U.S. patent application number 10/496857 was filed with the patent office on 2005-04-14 for extendable tube.
This patent application is currently assigned to INTUMED LTD.. Invention is credited to Besharim, Eliyahu, Besharim, Shlomo.
Application Number | 20050076914 10/496857 |
Document ID | / |
Family ID | 11074892 |
Filed Date | 2005-04-14 |
United States Patent
Application |
20050076914 |
Kind Code |
A1 |
Besharim, Shlomo ; et
al. |
April 14, 2005 |
Extendable tube
Abstract
An automatically operative medical insertion device (12) and
method including an insertable element (18) which is adapted to be
inserted within a living organism in vivo, a surface following
element (20), physically associated with the insertable element and
being arranged to follow a physical surface within the living
organism in vivo, a driving subsystem (15) operative to at least
partially automatically direct the insertable element along the
physical surface and a navigation subsystem (274) operative to
control the driving subsystem based at least partially on a
perceived location of the surface following element along a
reference pathway stored in the navigation subsystem.
Inventors: |
Besharim, Shlomo; (Beer
sheva, IL) ; Besharim, Eliyahu; (Beer Sheva,
IL) |
Correspondence
Address: |
DARBY & DARBY P.C.
P. O. BOX 5257
NEW YORK
NY
10150-5257
US
|
Assignee: |
INTUMED LTD.
15 Yehoshua Hatsoref Street
Beer Sheva
IL
84103
|
Family ID: |
11074892 |
Appl. No.: |
10/496857 |
Filed: |
November 11, 2004 |
PCT Filed: |
May 2, 2002 |
PCT NO: |
PCT/IL02/00347 |
Current U.S.
Class: |
128/207.14 ;
128/207.15 |
Current CPC
Class: |
A61M 16/0488 20130101;
A61M 16/049 20140204; A61B 5/062 20130101; A61B 5/4514
20130101 |
Class at
Publication: |
128/207.14 ;
128/207.15 |
International
Class: |
A62B 009/06; A61M
016/00 |
Foreign Application Data
Date |
Code |
Application Number |
Dec 5, 2001 |
WO |
PCT/IL01/01121 |
Claims
1. An automatically operative medical insertion device comprising:
an extendable insertable element which is adapted to be inserted
within a living organism in vivo; a surface following element,
physically associated with said insertable element and being
arranged to follow a physical surface within said living organism
in vivo; a driving subsystem operative to at least partially
automatically direct said insertable element along said physical
surface; and a navigation subsystem operative to control said
driving subsystem based at least partially on a perceived location
of said surface following element along a reference pathway stored
in said navigation subsystem.
2-9. (canceled)
10. An automatically operative medical insertion device according
to claim 1 and wherein said insertable element is a gastroscope and
wherein said physical surface comprises surfaces of the
intestine.
11. An automatically operative medical insertion device according
to claim 1 and wherein said insertable element is a catheter and
wherein said physical surface comprises interior surfaces of the
circulatory system.
12. An automatically operative medical insertion device according
to claim 1 and also comprising a reference pathway generator
operative to image at least a portion of said living organism and
to generate said reference pathway based at least partially on an
image generated thereby.
13-41. (canceled)
42. An automatically operative medical insertion device according
to claim 1 and wherein said also comprising a medical imaging
subsystem comprises including at least one of an ultrasound
scanner, an X-ray imager, a CAT scan system and an MRI system.
43-56. (canceled)
57. An automatically operative medical insertion device according
to claim 1 and wherein said insertable element comprises: a
mounting element which is arranged to be removably engaged with an
intubator assembly; and an extendable tube operatively associated
with said mounting element.
58. An automatically operative medical insertion device according
to claim 57 and wherein said extendable tube is arranged to be
pulled by a flexible guide operated by said intubator assembly.
59. An automatically operative medical insertion device according
to claim 57 and wherein said extendable tube comprises a coil
spring.
60. An automatically operative medical insertion device according
to clam 57 and wherein said extendable tube also comprises a
forward end member, on a distal end thereof.
61-64. (canceled)
65. An automatically operative medical insertion device according
to claim 57 and also comprising a flexible guide having mounted at
a distal end thereof a tip sensor, wherein said flexible guide
being formed with an inflatable and radially outwardly expandable
guide mounted balloon.
66. An automatically operative medical insertion device according
to claim 65 and wherein said inflatable and radially outwardly
expandable guide mounted balloon receives inflation gas through a
conduit formed in said flexible guide and extending therealong.
67. An automatically operative medical insertion device according
to claim 66 and wherein said conduit is connected to a source of
pressurized inflation gas.
68. An automatically operative medical insertion device according
to claim 67 and wherein said source of pressurized inflation gas is
located within said intubator assembly.
69. (canceled)
70. An automatically operative medical insertion device according
to claim 66 and wherein said inflation gas comprises pressurized
air.
71. An automatically operative medical insertion method comprising:
inserting an insertable element within a living organism in vivo by
extending said insertable element; physically associating a surface
following element with said insertable element and causing said
surface following element to follow a physical surface within said
living organism in vivo; directing said insertable element along
said physical surface using a driving subsystem; and controlling
direction of said insertable element based at least partially on a
perceived location of said surface following element along a
reference pathway stored in a navigation subsystem.
72-127 (canceled)
128. An automatically operative medical insertion method according
to claim 71 and also comprising: removably engaging said insertion
insertable element with an intubator assembly; and operatively
associating an extendable tube with said insertion insertable
element.
129. An automatically operative medical insertion method according
to claim 128 and wherein said extending comprises: operating a
flexible guide; and pulling said extendable tube by said flexible
guide.
130. An automatically operative medical insertion method according
to claim 128 and wherein said extending comprises at least one of
expanding and contracting a coil spring.
131. An automatically operative medical insertion method according
to claim 129 and also comprising forming a forward end member, on a
distal end of said extendable tube.
132-139. (canceled)
140. An automatically operative medical insertion method according
to claim 131 and also comprising: forming an inflatable and
radially outwardly expandable guide balloon on said flexible guide;
and inflating said guide meted balloon to tightly engage the
interior of said forward end member to provide extension of said
tube in response to forward driven movement of said flexible
guide.
141-142. (canceled)
Description
REFERENCE TO CO-PENDING APPLICATION
[0001] Applicants hereby claim priority of PCT Application No.
PCT/IL01/01121 filed Dec. 5, 2001, entitled "Apparatus For
Self-Guided Intubation".
[0002] The following U.S. patents are believed to represent the
current state of the art:
[0003] U.S. Pat. Nos. 6,248,112; 6,236,875; 6,235,038; 6,226,548;
6,211,904; 6,203,497; 6,202,646; 6,196,225; 6,190,395; 6,190,382;
6,189,533; 6,174,281; 6,173,199; 6,167,145; 6,164,277; 6,161,537;
6,152,909; 6,146,402; 6,142,144; 6,135,948; 6,132,372; 6,129,683;
6,096,050; 6,096,050; 6,090,040; 6,083,213; 6,079,731; 6,079,409;
6,053,166; 5,993,424; 5,976,072; 5,971,997; 5,957,844; 5,951,571;
5,951,461; 5,885,248; 5,720,275; 5,704,987; 5,592,939; 5,584,795;
5,506,912; 5,445,161; 5,400,771; 5,347,987; 5,331,967; 5,307,804;
5,257,636; 5,235,970; 5,203,320; 5,188,111; 5,184,603; 5,172,225;
5,109,830; 5,018,509; 4,910,590; 4,672,960; 4,651,746
[0004] Reference is also made to:
http://www.airwaycam.com/system.html
BACKGROUND OF THE INVENTION
FIELD OF THE INVENTION
[0005] The present invention relates to systems and methods for
automatic insertion of an element into a living organism in vivo
and to an extendable insertable element and a method of insertion
thereof.
SUMMARY OF THE INVENTION
[0006] The present invention seeks to provide improved systems and
methods for automatic insertion of an element into a living
organism in vivo.
[0007] There is thus provided in accordance with a preferred
embodiment of the present invention an automatically operative
medical insertion device including an insertable element which is
adapted to be inserted within a living organism in vivo, a surface
following element, physically associated with the insertable
element and being arranged to follow a physical surface within the
living organism in vivo, a driving, subsystem operative to at least
partially automatically direct the insertable element along the
physical surface and a navigation subsystem operative to control
the driving subsystem based at least partially on a perceived
location of the surface following element along a reference pathway
stored in the navigation subsystem.
[0008] There is also provided in accordance with a preferred
embodiment of the present invention an automatically operative
medical insertion method, which includes inserting an insertable
element within a living organism in vivo, physically associating a
surface following element with the insertable element and causing
the surface following element to follow a physical surface within
the living organism in vivo, directing the insertable element along
the physical surface using a driving subsystem and controlling
direction of the insertable element based at least partially on a
perceived location of the surface following element along a
reference pathway stored in a navigation subsystem.
[0009] Further in accordance with a preferred embodiment of the
present invention the driving subsystem is operative to fully
automatically direct the insertable element along the physical
surface. Alternatively, the driving subsystem is operative to
automatically and selectably direct the insertable element along
the physical surface.
[0010] Additionally in accordance with a preferred embodiment of
the present invention the navigation subsystem receives surface
characteristic information relating to the physical surface from
the surface following element and employs the surface
characteristic information to perceive the location of the surface
following element along the reference pathway.
[0011] Preferably, the surface characteristic information includes
surface contour information. Additionally, the surface
characteristic information includes surface hardness information.
Preferably, the surface contour information is three-dimensional.
Alternatively, the surface contour information is
two-dimensional.
[0012] In accordance with a further preferred embodiment of the
present invention, the insertable element is an endotracheal tube
and the physical surface includes surfaces of the larynx and
trachea. Alternatively, the insertable element is a gastroscope and
the physical surface includes surfaces of the intestine. In
accordance with another preferred embodiment, the insertable
element is a catheter and the physical surface includes interior
surfaces of the circulatory system.
[0013] Further in accordance with a preferred embodiment of the
present invention the insertion device also includes a reference
pathway generator operative to image at least a portion of the
living organism and to generate the reference pathway based at
least partially on an image generated thereby.
[0014] Preferably, the reference pathway includes a standard
contour map of a portion of the human anatomy. Additionally, the
standard contour map is precisely adapted to a specific patient.
Alternatively, the standard contour map is automatically precisely
adapted to a specific patient.
[0015] Further in accordance with a preferred embodiment of the
present invention the reference pathway is operator adaptable to
designate at least one impediment.
[0016] Additionally in accordance with a preferred embodiment of
the present invention the insertable element includes a housing in
which is disposed the driving subsystem, a mouthpiece, a tube
inserted through the mouthpiece and a flexible guide inserted
through the tube, the surface following element being mounted at a
front end of the guide.
[0017] Preferably, the mouthpiece includes a curved pipe through
which the tube is inserted. Additionally, the driving subsystem is
operative to move the guide in and out of the housing, through the
curved pipe and through the tube. Preferably, the driving subsystem
also operates to selectably bend a front end of the guide.
Additionally or alternatively, the driving subsystem is operative
to move the insertable element in and out of the living organism.
Additionally, the driving subsystem is also operative to selectably
bend a front end of the insertable element.
[0018] Further in accordance with a preferred embodiment of the
present invention the surface following element includes a tactile
sensing element.
[0019] Preferably, the surface following element includes a tip
sensor including a tip integrally formed at one end of a short rod
having a magnet on its other end, the rod extends through the
center of a spring disk and is firmly connected thereto, the spring
disk being mounted on one end of a cylinder whose other end is
mounted on a front end of the insertable element.
[0020] Further in accordance with a preferred embodiment of the
present invention the tip sensor also includes two Hall effect
sensors, which are mounted inside the cylinder on a support and in
close proximity to the magnet, the Hall effect sensors being spaced
in the plane of the curvature of the curved pipe. Each Hall effect
sensor includes electrical terminals operative to provide electric
current representing the distance of the magnet therefrom. The tip
sensor operates such that when a force is exerted on the tip along
an axis of symmetry of the cylinder, the tip is pushed against the
spring disk, causing the magnet to approach the Hall effect sensors
and when a force is exerted on the tip sideways in the plane of the
Hall effect sensors, the tip rotates around a location where the
rod engages the spring disk, causing the magnet to rotate away from
one of the Hall effect sensors and closer to the other of the Hall
effect sensors.
[0021] Still further in accordance with a preferred embodiment of
the present invention the driving subsystem operates, following
partial insertion of the insertable element into the oral cavity,
to cause the guide to extend in the direction of the trachea and
bend the guide clockwise until the surface following element
engages a surface of the tongue, whereby this engagement applies a
force to the surface following element
[0022] Additionally in accordance with a preferred embodiment of
the present invention the navigation subsystem is operative to
measure the changes in the electrical outputs produced by the Hall
effect sensors indicating the direction in which the tip is
bent.
[0023] Moreover in accordance with a preferred embodiment of the
present invention the navigation subsystem operates to sense the
position of the tip and the past history of tip positions and to
determine the location of the tip in the living organism and
relative to the reference pathway.
[0024] In accordance with yet another preferred embodiment, the
navigation subsystem operates to navigate the tip according to the
reference pathway. Additionally, the navigation subsystem operates
to sense that the tip touches the end of the trough beneath the
epiglottis. Additionally or alternatively, the navigation subsystem
is operative to sense that the tip reaches the tip of the
epiglottis. In accordance with another preferred embodiment, the
navigation subsystem operates to sense that the tip reached the
first cartilage of the trachea Additionally, the navigation
subsystem operates to sense that the tip reached the second
cartilage of the trachea Additionally or alternatively, the
navigation subsystem is operative to sense that the tip reached the
third cartilage of the trachea. Preferably, the navigation
subsystem operates to load the reference pathway from a memory.
[0025] Further in accordance with a preferred embodiment of the
present invention the driving subsystem is operative to push the
tube forward.
[0026] Still further in accordance with a preferred embodiment of
the present invention the driving subsystem includes a first motor
which operates to selectably move the insertable element forward or
backward, a second motor which operates to selectably bend the
insertable element and electronic circuitry operative to control
the first motor, the second motor and the surface following
element
[0027] Preferably, the electronic circuitry includes a
microprocessor operative to execute a program, the program
operative to control the first and second motors and the surface
following element and to insert and bend the insertable element
inside the living organism along the reference pathway.
[0028] Further in accordance with a preferred embodiment of the
present invention the driving subsystem is operative to measure the
electric current drawn by at least one of the first and second
motors to evaluate the position of the surface following
element.
[0029] Still further in accordance with a preferred embodiment of
the present invention the reference pathway is operative to be at
least partially prepared before the insertion process is activated.
Preferably, the medical insertion device includes a medical imaging
system and wherein the medical imaging system is operative to at
least partially prepare the reference pathway. Preferably, the
medical imaging subsystem includes at least one of an ultrasound
scanner, an X-ray imager, a CAT scan system and an MRI system.
[0030] Further in accordance with a preferred embodiment of the
present invention the medical imaging system operates to prepare
the reference pathway by marking at least one contour of at least
one organ of the living organism.
[0031] In accordance with another preferred embodiment, the medical
imaging system operates to prepare the reference pathway by
creating an insertion instruction table including at least one
insertion instruction. Preferably, the insertion instruction
includes instruction to at least one of extend, retract and bend
the insertable element.
[0032] Further in accordance with a preferred embodiment of the
present invention the navigation subsystem is operative to control
the driving subsystem based at least partially on a perceived
location of the surface following element and according to the
insertion instruction table stored in the navigation subsystem.
[0033] Additionally in accordance with a preferred embodiment of
the present invention the operative medical insertion device
operates to at least partially store a log of a process of
insertion of the insertable element. Additionally, the operative
medical insertion device transmits the log of a process of
insertion of the insertable element.
[0034] Further in accordance with a preferred embodiment of the
present invention the computer operates to aggregate the logs of a
process of insertion of the insertable element. Additionally, the
computer prepares the reference pathway based at least partially on
the aggregate.
[0035] Still further in accordance with a preferred embodiment of
the present invention the computer transmits the reference pathway
to the medical insertion device.
[0036] Further in accordance with a preferred embodiment of the
present invention the insertable element includes a guiding element
and a guided element. Additionally, the driving subsystem operates
to direct the guiding element and the guided element at least
partially together. Additionally or alternatively, the driving
subsystem is operative to at least partially automatically direct
the guide in a combined motion comprising a longitudinal motion and
lateral motion.
[0037] In accordance with yet another preferred embodiment, the
mouthpiece includes a disposable mouthpiece.
[0038] In accordance with still another preferred embodiment of the
present invention, the insertable element is extendable. In
accordance with yet another preferred embodiment, the insertable
element includes a mounting element which is arranged to be
removably engaged with an intubator assembly and an extendable tube
operatively associated with the mounting element Preferably, the
extendable tube is arranged to be pulled by a flexible guide
operated by the intubator assembly.
[0039] In accordance with yet another preferred embodiment of the
present invention, the extendable tube includes a coil spring.
Additionally or alternatively, the extendable tube also includes a
forward end member, on a distal end thereof.
[0040] Preferably, the forward end member includes a diagonally cut
pointed forward facing tube end surface. Additionally or
alternatively, the medical insertion device also includes a forward
end member mounted inflatable and radially outwardly expandable
circumferential balloon.
[0041] Preferably, the forward end member mounted inflatable and
radially outwardly expandable circumferential balloon receives
inflation gas through a conduit formed in a wall of the forward end
member and continuing through the tube to a one way valve.
[0042] In accordance with another preferred embodiment, the medical
insertion device also includes a flexible guide having mounted at a
distal end thereof a tip sensor. Preferably, the flexible guide is
formed with an inflatable and radially outwardly expandable guide
mounted balloon. Additionally, the inflatable and radially
outwardly expandable guide mounted balloon receives inflation gas
through a conduit formed in the flexible guide and extending
therealong. Preferably, the conduit is connected to a source of
pressurized inflation gas. Additionally or alternatively, the
source of pressurized inflation gas is located within the intubator
assembly. Preferably, the inflation gas comprises pressurized
air.
[0043] It is appreciated that the distances and angles referenced
in the specification and claims are typical values and should not
be construed in any way as limiting values.
BRIEF DESCRIPTION OF THE DRAWINGS AND APPENDICES
[0044] The present invention will be understood and appreciated
more fully from the following detailed description, taken in
conjunction with the drawings and appendices in which:
[0045] FIGS. 1A to 1L are a series of simplified pictorial
illustrations of a process of employing a preferred embodiment of
the present invention for the intubation of a human;
[0046] FIGS. 2A to 2F taken together are a flowchart illustrating a
preferred implementation of the present invention, operative for an
intubation process as shown in FIGS. 1A to 1L;
[0047] FIG. 3 is a simplified illustration of the internal
structure of a preferred embodiment of the present invention for
intubation of a human;
[0048] FIG. 4 is a simplified block diagram of a preferred
embodiment of the present invention;
[0049] FIGS. 5A to 5H are electrical schematics of a preferred
embodiment of the present invention for intubation of a human;
[0050] FIGS. 6A to 6K are a series of simplified pictorial
illustrations of a process of employing a preferred embodiment of
the present invention for insertion of an element into the
intestine of a human;
[0051] FIG. 7 is a preferred embodiment of a table comprising
instruction, operative in accordance with a preferred embodiment of
the present invention, for insertion of an element into the
intestine of a human as shown in FIGS. 5A to 5K;
[0052] FIG. 8 is a flowchart illustrating a preferred
implementation of the present invention, operative for a process of
insertion of an element into the intestine of a human as shown in
FIGS. 6A to 6K,
[0053] FIGS. 9A to 9F are a series of simplified pictorial
illustrations of an extendable endotracheal tube assembly
constructed and operative in accordance with a preferred embodiment
of the present invention in various operative orientations;
[0054] FIGS. 10A to 10G are a series of simplified pictorial
illustrations of the extendable endotracheal tube assembly of FIGS.
9A-9F employed with the medical insertion device of FIGS. 1A-8 for
the intubation of a human;
[0055] FIGS. 11A to 11F are a series of simplified pictorial
illustrations of an extendable endotracheal tube assembly
constructed and operative in accordance with another preferred
embodiment of the present invention in various operative
orientations; and
[0056] FIGS. 12A to 12G are a series of simplified pictorial
illustrations of the extendable endotracheal tube assembly of FIGS.
9A-9F employed with the medical insertion device of FIGS. 1A-8 for
the intubation of a human
LIST OF APPENDICES
[0057] Appendices 1 to 3 are computer listings which, taken
together, form a preferred software embodiment of the present
invention.
DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS
[0058] Reference is now made to FIGS. 1A to 1L, which are a series
of simplified pictorial illustrations of a system and methodology
for the intubation of a human in accordance with a preferred
embodiment of the present invention.
[0059] It is appreciated that the general configuration of the
mouth and trachea is generally the same for all humans except for
differences in scale, such as between an infant, a child and an
adult. In a preferred implementation of the present invention, a
standard contour map 10 of the human mouth and trachea is employed.
The scale of the map 10 may be further precisely adapted to the
specific patient, preferably automatically. Alternatively, the
scale of the map 10 is adapted to the specific patient
semi-automatically. In this alternative the operator can select the
scale of the map 10, for example by selecting between a child and
an adult. Thereafter the scale of the map 10 is automatically
adapted to size of the specific patient as a part of the intubation
process. As a further alternative or in addition the operator is
enabled to designate one or more typical impediments such as: a
tumor, a swelling, an infection and an injury. Selecting an
impediment preferably creates a suitable variation of the general
map 10.
[0060] FIG. 1A shows the map 10 and the location therein where a
tip sensor 11 of an intubator engages the mouth and trachea of the
patient. It is a particular feature of the present invention that
intubation is at least partially automatically effected by
utilizing the contour map 10 to monitor the progress of tip sensor
11 and thus to navigate the intubator accordingly.
[0061] As seen in FIG. 1A, an intubator assembly 12, suitable for
the intubation of a human, is partially inserted into an oral
cavity of a patient. The intubator assembly 12 preferably comprises
a housing 14 in which is disposed a guide driver 15, a mouthpiece
16, a tube 18 inserted through the mouthpiece 16, a flexible guide
20 inserted through the tube 18, and tip sensor 11 mounted at the
distal end of the guide 20. The mouthpiece 16 preferably comprises
a rigid curved pipe 24 through which the tube 18 is inserted.
Preferably the curved pipe 24 comprises a slit 49 on each side.
Alternatively, the curved pipe 24 is eliminated.
[0062] It is appreciated that some of the components comprising the
intubator assembly 12 may be disposable, for example, the tube 18
and the mouthpiece 16.
[0063] The guide driver 15 is operative to move the guide 20 in and
out of the housing 14, through the curved pipe 24 and through the
tube 18. The guide driver 15 is also operative to selectably bend
the distal end of the guide 20 clockwise and counterclockwise in
the plane of the curvature of the curved pipe 24 in the sense of
FIG. 1A.
[0064] Referring now to an enlargement of the tip sensor 11, it is
seen that tip sensor 11 preferably comprises a tip 28 preferably
integrally formed at one end of a short rod 30 having a magnet 32
on its other end. The rod 30 preferably extends through the center
of a spring disk 34 and is firmly connected thereto. The spring
disk 34 is preferably mounted on one end of a cylinder 36 whose
other end is mounted on the distal end of the guide 20, Preferably,
the tip sensor 11 also comprises two Hall effect sensors, 38 and
40, which are mounted inside the cylinder 36 on a support 41 and in
close proximity to the magnet 32. The Hall effect sensors 38 and 40
are preferably spaced in the plane of the curvature of the curved
pipe 24. Typically, each Hall effect sensor has electrical
terminals operative to provide electric current representing the
distance of the magnet 32 therefrom.
[0065] When a force is exerted on the tip 28 along the axis of
symmetry 42 of cylinder 36, the tip 28 is pushed against the spring
disk 34, causing the magnet 32 to approach the Hall effect sensors
38 and 40. Since the distance between the magnet 32 and each of the
Hall effect sensors 38 and 40 decreases, both Hall effect sensors
38 and 40 produce an increase in their output electric current When
a force is exerted on the tip 28 sideways in the plane of the Hall
effect sensors 38 and 40, the tip 28 rotates around the location
where the rod 30 engages the spring disk 34, as is shown in FIG.
1A. This causes the magnet 32 to rotate away from the Hall effect
sensor 40 and closer to the Hall effect sensor 38. The output
electric current of the Hall effect sensor 40 typically decreases
and the output electric current of the Hall effect sensor 38
typically correspondingly increases. Thus, it may be appreciated
that the tip sensor 11 enables electronic circuitry (not shown) to
measure the amplitude and the direction of force exerted on the tip
28 in the plane of the Hall effect sensors 38 and 40 and to compute
the orientation of a surface of a tissue against which the sensor
tip 28 is depressed, relative to the axis of symmetry 42.
[0066] It is appreciated that sensors other than Hall effect
sensors can be used to measure the direction and the amplitude of
the force exerted on the tip 28, or otherwise to measure the
proximity and the orientation of the adjacent surface.
[0067] During automatic operation of the system, following partial
insertion of the intubator assembly 12 into the oral cavity, as
shown in FIG. 1A, the guide driver 15 typically causes the guide 20
to extend in the direction of the trachea 44 and bends the guide 20
clockwise until the tip 28 engages a surface of the tongue 46. This
engagement applies a force to tip 28, which causes the tip to
rotate counterclockwise wherein the magnet 32 approaches the Hall
effect sensor 38. Electronic circuitry (not shown) inside the
housing 14, which measures the changes in the electrical outputs
produced by the Hall effect sensors 38 and 40, indicates that the
tip 28 is bent clockwise.
[0068] By sensing the position of the tip and employing the past
history of tip positions, the system of the present invention
determines the location of the tip sensor 11 in the oral cavity and
relative to the map 10. This location is employed in order to
navigate the intubator correctly, as described hereinbelow.
[0069] Reference is now made to FIG. 1B, which illustrates a
further step in the intubation in accordance with the present
invention. FIG. 1B shows the guide 20 extended further and reaching
an area between the base of the tongue 46 and the epiglottis 48 of
the patient
[0070] As seen in FIG. 1C, the guide 20 extends further forward
until the tip 28 touches the end of the trough beneath the
epiglottis 48.
[0071] As seen in FIG. 1D, the guide 20 bends counterclockwise and
touches the bottom surface of the epiglottis 48. Then the guide 20
retracts a little, while preserving continuous tactile contact
between the tip 28 with the bottom surface of the epiglottis
48.
[0072] As seen in FIG. 1E, the guide 20 retracts further until the
tip 28 of the tip sensor 11 reaches the tip 165 of the epiglottis
48 and then the tip 28 loses tactile contact with the surface of
the tip 165 of the epiglottis 48.
[0073] As seen in FIG. 1F, the guide 20 bends further
counterclockwise, then extends forward and then bends clockwise
until the tip 28 touches the upper surface of the epiglottis
48.
[0074] As seen in FIG. 1G, the guide 20 extends forward, preserving
continuous tactile contact with the epiglottis 48, until the tip 28
senses the first trough of the trachea 44.
[0075] As seen in FIGS. 1H and 1I the guide 20 extends further
forward until the tip 28 senses the second trough of the trachea
44.
[0076] As seen in FIGS. 1J and 1K, the guide 20 extends further
forward until the tip 28 senses the trough of the third cartilage
of the trachea 44. Then the guide 20 further extends, typically for
adults by 5 centimeters, to ensure that the tube 16 reaches to the
third cartilage.
[0077] As seen in FIG. 1L, the guide driver 15 is pulled out with
the guide 20 leaving the mouthpiece 16 and the tube 18 inside the
patient's mouth and trachea 44.
[0078] Reference is now made to FIGS. 2A to 2F, which, taken
together, area flowchart of the process of the intubation of a
human shown in FIGS. 1A to 1K.
[0079] FIG. 2A and 2B, taken together, correspond to the step of
the intubation process shown in FIG. 1A.
[0080] In step 100 of FIG. 2A the intubator assembly 12 is set to
perform intubation
[0081] In step 102 the intubator loads an intubation pattern map 10
from its memory.
[0082] In steps 104, 106 and 108 the intubator enables the operator
to set the scale of the intubation pattern map to the corresponding
size of the patient by selecting between an infant a child and an
adult.
[0083] In steps 110, 112 and 114 the intubator enables the operator
to adapt the intubation pattern map 10 to a type of intubation
impediment, preferably by selecting from a menu. As seen in FIG. 2A
the menu typically provides the operator with four optional
impediments: an infection, a swelling, a tumor and an injury, and a
fifth option not to select any impediment. It is appreciated that
various types of impediments can be defined as is typical for a
specific organ.
[0084] As seen in FIG. 2B, steps 120, 122, 124, 126, 128 and 130
cause the guide 20 to extend in the direction of the throat and
simultaneously bend clockwise until the tip sensor is depressed
against the surface of the tongue or until extension and bending
limits are reached. As seen in step 128, the bending limit is
preferably 50 degrees and the extension limit is preferably 2
centimeters. If the tip sensor is depressed, the scale of the
intubation pattern map 10 is preferably updated (step 132) to match
the particular scale or size of the intubated patient If at least
one of the extension limit and the bending limit is reached an
error message is displayed (step 134) and the intubation process is
stopped.
[0085] Reference is now made to FIG. 2C, which corresponds to FIGS.
1B and 1C. As illustrated in FIG. 2C, the guide driver 15 performs
sequential steps 140, 142, 144 and 146 in a loop, extending (step
140) guide 20 further into the patient's throat and along the
throat surface, following the intubation pattern map 10 and keeping
the tip in contact with the surface (steps 144, 146). When the
output electric currents from both Hall effect sensors 38 and 40
increase, the intubator assumes (step 142) that the tip 28 has
reached the end of the trough beneath the epiglottis 48. The point
of engagement between the tip 28 and the body is designated in FIG.
1C by reference numeral 147. The scale of the intubation pattern
map 10 is then preferably updated to match the patient's organ
structure (step 148).
[0086] Reference is now made to FIG. 2D, which corresponds to FIGS.
1D and 1E. As seen in FIG. 2D the guide driver 15 performs steps
150, 152 and 154 in a loop, bending the distal end of the guide 20
counterclockwise until the tip 28 touches the epiglottis 48, or
until a bending limit, preferably of 45 degrees is reached (step
154) and the intubation stops (step 156). The preferred point of
engagement between the tip 28 and the surface of the epiglottis is
designated in FIG. 1D by reference numeral 155. After sensing an
engagement between the tip 28 and the surface of the epiglottis,
the guide driver 15 performs steps 158, 160, 162, and 164 in a
loop, retracting the guide 20 further (step 158), and increasing
the bending of the guide 20 (step 164), until the tip of the guide
reaches the tip of the epiglottis 48, designated in FIG. 1E by
reference numeral 165. When the tip 28 reaches the tip of the
epiglottis 48, the tip 28 is released and the output electric
currents from both Hall effect sensors decrease to a minimum.
Preferably the intubation pattern map 10 is updated (step 166) to
match the patient's organ structure.
[0087] Reference is now made to FIG. 2E, which corresponds to FIGS.
1E and 1F. As seen in FIG. 2E, the guide driver 15 causes the guide
20 to move above and around the tip of the epiglottis 48 by causing
the guide 20 to bend counterclockwise, preferably by 45 degrees,
then to move forward down the throat by 5 millimeters and then to
bend clockwise, preferably by 10 degrees (Step 170). Then the guide
driver 15 performs steps 172, 174 and 176 in a loop, bending and
extending (step 174) until the tip 28 of the guide touches the
upper surface of the epiglottis 48 or until an extension limit,
preferably of 1 centimeter, or a bending limit, preferably of 50
degrees, is reached, and the intubation is stopped (step 178). A
preferred point of engagement between the tip 28 and the epiglottis
is designated in FIG. 1F by reference numeral 177.
[0088] Reference is now made to FIG. 2F, which corresponds to FIGS.
1G to 1K. As seen in FIG. 2F, "a cartilage crest counter N" is
first zeroed (step 180): Then the guide driver 15, performing steps
182 to 198 in a loop, causes the guide 20 to move the sensor tip 11
forward (step 182) along the surface of the trachea 44, preserving
contact between the tip 28 and the surface of the trachea (steps
186 and 188) by increasing the bend (step 188) as needed. Each time
a crest (189 in FIGS. 1H, 1I, 1J) of a cartilage of the trachea 44
is located the "cartilage crest counter" is incremented (step 190),
the tip 28 is moved about the crest (steps 192, 194, 196 and 198)
and the loop process repeats until the third cartilage is located.
Then the guide 20 further extends, typically for adults by 5
centimeters, to ensure that the tube 16 reaches to the third
cartilage. The guide driver 15 then signals to the operator that
the insertion is completed successfully (step 200).
[0089] Reference is now made to FIG. 3, which is a simplified
illustration of the internal structure of a preferred embodiment of
the present invention useful for intubation of a human. The
intubator assembly 12 preferably comprises the housing 14, the
guide driver 15, the mouthpiece 16, the tube 18, the flexible guide
20 inserted inside the tube 18 and the tip sensor 11 mounted at the
distal end of the guide 20. Preferably the mouthpiece comprises a
curved pipe 24.
[0090] Preferably, the guide driver 15 comprises a first motor 210
that drives a gearbox 212 that rotates a threaded rod 214. A
floating nut 216 is mounted on the threaded rod 214. As the motor
210 rotates the threaded rod 214, the floating nut 216 is moved
forward or backward according to the direction of the rotation. The
floating nut 216 is operative to move a carriage 218 along a bar
220 and thus to push or pull the guide 20. When the carriage 218
touches a stopper 222 the stopper 222 moves with the carriage 218
along the bar 220 and pushes the tube 18 forward.
[0091] A second motor 224 is connected to a disk 226 to which two
guide angulation wires 228 are attached at first end thereof. The
guide angulation wires 228 are threaded inside the guide 20 and
their other ends are connected to the distal end of the guide just
short of the tip sensor 11. When the motor 224 rotates the disk 226
clockwise one of the wires 228 is pulled and the second wire is
loosened. The wire that is pulled pulls and bends the distal end of
the guide 20 counterclockwise in the sense of FIG. 3. Accordingly,
when the motor 224 rotates counter-clockwise the second wire of the
two wires 228 is pulled and the first wire is loosened. The wire
that is pulled pulls and bends the distal end of the guide 20
clockwise in the sense of FIG. 3.
[0092] Electronic circuitry 229 is provided within the housing 14
and is preferably electrically connected to operating switches 230,
a display 232, the motors 210 and 224 and to the Hall effect
sensors 38 and 40 (FIG. 1A) in the tip sensor 11. Preferably, the
electronic circuitry 229 also comprises a microprocessor, operative
to execute a program. The program is preferably adapted to control
the switches 230, the display 232, motors 210 and 224 and the Hall
effect sensors 38 and 40 and to insert and bend the guide inside a
living organism, according to a predefined map until the tip of the
guide reaches a destination point inside the living organism.
Preferably the program is operative to cause the tip 28 of the
guide 20 to follow a predefined internal contour of an organ of the
living organism Preferably program is operative employ tactile
sensing to measure the position of the tip of the guide relative to
the surface organ of the living organism.
[0093] It is appreciated that the term "microprocessor" also
includes inter alia a "microcontroller".
[0094] Electrical batteries (not shown) are preferably provided
within the housing 14 to supply electric power to the electronic
circuitry, the tip sensor 11, the motors 210 and 224, the display
232 and all other elements of the present invention that consume
electricity. It is appreciated that external sources of electricity
can also be employed to provide power to the intubator assembly
12.
[0095] Communication interface (not shown), preferably employing
infra-red communication technology, is provided to enable
communication with external data processing equipment.
[0096] Preferably, a balloon 234 is provided at the distal end of
the tube 18 and a thin pipe (not shown) is inserted through the
pipe IS and is connected, through the side of the pipe, to the
balloon. The thin pipe enables an operator to inflate the balloon
when the distal end of the pipe 18 reaches the appropriate place in
the trachea, thus securing the distal end of the pipe to the
trachea.
[0097] Reference is now made to FIG. 4, which is a simplified
factional block diagram of a preferred embodiment of the guide
driver 15 described hereinabove. In FIG. 4 the guide 20 is driven
by two drivers. A longitudinal driver 240 preferably comprises a
motor 210, the gear 212, the threaded rod 214, the floating nut 146
and the carriage 218 of FIG. 3. A bending guide driver 242
preferably comprises the motor 224, the disk 226 and wires 228
(FIG. 3). The longitudinal driver 240 and the bending guide driver
242 are controlled by two software driver modules. A longitudinal
software driver module 244 controls the longitudinal driver 240 and
comprises two functions: an extend function 246 and a retract
function 248. A bending software driver 250 controls the bending
guide driver 242 and comprises two functions: a bend
counterclockwise function 252 and a bend clockwise function 254.
The functions 246, 248, 252 and 254 are operated by a propagation
control software module 256.
[0098] At the other end of the guide 20, the tip sensor 11 measures
the proximity and orientation of an adjacent surface. In a
preferred embodiment of the present invention the tip sensor 11
performs the proximity and orientation measurements by measuring
the force applied to a tactile tip by a surface of an adjacent
tissue. A tip sensor software driver module 260, operative to
receive input signals from the tip sensor 11, provides two input
functions: a counterclockwise tip rotation function 262 and a
clockwise tip rotation function 264. The measurements of the tip
positions as provided by the tip sensor software driver module 260
are collected and stored by a sensor log module 266.
[0099] The map 10 is loaded into memory and serves as an updatable
map 268. A comparator 270 compares the accumulated measurements
from the tip sensor 11 with the updated reference map 268. The
results of the comparisons are calculated by an update scale module
272 to provide a scaling factor that is applied to update the
updated map 268. Consequently a navigation module 274 employs the
updated map information to instruct the propagation control 256 to
execute the next step of the insertion program.
[0100] It is appreciated that a measurement of the electric current
drawn by at least one of the longitudinal guide drive and the
bending guide drive can also serve as an input to the comparator
270 to evaluate the position of the tip sensor.
[0101] Reference is now made to FIGS. 5A to 5H, which are, taken
together, an electrical schematic of a preferred embodiment of the
present invention useful for intubation of a human. Reference is
especially made to microprocessor 278, which is preferably
operative to operate a program to control the elements of the
intubator assembly 12, such as the operating switches 230, the
display 232, the motors 210 and 224 (FIG. 3), and the Hall effect
sensors 38 and 40 in the tip sensor 11 (FIG. 1A), and to perform
the intubation process, such as the process shown and described
hereinabove with reference to FIGS. 2A to 2F.
[0102] Reference is now made to FIGS. 6A to 6K, which are a series
of simplified pictorial illustrations of ten typical steps in a
process of employing a preferred embodiment of the present
invention useful for insertion of an element into the intestine of
a human.
[0103] It is appreciated that some of the organ systems of a living
organism are generally similar up to a scale factor, such as the
mouth and trachea system Other organs, such as the intestine
system, are generally different from one human body to the other.
Therefore, in order to employ the present invention to insert a
medical device or apply a medicine to a specific location within a
generally variable organ, a map of the organ, at least from the
entry point and until the required location, is prepared before the
insertion process is activated. The required map is preferably
prepared by employing an appropriate medical imaging system, such
as an ultrasound scanner, an x-ray imager, a CAT scan system or a
MRI system. The map can be a two dimensional map or a
three-dimensional map as appropriate for the specific organ.
Typically for the intestine system a three dimensional map is
required.
[0104] It is appreciated that an inserter according to a preferred
embodiment of the present invention for use in organs that are
variable in three dimensions is similar to the intubator assembly
12, preferably with the following modifications:
[0105] (1) The tube 18 may be replaced with a different insertable
device;
[0106] (2) An additional guide bending system employing elements
similar to motor 222, disk 224 and wires 226 is added and mounted
perpendicularly to the first system of motor 222, disk 224 and
wires 26, so that it is possible to bend the end of the guide in
three dimensions. It is appreciated that three-dimensional
manipulation is possible also by employing three or more motors;
and
[0107] (3) The tip sensor 11 preferably comprises four Hall effect
sensors to sense the motion of the tip 28 in three dimensions. It
is appreciated that it is possible to operate the tip sensor in a
three-dimensional space also by employing three Hall effect
sensors. It is also appreciated that other types of sensors can be
employed to measure the proximity and orientation of an adjacent
surface in three dimensions.
[0108] In a preferred embodiment of the present invention, when the
guide 20 performs longitudinal motion, such as insertion or
retraction, the guide 20 also performs a small and relatively fast
lateral motion. The combined longitudinal and lateral motions are
useful for sensing the surface of the organ in three dimensions and
hence to better determine the location of the tip sensor 11 in the
organ and relative to the map 10.
[0109] Due to limitations of the graphical representation, a
two-dimensional imaging and map is shown in FIGS. 6A to 6K.
[0110] As seen in FIG. 6A, a human organ, the intestine in this
example, is imaged, typically by a CAT scan system 280, and an
image 282 of the internal structure of the organ is produced.
[0111] In FIG. 6B the image 282 of the organ is used to create an
insertion map 284. Typically the image 282 is displayed on a
computer screen (not shown) and a pointing device, such as a
computer mouse or a light pen, is used to draw a preferred path 286
that the tip of the guide is to follow. The path is typically drawn
by marking a contour of the organ, and optionally marking the guide
bending points, as is shown and described with reference to FIGS.
1A to 1K Alternatively, a preferred path is created, such as path
286, not necessarily continuously following the contours of the
organ. As a further alternative, the map 10 or the path 286 is
converted into a set of insertion steps as is shown and described
hereinbelow with reference to FIG. 7.
[0112] Reference is now made to FIG. 7 together with FIG. 8 and
with FIGS. 6C to 6K. As shown in FIG. 7, a table 290 is provided
for storage in a computer memory and for processing by a computer
processor. The table 290 contains rows 292, wherein each row 292,
preferably comprises an instruction to perform one step in the
process of insertion of a medical insertion device into a living
organism such as shown and described with reference to FIGS. 6C to
6K Preferably each row 292 contains the expected values or the
maximal values for the extension of an insertion guide such as
guide 20, the bending of the insertion guide and the electrical
outputs from the Hall effect sensors 38 and 40 (FIG. 1A). In a
preferred embodiment of the present invention the row 292 contains
five sets of values:
[0113] (a) Initial bend 294 contains two values for bending the
guide from a straight position, in two perpendicular planes.
[0114] (b) Initial insertion 295 contains a longitudinal value for
extending or retracting the guide in centimeters.
[0115] (c) Initial sensor measurements 296 contains expected output
values of four sensors such as four Hall effect sensors, for
example, Hall effect sensors 38 and 40 of FIG. 1A. The initial
sensors measurements 296 are expected to be measured by the time
the guide reaches the value of the initial insertion 295.
[0116] (d) Insert distance 297 contains a longitudinal value for
further extending or retracting the guide in centimeters. Typically
the initial sensor measurements 296 are expected to be preserved,
while the guide is extended or retracted, by adapting the bending
of the guide.
[0117] (e) Final sensor measurements 298 contain expected output
values of the four sensors of step (c). The initial sensor
measurements 298 are expected to be measured by the time the guide
reaches the value of the insert distance 297.
[0118] It is appreciated that the path drawn in FIG. 6B can be
employed to prepare a table of instructions, such as table 290 of
FIG. 7.
[0119] Referring to FIG. 8, which is a flowchart illustrating a
preferred implementation of the present invention, operative for a
process of insertion of an element into the intestine of a human as
shown in FIGS. 6A to 6K The flowchart of FIG. 8 is a preferred
embodiment of a program, operative to be executed by a processor,
such as microprocessor 278 of FIG. 5A, comprised in a preferred
embodiment of the present invention, for insertion of an element
into a living organism, preferably by employing a table 290 shown
and described with reference to FIG. 7.
[0120] The preferred flowchart shown in FIG. 8 starts by loading
the table (step 300) such as the map shown in FIG. 7. The program
then reads a first row 292 from the map (step 302) and causes the
distal end of the guide 20 to bend according to the initial bending
values 294. Then the program causes the guide 20 to extend or
retract according to the initial insertion distance 295 of the
first row in the map. The program continues to bend and insert the
guide 20 until output values of the sensors match the expected
initial sensor measurement 296 of the row (steps 304, 306 and 308),
or until a limit is surpassed, an error message is displayed and
the program is stopped (step 310).
[0121] Preferably, the initial values of the sensors are measured
and then the program continues to extend or retract the guide 20
(step 312) until the sensors produce the final sensors measurements
298 values (step 314), while keeping in contact with the surface
(steps 316 and 318) or until at least one of predefined limits is
surpassed (step 320) where the program is stopped (step 310). If
the final sensor measurements 298 values are measured the program
proceeds to step 320 and loops through steps 302 and 320 until all
the rows 292 of the table are processed. Then the program displays
an insertion success message on the display 232 and halts (step
322).
[0122] As indicated by row No. 1 of FIG. 7 and FIG. 6C the guide is
bent, preferably by up to 45 degrees, to the left in the plane of
FIG. 6C and, while preserving contact with the left side of the
intestine, is extended up to 5 centimeters or until the sensor tip
engages the internal surface of the intestine head on at a point in
the map 284 designated by reference numeral 330.
[0123] As indicated by row No.2 of FIG. 7 and FIG. 6D the guide is
bent by up to 45 degrees to the right in the plane of FIG. 6D and,
while preserving contact with the left side of the intestine, is
extended up to 2.5 centimeters or until the sensor tip does not
sense the internal surface of the intestine at a point in the map
284 designated by reference numeral 332.
[0124] As indicated by row No.3 of FIG. 7 and FIG. 6E the guide is
bent by up to 110 degrees to the left in the plane of FIG. 6E and,
while preserving contact with the left side of the intestine, is
extended by 1 centimeter to a point in the map 284 designated by
reference numeral 334.
[0125] In accordance with row 4 of FIG. 7 and FIG. 6F the guide is
bent by up to 45 degrees to the right in the plane of FIG. 6F and
is extended by 6 centimeter to a point in the map 284 designated by
reference numeral 336.
[0126] As indicated by row No.5 of FIG. 7 and FIG. 6G the guide is
bent by up to 20 degrees to the right in the plane of FIG. 5G and,
while preserving contact with the right side of the intestine, is
extended by 4 centimeters to a point in the map 284 designated by
reference numeral 338.
[0127] As indicated by row No.6 of FIG. 7 and FIG. 6H the guide is
bent by up to -60 degrees to the left in the plane of FIG. 6H and
is extended by up to 3 centimeters or until the sensor tip engages
the internal surface of the intestine head on at a point in the map
284 designated by reference numeral 340.
[0128] As indicated by row No.7 of FIG. 7 and FIG. 61 the guide is
bent by up to 45 degrees to the right in the plane of FIG. 6I and
is extended by up to 1 centimeter or until the sensor tip engages
the internal surface of the intestine with its right side in a
point in the map 284 designated by reference numeral 342.
[0129] As indicated by row No.8 of FIG. 7 and FIG. 6J the guide is
extended by up to 1 centimeters or until the sensor tip engages the
internal surface of the intestine with its left side at a point in
the map 284 designated by reference numeral 344.
[0130] As indicated by row No.9 of FIG. 7 and FIG. 6K the guide is
bent by up to 45 degrees to the right in the plane of FIG. 6K and
is extended by up to 1 centimeter or until the sensor tip engages
the internal surface of the intestine head on at a point in the map
284 designated by reference numeral 346.
[0131] In a preferred embodiment of the present invention the
system and the method are operative for automatic operation.
Alternatively the present invention can be operated manually, by
providing to the operator the information collected by the sensor
log 266 form the tip sensor 11 and enabling the operator to control
manually the guide 20. In another alternative part of the procedure
is performed automatically and another part is performed manually.
For example, the guide 20 may be inserted automatically and a
medical device, such as the tube 18 may be inserted manually.
[0132] It is appreciated that a log of the process of insertion of
an insertable element into a living organism such as a human body
is preferably stored in an internal memory of the present invention
and that this log can be transmitted to a host computer. It is
appreciated that the host computer can aggregate insertion process
logs and thereby continuously improve relevant insertion pattern
maps such as the standard contour map 10. Thereafter, from time to
time or before starting an insertion process, the present invention
is capable of loading an updated map such as standard contour map
10.
[0133] It is also appreciated that the accumulated logs of
processes of insertions can be employed to improve the algorithm
for processing the maps, such as the algorithms shown and described
with reference to FIGS. 2A-2F and FIG. 8. The improved algorithm
can be transmitted to the present invention as necessary.
[0134] Reference is now made to FIGS. 9A to 9F, which are a series
of simplified pictorial illustrations of an extendable endotracheal
tube assembly constructed and operative in accordance with a
preferred embodiment of the present invention, in various operative
orientations.
[0135] Turning to FIG. 9A, it is seen that the extendable
endotracheal tube assembly, designated generally by reference
numeral 400, preferably comprises a mounting element 402 which is
arranged to be removably engaged with an intubator assembly (not
shown) such as intubator assembly 12 (FIGS. 1A-1L). Fixed to or
integrally formed with mounting element 402 is a mouthpiece 404,
which is preferably integrally formed with a rigid curved pipe 406.
Fixedly mounted onto mounting element 402, interiorly of rigid
curved pipe 406, is a mounting base 408 onto which is, in turn,
mounted, an extendable tube 410, preferably including a coil spring
411, typically formed of metal. Fixedly mounted onto a distal end
of extendable tube 410 there is preferably provided a forward end
member 412, preferably presenting a diagonally cut pointed forward
facing tube end surface 414.
[0136] Upstream of end surface 414, forward end member 412 is
preferably provided with an inflatable and radially outwardly
expandable circumferential balloon 416, which receives inflation
gas, preferably pressurized air, preferably through a conduit 418
embedded in a wall of forward end member 412 and continuing through
tube 410 to a one way valve 419.
[0137] It is noted that the extendable endotracheal tube assembly
400 may comprise an integrally formed mouthpiece assembly and an
integrally formed insertable extendable tube assembly. The
integrally formed mouthpiece assembly may comprise the mouthpiece
404 and the rigid curved pipe 406. The integrally formed extendable
tube assembly may comprise the extendable tube 410, the mounting
element 402, the mounting base 408, the coil spring 411, the
forward end member 412 with the end surface 414 and the
circumferential balloon 416, the conduit 418 and the one way valve
419.
[0138] Extending slidably through forward end member 412, tube 410,
mounting base 408 and mounting element 402 is a flexible guide 420,
which preferably corresponds in function inter alia to guide 20 in
the embodiment of FIGS. 1A-1L and preferably has mounted at a
distal end thereof a tip 421, which preferably corresponds in
structure and function inter alia to the tip 28 in the embodiment
of FIGS. 1A-1L. Tip 421 forms part of a tip sensor, preferably
enclosed in guide 420, which preferably corresponds in structure
and function inter alia to the tip sensor 11 in the embodiment of
FIGS. 1A-1L.
[0139] As distinct from that described hereinabove with reference
to FIGS. 1A-8, the flexible guide is preferably formed with an
inflatable and radially outwardly expandable balloon 422, which
receives inflation gas, preferably pressurized air, preferably
through a conduit 424 formed in flexible guide 420 and extending
therealong, preferably to a source of pressurized inflation gas,
preferably located within the intubator assembly (not shown).
[0140] FIG. 9B shows inflation of balloon 422 by means of
pressurized air supplied via conduit 424, causing balloon 422 to
tightly engage the interior of forward end member 412.
[0141] FIG. 9C illustrates extension of tube 410, which is
preferably achieved by forward driven movement of flexible guide
420 in tight engagement with forward end member 412, thus pulling
forward end member 412 and the distal end of tube 410 forwardly
therewith.
[0142] FIG. 9D illustrates inflation of balloon 416 by means of
pressurized air through one way valve 419 and conduit 418. As will
be described hereinbelow, this inflation is employed for sealing
the tube 410 within a patient's trachea.
[0143] FIG. 9E illustrates deflation of balloon 422 following
inflation of balloon 416, corresponding to desired placement and
sealing of tube 410 within the patient's trachea. FIG. 9F
illustrates removal of the flexible guide 420 from the tube
410.
[0144] Reference is now made to FIGS. 10A to 10G, which are a
series of simplified pictorial illustrations of the extendable
endotracheal tube assembly of FIGS. 9A-9F employed with the medical
insertion device of FIGS. 1A-8 for the intubation of a human.
[0145] Turning to FIG. 10A, it is seen that the extendable
endotracheal tube assembly, designated generally by reference
numeral 500, preferably comprises a mounting element (not shown)
which is arranged to be removably engaged with an intubator
assembly 503 which is preferably similar to intubator assembly 12
(FIGS. 1A-1L) or any other intubator assembly described hereinabove
but may alternatively be any other suitable intubator assembly.
Fixed to or integrally formed with the mounting element is a
mouthpiece 504, which is preferably integrally formed with a rigid
curved pipe 506. The extendable entotracheal tube assembly 500 is
shown inserted into a patient's oral cavity, similar to the
placement shown in FIG. 1A.
[0146] Fixedly mounted onto the mounting element, interiorly of
rigid curved pipe 506, is a mounting base 508 onto which is, in
turn, mounted, an extendable tube 510, preferably including a coil
spring 511 (FIG. 10C), typically formed of metal. Fixedly mounted
onto a distal end of extendable tube 510 there is preferably
provided a forward end member 512, preferably presenting a
diagonally cut pointed forward facing tube end surface 514.
[0147] Upstream of end surface 514, forward end member 512 is
preferably provided with an inflatable and radially outwardly
expandable circumferential balloon 516, which receives inflation
gas, preferably pressurized air, preferably through a conduit 518
embedded in a wall of forward end member 512 and continuing through
tube 510 to a one way valve 519.
[0148] It is noted that the extendable endotracheal tube assembly
500 may comprise a mouthpiece assembly and an extendable tube
assembly, which is inserted therein. The mouthpiece assembly
comprises the mouthpiece 504, which is integrally formed with the
rigid curved pipe 506. The extendable tube assembly comprises the
extendable tube 510, which is integrally formed together with the
mounting element, the mounting base 508, the coil spring 511, the
forward end member 512 with the end surface 514 and the
circumferential balloon 516, the conduit 518 and the one way valve
519.
[0149] Extending slidably through forward end member 512, tube 510,
mounting base 508 and the mounting element is a flexible guide 520,
which preferably corresponds in function inter alia to guide 20 in
the embodiment of FIGS. 1A-1L and preferably has mounted at a
distal end thereof a tip, which preferably corresponds in structure
and function inter alia to the tip 28 in the embodiment of FIGS.
1A-1L. The tip forms part of a tip sensor, preferably enclosed in
guide 520, which preferably corresponds in structure and function
inter alia to the tip sensor 1I in the embodiment of FIGS.
1A-1L.
[0150] As distinct from that described hereinabove with reference
to FIGS. 1A-8, the flexible guide is preferably formed with an
inflatable and radially outwardly expandable balloon 522, which
receives inflation gas, preferably pressurized air, preferably
through a conduit 524 formed in flexible guide 520 and extending
therealong, preferably to a source of pressurized inflation gas
preferably located within the intubator assembly 503.
[0151] The source of pressurized inflation gas may be an automatic
inflator/deflator 526. Additionally or alternatively, a one way
valve 528 may be provided for manual inflation. The automatic
inflator/deflator 526 may be fixed within intubator assembly 503 or
alternatively may be mounted therewithin for motion together with
flexible guide 520.
[0152] FIG. 10B shows inflation of balloon 522 by means of
pressurized air supplied via conduit 524, causing balloon 522 to
tightly engage the interior of forward end member 512.
[0153] FIG. 10C illustrates extension of tube 510, which is
preferably achieved by forward driven movement of flexible guide
520 in tight engagement with forward end member 512, thus pulling
forward end member 512 and the distal end of tube 510 forwardly
therewith.
[0154] FIG. 10D illustrates further extension of tube 510, by
forward driven movement of flexible guide 520 in tight engagement
with forward end member 512, thus pulling forward end member 512
and the distal end of tube 510 forwardly therewith. This further
motion is preferably provided based on the navigation functionality
described hereinabove with reference to FIGS. 1A-8. It is
appreciated that the forward driven movement of tube 510 as
described hereinabove with reference to FIGS. 1A-8, may be provided
by driven forward motion of the flexible guide 520.
[0155] FIG. 10E illustrates inflation of balloon 516 by means of
pressurized air through conduit 518 and one way valve 519. As will
be described hereinbelow, this inflation is employed for sealing
the tube 510 within a patient's trachea.
[0156] FIG. 10F illustrates deflation of balloon 522 following
inflation of balloon 516, corresponding to desired placement and
sealing of tube 510 within the patient's trachea. FIG. 10G
illustrates removal of the flexible guide 520 from the tube
510.
[0157] Reference is now made to FIGS. 11A to 11F, which are a
series of simplified pictorial illustrations of an extendable
endotracheal tube assembly constructed and operative in accordance
with another preferred embodiment of the present invention in
various operative orientations.
[0158] Turning to FIG. 11A, it is seen that the extendable
endotracheal tube assembly, designated generally by reference
numeral 600, preferably comprises a mounting element 602 which is
arranged to be removably engaged with an intubator assembly (not
shown) such as intubator assembly 12 (FIGS. 1A-1L). Fixed to or
integrally formed with mounting element 602 is a mouthpiece
604.
[0159] Fixedly mounted onto mounting element 602 is a mounting base
608 onto which is, in turn, mounted, an extendable tube 610,
preferably including a coil spring 611, typically formed of metal.
Fixedly mounted onto a distal end of extendable tube 610 there is
preferably provided a forward end member 612, preferably presenting
a diagonally cut pointed forward facing tube end surface 614.
[0160] Upstream of end surface 614, forward end member 612 is
preferably provided with an inflatable and radially outwardly
expandable circumferential balloon 616, which receives inflation
gas, preferably pressurized air, preferably through a conduit 618
embedded in a wall of forward end member 612 and continuing through
tube 610 to a one way valve 619.
[0161] It is noted that the extendable endotracheal tube assembly
600, comprising at least one of mounting element 602, mouthpiece
604, mounting base 608, tube 610, coil spring 611, forward end
member 612, end surface 614, circumferential balloon 616, conduit
618 and one way valve 619, may also be integrally formed as a
unified structure.
[0162] Extending slidably through forward end member 612, tube 610,
mounting base 608 and mounting element 602 is a flexible guide 620,
which preferably corresponds in function inter alia to guide 20 in
the embodiment of FIGS. 1A-1L and preferably has mounted at a
distal end thereof a tip 621, which preferably corresponds in
structure and function inter alia to the tip 28 in the embodiment
of FIGS. 1A-1L. Tip 621 forms part of a tip sensor (not shown),
preferably enclosed in guide 620, which preferably corresponds in
structure and function inter alia to the tip sensor 11 in the
embodiment of FIGS. 1A-1L.
[0163] As distinct from that described hereinabove with reference
to FIGS. 1A-8, the flexible guide is preferably formed with an
inflatable and radially outwardly expandable balloon 622, which
receives inflation gas, preferably pressurized air, preferably
through a conduit 624 formed in flexible guide 620 and extending
therealong, preferably to a source of pressurized inflation gas
preferably located within the intubator assembly (not shown).
[0164] FIG. 11B shows inflation of balloon 622 by means of
pressurized air supplied via conduit 624, causing balloon 622 to
tightly engage the interior of forward end member 612.
[0165] FIG. 11C illustrates extension of tube 610, which is
preferably achieved by forward driven movement of flexible guide
620 in tight engagement with forward end member 612, thus pulling
forward end member 612 and the distal end of tube 610 forwardly
therewith.
[0166] FIG. 11D illustrates inflation of balloon 616 by means of
pressurized air through conduit 618 and one way valve 619. As will
be described hereinbelow, this inflation is employed for sealing
the tube 610 within a patient's trachea.
[0167] FIG. 11E illustrates deflation of balloon 622 following
inflation of balloon 616, corresponding to desired placement and
sealing of tube 610 within the patient's trachea. FIG. 11F
illustrates removal of the flexible guide 620 from the tube
610.
[0168] Reference is now made to FIGS. 12A to 12G, which are a
series of simplified pictorial illustrations of the extendable
endotracheal tube assembly of FIGS. 11A-11F employed with the
medical insertion device of FIGS. 1A-8 for the intubation of a
human.
[0169] Turning to FIG. 12A, it is seen that the extendable
endotracheal tube assembly, designated generally by reference
numeral 700, preferably comprises a mounting element (not shown)
which is arranged to be removably engaged with an intubator
assembly 703 which is preferably similar to intubator assembly 12
(FIGS. 1A-1L) or any other intubator assembly described hereinabove
but may alternatively be any other suitable intubator assembly.
Fixed to or integrally formed with the mounting element is a
mouthpiece 704. The extendable entotracheal tube assembly 700 is
shown inserted into a patient's oral cavity, similar to the
placement shown in FIG. 1A.
[0170] Fixedly mounted onto the mounting element is a mounting base
708 onto which is, in turn, mounted, an extendable tube 710,
preferably including a coil spring 711 (FIG. 12C), typically formed
of metal. Fixedly mounted onto a distal end of extendable tube 710
there is preferably provided a forward end member 712, preferably
presenting a diagonally cut pointed forward facing tube end surface
714.
[0171] Upstream of end surface 714, forward end member 712 is
preferably provided with an inflatable and radially outwardly
expandable circumferential balloon 716, which receives inflation
gas, preferably pressurized air, preferably through a conduit 718
embedded in a wall of forward end member 712 and continuing through
tube 710 to a one way valve 719.
[0172] It is noted that the extendable endotracheal tube assembly
700, comprising at least one of mounting element, mouthpiece 704,
mounting base 708, tube 710, coil spring 711 (FIG. 12C), forward
end member 712, end surface 714, circumferential balloon 716,
conduit 718 and one way valve 719, may also be integrally formed as
a unified structure.
[0173] Extending slidably through forward end member 712, tube 710,
mounting base 708 and the mounting element is a flexible guide 720,
which preferably corresponds in function inter alia to guide 20 in
the embodiment of FIGS. 1A-1L and preferably has mounted at a
distal end thereof a tip, which preferably corresponds in structure
and function inter alia to the tip 28 in the embodiment of FIGS.
1A-1L. The tip forms part of a tip sensor, preferably enclosed in
guide 720, which preferably corresponds in structure and function
inter alia to the tip sensor 11 in the embodiment of FIGS.
1A-1L.
[0174] As distinct from that described hereinabove with reference
to FIGS. 1A-8, the flexible guide is preferably formed with an
inflatable and radially outwardly expandable balloon 722, which
receives inflation gas, preferably pressurized air, preferably
through a conduit 724 formed in flexible guide 720 and extending
therealong, preferably to a source of pressurized inflation gas
preferably located within the intubator assembly 703.
[0175] The source of pressurized inflation gas may be an automatic
inflator/deflator 726. Additionally or alternatively, a one way
valve 728 may be provided for manual inflation. The automatic
inflator/deflator 726 may be fixed within intubator assembly 703 or
alternatively may be mounted therewithin for motion together with
flexible guide 720.
[0176] FIG. 12B shows inflation of balloon 722 by means of
pressurized air supplied via conduit 724, causing balloon 722 to
tightly engage the interior of forward end member 712.
[0177] FIG. 12C illustrates extension of tube 710, which is
preferably achieved by forward driven movement of flexible guide
720 in tight engagement with forward end member 712, thus pulling
forward end member 712 and the distal end of tube 710 forwardly
therewith.
[0178] FIG. 12D illustrates further extension of tube 710, by
forward driven movement of flexible guide 720 in tight engagement
with forward end member 712, thus pulling forward end member 712
and the distal end of tube 710 forwardly therewith. This further
motion is preferably provided based on the navigation functionality
described hereinabove with reference to FIGS. 1A-8. It is
appreciated that the forward driven movement of tube 710 as
described hereinabove with reference to FIGS. 1A-8, may be provided
by driven forward motion of the flexible guide 720.
[0179] FIG. 12E illustrates inflation of balloon 716 by means of
pressurized air through conduit 718 and one way valve 719. As will
be described hereinbelow, this inflation is employed for sealing
the tube 710 within a patient's trachea.
[0180] FIG. 12F illustrates deflation of balloon 722 following
inflation of balloon 716, corresponding to desired placement and
sealing of tube 710 within the patients trachea. FIG. 12G
illustrates removal of the flexible guide 720 from the tube
710.
[0181] Appendices 1 to 3 are software listings of the following
computer files:
[0182] Appendix 1: containing file intumed.asm.
[0183] Appendix 2: containing file c8cdr.inc.
[0184] Appendix 3: containing file ram.inc.
[0185] The method for providing the software functionality of the
microprocessor 278, in accordance with a preferred embodiment of
the present invention, includes the following steps:
[0186] 1. Provide an Intel compatible computer with a Pentium II
CPU or higher, 128 MB RAM, a Super VGA monitor and an available
serial port.
[0187] 2. Install Microsoft Windows 95 or Microsoft Windows 98
Operating System.
[0188] 3. Install the Testpoint Development kit version 40
available from Capital Equipment Corporation, 900 Middlesex
Turnpike, Building 2, Billereca, Mass. 0821, USA.
[0189] 4. Connect a flash processor loading device COP8EM Flash,
COP8 In Circuit Emulator for Flash Based Families to the serial
port of the Intel compatible computer. The COP8EM flash processor
loading device is available from National Semiconductors Corp. 2900
Semiconductor Dr., P.O. Box 58090, Santa Clara, Calif. 95052-8090,
USA
[0190] 5. Place a COP8CDR9HVA8 microcontroller available from
National Semiconductors Corp., 2900 Semiconductor Dr., P.O. Box
58090, Santa Clara, Calif. 95052-8090, USA in the COP8EM Flash.
[0191] 6. Copy the files intumed.asm, c8cdr.inc, and ram.inc,
respectively labeled Appendix 1, Appendix 2 and Appendix 3 to a
temporary directory.
[0192] 7. Load the file intumed.asm by using the operating software
available with the COP8EM Flash device from National
Semiconductors.
[0193] 8. To run the intumed.asm; Install the COP8CDR9HVA8
microcontroller in its socket in the electrical circuit, which
detailed electronic schematics are provided in FIGS. 5A to 5H,
where the microcontroller is designated by reference numeral
278.
[0194] It is appreciated that the software components of the
present invention may, if desired, be implemented in ROM (read-only
memory) form. The software components may, generally, be
implemented in hardware, if desired, using conventional
techniques.
[0195] It is appreciated that the particular embodiment implemented
by the Appendix is intended only to provide an extremely detailed
disclosure of the present invention and is not intended to be
limiting.
[0196] It is appreciated that various features of the invention
which are, for clarity, described in the contexts of separate
embodiments may also be provided in combination in a single
embodiment Conversely, various features of the invention which are,
for brevity, described in the context of a single embodiment may
also be provided separately or in any suitable subcombination.
[0197] It will be appreciated by persons skilled in the art that
the present invention is not limited by what has been particularly
shown and described hereinabove. Rather the scope of the present
invention includes both combinations and subcombinations of the
various features described hereinabove as well as variations and
modifications which would occur to persons skilled in the art upon
reading the specification and which are not in the prior art.
* * * * *
References