Source: https://patents.google.com/patent/CN102858228B/en
Timestamp: 2020-01-24 17:45:39
Document Index: 220276080

Matched Legal Cases: ['art 108', 'art 106', 'art 108', 'art 310', 'art 310', 'art 310', 'art 312', 'art 310', 'art 108', 'art 310', 'art 310', 'art 410', 'art 504', 'art 502', 'art 504', 'art 108', 'art 310']

CN102858228B - propulsion system and using method thereof - Google Patents
propulsion system and using method thereof Download PDF
CN102858228B
CN102858228B CN201080064021.XA CN201080064021A CN102858228B CN 102858228 B CN102858228 B CN 102858228B CN 201080064021 A CN201080064021 A CN 201080064021A CN 102858228 B CN102858228 B CN 102858228B
CN201080064021.XA
CN102858228A (en
S·E·迪尔
2009-12-18 Priority to US61/288,259 priority Critical
2009-12-18 Priority to US61/288,060 priority
2010-12-15 Application filed by 库克医学技术有限责任公司 filed Critical 库克医学技术有限责任公司
2010-12-15 Priority to PCT/US2010/060442 priority patent/WO2011075510A2/en
2013-01-02 Publication of CN102858228A publication Critical patent/CN102858228A/en
2016-03-30 Publication of CN102858228B publication Critical patent/CN102858228B/en
The invention provides a kind of system, for armarium to be advanced to the selected target body part in patient body along endoscope.Described propulsion system comprises the rope with Part I and Part II, and described Part I is arranged via the service aisle of endoscope, and described Part II is arranged on described external tothe endoscope.Described propulsion system can comprise guiding device, and described guiding device is configured to exceed the distal part of described endoscope and armarium is advanced to selected target body part.
Propulsion system and using method thereof
The present invention relates to armarium, relate more specifically to a kind of propulsion system and using method thereof, for armarium being transported to selected target body part along endoscope.
Doctor uses endoscope to manifest body area, diagnose various situation and device is transported to treatment position in the process of Minimally Invasive Surgery.Service aisle typically via endoscope carrys out conveying equipment, the diameter of this service aisle is usually in the scope from about 2.0 to 3.5mm, and these equipment may be used for guide catheter and comprise other elongated equipment of tweezers, shears, brush, snare and basket.Can obtain the larger service aisle of diameter 5.0mm in some special endoscope, and these service aisles may be used for by relatively large equipment or the air-breathing or the reduced pressure capabilities that provide raising.But some equipment is for no other reason than that excessive and can not through available endoscope.And the special endoscope price with larger service aisle can be very expensive, and be difficult to insert pipe due to rigidity and external diameter increase.
Large equipment excessively for endoscopic working channel has to pass through alternative normally more traumatic operation and is imported into, such as laparoscopy or open operation.Laparoscopic surgery is included in the otch cutting 0.5-1.5cm in patient's stomach wall, thus peritoneoscope and other device are imported in abdominal cavity and pelvic cavity.Open operation is usually included in patient and cuts one or more long otch with it, then peels off muscle on a large scale, for a long time retracting tissue, denervates and carries out disconnection to tissue.Although effectively imported larger equipment, laparoscopic surgery and open surgery can increase the risk of complication for patients and wound, can extend cure time and hospital stays simultaneously.
Required is without the need to using trauma operation carries out equipment and the method for endoscope's importing for the excessive armarium of endoscope service aisle.Especially, equipment and method is needed to come along endoscope and import armarium in the outside of endoscope.
Equipment disclosed herein and method are used for armarium to import in body area, and more specifically to along external tothe endoscope, armarium are advanced to selected target body part.Typically, described propulsion system comprises for the rope along endoscope's puopulsion equipment.Described propulsion system may further include the guiding elements of the distal part for equipment being advanced beyond described endoscope.Equipment can be connected to described rope, is advanced to the distal end of described endoscope afterwards, and in certain embodiments, is advanced to the distal end of described guiding device, is preferably advanced in selected target body part.
In one aspect, provide a kind of system, for armarium being advanced to the selected target body part in patient body.In one embodiment, described propulsion system is suitable for using together with endoscope, described endoscope has portions of proximal, distal part, service aisle, hole and port, described service aisle extends to described distal part from described portions of proximal, described hole is arranged on described extremity office and is communicated with described service aisle, and described port is arranged on described proximal portion and is communicated with described service aisle.Described propulsion system comprises rope, and described rope extends to described hole from described portions of proximal to described distal part at described external tothe endoscope, and extends to described port and described port from described hole through described service aisle.
In another embodiment, described propulsion system comprises guiding device, and described guiding device comprises: elongated axle, and described elongated axle has portions of proximal and distal part; Fulcrum, described fulcrum is arranged on described extremity office and is configured to receive rope through described fulcrum; Variable durometer cable, described variable durometer cable is arranged on described elongated axle; And actuator, described actuator is set to contiguous described portions of proximal.Described variable durometer cable comprises: helical spring, and described helical spring extends to distal part from the portions of proximal of described elongated axle; And silk thread, described silk thread extends past described spring.Preferably, described silk thread is operatively connected to described spring in described extremity office.Be connected to described silk thread to described actuator operated.
In yet another aspect, provide a kind of method, for armarium being advanced to the selected target body part in patient body.In one embodiment, described method comprises: endoscope is advanced to selected target body part, armarium is connected to rope, and utilizes described rope to advance described armarium along described endoscope.Described endoscope comprises portions of proximal, distal part, service aisle, hole and port, described service aisle extends to described distal part from described portions of proximal, described hole is arranged on described extremity office and is communicated with described service aisle, and described port is arranged on described proximal portion and is communicated with described service aisle.During beginning, described rope extends to described hole from described portions of proximal to described distal part at described external tothe endoscope, and extends to described port and described port from described hole through described service aisle.By pulling out described rope through described port, described distal part can be advanced to connecting armarium from described portions of proximal along described endoscope.
In another embodiment, described method can comprise: through described service aisle, seal wire is advanced to described hole, is advanced to the target body site of the distal part exceeding described endoscope afterwards.Guiding device can be advanced to described hole through described service aisle, is advanced to the target body site of the distal part exceeding described endoscope afterwards.Armarium can be advanced to described target body site along described guiding device.
On the basis studying following the drawings and specific embodiments, those skilled in the art will know other system, method, feature and advantage.All these other systems, method, feature and advantage are all intended to be contained within this description, fall within scope of the present invention, and are subject to the protection of appended claims.
This system will be understood better with reference to the following drawings with description.Part in each accompanying drawing need not be proportional, and emphasis is display principle of the present invention.And in the drawings and in which, same Reference numeral represents the corresponding component run through in different views.
Figure 1A shows propulsion system 100.
Figure 1B shows equipment 120.
Fig. 2 A-2B shows the guided rings 200 be arranged in endoscope 102.
Fig. 2 C shows the axonometric chart of guided rings 200.
Fig. 2 D shows the cross-sectional view of the guided rings 200 presented along the line aa in Fig. 2 C.
Fig. 3 A-3C shows guiding device 300.
Fig. 3 D shows and is attached on rope and seal wire by guiding device 300.
Fig. 3 E-3F shows the alternate embodiment of guiding device 300.
Fig. 3 G shows the elongated component 302 be advanced in target body site 380.
Fig. 4 A-4B shows the endoscope cap 400 with fixed ramp.
Fig. 4 C-4E shows that have can the endoscope cap 400 on pivotable slope.
Fig. 4 F shows connecting rod 440.
Fig. 5 A shows endoscope sheath 500.
Fig. 5 B-5C shows cap component 530.
Fig. 5 D shows the coupling member 550 being connected to tube chamber 520.
Fig. 6 A-6H shows and utilizes propulsion system 100 to be transported in common bile duct by large plastics gallbladder support.
Unless otherwise defined, all technology used herein are identical with the implication that the those of ordinary skill in field, place of the present invention is understood usually with the implication of scientific terminology.In the situation where there is a conflict, by comprise being as the criterion of each definition herein.Method for optimizing and material are described below, but method that is similar with material with methods described herein or that be equal to and material can be used in practice of the present invention or test.Material disclosed herein, method and example be only illustrative and and not intended to be limit.
As used herein, term " comprises ", " comprising ", " having ", " containing ", " having ", " including " and modification thereof are intended to as the transitional phrase of open object, term or word, and it does not get rid of additional action or the probability of structure.Embodiment described herein that the present invention also can imagine " comprising " or key element, " by " its " form " and " primarily of " other embodiment of its " formation ", no matter whether it is explicitly indicated.
As used herein, term " biocompatible " means material substantially nontoxic in the biotic environment of its object purposes, and this material can not be repelled by the physiological system of patient substantially.When importing in Most patients health, biocompatible structure or material can not cause unacceptable disadvantageous, physiological reaction that is long-term or that increase or response.Such response is different from gentle temporary transient inflammation, and the latter typically occurs with outer surgical operation or be implanted in live body by foreign body.
As used herein, term " distally " means the direction substantially towards the target location within body area in the process of medical operating.
As used herein, term " nearside " means the direction substantially towards doctor in the process of medical operating.
As used herein, term " narrow " means the tube chamber of health relative to any narrowed portion of adjoining luminal part.
Figure 1A shows the propulsion system 100 comprising rope 104.Propulsion system is suitable for using together with endoscope 102.Endoscope 102 has portions of proximal 106, distal part 108 and proximally partly extends to the service aisle 110 of distal part.Service aisle is connected to the hole 112 being arranged on extremity office.Rope 104 along endoscope in outside proximally part 106 extend to distal part 108, and enter service aisle 110 via hole 112.Rope extends through service aisle to be got back to portions of proximal 106 and leaves at port one 14 place.Rope comprises first end 105 and the second end 107.Rope can comprise the connection element 116 being preferably located in the second end 107 place.Connection element can be attached to rope 104 or be formed with rope 104 entirety.Connection element can such as by cementing, bonding or sew up and be attached to rope.
Figure 1B shows the equipment 120 that can be transported to selected target body part.Equipment 120 is intended to usually represent any equipment can carried by propulsion system of the present invention.Equipment 120 can be suitable for providing carrying out for selected target body part the equipment treating or diagnose, or alternately can be configured for the equipment another treatment or diagnostic device being transported to selected target body part.Equipment 120 can be such as nasointestinal tube, the J portion of PEG-J pipe, colon solution pressure pipe, gallbladder support, delivery conduit, trocar sheath, conductor sheath or another kind of equipment.Equipment 120 comprises proximal end 124, distal end 126, and can have complementation and be and be configured to the connection element 122 that connects with connection element 116.Alternately, connection element 122 can be configured to directly be attached to rope 104.As what will more specifically make an explanation below, once selected target body part has arrived in endoscope 102 and equipment 120 is connected to rope, just can by retracting rope from port one 14 through service aisle 110 and equipment being advanced to the distal part of endoscope.Preferably, while use rope pulls from its distal end 126, can from its proximal end 124 pushing equipment 120.
Rope 104 can be any miscellaneous equipment that belt, silk thread, stitching thread, filament maybe can play the effect of the rope being suitable for object purposes.Preferably, rope is configured to bending and does not twist together.When by import additional device through endoscopic working channel or fall use service aisle to provide air-breathing or decompress(ion), preferably, rope occupies minimum space within it, and does not substantially interfere with operation.In one embodiment, rope can be diameter the be silk thread of 0.035 millimeter, and use together with the endoscope that such as can be 4.8 millimeters with service aisle diameter.In another embodiment, rope can be the flexible belt of such as nylon belt, and it is configured to the inner surface deferring to endoscopic working channel.Rope can be formed by multiple biocompatible material manufacture, and these biocompatible materials comprise metal alloy and polymeric material.The polymeric material be applicable to such as comprises nylon, polyester, polyethylene, the polyethylene of super high molecular weight and polypropylene.The metal alloy be applicable to such as comprises Nitinol.Rope can be coated with one or more of material.Preferably, rope be coated with water wetted material or other lubriation material at least partially, it can be convenient to the propelling of rope through body area.Rope such as can be coated with the STSBiopolymersInc.'s being located in New York Henry Etard biopolymer.
Connection element 116 and 122 can comprise any applicable structure being configured to temporarily connect two armarium.Such as, connection element can comprise closed-loop structure, as seen in figs. 1 a-1b.Connection element can comprise releasable maybe can rupture stitching thread, temporary transient or soluble binding agent or binding agent, magnet or its combination.Connection element can comprise biocompatible ball, this ball shrinkage, cementing or be otherwise designed to the motive force (such as, 3 pounds) of the q.s applied and landing or split, and can be safely passed gastrointestinal system afterwards or be absorbed.Alternatively, equipment 120 such as can utilize that can rupture or soluble stitching thread and directly be connected to rope.
Fig. 2 A-2B shows the guided rings 200 that the outer surface along endoscope 102 is arranged.Preferably, rope moves along endoscope along with it and passes guided rings, thus closely follows its track.Rope is maintained within ring and the mucosa breakage caused by rope or equipment 120 can be contributed to drop to minimum level, and can also prevent rope or equipment 120 from interfering with endoscope's picture reproducer (such as, its photographing unit, CCD or fiber optic component) in addition.Along with equipment 120 is transported to the distal part of endoscope, it can be formed at slip within guided rings and put in place, as shown in Figure 2 B.Equipment 120 can as one man bend with the distal part of endoscope and move subsequently.Guided rings can be configured to permission equipment 120 and pass completely through guided rings.Fig. 2 C shows the guided rings 200 with the tube chamber 202 for endoscope and the tube chamber 204 for equipment 120.Typically, guided rings is annular or sub-circular, and preferably has the minimum profile of wound, and wherein these rings comprise rounded edges, such as, as shown in the cross sectional top view in Fig. 2 D.Guided rings can combine with endoscope, is attached to endoscope by the binding agent of bio-compatible, is suitable for being snapped in endoscope, or the combination of these modes above.
Fig. 3 A-3G shows the guiding device 300 that can be used in distal part equipment being advanced beyond endoscope.Guiding device 300 comprises flexibility or half flexible elongated component 302, fulcrum 304 and variable durometer cable 306.Elongated component 302 comprises distal part 310 and portions of proximal 312.The length of elongated component and diameter range can depend on the working channel sizes of endoscope to be used and pending operation.Typically, the length range of elongated component 302 is from about 100cm to about 300cm.The scope of cross-sectional diameter is generally from about 1mm to about 3mm, and cross-sectional diameter is preferably configured for the service aisle through endoscope and advances.One of skill in the art will appreciate that all sizes provided at this are only intended to as an example, and the guiding device with different size can be substituted for concrete purposes.
Elongated component 302 comprises biocompatible material, and variable durometer cable 306 is wrapped by this material, and covers it in order to avoid be directly exposed to body area.This material can be such as expanded PTFE, politef, polyethylene or polypropylene.In an exemplary embodiment, elongated component 302 can by arranging heat-shrink tube (such as politef heat-shrink tube) and manufacturing making pipe pyrocondensation put in place afterwards on variable durometer cable 306.Elongated component can comprise one or more of material, and described material provides the attribute of sufficient intensity, amount of deflection and resistance against compression for this component, so that through the meander region of body part.Such material comprises nylon, polyether block amide, polyethylene terephthalate, politef, polyether-ether-ketone or its compositions.But, one of skill in the art will appreciate that elongated component can be formed, to provide the attribute of expection by other biocompatible material structure well known in the art.
Fulcrum 304 is attached to the distal part 310 of elongated component 302, or is formed with this distal part 310 entirety.Fulcrum can be configured for and receives rope 104 and provide any applicable structure a little, and rope can pass through or be pushed into around this point.Fulcrum 304 can be such as single ring architecture (Fig. 3 A), twin nuclei (Fig. 3 B) or have the cylindrical structural (Fig. 3 C) of tube chamber 305 extended through it.Ranging preferably from from about 1mm to about 3mm of the diameter d of fulcrum.In certain embodiments, fulcrum can be constructed by silk thread, stitching thread or filament and form.In other embodiments, fulcrum can be formed by the material structure of more rigidity.But fulcrum 304 can comprise any material being suitable for object purposes usually.Fulcrum such as can comprise the polymeric material of such as nylon and/or the metal material of such as Nitinol.
Multiple parts of guiding device can be coated with one or more of material.Preferably, elongated component 302 be coated with water wetted material or other lubriation material at least partially.Hydrophilic coating or other lubricant coating are considered to be convenient to equipment is advanced through body area or conductor equipment.In certain embodiments, fulcrum 304 can form through its steady material advanced and/or be coated with this material by being convenient to rope.Preferred material comprises politef, the polyethylene (UHMWPE) of super high molecular weight, nylon and polyformaldehyde.
Variable durometer cable 306 is arranged through elongated component 302, and to be included near fulcrum 304 proximally part 312 and to extend to the helical spring 342 of distal part 310.This spring comprises comparatively fine pith between adjacent turns.The silk thread 344 of such as rustless steel silk thread through spring 342 centre bore and extend, and be fixed to its distal end.Alternately, silk thread and spring both can be fixed to distal end.Silk thread 344 is operatively connected to the hand-held device 313 that contiguous proximal end 312 is arranged.Hand-held device 313 comprises the actuator 314 that can be used in compressing or separate pressing spring 342.Such as, in certain embodiments, actuator retraction in a proximal direction makes silk thread 344 retract.This retraction of silk thread reduces the distance between each circle in spring 342, and thus reduces the flexibility of spring.In U.S. Patent No. 4,215,703 and No.3,854, disclose the additional example of variable durometer cable in 473, its disclosure is included in herein by quoting in full.
By making the first end 105 of rope 104 through fulcrum 304, guiding device 300 can be retrofitted on rope 104 in the proximal portion of endoscope.Preferably, guiding device is also retrofitted in the proximal end of seal wire 350, this seal wire leave port one 14 and for intubate to target body site.Rope and seal wire such as can pass dicyclo fulcrum 304, as shown in Figure 3 D.Elongated component 302 can be advanced in service aisle 110 via port one 14 subsequently.Afterwards, elongated component can be pushed into through service aisle, be pushed out hole 112, and exceedes distal part 108 and be advanced to selected target body part.In certain embodiments, endoscope's lifter apparatus may be used for helping elongated component to be advanced in selected target region.Along with elongated component is advanced beyond the distal part of endoscope, rope is preferably advanced in target body site around fulcrum.
In an alternate embodiment, elongated component 302 can comprise the hole 318(Fig. 3 E-3F serving as fulcrum 304).Hole 318 is positioned in distal part 310, and is communicated with the tube chamber 316 that contiguous hole 320 extends.Guiding device can utilize " short thread technology " to be retrofitted on rope 104 in the proximal portion of endoscope.Especially, first end 105 can penetrate in hole 318, penetrates into tube chamber 316 and penetrate into subsequently outside hole 320 and hole 320.Afterwards, elongated component 302 can be pushed into through service aisle 110.Along with elongated component is advanced beyond the distal part of endoscope, rope is preferably therewith pulled, this rope from hole 318 around turning back.Guiding device can be retrofitted on seal wire 350 according to same process.But, one of skill in the art will appreciate that guiding device can have hole and tube chamber by configuration, thus can carry out additional equipment by short thread technology or long filament line technology if be applicable to.In U.S. Patent Application Publication No.2007/0167923, disclose this two technology, its disclosure is included in by quoting in full herein.
Once the distal part 310 of elongated component 302 arrives at target body site 380, then variable durometer cable 306 may be used for by elongated component sclerosis and anchoring put (Fig. 3 G) in place.Rope can be pulled from port one 14 through service aisle 110 subsequently, thus advances connecting device 120 towards target body site.Preferably, equipment 120 can utilize rope to be pulled at its distal end 126 place while its proximal end 124 place is pushed.Promote and pull equipment can reduce the generation of the wound that the tissue around by lead-in path causes, and being convenient to advance reposefully.In certain embodiments, equipment 120 can comprise sclerosis or strengthen element, to be provided for the abundant rigidity of effectively promotion for equipment.
Being imported to by the extension of endoscope and guiding device in the process in target body site, rope can be held stationary on demand.Preferably, rope long enough, thus control can be maintained two ends while endoscope and guiding device are advanced to target body site.In other words, rope is preferably more than the twice of endoscope length.In the embodiment utilizing guiding device, rope is preferably more than endoscope increases extending to outside hole 112 of length and elongated component 302 and the twice extending to the length of the part of target body site.Such as, the part leaving port one 14 of rope such as (can be located in the CookEndoscopyInc.'s of the Winston-saran of the North Carolina state by locking device wireGuideLockingDevice) or by keeping rope be held stationary in port.Similarly, the part that another end, particularly rope of rope to advance to portions of proximal 106 along endoscope in outside by locking mechanism or similar devices or can be held stationary by keeping rope.Along with elongated component 302 or equipment 120 are advanced in target body site, rope can be unlocked on demand.
Alternatively, the endoscope cap comprising slope can use together with propulsion system, thus contributes to conveying equipment 120.Along with equipment 120 arrives at the distal part of endoscope 102, cap just may be used for making equipment deflect in target body site, and this target body site is such as ductus pancreaticus.Fig. 4 A-4B shows the endoscope cap 400 of configuration for duodenoscope.This cap comprises the body 402 with proximal end 404 and distal end 406.Proximal end 404 comprises the hole 403 being configured to the distal part receiving endoscope.Cap 400 comprises the slope 405 that can be used in armarium is deflected towards selected target body part further.Cap 400 comprises further and is configured to hold the picture reproducer (such as, photographing unit, CCD or fiber optic component) of endoscope and the lateral apertures 407 of service aisle.
Body 402 and slope 405 can be formed by constructed of rigid materials.In certain embodiments, all or part of of body and slope can be transparent substantially.Such as, body can be constructed by bright carbonate polymer and form.Alternately, it can be constructed by the translucent or Opacifying polymers that another kind is bright and form, such as, formed by polyurethane, acrylic acid or nylon construction.The size of body 402 can make its external diameter and cap 400 that the external diameter of superincumbent endoscope will be used approximately identical.Such as, the external diameter of body 402 can be about 8.5mm to about 12mm, for using together with having the endoscope of such external diameter.One of skill in the art will appreciate that the size of body 402 can compatibly use together with the endoscope greater or lesser with diameter, and its cross section can also be used for using together with the endoscope similar with shape by configuration.
In certain embodiments, cap can comprise the bonding part 410 being configured to cap is fixed to endoscope.Bonding part can combine or be attached to this proximal end 404 with the proximal end 404 of cap.Preferably can form by providing the flexible material of friction inside diameter surface to construct from body 402 in the bonding part that nearside extends.Such as, bonding part can be constructed by the bright polyurethane being molded into body 402 and form.In other embodiments, it such as can be constructed by silicone or another kind of flexible polymer and form, and this flexible polymer will provide to be installed cap 400 and frictionally (but removedly) is attached to the ability of endoscope.
In an alternate embodiment, the whole cap comprising bonding part can be formed by constructed of rigid materials.Cap can comprise the applicable arbitrarily structure or material that are configured to cap to be attached to endoscope.Such as, cap can comprise binding agent, magnet, thread surface, pawl structures or other structure and material well known in the art.In another alternative embodiment, endoscope can comprise the structure for engaging cap near its distal end, such as complementary thread surface, the tab (s)/draw-in groove of interlocking or be configured to another kind of structure cap being attached to endoscope.Can find the Illustrative examples of such bonding part in U.S. Patent Application Publication No.2009/0105539, its disclosure is included in herein in full by reference.
Fig. 4 C-4E shows another embodiment of the cap 400 comprising the slope 420 being attached to cap pivotally.Slope comprises cross walkway 422 and 424.Alternatively, each respective path can comprise metal sleeve 423 and 425.Slope 420 is attached to cap pivotally by slope swinging mounting 426, and a part for this support is arranged partly over cross walkway 424.Cap may further include fixed ramp 428, and this fixed ramp is configured to provide the smooth transition portion from the outer surface of endoscope to slope 420.
Fig. 4 D-4E shows the cap of Fig. 4 C in the distal end being arranged on endoscope 102.Endoscope comprises lifter 430, and this lifter can be detachably connected to slope 420 by connecting rod 440.Lifter 430 comprises cross walkway 432,434 and 436.Alternatively, each respective path can comprise metal sleeve 433,435 and 437.Lifter is attached to endoscope pivotally by lifter swinging mounting 438, and a part for this support is arranged partly over cross walkway 434.Lifter silk thread 439 is connected to lifter 430 an end, and is operatively connected to the control system of the proximal portion being positioned at endoscope in another end.The manipulation of control system makes lifter silk thread move relative to endoscope.When lifter silk thread towards endoscope portions of proximal retract time, lifter 430 moves around lifter swinging mounting 438.Lifter may be used for making the equipment carried through service aisle 110 deflect into anticipated orientation.Such as, lifter may be used for seal wire 350 and guiding device 300 are deflected in the gallbladder system of patient.Can find that in U.S. Patent Application Publication No.2007/0208219 similar endoscope's lifter apparatus more specifically describes, its disclosure is included in herein in full by reference.
Connecting rod 440 comprises elongated component 442 and two attachment element 444(Fig. 4 F).Connecting rod can be attached to lifter 430 and slope 420 by attachment element is inserted into cross walkway 422 and 432.Attachment element 444 can be the cylindrical structural being attached to elongated portion 442 or combining with elongated portion 442.Preferably, being attached element can engaging around during its respective central axis axially-movable.Such as, attachment element can comprise the outside and inside that are separated by bearing, and bearing makes this outer peripheral rotate around attachment element central axis.Attachment element can comprise joint lifter 430 and the necessary any applicable structural detail in slope 420.Such as, attachment element 444 and cross walkway 422 and 432 can have complementary thread surface.
When lifter 430 and slope 420 are attached by connecting rod 440, the startup of lifter 430 makes slope 420 start.Fig. 4 D shows and is in lifter 430 in the first configuration and slope 420, and in this first configuration, lifter silk thread 439 is not retracted towards the portions of proximal of endoscope.Fig. 4 E shows and is in lifter 430 in the second configuration and slope 420, and in this second configuration, lifter silk thread is retracted towards the portions of proximal of endoscope.When puopulsion equipment downward along endoscope, slope 420 can start to the second configuration from the first configuration, to make the equipment that is transferred deflect towards selected target body part.It will be understood to those of skill in the art that in some cases, slope 420 does not need to start to the second configuration from the first configuration completely, but can start to the configuration required for concrete operation.
Alternatively, endoscope sheath can use together with propulsion system, so that along endoscope's conveying equipment.Fig. 5 A shows the sheath 500 with portions of proximal 502 and distal part 504.Sheath comprises for the first tube chamber 510 of endoscope and the second tube chamber 520 of equipment for being transferred along endoscope.Tube chamber 520 proximally part 502 extends to distal part 504, and has the hole 522 being positioned at distally and the hole 524 being positioned at nearside.As shown in the figure, endoscope 102 is arranged through tube chamber 510, and sheath extends to its distal part 108 in endoscope's portions of proximal 106.The width of sheath and length range can depend on the size of endoscope to be used.Typically, the length range of sheath is from about 100cm to about 200cm, and the wall thickness of sheath is between about 0.1mm to about 8mm.In one embodiment, sheath can be constructed by expanded PTFE (ePTFE) and form.
Alternatively, sheath can comprise the cap component 530 of the distal end being attached to endoscope 102, as shown in the endoscope that the end in Fig. 5 A is observed.Cap component can be the tubular structure with proximal end 532 and distal end 534.Proximal end 532 can be configured to the distal end engaging sheath.Alternately, cap can be fixedly attached to the distal end of sheath.Distal end 534 can have the opening 536 and 538 being configured to aim at hole 112 and endoscope's picture reproducer respectively.
Cap component 530 may further include the coupling member 540(Fig. 5 C engaging tube chamber 520 at hole 522 place).Coupling member 540 can be formed at the inner surface frictionally engaging tube chamber 520 near hole 522.Coupling member comprise proximal end 542, distal end 544 through it proximally end 542 extend to the tube chamber 546 of distal end 544.Preferably, equipment 120 can be pushed into along endoscope through sheath lumens 520, enters tube chamber 546, leaves afterwards and enter in body area.
Alternatively, sheath can comprise another coupling member 550, and this another coupling member is connected to tube chamber 520 at hole 524 place or is formed at hole 524 place and connects (Fig. 5 D) with tube chamber 520.Coupling member 550 comprises tube chamber 552, and equipment can be inserted into through this tube chamber 552, and the distal part afterwards through tube chamber 520 towards endoscope is pushed into.Coupling member 550 can be attached to the proximal end of sheath or combine with this proximal end.Preferably, coupling member 550 is configured to be attached to endoscope releasedly.Such as, coupling member can be configured to the portions of proximal of frictionally engaged endoscope and/or sheath.
Fig. 6 A-6H shows the method that along endoscope, armarium can be imported to selected target body part.In an exemplary embodiment, propulsion system can use together with endoscopic retrograde cholangiopancreatography (ERCP).ERCP relates to: duodenoscope to be inserted in patient's mouth and through esophagus, harmonization of the stomach duodenum, until its conduit arriving at gallbladder system and pancreas leads to duodenal region.The equipment be transferred through endoscopic working channel can subsequently through the ampulla of vater (PapillaofVater) for entering conduit system.Wherein, these equipment can be used in performing Diagnosis and Treat operation.The example of such equipment comprises seal wire, basket, snare, support, gets stone sacculus, conductor brush, conduit and typically have a diameter from the baby endoscope of 0.8mm to 4mm.
ERCP operation comprises and to be transported to by plastics gallbladder support in bile duct or ductus pancreaticus region that narrow just blocking drain.Obstruction may be caused by the tumor in bile duct or ductus pancreaticus.Typically, arrived patient body when there is symptom, tumor is in late period and is considered to perform the operation.Therefore, the processing method of cancer concentrates on extenuating of symptom usually.As the replacement scheme for the surgical bypass operation of extenuating, support can be carried by ERCP through barrier zone and be located, thus maintains the path being used for fluid and flowing through.But the maximum gauge of plastics gallbladder support depends on the diameter of endoscopic working channel usually.Therefore, in some cases, must by multiple Bracket setting within narrow, to allow abundant drain.Utilize propulsion system of the present invention, the plastics gallbladder support that diameter is greater than endoscopic working channel can be transported to bile duct or ductus pancreaticus.These larger pipes can be convenient to the drain carrying out conduit more fully, and can be not easy to block compared with its less corresponding part.
Fig. 6 A-6H shows and is transported in common bile duct by large plastics gallbladder support 610.Perform the operation so that endoscope 102 and rope 104 are arranged beginning in place, as shown in Figure 1.Endoscope can be advanced to subsequently in patient body and to be positioned in duodenum 602, to allow to observe Oddi's sphincter (SphincterofOddi) and the ampulla of vater 604, it is positioned at the opening part leading to common bile duct 606 and ductus pancreaticus.Next, seal wire 350 can extend outside hole 112, enters conduit system (Fig. 6 A) through the ampulla of vater (AmpullaofVater).Preferably, seal wire is pushed into by narrow 608.Dilating catheter can insert pipe for promoting on demand in the catheter.In U.S. Patent Application Publication No.2005/0059890, disclose the more specifically description of inserting pipe by means of dilating catheter in common bile duct, its disclosure is included in by quoting in full herein.Guiding device 300 can be installed on seal wire and rope 104 in the proximal portion of endoscope.The elongated component 302 of guiding device can be pushed into through endoscopic working channel, is extended out hole 112 afterwards outer and enter conduit system, advances (Fig. 6 B) all the time via fulcrum 304 on seal wire.Along with elongated component 302 is advanced in conduit system, the contact by itself and fulcrum 304 is also pushed into by rope.Preferably, fulcrum 304 is pushed into by narrow 608, thus gallbladder support is pulled when being advanced in target body site put in place.Once elongated component 302 is advanced to desired location, variable durometer cable 306 just can be engaged by operated actuator 314, thus makes elongated component 302 harden (Fig. 3 A and 6B).Sclerosis by place for elongated member anchoring, and can provide the rigidity preventing from wrinkle occur in the process of conveying equipment 120.
Next, gallbladder support can be connected to rope in the proximal portion of endoscope.Preferably, support is retrofitted to delivery conduit and is transferred via this delivery conduit, and this delivery conduit is configured to be connected to rope.Delivery conduit as equipment 120 comprises the connection element 122 for being connected to rope, and preferably includes hardening component or partially rigid part, thus can promote conduit from its proximal end 124.Promotion support or delivery conduit can reduce the tension force in importing process on rope, and can reduce the generation of mucosa breakage.Once coupled, just can by being in proximal direction pull-up running rope rope at port one 14 along endoscope's puopulsion equipment 120.
When arriving at the distal part of endoscope, promoting by continuing proximally end while utilizing rope 104 to pull, delivery conduit can be advanced along the elongated component 302 of guiding device 300.Preferably, delivery conduit is advanced to distal part 310, and is advanced to target body site (Fig. 6 C) thus.Once delivery conduit arrives at target location (that is, narrow), it just can depart from from rope subsequently and connect.Such as, when utilizing enough power at port one 14 place rope retracted to throw off connection element 116 from connection element 122 thus while making delivery conduit depart from connect from rope, delivery conduit can be maintained at proximal end.Rope can be drawn out outside conduit system subsequently, and is pulled back in endoscopic working channel 110.Guiding elements 300 and seal wire subsequently 350 can be advanced to outside conduit system, and are pushed into and get back in endoscope.Next, by utilizing interior ejector sleeve to promote out outside delivery conduit by support, gallbladder support 610 can be transported to the position (Fig. 6 D) of narrow 608.Delivery conduit can be removed subsequently from body area.One of skill in the art will appreciate that the entering of equipment, carry, depart from and connect and can change on demand from the step that target body site removes.Such as, if seal wire will be utilized to perform complementary procedure, then preferably can just partly to retract seal wire from bile duct.
In the alternate embodiment that above-mentioned ERCP performs the operation, endoscope cap 400 and/or endoscope sheath 500 can use together with propulsion system, so that equipment 120 is transported to narrow 608.Fig. 6 E shows the endoscope cap 400 in the distal end being arranged on endoscope 102.Along with it is transported to the distal part of endoscope, the angular movement of delivery conduit (equipment 120) is convenient on slope 405.Fig. 6 F shows the endoscope with endoscope sheath 500.Delivery conduit through sheath tube chamber 520 and be advanced to the distal part of endoscope.Fig. 6 G shows the endoscope cap 400 and sheath 500 that combinationally use.In this embodiment, cap comprises the coupling member 540 being connected to tube chamber 520.Cap also comprises the tube chamber 546(aimed at slope 405 and does not show), thus once equipment 120 leaves sheath lumens and tube chamber 546, equipment just will be crossing with slope 405 and thus deflected.
Although described each embodiment of the present invention, by clear, can there is more embodiment and implementation method in those skilled in the art within the scope of the present invention.Therefore, the present invention is only restricted according to appended claims and equivalent thereof.
Endoscope, described endoscope has portions of proximal, distal part, service aisle, hole and port, described service aisle extends to described distal part from described portions of proximal, described hole is arranged on described extremity office and is communicated with described service aisle, and described port is arranged on described proximal portion and is communicated with described service aisle; And
Flexible cable, described rope comprises Part I, described Part I extends to described hole at described external tothe endoscope from the portions of proximal of described endoscope, described rope also comprises Part II, described Part II extends to the portions of proximal of described endoscope through described service aisle from described hole, the Part I of wherein said rope comprises connection element, and described connection element is configured to be attached to armarium and motive force is applied to described armarium; And
Guiding device, described guiding device be configured to service aisle through described endoscope and along described rope Part II and advanced movably, described guiding device comprises elongated axle, described elongated axle has axle portions of proximal and axle distal part, described guiding device also comprises fulcrum, described fulcrum is arranged on described axle extremity office and is configured to receive described rope, along with described elongated axle is advanced beyond the distal part of described endoscope, described cable loop is around described fulcrum and be advanced in target body site
Wherein said elongated axle comprises variable durometer cable, and described variable durometer cable comprises:
Helical spring, described helical spring extends to described axle distal part from described axle portions of proximal;
Silk thread, described silk thread extends past described spring, and described silk thread is operatively connected to described spring in described axle extremity office; And
Actuator, is connected to described silk thread to described actuator operated, and is set to contiguous described axle portions of proximal, and the startup of wherein said actuator makes described spring be compressed.
2. propulsion system according to claim 1, wherein said connection element comprise closed-loop structure, releasable maybe can rupture stitching thread, temporary transient or soluble binding agent, magnet or its combination.
3. propulsion system according to claim 1, wherein said rope comprises hydrophilic or lubricant coating.
4. propulsion system according to claim 1, wherein said rope is selected from silk thread or belt.
5. propulsion system according to claim 1, comprise at least one guided rings further, at least one guided rings described is arranged on the outer surface of described endoscope, and is configured to guide described rope from described portions of proximal to described distal part along described endoscope.
6. propulsion system according to claim 1, wherein said fulcrum is by the wherein a kind of Structure composing in single ring architecture, twin nuclei or cylindrical structural.
7. propulsion system according to claim 1, wherein said elongated axle comprises hydrophilic or lubricant coating.
8. a propulsion system, be configured to use together with endoscope, described endoscope comprises portions of proximal, distal part, service aisle, hole and port, described service aisle extends to described distal part from described portions of proximal, described hole is arranged on described extremity office and is communicated with described service aisle, described port is arranged on described proximal portion and is communicated with described service aisle, and described propulsion system comprises:
Rope, described rope extends to described hole from described portions of proximal to described distal part at described external tothe endoscope, and extends to described portions of proximal from described hole through described service aisle; And
Guiding device, comprising:
Elongated axle, described elongated axle has axle portions of proximal and axle distal part;
Fulcrum, described fulcrum is arranged on described axle extremity office and is configured to receive described rope;
Variable durometer cable, described variable durometer cable is arranged via described elongated axle, comprise helical spring and silk thread, described helical spring extends to described axle distal part from described axle portions of proximal, described silk thread extends past described spring, and described silk thread is operatively connected to described spring in described axle extremity office; And
Actuator, is connected to described silk thread to described actuator operated, and is set to contiguous described axle portions of proximal.
9. propulsion system according to claim 8, wherein said fulcrum comprises the wherein a kind of structure in single ring architecture, twin nuclei or cylindrical structural.
10. propulsion system according to claim 8, wherein said elongated axle comprises the first hole, described first hole be positioned at described axle extremity office and with the second porosity communication, described second hole is set to contiguous described first hole and is positioned at described axle extremity office.
11. propulsion systems according to claim 8, wherein said elongated axle comprise hydrophilic or lubriation material at least partially.
12. propulsion systems according to claim 8, the diameter range of wherein said fulcrum is from 1mm to 3mm.
13. propulsion systems according to claim 8, wherein said elongated axle comprises hydrophilic or lubricant coating.
14. propulsion systems according to claim 8, wherein said rope is selected from silk thread or belt.
15. propulsion systems according to claim 8, wherein said rope comprises hydrophilic or lubricant coating.
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