Abstract:
An activating mechanism for activating an endoscopic ligator is disclosed. The activating mechanism includes a mounting member, a spool, and a line. The mounting member has a passage and is adapted to be inserted into an endoscope channel. The spool is coupled to the mounting member and the line is coupled to the spool and extends through the passage of the mounting member and into the endoscope. Also disclosed is an activating mechanism with a mounting member coupled to a spool. The mounting member has a longitudinal axis for insertion into an endoscope channel, and the spool has an axis substantially perpendicular to the axis of the mounting member. Each device can be operated by rotating the spool to pull a line that is in turn operable coupled to an endoscopic ligator.

Description:
This application is a continuation of U.S. patent application Ser. No. 09/011,798, filed Feb. 11, 1998, now U.S. Pat. No. 6,074,402, which is an application under 35 U.S.C. 371 of International Application No. PCT/US96/14374, filed Sep. 6, 1996, and is a continuation of U.S. application Ser. No. 08/524,069, filed Sep. 6, 1995, now U.S. Pat. No. 5,735,861. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of the Invention 
     The invention relates to the field of endoscopic ligation. More particularly, the invention relates to devices which are used to activate an endoscopic ligator for ligating lesions within a hollow organ of the body. 
     2. Background 
     Endoscopic ligating devices which apply elastic rings over selected body tissue are well known in the prior art. The ligating device is typically activated by retracting a line (string, wire, or cable) that is attached to a ligator disposed at the distal or insertion end of an endoscope. The line is threaded through a working or operating channel of the endoscope to the proximal end of the instrument. In some prior devices, the ligator can be activated by manually pulling on the activating line. In other devices, mechanically assisted operation is provided by means of a hand operated reel or trigger, or a motor drive mechanism. 
     Pre-existing activating mechanisms have generally not been securely mountable to the endoscope, or easily and securely attachable to variously configured endoscopes, have not operated with satisfactory control and accuracy, and have been difficult to disconnect. Wherefore, there is a need for a new activating mechanism which overcomes these shortcomings of prior activating mechanisms. 
     SUMMARY OF THE INVENTION 
     The present invention provides a new and unique activating mechanism for an endoscopic ligator which mounts to a variety of endoscopes and operates to provide precise control to effectuate ligation. The device is easy and convenient to use, and can be simply disconnected when the ligation procedure has been completed. 
     In one embodiment, an activating mechanism mounts to an endoscope by means of a mounting component which is inserted directly into a port of the endoscope. In this way, the activating mechanism can be securely and simply mounted to the endoscope with a single motion. In one specific embodiment, a mounting component is adapted to be fitted within an operating or working channel and/or within the operating channel&#39;s sealing port for a wide variety of endoscopes. In this manner, the secure attachment of the activating mechanism is simply accomplished for the ligating procedure to be conducted, and the mechanism can also be readily removed after the ligation has been performed. 
     In another aspect of the invention, there is further provided means for activating the ligating device which is precisely controllable and which can be simply disconnected upon the completion of the ligation procedure. In one embodiment, an activating component operates in a working mode in wnich the activation line can be retracted under precisely controlled tension to release the ligating bands as desired. When the procedure is suspended or completed, the activating component can be switched to a disengaged mode in which tension on the activation line is released to prevent unintended band release and to allow for easy disconnection of the activation line from the activating component. 
     It is an object of the present invention to provide an activating mechanism for an endoscopic ligator which easily mounts to an endoscope in a stable fashion. It is a further object of the present invention to provide an activating mechanism for an endoscope which can be securely mounted within a channel or auxiliary port of an endoscope. 
     It is a further object of the present invention to provide an activating mechanism for an endoscopic ligator which is precisely controllable to effectuate endoscopic ligation as desired. Yet another object is to provide such an activating mechanism which is convenient to use and which can be readily disconnected at the completion of the procedure. 
     These and other objects and advantages of the present invention will be apparent from a review of the following description of the preferred embodiment. 
    
    
     DESCRIPTION OF THE DRAWINGS 
     FIG. 1 is a longitudinal fragmented view of an endoscope with an endoscopic ligator (generally shown) that is located at the distal end of the endoscope. 
     FIG. 1A is a cross-sectional view of a first configuration of a proximal channel portion of an operating channel of the endoscope of FIG.  1 . 
     FIG. 1B is a cross-sectional view of a second configuration of the proximal channel portion of an operating channel of the endoscope of FIG.  1 . 
     FIG. 1C is a cross-sectional view of a third configuration of the proximal channel portion of an operating channel of the endoscope of FIG.  1 . 
     FIG. 2 is a top plan view of an activating mechanism for activating the endoscopic ligator of FIG.  1 . 
     FIGS. 3A-3C are views of a mounting component of the activating mechanism of FIG.  2 . 
     FIGS. 4A-4E are views of a base of the activating mechanism of FIG.  2 . 
     FIGS. 5A-5C are.views of a drive pin of the activating mechanism of FIG.  2 . 
     FIGS. 6A-6B are views of a spool of the activating mechanism of FIG.  2 . 
     FIG. 7 is a view of a knob of the activating mechanism of FIG.  2 . 
     FIGS. 8A-8B are views of a disengaged mode of operation of the activating mechanism of FIG. 2 wherein knob  60  is free to rotate in either direction (A or B). 
     FIGS. 9A-9B are views of a working mode of operation of the activating mechanism of FIG. 2 wherein knob  60  is only free to rotate in a single direction. 
     FIG. 10A is a view of the activating mechanism of FIG. 2 prior to insertion into the proximal channel portion of FIG.  1 A. 
     FIG. 10B is a view of the activating mechanism of FIG. 2 prior to insertion into the proximal channel portion of FIG.  1 C. 
     FIG. 10C is a view of the activating mechanism of FIG. 2 prior to insertion into the proximal channel portion of FIG.  1 C. 
     FIG. 11A is a view of the activating mechanism of FIG. 2 after insertion into the proximal channel portion of FIG.  1 A. 
     FIG. 11B is a view of the activating mechanism of FIG. 2 after insertion into the proximal channel portion of FIG.  1 B. 
     FIG. 11C is a view of the activating mechanism of FIG. 2 after insertion into the proximal channel portion of FIG.  1 C. 
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT 
     For the purposes of promoting an understanding of the principles of the invention, reference will now be made to the embodiment illustrated in the drawings and specific language will be used to describe the same. It will nevertheless be understood that no limitation of the scope of the invention is thereby intended, such alterations and further modifications in the illustrated device, and such further applications of the principles of the invention as illustrated therein being contemplated as would normally occur to one skilled in the art to which the invention relates. 
     Referring more particularly to the drawings, there is shown in FIG. 1 endoscope  10   a  with endoscopic ligator  14  attached to the distal or insertion end of endoscope  10   a . Endoscopic ligator  14  is generally shown in FIG. 1. A more detailed description of one type of ligator  14  is shown in pending U.S. application Ser. No. 08/260,380 filed on Jun. 14, 1994. Specific reference is made to FIGS. 16-20 and descriptions thereof in the &#39;380 Application, which disclosure is hereby incorporated by reference. The specification in co-pending U.S. application Ser. No. ------, filed on Sep. 6, 1996 as a continuation-in-part of of the above application Ser. No. 08/260,380 and entitled Endoscopic Ligating Apparatus is incorporated herein by reference as well. In general terms, ligator  14  carries a number of ligation bands that can be individually or collectively released from the ligator around a subject tissue. The present invention can also be adapted it for use with other ligators, such as the instrument in U.S. Pat. No. 5,320,630. 
     Endoscope  10   a  can be a conventional endoscope with an operating control portion  11   a , a flexible section  12   a , and a distal or insertion end portion  13   a . Endoscopic ligator  14  is located at distal end portion  13   a  of endoscope  10   a  and includes an activation line  15 . Endoscope  10   a  also includes an operating or working channel  16   a  which extends through endoscope  10   a  from distal end portion  13   a  to operating control portion  11   a  and to proximal opening  18   a . Activation line  15  is preferably threaded from ligator  14  through operating channel  16   a  and exits through proximal opening  18   a . 
     Referring still to FIG. 1, operating channel  16   a  includes a proximal channel portion  19   a  at the proximal opening  18   a , which can be constructed in a variety of configurations. For example, FIGS. 1A,  1 B and  1 C are cross-sectional views of proximal channel portions  19   a ,  19   b  and  19   c , respectively, each proximal channel portion having a different configuration. FIG. 1A shows endoscope b 1 a which is similar to a type of commercial endoscope generally sold by Pentax. FIG. 1B shows endoscope  10   b  which is similar to a type of commercial endoscope generally sold by Olympus. FIG. 1C shows endoscope  10   c  which is similar to a type of commercial endoscope generally sold by Fujinon. These endoscopes include sealing members  17   a-c , respectively, mounted at the corresponding proximal channel portions  19   a-c.    
     FIG. 2 is a top plan view of an activating mechanism  20  according to one embodiment of the present invention. Activating mechanism  20  includes mounting component  21  and activating component  22 . Activating componec  22  can include base  30 , drive pin  40 , spool  50 , knob  60 , roller clutch  70  (see FIG.  4 B), and retaining cap  90 . Mounting component  21  attaches to activating component  22  and is used to mount activating mechanism  20  to proximal channel portions  19   a ,  19   b ,  19   c , or to other auxiliary port or proximal channel portion configurations of other endoscopes. 
     FIG. 3A is a view of a first embodiment of mounting component  21 . Mounting component  21  includes coupling portion  23 , first mating portion  24   a , second mating portion  24   b  and outer sealing portion  25 . Coupling portion  23  is adapted to be connected to activating component  22 . Coupling portion  23 , for example, can be threaded, or press-fit into, or integral with activating component  22 . 
     The first, second and third mating portions  24   a-c , respectively, and outer sealing portion  25  of mounting component  21  are particularly configured in one specific embodiment as shown in FIG.  3 A. It is to be appreciated that mounting component  21  can be constructed in a variety of alternative configurations as well in accordance with the teachings of this invention. 
     The specific embodiment of the mounting component  21  shown in FIG. 3A can be engaged to an endoscope having a proximal opening  18   a  and proximal channel portion  19   a  as shown in FIG.  1 A. In the depicted endoscope  10   a , a sealing member  17   a  is provided at the proximal channel portion. The mounting component of FIG. 3A extends into proximal channel portion  19   a  through proximal opening  18   a  and sealing member  17   a . In this specific embodiment, first mating portion  24   a  is shaped to be fitted within proximal channel portion  19   a , while the second mating portion  24   b  is received within sealing member  17   a . In this specific embodiment, the outer sealing portion  25  is not received within the sealing member  17   a  or proximal channel portion  19   a  of the endoscope. 
     The fit between the mating portion  24   a-b  of the mounting component and the sealing member  17   a  and proximal channel portion  19   a  of the endoscopc provides a stable mount for the activating mechanism  20 . Mounting component  21  is configured to fit in a variety of ways to serve to enhance the secure mounting of the device to various endoscopes. For example, depending on the endoscope with which the activating mechanism is-being mounted, the fit may be a form fit in which the mounting component portion essentially follows the shape of the endoscope sealing member or proximal channel portion. The fit can also be a friction or a press fit or the length of the mounting component or a portion thereof, or alternatively, the mounting component portions could fit loosely within the endoscopic channel to provide enhanced stability by which the mounting component  21  restricts or limits relative movement of the activating mechanism  20  about the endoscopic operating channel. 
     The mounting component of FIG. 3A can be stably mounted to any of a variety of different endoscopes. In FIG. 1B, for example, first mating portion  24   a  and second mating portion  24   b  are sized to fit within proximal channel portion  19   b  of an endoscope which is differently design than that shown in FIG.  1 A. With the same structure of the mounting component, the outer sealing portion  25  can be received within the sealing member  17   b  of the endoscope in FIG. 1B as well as the endoscope of FIG.  1 A. As shown in further detail in FIGS. 10B and 11B, In FIG. 1B, the mating portions  24   a-b  are form or geometrically fitted within the proximal channel portion  19   b . The outer sealing portion  25  is also preferably resiliently or form fitted into the sealing member  17   b . As explained above, the mounting component portions are sized and configured to fit within the proximal channel portion  19   b  and/or sealing member  17   b  of variously designed endoscopes so as to help achieve a stable mounting of the device to the endoscope. 
     The mounting component of FIG. 3A can also be mounted, for example, to an endoscope of the type shown En FIG.  1 C. Again, the fitting of mounting component  21  within the sealing member  17   c  and/or proximal channel portion  19   c  of the endoscope loc can be accomplished in various ways which help to accomplish the stable mounting of activating mechanism  20 . In this specific example, it is to be noted that outer sealing portion  25  is not configured to extend into the sealing member  17   c , as is shown by the other above examples. 
     Mounting component  21  also preferably provides first threading channel  27  which extends through mounting component  21 . First opening  28  of first threading channel  27  is shown in FIG.  3 B and an opposite second opening  29  of first threading channel  27  is shown in FIG.  3 C. After mounting component  21  has been inserted into a proximal channel portion configuration, activation line  15  can be threaded into first opening  28  and out of second opening  29  for connection to activating component  22 . 
     FIG. 4A is a frontal view of base  30  of activating component  22 . Base  30  can include a base portion  30   a , first arm  31  connected to base portion  30   a , and a second arm  32  also connected to base portion  30   a . While the present invention contemplates that the connections of first arm  31  and second arm  32  can exist in any form, preferably first arm  31  and second arm  32  are integral with base portion  30   a . As shown in FIG. 4B, first arm  31  provides first receiving opening  33  and as shown in FIG. 4C, second arm  32  provides second receiving opening  34 . Base portion  30   a  defines recess  35  located on its bottom side and second threading channel  36  which communicates between recess  35  and the top side of base portion  30   a . FIG. 4D is a bottom side view of FIG. 4A, and further shows recess  35  and first opening  37  of second threading channel  36 . FIG. 4E is a top side of FIG. 4A, showing the top side of first arm  31  and second arm  32 , and second opening  38  of second threading channel  36  with an inner sealing member  39  located therein. When activation line  15  is threaded through mounting component  21 , it is Ad further threaded into first opening  37 , through an inner sealing member  39  disposed within second opening  38 , and out of second opening  38 . 
     FIG. 5A is a side view of drive pin  40 . Drive pin  40  preferably includes first rotating portion  41   a , second rotating portion  41   b , third rotating portion  42 , and fourth rotating portion  43 . Depending upon the mode of operation, first rotating portion  41   a  or second rotating portion  41   b  may be disposed within roller clutch  70  (see FIG. 4 b ) located within first receiving opening  33  of first arm  31 . First rotating portion  41   a  is dimensioned to rotate within roller clutch  70  while second rotating portion  41   b  is dimensioned to engage roller clutch  70  within first receiving opening  33  of first arm  31  to thereby allow for rotation in only one direction when activating component is set in its engaged working mode. FIG. 5B is a front view of drive pin  40 . First rotating portion  41   a  is configured to receive retaining cap  90  located on the end of drive pin  40  (see FIG.  2 ). Retaining cap  90  prevents the dislodging of first rotating portion  41   a  from first receiving opening  33 . FIG. 5C is a back view of drive pin  40 . 
     Referring back to FIG. 5A, third rotating portion  42  is disposed within second receiving opening  34  of second arm  32 . Third rotating portion  42  is designed to rotate in and slide within second receiving opening  34 . Drive pin  40  further includes a knurled portion  44  in third rotating portion  42  which connects to knob  60 . Fourth rotating portion  43  is designed to be disposed within spool  50 . 
     FIG. 6A is a side view of spool  50 . Spool  50  can include a slot  51  having a hole  52 . Hole  52  and slot  51  receive activation line  15  from second opening  38  of base  30 . Activation line  15  is coupled to hole  52  and slot  51  by slipping activation line into slot  51  and placing a knot in activation line  15  through hole  52 . FIG. 6B is a front view of spool  50 . Spool  50  further includes drive channel  53 . Drive channel  53  receives third rotating portion  43  of drive pin  40  both of which can have a square cross-sectional shape as illustrated. Spool  50  thus rotates in the same direction as drive pin  40  when the drive pin  40  is rotated by knob  60 , owing to the engagement between fourth rotating portion  43  of drive pin  40  and drive channel  53  of spool  50 . It is understood that fourth rotating portion  43  of drive pin  40  and drive channel  53  of spool  50  can assume a variety of configurations provided that the spool  50  will rotate with drive pin  40 . 
     FIG. 7 is a bottom side view of knob  60 . Knob  60  includes connecting recess  61 . Connecting recess  61  connects with drive pin  40  by fitting onto knurled portion of drive pin  40  (not shown). This connection enables knob  60  to rotate drive pin  40 . The connection also prevents third rotating portion  42  of drive pin  40  from dislodging out of second receiving opening  34 . The present invention contemplates that knob  60  can be operated either manually or mechanically. 
     FIGS. 8 and 9, with continued reference to FIGS. 2-7, are views of the two modes of operation for activating mechanism  20 . FIG. 8A depicts the disengaged mode of operation. Activation line  15  is threaded through mounting component  21  and base  30 , and is coupled to spool  50 . The disengaged mode of operation is based on a disengaged position of drive pin  40  within roller clutch  70 . FIG. 8A depicts third rotating portion  42  of drive pin  40  being substantially disposed outside of second arm  32 . FIG. 8A further shows first rotating portion  41   a  of drive pin  40  being substantially disposed within first arm  31 . In this position, first rotating portion  41   a  is within the one-way roller clutch  70 . This is the disengages position of drive pin  40 . As shown in FIG. 8B, when drive pin  40  is in the disengaged position, knob  60  can be rotated freely in either direction (A or B). After the attachment of activation line  15  to spool  50 , knob  60  can be rotated to wrap activation line  15  around spool  50 . To unwrap activation line  15 , knob  60  can be rotated in the opposite direction of the first rotation. 
     FIG. 9A depicts the working mode of operation. The working mode of operation is also based on a working position of drive pin  40  within roller clutch  70 . FIG. 9A shows the second rotating portion segment  42  being substantially disposed within second arm  32 . FIG. 9A further shows first rotating portion  41   a  being substantially disposed outside of first arm  31  with second rotating portion  41   b  in engaging contact with roller clutch  70 . As shown in FIG. 9B, when drive pin  40  is in the engaged position, knob  60  can only be rotated in one direction due to the engagement between second rotating portion  41   b  and clutch  70 . After the attachment of activation line  15  to spool  50 , knob  60  can be rotated in one direction to wrap activation line  15  around the spool  50  under controlled tension to release ligating bands from ligator  14  as desired. Upon completion of the procedure, activating component  21  may be reset in the disengaged mode to release the tension from activation line  15  and allow activation line  15  to be unwound from spool  50  and disconnected therefrom. 
     While two modes of operation has been described herein for activating mechanism  20 , activating mechanism  20  could less desirably be used exclusively in a working mode, with roller clutch  70  and second rotating portion  41   b  being maintained in engagement. In a less preferred embodiment, roller clutch  70  could be eliminated and an element, such as a one-way clip, could be used to engage the drive pin  40 , spool  50  and/or-knob  60  to restrict the rotation of knob in only one direction as illustrated in FIG.  9 B. 
     FIGS. 10A and 11A show how activating mechanism  20  is mounted to endoscope  10   a  of FIG. 1A by inserting mounting component  21  into proximal channel portion  19   a . For this illustration, endoscope  10   a  is shown provided with sealing member  17   a  which is coupled to proximal opening  18   a . FIG. 10A shows the alignment of activating mechanism  20  with proximal opening  18   a  prior to insertion of mounting component  21  therein. FIG. 11A shows mounting component  21  inserted into proximal channel portion  19   a . Upon insertion, first mating portion  24   a  and second mating portion  24   b  can achieve the fit within proximal channel portion  19   a  and sealing member  17   a , correspondingly, as described above in order to mount activating mechanism  20  to endoscope  10   a . As previously described, activation line  15  is threaded into and attached to activating mechanism  20 . 
     FIGS. 10B and 11B show how activating mechanism  20  is mounted to endoscope  10   b  of FIG. 1B by inserting mounting component  21  into proximal channel portion  19   b . For this illustration, endoscope  10   b  is shown provided with sealing member  17   b  which is coupled to proximal opening  18   a . FIG. 10B shows the alignment of activating mechanism  20  with proximal opening  18   b  prior to insertion of mounting component  21  therein. FIG. 11B shows mounting component  21  inserted into proximal channel portion  19   b . The fit between the first and second mating portions  24   a-b  and the proximal channel portion  19   b , and between outer sealing portion  25  and sealing member  17   b , can be as described above in order to mount activating mechanism  20  to endoscope  10   b  and outer sealing portion  25  seals with sealing member  17   b  of endoscope  10   b.    
     FIGS. 10C and 11C show how activating mechanism  20  is mounted to endoscope  10   c  of FIG. 1C by inserting mounting component  21  into proximal channel portion  19   c . For this illustration, endoscope  10   c  is shown provided with sealing member  17   c  which is coupled to proximal opening  18   c . FIG. 10C shows the alignment of activating mechanism  20  with proximal opening  18   c  prior to insertion of mounting component  21  therein. FIG. 11C shows mounting component  21  inserted into proximal channel portion  19   c . Again, the fit between the mounting component  21  and the proximal channel portion  19   c  and sealing member  17   c  can be as described above. 
     While the invention has been illustrated and described in detail in the drawings and foregoing description, the same is to be considered as illustrative and not restrictive in character, it being understood that only the preferred embodiment has been shown and described and that all changes and modifications that come within the spirit of the invention are desired to be protected.