CN100542474C

CN100542474C - Medical treatment device with path

Info

Publication number: CN100542474C
Application number: CNB2004100032780A
Authority: CN
Inventors: G·L·龙
Original assignee: Ethicon Endo Surgery Inc
Current assignee: Ethicon Endo Surgery Inc
Priority date: 2003-04-03
Filing date: 2004-02-03
Publication date: 2009-09-23
Anticipated expiration: 2024-02-03
Also published as: BR0305836A; CN1859941B; AU2003271310B2; CN1859941A; JP2004305714A; CA2463214A1; CN1535649A; CA2463214C; AU2003271310A1; JP4601943B2

Abstract

The invention provides a kind of medical treatment device with path, described medical treatment device is used for carrying out medical procedure in lumen of interest (such as gastrointestinal tract).This device comprises can be along the progressive elongate flexible member of path.This path can comprise loop section, can make this loop section advance in the elongate flexible member front.The end of flexible member can comprise video camera, light source, vacuum openings, and the service aisle that is used to receive medical apparatus and instruments.

Description

Medical treatment device with path

The application number that the application introduces December in 2002 application on the 5th is No.10/310, and the U.S. Patent application of 365 " Locally-Propelled Intraluminal Device with Cable Loop Trackand Method of Use " as a reference and require the priority of this U.S.'s 03404840 patent application.

Technical field

The present invention relates to a kind of medical treatment device, more particularly, the present invention relates to a kind of medical treatment device that can advance along the path of the inner chamber that is arranged in patient body.

Background technology

That the doctor usually uses is long, flexible endscope enters and observe tissue in patient's gastrointestinal (GI) road.For the top gastrointestinal, the doctor can be inserted into gastroscope clothes to be had in ataractic patient's mouth to check and to treat the tissue in esophagus, stomach and the nearly duodenum.For lower gastrointestinal tract, the doctor can have ataractic patient's anus to insert colonoscope to check rectum and colon by clothes.Some endoscopies have the service aisle that its diameter is about 2.5-3.5mm usually, and the part from handle extends to flexible the tip of the axis.The doctor can be inserted into medical apparatus and instruments in the service aisle with assisted diagnosis or the intravital tissue of treatment patient.The common use of doctor is flexible, biopsy forceps is checked by service aisle extraction living tissue from gastrointestinal mucosa lining of endoscope.

For the patient, insert flexible endscope, especially be inserted in the colon, normally very consuming time and uncomfortable process is even if clothes have downern.The doctor with flexible endscope be pushed into the convoluted s shape of colon, decline, horizontal and rising part needs a few minutes usually.The doctor can the insertion of endoscope or remove diagnosis in the process and/or the treatment colon in tissue.Flexible endscope usually in colon (such as splenic flexure place) at sigmoid colon place or colon form ring-type and tie a knot, therefore be difficult to make endoscope to be advanced further along colon.When forming ring, can stretch mesentery and make patient's pain of the power that is applied in order to promote endoscope.The part of colon possibly can't check that therefore tissue and the experience of doctor aspect the manipulation flexible endscope that this depends on the patient have increased the not danger of diagnosed disease.

Engineering LTD, Yoquneam Israel sells a kind of " M2A that is called in the U.S. ^TMSwallowable Imaging Capsure " device.This device comprises microcam, set of cells and mediator.Enterokinesia by nature is advanced to it in gastrointestinal tract.This device is generally used for diagnostic purpose and passes intestinal with the determined speed of natural enterokinesia of patient body.The international application no WO 0108548A1 that licenses to people such as C.Mosse has described a kind of self-propelled formula device that is suitable for passing the path with the wall that comprises the contractility tissue.The applicant discloses, and described device is particularly suitable for as endoscope and can will be brought in the internal organs such as article such as feeding tube, guide line, physiological sensor or conventional endoscope.On January 1st, 1999 Gastrointestinal Endoscopy Clinics of North AmericaThe 9th volume: the summary that can find to be used to promote endoscopic other alternative in the 145-161 page or leaf in people such as C.Mosse " Technical Advances and ExperimentalDevices for Enteroscopy ".

The scientists and engineers is continuing to seek improving one's methods and installing of the tissue (gastrointestinal tract) that is used for entering, diagnosing and/or treat bodily lumen.

Summary of the invention

The applicant has realized that described medical treatment device can be given the desired replacement scheme of doctor, to use traditional, reusable flexible endscope for demand property low-cost, can disposable medical treatment device.Eliminated the operator and made the conventional demand of adjusting, can reduce the desired experience of device of inserting like this, thereby allow the operator except that the doctor to use described device for the movable joint control of endoscope.Because gastroenterologist does not have ability to handle the patient that all need carry out colonoscopy usually, therefore allow to have other personnel (such as the nurse) of ability but help to carry out the equipment enhancement process ability of this program and make gastroenterologist treat more patient, so this is favourable.

In one embodiment, the invention provides a kind of medical treatment device, described medical treatment device comprises can pass the progressive elongated flexible element of bodily lumen on path.Described path can have loop section, and described loop section advances in the distally of flexible member, and described then element advances along path.The passage that described flexible member can comprise display, illuminator and be used for fluid (gas or liquid) and instrument.

The present invention also provides a kind of armarium that makes to pass through the mobile method of patient's body (such as passing through gastrointestinal tract).Described method can may further comprise the steps: the part of medical treatment device is arranged in the bodily lumen; Make the certain-length path advance along the distally of medical treatment device; And make medical treatment device advance on the path so that in inner chamber, move in the distally.The medical treatment device part of path nearside of synchronously withdrawing simultaneously of can advancing in the distally.

The present invention can be used for the diagnosis and the treatment that participate in organizing, comprise medical apparatus and instruments is positioned at the desirable tissue position that this medical apparatus and instruments includes but is not limited to utricule, dilator, organizes grasper, organizes cutter sweep, tissue fibers wrapping (stapling) installs, organizes painted or therapy equipment, vascular apparatus for ligating and device for cutting tissue.

Description of drawings

Though in claims, specifically set forth novel feature of the present invention, will more fully understand the present invention among all embodiment with reference to the following description and drawings.

Fig. 1 shows medical treatment device 70, and described medical treatment device 70 generally includes: movable equipment, such as the peplos 80 that is suitable in bodily lumen, moving; Compressible sleeve 40; Fixing head 50; Pipe cable 30; Cable 25, video-unit 72, handle 20 and motion control device 58.

Fig. 2 is the sectional view of the medical treatment device 70 shown in Fig. 1, and comprises cable spool 74, cable anchor 52 and be formed at cable 25 in the cable circle 54.

Fig. 3 is the cross-sectional view that is furnished with the gastrointestinal tract part of medical treatment device 70 with respect to the dissection milestone, and a described part comprises sigmoid colon 100, descending colon 102, left splenic flexure 112, transverse colon 104, right colic flexure 110, ascending colon 106 and caecum 108.

Fig. 4 is the detail drawing of Fig. 1 medical treatment device 70, shows circuit pack 34, drive cable 32 and peplos 80, and described peplos 80 comprises front end 64, rear end 65, first area 77, second area 78 and the 3rd zone 79.

Fig. 5 is the cross-sectional view that the line 5-5 along Fig. 1 is cut, and shows fixing head 50, cable anchor 52, center adnexa 56 and pipe cable 30.

Fig. 6 is the detail drawing of cross section of the pipe cable 30 of Fig. 5, shows cable 25, circuit pack 34, drive cable 32 and service aisle 36.

Fig. 7 is the isometric view of the peplos 80 of Fig. 4, the propulsive mechanism 44 that show sliding channel 90, clamps passage 91, service aisle 36 and comprise first mitre gear 82, second mitre gear 83, pulley 86 and pulley anchor clamps 87.

Fig. 8 is the cross-sectional view of the peplos 80 that cut of the line 8-8 along Fig. 7, shows drive cable 32, first mitre gear 82, second mitre gear 83, pulley 86, pulley anchor clamps 87 and cable 25,

Fig. 9 is the cross-sectional view of the peplos 80 that cut of the line 9-9 along Fig. 8, shows circuit pack 34, illuminator 96 and display 95.

Figure 10 is the cross-sectional view of the peplos 80 that cut of the line 10-10 along Fig. 9, shows the cable 25 in first mitre gear, 82 second mitre gears 83, pulley 86, pulley anchor clamps 87, the sliding channel 90 and clamps cable 25 in the passage 91.

Figure 11 is the sketch map of the related medical treatment device of one embodiment of the invention, the ring path that shows the flexible, elongate elements of extending from the handle of device and extend from the end of elongated member.

Figure 12 is the viewgraph of cross-section that is cut along the line 12-12 among Figure 11, shows the end of flexible, elongate elements.

Figure 13 A-E shows and makes the medical treatment device shown in Figure 11 advance to such an extent that pass the part of colon.

Figure 14 is the sketch map with handle of the motor that is used to advance and shrinks path.

Figure 15 be have a conduit and make that an end of path is fixed in flexible member terminal or be positioned at the sketch map of an embodiment the flexible member end near.

Figure 16 is the end-view that is cut along the cross section 16-16 among Figure 15.

Figure 17 is the sketch map that comprises two groups of guide lines and can be supported on an embodiment of two path loop sections in the common vertical plane.

Figure 18 is the end-view that is cut along the cross section 18-18 among Figure 17.

The specific embodiment

By example, illustrated and described the present invention in the bottom gastrointestinal colon that is used in human patients.Yet the present invention also can be used in human and other mammiferous other hollow organ's the bodily lumen.

Fig. 1 shows medical treatment device 70.Medical treatment device 70 can comprise: its shape and size are used for movable equipment such as the peplos 80 that moves by bodily lumen; Compressible sleeve 40; Fixing head 50; Pipe cable 30; Cable 25, video-unit 72, handle 20.

Peplos 80 has front end 64 usually, and described front end 64 is slick to be used for the not damaged path by the zigzag channel in gastrointestinal (GI) road (such as colon).In an embodiment of peplos 80, front end 64 is hemispheric, and rear end 65 is smooth to accept to be included in the content in the pipe cable 30.Peplos 80 also can be other shape, and the shape of or egg type taper, columniform, avette such as (but being not limited to) is to help passing colon.

Compressible sleeve 40 can extend to fixing head 50 from the rear end 65 of peplos 80.Can use binding agent that fixing head 50 is anchored on one's body the patient.Being attached to patient's other method on one's body includes but is not limited to glue, adhesive tape or is close to circle.Also can use and sew up or stapling, but painful owing to when placing or removing, existing, therefore not quite wish to use to sew up or stapling.In the application relevant with the bottom gastrointestinal tract, fixing head 50 may extend in the patient's anus.Wish that plate 50 has the firm adnexa that invests patient body, or other anchor clamps, so that fixing head 50 provides grappling, more in depth move in the colon thereby strengthen peplos 80.

The proximal part of pipe cable 30 can extend in the health outside, and can be connected with comprising the equipment of video-unit 72 with handle 20.The end portion of pipe cable 30 can be connected with the rear end 65 of the peplos 80 of colon inside.Pipe cable 30 can pass the opening in plate 50 and the sleeve 40, and pipe cable 30 can slip over opening with respect to plate 50 and sleeve 40.Pipe cable 30 is can be the most handy in light weight, flexible, the pipe of many inner chambers of plastics is made.For example, pipe cable 30 can have four inner chambers: be used for service aisle 36 the 3mm inner chamber, be used for circuit pack 34 3mm diameter inner chamber, be used to the 3mm diameter inner chamber that receives the 5mm diameter inner chamber of drive cable 32 and be used for receiving cable 25.The inner chamber of many other sizes and combination also is feasible.Pipe cable 30 also can comprise isolate thin-walled, with being with the flexiplast pipe that bands together, shrink wrap or the like.

Cable 25 can provide peplos 80 supported and propulsive path thereon.Cable 25 can multiple shape constitute, and comprises twisted shape rope strand, coated wire, the flat rubber belting of fiber or can have constant shape of cross section, comprises circle, triangle or rectangle.Cable 25 can include periodicity and/or the acyclic feature pattern that helps draw, such as tusk, hole or groove.Available any suitable material is made cable 25, includes but is not limited to comprise one or more materials of steel, nitinol, aluminum or titanium, and has and include but is not limited to the diameter of 0.5mm to 2.5mm.

As a kind of suitable material of cable 25 be have by diameter be 0.008 inch the stainless steel wire circumvolution around diameter be the guide line (guidwire) of 0.021 inch to 0.025 inch nitinol sandwich layer.Overall diameter can be between 0.037 inch to 0.041 inch, and interval welding that can 50cm or adhere to stainless steel coi so that with respect to the nitinol sandwich layer with stainless steel coi fixing in place in.The material suitable as the another kind of cable 25 is can be from Winston Salem, and the Wilson-Cook Medical of NC, the trade mark that the Inc. place buys are Elite protector ^TMThe guide line (guidwire) of Elite 480 wire guides (wireguide).

The proximal part of cable 25 is in the outside extension of health, so that the operator can handle it.Send into cable 25, pass peplos 80 by pipe cable 30, so that form the cable circle 54 of peplos 30 fronts (end).As described below, cable circle 54 can be used for advancing around the zigzag path of colon, eliminates the operator and must control the needs that carry out constant adjusting to the movable joint of endoscope, thereby can reduce for the experience requirement of inserting device.As the alternative of cable 25, also can use other path shape that is fit to, include but is not limited to flexible guide, chain, slide block and belt.

Still with reference to Fig. 1, video-unit 72 is supplied electric power to illuminator 96 (Fig. 9), and handles by the obtained video image of the display in the peplos 80 95 (Fig. 9), so that the operator can see the inner surface of inner chamber when it passes colon.Illuminator 96 can comprise bulb or the LED (light emitting diode) that is contained in the peplos 80, perhaps comprises optical fiber, light guide or is contained in light lens in the video-unit 72.An example that can be arranged in the bulb in the peplos 80 is to come from Carley Lamps (Torrance, Xenon#724 CA).Display 95 can be CMOS (CMOS complementary metal-oxide-semiconductor) or CCD (charge coupled device) video camera.Above any video camera that can be used on dimensionally in the peplos 80 all can have been bought on market.For example, can use a kind of CMOS chip, such as coming from Omnivision Technologies (Sunnyvale, #0V7620 CA).Circuit pack 34 is transmitting signal between video-unit 72 and the illuminator 96 and between video-unit 72 and display 95.

Handle 20 provides motion control device 58 so that promote the propelling of peplos 80 cables 25 along the line.Can advance peplos 80 by cable 25 along the line in any suitable manner.In one embodiment, handle 20 comprises motor and operatively controls flexible drive cable 32, described flexible drive cable 32 is configured in order to transmit moment of torsion, be positioned at the propulsive mechanism 44 (Fig. 7) of peplos 80 inside so that handle, thereby make medical treatment device 70 further move in the colon.In one embodiment, motion control device 58 has in order to the forward that changes the rotation of motor in handle 20 and oppositely sets, thereby makes peplos 80 move along cable 25 along forward with oppositely.

Near the position of the proximal part of the service aisle 36 health outside extends to handle 20 is so that the operator can repeatedly move into and shift out colon with medical apparatus and instruments.The end portion of service aisle 36 is passed in the opening of peplos 80 in front end 64 outer surfaces of peplos 80.Medical apparatus and instruments can be inserted into the near-end of service aisle 36, and under the situation that from bodily lumen, does not remove peplos 80 the guiding medical apparatus and instruments by the opening part of service aisle in peplos 80 outer surfaces.Therefore, when peplos passed inner chamber, the operator can be by medical apparatus and instruments near the interior cavity tissue 7 that is adjacent to peplos 80.Can include but is not limited to organize grasper, fibre cutting machine, cutter, clip enemator, device for cutting tissue, organize color applicator by the medical apparatus and instruments of service aisle guiding, and the device that is used for the branch dose out powders.

Fig. 2 shows the medical treatment device 70 among Fig. 1, and described medical treatment device 70 comprises the cable spool 74 of health outside and the cable circle 54 of peplos 80 fronts (end).Cable spool 74 stores the proximal part of cables 25, and can be used for launching the auxiliary length by the cable 25 of pipe cable 30 and sliding channel 90, to increase the size of the cable circle 54 of peplos 80 fronts in the colon.

Cable circle 54 is formed on the front of peplos 80 from the mid portion of cable 25.One end of cable circle 54 forms by extend outwardly into terminal cable from sliding channel 90, and the other end of cable circle 54 (return terminal) is made of the cable in the opening in 80 outer surfaces along proximal extension to peplos, and wherein said cable is admitted to (and by clamping passage 91 joints) by the clamping passage 91 in the peplos 80.Cable is crossed compressible sleeve 40 (pipe cable 30 outsides) to cable anchor 52 from clamping passage 91 proximal extensions.This layout makes user can send into the size (other end of circle by clamp passage 91 controls) of slave part to increase cable circle 54 of cable 25 by sliding channel 90.Because the size of cable circle 54 has increased, thus it in the front of peplos 80 directly " expansions " inside of inner chamber, and in inner chamber, be bent, thereby can and/or advance the path of peplos thereon in the formation of sweep near-end along described sweep.Cable circle 54 this is arranged in to simplify and passes colon process aspect and can be favourable.The operator can increase the length of circle part of cable simply so that carry out bending and turn in gastrointestinal tract, rather than attempts by the three-dimensional bending part control lead of inner chamber or the end of guide line.Then the operator use motion control device 58 (Fig. 1) make peplos 80 forward direction upper edge path (cable circle 54) advance so that peplos 80 by the sweep in the colon.

Fig. 3 shows the medical treatment device 70 that is arranged in the colon.Cable circle 54 at first is introduced into, and peplos 80, compressible sleeve 40 and fixing head 50 are followed thereafter.Useful binders or alternate manner are attached to anus or other suitable position securely with fixing head 50 then, form anchor point with respect to the patient.

There is shown the cable circle 54 of the sweep layout that centers in the sigmoid colon 100.The operator is by observing advancing of video-unit 72 (Fig. 1) monitoring peplos 80 and cable circle 54, and described video-unit 72 shows by the obtained image of display 95 (Fig. 9).When cable circle 54 arrives the abundant position that can form bending in colon, under the operator's who starts motion control device 58 (Fig. 1) control, peplos 80 cables 25 along the line are advanced a bit of distance by propulsive mechanism 44 (Fig. 7).This process has shortened the length of the cable circle 54 of peplos 80 fronts (end).

In order to make peplos 80 more in depth advance in the colon, the operator can make more proximal parts of cable 25 slip over pipe cable 30 and sliding channel 90, so that increase the size of the cable circle 54 of peplos 80 fronts once more.This process by colon more other sweep of depths (such as left splenic flexure 112 or right colic flexure 110) arranged auxiliary path.The operator continues to make cable 25 to slide and starts motion control device 58 (Fig. 1) in turn, so that make peplos 80 move to caecum 108 by descending colon 102, transverse colon 104 and ascending colon 106 in enhanced mode.

When peplos 80 cables 25 along the line advanced, compressible sleeve 40 began to decompress (increasing on length), thereby had kept from fixing head 50 to peplos 80 smooth and continual surface.

Fig. 4 is the detail drawing of medical treatment device 70, and described medical treatment device 70 generally includes peplos 80, compressible sleeve 40, fixing head 50 and pipe cable 30.In this embodiment, described peplos 80 comprises three zones (first area 77, second area 78 and the 3rd zone 79), so that assembling and hold propulsive mechanism 44 (Fig. 7).Other embodiment with other position of regional difference layout or quantity or propulsive mechanism also is feasible.Be positioned near peplos 80 front ends 64 display 95 (Fig. 9) and illuminators 96 (Fig. 9) and communicate with video-unit 72, so that show near the inside of the inner chamber the peplos 80 by circuit pack 34.Do not removing from bodily lumen under the situation of peplos 80, service aisle 26 allows the operator repeatedly to make medical apparatus and instruments move into and removes the patient to treat for carrying out near the peplos 80.

Compressible sleeve 40 can be carried out at least two kinds of functions.The first, when it more in depth advanced in the colon, compressible sleeve 40 can provide smooth, continuous, the flexible connection between fixing head 50 and the peplos 80, thereby can protect bodily lumen to be without prejudice when medical treatment device 70 is advanced in colon.In addition, compressible sleeve 40 can be used for radially limiting and is clamping a part of cable 25 between passage 91 and the cable anchor 52 to help advancing peplos 80 along the forward that more gos deep into colon.By radially limiting at a part of cable 25 that clamps between passage 91 and the cable anchor 52, sleeve 40 can help to prevent that second cast is formed in the cable 25 between peplos 80 and the fixing head 50 (preventing that the cable cast is formed in the back of peplos 80 (near-end)).Compressible sleeve 40 can be made with any suitable material, described material includes but is not limited to ePTFE (expanded polytetrafluoroethyl, ne), perhaps other extensible or on length increasable suitable flexible material so that hold because peplos more in depth moves in the gastrointestinal tract distance of increase between anchor 52 and peplos 80.

Propulsive mechanism 44 uses a part of cable 25 that clamps passage 91 inside, so that further peplos 80 is advanced in the colon.When starting motion control device 58 (Fig. 1), propulsive mechanism 44 makes a part of cable 25 (comprising cable circle 54 at first) move, and gets back to position between peplos 80 and the fixing head 50 by clamping passage 91.Therefore, the length of the cable 25 between peplos 80 and the fixing head 50 has increased.Because cable 25 is to be anchored to the patient's and radially limit by compressible sleeve 40 by fixing head 50, so cable 25 pull strength that provides axial force to be applied with counteracting propulsive mechanism 44, thereby make peplos 80 be further promoted in the colon.

Arrange that in peplos 80 propulsive mechanism 44 is favourable, this is because propulsive mechanism 44 advances a bit of distance from a position that is arranged in colon partly with peplos 80.This has reduced the whole length that promotes endoscope or other long flexible prolongation and has passed the required power of tortuous colon.Yet, also can use other mechanism or mechanism position to carry out described propelling.For example, propulsive mechanism 44 can be arranged in and make that the length of the cable 25 between fixing head 50 and the peplos 80 is Anywhere changeable on length, comprise isolation capsule between peplos 80 and the fixing head 50, invest the separate housings of fixing head 50 (or being contained in fixing head 50 parts).

Fig. 5 is the cross-sectional view of the medical treatment device 70 that cut of the line 5-5 along Fig. 1, shows to have the embodiment that its size is suitable for being fixed in the larger-diameter fixing head 50 of patient's anus.There is shown the cable anchor 52 as the rigid attachment of fixing head 50, described cable anchor 52 makes the end portion of cable 25 can not move with respect to fixing head 50.Center adnexa 56 will manage cable 30 remain on fixing head 50 in the heart so that align with colon by anus.

Fig. 6 shows the detail drawing of cross section of the pipe cable 30 of Fig. 5, shows the inner chamber of cable 25, the inner chamber of circuit pack 34, the inner chamber and the service aisle 36 of drive cable 32.Fig. 6 shows these inner chambers and relative positions and the size among this embodiment that manages cable 30.Multiple other size and layout are feasible.For example, also can increase auxiliary service aisle, the dimensioned of service aisle 36 can be got greatlyyer to allow passing through of bigger apparatus, the inner chamber that perhaps is used for drive cable 32 can be littler.Usually, pipe cable 30 preferably has lighter than minor diameter and weight, so that have as far as possible little resistance when colon advances when peplos 80 passes.

Fig. 7 is the compressible sleeve 40 of Fig. 4 and the isometric view of peplos 80, comprises sliding channel 90, the propulsive mechanism 44 that clamps passage 91, service aisle 36 and comprise first mitre gear 82, second mitre gear 83, pulley 86 and pulley anchor clamps 87.This view shows the relative position of these elements in three dimensions.

Propulsive mechanism 44 is worked by the length that changes the cable 25 between peplos 80 and the fixing head 50, and described fixing head 50 has been fastened onto on the patient's body.By this way, when this length of cable 25 increased, peplos 80 can more in depth move in the colon, and when this length reduced, peplos 80 shifted out colon backward.In this embodiment, propulsive mechanism 44 comprises the gear train that is contained in the peplos 80 as described below, but other position and system also are feasible.

Fig. 8 is the cross-sectional view of the peplos 80 that cut of the line 8-8 along Fig. 7, shows the layout of this embodiment middle gear of propulsive mechanism 44 (Fig. 7).The end portion of drive cable 32 is passed the rear end 65 of peplos 80 and is connected with first mitre gear 82 coaxially.Drive cable 32 is constituted for moment of torsion is delivered to first mitre gear 82 from handle 20, so that when the operator starts motion control device 58 (Fig. 1), first mitre gear 82 rotates around the axis with drive cable 32 conllinear.

In shown embodiment, mitre gear 82 and 83 (such as by suitable bearing or lining) is supported in the peplos 80, so that rotate around their rotation axiss separately, described rotation axis normally is perpendicular to one another.Each all is with miter angle cutting for the tusk of first mitre gear 82 and second mitre gear 83, so that be converted into rotation around become another axis of an angle of 90 degrees with first axle around rotatablely moving of the axis of drive cable 32.Therefore, when the operator started motion control device 58, first mitre gear 82 rotated around its rotating shaft, and transfers torque to second mitre gear 83, made gear 83 around its rotating shaft rotation.

Pulley 86 is connected in second mitre gear 83 coaxially, and pulley 86 is supported so that around the rotating shaft rotation of mitre gear 83.When 83 rotations of second mitre gear, pulley 86 is along with gear 83 rotates around its rotating shaft.Being contained in a part of cable 25 that clamps in the passage 91 contacts with pulley 86.When pulley 86 rotation,

clamp passage

91 and 87 combineds effect of pulley anchor clamps in case sliding stop and apply pull strength to cable 25 from pulley 86.With to advance the similar mode of locomotive train wheel along the railway path, pulley 86 cables 25 along the line advance peplos 80.The result of this motion has increased the length of the cable 25 between peplos 80 and the fixing head 50, so that peplos 80 further is advanced in the colon.

Fig. 9 is the cross-sectional view of the peplos 80 that cut of the line 9-9 along Fig. 8.There is shown the relative position of display 95, illuminator 96, cable 25 and pulley 86 in the peplos 80.In this embodiment, before passing the rear end 65 of peplos 80, circuit pack 34 is divided into two bundles.A branch ofly communicate, and another bundle communicates with display 95 with illuminator 96.Illuminator 96 emits beam with near the zone of the inner chamber in the irradiation peplos 80.The image that display 95 will be obtained in this position passes back to video-unit 72 by circuit pack 34, so that the operator observes.

Figure 10 is the cross-sectional view of the peplos 80 that cut of the line 10-10 along Fig. 9.As shown in this Fig, clamp passage 91 and be arranged and align so that cable 25 is directed in the pulley anchor clamps 87, and pulley anchor clamps 87 control cables 25 contact with pulley 86.Also showing sliding channel 90 among the figure is in the do not have barrier gastrointestinal position of (for example sharp curve in the colon or sweep), so that the operator can make cable 25 slide along forward, so that increase the size of the cable circle 54 (Fig. 2) of peplos 80 fronts.This embodiment shows the circuit pack 34 that is divided into two bundles, and wherein a branch of display 95 that is positioned at is connected, and another bundle is connected with illuminator 96.

Usually, medical treatment device 70 is pushed into by colon under operator's control, so that the inspection at position and treatment in the inner chamber.By anus medical treatment device 70 is positioned in patient's the colon.In this position fixing head 50 is attached on one's body the patient.The operator makes the proximal part of cable 25 advance so that increase the size of the cable circle 54 of peplos 80 fronts by pipe cable 30 and sliding channel 90.As mentioned above, this process provides peplos 80 along it and the path of row at the sweep of colon.

When observing video-unit 72, the operator can see near the inner chamber inside the peplos 80.The motion control device 58 of handle 20 is activated so that peplos 80 cables 25 along the line advance, and it is in depth moved in the colon.In order further to make peplos 80 advance, the operator supplies with the size of cable 25 with further increase cable circle 54 once more, and starts motion control device 58 once more.Repeat these steps and arrive operators up to peplos 80 and think the enough degree of depth, the described in many cases degree of depth is a caecum 108.Any time during this process, the operator can introduce and remove medical apparatus and instruments by service aisle 36, so that the intravital position of treatment patient.Therefore medical treatment device 70 can be used for diagnosis and treatment.

Figure 11 shows the related medical treatment device of another embodiment of the present invention 210.Medical treatment device 210 comprises from handle 220 terminal elongated, the flexible members 230 that extend.Flexible member 230 can invest on the handle 220 directly or indirectly, and can be pipe cable form.For " flexible ", its meaning is, element 230 has enough crooked flexible, so that fairly under the situation of not damaging the patient make element 230 be inserted in the bodily lumen (such as gastrointestinal tract) and along bodily lumen (such as gastrointestinal tract) to advance.Element 230 for the elongated meaning is, it has enough length, thereby the near-end 232 of the element 230 that permission links to each other with handle 220 is arranged in the outside of health, or is arranged near the inlet of bodily lumen, and makes the end 234 of element 230 advance in the bodily lumen.In one embodiment, flexible member 230 can have the length at least about 36 inches, and more particularly, for situation about being used in the colon, flexible member 230 preferably has about at least 100 inches length.Flexible member 230 can have the external diameter between about 0.1 and 1.0 inch, so that can arrange in the dried gastrointestinal tract and can advance in gastrointestinal tract.In one embodiment, flexible member 230 can be the catheter form, or has the shape of drain tubular type, and can have the external diameter between about 4-6mm, more particularly, is about 5mm.

Flexible member 230 can comprise the epitheca 236 that extends along the whole length of flexible member 230 substantially.Suitable sheath can be made with thin, flexible polymeric membrane or other flexible material that is fit to.A kind of suitable sheath material is about 0.02 inch porous ptfe tube (PTFE) for its thickness.The material that is fit to is that the International PolymerEngineering by Tempe Arizona makes.

In Figure 11, show the part of sheath 236 at end 234 places of flexible member 230 in the mode of analysing and observe, thereby represent flexible member 230 internal feature and with the end 234 of flexible member 230 parts that interrelate.Flexible member 230 comprises in order to receive the path guide that flexible member 230 can progressive path 250 thereon.Figure 11 illustrates the path guide of two

path conduits

242 and 244 forms.Path 250 is received in

path conduit

242 and 244, and can middle slip in pipe 242 and 244.

Path conduit

242 and 244 is arranged in the sheath 236, and can extend to the end with flexible member 230 ends from the nearly catheter end that is connected with handle 220.In Figure 11, show end, so that hold the path 250 that the longitudinal axis with respect to flexible member 230 extends from flexible member 230 at a certain angle with the path conduit of oblique angle cutting.

Can

path conduit

242 and 244 be connected in sheath 236 and/or be connected in handle 20 by any suitable mode (for example) by binding agent, elastic cord, ultrasonic bonding so that manage 242,244, sheath 236 and handle 20 move

together.Path conduit

242 and 244 also can be assemblied in the sheath 236 tightly and can be fixed in arbitrary end of sheath 236 by the heat-shrinkable tube (not shown).

Display also can be connected with the end of flexible member 230 with light source.In Figure 11 and Figure 12, optical fiber 320 extends, passes handle 220, passes flexible member 230 from light source 324, ends at the end of flexible member 230.Optical fiber 320 transmits light is adjacent to flexible member 230 ends with irradiation interior cavity tissue from light source 324.Video camera 420 and relevant camera optics device 424 can be set at the end of flexible member 230.Video camera can comprise built-in type optics and electronic component, and can comprise CCD or CMOS capacity.The video camera that is fit to is the MVC-Snake-1 video camera of MicroVideo ProductS manufacturing, and described video camera has the self-supporting ccd video camera that has built-in type optics and electronic component.Perhaps, also can use cmos camera, such as a kind of video camera of Welch Allyn of Schenectady New York manufacturing.Signal wires cable near-end ground is from video camera 420 extend through flexible members 230 and handle 220, so that provide signal to watch-dog 428 or other receptor/recorder that is fit to.

Flexible member 230 also can comprise the various raceway groove/passages that are used for transmitting from the more external tissue to the end 234 that is adjacent to flexible member 230 of patient gas, liquid or equipment.With reference to Figure 11 and Figure 12, vacuum tube 600 can pass flexible member 230 and handle 220 so that provide the vacuum source 620 of vacuum to communicate with end to flexible member 230.Similarly, fluid hose 700 can pass supply place 720 of element 230 and handle 220 to fluid (for example, water, saline solution, lubricating fluid).Figure 12 also shows the opening of service aisle pipe 800 of the end of flexible member 230.Service aisle pipe 800 can pass element 230 and handle 220 to receive medical apparatus and instruments 900.For example, after the end with flexible member 230 is arranged in desired locations place in the bodily lumen, can medical apparatus and instruments 900 (shown in Figure 11 have that of tweezers end 902 a kind of) be introduced with near near the tissue flexible member 230 terminal by channel 800.In Figure 11 and Figure 12, show and be with 500 to control with video camera 420 relatively with pipe 600,700 and 800 optical fiber 320.

The length of path 250 extensible flexible members 230.In Figure 11, show path 250 and comprise first and second ends 252 and 254 and the loop section 256 arranged along the path between first and second ends 252 and 254.Loop section 256 is arranged in the end of flexible member 230 ends.First and second ends 252 and 254 can be from handle 220 proximal extensions.If desired, can be wound, coil or be supported on the suitable bobbin from the path end of handle 220 proximal extensions or on the receptor in case not-go-

end portion

252 and 254 tangle.Path 250 extends (not having the path end in the inner chamber of flexible member 230 ends) in common successive mode at the not end of flexible member 230.

First and second ends can the hands artificially by the operator be handled so that advancing towards handle 220 in

end

252 or 254 extends to path 250 and pass flexible member 230 and advance, thereby increase loop section 256.Perhaps, end 252 can link to each other with schematically illustrated control unit 260 among Figure 11 with 254.In the embodiment shown in Figure 14, handle 220 can comprise two

switches

2210 and 2220 that are used for controlling independently

reversible motor

2240 and 2260, and

reversible motor

2240 and 2260 can be installed in the handle 220.Motor speed and/or moment of torsion can be by control unit 260 controls, and motor can comprise coupling mechanism, and described coupling mechanism applies frictional force so that according to the position of switch (towards flexible member 230 terminal ground) or (away from flexible member 230 near-end ground) drive track thread end backward forward to path 250.

In shown embodiment, path 250 is a single-piece, and it extends, passes handle 220 and pass conduit 242 to withdraw from near the conduits 242 the flexible member 230 terminal 234 terminally from first end 252.Path 250 extends so that extend around loop section 256 from the oblique section of conduit 242 is terminal, and enters into the oblique section of the conduit 244 on flexible member 230 opposite sides, and path 250 withdraws from from conduit 242 from the oblique section of described conduit 244.Loop section 256 comprises slick circular arc or other bending, and path 250 turns to (or subtend) at least about 90 degree in described circular arc or bending, more specifically, and at least about the angle of 180 degree.In Figure 11, path 250 turns to the angle greater than 180 degree in loop section 256.Pass conduit 244 and turn back to the second end 254 path 250 near-ends by handle 220.In Figure 11, show and excised a part of conduit 244 so that the path 250 that passes conduit 244 to be shown.

For make flexible member 230 (with and associated components) advance in the bodily lumen, the end of flexible member 230 can be arranged in the inlet of inner chamber.Can make (or two a) path end 252 and 254 advance (for example), make handle 220 and flexible member 230 keep static simultaneously by pushing away lightly on the path end towards handle 220.The advancing of path 250 arbitrary ends causes loop section 256 increasing on the length and causing path " to expose " when it advances to the terminal limit of flexible member in addition the time, so that the sweep along inner chamber advances in inner chamber.Loop section 256 from flexible member 230 ends advanced (as by video camera 420 appreciable) afterwards, flexible member 230 can advance along path 250 terminally.By promote on handle 220 terminally and synchronously near-end pulling in path end 252 or path end 254 make flexible member 230 (and relevant video camera 420 and optical fiber 320) be advanced further in the bodily lumen.Under the situation of bound by theory not, we think by driving handle 220 and appended flexible member 230, simultaneously (near-end ground) pulls back in path end 252 and 254, has reduced to make flexible member 230 pass through inner chamber (for example, gastrointestinal tract) the required power of advancing.Particularly, in one embodiment, can on (rather than two a) end 252/254, pull back simultaneously by terminal ground driving handle 220.

How Figure 13 A-E makes path 250 to advance in colon if schematically showing, and any flexible member 230 that makes can advance so that the end of flexible member 230 is arranged in desired locations place in the colon along path.In Figure 13 A, show after being inserted into medical treatment device in the gastrointestinal tract at first, path 250 is the shape of comparatively shrinking.In Figure 13 B-13D, make path advance, (by promoting one or two end 252 and 254) towards handle 220 by flexible member 230 terminally.Make path 250 advance and increased loop section 256, and exposed loop section 256 by handle 220 and element 230.In Figure 13 D, show loop section 256 and be exposed to the position relevant with the section start of transverse colon.Then as shown in Figure 13 E, by be pushed into handle/flexible member 230 in the gastrointestinal tract terminally, simultaneously synchronously in the end 252 and 254 of path 250 backward (towards near-end) draw, can make flexible member 230 advance to transverse colon with relevant video camera and light source.In Figure 13 E, on one in end 252/254, pull back, loop section 256 shrinks with respect to the near-end ground, position among its Figure 13 D in colon.If desired, can repeat the step that illustrates in turn among Figure 13 B-E, so that the end of flexible member 230 is arranged in the position of expectation.

Path 250 can be the guide line that has the circular section usually.As a kind of suitable material of path 250 be have by diameter be 0.008 inch the stainless steel wire circumvolution around diameter be the guide line (guidwire) of 0.021 inch to 0.025 inch nitinol sandwich layer.Overall diameter can be between 0.037 inch to 0.041 inch, and interval welding that can 50cm or adhere to stainless steel coi so that with respect to the nitinol sandwich layer with stainless steel coi fixing in place in.The material suitable as the another kind of path 250 is can be from Winston Salem, and the Wilson-Cook Medical of NC, the trade mark that the Inc. place buys are EliteProtector ^TMThe guide line of Elite 480 wire guides (wire guide), and have 0.035 inch diameter.The length that depends on the inner chamber that will walk, path can have about length more than 15 feet.

Path 250 can slide in path conduit 242 and 244.

Path conduit

242 and 244 can be made with low-friction material, perhaps it is handled to such an extent that have a low-friction coating.In one embodiment,

pipe

242 and 244 can be reinforce polyfluortetraethylene pipe with provide and path 250 between low frictional contact surface.This pipe can be the line of making such as the International PolymerEngineering by Tempe Arizona and reinforces polyfluortetraethylene pipe.Its external diameter can be less than or equal to about 0.10 ", and wall thickness can be about 0.016 ".

Though it is tubular that the path guide among Figure 11 is shown, it should be understood that the guide shape that also can adopt other, include but is not limited to passage, guide rail and slotted surface, as the guide that supports and guide path 250.In another embodiment, the internal diameter of sheath 236 can be suitable for providing the path guide.

Though figure 11 illustrates two conduits, but in an alternative embodiment, also can use a conduit (for example conduit 242), and path 250 can extend from first end (it is external to be positioned at the patient), by handle 220 and conduit 242, extend and then enter into conduit 242 around loop section 256.Perhaps, path 250 can extend from being positioned at the first external end of patient, extend and have by handle 220 and conduit 242, around loop section 256 and be fixed near the second ends terminal of flexible member 230 ends or flexible member 230 (path end will be in the external extension of patient in this case, and will advance to increase loop section 256 towards handle 220 in this path end).

The video camera and the light source that are arranged in flexible member 230 ends can be embedded in flexible member 230, so that can not come off.Perhaps, video camera and light source can be and invest flexible member 230 sealing device of (such as by threaded adnexa, clasp adnexa, bayonet type adnexa or the like) removably.In one embodiment, flexible member 230 (and relevant conduit, fluid hose and service aisle) can be disposable, and that video camera and optics can be is reusable.

Figure 15 and Figure 16 (end-view that is cut along the cross section 16-16 among Figure 15) show an embodiment, and this embodiment has a conduit 242, and camera unit in the separate unit 420 and light source.In Figure 15, show and excised a part of sheath 236.Path 250 extends from conduit 242, turns to by loop section 256, and such as by being fixed in the end that is attached to flexible member 230 on the end piece 285 that is positioned at flexible member 230 ends.

Figure 17 and 18 shows an embodiment, and described embodiment comprises two path 250A and 250B and is arranged at corresponding path loop section 256A and 256B in the vertical plane usually.In Figure 17, show sheath 236 so that expose guide rail 242A, 242B and 244B (guide rail 244A is not visible) with the form of analysing and observe, and optical fiber 320 and camera unit 240.In the embodiment shown in Figure 17 and 18, optical fiber 320 can pass with the hole in 500, and is with 500 optical fiber 320 can be controlled to such an extent that be adjacent to video camera 420.Other pipe path (for example among Figure 17 and 18 unshowned 600,700 and 800) also can be supported on in the hole in 500.Provide path retainer ring 257 so that with path 250A and 250B control and/or every in the position of expectation.Path retainer ring 257 can comprise that path 250A and 250B can slip over described hole around encircling 257 along the spaced apart holes (not shown hole) of circumference with 90 degree.Therefore, path retainer ring 257 is supported in path loop section 256A in first plane, loop section 256B is supported in be basically perpendicular in first planar second plane.Spoke 259 can be used for retainer ring 257 is supported in to be with on 500.If desired, if path 250A and 250B are supported to slip over ring 257, sheath 236 can be invested (for example, if path 250A and 250B pass in the hole of encircling in 257) on the retainer ring 257.

In another embodiment, path 250 can comprise that a line or other do not have obvious end (promptly, do not have end 252/254) the path sheet that is fit to, but also can change into comprise have close-shaped (for example, ring path, ellipse etc.) slick, continuous path, wherein the loop section of close-shaped path passes the end of flexible member 230 with extension flexible member 230 ends 234, and another close-shaped loop section extends the near-end of handle 220.In such embodiments, the loop section that extends handle 220 near-ends can be controlled so that the loop section end of flexible member 230 advances in bodily lumen by hands or by controller.

In each embodiment, it should be understood that, optionally, one or more sealing members can be provided, so that such as from the patient external a bit to the inner chamber a bit limit gas or flow of liquid is crossed or circulation flexible member 230, the end that especially is desirably in flexible member 230 provides vacuum or expectation with under the state in the inner chamber and the isolated situation of inner chamber state outward.For example, with reference to Figure 11 and 12, can provide interrelate with

guide rail

242 and 244 and with the sealing member that passage 800 interrelates, pass guide rail or passage 800 to prevent air.The sealing member that is used for passage can be the foraminous little flexible silicone rubber protective cover form of tool, and wherein path 250 or apparatus 900 can pass described hole.Similarly, the flexible cuff or the axle collar can be arranged on the flexible member 230, and can and be adjacent between the patient body part of opening part of patient's inner chamber at flexible member 230 sealing is provided.Lubricating gel body and other lubricated product also can be used for strengthening or providing sealing.

Though described various embodiment of the present invention, those of ordinary skills should be understood that described embodiment only provides as example.Can provide the present invention with the complete form of other medical treatment device, described other medical treatment device comprises the medical treatment device that is used in the service aisle, and complete element can by high-temperature sterilization and be encapsulated in sealed container or big envelope in pollute preventing.The present invention can be used as the independent disposable apparatus that uses and provides, and perhaps, also it can be constituted multi-purpose.In addition, each element of the present invention or parts all can be regarded the device that is used to carry out by the performed function of element or parts as.Do not breaking away under the situation of the present invention, those of ordinary skills can make various changes, variation and replacement to the present invention.Therefore, the present invention is limited by the spirit of claims and protection domain only.

Claims

1. medical treatment device that is used in the patient body inner chamber, described medical treatment device comprises:

Can be arranged in the peplos (80) in the bodily lumen, described peplos (80) comprises the path that therefrom passes;

Fixing head (50) is anchored on one's body the patient; And

Be arranged in the described path and to the terminal cable (25) that extends of this peplos (80), wherein, comprise a ring (54) to the part of the terminal cable (25) that extends of this peplos (80); With

Be positioned at the inner propulsive mechanism (44) of described peplos (80), has clamping passage (91) in the described peplos (80), propulsive mechanism (44) uses and clamps the inner a part of cable (25) of passage (91), by changing the length of cable between described peplos (80) and the fixing head (50), so that described peplos (80) is along described cable (25) location and mobile.

2. the medical treatment device described in claim 1 is characterized in that, described cable (25) is suitable for passing this peplos (80) and advances.

3. the medical treatment device described in claim 1 is characterized in that, comprises compressible sleeve (40), and compressible sleeve (40) extends to the fixing head (50) that is fixed in the patient from the rear end (65) of described peplos (80).

4. the medical treatment device described in claim 1 is characterized in that, described medical treatment device comprises imaging device.

5. the medical treatment device described in claim 1 is characterized in that, described medical treatment device comprises light source.

6. the medical treatment device described in claim 1 is characterized in that, described medical treatment device comprises and is used for making medical apparatus and instruments to enter the service aisle (36) of this bodily lumen from a position of bodily lumen outside.

7. the medical treatment device described in claim 1 is characterized in that, described medical treatment device comprises the passage that is used to this device end portion that vacuum is provided.

8. the medical treatment device described in claim 1 is characterized in that, described medical treatment device comprises and is used to this device end portion that fluidic passage is provided.

9. the medical treatment device described in claim 1 is characterized in that, described medical treatment device comprises the optics relevant with this device end portion.

10. the medical treatment device described in claim 9 is characterized in that, described optics can be removed from described device.

11. the medical treatment device described in claim 1 is characterized in that, described propulsive mechanism (44) comprising:

Be supported in the pulley (86) in the peplos (80);

Pulley anchor clamps (87), pulley anchor clamps (87) apply pull strength to cable (25), thereby described peplos (80) is moved along described cable (25);

Drive cable (32) is used for transmitting a torque to from the near-end of described cable (25) far-end of drive cable (32);

Gear train, have first mitre gear (82) and second mitre gear (83), first mitre gear (82) and second mitre gear (83) are supported in the peplos (80) so that rotate around separately rotation axis, described rotation axis is perpendicular to one another, each all is to cut with miter angle for the tusk of first mitre gear (82) and second mitre gear (83), the end portion of drive cable (32) is passed the rear end (65) of peplos (80) and is connected with first mitre gear (82) coaxially, pulley (86) is connected in second mitre gear (83) coaxially, first mitre gear (82) rotates around the rotating shaft with drive cable (32) conllinear, and transfer torque to second mitre gear (83), during second mitre gear (83) rotation, pulley (86) is along with the rotating shaft rotation of second mitre gear (83) around second mitre gear (83).