Multifunctional device for exploration and/or intervention, especially for medical use

The invention relates to a multifunctional device for exploration and/or intervention, especially for medical use, comprising a hollow handle, which is continued by a main catheter, and a carriage which is mounted so as to slide along the handle and which is coupled to an instrument by a mechanical connection extending inside the main catheter. According to the invention, at least one intermediate carriage is mounted so as to slide along the handle, each of said intermediate carriages having an attachment housed in the handle via a longitudinal slot, in the continuation of which there is a secondary catheter extending inside the main catheter. Moreover, an auxiliary carriage is mounted so as to slide along each intermediate carriage, each of said auxiliary carriages being coupled to an instrument by a mechanical connection extending inside the secondary catheter.

The invention relates to a multifunctional device for exploration and/or intervention, especially for medical use.

During medical examinations such as endoscopies, for example, it is common for the specialist to be called upon to perform a delicate operation requiring several instruments.

At the present time, one way of achieving this involves the use of an instrument known as a dual-channel therapeutic endoscope. However, such endoscopes are costly and few institutions are in a position to make them available to practitioners.

Thus, the technique most commonly adopted consists of successively using different instruments such as described in particular in patent application EP 1 665 993, including a hollow handle continued by a flexible conduit, known as the main catheter, and a carriage mounted so as to slide longitudinally along the handle, connected to an instrument by a mechanical connection extending inside the main catheter so as to enable the actuation and/or movement of the said instrument during longitudinal movements of the said carriage.

Thus, for example, the mucosectomy procedure involves three successive steps each requiring a separate apparatus: staining, separation, resection. However, this technique entails on one hand an additional financial cost and, secondly and more importantly, results in a loss of time which can be prejudicial by the fact that it occurs at a highly delicate moment.

The present invention aims to overcome this drawback and has the principal object of providing a multifunctional device integrating several instruments capable of being positioned together at an intervention site and capable of being operated individually or simultaneously, optionally by the same operator.

A further object of the invention is to provide a multifunctional device whose space requirement is comparable to that of a conventional instrument.

To this end, the invention discloses a multifunctional device for exploration and/or intervention, especially for medical use, including:a hollow handle continued by a flexible conduit, known as the main catheter,a carriage, known as the end carriage, mounted so as to slide longitudinally along an end portion of the handle located opposite the main catheter, connected to an instrument by a mechanical connection extending inside the said main catheter to allow the said instrument to be actuated and/or moved during longitudinal movements of the said end carriage.

According to the invention, the multifunctional device is characterised in that:the handle includes at least one intermediate portion having a peripheral wall in which is formed a longitudinal slot,a carriage, known as the intermediate carriage, is mounted so as to slide longitudinally along each intermediate portion of the handle,each of the said intermediate carriages including an attachment:suitably shaped to fit into the handle through the longitudinal slot formed in the corresponding intermediate portion,pierced with a longitudinal slot in the continuation of which is secured a flexible conduit, known as the secondary catheter, extending into the main catheter,and defining a conduit for passage of the mechanical connection linking the end carriage and its associated instrument, and optionally of each secondary catheter associated with an intermediate carriage mounted on an intermediate portion located between the end portion and the intermediate portion concerned,an auxiliary carriage is mounted so as to slide longitudinally along each intermediate carriage, each of the said auxiliary carriages being connected to an instrument by a mechanical connection extending into the slot formed in the attachment of the said intermediate carriage and in the secondary catheter associated with this intermediate carriage, so as to enable the said instrument to be actuated and/or moved during longitudinal movements of the said auxiliary carriage.

(It will be noted that, according to the invention, the term handle is understood to define a rigid body that can be manipulated by hand and having one or more rigid adapters or connectors for connecting a main catheter comprising a flexible tube to the said handle.)

According to the invention, at least two instruments, respectively connected to the end carriage and to each auxiliary carriage, can be positioned in the immediate vicinity of an intervention site, and can be used successively or simultaneously. Also, in an essential manner, all of the carriages including the intermediate and end carriages, and therefore the associated catheters including the secondary and main catheters, can be moved independently of each other, offering the possibility of relative movement of the instruments during the intervention, and numerous possibilities for relative positioning of the said instruments.

In addition, the multifunctional device is designed so that each secondary catheter extends inside the main catheter housing the mechanical connection connecting the end carriage to its associated instrument. Thus, the cross-section of the main catheter is comparable to that of the catheter of a known conventional instrument.

According to an advantageous embodiment, the multifunctional device according to the invention additionally includes an adapter for connecting a fluid injection device, formed in an end portion of the handle opposite the end portion whereon is mounted the end carriage, and adapted to emerge into the handle and to communicate with the main catheter.

Thus, not only is the main catheter designed to house the mechanical connection between the end carriage and the associated instrument, as well as each secondary catheter, but it also forms, without increasing its space requirement, a flow channel for a fluid.

Such an arrangement imparts to the device according to the invention an additional function of injecting a fluid, such as a cleaning or staining fluid, into the main catheter.

Furthermore, according to this embodiment, the main catheter advantageously houses a transverse membrane positioned in the vicinity of the free end of the said main catheter, the said membrane being pierced with holes for the passage of each secondary catheter and the mechanical connection connecting the end carriage and its associated instrument, and being pierced with holes designed to allow an injection of fluid in the form of a spray.

In addition, to the same end of enabling an injection of fluid in spray form, the catheter preferably includes an end portion of tapered shape.

According to another advantageous embodiment of the invention, the multifunctional device according to the invention also includes an adapter for introducing a guide wire, formed in an end portion of the handle opposite the end portion whereon is mounted the end carriage, and adapted to allow the introduction of a guide wire into the main catheter.

Thus, not only is the main catheter designed to house the mechanical connection connecting the end carriage to the associated instrument, as well as each secondary catheter, but it also forms, without increasing its space requirement, a conduit for introducing a guide wire.

According to another advantageous characteristic of the invention, each carriage includes a shell having a shape adapted to cover the handle.

In addition, each intermediate carriage and the handle have sections preferably in this case including at least one longitudinal ridge adapted so as to obtain a relative locking in rotation of the said intermediate carriage(s) and the handle.

Furthermore, in order to obtain stable relative positions of each intermediate carriage in relation to the handle, the shell of each intermediate carriage and the handle advantageously include opposing faces having conjugate members for reversibly locking the translational movement of the said elements.

According to another advantageous characteristic of the invention, the shell of each intermediate carriage includes a longitudinal notch defining a runner adapted to accommodate an auxiliary carriage formed by a slide capable of sliding in said runner.

Furthermore, in an advantageous manner according to the invention, at least one carriage of the multifunctional device, an end carriage and/or auxiliary carriage, is connected to its associated instrument by an electrically conductive mechanical connection, and includes a connector for connecting to an electric scalpel, electrically connected to the mechanical connection associated with the said carriage.

(For the sake of simplicity and clarity of the description, the multifunctional device according to the invention is described hereinbelow with reference toFIG. 1attached as a top view of the device, and the terms “upper, lower, side . . . ” in particular are used in accordance with this reference. Also, the terms such as posterior and anterior are used with the assumption that the device is being held in an operator's hand, and the terms posterior and rear typically correspond to the portions of the device closest to the operator's hand).

The multifunctional device for exploration and/or intervention shown by way of example in the Figures is intended especially for medical use.

Furthermore, in the accompanying figures, the multifunctional device is equipped with instruments particularly adapted for the performance of medical examinations such as endoscopies.

The multifunctional device according to the invention includes, in the first place, a rigid handle1which is subdivided longitudinally into:a posterior end portion2,an intermediate portion3,a reducing adapter4of generally conical shape,and an anterior tubular conduit5at the end of which is connected a flexible tube6constituting the main catheter of the multifunctional device.

The posterior section2of the handle1principally comprises two parallel longitudinal rails7,8extending from a posterior ring9providing thumb purchase, along which is mounted slidably over a travel “a” of about eight centimeters a carriage10, known as the end carriage, comprising:a central core13adapted to slide along the rails7,8,and two side wings11,12extending on either side of the central core13, each consisting of a ring for finger purchase.

This first carriage10is connected to an instrument by a mechanical connection extending inside the main catheter6, and its function is to actuate and/or move the said instrument during longitudinal movements of the said carriage.

In the example shown in the Figures, the mechanical connection consists of a cable made of an electrically conductive material14of which the end forms a ring15constituting a instrument known as a “loop” adapted:to be housed inside the main catheter6in at least a partially closed condition, in the retracted position of the end carriage shown inFIG. 8a,to extend in the continuation of the main catheter6, in a deployed open condition, in the forward position of the end carriage10shown inFIG. 8d, where the said end carriage has completed a translational movement of a distance equal to “a” from its retracted position.

In addition, the central core13of the end carriage10includes a connector16for connecting to an electric scalpel, electrically connected to the cable14secured to the said carriage, thereby imparting to the loop15an additional function of a cutting instrument.

The intermediate portion3of the handle1is composed of a tubular body of octagonal cross-section including an upper face3a,two parallel sides faces such as3b,two oblique upper faces such as3c,joining the upper face3awith the side faces3b, two lower oblique faces3dand a lower face3e.

Firstly regarding the intermediate portion3, the upper face3ais pierced by a longitudinal slot17of rectangular shape, having a length of about eight centimeters. Furthermore, this slot is delimited at its posterior end by a transverse stop fin18arranged so as to extend in projection from the upper surface3a.

The multifunctional device according to the invention includes a carriage19, known as the intermediate carriage, mounted so as to slide along the intermediate portion3, and principally comprising:a shell20of generally semi-octagonal shape adapted to cover the upper face3a,the oblique upper faces3cand the side faces3bof the intermediate portion3,and an attachment26positioned at the anterior end of the intermediate carriage19, and generally shaped as a rectangular parallelepiped adapted to extend inside the intermediate portion3of the handle1through the slot17.

The shell20of the intermediate carriage19includes, in the first place, two side walls such as20adisposed so as to overlap onto the side faces3bof the intermediate portion3, and each extended by a longitudinal oblique rim21, shown inFIG. 5, adapted to form a resilient hook for snapping the intermediate carriage19onto the intermediate portion3.

Each of the side walls20aadditionally includes a thickening22formed on the outer face of the shell20, and in which is formed a posterior longitudinal indentation23having a grooved surface, providing finger purchase for the intermediate carriage19.

The shell20of the intermediate carriage19additionally includes an upper face20bin which is formed a notch24extending from the posterior end of the said upper surface, of which the longitudinal inner edges25are shaped so as to define a runner adapted to accommodate an auxiliary carriage32consisting of a slide.

The shell20also includes two oblique upper faces20con the underside of each of which is formed a transverse bead31for reversible locking adapted to cooperate with transverse grooves50formed on the oblique upper faces3cof the intermediate portion3, so as to obtain stable relative positions of the intermediate carriage19along the handle1.

The attachment26of the intermediate carriage19is, in the first place, pierced by a longitudinal slot27and includes, in the continuation of the said slot, an adapter28for connecting a flexible tube29forming a catheter known as the secondary catheter adapted to extend inside the main catheter6. Furthermore, the attachment26is also pierced by a conduit30for passage of the cable14connecting the end carriage10and its associated instrument (loop)15.

The respective dimensions of the slot17and the attachment26of the intermediate carriage19are adapted to allow a longitudinal movement of the said carriage over a travel distance “b” of about four centimeters, between:a retracted position of the intermediate carriage19, shown inFIG. 8a, in which the said intermediate carriage is abutted against the stop fin18, and the secondary catheter29is retracted inside the main catheter6,and an extended position of the intermediate carriage19, shown inFIG. 8b, in which an end portion of a length substantially equal to “b” of the secondary catheter29extends inside the continuation of the end of the main catheter6.

In addition, over this travel distance, stable intermediate positions10are defined by the cooperation of the locking beads31with the grooves50.

It will be noted that the end carriage10of the multifunctional device according to the invention can also be composed of a carriage of the same design as the intermediate carriage described hereinabove.

As indicated above, the multifunctional device according to the invention also includes a third carriage32, known as the auxiliary carriage, comprising a slide adapted to move longitudinally relative to the intermediate carriage19.

The slide32has an upper face on which is formed a posterior longitudinal indentation33having a grooved surface for operating the said slide using the fingers.

In addition, the slide32includes an adapter34for connecting a syringe35communicating, via an elbow piece36, with a flexible conduit37adapted to extend inside the slot27formed in the attachment26of the intermediate carriage19then inside the secondary catheter29, and on the end of which is mounted an injection needle38.

The respective dimensions of the notch24and the slide32are adapted to allow a longitudinal movement of the auxiliary carriage over a useful travel distance “c” of about 1.5 centimeters, between:a forward position of the auxiliary carriage32, shown inFIG. 8c, in which an injection portion of a length substantially equal to “c” of the needle38extends inside the continuation of the end of the secondary catheter29,and retracted positions of the auxiliary carriage32, such as that shown inFIG. 8b, in which the needle38is retracted inside the secondary catheter29. It will be noted that the extreme retracted position of the auxiliary carriage32corresponds to a stop position of the said auxiliary carriage against the stop ridge18.

In addition, depending on the requirements related to the associated instruments, the movement of the auxiliary carriage may consist either of a unidirectional movement or a bidirectional movement on either side of a median neutral position.

The multifunctional device according to the invention additionally includes an adapter39for connecting a syringe40disposed in an intermediate position of the anterior tubular conduit5, so as to be in direct communication with the main catheter6. As shown inFIG. 1, this adapter39extends in a plane orthogonal to the plane in which the adapter34extends, along an axis inclined at 45° backwards relative to the longitudinal axis of the handle1.

Such an arrangement enables a fluid to be injected into the main catheter6, such as for example a cleaning fluid, a staining fluid, etc.

In addition, the main catheter6then includes, as shown inFIGS. 6 and 7, an anterior adapter41designed to be mounted, for example by interlocking, onto the free end of the said main catheter, the said adapter:including an end portion42of internally tapering shape,housing a transverse membrane43pierced, on one hand, with holes45,46for the passage of each secondary catheter29and of the cable14connecting the end carriage10and its associated instrument15and, on the other hand, injection apertures44designed to permit an injection of fluid in the form of a spray.

It will be noted that the adapter39can be used for different purposes and in particular can consist of an adapter for introducing a guide wire designed to enable a guide wire to be inserted into the main catheter6.

In this case, additionally, the main catheter6is not provided with the anterior adapter41and the membrane43.

The multifunctional device described hereinabove, equipped with a diathermy loop15connected to an electric scalpel, a sclerosis needle38and a channel for injecting a staining fluid, is particularly intended for medical use, for example to perform a mucosectomy,

Specifically, the device can be used to perform the three successive steps of a mucosectomy, namely: vital staining, submucosal injection and resection of the polyp.

Firstly, vital staining is performed using a syringe40connected to the adapter39making it possible to deliver the stainer directly into the main catheter6, then to distribute the stainer in the form of a spray by virtue of the membrane43.

At the submucosal injection stage, the latter is greatly facilitated by the presence at the injection site of the main catheter6and optionally the loop15which make it possible to obtain better exposure of the lesion and a submucosal injection of good quality.

Similarly, the third stage of polyp resection, carried out using the loop15, is greatly facilitated by the presence of the secondary catheter29and optionally of the needle38, which makes it possible to obtain better exposure of the lesion to be treated.

Additionally, all of these operations can be performed by a single operator.

Many other applications, especially in the medical field, are possible using multifunctional devices according to the invention equipped with various specific instruments.

Thus, by way of examples, mention may be made of the following applications in gastrointestinal endoscopy:lavage/stain-loop-clamplavage/stain-loop-“endoloop”lavage/stain-loop-hemostatic clip,lavage/stain-submucosal dissection knife (“flush knife”)-clamp.

By way of further application, mention may also be made of: sphincterotomy/infundibulotomy/guidewire, etc.