Abstract:
Endoscope and method comprise a micro endoscope with insertion end that is about 1-2 millimeters in outer diameter and includes an optical fiber image bundle, two optical laser fibers, two illumination source optical fiber bundles, along with three focusing lenses for image bundle and laser fibers. Insertion end may be inserted in a female milk duct, other body cavity, or internal organ to inspect for cells and lesions. Visual inspection is aided by the use of special mixtures of light sources to observe the distinction between normal and abnormal cells. If abnormal cells or lesions are detected and the surgeon decides cells or lesions are non-cancerous, the surgeon may then use endoscope to precisely burn, ablate, or otherwise kill abnormal cells at their point of origin on the milk duct, other body cavity, or internal organ. The procedure is minimally invasive and much less costly than many other similarly functioning medical procedures.

Description:
BACKGROUND OF THE INVENTION 
       [0001]    1. Field of the Invention 
         [0002]    The present invention relates to a micro-endoscope or endoscope apparatus used to visually inspection minute lesions or clusters of cells in a body cavity or interior organ of a human body. Endoscopes are frequently used with laparoscopic surgery where surgery is performed through a small incision or natural opening in the body. A surgeon uses an endoscope to see inside the patient&#39;s body. 
         [0003]    Endoscope has a distal end that includes an optical fiber bundle with thousands of fibers that is flexible with overall outer diameter of about 1-2 millimeters that is “insertable” into a typical female milk duct, other body cavity, or internal organ. 
         [0004]    One application of the present invention relates to the detection of abnormal cells in a human female breast. All breast cancer starts in the lining of the milk ducts. Milk ducts run like tree branches through the breast and culminate in 6-8 openings in the nipple. The widest ducts, near the nipple, are 1.5 mm to 2 mm in diameter. Ducts become microscopic towards the back of the breast near the chest wall. During micro endoscope procedure, the doctor is able to see the lining of the ducts by inserting the flexible fiber optic endoscope into a nipple opening of a milk duct. Endoscope can be used to inspect milk ducts for abnormal cells or lesions. Almost all abnormal conditions of the breast, including breast cancer, originate from the milk duct. If inspection is accomplished early enough in the event of an abnormal condition, the cellular origins of the abnormal conditions may be detected as they occur or at least at a very early stage of the condition, at which point effective measures may be taken to eradicate the condition from the breast at a very early stage, potentially saving the patient&#39;s life. This procedure may allow more precise identification of intraductal disease and may result in improved localization of intraductal lesions and may avoid surgery in women with endoscopically normal ducts. 
         [0005]    In other applications, endoscope can be used to inspect any part of the body through a small incision, small diameter opening or orifice, or other portal as small as about 1 millimeter in diameter. For example, endoscope may be used to inspect brain tissue, brain ventricles, eye tissue, eye orbital tissue, and other tissue where there is benefit to the use of small incisions on the order of a few millimeters in diameter. 
         [0006]    In other applications, endoscope can be used as an endoscopic surgery instrument. The invention includes the capability of targeting certain lesions or cells in the endoscopic viewing area for precise tissue ablation, tissue cutting, tissue resection, or tissue shrinking, without causing damage to surrounding normal cells. The invention allows for delivery of low-energy laser radiation at a specific point or target point within the surgeon&#39;s scope of view that may be small enough to focus on a cluster of cells. This is accomplished through the use of a low-energy marking laser along with a low-energy ablation, cutting, resection, or shrinking laser situated within the endoscope apparatus, where the optical fibers for such are included within a 1-2 millimeter outer diameter insertable distal end. If tissue ablation/cutting/resection is accomplished early enough in the event of an abnormal condition, the cellular origins of the abnormal conditions may be eradicated at a very early stage, thereby arresting the abnormal condition before it propagates. 
         [0007]    2. Description of Related Art 
         [0008]    It has been conventionally known that flexible optical fibers (fiber optics) can be inserted into small narrow body cavities or incisions where the fibers allow the surgeon to effectively see inside the small narrow body cavity or incision with non-invasive or minimally invasive procedural effects on the patient. Prior art endoscopes use various types of optical fibers to project images from inside of the patient&#39;s body to the outside where the surgical team may view them and use such views to guide them through the surgical procedure. Flexible optical cables are typically optically connected to cameras that are typically electrically connected by one or more cables to one or more computers that may analyze and present the data in any number of ways to many different devices that prove to aid the surgeon with any number of non-invasive or minimally invasive surgical procedures. 
         [0009]    Further it has been conventionally known that flexible optical fibers may be used to transmit laser light from outside of the patient&#39;s body to the inside surgical area, where the laser light may be used to help perform the surgical procedure by cutting or ablating tissue, for instance. 
         [0010]    This invention provides an endoscope with special illumination capabilities along with special surgical capabilities. This invention is first to provide the capability for a surgeon to visually inspect a milk duct or other body cavity or internal organ with the capability of illuminating a group of target cells in the patient&#39;s body with two distinct illumination sources that may be used simultaneously, so that when each illumination source characteristics are used to complement each other, where characteristics include the wavelength, intensity, coherence, phase, and polarization of the light source. The invention causes normal and abnormal cells in the target area to become much more visually distinguishable, where cells look differently than if being viewed by only one or multiple light sources with similar characteristics. When the two light sources have characteristics that complement each other, the change in visual characteristics of the cells renders distinction between normal and abnormal cells in the target area quite apparent. 
         [0011]    Moreover, this invention also provides the simultaneous capability of targeting the abnormal cells with two distinct laser sources, along with two special light sources, where the two laser sources can be used to precisely ablate or otherwise burn abnormal cells without damaging surrounding normal cells. 
       BRIEF SUMMARY OF THE INVENTION 
       [0012]    Endoscope comprises an insertion end with a distal tip that is a long thin member about 1-2 millimeters in outside diameter that may be inserted into the patient&#39;s body. Insertion end comprises an image-focusing lens optically connected to an image optical fiber bundle, at least two laser focus lenses, each optically connected to one of at least two laser optical fibers, and at least two illumination optical fibers bundles, where the distal ends of said fibers are positioned to shine light onto certain target area and said lenses are trained or positioned to focus on the same said target area. Endoscope further comprises at least two optical illumination ports each optically connected to an illumination source optical fiber bundle. Endoscope further comprises at least two laser ports each optically connected to a laser source optical fiber. Endoscope further comprises a view platform optically connected to the image optical fiber bundle. Endoscope further comprises a surgeon&#39;s handle point through which the surgeon may manipulate the insertion end and distal tip within the patient&#39;s body. 
         [0013]    Endoscope provides the capability to simultaneously shine one or more coherent light sources onto a laparoscopic target area to create more distinguishable viewing characteristics of normal and abnormal cells in the laparoscopic target area. 
         [0014]    Endoscope provides the capability to simultaneously shine one or more distinct light sources onto a laparoscopic target area to create more distinguishable viewing characteristics of normal and abnormal cells in the laparoscopic target area. 
         [0015]    Endoscope provides the capability to deliver laser energy to ablate, cut, burning, or resect to correct a problem, just after visual inspection of the problem, and during the same medical procedure in order to ablate, cut, burn, resect, or otherwise correct abnormal cells detected. 
         [0016]    Endoscope provides the capability to quickly change light sources incident upon the target area, whether coherent or incoherent light sources, to provide an additional method of making more distinguishable by sight normal and abnormal cells in the target area. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0017]      FIG. 1  is a top plan view of endoscope. 
           [0018]      FIG. 2  is a blow-up view of the distal end of endoscope where the distal end has been pre-inserted into an introducer, where the use of an introducer is typically used to help insert the distal end into the patient&#39;s body, and provide sterile water flow in front of the distal end of endoscope. 
           [0019]      FIG. 3  is a side perspective view of endoscope with camera and monitor attached, as is also typical for endoscopic viewing of a patient&#39;s body. 
           [0020]      FIG. 4  is a blow-up view of insertion fiber bundle or the insertion end of endoscope, along with two corresponding cross sectional views thereof. 
           [0021]      FIG. 5  is a blow-up view of the distal end of insertion fiber bundle or the tip of insertion end of endoscope, along with two corresponding cross sectional views thereof. 
           [0022]      FIG. 6  is side perspective view of endoscope with introducer, camera, and monitor attached, depicted while inserted into a patient&#39;s body, where the monitor depicts the high degree of differentiation between normal and abnormal cells that is provided by endoscope with this arrangement. 
       
    
    
     DEFINITION LIST 
       [0023]      
         [0000]    
       
         
               
               
             
           
               
                   
               
               
                 Term 
                 Definition 
               
               
                   
               
             
             
               
                  1 
                 Eyepiece 
               
               
                  2 
                 Focus Ring 
               
               
                  3 
                 Body Coupler 
               
               
                  4 
                 Scope Assembly 
               
               
                  5 
                 Fiber Optic Post I (Light Port I) 
               
               
                  5A 
                 Fiber Optic Post II (Light Port II) 
               
               
                  6 
                 Image Bundle, Illumination Bundle I, and Illumination Bundle II 
               
               
                  6A 
                 Image Bundle, Illumination Bundle I, Illumination Bundle II, 
               
               
                   
                 Laser Fiber I, and Laser Fiber II 
               
               
                  7 
                 Laser Fiber I Extended Lead 
               
               
                  8 
                 Surgeon&#39;s Handle Point 
               
               
                  9 
                 Luer Lock Connector 
               
               
                 10 
                 Laser Fiber Connector I (Laser Port I) 
               
               
                 11 
                 Laser Fiber II Extended Lead 
               
               
                 12 
                 Laser Fiber Connector II (Laser Port II) 
               
               
                 13 
                 Insertion Fiber Bundle containing Image Fiber Bundle, 
               
               
                   
                 Illumination Bundle I, Illumination Bundle II, Laser Fiber I, and 
               
               
                   
                 Laser Fiber II 
               
               
                 13A 
                 Distal End or Tip of Insertion Fiber Bundle 
               
               
                 14 
                 Milk Ducts of Human Breast 
               
               
                 15 
                 Data Cable connecting Camera to Computer 
               
               
                 16 
                 Camera 
               
               
                 17 
                 Camera Lens 
               
               
                 18 
                 Camera Coupler 
               
               
                 19 
                 Computer or Monitor 
               
               
                 20 
                 Normal Cells 
               
               
                 21 
                 Abnormal Cells 
               
               
                 23 
                 Introducer Assembly 
               
               
                 24 
                 Introducer Fluid Channel 
               
               
                 25 
                 Introducer Fluid Connector 
               
               
                 26 
                 Introducer Catheter 
               
               
                 32 
                 Outer sheath of Insertion Fiber Bundle 
               
               
                 33 
                 Illumination Optical Fiber Bundle I 
               
               
                 34 
                 Illumination Optical Fiber Bundle II 
               
               
                 35 
                 Image Optical Fiber Bundle 
               
               
                 36 
                 Laser Fiber I 
               
               
                 36A 
                 Laser Fiber II 
               
               
                 43 
                 Laser I Focus Lens 
               
               
                 45 
                 Image Bundle Focus Lens 
               
               
                 46 
                 Laser II Focus Lens 
               
               
                   
               
             
          
         
       
     
       DETAILED DESCRIPTION OF THE INVENTION 
       [0024]    Referencing  FIG. 1 , endoscope has a proximal end (upper left corner of figure) and a distal end (lower right corner of figure). Proximal end includes a subassembly comprising items  1 ,  2 , and  3  that is essentially a long hollow cylindrical body with optical lenses inside. The surgeon looks into item  1  (eyepiece) or a camera may connect with it to view cells in the target area. The distal end, items  13  and  13 A, may be inserted into the patient&#39;s body. Distal end is a low-friction flexible member that includes fiber optics that function to bring light to and from the patient&#39;s body cavity or internal organ. 
         [0025]    Endoscope comprises an eyepiece  1 , body coupler  3 , and scope assembly  4 . Scope assembly  4  comprises a bundle of optical fibers called an image bundle  35  that essentially runs the full length of flexible cables  6 ,  6 A, and  13 , extending to the distal end of endoscope  13 A. Image bundle  35  is a bundle of about 6,000-30,000 optical fibers that are each about 0.5-1.0 millimeters in outer diameter and about 0.5-2 meters long. Each optical fiber is one flexible continuous piece. Optical fibers are typically made of quartz or glass silica but could be made of any material that function as follows. An optical fiber passes light down the center of the fiber, where passing light is basically continuously reflected off of the outer surfaces of the fiber, thereby forcing the light to travel the full length of the fiber to pass out of the other end of the optical fiber. Light is kept in the core of the fiber as a result of total internal reflection. 
         [0026]    Eyepiece  1  may be replaced with camera coupler  18  and camera  16 . Camera  16  includes camera lens  17 . When operating in this mode, camera  16  produces and processes images from the target area of the patient. These images can then be sent to a computer or viewer  19  through data cable  15 . Images may be recorded on computer or viewer  19 . 
         [0027]    Scope assembly  4  further comprises an image bundle focus lens  45 , located at the distal end of the image bundle  35 . Every fiber of image bundle is optically connected to image bundle focus lens  45  so that light waves may pass from the interior of the patient&#39;s body through image bundle focus lens  45  and into all fibers of image bundle  35  without significant reflection or refraction loss. Thus, optical connections function to perform such connections with minimal reflection or refraction loss. Typically, optical connections are accomplished by pressing, terminating, or attaching polished optical fiber end(s) to the fiber, fibers, lens, or transition glass of the other optical device, where such is done by connector means, where standardized connectors, typically male and female, may be reversibly optically connected to press and hold these optics together. In this case, fiber ends are polished and precisely glued in place next to lens  45  with a special optical epoxy (not shown). Image bundle focus lens  45  is located at the center of the cross-section of the insertion end  13 A. Image bundle focus lens  45  is a lens with outside diameter of about 500 microns (μm). Image bundle focus lens  45  functions to focus the scattered light reflecting off of the target area and into image bundle  35 . Image bundle focus lens  45  focuses scattered light into parallel light that may more easily travel into, through, and out of image bundle  35  and on to the surgeon&#39;s view. 
         [0028]    Scope assembly  4  includes all fiber bundles, which are optically connected components in insertion end  13 A and all ports  5 ,  5 A,  10 , and  12 . Scope assembly  4  cannot be disassembled without disrupting the optical connections therein. Thus, insertion portions  13  and  13 A are permanently connected to scope assembly  4 . 
         [0029]    From scope assembly  4 , light waves originating from the interior of the patient&#39;s body then enter body coupler  3 , which comprises at least two lenses (not shown), one lens at each end of body coupler  3 . Body coupler distal lens functions to focus the generally “scattered” light from the interior of the patient&#39;s body emanating from scope assembly  4  into “parallel” light where light waves emanating from the other side of this lens are traveling generally in one direction parallel to the longitudinal axis of body coupler  3 . Eyepiece  1  comprises at least one lens (not shown). Body coupler proximal lens along with eyepiece lens are then used in tandem to focus the parallel light onto the surgeon&#39;s eye or camera array connected to a monitor, computer, or similar electronic device capable of receiving and displaying imaging signals from a camera array. 
         [0030]    In order to accomplish this focusing, body coupler  3  further comprises a focus ring  2 . Focus ring  2  functions to mechanically move by threaded means body coupler  3  longitudinally in relation to the body coupler proximal lens. By changing the distance between eyepiece lens and body coupler proximal lens, the plane of focus inside the patient&#39;s body may be adjusted, thereby allowing the surgeon to change his plane of focus inside the patient&#39;s body. The length of focus of the endoscope in the target area in best mode is about 3 millimeters, extending distally outward from the distal tip of insertion bundle  13 A. The technology of eyepiece  1 , focus ring  2 , and body coupler  3  and their interaction with scope assembly  4  are well known in the art of endoscopes. 
         [0031]    Scope assembly  4  further comprises two fiber optic posts or light ports  5  and  5 A and two laser fiber connectors or laser ports  10  and  12 . These ports are used to connect to external illumination sources and/or external laser sources where these light sources may be used as “incident light” to shine onto the target area inside the patient&#39;s body. Light ports  5  and  5 A provide the ability to optically connect to typical light sources such as: incandescent; light-emitting diode; gas discharge, including xenon, halogen, metal halide; or other light source. Such light sources are typically incoherent in that their wave fronts are generally spherical and travelling in diverging directions or are otherwise without constant relative phase. 
         [0032]    Laser ports  10  and  12  provide the capability to optically connect to typical laser sources like: Diode Pumped Solid-State Lasers, Fiber Lasers, Green Lasers, Diode Lasers, CO 2  Lasers, YAG Lasers, HeNe, Argon-ion, HeAg, NeCu, KTP/Nd:YAG, Nd:YVO4, Nd:YVO4, Nd:YLF, Nd:YAG, Yb:YAG, Yb:KGW, Yb:KYW, Yb:SYS, Yb:BOYS, Yb:CaF2, Ti:Sapphire, or other lasers. Laser ports  10  and  12  have extended leads  7  and  11  respectively to allow for easier laser connection and to allow placement of heavier laser equipment away from patient working area for the surgeon. Laser light sources are typically coherent in that their wave fronts are travelling in synchronized fashion, in phase, and propagating in parallel, in the longitudinal direction of the endoscope or fiber. Thus, endoscope provides the capability to shine as incident light into a milk duct, other body cavity, or incision, two separate incoherent light sources, as well as two separate coherent light sources. Also, endoscope provides the ability to vary phase, intensity, wavelength, polarization, and other characteristics of the light sources on an individual basis. 
         [0033]    Light ports  5  and  5 A are essentially hollow cylindrical members, with optical glasses inside, used as connectors to reversibly optically connect with other connectors of light sources. Light ports  5  and  5 A each comprise a threaded post that may be reversibly attached by threaded means to a female connector of an external light source (not depicted). Light ports  5  and  5 A each further comprise an optical glass that mates with another optical glass in the female optical connector of the light source. 
         [0034]    Scope assembly  4  further comprises illumination bundles I and II, which are items  33  and  34  respectively. Each illumination bundle  33 ,  34  is a bundle of about 6,000-30,000 optical fibers that are each about 0.5-1.0 millimeters in outer diameter and about 0.5-2 meters long. The proximal ends of each fiber are optically connected to optical glass of light ports  5  or  5 A. The proximal ends of each fiber are substantially perpendicular to longitudinal axis of the fiber and are polished to allow for minimal reflection or refraction as light passes from the illumination source optical connector to the optical glass of light port and into individual fibers of illumination bundles  33  and  34 . All fibers in illumination bundles  33  and  34  are packed around image bundle  35  along the full lengths of  6 ,  6 A,  13 , and  13 A. See cross sectional views on  FIGS. 4 and 5  for depictions of this arrangement. Distal ends of image bundle  33  and  34  are alternated around image bundle focus lens  45 , as shown in the cross section, so that the different incident lights of  33  and  34  will be evenly distributed over the whole target viewing area. The distal ends of each fiber, at  13 A, are substantially perpendicular to longitudinal axis of the fiber and are polished to allow for minimal reflection or refraction as light passes from the fibers and into the patient&#39;s body cavity. Thus, with bundles  33  and  34 , light passes from an external light source connector, into  5  or  5 A, then into individual fibers of bundles  33  or  34 , to exit there from, in a circular pattern of fibers surrounding the image bundle focus lens  45 . See  FIGS. 4 and 5 . 
         [0035]    Scope assembly  4  further comprises laser fibers I and II, which are items  36  and  36 A respectively. Each laser fiber  36 ,  36 A is a one-piece optical fiber about 100-250 microns (μm) in outer diameter and about 0.5-2 meters long. The proximal ends of each fiber are substantially perpendicular to longitudinal axis of the fiber and are polished to allow for minimal reflection or refraction as light passes from the laser source optical connector (not depicted) and into laser fiber  7  or  11 . Laser ports  10  and  12  are each industry standard laser source fiber optic adapters, used as connectors to reversibly optically connect to other optical connectors of lasers. Laser ports  10  and  12  comprise a threaded post that may be reversibly attached by threaded means to the female optical connector of an external laser source. Proximal ends of each fiber  36  and  36 A are pressed against optical glass or optical fiber in the female optical connector of the laser source. The distal ends of each fiber, at  13 A, are substantially perpendicular to longitudinal axis of the fiber and are polished to allow for minimal reflection or refraction as light passes from the fibers and into laser focus lens  43  or  46 . Thus, light passes from an external laser source connector, into  10  or  12 , into fiber  36  or  36 A, to run the full length of  7  or  11  and  6 ,  6 A,  13 , and  13 A, to exit there from into laser focus lens  43  or  46 , respectively. 
         [0036]    Scope assembly  4  further comprises laser focus lenses  43  and  46 , which are located at the distal end of endoscope at  13 A. See  FIG. 5 . Laser focus lenses  43  and  46  are located offset to the center of the cross-section of the insertion end  13 A. Laser focus lenses  43  and  46  each have outside diameters of about 100-250 microns (μm). Laser focus lenses  43  and  46  function to focus the parallel laser light travelling down fibers  36  or  36 A down onto a specific point or focal point in the target area. Ideally, the focal points of both  43  and  46  will be identical, so that both lenses focus their laser light onto the same point. This way, one laser source may act as a marking or targeting laser while another laser source may act as the actual burning or ablating laser. A targeting laser is required to accomplish the precise cell ablation or resection without damage to surrounding normal cells. Alternately, focal points may be located slightly adjacent to each other in the target area for lenses  43  and  46  respectively. Scope assembly  4  is assembled so that lenses  43  and  46  are optically connected to fibers  36  and  36 A respectively, so that fibers  36  and  36 A are connected to lenses  43  and  46 , respectively, to minimize reflection and refraction caused by the transition, in permanent fashion, to withstand flexing as  13  and  13 A are inserted into the patient&#39;s body. 
         [0037]    There are certain “recipes” of incident light, so to speak, where wave-interference between the different light sources causes normal cells  20  and abnormal cells  21  in the target area to become much more visually distinguishable. In other words, due to the wave nature of light, the use of two or more coherent light sources from different incident angles upon cells in the target area can sometimes cause different types of cells in the target area to become much more visually distinguishable. For instance, one visible light laser may be used as two incident coherent light sources by splitting the laser and feeding 50% through laser port  10  and 50% through laser port  12  thereby shining the target area with two exactly coherent light sources, shining at different angles upon the target area. When this occurs, the more apparent visual distinguishability effect has been seen to occur. Likewise, two separate visible lasers of the same type may be used, where one is connected to port  10  and the other to port  12  thereby shining the target area with identical light waves with constant relative phase from two separate light sources shining at different angles upon the target area. Likewise, when this occurs, the more apparent visual distinguishability effect has been seen to occur. 
         [0038]    It is believed that at least two coherent light sources shining from different incident angles is required for the aforementioned more apparent visual distinguishability effect to occur. This is due to the wave nature of light, where coherent light waves interfere constructively with each other, to yield different characteristics of light reflected from the target area than would be otherwise if incoherent incident sources were used. This property of light was initially investigated and used to create the first holographic or three-dimensional images. This type of light sources was required to make the holograms. To maximize the difference in incident angles between these light sources, lenses  43  and  46  would be placed at opposite ends of distal end of insertion fiber bundle  13 A, which arrangement is not depicted in  FIG. 5 . 
         [0039]    On the other hand, the surgeon may choose to simply change light sources by connecting different non-coherent light sources available in the operating room in various combinations in order to view cells in the target area for differences resulting from the variation in lighting of the target area. A benefit of the design is that it allows faster variation or changing of different light sources. Also, the surgeon&#39;s team may work ahead by completing any connections and disconnections of light sources before the surgeon actual calls for an incident light change. The endoscope provides the capability to use four distinct incident light sources on the target area thereby dramatically increasing the likelihood of attaining the more distinguishable normal  20  and abnormal  21  cell characteristics. 
         [0040]    Of course, the surgeon may choose to use both laser incident light and incoherent incident light. For instance, the use of one or more LED light sources in combination with one or more visible light laser incident light sources sometimes causes different types of cells in the target area to become more distinguishable. 
         [0041]    Insertion portions of endoscope  13  and  13 A further comprise a sheath or coating  32  on its outer surface, made of low-friction flexible material that is FDA-approved for internal body contact. In best mode sheath  32  is made of polyamide, but may be other material that is functionally equivalent. Coating  32  functions to protect optical fibers, keep optical connections together, and to allow the endoscope to easily slide in and out of a the milk duct, other body cavity, incision, or introducer  23 . Insertion portions  13  and  13 A represent advanced technological achievement given that all optical fibers and lenses mentioned above are assembled inside the 1-2 millimeter outside diameter insertion fiber bundle  13  and insertion end  13 A. Insertion portion  13  is also flexible so that it may be formed into an arc with 35-millimeter radius without breaking any optical fibers enclosed therein.  13  and  13 A can be about 6-30 cm long. 
         [0042]    The endoscope must be pre-inserted into an introducer  23  before insertion into a nipple/milk duct. An introducer  23  allows for the use of a lubrication fluid to help glide the distal end of the introducer or catheter  26  (with  13  and  13 A inside of it) into the nipple/milk duct. In most case saline solution is used for lubrication fluid. The saline solution flow enlarges the milk duct and allows the endoscope move inside the duct without damaging the duct linings by the tip of the endoscope. First elements  13  and  13 A of endoscope are inserted into the catheter  26  of introducer  23  as shown in  FIG. 2 . The inside diameter of  26  is slightly larger than the 1-2 millimeter outside diameter of  13  and  13 A. This allows saline solution to travel between these diameters so to speak. Then, luer lock connector  9  on endoscope is connected to another luer lock connector on introducer  23 . Next, connector  25  on introducer  23  is connected to another connector attached to the sources of saline solution (not shown) to form a fluid tight connection. In this way saline solution flows by gravity into connector  25 , to fill catheter  26  with saline solution. Saline solution then flows distally down  26 , flowing around  13 , to exit from the distal end of  26 . After  13 A is inserted into the nipple/milk duct, saline solution flow may be turned on to allow saline solution into the milk duct, which expands the milk duct. In this way, milk duct is expanded to allow for easier insertion of  13 A. As  13 A is inserted more, it opens more of the milk duct, thereby allowing further insertion, and so on until endoscope is inserted to location that the surgeons desires. Saline solution also spreads out the mild duct lining which helps the surgeon see clusters of cells lesions. After filling the milk duct, saline solution is absorbed into the patient&#39;s system. Saline solution flows by gravity or is pumped at a very at low pressure and low flow rate to achieve the characteristic described above. 
         [0043]    Catheter portion  26  of introducer  23  is typically made of stainless steel or other material approved for insertion into the body. Catheter portion  26  of introducer  23  may require special design and construction to mate with and perform properly with endoscope. Likewise, special design and construction of  26  may be required for specific body cavities or specific internal organ inspection. Thus, different procedures may require different introducers. 
         [0044]    The method of using endoscope includes first obtaining an endoscope as described above. 
         [0045]    Next, the surgeon must consider what incident light sources will be required in the procedure. All such incident light sources should be assembled. The first two such incident light sources should be connected by the appropriate fiber optic cables to fiber optic posts I and II,  5  and  5 A. 
         [0046]    Next, the surgeon may consider if any laser sources will be required in the procedure, noting that laser sources may be used for incident light sources or for common laser purposes such as tissue ablation, tissue cutting, tissue resection, or tissue shrinking. All such laser sources should be assembled. The first two such laser sources should be connected to laser fiber connectors I and II,  10  and  12 . 
         [0047]    The method of use of endoscope may include preparation of the duct, orifice, natural opening, or incision to numb the area and to dilate the duct, orifice, natural opening, or incision. Such preparation may include administration of topical lidocaine, injected lidocaine, or similar about 30 minutes prior to insertion of the endoscope into the duct, orifice, natural opening, or incision. Alternatively, local or general anesthetic may be used to render insertion of the endoscope more comfortable for the patient. Additionally, in the case of milk duct insertion into a breast, the breast may be massaged to promote nipple-aspirate fluid, a maneuver that helps to visually identity a ductal opening. 
         [0048]    The duct, orifice, natural opening, or incision may be further expanded using insufflator, a dilator, or introducer or combination thereof. With insufflation, a gas is injected or pumped in the duct, orifice, natural opening, or incision thereby enlarging the duct, orifice, natural opening, or incision to more easily allow insertion and desired movement of the endoscope within the duct, orifice, natural opening, or incision. An introducer works the same way however a liquid and not a gas is injected or pumped in the duct, orifice, natural opening, or incision to enlarge. A dilator uses a mechanical means to enlarging the duct, orifice, natural opening, or incision. 
         [0049]    Best mode procedure is as follows. Injection of approximately 1 cc of subcutaneous lidocaine without epinephrine into the nipple until it is fully distended. This will not only achieve adequate anesthesia but also highlight the duct openings as dimples on the nipple surface and relax the lactiferous sinus sphincter. An aspirator can be used to try to elicit nipple aspirate fluid from one or more ducts to aid in ductal opening identification, however, ducts without obvious fluid can also be cannulated with the distal end of endoscope. Once a possible location of a duct is identified, the ductal opening is gently probed with a dilator to confirm that it is indeed a duct. Additional larger dilators can be used to enlarge the duct. The largest should be left in the duct opening while the endoscope is prepared. Next, the introducer is prepared with a 10 cc of saline for insufflation. The dilator is removed from the duct to be studied and the introducer with its cannula and saline insufflation is inserted into the duct. The cannula is removed, insufflation is conducted as described above, and the distal end of endscope is passed through the introducer. 
         [0050]    After the duct, orifice, natural opening, or incision is expanded (if required), incident light sources are turned on and the endoscope is inserted and advanced into the duct, orifice, natural opening, or incision. The surgeon then manipulates the insertion end  13  of endoscope within the duct, orifice, natural opening, or incision in order to position distal tip  13 A as desired. The surgeon manipulates the endoscope by holding onto surgeon&#39;s handle point  8  and manipulating it accordingly. 
         [0051]    While inserting and manipulating endoscope, the surgeon has direct vision and examination of all tiers or branches of the duct, orifice, natural opening, or incision through eyepiece  1 , camera  16 , or computer or monitor  19 . Endoscope may be inserted into the duct, orifice, natural opening, or incision up to a blockage point caused by natural narrowing, one or more lesions, or other obstruction. 
         [0052]    The surgeon may try all available combinations of incident light sources using all four ports  5 ,  5 A,  10 , and  12 . For instance, if two different laser sources and two different illumination light sources are available to the surgeon, a total of 16 different lighting options may be surveyed to see which combination that provides illumination that yields the largest amount of visual distinguishability between normal and abnormal cells. 
         [0053]    If an abnormal lesion is found, the extent of the disease is marked out on the skin at the most proximal and most distal lesions, and axial extent is marked when disease is present in multiple peripheral branches of the same ductal tree, duct, orifice, natural opening, or incision. 
         [0054]    If any intraluminal pathology (abnormal cells or tissues) is identified, the surgeon may mark it for biopsy, or may use the laser capability of the endoscope system to burn, ablate, cut, shrink, or resection the abnormal cells or tissues. 
         [0055]    If tissue ablation, cutting, resection, or shrinking is required, the following procedure should be followed. A marking laser is connected to connector  10  or  11 . A marking laser is a cold laser that produces a visually apparent focal point where such focal point does not heat patient tissue. Next, a second laser is connected to connector  10  or  11 . The second laser produces enough energy to affect target cells when shined onto the target cells. The surgeon then turns on the marking laser and manipulates the insertion end of endoscope so that the marking laser is shining on one or more target abnormal cells. The surgeon then turns on the second laser to burn, ablate, cut, shrink, or resect the abnormal cells or tissues. The surgeon repeats these steps as necessary to burn, ablate, cut, shrink, or resection all abnormal cells or tissues as required. 
         [0056]    The findings of the endoscope can be recorded in a computer hard drive or monitor  19  through cable  15 . Both still images and video clips can be recorded as desired by the surgeon. The surgeon may record the procedure before, during and after the endoscope procedure. 
         [0057]    The above steps of endoscope procedure may be performed as an outpatient office procedure in a doctor&#39;s office under local sedation or in an operating room environment where the patient in under general anesthesia.