Note: Descriptions are shown in the official language in which they were submitted.
ENDOSCOPIC MULTI-TOOL
FIELD OF THE DISCLOSURE
This disclosure relates to endoscopic tools and in particular
endoscopic multi-tool.
BACKGROUND
An endoscope is a medical device for insertion into a body
passageway or cavity that enables an operator, positioned at a remote external
location, to perform certain surgical procedures at a site internal to the
patient's
body. In general, an endoscope includes a long, sometimes flexible tubular
member equipped with, for example, a miniature viewing device and an
illumination device. The endoscope has a proximal end that remains external to
the patient and a distal end having an endoscope tip for insertion into a body
cavity of the patient. The size and rigidity of commonly available endoscopes
occupy a large portion of restricted surgical working channels and cannot
access
certain anatomical structures due to the requirement for bending. While
flexible
endoscopes are available, they lack precise positioning and orientation due to
their flimsy nature.
SUMMARY
A hand-held endoscopic multi-tool includes a dextrous hollow tube,
a cap, a main body, a tool body, an endoscope and a tool. The dextrous hollow
tube has a generally rigid portion at the proximal end and a bendable portion
at
the distal end. The cap is operably attached to the distal end of the dextrous
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hollow tube. The main body is operably attached to the proximal end of the
dextrous hollow tube. The tool body is moveably connected to the main body
and moveable in a linear direction relative to the main body and co-axial to
the
dextrous hollow tube. The endoscope is housed within the tube and operably
attached to the cap. The tool housed within the tube and constrained by the
cap
such that the tool is operably coupled to the movement of the dextrous hollow
tube and the tool is operably attached to the tool body whereby movement of
the
tool body moves the tool.
The main body may include a tip articulation mechanism operably
attached to the dextrous hollow tube such that the bendable portion of the
dextrous hollow tube bends responsive to movement of the tip articulation
mechanism.
The tip articulation mechanism may include a plurality of cables
attached to the distal end of the dextrous hollow tube such that an applied
force
in the distal direction causes deformation.
The tip articulation mechanism may include a roll mechanism such
that activating the roll mechanism causes rotation of the dextrous hollow
tube.
The tip articulation mechanism may be a motorized tip articulation mechanism.
The tool may contain additional degrees of freedom.
The hand-held endoscopic multi-tool may further include a separate
component operably attached to both the tool body and the tool, such that the
component can rotate independently to the tool body but is rotationally
coupled
with the tool.
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The hand-held endoscopic multi-tool may further include a plurality
of cables operably attached to the distal end of the tool such that an applied
force
in the distal direction causes deformation of the distal end of the tool.
The hand-held endoscopic multi-tool may further include at least
one hollow tube housed within the tube and operably attached to the cap. The
at
least one hollow tube may be the tube portion of a suction and irrigation
system.
A secondary tool may be inserted into the at least one hollow tube.
The secondary tool may be manipulated in multiple degrees of freedom. The
secondary tool may further include a plurality of cables operably attached to
the
distal end of the tool such that an applied force in the distal direction
causes
deformation of the distal end of the tool. The secondary tool may be rotatable
wherein roll is achieved by physically turning the secondary tool.
The hand-held endoscopic multi-tool may have a plurality of
additional tools inserted through the cap and controlled by their respective
tool
bodies.
Further features will be described or will become apparent in the
course of the following detailed description.
BRIEF DESCRIPTION OF THE DRAWINGS
The embodiments will now be described by way of example only,
with reference to the accompanying drawings, in which:
Fig. 1 is a side view of an endoscopic multi-tool;
Fig. 2A is a perspective view of the tip of the endoscopic multi-tool
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of Fig. 1;
Fig. 2B is a side view of the tip of Fig. 2A and the capstan assembly
of the endoscopic multi-tool of Fig. 1;
Fig. 2B is a side view of the tip and the capstan assembly similar to
that shown in Fig. 2A but showing the tip in a bent position;
Fig. 3 is a side view of a portion of the endoscopic multi-tool of Fig.
1 and showing the actuation mechanism without supports;
Fig. 4A is a side view of the tip and the dissector extension and
retraction mechanism of the endoscopic multi-tool of Fig. 1;
Fig. 4B is a side view of the tip and the dissector extension and
retraction mechanism of Fig. 4A shown in an extended position and showing the
internal tubing;
Fig. 4C is an exploded perspective view of the dissector extension
and retraction mechanism of Figs. 4A and 4B;
Fig. 5 is a side view of the dissector extension and retraction
mechanism of Fig. 4A inside the full assembly of the endoscopic multi-tool;
Fig. 6 is a schematic view of the suction and irrigation system of the
endoscopic multi-tool of Fig. 1;
Fig. 7 is a side view of an alternate embodiment of the endoscope
multi-tool having an alternate tip articulation mechanism;
Fig. 8A is an enlarged side view of the tip articulation mechanism
and the tool mechanism of the endoscope multi-tool of Fig. 7;
Fig. 8B is an enlarged sectional view of only the tip articulation
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mechanism of Fig. 8A;
Fig. 9A is an enlarged sectional view of the tip articulation
mechanism similar to that shown in Fig. 8B
Fig. 9B is an enlarged sectional view of tip articulation mechanism
from Fig. 9A;
Fig. 10A is a partial perspective view of a dexterous hollow tube of
endoscope multi-tool of Fig. 7;
Fig. 10B is a partial perspective view of a dexterous hollow tube
similar to that shown in Fig. 10A but showing the tip of the hollow tube bent;
Fig. 100 is a partial perspective view of a dexterous hollow tube
similar to that shown in Fig. 10B but showing the tip bent in a direction
perpendicular to that of 10B;
Fig. 11A is an enlarged side view of the tip articulation mechanism
and the instrument articulation mechanism of the endoscope multi-tool of Fig.
7,
similar to that shown in Fig. 8A;
Fig. 11B is an enlarged sectional view taken from Fig. 11A in the
opposite direction of Fig. 8b and shows the instrument articulation mechanism
which is part of the tool body;
Fig. 12A is a side view of an alternate endoscopic multi-tool
showing the tool in the extended position;
Fig. 12 B is a side view of the alternate endoscopic multi-tool
showing the tool in the retracted position;
Fig. 13A is a side view of a suction-irrigation tube for use in the
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endoscopic multi-tool;
Fig. 13B is a side view similar to that shown in Fig. 13A but showing
an alternate tool inserted in the suction-irrigation tube of Fig. 13A;
Fig. 14A is a section view of Fig. 11B the tool body connected
through the gear to the instrument; and
Fig. 14B is a sectional view of Fig. 11B the tool body operably
connected to the instrument but showing the instrument tip bent.
DETAILED DESCRIPTION
Referring to figure 1, the endoscopic multi-tool is shown generally
at 100. Multi-tool 100 is a handheld, electromechanical instrument for
minimally
invasive surgery. Multi-tool 100 includes a steerable multifunctional tip 31,
a
base 7 and a handle 30.
A surgical device that consists of a steerable multifunctional tip that
is capable of performing suction/irrigation, vision, and dissection, where the
dissector can be manually translated into and out of the tube, and the outer
tube
is able to roll and pitch to position the dissector as required. The
articulation (roll
and pitch), suction and irrigation functions are electromechanically
activated.
Tip 31 is best seen in Figs 2 A to C. Tip 31 has an outer tube 1.
The outer tube shown herein has diameter of 4mm and is preferably made of
nitinol. Nitinol is a nominally rigid material that has super elastic
properties. The
outer tube 1 has a plurality of geometrical cuts 2 formed there to allow the
tube 1
to bend. It will be appreciated by those skilled in the art that other
materials may
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also be used for the out tube 1. Some may have the requisite rigidity,
flexibility
and bendability such that the geometrical cuts may not be needed.
A plurality of items is enclosed within the tube 1 of the tip 31. For
example, a waterproof flexible endoscope/camera on a chip system 3; a flexible
tube 4 for suction and irrigation; and a rigid dissector tip 5 are housed
within the
tube 1 of the tip 31. The tool 5 may be surgical tool with a functional end
effector.
The tool 5 may be -1mm in diameter and may include graspers, cautery, scalpel,
needles etc, all of which are attached to a tool flexible body. A cable 9 runs
through the tube 1 and is attached to the distal end of the tip such that the
tip will
bend responsive to the cable being pulled. A cap 6 is operably attached to the
outer tube 1 and ensures that the suction/irrigation tube 4, endoscope 3, and
tool
is rotationally coupled to the cap 6 such that when the tube 1 and cap 6
rotate
the items therein also rotate. Tool 5 is held in the cap 6 such that it can
easily
translate into and out of the cap 6 such that the tool can be extended or
retracted
from the cap 6. Tube 1 is operably attached to the base 7.
Base 7 includes a tip articulation mechanism 102 (best seen in Fig.
3), a tool translation assembly 104 (best seen in Figs 4A to C and Fig. 5) and
a
suction and irrigation system 106 (best seen in Fig. 6).
The tip articulation mechanism 102 includes an electromechanical
pitch mechanism 110 and an electromechanical roll mechanism 112. The
electromechanical pitch mechanism 110 includes a cable 9 that is operably
connected to a capstan 8 that is driven by a motor 10. Activation of the motor
10
will pull the cable 9, close the notches 2 and pitch (or bend) the outer tube
6 and
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its contents as best seen in Fig. 20.
The outer tube 1 of tip 31 is operably connected to a pair of
bevelled gears 11, 16 for 90 degree motion transfer that is driven by a motor
12.
Activation of the motor 12 will rotate bevelled gear 11, which in turn rotates
bevelled gear 16 thus activation of the motor 12 will roll (spin) the tip 31
and its
contents. Bevelled gear 16 is operably attached to the outer tube 6. Bevelled
gear 16 is hollow and allows the flexible instruments to run therethrough.
The motors 10, 12 are activated by the user through a joystick 13,
where each axis controls a different motor. The joystick 13 is located on a
handle 30 at the back of the instrument as shown in Fig. 1.
Tool translation assembly 104 is shown in Figs. 4A to C and Fig. 5.
Tool translation assembly 104 includes an inner hex portion and an outer hex
portion 15. As shown in Fig. 40 the inner hex 14 can freely slide in and out
of the
outer hex 15, but the inner hex portion 14 is rotationally fixed relative to
the outer
hex portion 15. The inner and outer hex portions are coaxial to the outer tube
1.
The inner hex portion 14 piece is operably attached to the bevelled gear 16
that
is operably attached to the outer tube 1 and can rotate with the outer tube
and
bevelled gear system. The flexible instruments can run through the inner hex
portion 14. Tool 5 is operably attached to the outer hex portion 15 at 17.
Tool 5
does not need to centered within outer hex portion 15. The other flexible
instruments run through the outer hex portion 15 and are not attached thereto.
A
bearing 18 is positioned distally, spaced from but concentric to the outer
tube 1.
The outer hex portion 15 is operably attached to the inside of the bearing 18
and
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concentric to it. Pushing on the bearing 18 in the axial direction of the
bearing
will translate the outer hex piece as well. A pusher handle 19 (shown in Fig.
5) is
operably attached to the outside of the bearing 18 such that the direction of
force
applied to push the handle 18 is parallel to the outer tube 1. Pushing on the
handle 19 will push the bearing 18 in its axial direction.
Supports 32 operably attached the tool translation assembly 104 to
the tip articulation mechanism 102. Supports 32 are attached to the tool
translation assembly 104 such that the inner hex portion 14 is free to rotate
with
the outer tube 1 but is otherwise constrained. The outer hex portion 15 is
free to
slide coaxially inwardly and outwardly relative to the outer tube1 and free to
rotate with the outer tube 1, but is otherwise constrained. The handle 19 is
supported by a carriage 20 and rail 21 or translational bearing mechanism,
which
also allows it to easily slide forwardly and backwardly (parallel to the outer
tube
1). Referring to Figs. 4A and 4B, Fig. 4A shows the tool 5 extended and Fig.
4B
shown the tool 5 retracted. The translation distance between the retracted
position and the extended position is shown at 22.
The suction and irrigation system is shown generally 106 in Fig. 6.
The suction and irrigation tube 4 is connected to a splitter 23. The splitter
23
splits into a saline portion 108 and a blood portion 110. The saline portion
includes a saline chamber 33 is in flow connection with a saline pump 26 and a
saline valve 24 and is in flow connection with one side of the splitter 23.
Similarly, the blood portion 110 is in flow connection with a suction pump 27
and
a suction valve 25 and is in flow connection with the other side of the
splitter 23.
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The saline portion 108 is for irrigation and the blood portion 110 is for
suction.
Saline pump 26 is operably connected to a saline button 28 on handle 30 (Fig.
1)
and saline valve 24 and suction valve 25. Suction pump 27 is operably
connected to suction pump 27 and saline valve 24 and suction valve 25.
Pressing one of two buttons (28-29) will activate the relevant pump, open one
valve and shut the other so that the suction and irrigation are separate.
An alternative embodiment of the design 300 is shown in Figs 7 to
11. The outer tube 301 is pictured operably attached to the main body 305. The
instrument 302 is operably attached to the tool body 303. A handle 330 is
operably attached to the main body 305. The tool body 303 has a carriage 340
which runs on a rail 304 that is operably attached to the main body 305, such
that
the tool body can slide coaxial to the outer tube 301 axis. Therefore, when
the
tool body 303 is moved forwards, the instrument 302 can extend past the distal
tip of the outer tube 301 and also retract when the tool body moves backwards
in
the axial direction.
An alternative tip articulation mechanism for the dextrous hollow
tube 301 bending is shown in Figs. 7 to 11. As shown in Figs 10A to 100 four
cables (314, 315, 315, 317) are attached to the distal tip of the outer tube
301.
Two pairs of cables form an opposing set (315 with 417, and 314 with 316) that
can bend the tube along one plane in two opposite directions (see 10B and
10C).
In this alternative design 300, each cables is threaded through the
outer tube 301, around a pulley and then operably attached to a capstan (311,
312, 313, 318) shown I figure 9A and 9B. The pairs of opposing capstans are
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rotationally coupled to a motor (310 and 309) such that the rotation of a
motor in
one direction, will pull one of the cables and loosen the opposing cable thus
bending the outer tube 301 in the desired direction.
Optionally, the instrument 302 is configured to roll relative to the
tool body as shown in Figs 12 to 14. The instrument 302 is operably attached
to a
gear 306, which is coupled to a second gear 307. The second gear is mounted
onto a motor shaft which drives said second gear 307, which drives the first
gear
306 and the instrument 302. Alternatively, the second gear can be manually
spun
by the user if a spin handle is included.
In this alternative embodiment 300, the instrument 302 is a hollow
tube which allows for a number of functions. For example, the hollow
instrument
302 can be a suction-irrigation tube as shown in figure 13A. The chamber has
an
outlet that a flexible tube 325 can plug onto which provides a good seal. This
flexible tube 325 can then be directed out of the main body 305 of the device.
Then a suction-irrigation system as shown in figure 6 can be connected to this
flexible tube 325.
In a second example, an existing flexible tool 327 can be threaded
through the flexible tube 325, the chamber 324, the gear 306, and then the
instrument 302, shown in Figure 13B. This flexible tool 327 could be but is
not
limited to graspers, a biopsy needle, cautery, forceps and other flexible
surgical
tools.
Furthermore, the instrument 302 can also be a dextrous hollow tube
that has a bendable portion at its distal end. Then a cable 335 attached to
the
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distal end of the instrument can be pulled by a capstan 336 attached to a
motor
337 to bend the instrument 302 (see Figure 14A and B). In the case that
suction
and irrigation are required, the cable goes through a seal, for example a
gasket
333 when it exits the suction-irrigation chamber 324.
In the case that the instrument 302 can roll, the chamber 324 will
also roll. Therefore, the cable is inserted into a sheath 334 that is operably
attached to the chamber by 333 and the motor/capstan 338 such that the sheath
maintains the cable length so that the cable can maintain tension at any
position,
as in a bike break.
The endoscopic multi-tool 100 is a handheld, electromechanical
instrument for minimally invasive surgery, composed of a steerable
multifunctional tip. The endoscopic multi-tool 100 includes a 2-DOF tube 1
that
houses several dextrous components including but not limited to:
suction/irrigation tube, endoscope, and swappable dissector
(blunt/grippers/scalpel/biopsy forceps etc.).
The outer tube 1 is defined as a small (sub 4mm) hollow tube with
thin walls (to maximize inner diameter and minimize outer diameter) that is
nominally rigid, but bendable in certain directions. This flexibility can be
achieved
in several ways:
a) Tube made of a nitinol (super-elastic nickel titanium) tube
with geometric cuts that remove material, allowing the tube to bend when cable
tension is applied. Original position is recovered when the tension is
released
(also known as a continuum wrist) as shown in Figs. 1 and 3;
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b) Tube made of a stainless-steel tube with a spiral cut that
allows it to bend in multiple directions with an applied cable tension as
shown in
Figs. 7 and 8.
The tube 1 is operably attached to the main body 7 of the
instrument 100 and is cable actuated. Each cable is attached to the distal end
of
the tube 1 and runs along the length of the tube. Pulling on the cables will
pull on
the tube, and since the tube is fixed into the main body 7, the force applied
will
cause the tube to bend in the direction that the cable is pulling. Each cable
is
wrapped onto a capstan that is rotated by a motor that is also operably
attached
to the main body of the instrument.
Each motor is activated by a joystick 13, for which the directions
depend on the actuation type. Roll and pitch are controlled by horizontal and
vertical joystick 13 motion, respectively. For pitch and yaw, the joystick 13
is
directly mapped to the desired activation direction.
An inner component such as tool 5 is operably attached to a tool
translation assembly, where the tool translation assembly is operably attached
to
the body of the instrument 100. The inner component 5 is also attached to a
tool
handle so that the user can manually extend or retract the inner component,
allowing the user to either improve reachability or a conceal instrument
during
navigation.
For space optimization, a single tube can be used for suction and
irrigation, allowing more components to be placed inside the outer lumen. This
main line runs along the outer tube 1 and the actuation unit but is eventually
split
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into separate one-way solenoid valves as shown in Fig. 6. Each valve leads to
a
pump that draws from or empties into separate reservoirs. Suction and
irrigation
are activated by pressing the buttons on the handle, engaging each respective
pump and valve, but never at the same time. The activation can be modified
from
the current binary method to an analog feature, where pressing harder will
proportionally increase the flow rate of the suction/irrigation.
The same steering mechanism for the outer lumen can also be
applied to the dexterous internal components. For example, the existing
silicone
suction and irrigation tube can be replaced by notched nitinol or steel with
spiral
cuts, however the former would require covered notches for flow to be
possible.
A gasket would also be necessary for the actuation cable to pass through so
that
it may attach to a capstan that can be actuated with a motor.
Generally speaking, the systems described herein are directed to
endoscopic tools. Various embodiments and aspects of the disclosure are
described in the detailed description. The description and drawings are
illustrative
of the disclosure and are not to be construed as limiting the disclosure.
Numerous specific details are described to provide a thorough understanding of
various embodiments of the present disclosure. However, in certain instances,
well-known or conventional details are not described in order to provide a
concise
discussion of embodiments of the present disclosure.
As used herein, the terms, "comprises" and "comprising" are to be
construed as being inclusive and open ended, and not exclusive. Specifically,
when used in the specification and claims, the terms, "comprises" and
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"comprising" and variations thereof mean the specified features, steps or
components are included. These terms are not to be interpreted to exclude the
presence of other features, steps or components.
As used herein the "operably connected" or "operably attached"
means that the two elements are connected or attached either directly or
indirectly. Accordingly, the items need not be directly connected or attached
but
may have other items connected or attached therebetween.
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