Surgery – Endoscope – Having imaging and illumination means
Reexamination Certificate
1999-02-01
2001-04-24
Leubecker, John P. (Department: 3739)
Surgery
Endoscope
Having imaging and illumination means
C600S104000, C600S106000
Reexamination Certificate
active
06221007
ABSTRACT:
BACKGROUND OF THE INVENTION
This invention relates to video endoscopy and to endosurgery, wherein endoscopy is understood to refer to all forms of medical endoscopy, including but not limited to laparoscopy, thoracoscopy, arthroscopy, gastroscopy, hysteroscopy, colonoscopy, and bronchoscopy, as well as to dental applications of endoscopy and to the use of endoscopic inspection instruments, such as borescopes, for nonmedical applications, wherein video endoscopy refers to endoscopic visualization utilizing video acquisition and display of endoscopic images and wherein endosurgery refers to all surgical procedures performed under endoscopic visualization, including but not limited to tissue and organ repair, resection, implantation, and biopsy.
More specifically, this invention is related to a method and apparatus for improving manual dexterity in endoscopy and endosurgery by combining endoscopic, manipulative, video image forming, and video image display means in a novel manner that provides the surgeon or operator with improved hand-eye coordination.
The advantages of diagnosis and therapy performed under endoscopic visualization are well known. Such procedures are minimally invasive, result in shortened hospital stays, more rapid recovery, less cosmetic damage, and lower overall costs compared to conventional “open” procedures. However, most surgeons have much greater difficulty performing common surgical maneuvers using endbsurgical instruments (long-shafted graspers, scissors, etc. commonly used in endoscopic surgery) under endoscopic visualization. Whether the image is viewed by the surgeon with his eye to the eyepiece or, as is increasingly common, on a video monitor, the surgeon has poor hand-eye coordination compared to that of open surgery. The surgeon moves the instruments hesitantly and often inaccurately, whereas in open surgery the motion is rapid and precise. Simple routines, such as suturing and knot tying, are tedious and time consuming, even for highly skilled endoscopic surgeons. As a result, endoscopic procedures generally take more operating-room time than their open counterparts and are more exhausting for the surgeon. Moreover, many capable surgeons can not adequately master endoscopic technique; consequently, surgeries that potentially could be done endoscopically are still being performed as open procedures. In laparoscopic surgery, surgeons that operate with an instrument in each hand require the assistance of another surgeon to hold and direct the laparoscope, which increases the cost of the procedure. There is a need for new endoscopic surgery instruments and methods to overcome these limitations. The present invention addresses this need. It improves on prior-art endoscopic methods by providing the surgeon with greater hand-eye coordination by making endoscopic surgery look and feel more like open surgery.
In the discourse that follows, reference is made to “enhanced presence”, which is defined below in connection with a special arrangement of a video endoscope, image display, and endosurgical instrument whereby the image of the distal tip of the endosurgical instrument is presented on a video display adjacent to the instrument handle and in a specific manner, along with the bodily tissues near the tip. The intent is to induce the surgeon to act as if the image of the tip, as seen in the display, is the tip itself. The reader will understand that the surgeon will not be actually deceived in this regard, but will, nevertheless, find it natural to respond as if he were. The surgeon will thus be led to instinctively use hand motions that are effective to accomplish endosurgical tasks, whereas with conventional endosurgical apparatus these motions are difficult to learn.
SUMMARY OF THE INVENTION
In accordance with the present invention, an endoscopic surgical system is provided for use in endoscopic surgery which includes an endosurgical instrument having an elongated shaft and an end-effector operably mounted to a distal end of the shaft. The endoscopic surgical system further includes a video endoscope device having an elongated telescope portion containing a distal viewing face, and a coupling device coupling the instrument to the endoscope device. This coupling substantially maintains the relative position of the elongated shaft adjacent the telescope portion such that the endoscope viewing face is rearward of the distal end effector to view the distal end-effector from a position along the shaft. A handle portion is operably coupled to the coupling device which enables the distal end-effector and the viewing face to be manually positioned as a single unit during endoscopic surgery. The handle portion is further configured to manually operate the end-effector. A video display device is operably coupled to the coupling device at a viewing angle and location therealong wherein an image of the end-effector displayed on the display device appears to be a substantially direct view of the end-effector that is positioned in-line with the insertion shaft.
In one aspect of the present invention, the handle portion is integrally formed with the endosurgical instrument, and the securing device is adapted to rigidly mount the handle portion to the instrument shaft. The coupling device includes a pair of opposed securing elements formed to releasably engage the handle portion and the telescope portion therebetween.
In another aspect, an adapter device is provided at a distal portion of the telescope portion of the endoscope which includes a bore portion formed and dimensioned for receipt of the instrument elongated shaft therethrough. This arrangement enables alignment of the end-effector in the field of view of the distal viewing end. A guide tube axially communicates with the bore portion for guided insertion of the elongated shaft through the guide tube and into the bore portion.
In another configuration of the present invention, the coupling device is configured to position the elongated shaft substantially parallel to adjacent the telescope portion, and is integrally formed with the handle portion. The integral handle portion and coupling device includes a bore formed and dimensioned for receipt of the instrument elongated shaft therein. A latch assembly releasably mounts the instrument to the handle portion between an unlatched condition, enabling removal of the elongated shaft from the bore, and a latched condition, releasably latching the instrument to the handle portion.
In yet another aspect, a linkage assembly operably couples the end-effector of the instrument to an actuation device of the handle portion for actuation of the end-effector when the latch assembly is moved to the latched condition. The linkage assembly includes an actuation rod disposed longitudinally along the elongated shaft which is coupled to the end-effector for movement between a first position and a second position. The linkage assembly further includes a boss member coupled to the actuation rod which operably engages the actuation device when the instrument is moved from the unlatched condition to the latched condition.
In another embodiment, a video endoscope system is provided for use by a surgeon in endoscopic surgery. The system includes a surgical instrument having an elongated shaft and an end-effector, and an elongated endoscope device including a telescope portion having a distal viewing face. A coupling device securably couples the instrument to the endoscope device in a manner substantially maintaining the relative position of the elongated shaft adjacent the telescope portion to facilitate viewing of the end-effector of the surgical instrument by the viewing face. A video display is mounted to the coupling device and adapted to display an image of the end-effector viewed by the distal viewing face. In accordance with this aspect of the present invention, a handle portion is operably coupled to the surgical instrument for actuation of the end effector, and is rigidly coupled to the coupling device for simultaneous positioning of end-effector and the endoscope viewing f
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