METHODS, DEVICES AND SYSTEMS FOR TREATING EUSTACHIAN TUBE DISORDERS
20190274887 ยท 2019-09-12
Assignee
Inventors
Cpc classification
A61B1/233
HUMAN NECESSITIES
A61B34/20
HUMAN NECESSITIES
A61F11/202
HUMAN NECESSITIES
A61B1/00135
HUMAN NECESSITIES
A61M25/10184
HUMAN NECESSITIES
A61M25/10181
HUMAN NECESSITIES
International classification
A61F11/00
HUMAN NECESSITIES
A61B1/00
HUMAN NECESSITIES
Abstract
A device for dilating an Eustachian tube of a patient including an inner member, an inflation fluid supply tube, a balloon, and a coupler. The inner member includes a lumen fluidly open at distal and proximal ends. The inner member has a distal portion, a proximal portion, and a central portion. The inflation fluid supply tube is fixedly disposed around the central. The inflation fluid supply tube has an opening disposed between first and second ends. A proximal portion of the inner member extends through the opening and the opening is fluidly sealed against an exterior surface of the inner member. The coupler is configured to selectively couple the inflation fluid supply tube to an endoscope. The coupler is configured to engage against an exterior surface of the inflation fluid supply tube. The coupler is disposable between the first end and the opening of the inflation fluid supply tube.
Claims
1. A device for use in dilating an Eustachian tube, the device comprising: an inner member comprising an elongated tubular body and a lumen fluidly open at a distal end and a proximal end, the inner member having a distal portion terminating at the distal end, a proximal portion terminating at the proximal end, and a central portion extending between the distal portion and the proximal portion; an inflation fluid supply tube fixedly disposed around the central portion of the inner member and including an inflation lumen, the inflation fluid supply tube having a first end, a second end opposite the first end, and an opening disposed between the first end and the second end, wherein the proximal portion of the inner member extends through the opening and the opening is fluidly sealed against an exterior surface of the inner member, and wherein the distal portion of the inner member extends distally beyond the first end; a balloon having a distal side opposite a proximal side, wherein the distal side is coupled to the inner member adjacent the distal end of the inner member and the proximal side of the balloon is in fluid communication with the inflation lumen; and a coupler configured to selectively couple the inflation fluid supply tube to an endoscope, wherein the coupler is configured to engage against an exterior surface of the inflation fluid supply tube and be disposable between the first end and the opening of the inflation fluid supply tube.
2. The device of claim 1, wherein the coupler is configured to frictionally engage with an outer surface of an endoscope sheath disposed along the endoscope.
3. The device of claim 1, wherein the inner member and the inflation fluid supply tube are each formed of a malleable material.
4. The device of claim 1, wherein the proximal end of the inner member is disposed exterior of the inflation fluid supply tube.
5. The device of claim 1, wherein the coupler longitudinally fixes the inflation fluid supply tube to the endoscope.
6. The device of claim 1, wherein the device includes at least two of the couplers spaced from one another along a length of the inflation fluid supply tube.
7. A dilation treatment system for use in dilating an Eustachian tube of a patient the system comprising: a dilation treatment device comprising: an inner member comprising an elongated tubular body and a lumen, the lumen fluidly open at and between a distal end and a proximal end; an inflation fluid supply tube fixedly disposed around a central portion of the inner member, the inflation fluid supply tube defining a first end, a second end, and an inflation lumen extending between the first end and the second end, the distal end of the inner member extended distally of the first end, the proximal end of the inner member extended through an opening of the inflation fluid supply tube; a balloon mounted to a distal portion of the inner member and fluidly coupled to the inflation lumen; an endoscope including an endoscopic insertion unit defining a viewing end; and a coupler configured to selectively couple the endoscopic insertion unit to the dilation treatment device with the endoscopic insertion unit extending parallel and longitudinally fixed relative to the inflation fluid supply tube, wherein the viewing end is disposed alongside a distal section of the inflation fluid supply tube, wherein the coupler is disposed between the first end and the opening of the inflation fluid supply tube.
8. The system of claim 7, wherein the distal portion of the inner member extends transversely away from the viewing end.
9. The system of claim 7, wherein the endoscopic insertion unit includes a sheath disposed on an insertion body, and further wherein the inner member and the endoscopic insertion unit are selectively coupled in parallel along an insertion length of the sheath.
10. The system of claim 7, wherein the viewing end is proximal the balloon.
11. The system of claim 7, wherein the balloon is disposed distal the viewing end.
12. The system of claim 7, wherein the inflation fluid supply tube is configured to maintain a pre-determined length during pressurization of the balloon.
13. The system of claim 7, wherein the coupler frictionally engages the endoscopic insertion unit and the inflation fluid supply tube.
14. The system of claim 7, wherein the coupler fixedly maintains the inflation fluid supply tube relative to the endoscopic insertion unit.
15. The system of claim 7, wherein the coupler releasably couples the endoscopic insertion unit and the dilation treatment device.
16. The system of claim 7, wherein the endoscopic insertion unit includes an insertion body disposed within a sheath, and further wherein the coupler is disposed around a circumference of the sheath and of the inflation fluid supply tube.
17. A method of endoscopically treating an Eustachian tube of a patient, comprising: coupling a dilation treatment device and an endoscope together with one or more couplers to form a dilation treatment system, wherein the endoscope includes an endoscopic insertion unit defining a viewing end, and further wherein the dilation device comprises: an inner member fixedly extending within an inflation fluid supply tube, the inner member including a distal portion extending distal a first end of the inflation fluid supply tube, a proximal portion extending proximally outside of the inflation fluid supply tube, and a lumen fluidly open at a distal end and a proximal end, and a balloon disposed on the distal portion of the inner member and fluidly coupled to the inflation fluid supply tube; wherein the step of coupling includes the dilation treatment device and the endoscopic insertion unit longitudinally fixedly aligned and coupled together by the one or more couplers, and the viewing end fixedly disposed proximal to the first end of the inflation fluid supply tube and proximal to the distal portion; advancing the dilation treatment system into a patient's anatomy; visualizing a position of the distal portion of the inner member within the patient's anatomy with the endoscope; positioning the distal portion of the inner member at a target site within the patient's Eustachian tube; inflating the balloon through the inflation fluid supply tube at the target site; and dilating an opening of the patient's Eustachian tube at the target site with the inflated balloon.
18. The method of claim 17, further comprising: suctioning bodily fluids from the patient's anatomy through the lumen of the inner member.
19. The method of claim 18, wherein the steps of suctioning and inflating are performed simultaneously.
20. The method of claim 17, wherein the steps of visualizing and positioning are performed simultaneously.
Description
BRIEF DESCRIPTION OF THE DRAWINGS
[0013]
[0014]
[0015]
[0016]
[0017]
[0018]
DETAILED DESCRIPTION
[0019] Surgical devices and systems embodying principles of the present disclosure can be employed in various types of surgical procedures including, but not limited to, treatment of Eustachian tube dysfunction. The surgical treatment systems, in accordance with aspects of the present disclosure, can provide for ease of use to the surgeon by allowing the surgeon to operate both an endoscope and a balloon dilation device simultaneously with one hand. Additionally, attaching the endoscope and balloon dilation devices together allows the surgeon to simultaneously insert and efficiently manipulate and operate the devices through the limited space available to treat the Eustachian tube.
[0020]
[0021] With additional reference to
[0022] The inner member 12 includes an exterior surface 29 and defines a lumen 32. The lumen 32 is fluidly open at and between the distal end 24 and the proximal end 28. The lumen 32 of the inner member 12 is suitable for pressure relief, irrigation, or aspiration. In some non-limiting embodiments, the inner member 12 can have an outer diameter on the order of 1 mm. The inner member 12 has a length suitable to extend fully within the patient's anatomy to the target site to position the distal portion 22 at the target site while the proximal portion 26 extends outside of the patient. The proximal end 28 can be positioned exterior of the patient to be fluidly open to the atmosphere or connectable to an aspiration source or an irrigation source, as appropriate. In some embodiments, the proximal portion 26 can also provide for grasping by a user or robotic arm from exterior of the patient.
[0023] The inner member 12, along with one or more other components of the dilation treatment device 11, is formed of biocompatible materials. Additionally, all or portions of the inner member 12 can be formed of a malleable material. The inner member 12 is formed to be manually bendable to a desired shape and to substantially retain the shape during a dilation procedure. For example, the center portion 30 and the proximal portion 28 of the inner member 12 can be malleable in conjunction with, or separate from, the distal portion 22. As used herein, the term malleable refers to being cable of being shaped, bent, or otherwise deformed by forces produced by manual manipulation of a human user such that the malleable element retains the deformation. The materials can be malleable, bendable, flexible and combinations of these characteristics. The inner member 12 can be formed of medical grade annealed aluminum, stainless steel, or nitinol, for example.
[0024] The balloon 14 can be an expandable balloon that is transitionable between a low-profile contracted, deflated state against the inner member 12 and an expanded, inflated state. The balloon 14 is illustrated in the expanded state. In some embodiments, the balloon 14 is sized and shaped for dilating a patient's Eustachian tube when transitioned to or toward the expanded state. The balloon 14 has a distal side 31 and a proximal side 33. In one embodiment, the balloon 14 is approximately 20 mm in length (between the distal and proximal side 31, 33) and has an expanded diameter of 5 mm to 7 mm. In some embodiments, the balloon 14 can be transparent or translucent. The balloon 14 is formed of a flexible biocompatible material. Any suitable expandable medical balloon material and construction available may be used.
[0025] The inflation fluid supply tube 16 is an elongate tubular sheath having an exterior surface 34. The inflation fluid supply tube 16 is sized to fit around the inner member 12 and includes or defines an inflation lumen 36 extending therethrough between opposing first and second ends 38, 40. An opening 42 is disposed between the first end 38 and the second end 40 of the inflation fluid supply tube 16. In one embodiment, the opening 42 is an aperture in a sidewall 44 of the inflation fluid supply tube 16. A distal section 46, terminating at the first end 38, can be shaped by a user or otherwise formed in a predetermined shape. In one embodiment, at least the distal section 46 of the inflation fluid supply tube 16 can be formed of a malleable material. The distal section 46 can be bendable by the user without breaking or losing required strength to assume a different shape useful in placement in the specific anatomy of a patient, and to retain substantially that shape during a dilation procedure. The inflation fluid supply tube 16 is formed of a material that does not substantially change in length during pressurization, such as pressurization used to inflate the balloon 14. The inflation fluid supply tube 16 substantially maintains a length between the first and second ends 38, 40 during pressurization of the balloon 14 and when not pressurized. The inflation fluid supply tube 16 is formed of a material that is suitably rigid to maintain the inflation lumen 36 along the length proximal of the distal section 46.
[0026] When assembled, the inner member 12 is longitudinally fixed within the inflation fluid supply tube 16. More particularly, the center portion 30 of the inner member 12 is disposed within the inflation fluid supply tube 16. The center portion 30 of the inner member 12 can extend within the inflation lumen 36 of the inflation fluid supply tube 16 or can be fluidly separated from the inflation lumen 36 (not shown). In one embodiment, the inflation fluid supply tube 16 is heat welded onto the inner member 12. In one embodiment, the inner member 12 is adhered to the inflation fluid supply tube 16 at the first end 38. In another embodiment, the inner member 12 is adhered to the inflation fluid supply tube 16 within the inflation fluid supply tube 16.
[0027] The distal portion 22 and proximal portion 26 of the inner member 12 extend and terminate outside of the inflation fluid supply tube 16. The proximal portion 26 of the inner member 12 extends through the opening 42 in the sidewall 44 of the inflation fluid supply tube 16. The opening 42 is configured to provide sealed passage of the inner member 12 from an interior to an exterior of the inflation fluid supply tube 16. The inflation fluid supply tube 16 can be fluidly sealed around the exterior surface 29 of the inner member 12 at the opening 42. For example, the opening 42 can be sealed against the inner member 12 with an interference fit, an adhesive or knurled. Other suitable means of sealing are also acceptable. The opening 42 is positioned along the inflation fluid supply tube 16 such that the proximal portion 26 of the inner member 12 extends a suitable distance from the first end 38 so as to be located at the exterior of the patient when the balloon dilation device 11 is inserted into an insertion pathway of the patient to the target treatment site.
[0028] The distal portion 22 of the inner member 12 extends distally through and at least partially beyond the first end 38 of the inflation fluid supply tube 16. The distal portion 22 can extend partially within the distal section 46 of the inflation fluid supply tube 16. The distal portion 22 of the inner member 12 extends beyond, or distal to, the first end 38 of the inflation fluid supply tube 16 to maintain the balloon 14. The balloon 14 is disposed around the inner member 12 with the distal side 31 of the balloon 14 coupled to the distal portion 22 of the inner member 12. The distal portion 22, along with the distal section 46 of the inflation fluid supply tube 16, provides suitable flexibility to the balloon dilation device 11 and can be bent to a desired shape to accommodate the patient's anatomy. In one embodiment, the inner member 12 and/or the inflation fluid supply tube 16 can be formed into a pre-determined geometry during manufacturing. In another embodiment, the inner member 12 and/or the inflation fluid supply tube 16 are formed to a determined shape by the surgeon or user.
[0029] The balloon 14 is mounted adjacent the distal end 24 of the inner member 12 along the distal portion 22 with the proximal side 33 of the balloon 14 coupled to the inflation fluid supply tube 16. The balloon 14 can be fixedly coupled to the inner member 12 and the inflation fluid supply tube 16 by welding, adhesive, or other suitable means. In one embodiment, the balloon 14 is disposed along the distal portion 22 with the distal side 31 disposed a suitable distance from the terminal distal end 24 of the inner member 12 to seal and couple the balloon 14 against the inner member 12 and maintain the internal pressure of the balloon 14 when inflated to the expanded state. In one embodiment, the distal side 31 of the balloon 14 is positioned 3 millimeters to 4 millimeters (mm) from the distal end 24 of the inner member 12. The first end 38 of the inflation fluid supply tube 16, and in particular, the inflation lumen 48, fluidly communicates with and terminates at the balloon 14 to inflate, or expand, the balloon 14, for example. The inflation fluid supply tube 16 can fluidly couple the inflation lumen 36 at the first end 38 of the inflation fluid supply tube 16 to the balloon 14 for rapid inflation and deflation of the balloon 14. The inflation fluid supply tube 16 does not expand under the pressures used to expand the balloon 14.
[0030] The coupler 18 can be employed to attach the balloon dilation device 11 to the endoscope 20.
[0031] Returning to
[0032] The insertion body 64, as well as the sheath 66 when provided, can be flexible in order to traverse the patient's anatomy without damage to the anatomy. The insertion body 64 can be a variety of sizes (e.g., length and diameter) suitable for insertion and navigation within the patient's anatomy. The insertion body 64 terminates at a viewing end 72. The viewing end 72 can be angled, rounded or squared off. The sheath 66 is sized and shaped to maintain the insertion body 64 and facilitate the provision of irrigation or suctioning to remove surgical debris from the viewing end 72 and can include air tubes, water tubes, or suction tubes (not shown) to flush away or suction away surgical debris from the viewing end 72. The sheath 66 can include a connection assembly 74 as an inlet and fluid connection to an irrigation or aspiration source (not shown). The endoscope 20 can include a camera 76 connectable to a monitor by way of a camera cable 78. Images received through the endoscope 20 can be view on the monitor by a user.
[0033] With additional reference to
[0034] With reference to
[0035] With continued reference to
[0036] With additional reference to the exploded view of
[0037] The inflation fluid supply tube 16 can be longitudinally fixed with respect to the endoscopic insertion unit 68. In the assembled state, the viewing end 72 of the endoscope 20 can be positioned proximal to the first end 38 of the inflation fluid supply tube 16. In one embodiment, the viewing end 72 of the endoscope 20 can be spaced a distance d from the first end 38 of the inflation fluid supply tube 16, and thus, also spaced from the balloon 14. The distance d is suitable to allow the balloon 14 to be inflated without interference, or obstruction, from the endoscope 20. In one embodiment, the distance d between the viewing end 72 and the first end 38 of the inflation fluid supply tube 16 can be 1 centimeter (cm). The system 10 can allow the surgeon to bend the distal portion 22 of the inner member 12 to accommodate the patient's anatomical constraints and to position the balloon 14 at least partially out of the field of view of the endoscope 20 for visualization. In some embodiments, the distal portion 22 of the inner member 12 maintaining the balloon 14 can be curved transversely away from the viewing end 72 of endoscope 20.
[0038] The dilation treatment system 10 formed of the combined endoscope 20 and balloon dilation device 11 allows the surgeon to use a single hand to manipulate the system 10 within the patient's anatomy to simultaneously visualize and treat, for example, the patient's Eustachian tube. In inserting the treatment system 10 into the patient's anatomy, the endoscope 20 is inserted and advanced simultaneously with balloon dilation device 11 for the treatment and observation of the Eustachian tube. In particular, the position of the distal portion 22 of the inner member 12 within the patient's anatomy can be visualized through the viewing end 72 of the endoscope 20 as the dilation treatment system 10 is advanced or otherwise positioned within the patient's anatomy. The distal portion 22 of the inner member 12 is maneuvered and positioned at a target site within the patient's anatomy with the assistance of the visualization provided by the endoscope 20.
[0039] During use, the second end 40 of the inflation fluid supply tube 16 can be fluidly coupled to an inflation source (not shown). The inflation source supplies pressurized fluid to inflate the balloon 14 through the inflation fluid supply tube 16 when the balloon 14 positioned at the target site, as confirmed by visualizing the position with the endoscope 20. The lumen 32 of the inner member 12 can be used for pressure relief of the patient's anatomy in response to, and in some cases simultaneously to, inflation of the balloon 14. Bodily fluids can be vented, suctioned, or otherwise removed, from the patient's anatomy through the lumen 32 of the inner member 12 during insertion as well as during and after inflation, for example. The balloon 14 may be held in the target position while maintained in the expanded state for an extended period of time, for example, several seconds or minutes. The extended period of time is suitable to effect an open dilated state to the Eustachian tube of the patient.
[0040] The balloon 14 may be returned to a deflated state and repositioned by advancing or withdrawing the dilation treatment system 10 within the patient's anatomy with the endoscope 20 providing visualization to properly reposition in the desired location within the Eustachian tube. The balloon 14 can then again be inflated and maintained in the expanded state for a suitable extended period of time to effect an open dilated state of the desired anatomical passageway. The balloon 14 can be deflated and the dilation treatment system 10 can be withdrawn from the patient's anatomy in a direction reverse of the insertion and advancement. In some embodiments, once withdrawn, the coupler 18 can be removed to uncouple and release the balloon dilation device 11 from the endoscope 20. The balloon dilation device 11 and the endoscope 20 can then independently be sterilized or disposed of.
[0041] Although the present disclosure has been described with reference to preferred embodiments, workers skilled in the art will recognize that changes can be made in form and detail without departing from the spirit and scope of the present disclosure.