Abstract:
The invention relates to medical instruments for the operation in patient&#39;s body cavity with the visualization of internal organs. The instrument has an original cleaning system, which includes a gas nozzle supplying a gas jet onto the optical surface under high pressure. This pressure is sufficient to enable the gas jet to be a single cleaning means for cleaning the optical surface in all clinical instances. A safety means prevents the patient&#39;s internal organs from barotrauma by the gas jet und includes a gas jet catcher and a suction pump of ejection type. The latter is arranged in the instrument&#39;s handle and can be used also for the removal of abundant secretions or body&#39;s small particles from the patient&#39;s cavity. Besides, the gas jet and the suction pump along with a control means form the system for pressure control within the patient&#39;s cavity.

Description:
BACKGROUND OF THE PRIOR ART  
         [0001]    1. Field of the Invention  
           [0002]    This invention relates generally to medical instruments for the operation in patient&#39;s body cavity requiring the visualization of internal organs. More particularly, it relates to intubating laryngoscopes, bronchoscopes, endoscopes of various applications, vacuum curettage devices, and the like.  
           [0003]    2. Brief Description of the Prior Art  
           [0004]    All the endoscope systems applied for the visualization of patient&#39;s internal organs comprise at least one endoscope distal optical member disposed at the endoscope distal end. The dirtying of the distal optical member surface with patient&#39;s secretions such as blood, mucus, vomit, fat creates significant difficulties for the internal organs visualization. These problems arise in the cases of bleeding an esophageal and gastrointestinal lesions, bleeding or copious secretions in airways, colonoscopy for poorly prepared patient, hysteroscopy during and after curettage and the like. Another problem obstructing the visualization is fogging the distal optical surface due to the temperature difference between the optical surface and patient&#39;s cavity. Therefore, cleaning the distal optical surface from patient&#39;s secretions and fog presents one of the most important problems of current endoscope developments.  
           [0005]    U.S. Pat. Nos. 4,509,507, 4,548,197, 4,667,655 disclose endoscope devices comprising an air supply pipe and a water supply pipe disposed within an endoscope housing and connected with a distal nozzle through which air and water are alternately supplied in front of a distal optical surface (viewing window). There is also a complex system for supply and control air and water disposed beyond the endoscope device and including a pump means, a control means, a water reservoir, and communications. The disadvantage of these endoscopes is low effectiveness of optical surface cleaning from very adhesive substances such as blood, mucus, fat due to low air pressure and the direction of air/water flow, which is not collides with the optical surface and, therefore, cannot sweep off the dirt. The supply of air/water flow of sufficient pressure is impossible, since this leads to barotrauma of patient internal organs by air/water jet. Moreover, the internal organ barotrauma also can be caused by internal pressure during the operation in closed body cavity. The devices have not any means for the removal of excessive air/water from body cavity or for the dissipation of air/water jet. Another disadvantage is excessive complexity and manufacturing cost of the endoscope system due to the dual (air and water) cleaning system and cumbersome supply and control system disposed beyond the endoscope device. Another disadvantage is the arrangement of air/water nozzle in front of the optical surface (see U.S. Pat. Nos. 4,509,507, 4,667,655) restricting the vision field of the optical surface.  
           [0006]    U.S. Pat. No. 3,903,877 discloses an endoscope comprising air and water pipes for alternate supply air and water to the distal optical surface through a nozzle. There are also the pump and control means providing the alternate supply of air and water to the nozzle and disposed beyond the endoscope device. Moreover, there is a suction port at the endoscope distal end and a suction pump disposed beyond the endoscope. The endoscope distal end is provided with a rubber barrier ring around the nozzle, distal optical surface and suction port. The disadvantage of this patent is very cumbersome and expensive design due to dual cleaning system including the numerous equipment disposed outside the endoscope device. The presence of the suction means and circular rubber barrier lowers the danger of internal organ barotrauma. However, upon sufficient air/water high pressure, these suction port and the barrier do not create a catcher able completely to catch air/water jet and to exclude its deflection towards patient internal organs and barotrauma them. Consequently, the possibility of optical surface effective cleaning is restricted. Moreover, during water supply, the suction means cannot remove only water from body cavity. Inevitably, it sucks in also air creating undesirable (and dangerous) vacuum in body cavity. Another disadvantage is relatively great duration of the cleaning process consisting of washing the distal surface and successive drying it by air.  
           [0007]    U.S. Pat. No. 3,980,078 discloses an endoscope having a nozzle supplying air and water to the distal optical surface, a suction pipe with a distal suction port, a distal circular hood, supply and suction pump means and control means disposed beyond the device. As distinct from U.S. Pat. No. 3,903,877, air and water are transferred to the nozzle with only one pipe. This somewhat simplifies the tubing, but complicates the supply control system. Moreover, there is a circular gap between the distal circular hood and endoscope distal end. This gap is communicated with the suction port to improve water removal from body cavity. On the other hand, the gap decreases the vacuum in the path of airflow going out of the nozzle and thereby lowers the possibility of its catch and removal. Generally, U.S. Pat. Nos. 3,903,877 and 3,980,078 have the same disadvantages above noted for U.S. Pat. No. 3,903,877.  
           [0008]    Thus, the common disadvantages of the endoscope systems with cleaning optics are: their excessive complexity caused by dual (gas and liquid) cleaning system and cumbersome and expensive pump and control means disposed outside the endoscope device; low cleaning effectiveness due to low pressure of cleaning fluid (gas and liquid); the absence of effective means for catching and removing the cleaning flow; the absence of reliable control means allowing to adjust the pressure in body cavity required for surgical operations.  
           [0009]    U.S. Pat. No. 4,497,550 discloses “Device for preventing the observing objective lens window of an endoscope from collecting moistures by directing a small flow of air over the front surface of the observing objective lens window to form a layer of air which has the same temperature as the ambient atmosphere”. The device comprises only one supplying gas channel and one nozzle and prevents the distal optical surface from fog arising. However, the device cannot provide cleaning the optical surface from patient&#39;s secretion due to low air pressure. The device does not comprise any means preventing patient internal organs from barotramna. Therefore, its air pressure cannot be increased up to the value sufficient for effective cleaning the optic surface.  
           [0010]    The attempts of cleaning the distal optic surface in laryngoscopes are disclosed by U.S. Pat. Nos. 5,431,152 and 5,183,031. In both cases, there is an oxygen channel supplying oxygen to the zone of the distal optic surface. However, this oxygen supply cannot effectively clean the optic surface due to the low oxygen pressure and the absence of special oxygen flow directing towards the optic surface. It is impossible to apply sufficient oxygen pressure here because the oxygen flow is directed distally and can cause the barotrauma of patient internal organs. The main object of such oxygen supply is the partial oxygenation of the patient.  
           [0011]    It should be noted, that the laryngoscopes with high pressure oxygen (≈50 psig) are applied in medical practice for high pressure jet ventilation (see U.S. Pat. Nos. 5,193,533 and 6,106,458). However, the application of oxygen high pressure for cleaning the optical surface is not disclosed in the prior art.  
           [0012]    U.S. Pat. No. 4,971,034 discloses “Body Cavity Pressure Adjusting Device” comprising a suction mechanism, gas sending mechanism, pressure and vacuum pipes, and pressure control system. The device is adapted to the use with an endoscope and designed for the adjustment of required pressure in body cavity. Main disadvantage of the device is that its application with the endoscope presents very cumbersome, expensive, and inconvenient combination including device suction and pressurized gas supply means, device pressure control system, device vacuum and pressure pipes as well as endoscope cleaning system with identical equipment.  
           [0013]    The vacuum curettage devices are disclosed by U.S. Pat. Nos. 3,863,624, 3,889,682, 4,063,556, 4,178,932, 4,870,975. They include: a cannula (or curette) communicated with a vacuum pump, which is disposed beyond the curettage device; a valve for selective applying the vacuum to the cannula; a reservoir for the collection of blood, body solid particles and the like; a filter partition separated the reservoir from the vacuum pump. The disadvantage of known curettage devices is the absence of a visualization means eliminating the possibility of operative estimate of curettage results. Practically, the curettage procedure is performed blindly. This worsens the quality of the procedure, leads to patient traumatization and successive complications, and extends the operation duration. The application of the visualization means immediately in the curettage device is hampered due to very significant dirtying the optical surface by curettage products. Another disadvantage of the curettage devices is the arrangement of the vacuum pump beyond the curettage device. This increases the number of communication, heightens the manufacturing cost of the curettage system, and is inconvenient in the operation.  
         SUMMARY OF THE INVENTION  
         [0014]    The object of the present invention is to provide an endoscope with the complete visualization of patient&#39;s internal organs even in the most awkward cases.  
           [0015]    Another object of the present invention is to provide the cleaning the endoscope distal optic surface only by means of gas jet.  
           [0016]    Another object of the present invention is to entirely prevent patient&#39;s internal organs from barotrauma.  
           [0017]    Another object of the present invention is to simplify the endoscope design and to lower its manufacturing cost.  
           [0018]    Another object of the present invention is to reduce the general duration of endoscopy procedure.  
           [0019]    Another object of the present invention is to improve the convenience of user operation.  
           [0020]    Another object of the present invention is to broaden the endoscope functional properties, specifically, to provide its possibility to serve as a means for body cavity pressure adjusting.  
           [0021]    Another object of the present invention is to broaden the endoscope applicability including the possibility of its application in laryngoscopes, bronchoscopes, vacuum curettage devices and the like.  
           [0022]    The above noted objects are accomplished by endoscope system, comprising: an elongated endoscope housing, an optical channel with distal optical surface, a cleaning system for cleaning the optic surface comprising a pressurized gas supply channel connected with a pressure gas source and having an outlet nozzle at housing distal end. The outlet nozzle is directed towards the optic surface so that a gas jet going out of the nozzle touches the optic surface providing its cleanness. The pressure value of gas supplied to the outlet nozzle is sufficient to enable the gas jet to clean completely the optic surface from any patient&#39;s secretions and to be a single means for cleaning the optic surface. All the components of the cleaning system are disposed inside of the endoscope device, with the exception of the pressure gas source disposed beyond the endoscope. There is also a safety means preventing the patient intenial organs from barotrauma by the gas jet.  
           [0023]    Using the gas jet as a single means for cleaning the optic surface significantly simplifies the endoscope design and lowers its manufacturing cost. The location of the all components of cleaning means inside the endoscope device also lowers the endoscope manufacturing cost and, moreover, improves the convenience of device control by user. Sufficiently high gas pressure supplied to the outlet nozzle as well as gas jet direction towards the optic surface provide complete cleaning the optical surface from any patient&#39;s secretion and a fog. Therewith, the gas jet of high pressure is not dangerous for patient internal organs due to the noted safety means. Complete uninterrupted visualization obtained with the noted cleaning means enables reducing the endoscopy procedure and heightening its quality.  
           [0024]    The safety means presents the combination of gas pressure value, the nozzle dimensions, the distance between the optic surface and nozzle, the angle between gas jet direction and optic surface, enabling safe dissipation of the gas jet after its passage of the optical surface. Moreover, additional gas jet dissipation and its deflecting proximally are provided with a barrier disposed in the path of gas jet movement. This safety means and low manufacturing cost, and can be applied for the operation in open body cavity, for instance in laryngoscopes.  
           [0025]    As applied to closed body cavity, the safety means includes a return channel designed for backward movement of cleaning gas, communicated with atmosphere by its proximal end, and having a catcher at its distal end. The catcher is designed for substantially entire catching the gas jet after its passage of said optic surface and for deflecting all the gas jet inward the return channel. The return channel prevents the patient internal organs from barotrauma caused both with the gas jet and with excessive gas pressure in body cavity.  
           [0026]    In version embodiment, the safety means comprises a suction pump of ejection type communicated with the return channel, disposed inside of endoscope device, and fed from the pressure gas source of the nozzle. The noted type, disposition, and gas source of the suction pump provide the design simplicity and low manufacturing cost of endoscope system. The suction pump improves the prevention of patient internal organs from barotrauma. Moreover, the suction pump in the combination with the pressurized gas supply channel and the control valve for the control of gas consumption through the return channel allows the adjustment of the pressure in patient body cavity.  
           [0027]    As applied to vacuum curettage device, the optic channel with the distal optic surface and pressurized gas supply channel with the outlet nozzle are disposed inside the tubular curettage cannula, which serves as the return channel for endoscope cleaning system. Endoscope safety means and vacuum curettage device have one common suction pump of ejection type disposed in the curettage housing and fed from the pressure gas source of the endoscope cleaning system. The device is equipped with the pressure control means for the adjustment of required pressure in the curettage cannula. The device provides good visualization of uterus internal wall even during curettage procedure, is entirely safe and characterized with compact, convenient, simple, and inexpensive design. This curettage device enables to reduce curettage procedure duration, to decrease the uterus traumatization, and to improve the curettage quality. 
       
    
    
     BRIEF DESCRIPTION OF THE DRAWING  
       [0028]    [0028]FIG. 1 shows the conceptual sketch of an intubating laryngoscope with the means for the dissipation and deflection of gas jet.  
         [0029]    [0029]FIG. 2 shows the cross section of the laryngoscope shown in FIG. 1.  
         [0030]    [0030]FIG. 3 shows the conceptual sketch of an intubating laryngoscope with a return channel.  
         [0031]    [0031]FIG. 4 shows the conceptual sketch of the endoscope with separate return channel and simplified suction pump.  
         [0032]    [0032]FIG. 5 shows the conceptual sketch of the endoscope with separate return channel without suction pump.  
         [0033]    [0033]FIG. 6 shows the conceptual sketch of the endoscope with the housing serving as a return channel.  
         [0034]    [0034]FIG. 7 shows the conceptual sketch of the endoscope with separate return channel, enhanced suction pump and the means for the adjustment of body cavity pressure.  
         [0035]    [0035]FIG. 8 shows the side elevation of the handle of the endoscope shown in FIG. 7.  
         [0036]    [0036]FIG. 9 shows the back view of the endoscope shown in FIG. 7.  
         [0037]    [0037]FIG. 10 shows the partial front view of the distal end of the endoscope shown in FIG. 7 FIG. 11 shows the conceptual sketch of the vacuum curettage device with a visualization means.  
         [0038]    [0038]FIG. 12 shows exterior side view of the vacuum curettage device with an endoscope.  
         [0039]    [0039]FIG. 13 shows the cross section of vacuum curettage device cannula.  
         [0040]    [0040]FIG. 14 shows the underside view of the curettage device distal end. 
     
    
     DETAILED DESCRIPTION OF THE INVENTION  
       [0041]    An explanation of the present invention is offered with reference made to the attached drawings in FIG. 1 to  14 .  
         [0042]    [0042]FIG. 1 shows a laryngoscope  20  with a blade  21 , a handle  22 , an optic channel  23  with a distal optic surface  24 , an eyepiece  25  and a connector  26  for computer display connection. There is also a pressurized gas supply channel  27  extending along the blade  21  and having an inlet port  28  connected with a pressure gas source (not shown), a valve  29  of type ON/OF, and an outlet nozzle  30  at its distal end. The nozzle  30  is directed towards the optic surface  24  so that a gas jet  31  going out of the nozzle  30  touches the optic surface  24  sweeping off the dirt from it. The pressure value of gas supplied to the nozzle  30  is sufficient to enable the gas jet  31  to completely clean the optic surface  24  from any patient&#39;s secretions and to be a single means for cleaning the optic surface  24 . This pressure value provides complete cleanness of the optic surface  24  however a safety means is necessary to prevent patient internal organs from barotrauma by the gas jet  31 . This safety means presents the combination of the endoscope parameters enabling safe deflection and dissipation of the gas jet  31  after its passage of the optic surface  24 . The noted endoscope parameters include the gas pressure value P, the nozzle  30  diameter D, the distance L between the optic surface  24  and the nozzle  30 , the angle α between the optic surface  24  and gas jet  31  direction, and the angle β between the gas jet direction and the distal extension of the axis of the optic channel  23  distal portion. In version embodiment, the noted parameters have following values: P=40-60 psig, D=0.8-1 mm, L=2-12 mm, α=5-30°, β&lt;70′. The angle β provides the gas jet direction proximally away of patient internal organs located in front of the optic surface  24 . The other parameters provide the dissipation of the gas jet  31 . Additional dissipation and proximal deflection of gas jet  31  is accomplished by a barrier  32  disposed in the path of gas jet movement after its passage of the optic surface  24  (FIG. 1, 2). The barrier  32  is equipped also with lateral deflectors  33 ,  34  restricting the gas jet movement in the side directions. Thus, described safety means prevent the internal organs from barotrauma by the gas jet  30 . However, they can be applied only in open patient&#39;s cavity, for instance in open mouth cavity, allowing free gas exit and thereby excluding the barotrauma of internal organs by excessive pressure in body cavity. Laryngoscope  20  provides complete cleaning the optic surface  24  thereby reducing the intubation procedure and patient&#39;s organ trauma. Moreover, it is characterized by simple, reliable, and inexpensive design due to using only gas for cleaning the optic surface  24  and the location of all its components inside of the laryngoscope (with the exception of the pressure gas source and computer display).  
         [0043]    The versions of the laryngoscope shown in FIG. 1, 2,  3  have the same designations of identical details. As distinct from FIG. 1, 2, laryngoscope  35  in FIG. 3 has a return channel  36  designed for backward movement of cleaning gas proximally from the zone of the optic surface  24 . The proximal end of the return channel  36  is communicated with atmosphere through a collector (not shown) of blood, mucus and other patient&#39;s secretions. The distal end of the return channel  36  presents a catcher  37  for substantially entire catching the gas jet  31  after its passing the optic surface  24  and deflecting it inward the return channel  36 . The catcher  37  includes a barrier portion  38  of the return channel  36  inner wall disposed in the path of the gas jet  31  at acute angle to it, deflecting the gas jet inwards the return channel  36  and thereby inducing gas backward movement in the return channel. In version embodiment, the laryngoscope  35  includes an ejection gas channel  39  in form of a branch of the gas supply channel  27  disposed in the suction pipe  40 , which presents a portion of the return channel  36 . The ejection gas channel  39  has an ejection outlet  41  directed proximally. The noted suction pipe  40  and the ejection outlet  41  form a simplified suction pump of ejection type, which additionally induces backward gas movement in the return channel  36 . This suction pump enhances laryngoscope safety means enabling the operation in closed body cavity and the removal abundant patient&#39;s secretions, for instance in the case of nasopharyngeal or oral cavity injuries.  
         [0044]    In version embodiment, the laryngoscope  35  includes a control means for the control of gas pressure inward the body cavity. This control means presents a control valve in the form of a throttle valve  42  allowing the change of gas consumption through the return channel  36 . It can be used, for instance, for some increasing the oxygen pressure in oral cavity for the purpose of patient oxygenation, when oxygen is used as a cleaning gas.  
         [0045]    All the components of the laryngoscope  35 , with the exception of pressure gas source and secretion&#39;s collector, are located inside the laryngoscope. All the advantages, noted for the laryngoscope  20 , are inherent also in the laryngoscope  35 . Both laryngoscopes can be used with the gas source of standard medical pressure, preferably oxygen piping system or pressure vessel. Therewith, the pressure of gas supplied to the nozzle  30  can be equal to the pressure in standard medical oxygen source, approximately 50 psig.  
         [0046]    The endoscopes, shown in FIG. 4 to  10 , have identical designations of the same details distinguished only by the first numeral.  
         [0047]    The endoscope  143  in FIG. 4 comprises an elongated housing  144 , a handle  145 , an optic channel  123  with a distal optic surface  124 , an eyepiece  125 , and a connector  126  of a computer display (not shown). There is also a cleaning system with a pressurized gas supply channel  127  having an inlet port  128  connected with a pressure gas source (not shown), outlet nozzle  130 , and a valve  129  of type ON/OF. The nozzle  130  is directed towards the optic surface  124  so that the gas jet  131  going out of the nozzle  130  touches the optic surface  124  cleaning it from patient&#39;s secretions and fog. The pressure of gas supplied to the nozzle  130  is sufficient to entirely clean the optic surface  124  from any patient&#39;s secretions and fog and to be a single means for complete cleaning the optic surface  124 . As a result, the endoscope  143  provides entire visualization of patient internal organs in all the cases of its application. The endoscope  143  is equipped with a safety means preventing patient internal organs from barotrauma. The safety means include a return channel  136  with a catcher  137  for substantially entire catching the gas jet  131 , a safety release valve  146 , and a simplified suction pump of ejection type. This pump comprises an ejection gas channel  139  with an ejection outlet  141  and a suction pipe  140  presenting a portion of the return channel  136 . The operation of identical simplified suction pump was described above as applied to the laryngoscope  35  in FIG. 3. The gas jet  131  enters the catcher  137  at acute angle to a barrier portion  138  of the return channel  136 , which deflects the gas jet inward the return channel  136 . The ejection suction pump induces a backward movement of cleaning gas with patient&#39;s secretion and draws off the gas to atmosphere through the return channel proximal end and a secretion&#39;s collector (not shown) disposed beyond the laryngoscope. The safety release valve  146  automatically opens in the case of unforeseen closing the control valve  142 , for instance because of its jamming, thereby preventing body cavity from excessive pressure. Thus, the safety means entirely prevents patient internal organs from barotrauma caused by the gas jet  131  and excessive pressure in body cavity. Manually controlled valve  142  allows the adjustment of the required pressure in body cavity. For this purpose, the endoscope also has an indication means including a pressure sensor  148  and indication device  147  for the measurement and indication of the pressure in body cavity. In FIG. 4, the sensor  148  presents the distal end of the pipe  149  communicated with usual mechanical mano-vacuumeter. The safety release valve  146  can be used for required pressure adjustment in body cavity. For this purpose, it is set for the required pressure. After partial or entire closing the vale  142  and heightening the pressure in body cavity to expected value, the valve  146  opens maintaining automatically the required pressure in body cavity. All the components of the endoscope  143 , with the exception of the pressure gas source and secretion&#39;s collector, are located inside of the endoscope device providing compact, simple, and inexpensive design. Important merit of the endoscope  143  is the arrangement of the nozzle  130  and the catcher  137  beyond the vision field y of the optic surface  124 .  
         [0048]    The endoscope  243  shown in FIG. 5 comprises many the same details with identical designations as in FIG. 4. Therefore, it is expedient to describe only the distinctions of the endoscope  243 . This endoscope is embodied without the suction pump. The catcher  237  has the barrier portion  238  of curvilinear form smoothly deflecting the gas jet  231  inward the return channel  236  with minimal losses of the dynamic thrust of the gas jet  231 . As a result, the gas jet  231  induces gas backward movement in the return channel  236  thereby providing the removal of cleaning gas from body cavity. This allows as well the adjustment of required pressure in body cavity by control valve  242 . The electronic digital manometer  247  is used for the indication of body cavity pressure. The barrier portion  238  has a distal baffle  250  additionally preventing some part of the gas jet  231  from going out into patient&#39;s cavity.  
         [0049]    A special feature of the endoscope  343  (FIG. 6) is that its elongated housing  344  is used also as the return channel  336  providing substantial design simplification and decreasing its manufacturing cost. The gas jet  331  collides with a barrier portion  338  at acute angle and is deflected inward the return channel  336  inducing a backward gas movement in the return channel. The merits of the return channel  336  are its relatively large dimensions and, as a consequence, low resistance to gas removal from body cavity as well as little restrictions of the vision field γ of the optical surface  324 . The return channel  336  with its catcher  337  is able to provide the gas consumption through the return channel  336  substantially equal to one through the nozzle  330 .  
         [0050]    The special features of the endoscope  443  (FIG. 7 to  10 ) are the catcher  437  of special form, enhanced suction pump  453 , and complicated pressure control system. The catcher  437  has a curvilinear form in the longitudinal section of the return channel  436  (FIG. 7) and horse-shaped distal aperture faced to the nozzle  430  by its concave side (FIG. 10). This increases the completeness of gas jet  431  catching and lowers the resistance to gas jet entering the return channel  436 . The suction pump  453  includes a separate ejection gas channel  454  and an ejection pipe in form of a short gas pipe  455  connected with the ejection gas channel  454  and having a narrowed portion  456  with side openings  457 . Openings  457  are communicated with the proximal end  458  of the return channel  436 . The short gas pipe  455  communicates with the secretion&#39;s collector (not shown) by the pipe  459 . The suction pump  453  is able to create higher vacuum and to provide increased consumption of gas and patient&#39;s secretions through the return channel  436 . It can operate not only as the noted safety means, but as an effective means for the removal of abundant secretions from patient&#39;s cavity as well. As distinct from the prior art, the pump  453  is characterized by simple, inexpensive design and small overall dimensions enabling its location inside of the endoscope handle  445 . The pump  453  is fed from the same pressure gas source that is used for gas supply to the nozzle  430 . The pressure control system of the endoscope  443  includes the members of the cleaning means (the pressurized gas supply channel  427 , the nozzle  430 ), the safety means (the return channel  436 , the suction pump  453 ), and the control means. The latter includes the manually controlled first control valve  442  for the control of gas consumption through the return channel  436  and the second control valve  451  presenting a valve of automatic pressure regulator  460  equipped with the means for manual setting the maintained pressure (standard widely spread pressure regulator). There is also the indication means including the pressure sensor  448  and the manometer  447  above described for the endoscopes  143 ,  243 . The endoscope  443  has the knob  452  of the valve  429  and the knob  453  of the valve  457  (FIG. 8, 9), which are conveniently located at the right side of the handle  445 . The control valve  442  has three following operation positions while the valve  429  is open (FIG. 8): the first position I, wherein gas consumption through the nozzle  430  is more than one through the return channel  436 ; the second position Π, wherein gas consumption through the nozzle  430  is equal to one through the return channel  436 ; the third position ΠI, wherein gas consumption through the nozzle  430  less than one through the return channel  436 . The first position enables to maintain required positive pressure in patient&#39;s cavity. The second position is neutral and does not exert some action on the pressure in patient&#39;s cavity. The third position can create the vacuum in patient&#39;s cavity and may be used for the removal of abundant secretions from patient&#39;s cavity. In all these positions, the endoscope  443  provides complete visualization of patient internal organs. The second control valve  451  additionally enhances the possibility of endoscope control.  
         [0051]    [0051]FIG. 11-14 show a vacuum curettage device  543  with a visualization means, comprising a tubular curettage cannula  544  with a distal window  571  connected with a curettage housing  545  and a curettage suction pump  553  for applying vacuum to the cannula  544 . The suction pump  553  is communicated with the cannula  544  via a suction pipe  561 , a filter  562 , a reservoir  568 , and proximal end  567  of the cannula  544 . The detachable reservoir  568  is designed for the collection of curettage products (blood, body particles), connected with the curettage housing  545  by latches  563 ,  564  and with the cannula proximal end  567  and the suction pipe  561  by means of sealing O-rings  565 ,  566 . The filter  562  is permeable for gas and impermeable for curettage products to prevent the suction pump from dirtying with them. In version embodiment, the reservoir  568  is separated from the curettage housing  545  and connected with the pipes  561  and  567  by hoses (not shown). The device  543  also comprises: an optic channel  523  with a distal optic surface  524 , an eyepiece  525 , and a connector  526  for the connection with a display (not shown); and a pressurized gas supply channel  527  having an inlet port  528  connected with a pressure gas source (not shown), a common valve  529  of type ON/OFF, the first control valve  560  and a nozzle  530 . The optic channel  523  and the pressurized gas supply channel  527  pass within the cannula  544  and, in version embodiment (FIG. 13, 14), are enclosed in a sheath  569 . The presence of the sheath  569  allows the use of the members  523  and  527  along with the curettage housing  545  as a reusable device parts while the cannula  544  and the reservoir  568  are disposable details. The optic surface  524  is disposed within the cannula  544  at its distal end and faces to the cannula distal window  571  so that the optic surface  524  vision field passes through the window  571 . The nozzle  530  is disposed within the cannula  544  and directed towards the optic surface  524  so that the gas jet  531  going out of the nozzle  530  touches the optic surface  524  providing its cleaning. The pressure value of gas supplied to the nozzle  530  is sufficient to clean completely the optic surface from any curettage products in spite of their abundance. As a result, the device provides complete visualization of uterus internal wall during the curettage procedure.  
         [0052]    The device has a safety means preventing patient internal organs from barotrauma by gas going out of the nozzle  530 . In the device  543  the curettage cannula  544  is used as a return channel of the safety means for the backward movement of cleaning gas. The curettage suction pump  553  is used also as a safety suction pump removing the cleaning gas via the return channel. The distal end of the cannula  544  has a barrier wall portion  538 , which serves as a barrier disposed in the path of the gas jet  530  at acute angle to gas jet direction deflecting the gas jet  530  inward the cannula  544 . Thus, the safety means entirely prevents patient internal organs from barotrauma. Note, all the components of the safety means present at the same time the components of the curettage device. As a result, substantial design simplification and lowering the device manufacturing cost are achieved. Moreover, this shows that device  543  is not simple sum of a vacuum curettage device and an endoscope.  
         [0053]    The suction pump  553  of ejection type is described above for the endoscope  443 . It is simple, compact, fed from the pressure gas source of the nozzle  530 , and disposed inside of the curettage housing  545 . In version embodiment (not shown), the suction pump of any type is disposed beyond the curettage device and connected with it by hoses. This design is some more expensive, but can be expedient for the replacement of existent vacuum curettage devices with using existent suction pump.  
         [0054]    The device  543  has a pressure control means for the control of the pressure inward the cannula  544 . This means includes a common valve  529  of ON/OFF type with a knob  571 , the first control valve  560  installed in the pressurized gas supply channel  527  and equipped with a knob  569 , and the second control valve  570  with a knob  572  installed in the path of gas moving through the cannula  544 , and the suction pump  553 . The device  543  is inoperative, when the valve  529  is in position OFF. Upon the curettage procedure, the valves  529  and  570  are open. The valve  560  also can be open, if the user needs the visualization during the curettage procedure. In the visualization position between or after curettage operations, the valves  529  and  560  are open and the valve  570  is open partly so that gas pressure in uterus is some more than atmosphere pressure. As a result, small excessive pressure some expandes uterus improving the visualization of its internal wall. The valves  529 ,  560 , and  570  allow also the other position combinations, which are desirable for user.  
         [0055]    In version embodiment (not shown), the valve  570  is disposed in the cannula proximal end  567  preventing the reservoir  568  from the noted small excessive pressure. In another version embodiment (not shown), the cannula  544  is equipped with the safety release valve, whose design, designation, and operation are identical with the valves  146 ,  246  in the endoscopes  143 ,  243  (FIG. 4, 5).