Patent ID: 12193650

DETAILED DESCRIPTION

The various features and advantages of the systems, devices, and methods of the technology described herein will become more fully apparent from the following description of the examples illustrated in the figures. These examples are intended to illustrate the principles of this disclosure, and this disclosure should not be limited to merely the illustrated examples. The features of the illustrated examples can be modified, combined, removed, and/or substituted as will be apparent to those of ordinary skill in the art upon consideration of the principles disclosed herein.

Arthroscopy is a procedure for diagnosing and treating joint problems. A surgeon inserts a small tube or cannula into a joint space through a small incision or portal. A fiberoptic or endoscopic camera is then passed through the portal and used to transmit a high-resolution image of the joint space to a video monitor. Arthroscopy allows the surgeon to see inside your joint without making a large incision. Arthroscopy is used to visualize many joints including the knee, hip, shoulder, ankle, spine, and wrist. Traditional arthroscopy uses a single portal for the endoscope (with or without irrigation and suction) and a second portal to pass instrumentation used for manipulating tissue within the joint space. A current trend in the surgical orthopedic marketplace is the miniaturization of arthroscopes and associated instrument forceps. Newer arthroscopic systems such as the Nanoscope system produced by Arthrex uses a very small endoscope cannula in one portal and a second portal to pass miniaturized forceps used for tissue manipulation through a second portal.

Smaller incisions and fewer portals allow for improved patient comfort, lower cost, decreased operative time, and the capability of performing arthroscopic procedures in the office rather than in the hospital or ambulatory surgery center setting. Until recently, few systems have even contemplated visualizing and manipulating tissue through a single portal. The Stryker SPA system uses a dual cannula device that is inserted through a single portal incision. Unfortunately. that portal is made large to accommodate both cannulas, one for the endoscope and the other for a powered micro-debrider. Having to manipulate two cannulas through a single portal is technically difficult.

Arthroscopy generally requires irrigation fluid and suction in order to clear debris and inflate the joint for improved visualization. Suction and irrigation hoses attach to connectors on the outside of the rigid cannula through which the endoscope is passed. These hoses are oriented perpendicular to the long axis of the cannula and extend sideways off of the cannula thereby adding to surgical clutter on the field and surgeon frustration during the procedure. The camera head cable and fiberoptic light cable further add to the number of cables and hoses intertangled and within the surgical field. When using a powered suction micro-debrider through a second portal, two more cables/hoses are added to the mix. As such, it is not common for there to be six hoses/cords all competing for space within the operative field. Because the surgeon must rotate and twist the scope during the procedure to improve visualization, the hoses often get tangled and twisted making the case more difficult and frustrating for the surgeon and scrub nurse.

Conventional arthroscopy used standard rod fiberoptic endoscopes for visualization. These endo scopes have distal tips that can visualize at different angles depending on the endoscope. Some examples include zero, thirty, seventy-degree rigid endoscopes. When endoscopes having angled fields of view are passed into a joint space, the surgeon must rotate the scope along its horizontal axis in order to visual the entire joint space. The surgeon must also lever the rod of the scope in a multitude of directions in order to capture a larger visual field. This rocking or levered manipulation of the scope as it passes through the portal can result in greater trauma to the incision site and joint space not to mention damage to the scope and increased surgeon fatigue.

Traditionally only a single instrument can be passed through an arthroscopic portal at one time. Some spinal arthroscopic systems are beginning to utilize single, rigid fiberoptic cannulas through which instruments can be passed (JOIMAX® minimally invasive spinal surgery). These systems utilize fiber optic strands to carry the image from the joint space through the cannula to the camera head CMOS chip that is attached to the proximal end of the instrument cannula. This results in an image quality that is potentially limited by the number of optical fibers delivering the image to the CMOS sensor. With the improvements in the miniaturization and resolution of CMOS chip technology, an endoscope camera/CMOS chip that is located at the tip of the cannula would be advantageous. Likewise, these optical spinal cannulas require rotating the entire handle in order to change the viewing angle or view around an instrument shaft. Such an action causes the hoses and cords that come off the handle to flop around the back of the handle while the cannula is being turned. These cannulas are also larger in diameter and in all instances require instruments to be passed through the cannula from proximal-to-distal and be operated by a second hand.

In some orthopedic arthroscopic procedures, a second instrument is required to effectively manage a surgical task. Should a second instrument be required, it becomes necessary to create a third incision/portal to accommodate the second instrument. This adds to surgical time, tissue injury, and patient discomfort. It is apparent that any means by which a surgeon can improve image resolution, limit the number of surgical portals, decrease incision size, reduce the need for endoscope rotation and/or levering, and minimize the number of surgical cords/hoses on the operative field would be a beneficial and welcomed advancement for the worldwide surgical marketplace.

As noted previously, current implementations of orthopedic arthroscopic cannulas, arthroscopic instruments, and arthroscopic endoscopes (arthroscopes) have limitations with respect to the ability to operate and visualize through a single portal and cannula. Current systems are cumbersome, difficult to set-up, require expanded video and stacked accessory components to operate, and are not integrated in a user-friendly manner. Other limitations of current arthroscopic systems include limited visualization within the joint space, need for levering of the arthroscope to access different portions of the joint space, need for a second or third incision/portal for instrument access, suction hose, irrigation tubing, and electrical cable management, awkward hand/wrist positioning for the surgeon, and the inability to rotate the camera orientation with respect to the instrument shaft and tool tip (and vice-versa).

To this end, implementations of this disclosure are directed to an improved arthroscopic system design that corrects these current deficiencies while at the same time reducing the number of necessary portals required for a particular procedure. In effect, implementations of this disclosure allow the surgeon to free-up one hand and at least one surgical portal. In so doing, the surgeon can manipulate the extremity with one hand while visualizing and using mechanical instrumentation with the other. The rotational cannula design enables the image angle to be changed without having to turn the whole wrist or endoscopic handle. In this simplified and ergonomic manner, physician fatigue is improved and tasks that usually require a second assistant are minimized. Additionally, operative time is decreased, patient comfort is increased, fewer parts require sterilization, optical clarity is improved, and the overall cost of the procedure is reduced. Implementations of the disclosed system also allow the surgeon to perform instrumentation with tools that are larger than the diameter on the optical cannula while at the same time maintaining optical visualization of the tool tip. The disclosed implementations herein present a better “mouse trap” and improved options for surgical instrumentation and visualization during arthroscopy. Very importantly, implementations of this device will make it easier to transition surgical procedures out of the hospital and ambulatory care centers and into the physician office, thereby decreasing facility and anesthesia costs and improving surgeon efficiency and patient satisfaction.

FIGS.1-2illustrate implementations of a rotatable, optical cannula system100in accordance with the disclosure. As illustrated inFIG.1-2, the optical cannula system100may include a reusable or disposable cannula120with an outer turn dial130. The cannula fits into an elongate, semicircular indentation (FIG.10A,178) located on the top surface of the endoscope handle170. The turn dial130has a collar extension125that likewise snaps into a molded indentation (FIG.2,173) within the inner surface of the distal endoscope handle170. When attached to the endoscope handle, rotation of the turn dial130causes the optical cannula turn in either clockwise or counterclockwise in a circumferential fashion. On the proximal end of the cannula120there is a located a suction/irrigation harness140that is permanently or removably attached to the optical cannula120. The cannula can turn freely within the irrigation harness when secured to the endoscope handle. Within the proximal aspect of the endoscope handle170there is a molded indentation designed to receive the irrigation harness140utilizing a “snap-in” mechanism or alternative means such as magnets, clips, clamps, grooves, or other means not limited to the implementations described herein. Not depicted inFIG.1-2is an electrical coupler located along the bottom surface of the irrigation harness140and a separate mating electrical coupler within the proximal molded indentation174of handle170(seeFIG.10A,177).

In certain implementations, a removable lever175is attached to the endoscope handle170. Along the proximal aspect of the lever there are bilateral extensions171. These lever extensions engage a removable locking key150that is designed to integrate with the back end of an instrument shaft110. The instrument shaft110is comprised of an inner shaft199and an outer shaft190. Movement of the inner instrument shaft within the outer shaft causes the mechanized movement of the tool tip attached to the end of the instrument shaft110(not depicted). Hinged movement of the lever against the endoscope body causes the locking key to reversibly move the inner instrument shaft in a direction opposite from the outer instrument shaft. In so doing, the tool tip is actuated. In certain scenarios when the mechanized aspects of the endoscope handle are not required, the instrument lever can be removed or snapped into a conforming indentation molded into the body of the endoscope handle172. Securing the lever175into the handle indentation172could be facilitated by a magnet or alternative mechanism depending on the implementation.

On the back of the locking key150there is a rotatable instrument shaft turn dial160that engages internally with a small circular gear117formed within a small horizontal segment of the outer instrument shaft110. The instrument shaft turn dial160rotates independently from the locking key150. When the locking key150is fully engaged, the gear projections within the inner circumference of the turn dial engage the gear projections on the outer instrument shaft in a manner that allows for easy rotation of the instrument shaft as it exits the proximal end of the optical cannula. Rotation of the instrument shaft is thereby independent of the optical cannula rotation performed by rotating a separate turn dial130located on the opposite, more distal end of the cannula.

A removable endoscope electrical cable180is shown to connect to the proximal undersurface of the endoscope handle170. Suction and irrigation hoses185attach to the undersurface of the suction/irrigation harness (FIG.11c). Various embodiments of how the suction and irrigation hoses interact with the suction/irrigation harness140are envisioned and described later herein. It is apparent however that the streamlined orientation of all electrical cables and suction/irrigation hoses is favorable when compared to current systems.

FIG.3shows a frontal view of the disclosed optical cannula system100.FIG.3highlights the internal features of the optical cannula120. In this implementation, a single camera CMOS chip200is seen just inside the periphery of the cannula. It is important to note that in these implementations the camera chip is located at the distal tip of the cannula and not inside a separate camera head attached to the proximal end of the cannula or endoscope handle. Positioning of the CMOS sensor at the tip of the cannula negates any loss of image resolution seen with conventional systems that use limited optical fibers to carry the image to a distal sensor. As imaging technology advances and the size of CMOS chips get smaller and resolution improves, the implementations of the disclosed system will show progressive quality improvement of displayed images when compared to systems that use conventional fiberoptic technology.

FIG.3shows irrigation210and suction220channels oriented peripherally within the lumen or cannula120. These irrigation and suction channels are carried horizontally along the length of the cannula and eventually end in holes in the outer cannula that communicate with fluid chambers located within the irrigation/suction harness140situated along the back end of the cannula. The optical cannula irrigation and suction channel borders are formed by the instrument shaft110and/or instrument working channel internally230, the optical cannula wall121externally, and the CMOS chip and optical light fibers200centrally. In other implementations, an LED emitter placed next to the CMOS chip might be used instead of optical fibers. In some implementations, there may not be a discrete internal working cannula that is incorporated into the central lumen of the outer cannula and in other implementations the instrument shaft alone could act as the internal border for the cannulas' irrigation and suction channels.

FIG.4shows a perspective view of a dual camera chip optical cannula300, which can be one implementation of the cannula120. Small gaps320,321laterally adjacent to the CMOS chips310,311could be used to accommodate the optical light fibers or LED emitters necessary for joint illumination. By utilizing two separate CMOS chips in a divergent orientation, both camera images could be displayed individually or side by side on a split image monitor. Each image would provide a different viewing angle of the anatomical landscape. Alternatively, the images could be digitally combined or “stitched” together in a manner that would create a larger, panoramic field of view. In this implementation, the CMOS chips of optical cannula embodiment300are oriented 30 degrees divergent from center. Cannula systems with varying angles of camera chip divergence using two or more camera CMOS chips are envisioned. By incorporating multiple camera chips into the tip of the cannula, multiple areas of the joint space could be visualized simultaneously and displayed in a compartmentalized, 3D, or panoramic fashion on a monitor display. Conventional arthroscopic systems have limited fields of view confined by the angulation of the rigid scope lens.

FIG.5shows an example diagrammatic representation of image cancellation using a dual camera chip cannula configuration. In this application, computerized digital manipulation of the combined CMOS camera images allows for display cancellation/removal of the instrument shaft occupying the central aspect of the operative view. Split screen images330of two unaltered pictures created by divergent CMOS sensors are located on the top of the diagram. The visualized object360is obscured by the instrument shaft370noted centrally along the inner aspect of each top picture. The lower left picture340combines the digitally manipulated pictures into a single picture in a manner that shows a transparent, but still visible outline of the instrument shaft380. The lower right picture350shows a digitally enhanced image with the instrument shaft completely removed from the scene. The photographed object remains visually complete as if the instrument shaft was never there. One can see how image cancellation technology could be used to improve joint space visualization during a reduced portal surgical procedure by digitally removing and reinserting the instrument shaft from the displayed image without actually removing the instrument shaft from the joint space.

FIG.6shows various implementations of how the rotatable, optical cannula120could interact with a stationary electrical couplers111a,111b,111cembedded within an endoscope handle170. The stationary electrical couplers111a,111bcan include contacts to which wires can be attached (e.g., with a service loop connection with the cannula120) to provide continuous electrical contact with the shaft110and camera chip200. The stationary electrical coupler111ccan include circumferential contacts which form part of a commutator. Another portion of the cannula system (e.g., endoscope handle170) can include contacts aligned with each of the circumferential contacts to provide continuous electrical contact with the shaft110and camera chip200.

FIG.7shows a visual representation of how a one-millimeter camera chip200can affect the size of the inner working channel230, irrigation channel210, and suction channel220of an optical cannula. A cannula120with outer diameters240aof 8 mm, a working channel230with diameter230aof 6.1 mm, an outer diameter250of 6 mm, a working channel230with diameter230bof 4.1 mm, an outer diameter260of 4 mm, and a, working channel230with diameter230cof 2.1 mm are respectively included for comparison.

Conventional arthroscopic cannulas typically require suction and/or irrigation ports that are integrated into the side wall of the cannula. These ports typically have shut-off valves/levers that regulate the flow of fluid through the cannula. Often these ports are oriented between 30 and 90 degrees away from the longitudinal axis of the cannula. Implementations of the disclosed system use an alternative means for directing suction and irrigation into and out of the cannula.FIGS.8-9show respective transparent and sagittal views of a suction/irrigation harness140interacting with the optical cannula120.

Instead of using fixated ports on the sides of the cannula, the disclosed cannula system100takes advantage of the rotational nature of the cannula and uses two independent fluid ports411,412to drain two separate fluid or suction channels421,422, respectively, located within the interior circumference of the harness140. A series of rubber seals431,432,433separate the two harness channels from one another and maintain a watertight seal against the cannula wall. A first port441within the outer cannula wall lines up with one of the channels inside of the suction/irrigation harness140and provides fluid or suction access between either the suction or the irrigation channel210or220spaced within the cannula interior. A second port442, which may be offset longitudinally and/or circumferentially from the first port441, provides access to the second harness chamber422. By offsetting the ports within the cannula wall and separating the harness channels, the suction and irrigation channels remain separate from one another. When the optical cannula120is rotated, ports441,442maintain communication with the corresponding interior fluid channels421,422of the harness140during the rotation.

In some embodiments, there may be a rubber seal or projection attached to the outer cannula wall that lines up with one or more of the channels within the suction/irrigation harness. When the cannula is rotated into a specific circumferential position, these projections/seals could be used to seal the irrigation or suction ports411,412and prevent further fluid movement through that respective port. Alternatively, a more traditional valve mechanism could be incorporated into or just outside of the harness ports411,412perhaps by a mechanical extension off of the port opening thus regulating fluid inflow or egress in a more traditional manner. Other methods of regulating fluid and suction flow through the harness ports are contemplated.

One aspect of the optical cannula system100described herein is unique when compared to conventional arthroscopic systems because it combines rotational cannula optics, mechanical activation of tool tips, suction irrigation, and a fully integrated endoscope into a single hand-held device.FIG.10Ashows a simplified schematic highlighting of one alternative endoscope handle170awith an electrical cable180attached to a receiving coupler179. The endoscope handle170ahas a molded cutout174(e.g., rectangular) incorporated into the endoscope housing meant to receive the irrigation/suction harness140described inFIGS.8-9. An electrical pathway may be provided for transmitting the image data from the camera chip located at the distal end of the cannula, through the length of the cannula to a slack wire within the suction/irrigation harness (not shown). The slack wire (not shown) connects to an electrical coupler located on the flat undersurface of the harness which contacts an endoscope coupler177located on the bottom of the endoscope harness cutout174. The electrical coupler can include an image processing module that receives the signal through the slack wire (or commutator). The image processing module can be disposed within the handle170a(e.g., internally). The electrical coupler can also be connected with the endoscope coupler177. Accordingly, the handle170acan be reusable to reduce costs of the assembly. Alternatively, the image data then transmits through the endoscope coupler177to the electrical cable180receiving coupler179and then to the endoscope cord which transmits the signal to an image processing control board located off of the operative field.

FIG.10Bshows a more detailed representation of an endoscope handle embodiment shown without the electrical connectors. A curvilinear cutout181is seen within the base of the harness indentation174that allows suction and irrigation tubes to pass through the bottom of the endoscope handle. This spatial relationship between the endoscope handle and the cords exiting the suction/irrigation harness is better appreciated inFIGS.11-12. The suction/irrigation tubes185,186can depart the endoscope handle in an orientation that allows for the tubes and electrical cable180to exit the device in a parallel, streamlined fashion (FIG.12,186). In one implementation, two semicircular indentations182may be incorporated into side projections along the outer base of the harness indentation174. These indentations would receive small circular projections (not shown in the diagram) located along the medial aspect of the lever extensions (FIG.2,171) along the back end of the endoscope lever175. The projections would be located in the mid aspect of the lever extension and not at the very end of the extension. Small circular projections would act to anchor the lever to the endoscope handle while at the same time allowing the lever175to hinge off of the proximal aspect of the endoscope handle.

Certain implementations and embodiments of the disclosed system allow for mechanical activation of instrument tool tips. Any of a variety of tool tips may be attached to an instrument shaft. For instrument tool tips that are too large to pass through the inner diameter of the optical cannula working channel, shafts could be inserted from distal-to-proximal into the optical cannula. Conversely, if the instrument tool tip is small enough to pass through the cannula, then the instrument shaft could be passed from either proximal-to-distal, or distal-to-proximal. In either instance, the intent is to work the instrument tool tip by the lever mechanism incorporated into the endoscope handle. Prior art has demonstrated means by which a mechanized handle can operate interchangeable tool tips and instrument shafts in a manner utilizing two integrated sliding instrument shafts, one inside the other. The outer circular shaft has a central channel through which a smaller diameter shaft can move back and forth. The movement interaction between the two instrument shaft components enables the tool tip to be opened and closed.

FIG.11shows an instrument shaft protruding out the proximal end of the optical cannula. In this implementation, the back end of the inner shaft191has an enlarged posterior extension attached to the inner instrument shaft component. The implementation diagramed inFIG.13, shows this widened shaft segment fashioned into a gear type configuration193. Such a configuration would facilitate precise rotation of the instrument shaft110within the cannula120. In these and other envisioned implementations, the gear teeth193located on the back end of the instrument shaft110could integrate with gear teeth161located within the central opening of a rotatable, instrument shaft turn dial160. The ability to independently rotate the instrument shaft and corresponding tool tip in a manner independent from the position of the optical camera chip (which itself is independently rotatable) would provide surgeons expanded visualization capabilities beyond that offered by traditional arthroscopic systems. Additionally, the ability to load instrument shafts with tool tips that are larger or otherwise configured in a manner that inhibit passing through a cannula inner diameter, expands the tool options available to the surgeon. Adding articulation capabilities to the cannula would even further improve surgical access and visualization especially when combined with the other features of the disclosed system.

Just distal to segment191is a segment of instrument shaft containing a small circumferential central groove192. This groove is embedded into the contour of the outer instrument shaft component110.FIG.11highlights a removable instrument shaft locking key150. The key is shown prior to engagement with the instrument shaft and bilateral endoscope handle lever extensions171. The locking key interacts with the instrument shaft, suction/irrigation harness, endoscope handle, and handle lever extensions in a manner that secures all items into position along the back end of the endoscope handle. The locking key150has front195and back198sections connected by a semi-flexible bridge194and separated by a slot196. This bridge194acts as a tension hinge to allow the front and back components of the locking key to spread apart from one another. When the locking key is fully engaged, lever extensions171project into gaps197within the lower sides of the locking key.

When the instrument lever175is squeezed against the endoscope handle170, the superior most aspect of the lever extensions rotate counterclockwise along the pivot point thereby displacing the back section of the locking key198away from the front section195. In this implementation, the front section195of the locking key is fixed into position against the irrigation/suction harness, outer instrument shaft, and endoscope handle while the back section of the locking key only engages the proximal shaft extension191. Counterclockwise movement of the back segment of the locking key causes the inner instrument shaft to move posteriorly in relation to the outer instrument shaft thus activating the distal tool tip mechanism.

FIGS.14-32illustrate an optical cannula system500. The optical cannula system500can include the structures and functionalities as the optical cannula system100as shown and described in relation toFIGS.1-13with the differences noted below. The optical cannula system500can include an endoscope600and a surgical tool700. The endoscope600can provide physical access to a surgical site for the surgical tool700, visual images, irrigation, suction and/or other surgical functionalities. The surgical tool700can be insertable and removable from the endoscope600. Although illustrated as a pair of grippers, the tool700can include any of a variety of different surgical tools. Alternatively, the tool700includes cutting tools, debriding tools, grasping tools, grinding tools, cauterizing tools, drilling tools, tissue sampling tools or other types of surgical tools.

The endoscope600can include a body670, a cannula620, a rotation mechanism660, an entry hub683, an electrical cable680, a first tube681, and/or a second tube682. The body670can include a distal end671and proximal end672. The proximal end672can include an aperture providing access through an outer wall into an interior673. The body670be generally cylindrically shaped between the distal end671and the proximal end672. The distal end671can be tapered toward the cannula620. The body670can include the entry hub683. The electrical cable680, the first tube681and/or the second tube682can enter into the body670through the entry hub683. The electrical cable680, the first tube681and/or the second tube682can extend outwardly in a parallel manner to prevent excessive interference or tangling when the endoscope600is in use. The electrical cable680can be removably coupled or permanently coupled with the entry hub683.

The cannula620can include a distal end621and a proximal end622. The cannula620can extend along an axis between the distal end621and the proximal end622. The cannula620can have an outer wall that extends from the distal end621to the proximal end622. The outer wall can have a cross-sectional shape extending from the distal end621to the proximal end622. The cannula620can include a first channel623. The first (working) channel623can extend from the proximal end622to the distal end621. The cannula620can include a second channel624. The second channel624can extend from the proximal end622to the distal end621. An inner wall629can separate the first channel623from the second channel624. The inner wall629can extend from the proximal end622to the distal end621. The first and second channels623,624can have substantially the same cross-sectional shapes from the proximal end622to the distal end621. The second channel624may include a cutout section625. The cutout section625can extend along a portion of the proximal end622(e.g., within the body670). The cannula620can comprise a metal alloy, medical grade polymer, or other material. In certain examples, the cannula620can comprise a polyether ether ketone (PEEK), liquid crystal polymer (LCP) material, carbon-reinforced nylon, glass-reinforced nylon, or other composite material. The cannula620can comprise a unitary structure of a single material.

The cannula620can include a first port626. The first port626can be through an outer wall of the cannula620. The first port626can be in communication with the first channel623. A second port627can be spaced from the first port626. The second port627can extend through the outer wall of the cannula620. The second port627can be in communication with the first channel623. The first and second ports626,627can extend through both sides of the outer wall of the cannula620. Alternatively, the first and second apertures626,627can each extend through one side of the outer wall of the cannula620, which can be on opposite sides of the first channel623(e.g., the first port626can be located on a first side of the outer wall and the second port627can be located on the opposite side of the outer wall). In another alternative the first and/or second ports626,627can be in communication with the second channel624. The first and second ports626,627can each extend through one side of the outer wall of the cannula620, which can be on opposite sides of the second channel624. In another alternative, the first port626is in communication with the first channel623and the second port627is in communication with the second channel624.

The proximal end622of the cannula620can be received within the interior673of the body670through the distal end671. The distal end621can protrude from the distal end671. The cutout section625can be within the body670. The distal end671can include an aperture for receiving the cannula620.

The endoscope600can include a forward seal628. The forward seal628can be formed of an elastic material. Forward seal628can include a central aperture. The central aperture can be sized to receive the cannula620and seal against the outer wall thereof. The seal628can include a portion that is at least partially received within the distal end671. The forward seal628can provide a liquid-tight seal between the cannula620and an inner wall of the central aperture and between the portion and the distal end671of the body670.

The rotation mechanism660can include a dial portion662, an insertion portion661, and/or an aperture663. The dial portion662can have a circumferential outer perimeter. The dial portion662can have a diameter similar to or greater than a diameter of the body670at the proximal end672. The insertion portion661can be cylindrical in shape. The insertion portion661can extend in a distal direction from the dial portion662. A distal end of the insertion portion661can have a reduced diameter relative to a proximal portion of the insertion portion661. An aperture663can extend through the dial portion662and the insertion portion661. The aperture663can include an inner wall sized to receive the proximal end622of the cannula620. The insertion portion can include a first aperture664and a second aperture665spaced from the first aperture664. The first and second apertures664,665can extend through the outer wall of the insertion portion661to provide communication within the aperture663.

The rotation mechanism660can be assembled with the body670. The rotation mechanism660can be assembled with the proximal portion672of the body670. The insertion portion661can be inserted within the interior space673. The dial662can abut the proximal end672. The rotation mechanism660can be rotatable relative to the body670, similar to the dial160of the system100. The proximal end622of the cannula620can be received within the insertion portion661. The proximal end622of the cannula620can be rotationally fixed with the insertion portion661such that rotation of the dial662rotates the cannula620. The apertures664,665can align with and/or be in communication with the ports626,627of the cannula620, respectively.

The endoscope600can include a harness assembly650. The harness assembly650can provide communication between the tubes681,682and the cannula620, including when rotated. The harness assembly650can include a plurality of spacers and seals that are configured to create one or more circumferential pathways for providing irrigation and/or suction to the cannula620(e.g., through the respective first and second ports626,627as will be discussed further below). The harness assembly650can include first, second, and/or third seals651,652,653. The seals651-653can be in the form of O-rings. The harness assembly650can include a first spacer654, a second spacer655, a third spacer656, and/or a fourth spacer657. The first and fourth spacers654,657can be cylindrical in shape. The second and third spacers655,656can include dual rings that are spaced apart by extension members655a,656a(FIG.32). Circumferential fluid pathways658,659(FIG.21) can be located between the dual rings created by the extension bars. A central aperture can extend through the harness assembly. The central aperture can extend through the first, second, and third seals651,652,653and the first, second, third, and fourth spacers654,655,656,657.

The endoscope600can include a harness block640. The harness block640can fit around the harness assembly650to form the circumferential pathways658,659. The harness block640can a central aperture642. The central aperture642can have an inner diameter and inner surface. The harness assembly650can be assembled within the central aperture642. The seals651,652,653can engage with the inner surface of the central aperture642. The harness block640can include a tab portion641. The tab portion641can be located on one side of the harness block640to provide a noncylindrical cross-sectional shape thereto (i.e., to prevent rotation within the body670). A first aperture (port)644can extend through an outer wall of the harness block640and provide fluid communication with the central aperture642. A second aperture (port)645can be spaced from the first aperture644and extend through the outer wall and provide fluid communication with the central aperture642.

The endoscope600can include a tool seal630. The tool seal630can include a first seal631. The first seal631can include flaps or slits that can pass a shaft of a tool therethrough. The tool seal can include a seal body633. The seal body633can be a cylindrically shaped member with an aperture therethrough (e.g., sized to receive the tool shaft). The seal body633can include a circumferential recess633a. The recess633acan be sized to fit an O-ring632. The O-ring632can be assembled within the recess633a. A proximal end of the seal body633can include a tapered recess opening. In some implementations, the tool seal630may be configured to be reversible.

The endoscope600can include a camera assembly690. The camera assembly690may include a camera chip like the camera chip200and/or additional camera chips. The camera assembly690can include a light source (e.g., LED or fiberoptic filament). The camera assembly690can be assembled within the distal tip621of the cannula620, such as within the second channel624. A signal wire (not shown) can extend along the channel624between the distal end621and the cutout section625within the second channel624. The wire can be attached with an electronic controller (PCB board)675within the body670(or otherwise connect with the electrical cable680). The controller675can include image processing capabilities and/or other functions. The connection between the signal wire and the electronic controller board675can be through a service loop, electrical commutator, or other means.

FIGS.21-22show the internal assembly of the endoscope600.FIG.21shows a detail21ofFIG.20. The harness block640can be assembled within the interior space673. The tab641can engage an inner surface of the body670to prevent rotation of the harness block within the body670. The harness assembly650can be assembled within the interior space or aperture642of the harness block640. The interior space673can be shaped such that the harness block640is in a fixed position (i.e., rotationally) within the interior space673such that the harness block640is fixed to the body670. The first aperture644can be aligned with and in fluid communication with the first tube681through an outer wall of the body670. The second aperture645can be aligned with and in communication with the second tube682through the outer wall of the body670.

The harness assembly650is assembled within the central aperture642of the harness block640. The first seal651can be located between the first spacer654and the second spacer655. The second seal652can be located between the second spacer655and the third spacer656. The third seal can be located between the third spacer656and the fourth spacer657. First spacer654can be located on a distal end of the harness assembly650. The fourth spacer657can be located on a proximal end of the harness assembly650. The second spacer member655can form a circumferential fluid pathway658. The third spacer656can form a circumferential fluid pathway659. The seals651,652,653can contact the inner surface of the harness block640to isolate the pathways658,659from each other. The circumferential pathways658,659can align with and/or be in fluid communication with the respective apertures644,645of the harness block640. Thereby the circumferential pathways658,659can align with and/or be in fluid communication with the respective tubes681,682.

The rotation mechanism660can be assembled with the body670. The insertion portion661can be inserted into the central passage of the harness assembly650through the proximal end672. The seals651,652,653can contact the outer surface of the insertion portion661to isolate the pathways658,659from each other. The first and second apertures (ports)664,665can align with and be in fluid communication with the respective circumferential pathways658,659.

The proximal end622and the cannula620can be received within the interior space673such as through the distal end671. The distal end622can be received within the insertion portion661. The aperture664of the rotation mechanism660can be aligned with and/or in fluid communication with the first port626of the cannula620. Accordingly, the first tube681, aperture644, circumferential pathway658, aperture664, and port626can be in fluid communication. The aperture665of the rotation mechanism660can be aligned with and/or in fluid communication with the second port627of the cannula620. Accordingly, the second tube682, aperture645, circumferential pathway659, aperture665, and port627can be in fluid communication.

The insertion portion661can be rotatable along a longitudinal axis thereof (e.g., by rotating the dial662). The cannula620can be locked into rotation with the rotation mechanism660. The rotation mechanism660can rotate relative to the harness assembly650, the harness block640, and/or the body670. Rotation of the insertion portion661within the harness assembly650can maintain alignment and/or fluid communication between the apertures of the cannula620and the tubes681,682through the circumferential pathways658,659. Rotation of the insertion portion661within the harness assembly650can be at least 90° or 360° and optionally unlimited (e.g., for a commutator).

The shaft seal630can be inserted into the insertion portion661through the aperture663. The shaft seal630can be a uni-directional seal. The shaft seal630can be inserted into the aperture663through the proximal end of the rotation assembly660. The shaft seal630and aperture663can aligned with the first channel623. The shaft seal630(e.g., the O-ring632) can seal against an inner surface of the aperture663. A tapered portion of the insertion portion661can provide a seat for the seal630. The shaft seal630can be inserted into a proximal portion of the insertion portion661. The first seal631can include a first seal member631aand a second seal member631b. The first seal member631acan include a dome shape. The second seal member631bcan attach with the first seal member631a. The first and/or second seal members631a,631bcan include a central aperture or slit therethrough. Optionally, the shaft seal630can be inserted in the reverse orientation as illustrated inFIG.21(e.g., to accommodate distal-to-proximal loading on an instrument shaft within the cannula). In an alternative embodiment, a rotatable or switchable lever can be included that couples with shaft seal630. The lever can switch between uni-directional seals (e.g., to accommodate distal-to-proximal loading on an instrument shaft within the cannula or differently sized seals) and/or provide an option for no seal at all depending on the instrument inserted into the handle.

FIGS.22-23shows the distal end621of the cannula620including the first channel623and the second channel624that are within an interior space defined by an outer wall of the cannula620. The outer wall of the cannula620can include a curved or circular lower portion621a. The outer wall of the cannula620can include a flat or upper portion621b. The curved portion621acan be attached with the flat portion621bon either side through curved or planar side portion. The first channel623can be located within the curved lower portion621a. Additionally, the first channel623can include a first side portion623aand a second side portion623b. Optionally, the first and second side portions623a,623bcan in use be at least partially separated. The first channel623can be sized to receive a shaft710of the tool700. The shaft710can include an outer shaft780and an inner shaft790. The first channel623can be sized such that the shaft710generally fills the channel623. Suction and irrigation can occur along the first and second side portion623a,623bor otherwise around the shaft710. Optionally, the channel623and the shaft710can be sized such that shaft710separates the first side portion623afrom the second side portion623bwhich can be located in upper opposite corners of the first channel623. In one alternative, the first side portion623acan be aligned with the first port626and the second side portion623bcan be aligned with the second port627such that irrigation can occur along the first side portion623aand suction can occur independently along the second side portion623b.

An inner wall629separates the first channel623from the second working channel624. The inner wall629can extend from the proximal end622to the distal end621. Alternatively, additional inner walls can be included to further divide the interior space of the cannula620. The second channel624can have a rectangular or trapezoidal cross-sectional shape. The shape of the second channel624can be sized such that the camera assembly690fits within the distal end of the second channel624. Alternatively additional camera chips or lights or other instruments can be fit within the second channel624. The camera assembly690can include a camera chip691and a light source692. The first channel623can have an arched cross-sectional shape with a circular portion and a flat portion. The outer wall of the cannula620can have a thickness T1 between the flat portion621band the second channel624. The outer wall of the cannula620can have a first upper rounded edge R1 and an a second upper rounded edge R2. A third curvature R3 can extend below the first channel623. An inner portion of the outer wall within the first channel623can have a curvature R4. The second channel have a height H1 and/or a width W1. The inner wall629can have a thickness T2. The outer wall between the third curvature R3 and the fourth curvature R4 can have a thickness T3. The second channel624can be spaced from the first channel623by a height H2. The outer wall of the cannula620can have a height H3 (e.g., centerline-to-centerline). The first channel623can have a height H4. The chart below provides certain desirable values and ranges for the dimensions of the cannula620. Alternatively, other cannula and channel dimensions are within the scope of the present disclosure.

Dimension (mm)Dimension Range (mm)R1/R20.50.1-3.0R34.42.5-8.0R43.62.0-7.0T1/T2/T30.40.1-4.0H11.30.5-4.0W12.40.5-8.0H22.80.5-8.0H36.14.0-12.0H43.62.0-9.0

FIGS.24-27show the tool700in further detail. The tool700can include the shaft710with a tool720on a distal end711of the shaft710. A proximal end712of the shaft710can be attached with a grip assembly730. The grip assembly730can include a grip body740, a lever750and/or an assembly sleeve760.

The shaft710can include an outer shaft780. The outer shaft780can include a distal end781and a proximal end782. The distal end781can attach with the tool assembly720. The proximal end782can include a proximal portion including a shoulder that aids in assembly with the grip portion730.

The shaft710can include an inner shaft790. The inner shaft790can be a control mechanism for the tool720. The inner shaft790can include a distal end791. The distal end791can be connected with the tool720such as for actuating a pair of grippers. A proximal end792can be attached with the grip assembly730(e.g., the lever750) for purposes of actuation.

The grip body740with a distal portion741and a proximal portion742. The distal portion741can include a general cylindrical shape with a slot743extending from the distal end proximally towards the proximal portion742. The slot743can provide access for assembling the shaft710with the grip portion730. The distal portion741can include a distal flange745. The slot743can extend through the distal flange745. A proximal flange746can be located proximal to the distal flange745. The grip body740can include a slot744for receiving one end of the grip level750. The distal portion741can include a shoulder or recess747. The shoulder or recess747can engage with the shoulder of the proximal end782of the outer shaft780. The shoulder or recess747can be aligned with the slot743or accessible therethrough.

The grip assembly730can additionally include a catch member770. The catch member770can include a distal end with a catch771. The catch771can be configured to engage the proximal end791of the inner shaft790. The catch771can be aligned with the slot743or accessible therethrough. The catch member770can include a proximal end772. The proximal end772can include a slot773. The catch member770can be assembled within the grip body740and held in place by the assembly sleeve760. The catch member770can be attached our coupled with the lever750for providing actuation of the inner shaft790. The proximal end of the inner shaft790can include a shoulder for attachment of the catch771.

The lever750can include a grip portion751that may include one or more finger holes. The lever750can include a shaft portion753that includes a pivot752. Pivot752can attach the lever750within the slot apertures744. The lever750can be pivotally connected at the pivot752. Alternatively, the lever750can be integrally formed with the grip body740(e.g., a living hinge). The lever750can include a pin754. The pin754can engage within a slot773on a proximal end772of the catch member770. The movement of the lever750can move the catch member770axially in line with the shaft710.

The assembly sleeve760can be assembled between the distal flange745and the proximal flange746. The assembly sleeve760can be rotatable about the distal portion741of the grip body740. The assembly sleeve760can be rotatable into and out of an assembly configuration in which a slot763of the assembly sleeve760aligns with the slot743on the grip body740. The shafts780,790can be assembled through the slot743when the slot763in the assembly configuration (FIG.27). This can also provide for a quick assembly and disassembly configuration for the tool700. After the shafts780,790have been inserted within the slot743, the assembly sleeve760can be rotated to move the assembly slot763and cover the slot743. This can lock the proximal ends782,792into place within the grip assembly730.

FIGS.28-32illustrates assembly the optical cannula system500with the tool700received within the endoscope600.FIG.28shows a first configuration with the jaws of the tool720and a first configuration (closed).FIG.29shows the tool720in a second configuration with the jaws open. The lever750having been actuated to advance the catch member770and actuate the jaws through the shaft790.FIG.30shows a detail30ofFIG.28.

The shaft710is received within the cannula620. When loaded proximally to distally, the shaft is inserted through the rotation mechanism660(e.g., aperture663) and into the first channel623of the cannula620. The shaft710can be inserted through the shaft seal630. The seal member631of the seal630can seal against the passage of fluid back through the aperture663. The first seal631can seal around the shaft710. The first seal631can be positioned distally relative to the body633.

When loaded distally-to-proximally, the tool700can be at least partially disassembled. The shaft710is inserted within the proximal end712entering the distal end621of the cannula620. The shaft seal630can be removed from the aperture663and replaced in the reverse orientation. The proximal end712can be loaded into the rotation mechanism660(e.g., aperture663) from the first channel623of the cannula620. The shaft710can be inserted through the shaft seal630. The seal member631of the seal630can seal against the passage of fluids back through the aperture663. The first seal631can seal around the shaft710. The first seal631can be positioned proximally relative to the body633. The shaft710can then be reassembled with the grip assembly730. Alternatively, to reversing the seal630, a second seal in the reverse orientation can be installed within the aperture633.

The distal portion741of the tool700can be received at least partially within the aperture663. The aperture663can include a length such that the distal portion741can be inserted to varying depths within the aperture663while still being engaged with the rotation mechanism660. In this manner, the tool portion720can be moved relative to the cannula620(e.g., the tool portion720can be extended and retracted relative to the distal end621). Optionally, the distal portion741can be sized such that the tool700can be rested within the rotation mechanism660. In this configuration, the tool700can rotate with the rotation mechanism660. In this configuration, the surgeon can free one hand to attend to other tasks while the endoscope600and tool700are held in the other hand. Otherwise, the tool700can be rotated or otherwise moved independent of the cannula620.

Certain Terminology

Terms of orientation used herein, such as “top,” “bottom,” “proximal,” “distal,” “longitudinal,” “lateral,” and “end,” are used in the context of the illustrated example. However, the present disclosure should not be limited to the illustrated orientation. Indeed, other orientations are possible and are within the scope of this disclosure. Terms relating to circular shapes as used herein, such as diameter or radius, should be understood not to require perfect circular structures, but rather should be applied to any suitable structure with a cross-sectional region that can be measured from side-to-side. Terms relating to shapes generally, such as “circular,” “cylindrical,” “semi-circular,” or “semi-cylindrical” or any related or similar terms, are not required to conform strictly to the mathematical definitions of circles or cylinders or other structures, but can encompass structures that are reasonably close approximations.

Conditional language, such as “can,” “could,” “might,” or “may,” unless specifically stated otherwise, or otherwise understood within the context as used, is generally intended to convey that certain examples include or do not include, certain features, elements, and/or steps. Thus, such conditional language is not generally intended to imply that features, elements, and/or steps are in any way required for one or more examples.

Conjunctive language, such as the phrase “at least one of X, Y, and Z,” unless specifically stated otherwise, is otherwise understood with the context as used in general to convey that an item, term, etc. may be either X, Y, or Z. Thus, such conjunctive language is not generally intended to imply that certain examples require the presence of at least one of X, at least one of Y, and at least one of Z.

The terms “approximately,” “about,” and “substantially” as used herein represent an amount close to the stated amount that still performs a desired function or achieves a desired result. For example, in some examples, as the context may dictate, the terms “approximately,” “about,” and “substantially,” may refer to an amount that is within less than or equal to 10% of the stated amount. The term “generally” as used herein represents a value, amount, or characteristic that predominantly includes or tends toward a particular value, amount, or characteristic. As an example, in certain examples, as the context may dictate, the term “generally parallel” can refer to something that departs from exactly parallel by less than or equal to 20 degrees. All ranges are inclusive of endpoints.

SUMMARY

Several illustrative examples of optical cannula systems have been disclosed. Although this disclosure has been described in terms of certain illustrative examples and uses, other examples and other uses, including examples and uses which do not provide all of the features and advantages set forth herein, are also within the scope of this disclosure. Components, elements, features, acts, or steps can be arranged or performed differently than described and components, elements, features, acts, or steps can be combined, merged, added, or left out in various examples. All possible combinations and subcombinations of elements and components described herein are intended to be included in this disclosure. No single feature or group of features is necessary or indispensable.

Certain features that are described in this disclosure in the context of separate implementations can also be implemented in combination in a single implementation. Conversely, various features that are described in the context of a single implementation also can be implemented in multiple implementations separately or in any suitable subcombination. Moreover, although features may be described above as acting in certain combinations, one or more features from a claimed combination can in some cases be excised from the combination, and the combination may be claimed as a subcombination or variation of a subcombination.

Any portion of any of the steps, processes, structures, and/or devices disclosed or illustrated in one example in this disclosure can be combined or used with (or instead of) any other portion of any of the steps, processes, structures, and/or devices disclosed or illustrated in a different example or flowchart. The examples described herein are not intended to be discrete and separate from each other. Combinations, variations, and some implementations of the disclosed features are within the scope of this disclosure.

While operations may be depicted in the drawings or described in the specification in a particular order, such operations need not be performed in the particular order shown or in sequential order, or that all operations be performed, to achieve desirable results. Other operations that are not depicted or described can be incorporated in the example methods and processes. For example, one or more additional operations can be performed before, after, simultaneously, or between any of the described operations. Additionally, the operations may be rearranged or reordered in some implementations. Also, the separation of various components in the implementations described above should not be understood as requiring such separation in all implementations, and it should be understood that the described components and systems can generally be integrated together in a single product or packaged into multiple products. Additionally, some implementations are within the scope of this disclosure.

Further, while illustrative examples have been described, any examples having equivalent elements, modifications, omissions, and/or combinations are also within the scope of this disclosure. Moreover, although certain aspects, advantages, and novel features are described herein, not necessarily all such advantages may be achieved in accordance with any particular example. For example, some examples within the scope of this disclosure achieve one advantage, or a group of advantages, as taught herein without necessarily achieving other advantages taught or suggested herein. Further, some examples may achieve different advantages than those taught or suggested herein.

Some examples have been described in connection with the accompanying drawings. The figures are drawn and/or shown to scale, but such scale should not be limiting, since dimensions and proportions other than what are shown are contemplated and are within the scope of the disclosed invention. Distances, angles, etc. are merely illustrative and do not necessarily bear an exact relationship to actual dimensions and layout of the devices illustrated. Components can be added, removed, and/or rearranged. Further, the disclosure herein of any particular feature, aspect, method, property, characteristic, quality, attribute, element, or the like in connection with various examples can be used in all other examples set forth herein. Additionally, any methods described herein may be practiced using any device suitable for performing the recited steps.

For purposes of summarizing the disclosure, certain aspects, advantages and features of the inventions have been described herein. Not all, or any such advantages are necessarily achieved in accordance with any particular example of the inventions disclosed herein. No aspects of this disclosure are essential or indispensable. In many examples, the devices, systems, and methods may be configured differently than illustrated in the figures or description herein. For example, various functionalities provided by the illustrated modules can be combined, rearranged, added, or deleted. In some implementations, additional or different processors or modules may perform some or all of the functionalities described with reference to the examples described and illustrated in the figures. Many implementation variations are possible. Any of the features, structures, steps, or processes disclosed in this specification can be included in any example.

In summary, various examples of optical cannula systems and related methods have been disclosed. This disclosure extends beyond the specifically disclosed examples to other alternative examples and/or other uses of the examples, as well as to certain modifications and equivalents thereof. Moreover, this disclosure expressly contemplates that various features and aspects of the disclosed examples can be combined with, or substituted for, one another. Accordingly, the scope of this disclosure should not be limited by the particular disclosed examples described above, but should be determined only by a fair reading of the claims.