An insufflator, an insufflating apparatus and a method for insufflating a vessel in the body of a human or animal subject

Abstract

An insufflating apparatus (50) for detecting a lesion in a colon of a human or animal subject comprises an insufflator (53), a colonoscope (55) and an image recognition apparatus (56). The colonoscope (55) is entered into the colon of a subject, and an image capturing device (85) of the colonoscope (55) captures an image of a targeted area of the colon which is applied to the image recognition apparatus (56). The image recognition apparatus (56) compares the captured image with a plurality of reference images of topographies of different degrees of evenness up to a predefined degree of evenness suitable for enabling detection of a lesion. A microprocessor (77) of the insufflator (53) reads a topography signal from the image recognition apparatus (56) indicative of the degree of evenness of the targeted area of the colon and operates a flow controller to increase the flow of insufflating gas to the colon until the targeted area is of the predefined degree of evenness, at which stage the image recognition apparatus (56) compares the captured image with lesion reference images to detect a lesion in the targeted area if such is present.

Description

[0001] An insufflator, an insufflating apparatus and a method for insufflating a vessel in the body of a human or animal subject

[0002] The present invention relates to insufflating apparatus for insufflating a vessel in the body of a human or animal subject, and in particular, though not limited to an insufflating apparatus for insufflating a vessel to permit detection of a lesion in or on an inner surface of a wall of the vessel, and preferably, for also detecting a lesion in or on an inner surface of a wall of the vessel. The invention also relates to an insufflator for insufflating a vessel in the body of a human or animal subject to permit detection of a lesion in or on an inner surface of a wall of the vessel. Further, the invention provides a method for insufflating a vessel in the body of a human or animal subject to permit detection of a lesion in or on an inner surface of a wall of the vessel and also for detecting a lesion in or on an inner surface of the wall of the vessel. The invention also relates to an insufflating apparatus for insufflating a vessel so that the inner surface of a wall of the vessel adjacent a targeted area thereof is of a predefined degree of evenness, and the invention also relates to an insufflator and a method for insufflating a vessel so that an inner surface of a wall of the vessel adjacent a targeted area thereof is of a predefined degree of evenness. The invention further relates to an insufflating apparatus, an insufflator and a method for insufflating a vessel to a predefined pressure value so that an inner surface of the wall of the vessel adjacent a targeted area thereof is of a predefined degree of evenness.

[0003] A colonoscopy procedure has become a main stay of colorectal cancer prevention, and entails the passage of a colonoscope or an endoscope anally through the rectum and in turn through the colon as far as the cecum. The colonoscope allows detection of lesions, such as pre-cancerous lesions, as well as pre-cancerous adenomas and / or pre-cancerous polyps hereinafter collectively referred to as lesions whether pre-cancerous or cancerous. Such lesions are typically removed using a snare instrument in order to prevent their further progression to become cancerous. The colon comprises a series of folds which tend to obscure or hide such lesions, thereby making it difficult, and in some cases almost impossible to detect such lesions, particularly pre-cancerous lesions, which, in general, are of a relatively small size. In order to address this problem and to aid in visualisation within the colon, the colon is insufflated, typically, through a colonoscope to flatten the folds of the colon, particularly adjacent a targeted area being inspected for the detection of such lesions, which is within the visualisation of the distal end of the colonoscope. This requires insufflating the colon to relatively high pressures, and in many cases to pressures as high as 25mmHg to 30mmHg. However, it has been found that to achieve adequate flattening of certain areas of the colon and thus adequate visualisation in order to enable the detection of relatively small lesions, such areas must be insufflated to a higher pressure than other areas of the colon. For example, it has been found that in order to achieve adequate flattening of the colon and thus adequate visualisation of areas within the transverse colon, the colon should be insufflated to higher pressures than pressures required to provide adequate flattening and visualisation in areas within the sigmoid colon. However, current insufflators require that during inspection, detection and removal of such lesions, the colon must be insufflated continuously at the highest pressure required. This, is undesirable, since maintaining the colon continuously at such high pressures may result in pain and discomfort to the subject.

[0004] Substantially similar problems also arise in other vessels, and in particular, relatively long vessels, for example, an intestine of a subject.

[0005] There is therefore a need for an insufflating apparatus and an insufflator which addresses at least some of these problems, and there is also a need for a method which addresses some of these problems.

[0006] The present invention is directed towards providing an insufflating apparatus and an insufflator for insufflating a vessel in the body of a human or animal subject which addresses at least some of these problems. The invention is also directed towards providing a method for insufflating a vessel in the body of a human or animal subject which addresses at least some of these problems.

[0007] The term "procedure” as used throughout this specification is intended to refer to any minimally invasive procedure, be it an investigative, a surgical or other such procedure.

[0008] The term "vessel” as used throughout this specification is intended to mean any vessel, lumen or cavity in the body of a human or animal subject which may be insufflated.

[0009] The term "endoscope” as used throughout this specification is intended to mean any type of endoscope or equivalent, such as, for example, a colonoscope.

[0010] According to the invention there is provided an insufflator for insufflating a vessel in the body of a human or animal subject in which an endoscopic procedure is being carried out, the insufflator comprising a flow controller adapted for controlling supply of insufflating gas to the vessel for insufflating thereof, a control means responsive to a location signal indicative of the location of a targeted area in the vessel at which the procedure is to be carried out for operating the flow controller to control the supply of insufflating gas to the vessel to maintain the pressure in the vessel (vessel pressure) at a predefined pressure value corresponding to one or both of the type of the vessel or the location of the targeted area in the vessel.

[0011] In one embodiment of the invention, a pressure values storing means accessible to the control means stores the predefined pressure value cross-referenced with the identity of the corresponding location in the vessel.

[0012] In another embodiment of the invention, a plurality of the predefined pressure values cross-referenced with the identities of corresponding locations in the vessel are stored in the pressure values storing means.

[0013] In another embodiment of the invention a plurality of predefined pressure values are stored for each location in the vessel, and are cross-referenced with the identity of the corresponding location.

[0014] In one embodiment of the invention, at least one of the predefined pressure value cross-referenced with the identity of at least one type of a characteristic of a subject is stored in the pressure values storing means for each of at least some of the locations in the vessel.

[0015] Preferably, a plurality of predefined pressure values cross-referenced with respective characteristics of subjects are stored in the storing means for each of at least some of the locations of the vessel.

[0016] Advantageously, a plurality of the predefined pressure values cross-referenced with corresponding types of a plurality of the characteristics of subjects are stored in the pressure values storing means for each of at least some of the locations of the vessel.

[0017] In one embodiment of the invention one of the characteristics of subjects comprises the sex of subjects, and preferably, the at least one predefined pressure value stored in the pressure values storing means for each of at least some of the locations in the vessel relate to female subjects, and the at least one predefined pressure value stored in the pressure values storing means for each of at least some of the locations in the vessel relate to male subjects. In another embodiment of the invention one of the characteristics of subjects comprises the age of subjects, and preferably, the at least one predefined pressure value stored in the pressure values storing means for each of at least some of the locations in the vessel relate to subjects of at least one age range, and preferably, at least one predefined pressure values are stored in the pressure values storing means corresponding to at least each of two age ranges of the subjects.

[0018] In another embodiment of the invention one of the characteristics of subjects comprises the body mass index of the subject, and preferably, the at least one predefined pressure values stored in the pressure values storing means for each of at least some of the locations in the vessel relate to at least one body mass index of subjects, and advantageously, the at least one predefined pressure values are stored in the pressure values storing means for each of at least some of the locations in the vessel relating to the different body mass indices of subjects.

[0019] In another embodiment of the invention one of the characteristics of subjects comprises the resting position of the subjects, and preferably, the at least one predefined pressure values stored in the pressure values storing means for each of at least some of the locations in the vessel relate to one resting position of a subject, and preferably, relate to two different resting positions of subjects, and preferably, a plurality of predefined pressure values are stored in the pressure values storing means for each of at least some of the locations in the vessel relating to respective different resting positions of subjects.

[0020] In one embodiment of the invention, the characteristics of subjects, for which a plurality of the predefined pressure values are stored in the pressure values storing means cross-referenced with the identities of the corresponding types of the respective characteristics for each of at least some of the locations in the vessel, comprise one or more of the sex of a subject, the age of a subject or the age range of a subject, the weight of a subject or the weight range of a subject, the body mass index of a subject or the body mass index range of a subject, and the resting position of a subject.

[0021] In another embodiment of the invention the plurality of the predefined pressure values are stored in the pressure values storing means cross-referenced with the identities of the corresponding locations in the vessel, and preferably, the plurality of the predefined pressure values are stored in the pressure values storing means in a pressure values look-up table cross-referenced with the identities of the corresponding types of the corresponding characteristics of subjects. In one embodiment of the invention at least one predefined pressure value is stored for each one of a plurality of different vessels.

[0022] In one embodiment of the invention the plurality of the predefined pressure values are stored in the pressure values storing means cross-referenced with the identities of the corresponding locations in the vessel.

[0023] In another embodiment of the invention the plurality of the predefined pressure values are stored in the pressure values storing means cross-referenced with the identities of the corresponding characteristics of the subject.

[0024] In another embodiment of the invention the pressure values storing means is stored in the storing means.

[0025] In one embodiment of the invention the pressure values storing means comprises a memory, and preferably, the memory comprises an electronic memory.

[0026] In one embodiment of the invention the insufflator comprises the pressure values storing means.

[0027] In an alternative embodiment of the invention the pressure values storing means is provided externally of and separate from the insufflator and is communicable with the control means of the insufflator.

[0028] Preferably, the storing means comprises an electronic memory, located in the insufflator, or externally of and separate from the insufflator and communicable with the control means.

[0029] In one embodiment of the invention the control means is responsive to a lesion present signal indicative of detection of a lesion to operate the flow controller to increase the vessel pressure to an elevated pressure above the pressure value at which the vessel is being currently maintained.

[0030] In one embodiment of the invention the control means is responsive to the lesion present signal to operate the flow controller to increase the vessel pressure to the elevated pressure by a preset pressure increase amount above the pressure value at which the vessel is being currently maintained.

[0031] In another embodiment of the invention the preset pressure increase amount by which the vessel pressure is increased above the pressure at which the vessel is currently being maintained lies in the range of 3mmHg to 8mmHg, and preferably, the preset pressure increase amount by which the vessel pressure is increased above the current pressure value at which the vessel is being maintained lies in the range of 4mmHg to 6mmHg, and advantageously, is approximately 5mmHg.

[0032] In one embodiment of the invention the preset pressure increase amount is stored in a storing means accessible to the control means.

[0033] In another embodiment of the invention the preset pressure increase amount is preset in the storing means, and in an alternative embodiment of the invention the preset pressure increase amount is selectable.

[0034] In another embodiment of the invention the lesion present signal comprises a manually generated lesion present signal, and in one embodiment of the invention the lesion present signal is generated by an electrical switch, which may be a foot pedal operated electrical switch, and / or a hand operated electrical switch.

[0035] In another embodiment of the invention the lesion present signal is produced in response to detection of a lesion in the targeted area.

[0036] In another embodiment of the invention the control means is responsive to a reduce pressure signal to operate the flow controller to reduce the supply of insufflating gas to the vessel to in turn reduce the vessel pressure to a reduced pressure below the pressure value at which the vessel is being currently maintained. Preferably, the control means is responsive to the reduce pressure signal to operate the flow controller to decrease the supply of insufflating gas to the vessel to in turn reduce the vessel pressure by a preset pressure reduction amount below the pressure value at which the vessel is being currently maintained in order to reduce the vessel pressure to the reduced pressure.

[0037] In another embodiment of the invention the reduce pressure signal is indicative of detection of a lesion.

[0038] In one embodiment of the invention the preset pressure reduction amount by which the vessel pressure is reduced below the pressure at which the vessel is currently being maintained lies in the range of 3mmHg to 8mmHg, and preferably, the preset pressure reduction amount by which the vessel pressure is reduced below the current pressure value at which the vessel is being maintained lies in the range of 4mmHg to 6mmHg, and advantageously, is approximately 5mmHg.

[0039] In one embodiment of the invention the preset pressure reduction amount is stored in a storing means accessible to the control means.

[0040] In another embodiment of the invention the preset pressure reduction amount is preset in the storing means, and in an alternative embodiment of the invention the preset pressure reduction amount is selectable.

[0041] In one embodiment of the invention the reduce pressure signal comprises a manually generated reduce pressure signal, and in one embodiment of the invention the reduce pressure signal comprises a manually generated reduce pressure signal by operating an electrical switch, which may be a foot pedal operated electrical switch and / or a hand operated electrical switch.

[0042] In another embodiment of the invention the reduce pressure signal is produced in response to detection of a lesion in the targeted area.

[0043] Preferably, the vessel pressure is maintained at the elevated pressure or the reduced pressure while the lesion present signal or the reduce pressure signal remains active, or until a return signal is applied to the control means to return the vessel pressure to the pressure at which the vessel had been maintained prior to the vessel pressure being increased to the elevated pressure or decreased to the reduced pressure from the vessel pressure.

[0044] In one embodiment of the invention the location signal indicative of the location of the targeted area in the vessel is derived from a signal indicative of the location of an endoscope in the vessel, and preferably, the location signal indicative of the location of the targeted area in the vessel is derived from a signal indicative of the location of an endoscope through which the procedure is being carried out at the targeted area. Preferably, the location signal indicative of the location of the targeted area in the vessel is determined in response to a signal indicative of the location of a distal end of the endoscope in the vessel.

[0045] In one embodiment of the invention the location signal indicative of the location of a targeted area in the vessel is manually generated, and preferably, is manually generated by a foot pedal operated electrical switch, or by a hand operated electrical switch.

[0046] In one embodiment of the invention the control means comprises a signal processor, and preferably, a microprocessor.

[0047] In one embodiment of the invention the insufflator is adapted for insufflating an elongated lumen of the subject.

[0048] In one embodiment of the invention the elongated lumen comprises a colon of a subject, and the predefined pressure values are stored for one or more of the sigmoid colon, the descending colon, the transverse colon or the ascending colon.

[0049] In one embodiment of the invention one of the locations of the colon for which at least one predefined pressure value is stored comprises the sigmoid colon.

[0050] In another embodiment of the invention one of the locations of the colon for which at least one predefined pressure value is stored comprises the descending colon.

[0051] In another embodiment of the invention one of the locations of the colon for which at least one predefined pressure value is stored comprises the transverse colon.

[0052] In another embodiment of the invention one of the locations of the colon for which at least one predefined pressure value is stored comprises the ascending colon.

[0053] In another embodiment of the invention the elongated lumen comprises the intestine of the subject.

[0054] In one embodiment of the invention an interface means is provided for inputting data to the control means for operation of the insufflator.

[0055] In another embodiment of the invention the location signal indicative of the location of a targeted area in the vessel is manually produced, and in one embodiment of the invention the location signal indicative of the location of a targeted area in the vessel is manually produced by a manually operable electrical switch, and preferably, the manually operable electrical switch comprises a foot pedal operated electrical switch, and in an alternative embodiment of the invention the manually operable electrical switch comprises a button operated electrical switch.

[0056] The invention also provides insufflating apparatus for insufflating a vessel in the body of a human or animal subject, the insufflating apparatus comprising the insufflator according to the invention for insufflating the vessel, and a means for producing the location signal indicative of the location of the targeted area.

[0057] In one embodiment of the invention the means for producing the location signal indicative of the location of the targeted area comprises a monitoring means for monitoring the location of an endoscope in the vessel and for producing the location signal as a signal indicative of the location of the endoscope in the vessel, and preferably, the signal indicative of the location of the endoscope in the vessel is adapted for applying to the control means of the insufflator.

[0058] In one embodiment of the invention the monitoring means for monitoring the location of an endoscope in the vessel is adapted for producing the location signal as a signal indicative of the location of a distal end of the endoscope in the vessel.

[0059] Preferably, the control means of the insufflator is adapted to determine the location of the targeted area from the location signal produced by the monitoring means indicative of the location of the endoscope in the vessel , and preferably, the control means is adapted to determine the location of the targeted area as a location adjacent the distal end of the endoscope, but distally from the distal end of the endoscope.

[0060] Preferably, the monitoring means is adapted for monitoring the depth of penetration of the endoscope into the vessel.

[0061] In another embodiment of the invention the monitoring means is adapted to monitor the endoscope as it is being urged inwardly into and / or outwardly from the vessel.

[0062] Preferably, the monitoring means is adapted to monitor a scale on the endoscope as the endoscope is being urged into and / or out of the body of the subject, the scale being readable by the monitoring means, and preferably, the scale comprises a graduated scale, and advantageously, a graduated scale comprising a plurality of graduations spaced apart longitudinally along the endoscope, and preferably, longitudinally equi-spaced apart graduations.

[0063] In another embodiment of the invention the monitoring means is adapted to abut the subject adjacent an orifice of the subject through which the endoscope is being entered into the body of the subject.

[0064] In one embodiment of the invention the monitoring means comprises an optical monitoring means, and in another embodiment of the invention the monitoring means comprises a magnetic monitoring means.

[0065] In an alternative embodiment of the invention the monitoring means for monitoring the location of the endoscope in the vessel comprises a fluoroscopic monitoring means, and preferably, the fluoroscopic monitoring means is adapted to monitor a fluoroscopic opaque marker on the endoscope for determining the location of the endoscope in the vessel, and preferably, the fluoroscopic opaque marker is located adjacent the distal end of the endoscope.

[0066] In one embodiment of the invention the fluoroscopic opaque marker comprises a radiopaque marker.

[0067] In an alternative embodiment of the invention the monitoring means for monitoring the location of the targeted area in the vessel and for producing the location signal indicative of the location of the targeted area in the vessel comprises an image recognition means adapted to determine the location of the targeted area in the vessel from a captured image of the targeted area. Preferably, the image recognition means is adapted to compare the captured image indicative of the targeted area in the vessel with at least one location reference image of at least one location in a reference vessel corresponding to the vessel, and to determine the location of the targeted area in the vessel from the comparison of the captured image with the at least one location reference image.

[0068] Preferably, the image recognition means is adapted to produce the location signal as a location signal indicative of the location of the targeted area in the vessel.

[0069] In one embodiment of the invention the captured image is captured by an image capturing means adapted to capture an image of the targeted area and to produce a signal indicative of the captured image, which preferably is readable by the image recognition means.

[0070] In one embodiment of the invention the image recognition means is adapted to compare the captured image with a plurality of location reference images of a plurality of locations in the reference vessel.

[0071] Advantageously, the image recognition means is adapted to compare the captured image with the plurality of the location reference images of each one of the plurality of the locations.

[0072] In one embodiment of the invention at least one of the location reference images of at least one of the locations in the vessel is derived from a reference vessel of a subject having at least one type of at least one characteristic.

[0073] In one embodiment of the invention the at least one of the reference images of the reference vessel corresponding to one of the characteristics of a subject corresponds to the sex of a subject.

[0074] In another embodiment of the invention the at least one of the reference images of the reference vessel corresponding to one of the characteristics of a subject corresponds to the age of a subject, and preferably, corresponds to an age range of a subject.

[0075] In another embodiment of the invention the at least one of the reference images of the reference vessel corresponding to one of the characteristics of a subject corresponds to a body mass index of a subject, and preferably, corresponds to a body mass index range of a subject.

[0076] In another embodiment of the invention the at least one of the reference images of the reference vessel corresponding to one of the characteristics of a subject corresponds to a rest position of a subject during a procedure.

[0077] In one embodiment of the invention at least one characteristic of a subject comprises one or more of the sex of a subject, the age of a subject or the age range of a subject, the weight of a subject or the weight range of a subject, the body mass index or the body mass index range of a subject and the resting position of the subject during the procedure.

[0078] In another embodiment of the invention the image recognition means is adapted to determine the location of the targeted area in the vessel from the location reference image which is a match with or the best match with the captured image. Preferably, the captured image of the targeted area is derived from an image capturing means of an endoscope located in the vessel.

[0079] Preferably, the location reference images are stored in a location reference image storing means cross- referenced with the identities of the corresponding locations in the reference vessel, the location reference image storing means being accessible to the image recognition means. Preferably, the location reference image storing means comprise a memory, and advantageously, an electronic memory.

[0080] In another embodiment of the invention the location reference images corresponding to the types of the characteristics of a subject are stored in the location reference image storing means cross-referenced with the identities of the characteristics and the types thereof.

[0081] Preferably, the location reference images are stored cross-referenced with the identities of the corresponding locations and the identities of the characteristics and the types thereof with which they correspond in a location reference image look-up table in the location reference image storing means.

[0082] In another embodiment of the invention the location reference image storing means is adapted to store the reference images in digital form.

[0083] In one embodiment of the invention the location reference images are grouped into respective groups thereof, relating to one or more of the following types of the characteristics, the sex of a subject, the age of a subject or the age range of a subject, the weight of a subject or the weight range of a subject, the body mass index of a subject, or the body mass index range of a subject, and rest positions of a subject during the procedure.

[0084] Preferably, the image recognition means is adapted to compare the captured imago sequentially with the respective location reference images in each group on a group-by-group basis.

[0085] In another embodiment of the invention, the location reference images for each location of the vessel are updated each time a match or a best match of a captured image with a location reference image is obtained for that location, and the captured image which is matched is passed through a learning model and stored as an additional location reference image along with the location reference image or additional location reference images for that location. Preferably, the number of additional location reference images for the respective locations are maintained at a predefined number of location reference images, and each time the number of additional location reference images for each location exceeds the predefined number of additional location reference images, the oldest one of the additional location reference images forthat location is deleted.

[0086] In one embodiment of the invention the additional location reference images are generated by an artificial intelligence algorithm. Preferably, the location reference images are stored in the location reference image storing means in digital form.

[0087] In another embodiment of the invention the image recognition means is adapted to determine the location of the targeted area in the vessel as the location in the reference vessel, the reference image of which, is a match or a best match with the captured image.

[0088] Preferably, the endoscope comprises an image capturing means for capturing the images of the respective targeted areas in the vessel. Advantageously, the image capturing means is located adjacent the distal end of the endoscope.

[0089] In one embodiment of the invention the endoscope comprises a scale formed thereon, and preferably, the scale formed on the endoscope comprises a graduated scale.

[0090] In another embodiment of the invention the endoscope comprises a radiopaque marker, and preferably, the radiopaque marker is located adjacent a distal end of the endoscope.

[0091] In one embodiment of the invention the endoscope comprises a colonoscope.

[0092] In another embodiment of the invention the predefined pressure values for the targeted areas in the different locations of the vessel lie in the range of 5mmHg to 30mmHg.

[0093] In another embodiment of the invention the vessel in which the procedure is being carried out comprises a colon of a subject, and preferably, the predefined pressure values lie in the range of 5mmHg to 30mmHg.

[0094] In one embodiment of the invention one of the predefined pressure values is provided for the targeted areas in the sigmoid colon, and in another embodiment of the invention one of the predefined pressure values is provided for the targeted areas in the descending colon.

[0095] In a further embodiment of the invention one of the predefined pressure values is provided for the targeted areas in the transverse colon, and in a further embodiment of the invention one of the predefined pressure values is provided for the targeted areas in the ascending colon.

[0096] In one embodiment of the invention the predefined pressure value stored for the targeted areas in the transverse colon is higher than the predefined pressure value stored for the targeted areas in the sigmoid colon.

[0097] The invention also provides an insufflator for insufflating a vessel in the body of a human or animal subject comprising a flow controller for supplying insufflating gas to the vessel for insufflating thereof, a control means responsive to a topography signal indicative of the topography of an inner surface of a wall of the vessel (vessel wall) adjacent a targeted area of the vessel for controlling the flow controller to supply the insufflating gas to the vessel to maintain the topography of the inner surface of the vessel wail adjacent the targeted area at a predefined degree of evenness to enhance mucosal visualisation thereof.

[0098] Preferably, the predefined degree of evenness of the inner surface of the vessel wall adjacent the targeted area is set to permit detection of a lesion in or on the inner surface of the vessel wall adjacent the targeted area.

[0099] Advantageously, the predefined degree of evenness of the targeted area of the inner surface of the vessel wall comprises a substantially flat surface.

[0100] In one embodiment of the invention an image recognition means is provided to determine the topography of the inner surface of the vessel wall adjacent the targeted area and to produce the topography signal indicative of the topography of the inner surface of the vessel wall adjacent the targeted area, the image recognition means being adapted to compare a captured image indicative of the topography of the inner surface of the vessel wall adjacent the targeted area with at least one topography reference image, one of the at least one topography reference image being indicative of a surface of topography of the predefined degree of evenness, the image recognition means being adapted to determine the degree of evenness of the inner surface of the vessel wall adjacent the targeted area from the comparison of the captured image with the at least one topography reference image.

[0101] In one embodiment of the invention the control means of the insufflator is responsive to the topography signal produced by the image recognition means being indicative of the degree of evenness of the inner surface of the vessel wall adjacent the targeted area being of a degree of evenness below the predefined degree of evenness to operate the flow controller to increase the flow of insufflating gas to the vessel until the topography signal is indicative of the predefined degree of evenness.

[0102] Preferably, the control means of the insufflator is adapted to operate the flow controller to incrementally increase the supply of insufflating gas to the vessel until the value of the topography signal is indicative of the inner surface of the vessel wall adjacent the targeted area being of the predefined degree of evenness.

[0103] In one embodiment of the invention the image recognition means is adapted to compare the captured image indicative of the topography of the inner surface of the vessel wall adjacent the targeted area with a plurality of the topography reference images indicative of surfaces of topographies of respective different degrees of evenness below the predefined degree of evenness.

[0104] Preferably, the degree of evenness of the topography of the reference surface of each topography reference image is different to the degrees of evenness of the topographies of the reference surfaces of the other topography reference images.

[0105] Preferably, the degrees of evenness of the topographies of the respective topography reference images increase progressively to the predefined degree of evenness.

[0106] Preferably, the image recognition means is adapted to compare the captured image of the inner surface of the vessel wall with a plurality of topography reference images of at least some of the locations in the vessel.

[0107] Preferably, the topography reference images are stored cross-referenced with values indicative of the degrees of evenness thereof in a topography reference image storing means, accessible to the image recognition means, and preferably, the topography reference image storing means comprises an electronic memory. Preferably, the topography reference images for respective locations in the vessel are stored cross- referenced with the corresponding values indicative of the degrees of evenness thereof and cross- referenced with the identity of the locations thereof in the topography reference image storing means.

[0108] In one embodiment of the invention the topography reference images are stored cross-referenced with corresponding values indicative of the degrees of evenness in a topography reference image look-up table in the topography reference image storing means.

[0109] In one embodiment of the invention the topography reference images are stored in digital form.

[0110] In another embodiment of the invention the captured image indicative of the topography of the targeted area of the inner surface of the vessel wall is produced as an electronic signal, and preferably, as an electronic signal in digital signal adapted for comparing with the topography reference images.

[0111] In one embodiment of the invention the topography reference images are derived from a reference vessel corresponding to the vessel.

[0112] In another embodiment of the invention a plurality of the topography reference images of reference surfaces for different locations in a reference vessel corresponding to the vessel are stored in the topography reference image storing means.

[0113] Preferably, a plurality of the topography reference images of reference surfaces of topographies of different predefined degrees of evenness are stored for each location of a reference vessel corresponding to the vessel for which the topography reference images are stored.

[0114] Preferably, the topography reference images of the reference surfaces of the topographies of the different degrees of evenness for each location of a reference vessel for which topography reference images are stored, are stored and cross-referenced with the values indicative of the degrees of evenness of the respective topography reference surfaces in the topography reference image storing means, and preferably, are stored and cross-referenced with the corresponding values of the degrees of evenness in the topography reference image look-up table stored in the topography reference image storing means. In another embodiment of the invention the topography reference images of the reference surfaces for each location of a reference vessel for which the topography reference images are stored are stored and cross-referenced with the identities of the corresponding locations of the reference vessel to which they relate in the topography reference image storing means, and preferably, are stored and cross-referenced in the topography reference image look-up table stored in the topography reference image storing means.

[0115] Preferably, the image recognition means is adapted to compare the captured image with the corresponding topography reference images indicative of the surface of the predefined degree of evenness before comparing the captured image with the other topography reference images.

[0116] Advantageously, the image recognition means is adapted to determine the degree of evenness of the topography of the inner surface of the vessel wall of the captured image of the targeted area as the degree of evenness of the topography reference image that is a match or a best match of the captured image. Preferably, the image recognition means is adapted to produce the topography signal to be of value corresponding to the value of the degree of evenness of the topography reference image which is a match with or the best match with the captured image.

[0117] In one embodiment of the invention the control means is responsive to the topography signal produced by the image recognition means being of value indicative of the topography of the inner surface of the vessel wall of the captured image of the targeted area being below the predefined degree of evenness for operating the flow controller to increase the supply of insufflating gas to the vessel until the value of the topography signal produced by the image recognition means corresponds to the value corresponding to the targeted area being of the predefined degree of evenness. Preferably, the control means operates the flow controller to incrementally increase the supply of the insufflating gas to the vessel until the value of the topography signal produced by the image recognition means corresponds to the targeted area being of the predefined degree of evenness.

[0118] In another embodiment of the invention a plurality of topography reference images of reference surfaces of topographies of respective different degrees of evenness are stored for different vessels in the topography reference image storing means.

[0119] In one embodiment of the invention the topography reference images are updated by an artificial intelligence algorithm. Preferably, the topography reference images are updated each time a match or a best match of a captured image is made with one of the topography reference images and the captured image is stored as an additional topography reference image along with the corresponding topography reference image and / or the corresponding additional topography reference images.

[0120] Advantageously, each captured image for which a match or a best match with a topography reference image is made is passed through a learning model prior to being stored as an additional topography reference image, and preferably, the number of additional topography reference images stored corresponding to each degree of evenness is limited to a predefined number of additional topography reference images, and each time the number of additional topography reference images for each degree of evenness exceeds the predefined number, the oldest one of the additional topography reference images for that degree of evenness is deleted.

[0121] In one embodiment of the invention the image recognition means compares the captured image with the topography reference images and the additional topography reference images.

[0122] In one embodiment of the invention a detecting means is provided for detecting a lesion in or on the inner surface of the vessel wall adjacent the targeted area, and preferably, the image recognition means comprises the detecting means.

[0123] In another embodiment of the invention the control means is responsive to the topography signal being indicative of the inner surface of the vessel wall adjacent the targeted area being of the predefined degree of evenness to produce a lesion scan signal.

[0124] In another embodiment of the invention the image recognition means is responsive to the lesion scan signal to compare a captured image of the inner surface of the vessel wall of the targeted area with at least one lesion reference image of a representation of a reference lesion, and on determining the presence of a lesion in or on the inner surface of the vessel wall of the targeted area, to produce a lesion present signal indicative of the detection of a lesion.

[0125] In another embodiment of the invention the image recognition means is responsive to the lesion scan signal to compare the captured image of the targeted area, the inner surface of the vessel wall of which is of the predefined degree of evenness with the at least one lesion reference image. In one embodiment of the invention the image recognition means is adapted to compare a captured image of the inner surface of the vessel wall of the targeted area of the predefined degree of evenness with the at least one lesion reference image.

[0126] In one embodiment of the invention the image recognition means is adapted to compare the captured image of the inner surface of the vessel wall of the targeted area with a plurality of lesion reference images of lesions of respective different types and / or respective different sizes.

[0127] In another embodiment of the invention the image recognition means is adapted to determine the presence of a lesion in response to a match or a best match of the captured image with the at least one lesion reference image being determined, and preferably, a plurality of lesion reference images are stored in the lesion reference image storing means and preferably, the lesion reference image storing means is accessible to the image recognition means. Preferably, the lesion reference images comprise respective representations of lesions of different types, and preferably, lesions of different sizes.

[0128] In one embodiment of the invention the at least one lesion reference image is stored in a lesion reference image storing means cross-referenced with an identity of the type and size of the lesion.

[0129] Preferably, the image recognition means is adapted to compare the captured image of the inner surface of the vessel wall of the targeted area sequentially with the lesion reference images, and preferably, the image recognition means is adapted to compare the captured image of the inner surface of the vessel wall of the targeted area sequentially with the lesion reference images.

[0130] Preferably, the image recognition means is adapted to determine the location of a detected lesion in or on the inner surface of the vessel wall adjacent the targeted areas.

[0131] Advantageously, the image recognition means is adapted to produce the lesion present signal comprising data indicative of the location of the lesion in or on the inner surface of the vessel wall adjacent the targeted area.

[0132] Preferably, the lesion present signal is adapted for applying to a visual display screen for displaying the inner surface of the vessel wall adjacent the targeted area with the lesion on the inner surface of the vessel wall of the captured image. In one embodiment of the invention the location of the lesion in or on the targeted area of the inner surface of the vessel wall of the vessel is determined by the image recognition means, and the lesion present signal produced by the image recognition means comprises a signal indicative of the location of the lesion in or on the targeted area of the inner surface of the vessel wall.

[0133] In one embodiment of the invention the lesion present signal is adapted for applying to a visual display screen, and preferably, the lesion present signal is adapted for applying to a visual display screen on which the current captured image of the targeted area is being displayed, and preferably, the lesion present signal comprises a data signal comprising data to highlight the location of the lesion in the current captured image displayed on the visual display screen, and preferably, the lesion present signal comprises a data signal comprising data to highlight the image of the lesion in the image of the current captured image of the targeted area displayed on the visual displayed screen by marking the image of the lesion with a ring extending around the lesion. Preferably, the lesion present signal is adapted for applying to a visual display screen of an endoscope through which the procedure is being carried out.

[0134] In one embodiment of the invention the lesion reference images are updated by an artificial intelligence algorithm.

[0135] Preferably, the lesion reference images are updated each time a match or a best match of the captured image is made with one of the lesion reference images, and the captured image is stored as an additional lesion reference image along with the corresponding lesion reference image and / or the corresponding additional lesion reference images, and preferably, the number of additional lesion reference images are limited to a predefined number of additional lesion reference images, and on the number of additional lesion reference images exceeding the predefined number thereof, the oldest one of the additional lesion reference images is deleted.

[0136] Preferably, the captured images of the respective targeted areas are compared with the additional lesion reference images.

[0137] In one embodiment of the invention the image recognition means is adapted to apply the lesion present signal indicative of the detection of a lesion to the control means of the insufflator, and preferably, the control means of the insufflator is responsive to the lesion present signal to operate the flow controller to increase the vessel pressure to an elevated pressure above the current vessel pressure.

[0138] In another embodiment of the invention the control means is responsive to the lesion present signal or to a manually produced signal indicative of the lesion present signal to operate the flow controller to increase the vessel pressure by a preset pressure increase amount to an elevated pressure above the current vessel pressure.

[0139] In one embodiment of the invention the control means is responsive to the lesion present signal to operate the flow controller to increase the flow of insufflating gas to the vessel in order to increase the vessel pressure to the elevated pressure above the current value of the vessel pressure by a preset pressure increase amount.

[0140] In one embodiment of the invention the preset pressure increase amount lies in the range of 3mmHg to 8mmHg, and preferably, the preset pressure increase amount lies in the range of 4mmHg to 6mmHg, and advantageously, the preset pressure increase amount is approximately 5mmHg.

[0141] In one embodiment of the invention the preset pressure increase amount is stored in a storing means accessible to the control means.

[0142] In one embodiment of the invention the control means of the insufflator is responsive to the lesion present signal produced by the image recognition means for producing a lesion alert signal alerting to the detection by the image recognition means of the presence of a lesion in or on the inner surface of the vessel wall of the targeted area.

[0143] In another embodiment of the invention the image recognition means comprises a part of the insufflator, or is separate from the insufflator and is communicable therewith.

[0144] In one embodiment of the invention the control means of the insufflator is responsive to a reduce pressure signal to operate the flow controller to reduce the flow of insufflating gas to the vessel for reducing the current vessel pressure by a preset pressure reduction amount from the current vessel pressure, and preferably, the reduce pressure signal is produced by a manually operated switch means.

[0145] In one embodiment of the invention the control means is responsive to the reduce pressure signal to operate the flow controller to decrease the supply of insufflating gas to the vessel to in turn reduce the vessel pressure by a preset pressure reduction amount below the current value of the vessel pressure to the reduced pressure.

[0146] In one embodiment of the invention the preset pressure reduction amount lies in the range of 3mmHg to 8mmHg, and preferably, the preset pressure reduction amount lies in the range of 4mmhg to 6mmHg, and advantageously, the preset pressure reduction amount is approximately 5mmHg.

[0147] In one embodiment of the invention the preset pressure reduction amount is stored in the storing means accessible to the control means.

[0148] In one embodiment of the invention the control means of the insufflator is adapted to maintain the vessel pressure at the elevated pressure or the reduced pressure for so long as the lesion present signal or the reduce pressure signal remain active, or until a return signal is produced to return the pressure of the vessel to the pressure thereof prior to the pressure having been increased to the elevated pressure or having been reduced to the reduced pressure.

[0149] In an alternative embodiment of the invention the reduce pressure signal Is produced by a manual means, and in one embodiment of the invention the manual means for producing the reduce pressure signal comprises a manually operated electrical switch.

[0150] In one embodiment of the invention the manually operated electrical switch for producing the reduce pressure signal comprises a foot pedal operated electrical switch, or a button operated electrical switch adapted for hand operation.

[0151] Additionally, the invention comprises an insufflating apparatus comprising the insufflator according to the invention, and an endoscope.

[0152] In another embodiment of the invention the insufflating apparatus further comprises the image capturing means.

[0153] In one embodiment of the invention the image capturing means is located in the endoscope, and preferably, adjacent the distal end of the endoscope. In another embodiment of the invention the endoscope comprises a colonoscope.

[0154] The invention also provides a method for insufflating a vessel in the body of a human or animal subject in which an endoscopic procedure is being carried out, the method comprising controlling the flow of insufflating gas to the vessel in response to a location signal indicative of the location of a targeted area in the vessel at which the procedure is to be carried out to maintain the pressure in the vessel (vessel pressure) at a predefined pressure value corresponding to one or both of the type of the vessel and the location of the targeted area in the vessel.

[0155] In one embodiment of the invention a plurality of the predefined pressure values cross-referenced with the identities of the corresponding locations in the vessel are stored, and preferably, are stored in a pressure values look-up table.

[0156] In another embodiment of the invention a plurality of the predefined pressure values are stored for each location in the vessel, and are cross-referenced with the identity of the corresponding location.

[0157] Preferably, at least one of the predefined pressure values is cross-referenced with the identity of at least one characteristic of a subject and is stored for at least one of the locations in the vessel.

[0158] Preferably, a plurality of the predefined pressure values for different types of the at least one characteristic of a subject are stored and cross-referenced with the identity of the at least one characteristic and the identity of the types thereof.

[0159] In another embodiment of the invention a plurality of the predefined pressure values are stored for respective characteristics of a subject and stored cross-referenced with the identities of the respective characteristics, and preferably are stored in the pressure values look-up table.

[0160] In one embodiment of the invention at least one of the characteristics relates to the sex of a subject, and at least one of the predefined pressure values stored for at least some of the locations in the vessel is stored and cross-referenced with the corresponding sex characteristic of a subject.

[0161] In another embodiment of the invention at least one of the characteristics relates to an age or an age range of a subject, and at least one of the predefined pressure values stored for at least some of the locations in the vessel is stored and cross-referenced with the corresponding age or age range characteristic of a subject.

[0162] In another embodiment of the invention at least one of the characteristics relates to a body mass index or a body mass index range of a subject, and at least one of the predefined pressure values stored for at least some of the locations in the vessel is stored and cross-referenced with the corresponding body mass index or body mass index range characteristic of a subject.

[0163] In another embodiment of the invention at least one of the characteristics relates to a resting position of a subject during a procedure, and at least one of the predefined pressure values stored for at least some of the locations in the vessel is stored and cross-referenced with the corresponding resting position characteristic of a subject.

[0164] Preferably, at least one characteristic of a subject relates to one or more of the age of a subject or the age range of a subject, the weight of a subject or the weight range of a subject, the body mass index of a subject or the body mass index range of a subject and / or the resting position of a subject during the procedure.

[0165] Advantageously, at least one of the predefined pressure values is stored for each one of a plurality of different vessels.

[0166] In one embodiment of the invention the plurality of the predefined pressure values are stored in the pressure values look-up table cross-referenced with the one or more characteristics of the subject.

[0167] In another embodiment of the invention the pressure values look-up table is stored in a pressure values storing means.

[0168] In one embodiment of the invention at least one predefined pressure value is stored for each one of a plurality of different vessels.

[0169] In one embodiment of the invention the location signal indicative of the location of the targeted area in the vessel is manually generated, and preferably, the location signal is generated by a manually operated electrical switch, and advantageously, the location signal is generated by a foot pedal operated electrical switch, and in another embodiment of the invention the manually operated switch comprises a button operated electrical switch.

[0170] In one embodiment of the invention the method further comprises controlling the flow of insufflating gas to the vessel in response to a lesion present signal to increase the vessel pressure to an elevated pressure by a preset pressure increase amount above the current predefined pressure value at which the vessel pressure is being maintained.

[0171] Preferably, the preset pressure increase amount lies in the range of 3mm to 8mm, and preferably, the preset pressure increase amount lies in the range of 4mmHg to 6mmHg, and advantageously, the preset pressure increase amount is approximately 5mmHg.

[0172] In another embodiment of the invention the preset pressure increase amount is preset in a storing means or is selectable.

[0173] In another embodiment of the invention the preset pressure increase amount is stored in a storing means.

[0174] In one embodiment of the invention the lesion present signal is manually generated, and in one embodiment of the invention the lesion present signal is manually generated by operating an electrical switch for generating the lesion present signal, and in one embodiment of the invention the manually operated electrical switch for generating the lesion present signal comprises a pedal operated electrical switch, and in another embodiment of the invention the manually operated electrical switch for generating the lesion present signal comprises a hand operated electrical switch.

[0175] In another embodiment of the invention the lesion present signal is generated in response to detection of a lesion in the vessel.

[0176] In another embodiment of the invention the method further comprises controlling the flow of insufflating gas to the vessel in response to a reduce pressure signal to decrease the vessel pressure by a preset pressure reduction amount below the current vessel pressure at which the vessel pressure is being maintained, and preferably, the preset pressure reduction amount lies in the range of 5mmHg to 8mmHg, and advantageously, the preset pressure reduction amount lies in the range of 4mmHg to 6mmHg, and more preferably, the preset pressure reduction amount is approximately 5mmHg.

[0177] In another embodiment of the invention the lesion present signal is indicative of detection of a lesion.

[0178] In one embodiment of the invention the reduce pressure signal is manually generated, and preferably, the reduce pressure signal is manually generated by a manually operated electrical switch for generating the reduce pressure signal, and in one embodiment of the invention the reduce pressure signal is manually generated by manually operating an electrical switch for generating the reduce pressure signal, and the manually operated electrical switch for generating the reduce pressure signal may be a foot pedal operated electrical switch and / or a hand operated electrical switch.

[0179] In another embodiment of the invention the reduce pressure signal is produced in response to detection of a lesion in the targeted area.

[0180] In another embodiment of the invention the lesion present signal is generated in response to activation of an instrument in the vessel, and preferably, in response to activation of an instrument to treat or remove a detected lesion in the vessel.

[0181] In another embodiment of the invention the lesion present signal is deactivated in response to deactivation of an instrument in the vessel, and preferably, deactivation of the instrument in the vessel adapted to treat or remove a lesion in the vessel.

[0182] In another embodiment of the invention the location signal indicative of the location of the targeted area in the vessel is manually generated, and preferably, the location signal is manually generated by a manually operated electrical switch for generating the location signal.

[0183] In an alternative embodiment of the invention the location signal indicative of the location of the targeted area in the vessel is derived from a signal indicative of the location of an endoscope in the vessel.

[0184] Preferably, the location signal indicative of the location of the targeted area in the vessel is derived from a signal indicative of the location of the distal end of the endoscope in the vessel.

[0185] In one embodiment of the invention the location of the endoscope in the vessel is determined by the depth of penetration of the endoscope into the vessel.

[0186] In another embodiment of the invention the movement of the endoscope inwardly and / or outwardly of the vessel is monitored for determining the depth of penetration of the endoscope in the vessel.

[0187] Preferably, the depth of penetration of the endoscope in the vessel is determined by monitoring a scale on the endoscope as the endoscope is being urged into or out of the body of the subject, and preferably, the depth of penetration of the endoscope in the vessel is monitored by monitoring a graduated scale on the endoscope, and preferably, by monitoring a graduated scale comprising a plurality of spaced apart graduations located along the endoscope.

[0188] In an alternative embodiment of the invention the location of the endoscope in the vessel is determined by fluoroscopic monitoring of a fluoroscopic opaque marker on the endoscope, and preferably, the fluoroscopic opaque marker is located adjacent the distal end of the endoscope.

[0189] In one embodiment of the invention the fluoroscopic opaque marker comprises a radiopaque marker.

[0190] In a further alternative embodiment the location of the endoscope in the vessel is determined by capturing an image of the targeted area of the vessel and providing an image recognition means to identify the location in the vessel of the targeted area from the captured image thereof, and the image recognition means is adapted to produce the location signal indicative of the location of the targeted area in the vessel.

[0191] In one embodiment of the invention the image recognition means is adapted to compare the captured image of the targeted area with at least one location reference image of a location in a reference vessel corresponding to the vessel.

[0192] In another embodiment of the invention the image recognition means is adapted to compare the captured image of the targeted area with a plurality of location reference images of respective locations in the reference vessel.

[0193] Preferably, a plurality of the location reference images are stored for each location in the reference vessel. In one embodiment of the invention at least one of the location reference images of at least one of the locations in the vessel is derived from a reference vessel of a subject having at least one type of at least one characteristic.

[0194] In one embodiment of the invention the characteristic to which the at least one of the reference images of the relevant location in the reference vessel relates is the sex of a subject.

[0195] In another embodiment of the invention the characteristic to which the at least one of the reference images of the relevant location in the reference vessel relates is an age or an age range of a subject.

[0196] In another embodiment of the invention the characteristic to which the at least one of the reference images of the relevant location in the reference vessel relates is a body mass index or a body mass index range of a subject.

[0197] In another embodiment of the invention the characteristic to which the at least one of the reference images of the relevant location in the reference vessel relates is a resting position of a subject during a procedure.

[0198] Preferably, the at least one characteristic of a subject comprises one or more of the sex of a subject, the age of a subject or the age range of a subject, the weight of a subject or the weight range of a subject, the body mass index of a subject or the body mass index range of a subject and / or the resting position of the subject during the procedure.

[0199] Preferably, the image recognition means determines the location of the targeted area in the vessel as the location of the location reference image with which the captured image is a match or a best match.

[0200] Advantageously, the location reference images are stored in a location reference image look-up table accessible to the image recognition means.

[0201] Preferably, the location reference images are cross-referenced with the identities of the corresponding locations thereof and the identities of the characteristics and types thereof with which they correspond in the location reference image look-up table. In one embodiment of the invention the location reference images are grouped into respective groups thereof relating to one or more of the following types of characteristics of a subject, the sex of a subject, the age of a subject or the age range of a subject, the weight of a subject or the weight range of a subject, the body mass index of a subject or the body mass index range of a subject, and / or the rest position of a subject during the procedure.

[0202] Preferably, the image recognition means is adapted to compare the captured image sequentially with the respective location reference images in each group thereof on a group by group basis.

[0203] In one embodiment of the invention location reference images for each location of the vessel are updated each time a match or a best match of a captured image with a location reference image is obtained for that location, and the captured image which is matched is passed through a learning model and stored as an additional location reference image along with the corresponding location reference image or additional location reference images for that location.

[0204] In one embodiment of the invention the number of additional location reference images for each one of the location is maintained at a predefined number of location reference images, and each time the number of additional location reference images for each location exceeds the predefined number of additional location reference images, the oldest one of the additional location reference images for that location is deleted.

[0205] Preferably, the additional location reference images are generated by an artificial intelligence algorithm.

[0206] In one embodiment of the invention the captured image of the targeted area is captured by an image capturing device of an endoscope.

[0207] Preferably, the image capturing means of the endoscope is located adjacent a distal end of the endoscope.

[0208] In one embodiment of the invention the insufflating gas is supplied to the vessel through a flow controller operated under the control of a control means.

[0209] In another embodiment of the invention the control means is responsive to the location signal for operating the flow controller to deliver the insufflating gas to the vessel at the predefined pressure value corresponding to the location of the targeted area in the vessel.

[0210] Preferably, the control means is responsive to the lesion present signal for operating the flow controller to increase the flow of insufflating gas to the vessel to increase the vessel pressure by the preset pressure increase amount.

[0211] In one embodiment of the invention the control means is responsive to the pressure reduce signal for operating the flow controller to reduce the flow of insufflating gas to the vessel to reduce the vessel pressure from the current vessel pressure by the preset pressure reduction amount.

[0212] In another embodiment of the invention the predefined pressure values for the targeted areas in the respective locations of the vessel lie in the range of 5mmHg to 30mmHg.

[0213] Preferably, the vessel in which the procedure is being carried out comprises a colon of a subject, and preferably, the predefined pressure values lie in the range of 5mmHg to 30mmHg.

[0214] In one embodiment of the invention the method is adapted for insufflating an elongated lumen.

[0215] In one embodiment of the invention the elongated lumen comprises a colon of a subject.

[0216] In one embodiment of the invention one of the locations of the colon for which at least one predefined pressure value is stored comprises the sigmoid colon.

[0217] In another embodiment of the invention one of the locations of the colon for which at least one predefined pressure value is stored comprises the descending colon.

[0218] In another embodiment of the invention one of the locations of the colon for which at least one predefined pressure value is stored comprises the transverse colon.

[0219] In another embodiment of the invention one of the locations of the colon for which at least one predefined pressure value is stored comprises the ascending colon. In one embodiment of the invention the predefined pressure value is provided for one or more of a sigmoid colon, a descending colon, a transverse colon and an ascending colon.

[0220] In another embodiment of the invention the predefined pressure value stored for the transverse colon is higher than the predefined pressure value stored for the sigmoid colon.

[0221] In another embodiment of the invention the elongated lumen comprises the intestine of a subject.

[0222] The invention also provides a method for insufflating a vessel in the body of a human or animal subject comprising controlling the supply of insufflating gas to the vessel in response to a topography signal indicative of the topography of an inner surface of a wall of the vessel (vessel wall) adjacent a targeted area in the vessel to maintain the topography of the inner surface of the vessel wall of the targeted area at a predefined degree of evenness to enhance mucosal visualisation thereof.

[0223] Preferably, the predefined degree of evenness of the topography of the inner surface of the vessel wall of the targeted area is set to permit detection of a lesion in or on the targeted area of the inner surface of the vessel wall.

[0224] Advantageously, the predefined degree of evenness of the topography of the inner surface of the vessel wall of the targeted area comprises a substantially flat surface.

[0225] In one embodiment of the invention the topography signal indicative of the topography of the inner surface of the vessel wall of the topography of the targeted area is derived from an image recognition means, and the image recognition means compares a captured image of the topography of the inner surface of the targeted area of the vessel wall with at least one topography reference image of a reference surface of topography of the predefined degree of evenness to determine the degree of evenness of the inner surface of the vessel wall of the targeted area of the vessel.

[0226] In one embodiment of the invention the image recognition means compares the captured image of the topography of the inner surface of the vessel wall of the targeted area with a plurality of topography reference images of reference surfaces of topographies of respective different degrees of evenness, and the image recognition means determines the degree of evenness of the inner surface of the vessel wall of the targeted area, as the degree of evenness of the reference surface of the topography reference image with which the captured image is a match or a best match.

[0227] Preferably, the topography reference images are stored and cross-referenced with values indicative of the degree of evenness of the corresponding reference surfaces thereof, and preferably, the topography reference images are stored in a topography reference image look-up table cross-referenced with the values indicative of the degree of evenness of the corresponding reference surfaces thereof.

[0228] Preferably, the values indicative of the degrees of evenness of the topographies of the reference surfaces of the topography reference images decrease progressively to the value indicative of the predefined degree of evenness.

[0229] Preferably, the topography signal produced by the image recognition means comprises the value indicative of the degree of evenness of the inner surface of the vessel wall of the targeted area.

[0230] In one embodiment of the invention a plurality of topography reference images of reference surfaces for different locations in a reference vessel corresponding to the vessel are stored.

[0231] Preferably, a plurality of topography reference images of reference surfaces indicative of topographies of different predefined degrees of evenness are stored for each location of the reference vessel for which a topography reference image is stored, and are cross-referenced with the values indicative of the degrees of evenness of the respective topography reference images, and the identities of the locations in the reference vessel.

[0232] In another embodiment of the invention the topography reference images of the reference surfaces for each location in a reference vessel for which topography reference images are stored, are stored and cross-referenced with the corresponding values indicative of the degrees of evenness thereof and the identities of the locations thereof in the reference vessel in the topography reference image look-up table.

[0233] In another embodiment of the invention the captured image is initially compared by the image recognition means with the topography reference image of the predefined degree of evenness, and if the topography reference image of the predefined degree of evenness is not a match with the captured image, the image recognition means sequentially compares the captured image with the topography reference images of decreasing degrees of evenness from the topography reference image of the predefined degree of evenness.

[0234] Preferably, if the topography signal indicative of the degree of evenness of the inner surface of the vessel wall of the targeted area is not indicative of the inner surface of the vessel wall of the targeted area being of the predefined degree of evenness, the supply of insufflating gas to the vessel is increased until the topography of the inner surface of the vessel wall of the targeted area is of the predefined degree of evenness, and preferably, the supply of insufflating gas to the vessel is increased incrementally.

[0235] In another embodiment of the invention a plurality of topography reference images of reference surfaces of topographies of respective different degrees of evenness are stored for different vessels.

[0236] In one embodiment of the invention the topography reference images are updated by an artificial intelligence algorithm.

[0237] In another embodiment of the invention the topography reference images are updated each time a match or a best match of a captured image is made with one of the topography reference images and the captured image is stored as an additional topography reference image along with the corresponding topography reference image and / or the corresponding additional topography reference images.

[0238] In one embodiment of the invention each captured image for which a match or a best match with a topography reference image is made is passed through a learning model prior to being stored as an additional topography reference image.

[0239] Preferably, the number of additional topography reference images stored corresponding to each degree of evenness is limited to a predefined number of additional topography reference images, and each time the number of additional topography reference images for each degree of evenness exceeds the predefined number, the oldest one of the additional topography reference images for that degree of evenness is deleted.

[0240] In one embodiment of the invention each captured image is compared with the topography reference images and the corresponding additional topography reference images until a match or a best match of the captured image with one of the topography reference images or the additional topography reference images is determined. In another embodiment of the invention at least one of the location reference images of at least one of the locations in the vessel is derived from a reference vessel of a subject having at least one type of at least one characteristic.

[0241] In another embodiment of the invention the at least one characteristic of a subject comprises one or more of the sex of a subject, the age of a subject or the age range of a subject, the weight of a subject or the weight range of a subject, the body mass index of a subject or the body mass index range of a subject and the resting position of the subject during the procedure.

[0242] In one embodiment of the invention the method further comprises monitoring the inner surface of the vessel wall of the targeted area of the vessel for a lesion, and on detecting a lesion in or on the inner surface of the vessel wall of the targeted area producing a lesion present signal indicative of the detection of a lesion.

[0243] In one embodiment of the invention the supply of insufflating gas to the vessel is increased in response to the lesion present signal to increase the vessel pressure from the current value thereof by a preset pressure increase amount to an elevated pressure.

[0244] In one embodiment of the invention the preset pressure increase amount lies in the range of 3mmHg to 8mmHg, and preferably, the preset pressure increase amount lies in the range of 4mmHg to 6mmHg, and advantageously, the preset pressure increase amount is approximately 5mmHg.

[0245] In one embodiment of the invention the preset pressure increase amount is preset, and in another embodiment of the invention the preset pressure increase amount is selectable.

[0246] In one embodiment of the invention the lesion present signal is manually generated, and preferably, the lesion present signal is manually generated by a manually operable electrical switch for generating the lesion present signal.

[0247] In another embodiment of the invention the lesion present signal is generated by a foot pedal operated electrical switch, or by a hand operated electrical switch comprising a button operated electrical switch for hand operation. In another embodiment of the invention the supply of insufflating gas to the vessel is decreased in response to a reduce pressure signal to decrease the current vessel pressure by a preset pressure reduction amount. Preferably, the preset pressure reduction amount lies in the range of 3mmHg to 8mmHg, and preferably, the preset pressure reduction amount lies in the range of 5mmHg to 6mmHg, and advantageously, the preset pressure reduction amount is approximately 5mmHg.

[0248] In another embodiment of the invention the reduce pressure signal is manually generated, and preferably, the reduce pressure signal is manually generated by a manually operable electrical switch for generating the reduce pressure signal, which may comprise a foot pedal operated electrical switch and / or a hand operated electrical switch.

[0249] In another embodiment of the invention the preset pressure reduction amount is preset or is selectable.

[0250] In another embodiment of the invention the reduce pressure signal is produced in response to detection of a lesion in the targeted area.

[0251] In one embodiment of the invention the vessel pressure is maintained at the elevated pressure or at the reduced pressure while the lesion present signal or the reduce pressure signal remains active.

[0252] In another embodiment of the invention the lesion present signal is derived from the image recognition means.

[0253] In one embodiment of the invention the image recognition means compares the captured image of the inner surface of the vessel wall of the targeted area with at least one lesion reference image comprising a representation of at least one lesion to determine the presence of a lesion in or on the inner surface of the vessel wall of the targeted area.

[0254] In one embodiment of the invention the image recognition means compares the captured image of the inner surface of the vessel wall of the targeted area of the predefined degree of evenness with the at least one lesion reference image.

[0255] Preferably, the image recognition means compares the captured image with a plurality of lesion reference images comprising images of different types of lesions and of different sizes thereof.

[0256] Advantageously, the image recognition means determines the presence of a lesion in or on the inner surface of the vessel wall of the targeted area on the captured image being a match ora best match with the at least one lesion reference image.

[0257] Preferably, the lesion reference images are stored and cross referenced with the identity of the type of lesion and the identity of the size thereof.

[0258] In another embodiment of the invention the captured image is compared sequentially with the lesion reference images, and in another embodiment of the invention the lesion reference images are categorised into groups, with each group of lesion reference images being indicative of a particular type of lesion, and preferably, each group of lesion reference images comprises a plurality of the lesion reference images of lesions of different sizes.

[0259] In one embodiment of the invention each captured image is sequentially compared with the images of each group of lesion reference images on a group-by-group basis.

[0260] Advantageously, an image of the captured image of the targeted area comprising a lesion therein is displayed on a visual display screen.

[0261] In one embodiment of the invention the lesion in the image displayed on the visual display screen is highlighted, and preferably, is highlighted by encircling the image of the lesion with a bright ring.

[0262] Preferably, the captured image is displayed on a visual display screen of an endoscope through which the procedure is being carried out.

[0263] In one embodiment of the invention the lesion reference images are updated by an artificial intelligence algorithm.

[0264] In one embodiment of the invention the lesion reference images are updated each time a match ora best match of the captured image is made with one of the lesion reference images, and the captured image is stored as an additional lesion reference image along with the corresponding lesion reference image and / or the corresponding additional lesion reference images, and preferably, the number of additional lesion reference images are limited to a predefined number of additional lesion reference images, and on the number of additional lesion reference images exceeding the predefined number thereof, the oldest one of the additional lesion reference images is deleted.

[0265] Preferably, each additional lesion reference image is determined by an artificial intelligence algorithm.

[0266] In another embodiment of the invention each captured image is compared with each of the lesion reference images and the additional lesion reference images.

[0267] In one embodiment of the invention at least one of the lesion reference images is derived from a reference vessel of a subject having at least one type of at least one characteristic.

[0268] In another embodiment of the invention the at least one characteristic of a subject comprises one or more of the sex of a subject, the age of a subject or the age range of a subject, the weight of a subject or the weight range of a subject, the body mass index or the body mass index range of a subject and the resting position of the subject during the procedure.

[0269] In one embodiment of the invention the lesion is removed by a snaring instrument extending through an endoscope to the targeted area of the inner surface of the vessel wall of the vessel.

[0270] In one embodiment of the invention the supply of insufflating gas to the vessel is controlled by a flow controller operated under the control of a control means, and the control means is responsive to the topography signal for controlling the supply of the insufflating gas to the vessel for maintaining the inner surface of the vessel wall of the targeted area at the predefined degree of evenness. Preferably, the control means is responsive to the lesion present signal for operating the flow controller to increase the flow of insufflating gas to the vessel to increase the vessel pressure by the preset pressure increase amount.

[0271] Advantageously, the control means is responsive to the reduce pressure signal for operating the flow controller to reduce the flow of insufflating gas to the vessel to reduce the vessel pressure by the present pressure reduction amount. In another embodiment of the invention the vessel comprises the colon of a subject, and preferably, the endoscope comprises a colonoscope, advantageously, entered anally into the colon of the subject.

[0272] In one embodiment of the invention the lesion comprises one of a pre-cancerous lesion, a pre-cancerous adenoma or a pre-cancerous polyp.

[0273] Further, the invention provides a method for insufflating a vessel for maintaining the topography of an inner surface of a wall of the vessel (vessel wall) of a targeted area in the vessel at a predefined degree of evenness, the method comprising reading a topography signal from a vision system indicative of the degree of evenness of the topography of the inner surface of the vessel wall of the targeted area, and controlling the flow of insufflating gas to the vessel for maintaining the topography of the inner surface of the vessel wall of the targeted area at a predefined degree of evenness.

[0274] In one embodiment of the invention the topography signal is read from an image recognition means adapted to compare a captured image of the inner surface of the vessel wall of the targeted area with at least one topography reference image, at least one of the at least one topography reference images having a reference surface of topography of the predefined degree of evenness.

[0275] The invention also provides a method for detecting a lesion in or on an inner surface of a wall of a vessel in a targeted area of the vessel, the method comprising comparing a captured image of the inner surface of the vessel wall in the targeted area with at least one lesion reference image comprising a representation of a lesion, and determining the presence of a lesion on the inner surface of the vessel wall in the targeted area on the captured image being a match or a best match of one of the at least one lesion reference image.

[0276] Preferably, the captured image of the inner surface of the vessel wall in the targeted area comprises a captured image of the inner surface of the vessel wall of a predefined degree of evenness.

[0277] Further the invention provides an insufflating apparatus for insufflating a vessel in the body of a human or animal subject, the insufflating apparatus comprising an insufflator for insufflating the vessel, and a detecting means for detecting a lesion in the vessel and for producing a lesion present signal on detecting a lesion in the vessel, the insufflator comprising a flow controller, and a control means, the control means being responsive to the lesion present signal for operating the flow controller to increase the supply of insufflating gas to the vessel to increase the vessel pressure by a preset pressure increase amount to an elevated pressure.

[0278] Further the invention provides an insufflating apparatus for insufflating a vessel in the body of a human or animal subject, the insufflating apparatus comprising an insufflator for insufflating the vessel, and a detecting means for detecting a lesion in the vessel and for producing a reduce pressure signal on detecting a lesion in the vessel, the insufflator comprising a flow controller, and a control means, the control means being responsive to the reduce pressure signal for operating the flow controller to reduce the supply of insufflating gas to the vessel to reduce the pressure in the vessel by a preset pressure reduction amount.

[0279] Further the invention provides an insufflating apparatus for insufflating a vessel in the body of a human or animal subject, the insufflating apparatus comprising an insufflator for insufflating the vessel, and a detecting means for detecting a lesion in the vessel, and for producing one of a lesion present signal or a reduce pressure signal on detecting a lesion in the vessel, the insufflator comprising a flow controller, and a control means, the control means being responsive to the lesion present signal for operating the flow controller to increase the supply of insufflating gas to the vessel to increase the vessel pressure to an elevated pressure, and the control means is responsive to the reduce pressure signal for operating the flow controller to reduce the supply of insufflating gas to the vessel to reduce the vessel pressure to a reduced pressure.

[0280] In one embodiment of the invention the control means is responsive to the lesion present signal to operate the flow controller to increase the supply of insufflating gas to the vessel to increase the current pressure in the vessel by a preset pressure increase amount to increase the vessel pressure to the elevated pressure.

[0281] In another embodiment of the invention the control means is responsive to the reduce pressure signal to operate the flow controller to decrease the supply of insufflating gas to the vessel to reduce the current pressure in the vessel by a preset pressure reduction amount to reduce the vessel pressure to the reduced pressure.

[0282] In one embodiment of the invention the preset pressure increase and reduction amounts lie in the range of 3mmHg to 8mmHg, and preferably, lie in the range of 4mmHg to 6mmHg, and advantageously, the preset pressure increase and reduction amounts are each approximately 5mmHg.

[0283] In one embodiment of the invention the lesion present signal is produced by the detecting means, and in another embodiment of the invention the reduce pressure signal is produced manually, and preferably, is produced by a manually operated electrical switch. In one embodiment of the invention the manually operated electrical switch comprises a foot pedal operated electrical switch, and in another embodiment of the invention the manually operated electrical switch comprises a button operated switch, preferably, operable by hand.

[0284] In an alternative embodiment of the invention the reduce pressure signal is produced by the detecting means, and in one embodiment of the invention the lesion present signal is produced manually, and preferably, is produced manually by a manually operated electrical switch. Preferably, the manually operated electrical switch comprises a foot pedal operated electrical switch, and in another embodiment of the invention the manually operated electrical switch comprises a button operated electrical switch, preferably, operable by hand.

[0285] In a further embodiment of the invention the detecting means comprises an image recognition means, and preferably, and image recognition means is adapted to compare a captured image of an inner surface of the vessel wall of a targeted area with at least one lesion reference image indicative of a lesion, and on determining a match or a best match of the captured image of the targeted area with the at least one lesion reference image, the image recognition means produces the one of the lesion present signal or the reduce pressure signal.

[0286] Preferably, the image recognition means is adapted to compare the captured image with a plurality of lesion reference images.

[0287] In one embodiment of the invention the lesion reference images are stored in a lesion reference image storing means accessible to the image recognition means.

[0288] The invention also provides an insufflating apparatus comprising an insufflator for insufflating a vessel, and a detecting means for detecting a lesion in or on an inner surface of a wall of the insufflated vessel (vessel wall) in a targeted area in the vessel, the detecting means comprising a means for comparing a captured image of the inner surface of the vessel wall in the targeted area with at least one lesion reference image indicative of a lesion, the detecting means being adapted to determine the presence of a lesion on the inner surface of the vessel wall in the targeted area on the captured image being a match or a best match of at least one of the at least one lesion reference images.

[0289] In one embodiment of the invention the inner surface of the vessel wall in the targeted area of the captured image is of a predefined degree of evenness. Preferably, the insufflator is adapted to maintain the vessel at a predefined pressure value for maintaining the inner surface of the vessel wall in the targeted area at the predefined degree of evenness.

[0290] The advantages of the insufflating apparatus according to the invention are many. A particularly important advantage of the invention is that by controlling the insufflating of a vessel to be responsive to the degree of evenness of the topography of the targeted area being of a predefined degree of evenness, once the inner surface of the vessel wall of the targeted area is at the predefined degree of evenness, no further increase in the pressure or increase in the flow of insufflating gas to the vessel is required. Thus, in general, the pressure to which the vessel is insufflated to produce sufficient visualisation of a targeted area in order to detect a lesion is less than would otherwise be required, and in some cases is significantly less than the pressure or the flow rate of insufflating gas which would otherwise be required if, for example, the pressure or flow rate of insufflating gas were being manually controlled. Additionally, the speed for carrying out the procedures for detecting and removing of lesions from a vessel is considerably increased.

[0291] Additionally, since the degree of evenness of the topography of the inner surface of the vessel wall of the targeted area is determined by comparing captured images of the targeted area with topography reference images of reference surfaces of degrees of evenness up to and including the predefined degree of evenness, the need to continuously monitor the pressure in the vessel is avoided. In fact, the pressure in the vessel need only be monitored to avoid any risk of the vessel pressure exceeding the maximum pressure value. Thus, if a channel is not available in the endoscope to permit continuous monitoring of the vessel pressure, the vessel pressure may be periodically measured through the insufflating channel of the endoscope or through any other channel of the endoscope or tube through which the vessel is being insufflated at periodic intervals during which the supply of insufflating gas to the vessel would be interrupted in order to allow accurate monitoring of the vessel pressure.

[0292] Another particularly important advantage of the insufflating apparatus is that by controlling the pressure at which the vessel is insufflated in response to the location of the targeted area at which the procedure is being carried out, and also in response to one or more characteristics of a subject such as, the sex, age, weight body mass index and / or the resting position of the subject during the procedure, the pressure to which the vessel is to be insufflated is also minimised, since in many locations of the vessel the pressure to which the vessel should be insufflated in order to produce the inner surface of the vessel adjacent the targeted area to be of the predefined degree of evenness and / or to produce adequate visualisation to carry out the procedure, for example, for identifying lesions in or on a targeted area, is lower than the pressure to which other parts of the vessel should be insufflated in order to produce the targeted area to be of the predefined degree of evenness and / or to produce adequate visualisation and likewise to carry out the procedure or to identify lesions. Thereby, the vessel is only insufflated at the higher predefined pressure values while the targeted areas are located in those areas of the vessel where higher predefined pressure values are required, and the vessel is insufflated at the lower predefined pressure values when the targeted areas are in those areas requiring the lower predefined pressure values, thereby, minimising the duration at which the vessel is maintained at the higher predefined pressure values.

[0293] A further important advantage of the insufflating apparatus is achieved by virtue of the fact that on detection of a lesion, the pressure in the vessel is elevated by the preset pressure increase amount above the current predefined pressure value in order to increase the working volume in the vessel to permit severing of a detected lesion. This advantage further minimises the duration the vessel pressure is maintained at the highest pressures.

[0294] Another important advantage of the insufflating apparatus, in which the lesion is detected by the image recognition unit, is that the lesion present signal indicative of the detection of a lesion in a targeted area is produced without any input from a surgeon or a clinician, and thus, the vessel pressure is automatically increased by the preset pressure increase amount to increase the working volume in the vessel to facilitate severing of the lesion, again without any input from the surgeon or clinician. This, thus, significantly reduces the time required to carry out the procedure, and furthermore, leaves the surgeon or clinician free to concentrate on the removal of the lesions, and also assists the surgeon or clinician in identifying the lesion and in particular identifying the location of the lesion.

[0295] The invention will be more clearly understood from the following description of some preferred embodiments thereof which are given by way of example only with reference to the accompanying drawings, in which: Fig. 1 is a block representation of an insufflating apparatus according to the invention for carrying out a method for insufflating a vessel also according to the invention in a human or animal subject and for detecting a lesion in the vessel,

[0296] Fig. 2 is a view of a part of a subject illustrating the colon of the subject with a part of the insufflating apparatus inserted into the colon,

[0297] Fig. 3 illustrates a look-up table for use in the insufflating apparatus of Fig. 1,

[0298] Fig. 4 is a plan view of a subject in a resting position taken up by the subject during which a procedure is being carried out on the subject with the insufflating apparatus of Fig. 1 ,

[0299] Figs. 5a to 5c are perspective views of a polyp being removed from the colon of a subject,

[0300] Fig. 6 is a block representation of an insufflating apparatus according to another embodiment of the invention for carryout out a method for insufflating a vessel also according to the invention and for detecting a lesion in the vessel,

[0301] Fig. 7 illustrates a topography reference image look-up table for use in the insufflating apparatus of Fig. 6,

[0302] Fig. 8 illustrates a lesion reference image look-up table for use in the insufflating apparatus of Fig. 6,

[0303] Fig. 9 is a view of a subject illustrating the colon of the subject with a part of the insufflating apparatus of Fig. 6 inserted into the colon,

[0304] Fig. 10 is a block representation of an insufflating apparatus according to another embodiment of the invention for carrying out a method for insufflating a vessel also according to the invention in a human or animal subject and for detecting a lesion in the vessel,

[0305] Fig. 11 is a view of a colon of a subject with a part of the insufflating apparatus of Fig. 10 inserted into the colon, Fig. 12 illustrates a location reference image look-up table for use in the insufflating apparatus of Fig. 10,

[0306] Fig. 13 is a block representation of an insufflating apparatus according to a further embodiment of the invention for insufflating a vessel for carrying out a method for insufflating a vessel according to the invention in a human or animal subject and for detecting a lesion in the vessel, and

[0307] Fig. 14 is a block representation of an insufflating apparatus according to a still further embodiment of the invention for carrying out a method for insufflating a vessel, also according to the invention in a human or animal subject and for detecting a lesion in the vessel.

[0308] Referring to the drawings and initially to Figs. 1 to 5 thereof, there is illustrated insufflating apparatus according to the invention indicated generally by the reference numeral 1 for insufflating a vessel, in this case, the colon 7 of a human subject 8 to a pressure dependent on the location of a targeted area 11 of the colon 7, at which a procedure is being carried out, as will be described below. In this embodiment of the invention the procedure is a procedure in which the insufflating apparatus 1 is adapted to detect a lesion, such as a pre-cancerous lesion, a pre-cancerous adenoma and / or a pre-cancerous polyp, discussed below, in the colon 7, and to remove the detected lesion therefrom. Although the lesion may be any type of lesion cancerous or pre-cancerous. The apparatus 1 comprises an insufflator also according to the invention and indicated generally by the reference numeral 3 for insufflating the colon 7, and a colonoscope indicated generally by the reference numeral 5 through which the colon 7 is insufflated and through which the procedure is carried out in the colon 7.

[0309] The insufflating apparatus 1 is adapted for determining the location of a distal end 10 of the colonoscope 5 in the colon 7 since the location of the distal end 10 of the colonoscope 5 is indicative of the location of the inner surface 14 of the wall 15 of the colon 7 adjacent the targeted area 11 within the field of view of the colonoscope 5, and in which the procedure is or may be carried out. The insufflator 3 is adapted for insufflating the colon 7 to a predefined pressure value corresponding to the location of the targeted area 11 in the colon 7, so that the colon 7 is insufflated to the extent that the topography 12 of the inner surface 14 of the colon wall 15 in the targeted area 11 is of a predefined degree of evenness to facilitate detection of a lesion. In this case the predefined degree of evenness required is such that the targeted area 11 of the inner surface 14 of the colon wall 15 is substantially flat. In Figs. 5a to 5c a pre-cancerous polyp 17 is illustrated on the inner surface 14 of the colon wall 15.

[0310] Turning initially to the insufflator 3, the insufflator 3 comprises a housing 19 illustrated in broken lines in Fig. 1, within which a flow controller 20 is located. A first inlet port 21 in the housing 19 is provided for connecting the insufflator 3 to an insufflating gas source 22. The insufflating gas source may be any suitable gas source, for example, a pressurised supply of carbon dioxide, which is readily available in an operating theatre of a hospital. The flow controller 20 receives the insufflating gas from the insufflating gas source 22 through the first inlet port 21. The insufflating gas is delivered by the flow controller 20 to the colon 7 through a first outlet port 23 located in the housing 19 and a gas line 26 which is coupled to an insufflating gas channel 27 of the colonoscope 5 for insufflating the colon 7. A pressure sensor 24 located in the housing 19 of the insufflator 3 is connected through a second outlet port 28 and a pressure monitoring line 25 to a suitable channel of the colonoscope 5 to permit monitoring of the pressure in the colon 7. The suitable channel may be any suitable channel of the colonoscope 5, for example, an instrument channel 29, a vacuum channel, or a channel purposed for suctioning or any other suitable channel.

[0311] A control means, for example, a signal processor, which in this embodiment of the invention comprises a microprocessor 30 located in the housing 19 controls the operation of the insufflator 3, and reads the colon pressure from the pressure sensor 24 and controls the flow controller 20 to deliver the insufflating gas to the colon 7 for maintaining the pressure in the colon 7 at an appropriate predefined pressure value as will be described below. An interface, which may be any suitable interface, but in this case comprises a touchscreen interface 31 is provided on the housing 19 for entering data to the microprocessor 30, as will be described below, and for displaying data produced by the microprocessor 30 relating to the procedure being carried out.

[0312] A means for determining the location of the distal end 10 of the colonoscope 5 in the colon 7 comprises a monitoring means, namely, an optical monitoring unit 32 for monitoring a plurality of graduations 33 of a graduated scale 34 which are longitudinally equi-spaced apart along the colonoscope 5. The graduations 33 of the graduated scale 34 comprise reflective rings extending circumferentially around the colonoscope 5, which are numbered to facilitate determining the depth of penetration of the colonoscope 5 into the colon 7 of the subject. The monitoring unit 32 is of ring shape and extends around the colonoscope 5 and is slideable along the colonoscope 5. The monitoring unit 32 is adapted to monitor the graduations 33 as the colonoscope 5 is being urged inwardly and outwardly of the subject for determining the location of the distal end 10 of the colonoscope 5 in the colon 7, and to produce a location signal indicative of the location of the distal end 10 of the colonoscope 5 in the colon 7, which approximates to the location of the targeted area 11. The monitoring unit 32 is adapted for engaging the subject adjacent the anus 35, so that the location of the distal end 10 of the colonoscope 5 in the colon 7 can be accurately determined as the colonoscope 5 is being urged through the anus 35 and in turn through the rectum 36 into the colon 7. The monitoring unit 32 may be secured by any suitable securing means to the body of the subject adjacent the anus 35, for example, by adhesive tape, straps or by any other suitable means. The location signal produced by the monitoring unit 32 is read by the microprocessor 30 for determining the location of the targeted area 11 of the inner surface 14 of the colon 7.

[0313] The predefined pressure values to which the colon 7 should be insufflated, so that the targeted area 11 is of the predefined degree of evenness is dependent on the location of the targeted area 11 in the colon 7, and on various characteristics of the subject, such as the sex, age, weight, body mass index and resting position of the subject during the procedure.

[0314] Referring now to Fig. 3 there is illustrated a part of a pressure values look-up table 38 which is stored in a memory 37 of the microprocessor 30. The pressure values look-up table 38 stores a plurality of predefined pressure values to which the colon 7 should be insufflated in order that the topography 12 of the inner surface 14 of the colon wall 15 of the targeted area 11 is of the predefined degree of evenness to allow detection of a lesion. The predefined pressure values to which the colon 7 should be insufflated such that the inner surface 14 of the colon wall 15 of the targeted area 11 is of the predefined degree of evenness are stored and cross-referenced in the pressure values look-up table 38 with the respective locations of the targeted areas 11 and characteristics of the subject. The characteristics of the subject are set forth in columns two to five of the pressure values look-up table 38, with the corresponding predefined pressure values set out in column seven, and the locations of the targeted areas 11 in the colon 7 are set out in column six of the pressure values look-up table 38. In this embodiment of the invention the predefined pressure values for the targeted areas 11 in four locations in the colon 7 are provided, namely, for the sigmoid colon 41 and the descending colon 45, the transverse colon 40 and the ascending colon 46.

[0315] Column one of the pressure values look-up table 38 indicates that the predefined pressure values are for the colon of human subjects. Other pressure values look-up tables comprising predefined pressure values for other vessels, for example, the intestine and the like may also be provided. In column two the sex of subjects is set out. In column three the age ranges of subjects are set out. In column four body mass index ranges of subjects are set out, while in column five the different resting positions of subjects during a procedure are set out. Although, in the pressure values look-up table 38 of Fig. 3, only age ranges, body mass index ranges and resting positions of subjects and the location in the colon are set forth for a male subject, it will be appreciated that similar data for a female subject will also be included in the pressure values look-up table 38. Indeed, as can be seen in column three, only two age ranges have been set forth, in many cases, more or less than two age ranges will be included, as will more or less than three body mass index ranges be included for each age range for subjects. Similarly, although three resting positions of subjects have been set forth in column five, more or less than three resting positions of subjects may be included in column five against each body mass index. It is also envisaged that in some embodiments of the invention an additional column may be provided in the pressure values look-up table to take account of the weights or the weight ranges of different subjects.

[0316] Typically, the age ranges included in column three, will be, for example, an age range which will cover infants, an age range which will cover children up to, for example, twelve years of age, an age range which will cover teenagers, typically, from thirteen to twenty-four, and possibly two further age ranges of adults, for example, from twenty-five to fifty-five and from fifty-six upwards. The body mass index ranges for subjects include a body mass index range for subjects of a normal body mass index range, subjects of an obese body mass index range, subjects of an extra obese body mass index range and subjects of a body mass index range below a normal body mass index range. The resting positions of a subject during the procedure may, for example, be a left lateral resting position as illustrated in Fig. 4 where the subject is lying on his or her left side with his or her knees adjacent the abdomen which may be identified in the pressure values look-up table 38 as the position 1 , a right lateral resting position, similar to the left lateral resting position, but with the exception that the subject is lying on his or her right side which may be identified in the pressure values look-up table 38 as the position 2, a resting position where the subject is lying on his or her back which may be identified in the pressure values look-up table 38 as the position 3, and a resting position where the subject may be lying face downwardly which could be included in the pressure values look-up table 38 as a position 4.

[0317] The predefined pressure values for each of the four locations of the colon vary depending on the sex, age and body mass index of a subject, and also the resting position of the subject during the procedure, since the compliance of the colon varies from subject to subject depending on the sex, age and body mass index of the subject and also depending on the resting position of the subject during a procedure. In general, the predefined pressure values to which the colon should be insufflated in order that the inner surface 14 of the colon wall 15 of the targeted areas 11 are of the predefined degree of evenness to facilitate detection of the lesions lie in the range from 5mmHg to 30mmHg, and in some cases lie in the range from 18mmHg to 28mmHg. It has been found that the predefined pressure value to which the colon should be insufflated to provide the inner surface 14 of the colon wall 15 of targeted areas 11 in the transverse colon 40 to be of the predefined degree of evenness is higher than the predefined pressure value to which the colon 7 should be insufflated such that the inner surface 14 of the colon wall 15 of the targeted areas 11 in the sigmoid colon 41 are of the predefined degree of evenness. In some cases, it is believed that there may be a difference of 10mmHg and possibly more between the predefined pressure value to which the colon 7 should be insufflated for targeted areas 11 in the transverse colon 40 and the predefined pressure value to which the colon 7 should be insufflated for targeted areas 11 in the sigmoid colon 41 in order that the inner surface 14 of the colon wall 15 of the respective targeted areas 11 are of the predefined degrees of evenness.

[0318] While in column seven of the pressure values look-up table 38 the predefined pressure values have been indicated as being pressure values numbers P1 to P41 and so on, it will be readily apparent to those skilled in the art that many of the predefined pressure values P1 to P41 may be similar to other ones of the predefined pressure values P1 to P41, and furthermore, the pressure values do not increase or decrease in accordance with the numbers 1 to 41 designating the pressure values.

[0319] A means for generating a lesion present signal indicative of a lesion having been detected in or on the inner surface 14 of the colon wall 15 in the current targeted area 11 in this embodiment of the invention comprises a manually operated electrical switch located externally of the housing 19 of the insufflator 3. In this case the manually operated switch for generating the lesion present signal comprises a foot pedal operated electrical switch 42. The foot pedal operated electrical switch 42 is connected to the microprocessor 30 through the housing 19 of the insufflator 3, and is operated by a surgeon or clinician on detecting a lesion in the current targeted area 11 in the colon 7, such that by depressing a foot pedal 43 of the foot pedal operated electrical switch 42, the electrical switch 42 is operated from an open circuit state to a closed circuit state to produce the lesion present signal.

[0320] The microprocessor 30 in response to the lesion present signal from the foot pedal operated switch 42 operates the flow controller 20 to increase the delivery of insufflating gas to the colon 7 to in turn increase the pressure in the colon 7 to an elevated pressure in order to increase the working volume in the colon adjacent the current targeted area 11 to facilitate removal of the detected lesion as will be described below. The pressure in the colon 7 is increased to the elevated pressure by increasing the current pressure in the colon 7, which should be the appropriate predefined pressure value, by a preset pressure increase amount stored in the memory 37 of the microprocessor 30. The preset pressure increase amount by which the pressure in the colon 7 is increased in response to the lesion present signal typically lies in the range of 5mmHg to 8mmHg, and more typically is of the order of approximately 5mmHg. The preset pressure increase amount may be preset in the memory 37 of the microprocessor 30, or may be selectable through the touchscreen interface 31.

[0321] The colon pressure is maintained at the elevated pressure for so long as the foot pedal 43 of the foot pedal operated switch 42 is depressed and the lesion present signal applied to the microprocessor 30 is active. On release of the foot pedal 43 of the foot pedal operated switch 42, the lesion present signal is terminated, and the microprocessor 30 in response to termination of the lesion present signal operates the flow controller 20 to reduce the delivery of insufflating gas to the vessel in order to reduce the pressure in the vessel to the predefined pressure value to which the colon 7 had been insufflated prior to the production of the lesion present signal.

[0322] In order to further assist in an understanding of the invention, the operation of the insufflating apparatus 1 will now be described. Initially, the surgeon or clinician enters the type of the vessel in which the procedure is to be carried out, in this case the colon, through the touchscreen interface 31 into the microprocessor 30. The sex of the subject, the age and body mass index of the subject are entered through the touchscreen interface 31 into the microprocessor 30. Alternatively, the age range and the body mass index range within which the age and the body mass of the subject lie, may be entered through the touchscreen interface 31 into the microprocessor 30. The resting position in which the body of the subject will be positioned during the procedure is also entered into the microprocessor 30 through the touchscreen interface 31. On entering the data relating to the vessel, the sex, the age, the body mass index and the resting position of the body of the subject, the microprocessor 30 is programmed to select the appropriate predefined pressure values from column seven of the pressure values look-up table 38 to which the colon 7 is to be insufflated when the targeted areas 11 are in the sigmoid colon 41, the descending colon 45, the transverse colon 40 and the ascending colon 46, which correspond with the entered data of the subject. The selected predefined pressure values are stored in the memory 37 of the microprocessor 30 and cross-referenced with the identities of the corresponding parts of the colon 7. If the preset pressure increase amount by which the colon pressure is to be increased above the current predefined pressure value of the colon is selectable, the value of the preset pressure increase amount is entered into the microprocessor 30 through the touchscreen interface 31 and stored in the memory 37 along with the predefined pressure values to which the colon 7 is to be insufflated selected from column seven of the pressure values look-up table 38.

[0323] With the subject 8 lying on an operating table 44 or other suitable support in the appropriate rest position, for example, the left lateral position as illustrated in Fig. 4, the monitoring unit 32 is secured to the body of the subject 8 adjacent the anus 35. The colonoscope 5 is then entered through the monitoring unit 32 through the anus 35 and the rectum 36 into the colon 7. As the colonoscope 5 is being urged into the colon 7, the microprocessor 30 operates the flow controller 20 to commence insufflating the colon 7. The colonoscope 5 is urged through the colon 7 until the distal end 10 of the colonoscope 5 is adjacent the cecum 39 of the colon 7. The colonoscope 5 comprises a visual display screen 6 on which images of targeted areas 11 in the colon 7, which are captured by an image capturing device 9 of the colonoscope 5, are displayed. The image capturing device 9 is located adjacent the distal end 10 of the colonoscope 5 and captures images of the targeted areas 11 of the colon 7 just distally of the distal end 10 of the colonoscope 5.

[0324] As the distal end 10 of the colonoscope 5 is entering the sigmoid colon 41 from the rectum 36, which the surgeon or clinician determines from the images captured by the image capturing device 9 displayed on the visual display screen 6 of the colonoscope 5, the surgeon or clinician enters a signal into the microprocessor 30 through the touchscreen interface 31 to indicate to the microprocessor 30 that the distal end 10 of the colonoscope 5 is adjacent the location where the sigmoid colon 41 transitions to the rectum 36. The surgeon or clinician observes the captured images of the colon 7 displayed on the visual display screen 6 as the colonoscope 5 is being urged through the colon 7, and on determining from the visual display screen 6 that the distal end 10 of the colonoscope 5 is adjacent the location where the sigmoid colon 41 transitions to the descending colon 45, the surgeon or clinician enters a signal to the microprocessor 30 through the touchscreen interface 31 to indicate to the microprocessor 30 that the distal end 10 of the colonoscope 5 is adjacent the transitioning of the sigmoid colon 41 to the descending colon 45. When the distal end 10 of the colonoscope 5 is adjacent the location where the descending colon 45 transitions to the transverse colon 40, the surgeon or clinician enters a signal to the microprocessor 30 through the touchscreen interface 31 to indicate to the microprocessor 30 that the distal end 10 of the colonoscope 5 is adjacent the location where the descending colon 45 transitions to the transverse colon 40. When the distal end 10 of the colonoscope 5 is adjacent the location where the transverse colon 40 transitions to the ascending colon 46, the surgeon or clinician enters a further signal to the microprocessor 30 through the touchscreen interface 31 to indicate to the microprocessor 30 that the distal end 10 of the colonoscope 5 is adjacent the location where the transverse colon 40 transitions to the ascending colon 46. When the distal end 10 of the colonoscope 5 is adjacent the cecum 39, the surgeon or clinician also enters a further signal through the touchscreen interface 31 to indicate to the microprocessor 30 that the distal end 10 of the colonoscope 5 is at the cecum 39.

[0325] As the colonoscope 5 is being urged through the colon 7 from the location at which the sigmoid colon 41 transitions to the rectum 36 to the location of the cecum 39, each time the monitoring unit 32 detects one of the graduations 33 of the graduated scale 34 on the colonoscope 5, the monitoring unit 32 outputs a signal indicative of detection of one of the graduations to the microprocessor 30. The microprocessor 30 counts the signals indicative of the detection of the graduations, and the microprocessor 30 is programmed to determine the length of the colon 7 of the subject between the transitioning of the sigmoid colon 41 to the rectum 36 and the cecum 39 from the count of the graduations and the signals inputted through the touchscreen interface 31 to the microprocessor 30 indicating the locations of the distal end 10 of the colonoscope 5 adjacent the transitioning of the sigmoid colon 41 to the rectum 36 and being adjacent the cecum 39. The microprocessor 30 is also programmed to determine the lengths of the sigmoid colon 41, the descending colon 45, the transverse colon 40 and the ascending colon 46 from the counts of the signals indicative of the detection of the graduations 33 on the colonoscope 5 and the signals inputted through the touchscreen interface 31 to the microprocessor 30 indicating the locations of the distal end 10 of the colonoscope 5 being adjacent the transitioning of the sigmoid colon 41 to the rectum 36, the transitioning of the sigmoid colon 41 to the descending colon 45, the transitioning of the descending colon 45 to the transverse colon 40, the transitioning of the transverse colon 40 to the ascending colon 46, and the cecum 39.

[0326] On having determined the lengths of the ascending colon 46, the transverse colon 40, the descending colon 45 and the sigmoid colon 41, the signal produced by the monitoring unit 32, which contains a count of the graduations 33 on the colonoscope 5, as the colonoscope 5 is being withdrawn through the colon 7 from the cecum 39 is effectively a location signal indicative of the current location of the distal end 10 of the colonoscope 5, and in turn is indicative of the current location of the targeted area 11.

[0327] With the distal end 10 of the colonoscope 5 adjacent the cecum 39, the surgeon or clinician commences to slowly withdraw the colonoscope 5 through the colon 7, and as the colonoscope 5 is being withdrawn through the colon 7, the surgeon or clinician manoeuvres the distal end 10 of the colonoscope 5 in order to scan the entire inner surface 14 of the colon wall 15 from one targeted area 11 to the next targeted area 11 as the targeted areas 11 of the colon wall sequentially come within the field of view of the image capturing device 9 of the colonoscope 5 and are displayed on the visual display screen 6 of the colonoscope 5.

[0328] As the colonoscope 5 is being withdrawn from the cecum 39 through the colon 7, the microprocessor 30 monitors the value of the location signal from the monitoring unit 32 in order to determine the location of the distal end 10 of the colonoscope 5, and in turn to determine the location of the current targeted area 11 in the colon 7 which is within the field of view of the image capturing device 9 of the colonoscope 5. The microprocessor 30 on determining the location of the current targeted area 11 in the colon 7, operates the flow controller 20 in response to the pressure read from the pressure sensor 24 to supply insufflating gas to the colon 7 at an appropriate rate in order to maintain the pressure in the colon 7 at the predefined pressure value appropriate to the location in the colon 7 within which the current targeted area 11 is located. As the colonoscope 5 is being withdrawn through the colon 7 and is being manoeuvred to sequentially scan the entire inner surface 14 of the colon wall 15, the captured images of the inner surfaces 14 of the colon wall 15 in the targeted areas 11 are sequentially displayed on the visual display screen 6 of the colonoscope 5, and the surgeon or clinician visually inspects targeted areas 11 sequentially displayed on the visual display screen 6 for the presence of a lesion.

[0329] On detecting a lesion in or on a targeted area 11 , the surgeon or clinician operates the pedal operated switch 42 by depressing the foot pedal 43 to produce the lesion present signal indicative of detection of a lesion. The microprocessor 30 in response to the lesion present signal operates the flow controller 20 to increase the supply of insufflating gas to the colon 7 to increase the pressure in the colon 7 from the current predefined pressure value to the elevated pressure by increasing the current predefined pressure value by the preset pressure increase amount, in this case by approximately 5mmHg, to in turn increase the working volume in the colon 7 to facilitate removal of the lesion. The pressure in the colon 7 is maintained at the elevated pressure for so long as the lesion present signal remains active, in other words, for so long as the foot pedal 43 of the foot pedal operated switch 42 remains depressed by the surgeon or clinician to maintain the switch 42 in the closed circuit state.

[0330] With the pressure in the colon 7 maintained at the elevated pressure, the surgeon or clinician as will be described in more detail below, removes the detected lesion. On completion of removal of the detected lesion, the surgeon or clinician removes his / her foot from the foot pedal 43, thereby operating the switch 42 into the open circuit state and deactivating the lesion present signal, and the microprocessor 30 operates the flow controller 20 to reduce the supply of insufflating gas to the colon 7 in order to reduce the pressure therein to the appropriate predefined pressure value corresponding to the location in the colon 7 within which the current targeted area 11 is located, and so operation of the apparatus 1 continues until the colonoscope 5 has been withdrawn through the entire length of the colon 7 from the cecum 39. In the absence of a lesion being detected in any of the targeted areas, the surgeon or clinician manoeuvres the colonoscope 5 to view the next adjacent targeted area 11.

[0331] In this embodiment of the invention the microprocessor 30 is also programmed to be responsive to a reduce pressure signal to operate the flow controller 20 to reduce the supply of insufflating gas to the colon 7 to reduce the colon pressure to a reduced pressure by reducing the current predefined pressure value or the current pressure at which the colon 7 is being insufflated by a preset pressure reduction amount. In this embodiment of the invention the preset pressure reduction amount is also equal to approximately 5mmHg, although, the preset pressure reduction amount by which the colon pressure is reduced may lie in the range of 3mmHg to 8mmHg. The reduce pressure signal is entered into the microprocessor 30 through the touchscreen interface 31. The value of the preset pressure reduction amount may be prestored in the memory 37, or may be selectable, and if selectable the preset pressure reduction amount would be entered into the memory 37 through the touchscreen interface 31 when entering the value of the present pressure increase amount and / or the data relating to the subject into the memory 37 through the touchscreen interface 31. Typically, the surgeon or clinician would require the colon pressure to be reduced by the preset pressure reduction amount in order to reduce tension in the colon wall which may be necessary on some occasions to enable grasping of a portion of the inner surface 14 of the colon wall 15 infected by a lesion, to enable removal of the lesion from the colon wall.

[0332] Referring now to Figs. 5a to 5c, the removal of one of the lesions 17, which in this case is a pre-cancerous polyp from the inner surface 14 of the colon wall 15 of one of the targeted areas 11 will now be described. On detection of the lesion 17, and with the foot pedal operated switch 42 producing the lesion present signal or the reduce pressure signal inputted through the touchscreen interface 31, the colon 7 is maintained by the flow controller 20 at the elevated pressure or the reduced pressure, as the case may be. The surgeon or clinician then urges a suitable snaring instrument, in this case a snaring instrument 47 through the instrument channel 29 of the colonoscope 5 until a snare 48 extending from a distal end 49 of the snaring instrument 47 extends through the distal end 10 of the colonoscope 5 into the colon 7 adjacent the current targeted area 11. The snare 48 of the snaring instrument 47 is then passed over the lesion 17, see Fig. 5a, and the snare 48 is withdrawn into the snaring instrument 47 through the distal end 49 thereof, see Fig. 5b, in order to sever the lesion 17 from the inner surface 14 of the colon wall 15 in the targeted area 11. As discussed above, on severing the lesion 17 from the targeted area 11 , the foot pedal 43 of the foot pedal operated switch 42 is released, if it had been operated, to terminate the lesion present signal. If the reduce pressure signal had been entered through the touchscreen interface 31, a further signal would be entered through the touchscreen interface 31 to cancel the reduce pressure signal. The microprocessor 30 is responsive to termination of the lesion present signal or to termination of the reduce pressure signal, as the case may be, to operate the flow controller 20 to reduce or increase, as the case may be, the supply of insufflating gas to the colon 7 in order to reduce or increase the pressure in the colon 7 to the predefined pressure value or the pressure value at which the colon 7 had been insufflated prior to activation of the lesion present signal or the reduce pressure signal.

[0333] It will of course be appreciated that any suitable appropriate instrument for removing any lesions such as adenomas or polyps may be used, and in some embodiments of the invention where suturing is required, a suitable suturing instrument will be urged through the instrument channel 29 of the colonoscope 5 after the snaring instrument 47 has been removed to complete any suturing which may be required at the site from which the lesion has been removed.

[0334] It will be appreciated that while the foot pedal operated switch 42 has been described as being adapted to produce the lesion present signal continuously while the foot pedal 43 thereof is maintained depressed, in some embodiments of the invention it is envisaged that the microprocessor 30 may be programmed so that each alternate time the foot pedal operated switch 42 is operated, the microprocessor 30 would read the alternate lesion present signals as deactivation signals. Thereby, the microprocessor 30 would read the signal produced by the first operation of the foot pedal operated switch 42 as being a lesion present signal indicative of the detection of a lesion in the current targeted area requiring the pressure in the colon to be raised to the elevated pressure, and the signal produced by the second operation of the foot pedal operated switch 42 as being a signal indicative of the completion of the removal of a lesion, and thus indicating deactivation of the lesion present signal, and the microprocessor 30 would then operate the flow controller to reduce the colon pressure from the elevated pressure to the predefined pressure value at which the colon had been insufflated prior to the first operation of the foot pedal operated switch 42 to produce the second signal, or to the predefined pressure value corresponding to the location of the current targeted area 11. It is also envisaged that the microprocessor 30 may be programmed to interpret each alternate inputting of the reduce pressure signal through the touchscreen interface 31 as being indicative of termination of the reduce pressure signal, and to operate the flow controller 20 accordingly.

[0335] Referring now to Figs. 6 to 9 there is illustrated insufflating apparatus also according to the invention indicated generally by the reference numeral 50 for insufflating a vessel in the body of a human subject during a minimally invasive procedure for maintaining the topography of an inner surface of a wall of the vessel of a targeted area at a predefined degree of evenness, and also for detecting the presence of a lesion in or on the inner surface of the vessel in a targeted area thereof, for example, a pre-cancerous lesion, a pre-cancerous adenoma or a pre-cancerous polyp.

[0336] The apparatus 50 comprises an insufflator 53 also according to the invention, a colonoscope 55 and an image recognition apparatus 56. The apparatus 50 is adapted for use in a colon 57 of a subject 58, and the insufflator 53 is adapted for insufflating the colon 57 so that the topography 62 of an inner surface 64 of the colon wall 65 of a targeted area 61 adjacent a distal end 60 of the colonoscope 55, which is within the field of view of the colonoscope 55, is maintained at a predefined degree of evenness to enable detection of a lesion in or on the inner surface 64 of the colon wall 65 in the targeted area 61 , for example, a pre-cancerous lesion, a pre-cancerous adenoma and / or a pre-cancerous polyp, similar to the lesion 17 described with reference to the insufflating apparatus 1 of Figs. 1 to 5.

[0337] Turning initially to the insufflator 53, the insufflator 53 comprises a housing 72 within which a flow controller 74 is located for controlling the supply of insufflating gas to the colon 57. The insufflator 53 is supplied with insufflating gas from an insufflating gas source 75 through a first inlet port 71 located in the housing 72. The insufflating gas source 75 may be any suitable source, and in this embodiment of the invention comprises a source of pressurised carbon dioxide gas which is readily available in an operating theatre or an endoscopy suite of a hospital. The insufflating gas from the insufflating gas source 75 is supplied to the flow controller 74 through the first inlet port 71. The flow controller 74 is connected to the colonoscope 55 through a first outlet port 73 and a gas line 76 connected to the first outlet port 73 for delivering insufflating gas to the colon 57 through an insufflating gas channel 63 of the colonoscope 55.

[0338] A control means, provided by a signal processor, which in this case comprises a microprocessor 77 located in the housing 72, controls the operation of the insufflator 53 and controls the flow controller 74 for controlling the supply of the insufflating gas to the colon 57 as will be described below. An interface, in this embodiment of the invention a touchscreen interface 79 for communicating with the microprocessor 77 is located on the housing 72. The touchscreen interface 79 is adapted to permit entry of data relating to the colonoscope 55 being used in conjunction with the insufflator 53, and entry of data and signals required by the insufflator 53 during carrying out of the procedure, as will be described below. The touchscreen interface 79 is also adapted to display relevant data relating to the insufflating of the subject as will also be understood by those skilled in the art.

[0339] A pressure sensor 80 located in the housing 72 is connected through a second outlet port 66 and a pressure monitoring line 81 to a suitable channel of the colonoscope 55 so that pressure in the colon 57 may be monitored by the pressure sensor 80 during insufflating of the colon 57. As discussed with reference to the colonoscope 5 described with reference to the insufflating apparatus 1 of Figs. 1 to 5, the colon pressure may be monitored through, for example, and instrument channel 29 of the colonoscope 55, a vacuum channel, a channel purposed for suctioning or any other suitable channel. The pressure sensor 80 produces a signal indicative of the colon pressure which is read by the microprocessor 77. The microprocessor 77 is programmed to compare the colon pressure with a maximum pressure value stored in a memory 83 of the microprocessor 77, and if the colon pressure exceeds the maximum pressure value, the microprocessor 77 is programmed to output a pressure alert signal which is applied to a sounder 82 of the insufflator 53 to alert a surgeon or a clinician to the excessive pressure in the colon 57. The maximum pressure value may be preset in a memory 83 of the microprocessor 77, or may be entered by the surgeon or clinician into the memory 83 through the touchscreen interface 79.

[0340] Turning now to the image recognition apparatus 56, the image recognition apparatus 56 may be located in the housing 72 of the insufflator 53 or it may be provided separately from the insufflator 53. In this embodiment of the invention the image recognition apparatus 56 is provided separately from the insufflator 53. The image recognition apparatus 56 comprises an image recognition means comprising an image recognition unit 84 located in a housing 78 of the image recognition apparatus 56. The image recognition unit 84 reads signals from an image capturing device indicative of the inner surface 64 of the colon wall 65 of the targeted area 61 , which is within the field of view adjacent the distal end 60 of the colonoscope 55.

[0341] The image capturing device may be an image capturing device of the colonoscope, or it may be a dedicated image capturing device of the image recognition unit 84, which would be located in a suitable channel of the colonoscope 55 adjacent the distal end 60 thereof for capturing images of the targeted areas 61. In this embodiment of the invention the image capturing device comprises an image capturing device 85 of the colonoscope 55 located adjacent the distal end 60 of the colonoscope 55. Signals indicative of images captured by the image capturing device 85 are relayed to the image recognition unit 84 through a cable 86 from the colonoscope 55. The signals produced by the image capturing device 85 are produced in digital form and are relayed to the image recognition unit 84 in digital form. The images captured by the image capturing device 85 are also displayed on a visual display screen 91 of the colonoscope 55.

[0342] The image recognition unit 84 is adapted to operate in two modes. In the first mode of operation the image recognition unit 84 is adapted to determine the degree of evenness of the topography of the inner surface 64 of the colon wall 65 of the targeted area 61 the subject of a captured image thereof. In the second mode of operation the image recognition unit 84 is adapted to scan the inner surface 64 of the colon wall 65 of the targeted area 61 for the presence of a lesion, and to detect the presence of a lesion in the targeted area 61 , the subject of a captured image thereof, should such a lesion be present.

[0343] In the first mode the image recognition unit 84 is adapted to sequentially compare captured images of the inner surfaces 64 of the colon wall 65 of respective targeted areas 61 with topography reference images 88 of reference surfaces, the topographies of which, are of different degrees of evenness, in order to determine the degree of evenness of the topography of the targeted area 61, the subject of each captured image. The topography reference images 88 are stored in digital form in an electronic memory 87 of the image recognition unit 84 in the form of a topography reference image look-up table 89, see Fig. 7. Five topography reference images 88 of five reference surfaces of topographies of different degrees of evenness are stored in the topography reference image look-up table 89. The five topography reference images 88 are stored in column one of the topography reference image look-up table 89 of Fig. 7, while values from "1” to “5” identifying the degree of evenness of the topographies of the reference surfaces of the respective topography reference images 88 are stored in column two of the topography reference image look-up table 89.

[0344] The value "1” in column two of the topography reference image look-up table 89 is indicative of the reference surface of the corresponding topography reference image 88 in column one of the topography reference image look-up table 89 being of topography of the predefined degree of evenness. The topography of the reference surface of the predefined degree of evenness is representative of a substantially flat surface, of a degree of flatness sufficient to enable detection of a relatively small lesion in or on the inner surface 64 of the colon wall 65 of any of the targeted areas 61 when the degree of evenness thereof is of the predefined degree of evenness. The value “5" in column two of the topography reference image look-up table 89 is indicative of the topography of the reference surface of the corresponding topography reference image 88 in column one of the topography reference image look-up table 89 being of a poor degree of evenness. The values "2” to “4" in column two of the topography reference image look-up table 89 are indicative of the topographies of the reference surfaces of the corresponding topography reference images 88 in column one of the topography reference image look-up table 89 being of progressively decreasing degrees of evenness from the degree of evenness of value “1” of the predefined degree of evenness to the value "5” thereof.

[0345] The image recognition unit 84 is adapted to compare the captured image of each targeted area 61 sequentially with the topography reference images in the topography reference image look-up table 89 commencing with the topography reference image of the degree of evenness of value “1" progressively through the topography reference images of the degrees of evenness from value "2” to value “5”. On determining the topography reference image which is a match or the best match of the captured image of the current targeted area 61, the image recognition unit produces a topography signal indicative of the degree of evenness of the topography of the topography reference image which is the match or the best match of the captured image. The value of the topography signal produced by the image recognition unit 84 is equal to the corresponding value of the values “1” to “5” corresponding to the degree of evenness of the topography of the reference surface of the topography reference image 88 with which the captured image is the match or the best match.

[0346] The microprocessor 77 reads the value of the topography signal produced by the image recognition unit 84 which is indicative of the degree of evenness of the topography of the inner surface 64 of the colon wall 65 of the targeted area 61, the subject of the captured image. The microprocessor 77 is programmed to operate the flow controller 74 to control the supply of insufflating gas to the colon 57 in response to the value of the topography signal to maintain the topography of the current targeted area 61 at the predefined degree of evenness.

[0347] If the topography signal produced by the image recognition unit 84 is of value “1”, which is indicative of the inner surface 64 of the colon wall 65 of the current targeted area 61 being of the predefined degree of evenness, the microprocessor 77 operates the flow controller 74 to maintain the supply of insufflating gas to the colon 57 at its current flow rate for maintaining the colon pressure at the current colon pressure, to in turn maintain the topography of the inner surface 64 of the colon wall 65 of the targeted area 61 at the predefined degree of evenness. If the value of the topography signal indicative of the degree of evenness of the topography of the inner surface 64 of the colon wall 65 of the current targeted area 61 produced by the image recognition unit 84 is of any of the values “2” to “5”, the microprocessor 77 operates the flow controller 74 to incrementally increase the rate of delivery of the insufflating gas to the colon 57 in order to incrementally increase the pressure in the colon 57 until the value of the topography signal produced by the image recognition unit 84 is equal to the value “1”, and the evenness of the inner surface 64 of the colon wall 65 of the current targeted area 61 is of the predefined degree of evenness.

[0348] The microprocessor 77 of the insufflator 53 is programmed to output a lesion scan signal to the image recognition unit 84 in response to the value of the topography signal produced by the image recognition unit 84 being equal to the value “1” for the currently captured image of the current targeted area 61. The image recognition unit 84 is responsive to the lesion scan signal to operate in the second mode of operation, and to scan the inner surface 64 of the colon wall 65 of the current targeted area 61 , which is now of the predefined degree of evenness, for the presence of a lesion. The image recognition unit 84 in response to the lesion scan signal from the microprocessor 77 to commence comparing the captured image of the current targeted area 61, now at the predefined degree of evenness, with a plurality of lesion reference images 90 of reference surfaces having representations of reference lesions of different types and different sizes stored in the memory 87 of the image recognition apparatus 56 to determine the presence of a lesion on the targeted area 61 should such a lesion be present thereon. The lesion reference images 90 of the reference surfaces having representations of lesions thereon are stored in a lesion reference image look-up table 93 which is stored in the memory 87, see Fig. 8.

[0349] The lesion reference image look-up table 93 comprises three lesion reference images 90 of each of three different types of lesions, each of three different sizes. The three lesion reference images 90 of a first one of the lesions, comprises three reference images of a pre-cancerous lesion of three different sizes, namely, a small pre-cancerous lesion, a medium size pre-cancerous lesion and a large pre-cancerous lesion. A second one of the lesions for which three lesion reference images 90 are stored in the lesion reference image look-up table 93 comprises reference images of pre-cancerous adenoma, namely, a lesion reference image 90 of a pre-cancerous adenoma of a small size, a lesion reference image 90 of a pre-cancerous adenoma of a medium size, and a lesion reference image 90 of a pre-cancerous adenoma of a large size. A third one of the lesions for which three lesion reference images 90 are stored is a pre- cancerous polyp, and three lesion reference images 90 of the pre-cancerous polyp, namely, a lesion reference image 90 of a pre-cancerous polyp of a small size, a lesion reference image 90 of a pre- cancerous polyp of a medium size and a lesion reference image 90 of a pre-cancerous polyp of a large size are stored in the lesion reference image look-up table 93. The lesion reference images 90 are stored in column one of the lesion reference image look-up table 93, and the identities of the lesion reference images 90 together with the sizes thereof are stored in column two of the lesion reference image look-up table 93.

[0350] The lesion reference images 90 of the pre-cancerous lesion are identified by the reference value "1” in column two of the lesion reference image look-up table 93, and their sizes are identified by the reference values “1" to “3” also in column two of the lesion reference value look-up table 93 as "1.1", “1.2” and “1.3”. The reference value “1.1” identifies the corresponding lesion reference image 90 as being a reference image of a pre-cancerous lesion of a small size. The reference value “1.2” identifies the corresponding lesion reference image 90 as being a reference image of a pre-cancerous lesion of a medium size, while the reference value “1.3” identifies the corresponding lesion reference image 90 as being a reference image of a pre-cancerous lesion of a large size. Similarly, the values “2.1”, “2.2” and “2.3” identify the corresponding lesion reference images 90 of a pre-cancerous adenoma of a small size, a medium size and a large size, respectively, while the reference values “3.1”, “3.2” and “3.3” identify the corresponding lesion reference images 90 of a pre-cancerous polyp of a small size, a medium size and a large size, respectively.

[0351] The image recognition unit 84 on receiving the lesion scan signal from the microprocessor 77 compares the current captured image of the current targeted area 61, the degree of evenness of which is of the predefined degree of evenness, sequentially with the nine lesion reference images 90, commencing with the lesion reference image 90 of the small pre-cancerous lesion, namely, the lesion reference image of reference value “1.1” to the lesion reference image 90 of the large polyp, namely, the lesion reference image of reference value “3.3” until a match or the best match for the captured image with one of the lesion reference images 90 has been determined.

[0352] On completion of the comparison of the current captured image of the current targeted area 61 with the lesion reference images 90, the image recognition unit 84 outputs a lesion present signal to the microprocessor 77 of the insufflator 53. If no match is found for the current captured image of the current targeted area 61 , the image recognition unit 84 outputs the lesion present signal of value zero to the microprocessor 77, thus indicating the absence of a match, and also the absence of a lesion in or on the inner surface 64 of the colon wall 65 of the current targeted area 61. If a match or a best match of the captured image of the current targeted area 61 is determined with any of the lesion reference images 90, the image recognition unit 84 outputs the lesion present signal to the microprocessor 77 of the relevant value “1.1” to “3.3” indicative of the identity of the lesion reference image 90 which matches the current captured image, or is the best match thereof, thus indicating the presence of a lesion, the type and the size of the lesion in the current targeted area 61.

[0353] Additionally, in this embodiment of the invention the lesion present signal, as well as identifying the lesion reference image which is a match of the captured image or the best match thereof, the lesion present signal may also include data identifying the location of the lesion in the current targeted area 61. This would enable the location of the lesion to be marked on the captured image of the targeted area displayed on the visual display screen 91 of the colonoscope 55.

[0354] On receiving the lesion present signal, the microprocessor 77 determines from the value of the lesion present signal whether a lesion is present in the current image of the current targeted area 61 or not. If the value of the lesion present signal is zero, the microprocessor 77 determines that the current image of the current targeted area 61 is free of lesions, and produces a data signal for display on the touchscreen interface 79 indicating that the current targeted area 61 is free of lesions, and outputs a signal to the image recognition unit 84 to operate in the first mode as already described to compare the captured image of the next targeted area 61, to which the surgeon or clinician has manoeuvred the colonoscope 55, with the topography reference images 88 of the topography reference image look-up table 89, until the inner surface 64 of the colon wall 65 is of the predefined degree of evenness.

[0355] If the lesion present signal is of value indicating the presence of a lesion in the current targeted area 61, the microprocessor 77 may output an alert signal to the sounder 82 to operate the sounder 82 to produce an audible lesion present alert signal indicating the presence of a lesion in the current targeted area 61. The microprocessor 77 also outputs a data signal to the touchscreen interface 79 to produce a message thereon indicating the presence of a lesion in the current targeted area 61.

[0356] Additionally, the microprocessor 77 on receiving the lesion present signal indicative of the presence of a lesion in the current targeted area 61 is programmed to operate the flow controller 74 to increase the supply of insufflating gas to the colon to in turn increase the pressure to which the colon is currently being insufflated by the preset pressure increase amount in order to increase the colon pressure to an elevated pressure so that the working volume within the colon adjacent the current targeted area 61 is increased to facilitate removal of the lesion. In this embodiment of the invention the preset pressure increase amount by which the current predefined pressure value to which the colon is being insufflated is increased in response to the second signal being indicative of detection of a lesion is approximately 5mmHg.

[0357] The microprocessor 77 is also programmed that on the lesion present signal being indicative of the detection of a lesion to output a signal to the visual display screen 91 of the colonoscope 55, on which the current captured image is being displayed, to highlight the lesion on the displayed image on the visual display screen 91 by encircling the image of the lesion with an image of a ring.

[0358] With the colon 57 insufflated to the elevated pressure, the surgeon or clinician removes the targeted lesion by inserting a snaring tool, similar to that described with reference to the insufflating apparatus 1 of Figs. 1 to 5 through an instrument channel 29 of the colonoscope 55 into the colon 57 to the current targeted area 61 and severing the lesion from the inner surface 64 of the colon wall 65 of the targeted area 61, as already described with reference to the insufflating apparatus 1 of Figs. 1 to 5.

[0359] On completion of the severing of the lesion from the targeted area 61 , the microprocessor 77 outputs the signal to the image recognition unit 84 to operate the image recognition unit 84 in the first mode to compare the captured image of the next targeted area, to which the surgeon or clinician has manoeuvred the colonoscope 55, with the topography reference images 88 of the topography reference image look-up table 89 until the inner surface 64 of the colon wall 65 of the next captured image is of the predefined degree of evenness. And so operation of the insufflation apparatus 50 continues.

[0360] It is envisaged that in some embodiments of the invention the microprocessor 77 may be programmed to be responsive to a reduce pressure signal to operate the flow controller 74 to reduce the supply of insufflating gas to the colon 57 to reduce the colon pressure to a reduced pressure by reducing the current pressure at which the colon 57 is being insufflated by a preset pressure reduction amount, which in this embodiment of the invention is also equal to approximately 5mmHg, although, the preset pressure reduction amount by which the colon pressure is reduced may lie in the range of 3mmHg to 8mmHg. Typically, a surgeon or clinician would enter the reduce pressure signal through the touchscreen interface 79 or through a manually operated electrical switch, such as a foot pedal operated switch similar to the foot pedal operated switch 42 of the insufflating apparatus 1 of Figs. 1 to 5. Turning now to the construction of the topography and lesion look-up tables 89 and 93, respectively, initially, the topography and lesion reference images are prepared from reference surfaces of a vessel similar to the vessel in which the procedure is to be carried out and from reference images of lesions of the types and sizes to be detected. The topography and lesion reference image look-up tables 89 and 93 are prestored in respective topography and lesion memories, which in this case are provided by locations in the memory 87 of the image recognition apparatus 56. However, once the topography and lesion reference images of the topography and lesion reference image look-up tables 89 and 93 have been constructed and stored in the memory 87, the reference images are updated by the application of artificial intelligence during use of the insufflating apparatus 50. Any suitable artificial intelligence algorithms may be used. However, in this embodiment of the invention each captured image which is a match or a best match of a corresponding one of the topography or lesion reference images in the topography or lesion reference image look-up tables 89 or 93 is passed through a learning model 94 of the image recognition apparatus 56 and stored as an additional topography reference image or an additional lesion reference image to the corresponding one of the topography reference image or lesion reference image with which it matched or is the best match thereof.

[0361] Additional topography and lesion reference images of each corresponding topography or lesion reference image are stored in the topography or lesion reference image look-up tables 89 or 93 until the number of additional topography or lesion reference images of each corresponding topography or lesion reference image reaches a predefined number of additional topography or lesion reference images, and on the number of additional topography or lesion reference images of a topography or lesion corresponding reference image exceeding the predefined number of additional reference images, the earliest one of the additional topography or lesion reference images is deleted and the new additional reference image is sequentially stored as the most recent reference image, and each time a new additional reference image is to be added to a corresponding reference image, the earliest additional reference image is deleted. Typically, the predefined number of topography reference images, or lesion reference images may lie in the range of 3 to 10, and typically, would be five additional reference images corresponding to the corresponding topography reference image, or the corresponding lesion reference image.

[0362] Depending on the mode of operation of the image recognition unit 84, each captured image is compared with the topography or lesion reference images and the additional topography and lesion reference images in the topography or the lesions reference image look-up tables. In other words, a number of captured images which matched with or were the best match with the first one of the topography reference image 88, namely, the topography reference image “1” in column 1 of the topography reference image look-up table 89 would be stored as additional topography reference images in the topography reference image look-up table 89 along with the topography reference image "1" of the topography reference images 88, until the number of additional topography reference images corresponding to the first topography reference image “1 ” exceeded the predefined number. At which stage the earliest stored one of the additional topography reference images stored in the topography reference image look-up table 89 corresponding to the first topography reference image “1” would be deleted, so that the number of additional topography reference images corresponding to the topography reference image “1” never exceeded the predefined number thereof, and so on for each of the topography reference images 88, and also for each of the lesion reference images 90, so that the number of additional lesion reference images would not exceed the predefined number of additional lesion reference images.

[0363] In use, with the insufflator 53 connected to the insufflating gas source 75 and to the colonoscope 55 as described above, and with the image recognition unit connected to the insufflator, and to the colonoscope 55 as also described above, the insufflating apparatus 50 is ready for use. The maximum pressure value over which the colon 57 should not be insufflated if it is not already preset in the memory 83 of the microprocessor 77 is selected and entered through the touchscreen interface 79 into the memory 83 of the microprocessor 77. The preset pressure increase amount, if it is not already present in the memory 83 of the microprocessor 77, is likewise selected and entered into the memory 83 of the microprocessor 77 through the touchscreen interface 79. The preset pressure reduction amount, if it is not already preset in the memory 83 of the microprocessor 77, is likewise selected and entered into the memory 83 of the microprocessor 77 through the touchscreen interface 79. With the maximum pressure value, the preset pressure increase amount and the preset pressure reduction amount stored in the memory 83 of the microprocessor 77, the surgeon or clinician enters the colonoscope 55 anally into the colon 57 of the subject. As the colonoscope 55 is being entered into the colon 57 the microprocessor 77 operates the flow controller 74 to commence insufflating of the colon 57.

[0364] Initially, the colonoscope 55 is urged through the colon 57 to the cecum 96, and the microprocessor 77 operates the flow controller 74 to insufflate the colon 57 to a pressure of approximately 15mmHg. The colonoscope 55 is then slowly withdrawn through the colon 57. As the colonoscope 55 is being withdrawn slowly through the colon 57, the surgeon or clinician manoeuvres the distal end 60 of the colonoscope 55 to scan the entire inner surface 64 of the colon wall 65 from one targeted area 61 to the next targeted area 61 within the field of view of the image capturing device 85 of the vision system of the colonoscope 55 from the cecum to the transition of the sigmoid colon 97 to the rectum 98. Initially, the vision recognition unit 84 is adapted to operate in the first mode of operation. As the first one of the targeted areas 61 of the colon 57 is within the field of view of the image capturing device 85 of the colonoscope 55, the image recognition unit 84 commences to read the signal from the image capturing device 85 indicative of the captured image of the first and current targeted area 61 adjacent the cecum 96, and sequentially compares the current captured image with the topography reference images 88 and any corresponding additional topography reference images in column 1 of the topography reference image look-up table 89 until a match or a best match of the captured image with one of the topography reference images 88 or the additional topography reference images is determined. On determining a match or a best match, the image recognition unit 84 produces the topography signal of value equal to the value in column two of the topography reference image look-up table 89 corresponding to the topography reference image 88 or the additional topography reference image with which the match or the best match is determined.

[0365] The microprocessor 77 on reading the value of the topography signal operates the flow controller 74 to incrementally increase the supply of insufflating gas to the colon 57 if the value of the topography signal is of any of the values “2" to “5”, indicating that the degree of evenness of the current targeted area 61 is not of the predefined degree of evenness. On the other hand, if the value of the topography signal is of value “1”, the microprocessor 77 controls the flow controller 74 to maintain the supply of insufflating gas to the colon 57 in order to maintain the degree of evenness of the current targeted area 61 at the predefined degree of evenness.

[0366] On the current targeted area 61 being of the predefined degree of evenness, the microprocessor 77 outputs the lesion scan signal to the image recognition unit 84 to operate the image recognition unit 84 to operate in the second mode. The image recognition unit 84 commences to compare the current captured image of the current targeted area 61 , which is now of the predefined degree of evenness, with the lesion reference images 90 and the additional lesion reference images, if any, of the lesions stored in column one of the lesion reference image look-up table 93. On completion of the comparison of the current captured image of the current targeted area 61 with the lesion reference images 90 and the additional lesion reference images, the image recognition unit 84 produces the lesion present signal of value zero in the absence of a lesion being detected. If a lesion has been detected, the image recognition unit 84 produces the lesion present signal to be of the value in column two of the lesion reference image look-up table 93 corresponding to the value of the lesion reference image 90 in column one thereof, with which the captured image of the current targeted area 61 is a match or the best match thereof. On the value of the lesion present signal produced by the image recognition unit 84 being of value zero indicating the absence of a lesion in the captured image of the current targeted area 61 , the microprocessor 77 produces the data signal which is applied to the touchscreen interface 79 indicating the absence of a lesion in the current targeted area, the microprocessor 77 outputs the signal to the image recognition unit 84 to return operation of the image recognition unit 84 to the first mode of operation. The surgeon or clinician then manoeuvres the colonoscope 55 to the next targeted area 61.

[0367] On the other hand, should the lesion present signal produced by the image recognition unit be indicative of the presence of a lesion in the current targeted area 61 , the microprocessor 77 outputs an alert signal to the sounder 82 to produce an audible alert signal alerting to the presence of a lesion in the targeted area 61, and a data signal is also applied by the microprocessor 77 to the touchscreen interface 79 to display a message thereon indicating the presence of a lesion in the current targeted area 61. The microprocessor 77 also outputs a signal to the visual display screen 91 of the colonoscope 55 to highlight the image of the lesion and its location on the visual display screen 91 of the colonoscope 55 by encircling the image of the lesion on the visual display screen 91 with an image of a ring extending around the lesion. The microprocessor 77 also in response to the lesion present signal being indicative of the presence of a lesion in the current targeted area 61 operates the flow controller 74 to increase the supply of insufflating gas to the colon 57 in order to raise the pressure in the colon by the preset pressure increase amount of 5mmHg above the current pressure to which the colon 57 is being insufflated, so that the colon is insufflated to the elevated pressure to increase the working volume within the colon 57.

[0368] The surgeon or clinician then severs the lesion from the targeted area 61. On severing of the lesion, the surgeon or clinician through the touchscreen interface 79 indicates completion of the severing of the lesion from the current targeted area 61, and the microprocessor 77 outputs the signal to the image recognition unit 84 to operate the image recognition unit 84 in the first mode, and operates the flow controller 74 to reduce the supply of insufflating gas to the colon 57 in order to return the colon pressure to the pressure at which the colon 57 had been insufflated up to the operation of the flow controller 74 by the microprocessor 77 in response to the lesion present signal from the image recognition unit 84. If the surgeon or clinician had entered the reduce pressure signal through the touchscreen interface 79 to reduce the pressure in the colon by the preset pressure reduction amount, on completion of severing of the lesion from the current targeted area 61 , the microprocessor 77 operates the flow controller 74 to increase the pressure in the colon 57 to the predefined pressure value to which the colon 57 had been insufflated prior to the inputting of the reduce pressure signal.

[0369] The surgeon or clinician then manoeuvres the colonoscope 55 to the next targeted area 61. With the image recognition unit 84 again operating in the first mode, the image recognition unit 84 remains operating in the first mode until the inner surface 64 of the colon wall 65 of the now current targeted area 61 is of the predefined degree of evenness. At which stage, the microprocessor 77 outputs the lesion scan signal, and the image recognition unit 84 commences to operate in the second mode, and so operation of the insufflating apparatus 50 continues.

[0370] The microprocessor 77 during insufflating of the colon 57 reads the signal from the pressure sensor 80 and compares the read signal with the maximum pressure value stored in the memory 83. If at any time during the insufflating of the colon 57 the colon pressure exceeds the maximum pressure value, the microprocessor 77 outputs a pressure alert signal to the sounder 82 to warn the surgeon or clinician of the excessive pressure in the colon 57. It is envisaged that in some embodiments of the invention the microprocessor 77 may also be programmed to automatically operate the flow controller 74 to reduce the flow rate of insufflating gas to the colon in order to reduce the pressure therein to or below the maximum pressure value in the event of the colon pressure exceeding the maximum pressure value.

[0371] While the topography reference image look-up table 89 has been described as comprising only five topography reference images of degrees of evenness of values from “1” to “5”, it is envisaged that any number of topography reference images may be stored in the topography reference image look-up table of degrees of evenness greater than or less than 5 degrees of evenness.

[0372] Additionally, while only one topography reference image of the predefined degree of evenness has been described as being stored in the topography reference image look-up table 89 for comparison with each and every one of the targeted areas of the colon from the cecum 96 to the transitioning of the sigmoid colon 97 from the rectum 98, it is envisaged that a plurality of topography reference images of predefined degrees of evenness may be stored in the topography reference image look-up table 89 for the different parts of the colon. For example, one topography reference image of the predefined degree of evenness may be stored in the topography reference image look-up table 89 for the sigmoid colon 97, and a topography reference image of the predefined degree of evenness may be stored in the topography reference image look-up table 89, for the descending colon, while a separate topography reference image of the predefined degree of evenness may be stored in the topography reference image look-up table 89 for the transverse colon, and a further topography reference image of the predefined degree of evenness for the ascending colon may also be stored in the topography reference image look-up table 89, and the respective predefined degree of evenness of the topography reference images would typically be different for each of the different parts of the colon. Additionally, a plurality of associated topography reference images would be stored in the topography reference image look-up table 89 associated with each one of the topography reference images of the predefined degrees of evenness. For example, four associated topography reference images may be stored for each one of the topography reference images of the predefined degrees of evenness, and the associated topography reference images would be of different degrees of evenness for each part of the colon below the corresponding predefined degree of evenness for that part of the colon. All such topography reference images of the predefined degrees of evenness and their associated topography reference images of degrees of evenness below the corresponding predefined degree of evenness would be stored and cross-referenced in the topography reference image look-up table 89, and would be cross-referenced with the identities of the respective parts of the colon to which they correspond.

[0373] In cases where a plurality of topography reference images of predefined degrees of evenness and their associated topography reference images of degrees of evenness less than the corresponding predefined degree of evenness are stored for the respective parts of the colon, the image recognition unit 84 would be programmed to compare the captured image from the current field of view with the topography reference image of the predefined degree of evenness and its associated topography reference images of degrees of evenness less than the corresponding predefined degree of evenness stored in the topography reference image look-up table 89 for the part of the colon within which the current field of view is located.

[0374] Further, it is envisaged that further topography reference images may be stored either for the colon as a single unit, and / or for the different parts of the colon and / or for portions of the different parts of the colon, whereby the topography reference images for the colon as a single unit or for each part of the colon or for each portion of each part of the colon would include a number of reference images for subjects of different characteristics, for example, any one or more of the following, subjects of different sex, subjects of different ages or different age ranges, subjects of different weight or different weight ranges, subjects of different body mass index or different body mass index ranges, or subjects lying in different rest positions during the procedure. In which case, on entering of the relevant data into the microprocessor 77 prior to the commencement of the procedure, one or more of the sex of the subject, the age or the age range within which the subject’s age falls, the weight of the subject or the weight range within which the weight of the subject falls, the body mass index or the body mass index range within which the body mass index of the subject falls or the rest position in which the subject will lie during the procedure, would be entered into the microprocessor 77 prior to commencement of the procedure.

[0375] Referring now to Figs. 10 to 12 there is illustrated insufflating apparatus according to another embodiment of the invention indicated generally by the reference numeral 100 for insufflating a vessel, in this embodiment of the invention the colon 102 of a subject 103 during a minimally invasive procedure, which may be an investigative, surgical or other procedure. However, in this embodiment of the invention the insufflating apparatus 100 will be described for insufflating the colon 102 of the subject 103 for the purpose of identifying lesions similar to those described with reference to the insufflating apparatus 1 of Figs. 1 to 5. In this embodiment of the invention the insufflating apparatus 100 comprises an insufflator 104 which is substantially similar to the insufflator 3 of the insufflating apparatus 1 described with reference to Figs. 1 to 5 and similar components are identified by the same reference numerals, and a colonoscope 105 through which the procedure is carried out in the colon 102. The colonoscope 105 is substantially similar to the colonoscope 5 of the insufflating apparatus 1 , and similar components are identified by the same reference numerals. However, in this embodiment of the invention the monitoring unit for monitoring the depth of penetration of the colonoscope 105 into the colon 102 has been omitted, and the graduations of the graduated scale have also been omitted from the colonoscope 105.

[0376] As mentioned above, the insufflator 104 is similar to the insufflator 3 of the insufflating apparatus 1 , and a pressure values look-up table similar to the pressure values look-up table 38 of Fig. 3 is stored in the memory 37 of the microprocessor 30. The pressure values look-up table 38 of the insufflator 104 comprises seven columns similar to the pressure values look-up table 38, and column seven of the pressure values look-up table 38 comprises the predefined pressure values to which the colon 102 should be insufflated to produce the targeted areas 11 in respective locations in the colon 102 to the degree of evenness sufficient for visually detecting the presence of a lesion. The pressure values in column seven in the pressure values look-up table 38 stored in the memory 37 of the microprocessor 30 like the pressure values look-up table 38 of Fig. 3 are based on the different locations in the colon 102 and various different characteristics of a subject, namely, the sex, the age, the body mass index and the resting position of the subject during the procedure.

[0377] The main difference between the insufflating apparatus 100 and the insufflating apparatus 1 lies in the generation of the location signal indicative of the location of the targeted area 11 in the colon 102 which is adjacent the distal end 107 of the colonoscope 105 and within the field of view of an image capturing device 115 located in the colonoscope 105 adjacent the distal end 107 thereof. In this embodiment of the invention the location signal is produced by an image recognition apparatus 110 which is provided separate from the insufflator 104 and from the colonoscope 105. The image recognition apparatus 110 comprises an image recognition means, in this embodiment of the invention an image recognition unit 112, which is adapted to compare the captured image of the current targeted area 11 within the colon 102 received from the image capturing device 115 of the colonoscope 105 with a plurality of location reference images 113 of a reference colon, in order to determine the location of the current targeted area 11. The location reference images 113 are stored in a location reference image look-up table 124. The location reference image look-up table 124 is stored in a location reference image storing means, in this embodiment of the invention an electronic memory 114 in the image recognition apparatus 110 accessible to the image recognition unit 112. The location reference image look-up table 124 is described below with reference to Fig. 12.

[0378] The image capturing device 115 produces a digital signal indicative of the captured image, which is applied to the image recognition unit 112.

[0379] The location reference images 113 stored in the location reference image look-up table 124 comprise images of different locations of the interior of the reference colon. In this embodiment of the invention the location reference images comprise location reference images 113 of a number of parts of the sigmoid colon of the reference colon corresponding to the sigmoid colon 117, a number of parts of the descending colon of the reference colon corresponding to the descending colon 118 of the colon 102, a number of parts of the transverse colon of the reference colon corresponding to the transverse colon 119 of the colon 102, a number of parts of the ascending colon of the reference colon corresponding to the ascending colon 120 of the colon 102, as well as the cecum of the reference colon corresponding to the cecum 121 of the colon 102. Additionally, the location reference images 113 comprise reference images of the transition from the sigmoid colon to the descending colon of the reference colon, an image of the transition of the descending colon to the transverse colon of the reference colon, and an image of the transition of the transverse colon to the ascending colon of the reference colon.

[0380] The location reference images 113 are stored in the location reference image look-up table 124 cross- referenced with the identity of the corresponding location in the reference colon as illustrated in Fig. 12. In column one of the location reference image look-up table 124, the location reference images 113 are stored. In column two of the location reference image look-up table 124, the location of each location reference image is stored corresponding to the corresponding location reference image 113. Any number of location reference images 113 may be stored in column one for each of the different locations of the reference colon.

[0381] In this embodiment of the invention three location reference images 113 are stored for three locations in the sigmoid colon of the reference colon, and these are identified in column one as being sigmoid colon 1, sigmoid colon 2 and sigmoid colon 3. The location reference image corresponding to the location sigmoid colon 1 is a reference image of the beginning of the sigmoid colon of the reference colon as it transitions from the rectum thereof. The location reference image corresponding to the location identified in column one as sigmoid colon 3 comprises an image of the transitioning of the sigmoid colon to the descending colon of the reference colon, and the location reference image 113 corresponding to the location identified in column one as sigmoid colon 2 comprises an image of a part of the sigmoid colon of the reference colon between the part of the sigmoid colon identified as the sigmoid colon 1 and the part of the sigmoid colon identified as the sigmoid colon 3. The three location reference images 113 identified in column one of the location reference image look-up table 124 as sigmoid colon 1, sigmoid colon 2 and sigmoid colon 3 are identified in column two of the location reference image look-up table 124 as images “1.1”, “1.2” and “1.3", respectively.

[0382] Since the descending colon of the reference colon is longer than the sigmoid colon, six location reference images 113 are stored in column one of six different locations of the descending colon of the reference colon identified in column one as descending colon 1 to descending colon 6 as one progresses through the descending colon from the sigmoid colon to the transverse colon. The location reference images 113 of the descending colon 118 are identified in column two of the location reference image look-up table 124 as “2.1” to “2.6”. The next location reference image 113 in column one of the location reference image look-up table 124 is a reference image of the transitioning of the descending colon to the transverse colon of the reference colon and is identified in column one of the location reference image look-up table 124 as transverse colon 1. Six location reference images of the transverse colon are stored in column one and identified as transverse colon 1 to transverse colon 6 in the order progressing from the descending colon to the ascending colon of the reference colon, and are identified in column two of the location reference image look-up table 124 as “3.1” to “3.6”. Six location reference images 113 of the ascending colon of the reference colon are stored in column one of the location reference image look-up table 124 as ascending colon 1 to ascending colon 6, the ascending colon 1 being an image of the transitioning of the transverse colon to the ascending colon of the reference colon. The location reference image 113, namely, ascending colon 6 is an image of the ascending colon adjacent the cecum of the reference colon. The images of ascending colon 1 to ascending colon 6 are identified in column two of the location reference image look-up table as “4.1” to “4.6".

[0383] The image recognition unit 112 is programmed to compare the captured image of each targeted area 11 sequentially with the stored location reference images 113 until a match or a best match of the captured image with the location reference images 113 is determined. The image recognition unit 112 determines the location of the matching or the best matching location reference image 113 as being the location of the current targeted area 11, and produces the location signal which is indicative of the location of the current targeted area 11 as being of the appropriate one of the values “1.1” to “4.6” corresponding to the matched or the best matched location reference image 113. The location signal is applied to the microprocessor 30 of the insufflator 104. The microprocessor 30 is similarly programmed as the microprocessor 30 of the insufflator 3, so that on receiving the location signal indicative of the location of the current targeted area 11, the microprocessor 30 determines the appropriate predefined pressure value from the pressure values look-up table 38 stored in the memory 37 of the microprocessor 30 to which the colon 102 should be insufflated to produce the inner surface 14 of the colon wall 15 of the predefined degree of evenness. The microprocessor 30 then controls the flow controller to alter if necessary the supply of insufflating gas to the colon 102 and to maintain the pressure in the colon 102 at the predefined pressure value corresponding to the current location of the targeted area 11.

[0384] The surgeon or clinician then visually inspects the captured image of the targeted area 11 displayed on the visual display screen 6 of the colonoscope 105 to detect the presence, or absence as the case may be, of a lesion. If a lesion is detected, the surgeon or clinician operates the food pedal operated switch 42 of the insufflator 104 to produce the lesion present signal indicative of the detection of a lesion. The microprocessor 30 on receiving the lesion present signal operates the flow controller 20 to increase the pressure in the colon by the preset pressure increase amount above the current predefined pressure value to the elevated pressure in order to increase the working volume within the colon to permit severing of the lesion by the snaring instrument 47 as already described with reference to the insufflating apparatus 1.

[0385] On completion of severing of the lesion from the targeted area 11 , the surgeon or clinician releases the foot pedal operated switch 42 thereby terminating the lesion present signal, and the microprocessor 30 operates the flow controller 20 to reduce the supply of insufflating gas to the colon 102 in order to return the colon pressure to the predefined pressure value at which the colon 102 had been insufflated prior to the production of the lesion present signal.

[0386] On completion of the severing of the lesion from the current targeted area or on detecting the absence of a lesion in or on the current targeted area, the surgeon or clinician then manoeuvres the colonoscope 105 to the next adjacent targeted area 11. The image recognition unit 112 then compares the captured image of the next adjacent targeted area 11 with the location reference images 113 in the location reference image look-up table 124 in order to determine the location in the colon 102 of the new current targeted area 11, and so operation of the insufflating apparatus 100 continues.

[0387] It is envisaged that in some embodiments of the invention in order to minimise the time required by the image recognition unit 112 for determining the location of each targeted area 11 , once the location of the first targeted area 11 has been determined and as the location of each subsequent targeted area 11 has been determined, the image recognition unit 112 may be programmed to compare the captured image of the current targeted area with the location reference images 113 of the remaining locations of the colon 102 not yet investigated, starting with the reference image of the current location and then the reference image of the next location in the direction of movement of the colonoscope 105 through the colon 102.

[0388] In this embodiment of the invention the location reference images 113 are continuously updated by the application of one or more suitable artificial intelligence algorithm. Each captured image which is a match or the best match with one of the location reference images 113 is passed through a learning module, and the captured image is then stored as an additional location reference image to the corresponding location reference image 113 in the location reference image look-up table as already described with reference to the updating of the reference images by the application of artificial intelligence to the topography and the lesion reference images of the topography and lesion reference image look-up tables of the insufflating apparatus 50 described with reference to Figs. 6 to 9.

[0389] Use of the insufflating apparatus 100 is similar to use of the insufflating apparatus 1. Initially, the colonoscope 105 is entered anally into the colon 102, and as the colonoscope 105 is being entered into the colon 102, the microprocessor 30 of the insufflator 104 commences insufflating of the colon 102. The colonoscope 105 is initially urged through the colon 102 to the cecum 121. The microprocessor 30 controls the flow controller 20 to maintain the pressure in the colon 102 at the predefined pressure value for the ascending colon 120. The surgeon or clinician then commences to slowly withdraw the colonoscope 105 through the colon 102 and commences to sequentially view the captured images of the targeted areas 11 displayed on the visual display screen 6 of the colonoscope 105, as the colonoscope 105 is being manoeuvred sequentially through the targeted areas 11. The image recognition unit 112 compares the captured image of each targeted area 11 with the location reference images 113 in the location reference image look-up table 124 as already described for determining the locations of the respective targeted areas, and produces corresponding location signals to the microprocessor 30 indicative of the location of the current targeted area 11. The microprocessor 30 then determines the appropriate predefined pressure value to which the colon 102 should be insufflated from the pressure values look-up table 38 stored in the memory 37 of the microprocessor 30, and operates the flow controller 20 to alter if necessary the supply of insufflating gas to the colon 102 and to maintain the supply of insufflating gas to the colon 102 in order to maintain the colon pressure at the predefined pressure value corresponding to the location of the current targeted area 11 in the colon 102.

[0390] Otherwise, the insufflating apparatus 100 and its use and operation is similar to that of the insufflating apparatus 1.

[0391] It is also envisaged that in this embodiment of the invention described with reference to Figs. 10 to 12, the microprocessor 30 may be programmed that on a reduce pressure signal being inputted through the touchscreen interface 31, the microprocessor 30 would operate the flow controller 20 to reduce the flow of insufflating gas to the colon 102 to in turn reduce the pressure to which the colon 102 is being insufflated by the preset pressure reduction amount.

[0392] It is envisaged that in this embodiment of the invention the image recognition unit 112 may be adapted to also scan the captured image of each targeted area 11 for a lesion on the colon pressure being at the predefined pressure value corresponding to the current targeted area 11. In which case, a lesion reference image look-up table similar to the lesion reference image look-up table of Fig. 8 of the insufflating apparatus 50 of Figs. 6 to 9, would be stored in the memory 114 of the image recognition apparatus 110. The image recognition unit 112 would operate in a similar manner as the image recognition unit 84 of the insufflating apparatus 50 of Figs. 6 to 9 to scan the inner surface 14 of the colon wall 15 of each targeted area 11 of the colon 102 for a lesion as already described with reference to the insufflating apparatus 50. In this embodiment of the invention described with reference to Figs. 10 to 12, the location reference images are updated by artificial intelligence in a manner similar to that described for updating the reference images for the insufflating apparatus 50 described with reference to Figs. 6 to 9. As a match or a best match of a captured image with a topography reference image, or a lesion reference image, the captured image matching or being a best match of the relevant reference image is passed through a learning model 116 of the image recognition apparatus 110 and is then stored in the memory 114 as an additional location reference image, or as an additional lesion reference image, as the case may be, and as already described with reference to the insufflating apparatus 50 of Figs. 6 to 9.

[0393] Referring now to Fig. 13 there is illustrated insufflating apparatus according to another embodiment of the invention indicated generally by the reference numeral 130 for insufflating a vessel, in this embodiment of the invention a colon of a subject during a minimally invasive procedure, which may be an investigative, surgical or other procedure. However, in this embodiment of the invention the insufflating apparatus 130 will be described for insufflating a colon for the purpose of identifying and removing lesions therefrom. The insufflating apparatus 130 comprises an insufflator 132 and a colonoscope 134. The insufflator 132 is substantially similar to the insufflator 3 of the insufflating apparatus 1 described with reference to Figs. 1 to 5, and similar components are identified by the same reference numerals. The colonoscope 134 is substantially similar to the colonoscope 55 of the insufflating apparatus 50 described with reference to Figs. 6 to 9, and similar components are identified by the same reference numerals as those of the colonoscope 55 illustrated in Fig. 6. In this embodiment of the invention the surgeon or clinician determines the location of the distal end 60 of the colonoscope 134 from the current captured image of the colon captured by the image capturing device 85 and displayed on the visual display screen 91 of the vision system of the colonoscope 134. As the distal end 60 of the colonoscope 134 passes from each of the parts of the colon to the next part thereof, the surgeon or clinician inputs a signal indicative of the part of the colon within which the distal end 60 of the colonoscope 134 is located, and in turn within which the current targeted area 11 is located, as will be described below.

[0394] Turning now to the insufflator 132, in this embodiment of the invention the insufflator 132 is provided with two foot pedal operated switches, namely, a first foot pedal operated switch 135 which is operated by a first foot pedal 136 and a second foot pedal operated switch 138 which is operated by a second foot pedal 139. The first foot pedal operated switch 135 is provided to produce the location signal indicative of the location of the targeted area 11 in the colon 7 as will be described below. The second foot pedal operated switch 138 is provided to produce the lesion present signal indicative of detection of a lesion 7 in the current targeted area 11 , in a similar manner as the foot pedal operated switch 42 of the insufflator 3 of the insufflating apparatus 1 of Figs. 1 to 5 produces the lesion present signal.

[0395] A pressure values look-up table similar to the pressure values look-up table 38 of Fig. 3 of the insufflating apparatus 1 is stored in the memory 37 of the microprocessor 30. Accordingly, use of the insufflating apparatus 130 in the insufflating of the colon 7 and the detection and removal of a lesion or lesions from the targeted areas is substantially similar to the operation of the insufflating apparatus 1 with the exception that the location signal is inputted to the microprocessor 30 through the first foot pedal operated switch 135.

[0396] Initially, the identity of the vessel, the sex, the age, the body mass index and the resting position of the subject during the procedure are entered into the microprocessor 30 through the touchscreen interface 31. If the preset pressure increase amount by which the current predefined pressure value is to be increased to the elevated pressure is selectable, it is also entered into the microprocessor 30 through the touchscreen interface 31. Thereafter, the surgeon commences to insert the colonoscope 134 anally into the colon 7. As the colonoscope 134 is being entered into the colon 7, the microprocessor 30 operates the flow controller to commence insufflating of the colon 7. The colonoscope 134 is then urged through the colon 7 to the cecum 39.

[0397] On the colon reaching the cecum 39, the surgeon or clinician operates the first foot pedal operated switch 135 by depressing the foot pedal 136 of the first foot pedal operated switch 135 to produce a first one of the location signals, which the microprocessor 30 is programmed to interpret as being indicative of the distal end of the colonoscope 134 being adjacent the cecum 39, and thus that the distal end 10 of the colonoscope 134 is located in the ascending colon 46. The microprocessor 30 selects the appropriate predefined pressure value from column seven of the pressure values look-up table 38 corresponding to the pressure value for the targeted areas 11 being in the ascending colon 46. The microprocessor 30 is programmed to maintain the pressure in the colon 7 at the appropriate predefined pressure value for the targeted areas 11 being in the ascending colon until the first foot pedal operated switch 135 is again operated by depressing the foot pedal 136 to produce a second one of the location signals when the distal end of the colonoscope 134 is located adjacent the transitioning of the ascending colon 46 to the transverse colon 40 as will be described below. While the distal end 60 of the colonoscope 134, and in turn the targeted areas 11 are in the ascending colon 46, the surgeon or clinician manoeuvres the distal end 60 of the colonoscope 134 sequentially through targeted areas 11 of the inner surface 14 of the colon wall 15 so that the entire inner surface 14 of the colon wall 15 of the ascending colon 46 is fully scanned by the surgeon or clinician through the colonoscope 134. The surgeon or clinician monitors the captured image of each targeted area 11 captured by the image capturing device 85 and displayed on the visual display screen 91 of the colonoscope 134 to detect a lesion in the displayed captured image of the targeted area 11 , and to ascertain the location of the distal end 60 of the colonoscope 134.

[0398] On a lesion 17 being detected in any of the targeted areas 11 in the ascending colon 46, the surgeon or clinician operates the second foot pedal switch 138 by depressing the second foot pedal 139 to produce the lesion present signal indicative of the detection of a lesion in the current targeted area 11. The microprocessor 30, as described with reference to the insufflator 3 of the insufflating apparatus 1, in response to the lesion present signal operates the flow controller 20 to increase the supply of insufflating gas to the colon 7, to in turn increase the colon pressure by the present pressure increase amount to the elevated pressure to increase the working volume within the colon. The surgeon or clinician then severs the polyp or other lesion as already described with reference to the insufflating apparatus 1.

[0399] On the surgeon or clinician determining from the visual display screen 91 of the vision system of the colonoscope 134 that the distal end 60 of the colonoscope 134 is adjacent the transitioning of the ascending colon 46 to the transverse colon 40, the surgeon or clinician operates the first pedal switch 135 to produce a second one of the location signals. The microprocessor 30 interprets the second one of the location signals as being indicative of the distal end 60 of the colonoscope 134 being adjacent the transitioning of the ascending colon 46 to the transverse colon 40, and in turn passing from the ascending colon 46 to the transverse colon 40. The microprocessor 30 in response to the second one of the location signal obtains the predefined pressure value from the pressure values look-up table 38 in the memory 37 of the microprocessor 30 for the transverse colon 40, and operates the flow controller 20 to supply the insufflating gas to the colon 7 to insufflate the colon 7 to the predefined pressure value corresponding to the targeted areas 11 being in the transverse colon 40. The microprocessor 30 continues to operate the flow controller 20 to maintain the pressure in the colon at the appropriate predefined pressure value for the targeted areas 11 being in the transverse colon 40, until the microprocessor 30 receives one of the lesion present signals from the second foot pedal switch 138 indicative of a lesion being detected, or a third one of the location signals from the first foot pedal switch 135 indicative of the distal end 60 of the colonoscope 134 being adjacent the transitioning of the transverse colon 40 to the descending colon 45 as will be described below. Operation of the insufflating apparatus 130 in the transverse colon 40 is similar to that described with reference to the ascending colon 46. The surgeon or clinician manoeuvres the distal end 10 of the colonoscope 134 through the transverse colon 40 and sequentially scans the targeted areas thereof in the transverse colon 40.

[0400] On the surgeon or clinician determining from the visual display screen 91 of the vision system of the colonoscope 134 that the distal end 10 of the colonoscope 134 is adjacent the transitioning of the transverse colon 40 to the descending colon 45, the surgeon or clinician operates the first foot pedal operated switch 135 to produce the third one of the location signals. The microprocessor 30 interprets the third one of the location signals as being indicative of the location of the distal end 60 of the colonoscope

[0401] 134 being adjacent the transitioning of the transverse colon 40 to the descending colon 45, and passing from the transverse colon 40 to the descending colon 45. The microprocessor 30 is responsive to the third one of the location signals to obtain the predefined pressure value for the descending colon 45 from the pressure values look-up table 38, and to operate the flow controller 20 to maintain the colon pressure at the appropriate predefined pressure value for the targeted areas 11 being in the descending colon until the microprocessor 30 receives a lesion present signal, or a fourth one of the signals indicative of the distal end 10 of the colonoscope 134 being adjacent the transitioning of the descending colon 45 to the sigmoid colon 41.

[0402] Operation of the insufflating apparatus 130 while the distal end 60 of the colonoscope 134 and in turn the targeted areas 11 are in the descending colon 45 is similar to the operation of the insufflating apparatus 130 while the distal end 10 of the colonoscope 134 is in the ascending colon 46 as described above.

[0403] On the surgeon or clinician determining from the visual display screen 91 of the vision system of the colonoscope 134 that the distal end 60 of the colonoscope 134 is adjacent the transitioning of the descending colon 45 to the sigmoid colon 41, the surgeon or clinician operates the first foot pedal switch

[0404] 135 to produce the fourth one of the location signals. The microprocessor 30 is responsive to the fourth one of the location signals to obtain the predefined pressure value for the sigmoid colon 41 from the pressure values look-up table 38, and to operate the flow controller 20 to maintain the pressure in the colon at the appropriate predefined pressure value for the targeted areas 11 being in the sigmoid colon 41, and so operation of the insufflating apparatus 130 continues as the distal end 60 of the colonoscope 134 is being manoeuvred through the sigmoid colon to sequentially scan the targeted areas 11 in the sigmoid colon as described with reference to the ascending colon 46.

[0405] On the surgeon or clinician determining from the visual display screen 91 of the vision system of the colonoscope 134 that the distal end 60 of the colonoscope 134 has reached the transitioning of the sigmoid colon to the rectum, the surgeon or clinician operates the first foot pedal operated switch 135 to produce a fifth one of the location signals indicating to the microprocessor 30 that the procedure being carried out in the colon has been completed, and the microprocessor 30 operates the flow controller 20 to terminate insufflating of the colon, and the colonoscope 134 is withdrawn from the colon through the anus 35 of the subject, prior to insufflating of the colon being terminated.

[0406] Otherwise, the insufflating apparatus 130 and its use is similar to that of the insufflating apparatus 1.

[0407] It is envisaged that in this embodiment of the invention in order to assist the surgeon or clinician, the microprocessor 30 may be programmed to be responsive to the inputting of the first one to the fourth one of the location signals through the first foot pedal operated switch 135, to output respective corresponding signals to the visual display screen 91 of the vision system of the colonoscope 134, which would highlight the relevant part of the image of the colon, in which based on the first to the fourth ones of the location signal inputted through the first foot pedal operated switch 135 the colon is being insufflating to the predefined pressure value thereof based on the targeted areas being in that highlighted part of the colon.

[0408] Referring now to Fig. 14 there is illustrated an insufflating apparatus according to a further embodiment of the invention indicated generally by the reference numeral 150. The insufflating apparatus 150 is substantially similar to the insufflating apparatus 1 described with reference to Figs. 1 to 5, and similar components are identified by the same reference numerals. The only difference between the insufflating apparatus 150 and the insufflating apparatus 1 is that the insufflator 3 of the insufflating apparatus 150 as well as being provided with the foot pedal operated switch 42, in this case a first foot pedal operated switch 42, is also provided with a second foot pedal operated switch 152, which is operated by a foot pedal 153. The first foot pedal operated switch 42 is provided for inputting the lesion present signal as already described in the insufflating apparatus 1, and the microprocessor 30 is responsive to the lesion present signal for controlling the flow controller 20 to increase the supply of insufflating gas to the colon 7 for in turn increasing the colon pressure from the current predefined pressure value by the preset pressure increase amount to the elevated pressure. The second foot pedal operated switch 152 is provided for inputting a reduce pressure signal to the microprocessor 30. The microprocessor 30 is responsive to the reduce pressure signal for controlling the flow controller 20 to reduce the supply of insufflating gas to the colon for in turn reducing the pressure in the colon from the current pressure at which the colon is being insufflated by the preset pressure reduction amount to reduce the colon pressure to a reduced pressure. In this embodiment of the invention the preset pressure increase amount and the preset pressure reduction amounts are of similar values, and each are approximately 5mmHg.

[0409] Use of the insufflating apparatus 150 is similar to that of the insufflating apparatus 1, with the exception that on the surgeon or clinician detecting a lesion in the current targeted area 11 from the captured image thereof displayed on the visual display screen 6 of the colonoscope 5, the surgeon or clinician may operate either the first or the second foot pedal operated switches 42 or 152, depending on whether the surgeon or clinician requires the colon pressure to be increased by the preset pressure increase amount or reduced by the preset pressure reduction amount. Additionally, in this embodiment of the invention the surgeon or clinician on detecting the presence of a lesion in the current targeted area, may initially operate the first foot pedal operated switch 42 to increase the colon pressure by the preset pressure increase amount in order to increase the working volume in the colon 7, and should the surgeon or clinician subsequently require the pressure in the colon 7 to be reduced, in order to reduce the tension in the colon wall to assist in grabbing the lesion, the surgeon or clinician may release the first foot pedal operated switch 42 to reduce the colon pressure to the predefined pressure value. Should a further reduction in the colon pressure below the predefined pressure value be required, the surgeon or clinician then operates the second foot pedal operated switch 152 in order to reduce the pressure in the colon 7 by the preset pressure reduction amount below the predefined pressure value.

[0410] It is envisaged that the flow controller may be responsive to activation of the second foot pedal operated switch 152 to reduce the current colon pressure by the preset pressure reduction amount whether the current colon pressure is at the predefined pressure value or is at a pressure equal to the sum of the predefined pressure value and the preset pressure increase amount should the colon pressure have been increased from the predefined pressure value by operation of the first foot pedal operated switch. It is also envisaged that the flow controller may be responsive to activation of the first foot pedal operated switch 42 to increase the current colon pressure by the preset pressure increase amount from either the predefined pressure value, or from a pressure value equal to the difference of the predefined pressure value and the preset pressure reduction amount should the colon pressure have been reduced from the predefined pressure value by operation of the second foot pedal operated switch 152. Otherwise, the insufflating apparatus 150 and its operation is similar to that of the insufflating apparatus 1 described with reference to Figs. 1 to 5.

[0411] While the image recognition units of the insufflating apparatus 50 and 100 have been described as comparing the captured images with reference images in look-up tables stored in the memories accessible to the image recognition units, it is envisaged that in some embodiments of the invention the look-up tables may be wholly or partly dispensed with, and the reference images may be developed solely using one or more suitable artificial intelligence algorithms. It is also envisaged that when the reference images in the look-up tables are' being updated using a suitable artificial intelligence algorithm and / or using a learning model, some or all of the original reference images may be deleted and replaced by some or all of the relevant captured images which match or are the best match of a corresponding reference image.

[0412] While specific artificial intelligence algorithms have been described for generating the various reference images, any other suitable artificial intelligence algorithms or systems for generating the reference images may be used. For example, it is envisaged that a model of the relevant reference images may be constructed using artificial intelligence from a series of images captured from a series of colons and / or a series of each of other vessels corresponding to the vessels with which the insufflating apparatus is to be used and has been used in carrying out relevant procedures therein, as well as lesions and sizes thereof encountered by the insufflating apparatus in the carrying out of earlier procedures. Such a model or models once generated would be stored in the memory of the image recognition apparatus or the memory of the microprocessor of the insufflator.

[0413] While the topography reference images of the predefined degrees of evenness of the inner surface of the colon and topography reference images of degrees of evenness less than the predefined degree of evenness have been described generally as being stored in the topography reference image look-up table, and while the lesion reference images of different types and different sizes of lesions have been described as being stored in a lesion reference image look-up table, while both the topography and lesion reference images have been described generally as being stored as images, the topography reference images and the lesion reference images will, in general, be stored in digital form, and will be stored in a form suitable for comparison with the captured images of the topography of the inner surface of the colon in the respective fields of view, and also to enable comparison with the captured images of the lesions in the respective fields of view in the colon, and such storing means for storing such images to enable comparison with captured images will be understood by those skilled in the art. For example, in some embodiments of the invention it is envisaged that the reference images would be stored in a manner which would enable feature vectors of captured images to be compared with corresponding type feature vectors of the stored images. Such comparisons will be well understood by those skilled in the art. Needless to say, other suitable methods for storing the reference images to enable comparison with corresponding captured images may be used.

[0414] It will also be appreciated that any other suitable comparing means for comparing the captured images with the stored reference images besides an image recognition unit may be provided.

[0415] While in the embodiment of the insufflating apparatus described with reference to Figs. 1 to 5, the microprocessor has been described as determining the length of the colon and the lengths of the sigmoid colon, the descending colon, the transverse colon and the ascending colon from signals inputted to the microprocessor indicative of the locations of the transitioning of the sigmoid colon from the rectum, the transitioning of the sigmoid colon to the descending colon, the transitioning of the descending colon to the transverse colon, and the transitioning of the transverse colon to the ascending colon and the location of the cecum and from signals read from the monitoring unit 32, it is envisaged that in some embodiments of the invention the length of the colon and the respective parts thereof may be determined by artificial intelligence whereby captured images of the colon would be compared with reference images of a colon in order to determine the length of the colon and the lengths of the parts thereof. The reference images may be reference images of a reference colon, and / or reference images generated during use of the insufflating apparatus over time.

[0416] It is also envisaged that some embodiments of the invention may comprise an insufflator, which would insufflate the vessel in which the procedure is being carried out to a pressure either selectable by the surgeon or clinician or a preset pressure value, or a series of selectable preset pressure values, and in which case, the insufflating apparatus would not include the look-up table of Fig. 3 with the predefined pressure values as described with reference to the insufflators of the insufflating apparatus 1, 100, 130 and 150, nor would they include a means whereby the location of the colonoscope or the endoscope is determined by comparing captured images of the current location of the targeted area with reference images. However, such an insufflating apparatus would be provided with an image recognition means, which would be adapted to detect the presence of a lesion in a targeted area. Such an image recognition means would typically compare the captured image of each targeted area with at least one reference image of a lesion, and preferably, the image recognition means would compare each captured image with a plurality of reference images of lesions of, for example, different types of lesions and different sizes thereof.

[0417] While the insufflating apparatus 1 , 50, 100, 130 and 150 have been described for use in a colon with a colonoscope, it is envisaged that each of the insufflating apparatus 1, 50, 100, 130 and 150 may be used in conjunction with, for example, an endoscope for carrying out any type of investigative or surgical procedure in any other vessel in the body of a human or animal subject, for example, the intestine, and in any other vessel of a lumen type nature in the body of a human or animal subject. In which case, it is envisaged that in carrying out any type of investigative or surgical procedure in any other vessel in the human or animal body, or indeed in the colon, the insufflating apparatus 1, 50, 100 and 130 would be configured to facilitate the carrying out of the relevant procedure.

[0418] It is also envisaged that in the insufflating apparatus 1, 100, 130 and 150 may be configured to include an image recognition apparatus which would compare captured images of targeted areas in a colon or any other vessel with reference images of reference surfaces which would include a representation of one or more different types of lesions in or on the reference surface to be detected by the image recognition unit, and on detection of the lesion, the image recognition unit would be programmed to produce the lesion present signal indicative of the detection of a lesion.

[0419] Additionally, while in the insufflating apparatus 1 a means for determining the location of the colonoscope has been described as comprising an optical monitoring means for monitoring reflective graduations of a graduation scale on the colonoscope, it is envisaged that any other suitable monitoring or positioning system for monitoring the location of the distal end of the colonoscope or the endoscope in the relevant vessel may be used, for example, a fluoroscopic positioning system whereby the distal end of the colonoscope would be provided with a radiopaque marker which would be identified by a fluoroscopic imaging system. Other suitable monitoring or positioning systems may also be provided for monitoring graduations on a colonoscope or an endoscope as it is being urged into the colon. The monitoring means may comprise a magnetic monitoring means which would monitor magnetic graduations on the colonoscope or endoscope, such magnetic graduations may be provided by any suitable magnetic means, and in some embodiments of the invention may comprise electro-magnetic coils spaced apart along the colonoscope or endoscope, which would produce a pulsed low intensity magnetic field, which may be picked up by receiver coils externally of the subject. Needless to say, where the apparatus 1 is being used in conjunction with an endoscope, similar comments apply to the use of an endoscope as apply to the use of a colonoscope with regards to determining the location of the endoscope in the vessel in which the procedure is being carried out.

[0420] While the insufflating apparatus 1, 50, 100, 130 and 150 have been described for use in detecting lesions on the inner surface of the colon wall of a colon, it will be readily apparent to those skilled in the art that the insufflating apparatus 1 , 50, 100, 130 and 150 may be used for detecting any type of lesion or growth, or indeed, for carrying out any other investigative or surgical procedure in any vessel in the body of a human or animal subject, for example, in the colon, the intestine, or any other vessel, and in particular, any other vessel of lumen type construction. In which case, an appropriate one of a colonoscope or an endoscope would be used, and would be entered into the vessel from an appropriate body orifice of the human or animal subject.

[0421] While the embodiments of the insufflating apparatus according to the invention described with reference to Figs. 1 to 14 have been described as comprising various features and elements, it will be readily apparent to those skilled in the art that features and / or elements described in any one or more of the embodiments may be incorporated into any other one or more of the embodiments described.

[0422] While the preset pressure increase and reduction amounts have been described as being similar, it will be appreciated that in some embodiments of the invention the preset pressure increase and reduction amounts may differ from each other. Additionally, it is envisaged that the ranges within which the preset pressure increase and reduction amounts may lie may also differ from each other.

[0423] It is envisaged that in the embodiments of the invention where a provision is made to input through the touchscreen interface whether the microprocessor should be responsive to the lesion present signal to rise the current colon pressure by the preset pressure increase amount, and / or to the reduce pressure signal to reduce the current colon pressure by the preset pressure reduction amount, other suitable means for entering one or more signals to indicate whether the microprocessor should increase or decrease the current colon pressure by the preset pressure increase amount or the preset pressure reduction amount may be provided. For example, in some embodiments of the invention one or more additional foot pedal switches, or hand operated switches may be provided, which would enable a surgeon or clinician to enter one or more signals to the microprocessor which would determine whether the colon pressure is to be increased or decreased by the preset pressure increase amount or the preset pressure reduction amount in response to the lesion present signal. Additionally, such additional switches may be provided to enable the preset pressure increase and reduction amounts to be selectable and also to be independently selectable.

[0424] It will also be appreciated that in the embodiment of the invention described with reference to Fig. 13 in which the surgeon or clinician enters one of five location signals to the microprocessor to indicate the location of the distal end of the colonoscope in the colon, such as, to indicate the location of the distal end of the colonoscope in the colon at the various transitions of the colon from the sigmoid colon to the rectum, from the descending colon to the sigmoid colon, from the transverse colon to the descending colon, and from the ascending colon to the transverse colon, and when the distal end of the colonoscope is located adjacent the cecum, in some embodiments of the invention a number of foot pedal operated switches, for example, four or five foot pedal operated switches, may be provided to enable the first to the fourth or fifth of the location signals to be inputted to the microprocessor.

[0425] While the signals and data have been described as being inputted to the microprocessor of the insufflator, and have been described as being inputted through a touchscreen or one or more foot pedal operated switches, it will be readily apparent to those skilled in the art that data and signals may be inputted to the microprocessor through any suitable interface means. Indeed, it is envisaged that in some embodiments of the invention some or all of the data and some or all of the signals may be inputted to the microprocessor of the insufflator as voice signals, and in which case, the insufflator would be provided with a voice activation unit which would convert the voice signals into machine readable signals which would be readable by the microprocessor.

[0426] It will of course be appreciated that in some embodiments of the invention the captured images of the targeted areas in the colon or other vessel in which the procedure is being carried out, may be displayed on the visual display screen of the endoscope or colonoscope, and / or on a visual display screen of the insufflator.

[0427] Further, it is envisaged that while specific predefined pressure values and predefined pressure value ranges have been described, the predefined pressure values and predefined pressure ranges may, and most likely will be different, depending on the vessel being insufflated. Indeed, in some embodiments of the invention the predefined pressure values and the predefined pressure ranges which have been described for a colon may vary outside those described.

[0428] While the signal processor of the insufflator has been described as comprising a microprocessor, and other suitable signal processor, for example, a microcontroller, a programmable logic controller or the like, may be used instead of a microprocessor. It is also envisaged that in the embodiments of the invention which include an image recognition apparatus, the image recognition apparatus may be operated under the control of the signal processor of the insufflator, instead of under the control of a separate signal processor of the image recognition apparatus. It will also be appreciated that in some embodiments of the invention the image recognition apparatus may be' integrally provided with the insufflator.

[0429] It is envisaged that in some or all of the insufflating apparatus according to the invention, the signal processor may be programmed to output an alert pressure signal in the event of the pressure in the colon or other vessel exceeding a predefined maximum pressure, or falling below a predefined minimum pressure value. In which case, the predefined maximum pressure and the predefined minimum pressure would be stored in the memory of the microprocessor, and may be preset or selectable.

[0430] It is also envisaged that in all the embodiments of the invention where reference values are stored in reference value look-up tables or other suitable reference value storing means, a plurality of reference values may be stored for different parts of the colon or other vessel, and also reference values may be stored for the different parts of the colon or other vessel which would be determined by the age, the weight, the body mass index or the resting position of the subject during the procedure.

Claims

Claims1. An insufflator for insufflating a vessel in the body of a human or animal subject in which an endoscopic procedure is being carried out, the insufflator comprising a flow controller adapted for controlling supply of insufflating gas to the vessel for insufflating thereof, a control means responsive to a location signal indicative of the location of a targeted area in the vessel at which the procedure is to be carried out for operating the flow controller to control the supply of insufflating gas to the vessel to maintain the pressure in the vessel (vessel pressure) at a predefined pressure value corresponding to one or both of the type of the vessel or the location of the targeted area in the vessel.

2. An insufflator as claimed in Claim 1 in which a pressure values storing means accessible to the control means stores the predefined pressure value cross-referenced with the identity of the corresponding location in the vessel.

3. An insufflator as claimed in Claim 2 in which a plurality of the predefined pressure values cross- referenced with the identities of corresponding locations in the vessel are stored in the pressure values storing means.

4. An insufflator as claimed in Claim 2 or 3 in which at least one of the predefined pressure value cross-referenced with the identity of at least one type of a characteristic of a subject is stored in the pressure values storing means for each of at least some of the locations in the vessel.

5. An insufflator as claimed in Claim 4 in which a plurality of the predefined pressure values cross- referenced with corresponding types of a plurality of the characteristics of subjects are stored in the pressure values storing means for each of at least some of the locations of the vessel.

6. An insufflator as claimed in Claim 4 or 5 in which the characteristics of subjects, for which a plurality of the predefined pressure values are stored in the pressure values storing means cross- referenced with the identities of the corresponding types of the respective characteristics for each of at least some of the locations in the vessel, comprise one or more of the sex of a subject, the age of a subject or the age range of a subject, the weight of a subject or the weight range of a subject, the body mass index of a subject or the body mass index range of a subject, and the resting position of a subject.

7. An insufflator as claimed in any of Claims 2 to 6 in which the plurality of the predefined pressurevalues are stored in the pressure values storing means cross-referenced with the identities of the corresponding locations in the vessel, and preferably, the plurality of the predefined pressure values are stored in the pressure values storing means in a pressure values look-up table cross-referenced with the identities of the corresponding types of the corresponding characteristics of subjects.

8. An insufflator as claimed in any of Claims 2 to 7 in which the storing means comprises an electronic memory, located in the insufflator, or externally of and separate from the insufflator and communicable with the control means.

9. An insufflator as claimed in any preceding claim in which the control means is responsive to a lesion present signal indicative of detection of a lesion in the targeted area to operate the flow controller to increase the vessel pressure by a preset pressure increase amount to an elevated pressure above the pressure value at which the vessel is currently being maintained.

10. An insufflator as claimed in Claim 9 in which the preset pressure increase amount by which the vessel pressure is increased above the pressure value at which the vessel is currently being maintained lies in the range of 3mmHg to 8mmHg, and preferably, the preset pressure increase amount by which the vessel pressure is increased above the pressure value at which the vessel is currently being maintained lies in the range of 4mmHg to 6mmHg, and advantageously, the preset pressure increase amount by which the vessel pressure is increased above the pressure value at which the vessel is currently being maintained is approximately 5mmHg.

11. An insufflator as claimed in Claim 9 or 10 in which the lesion present signal comprises a manually generated lesion present signal, and preferably, generated by a foot pedal operated electrical switch, and / or a hand operated electrical switch.

12. An insufflator as claimed in any preceding claim in which the control means is responsive to a reduce pressure signal to operate the flow controller to reduce the vessel pressure by a preset pressure reduction amount to a reduced pressure below the pressure value at which the vessel is currently being maintained.

13. An insufflator as claimed in Claim 12 in which the preset pressure reduction amount by which the vessel pressure is reduced below the pressure value at which the vessel is currently being maintained liesin the range of 3mmHg to 8mmHg, and preferably, the preset pressure reduction amount by which the vessel pressure is reduced below the pressure value at which the vessel is currently being maintained lies in the range of 4mmHg to 6mmHg, and advantageously, the preset pressure reduction amount by which the vessel pressure is reduced below the pressure value at which the vessel is currently being maintained is approximately 5mmHg.

14. An insufflator as claimed in Claim 12 or 13 in which the reduce pressure signal is indicative of detection of a lesion.

15. An insufflator as claimed in any preceding claim in which the location signal indicative of the location of the targeted area in the vessel is derived from a signal indicative of the location of an endoscope in the vessel.

16. An insufflator as claimed in any preceding claim in which the location signal indicative of the location of the targeted area in the vessel is determined in response to a signal indicative of the location of a distal end of an endoscope in the vessel.

17. An insufflator as claimed in any preceding claim in which the location signal indicative of the location of a targeted area in the vessel is manually generated, and preferably, is manually generated by a foot pedal operated electrical switch, or by a hand operated electrical switch.

18. An insufflator as claimed in any preceding claim in which the control means comprises a signal processor, and preferably, a microprocessor.

19. An insufflator as claimed in any preceding claim in which the insufflator is adapted for insufflating an elongated lumen of a subject.

20. An insufflator as claimed in Claim 19 in which the elongated lumen comprises a colon of a subject, and the predefined pressure values are stored for one or more of the sigmoid colon, the descending colon, the transverse colon or the ascending colon.

21. An insufflator as claimed in any preceding claim in which an interface means is provided for inputting data to the control means for operation of the insufflator.

22. An insufflating apparatus for insufflating a vessel in the body of a human or animal subject, the insufflating apparatus comprising the insufflator as claimed in any preceding claim, and a means for producing the location signal indicative of the location of the targeted area.

23. An insufflating apparatus as claimed in Claim 22 in which the means for producing the location signal indicative of the location of the targeted area comprises a monitoring means for monitoring the location of an endoscope in the vessel and for producing the location signal as a signal indicative of the location of the endoscope in the vessel, and preferably, the signal indicative of the location of the endoscope in the vessel is adapted for applying to the control means of the insufflator.

24. An insufflating apparatus as claimed in Claim 22 or 23 in which the monitoring means for monitoring the location of an endoscope in the vessel is adapted for producing the location signal as a signal indicative of the location of a distal end of the endoscope in the vessel.

25. An insufflating apparatus as claimed in any of Claims 22 to 24 in which the control means of the insufflator is adapted to determine the location of the targeted area from the location signal produced by the monitoring means indicative of the location of the endoscope in the vessel , and preferably, the control means is adapted to determine the location of the targeted area as a location adjacent the distal end of the endoscope, but distally from the distal end of the endoscope.

26. An insufflating apparatus as claimed in any of Claims 22 to 25 in which the monitoring means is adapted for monitoring the depth of penetration of the endoscope into the vessel.

27. An insufflating apparatus as claimed in any of Claims 22 to 26 in which the monitoring means is adapted to monitor a scale on the endoscope as the endoscope is being urged into and / or out of the body of the subject, the scale being readable by the monitoring means.

28. An insufflating apparatus as claimed in any of Claims 22 to 27 in which the monitoring means for monitoring the location of the endoscope in the vessel comprises a fluoroscopic monitoring means.

29. An insufflating apparatus as claimed in any of Claims 22 to 28 in which the monitoring means for monitoring the location of the targeted area in the vessel and for producing the location signal indicative ofthe location of the targeted area in the vessel comprises an image recognition means adapted to determine the location of the targeted area in the vessel from a captured image of the targeted area.

30. An insufflating apparatus as claimed in Claim 29 in which the image recognition means is adapted to compare the captured image indicative of the targeted area in the vessel with at least one location reference image of at least one location in a reference vessel corresponding to the vessel, and to determine the location of the targeted area in the vessel from the comparison of the captured image with the at least one location reference image.

31. An insufflating apparatus as claimed in Claim 29 or 30 in which the image recognition means is adapted to compare the captured image with a plurality of location reference images of a plurality of locations in the reference vessel.

32. An insufflating apparatus as claimed in any of Claims 29 to 31 in which the image recognition means is adapted to compare the captured image with the plurality of the location reference images of each one of the plurality of the locations.

33. An insufflating apparatus as claimed in any of Claims 29 to 32 in which at least one of the location reference images of at least one of the locations in the vessel is derived from a reference vessel of a subject having at least one type of at least one characteristic.

34. An insufflating apparatus as claimed in Claim 33 in which at least one characteristic of a subject comprises one or more of the sex of a subject, the age of a subject or the age range of a subject, the weight of a subject or the weight range of a subject, the body mass index or the body mass index range of a subject and the resting position of the subject during the procedure.

35. An insufflating apparatus as claimed in any of Claims 29 to 34 in which the image recognition means is adapted to determine the location of the targeted area in the vessel from the location reference image which is a match with or the best match with the captured image.

36. An insufflating apparatus as claimed in any of Claims 29 to 35 in which the captured image of the targeted area is derived from an image capturing means of an endoscope located in the vessel.

37. An insufflating apparatus as claimed in any of Claims 29 to 36 in which the location reference images are stored in a location reference image storing means cross-referenced with the identities of the corresponding locations in the reference vessel, the location reference image storing means being accessible to the image recognition means.

38. An insufflating apparatus as claimed in any of Claims 29 to 37 in which the location reference images corresponding to the types of the characteristics of a subject are stored in the location reference image storing means cross-referenced with the identities of the characteristics and the types thereof.

39. An insufflating apparatus as claimed in any of Claims 29 to 38 in which the location reference images are stored cross-referenced with the identities of the corresponding locations and the identities of the characteristics and the types thereof with which they correspond in a location reference image look-up table in the location reference image storing means.

40. An insufflating apparatus as claimed in any of Claims 29 to 39 in which the location reference images are grouped into respective groups thereof, relating to one or more of the following types of the characteristics, the sex of a subject, the age of a subject or the age range of a subject, the weight of a subject or the weight range of a subject, the body mass index of a subject, or the body mass index range of a subject, and rest positions of a subject during the procedure.

41. An insufflating apparatus as claimed in Claim 40 in which the image recognition means is adapted to compare the captured image sequentially with the respective location reference images in each group on a group-by-group basis.

42. An insufflating apparatus as claimed in any of Claims 29 to 41 in which the location reference images for each location of the vessel are updated each time a match or a best match of a captured image with a location reference image is obtained for that location, and the captured image which is matched is passed through a learning model and stored as an additional location reference image along with the location reference image or additional location reference images for that location.

43. An insufflating apparatus as claimed in Claim 42 in which the number of additional location reference images for the respective locations are maintained at a predefined number of location reference images, and each time the number of additional location reference images for each location exceeds thepredefined number of additional location reference images, the oldest one of the additional location reference images for that location is deleted.

44. An insufflating apparatus as claimed in Claim 42 or 43 in which the additional location reference images are generated by an artificial intelligence algorithm.

45. An insufflating apparatus as claimed in any of Claims 29 to 44 in which the location reference images are stored in the location reference image storing means in digital form.

46. An insufflating apparatus as claimed in any of Claims 22 to 45 in which the insufflating apparatus comprises an endoscope.

47. An insufflating apparatus as claimed in Claim 46 in which the endoscope comprises an image capturing means for capturing the images of the respective targeted areas in the vessel.

48. An insufflating apparatus as claimed in Claim 47 in which the image capturing means is located adjacent a distal end of the endoscope.

49. An insufflating apparatus as claimed in any of Claims 46 to 48 in which the endoscope comprises the scale formed thereon.

50. An insufflating apparatus as claimed in any of Claims 46 to 49 in which the endoscope comprises the radiopaque marker thereon, and preferably, the radiopaque marker is located adjacent the distal end of the endoscope.

51. An insufflating apparatus as claimed in any of Claims 22 to 50 in which the predefined pressure values for the targeted areas in the respective locations of the vessel lie in the range of 5mmHg to 30mmHg.

52. An insufflating apparatus as claimed in any of Claims 22 to 51 in which the vessel in which the procedure is being carried out comprises a colon of a subject, and preferably, the predefined pressure values lie in the range of 5mmHg to 30mmHg.

53. An insufflating apparatus as claimed in Claim 51 in which a predefined pressure value is provided for one or more of a sigmoid colon, a descending colon, a transverse colon, and an ascending colon.

54. An insufflating apparatus as claimed in Claim 52 or 53 in which the predefined pressure value stored for the transverse colon is higher than the predefined pressure value stored for the sigmoid colon.

55. An insufflator for insufflating a vessel in the body of a human or animal subject comprising a flow controller for supplying insufflating gas to the vessel for insufflating thereof, a control means responsive to a topography signal indicative of the topography of an inner surface of a wall of the vessel (vessel wall) adjacent a targeted area of the vessel for controlling the flow controller to supply the insufflating gas to the vessel to maintain the topography of the inner surface of the vessel wall adjacent the targeted area at a predefined degree of evenness to enhance mucosal visualisation thereof.

56. An insufflator as claimed in Claim 55 in which the predefined degree of evenness of the inner surface of the vessel wall adjacent the targeted area is set to permit detection of a lesion in or on the inner surface of the vessel wall adjacent the targeted area.

57. An insufflator as claimed in Claim 55 or 56 in which the predefined degree of evenness of the inner surface of the vessel wall adjacent the targeted area comprises a substantially flat surface.

58. An insufflator as claimed in any of Claims 55 to 57 in which an image recognition means is provided to determine the topography of the inner surface of the vessel wall adjacent the targeted area and to produce the topography signal indicative of the topography of the inner surface of the vessel wall adjacent the targeted area, the image recognition means being adapted to compare a captured image indicative of the topography of the inner surface of the vessel wall adjacent the targeted area with at least one topography reference image, one of the at least one topography reference image being indicative of a surface of topography of the predefined degree of evenness, the image recognition means being adapted to determine the degree of evenness of the inner surface of the vessel wall adjacent the targeted area from the comparison of the captured image with the at least one topography reference image.

59. An insufflator as claimed in Claim 58 in which the control means of the insufflator is responsive to the topography signal produced by the image recognition means being indicative of the degree ofevenness of the inner surface of the vessel wall adjacent the targeted area being of a degree of evenness below the predefined degree of evenness to operate the flow controller to increase the flow of insufflating gas to the vessel until the topography signal is indicative of the predefined degree of evenness.

60. An insufflator as claimed in Claim 58 or 59 in which the control means of the insufflator is adapted to operate the flow controller to incrementally increase the supply of insufflating gas to the vessel until the value of the topography signal is indicative of the inner surface of the vessel wall adjacent the targeted area being of the predefined degree of evenness.

61. An insufflator as claimed in any of Claims 58 to 60 in which the image recognition means is adapted to compare the captured image indicative of the topography of the inner surface of the vessel wall adjacent the targeted area with a plurality of the topography reference images indicative of surfaces of topographies of respective different degrees of evenness below the predefined degree of evenness.

62. An insufflator as claimed in any of Claims 58 to 61 in which the degrees of evenness of the topographies of the respective topography reference images increase progressively to the predefined degree of evenness.

63. An insufflator as claimed in any of Claims 58 to 62 in which the image recognition means is adapted to compare the captured image of the inner surface of the vessel wall with a plurality of topography reference images of at least some of the locations in the vessel.

64. An insufflator as claimed in any of Claims 58 to 63 in which the topography reference images are stored cross-referenced with values indicative of the degrees of evenness thereof in a topography reference image storing means, accessible to the image recognition means, and preferably, the topography reference image storing means comprises an electronic memory.

65. An insufflator as claimed in Claim 64 in which the topography reference images for respective locations in the vessel are stored cross-referenced with the corresponding values indicative of the degrees of evenness thereof and cross-referenced with the identity of the locations thereof in the topography reference image storing means.

66. An insufflator as claimed in Claim 64 or 65 in which the topography reference images are storedcross-referenced with corresponding values indicative of the degrees of evenness in a topography reference image look-up table in the topography reference image storing means.

67. An insufflator as claimed in any of Claims 58 to 66 in which the topography reference images are stored in digital form.

68. An insufflator as claimed in any of Claims 58 to 67 in which the captured image indicative of the topography of the inner surface of the vessel wall of the targeted area is produced as a digital signal.

69. An insufflator as claimed in any of Claims 58 to 68 in which the topography reference images are derived from a reference vessel corresponding to the vessel.

70. An insufflator as claimed in any of Claims 58 to 69 in which the image recognition means is adapted to determine the degree of evenness of the topography of the inner surface of the vessel wall of the captured image of the targeted area as the degree of evenness of the topography reference image that is a match or a best match of the captured image.

71. An insufflator as claimed in any of Claims 58 to 70 in which the image recognition means is adapted to compare the captured image with the corresponding topography reference images indicative of the surface of the predefined degree of evenness before comparing the captured image with the other topography reference images.

72. An insufflator as claimed in any of Claims 58 to 71 in which the topography reference images are updated by an artificial intelligence algorithm.

73. An insufflator as claimed in Claim 72 in which the topography reference images are updated each time a match or a best match of a captured image is made with one of the topography reference images and the captured image is stored as an additional topography reference image along with the corresponding topography reference image and / or the corresponding additional topography reference images.

74. An insufflator as claimed in Claim 72 or 73 in which each captured image for which a match or a best match with a topography reference image is made is passed through a learning model prior to beingstored as an additional topography reference image, and preferably, the number of additional topography reference images stored corresponding to each degree of evenness is limited to a predefined number of additional topography reference images, and each time the number of additional topography reference images for each degree of evenness exceeds the predefined number, the oldest one of the additional topography reference images for that degree of evenness is deleted.

75. An insufflator as claimed in any of Claims 58 to 74 in which the image recognition means is adapted for detecting a lesion on the inner surface of the vessel wall of the targeted area.

76. An insufflator as claimed in any of Claims 58 to 75 in which the control means is responsive to the topography signal being indicative of the inner surface of the vessel wall adjacent the targeted area being of the predefined degree of evenness to produce a lesion scan signal.

77. An insufflator as claimed in Claim 76 in which the image recognition means is responsive to the lesion scan signal to compare a captured image of the inner surface of the vessel wall of the targeted area with at least one lesion reference image of a representation of a reference lesion, and on determining the presence of a lesion in or on the inner surface of the vessel wall of the targeted area, to produce a lesion present signal indicative of the detection of a lesion.

78. An insufflator as claimed in Claim 76 or 77 in which the image recognition means is responsive to the lesion scan signal to compare the captured image of the targeted area, the inner surface of the vessel wall of which is of the predefined degree of evenness with the at least one lesion reference image.

79. An insufflator as claimed in Claim 77 or 78 in which the image recognition means is adapted to compare a captured image of the inner surface of the vessel wall of the targeted area of the predefined degree of evenness with the at least one lesion reference image.

80. An insufflator as claimed in any of Claims 77 to 79 in which the image recognition means is adapted to compare the captured image of the inner surface of the vessel wall of the targeted area with a plurality of lesion reference images of lesions of respective different types and / or respective different sizes.

81. An insufflator as claimed in any of Claims 77 to 80 in which the image recognition means isadapted to determine the presence of a lesion in response to a match or a best match of the captured image with the at least one lesion reference image being determined.

82. An insufflator as claimed in any of Claims 78 to 81 in which the at least one lesion reference image is stored in a lesion reference image storing means cross-referenced with an identity of the type and size of the lesion.

83. An insufflator as claimed in any of Claims 78 to 82 in which the image recognition means is adapted to determine' the location of a detected lesion in or on the inner surface of the vessel wall adjacent the targeted areas.

84. An insufflator as claimed in Claim 83 in which the image recognition means is adapted to produce the lesion present signal comprising data indicative of the location of the lesion in or on the inner surface of the vessel wall adjacent the targeted area.

85. An insufflator as claimed in Claim 84 in which the lesion present signal is adapted for applying to a visual display screen for displaying the inner surface of the vessel wall adjacent the targeted area with the lesion on the inner surface of the vessel wall of the captured image.

86. An insufflator as claimed in any of Claims 78 to 85 in which the lesion reference images are updated by an artificial intelligence algorithm.

87. An insufflator as claimed in any of Claims 78 to 86 in which the lesion reference images are updated each time a match or a best match of the captured image is made with one of the lesion reference images, and the captured image is stored as an additional lesion reference image along with the corresponding lesion reference image and / or the corresponding additional lesion reference images, and preferably, the number of additional lesion reference images are limited to a predefined number of additional lesion reference images, and on the number of additional lesion reference images exceeding the predefined number thereof, the oldest one of the additional lesion reference images is deleted.

88. An insufflator as claimed in any of Claims 78 to 87 in which the control means of the insufflator is responsive to the lesion present signal for producing a signal convertible to a human sensory perceptible lesion alert signal alerting to the detection by the image recognition means of the presence of a lesion inor on the inner surface of the vessel wall of the targeted area.

89. An insufflator as claimed in any of Claims 78 to 88 in which the control means is responsive to the lesion present signal or to a manually produced signal indicative of the lesion present signal to operate the flow controller to increase the vessel pressure by a preset pressure increase amount to an elevated pressure above the current vessel pressure.

90. An insufflator as claimed in any of Claims 58 to 89 in which the image recognition means comprises a part of the insufflator, or is separate from the insufflator and is communicable therewith.

91. An insufflator as claimed in any of Claims 55 to 90 in which the control means of the insufflator is responsive to a reduce pressure signal to operate the flow controller to reduce the flow of insufflating gas to the vessel for reducing the current vessel pressure by a preset pressure reduction amount from the current vessel pressure, and preferably, the reduce pressure signal is produced by a manually operated switch means.

92. An insufflating apparatus comprising the insufflator as claimed in any of Claims 55 to 91 and an endoscope.

93. An insufflating apparatus as claimed in Claim 92 in which the image capturing means is located in the endoscope.

94. An insufflating apparatus as claimed in Claim 92 or 93 in which the image capturing means is located adjacent the distal end of the endoscope for capturing an image of the targeted area distally of the distal end of the endoscope.

95. A method for insufflating a vessel in the body of a human or animal subject in which an endoscopic procedure is being carried out, the method comprising controlling the flow of insufflating gas to the vessel in response to a location signal indicative of the location of a targeted area in the vessel at which the procedure is to be carried out to maintain the pressure in the vessel (vessel pressure) at a predefined pressure value corresponding to one or both of the type of the vessel and the location of the targeted area in the vessel.

96. A method as claimed in Claim 95 in which a plurality of the predefined pressure values cross- referenced with the identities of the corresponding locations in the vessel are stored, and preferably, are stored in a pressure values look-up table.

97. A method as claimed in Claim 95 or 96 in which a plurality of the predefined pressure values are stored for each location in the vessel, and are cross-referenced with the identity of the corresponding location.

98. A method as claimed in any of Claims 95 to 97 in which at least one of the predefined pressure values is cross-referenced with the identity of at least one characteristic of a subject and is stored for at least one of the locations in the vessel.

99. A method as claimed in Claim 98 in which a plurality of the predefined pressure values for different types of the at least one characteristic of a subject are stored and cross-referenced with the identity of the at least one characteristic and the identity of the types thereof.

100. A method as claimed in Claim 98 or 99 in which a plurality of the predefined pressure values are stored for respective characteristics of a subject and stored cross-referenced with the identities of the respective characteristics, and preferably are stored in the pressure values look-up table.

101. A method as claimed in any of Claims 98 to 100 in which the at least one characteristic of a subject relates to one or more of the age of a subject or the age range of a subject, the weight of a subject or the weight range of a subject, the body mass index of a subject or the body mass index range of a subject and / or the resting position of a subject during the procedure.

102. A method as claimed in any of Claims 95 to 101 in which at least one of the predefined pressure values is stored for each one of a plurality of different vessels.

103. A method as claimed in any of Claims 95 to 102 in which the method further comprises controlling the flow of insufflating gas to the vessel in response to a lesion present signal to increase the vessel pressure to an elevated pressure by a preset pressure increase amount above the current predefined pressure value at which the vessel pressure is being maintained.

104. A method as claimed in Claim 103 in which the preset pressure increase amount lies in the range of 3mm to 8mm, and preferably, the preset pressure increase amount lies in the range of 4mmHg to 6mmHg, and advantageously, the preset pressure increase amount is approximately 5mmHg.

105. A method as claimed in Claim 103 or 104 in which the lesion present signal is manually generated, and preferably, the lesion present signal is manually generated by a manually operated electrical switch for generating the lesion present signal.

106. A method as claimed in any of Claims 103 to 105 in which the lesion present signal is generated in response to detection of a lesion in the targeted area in the vessel.

107. A method as claimed in any of Claims 95 to 106 in which the method further comprises controlling the flow of insufflating gas to the vessel in response to a reduce pressure signal to decrease the vessel pressure by a preset pressure reduction amount below the current vessel pressure at which the vessel pressure is being maintained, and preferably, the preset pressure reduction amount lies in the range of 5mmHg to 8mmHg, and advantageously, the preset pressure reduction amount lies in the range of 4mmHg to 6mmHg, and more preferably, the preset pressure reduction amount is approximately 5mmHg.

108. A method as claimed in Claim 107 in which the reduce pressure signal is manually generated, and preferably, the reduce pressure signal is manually generated by a manually operated electrical switch for generating the reduce pressure signal.

109. A method as claimed in any of Claims 95 to 108 in which the location signal indicative of the location of the targeted area in the vessel is manually generated, and preferably, the location signal is manually generated by a manually operated electrical switch for generating the location signal.

110. A method as claimed in any of Claims 95 to 108 in which the location signal indicative of the location of the targeted area in the vessel is derived from a signal indicative of the location of an endoscope in the vessel.

111. A method as claimed in Claim 110 in which the location signal indicative of the location of the targeted area in the vessel is derived from a signal indicative of the location of the distal end of theendoscope in the vessel.

112. A method as claimed in Claim 110 or 111 in which the location of the endoscope in the vessel is determined by the depth of penetration of the endoscope into the vessel.

113. A method as claimed in Claim 112 in which the movement of the endoscope inwardly and / or outwardly of the vessel is monitored for determining the depth of penetration of the endoscope in the vessel.

114. A method as claimed in Claim 112 or 113 in which the depth of penetration of the endoscope in the vessel is determined by monitoring a scale on the endoscope as the endoscope is being urged into or out of the body of the subject, and preferably, the depth of penetration of the endoscope in the vessel is monitored by monitoring a graduated scale on the endoscope.

115. A method as claimed in any of Claims 112 to 114 in which the location of the endoscope in the vessel is determined by fluoroscopic monitoring of a fluoroscopic opaque marker on the endoscope.

116. A method as claimed in any of Claims 110 to 115 in which the location of the endoscope in the vessel is determined by capturing an image of the targeted area of the vessel and providing an image recognition means to identify the location in the vessel of the targeted area from the captured image thereof, and the image recognition means is adapted to produce the location signal indicative of the location of the targeted area in the vessel.

117. A method as claimed in Claim 116 in which the image recognition means is adapted to compare the captured image of the targeted area with at least one location reference image of a location in a reference vessel corresponding to the vessel.

118. A method as claimed in Claim 117 in which the image recognition means is adapted to compare the captured image of the targeted area with a plurality of location reference images of respective locations in the reference vessel.

119. A method as claimed in Claims 117 or 118 in which a plurality of the location reference images are stored for each location in the reference vessel.

120. A method as claimed in any of Claims 117 to 119 in which at least one of the location reference images of at least one of the locations in the vessel is derived from a reference vessel of a subject having at least one type of at least one characteristic.

121. A method as claimed in Claim 120 in which the at least one characteristic of a subject comprises one or more of the sex of a subject, the age of a subject or the age range of a subject, the weight of a subject or the weight range of a subject, the body mass index of a subject or the body mass index range of a subject and / or the resting position of the subject during the procedure.

122. A method as claimed in any of Claims 117 to 121 in which the image recognition means determines the location of the targeted area in the vessel as the location of the location reference image with which the captured image is a match or a best match.

123. A method as claimed in any of Claims 117 to 122 in which the location reference images are stored in a location reference image look-up table accessible to the image recognition means.

124. A method as claimed in any of Claims 117 to 123 in which the location reference images are cross-referenced with the identities of the corresponding locations thereof and the identities of the characteristics and types thereof with which they correspond in the location reference image look-up table.

125. A method as claimed in any of Claims 117 to 124 in which the location reference images are grouped into respective groups thereof relating to one or more of the following types of characteristics of a subject, the sex of a subject, the age of a subject or the age range of a subject, the weight of a subject or the weight range of a subject, the body mass index of a subject or the body mass index range of a subject, and / or the rest position of a subject during the procedure.

126. A method as claimed in Claim 125 in which the image recognition means is adapted to compare the captured image sequentially with the respective location reference images in each group thereof on a group by group basis.

127. A method as claimed in any of Claims 117 to 126 in which location reference images for each location of the vessel are updated each time a match or a best match of a captured image with a locationreference image is obtained for that location, and the captured image which is matched is passed through a learning model and stored as an additional location reference image along with the corresponding location reference image or additional location reference images for that location.

128. A method as claimed in Claims 127 in which the number of additional location reference images for each one of the location is maintained at a predefined number of location reference images, and each time the number of additional location reference images for each location exceeds the predefined number of additional location reference images, the oldest one of the additional location reference images for that location is deleted.

129. A method as claimed in Claims 127 or 128 in which the additional location reference images are generated by an artificial intelligence algorithm.

130. A method as claimed in any of Claims 116 to 129 in which the captured image of the targeted area is captured by an image capturing device of an endoscope.

131. A method as claimed in Claim 130 in which the image capturing means of the endoscope is located adjacent a distal end of the endoscope.

132. A method as claimed in any of Claims 95 to 131 in which the insufflating gas is supplied to the vessel through a flow controller operated under the control of a control means.

133. A method as claimed in Claim 132 in which the control means is responsive to the location signal for operating the flow controller to deliver the insufflating gas to the vessel at the predefined pressure value corresponding to the location of the targeted area in the vessel.

134. A method as claimed in Claim 132 or 133 in which the control means is responsive to the lesion present signal for operating the flow controller to increase the flow of insufflating gas to the vessel to increase the vessel pressure by the preset pressure increase amount.

135. A method as claimed in any of Claims 132 to 134 in which the control means is responsive to the pressure reduce signal for operating the flow controller to reduce the flow of insufflating gas to the vessel to reduce the vessel pressure from the current vessel pressure by the preset pressure reduction amount.

136. A method as claimed in any of Claims 95 to 135 in which the predefined pressure values for the targeted areas in the respective locations of the vessel lie in the range of 5mmHg to 30mmHg.

137. A method as claimed in any of Claims 95 to 136 in which the vessel in which the procedure is being carried out comprises a colon of a subject, and preferably, the predefined pressure values lie in the range of 5mmHg to 30mmHg.

138. A method as claimed in Claim 137 in' which the predefined pressure value is provided for one or more of a sigmoid colon, a descending colon, a transverse colon and an ascending colon.

139. A method as claimed in Claim 138 in which the predefined pressure value stored for the transverse colon is higher than the predefined pressure value stored for the sigmoid colon.

140. A method for insufflating a vessel in the body of a human or animal subject comprising controlling the supply of insufflating gas to the vessel in response to a topography signal indicative of the topography of an inner surface of a wall of the vessel (vessel wall) adjacent a targeted area in the vessel to maintain the topography of the inner surface of the vessel wall of the targeted area at a predefined degree of evenness to enhance mucosal visualisation thereof.

141. A method as claimed in Claims 140 in which the predefined degree of evenness of the topography of the inner surface of the vessel wall of the targeted area is set to permit detection of a lesion in or on the targeted area of the inner surface of the vessel wall.

142. A method as claimed in Claims 140 or 141 in which the predefined degree of evenness of the topography of the inner surface of the vessel wall of the targeted area comprises a substantially flat surface.

143. A method as claimed in any of Claims 140 to 142 in which the topography signal indicative of the topography of the inner surface of the vessel wall of the topography of the targeted area is derived from an image recognition means, and the image recognition means compares a captured image of the topography of the inner surface of the targeted area of the vessel wall with at least one topography reference image of a reference surface of topography of the predefined degree of evenness to determinethe degree of evenness of the inner surface of the vessel wall of the targeted area of the vessel.

144. A method as claimed Claim 143 in which the image recognition means compares the captured image of the topography of the inner surface of the vessel wall of the targeted area with a plurality of topography reference images of reference surfaces of topographies of respective different degrees of evenness, and the image recognition means determines the degree of evenness of the inner surface of the vessel wall of the targeted area, as the degree of evenness of the reference surface of the topography reference image with which the captured image is a match or a best match.

145. A method as claimed in Claim 144 in which the topography reference images are stored and cross-referenced with values indicative of the degree of evenness of the corresponding reference surfaces thereof, and preferably, the topography reference images are stored in a topography reference image look-up table cross-referenced with the values indicative of the degree of evenness of the corresponding reference surfaces thereof.

146. A method as claimed in Claim 145 in which the values indicative of the degrees of evenness of the topographies of the reference surfaces of the topography reference images decrease progressively to the value indicative of the predefined degree of evenness.

147. A method as claimed in Claims 145 or 146 in which the topography signal produced by the image recognition means comprises the value indicative of the degree of evenness of the inner surface of the vessel wall of the targeted area.

148. A method as claimed in any of Claims 143 to 147 in which a plurality of topography reference images of reference surfaces for different locations in a reference vessel corresponding to the vessel are stored.

149. A method as claimed in any of Claims 1431 o 148 in which a plurality of topography reference images of reference surfaces indicative of topographies of different predefined degrees of evenness are stored for each location of the reference vessel for which a topography reference image is stored, and are cross-referenced with the values indicative of the degrees of evenness of the respective topography reference images, and the identities of the locations in the reference vessel.

150. A method as claimed in Claim 149 in which the topography reference images of the reference surfaces for each location in a reference vessel for which topography reference images are stored, are stored and cross-referenced with the corresponding values indicative of the degrees of evenness thereof and the identities of the locations thereof in the reference vessel in the topography reference image lookup table.

151. A method as claimed in any of Claims 143 to 150 in which the captured image is initially compared by the image recognition means with the topography reference image of the predefined degree of evenness, and if the topography reference image of the predefined degree of evenness is not a match with the captured image, the image recognition means sequentially compares the captured image with the topography reference images of decreasing degrees of evenness from the topography reference image of the predefined degree of evenness.

152. A method as claimed in any of Claims 143 to 151 in which if the topography signal indicative of the degree of evenness of the inner surface of the vessel wall of the targeted area is not indicative of the inner surface of the vessel wall of the targeted area being of the predefined degree of evenness, the supply of insufflating gas to the vessel is increased until the topography of the inner surface of the vessel wall of the targeted area is of the predefined degree of evenness, and preferably, the supply of insufflating gas to the vessel is increased incrementally.

153. A method as claimed in any of Claims 143 to 152 in which a plurality of topography reference images of reference surfaces of topographies of respective different degrees of evenness are stored for different vessels.

154. A method as claimed in any of Claims 143 to 153 in which the topography reference images are updated by an artificial intelligence algorithm.

155. A method as claimed in any of Claims 143 to 154 in which the topography reference images are updated each time a match or a best match of a captured image is made with one of the topography reference images and the captured image is stored as an additional topography reference image along with the corresponding topography reference image and / or the corresponding additional topography reference images.

156. A method as claimed in Claim 155 in which each captured image for which a match or a best match with a topography reference image is made is passed through a learning model prior to being stored as an additional topography reference image.

157. A method as claimed in Claim 155 or 156 in which the number of additional topography reference images stored corresponding to each degree of evenness is limited to a predefined number of additional topography reference images, and each time the number of additional topography reference images for each degree of evenness exceeds the predefined number, the oldest one of the additional topography reference images for that degree of evenness is deleted.

158. A method as claimed in any of Claims 154 to 157 in which each captured image is compared with the topography reference images and the corresponding additional topography reference images until a match or a best match of the captured image with one of the topography reference images or the additional topography reference images is determined.

159. A method as claimed in any of Claims 143 to 158 in which at least one of the location reference images of at least one of the locations in the vessel is derived from a reference vessel of a subject having at least one type of at least one characteristic.

160. A method as claimed in Claims 159 in which the at least one characteristic of a subject comprises one or more of the sex of a subject, the age of a subject or the age range of a subject, the weight of a subject or the weight range of a subject, the body mass index of a subject or the body mass index range of a subject and the resting position of the subject during the procedure.

161. A method as claimed in any of Claims 140 to 160 in which the method further comprises monitoring the inner surface of the vessel wall of the targeted area of the vessel for a lesion, and on detecting a lesion in or on the inner surface of the vessel wall of the targeted area producing a lesion present signal indicative of the detection of a lesion.

162. A method as claimed in Claim 161 in which the supply of insufflating gas to the vessel is increased in response to the lesion present signal to increase the vessel pressure from the current value thereof by a preset pressure increase amount to an elevated pressure.

163. A method as claimed in Claim 162 in which the preset pressure increase amount lies in the range of 3mmHg to 8mmHg, and preferably, the preset pressure increase amount lies in the range of 4mmHg to 6mmHg, and advantageously, the preset pressure increase amount is approximately 5mmHg.

164. A method as claimed in any of Claims 161 to 163 in which the lesion present signal is manually generated, and preferably, the lesion present signal is manually generated by a manually operable electrical switch for generating the lesion present signal.

165. A method as claimed in any of Claims 140 to 164 in which the supply of insufflating gas to the vessel is decreased in response to a reduce pressure signal to decrease the current vessel pressure by a preset pressure reduction amount.

166. A method as claimed in Claim 165 in which the preset pressure reduction amount lies in the range of 3mmHg to 8mmHg, and preferably, the preset pressure reduction amount lies in the range of 5mmHg to 6mmHg, and advantageously, the preset pressure reduction amount is approximately 5mmHg.

167. A method as claimed in Claim 165 or 166 in which the reduce pressure signal is manually generated, and preferably, the reduce pressure signal is manually generated by a manually operable electrical switch for generating the reduce pressure signal.

168. A method as claimed in any of Claims 161 to 167 in which the lesion present signal is derived from the image recognition means.

169. A method as claimed in Claim 168 in which the image recognition means compares the captured image of the inner surface of the vessel wall of the targeted area with at least one lesion reference image comprising a representation of at least one lesion to determine the presence of a lesion in or on the inner surface of the vessel wall of the targeted area.

170. A method as claimed in Claim 169 in which the image recognition means compares the captured image of the inner surface of the vessel wall of the targeted area of the predefined degree of evenness with the at least one lesion reference image.

171. A method as claimed in any of Claims 169 or 170 in which the image recognition meanscompares the captured image with a plurality of lesion reference images comprising images of different types of lesions and of different sizes thereof.

172. A method as claimed in any of Claims 169 to 171 in which the image recognition means determines the presence of a lesion in or on the inner surface of the vessel wall of the targeted area on the captured image being a match or a best match with the at least one lesion reference image.

173. A method as claimed in any of Claims 169 to 172 in which the lesion reference images are stored and cross referenced with the identity of the type of lesion and the identity of the size thereof.

174. A method as claimed in any of Claims 169 to 173 in which an image of the captured image of the targeted area comprising a lesion therein is displayed on a visual display screen.

175. A method as claimed in Claims 174 in which the lesion in the image displayed on the visual display screen is highlighted, and preferably, is highlighted by encircling the image of the lesion with a bright ring.

176. A method as claimed in any of Claims 169 to 175 in which the lesion reference images are updated by an artificial intelligence algorithm.

177. A method as claimed in any of Claims 169 to 176 in which the lesion reference images are updated each time a match or a best match of the captured image is made with one of the lesion reference images, and the captured image is stored as an additional lesion reference image along with the corresponding lesion reference image and / or the corresponding additional lesion reference images, and preferably, the number of additional lesion reference images are limited to a predefined number of additional lesion reference images, and on the number of additional lesion reference images exceeding the predefined number thereof, the oldest one of the additional lesion reference images is deleted.

178. A method as claimed in Claim 177 in which each additional lesion reference image is determined by an artificial intelligence algorithm.

179. A method as claimed in any of Claims 169 to 178 in which at least one of the lesion reference images is derived from a reference vessel of a subject having at least one type of at least oneI l l characteristic.

180. A method as claimed in Claim 179 in which the at least one characteristic of a subject comprises one or more of the sex of a subject, the age of a subject or the age range of a subject, the weight of a subject or the weight range of a subject, the body mass index or the body mass index range of a subject and the resting position of the subject during the procedure.

181. A method as claimed in any of Claims 140 to 180 in which the supply of insufflating gas to the vessel is controlled by a flow controller operated under the control of a control means, and the control means is responsive to the topography signal for controlling the supply of the insufflating gas to the vessel for maintaining the inner surface of the vessel wall of the targeted area at the predefined degree of evenness.

182. A method as claimed in Claim 181 in which the control means is responsive to the lesion present signal for operating the flow controller to increase the flow of insufflating gas to the vessel to increase the vessel pressure by the preset pressure increase amount.

183. A method as claimed in Claims 181 or 182 in which the control means is responsive to the reduce pressure signal for operating the flow controller to reduce the flow of insufflating gas to the vessel to reduce the vessel pressure by the present pressure reduction amount.

184. A method for insufflating a vessel for maintaining the topography of an inner surface of a wall of the vessel (vessel wall) of a targeted area in the vessel at a predefined degree of evenness, the method comprising reading a topography signal from a vision system indicative of the degree of evenness of the topography of the inner surface of the vessel wall of the targeted area, and controlling the flow of insufflating gas to the vessel for maintaining the topography of the inner surface of the vessel wall of the targeted area at a predefined degree of evenness.

185. A method as claimed in Claim 184 in which the topography signal is read from an image recognition means adapted to compare a captured image of the inner surface of the vessel wall of the targeted area with at least one topography reference image, at least one of the at least one topography reference images having a reference surface of topography of the predefined degree of evenness.

186. A method for detecting a lesion in or on an inner surface of a wall of a vessel in a targeted area of the vessel, the method comprising comparing a captured image of the inner surface of the vessel wall in the targeted area with at least one lesion reference image comprising a representation of a lesion, and determining the presence of a lesion on the inner surface of the vessel wall in the targeted area on the captured image being a match or a best match of one of the at least one lesion reference image.

187. A method as claimed in Claim 186 in which the captured image of the inner surface of the vessel wall in the targeted area comprises a captured image of the inner surface of the vessel wall of a predefined degree of evenness.

188. An insufflating apparatus for insufflating a vessel in the body of a human or animal subject, the insufflating apparatus comprising an insufflator for insufflating the vessel, and a detecting means for detecting a lesion in the vessel and for producing a lesion present signal on detecting a lesion in the vessel, the insufflator comprising a flow controller, and a control means, the control means being responsive to the lesion present signal for operating the flow controller to increase the supply of insufflating gas to the vessel to increase the vessel pressure by a preset pressure increase amount to an elevated pressure.

189. An insufflating apparatus for insufflating a vessel in the body of a human or animal subject, the insufflating apparatus comprising an insufflator for insufflating the vessel, and a detecting means for detecting a lesion in the vessel and for producing a reduce pressure signal on detecting a lesion in the vessel, the insufflator comprising a flow controller, and a control means, the control means being responsive to the reduce pressure signal for operating the flow controller to reduce the supply of insufflating gas to the vessel to reduce the pressure in the vessel by a preset pressure reduction amount.

190. An insufflating apparatus for insufflating a vessel in the body of a human or animal subject, the insufflating apparatus comprising an insufflator for insufflating the vessel, and a detecting means for detecting a lesion in the vessel, and for producing one of a lesion present signal or a reduce pressure signal on detecting a lesion in the vessel, the insufflator comprising a flow controller, and a control means, the control means being responsive to the lesion present signal for operating the flow controller to increase the supply of insufflating gas to the vessel to increase the vessel pressure to an elevated pressure, and the control means is responsive to the reduce pressure signal for operating the flow controller to reduce the supply of insufflating gas to the vessel to reduce the vessel pressure to a reducedpressure.

191. An insufflating apparatus comprising an insufflator for insufflating a vessel, and a detecting means for detecting a lesion in or on an inner surface of a wall of the insufflated vessel (vessel wall) in a targeted area in the vessel, the detecting means comprising a means for comparing a captured image of the inner surface of the vessel wall in the targeted area with at least one lesion reference image indicative of a lesion, the detecting means being adapted to determine the presence of a lesion on the inner surface of the vessel wall in the targeted area on the captured image being a match or a best match of at least one of the at least one lesion reference images.

192. An insufflating apparatus as claimed in Claim 191 in which the inner surface of the vessel wall in the targeted area of the captured image is of a predefined degree of evenness.

193. An insufflating apparatus as claimed in Claim 192 in which the insufflator is adapted to maintain the vessel at a predefined pressure value for maintaining the inner surface of the vessel wall in the targeted area at the predefined degree of evenness.

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