Patent Publication Number: US-2016220313-A1

Title: Instrumation for throacic surgery

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a U.S. National Stage Application filed under 35 U.S.C. §371(a) of International Patent Application No. PCT/US2014/050641, filed Aug. 12, 2014, which claims benefit of, and priority to, U.S. Provisional Patent Application Ser. No. 61/875,335, filed on Sep. 9, 2013, the entire content of which is incorporated herein by reference. 
    
    
     BACKGROUND 
     1. Technical Field 
     The present disclosure relates to an imaging device for viewing tissues during surgery. More particularly, the present disclosure relates to an imaging device incorporating surface and sub-surface tissue imaging modalities for simultaneously viewing surface and sub-surface tissues in real time. 
     2. Background of Related Art 
     During many surgical or radiological procedures, it is very helpful for health care providers to visualize both surface level features as well as features embedded in tissue or sub-surface features. For example, there is often a need for surgeons to have the ability to identify the location and geometry of underlying nodules or tumors. This is particularly useful during video assisted surgeries such as, for example, video assisted thoracic surgery (VATS). 
     This technique typically requires multiple imaging devices which are used separately. Initially, a camera or other surface imaging device is used to identify an operative site. Then, the camera is removed and a sub-surface imaging probe is placed at the site and utilized to image the underlying tissue including the targeted nodules or tumors. This takes extra time and may result in positional inaccuracy due to the insertion and removal of multiple imaging devices within the operative site. 
     Therefore, there exists a need for a single imaging device having multiple imaging modalities including surface tissue and sub-surface tissue imaging. There further exists a need for an imaging device which can generate surface and sub-surface images simultaneously. 
     SUMMARY 
     There is disclosed an imaging device for use in visualizing surface and sub-surface tissues during a surgical procedure. The imaging device generally includes a body portion, a line of sight surface imaging device connected to the body portion and a sub-surface imaging device connected to the body portion. The line of sight surface imaging device is offset from a longitudinal axis of the sub-surface imaging device and is movable between a retained position substantially in alignment with the sub-surface imaging device to a deployed position offset from a longitudinal axis of the sub-surface imaging device 
     The sub-surface imaging device may be coaxial with the body portion and extends from a distal end of the body portion. The sub-surface imaging device is a probe having a case and a sensor while the line of sight surface imaging device is a camera. 
     In one embodiment, the body portion includes a bay and the camera is movable between the deployed position offset from the body portion and the retained position wherein the camera resides in the bay. 
     In a specific embodiment, the camera is flexibly connected to the body portion. In an alternative specific embodiment, the camera is pivotally connected to the body portion. 
     In a further alternative embodiment, a case of the probe includes a bay and the camera is movable between the deployed position offset from the case of the probe and the retained position wherein the camera resides in the bay. 
     In a still further embodiment, the line of sight surface imaging device is coaxial with the sub-surface imaging device. In a more specific further embodiment, the line of sight surface imaging device is a ring of lenses that radially surrounds the sub-surface imaging device. 
     There is also disclosed a system for positioning and visualizing surface and sub-surface tissue. The system includes a surgical instrument having an elongate tubular member and an imaging device mounted on the elongate tubular member and including a line of sight surface imaging device and a sub-surface imaging device. 
     In one embodiment of the system, the imaging device is movably mounted on the elongate tubular member. In a more specific embodiment, the imaging device is offset from a longitudinal axis of the elongate tubular member. 
     The disclosed system further includes a display screen connected to the imaging device for viewing surface and sub-surface images generated by the line of sight surface imaging device and the sub-surface imaging device. 
     The system still further includes a converter for receiving the images generated and combining them into a merged image visible on the display screen. 
     There is also disclosed a method of positioning a sub-surface imaging probe on surface tissue and imaging sub-surface tissues. The method includes providing an imaging device having a body portion, a line of sight surface imaging device connected to the body portion and a sub-surface imaging device connected to the body portion. Surface tissue is viewed with the line of sight surface imaging device. The position of the sub-surface imaging device is viewed relative to the imaged surface tissue with the line of sight surface imaging device. The sub-surface imaging device is then positioned relative to the surface tissue and the sub-surface tissue is imaged with the now properly positioned sub-surface imaging device. 
     In a specific embodiment of the disclosed method, the images generated by the line of sight surface imaging device and sub-surface imaging device are viewed simultaneously in real time on a display screen. 
    
    
     
       DESCRIPTION OF THE DRAWINGS 
       Various embodiments of the presently disclosed multi-modality imaging device are disclosed herein with reference to the drawings, wherein: 
         FIG. 1  is a perspective view of one embodiment of a multi-modality imaging device mounted on a surgical instrument; 
         FIG. 1A  is an end view of the multi-modality imaging device and surgical instrument of  FIG. 1 ; 
         FIG. 2  is a perspective view of the multi-modality imaging device with a line of sight imaging device in a retained condition; 
         FIG. 3  is a perspective view of the multi-modality imaging device with the line of sight imaging device in a deployed condition; 
         FIG. 4  is a perspective view, with parts separated, of the multi-modality imaging device; 
         FIG. 5  is a perspective view, with parts separated, of an alternative embodiment of a multi-modality imaging device; 
         FIG. 6  is a perspective view of the multi-modality imaging device of  FIG. 5 ; 
         FIG. 7  is a perspective view of another alternative embodiment of a multi-modality imaging device; 
         FIG. 8  is a perspective view, with parts separated, of the multi-modality imaging device of  FIG. 7 ; 
         FIG. 9  is a perspective view of a further alternate embodiment of a multi-modality imaging device with a line of sight imaging device in a retained condition; 
         FIG. 10  is a perspective view of the multi-modality imaging device of  FIG. 9  with the line of sight imaging device in a deployed condition; 
         FIG. 11  is a perspective view of a still further alternate embodiment of a multi-modality imaging device; 
         FIG. 12  is an end view of the multi-modality imaging device of  FIG. 11 ; 
         FIG. 13  is a plan view of an imaging system incorporating the multi-modality imaging device and surgical instrument of  FIG. 1 ; 
         FIG. 14  is an image view of a sub-surface imaging probe of the multi-modality imaging device positioned against tissue taken from the line of sight device; 
         FIG. 15  is a three dimensional image of tissue taken by the sub-surface imaging probe; and 
         FIG. 16  is a compound image of  FIGS. 14 and 15 . 
     
    
    
     DETAILED DESCRIPTION OF EMBODIMENTS 
     Embodiments of the presently disclosed multi-mode imaging device will now be described in detail with reference to the drawings wherein like numerals designate identical or corresponding elements in each of the several views. As is common in the art, the term ‘proximal” refers to that part or component closer to the user or operator, i.e. surgeon or physician, while the term “distal” refers to that part or component further away from the user. 
     Referring initially to  FIG. 1 , there is disclosed one embodiment of a multi-mode imaging device or imaging device  10  for use in video assisted surgery along with a surgical instrument  12 . Imaging device  10  can be used as a standalone instrument or can be mounted on surgical instrument  12 . Surgical instrument  12  can be any of various types of surgical or radiological instrumentation. As shown, surgical instrument  12  generally includes a body portion  14  having an elongate tubular member  16  extending distally from body portion  14 . Imaging device  10  is mounted on surgical instrument  12  proximal of a distal end  18  of elongate tubular member  16 . 
     Imaging device  10  is provided to produce surface and sub-surface tissue images and generally includes a body portion  20 , a sub-surface tissue imaging device or probe  22  and a line of sight surface tissue imaging device or camera  24 . As used herein, the term “probe”  22  refers to sub-surface imaging devices including, but not limited to, ultrasound, photo-acoustic and/or fluorescent imaging devices while the term “camera”  24  refers to surface imaging devices including, but not limited to, visible cameras, near or mid-infrared cameras, fiber optic bundles, etc. As shown, imaging device  10  is movably mounted to elongate tubular member  16  of surgical instrument  12  by a flexible arm or stem  26 . A cable  28  extends from body portion  20  of imaging device  10  and through surgical instrument  12  to relay images provided by probe  22  and camera  24  to a remote video screen (not shown). 
     Probe  22  includes a lens or sensor  30  and a body portion or case  32 . Sensor  30  is provided for generating sub-tissue surface images and is mounted on a distal end  34  of a case  32 . In this embodiment, a proximal end  36  of case  32  extends from a distal end  38  of body portion  20 . 
     Camera  24  includes a lens  40  and a case  42 . In this embodiment, camera  42  is movably mounted to body portion  20  by a flexible arm or stem  44 . Camera  24  is movable between a retained position within body portion  20  and a deployed position (shown) offset from body portion  20  and probe  22 . A cable  46  extends from camera  24  and is in communication with cable  28  to transmit images to a remote display. 
     Referring to  FIGS. 1 and 1A , imaging device  10  is offset from a longitudinal axis A-A of elongate tubular member  16  of surgical instrument  12 . Camera  24  is also offset from probe  22 . This allows imaging device  10  to simultaneously view both surface and sub-surface tissue being operated on, or viewed by, surgical instrument  12 . In order to better position imaging device  10  relative to an operative site, surgical instrument  12  includes a rotation knob  48  affixed to elongate tubular member  16  and rotatably mounted on body portion  14  of surgical instrument  12 . 
     Referring now to  FIGS. 2-4 , in this embodiment, camera  24  is at least partially retained within a bay  50  formed in body portion  20  of imaging device  10 . Camera  24  is movable from a retained position at least partially within bay  50  of body portion  20  ( FIG. 2 ) to a deployed position off set from a longitudinal axis B-B of body portion  20  and probe  22  ( FIG. 3 ). This allows camera  24  to “see around” probe  22  and facilitate the placement of probe  22  against tissue. Various methods can be used to “release” camera  24  from bay  50  and return camera  24  to within bay  50 , such as, for example, a sliding cover, etc. 
     With reference to  FIGS. 3 and 4 , camera  24  is movably mounted to body portion  20  by flexible stem  44 . Flexible stem  44  may be formed integrally with body portion  20  or formed as a separate member out of a flexible material such as, for example, spring steel, etc. As best shown in  FIG. 4 , when formed as a separate member, flexible stem  44  is affixed to case  42  of camera  24  by a fastener  52  and to body portion  20  by a fastener  54 . 
     Referring to  FIGS. 5 and 6 , in an alternative embodiment, a proximal end  56  of flexible stem  44  extends through a slot formed in body portion  20  of imaging device  10  and is movable there through. Case  42  of camera  24  is still affixed to flexible stem  44  by fastener  52 . By exerting a distal force and a proximal tension on proximal end  56  of flexible stem  44 , camera  24  can be extended out of and withdrawn into bay  50  of body portion  20  of imaging device  10  to move camera  24  between the retained and deployed positions. 
     Referring now to  FIGS. 7 and 8 , there is disclosed an alternate embodiment of a multi-mode imaging device  60 . Imaging device  60  generally includes a body portion  62 , a sub-surface tissue probe  64  and a camera  66 . Probe  64  includes a case  68  extending distally from body portion  62  and a sensor  70  extending distally from case  68 . Specifically, a proximal end  72  of sensor  70  extends from a distal end  74  of case  68 . A proximal end  76  of case  68  extends from a distal end  78  of body portion  62 . In this embodiment, camera  66  is movably mounted to probe  64  and is retained at least partially within a bay  80  formed in case  68  of probe  64 . Camera  66  is movable from a retained position contained at least partially within bay  80  to a deployed position out of bay  80  such that a longitudinal axis C-C of camera  66  is offset from a longitudinal axis D-D case  68  of probe  64  and body portion  62 . This, again, allows camera  66  to view around probe  64  to visualize the operative site and assist in positioning probe  64  against tissue. 
     Camera  66  includes a case  82  having a lens  84  for viewing an operative site and assisting in positioning probe  64  against tissue. A cable  86  extends from case  82  of camera  66  to a display (not shown). In order to move camera  66  from the retained position to the deployed position, a U-spring  88  is provided between camera  66  and case  82 . Fasteners  90  and  92  secure U-spring  88  to camera  66  while fasteners  94  and  96  secure U-spring  88  to case  82  and within bay  80 . 
     Referring now to  FIGS. 9 and 10 , there is disclosed a further alternate embodiment of an imaging device  100 . Similar to prior embodiments, imaging device  100  generally includes a body portion  102 , a sub-surface imaging probe  104  and an extendable, surface viewing camera  106 . Probe  104  includes a case  108  and a sensor  110 . A proximal end  112  of case  108  extends distally from a distal end  114  of body portion  102 . Camera  106  generally includes a case  116  and a lens  118 . 
     Similar to imaging device  10  described hereinabove, camera  106  is retained at least partially within a bay  120  formed in body portion  102 . In this particular embodiment, body portion  102  includes a proximally extending body extension  122  defining bay  120 . A hinge  124  is provided to move camera  106  from the retained position at least partially within bay  120  to a deployed position out of bay  120  and offset from body portion  102  and probe  104 . A cable  126  extends from camera  106  through body portion  102  to a display device (not shown). 
     Hinge  124  can be formed as a living hinge integral with body portion  102  or as a separate pivoting member. In this embodiment, and in contrast to prior embodiments, camera  106  is pivoted out of bay  120  and away from body portion  102  and probe  104  rather than being biased away laterally by a spring or linkage. Specifically, hinge  124  is connected to body portion extension by a pivot  128  and to camera  106  by fasteners  130 . 
     Turing now to  FIGS. 11 and 12 , there is disclosed yet a further alternate embodiment of an imaging device  140 . Imaging device  140  includes a body portion  142 , a sub-surface probe  144  and a camera  146 . Sub-surface probe  144  is coaxial with body portion  142  about longitudinal axis E-E and includes a sensor  148 . 
     In this embodiment, camera  146  is also coaxial with body portion  142 , as well as sub-surface probe  144 . Camera  146  includes a ring of lenses  150  positioned circumferentially around sensor  148  of probe  144 . Individual lenses  152  of ring of lenses  150  may be utilized individually to image an area alongside of probe  144  or may be utilized simultaneously to generate a circular image around probe  144  to assist in positioning probe  144  precisely against surface tissue. Further, circle of lenses  150  may incorporate one or more visible light sources  154  in place of an individual lens  152  to illuminate the surface tissue. 
     Turning now to  FIGS. 13-15 , there is disclosed an imaging system  160  and a method of use. Imaging system  160  generally includes surgical instrument  12  and a multi-mode imaging device, such as, for example, imaging device  10  described herein above. Imaging system  160  additionally includes a display screen  162  for viewing images generated by probe  22  and camera  24 . A converter box  164  is provided to receive surface and sub-surface tissue image inputs though cable  28 , process the image inputs and transmit them to display screen through cable  166 . It should be noted that, while the disclosed system uses external display screen  162  and converter box  164 , surgical instrument  12  may be equipped with a self contained converter and display screen  168  to operate as a single integrated unit. 
     Referring to  FIGS. 13 and 14 , probe  22  is positioned against surface tissue ST by visualizing its location with the aid of camera  24 . By using camera  24  to view surface tissue ST, probe  22  can easily be positioned on surface tissue ST while avoiding other tissue structures such as, for example, veins V, fatty tissues FT, etc. 
     Referring to  FIG. 15 , once probe  22  has been properly positioned on surface tissue ST, a sub-surface image of sub-surface tissue structures SST, such as tumor T, can be generated and viewed on screen  162 . The images of the surface tissue ST ( FIG. 14 ) generated by camera  24  and the sub-surface tissue SST generated by probe  22  may be viewed on display screen  162  as side-by-side images on a split screen (not shown) or may be manipulated by converter box  164  to generate a single, real time, three dimensional image of surface tissue ST and underlying sub-surface tissues SST and tumor T ( FIG. 15 ). 
     The disclosed images can then be used to perform an operation on tumor T while avoiding surface tissue structures such as fatty tissue FT and veins V as well as avoiding any additional underlying tissues structures such as, for example, sub-surface veins VSST&#39;s, etc. In this manner imaging device  10  and system  160  provided a means of visualizing an operative area in real time, three dimensions. 
     It will be understood that various modifications may be made to the embodiments disclosed herein. For example, the disclosed line of sight surface imaging device may be movably mounted on other structure such as, for example, linkages, telescoping shafts, etc. Further, the disclosed lenses can be fixed angle, variable angle, wide angle, etc. Additionally, more than one probe or camera may be incorporated into the disclosed imaging devices. Therefore, the above description should not be construed as limiting, but merely as exemplifications of particular embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.