SUPPORT POUR ENDOSCOPE FLEXIBLE

Abstract

Support for an endoscope controller. The support includes a funnel into which the narrower end of the controller can be inserted so that the wider end of the controller rests on the funnel. The funnel is held atop a mechanical arm that can be moved with the controller held within the funnel. The connection between the support and the mechanical arm allows angular movement of the controller around three mutually orthogonal or equivalent pivots. The support has a fixed and locked state to hold the controller suspended in mid-air, and a mobile and unlocked state during which the controller can be held, moved, and used by the surgeon normally, freely, and without constraint.Therefore, the embodiment provides a ready-to-use support to hold the controller in any suspended position within reach of the mechanical arm, and all the surgeon has to do is lock and immobilize the support. (See Figure 26).

Description

Title of the invention: SUPPORT FOR FLEXIBLE ENDOSCOPE Scope of the invention

[0001] The present invention relates to positioning systems for medical instruments, such as endoscopes, used in minimally invasive surgery. Background of the invention

[0002] A conventional flexible endoscope is primarily designed to allow visualization of the interior of body cavities and therefore does not possess the functions and features that would make it a surgical instrument. However, third parties have designed and marketed accessories that can be attached to the suction channels of conventional endoscopes, adding surgical functions to the endoscope. Originally, these channels were intended for collecting and distributing fluids to and from body cavities, but these accessories have been so successful that the channels are now called instrument channels or biopsy channels.

[0003] An endoscope can be inserted into a body cavity in such a way that different surgical instruments can be inserted multiple times into the same biopsy channels to access and operate on the surgical area. This limits exposure and contact with non-relevant parts of the body cavity and minimizes unnecessary trauma.

[0004] A colonoscopy is a specific type of endoscopy, which involves inserting an endoscope into the large intestine through the anus. The surgeon performs standardized maneuvers such as "shake," "pull," and "push" to move and bend the endoscope around the intestinal folds. Once the endoscope has reached the desired depth, surgical instruments can be inserted and removed through a biopsy channel that opens onto the controller at the proximal end and onto the tip of the endoscope at the distal end. An assistant holds and stabilizes the controller during instrument changes, or the controller is placed on a table near the anus where the procedure was performed or on the patient's bed. The surgeon retrieves the controller whenever it is necessary to reposition the tip of the endoscope to access a larger portion of the surgical target.

[0005] The unpredictable and irregular movements involved in attaching and removing the controller, and the need to reposition the endoscope, have led some observers to believe that robotic endoscopic surgery of the gastrointestinal tract is inconceivable. It may therefore seem even more cumbersome for the surgeon to alternate between manually repositioning the endoscope and placing it in a suitable position, undisturbed, in order to use the robotic instruments.

[0006] It is therefore desirable to provide a device, a method or both, which allows the surgeon to switch from total control of the endoscope to remote control of the robotic surgical instrument without being disturbed. Summary of the invention

[0007] According to a first aspect, the invention provides a support for an endoscope, comprising a funnel to hold the endoscope controller; a support connected to the funnel to hold the funnel raised from the ground; the funnel allowing the controller to rotate freely around its axis.

[0008] Preferably, the support includes a pivot defining a horizontal axis around which the funnel can rotate.

[0009] Preferably, the support includes a torsion spring to apply a torque proportional to the angle of rotation of the funnel with respect to the vertical position around the horizontal axis.

[0010] Preferably, the support includes a pivot defining a vertical axis around which the funnel can pivot.

[0011] Preferably, the support can be moved to move the funnel horizontally and extended to lift the funnel vertically.

[0012] Preferably, the support can be extended to raise the funnel higher; the support including a damping mechanism to slow the return of the support from a high position to a lower original position.

[0013] Preferably, the support further includes a first locking mechanism which, when triggered, prevents the controller from rotating around the controller axis in the funnel.

[0014] Preferably, the first locking mechanism, when triggered, prevents the funnel from rotating around the pivot defining a vertical axis.

[0015] Preferably, the first locking mechanism, when triggered, prevents the funnel from rotating around the pivot defining a horizontal axis.

[0016] Preferably, the support further includes a second locking mechanism which, when triggered, prevents the support from moving the funnel.

[0017] Preferably, the support further includes a quick-release device for detaching the funnel from the support. Brief description of the figures

[0018] 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.

[0019] [Fig.1] represents a flexible endoscope;

[0020] [Fig.2] is a representation of the standard handles for holding the endoscope of the [Fig.l];

[0021] [Fig.3] is a representation of the standard handles for holding the endoscope of the [Fig.l];

[0022] [Fig.4] is a set of representations showing a funnel in which the the endoscope controller of [Fig.1] can be fixed;

[0023] [Fig.5] shows how the funnel of the [Fig.4] grasps the endoscope controller;

[0024] [Fig.6] represents a mechanical arm for holding the funnel of [Fig.4];

[0025] [Fig.7] represents different orientations of the controller provided by the funnel of the [Fig.4];

[0026] [Fig.8] represents a possible assembly of the mechanical arm of the [Fig.6];

[0027] [Fig.9] represents a variant of the mechanical arm mounting of [Fig.6];

[0028] [Fig. 10] shows how the embodiment of [Fig.9] is used in a suite for robotic surgery;

[0029] [Fig. 11] represents a plan view of the continuation of [Fig. 10];

[0030] [Fig. 12] represents another plan view of the continuation of [Fig. 10];

[0031] [Fig. 13] is a representation of a surgical instrument intended for use in robot-assisted endoscopic procedures;

[0032] [Fig. 14] is a representation of the steerable robotic arms provided on surgical instruments, as on [Fig. 12];

[0033] [Fig. 15] represents a variant of the support described in relation to the embodiment of [Fig.9];

[0034] [Fig. 16] represents the front view of the funnel in the support of the [Fig. 15];

[0035] [Fig. 17] represents the view of the support of [Fig. 15] with the funnel frame detached from the adapter;

[0036] [Fig. 18] is an exploded view of the funnel of [Fig. 15];

[0037] [Fig. 19] represents a locking mechanism that can be used in the funnel of the [Fig. 15];

[0038] [Fig. 20] is another view of the support of [Fig. 15] shown with the frame of the funnel detached from the adapter;

[0039] [Fig.21] represents a function of the embodiment of [Fig. 15];

[0040] [Fig.22] represents a function of the embodiment of [Fig. 15];

[0041] [Fig.23] represents a function of the embodiment of [Fig. 15];

[0042] [Fig.24] represents a function of the embodiment of [Fig. 15];

[0043] [Fig.25] represents a function of the embodiment of [Fig. 15];

[0044] [Fig.26] represents the functions of the embodiment of [Fig. 15];

[0045] [Fig.27] represents several functions of the embodiment of [Fig. 15];

[0046] [Fig.28] includes several photographs which show how a surgeon can hold and use the embodiment of [Fig. 15];

[0047] [Fig.29] is a negative example showing how the surgeon uses the endoscope without the implementation method of [Fig.9];

[0048] [Fig.30] represents another embodiment;

[0049] [Fig.31] represents yet another embodiment;

[0050] [Fig.32] represents yet another embodiment; and

[0051] [Fig.33] represents yet another embodiment.

[0052] Detailed description of particular embodiments

[0053] Fig. 1 represents a flexible endoscope 100, an optical instrument that can be introduced into the gastrointestinal (GI) tract through the anus or mouth in order to visualize a target location in the GI tract.

[0054] The endoscope comprises two main sections, one being the controller and the other a flexible insertion tube extending from the controller.

[0055] The controller has a rigid plastic outer casing and is shaped like a bulb on a cone that tapers gradually from the bulb. The insertion tube extends from the tip of the cone. The end of the endoscope at the tip of the insertion tube is radially flat and is equipped with a camera, a light source, and may offer other auxiliary functions such as a water jet. Transmission of the camera images to a video screen can be achieved via a fiber optic system or a sensor chip system.

[0056] Endoscopes used for gastrointestinal procedures are generally over one meter long, but are available in different lengths depending on the surgical area to be treated in the patient. The most distal part of the insertion tube, approximately 10 to 15 cm long, is a particularly flexible section that responds to the control buttons located on the controller's bulb.

[0057] Generally, one or two biopsy / instrument channels are provided inside the endoscope, each having one end open to the controller and the other end on the flat surface of the endoscope tip. The diameter of a biopsy channel can vary between approximately 2.8 mm and 3.7 mm. The tube diameter of an endoscope with two biopsy channels is generally greater than 1.2 cm. The tube thickness affects the ease of insertion.

[0058] To insert the flexible section into the patient through the anus, the surgeon holds the controller in one of two standard left-hand positions. Figure 2 illustrates the two positions. In one grip, the last two fingers of the left hand wrap around the cone to hold it in the palm, leaving the thumb, index, and middle fingers free to operate the dials 201 to maneuver the flexible section and the buttons to supply or collect fluids. In the other standard grip, The last three fingers are used to hold the cone, leaving the thumb and index finger free to operate the dials and buttons 203.

[0059] Figure 3 shows the right hand holding the tube from below, a short distance from its tip. The photograph of Figure 3 shows the same thing. The section is just short enough to provide sufficient structural strength to prevent downward bending, allowing the surgeon to insert the short distal length of the tube into the anus. The surgeon then gradually advances the tube into the patient in discrete sections of similar length. However, there are various ways to push the tube to bend it and guide it past the intestinal folds. This requires the left hand holding the controller to turn the knobs and press the buttons to move the curved section to navigate the intestinal folds, while the right hand performs the tube maneuvers, including standardized maneuvers.The maneuvers rely on the same fundamental movements of pushing, pulling, and rolling the tube, but with varying degrees of force and speed. Throughout the insertion process, the controller is held roughly vertically with the left hand. When the endoscope tip reaches the target site, the surgeon inserts a surgical instrument into the biopsy channels until the distal end of the surgical instrument emerges from the endoscope tip. The surgeon may need to alternate between controlling the endoscope controller and the surgical instrument to perform the surgical procedures. An assistant may also help control the surgical instrument, for example, by holding the instrument handle.

[0060] The present embodiment relates to a support for the controller of an endoscope. The support includes a funnel into which the narrower part of the controller can be inserted so that the wider part of the controller rests on the funnel. The funnel is held at the top of a mechanical arm that can be moved with the controller held in the funnel. The connection between the support and the mechanical arm allows angular movements of the controller about three mutually orthogonal or equivalent pivots.

[0061] The support has a fixed and locked state to hold the controller in a suspended position, and a mobile and unlocked state during which the controller can be held, moved, and used by the surgeon in a normal, free, and unrestricted manner. Therefore, the embodiment provides a ready-to-use support to hold the controller in any suspended position within reach of the robotic arm, as all the surgeon has to do is lock and immobilize the support.

[0062] Figure 4 is a schematic illustration of the rotational movements of the support 401 which allows the surgeon to hold, move and use the controller without constraint. as if it were not attached to the support. The support consists of a pair of C-shaped arms whose dimensions allow the controller to be grasped at a point along the conical body. In other embodiments, the C-shaped arms can be replaced by a hoop. Figure 5 shows the support having a dimension that grasps the controller just below a protrusion 501 of the controller, where the biopsy channel openings are located.

[0063] Figure 4A shows the controller capable of rotating within the support. Figure 4B shows the support capable of tilting about a pivot that defines a horizontal axis. Figure 4C shows the support capable of tilting about a pivot that defines a second orthogonal horizontal axis. Each drawing is accompanied by a representation showing the surgeon's hand holding the controller in a particular angular orientation.

[0064] Figure 6 shows one possible design of the mechanical arm 601, which is capable of moving the controller to different positions and heights within a limited space. Various designs of the mechanical arm are possible. The mechanical arm is assembled from different sections that are movably connected. In particular, a first section 603 and a second horizontal section 605, a third vertical section 607 extending from the distal end of the second section, and a fourth section 609 that can be inserted into the third section or extended telescopically from it.

[0065] The first section is anchored to a stable base by a pivot joint, J1, which allows the first section to pivot about a vertical axis 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 about a vertical axis in the same horizontal plane. Together, the joints J1 and J2 provide the telescopic section with a wide range of positions in the horizontal plane. In one embodiment, J1 allows the first section to pivot + / -100 degrees about J1, and J2 allows the second section to pivot + / -180 degrees about J2.

[0066] The fourth section, or inner section, is movably housed within the third vertical section, or outer section, collectively referred to as the telescopic section. Consequently, the inner section can be extended from the outer section to provide additional height to the support attached to the top of the telescopic section. 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 surgeon must exert to lift the controller. The joints and the telescopic section of the mechanical arm, as well as the distal end of the mechanical arm, are locked by a first locking mechanism comprising electrically released brakes which react to the same trigger.

[0067] However, the angular rotations of the support are locked by a second, separate locking mechanism that reacts to a different trigger. This is because the angular orientation of the controller is more likely to be adjusted during surgery to slightly modify the position of the endoscope tip to reach a larger portion of the surgical target. This generally involves rolling the endoscope to access certain parts of a target located on one side of the bowel.

[0068] Together, the translational movements provided by the mechanical arm and the angular rotation of the support around the three axes offer six degrees of freedom, allowing the controller to be moved into any position and rotated through any angle. The surgeon can thus hold, move, and orient the controller as desired to facilitate tube insertion, as if the endoscope were not attached to the support.

[0069] When the endoscope tip has reached the target position in the gastrointestinal tract, the surgeon can trigger a locking mechanism to immobilize the mechanical arm. A separate locking mechanism is used to lock the support in the desired angular orientation, as the surgeon may need to make fine adjustments to the endoscope's position, which may require angular reorientation of the controller.

[0070] Once immobilized by the two locking mechanisms, the endoscope is held stably at one end of the controller by the support and at the other end by its insertion into the patient's body. The surgeon or their assistant does not need to hold the endoscope for the entire duration of the procedure.

[0071] A flexible surgical instrument 611 can be introduced into a biopsy channel of the immobilized controller to perform an operation. The inset in [Fig. 6] shows a polypectomy neck, an example of a flexible surgical instrument 611, which has a lasso at the distal end of a long insertion tube that can be threaded into the biopsy channel. A handle at the proximal end of the polypectomy neck is used manually by the surgeon to extend and dilate the lasso, and then to pull it back to resect a polyp caught in the lasso. Other common terminal devices include electrosurgical knives and forceps, which are not shown.

[0072] Figure 7 shows different orientations of the controller provided by the support and placed in different spatial positions along three orthogonal axes defining space, provided by the mechanical arm. The change in orientation is due to the fact that the support is tilted 90 degrees upwards on the mechanical arm. Both vertical and horizontal configurations can be used at different times during the same surgical procedure. For example, it is more comfortable to hold the controller in the vertical configuration, especially for operating the dials and buttons during tube insertion. However, it is also possible to secure the holder in either the vertical or horizontal orientation, or at any angle in between. The disadvantage of securing the controller in a vertical orientation is that some slack must be allowed for the tube hanging downwards. In contrast, the horizontal configuration does not require any slack for the downward bend of the tube, as the tail of the cone can be directed towards the patient. It is also easier to transmit the force or torque needed to actuate the surgical instrument threaded into the biopsy channel if the tube is less curved.

[0073] The base of the mechanical arm can be attached to any source of physical stability. An example is provided in [Fig. 8], which shows the mechanical arm of [Fig. 6] attached to a video trolley 801, typically used to display video images captured by the endoscope camera. In the prior art, the video trolley has been used to suspend the endoscope.

[0074] As a result, the support allows for easy and quick switching from a freely mobile controller to a controller immobilized in any position in the air.

[0075] The triggers for actuating the two locking mechanisms can be provided in the form of, for example, pedals (not shown). To avoid any ambiguity, activating the pedals for the two locking mechanisms should not pose any difficulty for the surgeon, as people are accustomed to using machines requiring the control of two or more pedals, such as the brake and accelerator pedals of a car and the damper and mute pedals of a piano. Optionally, the triggers can be provided in the form of a hand-operated button, for example, located near the endoscope controller. Optionally, the locking and unlocking of the mechanical arm and support can be triggered simultaneously by a combination of triggers, including a hand-operated button and a pedal.Optionally, different unlocking modes can be provided with a single trigger using time-based input. For example, by pressing and holding a single pedal for 1 second and then releasing it, the surgeon can unlock one combination of joints / degrees of freedom. If the pedal is held and held for 2 seconds and then released, it can unlock a different combination of joints / degrees of freedom. To add an extra layer of safety to prevent accidental unlocking, the trigger may require two consecutive presses followed by holding the trigger before entering mode selection.

[0076] The support can be used in an endoscopic procedure which consists of inserting an endoscope orally, not shown, to support the controller while the surgeon uses a surgical instrument inserted into the biopsy channel.

[0077] In one embodiment, snap-on C-shaped arms may be used. In this case, the C-shaped arms are momentarily spread apart when pressed against the constriction to allow the controller to enter and be held within the space enclosed by the arms.

[0078] Fig. 9 represents a second embodiment of the support, which is attached to a mechanical arm connected to an actuation trolley 901 equipped with an actuator 903 for actuating robotic surgical instruments.

[0079] The actuator trolley is part of an operating room for robotic endoscopic surgery. Figure 10 shows that the suite also includes a control console 1002 for issuing commands to the actuator, and an endoscopic video trolley 801 similar to that shown in Figure 8, but without being anchored to a mechanical arm. The actuator trolley must be moved to a location such that the mechanical arm can be extended to the short side of an operating table 1004 where the patient is to lie.

[0080] Figure 11 shows the plan view of the arrangement or sequence for an endoscopic procedure using an anal entry. The actuator carriage is located on the right side of the control console, but the controller is accessible to the surgeon's left hand because the mechanical arm extends beyond the surgeon's left side.

[0081] Fig. 12 represents the plan view of the arrangement or sequence for an endoscopic procedure using an oral entry.

[0082] Figure 13 is a representation of a surgical instrument 1302 for robot-assisted endoscopic procedures. The surgical instrument comprises a transmission tube 1304 equipped with a coupler 1306 at the proximal end and a steerable robotic arm 1308 at the distal end. The transmission tube has a length of 0.5 m to 1.8 m and a diameter of 2.6 mm to 3.5 mm, and can be threaded into a biopsy channel in the endoscope, or threaded into channels of external instruments that are attached to the body of the endoscope.

[0083] The coupler located at the proximal end of the surgical instrument contains control coils (not shown). Wires attached to one end of the steerable arm are threaded through the transmission tube and connected at the other end to the coils inside the coupler. The coupler can be attached to the actuator to access and rotate the coils to wind or unwind the wires, thereby moving the steerable arm and a terminal device at the end of the steerable arm. [Fig. 14] is a representation of two steerable arms, each equipped with a terminal device 1402. The device can be a pair of forceps, a diathermy knife, an injection needle, part of a suture tool, etc.

[0084] The control console is a modified dentist's stool, equipped with an electromagnetic field (EMF) generator to monitor the coordinates of the two control pens.

[0085] The actuator located on top of the actuator carriage moves and actuates the surgical instruments at the end of the endoscope by reflecting the coordinates of the controllers in the electromagnetic field (EMF) as maintained and moved by the surgeon 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.

[0086] The endoscope's video carriage contains a processor that receives and processes the video signals from the images captured by the camera located at the end of the endoscope, and produces real-time images on the video monitor. The video carriage is positioned in front of the control console, in a location where the surgeon, seated in the chair, can comfortably view it. The actuator actuates the coils in the coupler to continuously reposition the steerable arms and actuate the terminal devices by tracking the coordinates of the controllers in the electromagnetic field (EMF) maintained and moved by the surgeon 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.

[0087] Figure 15 represents a variant of the support 401 (attached to a mechanical arm) which can be used in the present embodiment, although the support described in the preceding paragraphs is also usable. The support of [Fig. 15] can be separated into a funnel 1502 and an adapter 1504. Together, the funnel and the adapter provide the various angular orientations equivalent to those shown for the first embodiment of [Fig. 4]. The funnel is defined by a through hole in the form of a ring or closed loop forming a shallow housing frame. The frame houses mechanisms for attaching it to the adapter and for cooperating with the mechanisms inside the adapter.

[0088] The adapter and the funnel have parallel axes. The adapter can rotate coaxially and concentrically about the vertical axis of the telescopic section, while the funnel's axis is eccentric with respect to the adapter's axis and can rotate about the adapter's axis. The lower end of the generally elongated adapter can also rotate about a "horizontal pivot" 1506 that defines a horizontal orthogonal axis (x, y axes marked to represent similarity). of this horizontal axis with the x and y axes represented in [Fig. 4]). [Fig. 16] is a front view of the support of [Fig. 15]. The drawings on the left show the support without being connected to an endoscope controller, and the drawings on the right represent a controller inserted into the support.

[0089] Fig. 17 is a view of the support of Fig. 15 with the funnel detached from the adapter. Fig. 18 is an exploded view of the funnel, showing the frame opened in two parts, an upper half 1802 and a lower half 1806, exposing the rotating gear around the base of the rotating part 1804 of the funnel 1502.

[0090] One or more straps, for example medical-grade cable ties or elastic straps, may be provided to secure the endoscope controller partially inserted into the hoop. Preferably, a collar is provided, extending upwards from the edge of the frame defining the hoop. The collar may be made of rigid medical-grade plastic or a flexible medical-grade material. The collar allows the straps to exert pressure over a larger surface area against the controller for a secure fixation. The collar is provided over two-thirds of the hoop, so that the two sides of the collar adjacent to the remaining third of the hoop define a passage for the protrusion where the biopsy channel openings are located.To install the controller in the funnel, the tube is inserted end first and threaded into the funnel until the portion of the controller that is too large to pass through is reached. The protrusion is then slid between the two sides of the collar, and the straps are tightened and buckled onto both the collar and the controller. Ideally, once attached to the endoscope controller, the collar and funnel should not interfere with the surgeon's control or manipulation of the endoscope; that is, the surgeon can hold the controller normally while accessing functions such as insufflation, biopsy channels, control buttons, etc.

[0091] The side of the frame defining the hoop is rotatable relative to the rest of the frame and is located inside a rotary gear accessible within the frame. The center of the rotary gear is aligned with the axis zl of the funnel, which is also the axis of a controller fixed in the funnel.

[0092] The rotary gear can be engaged by a stop 1904, also located in the frame, to prevent the funnel from rotating within the frame. The stop 1904 is shown next to a rotary gear 1902 in [Fig. 19]. In other words, the stop is capable of preventing the controller from rotating within the frame. The stop is actuated by a drive mechanism in the adapter, which can be triggered to push the stop in order to engage the rotary gear by means of a foot pedal, as described in the preceding paragraph, and forms part of the second locking mechanism for immobilizing the orientation of the controller on the mechanical arm.

[0093] Figure 20 shows a mechanism for attaching the frame to the adapter, in the form of clips 2002 located on both sides of the frame that can snap onto corresponding retainers located on the corresponding sides of the adapter. Figure 20 also shows how the funnel can be attached to the adapter over the surgical drape 2004 covering the adapter and the rest of the mechanical arm, so that the adapter and the mechanical arm can be kept clean and protected during the operation. The surgical drape is generally pre-cut (not shown) to fit the relevant part of the adapter to allow the drive mechanism to press against the stop.

[0094] Figure 21 shows the rotation of a controller fixed in the funnel around the controller's axis zl. This rotation is necessary to coordinate the rolling of the controller with the rolling of the endoscope tip in the patient, since the endoscope tube is not designed to be twisted along the tube independently of the controller.

[0095] Figure 22 shows the rotation of the funnel's axis z1 around the telescopic section's axis z2. The axis of the adapter's lower end is coaxial with z2, while the frame, held on one side of the adapter, offsets the funnel's axis z1 relative to the telescopic section's axis z2. This configuration has the advantage of allowing the surgeon to turn the controller towards them, regardless of which side of the mechanical arm they are on, for tube insertion.

[0096] Furthermore, the funnel can pivot in a vertical plane around the horizontal pivot shown in [Fig. 15], which defines a horizontal axis located near the lower end of the adapter mounted on the vertical section of the mechanical arm. The diagram in [Fig. 23] illustrates a safety mechanism against accidental drop of the endoscope controller. This mechanism can be achieved by weight compensation elements such as a torsion spring or a torsion spring integrated into an electromagnetic brake in the horizontal pivot. If the electromagnetic brake is not already engaged and the surgeon releases their grip on the controller held in mid-air, the torsion spring generates a torsion that counterbalances the weight of the support and that of the controller. This allows the support to remain in the same orientation when the surgeon releases their grip on the fixed controller. Optionally, the torsion spring is adjustable.In some embodiments, only part of the controller's weight is compensated, in which case the support can continue to fall while moving around the horizontal pivot, but at a slower speed, so that the surgeon can catch the falling controller.

[0097] As a general rule, the torsion spring is calibrated so that there is no torque compensation when the support is vertically aligned in the vertical position. However, as shown in the graph in [Fig. 23], the torsion spring applies a torque proportional to the angle of the support around the horizontal pivot point as it deviates from the vertical position. This could also reduce user fatigue due to the lower weight. The support locking mechanism can be used to immobilize the support at any angle of deviation, such as a near-horizontal orientation of the controller shown in [Fig. 23].

[0098] A similar feature (not shown) is applied to vertical telescopic sections, in which a weight compensation spring is integrated into the telescopic section to prevent the controller from collapsing if the surgeon unexpectedly releases it.

[0099] This provides a damping mechanism (e.g., a rotary damper or a linear damper) in the telescopic section which slows the collapse of the telescopic section if the physician drops the support in the air, giving him time to catch the controller before the fall pulls on the tube and moves the end of the endoscope away from the surgical target, as shown in the progression from the drawing on the left to the drawing on the right in [Fig.24].

[0100] The horizontal pivot locking mechanism is part of the second locking mechanism intended to immobilize the angular orientation of the controller, while the telescopic section locking mechanism is part of the first mechanism intended to lock the translational position of the controller.

[0101] The [Fig.25] is the diagram of the revolution of the axis zl around the axis z2, corresponding to figures 21 and 22.

[0102] Fig. 26 shows how the adapter reproduces rotations equivalent to those shown in Figures 4B and 4C by rotating the funnel around the z2 axis and around the horizontal axis of the horizontal pivot 1506.

[0103] Fig. 27 represents the rotations described above in a single drawing.

[0104] Figure 28a illustrates how a surgeon can hold the controller in a standard grip and how the support does not impede normal manipulation of the endoscope. Figure 28b shows how the support, when the mechanical arm is immobilized, allows the surgeon to twist or roll the endoscope using an overhand grip (palm down) on the bulb. Figure 28c shows another overhand grip, but on the conical body of the controller. These grips can be moved when the surgeon has maximized the range of wrist rotation.

[0105] Fig. 29 is a negative example showing how, without this embodiment, the surgeon has to turn his own body at the waist to roll the controller further, although this type of manipulation is also possible when the endoscope is fixed to the support and the mechanical arm.

[0106] The following are the steps for using this embodiment:

[0107] - fix the controller of a flexible endoscope in the support, i.e. the funnel.

[0108] - attach the funnel to the adapter already installed on the mechanical arm (and also covered with a sheet), with the first and second locking mechanisms activated;

[0109] - while holding the fixed controller in your left hand, unlock the first and second locking mechanisms of the support and the mechanical arm using the triggers provided, i.e. the pedals;

[0110] - position the endoscope and the mechanical arm near the patient's opening (anus or mouth, etc.);

[0111] - Insert the endoscope while holding the controller in your left hand into a socket standard, by operating the dials and rolling the controller, and manipulating the insertion tube with the right hand;

[0112] - once the tip of the endoscope is sufficiently close to the tumor or the surgical site, trigger the first and second locking mechanisms;

[0113] - the surgeon can proceed with the resection of the tumor using instruments manual or robotic;

[0114] - minor adjustments to the position of the end of the endoscope may be performed without unlocking the first locking mechanism of the mechanical arm and by unlocking only the second locking mechanism to angularly reorient the support (funnel and adapter) in order to adjust the end of the endoscope;

[0115] - a significant repositioning can be achieved by unlocking both locking mechanisms to allow repositioning of the endoscope tip, the controller then being able to move freely in the mechanical arm and support, i.e. restoring full freedom of movement of the controller in the left hand.

[0116] Furthermore, the second embodiment can be modified, the modification involving only 5 of the provided degrees of freedom, one of the vertical axes of rotation being fixed. One of the axes z1 or z2 and the horizontal axis (x, y) shown in [Fig. 15] are sufficient to allow the endoscope to be rolled into the funnel with the endoscope tip inserted into the patient. Generally, the horizontal axis is somewhat aligned with the patient's alignment in this simplified embodiment to allow the endoscope tip to roll inside the patient.

[0117] With regard to the locking mechanism, each rotating joint and each telescopic section can be unlocked independently using a dedicated trigger, such as a series of buttons or pedals located within reach of the surgeon, or according to the system's pre-programmed modes on any appropriate graphical user interface. Therefore, each unlocked mode can involve any combination of degrees of freedom.

[0118] In another embodiment, as shown in [Fig. 30], the frame has an opening 3002 on its side to allow the controller to be inserted into the funnel, so that the funnel does not have to pass along the entire length of the flexible part of the endoscope. The rotating gear has a corresponding opening 3004 which is only visible when the opening of the funnel is rotated in the opposite direction to the opening of the frame.

[0119] Figure 31 represents another embodiment, the left-hand drawing being the side view and the right-hand drawing being the front view, which is a support 401 comprising only a funnel attached to a fixed-position support 3102, and only rotation within the funnel is provided. This embodiment serves as a support for the controller. Although less efficient than the other embodiments described, the endoscope tube can be inserted into the patient if sufficient clearance is provided for the surgeon to push, pull, and roll the tube for insertion. The ability to rotate the controller within the funnel is sufficient to allow slight repositioning of the endoscope tip. Optionally, the base of the support is equipped with casters to allow easy repositioning on the floor.

[0120] In the embodiment of [Fig. 18], the funnel has a wing that can be clipped onto a corresponding projection of the adapter. In another embodiment, as shown in [Fig. 32], a central snap-in mechanism is used instead to connect the frame to the adapter. Preferably, this central snap-in mechanism can be released using a single button 3202, even when the first and second locking mechanisms are activated.

[0121] Fig. 33 represents a variant of the funnel which can be removed from the frame, which is guided by an alignment projection 3302 to align with a corresponding depression 3304 in the frame.

[0122] 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 design, construction or operation without departing from the scope of the present invention as claimed.

Claims

Demands

1. Endoscope support, comprising a funnel for holding the endoscope controller; a support connected to the funnel for keeping it raised off the ground; the funnel allowing the controller to rotate freely around its axis.

2. Endoscope support according to claim 1 or claim 2, further comprising a pivot defining a horizontal axis around which the funnel can rotate.

3. Endoscope support according to claim 2, further comprising a torsion spring for applying a torque proportional to the angle of rotation of the funnel with respect to the vertical position around the horizontal axis.

4. Endoscope support according to claims 1 to 3, further comprising a pivot defining a vertical axis around which the funnel can rotate.

5. Endoscope support according to any one of the preceding claims, wherein a support can be moved to move the funnel horizontally and extended to lift the funnel vertically.

6. Endoscope support according to claim 5, wherein the support can be extended to raise the funnel higher; the support comprising a damping mechanism to slow the return of the support from a raised position to a lower original position.

7. Endoscope support according to any one of the preceding claims, further comprising: a first locking mechanism which, when triggered, prevents the controller from rotating around the controller axis in the funnel.

8. Endoscope support according to any one of the preceding claims, wherein the first locking mechanism, when triggered, prevents the funnel from rotating around the pivot defining a vertical axis.

9. Endoscope support according to any one of the preceding claims, wherein the first locking mechanism, when triggered, prevents the funnel from rotating around the pivot defining a horizontal axis.

10. Endoscope support according to any one of the preceding claims, comprising a second locking mechanism which, when triggered, prevents the support from moving the funnel.

11. Endoscope support according to any one of the preceding claims, comprising a quick-release device for detaching the funnel from the support.

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