tube 8 and the light source and camera. In an example of an endoscope, the outer diameter of the camera 703 may be 1.4 mm, the outer diameter of the suction / irrigation tube 8 may be 2.8 mm, and the diameter of each of the optical fibers may be less than 0.4 mm (or alternatively may be Use LEDs with comparable diameters), and the outer diameter of the inner tube 10 can be 5.3 mm.

FIG. 7C illustrates an endoscope in which a catheter 710 for insertion into a patient's skull extends 180 mm distally from the handle 700, and the suction / irrigation tube 708 can extend distally from the catheter 710 by up to 5 mm, such as through the thumb The rotary controller 700a is selected.

FIG. 8 illustrates an example of a distal tip that can be used with any of the endoscopes described herein in a perspective view. This example has a lighting module with front-view LED lights 802 and 803 and an imaging module with front-view camera 801, and a protrusion 804, which is preferably transparent to light from the lighting module and from the inside The tube 10 extends in the distal direction. Additionally, the illustrated tip may contain a suction / irrigation tube with a forward-looking opening and / or a lateral opening (not explicitly shown in FIG. 8). For example, the catheter 8 may extend in a channel in the inner tube 10 and protrude distally from the catheter 10 as needed.

8A to 8C illustrate alternative distal portions that can be used in place of the distal portion described above in any of the endoscopes described herein. 8A and 8B are side views showing the distal end of the inner tube 10 from which the hollow tube 804a projects in the distal direction. The catheter 804a is preferably tilted into the shape of a hypodermic needle and terminates in a sharp point. The side view of Fig. 8B shows the distal portion 8a of the suction / irrigation tube 8 protruding distally from the hollow tube 804a. Preferably, the distal end of the catheter portion 8a is also inclined similar to a hypodermic needle, wherein the cusp is preferably, but not necessarily, radially opposed to the cusp of the catheter 804a. FIG. 8C is a front view illustrating the arrangement of components in the inner tube 10: a hollow tube 804a and a suction / irrigation tube portion 8a therein, an imaging module 801, and light sources 802, 803. In use, after the inner tube is inserted into the patient's skull, the inclined tip of the hollow tube 804a may help to penetrate and / or break tissue, such as coagulating blood, and the inclined end of the aspiration / irrigation portion 8a may then Extend distally to further suppress coagulated blood or other materials and flush the sides or aspirate fluid or tissue.

FIG. 9A is a side view, and FIG. 9B is a side view of an example of a handle 900 that can be used in any of the endoscopes instead of the above-mentioned handle. The handle 900 includes a tilt / bend control 901, as well as a flushing controller in the form of a button 900c and a suction controller in the form of a slider 900b, the controls of which are respectively in the suction / irrigation tube 8 (not shown in FIGS. 9A and 9B). To) and fluid flow between the flushing coupler 100b and the suction coupler 100a. In addition, the handle 900 includes a lightness controller in the form of a wheel 902, and the user can rotate the lightness controller to increase or decrease LEDs, such as 701, 702 in FIGS. 7A and 7B, or 802 and 803 in FIG. 8 Lightness. In addition, the handle 900 may include one or more finger-operated controllers 903 that control the camera, such as 703 in FIGS. 7A and 7B or 801 in FIG. 8, such as to turn the camera on and off, and / Or control other functions, such as choosing between video clips and photos, or choosing between different operating modes of the camera, such as different resolutions, frames per second, etc.

FIG. 9B illustrates some internal elements of the handle 900, which may be the same as or similar to those of other examples of the handles described above. 9B illustrates valve 904 controlling fluid flow between suction / irrigation tube 8 (not seen in FIG. 9B) and suction and irrigation couplers 100a and 100b, with spring 907 biasing irrigation controller 900c therein The position where the fluid flow connection between the catheter 8 and the tube 100b is closed, and the spring 908 biases the suction control item 900b to a position where the suction control item closes the fluid flow connection of the catheter 8 and the suction coupler 100a. In addition, FIG. 9B illustrates an internal circuit board 905 (connected to the LED 701, 702 or 802, 803, and the brightness control item 902) for supplying power and control to the LED from an internal battery or from an external power source, for example. A cable, such as 600f in the example of FIGS. 6B and 6C, is connected to an external power source. FIG. 9B also illustrates a circuit board 906 that is coupled to a camera at the distal tip of the endoscope, such as a camera 703 or 801, and to a controller 903 to provide power and control signals to the camera and through a cable 910 Or, the image captured by the camera is carried to the external display 909 through a wireless connection.

10A and 10B are perspective views illustrating a distal portion of an endoscope using the stopper illustrated in FIGS. 6D and 6E, and a distal portion illustrated in FIGS. 8A to 8C. In FIG. 10A, the suction / irrigation tube 8 (and its distal portion 8a) is retracted and invisible. In Fig. 10B, the distal portion 8a of the suction / irrigation tube 8 is shown projecting distally.

FIG. 11 illustrates an example of an endoscope in a perspective view, which uses the portions illustrated in FIGS. 10A and 10B and can use any of the features of other endoscope examples disclosed herein. FIG. 11 further illustrates a handle 1102 that can be used in place of other described handles for any of the endoscope examples disclosed herein. The handle contains controls that can take the form of slide switches, buttons, joysticks (or other user-operated controls) 1104, 1106, and 1108, which can control the functions described above for other handles, for example, extensions And retract the suction / irrigation tube 8, control the suction and irrigation flow through the catheter 8 and its distal portion 8a, tilt / bend the distal portion of the inner tube 10, and the like. FIG. 11 further illustrates two pipes coupled to the proximal portion of the handle 1102 and connected to a suction and irrigation source, and at least one cable for connecting the power source of the video module and the light source at the tip of the endoscope and connecting The video module is connected to a video display and / or memory or other device to which photos or video clips from the video module should be supplied.

Although several embodiments are described, it should be understood that the new subject matter described in this patent specification is not limited to any one embodiment or combination of embodiments described herein, but instead encompasses multiple alternatives, modifications, and equivalents. In addition, although many specific details are set forth in the following description to provide a thorough understanding, some embodiments may be practiced without some or all of these details. In addition, for the sake of clarity, certain technical materials known in the relevant art have not been described in detail in order to avoid unnecessarily obscuring the new subject matter described herein. It should be clear that the features of one or several specific embodiments described herein may be used in combination with features or other described embodiments. In addition, the same reference numeral name in each drawing indicates the same element.

Various modifications may be made without departing from the spirit and scope of the new methods and systems described in this patent specification. Therefore, the scope of this patent specification is not limited to the embodiments described above, but is instead defined by the claims of the patents issued thereon based on the full scope of its equivalents.

8, 8a, 708, 500a2, 500b2, 600a1, 600b2 ‧‧‧ aspiration / irrigation tube / catheter

10,710‧‧‧Inner tube / catheter

10a‧‧‧inclined / curved part

10b‧‧‧ Depth Indicator Ruler

12‧‧‧ Casing

14‧‧‧ Externally threaded intermediate tube / conduit

16‧‧‧ Internally Rigid Outer Tube / Catheter

18, 618k‧‧‧stop

20‧‧‧ bias element

700a‧‧‧ Thumb Wheel Controller

701, 702; 802, 803‧‧‧ lighting modules

703, 801‧‧‧ imaging module

100, 500, 600, 700, 900, 1102‧‧‧ handle

1104, 1106 and 1108‧‧‧ Controls

100a‧‧‧suction port coupler

100b‧‧‧ flush port coupler

100a1, 100b1 ‧‧‧ Corresponding source of suction and flushing material

100c, 100d, 410, 418a, 418b, 418c, 502, 602, 900b, 900c, 900d

110, 910‧‧‧cables

112, 909‧‧‧Image display

114, 124‧‧‧ pipeline

116, 126, 418, 904‧‧‧ valves

118‧‧‧ tube

120‧‧‧ main tube

122, 907, 908‧‧‧ spring

200‧‧‧ Camera

202‧‧‧light source

201, 301, 501, 601, 901‧‧‧Tilt / bend controller

204, 208, 410, 412, 414, 416‧‧‧ extend-retract controller

903‧‧‧finger operated controller

905, 906‧‧‧Circuit board

300‧‧‧ Suction source

310, 312‧‧‧Wire section

310a‧‧‧wheel

902‧‧‧wheel / lightness control

804‧‧‧ protrusion

804a‧‧‧Hollow tube

600f‧‧‧ Conduits

618a‧‧‧Edge

618b‧‧‧Spokes

618d, 618e‧‧‧ wings

618f‧‧‧center

618l‧‧‧ center opening

1A and 1B are a side view and a top view of an example of an endoscope, respectively.

1C to 1E are schematic views illustrating an example of a valve that controls a suction / irrigation operation of an example of an endoscope.

2A to 2D are partial views of a distal end portion of the endoscope that can be used in the endoscope of FIGS. 1A and 1B or other examples of the endoscope.

3A and 3B are schematic diagrams illustrating an example of a mechanism for tilting / bending the distal tip of the endoscope example.

Figures 4A, 4B, and 4C illustrate schematics of an example of a single button that controls both the extension / retraction of the suction / irrigation tube and the suction / irrigation to the supply of the catheter according to the stroke of the finger-operated button.

4D and 4E are schematic diagrams illustrating examples of valve arrangements suitable for use in the mechanism of Figs. 4A to 4C.

Fig. 5 is a perspective view of an example of a handle of an endoscope and a pipe for connection to a suction and irrigation source.

6A to 6C are perspective views of an example of an endoscope having a stopper having an opening for passing a material such as cerebrospinal fluid, and FIGS. 6D and 6E illustrate schematic diagrams of an alternative stopper.

7A to 7C are perspective views of an example of a distal tip of an endoscope.

FIG. 8 is a perspective view of an alternative distal endoscope.

8A to 8C illustrate schematic diagrams of an alternative distal endoscope.

9A and 9B are schematic views illustrating an example of an endoscope handle.

10A and 10B are schematic diagrams illustrating an alternative embodiment of a portion of an intracranial endoscope.

FIG. 11 is a perspective view of an alternative embodiment of an intracranial endoscope.

(no)

Claims (22)

An intracranial endoscope includes: an internally threaded rigid outer tube having a proximal end portion and a distal end portion; an externally threaded intermediate tube, which is a rigid tube, which is screwed into the external tube for relative rotation therewith, This telescopes between an extended position and a retracted position; an inner tube having a proximal portion partially in the middle tube and a distal portion shaped, sized and configured for insertion into the skull of a patient; a stopper , Which is installed at the distal end of the intermediate tube to move axially relative to the intermediate tube, and a biasing element which biases the stopper toward the distal direction; wherein the inner tube has a phase opposite to its distal end; Adjacent inclined / curved portions, and extended and retracted positions relative to the intermediate tube; suction / irrigation tube in an extended position in which the suction / irrigation tube protrudes distally from the inner tube Sliding in the inner tube from a retracted position; a lighting module and an imaging module at a distal end of the inner tube, wherein the lighting module is configured to illuminate a vision in a skull of the patient Field, and the imaging module is configured to Capture and supply an image of the field of view for display to a user; a handle configured to be held by the user's hand and having a distal portion coupled to a proximal portion of the outer tube, and a proximal portion The handle includes a suction port coupler and an irrigation port coupler at a proximal portion of the handle, and the following user-operated controllers: (i) one or more suction and irrigation controllers, which are Configured to control flow between the suction / irrigation tube and the suction and irrigation port, (ii) a tilt / bend controller operatively associated with the tilt / bend portion of the inner tube To control the direction and degree of its tilt / bend; and (iii) an extension-retraction controller operatively associated with the suction / irrigation tube to control the distal end of the suction / irrigation tube The degree of protrusion from the inner tube to the distal end. The intracranial endoscope according to claim 1, further comprising a hollow tube surrounding the distal portion of the suction / irrigation tube and having a distal end, the distal end extending from the inner end The tube projects distally and is inclined in the shape of a hypodermic needle. The intracranial endoscope according to claim 1, wherein the suction / irrigation tube has a distal end inclined in the shape of a hypodermic needle. The intracranial endoscope according to claim 1, further comprising a hollow protrusion from a distal end of the inner tube, the hollow protrusion having a distal end with a tip inclined in the shape of a hypodermic needle, And wherein the suction / irrigation tube has a distal end with a tip inclined in the shape of a hypodermic needle, and the two tips are radially opposed. The intracranial endoscope according to claim 1, wherein the stopper includes an edge configured to press against a skull or other head surface of the patient while the inner tube extends to the A distance in the skull of the patient, the distance being at least partially limited by the position of the stopper relative to the inner tube. The intracranial endoscope according to claim 1, wherein the stopper includes two or more fins extending radially from a central region thereof, the fins being configured to press tightly against the The patient's skull or other head surface, while the inner tube extends into the patient's skull a distance, the distance being at least partially limited by the position of the stopper relative to the inner tube. The intracranial endoscope according to claim 1, wherein the stopper includes an opening configured to allow cerebrospinal fluid to flow through the opening while the stopper is pressed against the patient's skull Or other head surface and the inner tube is inserted into the patient's skull. The intracranial endoscope according to claim 1, wherein the one or more suction and irrigation controllers include one or more user-operated buttons configured to control inflow or outflow of the Move between the positions of the distal tip of the suction / irrigation tube. The intracranial endoscope according to claim 1, wherein the one or more suction and irrigation controllers include a single switch that moves in one direction to connect the suction / irrigation tube to Suction source and move in the other direction to connect the suction / irrigation tube to a source of irrigation material. The intracranial endoscope according to claim 1, wherein the tilt / bend controller includes a thumb-operated joystick. The intracranial endoscope according to claim 1, wherein the tilt / bend controller is configured to tilt a distal portion of the inner tube with respect to a longitudinal axis of the outer tube in at least two directions / bending. The intracranial endoscope according to claim 1, wherein the imaging module includes a control circuit housed in the handle. The intracranial endoscope according to claim 1, further comprising a display operatively associated with the imaging module to display an intracranial image captured therethrough. The intracranial endoscope according to claim 1, wherein the outer tube and the middle tube are configured to retract the middle tube from the outer tube to the distal end within a first selected distance, and the inner tube The tube is configured to extend a second selected distance from the intermediate tube to the distal end, thereby causing the distal end of the inner tube to be spaced up to the first and second from the distal end of the outer tube. A combination of selected distances. The intracranial endoscope according to claim 1, wherein at least a portion of the intracranial endoscope extending from the handle to the distal end is a disposable single-use instrument supplied in a sterile package. An intracranial endoscope includes: an outer tube having a proximal portion and a distal portion; an intermediate tube, which is a rigid tube, which is retractable in the outer tube between an extended position and a retracted position, and a sleeve Tube, the sleeve extending distally from the intermediate tube; a stopper at a distal portion of the sleeve, and a biasing element that biases the stopper in a distal direction An inner tube within the cannula, the inner tube being shaped, sized, and configured for insertion into a patient's skull; an aspiration / irrigation tube within the inner tube, configured relative to the inner tube The tube moves between an extended position and a retracted position; an imaging module and a lighting module at a distal end of the inner tube, wherein the lighting module is configured to illuminate a field of view within the skull of the patient, And the imaging module is configured to capture and supply an image of the field of view for display to a user, while the inner tube is inserted into the skull of a patient; a handle configured to be held by a user's hand, And having a distal portion coupled to a proximal portion of the outer tube, and a proximal end The handle includes: (i) a suction port coupler and a flush port coupler at a proximal portion of the handle, (ii) a user-operated suction and irrigation control item, which are configured respectively Controls the flow between the suction / irrigation tube and the suction and irrigation port, and (iii) user-operated extension-retraction controls that are operatively associated with the suction / irrigation tube To control the extent to which the distal end of the suction / irrigation tube protrudes from the inner tube to the distal end The intracranial endoscope according to claim 16, wherein the inner tube includes an inclined / curved portion adjacent to a distal end thereof, and the handle includes an inclined / curved controller operatively connected to the inner tube The portion of the tube controls the angle of the distal end of the inner tube with respect to a direction parallel to the axis of the outer tube. The intracranial endoscope according to claim 17, wherein the tilt / bend controller is configured to change the angle in a single plane. The intracranial endoscope according to claim 17, wherein the tilt / bend controller is configured to change the angle in a plurality of planes. The intracranial endoscope according to claim 16, wherein the stopper includes a radially extending portion and a space allowing a flow to pass through the stopper. The intracranial endoscope according to claim 16, wherein the suction / irrigation tube has a distal end that is inclined to form a tip. A method for using an intracranial endoscope includes: providing an outer tube; an intermediate tube, which is a rigid tube, which is retractable in the outer tube between an extended position and a retracted position; and a stopper, which is at the distal end Spaced from the intermediate tube and offset in the distal direction; an internal tube within the intermediate tube and the stopper, the internal tube being shaped, sized, and configured for insertion into the skull of a patient ; And a suction / suction tube within the inner tube configured to move between an extended position and a retracted position relative to the inner tube; a distal portion of the inner tube through an opening prepared therein Inserted into the skull of the patient until the stopper presses against the patient's skull or a skull-associated surface; optionally further inserts the inner tube to prevent the offset of the stopper ; Selectively extending the distal end of the suction / irrigation tube from the inner tube to the distal end; by a user controller mechanically fixed to the handle of the outer tube, selectively at a selected changing angle Applying suction and irrigation to said suction / irrigation tube; used in A light source at a distal end of the inner tube selectively illuminates a field of view in a skull of the patient, and imaging the field of view with a miniature camera at a distal end of the inner tube; Image captured by the camera.