Surgery – Truss – Perineal
Patent
1992-04-22
1994-08-16
Apley, Richard J.
Surgery
Truss
Perineal
604281, 604282, A61B 100, A61M 2501
Patent
active
053377338
DESCRIPTION:
BRIEF SUMMARY
BACKGROUND OF THE INVENTION
The invention relates to an inserting means for tubular, fiberoptic instruments, especially colonoscopes, gastroscopes, and the like, comprising a grip part and a flexible insertion part adapted to be pushed into an object to be examined, especially the human colon and including, between an inner wall and an outer wall, at least one intermediate space which is sealed outwardly and into which a fluid can be introduced. The outer wall of the insertion part is formed by a flexible hose which, however, is not inflatable like a balloon by the fluid in the intermediate space. The inner wall of the insertion part likewise is formed by a hose, and The intermediate space contains support elements through which the inner wall and the outer wall are mutually supported when the pressure in the intermediate space fails to reach a predetermined value.
An inserting means of this kind is known from U.S. Pat. No. 4,815,450. There the intermediate space contains ball shaped support elements between the inner and outer walls of the insertion part which elements are freely disposed and therefore movable in the intermediate space. As a consequence, the support elements may become shifted in the intermediate space and consequently do not always reliably fulfill their task of stiffening the insertion part when there is a vacuum in the intermediate space. The user therefore cannot rely on the inserting means keeping a particular desired configuration during a particular manipulation of a colonoscope or the like.
As is known, for example, from U.S. Pat. No. 4,696,544, there are fields of application for tubular fiberoptic instruments outside of the medical field, too, such as for examining pipelines, vessels, and machine parts. The term "object to be examined" is to be understood accordingly in the context of the present invention.
For inserting colonoscopes, also inserting means are being used which have a one-piece slip tube which is of great flexural stiffness as compared to the corresponding colonoscope and permits only relatively minor elastic bending. The inner diameter of such a slip tube for a colonoscope having an outer diameter of 15 mm, for instance, is barely 16 mm so that the colonoscope can be pushed through easily any time. The outer diameter of the slip tube is 19 mm, for example. The insertion part is 40 cm long. The length of the associated colonoscope usually is between 130 and 180 cm. A distal end portion, approximately 10 cm long, of the colonoscope usually can be moved in four directions (up/down and left/right) by means of setting wheels supported at the proximal end.
The physician performing an examination or treatment pushes the colonoscope from the anus into the colon. The colonoscope must be advanced up to the cecum in order to permit full examination of the colon. In doing that, the direction of movement of the colonoscope can be determined by its movable distal end portion. However, at the bends of the colon, namely at the sigmoid and especially at the two colon flexures, problems regularly occur, including the risk of injury, pain to the patient, and cramp-like contractions of the colon, even up to the impossibility of continuing the examination. These problems are related to the fact that the colon is soft and fixed only relatively little in the abdomen. After a deflection, the principal direction of the force by which the colonoscope is advanced no longer is towards the distal end of the colonoscope but instead towards the readily yielding wall of the colon, a fact which is unpleasant for the patient. Therefore, the cecum cannot be reached in about 10 to 15% of all cases.
These difficulties can be overcome only in part by the customary inserting means since they are suitable for guiding the colonoscope only through the rectum and, at best, the sigmoid and the colon descendens. Yet the problems described continue to exist at the left colon flexure, at the latest. Moreover, many patients already find it unpleasant that the sigmoid is forced into an almost rectilinear shape
REFERENCES:
patent: 4141364 (1979-02-01), Schultze
patent: 4551140 (1985-11-01), Shinohara
patent: 4696544 (1987-09-01), Costella
patent: 4717379 (1988-01-01), Ekholmer
patent: 4815450 (1989-03-01), Patel
patent: 4961738 (1990-10-01), Mackin
Bauerfeind Herbert
Bauerfeind Peter
Apley Richard J.
Leubecker John P.
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