Endoscope head with swiveling camera and work channel unit

Description

[0001] The present invention relates to an (endoscope-integrated) endoscope head or an (endoscope-separate) endoscope head attachment / endoscope head of the endoscope-adaptive type, each comprising at least one optical element for image transmission, a light source, and a working channel for guiding (minimally invasive) tools and / or for the flow of media. The invention further relates to an endoscope with such an endoscope head or endoscope head attachment. Background of the invention

[0002] Endoscopes are medical devices used for the visual exploration of cavities within a patient's body. They generally feature optical devices at the distal end (also called the endoscope head), which is closer to the body. Optionally, they include a working channel that extends from a proximal endoscope section or extracorporeal endoscope handle through a flexible / rigid or rigid endoscope shaft to the endoscope head. This channel allows for the extracorporeal insertion and use of a medical instrument such as forceps, scissors, needle, loop, knife, and the like.

[0003] Such endoscopes can optionally be equipped with additional capabilities, for example, by attaching a cap or sleeve radially to the outer surface of the distal end / endoscope head. This cap or sleeve is equipped with specific functions / functional elements, allowing the endoscope to be used not only for exploration and / or as access for therapeutic applications, but also as a minimally invasive instrument for performing surgical procedures. Alternatively, it is also possible to equip special endoscopes for very specific medical applications with such capabilities as an integral part of the device. However, such custom-made devices are only suitable for that specific application.

[0004] Various diagnostic and / or therapeutic procedures require, for example, imaging and / or, if necessary, therapeutic techniques on the bile and / or pancreatic ducts, as well as the hepatic ducts of the patient. Since the papilla of Vater, which forms the common opening of the bile and pancreatic ducts into the duodenum, projects laterally into the duodenum, conventional prograde (longitudinally facing) endoscopes are unsuitable for such procedures because there is insufficient space within the duodenum to align their prograde optics and working channel into a laterally facing position. State of the art

[0005] Prior art (e.g., US 2010 / 228086 A) discloses specially designed duodenoscopes for this purpose, which feature a lateral (sideways-viewing) or retrograde (backward-viewing) optic (also called "side view optic") and a laterally directed working channel. At the exit of the working channel of such duodenoscopes, a so-called Albarran lever is typically provided, which, by pivoting, allows for the targeted guidance / redirection of a tool guided within the working channel. The laterally directed arrangement of the functional units on the endoscope head enables imaging and treatment in the duodenum with optimal use of the available space.

[0006] However, endoscopes with side optics are very complex and expensive to manufacture and are therefore currently designed and produced as reusable devices. Furthermore, the curved working channel of such endoscopes, as well as the complex and undercut-rich design of the Albarran lever, have proven in practice to be impossible to sterilize, or the sterilization process has proven too damaging to the delicate construction of the Albarran lever, meaning that only disinfection is possible after a procedure with such a duodenoscope. As a result, a bacterial biofilm remains in the working channel and / or the auxiliary channel of the endoscope after a procedure. If this biofilm is then dislodged during a subsequent procedure, for example, when an instrument is inserted through the working channel, it can enter the bile duct and cause serious inflammation, even sepsis, in the patient.

[0007] Furthermore, such devices have the disadvantage that they can only be used for a few, very specific procedures in the duodenum, since neither the optics nor the working channel can be directed in a prograde direction. In addition, navigation within the body with sideways-facing endoscopes is generally rather difficult, as looking forward always requires bending the "deflecting" (actively bendable endoscope shaft section) immediately in front of the endoscope head by approximately 90°, which in turn requires more space in the transverse direction of the endoscope, which is only available in the stomach. German patent applications DE 20 2013 007 416 U1, JP H10 258022 A, DE 10209986 A1, US 5413107 A, and DE 10 2013224683 A1 disclose examples of prograde, flexible endoscopes with such a deflecting as described above. In some of the cited publications, the endoscope head is interchangeable and attached to the distal deflecting end.

[0008] Further endoscopes with a swiveling optic, capable of viewing both progradely and laterally, are known from the prior art, as described, for example, in DE 10 2013 222 279 A1 or DE 10 2012 220 578 A1. However, such endoscopes either lack a working channel (and are therefore used purely for diagnostic purposes) or have a fixed working channel in the prograde direction and are thus not suitable for the typical applications of duodenoscopes, which require a laterally oriented working channel.

[0009] From the patent application DE 10 2010 034 380 A1, an endoscope is known which has a swiveling mechanism in the form of a four-bar linkage, by means of which the distal tip of the endoscope can be connected to the proximal shaft.

[0010] US 2009 / 231 419 A1 describes an endoscope arrangement comprising an endoscope comprising a tubular body, a retrograde viewing imaging device located at a distal end of the tubular body, a channel extending through the tubular body, and an instrument extending through the channel of the endoscope and exiting from a distal opening of the channel.

[0011] Furthermore, US Patent 2012 / 041264 A1 discloses an endoscopic instrument with a jointed section of a shaft for flexibly connecting a distal shaft portion to a proximal portion of the shaft. For this purpose, the distal shaft portion is connected to the proximal shaft portion by two rigid joint rods of different lengths, each of which attaches to the distal and proximal shaft portions via a joint.

[0012] In summary, the duodenoscopes known to date are very expensive and complex to manufacture, suitable only for a very specific purpose, and also pose a significant hygiene risk.

[0013] In view of the disadvantages of the prior art described above, an objective of the present invention is to provide or retrofit an endoscope that can be used both as a prograde endoscope and as a sideways-oriented endoscope. A further preferred objective of the invention is to circumvent hygiene problems by providing such an endoscope as a disposable item or by providing a corresponding retrofit kit that can be used as a disposable product.

[0014] This problem is solved by an endoscope head having the features of claim 1. Advantageous further developments are the subject of the dependent claims. Brief description of the invention

[0015] In principle, an endoscope head according to the invention (integral solution) or an inventive (cap) attachment / endoscope head of the endoscope-adaptive type that can be placed on the endoscope head of a conventional endoscope (adaptive solution) comprises at least one optical element for image transmission, a light source, and a working channel for guiding tools and / or for the flow of media. Furthermore, the endoscope head / endoscope head attachment according to the invention has an internal pivoting device, different from the generally known "deflecting" device (i.e., additionally spaced distally from it), which is designed to pivot a section of the endoscope head / endoscope head attachment from a prograde orientation to a lateral or sideways orientation, i.e., about a pivoting axis transverse to the longitudinal direction of the endoscope, in particular continuously, but possibly also in increments.At least the optics and the working channel are directly or indirectly coupled to the swiveling device such that they swivel together with the swiveling device or the endoscope head section / attachment section that can be swivelled by it. In other words, an endoscope head / endoscope head attachment according to the invention forms a swiveling optics and working channel unit, so that an endoscope equipped / retrofitted with it can be used in both a prograde and a lateral orientation. Within the scope of this application, the term "optics" is used collectively to refer to all imaging devices known in the prior art in the field of endoscopy, such as a module consisting of a CMOS or CCD chip and a lens in the endoscope head / endoscope head attachment, or the use of optical fibers, etc. It is irrelevant whether the basic position of the swiveling device is prograde or lateral.To implement the inventive concept, it is only necessary that the swiveling device can assume both orientations, so that an endoscope with an endoscope head / endoscope head attachment according to the invention combines the functions of a prograde endoscope and a side-view endoscope. In principle, any pivotable or rotatable actuator / gear known from the prior art can be used as the swiveling device. The pivotable bearing of the swiveling device can, for example, be designed as a hinge with hinge pins and bushings, as a film hinge, or as a nose / edge that interacts with a corresponding guide contour. A Bowden cable, which can be actuated proximally and outside the patient, can be used, for example, to trigger a swiveling movement of the swiveling device. According to a preferred embodiment, the swiveling device can be pre-tensioned in a defined position.

[0016] Furthermore, the endoscope head / endoscope head attachment features an anti-kinking device designed to support the curving working channel when the swivel mechanism is pivoted into a lateral position, thus more effectively preventing kinking. The anti-kinking device supports the working channel in its curved state through a defined shape. This ensures the passage of surgical instruments and media through the working channel. Preferably, the anti-kinking device is designed to unfold / extend when the swivel mechanism is pivoted into a lateral position and to fold / retract again when it is pivoted back. The folding and unfolding mechanism can be implemented, for example, via a pair of guide contours or a spring preload.

[0017] Preferably, in addition to the optics and the working channel, a so-called auxiliary or secondary channel for additional suction and rinsing and / or at least a light source for joint swiveling with the swiveling device can be coupled. In other words, in a preferred embodiment, all functional units customary in the prior art can be swiveled from a prograde orientation to a lateral orientation while maintaining their relative orientation to one another.

[0018] A swiveling device according to the invention for swiveling the optics and working channel offers numerous advantages over endoscopes known in the prior art. An obvious advantage is that a single device can now be used flexibly for all tasks that previously required the purchase of several devices (gastroscope, colonoscope, duodenoscope). Compared to conventional side-viewing endoscopes, an endoscope with an endoscope head / endoscope head attachment according to the invention also has the advantage that navigation in and to the duodenum is considerably simplified in the prograde position of the optics.Where previously the endoscope tip had to be angled by 90° to allow a side-viewing endoscope head to look straight ahead—a feat only possible within the stomach due to the limited space available—the endoscope with the endoscope head / endoscope head attachment according to the invention can be inserted with a prograde viewing direction and only pivoted into the side-viewing orientation at the point of use, even in the most confined space. A further advantage of an optics and working channel unit according to the invention is a significantly larger possible field of view.

[0019] The swiveling device can preferably be designed such that the diameter or cross-sectional area of ​​the endoscope head / endoscope head attachment increases as little as possible during swiveling. Specifically, this means that, unlike a conventional endoscope which must be angled via deflection, the cross-sectional area of ​​the endoscope head / endoscope head attachment does not increase, or hardly increases, when moving from a prograde to a lateral orientation or vice versa. In other words, the swiveling device can be designed to swivel within the head itself. According to one embodiment, the swiveling device can be designed such that the cross-sectional area of ​​the endoscope head increases by no more than 25%, preferably no more than 10%, and particularly preferably no more than 5%, during such swiveling. This functional feature can be implemented constructively, for example, by...This is achieved by ensuring that the extension of the endoscope head section / attachment section pivoted by the swiveling device is shorter in the longitudinal direction of the endoscope than its extension in the transverse direction of the endoscope.

[0020] Preferably, the optics of an endoscope according to the invention can provide a viewing angle (without taking swivel movements into account) between 115° and 140°.

[0021] According to one aspect, the swiveling device can essentially be arranged (pivotally mounted) on a circumferential edge of the endoscope head / endoscope head attachment. In this way, for example, an entire distal section of the endoscope / endoscope head attachment, including all functional units located on or attached to it, can be swiveled.

[0022] In such an embodiment, the working channel and / or the auxiliary channel formed in or on the endoscope head / endoscope head attachment can preferably be arranged on the side diametrically opposite the pivot axis. This has the advantage that the largest possible radius of curvature of the working channel is achieved in the lateral position, thus preventing kinking of the working channel. According to an advantageous embodiment, the working channel can even be guided outside and along the endoscope head body / endoscope head attachment and essentially diametrically opposite the pivot axis of the pivoting device, in order to increase the distance between the working channel and the pivot axis to prevent kinking of the channel.

[0023] According to another embodiment, the working channel and / or the auxiliary channel can be designed to be kink-resistant per se, e.g. by selecting a suitable material (e.g. PTFE) or by providing supporting hose layers, such as wire spirals.

[0024] According to a further aspect of the invention, the endoscope head / endoscope head attachment can have a guide / sighting device designed to indicate the orientation of the swiveling mechanism. It is advantageous if the orientation of the working channel opening is projected onto a lumen or other tissue to be examined. For this purpose, the sighting device can preferably have a light pointer or laser pointer that is oriented essentially in the direction of the distal exit of the working channel within the swiveling section of the endoscope head / endoscope head attachment. This has the advantage that the user can see through the optics of the endoscope during treatment where a tool (medical instrument) guided through the angled working channel will strike, or how far the user must angle the swiveling mechanism to intubate the papilla of Vater.

[0025] According to a preferred embodiment, the endoscope head / endoscope head attachment can further comprise a tube or bellows structure that connects the swiveling device to the proximally adjacent, non-swiveled section of the endoscope head / endoscope head attachment or shaft section. When the swiveling device is now pivoted relative to the proximally adjacent section of the endoscope head / endoscope head attachment or shaft section, any gap that would normally arise from this swiveling movement is closed off from the surrounding environment by the tube section or bellows structure, which is preferably elastic in the longitudinal direction of the endoscope. In other words, the swiveling space of the swiveling device can be sealed by the tube or bellows structure.In this case, such a bellows, which lengthens like an accordion when one section of the endoscope head / endoscope head attachment is pivoted, can simultaneously take over the function of the aforementioned kink prevention device if the working channel is located radially outside the endoscope head / endoscope head attachment and thus lies against the outside of the bellows.

[0026] According to a particular, preferred aspect of the invention, the endoscope head according to the invention can be designed as an adaptable endoscope head or endoscope head adapter. That is, the endoscope can have a type of connection mask on the distal end face of the "deflecting" section, to which the endoscope head with the corresponding capability as described above can be coupled, or the endoscope head adapter can be detachably attached to an endoscope head surface, preferably an end face, of a known endoscope and thus serve as a retrofit attachment as described above. In other words, a commercially available endoscope head can be converted into an endoscope according to the invention with a swiveling device for pivoting the optics and the working channel by means of such an adapter. Such an endoscope head adapter can utilize the existing functional units of the endoscope to be converted, i.e.,It can be operationally connected / coupled to the optics and / or the light source and / or the working channel and be designed to at least extend the adapter's internal optics and working channel along the adapter's axial length and swivel accordingly using the pivoting mechanism. Likewise, the endoscope head adapter can also have its own internal optics and / or light source and / or its own working channel running along the converted endoscope (in addition to / parallel to the elements built into the endoscope head). Likewise, any combination is possible, meaning that some functional units of the converted endoscope are used, while other functional units are designed independently of the converted endoscope (parallel to it). The adaptability of such an endoscope head designed as an adapter can be achieved, for example, by a threaded connection, a snap-on or push-fit mechanism, or suction.An endoscope head adapter according to the invention can preferably be designed as a disposable product, whereas the endoscope can, for example, be a reusable product. This has the advantage that a commercially available prograde endoscope can be equipped with the swiveling device according to the invention, while the most hygiene-critical components (especially the various channels) can be disposed of after use.

[0027] Another aspect of the invention, which may be claimed independently, relates to an endoscope, in particular a disposable endoscope, with an endoscope head / endoscope head attachment according to the invention as described above. To enable treatment in the duodenal region, such an endoscope, in addition to an endoscope head / endoscope head attachment as described above, has a preferably flexible shaft through which and / or along which various operating and supply channels extend, enabling a connection of the various functional units of the endoscope head to a proximal operating station and a control / handling unit. By designing the endoscope according to the invention as a disposable endoscope that can be connected to a reusable handle, the hygiene issue discussed above becomes irrelevant, since all components inserted into the body are disposed of after treatment.

[0028] Preferably, an endoscope according to the invention can have an actively bendable distal shaft section, a so-called deflecting element, which is designed to be actuated by the user via a control / handling device from outside the patient, thus enabling the deflecting element to bend in at least one direction. The deflecting element preferably borders the endoscope head proximally. All embodiments customary in the prior art are suitable as deflecting elements, e.g., an embodiment with Bowden cables and jointly connected vertebrae / segments or an embodiment with hydraulic actuators.

[0029] According to a further preferred embodiment, the endoscope according to the invention can have a rotary drive or a rotary kinematic mechanism for rotating a distal section of the endoscope or the endoscope head about its longitudinal axis. In other words, it is advantageous if at least the section of the endoscope or the endoscope head in which the swiveling device is arranged can be rotated about the longitudinal axis of the endoscope. In this way, the effective radius of the swiveling optical working channel unit can be significantly increased. Preferably, the rotary drive can be arranged between the proximal end of an (actively bendable) deflecting element and the distal end of the flexible, passively bendable shaft. Preferably, such a rotatable endoscope according to the invention can have a deflecting element that can be angled in a single direction.In this way, the (rotatable) deflecting can be angled in virtually any direction, while the deflecting can be produced more easily, cheaply and with a slimmer profile. Character description

[0030] The invention is explained in more detail below with reference to preferred embodiments and the accompanying figures.

[0031] They show Fig. 1 a sketch of a prograde endoscope according to the state of the art in the exploration of a duodenum; Fig. 2 a detailed illustration of a state-of-the-art duodenoscope during a procedure on the papilla of Vater; Fig. 3 a representation of a first embodiment of an endoscope according to the invention in an un-deflected prograde orientation; Fig. 4 a representation of the first embodiment of an endoscope according to the invention in a deflected lateral or sideways looking orientation; Fig. 5a representation of a second embodiment of an endoscope according to the invention in a deflected lateral or sideways-looking orientation; and Fig. 6 an endoscope head adapter according to a preferred embodiment of the invention.

[0032] The Figs. 1 and 2 serve to explain a preferred area of ​​application of an endoscope or endoscope head according to the invention, as well as the endoscopes known to date in the prior art for this purpose.

[0033] As from Fig. 1As can be seen, the papilla of Vater (P) (the entry point of the common bile duct (G) and pancreatic duct (B) into the duodenum) is located in the posterior (dorsal) descending part (pars descendens) of the duodenum (D) and is relatively difficult to access due to the convoluted geometry of this system. The available space within the duodenum (D) is very limited, making interventions at the papilla of Vater (P) with prograde endoscopes impossible, as the required angle of the endoscope tip or deflecting section 10 towards the intervention site would leave insufficient distance to the lumen of the duodenum (D) for adequate imaging. Furthermore, bending the Deflecting 10 in the duodenum (D) poses a risk of injury due to the limited space. In the worst case, the lumen of the duodenum could even rupture during such a maneuver.

[0034] For this reason, the aforementioned duodenoscopes (E) are known to the state of the art, which have a sideways-looking optic and a correspondingly aligned working channel in order to make optimal use of the available space (cf. Fig. 2 Since such optics have a viewing angle of 125° to 140°, the endoscope can also be used retrogradely. However, such duodenoscopes (E) have the disadvantage that their lateral orientation of the optics and working channel is fixed. This makes general navigation within the patient more difficult and also renders such endoscopes inflexible in their applications. Furthermore, such duodenoscopes are currently only disinfectable, not sterilizable, which poses a significant hygiene risk.

[0035] A fundamental concept of the present invention is therefore to provide an endoscope, in particular an endoscope head or an endoscope head attachment, in which the internal optics and working channel are designed to be jointly pivotable by at least 90° (without the need for active deflection) in order to enable operation in both prograde and lateral orientations. In other words, the main objective of the present invention is to provide a combination device that unites the functions and advantages of a prograde gastroscope or colonoscope with those of a duodenoscope in a single device.

[0036] In Fig. 3Figure 1 shows a first exemplary embodiment of an endoscope 1 according to the invention in a first prograde orientation. The endoscope 1 has an endoscope head 2 at its distal end, which comprises various functional units such as an optic 3, a light source 4, and a working channel 5. For the sake of clarity, only the most essential functional units mentioned above are shown here and in the following; of course, an endoscope head according to the invention can additionally comprise various other functional units known in the prior art, such as cleaning nozzles for a lens of the optic 3, etc.

[0037] The working channel 5 extends from its distal opening or exit at the distal end face of the endoscope head 2, through a flexible shaft or along a flexible shaft of an endoscope 1 equipped with the endoscope head 2, to a proximal opening in the area of ​​the endoscope handle. It can thus be used, for example, for inserting surgical instruments or tools (W), such as a papillotome, or for applying media within the patient. The depicted endoscope 1 also has functional and supply channels 6, such as electrical lines, for supplying the functional units, transmitting data, and controlling the movements of the endoscope. These channels can be connected proximally to an operating station (not shown) or a controller / control unit (also not shown).Furthermore, such a shaft-type endoscope can have a so-called deflecting element between the endoscope head and the preferably flexible endoscope shaft. This deflecting element, extending from the passively flexible endoscope shaft, represents an actively bendable shaft section. This actively bendable shaft section can be bendable in all directions or, if necessary, only in one direction. In the latter case, a rotation ring can be arranged between the deflecting element and the endoscope shaft, which allows the deflecting element to rotate about the longitudinal axis of the endoscope relative to the endoscope shaft.

[0038] To enable the endoscope head 2, or preferably a distal section thereof, to be moved from a prograde orientation to a sideways-facing orientation, the endoscope or endoscope head has a pivoting device 7. In the first embodiment, this is implemented as a combination of a hinge 8 and a Bowden cable (not shown) and, in the example shown, allows the entire endoscope head 2 to be pivoted, preferably by an angle > 90°, so that the end face of the endoscope head 2 is oriented laterally, i.e., sideways to rearward, after pivoting. The hinge 8 can, for example, be implemented by a bolt guided in bushings, a film hinge, or a lug guided in a corresponding groove / guide contour.

[0039] Since an opening or gap develops between the pivoted head 2 and the shaft section proximally adjacent to it during such a pivoting process, a bellows, for example, is provided as a sealing element 9 to maintain the sterile barrier in the area of ​​the pivoting space. This bellows is expandable / stretchable in the longitudinal direction of the endoscope, particularly on the side facing away from the hinge. Instead of a bellows, an elastic, tubular connecting element can also be used, for example. The only important thing is that the sealing element 9, together with the head and the shaft, forms a sealed lumen and can be reversibly expanded / stretched in the longitudinal direction to bridge the distance traveled by the pivoting. Also for the purpose of reversible extendability, the functional and supply channels 6 in the illustrated first preferred embodiment are wound in a spiral.The working channel 5 is also preferably designed as a bellows or elastic hose in the swivel range.

[0040] In the illustrated embodiment, a bendable shaft section 10, the so-called deflecting element, adjoins the sealing element 9 proximally, as already indicated above. This deflecting element can, for example, as is common in the prior art, comprise a plurality of interconnected and pivotably linked links / rotors, which can be bent in one or more directions, for example, by means of Bowden cables or hydraulic actuators. In particular, such a deflecting element 10 can achieve a degree of curvature of at least 180° in one direction.

[0041] In the first preferred embodiment, a rotary drive 11 is located proximal to the deflecting element, thus being positioned between the deflecting element 10 and the passively flexible endoscope shaft 12. The rotary drive 11 is designed to enable relative rotation between the shaft sections 10 and 12 adjacent to each other proximally and distally. This has the advantage that, to align the endoscope head 2, particularly in the pivoted state, the entire endoscope 1 does not need to be rotated, which would cause considerable discomfort for the patient. Instead, a distal section of the endoscope can be selectively rotated into a desired orientation. The rotary drive could also be located directly proximal to the endoscope head 2. The rotary drive 11 can be implemented using various gears or rotary feedthroughs known in the prior art for the concentric relative rotation of two components.Typical examples include slewing rings / rotary drives, planetary gearboxes, or electro-hydraulic slip ring systems.

[0042] In Fig. 5An endoscope with an endoscope head according to a second preferred embodiment is shown. As illustrated here by way of example, the working channel 5 can also be guided on the outside of the endoscope shaft and head, preferably on the side diametrically opposite or facing away from the hinge 8, in order to maximize the bending radius of the working channel 5 in the lateral / sideways direction. As an additional feature, this embodiment optionally includes an anti-kinking device 13 or a support element which defines a contour along which the working channel 5 curves. In this way, kinking of the working channel 5 and a resulting blockage of the passage for medical instruments / tools can be prevented. The anti-kinking device 13 is preferably designed to unfold when the pivoting device 7 is pivoted into the lateral direction, e.g.by means of a spring preload, and to fold back into place when the pivoting device 7 is swung back, e.g. by a guide contour. Alternatively, the bellows can also be used as described above to radially support the working channel guided outside the bellows and thus prevent buckling.

[0043] In the second embodiment shown, the sealing element 9 is designed as an elastic silicone tube. In this embodiment, the electrical functional and supply channels are routed in the edge region of the shaft and via the hinge 8 into the endoscope head to supply the light sources 4, designed as LEDs 16 and a CMOS chip image sensor 15 of the optical unit 3, which are arranged on a circuit board 17. In the endoscope head 2 or on the circuit board 17, a light pointer 14 or a laser sighting device is also arranged in the illustrated embodiment, which is positioned essentially parallel to the distal exit of the working channel 5 in order to mark / indicate the approximate point of entry of a tool guided through the working channel at a target location in the patient by means of a light point.

[0044] In the example shown, the optics 3 are implemented as a CMOS chip 15 cooperating with a lens system. However, other solutions known in the prior art are also conceivable. For example, the image sensor 15 can also be shifted in the proximal direction, and the image can be guided to it via light guides (prisms and / or optical fibers). Likewise, the light source(s) 4 can be shifted in the proximal direction.

[0045] Fig. 6Figure 1 shows a further embodiment of the present invention, which may be claimed independently. In this case, the illustrated endoscope head 2 is designed as a separate adapter (endoscope head attachment) that can be detachably attached to a commercially available endoscope 1' or its internal endoscope head 2'. The centrally located working channel 5' of the modified endoscope 1' can also be used to apply a vacuum to a correspondingly prepared section of the underside of the endoscope head adapter 2, thus fixing the endoscope head adapter 2 to the endoscope 1'. The optics 3 of the illustrated endoscope head adapter 2 are independent of the internal optics of the endoscope 1', which are not shown.Furthermore, the illustrated endoscope head adapter 2 has its own working channel 5 for guiding tools and its own auxiliary channel, which are arranged along the endoscope 1' (on the outside) and are designed to pivot together with the swiveling device 7. The illustrated endoscope head adapter 2 also has its own light sources 4. The self-contained endoscope head adapter 2 thus configured is further connected, or connectable, to its own control unit (separate from that of the endoscope 1') for controlling the swiveling device, as well as to its own power supply and pump connections.

[0046] Crucially, in all the aforementioned embodiments, i.e., in the integral or adaptive solution, the working channel and the optics currently responsible for imaging are simultaneously pivoted by the same angle, ensuring that the optics and the distal opening of the working channel are always aligned in the same, coordinated direction. This guarantees that the endoscope can be optimally used for various purposes. In particular, when the adaptive solution concept is implemented, the additional advantage is gained that commercially available endoscopes can be used. The hygiene issue can be elegantly resolved by designing the adaptive endoscope head attachment, with its pivoting section featuring an additional / separate optics and an additional / separate working channel, as a disposable product. Reference sign

[0047] 1 Endoscope; 2 Endoscope head; 3 Optics; 4 Light source; 5 Working channel; 6 Functional and supply channels; 7 Swivel mechanism; 8 Swivel axis / hinge; 9 Sealing element / bellows; 10 Deflecting; 11 Rotary gear; 12 Flexible shaft; 13 Anti-kink device; 14 Light pointer; 15 Image sensor / CMOS; 16 LED; 17 Circuit board; B Pancreatic duct; D Duodenum; E Endoscope (duodenoscope) according to the state of the art; G Bile duct; M Stomach; PP Papilla of Vater; and W Tool.

Claims

1. Endoscope head (2) of the endoscope-integral type or of the endoscope-adaptive type in the form of an additional endoscope-head attachment each with at least - an optical unit (3) of its own for image transfer; - a lighting means (4) or a light guide of its own; and - a working channel (5) of its own for the guidance of medical tools (W) and / or throughflow of media, wherein the endoscope head (2) of the integral or adaptive, attachment-like type has an internal pivoting device (7) which is designed to pivot, in particular continuously, at least a portion of the endoscope head (2) from a prograde orientation into a lateral or a retrograde orientation, and at least the optical unit (3) and the working channel (5) are coupled directly or indirectly to the pivoting device (7) such that they are pivotable together with the latter while maintaining their relative orientation with respect to each other, characterized in that a kinking prevention device (13) which is configured to support the working channel (5), which bends during pivoting of the pivoting device (7) into the lateral orientation, via a desired shape.

2. Endoscope head (2) according to claim 1, characterized in that a pivot axis (8) of the pivoting device (7) is arranged substantially in the edge region of a cross-sectional area of the endoscope head (2).

3. Endoscope head (2) according to claim 2, characterized in that the working channel (5) is arranged in or on the endoscope head on a side of the endoscope cross-section opposite the pivot axis (8) of the pivoting device (7).

4. Endoscope head (2) according to claim 2 or 3, characterized in that the pivoting device (7) has a pivotable bearing in the form of a hinge (8), wherein the electrical functional and supply channels of the optical unit (3) and of the lighting means (4) are guided via the hinge (8) into the endoscope head (2).

5. Endoscope head (2) according to one of the preceding claims, characterized by a guiding device, in particular a light pointer (14), which is designed to indicate the orientation of the pivoting device and / or of the distal working channel exit relative to an adjacent endoscope head or shaft portion by projecting the orientation onto a lumen or other tissue to be examined.

6. Endoscope head (2) according to one of the preceding claims, characterized by a sealing element (9), which has in particular a tubular or bellows-like shape, which can be reversibly extended in the longitudinal direction of the endoscope and which connects the pivoting device (7) to a proximally adjacent endoscope head or shaft portion, to which the pivoting device (7) can be relatively pivoted, and which seals a pivoting space of the pivoting device (7) in the lateral or retrograde orientation thereof with respect to an environment.

7. Endoscope head (2) according to one of the preceding claims, characterized in that the kinking prevention device (13) is designed to fold open in the lateral or retrograde orientation of the pivoting device (7) in order to support the entrained working channel (5) from the radially inward direction against kinking by specifying a contour shape along which the working channel (5) curves.

8. Endoscope head (2) according to one of claims 1 to 7, characterized in that it is designed to be detachably fastened as an endoscope head adapter to an endoscope head surface or an endoscope shaft of an endoscope and to be operatively coupled to an optical unit and / or a lighting means and / or a working channel of the endoscope.

9. Endoscope (1) having a flexible shaft (12), which in particular has a deflecting portion (10), and a number of functional and supply channels (6), which can be connected to an operating station, characterized by an endoscope head (2) of the integral or adaptive, attachment-like type in accordance with one of claims 1 to 6.

10. Endoscope (1) according to claim 9, characterized by at least one rotary transmission (11) for rotating a distal portion of the endoscope (1) or of the endoscope head (2) about its longitudinal axis.