U.S. patent number 3,841,330 [Application Number 05/323,654] was granted by the patent office on 1974-10-15 for method and apparatus for bathing body cavities.
Invention is credited to Karl Storz.
United States Patent |
3,841,330 |
Storz |
October 15, 1974 |
METHOD AND APPARATUS FOR BATHING BODY CAVITIES
Abstract
An endoscope and the like comprising a shaft having independent
conduit means for delivering and withdrawing fluid extending from
its proximal to distal end. Pump means for pump fluid to and from
the body cavity. The pump being operated to deliver and withdraw an
equal volume simultaneously.
Inventors: |
Storz; Karl (Tuttlingen,
DT) |
Family
ID: |
5844990 |
Appl.
No.: |
05/323,654 |
Filed: |
January 15, 1973 |
Foreign Application Priority Data
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May 16, 1972 [DT] |
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2223760 |
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Current U.S.
Class: |
604/30 |
Current CPC
Class: |
A61M
31/00 (20130101); A61B 1/12 (20130101); A61B
1/00135 (20130101) |
Current International
Class: |
A61B
1/12 (20060101); A61M 31/00 (20060101); A61m
001/00 () |
Field of
Search: |
;128/230,241,240,2B,227,228,278,350,4 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Gaudet; Richard A.
Assistant Examiner: Yasko; J.
Attorney, Agent or Firm: Schaffer; Murray
Claims
What is claimed:
1. In combination, an endoscope or similar apparatus for operating
in a body cavity comprising a substantially hollow shaft having
first and second conduit means extending between the proximal and
distal ends respectively for the delivery and withdrawal of fluid
from said body, and tubular pump means comprising a flexible hose
extending respectively from said delivery and withdrawal conduit
means and a rotary eccentric actuator acting thereon for
simultaneously pumping an equal volume of fluid through said first
and second conduit means to and from said body.
Description
BACKGROUND OF THE INVENTION
The present invention relates to medical operating devices and in
particular to a device such as an endoscope employing means for
simultaneously bathing a body cavity.
Devices such as endoscopes are well known for performing many types
of operations, particularly in transurethal, urinary and bladder
sections. In such operations the removal of a bladder tumor or
growth in the bladder or bladder-neck is accomplished by employing
high frequency current during which it is preferable to first
expose the bladder or at least the situs of the operation to view
and then to perform the electrical cutting while simultaneously
bathing the area with a fluid media, as for example water. In order
to maintain the field of vision free of blood and other material a
water stream having a measurable pressure must be provided.
Accordingly, the endoscope used for the operation has been provided
with conduit means for delivering the fluid to the situs of the
operation. In the known devices the cross-section of the fluid
feeding channel has been so large that about 1 liter of water per
minute to the bladder is provided. This results in the rapid
filling of the bladder and requires that as much tissue be cut by
the doctor as soon as possible, since the filling of the bladder is
annoying to the patient, and if it is filled too much, does the
patient serious jeopardy. Because of this, it has been necessary
when using the known devices, to interrupt the operation as often
as 50 times, in order to remove the accumulated water. This
drainage of the bathing water takes virtually as much time as the
actual operation itself. This disadvantage is so severe that it
hampers and reduces the efficiency of the bathing and as well as
the display of the bladder to the doctor and also the clearing of
the field of vision.
Attempts have been made to overcome the above disadvantages through
the provision of a return duct by which the fluid may be removed.
In one device the annular chamber within the endoscope shaft is
used as the bathing media channel and a connecting socket for the
infeed and discharge of the media is fastened to the head portion
of the endoscope shaft itself. German Utility Pat. 1,980,836 shows
such a device. The limited area wherein both the channel for the
infeed and the duct for the discharge are arranged, hinders and
prevents the full flow of the media stream. In addition the actual
connection for the return flow duct, because of structural
imitations, is rather narrow, that is, its cross-section is
significantly smaller than the cross section of the infeed channel.
As as consequence, much more bathing fluid media flows into the
bladder than flows outwardly therefrom so that filling of the
bladder occurs, anyway. Therefore, even with the use of this
device, the operation must be interrupted periodically in order to
remove the accumulated fluid. This situation even occurs in those
device in which means are provided to maintain a continuous bathing
through an infeed canal which is separated from the return
duct.
Devices are also known in which a constant volume of fluid is
delivered to and withdrawn from the bladder in a closed system by
means of a circulating pump. This system requires that the
particulate matter such as bladder-stone particles be removed by
some type of filter means. However, since blood clots and blood
masses act to block and close up the filter means very quickly,
this system has its limitations. In addition, this system has the
disadvantage that fresh bathing liquid is not delivered to the
bladder, since the bathing liquid circulates in a closed
system.
The present invention has as its object the provision of apparatus
and particularly an improved endoscope means which overcomes the
disadvantages of the prior art and provides means for performing
the operation of the type described without interruption and with
the security desired.
SUMMARY OF THE INVENTION
The object of the present invention is obtained by providing an
endoscope device in which bathing media is continuously with or
intermediate the operative steps in short succeeding intervals
simultaneously pumped into and out of the body cavity, the inveed
and the discharge being maintained in equal volume. In this manner
it is assured that during the operation the delivered bathing media
is always equal to the discharged bathing media volume. This
prevents the excess filling of the bladder in every instance. It
is, therefore, possible for the first time to continue the
operation from beginning to end without interruption. The bladder
may thus be filled with a standing water column, before the
operation is commenced and then the tissue cut can be made with the
bladder full of bathing liquid as is most desirable from a medical
point of view. Nevertheless, in accord with the present invention,
once the operation is commenced, an exchange of equal volume of
liquid may be effected, so that while the bladder constantly
remains full, the liquid together with tissue, blood, etc., is
withdrawn, cleansed and recirculated and fresh liquid added. At no
time does excess liquid accumulate in the bladder.
In accordance with the present invention the pumping of the bathing
media into and out of the body is accomplished through the use of a
tubular pump having a feed and discharge tube arranged in parallel
and a rotary actuator eccentrically arranged between them. This
structure has the particular advantage that the eccentric actuator
can be arranged and connected simultaneously to pressurize the feed
tube and to exhaust the discharge leading to the corresponding
members in the endoscope device, so that it can control
simultaneously both the feeding and discharge of liquid through the
device. This arrangement has further advantages in that it is of
great simplicity, it is exteremely efficient and insures that both
the pumping in and exhausting out of the bathing fluid is created
from a single source having the same stroke frequency and volume of
pumping.
In accordance with a further feature of the present invention the
endoscope shaft may be formed having first a nozzle portion at the
distal end of the shaft by which the bathing media is delivered
directly to the site of the operation, and a second separate
discharge channel from the site. The connection for the actual
intake and for the discharge of the media may then be arranged on
the headportion or proximal end of the endoscope shaft. This
arrangement has the advantage that separate channels or ducts can
be provided through the endoscope for the intake and for the outlet
of fluid. Further, the discharge channel can be made at least equal
to or greater in cross-section than the inlet channel. Preferably,
the cross-section of the inlet channel is maintained substantially
smaller than the discharge channel so that a high enough pressure
is developed to wash the tissue from the lens etc., but
accumulation of the liquid in the cavity is avoided. In addition,
through the separation of the discharge channel from the inlet
channel it is insures that at least the same volume of fluid is
pumped out of the body cavity as is pumped into it.
A further feature of the present invention resides in the provision
that the inlet channel is formed in the nature of a throat or bulge
arranged about the viewing tube of the endoscope whereby the throat
provides an annular channal closed with respect to the viewing tube
and separate therefrom. Further this construction permits the
viewing tube to be independently and removably inserted in the
shaft so that it can be withdrawn easily and simply for cleaning
and sterilization. In addition, the interior of the shaft is also
available by being removable of the viewing tube for cleaning and
sterilization. The prior techniques of soldering the inlet channel
on the viewing tube, and thus requiring a small cross-section is
avoided.
Further details and particulars of the invention are given in the
following disclosure and will be seen in the accompanying
drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a plan view of apparatus embodying the present invention
which is connected to an endoscope device, seen extending
perpendicularly to the plan of the drawing; and
FIG. 2 is a partially sectional elevational view of the endoscope
adapted to receive the apparatus of the present invention.
DESCRIPTION OF THE INVENTION
The Figures show an endoscope adapted for use in transurethral
operations, and bladder sections of the known devices and is
generally of the construction well known in the art. Similar
devices, adapted for body insertion, may be employed. Because of
the wide knowledge in the art of such devices, the drawings are
schematic only, and of conventional structure, and therefore either
not shown or described herein. Reference, however, is made to the
inventor's copending applications, Ser. No. 177,349, 177,350 now
U.S. Pat. No. 3,791,379, 177,353 now abandoned, all filed Sept. 2,
1971, should details thereof be required for further understanding
of this invention.
As seen in the Figures, the device comprises an endoscope shaft 14
carrying at its proximal end a sleeve-like or throat connection 14a
for a first inlet 12 having adjustable pet-cock valve and a second
inlet 13 through which fluid media may be delivered. As seen in
FIG. 1, attached to the inlets 12 and 13 respectively are resilient
flexible infeed tubes 7 and 9, which are jointly connected to a
Y-connection 11 which is in turn connected to means for storing the
liquid media such as a bottle 10. Located above the connection 14a
is an outlet 25 to which is connected to the end of a resiliently
flexible discharge tube 8. The outlet 25 is not seen in FIG. 2,
since it lies at right angles to the inlets 12 and 13, but is
adapted to be formed at the upper end of the endoscope and to be in
communication with an annular chamber 2 formed internally within
the shaft 14, between the viewing tube 4 and the wall of the shaft
14. The inlet 13 is in communication with a channel 1 passing
formed by a tube passing through a groove in endoscope shaft 14,
extending in the longitudinal direction with the guide tube 3.
As seen in FIG. 2 the endoscope comprises an optical eyepiece 24
mounted at the upper end of a viewing tube 4, which extends through
a surrounding guide tube 3. At the lower end of the viewing tube 4
there is located an objective lens 15 through which the situs of
the operation can be viewed by the doctor. The viewing tube is set
within the endoscope shaft 14 and thus forms the annular discharge
channel 2. The channel 1 is formed by a tube or tubular section
formed along the length of the guide tube 3 and the viewing tube 4.
As seen in FIG. 2, a portion of the viewing tube 4 and the exterior
endoscope shaft 14 extends beyond the point at which the lens 15 is
secured, thus extending the discharge channel 2 below the lens. On
the other hand a portion of the shaft 14 terminates above the lens
15 so that the channel 2 opens at a level higher than the lens 15.
It will also be observed that the discharge channel 2 has a greater
cross-sectional area than the inlet or feed channel 1.
An elongated wire having a loop 16 at its lower end extends between
the endoscope shaft 14 and the viewing tube 4 below the lens 15.
The wire 16 is secured to a movable sleeve 17 located about the
guide tube 3 which is connected via a finger grip 21 and an
articulated pair of levers 18 and 22 to a boss at the upper end of
the endoscope on which the eye piece is secured. The boss contains
a palm or hand grip 23 permitting the carrier sleeve 17 to be
movable axially along the tube viewing tube 4 by manipulation of
the finger grip 21. In this manner the wire loop 16 may be extended
or retracted with respect to the situs of the operation. The wire
loop 16 of the course comprises the electrode of the high frequency
apparatus and is connected to a suitable power source in known
manner. The connection 14 a for the inlets 12 and 13 sits above the
shaft 14 and has a small conduit which connects the inlet 12 to the
annular channel 2. The inlet 12 is provided with the pet-cock so
that it can be opened and bathing fluid delivered directly through
this discharge channel 2 into the body cavity so that the bladder
may be initially filled with a predetermined amount of liquid via
the larger discharge channel so that the conductive electrode will
have sufficient conducting media and the cavity will be
sufficiently bathed, before the moment at which the operation may
begin.
Returning to FIG. 1 the inlet tube 7 from inlet 13 and the outlet
tube 8 from discharge 25 pass through a pump 5 having a rotatable
eccentric actuator 6. The pump 5 comprises a body in which a rotary
motor having a shaft on which the actuator 6 is mounted. The tubes
7 and pass through grooves in the body parallel to each other and
substantially tangential to the actuator, which is adapted to
engage both the tubes 7 and 8 simultaneously. The actuator 6
compresses the tubes in rhythmic sequence so as to pump fluid
through tube 7 and exhaust fluid through tube 8. The tubes 7 and 8
and the excenter 6 are positioned relative to each other that the
stroke, and the fequency of the pumping action is the same on both
tubes, although in opposite phase or direction and the volume of
compressed fluid in each of the tubes is the same. Therefore,
simultaneously a similar volume of fluid may be pumped into the
body cavity as is withdrawn. Actually, during use of the device,
the pet-cock connection 12 is opened so that the cavity is
initially filled to the most optimal level for the operation.
Thereafter, it is closed so that liquid is delivered only through
the smaller inlet 13 and channel 1 by the operation of the pump 5.
Simultaneously the same volume of fluid is withdrawn from the site
of the operation through the discharge channel 2. The inlet
connection 13 passes through a cut in the wall of the endoscope
shaft 14 and is soldered or welded to the tubular channel 1 to
provide a fluid tight arrangement so that the infeed of liquid is
sealed from the connection 12. The feed channel 1 extends the
length of viewing tube 4 and opens in the neighborhood of the
objective lens 15 so that the liquid pumped through the nozzle-like
opening tends to pass over this objective lens 15 maintaining it
free of any blood or particles during the operation. The discharge
flow of the liquid passes through the opening in the annular
discharge channel 2 one portion of which is immediately adjacent
the electrode wire loop 16 and the other portion of which is
located above the objective lens 15. In this way a current of fluid
from the inlet to the outlet is created insuring absolute cleaning
of both the situs of the operation and the distal end of the
endoscope.
The eye piece 24 and the viewing tube 4 are jointed together to be
removable axially from the endoscope shaft 14 by being pulled
upwardly through the sleeve 17 and the boss holding the lever 22.
By removing the eye piece 24 and the tube 4 on completion of or
even during the operation the bladder can be easily and quickly
emptied, since the liquid in the bladder will all run quickly
through the hollow interior of the endoscope shaft 14 without
interruption. This is advantageous particularly should an emergency
occur during the operation which requires instantaneous emptying of
the bladder. With the present invention, removal of the device
permits the eye piece to be cleaned and sterilized and opens the
entire enterior of the endoscope to cleaning and sterilization
also.
The present device is employed by first inserting the endoscope
shaft 14 together with the viewing tube 4 in the body cavity with
the pet-cock opened so that the body cavity is filled with the
bathing liquid delivered from the reservoir 10 through the annular
discharge chamber 2. The pump 5 is arranged so that the discharge
tube 8 is closed so that the liquid does not prematurely flow out
of the body. A pet-cock or other clamping valve mechanism may be
used on the tube 8 rather than using the pump to close the tube 8.
Such mechanism may be located either directly on the tube or on the
discharge connection 25. The pump 5 is then activated upon the
beginning of the operation itself and an additional amount of fluid
is directed via the Y-joint 11 into the tube 7, to the site of the
operation through the inlet channel 1. Since the inlet channel 1 is
of a smaller cross-sectional area than the discharge channel 2 the
amount of fluid passed into the bladder in this direction is so
great as to cause excess filling of the bladder.
As soon as the body cavity is filled in the described manner, the
pet-cock 12 is closed and if a clamp is used the clamp or other
device in discharge connection 25 and discharge tube 8 is opened.
Thereafter the doctor may begin his work and perform the operation
by activating the electrode 16. The pump 5 is continuously operated
so as to continuously feed and withdraw a constant amount of fluid
from the body cavity during the course of the operation. On the
other hand, if desired, the doctor may operate the pump at
intervals and only when the doctor considers it necessary to remove
blood and tissue from the site of the operation. In either event,
the same volume of water is delivered to the body cavity as is
simultaneously removed therefrom setting up a circulation of fluid
about the objective lens 5, the electrode 16, as well as in the
site of the operation so that the site is maintained in clean and
suitable condition for the continuation of the operation.
Since the discharge channel 2 is larger in cross-section than the
inlet channel 1 it is clear that the body cavity will at no time be
filled with an excess of fluid and further the blood particles,
tissue particles, and other solid material withdrawn will easily
pass through the discharge channel. The bladder is constantly
maintained with an optimal amount of fluid providing the necessary
conductive media for the electrode as well as suitable bathing and
therapeutic media. The smaller inlet cavity has a further advantage
in that, while the same volume of fluid is directed into the body
as is removed therefrom, the smaller cross-section increases the
pressure of the fluid so that the complete and proper washing of
the area is obtained. It also should be noted that the mouth of the
inlet channel 1 is positioned between the mouth of the outlet
channel 2 so that the two are not in close proximity to each other
and thus the incoming water can not be diverted to the outlet
without further performing its cleaning function.
Various modifications and embodiments will of course be evident to
those skilled in this art. Accordingly, the foregoing disclosure is
to be taken as illustrative only, and not limiting of the scope of
the present invention.
* * * * *