DISPOSABLE AND REUSABLE COMLEX SHAPED SEE-THROUGH ENDOSCOPE
Transparent domes useful for covering at least a lens located on a scope's distal face, taking the form of a single layer membrane affixed to the distal end of the scope, a solid cap attachable to and detachable from the distal end of the scope, or an inflatable and deflatable balloon having an exterior wall for contacting at least the lens at the scope's distal face. Methods for performing diagnostic or diagnostic and therapeutic procedures within bodily cavities including collapsed intestines using transparent domes and scopes.
This application claims priority of U.S. Provisional Application No. 61/278,970, filed Oct. 15, 2009, the contents of which are hereby incorporated by reference into this application.
FIELD OF THE INVENTIONThe present invention relates generally to medical imaging systems and, more particularly, to imaging systems for insertion into a lumen of a patient for viewing the lumen through a transparent dome at the tip of the system, and to methods of use of such systems that take advantage of the transparent dome structure, which systems and methods are particularly useful in performing colonoscopies.
BACKGROUND OF THE INVENTIONColonoscopy is a very common procedure. In the United States more than 20 million such procedures are done every year. Colonoscopy is a relatively expansive procedure necessitating intravenous sedation to alleviate pain. The cause of pain may be due to several factors, including dilation and stretching of the colon during air insufflations from the colon's normal collapsed state resembling a collapsed tortuous hose, and including looping out and stretching the nerve-laden colonic mesentery when a flexible colonoscope is pushed through multiple S-shaped curves in the colon. Some of these curves resemble, from the interior of the colon, a buckled-down hose. Recent studies show that if instead of air insufflations, water is used to open up the lumen, the colon gets stretched out but not as much as when the colon is opened with air, and the patient has much less pain. Nonetheless, such use of water results in stretching of the colon and pain to the patient.
Additionally, traditional scopes used in colonoscopies have blunt edges which can damage or perforate the colon. These scopes also tend to cease transmitting a usable image when their distal ends come too close to the wall of the lumen.
Accordingly, there is a need for devices and methods useful for performing a colonoscopy that require minimal insufflation of the colon, so as to minimize stretching out of the colon and pain to the patient, while at the same time minimizing the chance of damaging or perforating the colon and maintaining a usable image transmission.
SUMMARY OF THE INVENTIONThe present invention provides for the needs identified in the foregoing discussion by providing for a transparent dome useful for covering at least a lens located on a scope's distal face. In different embodiments of the present invention, the dome may comprise a single-layer membrane affixed to the distal end of the scope such that it also covers an air channel for inflating the transparent dome, or it may comprise a solid cap which is attachable to and detachable from the distal end of the scope, or it may comprise a balloon having an exterior wall for contacting at least the lens at the scope's distal face.
The present invention also provides for a transparent dome and a scope having a lens located at its distal face to be used by inserting the scope and the transparent dome into a bodily cavity and viewing, through the lens and the transparent dome, at least a portion of the bodily cavity. The present invention also provides for such a transparent dome and scope to be used by inserting the scope into a bodily cavity; using the lens of the scope, identifying a particular lesion of the bodily cavity; based on the identification of the particular lesion, advancing a catheter comprising a deflated transparent dome and a particular therapeutic tip chosen for its ability to treat the particular lesion, through an operative channel of the scope; inflating the transparent dome; and, under vision through the lens and the transparent dome, treating the particular lesion with the particular therapeutic tip of the catheter.
Because the wall of the bodily cavity is kept away from the lens 122, the operator avoids seeing only a red blot or similar obstruction, much like the effect when a camera operator touches his or her finger to the camera lens. Blood, clots, fecal material, and mucosa are all kept away from the lens 122 and prevented from obscuring it. The transparent dome 110 also transforms the blunt edge of the scope 120 into a smooth aerodynamic shape, thus decreasing the rate of perforation of the walls of the bodily cavity. As a result of these features, the distal end of the device may be inserted into a pool of blood in such locations as the fundus of the stomach and slid along the wall of the stomach until the point of bleeding is found. The transparent dome 110 may be made of any suitable material, such as a plastic. Preferably, it should be made from a material that is very transparent and which has a thin wall, so as not to distort the image or video received by the lens.
An air intake portion 113 of the transparent dome 110 connects the dome 110 with an air channel 124 and allows for air to be sent through the air channel 124, through the air intake portion 113 and into the transparent dome 110, thereby inflating it. The air channel 113 may be a channel of the scope 120, or it may be a catheter adapted for insertion into, and proximal and distal movement relative to, the scope 120.
The transparent dome 110 may have a color, such that it acts as a color filter for the lens 122. In particular, the color may be green, the transparent dome 110 acting as a green color filter for the lens 122. Such a green color filter is particularly helpful in allowing for easier recognition of flat lesions, such as those which may appear in a colon.
The transparent dome 210 also has an overhanging portion 218. The overhanging portion 218 may comprise a radially-outermost portion of the transparent dome 210 which extends, at a region of the transparent dome 210 approximately as distal as the distal face 121 of the scope 120, radially outwards beyond the edge of the distal face of the scope. The overhanging portion 218 also comprises a portion that extends more proximally than the distal face 121 of the scope 120. Advantageously, when the scope 120 and transparent dome 210 are pulled proximally within a bodily lumen, frictional resistance between the overhanging portion 218 and the inner wall of the bodily lumen consistently slows the speed of the pulling, thereby preventing “slip-off,” inconsistent rates of movement of the transparent dome 210 and scope 120 relative to the bodily cavity, and failing to see lesions through the lens 122 as a result.
Accordingly, a user may, after inserting the scope 120 and the transparent dome 210 into a bodily cavity, and while viewing, through the lens 122 and the transparent dome 210, at least a portion of the bodily cavity, pull the scope 120 and transparent dome 210 in a proximal direction through the bodily cavity under frictional resistance between the portion of the transparent dome 210 extending radially outwards beyond the edge of the distal face 121 of the scope 120 and the bodily cavity. Contacting the bodily cavity with the transparent dome 210 may also be used to flatten folds in the bodily cavity. Advantageously, this enlarges the potential field of view of the lens 122 when a fold is present, because in the absence of such a transparent dome 210 it would be necessary to deflect the fold with the distal face 121 of the scope 120 in order to see on the other side of the fold, and in the process there would be obstruction of the lens 122. The device could also help to visualize polyps on the distal sides of the folds where traditional scopes could not. Additionally, the transparent dome 210 may be pushed against an intestinal wall so as to open up the lumen of the bodily cavity and ease further distal advancement of the scope 120 and transparent dome 210 into the bodily cavity.
Moreover, a lesion in the bodily cavity may be palpated with the transparent dome 210, and the result of this palpation may be viewed through the lens 122 and the transparent dome 210. On the basis of this viewing, the hardness of the lesion may be determined. Alternately, a mucosal defect of the bodily cavity may be contacted with the transparent dome 210, and the result of this contacting may be viewed through the lens 122 and the transparent dome 210, On the basis of this viewing, such as by seeing whether the defect blenches, a user may differentiate between the mucosal defect being an abnormal sub-mucosal blood vessel and it being an intra-mucosal inflammation. The transparent dome 210 may also be used to apply direct pressure to a bleeding vessel of the bodily cavity to reduce bleeding. The various viewings may occur while at least the distal tip of the transparent dome 210 is in a pool of blood or is contacting a blood clot, as vision is maintained, unlike a situation where the lens is directly exposed to the pool of blood or blood clot.
The bodily cavity may be a generally collapsed small bowel and the insertion and viewing may be accomplished without releasing air or water into the small bowel. This generally collapsed small bowel may belong to an unsedated or comparatively unsedated patient, as pain is greatly reduced by not insufflating (and thereby stretching) the bowel. Accordingly, the present invention is very useful in small bowel enteroscopy, the procedure being peformed in a much shorter time and with less technical complexity than with conventional methods involving insufflations of the bowel.
The catheter 324 further comprises a therapeutic device 326 attached to its distal tip and at least partially located more distal than the transparent dome 310. The therapeutic device 326 may be, but is not limited to, a sclerotherapy needle, bicap, laser probe, polypectomy device, small biopsy forceps, or the like.
The transparent dome 1010, after being inserted along with the scope into a bodily cavity, may be allowed to have its exterior become dirtied by the bodily cavity. After this occurs, but while the scope and transparent dome 1010 are still inserted into the bodily cavity, the exterior of the transparent dome 1010 may be cleaned by water sprayed by the water channel 803 from the distal face 800 of the scope, allowing for easier viewing through the lens 801.
This embodiment, like the other embodiments, may be inserted into a bodily cavity. Before inflating the transparent dome 1210, the catheter 1224 holding the transparent dome 1210 may be inserted through the operative channel 126 of the scope 120. Initial inflation and/or hyperinflation of the transparent dome 1210 may occur after inserting the scope 120 and the transparent dome 1210 into the bodily cavity, or they may occur beforehand. After inflating the transparent dome 1210, at least the lens 122 on the distal face 121 of the scope 120 may be contacted with an exterior surface of the inflated transparent dome 1210. This exterior surface of the inflated transparent dome 1210 that will contact the lens 122 on the distal face 121 of the scope 120 may be generally flat. The contact may occur by pulling the catheter 1224 proximally relative to the scope 120, after the transparent dome 1210 has been inflated.
The transparent dome 1210 is shown in
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The use of the therapeutic device 1226 may occur while at least the distal tip of the transparent dome 1210 is in a pool of blood in the bodily cavity, or in direct contact with mucosa. As the transparent dome 1210 separates the lens 122 from the pool of blood or mucosa, vision of the bodily cavity is not greatly impaired by a red-out or like effect of blood or mucosa on the lens 122 itself.
In
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As the catheter 1324 and therapeutic device 1326 may be chosen on the basis an identification of a particular lesion in a bodily cavity, a diagnostic and therapeutic procedure may be performed without the need to insert a new scope between the diagnostic portion of the procedure and the therapeutic portion of the procedure. In particular, a method of use for a transparent dome 1326 and a scope having a lens 1301 located at its distal face 1300 is presented, involving: inserting the scope into a bodily cavity, such as but not limited to a small intestine; using the lens 1301 of the scope, identifying a particular lesion of the bodily cavity; based on the identification of the particular lesion, advancing a catheter 1324 comprising a deflated transparent dome 1310 and a particular therapeutic device 1326 or tip chosen for its ability to treat the particular lesion, through an operative channel 1302 of the scope; inflating the transparent dome 1310; and under vision through the lens 1301 and the transparent dome 1310, treating the particular lesion with the particular therapeutic device 1326 of the catheter. Of course, a transparent dome that is part of a different catheter or the same catheter 1324 may be used during the initial diagnostic portion of the procedure.
The above specific embodiments are illustrative, and many variations can be introduced on these embodiments without departing from the spirit of the disclosure or from the scope of the appended claims. For example, elements and/or features of different illustrative embodiments may be combined with each other and/or substituted for each other within the scope of this disclosure and appended claims.
Claims
1-48. (canceled)
49. A transparent dome for covering a distal face of an endoscope, including:
- a proximal end for sealing against at least a portion of the distal end of the endoscope; and
- a distal face for contacting a wall of a body cavity.
50. The transparent dome of claim 49 further including:
- an air-intake portion configured to seal around an air source;
- wherein the transparent dome is inflatable.
51. The transparent dome of claim 50, wherein the transparent dome further includes an inflatable balloon configured to seal against a lens of the endoscope.
52. The transparent dome of claim 51, wherein the balloon includes a flat region for sealing against the lens.
53. The transparent dome of claim 50, wherein the transparent dome is inflatable to a first inflated state and a second inflated state.
54. The transparent dome of claim 49, wherein the transparent dome further includes an overhanging portion extending radially and proximally outward from the proximal end of the transparent dome.
55. The transparent dome of claim 49, wherein the transparent dome further includes a channel axially extending between the proximal and distal ends of the transparent dome and configured to attach and radially surround a catheter insertable therein.
56. The transparent dome of claim 49, wherein the transparent dome is configured to be held by a catheter at a side region of the transparent dome.
57. The transparent dome of claim 49, wherein the transparent dome includes a generally convex distal face having a concave region positioned radially outwards of a maximally distal center point.
58. The transparent dome of claim 49, configured to filter at least one frequency of visible light.
59. The transparent dome of claim 49, wherein the transparent dome is a solid cap attachable to and detachable from the distal end of the endoscope.
60. The transparent dome of claims 59, wherein the solid cap has a generally circular axial projection.
61. The transparent dome of claims 59, wherein the solid cap has a generally crescent-shaped axial projection.
62. The transparent dome of claim 59, wherein the transparent dome includes a generally convex distal face having a concave region positioned radially outwards of a maximally distal center point.
63. The transparent dome of claim 59, configured to filter at least one frequency of visible light.
64. The transparent dome of claim 59, wherein the transparent dome further includes:
- a radially-outermost portion configured to extend radially beyond a radial extent of the endoscope.
65. The transparent dome of claim 49 wherein the transparent dome is a transparent single-layer membrane affixable to the distal end of the endoscope and inflatable into a generally dome-like shape.
66. A method for performing an endoscopic procedure using an endoscope having a lens located at a distal end of the endoscope and a transparent dome sealed to the distal end of the endoscope, the transparent dome including a proximal end for sealing against at least a portion of the distal end of an endoscope and a generally convex distal face for contacting a wall of a body cavity, the method including:
- inserting the endoscope and the transparent dome into a body cavity;
- viewing, through the lens and the transparent dome, at least a portion of the body cavity; and
- while viewing, using a therapeutic device extending from the distal end of the endoscope and exterior to the transparent dome on the portion of the body cavity being viewed.
67. The method of claim 66, wherein the step of using occurs while at least a distal tip of the transparent dome is in a pool of blood or is in direct contact with mucosa.
68. The method of claim 66, further including:
- inserting a catheter holding the transparent dome through an operative channel of the endoscope;
- after inserting, inflating the transparent dome;
- after inflating, contacting, by pulling the catheter proximally relative to the endoscope, at least the lens on the distal end of the endoscope with an exterior surface of the inflated transparent dome, wherein the transparent dome is held on a side of the catheter and wherein a therapeutic device of the catheter is withdrawn into the endoscope during the pulling; and
- slightly deflating the transparent dome and advancing the catheter and the withdrawn therapeutic device distally relative to the endoscope such that the therapeutic device becomes exposed while the transparent dome continues to contact at least the lens on the distal end of the endoscope.
Type: Application
Filed: Oct 15, 2010
Publication Date: Sep 13, 2012
Inventor: Boris Reydel (West Caldwell, NJ)
Application Number: 13/501,803
International Classification: A61B 1/31 (20060101); A61B 1/012 (20060101); A61B 1/018 (20060101); A61B 1/00 (20060101);