Systems and methods for intraoperative surgical scope cleaning

Abstract

An apparatus for cleaning a surgical scope includes a sheath that removably receives a tube of the surgical scope, the sheath including a wall configured to extend at least partially around the tube, a first conduit defining a liquid flow path, and a second conduit defining a gas flow path, and at least one nozzle located at a distal end of the distal portion of the wall and configured to direct a flow of liquid from the first conduit across a lens of the surgical scope and to direct a flow of gas from the second conduit across the lens of the surgical scope to remove the liquid from the lens.

Description

[Technical field]

[0001] The present disclosure relates generally to endoscopic surgery, and more particularly to cleaning of surgical scopes during surgical procedures. [Background technology]

[0002] (CROSS REFERENCE TO RELATED APPLICATIONS) This application claims the benefit of U.S. Provisional Application No. 62 / 854,165, filed May 29, 2019, the entire contents of which are incorporated herein by reference.

[0003] Laparoscopic surgery has been performed since 1901 but became more widespread in the mid-1980s with the introduction of rigid laparoscopes equipped with rod lens optics arrays and glass fiber optic illumination. Since then, laparoscopic surgery has evolved into the standard of care for many types of abdominal surgery.

[0004] Because surgeons depend on the images provided by the laparoscope, if the lens at the distal end of the laparoscope is not kept clean while in the surgical cavity, the surgeon's performance will be compromised. For example, the surgeon may have difficulty viewing the surgical field if the surface temperature of the lens is lower than the temperature of the surgical cavity, forming condensation on the lens, referred to as "scope fogging," if the lens comes into contact with tissue in the surgical cavity during surgery and becomes contaminated with fat, blood, tissue debris, bile, etc., referred to as "scope fouling," if fluids are splashed or spurted onto the laparoscope during surgery, such as blood from a perforated artery or irrigation fluid when irrigating the surgical site with pressurized saline, and accumulate on the lens, also referred to as "scope fouling," and if the laparoscope passes through a trocar to enter the surgical cavity and the lens comes into contact with blood, fat, tissue debris, or lubricant from the trocar seal, also referred to as "scope fouling."

[0005] Many attempts have been made to address the problems of lens fogging and scope contamination. However, these attempts have been largely unsuccessful, leading surgeons to repeatedly remove the laparoscope from the surgical cavity for cleaning, and then reinsert it into the surgical cavity to continue the procedure. Upon reinsertion into the surgical cavity through the trocar, the scope may become contaminated again, requiring the surgeon to repeat the cleaning process until a clear image of the surgical cavity is obtained.

[0006] Attempts to solve scope contamination and fogging have often been ineffective for several reasons. Designs that have lens cleaning features built into the scope itself have the advantage that the surgeon does not need to remove the scope from the operating cavity during surgery, but they can substantially complicate the scope design and make the scope difficult to clean and sterilize, affecting the reliability and useful life of the scope. Designs that have mechanisms for mechanically cleaning the scope, such as wipers or sponges, are difficult to keep clean and dry enough to be effective at cleaning the lens over the course of surgery. Such designs can also require the surgeon to move the scope back and forth over the cleaning mechanism, which can distract the surgeon from the surgical procedure.

[0007] Designs that have a sheath to prevent contact with fluids and debris substantially complicate the process of cleaning the lens if it becomes soiled, since it becomes more difficult to access the lens and often the sheath must be removed to properly clean the lens. Designs that include a sheath that, together with the exterior surface of the scope, forms a lumen through which fluid or gas is passed to clean the lens can generally only be configured to work with a particular make and model of laparoscope, since the fit between the scope and sheath is critical. Manufacturing tolerances of the scope and sheath, and the fact that the mating surfaces of one or the other become damaged over time due to reprocessing by hospital staff, can make such designs impractical.

[0008] Designs that have a film that prevents the lens from contacting fluids and tissues during a surgical procedure can suffer from a number of drawbacks. Any object placed in front of the lens of the scope will cause some degree of image degradation. The film may not completely seal and prevent lens dirt and fluids from penetrating and remaining in the sheath, which may also contaminate any new film that advances in front of the lens. Additionally, the film may not help prevent fogging, and the scope must be properly warmed up just prior to attaching the sheath and inserting it into the surgical cavity. If the scope is removed during surgery for any reason, it must be rewarmed before being reinserted into the surgical cavity or it will fog up again.

[0009] In laparoscopic surgery, designs that spray an irrigant onto the lens and aspirate away the waste have not been successful because it is often difficult to rely on suction flow to consistently draw and remove the fluid droplets across the lens due to the surface tension between the glass and the fluid droplets. Summary of the Invention

[0010] According to some embodiments, a surgical scope cleaner includes a sheath configured to slide over a surgical scope and at least one nozzle disposed on the end of the sheath to spray cleaning fluid and gas onto the lens at the end of the surgical scope to clean the lens. The sheath is configured to fit over the tube of the scope and through the lumen of the trocar so that the sheath remains in place on the scope during the surgical procedure. If the lens becomes dirty and / or foggy, liquid can be sprayed onto the lens and then gas can be sprayed onto the lens to remove any remaining liquid. The sheath includes conduits for liquid and gas that can be formed on one side of the sheath wall to maintain a small diameter so that the sheath can fit through a standard size trocar while attached to a standard size scope.

[0011] The surgical scope cleaner may be connected to a liquid management device that can control the delivery of fluids and gases from the scope cleaner to the lens. The fluid management device may also manage the delivery of other fluids to the surgical field, including, for example, acting as an insufflator to provide insufflation gases for insufflating the surgical cavity. The integrated tube set may be used to transport fluids between the surgical field and devices and / or other equipment, reducing clutter at the surgical field. The tube set may include connectors for connecting at least some of the tubes of the tube set to devices for efficient pre-operative setup.

[0012] According to some embodiments, an apparatus for cleaning a surgical scope includes a sheath for removably receiving a tube of the surgical scope, the sheath including a wall defining a channel for receiving the tube, a distal portion of the wall configured to extend only partially around a circumference of the tube, a first conduit defining a liquid flow path and a second conduit defining a gas flow path, and at least one nozzle located at a distal end of the distal portion of the wall and configured to direct a flow of liquid from the first conduit across a lens of the surgical scope and to direct a flow of gas from the second conduit across the lens of the surgical scope to remove the liquid from the lens.

[0013] In any of these embodiments, at least the distal portion of the wall can be configured for placement within a trocar during use.

[0014] In any of these embodiments, the device may further include a first port for connecting a liquid supply line to the first conduit and a second port for connecting a gas supply line to the second conduit.

[0015] In any of these embodiments, the liquid flow path from the first port to the first nozzle and the gas flow path from the second port to the second nozzle may be valve-free.

[0016] In any of these embodiments, the device may further include a receiver disposed at a proximal end of the sheath for receiving a housing of the surgical scope.

[0017] In any of these embodiments, the proximal portion of the wall may be configured to extend completely around the circumference of the tube of the surgical scope.

[0018] In any of these embodiments, only the distal portion of the wall may be disposed within the trocar during use.

[0019] In any of these embodiments, the distal end of the wall may be further away from the longitudinal axis of the tube of the surgical scope than the proximal end of the wall when the surgical scope is received within the sheath.

[0020] In any of these embodiments, the wall can be configured such that the distal portion of the wall can bend toward the longitudinal axis of the surgical scope tube during insertion into a trocar and can return to a position further away from the longitudinal axis of the surgical scope tube as the distal portion passes through the trocar.

[0021] In any of these embodiments, the first conduit may be adjacent to the second conduit.

[0022] In any of these embodiments, the at least one nozzle may be a first nozzle adjacent to a second nozzle.

[0023] In any of these embodiments, the first and second conduits may be formed in the thickness of the wall.

[0024] In any of these embodiments, the thickness of the wall may be non-uniform around a circumference of at least a portion of the wall.

[0025] In any of these embodiments, the at least one nozzle may be positioned to clean the surgical scope while the surgical scope views a surgical field.

[0026] In any of these embodiments, the at least one nozzle may be positioned so as to not obstruct the field of view of the surgical scope.

[0027] In any of these embodiments, the at least one nozzle may be disposed at a distal end of the sheath.

[0028] In any of these embodiments, at least the sheath may be made of plastic.

[0029] In any of these embodiments, the device may be disposable.

[0030] According to some embodiments, a method for cleaning a surgical scope while the surgical scope is inserted into a surgical cavity includes inserting the surgical scope into a surgical scope cleaner sheath, a distal portion of the sheath extending only partially around a tube of the surgical scope, inserting the surgical scope and the sheath into the surgical cavity, viewing the surgical cavity with the surgical scope inserted into the sheath of the surgical scope cleaner, and cleaning deposits from a lens of the surgical scope by spraying the lens with a liquid from at least one nozzle of the surgical scope cleaner to remove the deposits from the lens, and by blowing gas from the at least one nozzle of the surgical scope cleaner onto the lens of the surgical scope to remove the liquid from the lens.

[0031] In any of these embodiments, the sheath may include a first conduit defining a liquid flow path and a second conduit defining a gas flow path.

[0032] In any of these embodiments, inserting the surgical scope and the sheath into the surgical cavity may include inserting the surgical scope and the sheath through a trocar.

[0033] In any of these embodiments, the deposits may be cleaned from the lens in response to a user input to an endoscopic imaging device connected to the surgical scope.

[0034] In any of these embodiments, the deposits may be cleaned from the lens based on detection of the deposits by an image processing system via one or more images generated by an endoscopic imaging device connected to the surgical scope.

[0035] In any of these embodiments, the deposit may include condensation.

[0036] In any of these embodiments, the deposit may include one or more of a bodily fluid, a tissue, and one or more fluids introduced into the surgical cavity.

[0037] In any of these embodiments, the lens may be sprayed with the liquid for a first predetermined period of time and the lens may be sprayed with the gas for a second predetermined period of time.

[0038] According to some embodiments, an apparatus for supplying fluid to a surgical field includes a gas inlet port for connecting a supply line for supplying gas to the apparatus, a first outlet port for supplying a first flow of the gas for insufflating a surgical cavity during a surgical procedure, an actuator for controlling a flow of liquid for irrigating a surgical scope during the surgical procedure, and a second outlet port for supplying a second flow of the gas for removing liquid from the surgical scope during the surgical procedure.

[0039] In any of these embodiments, the actuator may include a solenoid.

[0040] In any of these embodiments, the actuator may be configured to close a flow path within the device.

[0041] In any of these embodiments, the actuator may be configured to close a flow path in a device connected to the device.

[0042] In any of these embodiments, the actuator may actuate a valve within the device.

[0043] In any of these embodiments, the device may further include a third outlet port for pressurizing a reservoir for the liquid flow.

[0044] In any of these embodiments, the first, second, and third outlets may be disposed within a receiver configured to receive a connector that connects the device to a tubing set for supplying fluid to the surgical field.

[0045] In any of these embodiments, the actuator may be configured to close the liquid flow path within the connector.

[0046] In any of these embodiments, the actuator may actuate a valve in the connector to control the liquid flow.

[0047] In any of these embodiments, the device may include a motor for driving a pump in the connector.

[0048] In any of these embodiments, the actuator may be configured to pinch a liquid flow tube to control the liquid flow.

[0049] In any of these embodiments, the apparatus may further include a second actuator configured to pinch a gas flow tube to control the second flow of the gas.

[0050] In any of these embodiments, the apparatus may further include a first regulator for providing the first flow of gas at a first pressure, and a second regulator for pressurizing a reservoir for the flow of liquid at a second pressure different from the first pressure.

[0051] In any of these embodiments, the device may further include a liquid inlet port for receiving the liquid from a reservoir.

[0052] In any of these embodiments, the device may further include a gas inlet port for receiving a flow of gas from the surgical cavity during the surgical procedure.

[0053] In any of these embodiments, the device may further include a communications port for receiving control commands for operating the actuator.

[0054] In any of these embodiments, the device may further include a controller configured to control the flow of liquid and the second flow of gas for cleaning the surgical scope.

[0055] In any of these embodiments, the controller may be configured to control a cleaning sequence that includes providing the flow of liquid for a first period of time and providing the second flow of the gas for a second period of time that at least partially follows the first period of time.

[0056] In any of these embodiments, the device may be configured to receive a scope cleaning command from an external system.

[0057] In any of these embodiments, the external system may include an image processing system.

[0058] In any of these embodiments, the external system may include an endoscopic imaging device that includes the surgical scope.

[0059] In any of these embodiments, the device may further include a user interface for accepting scope cleaning commands from a user.

[0060] According to some embodiments, a tube set for supplying fluid to a surgical field includes a connector for connecting the tube set to a fluid supply system, a first supply tube for supplying a first flow of gas for insufflating a surgical cavity during a surgical procedure, the first supply tube connected to a first port of the connector, a second supply tube for supplying a liquid for irrigating a surgical scope during the surgical procedure, the second supply tube connected to a second port of the connector, and a third supply tube for supplying a second flow of gas for removing the liquid from the surgical scope during the surgical procedure, the third supply tube connected to a third port of the connector.

[0061] In any of these embodiments, the tube set further includes an outer tube for housing the first, second, and third feeding tubes.

[0062] In any of these embodiments, the tubing set may be a single-use tubing set.

[0063] In any of these embodiments, the first, second, and third supply tubes may be made of plastic.

[0064] In any of these embodiments, the length of the tubing set may allow one end of the tubing set to extend into the surgical field and an opposite end to connect to at least one device for supplying fluid to the surgical field.

[0065] In any of these embodiments, the tubing set may further include an exhaust tube for evacuating smoke from the surgical cavity during the surgical procedure.

[0066] In any of these embodiments, the connector may include at least one filter for filtering smoke evacuated from the surgical cavity.

[0067] In any of these embodiments, the connector may include a housing with ports for connecting the first supply tube and the third supply tube to the fluid supply system.

[0068] In any of these embodiments, the housing may be configured to latch to a receiver of the fluid delivery system.

[0069] In any of these embodiments, the tube set may further include a reservoir connection tube for connecting to a reservoir of fluid for irrigating the surgical scope.

[0070] In any of these embodiments, the tubing set may further include a pressurized tube for supplying pressurized gas to pressurize the reservoir.

[0071] In any of these embodiments, the pressurization tube may be connectable to a pressurization sleeve for pressurizing a bag containing the reservoir.

[0072] In any of these embodiments, the connector may include a valve for controlling flow from the reservoir connection tube to the second supply tube.

[0073] In any of these embodiments, the connector may include a reservoir of the liquid for cleaning the surgical scope.

[0074] In any of these embodiments, the tubing set may further include an irrigation supply tube for supplying a fluid for irrigating the surgical cavity, the irrigation supply tube being connected to the connector.

[0075] Any of these embodiments may further include a surgical scope cleaning device connected to the second and third supply tubes for cleaning the surgical scope during the surgical procedure.

[0076] According to some embodiments, a method for supplying fluid to a surgical field includes connecting a connector of a tubing set having a first supply tube connected to a first port of a connector, a second supply tube connected to a second port of the connector, and a third supply tube connected to a third port of the connector to a fluid supply system; supplying a first flow of gas via the first supply tube for insufflating a surgical cavity during a surgical procedure, supplying a liquid via the second supply tube for irrigating a surgical scope during the surgical procedure, and supplying a second flow of gas via the third supply tube for removing the liquid from the surgical scope during the surgical procedure.

[0077] In any of these embodiments, the first gas flow and the second gas flow may comprise the same gas.

[0078] In any of these embodiments, the tubing set may be a sterile packaged tubing set.

[0079] In any of these embodiments, the tubing set may be a single-use tubing set.

[0080] In any of these embodiments, the method may further include evacuating the surgical cavity via an exhaust tube connected to a fourth port of the connector.

[0081] According to some embodiments, a system for cleaning a surgical scope of an endoscopic imaging device includes a control system communicatively connected to an apparatus for supplying fluid to a surgical scope cleaner, the control system configured to receive one or more images of a surgical field generated by the endoscopic imaging device, detect deposits on a lens of the surgical scope by analyzing the one or more images, and send commands to the apparatus to provide one or more fluids to the surgical field to clean the surgical scope.

[0082] In any of these embodiments, the system may include the device, which may be configured to provide a flow of liquid and a flow of gas to a surgical field for cleaning of a lens of the surgical scope during a surgical procedure.

[0083] In any of these embodiments, the apparatus may be configured to perform a cleaning sequence in response to receiving the command from the control system, and the cleaning sequence may include supplying the liquid flow for a first period of time and supplying the gas flow for a second period of time at least partially subsequent to the first period of time.

[0084] In any of these embodiments, the control system may be configured to analyze at least one of the one or more images by at least in part comparing the one or more images to at least one previously generated image.

[0085] In any of these embodiments, the control system may be further configured to provide a notification to a user that deposits on the lens have been detected, receive a confirmation from a user to clean the surgical scope, and in response to receiving the confirmation from the user, send the command to the device to provide the one or more fluids to the surgical field to clean the surgical scope.

[0086] In any of these embodiments, the confirmation from the user may be received from an endoscopic imaging device that is communicatively connected to the control system.

[0087] In any of these embodiments, the device may be configured to deliver an insufflation gas flow to the surgical field.

[0088] According to some embodiments, a method for cleaning a surgical scope of an endoscopic imaging device via a control system communicatively connected to an apparatus for providing fluid to a surgical scope cleaner includes receiving, in the control system, one or more images of a surgical field from the endoscopic imaging device, analyzing the one or more images to detect deposits on a lens of the surgical scope by the control system, and sending a command from the control system to the apparatus to provide one or more fluids to the surgical field to clean the surgical scope.

[0089] In any of these embodiments, the method may further include, in response to receiving the command from the control system, providing a flow of liquid and a flow of gas from the device to clean a lens of the surgical scope during a surgical procedure.

[0090] In any of these embodiments, providing the liquid flow and the gas flow may include providing the liquid flow for a first period of time and providing the gas flow for a second period of time at least partially subsequent to the first period of time.

[0091] In any of these embodiments, the method may further include providing a notification to a user that deposits on the lens have been detected, receiving a confirmation from a user to clean the surgical scope, and in response to receiving the confirmation from the user, sending the command to the device to provide the liquid flow and the gas flow to the surgical field to clean the lens of the surgical scope.

[0092] In any of these embodiments, the confirmation from the user may be received from an endoscopic imaging device that is communicatively connected to the control system.

[0093] Any of these embodiments may further include delivering an insufflation gas flow from the device to the surgical field.

[0094] According to some embodiments, an endoscope includes a body having an optical port and at least one fluid port, a shaft extending distally from the body, the shaft including a first wall portion housing an optical fiber for directing light introduced through the optical port, a second wall portion extending partially around the first wall portion, an optical component disposed at a distal end of the shaft, at least one fluid channel disposed between the first wall portion and the second wall portion and configured to transport fluid along the shaft, and at least one fluid outlet disposed at the distal end of the shaft and configured to direct fluid from the at least one fluid channel onto the optical component.

[0095] In any of these embodiments, the shaft may include a non-cylindrical outer surface defined by an outer surface of the first wall portion and an outer surface of the second wall portion.

[0096] In any of these embodiments, the width of the shaft in a first direction may be equal to the outer diameter of the first wall portion.

[0097] In any of these embodiments, the first wall portion may extend into the body.

[0098] In any of these embodiments, a seal may be disposed within the body to seal against the first wall portion.

[0099] In any of these embodiments, the second wall portion may extend distally from the body.

[0100] In any of these embodiments, the at least one fluid outlet may be defined by a distal end of the second wall portion.

[0101] In any of these embodiments, the shaft may include a single fluid channel and a single fluid outlet.

[0102] In any of these embodiments, the endoscope may be a sinusoscope. [Brief description of the drawings]

[0103] These features will become apparent to those skilled in the art from the detailed description of exemplary embodiments which may be taken in conjunction with the accompanying drawings. [Figure 1A] , [Figure 1B] 1A and 1B show a surgical scope cleaner attached to a surgical scope, according to some embodiments. [Figure 1C] FIG. 1C shows a distal end of a scope cleaner attached to a surgical scope, according to some embodiments. [Figure 1D] FIG. 1D is a cross-sectional view of a scope cleaner sheath showing liquid and gas conduits according to some embodiments. [Figure 1E] FIG. 1E is a cross-sectional view of a scope cleaner and a distal portion of a surgical scope 150, according to some embodiments. [Figure 1F] , [Figure 1G] 1F and 1G show alternative embodiments for positioning the nozzle head outside the field of view of the surgical scope, according to some embodiments. [Figure 1H] FIG. 1H shows an embodiment of the scope cleaner in which the sheath is not configured to angle away from the tube. [Figure 1I] , [Figure 1J] 1I and 1J illustrate the operation of a surgical scope cleaner according to some embodiments. [Diagram 2]FIG. 2 is a cross-sectional view of a portion of a scope cleaner configured to warm and provide a steady flow of gas to a surgical scope, according to some embodiments. [Diagram 3] FIG. 3 is a block diagram of an apparatus for managing fluid flow into and out of a surgical field, according to some embodiments. [Figure 4A] , [Figure 4B] , [Figure 4C] , [Figure 4D] 4A-4D show fluid supply devices and connectors for connecting multiple fluid lines to a device, according to some embodiments. [Figure 5A] , [Figure 5B] 5A and 5B show a fluid supply and tube set connector according to some embodiments, in which a fluid supply reservoir is integrated into the connector for supplying fluid to a scope cleaner. [Figure 6A] , [Figure 6B] 6A and 6B show a fluid supply and tube set connector according to some embodiments, in which a pump is integrated into the connector for pumping fluid from an external fluid supply reservoir to the scope cleaner. [Figure 7] FIG. 7 illustrates the use of a tube set in a surgical field, according to some embodiments. [Figure 8A] , [Figure 8B] 8A and 8B show the connection of a tubing set to a fluid supply management device, according to some embodiments. [Figure 9] FIG. 9 illustrates a method for delivering fluid to a surgical field, according to some embodiments. [Figure 10] FIG. 10 illustrates a method for cleaning a surgical scope while the scope is inserted into a surgical cavity, according to some embodiments. [Figure 11A] FIG. 11A shows a scope with integrated cleaning, according to some embodiments. [Figure 11B]FIG. 11B shows a perspective view of a cross section of a portion of a shaft of a scope with integrated cleaning according to some embodiments. [Figure 11C] , [Figure 11D] 11C and 11D are perspective and cross-sectional views of a distal portion of a scope with integrated cleaning according to some embodiments. [Figure 11E] FIG. 11E is a cross-sectional view of a proximal portion of the shaft and a portion of the body of a scope with integrated cleaning, according to some embodiments. [Figure 12] FIG. 12 illustrates a method for automatically detecting deposits on a lens of a surgical scope and sending a command to a connected device to initiate a cleaning sequence for the surgical scope, according to various embodiments. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0104] Implementations and embodiments of various aspects and variations of the systems and methods described herein will now be described in detail. Although some exemplary variations of the systems and methods are described herein, other variations of the systems and methods may include aspects of the systems and methods described herein combined in any suitable manner, having combinations of all or some of the aspects described.

[0105] Systems and methods for cleaning a surgical scope during a surgical procedure with minimal interruption to the surgical procedure are described below, according to various embodiments. According to some embodiments, a surgical scope cleaner includes a sheath that slides over the surgical scope and includes at least one nozzle for flushing the surface of the lens with a spray of liquid, such as saline, and then spraying the lens with a burst of gas, such as carbon dioxide. A conduit running along the sheath leads from an input port at the end of the cleaner that can be connected via a tubing set to a source of pressurized liquid and gas. The sheath can be configured to slide over a standard size scope and fit through the lumen of a standard size trocar. A surgical scope with the scope cleaner attached can be inserted through the trocar into the surgical cavity, and the cleaner can be used to clean the scope during the surgical procedure with minimal interruption to the procedure.

[0106] At least one nozzle integrated into the end of the sheath can be directed at the lens of the scope to spray a high velocity cleaning liquid and a burst of gas directly onto the lens. The at least one nozzle can be configured such that the high velocity liquid spray displaces the entire surface of the lens, i.e., pressure-cleans the lens. A burst of gas can be provided after completion of the liquid spray to dry the surface of the lens, or can be provided simultaneously with the liquid spray to increase and enhance the velocity of the liquid spray and its cleaning power. According to some embodiments, the sequence of the liquid spray and gas bursts, as well as the length of time they operate, can be controlled by electromechanical valves in a fluid management system to which the scope cleaner is connected.

[0107] In some embodiments, the liquid and gas used in the scope cleaner are saline and carbon dioxide, which are used in many laparoscopic procedures, with saline often used for irrigation or irrigation when needed during surgery, and carbon dioxide often used to insufflate (or inflate) the abdomen. Saline has been shown to be sufficient to clean blood, fat, and tissue debris from the lenses of scopes used in surgery. Thus, according to some embodiments, the surgical scope cleaner can be integrated into existing surgical systems.

[0108] According to some embodiments, the fluid management system to which the scope cleaner is connected can also be used to manage other fluids used in the surgical procedure. For example, the fluid management system that provides carbon dioxide to the scope cleaner can also function as an insufflator that provides carbon dioxide for insufflation to the surgical cavity. In some embodiments, the pressurized carbon dioxide gas received and conditioned by the system for insufflation can also be used to pressurize saline for lens cleaning and to dry the lenses after the cleaning cycle. Thus, scope cleaning can be provided without the need to add additional equipment to the operating room.

[0109] According to some embodiments, the scope cleaner can be integrated into the air delivery tubing set, which can help reduce clutter in the sterile field where the surgeon is operating. The clutter caused by the many hoses and wires attached to the instruments in the sterile field, and to the control unit and supply lines from outside the sterile field, can restrict the movement of the surgical team during surgery to avoid accidentally pulling or tripping on the hoses and wires, and can increase the chances that critical instruments will be pulled to the floor, causing damage and interrupting the surgical procedure. Thus, according to some embodiments, the tubes, hoses, wires, etc., including those for the surgical scope cleaner, are combined into a single tubing set, reducing clutter in and around the sterile field. The tubing set, including the scope cleaner, can be disposable, single use, or reusable to reduce long term costs for the user.

[0110] According to some embodiments, control of the flow of liquids and gases for the scope cleaner may be provided by the fluid management system so that surgical scope cleaning may be controlled by other equipment in the operating room via device controls. The fluid management system may be connected to a control unit that can receive commands from surgical staff in several different ways and transmit those commands to the fluid management system. These commands may occur, for example, as voice commands, button presses on the endoscopic camera head to scroll through menus and select options via an operating surgeon's display (OSD), button presses by support staff outside the sterile field on the touch screen of the control unit, or button presses on the touch screen of a remote tablet that may be used with the control unit. According to some embodiments, liquids and gases for scope cleaning may also be controlled by button presses on the touch screen of the fluid management system itself.

[0111] In some embodiments, a control unit or other device can analyze video from an endoscopic camera connected to a surgical scope with a scope cleaner to detect when a dirty and / or cloudy scope causes blurred images. Upon detecting dirty and / or cloudy scope, the control unit can send a command to the fluid management system to initiate a cleaning sequence.

[0112] In the following description of various embodiments, reference is made to the accompanying drawings in which is shown, by way of illustration, specific embodiments which may be practiced. It is to be understood that other embodiments and examples may be practiced and changes may be made without departing from the scope of the present disclosure.

[0113] It should further be understood that the singular forms "a," "an," and "the" used in the following description are intended to include the plural forms unless the context clearly dictates otherwise. It should also be understood that the term "and / or" as used herein means and encompasses one or more and all combinations of the associated listed items. It should also be understood that the terms "includes," "including," "comprises," and / or "comprising," as used herein, specify the presence of referenced features, integers, steps, operations, elements, components, and / or units, but do not exclude the presence or addition of one or more other features, integers, steps, operations, elements, components, units, and / or groups thereof.

[0114] Certain aspects of the present disclosure include the process steps and instructions described herein in the form of an algorithm. It should be noted that the process steps and instructions of the present disclosure can be implemented in software, firmware, or hardware, and when implemented in software, can be present on and downloaded to be operated from different platforms used by various operating systems. As will become apparent from the following description, unless otherwise indicated, descriptions using words such as "processing," "computing," "calculating," "determining," "displaying," "generating," and the like throughout this specification are understood to refer to the operation and processing of a computer system or similar electronic computing device that manipulates and transforms data represented as physical (electronic) quantities in computer system memory or registers, or other such information storage, transmission, or display devices.

[0115] The present disclosure in some embodiments also relates to an apparatus for performing the operations described herein. Such an apparatus may be specially constructed for the required purposes or may include a general-purpose computer selectively activated or reconfigured by a computer program stored in the computer. Such a computer program may be stored on a non-transitory computer-readable recording medium, such as, but not limited to, a floppy disk, a USB flash drive, an external hard drive, an optical disk, a CD-ROM, a magneto-optical disk, a read-only memory (ROM), a random access memory (RAM), an EPROM, an EEPROM, a magnetic or optical card, any type of disk including an application specific integrated circuit (ASIC), or any type of medium suitable for storing electronic instructions, each connected to a computer system bus. Furthermore, the computers referred to herein may include a single processor or may be architectures employing multiple processors to increase computing power.

[0116] The methods, apparatus, and systems described herein are not inherently related to any particular computer or other apparatus. In addition, various general-purpose systems may be used with programs in accordance with the teachings herein, or it may prove convenient to construct more specialized apparatus to perform the required method steps. The required structure for a variety of these systems will appear from the description below. In addition, the present invention is not described with reference to any particular programming language. It will be understood that a variety of programming languages ​​may be used to implement the teachings of the present invention as described herein.

[0117] 1A and 1B show a surgical scope cleaner 100 attached to a surgical scope 150, according to some embodiments. The surgical scope cleaner 100 can be configured to attach to a standard size surgical scope and insert into a surgical cavity through the cannula of a standard size trocar. With the surgical scope cleaner 100 attached, the surgical scope 150 can be used to image within the surgical cavity (along with an attached endoscope) during a surgical procedure. The surgical scope cleaner 100 can be used to remove dirt and / or condensation from the lens at the end of the surgical scope while the surgical scope remains in place within the surgical cavity during a surgical procedure.

[0118] In the illustrated embodiment, the surgical scope 150 includes an elongated, generally hollow tube 152 having a distal end 153 for insertion into a body cavity, such as through the lumen of a trocar. The tube 152 extends from a housing 154 in which an eyepiece 155 is mounted, providing a viewing port through which the surgeon views the surgical field (e.g., directly or via a connection between the viewing port, an endoscopic camera, and a display screen). An optical port 157 extends from the housing 154 for connecting the scope 150 to an illuminator via an optical cable to transmit light to a target through the scope 150. The surgical scope 150 can be, for example, a laparoscope. The surgical scope can be any type of surgical scope, including, for example, a surgical scope with an integrated camera.

[0119] The surgical scope cleaner 100 includes a sheath 102 that slides over a tube 152 of a surgical scope 150. The sheath 102 may define a generally cylindrical bore 126 that may be configured to fit the tube of a standard size scope. The bore 126 may be sized to allow the tube 152 to slide in and out of the sheath 102 while remaining radially fixed in position relative to the sheath 102 such that the tube 152 and the bore 126 share substantially the same longitudinal axis 124.

[0120] Nozzle head 110 is disposed at the distal end 103 of sheath 102 and extends beyond the distal end 153 of tube 152 of surgical scope 150. As described further below, liquids and gases can be sprayed / sprayed from nozzle head 110 to clean the lens at the end of tube 152. Scope cleaner 100 is configured such that the surgical scope remains attached on the surgical scope throughout the surgical procedure. The lens can be cleaned, if desired, without having to remove the surgical scope from the operating cavity.

[0121] The sheath 102 extends from a receiver 104 configured to receive the housing 154 of the surgical scope 150. The receiver 104 may include one or more retention features (not shown) for holding the housing 154 of the surgical scope 150. In some embodiments, the retention features may orient the scope relative to the sheath 102, which may be important for angled scopes (scopes having an angled distal end and a lens pointing at an angle from the central axis of the scope, e.g., 30 degrees or 45 degrees from the axis) to ensure that the nozzle is properly pointed at the angled lens. In some embodiments, the receiver 104 may be shaped to receive the housing 154 in the correct angular orientation to ensure that the nozzle head 110 is properly oriented with respect to the angled scope.

[0122] The liquid port 106 and the gas port 108 may be provided in the receiver 104 and connected to a liquid supply line 130 and a gas supply line 132, respectively, which are connected to liquid and gas sources. In some embodiments, the liquid port 106 and the gas port 108 extend from the sheath 102. As described further below, the liquid and gas supplied through the respective ports flow through at least one conduit within the sheath to at least one nozzle at the distal end 103 of the sheath 102 for spraying the liquid and blowing the gas onto the lens at the distal end 153 of the tube 152 of the surgical scope 150 to clean dirt and / or condensation on the lens.

[0123] 1C shows the distal end 103 of the sheath 102, which receives the distal end 153 of the tube 152 of the surgical scope 150. The distal end 103 has a nozzle head 110 that extends beyond the distal end 153 of the surgical scope 150. In the illustrated embodiment, the nozzle head 110 includes two nozzles arranged side by side - a liquid nozzle 112 and a gas nozzle 114. In other embodiments, the nozzles are spaced apart longitudinally rather than circumferentially. The nozzles are configured to direct their respective streams onto a lens 156 at the distal end of the tube 152 of the surgical scope 150. In some embodiments, a single nozzle is provided and both the liquid and gas conduits are provided to the single nozzle.

[0124] 1D is a cross-sectional view of a sheath 102 of a cleaner 100 showing liquid and gas conduits 118, 120 extending longitudinally through the sheath 102 and providing flow paths from liquid and gas ports 106, 108 to liquid and gas nozzles 112, 114 at a distal end 103 of the sheath 102, according to some embodiments. The sheath 102 includes a wall 116 within which the conduits 118, 120 are formed such that the conduits are completely enclosed around their longitudinal periphery. In the illustrated embodiment, the conduits 118, 120 are non-circular in cross-section and curved circumferentially about a longitudinal axis 124 through a portion of the circumference of the wall. Curved conduits can minimize the outer diameter of the wall while still providing sufficient flow rate through the conduits. In other embodiments, the conduits may be circular or any other suitable shape depending on the wall thickness and the desired flow rate and pressure drop through the conduits. The conduits 118, 120 may extend longitudinally through the wall from the liquid and gas ports 106, 108 to the nozzle head 110. In some embodiments, the liquid and gas conduits merge before reaching the nozzle head, such that a single conduit extends from the junction of the two conduits to the nozzle head 110. In some embodiments, the liquid and gas flow paths merge at or near the liquid and gas ports 106, 108, such that a single conduit extends substantially the entire longitudinal extent of the sheath 102.

[0125] The bore 126 of the sheath 102 may be cylindrical and configured to fit into a standard tube of a surgical scope. The exterior surface 122 of the sheath 102 may be cylindrical. In some embodiments, the exterior surface 122 of the sheath 102 may extend about a longitudinal axis 125 that is different from the longitudinal axis 124 of the bore 126 of the sheath 102 (see FIG. 1E). This off-center arrangement results in one side of the wall 116 being thicker than the other size of the wall 116, with the thicker portion of the wall accommodating the conduits 118, 120. This is shown in FIG. 1D. Thus, the walls can accommodate the conduits while keeping the outer diameter of the sheath 102 to a minimum so that the sheath 102 can fit within a standard size trocar while being attached to a standard size surgical scope.

[0126] 1E is a cross-sectional view of the distal portion of scope cleaner 100 and surgical scope 150. The distal end 153 of tube 152 of surgical scope 150 includes a lens 156. Each nozzle 112, 114 may include a channel 136 in nozzle head 110. A distal wall 138 of channel 136 may be angled such that fluid traveling longitudinally from conduits 118, 120 is directed by wall 138 toward the lens of the scope.

[0127] According to some embodiments, nozzle head 110 is configured such that the field of view of scope 150 is not obstructed by scope cleaner 100. The field of view of scope 150 is represented in FIG. 1E by dashed line 158. Nozzle head 110 may extend radially inward of outer diameter 160 of tube 152, but a radially innermost portion 128 of nozzle head 110 may be positioned relative to longitudinal axis 124 of tube 152 such that innermost portion 128 encroaches within the field of view.

[0128] In some embodiments, nozzle head 110 may be configured to reduce the amount of light that may be reflected onto lens 156. For example, at least a portion of nozzle head 110 that faces lens 156 may be made from a light absorbing material and / or may be colored to absorb light (e.g., colored black).

[0129] 1F and 1G show an alternative embodiment for positioning the nozzle head 110 outside the field of view of the surgical scope. In the illustrated embodiment, the distal portion 134 of the sheath 102 is angled away from the longitudinal axis 124 of the bore 126 of the sheath 102 such that the distal end 103 of the sheath 102 is radially spaced from the distal end 153 of the tube 152 when the cleaner 100 is attached to the scope 150. As a result, the nozzle head 110 is well outside the field of view of the scope 150. The sheath 102 is configured such that the distal portion 134 can bend back relative to the tube 152 so that the distal portion 134 can fit within a trocar when the cleaner 100 is inserted into the surgical cavity, as shown in FIG. 1G. When the distal portion 134 passes through the trocar and into the surgical field, the distal portion springs back outward. In some embodiments, the compliance of the material forming the sheath 102 allows the sheath to elastically deform inwardly towards the tube 152 and then spring back outwardly to a repeatable position.

[0130] As shown in FIG. 1A, the distal portion 134 of the sheath 102 extends only partially around the tube 152 such that the distal portion of the sheath 102 can move inwardly and outwardly relative to the tube 152. In some embodiments, the proximal portion of the sheath 102 can extend completely around the tube 152 while the distal portion only extends partially around the tube 152. This allows the distal portion of the sheath 102 to be angled away from the tube 152 while still allowing the sheath 102 to be securely mounted onto the tube 152. In some embodiments, the sheath 102 extends only partially around the circumference of the tube 152 along the entire length of the tube 152. According to various embodiments, the length of the distal portion of the sheath 102 that extends only partially around the tube 152 is selected such that only the distal portion of the sheath - the portion that extends only partially around the tube 152 - is disposed within the trocar during use. By having the portion of the sheath that is disposed within the trocar during use extend only partially around the tube 152, the overall size of the sheath with the tube 152 inserted can be reduced so that a smaller trocar can be used as compared to a sheath that extends completely around the tube 152.

[0131] In embodiments in which the sheath 102 is configured to angle away from the tube 152, the nozzle head 110 may be manufactured to be larger compared to embodiments in which the sheath 102 remains adjacent to the tube 152 along its entire length, which may increase manufacturability of the nozzle head 110 and / or improve nozzle performance.

[0132] 1H illustrates an embodiment in which the sheath is not configured to angle away from the tube 152. In this embodiment, the sheath 102 can extend completely around the tube 152 for the entire length of the sheath 102. Embodiments in which the sheath 102 remains adjacent to the tube 152 along the entire length of the sheath can also include a sheath that does not extend completely around the tube 152 for at least a portion of the length of the sheath.

[0133] In some embodiments, the scope cleaner 100 can be manufactured to be disposable and disposed of after being used in a surgical procedure. In other embodiments, the scope cleaner can be configured for reuse and therefore sterilizable. The scope cleaner 100 can be manufactured of any suitable material, including any suitable plastic or metal. Examples of suitable plastics include polycarbonate, acrylic, polyethylene terephthalate, cyclic olefin copolymer, and fluorinated ethylene propylene. In some embodiments, the scope cleaner is manufactured by extrusion of one or more of these plastics, or another suitable plastic. In some embodiments, the sheath 102 can be extruded from a first plastic and the nozzle head 110 can be molded from a different plastic and the two pieces can be joined together. This may be desirable in embodiments where the sheath 102 (in addition to the receiver 104 in some embodiments) has a first color and the nozzle head 110 has a second color, allowing for more material options for extrusion, reduced costs, and easier manufacturing. The scope cleaner can be molded, machined, 3D printed, or any combination thereof. The scope cleaner can be manufactured of multiple components that are assembled together. For example, the nozzle head 110 can be affixed to the distal end 103 of a separate sheath 102 that can be attached to the receiver 104.

[0134] According to some embodiments, the surgical scope cleaner 100 can be connected to a liquid and gas supply system that controls the delivery of liquid and gas to the surgical scope cleaner during use. Thus, the surgical scope cleaner 100 can be free of any valves, which can provide greater simplicity and less expensive manufacture and can be particularly advantageous for disposable scope cleaner embodiments. In other embodiments, the surgical scope cleaner can include one or more valves that can control the flow of liquid and / or gas. For example, the scope cleaner can include one or more push button actuated valves that can be activated by a user to provide a spray of liquid and / or a burst of gas. The one or more valves can be located, for example, in a receiver downstream of the ports 106, 108, or upstream of the ports, such as in a tubing set that connects the cleaner to a liquid and gas source.

[0135] 1I and 1J show the operation of the surgical scope cleaner 100 according to some embodiments. First, as shown in FIG. 1H, liquid such as saline is sprayed from the nozzle head 110 onto the lens 156 to remove deposits on the lens. The deposits can be, for example, blood, fat, tissue debris, or bile from the surgical cavity, lubricants from the seal of the trocar through which the surgical scope is inserted, fluids sprayed into the surgical cavity during the surgical procedure such as saline or therapeutic agents for flushing, or any other material that can deposit on the lens. The liquid can be supplied to the scope cleaner 100 from a pressurized source such that the liquid impinges on the lens at a rate sufficient to mechanically remove the deposits. The liquid can also act to dissolve at least a portion of the deposits to aid in their removal. In some embodiments, the liquid pressure at the pressurized source is at least 1 psi, at least 3 psi, at least 5 psi, or at least 10 psi. In some embodiments, the liquid pressure at the pressurized source is 50 psi or less, 30 psi or less, 20 psi or less, or 10 psi or less.

[0136] Next, as shown in FIG. 1J, a jet of gas is delivered from the nozzle head 110 onto the lens to remove any remaining liquid and loose deposits on the lens. The gas may be, for example, carbon dioxide, which is commonly available in the surgical field, such as for insufflating surgical cavities. As with the liquid, the gas may be provided from a pressurized gas source such that a burst of gas is sprayed onto the nozzle at a relatively high velocity. In some embodiments, the gas pressure in the pressurized gas source is at least 5 psi, at least 10 psi, at least 50 psi, or at least 100 psi. In some embodiments, the gas pressure in the pressurized gas source is 500 psi or less, 250 psi or less, 150 psi or less, or 100 psi or less. The burst of gas blows the sprayed liquid and any remaining deposits off the lens, leaving it clean and clear. In the event that deposits remain, the cleaning sequence can be repeated as necessary.

[0137] In some embodiments, at least a portion of the period during which the gas is delivered can overlap with at least a portion of the period of the liquid spray, which can increase the velocity of the liquid spray and increase its cleaning power.

[0138] In some embodiments, the scope cleaner may be configured to prevent fogging of the lens of the scope by warming the surgical scope and / or providing a steady flow of gas to the surgical scope. FIG. 2 is a cross-sectional view of a portion of a scope cleaner 200 configured to warm a surgical scope and provide a steady flow of gas to the surgical scope, according to some embodiments. One or more resistive heating wires 234 may be incorporated into the sheath 202 for heating to prevent fogging. One or more wires 234 may be molded into the wall 216 of the sheath 202 and heat the tubes of a surgical scope received therein. Alternatively or additionally, one or more wires 236 may extend into the gas conduit 220 to heat the gas as it flows. One or more wires 234 and / or 236 may be connected to a power source, for example, via wiring incorporated into a tubing set that includes tubes carrying liquids and gases for the scope cleaner 100.

[0139] In some embodiments, the scope cleaner 200 is configured to provide a steady flow of gas to prevent fogging while also providing a burst of gas for a cleaning sequence. The cleaner 200 may include a shuttle valve 238 with two separate gas inlets 240 and 242 for connecting to two separate gas tubes. The first gas inlet 240 can be used to provide a low pressure gas that, when flowing, provides a steady flow of gas down the gas conduit 220 and out onto the lens of the scope. The low pressure gas may be regulated, for example, to 2 psi or less. A burst of high pressure gas through the second gas inlet 242 forces the shuttle valve 244 to a position that closes the low pressure line, opening the flow path for the high pressure burst to flow down the gas conduit 220 to the lens of the scope. When the high pressure burst ends, the pressure from the low pressure gas returns the shuttle valve to a position that allows low pressure gas to flow.

[0140] In some embodiments, the low pressure gas flow can be the insufflation gas flow for insufflating the surgical cavity, thereby eliminating the need for a separate air line and inlet to the surgical cavity. In some embodiments, the scope cleaner is configured for scope heating, gas heating, and / or steady gas flow.

[0141] According to some embodiments, the liquid and gas supply for the surgical scope cleaner may be incorporated into the device that manages the flow of other fluids to and from the surgical field. In addition to the liquid and gas supply for the surgical scope cleaner, examples of other fluid management that may be provided according to various embodiments include providing insufflation gas to pressurize the patient's surgical cavity, evacuating smoke that may occur within the surgical cavity via cauterization, providing irrigation fluid within the surgical cavity, removing fluids from the surgical cavity, and providing therapeutic agents to the surgical cavity.

[0142] 3 is a block diagram of an apparatus 300 for managing fluid flow to and from a surgical field, according to some embodiments. Apparatus 300 controls the flow of liquids and gases to a surgical scope cleaner, such as scope cleaner 100, as well as the flow of insufflation gas to pressurize a surgical cavity. Apparatus 300 may be configured to manage any other fluid flow required for the surgical field. Surgical scope cleaners and devices, such as trocars, for directing insufflation gas into the surgical cavity may be connected to apparatus 300, for example, via flexible tubing extending from apparatus 300 into the surgical field.

[0143] The device 300 includes a first gas supply port 302 for providing a gas supply to a surgical scope cleaner and a second gas supply port 304 for supplying an insufflation gas flow to a patient's surgical cavity. The device 300 includes a gas inlet port 306 for supplying gas to the device 300. The gas inlet port 306 can be connected to a pressurized gas supply, such as a carbon dioxide wall or service head outlet or a carbon dioxide canister.

[0144] The gas supply to the first and second gas supply ports 302, 304 can be controlled via first and second gas flow control subsystems 308 and 310, respectively. Each gas flow control subsystem can include, for example, a pressure regulator 312 for stepping down the pressure of the gas supplied to the device 300 and a valve 314 for turning on and off the flow of gas to the respective port 302, 304. In some embodiments, a single pressure regulator 315 can be used for both the first and second gas supply ports 302, 304.

[0145] The apparatus 300 also includes an actuator 316 for controlling the flow of fluid to the surgical scope cleaner. The actuator 316 may be operatively connected to an inflow device 318 that connects a fluid supply reservoir 320 to a fluid supply port 322. The surgical scope cleaner may be connected to the fluid supply port 322 via a tube for receiving fluid from the fluid supply reservoir 320 as controlled by the actuator 316 and the inflow device 318.

[0146] The actuator 316 and the inflow device 318 can be implemented in different ways according to various embodiments. In some embodiments, the inflow device 318 is a valve that is moved between an open and closed position by the actuator 316. In other embodiments, the inflow device 318 is a flexible tube that is compressed by the actuator 316 to close the flow path through the inflow device 318. The actuator 316 can be a linear actuator, such as a solenoid, that operates a valve or compresses a flexible tube. In other embodiments, the actuator 316 is a rotary actuator, such as a stepper motor or servo motor, that rotates the valve between the open and closed positions. In some embodiments, the inflow device 318 is a pump that is actuated by the actuator 316. The actuator 316 can be, for example, a motor that rotates a shaft to which the pump is attached.

[0147] In the illustrated embodiment, the inflow arrangement 318 is separate and external to the device 300, such that the liquid flow path is entirely external to the device 300. This arrangement can be advantageous in that no device components require sterilization. In other embodiments, the inflow arrangement 318 may be included within or as part of the device 300.

[0148] The fluid supply reservoir 320 can be any suitable reservoir for providing the fluid required for scope irrigation. For example, the fluid supply reservoir 320 can be a saline bag connected via tubing to the inflow device 318, or can be combined with the inflow device 318 into a single unit. In some embodiments, the fluid supply reservoir 320 is integrated into the device 300.

[0149] The device 300 may include other fluid supply or exhaust components. For example, the device 300 may include a vacuum controller 324 for providing a vacuum to the surgical field via a vacuum port 326. The vacuum may be used, for example, to evacuate smoke from the surgical field and / or to aspirate liquids, such as blood, from the surgical field.

[0150] In some embodiments, the device 300 includes a liquid reservoir pressurization subsystem 336 for pressurizing the liquid supply reservoir 320 using the same gas or a different gas used for scope irrigation. The pressurization subsystem 336 can supply pressurized gas, such as gas from the gas inlet port 306, to the liquid supply reservoir 320. In some implementations, the pressurized gas can create a head pressure in the reservoir 320. In other embodiments, the pressurized gas can compress the reservoir itself. For example, the reservoir can be a saline bag fitted within a pressurization sleeve 338 that receives pressurized gas from the liquid reservoir pressurization subsystem 336.

[0151] The liquid reservoir pressurization subsystem 336 can include one or more valves 340 for controlling the flow of pressurized gas, which can be the same gas provided through the gas inlet port 306. In some embodiments, the liquid reservoir pressurization subsystem 336 can include a pressure regulator 342 for stepping down the pressure received through the inlet port 306 or through one or more upstream regulators, such as regulator 315. In some embodiments, the device can be configured to control the liquid reservoir pressurization subsystem 336 to automatically depressurize the pressurization sleeve 338 at the end of a surgical procedure, such as when gas delivery is stopped.

[0152] The gas flow control subsystems 308, 310, the actuator 316, and any other electronic components of the device 300 may be controlled via a controller 328. The controller 328 may include one or more processors and a memory that stores instructions for execution by the one or more processors to control fluid management by the device 300. The controller 328 may provide electrical signals to the actuator 316 that operate one or more valves and / or pressure regulators of the control subsystems 308, 310. The controller may also be used to control any other fluid management subsystems, including the vacuum controller 324 and the liquid reservoir pressurization subsystem 336.

[0153] The controller 328 may be communicatively connected to an external control system 334 via a communications port 330 to receive liquid and gas supply control commands from the external system 334. For example, the controller 328 may receive a command to execute a cleaning sequence for a surgical scope cleaner, in response to which the controller can control the actuator 316 to supply liquid to the surgical scope cleaner for a predetermined period of time to spray onto the lens of the surgical scope, and control the first gas flow control subsystem 308 to supply a flow of gas to the surgical scope cleaner for a second predetermined period of time to blow the liquid off the lens of the surgical scope, as described above.

[0154] The device 300 may include a user interface 332 for a user to control one or more aspects of the liquid and gas delivery from the device. The user interface 332 may be used, according to various embodiments, to receive commands, for example, to start and stop the insufflation gas flow and / or to change the insufflation gas pressure, or to control any other function of the device 300.

[0155] In some embodiments, lines for conducting fluids managed by a fluid delivery device such as device 300 to the surgical field are connected directly to ports on the device. In other embodiments, the delivery lines are connected to connectors that are connected to receptacles on the device. Figure 4A shows a fluid delivery device 400 in which a connector 410 is used to connect multiple fluid lines to the device 400.

[0156] Connector 410 includes a gas supply port 412 for supplying gas to the surgical scope cleaner via a gas supply line 414, a liquid supply port 416 for supplying liquid to the surgical scope cleaner via a liquid supply line 418, and a liquid inlet port 420 for receiving liquid from an external liquid reservoir for the surgical scope cleaner via a liquid inlet line 421. A liquid reservoir pressurization port 424 may be included for supplying pressurized gas to a liquid supply reservoir, such as reservoir 320 of FIG. 3, via a liquid reservoir pressurization line 422.

[0157] The connector 410 also includes an insufflation gas supply port 426 for supplying an insufflation gas flow to the surgical cavity via an insufflation gas line 428, and a smoke exhaust port 430 for exhausting smoke from the surgical cavity via a smoke exhaust line 432. The connector 410 can include an inlet filter housing 434 that houses one or more filters for filtering smoke received via the exhaust port 430. The connector 410 can include other filters for filtering fluids provided to and received from the surgical field.

[0158] The connector 410 may be removably received in a receptacle 450 of the device 300. One or more latches 452 may be used to retain the connector 410 in the receptacle 450. One or more ejection mechanisms 454 may be used to release the one or more latches 452 to remove the connector 410 from the receptacle 450.

[0159] 4B illustrates a receptacle 450 according to some embodiments. The receptacle 450 includes a first gas supply port 402 for supplying a flow of gas to a surgical scope cleaner, a second gas supply port 404 for supplying an insufflation gas flow to the surgical cavity, and a smoke exhaust port 430 for exhausting smoke from the surgical cavity. The receptacle 450 also includes a liquid reservoir pressurization port 456 for providing pressurized gas to a liquid supply reservoir, such as the liquid supply reservoir 320 of FIG. 3.

[0160] The receptacle 450 may include a switch 458 that is depressed or otherwise actuated when the connector 410 is received within the receptacle 450. The switch 458 may be connected to a controller, such as controller 328 of FIG. 3, which may control the flow of one or more fluids based on the state of the switch such that there is no flow through one or more of the ports of the receptacle 450 when the connector 410 is not received in the receptacle 450. The receptacle 450 also includes an opening 460 through which an end of an actuator extends for actuating a flow control device within the connector 410, as described further below. The receptacle 450 may also include an electrical connection 462 for providing electricity to one or more heating tubes connected to the connector 410.

[0161] A back side (not shown) of connector 410 includes ports that fit into the ports of receptacle 450 described above. One or more seals may be provided in any of the ports in receptacle 450 and / or any of the ports on the back side of connector 410. The back side also includes an opening for receiving an end of an actuator.

[0162] 4C and 4D are cross-sections of the connector 410 positioned within the receptacle 450, showing an inlet device 436 incorporated within the connector 410. The inlet device 436 includes a valve 438 that is moved laterally to open and close a liquid flow path 440 through the inlet device 436. FIG. 4C shows the closed position, and FIG. 4D shows the valve 438 in an open position. The valve 438 is moved from the closed position to the open position by one end 439 of a lever 442 and returned to the open position via the force of a spring 444. The lever 442 pivots about a pivot axis 445. To actuate the valve 438, a plunger 446 of its latitudinal actuator 448 within the device 400 pushes against the other end 443 of the lever 442, pivoting the lever about the pivot axis 445 and pushing the end 439 of the lever 442 against the valve 438, forcing the valve to move laterally against the force of the spring 444 to the open position. As shown in FIG. 4D, with valve 438 in the open position, liquid from the liquid supply reservoir can flow through inflow device 436 via liquid inlet port 420 and out to the surgical scope cleaner via liquid supply port 416.

[0163] 5A-5B show a fluid supply device 500 and a tube set connector 510, in which a liquid supply reservoir for supplying liquid for the scope cleaner is incorporated into the connector 510, according to some embodiments. Similar to the connector 410, the connector 510 includes a gas supply port 512 for supplying gas to the surgical scope cleaner via a gas supply line 514, a liquid supply port 516 for supplying liquid to the surgical scope cleaner via a liquid supply line 518, an insufflation gas supply port 526 for supplying an insufflation gas flow to the surgical cavity via an insufflation gas line 528, and a smoke exhaust port 530 for exhausting smoke from the surgical cavity via a smoke exhaust line 532, as shown in FIG. 5A. However, unlike the connector 410, the connector 510 does not have a liquid supply port for receiving liquid from an external liquid reservoir. Instead, the connector 510 includes an internal liquid reservoir 590.

[0164] The connector 510 may include a reservoir fill port 592 for filling the liquid reservoir 590 with a liquid, such as saline. The fill port 592 may have a one-way valve for sealing the port when the reservoir 590 is pressurized, as discussed further below. A bleeder valve 594 may be provided to bleed air when filling the reservoir 590.

[0165] 5B shows a receptacle 550 of device 500 that receives connector 510, according to some embodiments. Receptacle 550 includes a first gas supply port 502 for supplying a flow of gas to a surgical scope cleaner, a second gas supply port 504 for supplying an insufflation gas flow to the surgical cavity, and a smoke exhaust port 530 for exhausting smoke from the surgical cavity. Receptacle 550 includes a liquid reservoir pressurization port 556 for providing pressurized gas to a liquid reservoir 590 for pressurizing liquid provided to the scope cleaner.

[0166] According to some embodiments, an inflow device in the form of a valve is provided within device 500 to control the flow of liquid from reservoir 590. Receptacle 550 thus includes a liquid inlet 552 for receiving liquid from reservoir 590 (via connection with an outlet at the rear of connector 510, not shown), and a liquid outlet 554 for providing liquid to the scope cleaner via connector 510. The inflow device is provided in a flow line extending between liquid inlet 552 and outlet 554. The inflow device can be actuated by an actuator, such as a solenoid, to turn the flow of liquid on and off. When reservoir 590 is pressurized, opening the valve of the inflow device allows liquid to flow to the scope cleaner.

[0167] 6A and 6B show a fluid delivery device 600 and a tube set connector 610 in which a pump is integrated into the connector 610 to pump liquid from an external liquid supply reservoir to the scope cleaner, according to some embodiments. The connector 610 includes a gas supply port 612 for supplying gas to the surgical scope cleaner via a gas supply line 614, and a liquid supply port 616 for supplying liquid to the surgical scope cleaner via a liquid supply line 618. A liquid inlet port 620 for receiving liquid from an external liquid reservoir, such as reservoir 320 of FIG. 3, via a liquid inlet tube 622 can lead to a pump impeller housed within a pump housing 670. The connector 610 includes an insufflation gas supply port 626 for supplying an insufflation gas flow to the surgical cavity via an insufflation gas line 628, and a smoke exhaust port 630 for exhausting smoke from the surgical cavity via a smoke exhaust line 632.

[0168] 6B shows a receptacle 650 and a rear side 611 of a connector 610 that interfaces with the receptacle 650. Extending through the rear side 611 of the connector 610 is a shaft 640 for a pump impeller housed within the connector 610. Attached to the shaft 640 is a first coupler 642 that mates with and is driven by a second coupler 644 in the receptacle 650. The second coupler 644 is attached to the shaft of a motor located within the device 600. The motor drives the pump impeller to pump fluid from an external fluid supply reservoir to the scope cleaner.

[0169] The pump can be started and stopped to control the flow of liquid to the scope cleaner. Additionally or alternatively, an actuator can be used to open and close a liquid flow path in the connector 610. In the embodiment shown in FIG. 6B, a plunger 646 of the actuator, which can be in the form of a solenoid, extends from a receptacle 650 and is received in an opening 648 in the back side 611 of the connector 610. The plunger 646 extends to a liquid flow line 652 in the connector 610 that leads from the pump to the liquid supply port 616. The plunger 646 can be extended through the action of the solenoid to pinch off the liquid flow line 652. Thus, in this embodiment, the inflow device is the liquid flow line 652 that is pinched down by the actuator plunger 646 to block the flow of liquid. The pump can be operated continuously, and the flow of liquid to the scope cleaner can be controlled by pinching the liquid flow line 652. In some embodiments, the flow from the pump can also be controlled via a valve, such as valve 438 in Figures 4C-4D. In some embodiments, the pump may pressurize the liquid continuously, and the flow can be controlled, for example, by a pinching actuator or valve.

[0170] According to some embodiments, the pinching actuator may also be used to control the flow of one or more other fluids, including, for example, a gas supply for a scope cleaner. FIG. 6B shows a second plunger 654 extending from a receptacle 650 to pinch a second flow line 656 in the connector 610. The second flow line may be, for example, part of a scope cleaner gas flow path through the connector 610. This configuration may eliminate the need for a valve located within the device to control the gas flow to the scope cleaner. In some embodiments, a valve is provided to control the flow through the second flow line 656.

[0171] According to some embodiments, the inclusion of a pump within the connector 610 provides the device with the ability to manage the supply of fluid to the surgical field for additional purposes, such as irrigation within the surgical cavity. One or more additional fluid flow path lines can lead from the pump to one or more additional tubes extending from the connector 610. Returning to FIG. 6A, an irrigation outflow port 672 can be included to provide irrigation outflow from the pump via irrigation tubing 674 to an irrigation supply device used to irrigate the surgical cavity. In some embodiments, the second plunger 654 or additional plungers can be used to pinch the flow lines for the irrigation fluid within the connector 610 to control the flow of the irrigation fluid.

[0172] According to some embodiments, a connector, such as connector 610, can include wires, cables, or other lines for providing electrical and / or data communication. In the embodiment shown in Figures 6A-6B, connector 610 includes a monopolar RF connector 680 and cable 682 for providing electricity to an electrocautery instrument in the surgical field. Connector 680 can interface with a power port 684 in receptacle 650, as shown in Figure 6B. Connector 610 can also include a control signal connector 686 for connecting a control signal wire 688 that can be used to control one or more functions of device 600, such as delivery of liquids and / or gases, operation of a pump, or any other function. Wire 688 can lead, for example, to a switch or other remote control located in the surgical field that can be operated by a user.

[0173] According to some embodiments, an integrated tubing set can be used to provide fluids managed by a fluid supply management device, such as device 300, 400, 500, or 600, to a surgical field. An integrated tubing set can reduce clutter at a surgical field by grouping fluid supply lines together. An integrated tubing set can include a connector to which some or all of the lines connect, such as any of connectors 410, 510, or 610, which can simplify the set-up process for connecting the lines to one or more instruments. An integrated tubing set can also include one or more integrated devices that can be used to deliver fluids to or from the surgical field, such as a surgical scope cleaner and a suction / irrigation device. An integrated tubing set can be a disposable, single-use tubing set, or a reusable tubing set that is sterilized between uses.

[0174] FIG. 7 illustrates the use of a tube set 700 in a surgical field, according to some embodiments. The tube set 700 includes a surgical scope cleaner 702 connected to a scope irrigation gas supply tube 704 and a scope irrigation fluid supply tube 706, constructed according to the principles described above. In this embodiment, the surgical scope cleaner 702 is an integrated component of the tube set with the scope cleaner and connected supply tubes pre-connected, but in other embodiments, the scope cleaner is not provided as part of the tube set, and the tube set's supply tubes 704 and 706 are connected to the scope cleaner in preparation for a surgical procedure, such as in an operating room. The surgical scope cleaner 702 can be attached to a surgical scope 762 that is fitted with an endoscopic camera 746. The surgical scope cleaner 702 and surgical scope 762 can be inserted into a surgical cavity 750 through a first trocar 730 to visualize the surgical cavity. If a lens 764 at the end of the surgical scope 762 becomes dirty or fogged, the scope cleaner 702 can be used to clean the lens 764 according to the principles described above.

[0175] The tubing set 700 may include a suction and irrigation device 708 connected to an irrigation supply tube 710 and a suction tube 712. The suction and irrigation device 708 may be inserted into a second trocar 734 to provide suction and irrigation within the surgical cavity 750. The suction and irrigation device 708 may be an integrated component of the tubing set or may be connected to the tubing set in preparation for surgery.

[0176] The tubing set 700 may also include an insufflation gas supply tube 714 that may be connected to a port 732 of the third trocar 735 to provide pressurized gas to the surgical cavity 750. The tubing set also includes a patient outflow tube 716 that may be connected to a port 736 of the second trocar 734 to extract gases, such as smoke, from the surgical cavity 750.

[0177] The tubes of the tube set 700 can be held together by an outer tube 718, which can aid in operating room cleanup. In some embodiments, the tubes are held together by one or more straps wrapped around the tubes. The tube set can include other lines that extend into the surgical field, such as a monopolar wire 740 for supplying current to a cauterization tool 742. The tube set can also include one or more data wires 744 and / or optical cables for connecting a camera control unit and / or illuminator to an endoscopic camera 746 mounted on a surgical scope 762. According to various embodiments, the tube set can incorporate a laparoscopic sprayer that can deliver pressurized gas from a fluid management device to spray a therapeutic agent, such as a hemostatic agent, into the surgical cavity.

[0178] 8A and 8B show the connection of a tubing set 700 to a fluid supply management device 800, such as any of devices 300, 400, 500, and 600 described above, according to some embodiments. A non-patient end 760 of the tubing set 700 includes a connector 770, such as any of connectors 410, 510, and 610, to which some or all of the tubing of the tubing set is pre-attached. The connector 770 connects to a receptacle 850 of the fluid supply management device 800. In the illustrated embodiment, the tubing set 700 includes a fluid supply tube 720 connected to a fluid supply reservoir 780, which may be, for example, a saline bag, for supplying fluid to the surgical field, such as for a scope cleaner and / or an irrigation supply device. FIG. 8B shows the connection of a suction line 722 of the tubing set 700 to a suction device 724.

[0179] Although not shown, one or more lines of the tubing set may be connected to other equipment in the operating room. For example, one or more communication lines for an endoscopic camera may be connected to a camera control unit 810, and an optical cable may be connected to a lighting device 820.

[0180] In some embodiments, the tubing set can be configured such that the gas lines connected to the scope cleaner can be disconnected from the scope cleaner and attached to another device used during the surgical procedure, such as, for example, a spray wand for spraying a hemostatic sclerosing agent at a wound site in the surgical cavity or a medication to provide a therapeutic healing effect to an area of ​​the surgical cavity. The pressurized gas can be used to provide power for a gas-powered instrument or power tool. In some embodiments, the liquid lines connected to the scope cleaner can be disconnected from the scope cleaner to provide power to another device used in the surgical field. In some embodiments, both the gas lines and the liquid lines can be disconnected from the scope cleaner and used to power and / or control another device used in the surgical field. In some embodiments, signal lines from the fluid delivery system can be provided to connect to the device to which the liquid and / or gas lines are connected, either to the scope cleaner or any other device that interfaces with the liquid and / or gas lines. Information related to the type of device to which the line(s) are connected to the fluid delivery system can be communicated via the signal lines so that the fluid delivery system can provide the appropriate liquid and / or gas flow to the connected device. For example, if the line is connected to a scope cleaner, the fluid delivery system may register (via a signal on the signal line) that the scope cleaner is connected and provide a flow of liquid and gas per the cleaning sequence; if the liquid and / or gas line is connected to a device that is powered by liquid and / or gas, the fluid delivery system may recognize this connection via the signal line and may provide a continuous flow of liquid and / or gas.

[0181] FIG. 9 illustrates a method 900 for supplying liquid to a surgical field, according to some embodiments. In step 902, a connector of a tube set is connected to a liquid supply system. The connector may be, for example, any of connectors 410, 510, or 610, and the liquid supply system may be any of devices 400, 500, or 600. The tube set may be, for example, tube set 700 of FIG. 7. The tube set includes a first supply tube connected to a first port of the connector, a second supply tube connected to a second port of the connector, and a third supply tube connected to a third port of the connector. For example, referring to FIG. 4, the tube set may include an insufflation gas line 428 connected to an insufflation gas supply port 426, a liquid supply line 418 connected to a liquid supply port 416, and a gas supply line 414 connected to a gas supply port 412.

[0182] In step 904, a first gas flow for insufflating the surgical cavity is supplied during the surgical procedure via a first supply tube. For example, carbon dioxide may be supplied via insufflation gas line 428 of FIG. 4 to insufflate the surgical cavity. In step 906, a liquid for irrigating the surgical scope is supplied during the surgical procedure via a second supply tube. For example, saline or a saline solution may be supplied to a surgical scope cleaner, such as scope cleaner 100, via liquid supply line 418 of FIG. 4. In step 908, a second gas flow for removing liquid from the surgical scope is supplied during the surgical procedure via a third supply tube. For example, carbon dioxide may be supplied to the surgical scope cleaner via gas supply line 414.

[0183] In some embodiments, the method 900 further includes unpacking a pre-sterilized and packaged tubing set prior to connecting the connector to the liquid delivery system. In some embodiments, the packaged tubing set includes a scope cleaner. In other embodiments, the method 900 further includes attaching second and third supply tubes that are connected to the surgical scope before or after the tube set connectors are connected to the liquid delivery system. In some embodiments, the method 900 includes disposing of the tubing set after use in a single surgical procedure. In other embodiments, the method 900 includes resterilizing the tubing set after use.

[0184] In some embodiments, the method 900 further includes evacuating the surgical cavity via an exhaust tube connected to a fourth port of the connector. For example, smoke from the surgical cavity can be evacuated via a smoke exhaust line 432 connected to a smoke exhaust port 430 of the connector 410 connected to the device 400.

[0185] FIG. 10 illustrates a method 1000 for cleaning a surgical scope while it is inserted into a surgical cavity, according to some embodiments. In step 1002, a surgical scope, such as the scope 150 of FIG. 1A, is inserted into a sheath of a surgical scope cleaner, such as the sheath 102 of the scope cleaner 100. In step 1004, the surgical scope and sheath are inserted into the surgical cavity. For example, referring to FIG. 1A and FIG. 7, the tube 152 of the surgical scope 150, with the sheath 102 of the cleaner 100 attached, is inserted into the surgical cavity 750 through the lumen of the trocar 730. In step 1006, the surgical cavity is observed using the surgical scope inserted into the sheath of the surgical scope cleaner. For example, an image generated by the endoscopic camera 746 of FIG. 7 may be displayed via a display in the operating room and observed by the surgeon.

[0186] In step 1008, deposits from the lens of the surgical scope may be cleaned by spraying the lens with a liquid from at least one nozzle of the surgical scope cleaner to remove deposits from the lens, and by blowing a gas from at least one nozzle of the surgical scope cleaner to remove liquid from the lens. For example, referring to FIG. 1C, deposits from the lens 156 of the surgical scope 150 may be cleaned by spraying the lens 156 with saline from nozzle 112 of the surgical scope cleaner 100 to remove deposits from the lens 156, and then blowing a burst of carbon dioxide from nozzle 114 of the surgical scope cleaner 100 to remove the saline from the lens 156. Each of the liquid spray and the burst of gas may be provided for a predetermined period of time, which may be the same or different lengths. The respective periods of the liquid spray and the burst of gas may overlap, such that the liquid and the gas are provided simultaneously for at least a portion of the time.

[0187] In some embodiments, the cleaning sequence described above can be performed in response to a user command. For example, a user can see blurring indicative of dirt and / or fogging of the scope lens on one or more endoscopic images or videos displayed on a display in the operating room and can issue a command to initiate a scope cleaning sequence. The command can be provided, for example, via a button press on an endoscopic camera, such as endoscopic camera 746 of FIG. 7. The button press can be communicated via communication line 744 to a camera controller, such as camera controller 810 of FIG. 8B. The camera controller can be communicatively connected to the fluid management apparatus. For example, with reference to FIG. 3, the camera controller can be a component of an external system 334 or can be communicatively connected to an external system 334 that is communicatively connected to the fluid management apparatus 300. Based on the user's command, the external system 334 can send a command to the apparatus 300 to perform a cleaning sequence. The user may press a button that he / she temporarily attaches to the scope, camera head, or a button integrated into the proximal end of the scope cleaning sheath with an electrical wire running through a connector to an insufflator, said button / switch being integrated into the tubing set.

[0188] In some embodiments, an image analysis and control system, such as various embodiments of the external system 334, includes image processing that analyzes one or more images or one or more video frames generated by an endoscopic imaging device to detect contamination and / or fogging of the scope. When contamination and / or fogging of the scope is detected, the control system can send a control command to the fluid management device 300 to perform a cleaning sequence. Thus, in some embodiments, the control system includes one or more processors and a memory storing one or more programs for executing a method of automatically detecting deposits on the lens of a surgical scope and sending a command to a connected device to initiate a cleaning sequence for the surgical scope. An exemplary method performed by the control system, according to various embodiments, is method 1200 of FIG. 12. In step 1202 of method 1200, the control system receives one or more images of a surgical field from an endoscopic imaging device communicatively connected to the control system. The endoscopic imaging device includes an endoscopic camera connected to a scope inserted into a surgical cavity, such as the surgical scope 150. The scope may be received in a scope cleaner, such as surgical scope cleaner 100, or may have an integrated cleaner function, such as scope 1100 of FIGS. 11A-E. In step 1204, the control system automatically detects deposits on the lens of the surgical scope by analyzing one or more images. Any suitable image processing algorithm or combination of algorithms may be used to detect deposits. In step 1206, the control system transmits a command to a communicatively connected fluid management device to provide one or more fluids to the surgical field to clean the surgical scope. In some embodiments, the command may be transmitted automatically in response to detection of deposits. According to various embodiments, in response to receiving a command from the control system, the fluid management device provides a flow of liquid and / or gas from the device to the surgical scope cleaner or to a surgical scope with integrated cleaning to clean the lens of the surgical scope during a surgical procedure.In some embodiments, the liquid flow is provided initially for a first period of time and the gas flow is provided for a second period of time that at least partially follows the first period of time.

[0189] In some embodiments, the image analysis and control system may provide a notification to a user that soiling and / or fogging has been detected, such as on a display in the operating room. The image analysis and control system may wait for confirmation from the user to initiate the cleaning sequence. The user may confirm that the cleaning sequence may be performed via any suitable user input, such as a voice command, a button press on the camera head, or a button press on a user interface of the image analysis and control system. In response to receiving the user command, the image analysis and control system may send a start cleaning sequence command to the fluid management device, which may respond by controlling the cleaning sequence.

[0190] The liquid cleaning device may control the cleaning sequence by activating an actuator to provide a flow of liquid to the scope cleaner. For example, the controller 328 of the device 300 may send a command to the actuator 316 to allow the inflow device 318 to flow the liquid received from the reservoir 318. With reference to Figures 4C and 4D, this may include controlling the solenoid 448 so that the plunger 446 moves the lever 442 to move the valve 438 to an open position. In some embodiments, the cleaning sequence includes spraying the lens with liquid for a first predetermined period of time. Once this period has elapsed, the actuator may be controlled to stop the flow of liquid. For example, the plunger 446 may be retracted and the valve 438 may return to a closed position by the force of the spring 444.

[0191] The liquid irrigation device may continue the irrigation sequence by opening the valve to allow pressurized gas to flow to the surgical scope cleaner. For example, referring to FIG. 3, the controller 328 may control valve 314 to open to allow pressurized gas from gas supply inlet 306 to flow to the scope cleaner (e.g., as regulated by regulator 312 or regulator 315). Gas may be supplied for a second predetermined period of time. The burst of gas may be provided while the liquid is being provided or may be provided entirely after the liquid is provided.

[0192] According to some embodiments, the surgical scope irrigation is incorporated into the surgical scope itself by constructing at least one liquid channel and at least one liquid outlet in the scope shaft. This can be particularly advantageous for small surgical scopes, such as sinus scopes, where a separate irrigation sheath can be prohibitively large for insertion into narrow passages, such as within the sinuses. Thus, according to various embodiments, the scope and irrigation sheath functions are combined into a single solution - a scope with integrated irrigation capabilities. By combining these two traditionally separate functions, the overall size of the scope with irrigation capabilities can be minimized, achieving a much smaller cross-sectional area than a separate scope and sheath solution. According to various embodiments, incorporating the irrigation solution into the scope has other advantages, including reducing the amount of reflection and other visual impairments (such as obstructed vision) introduced by a separate sheath, and preserving the working length of the scope that is shortened by the sheath.

[0193] According to various embodiments, a scope with integrated irrigation may be particularly suitable for functional endoscopic sinus surgery (FESS) and transnasal skull base surgery, where the cross-sectional size of the inserted device is a major design limitation due to the limited size of the surgical space. According to various embodiments, by integrating the irrigation channel into the scope, the size of the combined solution can be as small as an elliptical cross-section of 4.6 mm high and 4.0 mm wide (the size of a conventional sinusscope) while maintaining an irrigation channel cross-sectional area large enough for use with pumps and tubing traditionally used in the operating room.

[0194] 11A-E show a scope with integrated cleaning capabilities, according to some embodiments. Looking first to FIG. 11A, the scope 1100 includes a shaft 1102 extending distally from the body and configured to be inserted into a surgical cavity during use. The shaft 1102 includes at least one liquid channel (described further below) that directs liquid to at least one liquid outlet 1114 at a distal end 1116 of the shaft 1102. The at least one liquid outlet 1114 is configured to direct liquid onto an optical component 1112 (such as a window or lens) located at the distal end 1116 of the shaft.

[0195] The body 1104 includes an eyepiece 1106 disposed at a proximal end 1118 of the scope 1100. The eyepiece 1106 can be configured to connect the scope 1100 to an imaging device. The body includes an optical port 1108 that can be configured as an optical cable connector for connecting to an optical cable that provides illumination to the scope 1100. The body 1104 also includes at least one liquid port 1110 for connecting to at least one liquid supply and / or exhaust supply system for supplying liquid and / or exhaust to the scope 1100. The at least one liquid port 1110 can be configured for a liquid, such as saline, or for a gas, such as carbon dioxide (as used herein, the term "fluid" encompasses liquids and gases). In some embodiments, the body 1104 includes a single fluid port 1110. In some embodiments, the body 1104 includes multiple fluid ports 1110, such as liquid ports and gas ports. In some embodiments, the fluid ports 1110 can be used to deliver both liquid and gas, either sequentially (such as via an upstream valve) or simultaneously (such as by increasing the pressure of the delivered liquid). In some embodiments, fluid flows both in and out of the ports 1110, such as by peristaltic action of the fluid delivery system. At least one fluid port 1110 can be configured to connect to conventional tubing used to deliver fluid to a surgical field.

[0196] 11B shows a perspective view of a cross section (taken on line AA in FIG. 11A) of a portion of the shaft 1102 of the scope 1100. The shaft 1102 includes at least one fluid channel 1120 for fluid flow between at least one fluid port 1110 in the body 1104 and at least one fluid outlet 1114 at the distal end 1116 of the shaft 1102. The at least one fluid channel 1120 is disposed between a first wall portion 1122 that corresponds to the outer tubular wall of a conventional scope shaft (see tube 152 of scope 150 in FIGS. 1A-1B for an example of an outer tubular wall of a conventional scope configuration) and a second wall portion 1130 that extends at least partially around the first wall portion 1122.

[0197] According to various embodiments, the second wall portion 1130 extends only partially around the first wall portion 1122 such that the outer surface of the shaft 1102 is formed by the second wall portion 1130 and the portion of the first wall portion 1122 that is not surrounded by the second wall portion 1130. With the second wall portion 1130 extending only partially around the first wall portion 122, the outer surface of the shaft 1102 is non-cylindrical. The increase in size required to accommodate the at least one fluid channel 1120 is concentrated in the width 1134 of the shaft 1102 in the long axis direction, with little or no increase in the width 1132 in the short axis direction compared to a conventional endoscope shaft of the same size. In some embodiments, the first wall portion 1122 is cylindrical and the width 1132 of the shaft 1102 in the short axis direction is equal to the diameter of the first wall portion 1122, resulting in no increase in the width of the shaft 1102 along the short axis compared to a conventional scope shaft of the same size. For example, an endoscope 1100 sized to correspond to a conventional 4 mm scope may have a width 1132 along its minor axis of 4 mm.

[0198] According to various embodiments, the first wall portion 1122 and the second wall portion 1130 are integrated into a unitary piece, which may be formed in any suitable manner, such as via welding, extrusion, and / or machining of the second wall portion 1130 to the first wall portion 1122. In some embodiments, multiple fluid channels are provided between the first wall portion 1122 and the second wall portion 1130, such as configured as the two conduits 118 and 120 shown in FIG. 1D.

[0199] The shaft 1102 includes an inner tube 1124 disposed radially inward of a first wall portion 1122 and which together with the first wall portion 1122 defines a channel 1126 for placing an optical fiber carrying light from an optical cable connected to the optical port 1108. The inner tube 1124 defines an optical channel 1128 for directing light from the scene and may house one or more optical components (not shown).

[0200] 11C and 11D are perspective and cross-sectional views of a distal portion of the shaft 1102, according to various embodiments. At least one fluid outlet 1114 is provided at the distal end 1116 of the shaft 1102 and configured to direct fluid from the at least one fluid channel 1120 onto an optical component 1112 disposed at the distal end 1116 of the shaft 1102. The at least one fluid outlet 1114 is configured to turn a fluid flow to impinge on the optical component 1112 to clean and / or blow off deposits from the optical component 1112. In some embodiments, the at least one fluid outlet 1114 is formed by rolling inward a distal end of the second wall portion 1130. In some embodiments, a separate fluid outlet 1114 is bonded to the distal end of the second wall portion 1130. In some embodiments, the at least one fluid outlet is rigidly positioned on the shaft 1102 to ensure that the at least one fluid outlet does not obscure the field of view of the endoscope 1100. The at least one fluid outlet may be configured to minimize reflections, such as by including an anti-reflective coating or being formed of an anti-reflective material.

[0201] In some embodiments, a fluid outlet may be provided for each of the multiple fluid conduits. For example, the multiple fluid outlets may be configured as in nozzle head 110 of FIG. 1C, which includes two nozzles 112, 114. In some embodiments, a single fluid outlet may be provided for the multiple fluid conduits. The single fluid outlet may be configured to sequentially provide fluids from the multiple conduits, such as a liquid spray followed by a gas spray, and / or to provide a mixture of fluids from the multiple conduits.

[0202] 11E is a cross-sectional view of a proximal portion of the shaft 1102 and a portion of the body 1104, according to some embodiments. The at least one liquid port 1110 communicates with the at least one fluid channel 1120 of the shaft 1102 via a fluid passageway 1136 in the body 1104. In some embodiments, the fluid passageway 1136 is defined by a gap between the first wall portion 1122 and an opening in the body 1104 formed to receive the first wall portion 1122.

[0203] The second wall portion 1130 can be sealed to the body 1104 to prevent fluid leakage, such as by welding the second wall portion 1130 to the body 1104. In some embodiments, the second wall portion 1130 terminates at the body 1104.

[0204] According to some embodiments, the first wall portion 1122 extends into and terminates within the body 1104. An optical fiber 1138 from the optical port 1108 extends into the channel 1126. The inner tube 1124 may extend toward the proximal end of the body 1104 and terminate at the eyepiece 1106.

[0205] According to various embodiments, to prevent leakage of fluid into the optical portion of the body 1104, a seal 1140 is disposed within the body 1104 to seal between the body 1104 and an outer surface of the first wall portion 1122 at a location between the liquid port 1110 and the optical port 1108. The seal 1140 can prevent fluid from flowing proximally to the optical port portion of the body 1104.

[0206] The endoscope 1100 can be used according to any of the methods described above, including method 900 of FIG. 9 and method 1000 of FIG. 10, except that the fluid flow and nozzles are provided directly on the endoscope 1100, rather than as part of a sheath. For example, according to various embodiments, one or more tubes of one or more fluid delivery systems, such as device 300 for managing fluid flow to and from the surgical field of FIG. 3, fluid delivery device 400 of FIGS. 4A and 4B, fluid delivery device 500 of FIGS. 5A-5B, or fluid delivery device 600 of FIG. 6, are connected to one or more fluid ports 1110 of the endoscope 1100. This can be done, for example, using tube set 700 of FIG. 7. The endoscope 1100 is then inserted into the patient's body. Due to the smaller size of the shaft 1102 of the endoscope 1100, compared to an irrigation sheath for a scope of the same relative size, a smaller space and / or a smaller incision (for a smaller trocar) can be achieved. The endoscope 1100 can be used in a conventional manner, and as deposits form on the optics 1112, one or more fluids can be directed to the optics 1112 to remove the deposits. Triggering of fluid flow can be accomplished in any suitable manner, including by following any of the methods described herein for sheath-based cleaning.

[0207] According to some embodiments, the endoscope 1100 is configured as a sinusoscope and has a single fluid port 1110, a single fluid channel 1120, and a single fluid outlet 1114. The endoscope 1100 is attached to commercially available sinusoscope flushing pump(s) via tubing connected to the fluid port 1110. When the pump is activated, fluid (such as saline) flows into the fluid port 1110, through the fluid channel 1120, and over the optical components 1112 of the endoscope 1100, cleaning deposits (such as dirt or haze) from the optical components 1112. During the reverse cycle of the pump(s), fluid may be drawn back into the fluid channel 1120 via the fluid outlet 1114 (which then functions as a fluid inlet) to remove fluid from the optical components 1112 of the endoscope 1100. According to various embodiments, the cross-sectional area of ​​the fluid channel 1120 is optimized to prevent the creation of backpressure within the tube while allowing for proper velocity and direction of fluid at the distal end 1116 of the endoscope 1100.

[0208] The foregoing disclosure has been disclosed with reference to specific embodiments for purposes of illustration. However, the illustrative discussion above is not intended to be exhaustive or to limit the invention to the precise forms disclosed. Many modifications and variations are possible in light of the above teachings. The embodiments were chosen and disclosed in order to best explain the principles of the technology and their practical application. In this way, those skilled in the art can best utilize the technology and various embodiments with various modifications suited to the particular use contemplated.

[0209] Although the present disclosure and examples have been fully described with reference to the accompanying drawings, it should be noted that various changes and modifications will become apparent to those skilled in the art. Such changes and modifications should be understood as being included within the scope of the disclosure and examples as defined by the claims. Finally, the entire disclosures of the patents and publications referenced in this application are incorporated herein by reference.

Claims

1. 1. An apparatus for cleaning a surgical scope, comprising: A sheath for removably receiving a tube of the surgical scope, a wall defining a channel for receiving the tube, the wall having a distal portion configured to extend only partially around a circumference of the tube; a first conduit defining a liquid flow path; a second conduit defining a gas flow path; a sheath having at least one nozzle located at a distal end of the distal portion of the wall and configured to direct a flow of liquid from the first conduit across a lens of the surgical scope and to direct a flow of gas from the second conduit across the lens of the surgical scope to remove the liquid from the lens; a receiver disposed at a proximal end of the sheath for receiving a housing of the surgical scope; having The apparatus, wherein the receiver is configured to receive the housing at a predetermined angular orientation about a longitudinal axis of the sheath.

2. The device of claim 1 , wherein the distal portion of the wall is configured for placement within a trocar during use.

3. 3. The apparatus of claim 1 or 2, further comprising a first port for connecting a liquid supply line to the first conduit and a second port for connecting a gas supply line to the second conduit.

4. 4. The apparatus of claim 3, wherein the liquid flow path from the first port to the first nozzle and the gas flow path from the second port to the second nozzle are valve-free.

5. 5. The apparatus of claim 1, wherein the proximal portion of the wall is configured to extend completely around the circumference of the tube of the surgical scope.

6. 6. The device of claim 1, wherein only the distal portion of the wall is disposed within a trocar during use.

7. 7. The apparatus of claim 1, wherein a distal end of the wall is further away from a longitudinal axis of the tube of the surgical scope than a proximal end of the wall when the surgical scope is received within the sheath.

8. 8. The device of claim 7, wherein the wall is configured such that the distal portion of the wall can bend toward the longitudinal axis of the surgical scope tube during insertion into a trocar and can return to a position further away from the longitudinal axis of the surgical scope tube as the distal portion passes through the trocar.

9. 9. The apparatus of claim 1, wherein the first conduit is adjacent to the second conduit.

10. 10. The apparatus of claim 9, wherein the at least one nozzle is a first nozzle adjacent to a second nozzle.

11. 11. Apparatus according to any one of claims 1 to 10, wherein the first and second conduits are formed in the thickness of the wall.

12. 12. The device of claim 11, wherein the thickness of the wall is non-uniform around a circumference of at least a portion of the wall.

13. 13. The apparatus of any one of claims 1 to 12, wherein the at least one nozzle is positioned to clean the surgical scope while the surgical scope views a surgical field.

14. 14. The apparatus of claim 13, wherein the at least one nozzle is positioned so as to not obstruct the field of view of the surgical scope.

15. 15. The device of claim 1, wherein the at least one nozzle is disposed at a distal end of the sheath.

16. 16. The device according to any one of the preceding claims, characterized in that at least the sheath is made of plastic.

17. 17. The device of any one of claims 1 to 16, wherein the device is disposable.

18. 1. A system for cleaning a surgical scope of an endoscopic imaging device while the scope is inserted into a surgical cavity, comprising: An apparatus for cleaning a surgical scope according to any one of claims 1 to 17; a control system communicatively connected to the device for supplying fluid to the device for cleaning; having the cleaning device is inserted into the surgical cavity with the surgical scope inserted into the sheath; The control system includes: receiving one or more images of a surgical field generated by the endoscopic imaging device; detecting deposits on a lens of the surgical scope by analyzing the one or more images; Based on the detection of deposits on the lens, sending a command to a device for cleaning to provide one or more fluids to the surgical field to clean the surgical scope. It is configured as follows: The cleaning device, in response to receiving the command from the control system, spraying a liquid from the at least one nozzle onto the lens to remove the deposits from the lens; Blowing gas from the at least one nozzle onto the lens to remove the liquid from the lens. A system characterized by:

19. 20. The system of claim 18, wherein the surgical scope and the sheath are inserted into the surgical cavity through a trocar.

20. The control system further comprises: providing a notification to a user that deposits on the lens have been detected based on the detection of deposits on the lens; The system of claim 18 or 19, characterized in that the command is transmitted to the device for cleaning in response to a user input to the endoscopic imaging device connected to the surgical scope made by the user upon receiving the notification.

21. 21. The system of claim 18, wherein the buildup comprises condensation.

22. 22. The system of any one of claims 18 to 21, wherein the deposit comprises one or more of bodily fluids, tissue, and one or more fluids introduced into the surgical cavity.

23. 23. The system of any one of claims 18 to 22, wherein the device for cleaning sprays the liquid onto the lens for a first predetermined period of time and blows the gas onto the lens for a second predetermined period of time.

Images