CA1180620A

CA1180620A - Endoscope assembly and surgical instrument for use therewith

Info

Publication number: CA1180620A
Application number: CA000410268A
Authority: CA
Inventors: Charles D. Cawood
Original assignee: Individual
Current assignee: Individual
Priority date: 1981-09-28
Filing date: 1982-08-27
Publication date: 1985-01-08
Also published as: EP0089989A1; PT75554B; GR76730B; ES8401315A1; AU551780B2; WO1983000992A1; JPS58501500A; US4759348A; IT8223480A0; IT1152665B; PT75554A; ZA826136B; EP0089989A4; AU8956382A; ES516033A0

Abstract

ENDOSCOPE ASSEMBLY AND SURGICAL
INSTRUMENT FOR USE THEREWITH

Abstract An endoscope assembly, and the surgical instrument associated with it, capable of providing superior visibility of an operative site while at the same time insuring the transmission of tactile information to the surgeon through the handle of the instrument. The endoscope assembly comprises an optical head equipped with a connector or connectors for externally and releasably attaching the head to a surgical instrument at the neck portion adjacent the operating end thereof, an eyepiece or other viewing unit remote from the head, and an elongated flexible cable extending between the two. In the embodiment disclosed, the cable contains a light-transmitting waveguide for illuminating the operative area and a fiberoptic bundle for transmitting a coherent image of the area so illuminated. The cable may also be provided with a passage for delivering irrigating fluid (liquid or gas) to the operative site.

Description

Background ard Summary Various types of specialized forceps, clamps, and other surgical instruments have been developed over the years for use in performing specific surgical operations, and in many cases the con`iguration and construction of such instruments has been based not only on anatomical considerations but also on the importance of providing ~he surgeon with tactile information essential in achieving proper control over such an instrument. Thus, forceps used for removal of kidney stones generally have angular shank portions of minimal length so that the closed jaws of such an instrument can be readily inser~ed into the kidney through an incision in the renal pelvis, and the tips of the closed jaws may then be used as a probe to help the surgeon locate the stones requiring removal. Visual aids such as fluoroscopy and x-radiography are often used, but a surgeon mani?ulating such an instrument must nevertheless rely primarily on tactile sensitivity to locate, grasp, and remove the calculi.

More recently, endoscopic instrumen.s have been developed to provide surgeons with an internal view of the organ or body pzssage requirins treatment, such endosco~es ty?ically having channels through wnich a miniaturized forceps, commorly called flexible ins~ruments, are inserted and advznced. While such a svstem does ?rovide the surgeon ,~i.h an internal view of the operative site, miniaturization reduces the effectiveness of the flexible instrumert for ~ny ur.ctions such as, for example, grasping and removing la-~e~ size kidney stones. Moreover, the flexibility of the 3~j gra_?ins ~or cutting) instrument, and the distance between 6~2~

its jaws and the remote handles held by the surgeon, all but eliminate the transmission of tactile signals and require that almost complete reliance be placed on endoscopic observation in performing surgical manipulations.
Not only zre the surgeon's hands spaced well away from the distal end of the endoscope and the jaws of ~he instrument, - but they are normally fully occupied by the manipulations required at the proximal end of the equipment. One hand is common~y used to hold and direct the endoscope while the other is used to direct and operate the flexible instrument and also to control the irrigation system -- all such manipulations occurring at the proximal end of the endoscopic system, well away from t~e organ or body ?art undergoing surgical treatment. ~ny tactile feedback is ~inimal because of the lack of rigidity of the instrument and the distance between its jaws and operating controls.
ReLerences illustrative of the state of the art ~ S-;~ are~,?atents 3,960,143, 4,046,149, 4,046,150, 4,043,323, and 3,413,976. Other publica.ions are Tsuchida, S., A ~ew Operative Fiber?velosco~e, Journal ol Urology, 117:643~ lay 1977), Olinger, C.?. & R.L. Ohlhaber, Eigh'een-Guage Needle Endoscope with le~ible Viewing System, Su-g. Neurol. 4:537-8 (1975), Stotter, ~., ~.3. Wiendl, & 3. Ultsch, An Im?roved Flexible Cholansioscope, Endoscopy 7:150-3 (1975), Gittes, R.~., Operative Nephrosco?y, Journal of Urology, 116:148-52 (1976), Miki, M., Y. Inaba, & T. Machida, Operative Nephrosco?y with ~ibero?tic Scope: Prelimin2ry ~eport, Journal o' ~rology, 119:166-8 (~ebruary 1978).

An objec. or this invention thereIore lies in ,() providing ~n endosco?e assembly and surgical instrument which 6~

allow a surgeon to use both hands at the surgical site, thereby providing maximum tactile input through hand contact with the organ and the surgical instrument used to enter that organ, while at the same tlme providing endoscopic visualization of the interior of the organ and the tip action of the instrument involved. A further object is to provide a system ~~ which allows a surgeon to use an instrument having greater holding capacity and effectiveness than a miniaturized intraluminal grasping i~strument, and which also provides the surgeon with both tactile input and visual confirmation.
Another object is to provide an endoscopic attachment for a rigid sur~ical instrument having jaws for probing, grasping, and/or cutting, the attachment being removable when not needed, or when its use is require~ with another related type of instru~ent. A still further object is to provide a low profile e~doscopic attachment which con~a`ins flexible transmitting means for illuminating and transmitting images, and which also provides a passage for irrigation of the operative site.

In brief, the instrument used in the combination of this invention may be any o_ a variety or specialized instruments used for probing and grasp~ng or, in some cases, cutting, which are designed to be held and operated by one hand and~icn provide the surgeon with a high level of tac+ile input. For that _ ?urpose, such an inst_ument should have 2 handle or shank portion o_ rigid construction. For example, where the instrument is to be useZ ! or nephrolithotomy or phelolithotomy with calyceal s~one e~.traction, the instrument may be a modi~ied version of conven~ional Ray o~ Randall force~s. Such instruments are rigid enoush to be ?reciselv manipulated by the surgeon's hand r. close ?roximity to the kidney (preferably with the other hand holding and manipulatins the kidnev), while providin~ maximum tac_ile sensi ivity and 5u-f iC ien.ly greater capability for %~

grasping and removing larger stones (those having a diameter greater than about 0.8 centimeters! as well as stones of smaller size~

The endoscope assembly includes an elongated flexible cable equipped at one end with an eyepiece or other viewing means and at the othex with an optical head. Only the head is ~ directly and externally connected to the instr~ent, such rigid connection being made to the instrument's neck portion adjacent the jaws thereof. The cable transmits images or image-producing signals from the illuminated operative site at the head bacX to the viewing means so th2t the surgeon will have visual con~irma~
tion of the action of the instrument's working end as well as direct tactile inpu. txznsmitted through the rigid handle or shank of the hand-held insl.rument.

In the particular embociment disclosed, the connection between the optical head and ~he instrument is releasable, the head being equipped with one or more spring clips for detachably en~asing the instrument's neck por~ion. ~he head is generallv crescent-sha?ed in cross section so that its contour complements 20 t;~2_ of the instr~ment. .~ coneren. optic bundle ex,ends from the head and through the ~lexible ca~le to the eyepiece -or providing ,ne surgeon with visual confinmation of the instrument's tip or jaw action which, 25 already indic2ted, is also confi;med by _ direct tactile input. ~he illuminating means may take the 'or~ of 2 ligh-transmi~ting wavecuide extending through the cable to illuminate the o?erative a-ec, such waveguide being connected at i_s ~roximal er.d to a sui~able high-intensity light source.
Tdeall~, the cable 21so ?rovides 2 flow passage for the delivery o~ 'luid (liquid or gas) for ir-iga'ion or other purposes, the 3~ 10W passase and tne ll~.inating means being disposed on opposite si~ s o-r ~he cohe-e-.t i~age-transmit~ing waveguide.

A support is provided ~or holding the eyepiece so that the surgeon's hands are free to remain near the operative site at the distal end of the instrument. The support may take the form of a standard adapted to be mounted upon a floor, table, or other stationary surface, or a headband worn by the surgeon Other features, objects, and advantages of the invention will become appaxent from the specification and drawings.

Drawings Figure 1 is a per.spective view, shown partl~
diag~ammatically, depicting the complete system oî an embodiment of this invention.
Figure 2 is an enlarged fragmentary perspective view showing the distal ends of the inst~ument and endoscope assembly.
Figure 3 is a perspective view of the distal end of the endoscope assem,ly in the same ~osition illustrated in Figure

2, but wit;n the head and cable being shown in phantom to illus-trate a cli~ construction for securing the endoscope to the neck of a surgical instrument.
Fisure 4 is an enlarged cross sectional view taken alons line 4-4 o Figure 2.
~ igure 5 is an enlarged cross sectional view alons line ~-S or Figure 2.
- ~igure 6 is a -asmentary perspective view illustrating zlternative support mezns .or holding the eyepiece Or the endosco?e assembly in operation position.

Detailed Description of Pre~erred Embodiment r'~efer~ing to the drawlngs, `he numer21 10 generally ce~.ignates a comple~e operating system comprising a hand-3r) holdz~le surgical ins,r~ment ll, an endoscope assembly 12,s~pport mezns 13 for ~he eyepiece o~ thzt assembly, a light 2~

source 14, and one or more sources 15 and 16 of irrigating fluid.

The instrument 11 includes a handle portion 17 dimensioned and constructed to be held and operated by one hand, a rigid shank portion 18 which extends a limite2 distance from the handle and which, in the embodiment illustrated, is curved near its distal end, a neck portion 19 which may constitute a distal extension of the shank portion, and jaws 20 operatively connected to the operating elements of handle portion 17 and adapted to open and close when the elements of the handle portion are manipulated.
In its general outline and construction, the particular instrument 11 illustrated in the drawings is essentizlly a modified version of 2 forceps commonly known as a Ray kidney stone forceps, although i. will be understood that or other types of surgery the instrument 11 may assume a substantially different appearance. It is believed essential, however, that regardless of the configuration and intended use of the instrumen~, such instrumen~ mus. be small enough to be held and o?erated by one hand, have an operating end normally ?rovided wilh jaws for grasping and/or cutting, and be rigid enough to provide the surgeor. wi.h positive tactile feedback in use.

Handle portion 17 is shown having a pair of lever elements 17a and 17b equi?ped with finger loops 17c. While such an arrangement has been found effective for purposes of inst~ument manipulation and control, other arrangements .ma~ be substituted. ~or exam?le, 2 handle composed of a pair o~ reciproca~le elemen's, 2S generally disclosed in

3~ cer~ain of the aforementioned paten,s, may also be - e~ -ctive1y used.

Endoscope assembly 12 includes an elonsated flexible cable 21 equipped at.its proximal end with eyepiece 22 and at its distal end with optical head 23. The cable 21 has a sheath 24 formed of any suitable resilient and flexible polymeric material through which ,lexible ~ransmitting means ? 5 and 26 extend. One such means 26 transmits energy from source 14 to the head 23 for illuminating the site of surgical trea~ment.
The other transmitting means 25 ~ransmits images or image-producing signals from head 23 to the viewing means (eyepiece) 2~.

In the embodiment illustrated, the transmi,ting means 25 comprises a coherent bundle o~ glass fibers capable of transmitting an image from the operative site to the viewer, although it is conceivable that such means might take other forms such as, for example, a ,lexible conductive lead ror transmitting electrical sic,nals from a receiver or scanner in the head to the viewing means where such signals are then processed to produce .he visual images. Similarly, while illuminating means 26 is depicted and desc~ibed herein as a fibero~tic bundle, it might take the form of ~ lexible electrical conductor acting in combinatior with a nead-mounted lamp or othe~ illuminating device, or a waveguide consisting essen~ially of a sing1e light-transmitting fiber or tube.

In the ~referred embodiment shown in ~he drawings, the .~lexible cable is o- rounded or oval cross section and the image-transmitting bu~,dle 25 ex;ends throush ~h2t cable along t:ne central axis thereol. The illumina,ing buncdle or waveguide 26 ~ay be of smaller cross sectional area tnan ~e image-t-ans~itting bun~le a~.d m2y be dis?osed aiongside ~he latter, ln ~";-ich case the ill~minatin~ bundle 26 may be crescent-shaped 30 Ln ~-OSS section (Fig~re 5).

The flexible sheath 24 of the cable may also include a flow passage 27 extending along that si.de of the coherent fiberoptic cable 25 opposite fxom the illuminating cable 26 (Figure 5). The îlow passage may be defined by an inner protective flexible tube 28 which extends through the cable and which exits therefrom at or near eyepiece 22. As shown in -- Figure 1, tube 28 may extend to a branched coupling 29 e~uipped with check valves 30 and 31. One of the branches may lead through hose 32 to a pulsatile source of irrigating fluid 16, whereas the other branch may lead through hose 33 to a suspended bag 15 which serves 2S a non-pulsating fluid source.
A manually-operated va~ve (not shown) may be ?rovided in line 33 to control fluid flow, it being ~nderstood that âuring an o?erative procedure a continuous flow at low pressure is normally required for internal viewing. ~nen pulsatile $10w is needed, source 16, which may be driven by an electric vibrator in a manner well known in the art in connection with oral hygiene irrigating devices, may be activated and deacti~ated by a suitable foot controller 34. The ?ulsatile llow Crom source 16 is intended to be used ~or clearin~ awav any tissue par.icles, blood, or other ma~ter ~o p-event obscuring o- the view through eyepiece 22 and/or for dislodging small particles ~rom the organ's interio~ (such as stone particles ~-i.hin the calyces of the kidney).
The viewing means or eyepiece 22 shown in ~igure 1 is ~cunted u?on sup?ort mea~.s 13 in the form OlC a standard 35 ada?ted to ~e secured at its lowe_ end 36 .o a table, floor, or other stationary support sur~ace. The standard should ~e capable of -slescoping, anc should ~e ?ro~ided with 2 pivotal connector at its u?per end, to ?ermi~ ~Jertical and angular adjustment of the eyD~iece. The base 37 of the s~andard may take the form of a ~la~p, suctior. cu? assembly or tri?od leg cons.ruc~ion, all 2S
k~.o"n in tnD art.

The standard-equipped support 13 represents a preferred construction because it may be used to locate the eyepiece 22 in any suitable position selected by the surgeon while still readily permitting ,he surgeon to look away from the eyepiece when direct viewing of the operative site, or instrument 11, or any other object or person, is required.
_ ~owever, it has also been found ef.ective to provide support means in the form of a headband 38 and connector 39 as depicted in ~igure 6. The connector 39 is secured to both the headband and eyepiece 22 and is adjustable to facilitate positioning of the eyeplece directly in front of the wearer's eye. Band 38 may also be adjustable as indicated in Figure 6.

Head 23 is an extension of cable 21 and contains extended portions of fiberoptic bundles 25 and 26 2S well as o' irrigation tube 28. Objec_ive lens 25a is mounted at ~he ex~reme distal end of bundle 25 and, i-- desired, a similar lens 26a may be ?rovidea at the distal end OT ~undle 26, the latter being more use-ul for ?reventing fluids from ~nvading bundle 26 than for o~ti_al ~ur~oses. A protective casing 23a ~ormed of rigid mate_ial mav e~tend abou. the head, not only tO prever.t damage to the o?tics encased wi~hin the head but also 'o provide a secure attachment for one or mo~e attacr~ent clips 40.

-- Refer-ing to Figu~es 3 and 4, it will be observed .hat a pair o s?ring clips 40 zre secured to the underside o. head casing 23a and are ?rovided with arcuate s?ring arms -~r~. cr~ ~eceive the neck ~ortion 19 of ins,rument 11. The ~tra?s or arms 41 of the cli?s a-e received in channels 42 ~ro~-~ided in the neck por.ion 19 to secure head 23 against ~r) lonci'udinal slid ng movement along the neck anc to assist e user in ?ro?erly ?ositioning ,he nead when endosco?e 12 ' ~ _0 5e cou21ed o inst-ument 11. To ~nsure a rigia but , ~) releasable in~erconnection between head 23 and instrument ll, a pair of longitudinally-spaced clips 40 are shown in the drawings; however, it is to be understood that a greater or smaller number of such clips may be suitable for purposes of this invention.

In the operation of this system as, for example, in the case of kidney stone removal, a surgeon may find that a number of different instruments ll, all of the same genexal construction but with different shank curvatures, will be necessary in order to enter diîferent calyces for stone dete.ction and removal. In that event, head 23 may be readily detached from one instrumen~ and cli?ped to the neck of another instrument of different curvature. Further$~re, in certain instances where the surgeon concludes that visual verification through an endoscope is unnecessary, and where tactile input and external observa.ion are sufficient, the endoscope 12 may be completely disconnected and at least temporarily laid aside.

h~.ile the sco?e assembly 12 has been descxibed in conjunctlon with surgical ins~ruments, it is believed evident tnat such assembly might be adapted for use with any essentially rigid hand-held instrument that must be oriented and manipulated under conditions which require the o?erator to receive and -espond to tactile signals transmitted through the instrument itself and which, because of tne nature of the operation, p~event the operator f-om directly viewing the working end of t:~e lnstrument and th~ operative site. ~nder such circum-stznces, the rigidi~y of the instrument, and the fact that it is hand held, allow ~he instrument to function as an extension o~ _he hand ar.d to ~e oriented, steered, and manipulated in part through tactile sensations which yield a ?erception of the action of the instrument in the "mind's eye" of the user. The visual input provided by the scope assem~ly 12 serves to confirm and supplement such tactile input to give the operator greater control over the operation of the instrument, whether it be in a surgical or non-surgical procedure.

While in the foregoing I h~ve disclosed an embodiment of the inven~ion in considerable detail for purposes of illustration, it will be understood by those skilled in the art that many or these details may be varied without departins from the spirit and scope of the invention.

Claims

THE EMBODIMENTS OF THE INVENTION IN WHICH AN EXCLUSIVE
PROPERTY OR PRIVILEGE IS CLAIMED ARE DEFINED AS FOLLOWS:

1. In combination with a surgical instrument dimensioned and adapted to be held and operated by one hand; said instrument having non-flexible handle, shank, and operating end portions rigidly connected to each other to provide tactile feedback therethrough to a user gripping and manipulating said handle portion when objects are engaged by said operating end portion; an image-receiving assembly comprising an optical head, viewing means remote from said head, and an elongated flexible cable assembly extending therebetween; mounting means rigidly but detachably securing said head externally to said operating end portion of said instrument; said instrument and said viewing means being independently movable in relation to each other to the extent permitted by said flexible cable assembly; said cable assembly including first flexible transmitting means extending therethrough for transmitting energy to said head for illuminating a working area adjacent said operating end portion;
and second flexible transmitting means extending through said cable from said head to said viewing means for providing at said viewing means an image of the work area illuminated by said first transmitting means adjacent said operating end portion.

2. The combination of Claim 1 in which said mounting means comprises a least one spring clip.

3. The combination of Claim 1 in which said mounting means comprises a pair of spring clips spaced longitudinally apart along said head.

4. The combination of Claims 2 in which each spring clip is mounted upon said head and releasably embraces said operating end portion of said instrument.

5. The combination of Claim 4 in which said operating end portion of said instrument is peripherally grooved to receive said clips and to anchor said end portion and head against relative longitudinal sliding movement.

6. The combination of Claim 1 in which said head is generally crescent-shaped in transverse section.

7. The combination of Claim 6 in which said second flexible transmitting means comprises a coherent image-transmitting fiberoptic bundle extending through said head along the longitudinal symmetrical midplane thereof.

8. The combination of Claim 7 in which said first flexible transmitting means comprises a light-conducting wave-guide extending through said head along one side of said second bundle.

9. The combination of Claim 8 in which an irrigation passage extends through said cable assembly for delivering irrigating fluid through said head to a work area, said irrigating passage extending through said head along the side of said image-transmitting fiberoptic bundle opposite from said light-transmitting waveguide.

10. In combination with a surgical instrument adapted to be held and operated by one hand and equipped with a rigid shank portion terminating in an operating end portion;
scope assembly comprising a generally rigid head portion, viewing means remote from said head portion, and an elongated flexible cable assembly extending between said head portion and said viewing means connecting means detachably but rigidly securing said head portion alongside said operating end portion of said instrument; said scope assembly including a fiberoptic waveguide extending through said cable assembly for transmitting light to said head portion for illuminating a work area adjacent the operating end portion of said instrument; and a fiberoptic bundle of oriented fibers extending through said cable from said head portion to said eyepiece for transmitting a coherent image of the work area illuminated by said waveguide; and support means for supporting said viewing means for viewing the image of the illuminated work area by a user.

11. The combination of Claim 10 in which said connecting means comprises at least one spring clip mounted upon said head portion and releasably engaging the operating end portion of said instrument.

12. The combination of Claim 11 in which said operating end portion of said instrument is peripherally grooved to receive said clip and to lock said end portion of said instrument and said head portion of said scope against relative longitudinal sliding movement.

13. The combination of Claim 10 in which said head is generally crescent-shaped in transverse section.

14. The combination of Claim 13 in which said fiberoptic bundle extends through said head portion along the longitudinal midplane of symmetry thereof.

15. The combination of Claim 14 in which said waveguide extends through said head portion along one side of said fiberoptic bundle.

16. The combination of Claim 15 in which an irrigation passage extends through said scope assembly for delivering irrigating fluid through said head portion to a work area, said irrigating passage extending through said head portion along the side of said fiberoptic bundle opposite from said waveguide.

17. The combination of Claim 10 in which said support means comprises a standard connected at its upper end to said viewing means and equipped at its lower end with means for engaging a stationary support surface.

18. The combination of Claim 10 in which said viewing means comprises an eyepiece and said support means comprises a headband adapted to be worn by a user and equipped with means for retaining said eyepiece.

19. An endoscopic attachment for use with rigid hand-held surgical instruments, comprising viewing means, an objective head remote from said eyepiece, and an elongated flexible cable assembly extending therebetween, said cable assembly including first flexible transmitting means exten-illuminating an operative site adjacent the operating end portion of surgical instrument and second flexible transmitting means extending through said cable from said head to said viewing means for transmitting an image of an operative site illuminated by said first transmitting means;
coupling means for operatively connecting a light source to said first transmitting means; and spring clip means secured to said head for releasably attaching said head to the operating end portion of a rigid hand-held surgical instrument.

20. The attachment of Claim 19 in which said head is elongated and generally crescent-shaped in cross section, having a convex top surface and a generally flat undersurface;
said string clip means being secured to said head along said undersurface.

21. The attachment of Claim 20 in which said spring clip means comprises a pair of spring clips spaced longitu-dinally apart with respect to said head along the undersurface thereof.

22. The attachment of Claims 19, 20 or 21 on which said spring clip means includes a spring arm extending generally transversely beneath said head for flexing movement in a generally transverse plane.

23. The attachment of Claim 20 in which said head includes a rigid outer side casing, said spring clip means being secured to said casing.

24. The attachment of Claims 19 or 23 in which said cable assembly includes a sheath of resilient polymeric material surrounding said first and second transmitting means and extending along the length thereof, said sheath have a portion thereof extending into said head.

25. The attachment of Claim 20 in which said second transmitting means extends through said head along the longitudinal midplane of symmetry thereof.

26. The attachment of Claim 25 in which said first transmitting means extends through said head along one side of said second transmitting means.

27. The attachment of Claim 26 in which an irrigation passage extends through said cable assembly and head for delivering irrigating fluid to an operative site, said irrigating passage extending through said head along the side of said second transmitting means opposite from said first transmitting means.

28. The combination of Claims 1 or 10 in which said operating end portion of said instrument includes a pair of jaws operatively connected through said shank portion to said handle portion of said instrument.