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An endoscope characterized by two separate yet generally coextensive fluid
conduits disposed along the length thereof, thereby making feasible the
establishment of a continuous, uninterrupted tissue-irrigating flow of
fluid to and from a zone of examination and treatment into which the lead
portion of the endoscope is introduced, so as to purge the zone to enhance
the viewing therewithin and to facilitate treatment including surgical
procedures carried out in the zone. Sensing means, pressure indicator
means, and regulator means are provided for monitoring and controlling the
fluid flow rate and for setting and limiting fluid pressure in the system.
Primary Examiner: Gaudet; Richard A.
Assistant Examiner: Layton; Henry S.
Attorney, Agent or Firm:Kegan, Kegan & Berkman
What is claimed is:
1. In an endoscope including conduit means insertable longitudinally into a restricted passage communicating with a body cavity for transmittal of a fluid stream through said
passage and into and from a zone of treatment subjected to a surgical technique,
tissue treatment means including means for removing tissue from said zone,
optical means for viewing said zone,
means for illuminating said zone,
means for selectively manipulating said tissue treatment means in carrying out said surgical technique,
pump means for driving fluid through said conduit means for said zone of treatment, thereby to establish a continuous fluid flow circuit for passage of fluid into and discharge of fluid from said zone of treatment in an uninterrupted stream, and
fluid impelling means distinct from said pump means
the improvement comprising:
flow rate synchronization means operable functionally in a series flow path including a zone of treatment to synchronize said fluid impelling means volume-wise with said pump means to preclude pressure buildup in said zone of treatment by reason
of fluid forced into said zone of treatment, and to obviate collapse of said body cavity as a result of fluid evacuation therefrom.
The present invention relates to an endoscope or similar
instrument finding utility in the examination of the interior of a hollow organ, as, for example, the urethra, and the bladder. More particularly, the invention is directed to a resectoscope with a markedly improved fluid transmitting system
characterized in that it includes two separate yet generally coextensive fluid conduits disposed along the length of the device, one conduit constituting a fluid input channel or passage and the other a fluid return or exhaust passage, both in
communication with an internal body cavity or medical treatment zone.
It is an important feature of the invention that the fluid conduit system makes it feasible to establish a continuous, uninterrupted tissue-irrigating flow of fluid to and from a zone of examination and treatment into which the lead portion of
the endoscope is introduced. The technique which is made possible through the use of the improved apparatus of the invention enables one to purge the zone of treatment to enhance the viewing therewithin and to facilitate surgical procedures which may be
In a preferred embodiment of the invention the apparatus includes fluid pressure sensing and indicator means together with pressure regulating means and guage means for monitoring and controlling the fluid flow rate and for adjusting and limiting
the fluid pressure in the system.
It will be appreciated by those skilled in the art that the subject invention is a marked, significant improvement over the prior art related devices which utilize but a single fluid conduit or passage running through the probe or sheath of the
endoscope. The art is replete with descriptions of prior art diagnostic and surgical instruments including cystoscopes which function with the benefit of only a single fluid transmission duct. Such a cystoscope is described in Wallace U.S. Pat. No.
2,487,498, and the entire disclosure of that patent is hereby incorporated herein by reference to the extent that it is not inconsistent herewith.
Other and further features and advantages of the invention will become apparent from the following
description considered in conjunction with the drawings in which:
FIG. 1 is a side elevational view of a resectoscope incorporating the present invention, portions of the instrument being cut away to show the components contained within the outer sheath;
FIG. 2 is a cross-sectional view taken substantially on the line 2--2 of FIG. 1 and showing the arrangement of the fluid input and the fluid exhaust passages extending through the sheath of the resectoscope;
FIG. 3 is a cross-sectional view similar to FIG. 2 but showing a second arrangement of the fluid input and exhaust passages;
FIG. 4 is a cross-sectional view, similar to FIG. 3 but showing still another arrangement of the fluid input and fluid exhaust passages; and
FIG. 5 is a schematic representation of the fluid pumping and control system used in conjunction with the improved resectoscope of the invention.
The aims and objects of the invention are accomplished by providing, in an endoscope, a pair of fluid conduits communicating between a fluid supply reservoir and an internal body zone of medical treatment to establish a continuous, uninterrupted
purging flow of fluid into and from the zone of treatment. In addition to the fluid reservoir and the pump for impelling the fluid through the conduit system, there is provided auxiliary equipment to enhance the procedure and to serve as controls and
protective devices ensuring proper operation under all conditions. Included in this auxiliary equipment are valves for regulating the fluid flow rate, pressure control elements for setting the required pressure in the fluid system, gauge means for
monitoring the pressure in the system, and automatically-operating limit controls to ensure that no pressures above those desired are established in the system, particularly in the critical zone of treatment. All of the above structures are in addition
to the conventional components of an endoscope, including the viewing or optical system, the illuminating system, and surgical elements such as a wire loop and the mechanical means for manipulating the loop.
For purposes of illustration, the endoscope of the invention will be described with specific reference to a cystoscope. Since the component elements of the device other than the fluid flow system and its associated components do not constitute
part of the subject invention, no detailed description of these parts is provided herein.
Referring now to the drawing, and particularly to FIGS. 1 to 4, for purposes of illustrative disclosure, a preferred embodiment of one form of the invention
is shown incorporated in a cystoscope 20. As depicted, the cystoscope 20 includes a tubular endoscopic sheath 24 of substantially rigid construction and preferably composed of a plastic composition. Extending lengthwise through the sheath 24 is a probe
assembly 26 carrying a viewing device constituting a surgical telescope 28 terminating at its forward end in a viewing lens 30. Also extending linearly through the sheath 24 as part of the probe assembly are electrical conductors 32 contained in a pipe
34 and used to supply power from a power supply (not shown) to an illuminating bulb 40, in the conventional manner. The probe assembly 26 also carries a pipe-encased surgical device or excising wire 42 which, as shown, terminates at its forwardly
extremity in a loop 44.
The wire 42 and its terminal loop 44 are manipulable forwardly and rearwardly through a longitudinally extending sleeve 46 by means of an assembly including a gear 48 and a ratchet 50 controlled by a hand lever 52. The wires 42 are connected to
an electrical jack 54 whereby electric current may be plugged in and fed to the loop 44.
Contained within and extending lengthwise through the sheath 24 are a pair of fluid conduits 56 and 58 terminating at the forward end of the cystoscope in ports or openings communicating with the zone in which the viewing lens 30, the light 40
and the wire loop 44 function when the instrument is put to use. The first conduit 56 constitutes the fluid input passage while the second conduit 58 is the fluid exhaust or return conduit.
In the particular embodiment of the invention illustrated, the conduits are demarked interiorly of the sheath 24 by means of a pair of longitudinally extending radial ribs or flanges 60 and 62 projecting between the inner wall surface 68 of the
sheath 24 and the outer wall surface 72 of the probe assembly 26 passing through the sheath 24, all as indicated in FIG. 2. While in the specific form of the invention illustrated in FIG. 2 the ribs 60 and 62 are formed integrally with the sheath 24,
preferably as a unitary extrusion, and the inwardly directed ends 80 and 82 of the ribs 60 and 62 ride upon and engage the surface 72 of the probe assembly 26 in fluid sealing engagement therewith, it will be appreciated that other mechanical
arrangements are possible. For example, as indicated in the cross sectional view of FIG. 3 the radial ribs 90 and 92 which demark the two longitudinally extending passages 56 and 58 may be made of steel as part of the outer shell 34 of the probe
assembly 26 and may bear upon the inner wall 68 of the sheath 24 in fluid sealing engagement. Many other suitable variations are possible including an arrangement in which the in-put conduit 56 and the exhaust conduit 58 are carried entirely by and
constitute an integrally formed part of the sheath 24. Such an arrangement is indicated schematically in FIG. 4 in which internal webs 94 and 96 cooperate with the sheath 24 to form the conduits.
The rearward end 100 of the sheath 24 is sealed into or otherwise affixed to a collar 104 sleeved on an annular neck 106 in fluid tight engagement therewith to fasten the sheath on the resectoscope. A pair of stub pipe connectors 108 and 110 are
sealed through the wall 114 of the collar 104 and communicate interiorly of the collar with the rearward ends of the fluid conduits 56 and 58 completing the connection between the interior of the sheath and the connections 108 and 110 to which flexible
hoses (not shown) may be attached. Thus, the controlled introduction of isotonic fluid through the stub 108 causes the fluid to flow linearly through the conduit 56 and to discharge in the treatment zone 116 and, thereafter, to continue its path to
return through the conduit 58 and to be discharged through the stub 110 exteriorly of the cystoscope 20.
The basic features and the inventive concepts of the subject development having been set forth, there is depicted in FIG. 5 a schematic representation of exemplary control apparatus used in ensuring that the fluid stream is properly introduced
through the cystoscope, to the zone of treatment, and thence from that zone back through the cystoscopic device, to be discharged. The apparatus described includes various safety devices and controls, all directed to making the entire procedure safe and
reliable under all contingencies.
Referring now more particularly to FIG. 5 there is shown, in conjunction with the improved cystoscope of the invention, the fluid pumping and irrigation system together with pressure regulators, valves, other controls, safety devices, and gauges. A motor 120 is coupled to a fluid pump 124 by means of a mechanical coupling 126 connecting the output shaft 128 of the motor to the in-put drive shaft 132 of the pump 124, whereby actuation of the pump is effective to transfer an isotonic solution 140,
e.g. 1.1% glycine, or any other desired liquid preparation, from a reservoir 142 through a pick-up tube 146 for delivery into a cystoscopic fluid feed line 150. Connected between the pump 124 and the cystoscope 20 is a fluid pressure regulator 154, a
control valve 156, a fluid pressure gauge 160, and a fluid pressure limiting control 164. At its discharge end 166 the fluid in-put lead line 150 is connected directly to fluid in-put stub 108 of the cystoscope 20, all as shown. After delivery of the
irrigating fluid through the conduit 56 of the cystoscope 20 into the zone of treatment 116, the fluid is removed through the passage 58 leading to an input end 170 of a discharge tube 174 connected to the output lead 110 of the cystoscope. Finally, the
fluid is discharged to a collecting vessel 180 or drain provided with a discharge valve 182. The flow rate may be varied as the physician determines, and rates of up to about 1000 cc/min. have been used effectively. Connected between the fluid
discharge port 110 of the cystoscope 20 and the drain 180 in the discharge line 174 is a pressure limit control 184, a pressure gauge 186, and a valve 188.
Those skilled in the medical art involved will appreciate that the pressure regulators, gauges, and limit controls for the fluid pressure serve important safety and control functions and enable the physician to know at all times the precise
conditions in the treatment system. The pressure limit controls 164 and 184 are automatic in operation and ensure that a pressure in excess of a predetermined, selectable value does not develop in the zone of treatment. The gauges 160 and 186 provide a
constant visual indication of the actual pressure in the system, and the pressure regulator 154 and the control valves 156 and 188 impart desirable versatility to the apparatus.
Optionally, a filter 190 may be coupled into the pick-up tube 146 so that fluid 140 transmitted through the input line from the reservoir 142 will be free of objectionable solids. In a preferred operational technique, the flow rate through the
input line or passage 56 to the operation zone 116 will be greater than the lineal flow rate in the return line 58. The greater cross sectional area of the return line will facilitate the removal of solids from the operational zone. It is also a
feature of the operational techniques contemplated that the input fluid discharge port will be sufficiently close to the viewing lens 30 so that a constant flow of fluid will wash the surface of the lens and enhance viewing capabilities. An additional
feature of the preferred embodiment of the invention illustrated is the incorporation of a second pump 194, located in the fluid discharge line 174 of the fluid pumping apparatus depicted in FIG. 5. The pump 194 is functionally synchronized, volume-wise
with the fluid input pump 124 so that there will be no pressure buildup in the treatment zone 116, and no tendency for collapse of the organ due to evacuation.
While several different mechanical arrangements have been described for the fluid input and the fluid exhaust lines in the endoscope of the invention, those skilled in the art will appreciate that still other mechanical variations are possible,
including coaxial passages such as one tube wholely within the other to provide a system in which the input passes through a tube while the exhaust is discharged through an annular passage surrounding that tube.
While there have been described what are considered to be preferred embodiments of the invention, it will be obvious to those skilled in the art that various changes and modifications may be made without departing from the invention, and it is
intended that the appended claims cover all such modifications as fall within the spirit and scope of the invention.