U.S. patent application number 11/669633 was filed with the patent office on 2007-11-22 for handle for multifunction endoscope.
This patent application is currently assigned to AMS Research Corporation. Invention is credited to Ken Arnold, Eduardo Asturias, James Raymond Kermode, Victor Lazzaro, Kester Nahen, Douglas G. Stinson.
Application Number | 20070270647 11/669633 |
Document ID | / |
Family ID | 38724053 |
Filed Date | 2007-11-22 |
United States Patent
Application |
20070270647 |
Kind Code |
A1 |
Nahen; Kester ; et
al. |
November 22, 2007 |
Handle for Multifunction Endoscope
Abstract
A multifunction endoscope handle comprises a body cover, a first
body cover extension and a second body cover extension. The body
cover comprises distal and proximal ends with a waist of
therebetween. The proximal and distal end circumferences part each
larger than the waist circumference. The body cover also comprises
an outer surface tapering from the distal and proximal ends to the
waist. Both of the first and second body cover extensions extend
radially outwardly directions from the outer surface of the body
cover. In some embodiments the proximal circumference is larger
than the distal circumference. The outer surface is preferably a
smoothly tapering outer surface. The body cover may comprise a
plurality of ports at a proximal portion thereof.
Inventors: |
Nahen; Kester; (Heildeberg,
DE) ; Arnold; Ken; (Soquel, CA) ; Stinson;
Douglas G.; (Fremont, CA) ; Asturias; Eduardo;
(San Francisco, CA) ; Lazzaro; Victor; (Discovery
Bay, CA) ; Kermode; James Raymond; (Los Altos,
CA) |
Correspondence
Address: |
HAYNES BEFFEL & WOLFELD LLP
P O BOX 366
HALF MOON BAY
CA
94019
US
|
Assignee: |
AMS Research Corporation
Minnetonka
MN
|
Family ID: |
38724053 |
Appl. No.: |
11/669633 |
Filed: |
January 31, 2007 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
60747780 |
May 19, 2006 |
|
|
|
Current U.S.
Class: |
600/131 ;
600/153 |
Current CPC
Class: |
A61B 1/0017 20130101;
A61B 1/015 20130101; A61B 2018/2272 20130101; A61B 1/07 20130101;
A61B 18/24 20130101; A61B 2090/035 20160201; A61B 2090/034
20160201; A61B 1/018 20130101 |
Class at
Publication: |
600/131 ;
600/153 |
International
Class: |
A61B 1/00 20060101
A61B001/00 |
Claims
1. A handle for a multifunction endoscope comprising: a body cover
comprising: distal and proximal ends with an axis extending
therebetween; a waist between the distal and proximal ends; the
distal and proximal ends and the waist having distal and proximal
circumferences and a waist circumference, respectively; the
proximal circumference being larger than the waist circumference
and the distal circumference being larger than the waist
circumference; and an outer surface, the outer surface tapering
from the distal end to the waist and from the proximal end to the
waist; a first body cover extension extending in a first radial
direction from the outer surface of the body cover between the
proximal end and the waist; and a second body cover extension
extending in a second radial direction from the outer surface of
the body cover between the proximal end and the waist.
2. The handle according to claim 1 wherein the proximal
circumference is larger than the distal circumference.
3. The handle according to claim 1 wherein the outer surface is a
smoothly tapering outer surface.
4. The handle according to claim 1 wherein the distance between the
distal and proximal ends is 8 to 15 cm.
5. The handle according to claim 1 wherein the distance between the
distal and proximal ends is 9 to 12 cm.
6. The handle according to claim 1 wherein the first and second
body cover extensions comprise forward-facing surfaces, said outer
surface and said forward facing surfaces creating a smoothly
curving user-grasping surface.
7. The handle according to claim 1 wherein the second radial
direction extends both radially outwardly away from the axis and
axially towards the distal end.
8. The handle according to claim 1 wherein the body cover comprises
a proximal portion, the proximal portion comprising a plurality of
ports.
9. The handle according to claim 1 further comprising a first port
at the first body cover extension, a second port at the second body
cover extension and a third port at the proximal end and along the
axis.
10. The handle according to claim 9 further comprising an
illumination fitting at the first port, an optical fiber fitting at
the second port and a camera fitting at the third port.
11. The handle according to claim 10 further comprising a valve at
the second body extension associated with the second port.
12. The handle according to claim 1 further comprising a second
body cover positioned distally of the distal end of the body
cover.
13. The handle according to claim 12 farther comprising fourth and
fifth ports in the second body cover.
14. The handle according to claim 13 for the comprising an inflow
fitting at the fourth port and an outflow fitting at the fifth
port.
15. The handle according to claim 12 further comprising a coupler
between the second body cover and the body cover.
16. A multifunction endoscope comprising: a handle made according
to claim 1; an external cannula extending from the handle; a port
at the second body cover extension; an optical fiber extending
through the handle and external cannula with a proximal portion of
the optical fiber extending proximally from the port; a
user-manipulable knob mounted to the proximal portion of the
optical fiber, so that a user may grasp the body cover of the
handle with one hand and manipulate the optical fiber through the
user-manipulable knob with the other hand.
17. A method for manipulating an endoscope comprising: selecting an
endoscope comprising a handle made according to claim 1, an
external cannula extending from the handle, and an optical fiber
extending through the handle and through the external cannula with
a proximal portion of the optical fiber extending proximally from a
port at the second body cover extension; grasping the body cover of
the handle with a first hand using a chosen gripping technique;
grasping a user-manipulable knob mounted to the proximal portion of
the optical fiber with a second hand; and selectively moving the
optical fiber within the external cannula by at least one of
rotating the optical fiber around its own axis and longitudinally
sliding the optical fiber through the external cannula using the
user-manipulable knob.
18. A handle for a multifunction endoscope comprising: a body cover
comprising: distal and proximal ends with an axis extending
therebetween; a waist between the distal and proximal ends; the
distal and proximal ends and the waist having distal and proximal
circumferences and a waist circumference, respectively; the
proximal circumference being larger than the distal circumference
and the distal circumference being larger than the waist
circumference; and an outer surface, the outer surface smoothly
tapering from the distal end to the waist and from the proximal end
to the waist; a first body cover extension extending in a first
radial direction from the outer surface of the body cover between
the proximal end and the waist; a second body cover extension
extending in a second radial direction from the outer surface of
the body cover between the proximal end and the waist; the first
and second body cover extensions comprising forward-facing
surfaces, said outer surface and said forward facing surfaces
creating a smoothly curving user-grasping surface; a first port at
the first body cover extension, a second port at the second body
cover extension and a third port at the proximal end and along the
axis; a second body cover positioned distally of the distal end of
the body cover; fourth and fifth ports at the second body
cover.
19. The handle according to claim 18 wherein the second radial
direction extends both radially outwardly away from the axis and
axially towards the distal end,
20. The handle according to claim 18 further comprising: an
illumination fitting at the first port; an optical fiber fitting at
the second port; a camera fitting at the third port; a valve at the
second body extension associated with the second port; an inflow
fitting at the fourth port; and an outflow fitting at the fifth
port.
Description
CROSS-REFERENCE TO RELATED APPLICATION
[0001] This application claims the benefit of Provisional Patent
Application No. 60/747,780 filed 19 May 2006, entitled Endoscope
for Fiber Optic Procedures, Attorney Docket LSCP 1026-1.
BACKGROUND OF THE INVENTION
[0002] 1. Field of the Invention
[0003] The present invention relates generally to endoscopes, and
in particular the configuration of a handle used for a
multifunction endoscope.
[0004] 2. Description of Related Art
[0005] An endoscope is an illuminated medical device used look
inside the body and examine organs. An endoscope can be rigid or
flexible. Endoscopes designed for particular procedures often have
specialized names, such as cystoscope (bladder), nephroscope
(kidney), bronchoscope (bronchi), laryngoscope (larynx), otoscope
(ear), arthroscope (joint) and laparoscope (abdomen). In addition
to being used for viewing and examination, endoscopes are often
used with various types of medical instruments for diagnostic and
therapeutic procedures. An example of these medical instruments
includes a medical laser device using fiber optics to deliver the
laser energy to, typically, the distal end of the endoscope. Other
medical instruments that can be used with endoscopes include
grasping, cutting, tissue sampling and suturing medical instruments
as well as medical instruments designed to provide energy other
than laser energy such as RF and ultrasonic energy.
[0006] Endoscopic removal of tissue by means of lasers has been
realized in procedures such as photoselective vaporization of
prostate (PVP) for the treatment of lower urinary tract symptoms
(LUTS) due to benign prostatic hyperplasia (BPH). Lasers in the
visible and invisible spectral range have been utilized for
endoscopic procedure of tissue removal. Tissue removal is typically
carried out under endoscopic visualization of the operating field
through a telescope. Laser light is guided to the operating field
by an optical light guide (laser fiber). To steer the light guide
to the target tissue an endoscope is often utilized. In some
implementations the telescope can be embodied in the endoscope as a
fixed or modular component.
[0007] Performing a surgical laser procedure through an endoscope
creates several challenges. Vaporization of tissue in a body cavity
filled with an irrigant creates vapor bubbles and tissue particles
that get released into the irrigant and that can obscure the view
of the surgeon.
[0008] Controlling the surgical effect the laser has on tissue
requires the surgeon to position the laser fiber with high
precision. The surgeon has to consider the characteristics of the
laser beam such as its divergence coming out of the laser fiber and
control the distance between laser fiber and tissue to achieve the
desired effect. In some instances the laser effect can change its
nature dependent on the distance between laser fiber and tissue. In
some cases vaporization will occur when the fiber is close to
tissue but coagulation without vaporization will occur when the
fiber is further away from tissue.
[0009] The surgeon has to control the position of the distal tip of
the laser fiber relative the distal tip of the endoscope to avoid
damage to the endoscope by unintentional exposure of the endoscope
to laser light.
[0010] Thus, in some high power laser applications, it is possible
to damage an endoscope by inadvertently directing laser radiation
into the structure. In addition, it is necessary to provide for an
effective irrigation flow in such systems. Finally, is desirable to
provide a structural design which is comfortable to hold and
utilize by surgeons. An endoscope is described herein that allows
surgeons to safely and effectively perform laser surgery, including
transurethral laser vaporization of prostate tissue.
SUMMARY OF THE INVENTION
[0011] A simple endoscope used for examination of an organ may have
only two ports, one for the light source and one for the optical
image. However, endoscopes used for medical procedures such as
ablation of tissue using laser energy will typically have many more
ports and therefore make the design of the proximal portion of the
endoscope more complicated. The increased complexity includes the
presence of tubes, lines, wires and other things extending from the
proximal portion of the endoscope. One aspect of the invention is
the recognition that different individuals using the same endoscope
will often hold and manipulate the endoscope by its proximal
portion in different ways. This is particularly true for
multifunction endoscopes used for both of viewing and for
treatment, at least in part because of the increased complexity of
the procedure and the number of things extending from the proximal
portion, as well as the personal preferences of the operator.
[0012] A handle for a multifunction endoscope comprises a body
cover, a first body cover extension and a second body cover
extension. The body cover comprises distal and proximal ends with
an axis extending therebetween with a waist between the distal and
proximal ends. The distal and proximal ends and the waist have
distal and proximal circumferences and a waist circumference,
respectively. The proximal circumference is larger than the waist
circumference and the distal circumference is larger than the waist
circumference. The body cover also comprises an outer surface, the
outer surface tapering from the distal end to the waist and from
the proximal end to the waist. The first body cover extension
extends in a first radial direction from the outer surface of the
body cover between the proximal end and the waist. The second body
cover extension extends in a second radial direction from the outer
surface of the body cover between the proximal end and the
waist.
[0013] In some embodiments the proximal circumference is larger
than the distal circumference. The outer surface is preferably a
smoothly tapering outer surface. The body cover may comprise a
plurality of ports at a proximal portion thereof. The handle may
also comprise a second body cover positioned distally of the distal
end of the body cover. The second body cover may comprise
additional ports therein.
[0014] A method for manipulating an endoscope comprises selecting
an endoscope, the endoscope comprising a handle, an external
cannula extending from the handle, and an optical fiber. The
optical fiber extends through the handle and through the external
cannula with a proximal portion of the optical fiber extending
proximally from a port at the second body cover extension. The body
cover of the handle is grasped with a first hand using a chosen
gripping technique. A user-manipulable knob mounted to the proximal
portion of the optical fiber is grasped with a second hand. The
optical fiber is selectively moved within the external cannula by
at least one of rotating the optical fiber around its own axis and
longitudinally sliding the optical fiber through the external
cannula using the user-manipulable knob.
[0015] Other features, aspects and advantages of the present
invention can be seen on review the Figs., the detailed
description, and the claims which follow.
BRIEF DESCRIPTION OF THE DRAWINGS
[0016] FIG. 1 is a simplified overall view of a multifunction
endoscope including a handle made according to the invention;
[0017] FIG. 1A is a simplified side view of a portion of a laser
fiber showing a rotation limiting element, a coupler and a fiber
manipulator mounted thereto;
[0018] FIG. 2 is an enlarged view of the handle of FIG. 1;
[0019] FIGS. 3-6 illustrate four different handle holding
techniques accommodated by the handle of FIGS. 1 and 2; and
[0020] FIGS. 7 and 8 are somewhat simplified overall
cross-sectional views with crosshatching omitted for clarity,
[0021] FIG. 9 is a proximal end half-sectional elevational view,
and
[0022] FIGS. 10 and 11 are top and bottom half-sectional plan views
of the endoscope of FIG. 1 further illustrating the shape of the
outer surface of the handle;
[0023] FIG. 12 a side view of the distal end of the endoscope
positioned within a urethra near prostate tissue;
[0024] FIG. 13 is a perspective view of the opening at the distal
end of the endoscope, looking from the working region into the
opening;
[0025] FIG. 14 is a somewhat simplified cross-sectional view, with
crosshatching omitted for clarity, illustrating the cooperation of
a travel limiter and a pin within a fiber lumen on the
endoscope;
[0026] FIG. 15 illustrates the structure of a travel limiter for
use with a fiber adapted for the endoscope described herein;
[0027] FIG. 16 is an end view of the fiber lumen with a travel
limiter cam positioned inside in a vertical position; and
[0028] FIG. 17 is an interview of the fiber lumen with a travel
limiter cam positioned in a rotated position.
DETAILED DESCRIPTION
[0029] FIG. 1 illustrates a multifunction endoscope 10, such as a
transurethral cystoscope, including a handle 12 with an external
cannula 14 extending distally from the handle 12. In this
embodiment multifunction endoscope 10 is designed for use with a
medical laser device of the type including an optical fiber 16
having a fiber end member 19 which extends into a cavity formed by
a hood structure (described in more detail below and in Provisional
Patent Application No. 60/747,780, the disclosure of which is
incorporated by reference) on the distal tip 18 of external cannula
14. The optical fiber 16 has a fiber manipulator knob 17 attached
near the handle 12, that is adapted to be used by a surgeon to
manipulate the position of the fiber end member, rotationally and
longitudinally. External cannula 14 has a number of passageways or
lumens formed by an internal structure, not shown, extending
generally from handle 12 to distal tip 18 to accommodate, in this
disclosed embodiment, optical fiber 16 and fiber end element 19, a
telescope type of visualization device typically coupled to a
display monitor (not shown), an inflow irrigation pathway, and an
outflow or suction pathway. The endoscope 10 in the illustrated
embodiment includes an internal cannula which receives the fiber 16
in a manner which allows easy movement of the fiber 16 at least
over a range of motion that allows manipulation of the fiber end
member 1 longitudinally and rotationally within a working field by
a surgeon grasping the fiber manipulator knob 17. Other embodiments
are adapted for manipulation of the fiber end member 19 by a
mechanical system under computer control with active feedback based
on the video images of the procedure, with or without real time
user input.
[0030] Individual lumens may be used for a single purpose, such as
delivery of irrigation liquid, or for two or more purposes, such as
housing the telescope and a optical fiber.
[0031] As suggested in FIG. 1, a laser beam 20 is directed
laterally in the illustrated embodiment from fiber end element 19
in a side-firing fashion. Optical fiber 16 could also have an end
element adapted for forward firing. Visualization in the general
direction of laser beam 20 is provided by a telescope with
appropriately angled optical elements at its distal end. In
addition, other types of medical instruments may be used as a part
of endoscope 10 instead of, or in addition to, a medical laser
device.
[0032] FIG. 1A is a simplified diagram of an optical fiber assembly
adapted for use with the endoscope of FIG. 1. The fiber 16 is
connected to a coupler 71 adapted to connect the fiber to the
output of a laser system. The fiber end element 19 in the
illustrated embodiment comprises a fused quartz cap which captures
air between a beveled end 21 of the fiber 16. The air/fiber
interface provided by the beveled end 21 causes essentially total
internal reflection of the beam 20 in the side firing direction. At
a predetermined distance from the fiber end element 19, a rotation
limiting element 76, in the form of a cam in this embodiment, is
attached to the fiber 16. The rotation limiting element 76 is
adapted to cooperate with a corresponding element within the
endoscope, as described in more detail below and in Provisional
Patent Application No. 60/747,780, the disclosure of which is
incorporated by reference, to prevent the surgeon from withdrawing
the fiber end element 19 into the cannula so that the beam 20 does
not damage the cannula, and to prevent the surgeon from rotating
the fiber end element 19 toward the hood structure on the distal
tip 18 of the external cannula, so that the beam 20 does not damage
the hood structure on the distal tip 18. In addition, the fiber is
threaded through a coupler 70, which is adapted to couple with a
fiber port on the endoscope 10, as illustrated in FIG. 1, which
secures the rotation limiting element 76 within the endoscope, and
provides a seal on the cannula within which the fiber 16 is
received without interfering with movement of the fiber as
described above within the predetermined ranges of longitudinal and
rotational motion.
[0033] In a preferred embodiment the longitudinal motion of optical
fiber 16 is directed axially along axis 28 (illustrated in FIG. 2)
and also rotationally about its own axis to permit laser beam 20 to
be directed proximally and distally as optical fiber 16 moves
generally along axis 28 as well as being swept side to side as
optical fiber 16 rotates about its own axis. Distal tip 18 of
external cannula 14 is beveled to permit this range of movement of
laser beam 20 while providing for proper viewing of working region
68.
[0034] FIG. 2 shows more detail of handle 12. Handle 12 includes a
body cover portion or cover 22 having a distal end 24 and a
proximal end 26 and defining a central axis 28. The axial distance
between distal and proximal ends 24, 26 is preferably about 8 to 15
cm, and typically about 9 to 12 cm. This size range is chosen
primarily to accommodate different hand grasping techniques, such
as shown in FIGS. 3-6, for users with a range of sizes of hands and
styles of use for the endoscope. Handle 12 also includes a
supplemental body cover 30 positioned distally of body cover 22
with a bayonet mount 32 therebetween adapted for covering the
proximal end of the external cannula 14 and various fittings used
for connecting the internal structures to the external cannula 14.
The external cannula 14 is connected with irrigation inflow and
outflow fittings 34, 36, and secured by bayonet mount 32 to
internal structures (not shown) which are adapted to receive the
telescope 64 and the fiber 16. Handle 12 has a number of ports
opening into the interior of the handle. For example, inflow and
outflow fittings 34, 36 extend from supplemental body cover 30 and
provide access to inflow and outflow ports 38, 40 which open into
an inflow irrigation pathway defined by internal structures and an
outflow or suction pathway extending along external cannula 14.
Inflow fitting 34 may be connected to a source of an appropriate
irrigation liquid, such as saline fed by a gravity feed structure
or by a pump, while outflow fitting 36 may be connected to an
appropriate suction source.
[0035] Body cover 22 has a smoothly tapering outer surface 48 that
tapers radially inwardly from distal and proximal ends 24, 26
towards a central or waist portion 42. The circumference of
proximal end 26 is larger than the circumference of distal end 24,
which is larger than the circumference of waist portion 42. Outer
surface 48 has a generally circular, slightly oval cross-sectional
shape along axis 28 with a diameter in a range of about 1.5 to 2
cm, for example. Outer surface 48 may have other, preferably
smoothly curving, shapes, such as egg-shaped, at various positions
along axis 28 or along the entire length of axis 28.
[0036] Handle 12 also has first and second body cover extensions
44, 46 extending radially outwardly from the outer surface 48 of
body cover 22 adapted to comfortably shield the surgeon's hand from
fittings for the telescope and the fiber 16. Extensions 44, 46 are
positioned between proximal end 26 and waist portion 42. Extensions
44, 46 have smoothly curving, distally-facing outer surfaces 50, 52
to provide a smooth transition between outer surface of 48 of body
cover 22 and extensions 44, 46. As seen in FIG. 2, first body cover
extension 44 extends generally directly radially outwardly while
the second body cover extension 46 extends both radially outwardly
and distally. An illumination fitting 54 extends from first body
cover extension 44 and opens into an illumination port 56. An
optical fiber fitting 58 extends from second body cover extension
46 and opens into an optical fiber port 60. Optical fiber 16 passes
through fitting 58, through port 60, and through an appropriate
passageway in handle 12 for entry into and through an appropriate
lumen within external cannula 14. A valve handle 72 is mounted
flush with second body cover extension 46 with a smooth or
otherwise comfortable surface transition. The valve handle 72 is
turned to control a stop cock within the handle 12, to seal off
port 60 when desired, typically when optical fiber 16 is removed
from handle 12.
[0037] As shown in FIG. 2, smoothly tapering outer surface 48 is
provided with a number of grooves 62 to facilitate grasping by the
user. The same or other types of embossing or debossing may also be
provided for outer surface 48 as well as outer surfaces 50, 52 to
promote a good grip of handle 12. One or more of outer surfaces 48,
50 and 52 may be provided with a mat or other suitable surface
texture. In the preferred embodiment body cover 22 is of a stiff
polymer material or metal. In alternative embodiments, the entire
body cover 22, portions of body cover 22 and/or a skin on the body
cover 22 may comprise a resilient or otherwise yieldable
material.
[0038] Endoscope 10 also includes a telescope 64 extending through
a telescope port 65 at proximal end of 26 and aligned with axis 28.
Telescope 64 includes a camera fitting 66 to permit images of the
working region 68 in the vicinity of laser beam 20 captured by the
telescope at distal tip 18 to be recorded and/or monitored during
use. Illumination port 56 is coupled to the interior of telescope
64 so the light from the illumination source passes distally along
the telescope to illuminate working region 68.
[0039] In a preferred embodiment the motion of optical fiber 16 is
both axially along axis 28 and also rotationally about its own axis
to permit laser beam 20 to be directed proximally and distally as
optical fiber 16 moves generally along axis 28 as well as being
swept side to side as optical fiber 16 rotates about its own axis.
Distal tip 18 of external cannula 14 is beveled to permit this
range of movement of laser beam 20 while providing for proper
viewing of working region 68. This manipulation of optical fiber
16, see FIGS. 1 and 1A, can be aided by the use of a coupler 70, a
fiber manipulator knob 17 and a rotation limiting element 76. Fiber
manipulator knob 17 and rotation limiting element 76 are both
secured to optical fiber 16 while optical fiber 16 slides freely
through coupler 70. Coupler 70 engages optical fiber fitting 58,
typically through the use of a luer coupling. The axial movement of
the distal tip of optical fiber 16 at the distal tip 18 of external
cannula 14 is limited in the distal direction by the engagement of
fiber manipulator knob 17 with coupler 70 and in the proximal
direction by the engagement of rotation limiting element 76 with
coupler 70. Other structure or methods for limiting this axial
movement to fixed or adjustable distances may also be used. By
limiting the axial or longitudinal movement of optical fiber 16
through coupler 70, laser beam 20 is kept within working region 68.
Rotation limiting element 76 is designed to engage structure, not
shown, within handle 12 to limit the rotation of optical fiber 16
about its own axis. It is important, especially when laser beam 20
is a high-power laser beam, to prevent laser beam 20 from impinging
against external cannula 14, possibly causing external cannula 14
to be vaporized, by pulling optical fiber 16 too far into the
sheath or by over-rotating optical fiber 16 during lasing
operations.
[0040] FIGS. 7-11 are somewhat simplified half-section views of
endoscope 10 showing body cover 22 and body cover extensions 44, 46
from different vantage points. Proximal end 26 of body cover 22
provides an opening 80 into the interior of handle 12 for telescope
64. First body cover extension 44 is a generally U-shaped structure
having an outer edge 82 that partially defines illumination port
56. Outer edge 82 joins with proximal end of 26 for receipt of
illumination fitting 54 extending from telescope 64. This
configuration facilitates insertion of telescope 64 into and
removal of the telescope from handle 12 and external cannula
14.
[0041] FIGS. 3-6 illustrate four typical ways a surgeon can
comfortably and securely hold or grasp handle 12 of endoscope 10 by
grasping body cover 22 with one hand while leaving the other hand
(not shown) free to manipulate optical fiber 16 using fiber
manipulator knob 17 to adjust both the axial and rotary positions
of laser beam 20. Other grasping techniques may be accommodated by
the shape of handle 12. The different grasping techniques can be
based upon different personal preferences as well as the particular
procedure being accomplished. For example, an operator may find the
grasping technique of FIG. 6 to be most satisfactory when initially
introducing the endoscope to the target site to provide the most
sensitivity to this procedure. The provision of the smaller
circumference waist portion 42 provides an exceptionally secure
grasping surface between the user's thumb and opposed fingers. The
grasping techniques of FIGS. 3 and 4 provide extremely stable and
secure positioning of handle 12 due to the provision of the smaller
circumference waist portion 42 and the larger circumference
proximal end 26, as well as first and second body cover extensions
44, 46 with their smoothly tapering, forward facing outer surfaces
50, 52. The grasping technique of FIG. 5 may be chosen by some
users when, for example, manipulating optical fiber 16 extending
from optical fiber fitting 58. In all cases, the smoothly tapering
surfaces from the larger circumference distal and proximal ends 24,
26 to the smaller circumference waist portion 42 provide a
comfortable and a secure gripping surface for the user.
[0042] FIG. 12 illustrates the distal end 18 of the endoscope
positioned within a urethra adjacent prostate tissue. The fiber end
element 19 directs radiation 20 into the prostate tissue to cause
vaporization or other effects in the tissue. The distal end 18
includes a hood structure 101 with a blunt distal face 102 adapted
to be inserted into the urethra. The hood structure 101 acts as an
obturator which prevents constriction of the urethra onto the fiber
end element 19, and defines an open area between the top surface
103 and the working region 68 on the prostate tissue. The internal
structure (not shown) within the external cannula at the distal end
18 includes a guide element that is adapted to movably support the
optical fiber in a position so that the emission face of the end
element 19 is spaced away from the working region 68 on the
prostate tissue within the open area defined by the hood structure
101. In addition, the external cannula includes a nozzle for
directing inflowing irrigant, and regions for suction of outflowing
irrigant which together define an irrigation pathway represented by
arrows 104. The irrigation pathway 104 flows across the emission
face of the fiber end element 19 as the fiber end element 19 is
moved within the open area, maintaining irrigation flow during the
delivery of radiation to facilitate clear visualization through the
telescope and to maintain the emission face of the fiber end
element 19 clear of debris.
[0043] FIG. 13 provides a prospective of the distal end of the
endoscope outer cannula from the direction of the working region
68. As illustrated in FIG. 13, the distal face 102 of the endoscope
represents the end of a hood structure. An opening on the end of
the external cannula is defined by the distal face 102, and side
walls which slope away from the end. The inner cannula 110 includes
a first lumen having an upper ridge 112 which receives the
telescope so that the telescope face 108 faces the working region
68, and which supports the fiber end element 19. Thus the upper
ridge 112 has a radius which matches that of the telescope, and the
lower ridge 113 as a radius which matches that of a bearing surface
on the fiber end element 19. An irrigant inflow channel is defined
by a second lumen which is bonded to the first lumen by welding or
otherwise, and having crescent shaped opening 106 which acts as an
irrigant nozzle directing irrigation flow outwardly over the fiber
end element 19. In the illustrated embodiment, a tube 107 is
attached to the outside surface of the upper ridge 112 of the first
lumen acting as a spacer between the inner cannula that defines the
first and second lumens, and of the inside wall at the top of the
outer cannula. An opening established by tube 107 between the inner
cannula and the external cannula provides an irrigation outflow
channel which is coupled to a suction source tending to cause the
irrigant which is forced through the crescent shaped opening 106 of
the irrigant inflow channel to flow outwardly and an upwardly
across the fiber end element 19.
[0044] FIG. 14 illustrates the proximal end of the lumen in the
endoscope adapted received the fiber and cooperate with the travel
limiter 300, which is shown apart from the fiber in the drawing.
The fitting 58 defines a lumen 275 into which the fiber with of the
travel limiter 300 bonded thereto is received. The fitting 58 is
coupled to a stopcock valve 278 which is opened to receive the
fiber, and provide a continuous lumen within which the travel
limiter 300 is able to move. On the distal side of the stopcock
valve 278, a tube is bonded which directs the fiber into the
internal structure of the endoscope as described above. As shown in
FIG. 14, the cover 65 includes an extension 46 surround the
stopcock valve 278 and the tube 280, while the fitting 58 extends
outwardly. A pin 276 extends into the lumen 275 and cooperates with
the travel limiter 300 to prevent rotation beyond a predefined arc
of the fiber.
[0045] The structure of the travel limiter 300 (in the form of a
cam in this embodiment) is illustrated in FIG. 15. The travel
limiter includes a cylindrical fiber sheath body 310 adapted to fit
over the sheath of the optical fiber and be bonded thereto.
Appendages 311, 312, 313 are formed on the body 310 with arcuate
outside surfaces (e.g. surface 315 on appendage 312) which are
adapted to slide rotationally within the lumen 275. A ridge 314
extends along the major axis of the body 310 having sidewalls with
a rear beveled surface 320 (and a front beveled surface) set at an
angle theta, such as about 60.degree.. The sidewalls are positioned
so that in cooperation with the pin 276, rotational movement of the
fiber is limited to a predefined arc.
[0046] Although not shown in FIG. 14, seal 70 when attached to the
fitting 58 acts to prevent longitudinal motion of the travel
limiter 300 in a direction away from the distal end of the
endoscope. Longitudinal motion in a direction toward the distal end
of the endoscope is not actively limited in this embodiment, but is
controlled by the surgeon by observing the fiber end element within
the field of view of the telescope. In an alternative embodiment, a
structure may be added to limit longitudinal motion toward the
distal end. The length of the ridge 314 is selected so that when
the fiber is fully withdrawn against the seal 70, the ridge remains
in a position to cooperate with the pin 276, thereby providing for
control of rotational motion of the fiber over a predefined length
of longitudinal motion which is the equal to about twice the length
of the ridge 314.
[0047] FIG. 16 illustrates positioning of the travel limiter 300
from an end of view within the lumen 275. Appendages 311 and 312
and the ridge 314 are adapted to secure the body 310 at a position
that is substantially centered within the lumen 275, and so that as
the fiber is rotated, it remains positioned near the center and
does not contact the pin 267.
[0048] As illustrated in FIG. 17, when the fiber is rotated in a
counterclockwise direction, the ridge 314 eventually contacts the
tin 276 to limit the rotational motion. The ridge 314 cooperates in
a similar manner with the pin 276 to limit clockwise motion. In
illustrated embodiment, the travel limiter will allow rotational
motion of about 270.degree., with the remaining 90.degree. of the
circle being blocked to prevent irradiation of the hood structure
on the distal end of the endoscope.
[0049] The above descriptions may have used terms such as above,
below, top, bottom, over, under, et cetera. These terms are used to
aid understanding of the invention are not used in a limiting
sense.
[0050] While the present invention is disclosed by reference to the
preferred embodiments and examples detailed above, it is to be
understood that these examples are intended in an illustrative
rather than in a limiting sense. It is contemplated that
modifications and combinations will occur to those skilled in the
art, which modifications and combinations will be within the spirit
of the invention and the scope of the following claims.
[0051] Any and all patents, patent applications and printed
publications referred to above are incorporated by reference.
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