Overtube-Assisted Endoscopic Access to Vater's Papilla
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Solution Overview
Problem
Endoscopic procedures for accessing the Vater's papilla in patients with Roux-en-Y gastrectomy are challenging due to the difficulty in navigating the jejunum-to-jejunum anastomosed and jejunum-anastomosed bent portions, where standard endoscopes face issues in both insertion and treatment views.
Innovation Solution
An endoscopic system comprising an overtube with an insertion channel and assist means that allows for the insertion of an endoscope to access the Vater's papilla by changing the insertion path through the jejunum-to-jejunum anastomosed portion, using a combination of forward-viewing and side-viewing endoscopes to facilitate both insertion and treatment.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Ease of operation
If a forward-viewing endoscope is used for easy insertion, then insertion performance is improved, but treatment capability deteriorates because the view in the treating direction cannot be secured
Solution Approach 1:
The patent employs nested doll by placing a side-viewing endoscope inside an overtube that was initially inserted with a forward-viewing endoscope. The forward-viewing endoscope facilitates insertion, then is removed and replaced with a side-viewing endoscope for treatment, while the overtube remains in place to guide the second endoscope to the target location.
Solution Approach 2:
The overtube serves as an intermediary device that mediates between the two endoscope types. It is first inserted with the forward-viewing endoscope for navigation, then retains its position to guide the subsequent insertion of the side-viewing endoscope for treatment, thus bridging the gap between insertion ease and treatment capability.
2Adaptability or versatility
If a side-viewing endoscope is used for treatment capability, then treatment performance is improved, but insertion performance deteriorates because the view in the inserting direction cannot be secured
Solution Approach 1:
The patent applies preliminary action by first inserting the forward-viewing endoscope through the overtube to navigate to the target location and identify the insertion point. This preliminary navigation establishes the path and positioning, making the subsequent treatment with the side-viewing endoscope more effective.
Solution Approach 2:
The side-viewing endoscope is nested within the overtube after the forward-viewing endoscope has established the correct positioning. The overtube acts as a guide that was previously positioned by the first endoscope, now facilitating the insertion of the second endoscope for treatment.
3Speed
If the overtube is inserted to reach the papilla, then access to the target is improved, but navigation through complex anatomical structures deteriorates due to difficulty in passing the jejunum-to-jejunum anastomosed and jejunum-anastomosed bent portions
Solution Approach 1:
The patent applies local quality by using different endoscope types with specific viewing directions suited for different phases of the procedure. The forward-viewing endoscope provides optimal view quality for navigation through complex anatomy, while the side-viewing endoscope provides optimal view quality for treatment at the target site.
Solution Approach 2:
The overtube serves as a mediator that simplifies navigation through complex anatomical structures by providing a stable, pre-positioned channel. Once the forward-viewing endoscope positions the overtube correctly, the overtube becomes a straightforward path that eliminates the need to navigate complex bends and anastomoses again with the treatment endoscope.
Data Source
AI summary
With a first endoscope inserted through an overtube, the overtube is orally inserted into an object being examined, and a distal end portion of an insertion tube of the first endoscope is made to advance, within the object, from a jejunum via a jejunum-to-jejunum anastomosed portion and a jejunum-anastomosed bent portion so that the distal end portion is located adjacently to a Vater's papilla of a duodenum. The overtube is then sent to a position which is adjacent to the Vater's papilla along the insertion tube of the first endoscope. After this, the first endoscope is pulled from the overtube. A second endoscope is then inserted into the overtube to make a distal end portion of its insertion tube protrude from the distal end of the overtube and is located adjacently to the Vater's papilla. The second endoscope thus-approached is used to treat the Vater's papilla and the tissue therearound.