POSITIONING SYSTEM FOR AN ENDOSCOPE AND ASSOCIATED METHOD

Abstract

Endoscope positioning system, comprising a support arm having a support end for holding an endoscope close to the endoscope; the support arm capable of extending horizontally from a base to translate the distal end of the endoscope in a horizontal plane including a y-axis; the support capable of being moved to translate the endoscope in a vertical direction including a y-axis orthogonal to the y-axis and an x-axis orthogonal to the z and y axes; the support arm including a stop resisting rotational movements of the support about the y-axis. (See Fig. 24)

Description

Title of the invention:

[0001] POSITIONING SYSTEM FOR AN ENDOSCOPE AND METHOD PARTNER Scope of the invention

[0002] The present invention relates to positioning systems for medical instruments, such as endoscopes, used in minimally invasive surgery. Background of the invention

[0003] Generally, an endoscope is an instrument primarily intended for visualizing the inside of a patient's body and may not have built-in surgical capabilities. However, some endoscopes are equipped with one or two channels for functions such as suction, the introduction of fluids, or the insertion of surgical instruments. A generic endoscope equipped in this way can be used to perform minimally invasive surgery, the endoscope protecting the surrounding tissues from trauma caused by the repeated insertion of surgical instruments during a procedure.

[0004] Some of this equipment is configured for robotic control, leading to the use of robots in endoscopic surgery. In particular, the applicant has invented a range of robotic instruments, or steerable arms, with a diameter between 2.6 mm and 3.5 mm, designed to be inserted into the instrument channel of generic / standard endoscopes (such as colonoscopes, gastroscopes, and cystoscopes), or alongside the endoscope itself. The successful miniaturization of robotic surgical instruments can significantly improve the possibility of accessorizing and enhancing the surgical capabilities of generic endoscopes, paving the way for increased safety and efficiency in minimally invasive procedures.

[0005] However, some types of endoscopic surgery, such as transurethral procedures (e.g., using a cystoscope / resectoscope), have been slow to adopt the use of robot-assisted surgical instruments. In standard transurethral procedures, once the cystoscope is inserted into the bladder through the urethra, the surgeon must hold and maneuver it manually. This requires maintaining and adjusting its angle relative to the surgical target throughout the operation. Finding a suitable support structure capable of holding the cystoscope during the procedure can be difficult due to its short length. Given the need to keep the cystoscope in a relatively confined position throughout the operation, the surgeon only pulls a Minimal ergonomic advantage of using robotic accessories, which reduces the commercial justification for the associated costs.

[0006] Therefore, to advance transurethral surgery, the development of robotic surgical instruments must be complemented by an effective means of supporting the endoscope. It is thus desirable to provide a positioning system that holds the cystoscope stably and securely, enabling surgeons to use advanced surgical tools more effectively during a procedure. Summary of the invention

[0007] According to a first aspect, the invention proposes a positioning system for a rigid body endoscope, comprising: an adapter support for holding the rigid body endoscope; a support handle for the rigid body endoscope in a space; the adapter support being rotatably mounted on the support handle so that the rigid body endoscope can perform yaw and pitch movements; a stop to prevent the rigid body endoscope from rolling.

[0008] An example of a rigid-body endoscope is a cystoscope / resectoscope having an elongated sheath intended to be inserted into the urethra and bladder.

[0009] Preferably, the positioning system for a rigid-body endoscope further comprises: a reversible lock to prevent the adapter bracket from rotating. An endoscope positioning system, as mentioned above, comprising a support arm for the support handle; the support arm being movable to translate the support handle from one position to a new position in space.

[0010] Preferably, the positioning system for a rigid-body endoscope further includes sensors to monitor the horizontal distance between the new position of the support arm and a baseline reference.

[0011] Preferably, the positioning system for a rigid-body endoscope further includes sensors to monitor the height of the new position of the support arm.

[0012] Preferably, the positioning system for a rigid-body endoscope further includes a release trigger to release a locking mechanism in the support arm.

[0013] Preferably, the unlocking mechanism is provided on the support handle to allow a one-handed grip to move the end of the support and trigger the unlocking.

[0014] Preferably, the positioning system for a rigid-body endoscope further comprises an actuator intended to be mechanically connected to parts robotics in the endoscope; the actuator being able to react to the new position of the support arm and move to maintain a certain distance between the support arm and the actuator.

[0015] Preferably, the positioning system for a rigid body endoscope further comprises a positioning trolley; wherein the actuator is movably mounted on a positioning trolley; and the basic reference of the support arm is the positioning trolley.

[0016] According to a second aspect, the invention proposes a method for positioning a cystoscope in a bladder for protection against shocks; the cystoscope being rotatably mounted by a proximal part of the cystoscope on a movable support; such that the cystoscope can perform yawing and / or pitching movements on the movable support; and the cystoscope being prevented from rolling; the method comprising the steps of locking the rotatably mounted cystoscope in an orientation allowing its introduction into a bladder; when the distal end of the cystoscope has passed the uvula in the bladder, unlocking the rotatable mounting; locking the movable support in the current position; such that the cystoscope can rotate around the uvula and the rotatable mounting, and slide into the uvula to dissipate the force of a shock. Brief description of the drawings

[0017] It will be helpful to describe the present invention in more detail with reference to the accompanying drawings, which depict possible arrangements of the invention, in which the same numerals refer to identical parts. Other arrangements of the invention are possible, and therefore, the specific details of the accompanying drawings should not be construed as replacing the generality of the preceding description of the invention.

[0018] [Fig-1] represents an Olympus™ cystoscope disassembled into several parts;

[0019] [Fig.2] represents the assembled cystoscope of [Fig.1];

[0020] [Fig.3] is a simple representation of a bladder;

[0021] [Fig.4] is a diagram of a cystoscope such as that of [Fig.1] mounted on a support handle;

[0022] [Fig.5] schematically represents the operation of a ball joint located between the cystoscope of [Fig.2] and a support handle;

[0023] [Fig.6] represents an adapter support comprising the ball joint of [Fig.5];

[0024] [Fig.7] shows how an inner sheath of the cystoscope of [Fig.1] is arranged in the adapter support of [Fig.6];

[0025] [Fig.8] represents a preferred model of the support handle schematically illustrated in [Fig.4];

[0026] [Fig.9] is the representation of an example of a mechanical arm that can be used for support the support handle;

[0027] [Fig. 10] represents an example where the base of the mechanical arm can be fixed;

[0028] [Fig. 11] represents how a user can release a locking mechanism from the mechanical arm of the [Fig.9];

[0029] [Fig. 12] and [Fig. 13a] show how the support handle of [Fig.5] can be moved;

[0030] [Fig. 13b] shows how the device adapts to the movements of the bladder and the patient;

[0031] [Fig. 14] is a representation showing a negative example in which the cystoscope can roll;

[0032] [Fig. 15] represents the difference compared to the example in [Fig. 14] if the bearing is prevented;

[0033] [Fig. 16] represents a surgical accessory allowing a generic cystoscope to be configured to perform robot-assisted surgery;

[0034] [Fig. 17] is a representation of a surgical instrument supplied in the surgical accessory of [Fig. 16];

[0035] [Fig. 18] is a representation of two steerable arms extending out of the instrument channels at the end of an endoscope;

[0036] [Fig. 19] is a photograph of the distal end of the embodiment shown in [Fig. 16];

[0037] [Fig.20] is a photograph of the embodiment shown in [Fig. 19], assembled with other parts of a cystoscope;

[0038] [Fig.21] is a photograph of the distal end of the embodiment shown on the [Fig.20];

[0039] [Fig.22] is a representation of the embodiment of [Fig.20] maintained in an adapter support;

[0040] [Fig.23] represents an operating room in which the embodiment of the [Fig.20] can be used;

[0041] [Fig.24] represents a positioning trolley used in the room of the [Fig.23];

[0042] [Fig.25] and [Fig.26] represent the operation of an actuator platform used in the room shown in [Fig.22];

[0043] [Fig.27] is a counterexample to be compared with the previous figures;

[0044] [Fig.28] represents an alternative to the adapter support of [Fig.7];

[0045] [Fig.29] represents two other variants of the adapter support of [Fig.7];

[0046] [Fig.30] illustrates an embodiment in which the adapter support is fixed on the outer sheath in a sliding manner; and

[0047] [Fig.31] represents the embodiment of [Fig.30] which can move in a plan while sliding on the outer sheath in order to adapt to the arcuate trajectory of the proximal end of the outer sheath.

[0048] Detailed description of specific embodiments

[0049] Fig. 1 is a photograph of a disassembled cystoscope, more precisely called a resectoscope, of the Olympus™ brand. From the top of the photograph, the parts of the cystoscope include an outer sheath 0101, an inner sheath 0103, a working element 0105, an electrode 0107 and a telescope 0109.

[0050] Figure 2 is a photograph of an assembled cystoscope 0201. The telescope, working element, and electrode are inserted into the inner sheath, and the inner sheath is inserted into the outer sheath. The distal end of the electrode is fitted with a diathermy knife. The working element has a spring-loaded handle that deploys the diathermy knife when pressed by the physician. The spring returns the handle and diathermy knife to their initial positions when pressure on the handle is released. The diathermy knife can be used to incise a bladder or prostate. The cables for supplying the electrosurgical power required for the operation of the diathermy knife are not shown.

[0051] To be precise, it is the telescope that is a cystoscope and that has an eyepiece at the proximal end and a lens at the other end which allows the inside of the bladder to be seen. However, in common parlance, the entire set of these devices is often referred to as a cystoscope, a term which is used in this description.

[0052] As can be seen in [Fig. 3], a bladder 0301 comprises a chamber for storing urine produced by the kidneys (not shown), which is introduced into the bladder by two ureters 0305. The lower part of the bladder is funnel-shaped, comprising a trigone that tapers gently to an internal urethral orifice (or uvula) 0303. The internal urethral orifice is the open internal end of a urethra 0307. The urethra is a passage that terminates in an external urethral orifice 0309. A cystoscope is inserted, tip first, into the external urethral orifice and then advanced through the urethra until the tip emerges inside the bladder.

[0053] References to the forward direction in the following paragraphs refer to the direction in which the cystoscope points when held parallel to the ground, regardless of its tilt or yaw. The distal part of the cystoscope is anterior and the proximal part is posterior.

[0054] Figures 4 and 5 are diagrams of a support handle 0403 mounted with a cystoscope using an adapter bracket 0401. The support handle is connected to the distal end of a mechanical arm (not shown in [Fig. 4]; this is the mechanical arm extending from a weight-bearing structure). The mechanical arm can be extended reversibly horizontally into any position at inside an area and also vertically at different heights, which allows the support handle to be placed in a given position in a certain three-dimensional space.

[0055] The positions of the support handle can be represented as components in the three axes, as shown in Figures 4 and 5, where r is the vertical axis, q is the horizontal axis forward and backward, and p is the horizontal orthogonal axis to the sides. In some cases, the pqr coordinate system may be identical or interchangeable with the xyz coordinate system.

[0056] The adapter bracket is attached to the posterior part of the cystoscope, near the handle of the working element. A pivot connects the base of the adapter bracket to the top of a suitable support handle, allowing the cystoscope to be oriented in any direction. In the preferred embodiment, the cystoscope is prevented from rolling about its axis. In other words, five of the six standard degrees of freedom are provided for positioning and orienting the cystoscope, i.e., forward / backward along the y-axis, up / down along the z-axis, left / right along the x-axis, in pitch about the x-axis, and in rotation about the z-axis. Rolling about the y-axis can be prevented by means of any suitable locking mechanism. Preferably, the pivot includes pivots for pitch and yaw movements that are co-located. In one example, the pivot is a ball joint.

[0057] Figure 6 is an example of the adapter support comprising a ball joint and a 0603 clamp for holding onto the inner or outer sheath of the cystoscope.

[0058] Figure 7 is a view of the clamp opened axially into two lateral halves. The two halves close together to define an internal cylindrical channel 0601 into which the inner sheath is placed. Preferably, a medical-grade rubber or foam component 0801 is wrapped around the clamped portion of the inner sheath. A button 0607 is provided to bring the halves together so that the clamp securely grips the contents of the internal cylindrical channel. The component deforms under the force of the clamp and conforms to the internal surfaces of the cylindrical channel, as well as to and around the portion of the inner sheath held in the clamp. This deformable shape allows the clamp to hold different brands of cystoscopes with inner sheaths of varying diameters.

[0059] Beneath the cylindrical channel is a cradle 0605 designed to close over a ball. The ball is connected to a support 0609 by a relatively narrow neck, and the support is designed to be mounted on a support handle. Figure 8 shows a preferred design of the support handle of the embodiment on which the adapter support can be mounted.

[0060] The insert in [Fig.6] is the corresponding front view of the adapter support with the clamps closed, but without showing the ball of the ball joint, so that the passage channel 0602 intended to receive the neck of the ball is more clearly visible.

[0061] The cradle has a corresponding internal shape and size, with a small additional space, so that the cradle can move all around the ball. The clamp is composed of two lateral parts, each defining a portion of the cylindrical channel and a portion of the cradle, so that the clamp can close over the inner sleeve and the ball / spherical joint. The same clamping knob allows a screw to be tightened to secure the clamp to the foam and the inner sleeve, separate from another clamping device that closes a posterior portion of the cylindrical channel onto a corresponding posterior portion of the inner sleeve. In other words, the clamp and the cylindrical channel it encloses are divided into an anterior and a posterior portion, the anterior portion being able to open into two halves that close to define the cylindrical channel and the cradle located beneath it, as shown.The rear part can be opened and closed independently of the front part, and is fixed by a bolt to a corresponding part of the inner sheath, so that the inner sheath does not fall out when the clamp is opened.

[0062] This allows the cradle to be tightened or loosened around the ball in order to manually fix or release the angular position of the adapter support around the ball using the button, without moving the inner sheath.

[0063] Both sides of the clamp close almost completely around the ball, except for a passage channel for the passage of the cervix when the clamp is rotated up and down around the horizontal x-axis, by sliding the cradle over the ball. The clamp can also rotate around the cervix to pivot the elongated body of the cystoscope on the horizontal plane. Consequently, the ball joint can pivot vertically when the canal is moved beyond the cervix, and horizontally or orthogonally when the clamp rotates around the ball. The two planes of movement define the three-dimensional spaces in which the inner tube can be oriented at any angle on the ball joint.

[0064] Turning the knob tightens the cradle onto the ball joint, thus locking the ball joint and the inner sheath in an angular orientation. This is useful when the physician inserts the inner sheath, assembled with the rest of the cystoscope inside the outer sheath, into the urethra. Once a sufficient length of the cystoscope is inserted into the urethra, or when the tip of the cystoscope has reached the bladder, the knob is released to restore the pivot's movement. In buttonless embodiments, the physician can simply use both hands to align the cystoscope for insertion into the urethra.

[0065] The ball joint can be mounted on top of the support handle in order to fix the adapter bracket onto the support handle.

[0066] In the adapter support of [Fig. 6], the y-axis extends through the plane of symmetry of the inner sheath and, consequently, of the assembled cystoscope. However, the x-axis is slightly offset and lies just below the inner sheath. Ideally, the z- and x-axes would coincide with an imaginary point inside the cystoscope, which would correspond to the physician's intuition when moving the support handle. Nevertheless, the offset of the x-axis is negligible in this embodiment.

[0067] However, the z and x axes of certain embodiments can be completely offset from the cystoscope and from each other, and the physician only needs a moment to become familiar with the sensation provided by the offset end of the cystoscope. In order for the cystoscope to pivot freely on the handle, so as to be oriented towards the urethra in any position to which the physician pushes the support handle, both axes must be located above the handle. If one or both of the pivots are located below the handle, for example, at a point along the telescopic section, the pivot cannot rotate freely. The physician must then determine the rotation around the pivot, which can prove difficult. The free pivoting of the pivots above the handle allows the cystoscope to respond to the slight pressure exerted by the urethra around the inserted portion of the cystoscope.Vertical and lateral movements of the handle change the orientation of the cystoscope around the external urethral sphincter, and the posterior end of the cystoscope pivots to accommodate the reorientation. This means that the force applied by the physicians is dissipated by the angular repositioning around the external urethral sphincter and the pivoting, so that minimal force is transferred to the patient.

[0068] Figure 12 shows how the support handle can be used to pivot solely around the patient's external urethral sphincter / bladder without any relative translation of the cystoscope insertion within the patient. This is achieved through the vertical and horizontal movement of the support handle around the patient's external urethral sphincter. In other words, the spherical surface is located at a fixed distance from the patient's external urethral sphincter. The dashed circle represents the bladder or any other surgical space within a patient. A dashed circle represents the bladder, and a smaller solid circle represents the external urethral sphincter or a keyhole incision through which the cystoscope extends. The external urethral sphincter represents a virtual biaxial pivot at the distal end of the inserted cystoscope.In other words, during transurethral bladder surgery, the proximal end of the cystoscope outside the bladder can be moved or translated. in different positions, and the external sheath follows the movement by rotating around the immobile external urethral sphincter.

[0069] The urethra into which the external sheath is inserted is moved with it.

[0070] The support handle is fixed to a mechanical arm, preferably, but not necessarily, by a rotating connection which allows the support handle to rotate around a vertical axis on the mechanical arm.

[0071] Figure 9 shows an example of a mechanical arm that can be used to support the support handle. Figure 10 shows that the base of the mechanical arm can be attached to an operating table. However, the mechanical arm can be attached to any structure capable of supporting a weight, even a surgical chair or a wall located at an appropriate distance from the operating table.

[0072] The mechanical arm is divided into different sections that are rotationally connected. The section closest to the proximal end is called the first section 0903, and the section equipped with the support handle is the fourth section 0909. There are two horizontal sections, the first section and the second section 0905. The third section 0907 extends vertically from the second section. The fourth section is a telescopic section that can extend upwards from the third section.

[0073] The first section is connected to a base by a pivot joint, J1, which allows the first section to pivot in a horizontal plane. The second section is connected to the first section by a pivot joint, J2, which allows the second section to pivot in the same horizontal plane. In one embodiment, J1 allows the first section to pivot + / -100 degrees around J1, and J2 allows the second section to pivot + / -180 degrees around J2.

[0074] Together, the joints J1 and J2 allow the telescopic section to adopt a wide range of positions in the horizontal plane.

[0075] The telescopic section comprises an extendable inner section movably housed within an outer section. The inner section is extendable from within the outer section to provide additional height. Preferably, the telescopic section is equipped with a spring that pushes the inner section upward with a small force that counteracts the weight of the inner section. This eliminates some of the additional force that the physician must exert to lift a portion of the telescopic section when raising the cystoscope.

[0076] Optionally, the support handle can pivot around the vertical axis, allowing it to be adapted to the physician's dominant hand. The rotation of the support handle relative to the telescopic section depends on the grip on the handle and the positioning of the mechanical arm, and is separate from and independent of the movement of the cystoscope's cord which depends on the positions of the bladder and the positioning of the mechanical arm.

[0077] The joints and telescopic section of the mechanical arm, as well as the support handle located at the distal end of the mechanical arm, are locked by electrically released brakes. A button 0801, visible in [Fig. 8], located on the support handle, allows the brakes to be released when pressed. The left-hand drawing of [Fig. 11] shows the physician's hand holding the handle and simultaneously pressing the brake release button in a single action. This action allows the physician to move the support handle. The right-hand drawing of [Fig. 11] shows the physician's index finger raised from the release button, which locks all the joints and parts as described and fixes the support handle in its current spatial position. Therefore, the physician only needs to release the support handle once it has been moved to the desired position to hold it there.This gives the mechanical arm a safety function in case of a power failure in the operating room, preventing the cystoscope from collapsing or changing position.

[0078] The pivot, i.e., the ball joint, is not locked with the joints of the mechanical arm and does not respond to the release button. The button, already described in a previous paragraph, is turned manually to lock the ball joint.

[0079] To use the cystoscope mounted on the support handle, the physician orients the cystoscope at an angle that approximately corresponds to the intended trajectory for entering the patient's urethra and bladder, then turns the knob on the support adapter to hold the cystoscope in this orientation. The physician then grasps the support handle, pressing the release button located in the handle, which loosens the joints, the telescopic section, and also the support handle if it is rotatable on the telescopic section. The physician then moves the support handle to bring the tip of the cystoscope into the external urethral opening and pushes the tip into the urethra.

[0080] Although the ball joint can pivot, its mounting on the support handle is rigid, and between the force applied to move the support handle to pass the outer sheath through the urethra and the force required to stretch the urethra (human flesh being slightly extensible), the former is greater. Consequently, the urethra yields to the passage of the outer sheath. A lubricant can be applied to the surface of the outer sheath to reduce friction with the urethra and facilitate passage.

[0081] Finally, as shown in Figure 13, the tip of the externally sheathed cystoscope emerges from the internal urethral orifice inside the bladder. At this stage, the physician Turn the knob in the opposite direction to restore the movement of the ball joint between the back of the cystoscope and the top of the support handle. This gives the cystoscope the characteristics or functions of a two-pivot beam capable of rotating in three dimensions, one pivot being fixed in space and the other movable. If the fixed pivot is slidably attached to the beam, any new position of the other pivot, which is not sliding on the beam, can be adjusted by changing the angle or reorienting both pivots and by sliding the beam through the fixed pivot.

[0082] Similarly, the external urethral sphincter, by the urethra's grip on the cystoscope, provides a pivot, albeit a virtual one. The ball joint provides the other pivot. The urethra's grip on the cystoscope is not as strong as the ball joint's attachment to the support handle.

[0083] Once the ball joint is released, the support handle can also be moved in any direction on the x, y or z axes around the virtual pivot located at the level of the external urethral sphincter.

[0084] When the tip of the cystoscope has entered the bladder, the physician usually continues to move the support handle up, down, left and right to navigate inside the bladder, and the cystoscope continues to pivot on the support handle and around the opening of the bladder to accommodate the movement of the support handle while remaining extended beyond the internal opening of the bladder.

[0085] In general, the physician continues to move the support handle along the three axes described in Figures 4 and 5 to navigate within the bladder. Figure 13a shows curved arrows that represent the movements of the posterior part of the cystoscope along an imaginary curved surface if the physician wishes to maintain a constant length of the cystoscope within the bladder despite angular repositioning of the cystoscope. The design of the embodiment provides the possibility of moving along such a curved trajectory.

[0086] Although the patient, the cystoscope, the support handle, and the mechanical arm are not intended to move, if an accidental shock occurs to the cystoscope, the support handle, or the mechanical arm, the device is able to dissipate the force of the shock by not resisting the movement of the posterior end of the cystoscope, as it can be reoriented on the ball joint in the urethra and can be slid into the urethra. This minimizes any transfer of force to the patient.

[0087] Conversely, if the patient were to move unexpectedly, for example by bumping into the operating table, the bladder could be displaced. As shown in [Fig. 30], the effects can be understood by considering the pivot of the support-adapter as rotating but fixed, while the external urethral sphincter is a movable pivot. through which the cystoscope can slide along the urethra. Displacement of the patient's external urethral sphincter causes a change in the orientation of the cystoscope at the external urethral sphincter and the ball joint, accompanied by a sliding of the cystoscope inward or outward from the bladder. In this way, the impact that displaces the patient is dissipated or diverted so as not to be transferred to the patient.

[0088] In general, the structural strength of the locked mechanical arm, fixed to a base, is expected to be sufficient to withstand minor accidental shocks. In the unlikely event that the mechanical arm or the patient is displaced by an accidental shock, the device is capable of dissipating or redirecting the force and reducing the impact on the patient.

[0089] It is not necessary to take into account other more violent or deliberate impacts, since this embodiment is intended for a highly controlled situation in an operating room where no actor moves or carries heavy objects in an uncontrolled and random manner.

[0090] Thanks to the secure support of an immobilized mechanical arm, the physician can concentrate on using the working element or other accessory instruments to perform a procedure. It is not necessary for the physician or an assistant to hold the cystoscope throughout the entire procedure.

[0091] One of the advantages of this technique is the reduction of resistance exerted on the urethra during repositioning of the cystoscope. There is always a risk of resistance when the cystoscope slips over the urethra during repositioning, but at least the resistance exerted by the rolling of the cystoscope sheath is eliminated. This allows the working element to be maintained in the desired alignment. However, the handle of the working element can be adjusted to place it in an ergonomic position. Nevertheless, the ability to maintain the level rolling of the cystoscope is more important in robot-assisted cystoscopic procedures, as the robotic instruments may need to be level or in a predictable orientation to provide intuitive commands to the surgeon.

[0092] Figure 14 is a representation of a negative example demonstrating how, if the cystoscope can roll or tilt around the y-axis, repositioning the cystoscope can cause it to roll due to lateral forces or resistance exerted by the urethra. The rolling is represented by the misorientation of the reticle marking the magnified views of the tip of the cystoscope. The occurrence and extent of the rolling can depend on the relative position of the urethra and the support handle, and can vary depending on the speed at which the support handle is moved, creating unpredictability or poor control of the rolling. In contrast, Figure 15 illustrates that the cystoscope remains level because there is no rolling during repositioning of the cystoscope, represented by The absence of misalignment between the reticles on the magnified views of the cystoscope tip. The advantage of this feature is more clearly visible in a robotic system such as the one described in the following paragraphs.

[0093] The positioning system allows for a smooth transition from a freely mobile cystoscope to a cystoscope in a fixed position in the air, an advantageous feature that is particularly valuable when used to position a cystoscope suitable for robot-assisted transurethral surgery. An example is shown in [Fig. 16], which includes a single-use robotic surgical accessory compatible with generic cystoscopic telescopes and external sheaths, which can be packaged in a sterile container (container not shown) and supplied as a tool kit.

[0094] The robotic surgical accessory comprises two robotic surgical instruments pre-installed in a disposable inner sheath that replaces the original generic inner sheath.

[0095] Figure 17 represents a single surgical instrument 1501 comprising a transmission tube 1505 equipped with a coupler 1507 at its proximal end and a steerable arm 1503 at its distal end. The transmission tube has a length of between 0.5 m and 1.8 m and a diameter of between 2.8 mm and 3.7 mm.

[0096] Figure 18 is a representation of two steerable arms, each equipped with a terminal effector 1801. The effector can be a forceps, a diathermy knife, an injection needle, part of a suture tool, etc. For transurethral resection of bladder tumors (TURBT), the proposed terminal effectors are a tissue clamp and a bipolar knife, and the tool kit is called the TUR kit ("Transurethral Resection") for convenience.

[0097] The coupler contains control coils (not shown). Wires attached at one end to the steerable arm or the end effector are threaded through the transmission tube and connected at the other end to the coils inside the coupler. The coupler can be coupled to an actuator capable of accessing and rotating the coils to tension or release the wires, thereby moving the steerable arm and the end effector. The couplers in the TUR kit are held in a carrying handle. A flexible guide, designed to encapsulate and protect each transmission tube, extends from the couplers to an adapter bracket attached to the rear of the disposable inner sheath.

[0098] Thus, as shown in [Fig. 19], which is a photograph of the top view of the disposable inner sheath, the transmission tubes of the surgical instruments extend from inside the couplers, each through a flexible guide (for protection), into the adapter bracket laterally and from opposite sides. The adapter bracket is fixed to the rear part of the disposable inner sheath. The arms steerable at the distal end of the surgical instruments emerge from the tip of the internal sheath.

[0099] Figure 20 shows the disposable inner sheath of Figure 19 assembled by being inserted into the outer sheath. The telescope is also inserted into the outer sheath, which is visible through the eyepiece located at the rear of the disposable inner sheath. This is the configuration for insertion through the urethra and bladder. The cable providing electrosurgical power for bipolar diathermy is not visible in Figure 20. The camera head and light guide that provide visualization and illumination of the telescope are also not shown in Figure 20. The inner sheath and working element of the generic cystoscope are not used.

[0100] Fig. 19 shows the arrangement of the TUR kit and Fig. 20 shows the arrangement for entry into the urethra.

[0101] The disposable inner sheath is ideally made of the same or a similar material to the original inner sheath. However, other materials such as a different metal alloy, plastic, fiberglass, ceramic, etc., may be used. It may be necessary for the inner sheath to be electrically conductive in certain areas.

[0102] Figure 21 is a photograph of the steerable arms of two surgical instruments extending from the outer sheath. The lens at the distal end of the telescope can also be seen. Figure 22 shows the disposable inner sheath held inside the clamp of the adapter holder immediately above the ball joint, and the flexible guides entering the adapter holder from the posterior part of the cystoscope. The two surgical instruments are not visible in Figure 22.

[0103] The steerable arms must be retracted into the inner sheath before the cystoscope can be inserted into the external urethral orifice. In the simplest version, the physician retracts the steerable arms into the inner sheath by pulling on the transmission linkage or coupler of the surgical instrument, which may be provided by a mechanism within the coupler. Further details are contained in another patent application, and it suffices to specify that the steerable arms can be retracted into the inner sheath so as not to protrude from the front of the inner sheath during insertion into the patient.

[0104] Fig. 23 represents a robotic operating room for transurethral surgery, comprising an operating table 2301, a positioning trolley 2303, a control console 2305 and a display screen on top of a trolley 2307. The base of the mechanical arm for holding the support is fixed to the front of a positioning trolley, shown here arranged in a straight line with the short side of the operating table.

[0105] The control console is a modified dentist's stool, also known as a surgical chair. An electromagnetic field (EMF) generator installed on the dentist's stool creates an EMF capable of monitoring the coordinates of the two control pens. The trolley is equipped with a display screen and is positioned in front of the control console.

[0106] Robot-assisted transurethral surgery begins with grasping the inner sheath of [Fig. 19] and producing the cystoscope of [Fig. 20] by mounting the inner sheath adapter bracket onto the support handle of the mechanical arm extending from the positioning trolley. The couplers of the TUR kit are coupled to an actuation platform located on top of the positioning trolley, which is capable of reproducing the movements of the control styli that are moved and used by the surgeon in response to the view of the inside of the bladder displayed on the trolley's screen, as seen through the telescope in the outer sheath, in order to operate on the bladder. The telescope is equipped with a camera system that cooperates with the telescope's eyepiece to generate the image on the screen (not shown).

[0107] As shown in [Fig.25], the base of the adapter support has a dimension and mounting force that allows it to be mounted on the support handle with a surgical drape between the two, so that the support handle and the mechanical arm remain sterile throughout the operation.

[0108] The actuation platform actuates the coils in the coupler to continuously reposition the steerable arms and actuate the end effectors by following the coordinates of the controllers in the electromagnetic field (EMF) maintained and moved by the physician in the control console. Further details concerning the control console are the subject of other patent applications, and it suffices here to note that the steerable arms react remotely to the control console.

[0109] Preferably, the actuation platform on the positioning carriage that actuates the steerable arm reacts to any change in the distance between the actuator and the support handle, and moves automatically to maintain a predetermined distance. To this end, the joints of the horizontal part of the mechanical arm are monitored by suitable sensors that measure the angle of the relevant pivots and transmit the information to a processor located in the positioning carriage in order to calculate the distance and direction of the support handle relative to the base of the mechanical arm. Figure 25 illustrates, from top to bottom, how if the support handle is too close to the actuator platform, this could cause extreme curvature of the transmission link between the couplers. and the steerable arms, the actuator platform moves away from the support handle in order to straighten the transmission links and reduce their curvature.

[0110] Figure 26 shows, from top to bottom, how if the support handle is too far from the actuator platform, the latter moves closer to the support handle. This creates a curvature due to the dynamically maintained excess length of the transmission linkage, which prevents the transmission links from maintaining tension and unintentionally tilting the cystoscope. Optionally, but not necessarily, the telescopic extension is also monitored to calculate the position of the actuation platform and may cause the actuation platform to rise or fall depending on the height of the support handle.

[0111] Although the foregoing description has described preferred embodiments of the present invention, persons versed in the relevant technical matters will understand that many variations or modifications can be made to the details of the design, construction or operation without departing from the scope of the present invention as claimed.

[0112] For example, [Fig. 27] represents another version of the adapter support in which the pivot ensuring yaw rotation is located at a certain distance from the pivot ensuring pitch rotation, instead of being co-located or coincident. However, in all preferred embodiments, the cystoscope is prevented from performing any roll. Roll may be acceptable in fully manual and non-robotic cystoscopes, since there are no robotic arms that depend on a relatively fixed or predictable orientation, for example, the horizontal.

[0113] Other preferred embodiments have co-located pivots that are also aligned with the axis of the elongated cystoscope. Figure 28 shows two such embodiments using different variants of nested rotating frames, the first being rotatably mounted on the support handle to allow pitching, and the second being rotatably mounted on the first frame to allow yaw movement. However, the adapter-support described in the preceding paragraphs and in Figure 6 is preferred to the examples in Figure 28 because it is easier to stop all rotation using a single actuator, such as the button.

[0114] Furthermore, as the informed reader will understand, this description of the counterparts in any embodiment includes embodiments in which these counterparts are in reversed positions. For example, [Fig. 29] is a simplified representation of a variant of the embodiment shown in [Fig. 7], but with the ball fixed to the inner sleeve and the clip attached rigidly to the support (not shown) for mounting on top of the support handle. Not all drawings in this patent application are to scale. For the sake of clarity. Therefore, the relative size of the components shown may be larger or smaller than in a real product of equivalent design.

[0115] In preferred configurations, the above-described embodiments of a cystoscope include a posterior portion held pivotally but immobile by a combination of the support arm structure and a locking mechanism. However, as shown in [Fig. 30], it is possible to provide a version of the inner sheath that is held slidably within the adapter support. Straight-line movements of the support handle in a plane, represented as up and down movements, do not prevent the outer and inner sheaths from sliding through the adapter support. This allows the proximal end of the cystoscope to exhibit a curved trajectory even if the support handle is moved linearly along the vertical axis.

Claims

Demands

1. Positioning system for a rigid body endoscope, comprising: an adapter bracket for holding the rigid body endoscope; a support handle for the rigid body endoscope; the adapter bracket being rotatably mounted on the support handle so that the rigid body endoscope can perform yaw and pitch movements; a stop to prevent the rigid body endoscope from rolling.

2. Positioning system for a rigid body endoscope according to claim 1, comprising a reversible lock to prevent the adapter support from rotating.

3. Endoscope positioning system according to claims 1 and 2, comprising a support arm for the support handle; the support arm being able to be moved to translate the support handle from one position to a new position in space.

4. Endoscope positioning system according to claim 3, comprising sensors for monitoring the horizontal distance of the new position of the support arm relative to a baseline reference.

5. Endoscope positioning system according to claim 3 or claim 4, comprising sensors for monitoring the height of the new position of the support arm.

6. Endoscope positioning system according to claim 4 or claim 5, comprising a release trigger for releasing a locking mechanism in the support arm.

7. 7. Endoscope positioning system according to claim 6, wherein the unlocking mechanism is provided on the support handle to allow one-handed gripping to move the support end and trigger the unlocking.

8. Endoscope positioning system according to claim 4 or claim 5, further comprising an actuator intended to be mechanically connected to robotic parts in the endoscope; the actuator being capable of reacting to the new position of the support arm and moving to maintain a certain distance between the support arm and the actuator.

9. 9. Endoscope positioning system according to claim 8 dependent on claim 4, further comprising a positioning carriage; in which the actuator is movably mounted on the positioning carriage; and the basic reference of the support arm is the positioning carriage.

10. 10. A method of positioning a cystoscope in a bladder for protection against shocks; wherein the cystoscope is rotatably mounted by a proximal portion of the cystoscope on a movable support; such that the cystoscope can perform yawing and / or pitching movements on the movable support; and the cystoscope being prevented from rolling; the method comprising the steps of locking the rotatably mounted cystoscope in an orientation permitting its introduction into a bladder; when the distal end of the cystoscope is inserted into the urethra, unlocking the rotatable mounting; locking the movable support in the present position; such that the cystoscope can rotate around the external urethral sphincter and the rotatable mounting, and slide into the urethra to dissipate the force of a shock.

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