Illuminating bougie and methods for diagnostic, therapeutic and surgical procedures

An illuminated bougie in which the elongate bougie body is formed of flexible light-transmitting material. A socket for detachably attaching the light-transmitting end of a fiber optic bundle is formed in the proximal end of the bougie.

This invention relates to medical devices and methods of use in diagnostic, 
therapeutic and surgical procedures. 
The principal object of the invention is to provide an improved bougie for 
transmitting light to body tissue. 
Another object of the invention is to provide improved diagnostic, 
therapeutic and surgical procedures which involve use of such a 
light-transmitting bougie.

The publication entitled Laryngoscope, Volume 96, page 1040 (1986) 
described a device consisting of a hollow tapered esophageal bougie. An 
elliptical portal was formed in the distal end of the bougie. A fiber 
optic bundle, the terminal end of which was cut at a 40.degree. angle, was 
then inserted into the lumen of the bougie, such that the terminal end of 
the bundle was then cemented to fix it in the portal. Thus, the bougie 
described in this article could only transilluminate a very small portion 
of the esophagus which was directly adjacent the oval portal at the distal 
end of the bougie. By contrast, as will appear more fully below, the 
bougie which I have invented can illuminate body tissue along a 
substantial length corresponding to the length of a major light emitting 
portion. 
Schellenberg, U.S. Pat. No. 1,704,764, disclosed a hollow perforate colonic 
exploration device formed of translucent rubber, into which a hot-filament 
electric lamp could be temporarily inserted, to facilitate taking a 
picture of the walls of the colons and intestines. 
Aiken, U.S. Pat. No. 2,797,683, disclosed a rigid bronchoscope formed of a 
plastic material which transmits light by internal reflection, to be 
emitted by the leading (distal) tip of the device, in a manner similar to 
the devices described in the Laryngoscope article, cited above. 
Briefly, in accordance with my invention, my illuminated bougie comprises 
an elongate bougie, shaped and dimensioned to be inserted into the body, 
and having a proximal end and a distal end. The bougie is formed of a 
flexible light-transmitting material which transmits and diffuses light 
laterally to illuminate adjacent body tissue along its length. Means are 
provided for attaching the proximal end of the bougie to the 
light-transmitting end of a fiber optic bundle. 
In accordance with another aspect of the invention, I provide a method of 
illuminating interior body tissue, which includes the steps of inserting 
the bougie described above into the body, locating the light-transmitting 
bougie adjacent selected body tissue to be illuminated, and transmitting 
light through said bougie to illuminate the selected body tissue. 
In a more specific embodiment of the invention, the apparatus and method 
described above are used to illuminate and/or transilluminate selected 
body tissue for surgical procedures. 
In another embodiment of the invention, the apparatus and method described 
above are used to illuminate selected body tissue for diagnostic 
procedures. 
In still another embodiment of the invention, the apparatus and method 
described above are used to illuminate selected body tissue for 
phototherapy procedures. 
According to the broadest aspects of the invention, the bougie is inserted 
within the body through any normal body opening or, through an incision, 
into any body cavity, organ or vessel. 
The drawings are presented for the purpose of illustrating the practice of 
my invention, so as to enable those skilled in the art to understand and 
practice it, but are not invented as limitations upon the scope of the 
invention. Further, the drawings illustrate the best mode which I 
presently contemplate for carrying out my invention, again without 
intending to limit the scope thereof. In these drawings, like reference 
characters depict the same elements in the several views. 
Turning now to the drawings, FIG. 2 depicts a presently preferred 
embodiment of the invention, consisting of a bougie 10 formed entirely of 
light-transmitting material. The upper proximal portion A is cylindrically 
shaped and the remainder is tapered towards the distal end 14. The bougie 
10 is imperforate and flexible and is preferably solid. Means are 
provided, such as a socket 15 formed in the proximal end 16 of the bougie 
10 and cooperating collar 18, for attaching the light-transmitting 
terminal end 17 of a fiber optics bundle 13 to the light-transmitting 
proximal end of the bougie 10. In the embodiment depicted in FIG. 1, light 
from the terminal end 17 of the fiber optic bundle 13 is transmitted 
laterally from the bougie 10 along its entire length for illumination of 
adjacent tissue. 
The shape and dimensions of the bougie can be varied to suit the end use of 
the device. Thus, for upper laryngeal and esophagus surgery, i.e., 
Zencker's diverticulum, Barrett's esophagus resections, thoracoscopy, 
e.g., surgery for ulcer disease, vagotomy for morbid obesity, for reflux 
esophagitis and for placement of the prosthesis in accordance with my U.S. 
Pat. No. 5,006,106, the length of the bougie 10 is suitable 20 cm for 
adults and 15 cm for children. The diameter is suitably 36-40 French for 
adults and 18-26 French for children. (French size.apprxeq.diameter in 
mm.times.3). For insertion into the body through normal body openings, the 
size of the bougie are adapted for insertion through the opening in 
question and for location adjacent the selected body tissue to be 
diagnosed, treated or surgically manipulated. For insertion through an 
incision into body cavities, organs or vessels, the dimensions of the 
bougie are selected to suit the requirements of the procedure. 
The bougie is used to illuminate or transilluminate organs, cavities and 
vessels in laparoscopy and regular surgery. The bougie is also used for 
visualizing parts of the body using the eyes or special photographic 
equipment, by providing intense light to the outside or from the inside of 
organs, cavities or vessels. 
For diagnostic purposes the bougie is used where the light will show 
pathology from the inside or outside the body, using intense, continuous 
or intermittent light bursts, high intensity bulbs or lasers of different 
colors. For example, very intense light from an esophageal bougie allows 
the observer the body to see and to circumferentially photograph the chest 
cavity from outside the body and to arrive at diagnostic conclusions based 
on light and shadow on lungs, heart, mediastinum and chest wall, without 
the injurious effects of x-rays. 
For phototherapeutic purposes the bougie is used to transmit continuous or 
intermittent light, regular or laser beams, e.g., for the treatment of 
tumors which have been sensitized with photosensitizers such as porphyrin 
derivatives and for killing bacteria which have been stained with a 
sensitizing dye. Tumors of the skin, oral, anal, rectal and colonic 
cavities, esophagus, stomach, intestine, liver, pancreas, kidney, bladder, 
ureter, lung and heart, large and small vessels and even bone can be 
treated this way, as well as tumors of the brain and spinal column. Small 
size bougies, even microscopic, can be used to visualize, diagnose and 
treat small vessels, urethra, ureters, acoustic and respiratory channels 
using the types of light referred to above. 
In the preferred embodiment the bougie 10 is formed of molded silicone 
plastic or similar flexible plastic having a hardness of approximately 50 
durometer (Shore A). Micrometalic particles can be dispersed in the 
plastic to improve lateral diffusion of the light. Polishing the external 
surface of the bougie causes light to be transmitted further toward the 
distal end before it is diffused laterally. However, when body tissue 
contacts the bougie, the bougie surface-air interface is altered, causing 
lateral diffusion of the light along the length contacted by the body 
tissue. 
A typical laparoscopicprocedure, involving the use of the bougie of my 
invention is depicted in FIG. 2. The procedure is facilitated by 
illuminating by the esophagus 21 by means of the bougie 10 which is 
inserted intra-orally. The wall 21a of the distal esophagus is 
sufficiently thin to transmit a substantial portion of the light emitted 
by the bougie 10, facilitating viewing the esophagus and placement of the 
prosthesis 22, viewing the procedure through a laparoscopic optical 
viewing device 23. 
As further depicted in FIG. 3, the light-transmitting fiber optics bundle 
13, attached at its distal end 17 to the proximal end of the bougie 10, 
comprises the optical fibers 31, encased in a suitable sheath 32, e.g., 
silicone plastic. A suitable detachable connection 33 is provided so that 
the bougie 10 and attached fiber optics bundle 13 can be disconnected form 
the remote flight source (not shown) for disposal or sterilization and 
reuse. Since no heat is transmitted from the bougie, it can be left in 
place during the entire course of a procedure, even several hours, if 
necessary, without burning the body tissue it contacts, because the light 
is transmitted to the bougie by a fiber optic bundle from a light source 
many feet away, rather than from an incandescent filament inside the 
bougie.