ENDOSCOPE WITH EXTENSIBLE WORK CHANNEL

Abstract

A work channel arrangement of an endoscope for guiding medical tools and/or for the through-flow of media. The work channel arrangement has a work channel which is flexible at least in part and extensible relative to the endoscope and which can be moved from a first position, in which the work channel outlet is oriented in the axial direction of the endoscope head, to a second position in which it is extended in the distal direction relative to the first position and in which the work channel outlet is or can be deflected, by means of a guide mechanism, to a predetermined lateral or rearward direction.

Claims

1. An endoscope with an endoscope body, endoscope head extending in an axial direction, and a work channel arrangement for guiding medical tools and/or for the flow of media up to a distal endoscope head, the work channel arrangement comprising: a work channel configured to be flexurally elastic at least in sections and extendable relative to the endoscope body, the work channel being movable between a first position, in which a work channel exit at a distal end of the work channel is oriented in the axial direction of the endoscope head, and a second position extended distally relative to the first position; an entrainer, which is anchored at the work channel in an area of the work channel exit and operable from a handle part of the endoscope, the entrainer being configured to pull the work channel from the first position to the second position; a guiding device configured to deflect the work channel exit in a predetermined lateral or retrospective direction relative to a longitudinal axis of the endoscope, when the work channel is in the second position; and a deflection device positioned distally in front of the distal end of the work channel when the work channel is in the first position, and configured to deflect the entrainer, such that, when a tensile force is applied via the entrainer from the proximal direction, the work channel is first pulled distally and then, following the deflection of the entrainer, is pulled into the predetermined lateral or retrospective direction relative to the longitudinal axis of the endoscope, when the work channel is in the second position.

2. (canceled)

3. The endoscope according to claim 1, wherein the guiding device comprises a guide surface which is convex towards the distal end of the endoscope, the guide surface being configured such that the work channel is pulled against the guide surface by the entrainer when the work channel is in the second position, whereby the guiding device supports the work channel from radially inside and gives the work channel a defined curvature due to the work channel's flexural elasticity.

4. The endoscope according to claim 1, wherein the work channel has an extension portion that is configured to lengthen in the axial direction of the work channel when the work channel is subjected to a tensile load and thereby supports the extension movement of a distal work channel portion.

5. (canceled)

6. (canceled)

7. (canceled)

8. The endoscope according to claim 13, wherein during a pivoting movement of the distal endoscope head portion, a guiding device folds open, to thereby support the extended work channel from radially inside with a defined curved contour.

9. An endoscope according to claim 1, wherein the endoscope comprises an optical unit facing in the axial direction and an additional optical unit facing in the lateral direction, or has an obliquely oriented optical unit, or the optical unit is configured so that it can be transferred from an orientation facing in the axial direction to an orientation facing in the lateral direction.

10. The endoscope according to claim 1, wherein the endoscope head is of an endoscope-adaptive type in the manner of a separate, additional endoscope head attachment and comprises the work channel arrangement.

11. The endoscope according to claim 3, wherein the guide surface is a convexly extending guide groove.

12. The endoscope according to claim 4, wherein the extension portion is a telescopable and/or expandable portion of the work channel.

13. An endoscope with a work channel arrangement for guiding medical tools and/or for the flow of media up to a distal endoscope head, the endoscope comprising: a work channel, which is designed to be flexurally elastic at least in sections, extendable relative to an endoscope body, and displaceable from a first position, in which a distal work channel exit is oriented in the axial direction of the endoscope head, into a second position, in which the work channel is extended distally relative to the first position; and a guiding device via which the distal work channel exit is deflected or deflectable in a predetermined lateral or retrospective direction, when the work channel is in the second position; wherein a distal endoscope head portion is designed to be pivotable into a lateral position relative to a longitudinal axis of the endoscope; and wherein the work channel is fixed to said distal endoscope head portion, such that when the distal endoscope head portion performs a pivoting movement, the distal endoscope head portion serves as an entrainer and extends and deflects the work channel into the predetermined lateral or retrospective direction.

14. The endoscope according to claim 13, wherein the work channel has an extension portion that is configured to lengthen in the axial direction of the work channel when the work channel is subjected to a tensile load and thereby supports the extension movement of a distal work channel portion.

15. An endoscope according to claim 13, wherein the endoscope comprises an optical unit facing in the axial direction and an additional optical unit facing in the lateral direction, or has an obliquely oriented optical unit, or the optical unit is configured so that it can be transferred from an orientation facing in the axial direction to an orientation facing in the lateral direction.

16. The endoscope according to claim 13, wherein the endoscope head is of an endoscope-adaptive type in the manner of a separate, additional endoscope head attachment and comprises the work channel arrangement.

Description

BRIEF DESCRIPTION OF THE FIGURES

[0030] FIG. 1 shows a view for illustrating a field of application of an endoscope with a work channel arrangement according to the invention;

[0031] FIG. 2 shows a perspective view of an endoscope according to a first embodiment of the invention with orthograde oriented work channel exit;

[0032] FIG. 3 shows a perspective view of an endoscope according to the first embodiment of the invention with an extended, laterally oriented work channel exit;

[0033] FIG. 4 shows a perspective view of an endoscope according to a second embodiment of the invention with orthograde oriented work channel exit;

[0034] FIG. 5 shows a perspective view of an endoscope according to the second embodiment of the invention with extended, laterally oriented work channel exit;

[0035] FIG. 5A shows an alternative guiding device for an extendable work channel;

[0036] FIG. 6 shows a perspective view of an endoscope according to a third embodiment of the invention with orthograde oriented work channel exit;

[0037] FIG. 7 shows a perspective view of an endoscope according to the third embodiment of the invention with extended, laterally oriented work channel exit;

[0038] FIG. 8 shows a further embodiment with inclined optical unit;

[0039] FIG. 9 shows a further embodiment with pivotable optical unit; and

[0040] FIG. 10 shows an alternative extension portion for an extendable work channel.

[0041] As can be seen from FIG. 1, the major duodenal papilla (P) is located in the rearward (dorsal) descending part (pars descendens) of the duodenum (D) and relatively difficult to access due to the tortuous geometry of this system. The space available in the region of the duodenum (D) is very limited, which means that procedures on the major duodenal papilla (P) are not possible with common prograde endoscopes, since at an appropriate angle, the endoscope tip would no longer have sufficient distance to the lumen of the duodenum (D) for proper imaging in the direction of the procedure portion.

[0042] Due to this reason, the aforementioned duodenoscopes are known from the prior art, which have a fixed sideways or retrospective optical unit as well as a correspondingly oriented working channel in order to make optimum use of the available space. However, such duodenoscopes have the disadvantage that they are fixed in their lateral/retrograde orientation of the optical unit and the working channel. On the one hand, this makes general navigation within the patient difficult and on the other hand makes such endoscopes inflexible in their possible applications. In other words, they are expensive special devices for a narrowly limited field of application.

[0043] A basic idea of the present invention is therefore to provide a work channel mechanism for an endoscope which is shiftable from an orientation looking straight ahead to a lateral or retrospective orientation.

FIRST EMBODIMENT

[0044] FIG. 2 shows a first exemplary embodiment of an endoscope 2 according to the invention. An endoscope head 4 is arranged at the distal end of the endoscope 2, which has different functional units such as an optical unit 6; a cleaning nozzle 7 for the lens of the optical unit 6, and a lighting means 8. For the sake of clarity, only the most necessary functional units mentioned above are shown in the Figures; of course, an endoscope head 4 according to the invention can also have various other functional units known from the prior art, such as e.g. suction channels.

[0045] A work channel 10 of the endoscope 2 extends from its distal opening or its work channel exit 11 at the distal end of the endoscope 2, through a flexible shaft or along a flexible shaft of an endoscope 2 equipped with the endoscope head 4, to a proximal opening in the area of the endoscope handle (not shown) and can thus be used, for example, for the introduction of surgical instruments or tools (W), such as a papillotome, or for the application of media in the patient. The shown endoscope 2 furthermore has functional and supply channels running inside it (not shown), such as electrical lines, for supplying the functional units, for transmitting data, and for controlling the movements of the endoscope, which can be connected in the proximal direction to an operating station (not shown) or a controller/control device (also not shown). Furthermore, such an endoscope of the shaft type can have a so called deflecting portion between the endoscope head 4 and the preferably flexible endoscope shaft, which represents an actively-bendable shaft portion in extension of the passively-bendable endoscope shaft. This actively-bendable shaft portion can either be bendable in all directions or, if applicable, only in one direction, whereby in the latter case a rotation ring can be arranged between the deflecting portion and the endoscope shaft, which keeps the deflecting portion rotatable around the longitudinal axis of the endoscope with respect to the endoscope shaft.

[0046] In the first embodiment of an endoscope according to the invention shown in FIGS. 2 and 3, the work channel 10 is held in an extendable manner. More precisely, a distal end portion 12 of the work channel 10 is telescopable relative to the work channel base body. However, the extendability can just as well be created in a different way, as is explained in more detail at another point. The distal end portion 12 of the work channel 10 is also kept flexurally elastic. The extendability of the work channel 10 in combination with the flexural elasticity ensures that the work channel 10 can be transferred from the proximally retracted position looking straight ahead as shown in FIG. 2 to the distally advanced and deflected position shown in FIG. 3.

[0047] In the first embodiment, the work channel is extended by an entrainer 16 (here a cable control). The entrainer can be actuated from the proximal handle piece and pulls the distal end portion 12 of the work channel 10 into the laterally oriented position. The telescopable distal end portion 12 of the work channel 10 extends from the work channel portion located proximally in front of it. During the extension movement, a guiding device 14 ensures that the work channel is deflected in a defined manner. In the first embodiment of the invention, the guiding device 14 is designed as a kind of ramp with a guiding groove or channel, which provides a defined curvature for the distal end portion 12 of the work channel 10. The guiding device 14 arches like a dome towards the distal endoscope end. In this way, the pulling force exerted by the entrainer 16 is deflected by the guiding device 14 by approximately 180° at the beginning of the pulling process, so that the work channel 10 is pulled distally forward, and acts proximally at the end of the pulling movement, so that the work channel 10 is held against the guiding device 14 and adapts to it. This ensures a defined radius of curvature through which a surgical instrument, for example, can be pushed and also prevents kinking when transferring the work channel 10 from orthograde to lateral orientation.

[0048] As can be seen in FIGS. 2 and 3, the work channel 10 basically runs on the side of the endoscope facing away from the optical unit 6. When the distal end portion 12 of the work channel 10 is extended and deflected, it is deflected by the guiding device 14 in such a way that it faces in the same direction as the optical unit 6. In this way, the radius of curvature of the work channel 10 is maximized in the deflected state, which facilitates the performance of minimally invasive surgical procedures. In this configuration version, the work channel 10 runs outside the endoscope shaft, but can also be located inside it (in the peripheral region), as can be seen in some of the following embodiments.

[0049] The entrainer 16 or the cable control of the first embodiment can be operated manually, e.g. by means of a rotary or toggle lever, or can be power-operated by means of an electric motor or a hydraulic system.

[0050] When the endoscope head 4 shown in FIGS. 2 and 3 is completely assembled, a cap is placed over it, which is not shown here, which shields the components and gives the endoscope head 4 a continuous, smooth contour at its distal end, which facilitates the insertion of the endoscope 2. Furthermore, the endoscope 2 of the first and all further embodiments can be covered with a protective cover in order to seal the endoscope 2 and to improve its sliding properties.

SECOND EMBODIMENT

[0051] In the second embodiment shown in FIGS. 4 and 5, the entire work channel 10 is designed to be movable relative to the endoscope in its axial direction. In this way, an advancing movement can be generated proximally from the handle part, which causes the distal work channel end to be extended. The advancing movement can, for example, be actuated manually via a rotary or lever mechanism or by means of a drive unit (e.g. linear motor). In such a embodiment, the work channel 10 has to be designed with a correspondingly high shear stiffness so that the advance movement can be transferred all the way to the distal tip of the endoscope. In the second embodiment of FIGS. 4 and 5, the guiding device 20 is designed as a kind of corset made of a shape memory material. In the advanced state, a predetermined, curved state of the guiding device 20 can be achieved by influencing the temperature from the handle part. For this purpose, the guiding device 20 is connected in a heat-conducting manner to a corresponding temperature influencing device (not shown). The corset-like guiding device also stiffens the distal end portion 12 of the work channel 10 so that it can force a deflection of minimally invasive surgical instruments and tools pushed through it.

[0052] In the second embodiment, the work channel 10 runs inside the endoscope shaft on the side of the endoscope 2 facing away from the optical unit 6 and is deflected by the guiding device 20 towards the viewing direction of the optical unit 6 to allow treatment in a lateral direction.

[0053] As an alternative or in addition to the shape-memory material, as shown in FIG. 5A, at least one separate Bowden cable 21 can be used as a guiding device for active angulation of the work channel 10. Here, the Bowden cable 21 runs largely in the wall of the work channel 10, exits the wall in an area in front of the work channel exit 11 and is anchored to the work channel 10 in the area of the work channel exit 11. In this way, the distal end portion 12 of the work channel 10 can be controlled (angled) autonomously from the handle part, e.g. by means of a lever or an electric drive, in order to intubate the major duodenal papilla in a targeted manner.

THIRD EMBODIMENT

[0054] In a third embodiment shown in FIGS. 6 and 7, a distal portion of the endoscope head 4 is configured as a pivotable end cap. In the example shown, the pivotable end cap is attached in an articulated manner to a hinge in the edge area of the endoscope head 4 and can be operated for pivoting, e.g. via a Bowden cable. The distal end portion 12 of the work channel 10 is anchored to the pivotable end portion of the endoscope head and is entrained when the head is pivoted.

[0055] In order to be able to operate in both the orthograde and the lateral direction with an endoscope according to the invention, it is important to have imaging capabilities in both of these directions. In the first embodiment shown in FIGS. 2 and 3, an optical unit 6 and lighting means 7 are each configured in duplicate, oriented once in the orthograde direction and once in the lateral direction. The user can thus switch back and forth between these two imaging modes or have both output simultaneously (e.g. on different screens), as required.

[0056] A variant of an advantageous imaging device shown in FIG. 8 uses a single, obliquely (between orthograde and lateral) oriented optical unit 6. By using an optical unit 6 with a sufficiently wide angle of view, (surgical) work can be performed in both orthograde and lateral positions of the work channel 10. Preferably, the optical unit of an endoscope according to the invention can provide a viewing angle between 115° and 140°.

[0057] In a further configuration version, shown in FIG. 9, the optical unit 6 is designed to be pivotable. Comparable to a telescope in an observatory, the objective lens can protrude slightly from the surface of the endoscope head 4 and can be designed to pivot between an orthograde and a lateral orientation. A Bowden cable, a chain drive or the like can be used to pivot the optical unit. If the viewing angle is large enough, it is also sufficient if the optical unit 6 can pivot in an area between these two end positions.

[0058] As already indicated, there are several ways to achieve the extendability of the work channel. A telescope-like portion has already been described, which is shown in FIG. 6, for example. The telescope-like extension portion 18 has two or more cylindrical partial tubes with one lying coaxially inside the other. The distal, inner partial tube (here the distal end portion 12 of the work channel 10) can move out of the outer partial tube. Advantageously, a stop is provided which limits the extension movement (this can also be achieved by a slight conicity). In addition, a seal is provided between the relatively movable partial tubes in the embodiment shown.

[0059] FIG. 10 shows an alternative extension portion 18 of the corrugated tube design. The outer sheath of the work channel 10 is corrugated/gathered in such a embodiment. In the case of a tensile load, the tube/channel length required for the extension movement of the distal end portion of the work channel 12 can be obtained from this corrugated/gathered area.

[0060] The present embodiments can also be carried out without extension portion 18 by taking the work channel length required for the extension movement from its inherent elasticity, for example.

[0061] In the context of this disclosure, it is planned to combine elements of the embodiments described above. For example, an entrainer 16 according to the first embodiment could be combined with a shape-memory material portion 20 according to the second embodiment. Furthermore, the method of lengthening (telescope portion, corrugated tube, completely movable work channel, etc.) is interchangeable between the embodiments.

LIST OF REFERENCE SIGNS

[0062] 1 work channel arrangement; [0063] 2 endoscope; [0064] 4 endoscope head; [0065] 5 distal end portion/end cap [0066] 6 optical unit; [0067] 7 cleaning nozzle; [0068] 8 lighting means; [0069] 10 work channel; [0070] 11 work channel exit; [0071] 12 distal end portion of the work channel; [0072] 14 guiding device/ramp; [0073] 16 entrainer; [0074] 18 extension portion/telescope portion; [0075] 20 guiding device/shape-memory material; [0076] 22 guiding device; [0077] D duodenum; [0078] P major duodenal papilla; and [0079] W tool.