Wearable handheld device that attaches to an endoscope tube

Description

Wearable handheld device that attaches to an endoscope tube *** DESCRIPTION Field of invention The present invention relates to a wearable handheld device attachable to an endoscope tube, which allows the tube of an endoscope to be constrained endoscope in the surgeon's hand. State of the art Diagnostic and interventional endoscopy is a technique that consists in the introduction of an endoscope through a natural orifice of the human body or, in rare cases, through an incision made in the patient's tissues, by which the surgeon can observe, via a monitor, the organ or area to be treated. Furthermore, through the endoscope it is possible to introduce into the patient's body, and use a variety of instruments to take tissue samples for the diagnose or perform interventions, such as, for example, the removal of a polyp. In practice, endoscopy is used in various fields of medicine: it is very common in pulmonology, called bronchoscopy, for diagnosis and therapy of neoplasms, in gynecology, called hysteroscopy, to treat pathologies of the uterus such as cysts, endometriosis, fibroids. Endoscopic surgery is also used in other fields such as otorhinolaryngology, where it is very common endoscopic sinus surgery to treat lesions or problems within the nose, which impede normal breathing, which affect the sense of smell or which cause pain in the face and head. In the field of gastroenterology and General and digestive surgery, diagnostic endoscopy and interventional is used for the collection of tissue for histological analysis, the removal of polyps and tumors, treatment of hemorrhages, treatment of benign and malignant stenosis of the digestive tract, treatment of obesity, or treatments for biliary tract diseases, etc. A conventional endoscope includes a handle (or handpiece) from which a tube extends. The handpiece generally includes knobs directional and insufflation, washing and suction buttons. The knobs directional allow you to orient the end of the tube inserted into the patient. tube can be inserted into the patient's body through a natural or surgical orifice of the patient (for example through the anal orifice into the intestine, or, through the oral orifice, in the upper digestive tract). Through a lateral entrance an accessory can be inserted into a special channel in the tube on the handle consisting of a sheath, a surgical instrument (operating instrument) and a surgical instrument actuator mounted and operable on a handle of the accessory. The sheath extends inside and along the tube and is sliding in the tube in the longitudinal direction, that is, back and forth along the tube. The sheath exits the tube at an orifice at the tip of the tube of the endoscope. At the end of the sheath that emerges from the tip of the endoscope tube contains a surgical instrument, such as forceps or polypectomy loops. A thread is smoothly inserted inside the sheath. metal that allows the activation of the surgical instrument; one end of the metal wire engages the surgical instrument and the opposite end of the wire metallic engages the actuator mentioned above. The actuator is configured to activate and deactivate the surgical instrument on command, for example to close and to open the forceps, and to orient or rotate the surgical instrument. In practice, therefore, the tube is inserted into the patient's body, the sheath is inserted slidingly into the tube and the metal wire is inserted slidingly into the sheath. Initially the surgeon inserts the equipped tube into the patient's body with sheath and surgical instrument placed inside the tube. Once that the end of the tube was brought to the surgical site, the surgeon Stop the tube and push the sheath to extract the surgical instrument 1-2 cm. at this point the surgeon acts both on the actuator of the surgical instrument and on the sheath, to move the surgical instrument relative to the tube and the body of the patient, activate and deactivate the surgical instrument, and perform the surgery. If necessary, via the directional knobs and insufflation buttons, washing and suction present on the endoscope handle, the surgeon changes the orientation of the tube and proceeds to carry out insufflations, washings and aspirations. Since there are three components to be moved with just two hands, the tube of the endoscope, the sheath and the actuator of the surgical instrument, once Once the surgical site has been identified and reached, the surgeon leaves the endoscope tube in the position reached, and it is used with the hands to use only the sheath and the actuator of the surgical instrument. If it becomes necessary to move the endoscope tube again, normally the right hand is used for push or pull the endoscope tube while the left hand operates alternatively on the actuator of the surgical instrument or on the sheath, but it cannot act on both actuator and sheath. When the endoscope tube has reached the desired position, it is left and remains inserted into the patient, but not retained by the surgeon. For this reason, keep the endoscope tube stationary during use of the surgical instrument can be difficult. When the surgeon pulls the sheath, to retract the surgical instrument into the patient's tissue, for example, during the removal of a polyp, the endoscope tube reacts can move in the opposite direction, that is, it can insert itself further into the body of the patient, or it can move together with the sheath by slipping off the patient's body patient. For example, when the surgical instrument applies pressure on the patient's tissues, the endoscope tube may be subjected to a push in opposite direction, or counter-thrust, which can cause the loss of the correct position of the surgical instrument in the surgical site. For example, in the technique note that performing a colonoscopy requires that the left hand be held the handle (the handle) of the endoscope, and the fingers of the left hand are can be used to operate the directional knobs and insufflation buttons, suction and washing present on the handle, and the right hand is used to push and retract the endoscope tube with axial and di-axial movements rotation. It is clear, therefore, that two hands do not allow the management of all the events that may arise during the intervention, and for this reason the intervention of an assistant who coordinates with the surgeon is often required to keep the endoscopic tube stationary, with your hands, when necessary, or the surgeon maintains control of the endoscopic tube and the assistant acts on the actuator, when requested by the surgeon. There are other techniques to hold the endoscope tube, namely to keep it stationary with respect to the patient while using the instrument surgical. One technique involves the surgeon using three fingers of a hand, usually the same hand used to grip the handle of the endoscope: the surgeon clamps the endoscope tube between the three fingers and the grip, while supporting the grip with the same hand. Another technique is to use floor supports in the operating room. The supports are positioned on the floor and extend vertically; they are equipped with at least one swivel arm on which is mounted a clamp. The clamp can be locked onto the endoscopic tube and the arm is lockable in the chosen position. An example is shown in US 11,464,396, particularly in figures 12A and 12B. None of the techniques described above are satisfactory. The help of an assistant is not always available and, in any case, it poses problems of a regulatory, procedural and insurance nature, as well as managerial. The use of the three fingers of the hand with which the grip is held It is particularly uncomfortable for the surgeon and prevents the use of directional knobs and is not practical for surgeons with small hands. Floor supports are not always stable enough and However, they have dimensions that limit the freedom of movement of the surgeon and the medical staff around the patient. Furthermore, they have significant costs. For example, with regards to polypectomy procedures it is estimated that: - approximately 69% of the interventions are performed without holding the tube endoscopic, - approximately 29% of the interventions are performed with the third technique, that is with the surgeon holding the endoscopic tube together with the handle of the endoscope, and - approximately 2% of the interventions are performed with the second technique, that is with the help of an assistant. Summary of the invention The purpose of the present invention is to provide a device which allows for effective use of the endoscope tube, holding it or moving it as needed, avoiding the inconveniences described above, in particular a device that allows the tube to be moved of the endoscope, the sheath and the actuator of the surgical instrument so selective, with only two hands, without the external intervention of an assistant. The present invention therefore concerns a handheld device and wearable according to claim 1 for securing the endoscope tube to the surgeon's hand. The device is equipped with a hook portion configured for hold a tube of an endoscope inside which is housed, sliding, a (endoscopic) sheath with a surgical instrument inside it. Therefore, the surgeon: - with the hand on which the device is worn or tied, in particular the right hand, can move the endoscope tube relative to the body of the patient and can independently use the instrument actuator surgical inserted into the endoscopic sheath, and - with the other hand, the left, he can use it independently the handle (handpiece) of the endoscope, as well as the directional knobs and buttons on the handle. Additionally, by temporarily unhooking the endoscope tube from the device, the surgeon can use the same right hand on which it is mounted the device to act directly on the endoscopic sheath, moving it or holding it against the endoscope tube. In practice, thanks to the handheld and wearable device, the surgeon can perform three operations, even independent of each other, using two hands. In this in this way there is no strict need for the help of an assistant, but the surgeon can perform the endoscopy completely independently. Evidently, it is not even necessary use floor supports. Once the surgical instrument has been correctly positioned in Correspondence of the surgical site, the surgeon can perform the three operations, possibly hooking and unhooking the endoscope tube to / from the device, even repeatedly, if necessary. The device according to the present invention therefore allows the use only one hand, the one on which the device is worn, for maintain the position of the endoscope tube stationary during the procedure. In addition, the device according to the present invention provides the surgeon immediate feedback on the force exerted by the instrument surgical and the reaction offered by the patient's body tissues: the surgeon feels directly on the hand the traction force or the push exerted on the tube or by the endoscope tube and can intervene immediately to adjust the force performed with the surgical instrument. The device described here is therefore a simple but effective tool that provides the surgeon with the ability to control and move independently and selectively select the endoscopic tube, the endoscopic sheath and the surgical instrument. In the preferred embodiment the device comprises a body can be attached to the metacarpus of the hand, or worn on the hand so as to offer the attachment portion of the endoscope tube at the height of the metacarpus. In In general, the attachment portion may also be found in correspondence with other points of the hand, for example at the wrist, but have the attachment portion on the metacarpus has the advantage of allowing, if necessary, to be able to use your fingers on the endoscope tube, to squeeze it or to tighten the endoscopic sheath between the fingers and the endoscope tube, while the latter is held by the hook portion. Preferably the device comprises a first clamp constrained to the body; the first clamp is equipped with closing jaws on the metacarpus of the hand. In this embodiment, therefore, the device closes on the hand as a clothes peg. Alternatively, the device can be a glove that fits over the hand and provided externally with the hook portion. More preferably the jaws of the first clamp are lockable on the edge outside of the metacarpus of the hand, that is, on the portion that continues with the little finger. The body can be stationary with respect to the first clamp, or the first clamp is hinged to the body so as to allow the body to rotate with respect to at the first clamp. In the preferred embodiment the hooking portion is a second clamp equipped with closing jaws on the tube of an endoscope, for example a spring clamp. In one embodiment the attachment portion is bonded to the body by means of a hinge. In this configuration the attachment portion is rotatable with respect to the body (between a first position, corresponding to the portion distal attachment from the palm of the hand, for example at the back of the hand, and a second position, proximal to the palm of the hand, to example at the outer edge of the palm of the hand. For example, the hinge that connects the hook portion to the body of the device is an elastic hinge, that is, a hinge opposed by a spring or an elastic element, or the device comprises configured elastic means to constantly exert a force on the hook portion that tends to return the hook portion to the first position. In the embodiment with the coupling portion rotatable with respect to to the body, the device comprises a lever that can be operated by the wearer, i.e. by the surgeon, to rotate the attachment portion relative to the body between the first position and the second position. The lever just described extends from the body towards the palm of the wearer's hand, with length compatible with activation by the little finger only, or just the little fingers and ring finger, of the wearer. In other words, the lever is short so as not to take up all the palm of the hand and leave space for the fingers to be able to grip the actuator of the surgical instrument (operating instrument) placed inside the sheath endoscopic. In one embodiment the device is a kit that also includes an endoscopic sheath locking element on the handle / handpiece of the endoscope, at the entrance port of the sheath in the handle / handle of the endoscope. For example, the element of locking is a ring that holds the endoscopic sheath on the handle / handle of the endoscope. The use of the wearable handheld device includes: - fit or strap the device onto a surgeon's hand, typically the right hand; - attach an endoscope tube to the device; - move your hand with the device to change the position of the endoscope tube relative to a reference, such as the patient, or keep your hand still with the device to keep the device stationary position of the endoscope tube relative to the same reference, and - operate an actuator of the instrument with the fingers of the same hand surgical. The surgeon can use the other hand, the left, to control the handle / handpiece of the endoscope with its directional knobs and buttons. If necessary, the surgeon can temporarily release the tube of the endoscope from the device, and then from the right hand, to go and act directly on the endoscopic sheath, adjusting its longitudinal position with respect to the handle / handle of the endoscope. Once the desired position, the surgeon can reattach the endoscope tube to the device on the right hand. When it is no longer necessary to move the sheath endoscopic compared to the handle / handle of the endoscope, the surgeon can use a sheath locking ring on the handle / handpiece of the endoscope. Short list of figures Further features and advantages of the invention will become clearer. highlighted by examining the following detailed description of a form of preferred, but not exclusive, embodiment illustrated for illustrative purposes only and not limitative, with the support of the attached drawings, in which: - Figure 1 is a perspective view of a first device according to the present invention, fitted on a surgeon's hand, in a first configuration; - Figure 2 is a perspective view of the device shown in Figure 1, fitted onto a surgeon's hand, in a second configuration; - Figures 3-5 are perspective views of a second device of the present invention. invention, fitted on a surgeon's hand, in three corresponding configurations; - Figures 6-8 are sectional views of a third device according to the present invention. invention in three corresponding configurations; - Figure 9 is a sectional view of the third device shown in Figures 6- 8, about to be fitted onto the surgeon's hand; - Figure 10 is a sectional view of the third device shown in the figures 6-9, worn on the surgeon's hand and gripped on an endoscopic tube; - Figures 11 and 12 are schematic views showing the use of the device of figure 1 during surgery. Detailed description of the invention Figures 1 and 2 show a first embodiment 1 of the device 1 according to the present invention, which has the function of holding the tube of a endoscope on the surgeon's hand, without impeding the articulation of the fingers. For for this reason, the device 1 engages a portion of the hand other than the fingers. For example, device 1 is configured to engage the palm of the hand, in particular the area of ​​the metacarpal (fifth bone) in front of the little finger, or the back of the hand, or at most the wrist. For simplicity, device 1 will be defined as palm-sized precisely to indicate the ability to be constrained, in a way removable, to these anatomical parts. Therefore, the term palmar is to be understood with a broad meaning, not limited to just the palm of the hand. In addition to being handheld, the 1 device is also wearable, in the sense which is not intended to be challenged by the surgeon, because this would require the use of the fingers, but is intended to be tied to the hand even leaving your fingers free. The handheld and wearable device 1, hereinafter simply “device” 1, comprises a body 2 specifically shaped to allow the constraint on the surgeon's hand. In the example shown in the figures, body 2 is a first spring-loaded clamp, which can be opened and closed, shaped to tighten on the Metacarpus 3 of the hand M, especially the right hand. Body opening 2 It can be obtained manually by the surgeon, equivalent to opening a clothes peg. The spring (not shown) provides the push that keeps the body 2 closed on the hand M: clearly, the pressure exerted will be sufficient to prevent accidental disengagement of device 1 from hand M, but not excessive enough to cause discomfort or pain to the surgeon. On the body 2 there is a hinge 4 which supports a portion of hook 5 having the function of holding the T-tube of an endoscope. The portion of coupling 5 is then hinged to the body 2 so that it can rotate to change the position of the endoscope tube T in relation to the hand M. In In particular, the coupling portion 5 can be rotated between a first, external position relative to hand M and distal to the palm of hand M, in which the tube T extends to a distance from the back of the hand M, and a second position, proximal to the palm of the hand M, or in any case more internal, in which the tube T extends to the palm of the hand M, for example parallel to the little finger. In the preferred embodiment the hinge 4 is adjustable, in the sense that the surgeon, by acting on the hinge, can regulate its hardness and you can eventually block the hinge to prevent the portion from rotating of hook 5. For example, hinge 4 has a small adjustment knob, rotatable by the surgeon to adjust the hardness of the hinge 4. As shown in the figures, the hook portion is U-shaped, or C-shaped, and is flexible to allow the T-tube to be snapped into place portion 6 in the U or C shape, and the consequent blocking of the tube T, however removable. Alternatively, the hook portion is a second spring that can be opened and lockable, surgeon-operated to attach the endoscope T-tube. In the example shown, the device 1 comprises a lever 7, which extends from the body 2 towards the palm of the hand M, which can be operated by the surgeon with the same hand M. the lever 7 can be rotated by the surgeon, at any time, to cause the rotation of the hook portion 5, from the first position shown in figure 1 to the second position shown in figure 2. The length of the lever 7 it is such that it can be operated only with the little finger, or with the little finger and with the ring finger, without extending beyond what is necessary so as not to get in the way uselessly the palm of the hand. The lever 7 is contrasted by elastic elements 8 which exert constantly a restoring force of the hook portion 5 in the first position of figure 1. Figure 2 shows the coupling portion 5 rotated with respect to the position initial shown in figure 1. The arrow indicates the direction of rotation. Rotation is was given by the surgeon by means of lever 7. As will be clarified below, the rotation is used to bring the T-tube of the endoscope within reach, i.e. in a comfortable position for the surgeon to grip with his fingers. Figures 3-5 show in perspective, and in a sequence of use, a second embodiment 1' of the wearable handheld device, which is differs from the first embodiment 1 only in that the hook portion 5 faces the opposite side. In figure 3 the device 1' is connected to the tube T of the endoscope, i.e. the tube T is snap-fitted into the hook portion 5. The hook portion 5 is find in the first position, the initial one, corresponding to the T tube of the endoscope that extends parallel to the back of the hand M, from the side opposite to the palm of the hand M. In this configuration the tube T does not can accidentally disengage the hook portion 5 and does not obstruct the normal use of the hand M by the surgeon. In fact, the palm of the hand M remains free, just as the fingers remain free. The M hand can therefore be used by the surgeon for other operations than simply the retaining the T-tube of the endoscope. For example, the surgeon can use the fingers to move the endoscope sheath relative to the T-tube. Figure 4 shows the device 1' in a second configuration in the which, having pushed the lever 7 with the little finger, the surgeon brought the portion of hook 5 closest to the palm of the hand M, and in particular in proximity of the last metacarpal bone of the hand M. in this position, the tube T can be grasped by the surgeon with the little finger, meaning that the little finger can be partially wrapped around the T-tube. Figure 5 shows the device 1' in a third configuration in which, having further pushed the lever 7 with the little finger, the surgeon brought the hook portion 5 in the second position, in which the tube T of the endoscope extends practically parallel to the little finger. In this position, the T-tube of the endoscope is easily gripped by the surgeon with one or more fingers of the hand M to move the tube T relative to the patient, possibly maintaining a grip on the endoscopic sheath as well. Clearly, releasing lever 7 causes the automatic return of the hook portion 5 in the initial position shown in figure 3, by way of of the action of elastic elements 8. During the movements of the hook portion 5 shown in the figures 3-5, the body 2 of the device 1' remains firmly gripped on the metacarpus of the hand M. Figures 6-8 show in section, and in a sequence of use, a third 1” embodiment of the wearable handheld device, in which the body 2 is a first clamp equipped with two jaws 2' and 2” that can be rotated on a first pin 2”' parallel to the hinge 4 and in which the hook portion 5 is a second pliers with two jaws 5' and 5” rotating on a 5” pin parallel to the hinge 4. For simplicity, the endoscope's T-tube is not shown. The 2' and 2” jaws of the first clamp 2 open and close to lock on the outer edge of the metacarpal of the hand, as shown in relation to the Solutions 1 and 11. The 5' and 5” jaws open and close to lock onto the pipe T of the endoscope. Figure 6 shows the 1” device in the first position of the portion of hook 5, equivalent to that shown in figure 3. Figures 7 and 8 show the passage of the hook portion 5 to the second position, due to the effect of the surgeon's use of lever 7. The intermediate position of the portion of hook 5 of figure 7 is equivalent to that shown in figure 4 and the final position of the hook portion 5 shown in figure 8 is equivalent to the position in figure 5. Figures 9 and 10 are cross-sectional views of the 1” device in use. In In particular, figure 9 shows the insertion of the external edge M' of the metacarpal of the surgeon's hand M between jaws 2' and 2”. Pushing the hand between the jaws 2', 2”, the elastic hinge 2”' is opened and then closed, for squeeze the jaws 2' and 2” around your hand, as shown in figure 10. In Figure 10 also shows, in cross-section, the tube T closed between the jaws 5' and 5” of the hook portion 5. The use of the 1, 1', 1” device both during training outside the human body, both during a real endoscopy on a patient, provides that the surgeon wears the 1, 1', 1” device on the hand, as described above, with the T-tube of the endoscope stuck in the coupling portion 5. With the device 1, 1', 1” worn on the hand M, the endoscope tube T becomes integral with the right hand M of the surgeon who, consequently, acquires control of the longitudinal position of the T-tube. This means that the surgeon acquires the ability to push the T-tube into the patient's body, or retract it from the patient's body patient, while maintaining full functionality of the fingers of the same hand M, which can now be used to operate the actuator of the surgical instrument, leaving the left hand free to act on the endoscope handle / handle and its controls. It is then less need for external help, such as an assistant, or floor supports for the T-tube. Since the 2”' and 5”' zippers are elastic, you just need to pull the T tube of the endoscope with force to extract it from the 5' and 5” jaws and, similarly, it is enough force to remove the hand M from the jaws 2', 2”. Examples 1, 1' and 1” shown and described above are not limiting: the handheld and wearable device according to the present invention is realizable even differently, for example as a glove equipped with the portion of hook 5, regardless of whether the hook portion 5 is hinged or not. What matters is the surgeon's ability to be able to continue to use the right hand M to operate the instrument actuator surgical, while maintaining control of the longitudinal position of the T-tube. Figure 11 is a schematic view of a patient P undergoing a endoscopic surgery. Surgeon S wears device 1 on his right hand M according to the present invention. The tube of an endoscope is attached to the device 1, as explained above, and is inserted into the intestine of the patient P through the colon. With the same right hand, surgeon S holds an actuator 12 of the surgical instrument which is inserted into the endoscopic sheath 10, which a its turn is inserted into the T tube through the handle / handle 11 of the endoscope. On screen 9 the surgeon S displays the acquired image from the camera mounted on the end of the endoscopic tube T. With the hand left the surgeon S holds the handle / handle 11 of the endoscope, equipped of directional knobs and buttons for insufflation, suction and washing, overall indicated with reference 13. Using device 1, the surgeon can move the T-tube along the intestine. of the patient P to bring the surgical instrument to the site surgical. Once the surgical site is reached, the surgeon holds the right hand and, therefore, keeps the T-tube stationary with respect to the patient P, and proceeds to operate the actuator 12 to operate the surgical instrument. As shown in figure 12, if at this stage it is necessary to use of the directional knobs and the insufflation, suction and washing buttons 13 present on the handle / handle 11 of the endoscope, or it becomes it is necessary to move the sheath 10 with respect to the T tube and the handle / handpiece 11, the surgeon can proceed to unhook the T-tube from the device 1, for example using the left hand or making a rotary motion with the right hand M is enough to get the disengagement. At this point with the right hand intervenes directly on the sheath 10, or on the controls 13, until obtaining the correct positioning of the endoscopic sheath and, therefore, of the instrument surgical and proceeds with the surgery. If necessary, the surgeon S can reattach the T-tube to the device 1 to keep the T-tube stationary or to move the T-tube during the procedure, without it becoming tightly the help of an assistant is required. If necessary, the endoscopic sheath 10 can be temporarily held on the handle / handle 11 of the endoscope by an element locking, such as a ring (not shown).

Claims

CLAIMS 1. A handheld device (1, 1', 1”) wearable on a hand (M), provided with a hook portion (5) configured to hold a tube (T) of an endoscope.

2. Device (1, 1 ', 1 ”) according to claim 1, comprising a body (2) attachable to the metacarpus of the hand (M).

3. Device (1, 1', 1”) according to claim 2, comprising a first clamp constrained to the body (2), wherein the first clamp is provided with jaws (2', 2”) that can close on the metacarpus of the hand (M).

4. Device (1, 1', 1”) according to claim 3, wherein the jaws (2', 2”) of the first clamp are closable on the outer edge of the metacarpus of the hand (M).

5. Device (1, 1', 1”) according to claim 3 or claim 4, wherein the jaws (2', 2”) of the first gripper are hinged to the body (2), and the body (2) is rotatable with respect to the jaws (2', 2”) of the first gripper.

6. Device (1, 1 ', 1 ”) according to any of the preceding claims 1-5, wherein the coupling portion (5) is a second clamp equipped with jaws (5', 5”) that can close on the tube (T) of an endoscope.

7. Device (1, 1 ', 1 ”) according to any of claims 2-6, wherein the coupling portion (5) is constrained to the body (2) by means of a hinge (4), and wherein the coupling portion (5) is rotatable with respect to the body (2) between a first position, corresponding to the coupling portion (5) distal from the palm of the hand (M), and a second position, proximal to the palm of the hand (M).

8. Device (1, 1', 1”) according to claim 7, wherein the hinge (4) is elastic or the device (1, 1', 1”) comprises elastic means (8) configured to constantly exert a force on the hook portion (5) which tends - 20 CENN001BIT Vincenzo CENNAMO Biesse Srl to bring the hook portion (5) back to the first position.

9. Device (1, 1', 1”) according to any of the preceding claims 7-8, comprising a lever (7) operable by the wearer to rotate the hook portion (5) relative to the body (2) between the first position and the second position.

10. Device (1, 1', 1”) according to claim 9, wherein the lever (7) extends from the body (2) towards the palm of the wearer's hand (M) with a length compatible with activation by the little finger only, or by the little and ring fingers only, of the wearer.

11. A method for simulating an endoscopy outside the human body with the device (1, 1', 1”) according to any of the previous claims 1-10, comprising: - fitting or constraining the device (1, 1', 1”) on a hand (M) of a surgeon (S); - fixing a tube (T) of an endoscope to the device (1, 1', 1”); - moving the hand with the device (1, 1', 1”) to vary the position of the tube (T) of the endoscope with respect to a reference, or keeping the hand with the device (1, 1', 1”) still to maintain the position of the tube (T) of the endoscope with respect to the same reference, and - operating or moving with the fingers of the same hand (M) an actuator (12) of a surgical instrument inserted in the tube (T) of the endoscope.

12. Method according to claim 11, wherein using the other hand, the surgeon (S) holds / controls a handle / handpiece (11) of the endoscope.

13. Method according to claim 11 or claim 12, comprising: - 21 CENN001BIT Vincenzo CENNAMO Biesse Srl - unhooking the endoscope tube (T) from the device (1, 1 ', 1 ”) by the hand (M) and using the same hand (M) to move an endoscopic sheath (10) relative to the endoscope tube (T).