Endoscopic External Auxiliary Working Channel Apparatus

Abstract

The invention relates to a detachable apparatus that provides an external auxiliary working channel to a flexible endoscope. The auxiliary channel carrier / outlet section (2), located at the distal end, is positioned adjacent to the distal part of the endoscope (1) and works in conjunction with the flexible auxiliary cannula (3) that runs along the outer surface of the endoscope. The fixed guide section (4) on the apparatus passively tilts the distal part of the auxiliary cannula from the circumferential position of the endoscope towards the central working area in front of the distal end, angles the distal axis of the channel relative to the longitudinal axis of the endoscope. A cutting or dissection instrument (7) can be used through the main working channel of the endoscope while a gripping forceps (10) is passed through the auxiliary channel. During the withdrawal of the tissue grasped by the gripping instrument, the inclined channel geometry imparts a transverse / radial or oblique component to the traction force relative to the endoscope axis.The system facilitates the simultaneous use of independent traction and procedure instruments with a single-channel endoscope, especially in EMR and ESD procedures.

Description

1 TARIFF Endoscopic External Auxiliary Working Channel Apparatus TECHNICAL FIELD The invention provides a detachable solution for the field of medical endoscopy, and especially for flexible endoscopes. The invention relates to apparatuses that provide an external auxiliary working channel. More specifically, The distal portion of a flexible cannula that runs along the outer surface of the endoscope guiding with a passive and fixed geometry towards the working area in front of its distal end; Thus, the main operation of the endoscope is performed with the holding instrument used through the auxiliary channel. Simultaneous and independent trading instruments used through the channel It relates to a distal end device that enables its use. STATE OF THE ART Endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD) and in similar procedures, traction of the lesion or the created mucosal flap in the appropriate direction. obtaining, visualizing the working plane and the cutting or dissection instrument. This is important in terms of opening up the area where it can work. In single working channel endoscopes, the main working channel cutting, dissection, coagulation or snare such as procedure instruments because it is used by, it is simultaneously an independent gripping or traction instrument. Its use may remain limited. To meet this need, endoscopes with dual working channels and external endoscopes are available. Additional working channels can be used. However, dual channel Endoscopes may require specialized and relatively expensive equipment. External auxiliary channels The holder passed through this channel is only valid if it extends parallel to the endoscope shaft. A significant portion of the traction force generated when the instrument is withdrawn is due to the endoscope. It can be oriented along the longitudinal axis. In this case, the lesion is located in the treatment area. by removing and opening the submucosal plane, the desired transverse or The oblique force component may be limited. Therefore, with a standard single-channel endoscope, it has low mechanical complexity. It can carry an attachable, replaceable auxiliary channel that runs outside the endoscope, and The distal exit of the accessory canal in question can be achieved with a mobile articulation, traction wire, or active without requiring a steering mechanism, towards the central working area of ​​the endoscope. A device is needed to make it angled. THE PURPOSE OF THE INVENTION AND THE TECHNICAL PROBLEM IT SOLVED. 2 The main purpose of the invention is to provide an external auxiliary working channel to a standard endoscope. and the distal portion of this channel from the peripheral / external position of the endoscope a detachable apparatus that directs the device toward the central working area in front of the distal end to provide. Another aim of the invention is to prevent lesion of the retaining instrument exiting the external accessory canal. or the ability to grasp the mucosal flap in the central working area; gripping instrument When retracted proximally, the lesion is only parallel to the longitudinal axis of the endoscope. The goal is to provide a traction component that is not present in the area, either transverse / radial or oblique. Other aims of the invention include a fixation structure adaptable to different endoscope diameters. to create, enable the removal and replacement of the auxiliary cannula when necessary, the optical and illumination surfaces of the endoscope and the main working channel outlet are possible to leave it as free as possible and to insert the auxiliary cannula in a low profile along the endoscope shaft The goal is to hold it firmly in place with an intermediate fixing element. A BRIEF DESCRIPTION OF THE INVENTION The invention is an apparatus that can be attached to the distal part of an endoscope (1) as a distal aid. channel carrier / outlet section (2), external auxiliary extending along the outer surface of the endoscope working channel or cannula (3), the distal part of the said cannula to the distal endoscope A fixed guide that directs the tip in an inclined manner towards the working area in front of it. section (4), at least one intermediate fixation that stabilizes the cannula along the endoscope shaft the ring (5) and the long and short fixation ring that enables the apparatus to be fixed to the endoscope. includes arms or straps (6, 6a). Fixed guide section (4), general along the endoscope shaft of the external auxiliary cannula (3) The cannula, progressing longitudinally, transitions from its initial end to its distal end, at the distal end of the endoscope. It passively deflects the tip in a direction approaching the central working area in front of it. Thus, the distal exit direction of the external accessory canal is relative to the longitudinal axis of the endoscope. It creates a non-zero angle and the process exits the main working channel of the endoscope. A second instrument path independent of the instrument (7) is formed. an external auxiliary canal with a gripping forceps or similar grasping instrument (10) It can be passed through. When the retaining instrument is withdrawn after grasping the lesion, the guide Due to the curved canal direction determined by section (4), the lesion can only be seen with an endoscope. It can be subjected to traction with a component that moves it away from the processing plane, rather than towards the tip. Same with the cutting or dissection instrument (7) passed through the main working channel of the endoscope The lesion can be treated. 3 BRIEF DESCRIPTION OF THE FIGURES Figure 1 shows a general perspective view of the apparatus that is the subject of the invention. Figure 2 shows the reverse perspective view of the device that is the subject of the invention. Figure 3 shows the general system view of the device subject to the invention when attached to the endoscope. It shows. Figure 4 shows a close-up view of the distal end region of the system. Figure 5 shows the traction of the lesion (9) with the gripping device (10) coming out of the external auxiliary canal. the cutting / dissection instrument (7) coming out of the main working channel of the endoscope and taking it out This diagram shows the working principle of the procedure performed on the lesion. DETAILED DESCRIPTION OF THE INVENTION The distal end apparatus shown in Figure 1 and Figure 2 is attached to the distal section of the endoscope (1) or The device is detachably fitted to the shaft section adjacent to the distal end. The device assists the distal end. channel carrier / outlet section (2), fixed guide section (4) and fixing arms (6, 6a) a partial circumferential fitting that together covers at least part of the circumference of the endoscope It can form a structure. This structure does not have to be a perfectly closed loop, and the apparatus an open or C-like geometry that will allow the endoscope to be inserted laterally It may include. Extended fixing arms ensure the device remains securely in place on the endoscope. or straps (6, 6a) are used. In one application form, more than one of these arms are used. There are multiple adjustment holes, and the appropriate one is selected using a pin or protrusion on the device. or it is paired with an equivalent locking element. Thus, the device has a different outer diameter. It is adaptable to endoscopes. The long and short fixing arms are compatible with other parts of the apparatus. It can be produced as an integrated unit or as separate parts. External auxiliary working channel (3), a separate flexible tube from the apparatus, catheter, cannula, sheath or it may be a luminescent polymer element. The auxiliary channel is separate and removable from the device. This means that auxiliary channels with different inner diameters or different lengths can be used with the same apparatus. It allows for the use of the auxiliary channel and its replacement after the procedure. Example Although the prototype can utilize 14 French aspiration probes, the invention is specific to a particular French probe. It is not limited by size or a specific type of commercial probe. As shown in Figure 3, the external auxiliary working channel (3) is located outside the endoscope (1). It extends along the surface towards the distal end. In one or more regions of the endoscope shaft The intermediate fixation ring (5) used prevents the auxiliary channel from moving too far away from the endoscope and It reduces uncontrolled movement along the shaft. Intermediate fastening element: ring, open ring, clip, 4 an equivalent low-profile band or endoscope that holds the auxiliary channel adjacent to each other. It could be a structure. One of the key structural features of the invention is the fixed part located on the distal end apparatus. It is the guide section (4). The fixed guide section is a flexible section coming from the outside of the endoscope. the distal segment of the accessory canal (3), from the proximal circumferential position of the canal a direction approaching the central working area in front of the distal end of the endoscope It brings it here. Here, the “central working area” is in front of the distal surface of the endoscope, the endoscope's The imaging area refers to the region where the main working channel exit reaches the target tissue. Fixed guide section (4), inclined or curved support surface, ramped channel, It can be constructed as a fixed-angle tube socket or a combination thereof. Auxiliary canal (3) When this guide section is placed, the flexible distal part fits into the fixed geometry of the apparatus. The device adjusts and acquires a non-zero angle relative to the longitudinal axis of the endoscope. This orientation... It is passive; that is, an articulation joint that is also operated by the user, proximal. It does not require a tension wire, balloon, or hydraulic or pneumatic deforming element. The slope of the guide section (4) is such that the distal exit of the auxiliary canal is centered on the endoscope It is selected in a way that will guide it towards the work area. In other words, the assistant The distal axis of the canal converges from peripheral to central. This geometry, externally The gripping instrument exiting the channel is applied to the target lesion via the main working channel. It allows access via a different approach depending on the tool. The inclination of the guide section. angle, radius of curvature and length; flexibility of the auxiliary channel used, outer diameter and It can be changed according to the geometry of the endoscope. In Figure 4, the distal auxiliary canal carrier / outlet section (2), external auxiliary canal (3), fixed guide section (4) and distal exit of external auxiliary canal that directs to the center The positional relationship between the region (8) is shown. The apparatus is the optical region of the endoscope. windows, lighting elements, air and water outlets, and the main working duct It is positioned in a way that will not obstruct the view as much as possible. Figure 5 shows an example of the working principle. Passed through an external auxiliary channel. grasping forceps or grasping instrument (10), polypoid lesion (9) or mucosal flap It grasps a suitable portion of the external canal. When the retaining instrument is retracted proximally, the external canal... A tensile force is generated in the opposite direction of the distal direction, which is inclined towards the center. This The force is not only on the lesion approaching the endoscope tip, but also on the length of the endoscope. by lifting it with a transverse / radial or oblique component to its axis and opening up the processing area It contributes. Simultaneously, a cutter is passed through the endoscope's main working channel. The dissection instrument (7) can be directed to the base of the lesion or to the submucosal plane. Thus, with a single working channel, an endoscope allows for two independent instruments. Simultaneous use becomes possible: instrument traction in the external auxiliary channel. while providing instrument cutting, dissection, coagulation or induction in the main channel of the endoscope It performs the snare action. The traction effect provided by the invention is not dependent on a specific anatomical “upward” orientation. By selecting the circumferential placement direction of the device around the distal end of the endoscope, the aid can be assisted. The inclination plane of the channel towards the center can be adjusted according to the location of the target lesion. This Therefore, the same structural principle results in different traction directions at different lesion positions. It can be used to create. The distal auxiliary canal carrier / outlet section of the apparatus (2), fixed guide section (4) and Fixing arms (6, 6a) as a single piece or permanently or detachably attached. It can be produced in the form of multiple connected parts. Production methods include injection molding and additive molding. Manufacturing can be accomplished through three-dimensional printing, machining, or another suitable method. The materials used include biocompatible polymers, elastomers, and silicones, depending on the intended use. It may contain composite or metal. The apparatus is disposable or requires appropriate sterilization. They can be designed to be reusable and resistant to various conditions. The invention is not limited solely to colonoscopy or ESD procedures. It also includes external and independent applications. a second instrument pathway and a fixed distal exit of this pathway directed towards the center Useful for EMR, gastroscopic procedures, hemostasis, foreign body removal, clipping. It can also be used in endoscopic procedures such as this application. INDUSTRIAL APPLICABILITY The apparatus and components covered by the invention are suitable for mass production and for the manufacture of medical devices. They can be produced using various methods. Depending on different endoscope and auxiliary channel diameters. It is customizable and can be used with standard endoscopic accessories. 6 REFERENCE NUMBERS 1 - Endoscope / endoscope shaft 2 - Distal accessory canal carrier / outlet section 3 - External auxiliary working channel / cannula 4 - Fixed inclined guide section leading to the center. - Intermediate fixing ring / element 6 - Long fastening handle / strap 6a - Short fixing arm / strap 7 - The procedure / cutting-dissection instrument passed through the main working channel. 8 - Distal exit region of the external accessory canal 9 - Lesion / target tissue - Grasping instrument / forceps passed through an external auxiliary channel

Claims

7 REQUESTS 1. A detachable attachment that can be attached to the distal section of an endoscope (1), the outside of the endoscope distal auxiliary carrying the flexible external auxiliary working channel (3) that extends along its surface channel carrier / outlet section (2), fixed guide section (4) and fixing elements (6, 6a) 5 It is an endoscopic external auxiliary working channel apparatus containing a fixed guide. section (4), distal part of the auxiliary canal (3) from the circumferential position of the endoscope passively with the fixed geometry of the apparatus towards the central working area in front of the distal end by tilting the distal axis of the accessory canal to a non-zero ratio with respect to the longitudinal axis of the endoscope and maintaining a fixed angle during use. 10 2. According to Claim 1, it is an apparatus whose characteristic is that it covers at least a portion of the outer circumference of the endoscope. A partially circumferential, open design that accommodates and allows the apparatus to be attached to the endoscope laterally. It includes a ring or C-shaped gripping surface.

3. The apparatus according to claim 1 or 2, its feature being; the fixed guide section (4), auxiliary articulation joint, proximal control wire, hydraulic, distal direction of the canal (3) 15 The apparatus is fixed without a pneumatic or other active steering mechanism. It is created by its geometry.

4. It is an apparatus according to any of the previous requirements, and its characteristic is; the fixed guide section. (4), at least one inclined, ramped and / or curved path that deviates the distal part of the accessory canal (3). It includes a support surface. 20 5. It is an apparatus according to any of the previous requirements, and its characteristic is; external auxiliary operation. The channel (3) can be separated from the apparatus, removed and replaced with a different tubular element. It is the fact that.

6. An apparatus according to any of the previous requirements, characterized by having at least one long fixing point. It must include one arm (6) and at least one short fixing arm (6a) and at least 25 of those arms. multiple adjustment holes or connectors that accommodate different endoscope outer diameters It includes location.

7. It is an apparatus according to any of the previous requirements, and its feature is the auxiliary channel (3) at least one proximal end device positioned to hold it adjacent to the endoscope shaft. It includes an intermediate fixing ring or element (5). 30 8. It is an apparatus according to any of the previous requirements, and its feature is that the auxiliary channel (3) is flexible. This can be a catheter, aspiration probe, cannula, sheath, or polymer tube with a lumen. 8 9. According to claim 8, it is an apparatus and its feature is; the auxiliary channel (3) 14 French nominal outer diameter It has an aspiration catheter.

10. It is an apparatus according to any of the previous requirements, and its feature is that it is inside the auxiliary channel (3). lumen gripping forceps, grasping forceps, snare, clip applicator or tissue 5 It is suitable for the passage of another endoscopic instrument compatible with its traction.

11. It is an endoscopic instrument system characterized by its flexible design with a single fixed working channel. endoscope (1), apparatus according to any of order 1-10, auxiliary channel (3), auxiliary the retaining instrument (10) passed through the canal and the endoscope’s built-in working canal including the instrument (7) used in the procedure; fixed 10 of the distal part of the auxiliary canal passively directed towards the central work area with the guide section (4) It is the fact that.

12. The system according to claim 11, and its feature is that the gripping instrument (10) is a tissue gripping instrument. forceps and procedure instrument (7) endoscopic dissection blade, electrosurgical It is a cutting / coagulation instrument or a snare. 15 13. The system according to request 11 or 12, and its feature is; the distal exit of the auxiliary canal (3). The endoscope's main working channel is separate from the outlet and the instruments (7, 10) are used simultaneously. and its ability to be moved independently.

14. The system is defined according to either of the requirements 11-13, and its characteristic is that it has a fixed guide section. (4), applied during proximal pulling of the tissue grasped with the gripping instrument (10) 20 the force having a transverse, radial and / or oblique component to the longitudinal axis of the endoscope It is the ability to make it possible.

15. The system according to any of the claims 11-14, and its feature is a flexible endoscope (1). This involves a colonoscope or gastroscopy.

16. The apparatus according to any of the claims 1-10, its characteristic being; the distal end apparatus of the endoscope 25 The fixed guide section (4) can be fixed in different angular positions around it. The traction plane created can be selected according to the location of the target lesion.

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