CA2430834A1 - Apparatus for self-guided intubation - Google Patents

Apparatus for self-guided intubation Download PDF

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Publication number
CA2430834A1
CA2430834A1 CA002430834A CA2430834A CA2430834A1 CA 2430834 A1 CA2430834 A1 CA 2430834A1 CA 002430834 A CA002430834 A CA 002430834A CA 2430834 A CA2430834 A CA 2430834A CA 2430834 A1 CA2430834 A1 CA 2430834A1
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CA
Canada
Prior art keywords
medical insertion
automatically operative
automatically
operative medical
operative
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Granted
Application number
CA002430834A
Other languages
French (fr)
Other versions
CA2430834C (en
Inventor
Shlomo Besharim
Eliyahu Besharim
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Intumed Ltd
Original Assignee
Intumed Ltd.
Shlomo Besharim
Eliyahu Besharim
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Intumed Ltd., Shlomo Besharim, Eliyahu Besharim filed Critical Intumed Ltd.
Publication of CA2430834A1 publication Critical patent/CA2430834A1/en
Application granted granted Critical
Publication of CA2430834C publication Critical patent/CA2430834C/en
Anticipated expiration legal-status Critical
Expired - Fee Related legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0488—Mouthpieces; Means for guiding, securing or introducing the tubes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient
    • A61B5/061—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body
    • A61B5/062—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body using magnetic field
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0488—Mouthpieces; Means for guiding, securing or introducing the tubes
    • A61M16/049—Mouthpieces
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/45—For evaluating or diagnosing the musculoskeletal system or teeth
    • A61B5/4514—Cartilage

Abstract

An automatically operative medical insertion device (12) and method includin g an insertable element (18) which is adapted to be inserted within a living organism in vivo, a surface following element (20) , physically associated with the insertable element (18)and being arranged to follow a physical surface within the living organism in vivo, a driving subsystem (15) operati ve to at least partially automatically direct the insertable element (18) along the physical surface and a navigation subsystem (274) operative to control t he driving subsystem based at least partially on a perceived location of the surface following element(20) along a reference pathway stored in the navigation subsystem (274).

Claims (107)

1. An automatically operative medical insertion device comprising:
an insertable element which is adapted to be inserted within a living organism in vivo;

a surface following element, physically associated with said insertable element and being arranged to follow a physical surface within said living organism in vivo;
a driving subsystem operative to at least partially automatically direct said insertable element along said physical surface; and a navigation subsystem operative to control said driving subsystem based at least partially on a perceived location of said surface following element along a reference pathway stored in said navigation subsystem.
2. An automatically operative medical insertion device according claim 1 and wherein said driving subsystem is operative to fully automatically direct said insertable element along said physical surface.
3. An automatically operative medical insertion device according to claim l and wherein said driving subsystem is operative to automatically and selectably direct said insertable element along said physical surface.
4. An automatically operative medical insertion device according to any of the preceding claims and wherein said navigation subsystem receives surface characteristic information relating to said physical surface from said surface following element and employs said surface characteristic information to perceive the location of said surface following element along said reference pathway.
5. An automatically operative medical insertion device according to claim 4 and wherein said surface characteristic information comprises surface contour information.
6. An automatically operative medical insertion device according to claim 4 and wherein said surface characteristic information comprises surface hardness information.
7. An automatically operative medical insertion device according to claim 4 and wherein said surface contour information is three-dimensional.
8. An automatically operative medical insertion device according to claim 4 and wherein said surface contour information is two-dimensional.
9. An automatically operative medical insertion device according to any of the preceding claims and wherein said insertable element is a endotracheal tube and wherein said physical surface comprises surfaces of the larynx and trachea.
10. An automatically operative medical insertion device according to any of claims 1 -8 and wherein said insertable element is a gastroscope and wherein said physical surface comprises surfaces of the intestine.
11. An automatically operative medical insertion device according to any of claims 1 -8 and wherein said insertable element is a catheter and wherein said physical surface comprises interior surfaces of the circulatory system.
12. An automatically operative medical insertion device according to any of the preceding claims and also comprising a reference pathway generator operative to image at least a portion of said living organism and to generate said reference pathway based at least partially on an image generated thereby.
13. An automatically operative medical insertion device according to . claim 12 and wherein said reference pathway comprises a standard contour map of a portion of the human anatomy.
14. An automatically operative medical insertion device according to claim 13 and wherein said standard contour map is precisely adapted to a specific patient.
15. An automatically operative medical insertion device according to claim 13 or claim 14 and wherein said standard contour map is automatically precisely adapted to a specific patient.
16. An automatically operative medical insertion device according to any of claims 12 to 15 and wherein said reference pathway is operator adaptable to designate at least one impediment.
17. An automatically operative medical insertion device according to any of the preceding claims and wherein said insertable element comprises a housing in which is disposed said driving subsystem; a mouthpiece, a tube inserted through the mouthpiece and a flexible guide inserted through the tube, said surface following element being mounted at a front end of said guide.
18. An automatically operative medical insertion device according to claim 17 and wherein said mouthpiece comprises a curved pipe through which said tube is inserted.
19. An automatically operative medical insertion device according to claim 18 and wherein said driving subsystem is operative to move said guide in and out of said housing, through said curved pipe and through said tube.
20. An automatically operative medical insertion device according to claim 19 and wherein said driving subsystem is also operative to selectably bend a front end of said guide.
21. An automatically operative medical insertion device according to any of the preceding claims and wherein said driving subsystem is operative to move said insertable element in and out of said living organism.
22. An automatically operative medical insertion device according to any of the preceding claims and wherein said driving subsystem is also operative to selectably bend a front end of said insertable element.
23. An automatically operative medical insertion device according to any of the preceding claims and wherein said surface following element comprises a tactile sensing element.
24. An automatically operative medical insertion device according to any of the preceding claims and wherein said surface following element comprises a tip sensor including a tip integrally formed at one end of a short rod having a magnet on its other end, said rod extends through the center of a spring disk and is firmly connected thereto, said spring disk being mounted on one end of a cylinder whose other end is mounted on a front end of said insertable element.
25. An automatically operative medical insertion device according to claim 24 and wherein said tip sensor also comprises two Hall effect sensors which are mounted inside said cylinder on a support and in close proximity to said magnet, said Hall effect sensors being spaced in the plane of the curvature of the curved pipe, each Hall effect sensor having electrical terminals operative to provide electric current representing the distance of the magnet therefrom, said tip sensor being operative such that when a force is exerted on the tip along an axis of symmetry of said cylinder, said tip is pushed against said spring disk, causing said magnet to approach said Hall effect sensors and when a force is exerted on said tip sideways in the plane of said Hall effect sensors, said tip rotates around a location where said rod engages said spring disk, causing said magnet to rotate away from one of said Hall effect sensors and closer to the other of the Hall effect sensors.
26. An automatically operative medical insertion device according to claim 17 and wherein said driving subsystem is operative, following partial insertion of said insertable element into the oral cavity, to cause the guide to extend in the direction of the trachea and bend the guide clockwise until said surface following element engages a surface of. the tongue, whereby this engagement applies a force to said surface following element.
27. An automatically operative medical insertion device according to claim 25 and wherein said navigation subsystem is operative to measure the changes in the electrical outputs produced by the Hall effect sensors indicating the direction in which the tip is bent.
28. An automatically operative medical insertion device according to claim 27 and wherein said navigation subsystem is operative to sense the position of said tip and the past history of tip positions and to determine the location of said tip in said living organism and relative to said reference pathway.
29. An automatically operative medical insertion device according to claim 27 and wherein said navigation subsystem is operative to navigate said tip according to said reference pathway.
30. An automatically operative medical insertion device according to claim 29 and wherein said navigation subsystem is operative to sense that said tip touches the end of the trough beneath the epiglottis.
31. An automatically operative medical insertion device according to claim 27 and wherein said navigation subsystem is operative to sense that said tip reaches the tip of the epiglottis.
32. An automatically operative medical insertion device according to claim 27 and wherein said navigation subsystem is operative to sense that the tip reached the first cartilage of the trachea.
33. An automatically operative medical insertion device according to claim 32 and wherein said navigation subsystem is operative to sense that the tip reached the second cartilage of the trachea.
34. An automatically operative medical insertion device according to claim 33 and wherein said navigation subsystem is operative to sense that the tip reached the third cartilage of the trachea.
35. An automatically operative medical insertion device according to any of the preceding claims and wherein said navigation subsystem is operative to load said reference pathway from a memory.
36. An automatically operative medical insertion device according to claim 17 and wherein said driving subsystem is operative to push said tube forward.
37. An automatically operative medical insertion device according to any of the preceding claims and wherein said driving subsystem comprises:
a first motor operative to selectably move said insertable element forward or backward;

a second motor operative to selectably bend said insertable element; and electronic circuitry operative to control said first motor, said second motor and said surface following element.
38. An automatically operative medical insertion device according to claim 37 and wherein said electronic circuitry comprises a microcontroller operative to execute a program, said program operative to control the said first and second motors and said surface following element and to insert and bend said insertable element inside said living organism along said reference pathway
39. An automatically operative medical insertion device according to claim 37 or claim 38 and wherein said driving subsystem is operative to measure the electric current drawn by at least one of said first and second motors to evaluate the position of said surface following element.
40. An automatically operative medical insertion device according to any of the preceding claims and wherein said reference pathway is operative to be at least partially prepared before the insertion process is activated.
41. An automatically operative medical insertion device according to claim 40 and wherein said medical insertion device comprises a medical imaging system and wherein said medical imaging system is operative to at least partially prepare said reference pathway.
42. An automatically operative medical insertion device according to claim 41 and wherein said medical imaging subsystem comprises at least one of an ultrasound scanner, an x-ray imager, a CAT scan system and an MRI system.
43. An automatically operative medical insertion device according to claim 40 and wherein said medical imaging system is operative to prepare said reference pathway by marking at least one contour of at least one organ of said living organism.
44. An automatically operative medical insertion device according to claim 41 and wherein said medical imaging system is operative to prepare said reference pathway by creating an insertion instruction table comprising at least one insertion instruction.
45. An automatically operative medical insertion device according to claim 44 and wherein said insertion instruction comprises instruction to at least one of extend, retract and bend said insertable element.
46. An automatically operative medical insertion device according to claim 44 and wherein said navigation subsystem is operative to control said driving subsystem based at least partially on a perceived location of said surface following element and according to said insertion instruction table stored in said navigation subsystem.
47. An automatically operative medical insertion device according to any of the preceding claims and wherein said operative medical insertion device is operative to at least partially store a log of a process of insertion of said insertable element.
48. An automatically operative medical insertion device according to claim 46 and wherein said medical insertion device comprises a computer and wherein said medical insertion device is operative to transmit said log of a process of insertion of said insertable element.
49. An automatically operative medical insertion device according to claim 48 and wherein said computer is operative to aggregate said logs of a process of insertion of said insertable element.
50. An automatically operative medical insertion device according to claim 49 and wherein said computer is operative to prepare said reference pathway based at least partially on said aggregate.
51. An automatically operative medical insertion device according to claim 50 and wherein said computer transmits said reference pathway to said medical insertion device.
52. An automatically operative medical insertion device according to claim 1 and wherein said insertable element comprises a guiding element and a guided element.
53. An automatically operative medical insertion device according to claim 52 and wherein said driving subsystem is operative to direct said guiding element and said guided element at least partially together.
54. An automatically operative medical insertion device comprising:
an insertable element which is adapted to be inserted within a living organism in vivo;
a surface following element, physically associated with said insertable element and being arranged to follow a physical surface within said living organism in vivo;
a driving subsystem operative to at least partially automatically direct said insertable element along said physical surface; and a navigation subsystem operative to control said driving subsystem based at least partially on a perceived location of said surface following element along a reference pathway stored in said navigation subsystem;
said insertable element comprises a disposable mouthpiece.
55. An automatically operative medical insertion device according to claim 7 and wherein said driving subsystem is operative to at least partially automatically direct said guide in a combined motion comprising a longitudinal motion and lateral motion.
56. An automatically operative medical insertion method comprising:
inserting an insertable element within a living organism in vivo;
physically associating a surface following element with said insertable element and causing said surface following element to follow a physical surface within said living organism in vivo;
automatically and selectably directing said insertable element along said physical surface; and controlling direction of said insertable element based at least partially on a perceived location of said surface following element along a reference pathway stored in said navigation subsystem.
57. An automatically operative medical insertion method according to claim 56 and wherein said controlling comprises receiving surface characteristic information relating to said physical surface from said surface following element and employing said surface characteristic information to perceive the location of said surface following element along said reference pathway.
58. An automatically operative medical insertion method according to claim 57 and wherein said surface characteristic information comprises surface contour information.
59. An automatically operative medical insertion method according to claim 57 and wherein said surface characteristic information comprises surface hardness information.
60. An automatically operative medical insertion method according to claim 58 and wherein said surface contour information is three-dimensional.
61. An automatically operative medical insertion method according to claim 58 and wherein said surface contour information is two-dimensional.
62. An automatically operative medical insertion method according to any of claims 56 to 61 and wherein said insertable element is an endotracheal tube and wherein said physical surface comprises surfaces of the larynx and trachea.
63. An automatically operative medical insertion method according to any of claims 56 to 61 and wherein said insertable element is a gastroscope and wherein said physical surface comprises surfaces of the intestine.
64. An automatically operative medical insertion method according to any of claims 56 to 61 and wherein said insertable element is a catheter and wherein said physical surface comprises interior surfaces of the circulatory system.
65. An automatically operative medical insertion method according to any of the claims 56 to 64 and also comprising generating reference pathway by imaging at least a portion of said living organism and generating said reference pathway based at least partially on an image generated by said imaging.
66. An automatically operative medical insertion method according to any of the claims 56 to 65 and also comprising generating said reference pathway comprising a standard contour map of a portion of the human anatomy.
67. An automatically operative medical insertion method according to claim 66 and also comprising precisely adapting said standard contour map to a specific patient.
68. An automatically operative medical insertion method according to claim 67 and also comprising automatically precisely adapting said standard contour map to a specific patient.
69. An automatically operative medical insertion method according to any of claims 56 to 68 and also comprising adapting said reference pathway to designate at least one impediment by an operator.
70. An automatically operative medical insertion method according to any of claims 56 to 69 and also comprising:
providing:
a flexible guide, said surface following element being mounted at a front end of said flexible guide;
a housing in which is disposed said driving subsystem;
a mouthpiece and a tube;
inserting said flexible guide through said tube;
inserting said tube trough said mouthpiece; and driving said flexible guide employing said driving subsystem.
71. An automatically operative medical insertion method according to claim 70 and wherein said mouthpiece comprises a curved pipe through which said tube is inserted.
72. An automatically operative medical insertion method according to claim 71 and also comprising moving said guide in and out of said housing, through said curved pipe and through said tube employing said driving subsystem.
73. An automatically operative medical insertion method according to claim 72 and also comprising selectably bending a front end of said guide employing said driving subsystem.
74. An automatically operative medical insertion method according to any of claims 56 to 73 and also comprising moving said insertable element in and out of said living organism employing said driving subsystem.
75. An automatically operative medical insertion method according to any of claims 56 to 74 and also comprising selectably bending a front end of said insertable element.
76. An automatically operative medical insertion method according to any of claims 56 to 75 and wherein said surface following element comprises a tactile sensing element.
77. An automatically operative medical insertion method according to any of claims 56 to 77 and wherein said physically associating a surface following element with said insertable element comprises:
integrally forming a tip at one end of a short rod having a magnet on its other end;
extending said rod through the center of a spring disk;
firmly connecting said spring disk to said rod;
mounting said spring disk on one end of a cylinder;
mounting another end of said cylinder on a front end of said insertable element.
78. An automatically operative medical insertion method according to claim 78 and wherein said surface following element also comprises two Hall effect sensors, each Hall effect sensor having electrical terminals operative to provide electric current representing the distance of the magnet therefrom and also comprising:
mounting said Hall effect sensors inside said cylinder on a support and in close proximity to said magnet;
spacing said Hall effect sensors in the plane of the curvature of the curved pipe;
said tip sensor being operative such that when a force is exerted on the tip along an axis of symmetry of said cylinder, said tip is pushed against said spring disk, causing said magnet to approach said Hall effect sensors and when a force is exerted on said tip sideways in the plane of said Hall effect sensors, said tip rotates around a location where said rod engages said spring disk, causing said magnet to rotate away from one of said Hall effect sensors and closer to the other of the Hall effect sensors.
79. An automatically operative medical insertion method according to claim 70 and also comprising:
partially inserting said insertable element into the oral cavity;
causing the insertable element to extend in the direction of the trachea;
bending the guide clockwise until said surface following element engages a surface of the tongue, whereby this engagement applies a force to said surface following element.
80. An automatically operative medical insertion method according to claim 77 and also comprising measuring the changes in the electrical outputs produced by the Hall effect sensors indicating the direction in which the tip is bent by employing said navigation subsystem.
81. An automatically operative medical insertion method according to claim 80 and also comprising sensing the position of said tip and determining the location of said tip in said living organism and relative to said reference pathway based on the past history of tip positions.
82. An automatically operative medical insertion method according to claim 80 and also comprising navigating said tip according to said reference pathway employing said navigation subsystem.
83. An automatically operative medical insertion method according to claim 82 and also sensing said tip touching the end of the trough beneath the epiglottis.
84. An automatically operative medical insertion method according to claim 80 and also comprising sensing said tip reaching the tip of the epiglottis.
85. An automatically operative medical insertion method according to claim 80 and also comprising sensing the tip reaching the first cartilage of the trachea.
86. An automatically operative medical insertion method according to claim 85 and also sensing the tip reaching the second cartilage of the trachea.
87. An automatically operative medical insertion method according to claim 86 and also sensing the tip reaching the third cartilage of the trachea.
88. An automatically operative medical insertion method according to any of claims 56 to 87 and also loading said reference pathway from a memory to said navigation subsystem.
89. An automatically operative medical insertion method according to claim 70 and also pushing said tube forward employing said driving subsystem.
90. An automatically operative medical insertion method according to claim any of claims 56 to 89 and wherein said driving subsystem comprises a first motor operative to selectably move said insertable element forward or backward and a second motor operative to selectably bend said insertable element; and controlling said first motor, said second motor and said surface following element by employing said electronic circuitry.
91. An automatically operative medical insertion method according to claim 90 and wherein said electronic circuitry comprises a microprocessor and also comprising executing a program, said executing a program comprising:
controlling said first and second motors and said surface following element;
and inserting and bending said insertable element inside said living organism along said reference pathway.
92. An automatically operative medical insertion method according to claim 90 or claim 91 and also comprising:
measuring the electric current drawn by at least one of said first and second motors; and evaluating the position of said surface following element;
by employing said driving subsystem.
93. An automatically operative medical insertion method according to any of claims 56 to 92 and also comprising preparing said reference pathway at least partially before the insertion process is activated.
94. An automatically operative medical insertion method according to claim 93 and wherein said medical insertion method comprises providing a medical imaging system and also comprising preparing said reference pathway at least partially by employing said medical imaging system.
95. An automatically operative medical insertion method according to claim 94 and wherein said medical imaging subsystem comprises at least one of an ultrasound scanner, an x-ray imager, a CAT scan system and an MRI system.
96. An automatically operative medical insertion method according to claim 93 and wherein also comprising preparing said reference pathway by marking at least one contour of at least one organ of said living organism.
97. An automatically operative medical insertion method according to claims 56 to 96 and also comprising preparing said reference pathway by creating an insertion instruction table comprising at least one insertion instruction.
98. An automatically operative medical insertion method according to claim 97 and wherein said insertion instruction comprises instruction to at least one of extend, retract and bend said insertable element.
99. An automatically operative medical insertion method according to claim 97 and wherein also comprising controlling said driving subsystem based at least partially on a perceived location of said surface following element and according to said insertion instruction table stored in said navigation subsystem.
100. An automatically operative medical insertion method according to any of claims 56 to 99 and also comprising storing at least partially a log of a process of insertion of said insertable element.
101. An automatically operative medical insertion method according to claim 100 and wherein said medical insertion method comprises providing a computer and also comprising transmitting said log of a process of insertion of said insertable element to said computer
102. An automatically operative medical insertion method according to claim 101 and aggregating said logs of a process of insertion of said insertable element by employing said computer.
103. An automatically operative medical insertion method according to claim 102 and also comprising preparing said reference pathway based at least partially on said aggregate.
104. An automatically operative medical insertion method according to claim 103 and also comprising transmitting said reference pathway from said computer to said medical insertion device.
105. An automatically operative medical insertion method according to any of the claims 56 to 104 and wherein said insertable element comprises a guiding element and a guided element.
106. An automatically operative medical insertion method according to claim 105 and wherein said driving subsystem is operative to direct said guiding element and a said guided element at least partially together.
107. An automatically operative medical insertion method according to claim 60 and wherein said directing comprises automatically and selectably directing said insertable element in a combined motion comprising a longitudinal motion and lateral motion.
CA2430834A 2000-12-06 2001-12-05 Apparatus for self-guided intubation Expired - Fee Related CA2430834C (en)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
IL140136A IL140136A (en) 2000-12-06 2000-12-06 Apparatus for self-guided intubation
IL140136 2000-12-06
PCT/IL2001/001121 WO2002045768A2 (en) 2000-12-06 2001-12-05 Apparatus for self-guided intubation

Publications (2)

Publication Number Publication Date
CA2430834A1 true CA2430834A1 (en) 2002-06-13
CA2430834C CA2430834C (en) 2010-04-20

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CA2430834A Expired - Fee Related CA2430834C (en) 2000-12-06 2001-12-05 Apparatus for self-guided intubation

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US (2) US7089928B2 (en)
EP (1) EP1349522B1 (en)
JP (1) JP2004522480A (en)
AT (1) ATE415854T1 (en)
AU (2) AU2002222450B2 (en)
CA (1) CA2430834C (en)
DE (1) DE60136847D1 (en)
IL (1) IL140136A (en)
WO (1) WO2002045768A2 (en)
ZA (1) ZA200304238B (en)

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US7089928B2 (en) 2006-08-15
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