Abstract:
A sleeve for holding an endoscope used in surgical procedures including a hollow cylinder for receiving the endoscope, a docking member at the proximal end of the cylinder for receiving the viewing hub of the endoscope, a continuous suction supply adjacent the distal end of the cylinder, and a pressurized fluid supply for use when needed to clean the window of the endoscope.

Description:
BACKGROUND OF THE INVENTION 
     This invention relates to an endoscope sleeve and, more particularly, to a sleeve for endoscopes used in surgical procedures which provides continuous suction and selective application of fluid to clean the endoscope window and also to clean or irrigate the operative field with a fine fluid spray. 
     Generally, endoscopes designed for surgery are adapted to be inserted in a body cavity, such as the nasal cavity, the pituitary cavity, the cranial cavity, or the middle ear. Surgical endoscopes are used to observe the condition of a body part within the cavity through a window at the distal end of the endoscope while surgical procedures are performed on that body part using instruments with elongated shafts and cutting tips inserted alongside the endoscope. Surgical endoscopes intended to be used with the sleeve of the present invention, like the 4 mm. sinus endoscopes available from Karl Storz and Smith &amp; Nephew Richards, are to be distinguished from the much longer and thinner flexible endoscopes typically used only for examination and diagnostic purposes. Such surgical endoscopes should also be distinguished from laporoscopes used in laporoscopy where continuous pressure is typically required to keep the field inflated. 
     Currently, surgical endoscopes are provided with various devices for cleaning the surface of the distal window as it becomes soiled and fogged during the course of procedures conducted within the body cavity. These devices supply fluid and/or suction to the area of the distal window in various complex arrangements. The prior devices, however, are less than satisfactory in environments such as the nasal cavity, where the endoscope window is nearly continuously being soiled or fogged as surgical procedures are conducted. These prior art devices are often ineffective in quickly and effectively removing the fluids and tissue which accumulate on the endoscope window during the course of the surgical procedure. Such devices also typically do not supply continuous suction to the operative site, including when a window cleaning operation is underway, which is highly desirable. 
     It is essential to have a clear field in order to see the anatomy during the course of endoscopic surgical procedures. The nasal cavity, for example, is a particularly difficult environment because of the substantial mucus flow produced there and the requirement that a clear operative field be maintained. For example, when it is not possible to see through the endoscope, there is a danger that a continuously active suction port will touch surrounding nasal tissue, pulling it into the suction conduit, causing tissue damage and clogging the port. 
     Prior devices which do supply fluid for cleaning the endoscope window but do not carefully control the directionality of this fluid are problematic. These prior devices can project the fluid directly onto certain particularly sensitive surfaces within a cavity, such as a cranial cavity or an eye orbit damaging tissue in the cavity. Also, prior devices that do supply fluid for cleaning the endoscope window are often erratic in the amount of fluid delivered. This results in ineffective cleaning of the endoscope window. 
     Finally, many prior surgical endoscope sleeves are bulky and tend to impede the effective use of the surgical instruments used alongside the endoscope sleeve combination in the close quarters encountered, for example, in the nasal cavity, the pituitary cavity, the cranial cavity, or the middle ear. Such bulky surgical endoscope sleeves tend to prevent or impair proper alignment of instruments with the endoscope. 
     SUMMARY OF THE INVENTION 
     It is accordingly an object of this invention to provide an endoscope sleeve that can be easily adapted for use with different endoscopes for providing selective and effective cleaning and defogging of the endoscope window, and irrigation and suction to operative sites where the device is being used. 
     Another object of the present invention is to provide an endoscope sleeve that irrigates the operative field with a fluid spray. 
     Yet another object of the present invention is to provide an endoscope sleeve that provides continuous suction to clear away debris, smoke, etc. produced in the cavity during the course of surgical procedures. 
     It is a further object of this invention to provide an endoscope sleeve that does not interfere with the entry, manipulation or alignment of instruments used in operative procedures under guidance of the endoscope. 
     A still further object of the present invention is to provide an endoscope sleeve that is particularly useful in endoscopic sinus surgery and in endoscopic pituitary surgery. 
     These and other objects and advantages of the invention will become apparent from the description and claims which follow. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     FIG. 1 is a perspective view of an empty sleeve in accordance with the present invention, cut away at its proximal end to highlight the mechanism provided for locking an endoscope in the sleeve; 
     FIG. 2 is a partial end view, in perspective, of the empty sleeve of FIG. 1; 
     FIG. 3 is an elevation view of the sleeve of FIG. 1 in which an endoscope has been mounted and in which the sleeve is cut away at its proximal end to show the proximal end of the endoscope resting in the sleeve; 
     FIG. 4 is an enlarged cross-sectional view of the distal end of the sleeve of the present invention taken along lines  4 — 4  of FIG. 1; 
     FIG. 5 is an end view of and end view of a sleeve in accordance with the invention and corresponding to that of FIG. 2, showing the suction and fluid ports disposed adjacent the window of an endoscope mounted in the device; 
     FIG. 6 is an elevation view of a sleeve in accordance with the present invention in which the fluid and pressure supply are connected to the sleeve; and 
     FIG. 7 is an enlarged view of a portion of the distal end of the sleeve and endoscope of FIG. 6 demonstrating the manner in which an endoscope window is cleaned in accordance with the present invention. 
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
     Turning first to FIGS. 1 and 2, a sleeve in accordance with the present invention is illustrated at  10 . The sleeve includes a fluid inlet port  12  and a suction port  14 , with both ports angled toward the proximal end of the sleeve. Each of the ports has a conventional nipple  15  for frictionally attaching hoses to supply fluid and suction as appropriate. Fluid inlet port  12  is in communication with a fluid conduit  16  which opens onto the distal end  20  of the sleeve while suction port  14  is in communication with a suction conduit  18  which also opens onto the distal end  20  of the sleeve. As explained in more detail below, the suction conduit transports fluid, mucus and smoke away from the operative field, and the fluid conduit supplies fluid (typically sterile saline) to the distal end of the sleeve to clean the distal window of an endoscope mounted in the sleeve. 
     The fluid and suction conduits are attached to the side of a hollow rigid cylinder  22  dimensioned to receive the outer tube of an endoscope. Cylinder  22  also includes an annular docking member  24  mounted to the proximal end  26  of cylinder  22 . 
     As can be seen most clearly in the enlarged distal end view of the empty sleeve shown in FIG. 2, the distal end  32  of suction conduit  18  is a generally annular opening located in a plane which is generally perpendicular to the longitudinal axis of the sleeve. The distal end  34  of rigid cylinder  22  is similarly generally annular and lies generally in the same plane as the distal end of the suction conduit. This cylinder is preferably of a length just slightly shorter than the outer tube of the endoscope which is to be fitted to the sleeve so that the window at the distal end of the endoscope lies just beyond the distal end of the cylinder. 
     The distal end  36  of fluid conduit  16  is capped with an overhanging portion or hood  38  which is open on the side to provide a fluid outlet  40  opposite distal end  34  of cylinder  22 . Additionally, a notch  42 , preferably half moon in shape, may be cut out of the distal end of cylinder  22  to provide improved access to the endoscope window. As explained in more detail below, hood  38  insures that the fluid passing through fluid conduit  16  and out of outlet  40  will be directed against the distal window of the endoscope mounted in sleeve  10 . 
     In FIG. 3, an endoscope  28  for use in endoscopic cavity surgery is shown mounted in cylinder  22  of sleeve  10  of the invention. Docking member  24  is cut away at A to show the viewing hub  44  at the proximal end of the elongated tube  46  of the endoscope mounted in docking member  24 . 
     Docking member  24  is illustrated in more detail in FIG.  4 . This member includes a cavity  50  configured to snugly receive the viewing hub of the endoscope with the conical leading surface  52  of the hub (FIG. 3) abutting a corresponding conical surface  54  in the docking member. An annular groove  56  is provided spaced from conical surface  54  to receive an “O” ring  59  which helps position the viewing hub in place in the sleeve and minimizes seepage through the sleeve. An enlarged cylindrical opening  58  is provided at the proximal end of the docking member to receive a corresponding enlarged proximal portion  60  (FIG. 3) of the viewing hub of the endoscope. Removal of the endoscope from the sleeve will require the application of sufficient force to displace the locking ring from the annular groove, whereupon the entire endoscope may be removed from the sleeve. Removal of the endoscope from the sleeve will require the application of sufficient force to pass “O” ring  56 , whereupon the entire endoscope may be removed from the sleeve. 
     Thus, the scope is mounted in the sleeve by inserting tube  46  of the scope into cylinder  22  of the device until the viewing hub of the endoscope is fully seated in the docking member of the device. Turning now to FIG. 5, the window  62 , at the distal end of endoscope tube  46  will now preferably be offset about 2 mm. to 3 mm. beyond the end of cylinder  22 . Although the window of the endoscope will typically be perpendicular to the longitudinal axis of the endoscope, it may have angulations of up to 30°. Since the window extends such a short distance beyond from the end of cylinder  22 , fluid directed from outlet  40  will perform the intended function at all of these angulations. 
     Turning now to FIG. 6, the endoscope sleeve of the present invention is shown with flexible air and suction hoses,  70  and  72  respectively, in place on nipples  15  of fluid and suction ports  12  and  14 , connecting the suction and fluid ports to an appropriate supply of suction, and a high pressure supply of fluid. Preferably suction will be that conventionally supplied by the high continuous wall suction source available in the operating room. 
     Flexible hose  70  extending from the nipple on fluid port  12  is connected to a control valve  74 , and a further portion of flexible tubing  76  which, in turn is connected to the high-pressure fluid source  80  as discussed below. This valve is a conventional on/off fluid control valve which is “off” until spring biased button  78  is pressed to turn “on” the fluid flow and returns to the “off” condition when the button is released. This valve is preferably located in the fluid line a substantial distance from the point of attachment of hose  70  to fluid port  12 . It is preferred that this spacing be at least about 15 cm. Locating switch  74  off of the sleeve and away from the surgical field makes it possible to provide a particularly compact sleeve  10  which produces minimal obstruction of cutting and other instruments (not shown) inserted alongside the sleeve during the course of an endoscopic procedure. Additionally, this remote fluid on-off control can be handled, for example, by the surgeon&#39;s first assistant, surgical scrub nurse or other assistant who can act on either the surgeon&#39;s instructions or by watching the procedure proceeding on a monitor connected to the endoscope operating in a conventional manner. 
     The pressure provided at fluid source  80  should be at least about 100 cm to 120 cm of H 2 O. One desirable way of providing this pressure is with a conventional bag of intravenous fluid  82  held in a pressure cuff  84  as is typically used to provide rapid intravenous administration. A conventional infusion pressure pump cannot supply sufficient fluid pressure. The application of this high pressure fluid is possible because the cavity in which the endoscopic procedure is performed communicates with the atmosphere, permitting the release of pressure introduced by the high-pressure fluid. 
     FIG. 7 shows high pressure fluid  90  (saline) directed against the surface of endoscope window  60  to defog and clean debris from the window and to produce a fine spray  92  as the fluid is deflected back from the window surface. The fluid must be provided at a pressure which greatly exceeds the suction force. Preferably, the fluid will be provided at a pressure of at least about 12 cm to 25 cm of H 2 O at the distal end of the fluid conduit. For example, a pressure of 150 mm of mercury may be provided on cuff  84  to produce fluid pressure sufficient to support a 40 cm column of water. This high pressure quickly and effectively cleans the surface of the endoscope window, irrigating the field and cleaning the end of the scope in a single operation. Thus, as the procedure proceeds, the surgeon will operate valve  74  from time to time to both clear the window of the endoscope and clear the entire operative area. 
     There has been described herein an endoscope sleeve free from the shortcomings of the prior art. It will be apparent to those skilled in the art that modifications may be made without departing from the spirit and scope of the invention. Accordingly, it is not intended that the invention be limited except as may be necessary in view of the appended claims.