U.S. patent application number 10/886153 was filed with the patent office on 2005-02-10 for method and apparatus for magnetically controlling endoscopes in body lumens and cavities.
Invention is credited to Blume, Walter M., Epplin, Gerard H., Garibaldi, Jeffrey M..
Application Number | 20050033162 10/886153 |
Document ID | / |
Family ID | 23123201 |
Filed Date | 2005-02-10 |
United States Patent
Application |
20050033162 |
Kind Code |
A1 |
Garibaldi, Jeffrey M. ; et
al. |
February 10, 2005 |
Method and apparatus for magnetically controlling endoscopes in
body lumens and cavities
Abstract
A magnetically navigable endoscope system includes an endoscope
having a proximal end and a distal end, the distal end having a
magnetic body; a component which transmits an image, associated
with the distal end; a display component for displaying the image;
a magnetic field generating apparatus for generating a magnetic
field to orient the magnetic body and thus the distal end of the
endoscope; and a controller coordinated with the display for
controlling the magnetic field generating apparatus to selectively
change the magnetic field to change the orientation of the magnetic
body and thus the distal end of the endoscope.
Inventors: |
Garibaldi, Jeffrey M.; (St.
Louis, MO) ; Blume, Walter M.; (Webster Groves,
MO) ; Epplin, Gerard H.; (St. Louis, MO) |
Correspondence
Address: |
HARNESS, DICKEY, & PIERCE, P.L.C
7700 BONHOMME, STE 400
ST. LOUIS
MO
63105
US
|
Family ID: |
23123201 |
Appl. No.: |
10/886153 |
Filed: |
July 6, 2004 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
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10886153 |
Jul 6, 2004 |
|
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09292096 |
Apr 14, 1999 |
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Current U.S.
Class: |
600/429 |
Current CPC
Class: |
A61B 5/6885 20130101;
A61B 1/00158 20130101; A61B 1/01 20130101; A61B 1/00071 20130101;
A61B 1/0051 20130101; A61B 1/00039 20130101; A61B 1/0005
20130101 |
Class at
Publication: |
600/429 |
International
Class: |
A61B 005/05 |
Claims
What is claimed is:
1. A magnetically navigable endoscope system comprising: an
endoscope having a proximal end and a distal end, the distal end
having a magnetic body; an imaging device which transmits an image,
associated with the distal end; a display component for displaying
the image; a magnetic field generating apparatus for generating a
magnetic field to move the magnetic body and thus the distal end of
the endoscope; a controller coordinated with the display for
controlling the magnetic field generating apparatus to apply a
magnetic field to change the position of the magnetic body and thus
the position of the distal end of the endoscope.
2. The magnetically navigable endoscope system according to claim 1
wherein the controller controls the magnetic field generating
apparatus to apply a magnetic field of a specific direction to
change the orientation of the magnetic body and thus the
orientation of the distal end of the endoscope.
3. The magnetically navigable endoscope system according to claim 1
wherein the controller controls the magnetic field generating
apparatus to apply a magnetic gradient to move the magnetic body
and thus the location of the distal end of the endoscope.
4. The magnetically navigable endoscope system according to claim 1
wherein the controller controls the magnetic field generating
apparatus to apply a magnetic field and a magnetic gradient to
apply a magnetic field of a specific direction to change the
orientation of the magnetic body and to apply a magnetic gradient
to move the magnetic body and thus the orientation and location of
the distal end of the endoscope.
5. The magnetically navigable endoscope system according to claim 1
wherein the controller is on the endoscope, adjacent the proximal
end.
6. The magnetically navigable endoscope system according to claim 1
wherein the controller is operable in at least two mutually
perpendicular directions, movement in which causes the magnetic
field generating apparatus to change the magnetic field to move the
distal end of the endoscope in two mutually perpendicular
directions.
7. The magnetically navigable endoscope system according to claim 1
wherein the display includes indicia indicating an orientation of
the displayed image, and wherein the controller is operable in at
least two mutually perpendicular directions, and movement in the
first direction causes the magnetic field generating apparatus to
change the magnetic field to move the distal end of the endoscope
in a first plane relative to the indicia, and movement in the
second direction causes the magnetic field generating apparatus to
change the magnetic field to move the distal end of the endoscope
in a second plane, perpendicular to the first place.
8. The magnetically navigable endoscope system according to claim 7
wherein the first plane is aligned with the indicia.
9. The magnetically navigable endoscope system according to claim
6, wherein the display has vertical and horizontal directions, and
wherein the movement of the controller in one of the mutually
perpendicular directions causes the magnetic field generating
apparatus to change the magnetic field to move the distal end of
the endoscope in the vertical direction as displayed on the
display, and wherein the movement of the controller in the other of
the mutually perpendicular direction causes the magnetic field
generating apparatus to change the magnetic field to move the
distal end of the endoscope in the horizontal direction as
displayed on the display.
10. The magnetically navigable endoscope system according to claim
9 further comprising a signal processor orienting the image on the
display so that the vertically "up" direction of the image is
oriented at the top of the display regardless of the actual
orientation of the axis of the endoscope.
11. The magnet assembly according to claim 1 wherein the endoscope
includes a magnet channel, and wherein there is at least one magnet
body disposed in the magnet channel adjacent the distal end.
12. The magnet assembly according to claim 1 wherein there are a
plurality of magnet bodies in the distal end portion of the
endoscope.
13. The magnet assembly according to claim 1 wherein the magnet
body comprises a permanent magnetic material.
14. The magnet assembly according to claim 1 wherein the magnet
body comprises a permeable magnetic material.
15. A magnetically navigable endoscope system comprising: an
endoscope having a proximal end and a distal end, the distal end
having a magnetic body; a component which transmits an image,
associated with the distal end; a two-dimensional display for
displaying the image from the image-transmitting component, the
display having a vertical and horizontal direction; a magnetic
field generating apparatus for generating a magnetic field to
orient the magnetic body and thus the distal end of the endoscope;
a controller for controlling the magnetic field generating
apparatus to selectively apply to apply a magnetic field to change
the position of the magnetic body and thus the position of the
distal end of the endoscope, the controller operable in at least
two mutually perpendicular directions, movement of the controller
in one of the mutually perpendicular directions causing the
magnetic field generating apparatus to change the magnetic field to
move the distal end of the endoscope in the vertical direction as
displayed on the display, and wherein the movement of the
controller in the other of the mutually perpendicular direction
causes the magnetic field generating apparatus to change the
magnetic field to move the distal end of the endoscope in the
horizontal direction as displayed on the display.
16. A method of magnetically navigating an endoscope, the method
comprising displaying an image from the distal end of the endoscope
on a display, the display including an orientation indicia; and
operating a controller to control the application of a magnetic
field to the distal end of the endoscope, the controller being
operable in at least two mutually perpendicular directions,
movement of the controller in one of the mutually perpendicular
directions causing the magnetic field generating apparatus to apply
a magnetic field to move the distal end of the endoscope in a first
plane relative to the orientation indicia on the display, and
wherein the movement of the controller in the other of the mutually
perpendicular directions causes the magnetic field generating
apparatus to change the magnetic field to move the distal end of
the endoscope in a second plane, perpendicular to the first
plane.
17. A method of magnetically navigating an endoscope, the method
comprising displaying an image from the distal end of the endoscope
on a display operating a controller to control the application of a
magnetic field to the distal end of the endoscope, the controller
being operable in at least two mutually perpendicular directions,
movement of the controller in one of the mutually perpendicular
directions causing the magnetic field generating apparatus to
change the magnetic field to move the distal end of the endoscope
in the vertical direction as displayed on the display, and wherein
the movement of the controller in the other of the mutual
perpendicular directions causes the magnetic field generating
apparatus to change the magnetic field to move the distal end of
the endoscope in the horizontal direction as displayed on the
display.
18. A magnetically navigable endoscope system comprising: an
endoscope having a proximal end and a distal end, the distal end
having a magnetic body; a component which transmits an image,
associated with the distal end; a two-dimensional display for
displaying the image from the image-transmitting component, the
display having a vertical and horizontal direction; a magnetic
field generating apparatus for generating a magnetic field to move
the magnetic body and thus the distal end of the endoscope; and a
controller for identifying the volume over which to orient the
endoscope and controlling the magnetic field generating apparatus
to selectively change the magnetic field to change the orientation
of the magnetic body and thus the distal end of the endoscope over
the specified volume.
19. A method of magnetically controlling an endoscope in body
lumens and cavities, the method comprising: localizing the distal
end of an endoscope; registering the location of the distal end of
the endoscope to a pre-operative image set such as an MR or CT;
identifying a direction on the pre-operative image set; and
controlling the magnetic field generating apparatus to move the
distal end of the endoscope in the identified direction.
20. The method of magnetically controlling an endoscope according
to claim 19 wherein the magnetic field generating apparatus
generates a magnetic field in the identified direction to orient
the distal end of the endoscope in the identified direction.
21. The method of magnetically controlling an endoscope according
to claim 19 wherein the magnetic field generating apparatus
generates a magnetic field with a gradient in the identified
direction to advance the distal end of the endoscope in the
identified direction.
22. The method of magnetically controlling an endoscope according
to claim 19 wherein the magnetic field generating apparatus
generates a magnetic field with a field direction and gradient in
the identified direction to orient and advance the distal end of
the endoscope in the identified direction.
23. A method of magnetically controlling an endoscope in body
lumens and cavities, the method comprising: localizing the distal
end of an endoscope; registering the location of the distal end of
the endoscope to a pre-operative image set such as MR or CT;
programming a volume over which to movethe endoscope; and
controlling the magnetic field generating apparatus to move the
distal end of the endoscope in the specified volume.
24. A method of magnetically navigating an endoscope in a body
lumen or cavity with an applied magnetic field, the method
comprising: displaying an image from the distal end of the
endoscope in an orientation relative to a directional control such
that operation of the directional control in a selected direction
relative to the displayed image causes the applied magnetic field
to change to move the distal end of the endoscope in a
corresponding direction on the display, and operating the
directional control corresponding to the desired direction as
displayed upon the displayed image to apply a magnetic field to
move the distal end in the desired direction as displayed upon the
displayed image.
25. The method according to claim 24 wherein operating the
directional control applies a magnetic field in the selected
direction to orient the distal end of the endoscope in the desired
direction.
26. The method according to claim 24 wherein operating the
directional control applies a magnetic field with a gradient in the
selected direction to advance the distal end of the endoscope in
the desired direction.
27. The method according to claim 24 wherein operating the
directional control applies a magnetic field in a selected
direction, and with a gradient in the selected direction to orient
and advance the distal end of the endoscope in the desired
direction.
28. The method according to claim 24 wherein the step of displaying
an image includes periodically reorienting the image by operating
the directional control to change the applied magnetic field to
move the distal end of the endoscope. identifying the direction of
movement of the distal end of the endoscope on the display; and
reorienting the image on the display so that the direction of
movement caused by operating the control intuitively corresponds to
the directions on the displayed image.
29. The method according to claim 24 wherein the endoscope is
navigated through one of the lungs, the urinary tract, or the
gastrointestinal tract, brain, and heart.
30. A magnetically navigable endoscope system comprising: an
endoscope having a proximal end and a distal end, the distal end
having a magnetic body; an imaging device which transmits an image,
associated with the distal end; a plurality of sensors triggered by
contact with the wall of a body lumen or cavity, distributed around
the distal end; a two-dimensional display for displaying the image
from the imaging device, the display having a vertical and
horizontal direction; a magnetic field generating apparatus for
generating a magnetic field to orient the magnetic body and thus
the distal end of the endoscope; a computer which monitors feedback
of the wall contact sensors and adjusts the magnetic field
generating apparatus to selectively modify the magnetic field to
change the orientation of the magnetic body such that the endoscope
is automatically positioned within the body lumen or cavity.
31. The system according to claim 30 wherein the computer that
monitors the feedback of the wall contact sensors adjusts the
magnetic field generating apparatus to selectively modify the
magnetic field to position the endoscope in generally the center of
the body lumen or cavity.
32. The system according to claim 30 wherein the computer that
monitors the feedback of the wall contact sensors adjusts the
magnetic field generating apparatus to selectively modify the
magnetic field to position the endoscope generally adjacent a
selected wall of the body lumen or cavity.
33. The system according to claim 30 further comprising an
advancing mechanism for advancing the endoscope.
34. The system according to claim 33 further comprising an
interlock for preventing operation of the advancing mechanism when
a predetermined number of wall-sensors are triggered.
35. A magnetically controllable endoscope having a proximal end, a
distal end, a magnetic body associated with the distal end, the
endoscope having at least two sections along its length of
different flexibilities of its length.
36. The magnetically controllable endoscope according to claim 35,
wherein the endoscope comprises a proximal section and a distal
section, and wherein the distal most section is more flexible than
the proximal section.
37. The magnetically controllable endoscope according to claim 35
wherein the magnetic body comprises a permanent magnetic
material.
38. The magnetically controllable endoscope according to claim 35
wherein the magnetic body comprises a permeaable magnetic
material.
39. The magnetically controllable endoscope according to claim 35
further comprising a binder in the endoscope, and wherein the
regions of different flexibility are formed by selective leaching
of the binder.
Description
FIELD OF THE INVENTION
[0001] This invention relates to magnetically controlling
endoscopes, and in particular to a method and apparatus for
magnetically controlling endoscopes in body lumens and
cavities.
BACKGROUND OF THE INVENTION
[0002] Endoscopes, which allow viewing of the interior of body
lumens and cavities, are increasingly used in conducting medical
procedures. One of the greatest difficulties in using endoscopes is
navigating the distal end of the endoscope within the body to the
procedure site. Standard endoscopes are steered using articulation
wires secured to the distal end and which extend to the proximal
end, where they can be operated by mechanisms incorporated in the
proximal end of the endoscope. The articulation wires pull the
distal end of the endoscope, causing it to articulate in the
desired direction. Some endoscopes have a single plane of
articulation, and navigation is affected by a combination of
articulation and rotation of the endoscope. Other endoscopes have
two planes of articulation, and navigation is effected by
combinations of movement in the two planes. Neither of these types
of endoscopes provides simple and easy omnidirectional navigation.
Another problem with wire-controlled endoscopes is that the control
over the movement of the tip of the endoscope diminishes with each
successive bend in the endoscope, so as the endoscope is navigated
through a particularly tortuous path through the body, navigation
becomes increasingly difficult.
[0003] Magnetic navigation of an endoscope eliminates the
difficulties encountered with mechanical navigation. A magnetic
field can be generated to orient the tip of the endoscope in
virtually any direction, and is not limited to movement in one or
two planes. Furthermore, tip deflection is based solely on the
strength of the magnetic field, and thus navigation is not affected
by the path of the endoscope. However, it can be difficult for a
medical professional to quickly and easily control the magnetic
field in order to effectively magnetically navigate an endoscope.
What has been needed is an effective way of controlling the
application of magnetic fields to both orient and move magnetic
devices, such as endoscopes.
SUMMARY OF THE INVENTION
[0004] The present invention provides a method and apparatus for
magnetically navigating devices such as an endoscope through body
lumens and cavities. Generally the magnetically navigable endoscope
system of the present invention comprises an endoscope with a
magnetic member, a component in the endoscope which transmits an
image associated with the endoscope's distal end, a display to view
the image, an input device, a computer with image processing
software and a magnetic field generating apparatus for generating a
magnetic field to orient the magnetic member. The endoscope
construction can be similar to a standard endoscope without the
articulation wires. The magnetic member is contained in the distal
segment of the endoscope to orient the endoscope upon the
application of an external magnetic field. The video image (e.g., a
optical, ultrasound, or infrared image) from the endoscope is sent
to a computer with image processing software, which provides
general graphics overlays (i.e. lines and text) and image rotation
functions. An input device such as a controller connected to the
computer allows a physician to specify the change in deflection
angle of the endoscope's distal end. As the controller is moved to
the left, right, forward or backward positions, the computer senses
the controller's position and accordingly processes a change in the
magnetic field direction. The computer then causes the magnetic
field generating apparatus to apply the new magnetic field
direction.
[0005] Generally the method of magnetically navigating endoscopes
of the present invention comprises specifying the direction to
orient the endoscope using a variety of input devices and user
interfaces, while the endoscope is manually or automatically
advanced in the body lumen or cavity.
[0006] The method of the present invention can also be used in
navigating the distal end of an endoscope in the bronchia;
navigating the distal end of an endoscope in the brain; navigating
the distal end of an endoscope in the colon and/or intestines; and
navigating the distal end of the endoscope in the heart.
[0007] The endoscopes used with the method of this invention are
preferably constructed to facilitate the recovery and
re-integration of the image bundle, the light bundle, and the
magnetics into new endoscopes, so that the endoscopes can be made
disposable. Thus the entire endoscope of the present invention can
be made re-usable or disposable.
[0008] The magnetically navigable endoscope system of the present
invention allows a health care professional to quickly and
intuitively navigate the endoscopes through body lumens and
cavities. In the preferred embodiment, the system interface allows
the health care professional to move the endoscope through the body
without having to get involved in directly controlling the magnetic
field direction and strength. This is achieved by allowing the
physician to directly visualize the body lumen or cavity in which
the endoscope is located, and navigate based on this viewed
image.
[0009] According to the method and apparatus of this invention, the
distal end of an endoscope can be oriented in virtually any
direction. Moreover, the navigation is unaffected by the path of
the endoscope. These and other features and advantages will be in
part apparent, and in part pointed out hereinafter.
BRIEF DESCRIPTION OF THE DRAWINGS
[0010] FIG. 1 is a schematic view of an apparatus for magnetically
controlling endoscopes according to the principles of this
invention;
[0011] FIG. 2 is a schematic side elevation view of an endoscope
for use with this invention;
[0012] FIG. 3 is a transverse cross-sectional view of the
endoscope;
[0013] FIG. 4 is a side elevation view of the distal end portion of
the endoscope;
[0014] FIG. 5 is a perspective view of a first alternate
construction of the distal end portion of the endoscope;
[0015] FIG. 6 is a side elevation view of a second alternate
construction of the distal end of the endoscope;
[0016] FIG. 7 is a longitudinal cross-sectional view of a third
alternate construction of the distal end of the endoscope;
[0017] FIG. 8 is a side elevation view of an alternate endoscope
construction, including an integral controller;
[0018] FIG. 9 is a front elevation view of a possible display for
use in navigating endoscopes according to the present invention;
and
[0019] FIG. 10 is an end elevation view of the distal end of an
endoscope provided with a plurality of pressure sensors around the
circumference of its distal end;
[0020] FIG. 11 is a perspective view of the distal end of the
endoscope showing an exemplary construction of the pressure
sensors
[0021] FIG. 12 is a view of the distal end of an endoscope being
navigating within a kidney.
[0022] Corresponding reference numerals indicate corresponding
parts throughout the several views of the drawings.
DETAILED DESCRIPTION OF THE INVENTION
[0023] A system for navigating endoscopes through body lumens and
cavities is indicated generally as 20 in FIG. 1. The system 20
comprises an endoscope 22, a light. source 24 connected to the
endoscope to provide light to illuminate the body lumen or cavity
surrounding the distal end of the endoscope, an imaging device 26,
for example a camera, for capturing images of the body lumen or
cavity surrounding the distal end of the endoscope and a computer
28 for processing the image captured by the imaging device 26 and
displaying the image on a display 30. Of course instead of a camera
for capturing optical images, the imaging device could be an
ultrasonic imaging device or an infrared imaging device, or some
other suitable imaging device. The computer 28 is also connected to
a controller, such as a controller 32, for receiving input for
controlling endoscope 22, and processing the input to create an
output control signal to the magnetic field generating device 34 to
control the magnetic field applied to the distal end of the
endoscope to move (orient and/or advance) the distal end of the
endoscope in the desired direction.
[0024] The magnetic field generating device 34 is one that is
capable of generating a magnetic field of selected direction and
strength in an operating volume within a patient. An example of
such a system is that disclosed in co-assigned, copending U.S.
patent application Ser. No. 09/211,723, field Dec. 14, 1998,
entitled Open Field System for Magnetic Surgery, incorporated
herein by reference. The magnetic field direction and field
strength in this system can be controlled by controlling the
currents applied to the electromagnetic coils comprising the
system. One of ordinary skill in the art could easily implement a
software algorithm to control a system which provides appropriate
magnetic field direction and strength to achieve a selected
orientation or movement. The magnetic field for navigating the
endoscope in accordance with the present invention could also be
provided with an articulated magnet, for example like that
disclosed in co-assigned, co-pending U.S. Patent Application Ser.
No. 60/118,959, filed Feb. 4, 1999, entitled An Efficient Permanent
Magnet Means to Produce an Arbitrary Field and incorporated herein
by reference.
[0025] The endoscope 22 is best shown in FIG. 2. The endoscope 22
has a proximal end 36 and a distal end 38. As shown in FIG. 3, the
endoscope has a plurality of inner lumens, depending upon the
application. In this preferred embodiment there are four such
lumens 42, 44, 46 and 48.
[0026] The lumen 42 forms a working channel 52 extending the entire
length of the endoscope 22, and providing a passage for one or more
surgical instruments.
[0027] The lumen 44 forms a passage for light bundle 54 which is
preferably a bundle of optical fibers extending substantially the
length of the endoscope 22. The proximal end of the light bundle 54
is optically connected to a connector 56 on the side of the
proximal end portion of the endoscope 22, and the distal end of the
light bundle 54 terminates at the distal end 38 of the endoscope.
The light source 24 is connected via connector 56 to the light
bundle 54 to illuminate the area surrounding the distal end 38 of
the endoscope 22. Of course, with an imaging system other than an
optical system, e.g., ultrasonic or infrared imaging, the light
source 24 is not necessary.
[0028] The lumen 46 forms a passage for image path 56 which, in the
case of an optical imaging device 26, is preferably a bundle of
optical fibers extending substantially the length of the endoscope
22. In the case of an ultrasonic or infrared imaging device 26, the
imaging path 56 could be a wire or cable. The proximal end of the
image path 56 is connected to a connector 60 on the distal end of
the endoscope 22, and the distal end of the image bundle 56
terminates at the distal end 38 of the endoscope. The imaging
device 26 is connected via connector 60 to the image path 56 to
receive images from the area surrounding the distal end 38 of the
endoscope 22. The imaging device 26 is in turn connected to the
computer 28, which processes the image signal from the imaging
device and displays in the image on the display 30.
[0029] The lumen 48 forms an optional magnet channel 60 which
allows one or more magnets 62 to be positioned along the length of
the endoscope 22 to permit the endoscope to be moved (oriented
and/or advanced) by an applied magnetic field. The magnets could be
made either of a permanent magnetic material, such as
neodymium-iron-boron, or of a permeable magnetic material, such as
cold rolled steel or Hiperco.TM.. The magnets 62 are shaped to
maximize their field strength for their size, and thus are
typically cylindrical, and are preferably placed adjacent the
distal end 38 of the endoscope 22. The distal end portion of the
endoscope, showing the position of the magnet 62, is shown in FIG.
4.
[0030] The endoscope 22, and in particular the lumens 42, 44, 46,
and 48, and the space surrounding the lumens 42, 44, 46, and 48,
can be filled with a filler to secure the components in the
endoscope. However portions of the filler along the length of the
endoscope can be selectively removed by leaching to reduce the
weight and stiffness of the catheter. For some applications,
substantially all of the filler between the proximal and distal
ends will be leached away, leaving the filler at the proximal and
distal ends to hold the components in their proper orientation. It
is also possible that selected portions of the filler material
between the proximal and distal ends of the endoscope are
leached.
[0031] The flexibility of the endoscope can vary along its length,
to suit the particular function of the endoscope. In most
embodiments, it is preferred that at least the distal end portion
be highly flexible so that it can readily align with an applied
magnetic field. For most applications, a highly flexible portion at
least 3 cm long should be sufficient. The flexibility is preferably
such that the distal end of the endoscope can bend at least about
120.degree. with respect to the longitudinal axis of the
immediately proximal portion of the endoscope, with a radius of
curvature of about 2 cm or less.
[0032] A first alternate construction of the distal end of the
endoscope is shown in FIG. 5. As shown in FIG. 5 the portion of the
endoscope adjacent the distal end 38 can include a helical coil 64.
The coil 64 can be made of a highly flexible permeable magnetic
material to provide an alignment force of the end portion of the
endoscope under an applied magnetic field. The coil 64 could also
be made of a non-magnetic material to simply provide axial
stiffness when the tip is arched by the magnetic field.
[0033] A second alternate construction of the distal end 38 of the
endoscope 22 is shown in FIG. 6, in which the distal end of the
endoscope is provided with a machined tip 66, preferably made from
a permanent or permeable magnetic material. The machined tip 66 can
provide the sole or additional alignment force for the tip to
orient with the externally applied magnetic field.
[0034] A third alternate construction of the distal end 38 of the
endoscope 22 is shown in FIG. 7, in which multiple magnet bodies
are used to achieve greater magnetic torque. As shown in FIG. 7,
the distal end section of the third alternate construction of the
endoscope contains a plurality of magnet rings 67. The rings 67 are
retained in the distal end section, and do not significantly impair
the flexibility of the distal end section. The rings 67 provide
sufficient magnet material so that a substantial torque can be
applied to the distal end of the endoscope.
[0035] An alternate endoscope for use with this invention is
indicated generally as 22' in FIG. 8. Endoscope 22' is similar in
construction to endoscope 22, and corresponding parts are
identified with corresponding reference numerals. Unlike endoscope
22, endoscope 22' includes an integral controller 68 which can be
used instead of the controller 32. This allows the physician to
navigate the endoscope 22' without removing his or her hands from
the endoscope. The controller 68 could consist of a joystick
attached to the endoscope's proximal end which the physician can
manipulate to control the distal end of the endoscope. The
controller 68 could alternatively consist of one or one or more
sensors for sensing the orientation of the proximal end of the
endoscope, and in which this sensed orientation can indicate the
desired direction for the distal end of the endoscope. Thus by
simply manipulating the proximal end of the endoscope, the
physician can control the distal end of the endoscope.
[0036] The computer 28 processes the image from the imaging device
26, adds an overlay, such as that shown in FIG. 9, and displays the
image in an orientation intuitively coordinated with the controller
32. In this preferred embodiment, the controller and computer
operate to control the externally applied magnetic field so that
moving the controller left causes the magnetic field generating
device 24 to change the applied magnetic field and move the distal
end 38 of the endoscope 22 left as viewed on the display 30. Moving
the controller 32 right causes the magnetic field generating device
24 to change the applied magnetic field and move the distal end 38
of the endoscope 22 right as viewed on the display 30. Moving the
controller 32 forward causes the magnetic field generating device
24 to change the applied magnetic field and move the distal end 38
of the endoscope down as viewed on the display 30. Moving the
controller 32 backward causes the magnetic field generating device
24 to change the applied magnetic field and move the distal end 38
of the endoscope 22 up as viewed on the display 30. However, these
corresponding directions could be swapped, depending upon the
user's preference.
[0037] To facilitate navigation it is desirable to have the display
image coordinated with the controls for navigating the medical
device. This can be accomplished in several different ways. The
display image and the control can be periodically synchronized. The
user can move the control in a preselected direction, for example,
up, observe which direction the image on the display screen moves,
and mark this direction on the display as the "up" direction. This
marking can be conveniently done by moving a cursor or other
indicator on the display with a mouse or similar input device. The
user positions the cursor or other indicator to indicate the
preselected direction and triggers the calibration, for example by
clicking the mouse. The computer can then reprocess and reorient
the image so that it is intuitively oriented with respect to the
control. Alternatively one or more indicia 70, indicating the
orientation of the image can be displayed on the display. The
physician can use the indicia to properly operate the controller.
For example, if the physician wants to move the endoscope in the
direction of the "U" indicia 70, the physician moves the controller
back--regardless of where the "U" indicia is actually located on
the display 30. Similarly, if the physician wants to move the
controller in the direction of the "R" indicia 70, the physician
moves the controller to the right--regardless of where the "R"
indicia is actually located on the display 30.
[0038] Another way of coordinating the display image with the
controls for navigating the medical device is to provide some
orientation indicator on the medical device so that the actual
orientation can be determined. For example a radiopaque marker can
be included on the medical device so that the orientation of the
medical device can be determined visually on the display or
automatically through image processing. Alternatively, some other
system for remotely determining the orientation of the medical
device, such as an optic sensor, a magnetic sensor, or an
ultrasonic sensor can be used to obtain information about the
orientation of the medical device. The computer can process the
information about the orientation of the medical device and either
re-orient the displayed image, or adjust the operation of the
magnetic field control to intuitively coordinate the image and the
operation of the control.
[0039] Of course, the image displayed on the display 30 can be
oriented absolutely, i.e. so that vertical in the displayed image
corresponds to actual vertical, and the controller coordinated so
that the movement of the controller back moves the endoscope up,
forward moves the endoscope down, and left moves the endoscope
left, and right moves the endoscope right. Alternatively the image
displayed on the display can be oriented relative to the control,
such that regardless of the actual orientation, moving the control
back moves the endoscope up as viewed on the display, moving the
control forward moves the endoscope down as viewed on the display,
moving the control left moves the endoscope left as viewed on the
display, and moving the control right moves the endoscope right as
viewed in the display.
[0040] The magnetically navigable endoscope system of the present
invention can also include one or more sensors 80, triggered by
contact with an anatomical structure such as the wall of a body
lumen or cavity. As shown in FIGS. 10 and 11, these sensors 80 can
be distributed around the distal end of the endoscope to sense
contact anywhere around the circumference of the distal end of the
endoscope. The sensors may be, for example a spring contact 82
projecting from the exterior sidewall of the endoscope, resiliently
biased away from contact 84, such that pressure (such as from the
endoscope contacting an internal body structure such as the wall of
a lumen or cavity) forces the contacts together. A controller, such
as a computer, monitors the signals from the sensors and can
control the magnetic field generating apparatus to selectively
modify the magnetic field to change the orientation of the magnetic
body such that the distal end of the endoscope remains in the
desired position within the body lumen or cavity in which it is
located. For example in some applications, it will be desirable
that the endoscope remain substantially centered within a body
lumen or cavity, to facilitate its advancement in the lumen or
cavity. In other applications, it will be desirable that the
endoscope remain in contact with one of the walls of the body lumen
or cavity, for example for electrical mapping of the tissue or some
other procedure. The system can include an advancing mechanism for
advancing the endoscope, and an interlock for preventing operation
of the advancing mechanism when a pre-determined number of sensors
are triggered.
[0041] In a preferred mode of operation, the distal end of the
endoscope is localized, for example by manually identifying the
distal end of the endoscope on the displays of a bi-planar
fluoroscopic imaging system. The physician can easily do this with
a computer mouse or other input device, by manipulating a cursor
over the end and clicking. Identifying the position of the distal
end of the endoscope on two different planar images, uniquely
identifies the end of the endoscope in three-dimensional space. The
location of the distal end of the endoscope is then registered to a
pre-operative image set such as an MR or CT image set. Once the
distal end of the endoscope is registered on the pre-operative
image set, the physician then identifies a direction on the
preoperative image set. The magnetic field generating apparatus
then generates the appropriate magnetic field to move (orient
and/or advance) the distal end of the endoscope in the identified
direction.
[0042] Alternatively, after the endoscope is localized, and the
position registered on a pre-operative MR or CT image set, the
physician could identify inputs a volume over which to move (orient
and/or advance) the endoscope. This can be conveniently done by
indicating the volume on a preoperative MR or CT image set. The
magnetic field generating apparatus then generates the appropriate
magnetic field to move (orient and/or advance) the distal end of
the endoscope in the specified volume.
[0043] The method of the present invention can be used for
navigating medical devices virtually anywhere in the body. For
example the method of the present invention can be used with
ureterscopes, navigating the distal end of the endoscope in the
calix of the kidney, as shown in FIG. 12.
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