U.S. patent number 3,709,214 [Application Number 05/193,217] was granted by the patent office on 1973-01-09 for gas obturating method.
Invention is credited to Jack R. Robertson.
United States Patent |
3,709,214 |
Robertson |
January 9, 1973 |
GAS OBTURATING METHOD
Abstract
A method of diagnosis and/or therapy of an internal part of the
body accessible from an adjacent body opening, characterized by the
use of an endoscope having a passageway therein which terminates in
a tubular distal end insertable into the opening and into close
proximity to the desired body part, and including the steps of:
placing the tubular distal end of the endoscope at the proximal end
of the body opening. While simultaneously introducing a gas under
pressure into the passageway in the endoscope at a rate such that
the gas entering the body opening ahead of the tubular distal end
of the endoscope acts as an obturator facilitating insertion so
that the endoscope may be moved longitudinally of the body opening,
and performing an indicated diagnostic and/or therapeutic operation
on the desired body part through the passageway in the endoscope
during and/or after movement of the tubular distal end of the
instrument longitudinally of the body opening. The method includes
the additional step of visually examining the walls of the body
opening through the passageway in the endoscope as the tubular
distal end of the instrument is moved longitudinally of the body
opening so that the walls of the body opening are examined before
the instrument can have any traumatic effect thereon. The tubular
distal end of the endoscope comprises a removable barrel suitable
for a particular diagnostic and/or therapeutic operation and
replaceable by a different barrel suitable for a different
diagnostic and/or therapeutic operation. Thus, the endoscope may be
used as an anoscope, a proctoscope, a sigmoidoscope, a coloposcope,
a hysteroscope, a culdoscope, an amnioscope, a urethroscope, a
cystoscope, a laparoscope, and the like. The barrel may carry an
inflatable cuff where appropriate to provide a substantially gas
tight seal between the barrel and the periphery of the proximal end
of the body opening.
Inventors: |
Robertson; Jack R. (Santa Ynez,
CA) |
Family
ID: |
22712696 |
Appl.
No.: |
05/193,217 |
Filed: |
October 27, 1971 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
Issue Date |
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885248 |
Dec 15, 1969 |
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Current U.S.
Class: |
600/156; 600/105;
600/109; 359/509 |
Current CPC
Class: |
A61B
1/313 (20130101); A61B 1/307 (20130101); A61B
1/303 (20130101); A61M 13/003 (20130101); A61B
1/31 (20130101) |
Current International
Class: |
A61M
13/00 (20060101); A61B 1/307 (20060101); A61B
1/303 (20060101); A61B 1/31 (20060101); A61B
1/313 (20060101); A61b 001/00 () |
Field of
Search: |
;128/2,4,5,6,7,8,9,341,342,343,344 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Laudenslager; Lucie H.
Parent Case Text
CROSS REFERENCE TO RELATED APPLICATION
This application is a division of my application Ser. No. 885,248,
filed Dec. 15, 1969, and now abandoned.
Claims
I claim as my invention:
1. A method of diagnosis and/or therapy of an internal part of the
body accessible from an adjacent body opening, characterized by the
use of an instrument having a passageway therein which terminates
in a tubular distal end insertable into the opening and into close
proximity to the desired body part, and including the steps of:
a. placing the tubular distal end of the instrument at the proximal
end of the body opening;
b. introducing a gas under pressure into the passageway in the
instrument, while moving the tubular distal end of the instrument
longitudinally of the body opening, at a rate such that the gas
entering the body opening ahead of the tubular distal end of the
instrument acts as an obturator facilitating insertion; and
c. performing an indicated procedure on the desired body part
through the passageway in the instrument with the tubular distal
end of the instrument inserted into the body opening.
2. A method as set forth in claim 1 including the step of visually
examining the walls of the body opening through the passageway in
the instrument as the tubular distal end of the instrument is moved
longitudinally of the body opening so that the walls of the body
opening are examined before the instrument can have any traumatic
effect thereon.
3. A method according to claim 1 including the step of inflating a
body cavity with which said body opening communicates by
introducing gas thereinto through the passageway in the
instrument.
4. A method as defined in claim 1 including the step of viewing the
interior of the body opening and/or a body cavity with which it
communicates through the passageway in the instrument while
introducing a gas into the passageway.
5. A method according to claim 1 including the step of providing a
substantially gas tight seal between the periphery of the body
opening and the tubular distal end of the instrument.
Description
BACKGROUND OF INVENTION
The present invention relates in general to an endoscope and to a
method of using same in performing indicated diagnostic and/or
therapeutic operations on various internal parts of the body
accessible from adjacent body openings. The term "endoscope" is
used generically herein to include various species for use in
diagnostic and/or therapeutic operations on corresponding internal
parts of the body, examples being amnioscopes, colposcopes,
culdoscopes, hysteroscopes, vaginoscopes, urethroscopes,
cystoscopes, anoscopes, protoscopes, sigmoidoscopes, and
laparoscopes (peritoneoscopes).
In each instance, the instrument of the invention is provided with
a passageway therethrough which terminates in a tubular distal end
insertable into the proximal end of the appropriate body opening
and movable longitudinally thereof into close proximity to the body
part to be subjected to diagnosis and/or therapy. This body part
may comprise the walls of the body opening itself, the walls of a
passage communicating with the opening, the interior of an organ
communicating with the opening, the exterior of an organ accessible
through the opening, or the like.
SUMMARY AND OBJECTS OF INVENTION
With the foregoing as background, the primary object of the present
invention is to introduce a gas under pressure into the passageway
in the instrument, while moving the tubular distal end of the
instrument longitudinally of the desired body opening, at a rate
such that the gas entering the body opening ahead of the tubular
distal end of the instrument facilitates insertion by dilating the
body opening, and any body passage communicating therewith into
which the tubular distal end of the instrument may be inserted.
Thus, the gas introduced through the passageway in the instrument
acts as a substitute for the usual mechanical obturator, and will
be defined herein as constituting an obturator for convenience.
Preferably, the gas employed is an inert one, such as carbon
dioxide, nitrous oxide, helium, or the like, such gases being
absorbed readily by the body after completion of the diagnostic
and/or therapeutic procedure.
The employment of a gas as an obturator facilitating insertion has
numerous advantages. First, by dilating the body opening ahead of
the tubular distal end of the instrument, the gaseous obturator of
the present invention greatly facilitates insertion. Secondly, it
greatly reduces the risk of injury to the walls of the body
opening, or any connecting body passage, as compared to the
conventional mechanical obturator. A further and extremely
important advantage is that the walls of the body opening, and any
connecting body passage, may be examined visually through the
passageway in the instrument during insertion of the instrument,
something which is impossible with a mechanical obturator.
Consequently, the desired examination can be carried out before the
instrument can have any traumatic effect on the areas to be
observed. This is an important feature of the invention since it
assures the physician that any traumatic condition he may see was
not caused by the instrument he is using.
Another important feature of the invention is that any body part
which requires dilation for proper examination can be dilated by
the gas which serves as an obturator, or by additional gas
introduced through the passageway in the instrument. For example,
in a urethroscope species of the invention, the urethra may be
dilated with gas as required for proper examination, instead of
using water, as is conventional. The use of a gas as a dilator has
the additional and very important advantage of providing a clear
visual field, the visibility in a gas field being vastly superior
to that in a water field. It is also technically impossible to
dilate the distal urethra with water.
Yet another advantage of the gaseous obturating procedure of the
invention is that the gas used as an obturator, or additional gas
introduced through the passageway in the instrument, may be used to
inflate a body cavity or organ to be subjected to diagnosis and/or
therapy. This combination gaseous obturating and inflating
technique may be used in conjunction with a laparoscope of the
invention to inflate the abdominal cavity to facilitate an
indicated diagnostic and/or therapeutic procedure on an organ
therein, or it may be used in conjunction with other species of the
generic endoscope of the invention to inflate corresponding organs
susceptible to this technique.
It might be well to point out at this juncture that the use of a
gas under pressure as an obturator is applicable to most endoscope
species of the invention. The colposcope is an exception since it
involves only simple vaginal insertion requiring no obturation.
In accordance with the invention, any indicated diagnostic and/or
therapeutic procedure may be carried out through the same
passageway in the instrument which serves to introduce the
obturating, dilating and/or inflating gas. The proximal end of the
passageway in the instrument may be equipped with suitable optical
viewing means, which is preferably removable so that different
magnifications may be used as required. Also, photographic means
may be substituted if desired in the event that a photographic
record of the condition of a particular body part is desired. Also,
any suitable diagnostic technique, other than visual or
photographic examination, and any suitable therapeutic technique,
may be carried out through the passageway in the instrument, at the
same time carrying out visual observations through the same
passageway. This may be accomplished by inserting the desired
diagnostic and/or therapeutic device through the optical viewing
means. Thus, the physician can obtain urine samples, perform
biopsies, carry out cauterization procedures, and the like, while
visually observing such procedures.
Another object of the invention is to provide a substantially gas
tight seal between the tubular distal end of the instrument and the
periphery of the body opening in instances where it is necessary to
prevent the escape of gas to maintain inflation. A related object
is to provide an instrument, such as a culdoscope, the tubular
distal end of which is provided with an inflatable cuff or cuff
means for maintaining a substantially gas tight seal around the
body opening.
Still another and important object of the invention is to provide
an instrument which may be converted from one endoscope species to
another simply by interchanging barrels each capable of forming the
tubular distal end of the instrument. More particularly, an object
of the invention is to provide an endoscope the tubular distal end
of which comprises a removable barrel suitable for a particular
diagnostic and/or therapeutic operation and replaceable by a
different barrel suitable for a different diagnostic and/or
therapeutic procedure. With this construction, the same basic
instrument may be used for a wide variety of purposes simply by
selecting the appropriate barrel, optics, and diagnostic and/or
therapeutic accessories.
The foregoing objects, advantages, features and results of the
present invention, together with various other objects, advantages,
features and results thereof which will be evident to those skilled
in the endoscopic art in the light of this disclosure, may be
achieved with the exemplary embodiments of the invention
illustrated in the accompanying drawing and described in detail
hereinafter.
DESCRIPTION OF DRAWING
In the drawing:
FIG. 1 is a view, partially in side elevation and partially in
longitudinal section, of one endoscope species of the invention,
which species is suitable for use as a male or female urethroscope
or cystoscope, a hysteroscope, or a vaginoscope;
FIG. 2 is a view, partially in side elevation and partially in
longitudinal section, of a cuff-equipped barrel which may be
substituted for the barrel of FIG. 1 to convert the instrument of
the invention into a culdoscope or laparoscope;
FIG. 3 is a transverse sectional view taken as indicated by the
arrowed line 3--3 of FIG. 2;
FIG. 4 is an enlarged transverse sectional view taken as indicated
by the arrowed line 4--4 of FIG. 2;
FIG. 5 is an enlarged, fragmentary sectional view taken as
indicated by the arrowed line 5--5 of FIG. 2; and
FIG. 6 is a semidiagrammatic sectional view illustrating the
culdoscopic species of the invention in use.
DESCRIPTION OF EXEMPLARY EMBODIMENTS OF INVENTION
Referring initially to FIG. 1 of the drawing, the female
urethroscope or cystoscope illustrated therein is designated
generally by the numeral 10 and comprises a housing 12 equipped
with a handle 14 and a removable barrel 16 threadedly, or
otherwise, connected to the housing to form the tubular distal end
of the instrument. As disclosed in more detail in the
aforementioned copending applications, the housing 12 contains a
lighting system and the handle 14 contains a source of gas under
pressure, reference being made to the copending applications for
more detailed disclosures. The lighting system in the housing 12
may be supplied with light through an optical fiber cable 18, and
gas may be supplied from the source in the handle 14 under the
control of a normally open valve 20 on the handle.
The instrument 10 is provided with a passageway 22 which extends
through the housing 12 and the barrel 16. Light from the lighting
system in the housing 12 is projected through the passageway 22 to
the distal end thereof, and gas under pressure is introduced into
the passageway, under the control of the valve 20, through a
passage 24. The housing 12 carries a removable optical viewing
means 26 in communication with the proximal end of the passageway
22. Preferably, the viewing means 26 is threadedly connected to the
housing 12 in alignment with the passageway 22. If a different
magnification is desired, the viewing means 26 may be removed and
another substituted. Alternatively, a photographic means, not
shown, may be substituted if a photographic record is desired. The
particular optical viewing means 26 illustrated is equipped with
means 28 providing a passage therethrough for any desired
diagnostic and/or therapeutic device, not shown, such as a urine
sampler, a cauterizing implement, an instrument for performing a
biopsy, or the like. The particular procedure being carried out may
simultaneously be observed through the viewing means 26.
The barrel 16, which may be formed of metal, plastic, or any
suitable material, is of a size to permit ready insertion into the
male or female urethra and through it into the bladder. In the
particular construction illustrated, the barrel 16 is provided
adjacent its proximal end with a vent 30 equipped with a valve 32
which may be opened to release air or gas from the urethra or
bladder if desired.
Considering the operation of the urethroscope or cystoscope 10, the
distal end of the barrel 16 is inserted into the proximal end of
the urethra 34 and gas under pressure is introduced into the
passageway 22 under the control of the valve 20. This gas enters
the urethra 34 ahead of the tubular distal end of the instrument 10
and tends to dilate urethra ahead of the distal end of the barrel
16, as indicated at 36. Thus, the gas acts as an obturator
facilitating insertion of the barrel 16 into the urethra and, if
desired, through the urethra into the bladder, which can be
inflated by the gas to the extent necessary to permit a complete
examination of the interior thereof. As previously pointed out, the
walls of the urethra may be examined with this technique as the
barrel 16 is being inserted, thereby assuring the physician that
any traumatic condition he may observe through the optical viewing
means 26 pre-existed, and was not caused by the instrument 10. The
physician is able to view the interior of the urethra and, if
desired, the interior of the bladder, in a gas field, which
provides much greater clarity than the conventional water field.
Furthermore, the urethrovesical junction functions normally in a
gas field and its function can be observed, which is not true of a
water field. The use of a gas has other advantages in the field of
urology also. For example, urine samples may be obtained from the
ureters as urine spurts therefrom. When a water field is used, this
technique cannot be employed, it being necessary to use a ureteral
catheter, with the attendant risk of trauma to the interior of the
ureter. In operative surgery, structures may be viewed through the
endoscope, prior to placing sutures and following the placing of
sutures, to determine whether the procedure has been accomplished
as in the tightening of the urethrovesical junction in the
treatment of stress incontinence. Furthermore, with a gas field,
topical solutions may be applied to indicated areas as required,
something which is totally impossible with a water field.
Additionally, smears or scrapings of tissue for analysis for
possible malignancy can be accomplished in a gas medium, but not in
a water field. These and various other advantages of gas
obturation, dilation and inflation are applicable not only to the
instrument 10, but to various other species of the endoscope of the
invention.
Turning now to FIGS. 2 to 6 of the drawing, the invention is
illustrated therein as embodied in a culdoscope or laparoscope 50.
FIG. 6 specifically shows the instrument 50 in use as a culdoscope,
and it will be referred to hereinafter as a culdoscope for
convenience.
The culdoscope 50 includes a barrel 52 of appropriate dimensions
which may be threadedly, or otherwise, connected to the housing 12
as a substitute for the barrel 16. The barrel 52 is provided
adjacent its proximal end with a gate valve 54 pivotable between
open and closed positions through a complementary, generally
chordal slot 56 in the barrel. When the gate valve 54 is in its
open position, an elastomeric valve 58 suitably secured to the
barrel 52 closes automatically to prevent the escape of gas from
the interior of the barrel. As shown in FIG. 5, the elastomeric
valve 58 is provided with a generally chordal slit 60 having
overlapping edges 62 which automatically seal against the escape of
internal pressure when the gate valve 54 is pivoted open. When it
is desired to close the gate valve 54, it passes between the
overlapping edges 62 of the slit 60 into the barrel 52.
The gate valve 54 is normally open, and is closed only when it is
desired to substitute one optical viewing means 26 for another, or
a photographic means for the optical viewing means, after the
barrel 52 has been inserted through a small opening at the top of
the vagina into the cul-de-sac, as shown in FIG. 6 of the drawing.
Thus, an optical or photographic substitution may be made without
loss of gas previously introduced into the peritoneal cavity to
inflate same to facilitate diagnostic and/or therapeutic
procedures.
The culdoscope barrel 52 is also provided with an inflatable
annular cuff or cuff means 64 which, as shown in FIG. 6, may be
inflated through an elastomeric tube 66, after insertion of the
distal end of the barrel 52 into the cul-de-sac, to prevent the
escape of gas from the peritoneal cavity around the exterior of the
barrel 52. As will be clear from FIG. 6, the cuff 64 engages the
walls of the vagina in a substantially gas tight manner to prevent,
or at least minimize, loss of gas from the peritoneal cavity.
In the particular construction illustrated, the cuff 64, which is
preferably made of an elastomeric material, includes an inner tube
68 carrying an inflatable annular chamber 70 with which the
inflation tube 66 communicates. The inner tube 68 fits the barrel
52 snugly to hold the cuff 64 in place during insertion. Subsequent
inflation of the annular chamber 70 urges the outer periphery
thereof firmly against the vaginal walls, and further urges the
inner tube 68 firmly against the exterior of the barrel 52.
The culdoscope version 50 of the endoscope of the invention may be
used in a similar fashion to the instrument 10, and has similar
advantages. Consequently, a more detailed description is not
necessary to a complete disclosure of the invention.
It will be understood that although the foregoing disclosure has
been limited to a barrel 16 for a female urethroscope or cystoscope
and to a barrel 52 for a culdoscope or hysteroscope, other barrels
may be substituted to obtain other species of the basic endoscope
of the invention. For example, the endoscope may be converted to an
anoscope, proctoscope, sigmoidoscope, amnioscope, male urethroscope
or cystoscope, laparoscope, or the like, by substituting an
appropriate barrel. Also, telescopes permitting viewing at an
angle, or even retrograde viewing, may be substituted. The
endoscope of the invention may be used as a colposcope without a
barrel.
The previous disclosure has suggested a number of diagnostic and/or
therapeutic procedures which can be carried out by way of the
passageway 22 through the instrument, and which can be observed
visually at the same time. Numerous other diagnostic and/or
therapeutic procedures may be carried out with the various versions
of the basic endoscope. For example, utilizing the instrument 10 as
a hysteroscope, the physician may carry out and simultaneously
observe, through the barrel 16, such procedures as taking of
biopsies, suction or aspiration of uterine contents, dilation of
the uterus and curettage, removal of polyps, opening of Fallopian
tubes by means of the gas used to dilate the uterus, cryosurgery,
cautery or fulgaration, insertion of intrauterine devices,
determining whether intrauterine devices are still in place, and
the like. In each of these techniques, the ability to introduce a
gas into the uterus through the barrel 16 to dilate the uterus is
of paramount importance since the dilating gas field permits a
clear view of the interior of the uterus in each instance.
Somewhat analogous diagnostic and/or therapeutic techniques may be
carried out in conjunction with each of the other species of the
generic endoscope of the invention. Consequently, further
explanations herein are not necessary.
Various materials may be used for the various parts of the
different species of the endoscope of the invention. Any parts
which contact or can contaminate the bodies of the patients must,
of course, be sterile, and this may be accomplished by making such
parts of sterilizable materials, or of aseptic disposable
materials.
Although exemplary embodiments of the invention have been disclosed
for purposes of illustration, it will be understood that various
changes, modifications and substitutions may be incorporated in
such embodiments, and that the invention may be incorporated in
numerous other embodiments, all without departing from the spirit
of the invention as defined by the following claims.
* * * * *