Abstract:
Exemplary aspects of a medical instrument system are disclosed. The system may have a support frame movably coupled to a patient table, the support frame having a computer display support, and an endoscope holder, wherein the computer display support and the endoscope holder are coupled to move together as a single unit. In some aspects, the system includes a computer display device, and an endoscope, wherein the computer display device and the endoscope are coupled to the support frame to move together as a single unit, and the patient table, computer display device, and the endoscope are arranged along a common longitudinal axis.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application claims the benefit of priority of U.S. Provisional Application No. 62/288,868, filed Jan. 29, 2016, the entirety of which is incorporated by reference into this application. 
     
    
     TECHNICAL FIELD 
       [0002]    The present disclosure relates generally to medical instrument systems. 
       BACKGROUND 
       [0003]    Retrieval devices and systems allow physicians and other medical professionals to remove various materials from a patient, including organic material (e.g., blood clots, tissue, and biological concretions such as urinary, biliary, and pancreatic stones) and inorganic material (e.g., components of a medical device or other foreign matter). For example, biological concretions can develop in the kidneys, pancreas, ureter, or gallbladder, and cause blockages or other complications within the body. Minimally-invasive medical procedures may be used to remove these materials through a natural orifice, such as lithotripsy and ureteroscopy, or through an incision, such as percutaneous nephrolithotomy. 
         [0004]    Current ureteroscopic procedures typically require two or more people, wherein a physician controls the ureteroscope with both hands, using one hand to grasp the handle and the other to hold the distal portion of the ureteroscope as it enters the urinary tract via the urethral meatus. An assistant inserts, manipulates, and retracts a tool such as a stone retrieval basket, forceps, or a laser through a working channel of the ureteroscope. Thus, the procedure may require, among other things, controlling the movement of the ureteroscope into and out of the patient, steering the ureteroscope within the patient, movement of the tools through the ureteroscope, and actuation of the tools once they are positioned at a desired site. 
         [0005]    With these various movements of the ureteroscope and tool is a desire by the physician to track such movement and monitor other aspects of the patient and the procedure. Currently, this information may be located at different locations within the operating room, requiring the physician to focus attention away from the holding and/or manipulating the ureteroscope and/or tools. The present disclosure is directed to these issues and other issues in the art. 
       SUMMARY 
       [0006]    Aspects of the present disclosure relate to an endoscopic device and method. Numerous aspects of the present disclosure are now described. 
         [0007]    One aspect is a medical system. This system may comprise a support frame movably coupled to a patient table, the support frame may have a computer display support, and an endoscope holder, wherein the computer display support and the endoscope holder are coupled to move together as a single unit. 
         [0008]    Aspects of this system may additionally and/or alternatively include any one or more of the following features. The support frame and endoscope holder may share a common longitudinal axis. The computer display support may share a common longitudinal axis with the support frame and endoscope holder. The support frame may share a common longitudinal axis with the patient table. The support frame may further include at least one actuator for controlling an instrument coupled to the support frame. The instrument may be at least one of an endoscope, a stone retrieval basket, a laser unit, or a fluid generator. The support frame may be slidably coupled to the patient table. The computer display support may form a display plane at an acute angle with respect to a top plane of the patient table. The support frame may further include one or more spools. The support frame may further include a support beam, a vertical endoscope beam, and a handrail. The support beam may couple to the patient table, and the endoscope beam may be located distal of the handrail. The handrail may be positioned at approximately the same angle as a display plane of the computer display support. The system may further include at least one of an endoscope, a computer display device, a stone retrieval basket, a laser unit, or a fluid generator. The system may further include an instrument holder coupled to the handrail. The system may further include a ureteroscope received in the endoscope holder. 
         [0009]    Another aspect is a medical instrument system. This system may comprise a support frame movably coupled to a patient table, the support frame having a computer display device, and a plurality of medical instruments, wherein the computer display device and the plurality of medical instruments are coupled to the support frame to move together as a single unit. 
         [0010]    Aspects of this system may additionally and/or alternatively include any one or more of the following features. One of the plurality of medical instruments may include an endoscope. The computer display device may display one or more videos image from the endoscope, a medical procedure information, and a patient information. The computer display device and the endoscope may be coupled to the support frame to move together as a single unit. The patient table, the computer display device, and the endoscope may be arranged along a common longitudinal axis. The computer display device may be located proximal of the endoscope, while the endoscope may be located proximal of the patient table. 
         [0011]    It may be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the invention, as claimed. As used herein, the terms “comprises,” or any other variation thereof, are intended to cover a non-exclusive inclusion, such that a process, method, article, or apparatus that comprises a list of elements does not include only those elements, but may include other elements not expressly listed or inherent to such process, method, article, or apparatus. The term “exemplary” is used in the sense of “example,” rather than “ideal.” 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0012]    The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate exemplary aspects of the present disclosure and together with the description, serve to explain the principles of the disclosure. 
           [0013]      FIG. 1  illustrates a perspective view of the medical instrument system according to the present disclosure; 
           [0014]      FIG. 2  illustrates an end view of the medical instrument system of  FIG. 1 ; 
           [0015]      FIG. 3  illustrates a side view of the medical instrument system of  FIG. 1  in a first position; and 
           [0016]      FIG. 4  illustrates a side view of the medical instrument system of  FIG. 1  in a second position. 
       
    
    
     DETAILED DESCRIPTION 
       [0017]    Reference is now made in detail to examples of the present disclosure, examples of which are illustrated in the accompanying drawings. Wherever possible, the same reference numbers will be used throughout the drawings to refer to the same or like parts. The terms “proximal” and “distal” are used herein to refer to the relative positions of the components of the instrument system. When used herein, “proximal” refers to a position relatively closer to a user of the instrument system. In contrast, “distal” refers to a position relatively farther away from the user of the instrument system. As used herein, the terms “generally,” “approximately,” and “substantially” indicate a range of +/−5% of the stated value. 
         [0018]      FIG. 1  illustrates a perspective view of the medical instrument system  10  according to the present disclosure. The medical instrument system  10  is coupled to a patient table  2  that supports a patient  4  during a medical procedure. The medical instrument system  10  includes a support frame  12 , an endoscope  14 , a medical instrument  16 , a computer display device  18 , a central processing unit (or “CPU”)  20  connected to the display device  18 , a laser unit  22 , and a fluid generator  24 . 
         [0019]    The laser unit  22  may be any type of laser unit, for example, a holmium laser unit, a holmium:YAG laser unit, a carbon dioxide laser unit, or another suitable laser unit. The fluid generator  24  may be any device and/or devices that can supply fluid (e.g., saline) to endoscope  14 . The fluid generator  24  may include components such as a fluid source, a pump, a control system, a heat exchanger, a filter, a temperature sensor, a pressure sensor, a supply line, and/or various user input devices. 
         [0020]    As best shown in  FIGS. 1 and 3 , the support frame  12  may include a primary support beam  30 , a handrail support  32 , a handrail  34 , an endoscope support beam  36 , an endoscope holder  38 , and one or more spools  40 . Any spool  40  may be used to hold a length of a fiber, or a length of a sheath, such as those forming part of a medical instrument sheath used in biopsy, lithotripsy. Exemplary uses of the one or more spools  40  are described further below. The primary support beam  30  may include a generally straight portion  28  having a distal end  42  slidably coupled to an underside of patient table  2 . The primary support beam  30  may also include an angled proximal end  46  coupled to the handrail support  32 . The coupling of the angled proximal end  46  of primary support beam  30  to the handrail support  32  may be a fixed connection as shown, or may be an adjustable connection via a rotatable and lockable joint or similar connection. Such an adjustable connection may allow the angle of the handrail support  32  and accompanying handrail  34  to be adjusted to a desired angle, such as angle  120  in  FIG. 3 . 
         [0021]    As best seen in  FIGS. 2 and 3 , the handrail support  32  may include a beam extending normal to the primary support beam  30 . The handrail  34  may be attached to both ends of the handrail support  32 . Handrail support  32  may also be coupled to a computer display support  48  ( FIG. 3 ) that will be described in more detail below. While handrail support  32  is shown as a straight beam in  FIGS. 1-4 , handrail support  32  could be formed in different configurations. 
         [0022]    Referring again to  FIG. 3 , and as noted above, support frame  12  may include an endoscope support beam  36  extending vertically from support beam  30  to a height above a top of handrail  34 . Endoscope support bean  36  may be rotatably connected to the endoscope holder  38  to allow for rotation of endoscope  14  and endoscope holder  38  about axis  116  ( FIG. 4 ). This rotational connection between endoscope support beam  36  and endoscope holder  38  can be achieved by, for example, one or more tongue and groove connections (not shown) between a proximal end  50  of the endoscope holder  38  and a top portion  90  of support beam  36 . 
         [0023]    Endoscope support beam  36  ( FIG. 3 ) may also be coupled to any of the one or more spools  40 . As shown in  FIG. 1 , two spools  40  may be included, a first spool  40 A for a laser fiber  54  associated with laser unit  22 , and a second spool  40 B for a sheath of medical instrument  16 . First and second spools  40 A and  40 B may each be rotatably coupled about the endoscope support beam  36 . The rotation of spools  40 A,  40 B may allow feeding and withdrawing of laser fiber  54  or sheath  52  of medical instrument  16  through a working channel of endoscope  14  during a medical procedure. Referring to  FIG. 3 , first spool  40 A, for example, can be formed in any manner, and may include a base cylinder  56 A on which the laser fiber  54  is spooled, and a plurality of sidewall members  58 A on both sides of the based cylinder  56 A to restrict movement of the laser fiber  54  axially on base cylinder  56 A. Sidewall members  58 A can also provide a gripping portion for manual control of spool  40 A. Although not shown, second spool  40 B of  FIG. 1 , like first spool  40 A, may similarly include a base cylinder and sidewall member configured for use with sheath  52  of medical instrument  16 . Either of the first and second spools  40 A an  40 B may be used independently with laser fiber  54  or sheath  52  of medical instrument  16 . 
         [0024]    Referring to  FIG. 2 , handrail  34  may include a pair of parallel side rails  60 ,  62 , a top rail  64 , and a bottom rail  66 . The side, top and bottom rails  60 ,  62 ,  64 , and  66  may form a generally square or rectangular shape, but it is understood that other shapes could be used. For example, handrail  34  may be of any shape that facilitates handling of the support frame  12  and supporting of display device  18 , and need not necessarily include rails. The top rail  64  may include an instrument holder  68  for receiving a medical instrument. Side rails  60 ,  62 , may include actuators  70 ,  72 ,  74 , and  76  for controlling various aspects of the medical instrument system  10 , as will be discussed in more detail below. Handrail  34  may also couple to display support  48  ( FIG. 3 ) along top rail  64  to receive display device  18 . 
         [0025]    Instrument holder  68  ( FIG. 2 ) may include at least one clip  78  extending from top rail  64  of handrail  34 . The clip  78  may have a U or C shape and may be sized to receive a handle of medical instrument  16 . The clip  78  may be flexible to provide a snap in fit for the medical instrument  16 , or may be adjustable and lockable for receiving and securing medical instrument  16 . The medical instrument  16  may be, for example, a stone retrieval basket, a grasper, or any other medical instrument appropriate for the desired medical procedure. The location of clip  78  on the top rail  64  positions the medical instrument  16  adjacent the endoscope  14  (or an associated one of the one or more spools  40 ) to facilitate, for example, a portion of the sheath  52  of the medical instrument  16  being fed over second spool  40 B and through a working channel of the endoscope  14  to a desired patient site. Another clip  78  may be used with laser fiber  54 . 
         [0026]    Actuators  70 ,  72 ,  74 , and  76  located on side rails  60 ,  62  may be in the form of buttons or levers, as shown, or may be any other type of actuator, such as switches, joysticks, and/or rollers. While the actuators  70 ,  72 ,  74 , and  76  are shown on the side rails  60 ,  62 , they may be located elsewhere, such as on top and/or bottom rails  64 ,  66 . The actuators  70 ,  72 ,  74 , and  76  may control various features of support frame  12 , endoscope  14 , medical instrument  16 , laser unit  24 , fluid generator  26 , and/or any other feature or device of medical instrument system  10 . For example, the actuators  70 ,  72 ,  74 , and  76  may control fluid generator  26  to supply suction and/or irrigation fluid through the endoscope  14 , control steering/deflection of a distal end of endoscope  14 , control movement of the support frame  12  relative to patient table  2 , control the rotation of the one or more spools  40 , feeding or withdrawing of laser fiber  54  or sheath  52  directly, and/or actuation (opening/closing) of an end effector or basket of the medical instrument  16 . Such control can be achieved through various motive systems and through a wired or wireless connection. 
         [0027]    As noted above, the display support  48  ( FIG. 3 ) may be coupled to top rail  64  of handrail  34  and to handrail support  32  so as to orient the display device  18  in a display plane that is parallel to a plane of the handrail  34 . The display plane corresponds to the plane formed by the top/display surface of display device  18 . Display plane of display device  18  may also form an acute angle with respect to a top plane of the patient table  2 . Alternatively, display support  48  could be coupled to one or both of top rail  64  and handrail support  32  in a manner that would allow for adjustment of the display plane of the display device  18 . Display support  48  may include a back plate or back frame  77  ( FIGS. 2-3 ) that is sized to receive display device  18 . For example, back frame  77  can be custom sized with flexible corner tabs  80  that fixedly grip corners of the display device  18 . Alternatively, the back frame  77  can be adjustable to receive and secure display devices  18  of various sizes. 
         [0028]    Computer display device  18  can be a tablet type computing system having a touch screen display and conventional computer components, such as a CPU, memory, video and graphics cards, wireless and wired networking devices, audio devices, one or more input/output ports, a power supply, and/or any other suitable computer features. The display device  18  may also form a computer with a separate CPU as shown in  FIG. 1 . While not shown in the figures, display device  18  may include connections to receive or send information from various patient monitoring systems and devices (e.g., an image) and/or other sensors of endoscope  14 , laser unit  22 , fluid generator  24 , one or more spools  40 , and/or any other component or feature of medical instrument system  10 . Such connections may allow display device  18  to display patent information and vitals, video images from an image sensor of endoscope  14 , procedure information such as a procedure timer, how much irrigation fluid (saline) has been used, and/or laser firing history and power. Display device  18  may also include actuators, physical or graphical, for controlling features of medical instrument system  10 . For example, display device  18  may include actuators for controlling the withdrawal or feeding of the laser fiber  54  or sheath  52  of medical instrument  16  through the working channel of endoscope  14 . Power may be supplied to display device  18  in any conventional manner, and the display device  18  can be controlled by activation of the touch screen, or by voice or gesture controls. 
         [0029]    As noted above, endoscope  14  may be received in endoscope holder  38 . Referring to  FIG. 3 , endoscope holder may include a top portion  84  including a port assembly  86  hingedly connected to a proximal end  50  of endoscope holder  38  by, for example, a hinge pin  89 . In the open position (shown in dashed lines in  FIG. 3 ), the port assembly  86  provides an opening in the top portion  84  of endoscope holder  38  to allow placement of the endoscope  14  therein. The port assembly  86  may include a distal end  92  forming a clip  94  for securing to a distal end of  96  of endoscope holder  38 , or to the endoscope  14  itself, when the port assembly  86  is moved to a closed position to secure the endoscope  14 . The opening and closing of port assembly  86  could be done manually as shown in  FIG. 3 , or selectively moved via a motor and one of actuators  70 ,  72 ,  74 , or  76 . 
         [0030]    Port assembly  86  ( FIG. 3 ) may also include a port  98  ( FIG. 1 ) for receiving the laser fiber  54  and/or sheath  52  of medical instrument  16 . The port assembly  86  may include an internal friction roller mechanism (not shown) that can grip the laser fiber  54  and/or sheath  52 , and can be actuated automatically by one of actuators  70 ,  72 ,  74 ,  76  ( FIG. 2 ) to feed or withdraw the laser fiber  54  and/or sheath  52 . In addition or alternatively, port  98  may include a rotatable ring or toggle control  100  that enables rotation of the laser fiber  54  and/or sheath  52  as shown by double arrow  118  in  FIG. 4 . Rotatable ring  100  may be manually controlled to switch between the use of laser fiber  54  and/or sheath  52 . For example, fiber  54  and/or sheath  52  may be manually passed through ring  100 , or automatically passed through ring  100  using a feeder mechanism operable with actuators  70 ,  72 ,  74 ,  76 . 
         [0031]    According to one aspect, fiber  54  and sheath  52  are slip fit through a grommet in ring  100  that allows dynamic advancement/withdrawal through ring  100  using manual or motorized controls. The grommet may be a compressible element that is frictionally engageable with an exterior surface of either fiber  54  or sheath  52 . For example, the grommet may allow advancement/withdrawal of fiber  54  and/or sheath  52  when in an uncompressed, low friction position; and rotation of either or both of fiber  54  or sheath  52  when in a compressed, high friction position. Grommet shape, length and material are such that rotation of ring  100  in either direction of double arrow  118  maintains enough friction for 45 degree rotation left or right. An exemplary grommet may be made of silicone robber. Ring  100  may also contain a cam feature such that rotation exerts radial compression of the grommet when ring  100  is rotated so as to create additional friction and further enable rotation of fiber  54  or sheath  52 . 
         [0032]    Endoscope  14  may be any conventional endoscope, such as a ureteroscope, or cystoscope, and may include for example, a light system, image sensor, and working channel (not shown). As noted above, the working channel may receive one or more of laser fiber  54 , sheath  52  of medical device  16 , irrigation fluid from fluid generator  26 , and/or a guidewire (not shown). Communication and power connections (not shown) may extend from endoscope  14  to display device  18  and/or CPU  20  to supply the necessary information to display device  18 . 
         [0033]    During use of the medical instrument system  10 , gross movement of the endoscope  14  with respect to the patient  4  can be achieved by manually or automatically moving the support frame  12  in the direction shown by arrows  110 . This gross movement may be part of the endoscope insertion steps of the procedure and may include a movement of up to 300 mm as indicated by arrow  112  and a comparison of positions between  FIG. 3  and  FIG. 4 . If moved manually, the support frame  12  can be pushed or pulled by handrail  34  with the hands or a chest/waist of the physician. Movement of the support frame  12  could also be achieved automatically, for example via a rack and pinion type drive system between the patient table  2  and the primary support beam  30 , with actuation of the drive system via one of actuators  70 ,  72 ,  74 , or  76  of handrail  34 . 
         [0034]    Fine motion of the laser fiber  54  and sheath  52  of medical instrument  16  through endoscope  14  may also be achieved manually or automatically. If manually, the physician can physically feed or withdrawal the laser fiber  54  and/or sheath  52  through endoscope  14 . As noted above, port assembly  86  may optionally include an internal friction roller mechanism (not shown) that can grip the laser fiber  54  and/or sheath  52  and can be actuated via one of actuators  70 ,  72 ,  74 , or  76  of handrail  34  to automatically feed or withdrawal the laser fiber  54  and/or sheath  52  within the working channel of endoscope  14 . 
         [0035]    Similarly, endoscope  14  may be rotated manually or automatically about axis  116  as shown by double arrow  114 . This rotation, along with the steering/deflection of the distal end of endoscope  14  allows for approximately 360 degrees of movement of the distal end of endoscope  14 . 
         [0036]    Support frame  12  may be formed of any appropriate material, such as stainless steel. Further, while the present disclosure references the use of a ureteroscope type endoscope  14  and stone retrieval basket type medical instrument  16  in association with a ureteroscopy procedure, it is understood that the present medical instrument system  10  may be use with various other types of instruments and procedures. 
         [0037]    Medical instrument system  10  provides a consolidated interface for controlling the motion of various components of the system, and for monitoring various aspects of the patient  4  and procedure. This is achieved, for example, by arranging the support frame  12 , endoscope holder  36 , endoscope  14 , patient table  2 , computer display support  48 , and display device  18  generally about a common longitudinal axis  44  as shown in  FIG. 2 . Providing the display device  18  on the support frame  12  allows the physician to monitor instrument movement, procedure information, and patient information, all in the same direction of view with endoscope  14 , medical instrument  16 , and patient  4 . Moreover, by providing the physician with hands free support of the instrumentation, system  10  may also reduce cognitive load and improve the ergonomics of procedures that otherwise require manual support of numerous devices. Further, the consolidation provided by medical instrument system  10  may allow the physician to sit during the medical procedure because many of the monitoring and control aspects of the procedure are reachable or viewable from the chair. 
         [0038]    While principles of the present disclosure are described herein with reference to illustrative embodiments for particular applications, it should be understood that the disclosure is not limited thereto. Those having ordinary skill in the art and access to the teachings provided herein will recognize additional modifications, applications, embodiments, and substitution of equivalents all fall within the scope of the embodiments described herein. Accordingly, the invention is not to be considered as limited by the foregoing description.