Abstract:
Articulating laryngoscope to aid in the intubation of patients by providing illumination of the oral cavity and trachea during the process having, for example, ‘fingers’ with fiber optic lights at the ends and at joints of the fingers, fingers spread open or ‘flower’ when the device is deployed, gently retracting and compressing soft tissues in the oral cavity and providing medical professionals with much better illumination of the passageway they are addressing, constructed from a malleable material, including rubber, plastics/polymers, and carbon fiber, instead of hard metal. The fingers may have multiple light sources to ensure a flooding of the patient&#39;s oropharynx with light. Some versions might have fiber-optic cameras connected to one or more fingers for use in teaching and research, and one might have suction capability to facilitate removal of solids and fluids, one embodiment can have at least one finger with a scalpel at its distal end.

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
     The present application is a U.S. National Stage under 35 USC 371 filing of International Application Number PCT/US2010/01000, entitled Articulating Laryngoscope filed on Apr. 2, 2010, which is a Nonprovisional Application of U.S. Provisional Application Ser. No. 61/166,037, entitled “FLOWERING LARYNGOSCOPE” filed on Apr. 2, 2009, which are both incorporated herein by reference. 
     FIELD OF THE INVENTION 
     The present invention is related generally to the field of laryngoscopes. 
     BACKGROUND OF THE INVENTION 
     The purpose of the laryngoscope is to aid in intubation. During the intubation process, a laryngoscope is used to open the airways and provide enough light to enable the user to pass an endotracheal tube through the vocal cords, securing the airway so as to provide ventilation to the lungs. 
     Orotracheal intubation by direct laryngoscopy is the method of airway management in critically ill and injured patients, as well as patients undergoing all types of surgery in which general anesthesia is used. Intubation is performed by anesthesiologists, nurse anesthetists, emergency medicine and critical care physicians, dentists and maxillofacial surgeons, veterinarians, and in the out-of-hospital setting by paramedics. Orotracheal intubation is performed many thousands of times daily in the US, and millions of times daily worldwide in operating rooms, emergency departments, intensive care units, and every ambulance in the world. 
     SUMMARY OF THE INVENTION 
     According to the invention, there is provided an articulating laryngoscope, as defined in claims  1 - 37 . 
     For a better understanding of the present invention, together with other and further objects thereof, reference is made to the accompanying drawings and detailed description. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The present invention is illustratively shown and described in reference to the accompanying drawings, in which: 
         FIGS. 1 and 2  illustrate the side and front views, respectively, of one embodiment of articulating laryngoscope  1  of the present invention in the closed position; 
         FIGS. 3 and 4  illustrate the side and front views, respectively, of one embodiment of articulating laryngoscope  1  of the present invention in the deployed or open position; 
         FIG. 5A  is a perspective view of another embodiment of the present invention illustrating extension of the finger members; 
         FIG. 5B  is a perspective view of the embodiment of  FIG. 5A  illustrating relative angular positions of finger members in the extended (open) position; 
         FIG. 6  is a perspective view of the embodiment in  FIG. 5A  in the closed position; 
         FIG. 7  is a block diagram schematic illustrating exemplary elements of the present invention; and 
         FIGS. 8A-C  are illustrations of a protective sleeve; 
         FIGS. 9A-C  are illustrations of modular finger holder embodiments; 
         FIG. 10A-B  are illustrations of the illumination system of one embodiment of the present invention; 
         FIG. 11  is an illustration of flexion and extension of a finger member; and 
         FIG. 12  is a front view of an individual finger member illustrating 360° rotational capability. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     As used herein in the specification and claims, including as used in the examples and unless otherwise expressly specified, all numbers may be read as if prefaced by the word “about”, even if the term does not expressly appear. Also, any numerical range recited herein is intended to include all sub-ranges subsumed therein. 
     Articulation is defined as a joint on a finger. 
     Actuation is defined as the movement at or about one or more joints. 
     Articulating laryngoscope  1  is designed to be equipped with many functional features including but not limited to, mechanical opening of air passage for ease of intubation, illumination of an air passage during intubation and for examination, delivery of gases and liquids, including medications; suction for removal of fluids including blood and mucus; cauterization to stop bleeding; removal of foreign objects and biopsy specimens; real-time video during intubation to guidance of articulating laryngoscope  1 ; and video recording and camera still images for evaluation and teaching; and surgical instruments including, but not limited to, scalpel, staple and suture. 
       FIGS. 1 and 2  illustrate the side and front views, respectively, of one embodiment of articulating laryngoscope  1  having six (6) fingers or projections or phalanges  2  (terms are interchangeable) arranged in a generally U or C shape configuration  11  in the closed position. The U or C shape configuration  11  provides vision for the user of the articulating laryngoscope  1  to observe the uvula, palatine tonsils, oropharynx, esophagus, larynx, and trachea as articulating laryngoscope  1  is guided into position. Therefore, open side  12  of U or C shape configuration  11  is defined as being facing up in an opposing direction relative to handle  13 . Handle  13  can contain PLC  22 , trigger or controller  14 , AC/DC (battery) power source  29 , and interfaces/ports/connections for suction source  27 , oxygen source  28 , and other fluid delivery input  35  (See  FIG. 7 ). Handle  13  operably connects and communicates with fingers  2  at interface  36  by mechanical and electrical means known to one of skilled in the art 
       FIGS. 3 ,  4 ,  5 A,  5 B, and  11  illustrate the structure of articulating laryngoscope  1  that provide the function of member actuation to open air passageways. Fingers  2  have joints  3  that couple together a plurality of segments  5  such that at least segments  5  of fingers  2  can articulate, which means movement upward, downward, or in a circular or elliptical path along or about a central axis C.  FIG. 5A  illustrates segments  5  can have different lengths  6 , and thickness or diameters  7 . Each segment  5  can be tapered  8  with thickness or diameter decreasing as adjacent segments  5  are attached at joints  3  from proximal end  4  and distal end  9 . A plurality of segments  5  form member  19 . Joints  3  provide functionality for manipulation of members  19  in many directions when actuated by a trigger  14  or other control mechanism. 
       FIGS. 3 and 4  illustrate side and front views, respectively, of articulating laryngoscope  1  deployed or open position where members  19  extend or flex toward, for example, tissue to open an airway of the oropharynx.  FIGS. 5A-B  illustrate another actuation of fingers  2  in a “flowering” arrangement where all fingers  2  are extending outwardly away from each other for the maximum opening. Fingers  2  can be manipulated to bring finger ends  15  of members  19  in contact therewith to grab or pinch an object for extraction. 
     With regards to the actuation mechanism,  FIG. 6  is an illustration of a closed laryngoscope with one or more channels that can contain embedded wires  21  for controlled finger actuation, fiber optics or light emitting diodes (LED)  22  for illumination or video, and tubes  23  for suction and fluid delivery, including oxygen and medication. 
     Now turning to  FIGS. 1 and 7 , one embodiment of the actuation mechanism includes a handle  13  with an interface coupler  42  to operably connect handle  13  with fingers  2 . Fingers  2  will interlock with handle  13  in such a way as to make physical and electrical communication with AC/DC (battery) power source  28  and PLC  22 , both of which are contained in handle  13 , and the moveable components in fingers  2 . For instance, the actuation may be driven by manual operator energy, for example squeezing trigger  14  mechanical links to finger  2  resulting in the displacement of a physical conducting element such as a metal wire  21 . At the interlocking point  36  on handle  13 , wire  21  can be coupled to a flexible transducing element  40  in finger  2  or finger tip  15 . 
     In one embodiment of flexible transducing element  40  can be spring hinges  41  at joints  3 . Displacement of wire  21  in handle  13  will thus result in commensurate displacement of the flexible transducing element  40  in finger  2 , resulting in flexion and extension of finger  2  about a central axis C ( FIGS. 5B and 11 ). Each finger  2  has its own central axis C as illustrated in  FIGS. 1 ,  3 ,  5 B, and  11 . Axis C can be linear or non-linear. Flexion is defined is an angular inward movement (interior surface side) φ 1 , φ 2 , φ 3  (where φ 3 =φ 2 −φ 1 ), etc. of each finger segment  5  from central axis C, about 0° up to about 180°, and any angle therebetween. Extension is defined as an angular outward movement (exterior surface side) θ 1 , θ 2 , θ 3  (where θ 3 =θ 2 −θ 1 ), etc. of each segment  5  from central axis C, about 0° up to about −180°, and any angle therebetween. 
     Turning now to  FIG. 11  for a detailed discussion of actuation. The actuation of the individual fingers  2  can be controlled in such a way as to facilitate flexion (solid image of individual finger  2 ) and extension (dotted line image of individual finger  2 ) in two directions about a central axis C. Though the following disclosure illustrates bi-directional linear motion (up and down), it is within the contemplation of this invention that individual finger  2  can also rotate 360° about axis C ( FIG. 12 ). The path can be circular  52  or elliptical  53  as shown in  FIG. 11 . This action may be accomplished by integrating two separate conducting element (such as a metal wire  21 ) into finger  2  and handle  13 , one which transduces input energy to force for actuation, and the other which places restrictions or enables actuation in one direction about the axis while creating the opposite condition for the opposite direction. For instance, activation of the directional limiter (not shown) may slide two subsurface metal restrictors (not shown) into place and out of place, respectively, on opposite sides of a joint  5 , facilitating movement toward the side without a restrictor plate, and inhibiting movement toward the side with a restrictor plate. Conduction of actuation energy will then result in movement in the former direction. 
     As discussed above, members  19  include an embedded actuation mechanism  20 . As shown in  FIG. 6 , one embodiment of actuation mechanism  20  includes a pair of wires  21  extending from proximal end  4  to finger tip  15  at distal end  9 . Both wires  21  are connected to trigger  14  to pull one of the wires to control actuation of a particular member  19 . Another embodiment of actuation mechanism  20  can be gears (not shown) in to joints  3  linked by rotating rods connected to a motor in handle  13 . Yet another embodiment of actuation mechanism  20  can be motors at joints  3  responsive to an electronic stimulus or a signal. Trigger  14  can be connected to actuation mechanism mechanically or electrically, such as by a programmable logic controller (PLC)  22  or controller with logic to determine which wire of the pair of wires to pull to actuate a member  19 . One or more strain gauge  23  disposed along the length of members  19  can be used to regulate pressure of members  19  against tissue. The pressure can be monitored by the user on display  30  ( FIG. 7 ) for manual termination of the member actuation when a pressure limit is reached or the termination can be automated with an automatic shutoff when a pressure limit is reached. 
     One embodiment of the present invention can lock finger  2  positions by locking of the trigger at a set displacement. Alternatively, the source of actuation may be electrical energy derived from a DC (battery) power source  29  or AC common line power source, in which case interface coupler  42  at the interface  36  on handle  13  will bring physical contact between conductive electrical wiring (not shown) in the handle and the designated in finger  2 , continuing through each finger segment  5  to a successive series of motors, in series or in parallel within each finger  2 . 
     Now turning to  FIGS. 10A-B  illustrating one embodiment of the illumination function of the present invention. Joints  3  can include an opening  10  for light illumination when member  19  is flexed or extended or closed.  FIG. 5A  illustrates another embodiment for light illumination that includes finger material being made of translucent or clear substrate containing subsurface light sources  16  (fiber optics or LEDs) below the external surface  17  of the material to protect the light source  16  from contamination or prevent malfunctioning of joint  3  due to blockage caused by foreign objects.  FIG. 10B  illustrates illumination of the oropharynx to view the trachea and esophagus for intubation with the light illumination system of the present invention. 
     Joints  3  can also use opening  10  for suction or other fluid delivery when member  19  is flexed or extended ( FIG. 10A ) or closed. Openings  10  can be disposed along segments  5  in any location, such as midway between joints  3 . Finger  2  can include a fluid delivery outlet  25  at finger end  15  capable of delivering forced air or other medical gases (including oxygen), liquids and medicines ( FIG. 2 ) as well as suction. A balloon (not shown) can be fluidly connected to end  15  of finger  2  by fluid delivery line  25  for inflation to open up the passage way or to close off a passage way. 
     Now returning to  FIG. 5A  illustrate another embodiment of the present invention including webbing  33  between members  19  to function as a barrier to hold back tissues such as the tongue, fluids (such as blood, saliva, mucus), food particles, or other foreign objects that obscure the vision of the user and block the passageway. Webbing  33  can be disposed between one pair of member  19  (as shown in  FIG. 5A ) or between all members  19 . 
       FIG. 7  illustrates exemplary functions and component connectivity of articulating laryngoscope  1 . PLC  22  can control illumination of lights on/off/brightness/direction adjustment; suction on/off/pressure; automatic member actuation shutdown when members  19  exceeds a range of motion limit or when a strain gauge  23  embedded in finger tip  15  exceeds pressure limit; optical focus and field of view; camera on/off/video/still images/run time shutoff/routing of optical signal to display  30 /lens directional adjustment; scalpel actuation measured by depth of cut into tissue and stroke length of cut; oxygen flow rate and mixture; suction flow rate; grasping control logic  32  that accounts for strain gauge  23  readings to adjust actuation of members  19  to assure grasping pressure is not beyond crush limits to avoid destruction or disintegration of object within the patient. 
     Other embodiments of articulating laryngoscope  1  can also include the following features: 
     A. grasping control  32  can include member  19  pinching function to stop, for example, bleeding; 
     B. member  19  can include an endotracheal tube mounted on it; 
     C. member  19  can include a cauterizer mounted on end  15  to stop bleeding; 
     D. member  19  can be constructed in multiple sizes for infants, toddlers, teenager, adults, and animals. Size can also be adapted for dental use, vaginal examinations and procedures, and other cavity examinations and procedures. 
     E. member  19  can include a biopsy needle  51 . 
     Fingers  2  can be a monolithic structure formed from a single injection mold. Finger base structure  18  can be rigid at proximal end  4  over segment length  6 , where there is no relative movement between members  19 . The remaining portion of members  19  can be independently operable and moveable relative to adjacent members  19 . 
     Another embodiment of fingers  2  can be a plurality of assembled components wherein a plurality of members  19  are mechanically connected at joints  3  by any conventional means such as ball and socket, hinges, or straps. Materials for fingers  2  and members  19  can include plastic, carbon fiber, polymers, any semi-rigid material, or combination thereof. Material can have antibiotic and healing properties. Members  19  are sufficiently malleable to be self contouring to tissue during actuation that will distribute the force or pressure substantially evenly to prevent point contact for a prolonged period to minimize tissue damage. 
     Materials for handle  13  can include stainless steel, aluminum, plastic, carbon fiber, rubber, polymers, any semi-rigid material, or combination thereof. 
     Now turning to  FIGS. 8A-C , disposable sleeve  34  can be slipped over member  19  without webbing to function as a protective covering for reusable fingers  2  to either minimize or eliminate the need for sterilization. One embodiment of sleeve  43  can be used for a single member  19  ( FIG. 8B ). Another embodiment of sleeve  44  can be used for an entire finger  2  assembly ( FIG. 8C ) similar to a glove. 
     Another embodiment of the present invention is modular and includes separate, removable fingers  2  that can be selected for its function (such as suction, fluid delivery, light optics, camera lens, and scalpel) and fitted within a holder for a plurality of fingers  2 . Fingers  2  can be made of a low cost, sterile material for disposable purposes or the fingers can be made of materials designed for repeated use and sterilization between uses. Now turning to  FIGS. 9A-C  with illustrations of embodiments of the present invention with a finger base for modular configurations to hold individual members  2 .  FIG. 9A  illustrates one embodiment of block holder  45  made of malleable material (for example plastic) for individual finger  2 . Block holder  45  includes finger attachment devices  46  that can be a hole to receive individual member  2  therein, or a pin to receive individual member  2  thereon. Pin  46  can include a hole therethrough for suction or fluid delivery. Block  45  can directly connect with handle  13 .  FIGS. 9B-C  illustrate holder embodiments  47 ,  49  being generally U or C shaped and made of malleable material (for example plastic) having hole  48  to receive individual member  2  therein. Holder  47  includes a block  50  that can used to secure holder  47  while inserting and removing individual fingers  2 . Individual fingers  2  inserted into holder  47 ,  49  can directly connect to handle  13 . 
     While the disclosure has been described in detail and with reference to specific embodiments thereof, it will be apparent to one skilled in the art that various changes and modifications can be made therein without departing from the spirit and scope of the embodiments. Thus, it is intended that the present disclosure cover the modifications and variations of this disclosure provided they come within the scope of the appended claims and their equivalents.