DEVICE AND METHOD FOR PERFORMING AN ENDOSCOPIC EXAMINATION FREE FROM CONTAMINATION

Abstract

Endoscope with contamination protection device comprising a rigid or flexible shaft, at a distal end of which optics and a lighting device are disposed, a handle adjoining the shaft, an inner sheath, which is closed at its one distal end and is optically transparent at least on the end face and which is unrolled along the shaft in the manner of a condom, at least one air tube and water tube, which terminate openly at the distal end of the inner sleeve and are connected thereto and are positioned between the shaft and inner sleeve, and a handle attachment, which is plugged onto the handle with an air and a water valve, to which the air and water tubes are connected, an outer sleeve envelops the inner sleeve and, at a proximal end of the inner sleeve, is connected in an air, water and germ-tight manner to the same.

Claims

1. Endoscope with contamination protection device comprising: a rigid or flexible shaft (1), at the tip of which optics (11), a lighting device (12) and a nozzle (13) are disposed, a handle (2) adjoining the shaft (1), an inner sheath (3) which is closed at its one distal end and is optically transparent at least on the end face and which is unrolled along the shaft (1) in the manner of a condom, at least one air tube (4a) and a water tube (4b), which terminate openly at the distal end of the inner sleeve (3) and are connected thereto and are positioned between the shaft (1) and inner sleeve (3), and characterised in that an outer sleeve (6) envelops the inner sleeve (3) and, at a proximal end of the inner sleeve (3), is connected in an airtight, watertight and germ-tight manner to the same.

2. Endoscope according to claim 1, characterised in that, at one distal end of the outer sleeve (6), a first connecting piece (61a) is integrally formed, and diaper pants (7a) for a patient to be coloscopically examined are provided, which have an opening with a first receiving part (71a), to which the first connecting piece (61a) of the outer sleeve (6) is connected in an airtight, watertight and germ-tight manner, and/or a second connecting piece (61b) is integrally formed, and a bite ring (7b) for a patient to be gastroscopically examined is provided, which has an opening with a second receiving part (71b), to which the second connecting piece (61b) of the outer sleeve (6) is connected in an airtight, watertight and germ-tight manner, and/or a third connecting piece (61c) is integrally formed, and separating wall (7c) or cabin for a patient to be examined behind it is provided, which has an opening with a third receiving part (71c), to which the third connecting piece of the outer sleeve (6) is connected in an airtight, watertight and germ-tight manner.

3. Endoscope according to claim 1, characterised in that a film with an opening is welded onto a distal end of the outer sleeve (6) in an airtight, watertight and germ-tight manner, and, by means of a holding device, is spanned in front of a patient to be examined.

4. Endoscope according to claim 1, characterised in that the inner sleeve (3) and outer sleeve (6) consist of airtight and watertight material that is impervious to pathogens, and/or of flexibly compressible material, that is to say can in particular be rolled up or folded in the manner of a bellows.

5. Endoscope according to claim 1, characterised in that in the shaft (1), there runs at least one instrument channel (10), which opens at the shaft tip into a distal instrument channel opening (101) in each case and, at the handle (2), in a proximal instrument channel opening (102), the inner sleeve (3) has at its end face an operating tube opening (30c) that is congruent with the distal instrument channel opening (101), and the operating tube opening (30c) has an adjoining operating tube (4c), which is positioned in the instrument channel (10) and projects out of the instrument channel opening (102).

6. Endoscope according to claim 5, characterised in that the operating tube (4c) has, in its section that projects out of the proximal instrument channel opening (102), a predetermined breaking point (4c0), and in that a protective tube (4c1), made of a polymeric material, which has a higher elongation at break than a material of the operating tube (4c), is fastened on an outer or inner side of the operating tube (4c) such that the protection tube (4c1) is connected upstream as well as downstream of the predetermined breaking point (4c0) in a manner that is airtight, watertight and germ-tight (4c).

7. Endoscope according to claim 1, characterised by valve holders (22a, 22b) in the handle (2), into which an air valve (5a) and a water valve (5b) or a combined air/water valve (5ab) integrated in a valve block (5ab), as well as a suction valve (5d) can be plugged, and a two-way tube manifold (24), which is plugged at a distal, in particular conically designed end (241) into a proximal end of the operating tube (4c), the tube distributor (24) having, in particular, an instrument opening (242) and a ring nut (243), which is movable axially relative to the tube (4c) and by means of which a proximal instrument channel opening (102) of the endoscope can be fastened.

8. Endoscope according to claim 1, characterised by a handle (21) that is plugged onto the handle attachment (2), in which the following are retained: an air valve (5a) and a water valve (5b) in a valve holder (22), an instrument holder (23) with, inserted therein, a 2-way tube manifold (24), on the distal end of which the operating tube (4c) is connected, a suction valve (5d) and a suction tube (4d), which is connected on a first proximal end of the tube manifold (24) and on the suction valve (5d).

9. Endoscope according to claim 8, characterised in that, at a second proximal end of the tube manifold (24), an instrument protector (8) is connected, which consists of an instrument tube (81), which can be gathered together in the manner of a bellows, and, on each end, has an instrument protection cap (82) with an opening at its end, and has a length that is larger than one length of the operating tube (4c).

10. Endoscope according to claim 1, characterised in that the inner sleeve (3) and/or the outer sleeve (6) on a proximal end of the shaft (1) is fastened on an outer surface of the shaft (1), in particular in that it is pressed, by means of a clip (91) or a rubber ring, on a proximal clamping bracket (93), which is disposed on the outer surface of the shaft (1) and has a proximal seal (92) placed below it, and has passages for the air tube (4a) and water tube (4b).

11. Endoscope according to claim 1, characterised in that the distal end of the inner sleeve (3) is designed as an essentially hollow cylindrical cap (31) with an open end face, which, at an end face opposite the open end face, has an air tube opening (30a) and a water tube opening (30b), on which the air tube (4a) and water tube (4b) are integrally formed, a yoke-like gripper (33) with a click-closure (331, 331) being integrally formed on the cap (31) and the fastening of the cap (31) on the distal end of the shaft (1) being ensured in that it is mounted on a distal clamping bracket (96) that is disposed on an outer surface of the shaft (1) and is underlaid by a distal gasket (95) and has passages for the air tube (4a) and water tube (4b), or for clamping on the distal end of the shaft, axially running elastic branches are integrally formed on an open end face of the cap (31).

12. Endoscope according to claim 1, characterised in that the inner sleeve (3) and outer sleeve (6) are made in one piece, that is to say that the airtight, watertight and germ-tight connection of the outer sleeve (6) to the proximal end of the inner sleeve (3) are already provided during manufacturing, for example by welding and/or the inner sleeve (3) is underlaid by a fabric tubing and/or the outer sleeve (6) encloses the handle (2) and the handle attachment (21).

13. Endoscope according to claim 12, characterised in that, the two-way tube manifold (24) is integrated into that section of the outer sleeve (6) that envelops the handle (2) and the handle attachment (21).

14. Method for mounting a contamination protection device for an endoscope according to claim 1, characterised by the steps: application to the optically transparent region at the distal end of the inner sleeve (3) of a substance that produces optical contact with the optics (11) of the endoscope, plugging the handle attachment (21) onto the handle (2), introducing the distal end of the endoscope shaft (1) into the rolled-up inner sleeve (3), condom-like unrolling of the inner sleeve (3) with inclusion of the shaft (1) and of the air tube (4a) and water tube (4b) positioned thereon, connecting the proximal ends of air tube (4a) and water tube (4b) with air valve (5a) and water valve (5b) on the handle attachment (21), pushing the rolled-up outer sleeve (6) over the inner sleeve (3) and fastening, in an airtight, watertight and germ-tight manner, on the proximal end of the inner sleeve (3), and condom-like unrolling the outer sleeve (6) beyond the tip of the endoscope shaft (1).

15. Method for mounting a contamination protection device for an endoscope according to claim 14, characterised in that, subsequently a first or second or third connection piece (61a,b,c) of the exterior sleeve (6) is connected to thea first or second or third connection part (71a,b,c), respectively.

16. Method for mounting a contamination protection device for an endoscope according to claim 14, characterised in that, for fastening and connecting the inner sleeve (3) and outer sleeve (6), the following steps are performed: bonding of a proximal gasket (92) onto the outer surface of a proximal end of the shaft (1), application of a proximal clamping bracket (93) on the proximal gasket (92), bonding of a distal gasket (95) onto an outer surface of a distal end of the shaft (1), mounting a distal clamping bracket (96) on the distal gasket (95) using a positioning aid (960), positioning the air tube (4a) and water tube (4b) in passages on the distal clamping bracket (96), plugging a cap (31) onto the distal clamping bracket (96), positioning the air tube (4a) and water tube (4b) in passages on the distal clamping bracket (93), positioning proximal ends of the inner sleeve (3) and outer sleeve (6) over the proximal clamping bracket (93), and clamping the inner sleeve (3) and outer sleeve (6) between the proximal clamping bracket (93) and a clip (91) or rubber ring.

17. Method for mounting a contamination protection device for an endoscope according to claim 16, characterised in that, before introduction of the distal end of the shaft (1) into the rolled up inner sleeve (3), the proximal end of ab operating tube (4c) is introduced into a distal instrument channel opening (101) to the extent that it projects out of a proximal instrument channel opening (102) and in that subsequently the proximal end of the operating tube (4c) is connected to a distal end of a 2-way tube manifold (24, 24), a first proximal end of the tube manifold (24, 24) is connected to a suction valve (5d) by means of a suction tube (4d) and a second proximal end of the tube manifold (24, 24) is connected to an instrument protector (8), which is folded in the manner of a bellows.

18. Method according to claim 17, characterised in that the tube manifold (24) is fastened by means of a ring nut (243) directly on the proximal instrument channel opening (102).

19. Method according to claim 16 for preparing an endoscope for a second, contamination-protected endoscopic examination after the contamination-protected performing of a first endoscopic examination of which the last step consists in the pulling out of the endoscope shaft from the examined body orifice, characterised by the steps: separating the outer sleeve (6) in the region of its distal end as well as from the air tube (4a) and water tube (4b) in the region of the handle (2), in each case with a torch cutter, and removal and disposal of the contamination protection device, clamping brackets (93, 96), which may be fastened on the outer surface of the shaft, being left on the endoscope, provision of a further contamination protection, comprising inner sleeve (3), outer sleeve (6) and water, air and operating tubes (4a, 4b, 4c) and assembly of the further contamination protection according to the steps defined in claim 16, wherein the mounting of the proximal clamping bracket (93) and distal clamping bracket (96) possibly are omitted as redundant.

Description

[0069] FIG. 1 shows an overall view of an advantageous embodiment of the endoscope according to the invention with contamination protection device. The distal end of the inner sleeve 3 lying on the endoscope shaft 1 is formed by the cap 31 with the end face 30. On the end face 30, there are disposed the air-tube opening 30a, the water-tube opening 30b and the working-tube opening 30c. The air and water tubes 4a, 4b, which are connected to the air and water-tube openings 30a, 30b are led from the interior of the cap 31, through the openings present in the outer surface thereof, to the outside of the endoscope shaft 1. Starting from the end face 30, the inner sleeve 3 is integrally formed on the outer surface of the cap 31 and covers the openings on the cap 31 which are provided for passage of the air and water tubes 4a, 4b, as well as, furthermore, the entire endoscope shaft 1 together with air and water tubes 4a, 4b running thereon. A sealing of that part of the endoscope that is to be introduced into the body orifice of a patient that is to be examined is thus ensured, which is thereby completed in that the instrument channel 10 that runs in the interior of the endoscope shaft 1 is lined by the working channel that is connected to the working channel opening 30c. The endoscope shaft that is sealed in this way is enveloped by the outer sleeve 6 so that the interspace forms a protective volume in which, during the endoscopic examination, body fluids escaping from the patient's body orifice are intercepted. At the patient side, this protection volume is sealed by means of a connection piece 61 which is provided on the outer sleeve 6, and can be connected to suitable diaper pants 7a or a bite ring 7b. The sealing of the protection volume at the proximal end of the endoscope shaft 1 is ensured in the embodiment shown in FIG. 1 by the clip 91, which, in the inner and outer sleeve 3, 6, presses on a proximal clamping bracket 93 located beneath it. The ends of of the inner and outer sleeves 3, 6 that project beyond this are taken up in the clamp 94 and thus secured, for example, against tearing. For passing air and water tubes 4a, 4b beyond the proximal end of the protection volume, corresponding slits are provided in the proximal clamping bracket 93 located under clip 91, outer and inner sleeve 6, 3. The handle attachment 21, with the valve holder 22 and the instrument holder 23, is mounted on the handle 2, into which the air, water and suction valve 5a, 5b, 5d as well as the two-way tube manifold 24 are plugged. The two-way tube manifold 24, which is connected with its distal end to the operating tube 4c projecting from the proximal instrument channel opening 102 permits, via its two proximal ends, access to the instrument channel 10. The proximal leg of the tube manifold 24, which forms the straight-line extension of the distal leg is provided for an instrument 80 passed through on a Bowden cable, by means of which minimally invasive surgical interventions and biopsies can be performed. On the angled legs of the tube manifold 24, the suction tube 4d and the associated suction valve 5d are connected. Air and water valve 5a, 5d are connected to the air and water tubes 4a, 4b leading to the distal end of the endoscope shaft. The tubes leading out of the valves 5a, 5b, 5d of the endoscope are connected to suitable devices for application of low or high pressure or water, which are not loaded within the scope of the present invention.

[0070] FIG. 2 shows a detail view of the distal end of an advantageous embodiment of the endoscope according to the invention. Beneath the optically transparent end face 30 of the inner sleeve 3 or of the cap 31, the lighting devices 12 can be found, the optics 11 used for imaging, as well as the nozzle 13, which is not operated with the use of the endoscope according to the invention. The end face 30 is penetrated by the air tube 4a, which opens in the air tube opening 30a, the water tube 4b with the water-tube opening 30b, as well as the operating tube 4c, which runs in the instrument channel 10, with the operating tube opening 30c. Furthermore, FIG. 2 shows the distal clamping bracket 96, which, underlaid by the distal gasket 95, encloses the outer surface of the endoscope shaft 1 and acts as a receptacle for the cap 31 that is plugged thereon.

[0071] With reference to FIGS. 3 to 6, details of a particularly advantageous embodiment of the endoscope according to the invention are shown, and the steps necessary for mounting the contamination protection device are illustrated.

[0072] FIGS. 3a to 3d show the assembly of a clamping bracket 96 at the distal end of the endoscope shaft 1. To ensure correct seating of the cap 31 to be mounted thereon, during assembly of the clamping bracket 96, both its axial and radial positioning on the outer surface of the endoscope shaft 1 are of importance. It must be ensured that the end face 30 of the cap 31 is spaced from the end face of the endoscope shaft such that, first, it does not cause a significant restriction of the angle of view of the endoscope optics 11, but, second, there is sufficient space to lead air and water tubes 4a, 4b from the outside of the endoscope shaft 1 to the end face 30 of the cap 31. Furthermore, it must be ensured that the operating tube opening, which in an advantageous embodiment is disposed on the end face 30 of the cap 31, in line with the instrument channel opening 101 on the end face of the endoscope shaft. Furthermore, the air and water tube openings 30a, 30b must not cover or shade the lighting devices 12 on the shaft tip. The present invention therefore teaches the advantageous use of a positioning aid 960 for the assembly of the clamping bracket 96, as illustrated in FIGS. 3a to 3d. The positioning aid 960 is connected to the clamping bracket 96 via predetermined breaking points and is broken off after successful assembly. The essential elements of the positioning aid 960 are a pin, which is disposed on the end face and faces into the interior, and is inserted into the instrument channel opening 101, as well as an end-face opening, which is placed over the nozzle 13, which projects out of the shaft tip. Thereby, the radial orientation of the positioning aid, together with clamping brackets fastened thereon, is clearly fixed and it is ensured that the recesses provided for passing through air and water tubes 4a, 4b are correctly positioned in the spring, which surrounds the clamping bracket in the sense described at the outset. The axial position of the clamping bracket 96 is fixed in that the positioning aid 960 is pressed in an interlocking manner onto the end face of the shaft tip.

[0073] The clamping bracket 96 and positioning aid 960 are advantageously embodied in two parts in each case and the connection between the two is produced by means of a clamp-like engagement.

[0074] FIG. 4a shows a detail view of the distal end of the endoscope shaft 1 during the assembly of an embodiment of a contamination protection device according to the invention. The inner sleeve 3 is therein first rolled up as far as the cap 31. The operating tube 4c is introduced into the instrument channel 10 in the endoscope shaft 1 and the air and water tubes 4a, 4b, which are not shown here, are shifted on the outside of the shaft 1. The distal gasket 95 and the distal clamping bracket 96 are, as shown in FIGS. 3a to 3d, mounted around the endoscope shaft 1.

[0075] FIG. 4b shows a view of the same assembly situation from the opposite perspective. The groove embossed into the cap 31 can be seen therein, into which the spring surrounding the clamping bracket 96 engages for the purpose of connection.

[0076] FIG. 5a shows the mounting of an advantageous embodiment of a contamination protection device according to the invention on the proximal end of the endoscope shaft 1. It shows the proximal clamping bracket 93 on the gasket 92 as well as the air and water tubes 4a, 4b, for the passage of which corresponding recesses are provided on the clamping bracket 93. At the upper edge of the figure, the fabric tube 32 is shown, which firmly envelopes the endoscope shaft 1 together with the air and water tubes 4a, 4b running thereon, and forms an underlay for the inner sleeve 3 to be unrolled.

[0077] In FIG. 5b, the inner sleeve 3 is completely unrolled over the endoscope shaft 1 such that it also covers the proximal clamping bracket 93. Furthermore, the outer sleeve 6, in a rolled up condition, has been pushed up over the inner sleeve 3, also as far as the proximal clamping bracket 93. Wth the use of such an embodiment in which the inner and outer sleeve 3, 6 are produced in one part, that is to say, for example welded to one another, the assembly is simplified in that the outer sleeve 6 does not have to be separately pushed up over the inner sleeve 3 as far as the proximal shaft end, but this has already been performed during the unrolling of the inner sleeve 3.

[0078] FIG. 5c the interlocking fixing of the inner and outer sleeve 3, 6, with the aid of the clip 91, which presses the two sleeves onto the proximal clamping bracket 93, which is located below. The free ends of the inner and outer sleeves 3, 6, which project beyond the clip 91 are additionally held together by the clamps 94 and, for example, protected against accidental tearing. Subsequent to the fixing on the proximal shaft end in this manner, the outer sleeve 6 is unrolled as far as beyond the distal shaft end.

[0079] Neither the proximal clamping bracket 93 nor the distal clamping bracket 96 has to be removed between two contamination-protected examinations. That is to say the time required until preparation of the endoscope for a further examination is advantageously reduced in that after the dismounting of the contamination protection the clamping brackets, together with the gaskets located blow remain on the shaft and are used for fastening a further contamination protection.

[0080] FIGS. 6a to 6c show partial sections of the mounting of an embodiment of the handle attachment 21 according to the invention. This is typically produced in at least two parts, one part representing an ergonomically formed handle 21, illustrated in FIG. 6a, which is mounted laterally on the handle 2 of the endoscope.

[0081] Opposite this, in FIG. 6b, a part with valve holder 22 and instrument holder 23, is mounted as counterpart and connected to the handle 21, for example via a click connection. The valve holder 22 is characterised by receptacles for three valves, the instrument holder 23 forms a receptacle for the two-way tube manifold 24, which is disposed above the proximal instrument channel opening 102.

[0082] FIG. 6c shows the final assembly state. The three valves for air, water and suction 5a, 5b, 5c are inserted into the corresponding receptacles on the valve holder 22 and connected to the air and water tubes 4a, 4b coming from the distal end of the endoscope shaft 1, as well as the suction tube 4d. The tubes emerging from the valves are connected to corresponding devices, by means of which the channels can be supplied with superatmospheric or subatmospheric pressure or water. During the endoscopic examination, the three valves 5a, 5b, 5d can be opened by the treating doctor by finger pressure. In an advantageous embodiment, these valves are inexpensive disposable products that can be discarded and exchanged after each examination. Furthermore, FIG. 6c shows the Y-shaped two-way tube manifold 24, which is plugged into the instrument holder 23, and is connected to the operating tube 4c projecting out of the proximal instrument channel opening 102. To the manifold legs emerging laterally, the suction tube 4d is connected; the straight-line legs of the manifold serves as access for the instrument 80 used in the course of the examination. The region between the distal end of the two-way tube manifold 24 and the proximal instrument channel opening 102, in which the operating tube 4c is exposed, is provided for cutting the operating tube 4c in the course of dismounting after endoscopy is completed. For cutting, a torch cutter should advantageously be used, which directly fuses the two cut ends in a sterile manner, in order to avoid escape of the contamination present in the operating tube 4c.

[0083] FIG. 7 shows an embodiment of the contamination protection device pre-assembled during production for rapid and user-friendly attachment to the endoscope shaft 1. The goal is pursued of drawing the device onto the shaft 1 in one piece. To this end, the inner sleeve 3 and outer sleeve 6 lie on one another and are rolled up together as far as the cap 31. Behind this, the air and water tubes 4a, 4b, which open in the end face of the cap 31, are helically wound, the winding having a larger diameter than the shaft 1. Both tubes 4a, 4b are fixed on the clamp 94 and, with their proximal ends, connected to air valve 4a and water valve 5b. For mounting, the proximal end of the operating tube 4c, which also opens distally in the end face of the cap 31, is introduced into the distal instrument channel opening 101 and the entire structure mentioned above is pushed over the shaft tip onto the shaft 1 until the cap 31 engages on the distal clamping bracket 96 previously assembled. The clamp 94 is pushed over the proximal clamping bracket 93, which was also assembled previously, and in the process the inner sleeve 3 and outer sleeve 6 are unrolled. Subsequently only the proximal ends of the two sleeves 3, 6 are inserted into the clamps 94 and the clip 91 is closed around it, for fixing and sealing in the region of the proximal clamping bracket 93. Finally, the air valve 5a and water valve 5b are fastened on the handle attachment 21 and the operating tube projecting out of the proximal instrument channel opening 102 is connected to the two-way tube manifold 24.

[0084] FIG. 8 shows an advantageous embodiment of the cap 31, which is suitable for use without a distal clamping bracket. For this purpose, a yoke-like gripper 33 is integrally formed on the proximal end of the cap 31. Said clamp is produced from a suitably deformable polymer and can be bent together around the endoscope shaft and fixed via the click-closure 331, 331. Air tube opening 30a and water tube opening 30b are here disposed in a tubular form in a bridge 332, which connects the clamp 31 and gripper 33. The advantage of this embodiment consists in a small diameter in comparison to the variant with distal clamping bracket. The cap 31 shown in FIG. 8 with gripper 33 may advantageously also be used in a production-preassembled embodiment of the contamination protection device corresponding to FIG. 7. In addition, the distal end of the cap can also be made from an optically neutral shrink tube.

[0085] FIG. 9 shows the objects described in claims 2 to 4, which serve for patient-side connection of the distal end of the outer sleeve 6. This is, first, the diaper pants 7a according to the invention, which are used in coloscopies. These diaper pants 7a are put on by the patient to be examined and have an opening with a connection part 71a, which is suitable for positioning the body orifice to be examined, i.e. anus or ileostomy. To this connection part 71a, the outer sleeve 6 can be connected by means of the connection piece 61a, which is provided in an advantageous embodiment at its distal end, so that an airtight, watertight and germ-tight connection is produced. In the course of the coloscopy, the endoscope shaft 1, protected by the inner sleeve 3 is then pushed through the opening provided in the diaper pants 7a and into that body orifice of the patient that is to be examined. The intestinal contents emerging during the examination are thus prevented by the diaper pants 7a, on one hand, and the protective volume formed between the inner and outer sleeve 6, 3 on the other hand from escaping into the examination environment.

[0086] For gastroscopies the bite ring 7b according to the invention is used, on the opening of which is provided the connection part 71b. This serves in turn for patient-side connection of the outer sleeve 6 via the connection piece 61b. During the examination, to avoid or minimise the leaking of saliva from the patient's mouth corners and resulting contamination of the outer side of the outer sleeve 6, the bite ring 7b can be further extended with sections that enclose the patient's face or at least jaw part.

[0087] Alternatively to the diaper pants 7a or bite ring 7b, a partition wall 7c with opening and connection part 71c can be used, behind which the patient is positioned during the endoscopic examination. The treating doctor acts from the front side of the partition wall and is thus protected against direct contamination. In a further advantageous embodiment, the partition wall 7c may take the form of a cabin that is closed except for the passage opening, in which all the contamination removed from the patient during the examination can remain enclosed.

[0088] FIG. 10 shows an embodiment of the endoscope according to the invention in which a spanned film 7c is used as a separation between the patient and treating doctor. This film is provided with an opening on which the outer sleeve 6 is welded at its distal end, an airtight, watertight and germ-tight connection being thereby realised. The separating film 7c should be dimensioned such that it can be folded over and laid beneath the patient to be examined. By this means, all the contamination occurring during the examination is collected on the film and kept away from the rest of the examination environment, in particular the patient table.

[0089] FIG. 11 shows the instrument protection 8 according to the invention along with a passed-through instrument 80, which usually consists of a micro-device 80a on an instrument Bowden cable 80b and can be operated with the operating element 80c. The instrument protection 8 consists of an instrument tube 81, which is pushed on here in the manner of a bellows and is limited at both ends by the instrument tube caps 82, on the end faces of which openings for passing through the instrument 80 are provided. During the endoscopic examination, the instrument protection 8, in the illustrated condition in which it is gathered together in the manner of a bellows, is connected to the proximal end of the straight-lined leg of the two-way tube manifold 24. In order, after surgical intervention, to remove the contaminated part of the instrument 80 from the operating tube 4c without thereby releasing contamination, the end is drawn into the instrument tube 81, which, for this purpose is drawn out to its full length. The length of the instrument tube 81 is correspondingly to be dimensioned such that the micro-device 80a along with the Bowden cable 80b can be completely enveloped by it. After drawing of the instrument 80 into the instrument protection 8, the latter can be removed from the two-way tube manifold 24, all contamination now being retained in the interior of the instrument tube 81.

[0090] FIGS. 12a to 12c show an advantageous embodiment of the operating tube 4c according to the invention with a protective tube 4c1, which is compatible with contamination-protected dismounting.

[0091] FIG. 12a shows the mounted operating tube 4c, which projects out of the proximal instrument channel opening 102, and is connected to the distal end of the two-way tube manifold 24 in the instrument holder 23. In this freely accessible section, the operating tube 4c has a predetermined breaking point 4c0, for example in the form of a surrounding notch. Before and after this predetermined breaking point 4c0, the protection tube 4c1 is connected in an airtight, watertight and germ-tight manner to the outer side of the operating tube 4c, typically by means of a welded or adhesive bond.

[0092] FIG. 12b shows how the protection tube, after breaking of the predetermined breaking point 4c0 is drawn in length by pulling at the two cut ends of the operating tube 4c, and is thereby ultimately torn apart.

[0093] The polymeric material used for the protection tube 4c1 should have a significantly higher elongation at break than the material of the operating tube 4c, so that the torn-apart end sections, as shown in FIG. 12c, are plastically deformed to such an extent that they close the ends of the operating tube 4c in the manner of a pocket and protect it before escape of the contamination.

[0094] Instead of the embodiment shown here with protection tube 4c1 fastened on the outer side of the operating tube 4c, thus could also be mounted analogously in the interior of the operating tube.

[0095] FIG. 13 shows a perspective overall view of a further embodiment of the endoscope according to the invention with contamination protection device in which the two-way tube manifold is connected directly on the proximal instrument channel opening.

[0096] Instead of using a handle attachment for fastening the two-way tube manifold and the valves, the tube manifold 24 is connected directly to the proximal instrument channel opening 102. The air and water valves are combined in a single valve 5ab, which is used together with the suction valve 5d in holders which are provided in the handle 2 for this purpose.

[0097] To the two-way tube manifold 24, first, the proximal end led out of the proximal instrument channel opening 102 of the operating tube 4c and, further, the suction tube 4d leading to the suction valve 5d are connected. The tubes for the compressed air 4a and the water supply 4b are wound around the shaft 1 for security and led to the combined air/water valves 5ab, and connected there.

[0098] FIG. 14 schematically shows in detail the two-way tube manifold suitable for direct connection to the instrument channel opening of the embodiment shown in FIG. 13.

[0099] The Y-shaped two-way tube manifold 24 has three ends or connections. With the distal end 241, which may in particular be conically formed, it can be plugged into the proximal end 242 of the operating tube 4c led out of the instrument channel opening 102. At one of the two proximal ends, the suction tube 4d is connected. The other end 242 is open and serves as instrument access.

[0100] For fastening to the proximal instrument channel opening, the tube manifold 24 is equipped with a ring nut 243, which is seated on the tube manifold 24 so as to be axially displaceable. A collar 244, which is radially prominent and is integrally formed on the distal end 241 interacts with a stop on the ring nut 243, in order after fixing of the ring nut on a corresponding connection means of the proximal instrument channel opening 102, to fasten the tube manifold thereon. The instrument channel opening 102 may for this purpose have a widespread Luer lock connection.

[0101] The (partial) FIGS. 15A-D illustrate the procedure during direct connection of a tube manifold of the embodiment according to FIGS. 13 and 14.

[0102] First, as shown in partial Figure A, the operating tube 4c is pushed a sufficient distance out of the proximal instrument channel opening 102. Then the two-way tube manifold 24 is connected to the distal end 41 thereof by plugging in the operating tube, partial Figure B. The operating tube 4c is designed here such that, due to the compressive forces exerted by plugging in the two-way tube manifold 24, the proximal operating tube end is compressed in the manner of a bellows and the bellows section 4c is formed in this manner. Partial figure C shows the step in which the ring nut 243 of the tube manifold 24 is connected with the aid of a connection means, in this case a Luer lock connection, to the proximal instrument channel opening. The endoscope is now ready for an examination or an operation. After its end, as indicated in partial figure D, the two-way tube manifold 24 is released again and, together with the operating channel of the proximal instrument channel openings 102, pulled off, whereby the bellows section 4c of the operating channel 4c unfolds again. By means of a torch cutter, the operating tube can be cut in one step and sealed and thus drawn, in a contamination free condition, distally out of the instrument channel.

[0103] FIG. 16 shows a further embodiment of an endoscope according to the invention with two instrument channels and correspondingly two operating tubes.

[0104] The distal end of the shaft 1, shown in the left-hand partial figure, has two distal instrument channel openings 101, into which, within the scope of the contamination protection according to the invention, an operating tube 4c in each case is to be pushed. The two instrument channels of the endoscope shown here open proximally into two corresponding instrument channel openings 102, partial figure top right. This partial figure also shows the valve holders with valves 5ab for air and water, as well as 5d for suction. The partial figure below right shows the instrument channel openings 102 sealed with protective caps.

LIST OF REFERENCE CHARACTERS

[0105] 1 Shaft [0106] 10 Instrument channel [0107] 101 Instrument channel opening, distal [0108] 102 Instrument channel opening, proximal [0109] 11 Optics [0110] 12 Lighting device [0111] 13 Nozzle [0112] 2 handle [0113] 20 Operating element Shaft tip angling [0114] 21 Handle attachment [0115] 22 Valve holder [0116] 23 Instrument holder [0117] 24, 24 2-way tube manifold [0118] 241 Distal end of 24 and 24 [0119] 242 Instrument opening of 24 [0120] 243 Ring nut [0121] 3 Inner sleeve [0122] 30 Inner sleeve end face [0123] 30a Air-tube opening [0124] 30b Water-tube opening [0125] 30c Operating tube opening [0126] 31 Cap [0127] 32 Fabric tube [0128] 33 Gripper [0129] 331, 331 Click-closure [0130] 332 Bridge [0131] 4a Air tube [0132] 4b Water tube [0133] 4c Operating tube [0134] 4c Bellows section [0135] 4c0 Predetermined breaking point [0136] 4c1 Protective tube [0137] 4d Suction tube [0138] 5a Air valve [0139] 5b Water valve [0140] 5ab Combined air and water valve [0141] 5d Suction valve [0142] 6 Outer sleeve [0143] 61a,b,c Connection pieces [0144] 7a Diaper pants [0145] 7b Bite ring [0146] 7c Partition wall [0147] 71a,b,c Connection pieces [0148] 8 Instrument protection [0149] 81 Instrument tube [0150] 82 Instrument tube cap [0151] 80 Instrument [0152] 80a Micro unit [0153] 80b Instrument Bowden cable [0154] 80c Operating element instrument [0155] 91 Clip [0156] 92 Gasket, proximal [0157] 93 Clamping bracket, proximal [0158] 94 Clamp [0159] 95 Gasket, proximal [0160] 96 Clamping bracket, proximal [0161] 960 Positioning aid