Handheld wearable device attachable to an endoscope insertion tube

Abstract

A handheld, wearable device is described for attaching the endoscope insertion tube to a surgeon's hand, specifically the right hand which is normally used to operate the endoscope. The device is provided with a hooking portion configured to hold an endoscope insertion tube. Therefore, with the hand on which the device is fitted or constrained to, the surgeon is able move the endoscope insertion tube with respect to the patient's body, and with the fingers of the same hand, the surgeon is able to use a surgical instrument actuator inserted into an endoscopic sheath, which in turn is inserted into the endoscope insertion tube. With the other hand, the surgeon is able to independently use the endoscope handle / handpiece and the respective controls, namely, directional knobs and buttons for insufflating, suctioning and irrigating. The device allows the endoscope insertion tube to be released in order to free the hand when the endoscopic sheath needs to be moved with respect to the endoscope insertion tube.

Description

[0001] Handheld wearable device attachable to an endoscope insertion tube ****

[0002] DESCRIPTION

[0003] Field of the invention

[0004] The present invention relates to a handheld wearable device attachable to an endoscope insertion tube, which device allows the endoscope insertion tube to be constrained to the surgeon's hand.

[0005] State of the art

[0006] Diagnostic and surgical endoscopy is a technique involving the introduction of an endoscope through a natural orifice in the human body or, in rare cases, through an incision made in the patient's tissues, by means of which the surgeon can visualize the organ or area to be treated via a monitor. Furthermore, through the endoscope a variety of instruments can be inserted, and utilized, into the patient's body, which are adapted to take tissue samples for diagnosis or perform procedures, such as, for example, polyp removal.

[0007] In practice, endoscopy is used in various fields of medicine: it is very common in pneumology, called bronchoscopy, for the diagnosis and therapy of neoplasms, and in gynecology, called hysteroscopy, to treat uterus disorders such as cysts, endometriosis and fibromas. Endoscopic surgery is also used in other fields, such as otorhinolaryngology, where endoscopic sinus surgery is very common to treat lesions or problems within the nose which prevent normal breathing, affect the smell or cause facial and head pain. In gastroenterology and general and digestive surgery, diagnostic and surgical endoscopy is used for taking tissues for histological analysis, removing polyps and tumors, treating hemorrhages, treating benign and malignant digestive tract stenoses, treating obesity or treating biliary tract diseases, etc.

[0008] A conventional endoscope comprises a handle (or handpiece) from which a tube extends. The handle generally comprises directional knobs and buttons for insufflating, irrigating and suctioning. The directional knobs allow the tube end inserted into the patient to be steered. The tube can be inserted into the patient's body through a natural or surgical orifice (for example, through the anal orifice into the intestine, or through the oral orifice, into the upper digestive tract). An accessory consisting of a sheath, a surgical instrument (operating instrument) and a surgical instrument actuator mounted and operable on the accessory's handle can be inserted into a specific tube channel through a side inlet of the handle. The sheath extends inside and along the tube and slides longitudinally, i.e. , back and forth along the tube. The sheath comes out of the tube at a port on the tip of the endoscope insertion tube. At the end of the sheath that comes out of the tip of the endoscope insertion tube, there is a surgical instrument, such as polypectomy forceps or snares. A metal wire is slidably inserted into the sheath to allow the surgical instrument to be activated; one end of the metal wire engages the surgical instrument and the opposite end of the metal wire engages the above mentioned actuator. The actuator is configured to activate and deactivate the surgical instrument on command, such as to close and open the forceps, and to steer or rotate the surgical instrument.

[0009] In practice, therefore, the tube is inserted into the patient's body, the sheath is slidably inserted into the tube and the metal wire is slidably inserted into the sheath.

[0010] The surgeon initially inserts into the patient's body the tube equipped with a sheath and surgical instrument, which are positioned inside the tube. Once the end of the tube has reached the surgical site, the surgeon stops the tube and pushes the sheath to pull the surgical instrument 1-2 cm out. At this point, the surgeon operates both the surgical instrument's actuator and the sheath, in order to move the surgical instrument with respect to the tube and the patient's body, to activate and deactivate the surgical instrument and to perform the surgery. If required, the surgeon adjusts the tube's orientation by using the directional knobs and the insufflating, irrigating and suctioning buttons on the endoscope handle and performs insufflation, irrigation and suctions.

[0011] Since there are three components to be moved with just two hands, the endoscope insertion tube, the sheath and the surgical instrument actuator, once the surgical site has been targeted and reached, the surgeon leaves the endoscope insertion tube in place, and only handles the sheath and the surgical instrument actuator. If the endoscope insertion tube needs to be moved again, the right hand is usually used to push or pull the endoscope insertion tube, while the left hand alternately acts on the surgical instrument actuator or the sheath but cannot operate both the actuator and sheath.

[0012] Once the endoscope insertion tube has reached the desired position, it is released and remains inserted into the patient but not held by the surgeon. For this reason, keeping the endoscope insertion tube stationary while using the surgical instrument can be difficult. When the surgeon pulls the sheath toward him or her, to retract the surgical instrument gripping the patient's tissue, for example, while removing a polyp, the endoscope insertion tube can react by moving in the opposite direction, i.e. it can insert itself further into the patient's body or it can move with the sheath, slipping out of the patient's body.

[0013] For example, when the surgical instrument applies pressure on the patient's tissue, the endoscope insertion tube may be subjected to a push in the opposite direction, or push backward, which can cause the surgical instrument to lose its correct position at the surgical site. For example, in the known art, performing colonoscopy requires the left hand to hold the handle (the handpiece) of the endoscope, with the fingers of the left hand used to operate the directional knobs and the insufflating, suctioning and irrigating buttons on the handle, and the right hand used to push and draw back the endoscope insertion tube with axial and rotational movements. It is therefore clear that two hands do not allow for the management of all the possible situations that may arise during the procedure, and for this reason, the action of an assistant is often required which cooperates with the surgeon in order to keep the endoscope insertion tube stationary, either manually when necessary, or with the surgeon maintaining the control of the endoscope insertion tube while the assistant operates the actuator on surgeon demand.

[0014] There are other techniques for holding the endoscope insertion tube, i.e., for keeping it stationary with respect to the patient while using the surgical instrument.

[0015] One technique involves the surgeon using three fingers of one hand, usually the same hand used to hold the endoscope handle: the surgeon clamps the endoscope insertion tube between the three fingers and the handle, while supporting the handle with the same hand.

[0016] Another technique involves the use of floor stands in the operating room. The stands are positioned on the floor and extend vertically; they are provided with at least one swiveling arm to which a gripper is mounted. The gripper can be clamped onto the endoscope insertion tube and the arm can be clamped in the chosen position. An example is shown in US 11.464.396, specifically in figures 12A and 12B.

[0017] None of the above-described techniques are satisfactory.

[0018] The aid of an assistant is not always available and, anyway, it raises regulatory, procedural and insurance, as well as management concerns.

[0019] Using the three fingers of the hand with which the handle is held is particularly uncomfortable for the surgeon, prevents the use of the directional knobs and is not viable for surgeons with small hands.

[0020] Floor stands are not always stable enough and, however, their size limits the freedom of movement of the surgeon and medical staff around the patient. Furthermore, they have substantial costs.

[0021] For example, with regard to polypectomy procedures it is estimated that:

[0022] - about 69% of the procedures are performed without retaining the endoscope insertion tube,

[0023] - about 29% of the procedures are performed with the third technique, that is with the surgeon holding the endoscope insertion tube together with the endoscope handle, and

[0024] - about 2% of the procedures are performed with the second technique, i.e. , with the aid of an assistant.

[0025] Summary of the invention Object of the present invention is to provide a device that allows the endoscope insertion tube to be used effectively, holding it or moving it as needed, thus overcoming the above-described drawbacks, in particular, a device that allows the endoscope insertion tube, the sheath and the actuator of the surgical instrument to be moved selectively, with just two hands, without the external involvement of an assistant.

[0026] The present invention therefore relates to a handheld, wearable device according to claim 1 for attaching the endoscope insertion tube to a surgeon's hand.

[0027] Herein, the term wearable is used to refer to a device that can be constrained, clamped onto the user's hand, contrary to a device that can be gripped, but it can not be clamped onto the hand. The term wearable thus identifies a peculiar feature of the device that, once clamped on the hand, gives the user the freedom to open and close the hand and use the fingers, without dropping the device as a consequence. Therefore, a device that can be gripped but not clamped on the hand does not fall within the definition provided herein of wearable device.

[0028] The device is provided with a hooking portion configured to hold an endoscope insertion tube inside which a sliding (endoscopic) sheath is housed with a surgical instrument inside thereof.

[0029] Thus, the surgeon:

[0030] - is able, with the hand on which the device is fitted or constrained, in particular the right hand, to move the endoscope insertion tube with respect to the patient's body and to independently use the actuator of the surgical instrument inserted into the endoscopic sheath, and

[0031] - is able to independently use, with the other hand, the left, the handle (handpiece) of the endoscope, as well as the directional knobs and buttons on the handle.

[0032] Furthermore, by temporarily releasing the endoscope insertion tube from the device, the surgeon can use the same right hand on which the device is mounted, to directly act on the endoscopic sheath by moving or holding it with respect to the endoscope insertion tube. Indeed, the device stays hooked on the hand, without falling off, despite the hand is used to act on the sheath.

[0033] In practice, thanks to the handheld, wearable device, the surgeon can perform three operations, which can also be independent of each other, by using two hands. This way, there is no strict need for the aid of an assistant, but the surgeon can perform the endoscopy completely independently. Clearly, floor stands are not needed either.

[0034] Once the surgical instrument has been correctly positioned at the surgical site, the surgeon can perform the three operations, possibly hooking and releasing the endoscope insertion tube to / from the device, even repeatedly, if required.

[0035] Thus, the device according to the present invention allows for the use of only one hand, the very hand on which the device is fitted / worn and clamped, to keep the position of the endoscope tube stationary during surgery.

[0036] In addition, the device according to the present invention provides the surgeon with immediate feedback on the force exerted by the surgical instrument and the reaction provided by the patient's body tissues: the surgeon directly feels on his hand the pulling or pushing force exerted on / by the endoscope insertion tube and can intervene immediately to adjust the force exerted with the surgical instrument.

[0037] The device described herein is therefore a simple yet effective tool that provides the surgeon with the ability to independently and selectively control and move the endoscope insertion tube, the endoscopic sheath and the surgical instrument.

[0038] In the preferred embodiment, the device comprises a body that can be constrained to the metacarpal bones of the hand or can be fitted onto the hand in a stationary manner, that is, clamped without the possibility of accidental release from the hand, so as to provide the hooking portion of the endoscope insertion tube at the height of the metacarpal bones. Generally, the hooking portion can also be at other locations on the hand, such as the wrist, but having the hooking portion on the metacarpal bones has the advantage of allowing the fingers to be used on the endoscope insertion tube, if necessary, to tighten it or to tighten the endoscopic sheath between the fingers and the endoscope insertion tube, while the latter is held by the hooking portion.

[0039] Preferably, the device comprises a first gripper constrained to the body; the first gripper is provided with jaws which are lockable on the metacarpal bones of the hand. In this embodiment, therefore, the device locks on the hand like a clip. Alternatively, the device may be a glove that can be fitted on the hand and provided with the hooking portion externally.

[0040] More preferably, the jaws of the first gripper are lockable on the outer edge of the metacarpal bones of the hand, that is, on the portion that continues with the little finger.

[0041] The body may be stationary relative to the first gripper, or the first gripper is hinged to the body so as to allow the body to rotate relative to the first gripper.

[0042] In the preferred embodiment, the hooking portion is a second gripper provided with jaws that are lockable on an endoscope insertion tube, for example an elastic gripper.

[0043] In an embodiment, the hooking portion is constrained to the body by means of a hinge. In this arrangement, the hooking portion can be rotated with respect to the body (between a first position corresponding to the hooking portion distal from the palm of the hand, for example, at the back of the hand, and a second position proximal to the palm of the hand, for example, at the outer edge of the palm of the hand).

[0044] For example, the hinge connecting the hooking portion to the body of the device is an elastic hinge, i.e., a hinge counteracted by a spring or an elastic element, or the device comprises elastic means configured to constantly exert a force on the hooking portion that tends to return the hooking portion to the first position. In the embodiment with the hooking portion rotatable with respect to the body, the device comprises a lever that can be operated by the wearer, i.e. , the surgeon, to rotate the hooking portion with respect to the body between the first position and the second position. The lever described above extends from the body toward the palm of the wearer hand, by a length compatible with the activation by the wearer’s little finger only, or wearer's little and ring fingers only. In other words, the lever is short so as not to take up the entire palm of the hand and to leave room for the fingers to grip the actuator of the surgical instrument (operating instrument) located inside the endoscopic sheath.

[0045] In an embodiment, the device is a kit that also comprises a clamping element for clamping the endoscopic sheath to the endoscope handle / handpiece, at the sheath inlet port in the endoscope handle / handpiece. For example, the clamping element is a ring that holds the endoscopic sheath to the endoscope handle / handpiece.

[0046] The use of the handheld wearable device provides:

[0047] - fitting or constraining the device onto a surgeon's hand, typically the right hand, in a stationary manner, i.e., clamped on the hand, not releasable accidentally;

[0048] - attaching an endoscope insertion tube to the device;

[0049] - moving the hand with the device to change the position of the endoscope insertion tube with respect to a reference, for example the patient, or keeping the hand with the device still to keep the position of the endoscope insertion tube stationary with respect to the same reference, and

[0050] - operating with the fingers of the same hand an actuator of the surgical instrument.

[0051] The surgeon can use the other hand, the left hand, to control the handle / handpiece of the endoscope with the respective directional knobs and buttons.

[0052] If required, the surgeon can temporarily release the endoscope insertion tube from the device, and hence from the right hand, to directly operate the endoscopic sheath by adjusting the longitudinal position thereof with respect to the endoscope handle / handpiece. Once the desired position is reached, the surgeon can hook back again the endoscope insertion tube to the device on the right hand. When moving the endoscopic sheath with respect to the endoscope handle / handpiece is no longer needed, the surgeon can use a sheath that clamps the ring on the endoscope handle / handpiece.

[0053] Brief list of the figures

[0054] Further characteristics and advantages of the invention will be more evident by the review of the following detailed description of a preferred, but not exclusive, embodiment which is depicted for illustration purposes only and without limitation, with the aid of the attached drawings, in which:

[0055] - figure 1 is a perspective view of a first device according to the present invention, fitted on a surgeon's hand, in a first configuration;

[0056] - figure 2 is a perspective view of the device shown in figure 1 , fitted on a surgeon's hand, in a second configuration;

[0057] - figures 3-5 are perspective views of a second device of the present invention, fitted on a surgeon's hand, in three corresponding configurations;

[0058] - figures 6-8 are sectional views of a third device according to the present invention in three corresponding configurations;

[0059] - figure 9 is a sectional view of the third device shown in figures 6-8, about to be fitted on the surgeon's hand;

[0060] - figure 10 is a sectional view of the third device shown in figures 6- 9, fitted a surgeon's hand and gripping an endoscopic tube;

[0061] - figures 11 and 12 are schematic views showing the use of the device of figure 1 during a surgical procedure.

[0062] Detailed description of the invention

[0063] Figures 1 and 2 show a first embodiment 1 of the device 1 according to the present invention, having the function of holding an endoscope insertion tube on the surgeon's hand, without hindering the articulation of the fingers. Thereby, the device 1 engages a portion of the hand other than the fingers. For example, the device 1 is configured to engage the palm of the hand, specifically the metacarpal bones area (fifth bone) in front of the little finger, or the back of the hand, or possibly the wrist. For simplicity's sake, the device 1 will be referred to as a handheld device precisely to specify its ability to be firmly but removably constrainable to these anatomical parts. Therefore, the term handheld is to be understood in a broad meaning, not limited to just the palm of the hand.

[0064] In addition to being handheld, the device 1 is also wearable in the sense that it is not intended to be gripped by the surgeon, as this would require the use of the fingers and require keeping the hand closed to hold the device, but it is intended to be constrained, clamped to the hand while leaving the fingers and the hand itself free.

[0065] The handheld and wearable device 1 , hereinafter simply “device” 1 , comprises a body 2 specifically shaped to allow it to be constrained to the surgeon's hand. In the example shown in the figures, the body 2 is a first springloaded gripper, which can be opened and closed, shaped to be clung on the metacarpal bones 3 of the hand M, specifically the right hand. The opening of the body 2 can be manually achieved by the surgeon, similar to the opening of a clothes peg. The spring (not shown) exerts the push that keeps the body 2 closed on the hand M: clearly, the pressure exerted will be sufficient to prevent accidental disengagement of the device 1 from the hand M, but not excessive enough to cause discomfort or pain to the surgeon.

[0066] On the body 2 there is a hinge 4 which supports a hooking portion 5 having the function of holding an endoscope insertion tube T. The hooking portion 5 is therefore hinged to the body 2 so that it can rotate to change the position of the endoscope insertion tube T relative to the hand M. In particular, the hooking portion 5 can be rotated between a first position, external with respect to the hand M and distal with respect to the palm of the hand M, into which the tube T extends at a distance from the back of the hand M, and a second position, proximal, or however more internal with respect to the palm of the hand M, into which the tube T extends at the palm of the hand M, for example parallel to the little finger.

[0067] In the preferred embodiment, the hinge 4 is adjustable, meaning that the surgeon can adjust the toughness thereof and can possibly lock the hinge to prevent rotations of the hooking portion 5 by acting on the hinge. For example, the hinge 4 has a small adjustment knob, which can be rotated by the surgeon in order to adjust the toughness of the hinge 4.

[0068] As shown in the figures, the hooking portion is U- or C-shaped and is flexible to allow the tube T to be snap fitted into the U- or C-shaped portion 6, thus removably clamping the tube T. Alternatively, the hooking portion is a second spring that can be opened and closed, and operated by the surgeon to hook the endoscope insertion tube T.

[0069] In the example shown, the device 1 comprises a lever 7 which extends from the body 2 towards the palm of the hand M, and which can be operated by the surgeon with the same hand M. The lever 7 can be rotated by the surgeon, at any time, to cause the rotation of the hooking portion 5 from the first position shown in figure 1 to the second position shown in figure 2. The length of the lever 7 is such that it can be operated with only the little finger, or with the little finger and the ring finger, without overly extending so as not to unnecessarily hinder the palm of the hand.

[0070] The lever 7 is counteracted by elastic elements 8 which constantly apply a returning force on the hooking portion 5 to the first position of figure 1 .

[0071] Figure 2 shows the hooking portion 5 rotated with respect to the starting position shown in figure 1. The arrow shows the direction of rotation. The rotation was imparted by the surgeon by means of the lever 7. As will be explained hereinafter, the rotation acts to bring the endoscope insertion tube T within reach, i.e., to a position convenient for the surgeon to grip it with his fingers.

[0072] Figures 3-5 show in perspective, and in a sequence of use, a second embodiment T of the handheld wearable device, which differs from the first embodiment 1 only in that the hooking portion 5 faces the opposite side.

[0073] In figure 3, the device T is gripping the endoscope insertion tube T, i.e., the tube T is snap fitted into the hooking portion 5. The hooking portion 5 is in the first, starting position, corresponding to the endoscope insertion tube T extending parallel to the back of the hand M, on the opposite side from the palm of the hand M. In this configuration, the tube T cannot accidentally disengage the hooking portion 5 and does not hinder the normal use of the hand M by the surgeon. Indeed, the palm of the hand M remains free, as well as the fingers. The hand M can therefore be used by the surgeon for operations other than simply holding the endoscope insertion tube T. For example, the surgeon can use his fingers to move the sheath of the endoscope with respect to the tube T.

[0074] Figure 4 shows the device T in a second configuration in which, the lever 7 having been pushed with the little finger, the surgeon has brought the hooking portion 5 closer to the palm of the hand M, and in particular close to the last metacarpal bone of the hand M. In this position, the tube T can be grasped by the surgeon with the little finger, meaning that the little finger can be partially wrapped around the tube T.

[0075] Figure 5 shows the device T in a third configuration in which, the lever 7 having been further pushed with the little finger, the surgeon has brought the hooking portion 5 into the second position, in which the endoscope insertion tube T almost extends parallel to the little finger. In this position, the endoscope insertion tube T can be easily grasped by the surgeon with one or multiple fingers of the hand M in order to move the tube T with respect to the patient, possibly also holding a grip on the endoscopic sheath.

[0076] Clearly, releasing the lever 7 results in the automatic return of the hooking portion 5 to the initial position shown in figure 3, due to the action of the elastic elements 8.

[0077] During the displacements of the hooking portion 5 shown in figures 3-5, the body 2 of the device T remains firmly locked on the metacarpal bones of the hand M. Figures 6-8 show in section, and in a sequence of use, a third embodiment 1” of the handheld wearable device, in which the body 2 is a first gripper provided with two jaws 2' and 2” rotatable on a first pin 2”’ parallel to the hinge 4 and in which the hooking portion 5 is a second gripper with two jaws 5' and 5” rotatable on a pin 5”’ parallel to the hinge 4. For simplicity, the endoscope insertion tube T is not shown.

[0078] The jaws 2' and 2" of the first gripper 2 open and close to clamp onto the outer edge of the metacarpal bones of the hand, as shown in relation to solutions 1 and 11. The jaws 5' and 5" open and close to clamp onto the endoscope insertion tube T.

[0079] Figure 6 shows the device 1” in the first position of the hooking portion 5, equivalent to the one shown in figure 3. Figures 7 and 8 show the switching of the hooking portion 5 to the second position, as a result of the use of the lever 7 by the surgeon. The intermediate position of the hooking portion 5 in figure 7 is equivalent to the one shown in figure 4 and the final position of the hooking portion 5 shown in figure 8 is equivalent to the position in figure 5.

[0080] Figures 9 and 10 are sectional views of the device 1” in use. In particular, figure 9 shows the insertion of the outer edge M' of the metacarpal bones of the surgeon's hand M between the jaws 2' and 2”. By pushing the hand between the jaws 2' and 2”, the elastic hinge 2”' is opened and then closed again, to tighten the jaws 2' and 2” around the hand, as shown in figure 10. In figure 10 the tube T is also shown, in section, closed between the jaws 5' and 5” of the hooking portion 5.

[0081] The use of the device 1 , T, 1”, both during training outside the human body and during an actual endoscopy on a patient, requires the surgeon to wear the device 1 , T, 1” on the hand, as described above, with the endoscope insertion tube T clamped in the hooking portion 5. With the device 1 , T, 1” worn on the hand M, the endoscope insertion tube T becomes integral with the right hand M of the surgeon who, consequently, takes control of the longitudinal position of the tube T. This means that the surgeon may push the tube T into the patient's body, or retract it from the patient's body, while maintaining full operability of the fingers of the same hand M, which, at this point, can be used to operate the actuator of the surgical instrument, thus leaving the left hand free to operate the handle / handpiece of the endoscope and controls thereof. Therefore, there is no further need for external assistance, such as that of an assistant, or floor stands for the tube T.

[0082] Since the hinges 2”' and 5”' are elastic, forcibly pulling the endoscope insertion tube T is enough to extract it from the jaws 5' and 5” and, similarly, applying force is enough to pull the hand M out of the jaws 2', 2”.

[0083] The examples 1 , T, and 1" shown and described above are not limiting: the handheld, wearable device according to the present invention can also be made differently, for example as a glove equipped with the hooking portion 5, regardless of whether the hooking portion 5 can be hinged or not. What is relevant is the possibility for the surgeon to be able to continue using his right hand M to operate the actuator of the surgical instrument, while maintaining control of the longitudinal position of the tube T.

[0084] Figure 11 is a schematic view of a patient P undergoing endoscopic surgery. The surgeon S wears the device 1 according to the present invention on his right hand M. The endoscope insertion tube is hooked to the device 1 , as explained above, and is inserted into the intestine of the patient P through the colon. With the same right hand, the surgeon S holds an actuator 12 of the surgical instrument which is inserted into the endoscopic sheath 10, which in turn is inserted into the tube T through the handle / handpiece 11 of the endoscope. On the screen 9, the surgeon S views the image acquired by the camera mounted to the end of the endoscope insertion tube T. With his left hand, the surgeon S holds the handle / handpiece 11 of the endoscope, which is provided with directional knobs and buttons for insufflating, suctioning and irrigating, collectively denoted by the reference 13.

[0085] Thanks to the device 1 , the surgeon can move the insertion tube T along the intestine of the patient P to bring the surgical instrument to the surgical site. Once the surgical site is reached, the surgeon keeps his right hand still, thus keeping the insertion tube T stationary with respect to the patient P, and proceeds to operate the actuator 12 to activate the surgical instrument.

[0086] As shown in figure 12, if at this stage the use of the insufflating, suctioning and irrigating directional knobs and buttons 13 on the handle / handpiece 11 of the endoscope is required, or if moving the sheath 10 with respect to the insertion tube T and the handle / handpiece 11 is required, the surgeon can release the insertion tube T from the device 1 , for example by using the left hand or making a rotary movement with the right hand M sufficient to achieve disengagement. At this time, with the right hand, he acts directly on the sheath 10, or on the controls 13, until the correct positioning of the endoscopic sheath and, therefore, of the surgical instrument is achieved and carries on with the procedure. If required, the surgeon S can hook back again the insertion tube T to the device 1 to keep the insertion tube T stationary or to move the insertion tube T during the procedure, without the assistance of an assistant being strictly needed.

[0087] If required, the endoscopic sheath 10 can be temporarily held on the handle / handpiece 11 of the endoscope by a clamping element, e.g. a ring (not shown).

Claims

CLAIMS1. A handheld device (1 , 1 ', 1”) wearable and constrainable on a hand (M), provided with a hooking portion (5) configured to hold an endoscope insertion tube (T).

2. Device (1 , 1', 1”) according to claim 1 , comprising a body (2) constrainable to the metacarpal bones of the hand (M).

3. Device (1 , T, 1”) according to claim 2, comprising a first gripper constrained to the body (2), wherein the first gripper is provided with jaws (2', 2”) which are lockable on the metacarpal bones of the hand (M).

4. Device (1 , 1', 1”) according to claim 3, wherein the jaws (2', 2”) of the first gripper are lockable on the outer edge of the metacarpal bones of the hand (M).

5. Device (1 , T, 1”) according to claim 3 or claim 4, wherein the jaws (2', 2”) of the first gripper are hinged to the body (2), and the body (2) is rotatable with respect to the jaws (2', 2”) of the first gripper.

6. Device (1 , 1', 1”) according to any one of preceding claims 1-5, wherein the hooking portion (5) is a second gripper provided with jaws (5', 5”) which are lockable on an endoscope insertion tube (T).

7. Device (1 , 1', 1”) according to any one of claims 2-6, wherein the hooking portion (5) is constrained to the body (2) by means of a hinge (4), and wherein the hooking portion (5) is rotatable with respect to the body (2) between a first position corresponding to the hooking portion (5) distal from the palm of the hand (M), and a second position proximal to the palm of the hand (M).

8. Device (1 , 1 ', 1”) according to claim 7, wherein the hinge (4) is elastic or the device (1 , 1', 1”) comprises elastic means (8) configured to constantly apply a force on the hooking portion (5), which force tends to return the hooking portion (5) to the first position.

9. Device (1 , 1', 1”) according to any one of preceding claims 7-8, comprising a lever (7) operable by the wearer to rotate the hooking portion (5) with respect to the body (2) between the first position and the second position.

10. Device (1 , 1', 1”) according to claim 9, wherein the lever (7) extends from the body (2) towards the palm of the wearer hand (M) by a length compatible with the activation by the wearer’s little finger only, or wearer's little and ring fingers only.

11. A method for simulating endoscopy outside the human body with the device (1 , 1 1 ”) according to any one of preceding claims 1 -10, comprising:- fitting or constraining the device (1 , 1 ', 1”) onto a hand (M) of a surgeon (S);- attaching an endoscope insertion tube (T) to the device (1 , 1 ', 1”);- moving the hand with the device (1 , 1 ', 1”) to change the position of the endoscope insertion tube (T) with respect to a reference, or keeping the hand with the device (1 , 1', 1”) still to keep the position of the endoscope insertion tube (T) stationary with respect to the same reference, and- operating or moving, with the fingers of the same hand (M), an actuator (12) of a surgical instrument inserted into the endoscope insertion tube (T).

12. Method according to claim 11 , wherein the surgeon (S) grabs / controls an endoscope handle / handpiece (11), by using the other hand.

13. Method according to claim 11 or claim 12, comprising:- releasing the endoscope insertion tube (T) from the device (1 , 1', 1”) from the hand (M) and using the same hand (M) to move an endoscopic sheath (10) with respect to the endoscope insertion tube (T).

Images