COMBINED ULTRASONIC AND DIRECT VISUAL HYSTEROSCOPE

Abstract

An interventional hysteroscope includes a shaft, an optical imaging element, an ultrasonic imaging element and a treatment element, such as an ablation needle. The shaft has a distal end, a proximal end, and a longitudinal axis therebetween, and the optical imaging element is disposed at the distal end of the shaft. The ultrasonic imaging element is also disposed at the distal end of the shaft and is configured to image along a laterally oriented image path. The treatment element is configured to be deployed from the shaft along a laterally oriented treatment path, and the imaging path and the treatment path intersect at an intersectional location spaced laterally away from the shaft. A display is configured to present both an optical image from the optical imaging element and an ultrasonic image from the ultrasonic imaging element and to present a marker on the ultrasonic image at a location corresponding to the intersectional location.

Claims

1. An interventional hysteroscope comprising: a cannula having a distal end, a proximal end, and a longitudinal axis therebetween; an optical imaging element at the distal end of the cannula; an ultrasonic imaging element at the distal end of the cannula, the ultrasonic imaging element being configured to image along an imaging path; a treatment element configured to be deployed from the cannula along a treatment path, wherein the treatment element does not comprise the ultrasonic imaging element, and wherein the imaging path and the treatment path intersect at an intersectional location spaced from the cannula; and a display configured to present both an optical image from the optical imaging element and an ultrasonic image from the ultrasonic imaging element; wherein the display is further configured to present a marker on the ultrasonic image at a location corresponding to the intersectional location.

2. An interventional hysteroscope as in claim 1, further comprising a display disposed on a handle attached to the proximal end of the cannula.

3. The interventional hysteroscope of claim 1, wherein the cannula comprises one or more lumens for one or more of an endoscope, an ultrasound source, a guide channel for directing the treatment element into the intersection, fluid irrigation and fluid evacuation channels, and a working channel for an additional operating instrument.

4. The interventional hysteroscope of claim 3, wherein the endoscope comprises a CMOS chip and a transparent or semi-transparent tip at a distal end of the endoscope, wherein the distal end of the endoscope comprises the optical imaging element.

5. The interventional hysteroscope of claim 4, wherein the transparent or semi-transparent tip is configured to preserve a visual image upon contact with a tissue.

6. The interventional hysteroscope of claim 3, wherein the endoscope and the ultrasound source are configured to be disposed in a single lumen in the cannula.

7. An interventional hysteroscope as in claim 1, wherein the treatment element comprises a superelastic needle, wherein a distal end on the superelastic needle comprises a diverging array of needle segments.

8. An interventional hysteroscope as in claim 7, further comprising a needle lumen having a laterally deflected distal portion relative to the longitudinal axis of the cannula, wherein the superelastic needle is slidably mounted in the lumen so that a distal portion of the needle deflects laterally relative to the longitudinal axis of the cannula as the needle is advanced longitudinally through the lumen.

9. An interventional hysteroscope as in claim 1, further comprising a rotating mirror at the distal end of the cannula, wherein the ultrasonic imaging element faces proximally into the rotating mirror, wherein the rotating mirror reflects outgoing and incoming ultrasound energy laterally relative to the longitudinal axis of the cannula.

10. The interventional hysteroscope of claim 1, wherein the imaging path and the treatment path are laterally oriented such that an angle between the imaging path and the treatment path is between 0 degrees and 45 degrees.

11. The interventional hysteroscope of claim 1, further comprising one or more electrodes disposed in one or more channels in the cannula, wherein the one or more electrodes are configured to supply power to the optical imaging element and the ultrasonic imaging element.

12. A method for deploying at least one needle in tissue, the method comprising: capturing an optical image of a surface of the tissue with an optical imaging element disposed at a distal end of a device; capturing an ultrasound image of the tissue with an ultrasonic imaging element disposed at the distal end of the device and configured to image along an imaging path; extending a treatment element from the distal end of the device along a treatment path, wherein the treatment element is separate from the ultrasonic imaging element and comprises the at least one needle, and wherein the imaging path and the treatment path intersect at an intersectional location spaced away from the device; displaying a real time optical image of the surface of the tissue; displaying a real time ultrasonic image of the tissue including an anatomical feature to be treated; presenting a marker on the ultrasonic image at a location corresponding to the intersectional location; aligning the marker with the displayed anatomical feature to be treated; and applying energy through the treatment element to treat the anatomical feature.

13. The method of claim 12, wherein the imaging path and the treatment path are laterally oriented such that an angle between the imaging path and the treatment path is between 0 degrees and 45 degrees.

14. The method of claim 12, further comprising reflecting outgoing and incoming ultrasound energy laterally relative to a longitudinal axis of the device via a rotating mirror, wherein the rotating mirror is disposed at the distal end of the device and the ultrasonic imaging element faces proximally into the rotating mirror.

15. The method of claim 12, wherein the anatomical feature comprises a uterine fibroid.

16. The method of claim 12, wherein applying the energy through the treatment element to treat the anatomical feature comprises ablating the anatomical feature.

17. The method of claim 16, wherein the anatomical feature is ablated with radiofrequency energy.

18. The method of claim 16, wherein the anatomical feature is ablated using the at least one needle.

19. The method of claim 18, wherein the anatomical feature is ablated using at least one diverging needle segment of the at least one needle.

20. The method of claim 12, wherein extending the treatment element comprises advancing the at least one needle laterally relative to a longitudinal axis of the device.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0009] FIGS. 1A and 1B show the combined ultrasonic and visual hysteroscope inserted into the uterus, and the simultaneous images displayed on the video monitor.

[0010] FIG. 2A-2C depict the combined ultrasonic and visual hysteroscope, the components comprising its cannula portion, including a multiple pronged ablation needle element, and the resultant images displayed on its video monitor.

[0011] FIG. 3A-3C depict the configuration of the multiple pronged ablation needle element in the combined ultrasonic and visual hysteroscope.

[0012] FIG. 4A-4C depict the combined ultrasonic and visual hysteroscope incorporating a single ablation needle element, and the resultant images displayed on the video monitor.

[0013] FIGS. 5A and 5B shows the configuration of the multiple channels incorporated in the combined ultrasonic and visual hysteroscope cannula.

[0014] FIG. 6 shows a side view of the ultrasonic imaging path and the ablation treatment path intersecting at a location spaced laterally from the shaft of an example device in accordance with embodiments described herein.

[0015] FIG. 7 shows a side view of the ultrasonic imaging element in tandem axial alignment with an example rotating reflective element in accordance with embodiments described herein.

[0016] FIG. 8 shows a side view of the projected ablation treatment target location aligned with example anatomical structures observed in an example ultrasonic image as viewed top-down on an example device video monitor in accordance with embodiments described herein.

DETAILED DESCRIPTION OF THE DRAWINGS

[0017] FIG. 1A illustrates the combined ultrasonic and visual hysteroscope 10 as it is inserted into the uterus 11. The cannula portion 13 of hysteroscope 10 contains a solid spherical distal lens 14 that allows visualization of both the uterine cavity, as well as tissue in contact with lens 14. This is not the case with conventional untipped endoscopes, which display a blurry image if the endoscope lens contacts tissue. An intramural fibroid lesion 12 is present within the muscular wall of uterus 11. Intramural fibroid 12 is not visible via endoscopic visualization, but it is visible via ultrasonic scanning. The combined ultrasonic and visual hysteroscope 10 incorporates the capability to deliver saline irrigation into the uterus 11, and to evacuate irrigation fluid and blood from the uterine cavity. Two female luer lock fittings 15 situated on the device allow attachment of an irrigation line and a suction line. A video monitor 16, generally a liquid crystal display (LCD) monitor, is incorporated in the device. The combined ultrasonic and visual hysteroscope device 10 is powered by a 9-volt battery, and the entire device is intended to be disposable after a single use.

[0018] FIG. 1B is an enlarged image of the video monitor 16, showing the simultaneous viewing of the endoscopic image 17 and the ultrasonic image 18. An indicator dot 19 appears on the ultrasonic image 18, and this dot 19 corresponds to the location of tip of the ablation needle that is advanced out of the ultrasonic and visual hysteroscope 10. Placement of the indicator dot 19 on the ultrasonic image 18 of the fibroid 12 aligns needle insertion with the fibroid 12 for ablation.

[0019] FIG. 2A is an illustration of the combined ultrasonic and visual hysteroscope 10 inserted into the uterus 11. FIG. 2B is a longitudinal sectional view of the cannula portion 13 of hysteroscope 10, depicting several of the components inside the cannula 13. A 3 mm diameter lumen 20 in the inferior aspect of cannula 13 houses an optical imaging element or CMOS chip camera 21 on its distal end. The CMOS chip camera 21 is bonded to a solid, optically clear spherical lens 22. The spherical lens 22 may be formed of a drop of ultraviolet light curable adhesive that is applied directly to the distal face of the CMOS chip camera 21, or it may be an injection molded polymer lens that is bonded with ultraviolet cure adhesive to the CMOS chip 21.

[0020] An ultrasound imaging element or ultrasound transducer 25 lies in the inferior lumen 20 of cannula 13, proximal to the CMOS chip camera 21. A 5 mm-7 mm gap lies between the CMOS chip 21 and the ultrasound transducer 25. The ultrasound transducer 25 faces in the proximal direction of cannula 13, such that its beam is directed inward in cannula 13, while the CMOS chip camera 21 views laterally outward from cannula 13. A rigid rod 27 with a distal angled reflective surface 28 lies approximately 10 mm-15 mm proximal to the ultrasound transducer 25, and the rod 27 rotates at a frequency of approximately 20-40 Hz. Ultrasound beams emitted from the transducer 25 strike the reflective surface 28 and exit via an opening 29 in the inferior wall of cannula 13. The reflected beams 30 image tissue beneath the endometrial surface of the uterus 11. Intramural lesions, such as a fibroid 12, may thus be observed via ultrasonic imaging.

[0021] A rigid angled tube 31 is positioned superior to the ultrasonic and video camera lumen 20, and the angled portion of tube 31 extends down to the inferior aspect of the cannula 13 in the gap between the CMOS chip camera 21 and the ultrasound transducer 25. Rigid angled tube 31 guides the forward advancement of a radiofrequency ablation element 32. Radiofrequency ablation element 32 is typically formed of super-elastic metal such as Nitinol, to enable it to accommodate passage through the angled portion of tube 31 and to extend straight downward to intersect with fibroid 12. A distal portion of the ablation element 32 may be formed as multiple needle segments 33 to diverge and engage a larger volume of the fibroid 12 for enhanced ablation energy delivery.

[0022] Also visible in the sectional view of cannula 13 are insulated wire conductors 23 and 26, that lie superior to inferior lumen 20. Wire conductor 23 enters a superior aspect of inferior lumen 20 at its distal end to supply power to the CMOS chip camera 21, while wire conductor 26 enters inferior lumen 20 at the site of the ultrasound transducer 25 to power that device.

[0023] FIG. 2C is an enlarged view of the video monitor image 16, depicting the simultaneous projection of the endoscopic image 17 and the ultrasonic image 18. Visible in the ultrasonic image 18 is the shadow of the multiple ablation needle segments 33, the fibroid 12 and an indicator dot 19 corresponding to the path of the main axis of the ablation element 32 as it extends laterally from cannula 13. During use of the combined ultrasonic and visual hysteroscope 10, the physician maneuvers the device to center the indicator dot 19 on the ultrasonic image of the fibroid 12, followed by targeted advancement of the ablation needle segments 33 into the body of fibroid 12.

[0024] FIG. 3A shows a longitudinal sectional view of the cannula 13, with the ablation element 32 lying inside the rigid angled guide 31, and the multiple needle segments 33 that comprise the distal end of ablation element 32. FIG. 3B depicts an embodiment of a configuration of the ablation element 32, with multiple wire elements 33 containing distal angled needle points and preformed bends 34 of the distal segment. The distal bent segment of wire element is approximately 2-3 cm in length. The entire length of the wire elements 33 proximal to the bend 34 may be constrained by an outer sheath 35 that maintains the orientation of the distal wire elements in a splayed out position. Outer sheath 35 may be composed of a heat shrink polymer such as polyolefin or polyethylene terephthalate (PET) that is shrunk around the bundle of wire elements 33 whose straight portions are attached together using ultraviolet cured adhesive. Alternatively, outer sheath 35 may be a metal tube formed out of a material such as stainless steel, with its outer surface insulated with a non-conductive polymer such as polyolefin, polyethylene or polytetrafluoroethylene (PTFE). FIG. 3C is a cross-sectional view of the straight section of the ablation element 32, composed of multiple strands of super-elastic wire 33 encased by an outer sheath 35. Each strand of super-elastic wire 33 may be approximately 0.5 mm in diameter, and the outer diameter of the ablation element 32 may be approximately 1.2 mm in diameter.

[0025] FIG. 4A depicts an alternate version of the combined ultrasonic and visual hysteroscope 10 inserted into the uterus 11. FIG. 4B is a longitudinal section of the device cannula 13, showing that the ablation element 32 in this version is comprised of a single solid super-elastic metal needle. When the hysteroscopic device 10 is used to ablate a large fibroid 12, the ablation element 32 is inserted and withdrawn multiple times in different regions of the fibroid 12 to perform the therapy. FIG. 4C is an enlarged view of the video monitor image 16, with the ultrasonic image 18 displaying the shadow of the single ablation needle element 32 as it enters the fibroid 12. The indicator dot 19 targets the entry location of the ablation needle 32 into the fibroid 12.

[0026] FIG. 5A is a side sectional view of cannula 13, depicting the inferior lumen 20 housing the ultrasound transducer 25 and the CMOS chip 21. Angled tube 31 lies superior to inferior lumen 20, and it houses ablation element 32 with its multiple distal needle segments 33. FIG. 5B is a cross-sectional view of cannula 13, showing the angled tube 31 and instrument channel 35 lying superior to inferior lumen 20. Two additional channels 35 lie lateral to angled tube 31 and instrument channel 35, to provide separate conduits for irrigation and suction during therapeutic uterine procedures. Also present in the FIG. 5A and FIG. 5B are the insulated electrodes lying in their own channels bounded by inferior lumen 20, angled tube 31, adjacent irrigation/suction channel 35; and inferior lumen 20, instrument channel 35, and adjacent irrigation/suction channel 35. One electrode 23 supplies power to the CMOS chip 21, and the other electrode 26 supplies power to the ultrasound transducer 25. Cannula 13 may be formed of individual semi-rigid metal or polymer tubes constrained together in the desired configuration using adhesive and an outer covering of heat shrink polymer, or it may be a multi-lumen extruded polymer tube with a short tubular section added between the ultrasound transducer 25 and the CMOS chip 21 to form the angled tube 31.

[0027] FIG. 6 shows the path of the ultrasonic imaging beam 30 striking the target intramural fibroid 12 in the wall of uterus 11. The ablation treatment multiple needle component 33 may advance out of the cannula device 13 and the needle component 33 can intersect with the ultrasonic imaging beam 30 at the site of intramural fibroid 12.

[0028] FIG. 7 shows that both the ultrasonic imaging element 25 and the rotating reflective element 28 are situated in the inferior lumen 20 of the cannula 13 in axial alignment, such that ultrasonic beam 30 emitted by ultrasonic imaging element 25 can strike rotating reflective element 28 and may exit out of the side of cannula 13.

[0029] FIG. 8 shows the cannula 13 in an anatomical treatment position inside the cavity of uterus 11, with the corresponding ultrasonic image 18 visible in the device video monitor 16. When the indicator cursor 19 on the ultrasonic image 18 is placed in the center of the ultrasonic image of the intramural fibroid 12, advancement of ablation needle component 33 can be automatically aligned to intersect with the anatomic position of intramural fibroid 12, and images of both the ablation needle component 33 and its entry into the intramural fibroid 12 may be observed in the ultrasonic image 18 in device video monitor 16, which can assist proper ablation of fibroid 12 deep in the wall of uterus 11.