WO2021090056A1 - Ultrasons et endoscopie combinés - Google Patents

Ultrasons et endoscopie combinés Download PDF

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Publication number
WO2021090056A1
WO2021090056A1 PCT/IB2020/000470 IB2020000470W WO2021090056A1 WO 2021090056 A1 WO2021090056 A1 WO 2021090056A1 IB 2020000470 W IB2020000470 W IB 2020000470W WO 2021090056 A1 WO2021090056 A1 WO 2021090056A1
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WO
WIPO (PCT)
Prior art keywords
ultrasound
cannula
probe
camera
ultrasound probe
Prior art date
Application number
PCT/IB2020/000470
Other languages
English (en)
Inventor
Zengpin Yu
Original Assignee
Suzhou Acuvu Med Tech Co Ltd
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Suzhou Acuvu Med Tech Co Ltd filed Critical Suzhou Acuvu Med Tech Co Ltd
Priority to DE112020005495.0T priority Critical patent/DE112020005495T5/de
Priority to GB2208340.6A priority patent/GB2605317B/en
Priority to US17/774,656 priority patent/US20220378400A1/en
Priority to CN202011240759.9A priority patent/CN113143188A/zh
Publication of WO2021090056A1 publication Critical patent/WO2021090056A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00002—Operational features of endoscopes
    • A61B1/00004—Operational features of endoscopes characterised by electronic signal processing
    • A61B1/00009—Operational features of endoscopes characterised by electronic signal processing of image signals during a use of endoscope
    • A61B1/000094—Operational features of endoscopes characterised by electronic signal processing of image signals during a use of endoscope extracting biological structures
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00002—Operational features of endoscopes
    • A61B1/00004—Operational features of endoscopes characterised by electronic signal processing
    • A61B1/00009—Operational features of endoscopes characterised by electronic signal processing of image signals during a use of endoscope
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
    • A61B1/015—Control of fluid supply or evacuation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/012—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor
    • A61B1/018—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor characterised by internal passages or accessories therefor for receiving instruments
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/04—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/06—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor with illuminating arrangements
    • A61B1/0661—Endoscope light sources
    • A61B1/0676—Endoscope light sources at distal tip of an endoscope
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/303—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the vagina, i.e. vaginoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/307—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the urinary organs, e.g. urethroscopes, cystoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/12—Diagnosis using ultrasonic, sonic or infrasonic waves in body cavities or body tracts, e.g. by using catheters
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/44—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device
    • A61B8/4444—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device related to the probe
    • A61B8/445—Details of catheter construction
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/46—Ultrasonic, sonic or infrasonic diagnostic devices with special arrangements for interfacing with the operator or the patient
    • A61B8/461—Displaying means of special interest
    • A61B8/463—Displaying means of special interest characterised by displaying multiple images or images and diagnostic data on one display

Definitions

  • This patent specification generally relates to a medical device for use in tissue and organ examinations. More particularly, some embodiments relate to combined ultrasound and endoscopy systems for examining internal organs and other internal body structures.
  • Ultrasound are sound waves with frequencies which are higher than those audible to humans (>20,000 Hz).
  • Ultrasonic images also known as sonograms, are made by sending pulses of ultrasound into tissue using a probe. The ultrasound pulses echo off tissues with different reflection properties and are recorded and displayed as an image.
  • Medial ultrasound is conventionally used for creating images of internal organs as well as other body structures such as tendons, muscles, joints, and blood vessels.
  • medical ultrasound commonly uses transducers designed to be used externally, such as through the lower abdominal wall in the case of gynecologic ultrasonography, occasionally the ultrasonic transducer is configured for insertion into an internal organ or other structure.
  • One such example is a sonohysterogram procedure which is use for imaging of the uterus.
  • the procedure includes inserting fluid and an ultrasound probe into the uterus and can provide sonographic images of uterine structures.
  • the sonohysterogram procedure may be preceded by an endoscopy procedure to obtain direct vision images of the uterine walls, conventionally a sonohysterogram procedure is performed “blind” or without any live visual aid during the insertion of the ultrasound probe.
  • an integrated visual and ultrasound device comprises: an ergonomic handle configured for grasping by hand and having proximal and distal portions; a cannula extending distally from the distal portion of the handle and having a distal portion extending along a longitudinal axis; a distally facing camera secured at the distal portion of the cannula and having a camera field of view (FOV) encompassing a selected solid angle and a camera direction of view (DOV) that is angled relative to said axis; an ultrasound probe positioned at the distal portion of the cannula for both rotation about said axis relative to the distal portion of the cannula and for tilting relative to said axis; a probe steering mechanism mounted at the proximal end of the handle and operatively coupled with the ultrasound probe to selectively tilt the ultrasound probe relative to said axis over a selected angular range; and a probe rotation mechanism mounted at the proximal end of the handle and operatively coupled with the ultrasound probe to
  • said integrated visual and ultrasound device can further include one or more of the following features: the cannula can comprise at least one lumen and can further include a shaft connecting the probe steering mechanism and the ultrasound probe, wherein said shaft is removably received in said lumen; a belt that is in said shaft can be coupled to and driven by said probe rotation mechanism and gearing can be secured to said ultrasound probe and driven by said belt to selectively rotate the ultrasound probe about said axis; the probe rotation mechanism can be configured to rotate the ultrasound probe through at least 180 degrees; the ultrasound probe can be secured to a rotation plate that rotates about a pivot axis transverse to said longitudinal axis, and a bar inside said shaft can couple said probe steering mechanism to said rotation plate and respond to rotation of the steering mechanism to pivot the rotation plate and thus the ultrasound probe relative to said longitudinal axis; said steering mechanism can be configured to tilt said ultrasound probe in two opposite directions relative to said longitudinal axis through an angle up to 180 degrees in at least one of said directions; said steering mechanism can be configured to tilt said
  • a medical device comprises: an elongated shaft having a distal portion extending along a longitudinal axis and a proximal portion, wherein the shaft is shaped and dimensioned for insertion into a sheath or a working channel of an endoscope cannula configured for insertion into a patient; an ultrasound probe that is at the distal portion of the shaft and is configured to protrude from a distal end of the sheath or cannula and to provide ultrasound images; a housing secured to the proximal portion of the shaft; a probe rotation mechanism mounted on or in the housing and operatively coupled with shaft to rotate the shaft and thus the ultrasound probe about said axis over a selected rotation angular range; and a probe steering mechanism mounted on or in the housing and operatively coupled with the ultrasound probe to tilt the ultrasound probe relative to said axis over a selected tilting angle range.
  • the medical device can further include one or more of the following features: a rotation sensor operatively coupled with the probe rotation mechansim and configured to provide an electronic signal indicative of rotation of the ultrasound probe about said axis; and said shaft can be shaped and dimensioned for insertion into a working channel of an endoscope that has a camera at a distal end thereof, wherein the ultrasound probe is configured to protrude distally from said camera when the shaft in inserted into said working channel.
  • a method comprises: providing an integrated camera and ultrasound imaging device comprising an elongated cannula having a distal portion extending along a longitudinal axis; inserting the cannula into an object; operating a camera mounted at a distal portion of the caimula to provide camera images of an interior portion of the object taken with a direction of view of the camera that is angled relative to said axis; operating an ultrasound probe also mounted at the distal portion of the cannula and protruding distally from said camera to provide ultrasound images of an interior portion of the object; selectively rotating the cannula and the camera about said axis through a selected rotation angle to view interior portions of the object from different directions, under manual control exerted at a proximal portion of the imaging device; selectively rotating the ultrasound probe about said axis and selectively tilting the ultrasound probe relative to said axis to obtain ultrasound images of selected portions of the object taken from different directions in a solid angle greater than 180 degrees, under manual control exert
  • the method can further comprise one or more of the following: sensing rotation of the ultrasound probe and controlling the display of ultrasound images as a function of the sensed rotation of the ultrasound probe; providing a handle configured for grasping by hand, wherein said cannula is secured to said handle; providing a handle comprising a single-use handle portion to which said device is secured and a multiple-use handle portion releasably secured to the single-use portion and including electronics for processing the ultrasonic images from the ultrasound probe; selectively withdrawing the ultrasound probe from the cannula while the cannula remains inserted in the object and inserting a surgical instrument in a cannula lumen vacated by the withdrawn ultrasound probe; selectively bending the cannula; said rotating the cannula is under manual control by rotating said integrated camera and ultrasound imaging device; said selectively rotating the cannula is under manual control by rotating a cannula rotation mechanism operatively coupled with the cannula to selectively rotate the cannula and thus
  • FIGs. 1 A- 1C are schematic diagrams showing examples of combined ultrasound and endoscopy systems (CUES), according to some embodiments;
  • FIGs. 2A, 2B, 2C and 2D are right, left, top and front views of the handheld portion of a combined ultrasound and endoscopy system (CUES), according to some embodiments;
  • CUES combined ultrasound and endoscopy system
  • FIGs. 3 A and 3B are perspective and top views of the distal end of a handheld portion of a combined ultrasound and endoscopy system (CUES), according to some embodiments;
  • CUES combined ultrasound and endoscopy system
  • FIGs. 4A and 4B are partial perspective views of a cannula forming part of a combined ultrasound and endoscopy system (CUES), according to some embodiments;
  • CUES combined ultrasound and endoscopy system
  • FIGs. 5 A, 5B and 5C are perspective views showing further details of mechanisms for steering and rotation of an ultrasonic probe head that forms part of a combined ultrasound and endoscopy system (CUES), according to some embodiments;
  • CUES combined ultrasound and endoscopy system
  • FIG. 6 is a perspective view illustrating further detail of the distal tip of a combined ultrasound and endoscopy system (CUES), according to some embodiments;
  • FIG. 7 is a perspective view of a flexible handheld portion forming part of a combined ultrasound and endoscopy system (CUES), according to some embodiments;
  • FIGs. 8A and 8B are diagrams showing further detail of separable handheld portion of a combined ultrasound and endoscopy system (CUES), according to some embodiments;
  • CUES combined ultrasound and endoscopy system
  • FIGs. 9A-9C are diagrams illustrating further detail of the distal tip and cannula of a combined ultrasound and endoscopy probe, according to some embodiments.
  • FIGs. 10A-10C are diagrams illustrating further detail of the distal tip and cannula of a combined ultrasound and endoscopy probe, according to some embodiments.
  • FIGs. 11 A and 11B are schematic diagrams showing further examples of combined ultrasound and endoscopy systems (CUES), according to some embodiments.
  • CUES combined ultrasound and endoscopy systems
  • a processor encompasses one or more processors, for example a single processor, or a plurality of processors of a distributed processing system for example.
  • a controller or processor as described herein generally comprises a tangible medium to store instructions to implement steps of a process, and the processor may comprise one or more of a central processing unit, programmable array logic, gate array logic, or a field programmable gate array, for example.
  • distal and proximal refer to locations referenced from the apparatus and can be opposite of anatomical references.
  • a distal location of a probe may correspond to a proximal location of an elongate member of the patient
  • a proximal location of the probe may correspond to a distal location of the elongate member of the patient.
  • a device includes a probing portion for direct insertion into a body cavity.
  • the probing portion is brought into proximity to the tissue and/or area that is to be examined.
  • a probe encompasses an object inserted into a subject such as a patient.
  • an endoscopy ultrasound hysterography and cysterograph system is described.
  • the system can be more generally described as combined ultrasound and endoscopy system (CUES).
  • the EUHCS and CUES are medical devices that allow a doctor to obtain video images and organ information inside of uterus, bladder or other organs.
  • the endoscopy images and ultrasound images are displayed at real time simultaneously on a monitor or two separate monitors allowing a doctor to see both the surface and inside tissue of organs and can be transmitted electronically to other devices such as work stations that can be at remote locations and/or PACS (Picture Archiving and Communication Systems).
  • applications for the EUHCS include: (1) early diagnosis of endometrial cancer; (2) providing endometrial cancer stage information by the depth, area and scope of cancerous infiltrating myometrium; (3) monitoring of hysteroscopic surgery to improve surgical safety and accuracy and success rate; and (4) detecting, diagnosing, and determining the stage of ovarian and/or fallopian tube cancers.
  • the devices and methods of this patent specification can account for the shape of uterus.
  • the cervical canal and part of uterus cavity are cylindrical in shape.
  • the lower surface of the upper uterine fundus is horizontally oriented with respect to the cervical canal and lower uterine cavity.
  • the hysteroscope and ultrasound probe are configured to image in both vertical and horizontal directions.
  • the shape of the bladder can be accounted for when providing combined ultrasound and endoscopy images of the bladder.
  • the bladder is in a spherical shape.
  • a flexible cystoscope and ultrasound catheter probe can be used to image the entire bladder or at least a desired portion thereof.
  • FIGs. 1 A- 1C are schematic diagrams showing examples of combined ultrasound and endoscopy systems (CUES), according to some embodiments.
  • the system 100 includes a handheld portion 110 and tower system 112 which are interconnected via cables 134 and 136 and processing units 180, 182 and 184.
  • the handheld portion 110 is configured as a single-use unit and is disposable following a single use.
  • the handheld portion 110 is configured to separate into an upper single use portion 120 and a lower multiple-use handle portion 130. In such cases the single-use portion 120 is detachable from the handle portion 130, for example along dashed line
  • different types of versions of the single-use portions can be made available for mating with the same multiple-use portion.
  • three versions of single-use portions are shown in sterile packages or pouches 121, 122 and 123.
  • pouch 121 an entire handheld portion 110 is being supplied.
  • pouch 123 a separable upper single use portion is being supplied for mating with the same multiple-use portion shipped in pouch 121 or with a like multiple-use portion, and in pouch 124, a flexible cannula version is being supplied.
  • the tower system 112 includes column 140 mounted to a wheeled base 142.
  • the tower system 112 includes two di splays 150 and 152, keyboard 160, a mouse 162 and processing system 170.
  • the processing system 170 can functionally include ultrasound image processing unit 182, endoscopy optical image processing unit 180 (which is labeled Hysteroscope Unit in the Figures) and graphics unit 184 to perform image display and management processing.
  • display 150 is configured to display ultrasound images 154 from the ultrasound transducer module on the distal tip of unit 110
  • the display 152 is configured to display live direct visual images 156 from the camera module on the distal tip of unit 110.
  • display monitors 150 and 152 can be touch sensitive for receiving user input as well as high resolution.
  • each of the displays 150 and 152 are configured to display high definition graphics at pixel resolutions of 1280x720, 1920x1080, 2048x1080, 2560x1440, 3840x2160, or higher.
  • the camera image display 152 shows live video image
  • the ultrasound image 154 shown on display 152 is generated by an ultrasound transducer at a known position relative to the camera.
  • the ultrasound image and camera image can be precisely correlated in position and orientation inside the human cavity (e.g. uterus 102, shown in FIG. 1).
  • the side by side display of anatomy ultrasound 154 and camera image 156 allows physicians to simultaneously see the ultrasound image guided by camera image in real time.
  • the camera module on the distal tip of unit 110 is configured and mounted such that at least a portion of the ultrasound probe head 252 is visible the operator in camera image 156 as ultrasound probe head portion 158. Providing ultrasound probe head portion 158 on live camera image 156 can provide valuable information and feedback to the operator as to the current orientation and position of ultrasound probe head 252.
  • processing system 170 includes ultrasound image processing unit 180, endoscopy image processing/hysteroscope unit 182 and image display and management system / graphics unit 184.
  • the handheld unit 110 is connected to ultrasound processing unit 182 and hysteroscope unit 180 via cables 134 and 136, respectively.
  • Processing system 170 can also include a suitable personal computer or a workstation that includes one or more processing units 174, input/output devices such as CD and/or DVD drives, internal storage
  • RAM random access memory
  • PROM read-only memory
  • EPROM electrically erasable read-only memory
  • magnetic-type storage media such as one or more hard disks 172 for storing the medical images and related databases and other information, as well as graphics processors suitable to power the graphics being displayed on displays 150 and 152.
  • tower system 112 is powered by a medical grade power supply
  • a fluid control system 186 is attached to the handheld portion 110 via fluid line(s) 132. In some case there are two fluid lines so that in-flow and out-flow fluids can both be controlled.
  • FIG. IB illustrates a system similar to FIG. 1 A with a different display configuration, according to some embodiments.
  • a single display monitor 150 can be used as shown in FIG. IB.
  • the endoscopy image 156 and ultrasound image 154 are combined by graphics unit 184.
  • the endoscopy image 156 and ultrasound image 154 are displayed side by side simultaneously on a high-resolution single monitor 150 as shown.
  • this display configuration can give physicians a better visual effect during diagnostic and surgical procedures.
  • FIG. 1C shows another example of a combined ultrasound and endoscopy system
  • the CUES system 100 includes the handheld portion 110 being attached to two separate tower systems 116 and 118.
  • Each of the systems 116 and 118 can be identical or similar to tower system 112 shown in FIGs. 1 A and IB.
  • the ultrasound images 154 are being displayed on monitor 150 of tower system 116, while the endoscopy images 156 are being displayed on monitor 152 of tower system 118.
  • the two tower systems 116 and 118 are positioned such that the monitors 150 and 152 are side by side, so that the physician can view both images simultaneously.
  • the hysteroscope unit 180 may be included in tower system 118 and the ultrasound processing unit 182 may be included in tower system 116.
  • FIGs. 2 A, 2B, 2C and 2D are right, left, top and front views of the handheld portion of a combined ultrasound and endoscopy system (CUES), according to some embodiments.
  • the handheld portion 110 includes a cannula 240 and a distal tip 250.
  • cannula 240 can be rigid, flexible (such cannula 740 in FIG. 7) or semi-rigid.
  • the cannula 240 can be made of a slightly bendable material such that the operator can slightly deflect the cannula, for example by 5-20 degrees, by manually pushing or pulling on the cannula shaft.
  • the distal tip includes an ultrasound probe head 252 that can be rotated and “steered.”
  • the ultrasound probe head 252 is configured to be rotated about a central longitudinal axis 254 as shown by dotted arrow 256, as well as steered as indicated by dotted arrow 258 to angle the ultrasound probe head 252 relative to axis 254.
  • the rotation and steering of probe head 252 are both controlled at the proximal end 260 of cannula 240.
  • the steering of probe head 252 is controlled by turning a wheel 262
  • the rotation of probe head 252 is controlled by turning a wheel 264.
  • mechanisms other than a wheel can be used to control the rotation of probe head 252. Such mechanisms include, without limitation, levers, sliders, sticks and trackballs.
  • the ultrasonic probe head 252 includes an ultrasound transducer made from a traditional piezoelectric material such as PZT or from semiconductor materials.
  • the dimension of the transducer can be 2-4 mm width and 10-20 mm length.
  • the transducer in head 252 can include up to 128 elements (or more). See e.g. ultrasound transducer array 610 in FIG. 6.
  • the ultrasound transducer array can be configured as a linear or phased array, or single element transducer having a frequency from 5 MHz to 10 MHz for general imaging to cover the entire uterus and bladder; and 10 MHz to 30 MHz for superficial uterus endometrial and bladder lining images.
  • each transducer element can have its own cable.
  • the cables can be bundled together and connected to an ultrasound processing unit (such as unit 182 shown in FIG. 1).
  • ultrasound processing unit 182 can be integrated into and form part of processing system 170 (shown in FIG. 1), and in some other embodiments, some or all of ultrasound processing unit 182 can be separated from processing system 170.
  • the handle 130 in the cases handle 130 is configured as part of the single-use portion, the handle 130 can include compact ultrasound processing unit 272 as shown in FIG. 2 A.
  • the compact ultrasound processing unit 272 in handle 130 can be made at lower cost and preform less functionality than cases where the handle is not configured to be single-use, such as handle 830 shown in FIG. 8A.
  • an ASIC in order to reduce the number of cables running from probe head 252, an ASIC can be included in probe head 252.
  • the ASIC can include high voltage switches and control circuits to drive the individual transducer elements and route echo signals to processing unit 252.
  • a reduced number of coaxial cables can then be used to carry ultrasound transmit and receive signals, control signals and electrical power between probe head 252 and ultrasound processing unit 182.
  • the cannula 240 can be long, thin, and rigid or semi- rigid.
  • the cross-section of cannula 240 perpendicular to its main longitudinal axis may be substantially circular. It should be noted the cross-section may have any suitable shape, such as oval.
  • the diameter of the cannula may differ depending on the sort of endoscopy, such as from 3 mm and up to 15 mm.
  • the cannula can include a working channel (working channel distal port 280 is shown in FIG. 2D). The working channel can be accessed from a port (not shown) on the rear end of proximal end 260.
  • Cannula 240 may include one or more fluid channels in fluid communication with various fluid ports. The cannula
  • cannula 240 may include one channel to be shared by an inflow and an outflow. Alternatively, the cannula may include two or more channels with separate inflow and outflow. According to some embodiments, cannula 240 also includes one or more fluid lumens that are fluidically isolated from the working channel. The fluid lumens can lead to fluid ports 246 and 244 that are disposed on the left and right sides, respectively, of the distal end of the cannula 240. The fluid lumens can be in fluid communication with the fluid ports 230 and 232 at the bottom of the handle 130. According to some embodiments, the right-side fluid port 230 is connected to the right-side fluid ports 244, and the left-side fluid port 232 is connected to the left-side fluid ports
  • Cannula 240 is also configured to accommodate a plurality of electrical conductors used to provide power, control signals to and receive video/image data from to the camera and lighting modules 270 and ultrasound probe head 252 at distal tip 250.
  • the conductors can be insulated and disposed within a separate lumen within cannula 240, in other cases some or all of the conductors can be disposed within a lumen that is also used for another purpose (e.g. fluid and/or device/tool channel).
  • one or more optical fibers can pass through cannula 240 for purposes of data transmission and/or supplying illumination light to distal tip 250.
  • Cannula 240 can also include one or more separate lumens for one or more of the rods or bars used to control the rotation and/or steering of the ultrasound probe head 252.
  • Handle portion 130 includes a main body that is dimensioned and shaped to allow secure and ergonomic grasping by the operator's hand. Handle portion 130 also includes one or more buttons 212 that can be configured to allow execution of common tasks during use. For example, the button 212 can be programmed to control LED lighting level (of LEDs at the distal tip 250), capture still images and/or start and stop recording to video images, and capture and/or start and stop recording to ultrasound data and/or ultrasound images. According to some embodiments, an upper housing 242 can also be provided as shown.
  • the camera and lighting modules 270 at the distal tip of cannula 240 include a camera module that has a field of view of approximately 120 degrees.
  • the camera module can be mounted such that its direction of view (DOV) is at an oblique angle from the main longitudinal axis of cannula 240.
  • DOV direction of view
  • the oblique angle is between zero and 30 degrees.
  • An optical component such as a prism can also be used to provide this oblique angle. Further details of techniques for altering the direction of view of the camera module can be found in co-pending
  • the cannula 240 is connected to a rotation wheel
  • the cannula rotation wheel 290 By turning the cannula rotation wheel 290, as indicated by dashed arrow 292, the cannula 240, and the camera and lighting modules 270 can also be rotated, as indicated by dashed arrow 294.
  • the cannula 240 can be configured to rotate by 180 degrees (or more), such that camera and lighting modules 270 can provide at least of 180 degrees viewing angle in the uterus, bladder and other organ cavities.
  • the handle portion 130 contains a set of electronics
  • a rotation sensor 276 is included on wheel 264 and is configured to measure or detect the rotational position of the ultrasound probe head 252. The rotation sensor 276 data are used by the ultrasound processing unit 182 (shown in FIG. 1) for constructing three-dimensional ultrasound images.
  • FIGs. 3 A and 3B are perspective and top views of the distal end of a handheld portion of a combined ultrasound and endoscopy system (CUES), according to some embodiments.
  • CUES combined ultrasound and endoscopy system
  • FIG. 3 A the camera and lighting modules 270 are shown to include a camera module 320 and two LEDs 330 and 332.
  • the dotted outlines 312 and 314 illustrate the steering range of the ultrasonic probe 252.
  • the probe 252 is shown in solid outline in a vertical or “neutral” position 310.
  • the probe head 252 pivots about a hub 312 and can be positioned approximately 90 degrees in either direction, as shown.
  • fluid irrigation can be provided by flowing fluid into and/or out of the working channel distal port 280 and/or the side fluid ports 246 and 244.
  • the working channel distal port 280 is used for “in flow” or flowing fluid into the organ/tissues of interest while the side fluid ports 246 and 244 are used for “out flow” or receiving flowing fluid from the organ/tissues of interest.
  • one of the fluid ports 230 and 232 at the bottom of the handle 130 can be used for in flow and the other can be used for out flow.
  • FIGs. 4A and 4B are partial perspective views of an ultrasound probe forming part of a combined ultrasound and endoscopy system (CUES), according to some embodiments. Shown is ultrasound probe assembly 410 that is configured for deployment through a channel of an endoscopic cannula. FIG. 4A illustrates further details of the steering control of the ultrasonic probe head 252. The rotation of wheel 262 at the proximal end 260, as indicated by dotted arrow
  • FIG. 4B illustrates further details of the rotation control of the ultrasonic probe head 252 about axis 254, as indicated by arrow 454. The rotation of the probe head 252 is controlled by rotating wheel 264, as indicated by arrow 464. According to some embodiments, the entire ultrasound assembly 410 shown in
  • FIGs. 4A and 4B can be configured for use in the working channel of a conventional endoscopy systems to provide ultrasonic capability to an endoscopy system, thereby forming a combined ultrasound and endoscopy system (CUES).
  • a cable connector (not shown) is provided at the proximal end 260 of the assembly 410.
  • the cable connector is used for power, control, and transmitting and receiving ultrasound signals and/or data from and to the ultrasound probe head 252.
  • FIGs. 5 A, 5B and 5C are perspective views showing further details of mechanisms for steering and rotation of an ultrasonic probe head that forms part of a combined ultrasound and endoscopy system (CUES), according to some embodiments.
  • FIG. 5 A shows further detail of the steering of the ultrasonic probe head 252.
  • the steering motion is indicated by the dotted arrow 552.
  • the steering is controlled by the axial translation of a push bar 520, as indicated by arrow 518.
  • Moving bar 520 forward or backwards pushes or pulls the rotation plate 550 which pivots on a hub (not shown) about axis 512.
  • rotation plate 550 is configured to provide a range of motion of at least 120 degrees.
  • the steering system can be configured to provide equal amounts of steering range in either direction, but in other embodiments the steering range is not equal, which provides greater steering / probe deflection in one direction. Note that by providing rotation of the probe head 252 and/or rotation of the entire cannula shaft 240, the ultrasonic transducers array 610 (shown in FIG. 6) in probe head 252 can be oriented with respect to the tissues of interest over a relatively wide range, thereby enhancing the ability for clear and useful ultrasonic imaging.
  • FIG. 5B shows further detail of the rotation of the ultrasonic probe head 252.
  • the rotational motion about axis 254 is controlled by moving a belt 570, as indicated by arrow 574.
  • the belt 570 rotates a gear piece 540 about axis 542.
  • Gear piece 540 has a bevel gear that meshes with a bevel gear on the proximal end of probe head 252.
  • steering control push bar 520 Also visible in FIG. 5B is steering control push bar 520.
  • the probe head 252 can be configured with a range of rotational motion about axis 254 of approximately 360 degrees.
  • FIG. 5C illustrates further detail of the operation of the distal end steering and rotational control wheels 262 and 264. Steering control wheel 262 rotates as indicated by arrow
  • the wheel 262 connected via a rod to a bevel gear that meshes with a bevel gear on wheel
  • Rotation sensor 276 is also shown.
  • the rotation sensor 276 can be connected to the hub of wheel 264 as shown or it can be positioned inside of rotation wheel 264.
  • the rotation sensor 276 can be an optical encoder or another meter such as potentiometer.
  • the rotation sensor 276 provides the ultrasound transducer position where a frame of ultrasound data is acquired.
  • the position information is attached to a frame of ultrasound data which will be used to construct a 3D ultrasound image.
  • the rotation position information can also be sent to the ultrasound processing unit 182.
  • the position information can be used to trigger an ultrasound timing control unit to start transmitting ultrasound waves and receiving ultrasound data.
  • the distance of two frames of ultrasound images can be precisely controlled to about 0.1 mm spatial resolution.
  • FIG. 6 is a perspective view illustrating further detail of the distal tip of a combined ultrasound and endoscopy system (CUES), according to some embodiments.
  • the distal tip 250 includes the camera and lighting modules 270, the working channel distal port 280 and ultrasound probe head 252.
  • the working channel has an inner diameter of about 3.2 mm such that standard surgical devices can be disposed therein to carry out various surgical procedures. Examples of such devices include: biopsy needles, injection needles, forceps, tubes, knives, snares, probes, coagulator devices, brushes, laser devices, microwave devices (e.g. for ablation), and photodynamic tools.
  • the camera and lighting modules include: biopsy needles, injection needles, forceps, tubes, knives, snares, probes, coagulator devices, brushes, laser devices, microwave devices (e.g. for ablation), and photodynamic tools.
  • the camera and lighting modules include: biopsy needles, injection needles, forceps, tubes, knives, snares, probes, coagul
  • a camera module 320 can include a CMOS image sensor such as model number OVM6946 from
  • camera module 320 is about
  • 1.05 mm x 1.05 mm has about 400 x 400 pixel resolution, and has about a 120-degree field of view, and can capture video at 30 frames per second.
  • FIG. 7 is a perspective view of a flexible handheld portion forming part of a combined ultrasound and endoscopy system (CUES), according to some embodiments.
  • the flexible handheld portion 710 is configured to be connected to a tower system such as by cables
  • Handheld portion 710 includes a proximal handle portion 734 configured for ergonomic grasping by hand
  • the flexible handheld portion 710 includes a distal tip 750 that includes a camera and lighting modules 770, ultrasonic probe head 752, and working channel distal port 780.
  • the ultrasound probe head 752 need not include its own rotation capability. According to some embodiments, the ultrasound probe head 752 is configured to reduce steering and/or rotation range of motion when compared to probe head 252, shown and described elsewhere herein. According to some embodiments, two proximal fluid ports 730 and 732 are configured to provide fluid in flow and fluid out flow and are analogous to fluid ports 230 and 232 shown in
  • FIGs. 2A-2D are identical to FIGs. 2A-2D.
  • a flexible CUES such as shown in FIG. 7 can be more suitable for male urological patients than a rigid CUES.
  • locations in the bladder can be more easily accessed and less painful for male patients when using a flexible CUES.
  • the flexible CUES can be used to better access the ureter and make ultrasound scans of the kidney.
  • the flexible CUES may also be better suited to reach and obtain ultrasound images of certain locations in the uterus that a rigid hysteroscope cannot easily access.
  • FIGs. 8A and 8B are diagrams showing further detail of separable handheld portion of a combined ultrasound and endoscopy system (CUES), according to some embodiments.
  • the handheld portion 810 has many components that are similar and/or identical to handheld portion 110 shown and described elsewhere herein.
  • handheld portion 810 is configured to be separable into an upper single-use portion 840 and a lower multiple-use portion 830.
  • the two portions 830 and 840 are able to mate and un-mate with each other by hand-operation that does not need tools.
  • handle portion 830 includes a socket 860 that is dimensioned to couple with male mating portion 861 that protrudes from single-use portion 840.
  • the action of mounting and un-mounting is shown by dotted arrow 866.
  • the handle portion 830 may house or comprise components configured to process image data, generate control signals, provide power, or establish communication with other external devices.
  • the communication may be wireless or wired communication.
  • the wireless communications may include Wi-Fi, radio communications, and
  • the handle portion may house a sensor assembly to measure a relative position between the cannula and the handle portion.
  • the sensor assembly may measure relative position or orientation of the handle to its environment. Examples of such sensor assemblies are described further below.
  • FIG. 8B shows the single use portion 840 being supplied in a sterile package or pouch 123. Since the lower portion of the handle 830 is configured for multiple-use (rather than single-use, such as handle 130 shown in FIGs. 2A-2D), according to some embodiments greater processing capabilities are incorporated therein.
  • electronics unit 872 can be included in lower handle portion 830 to provide some or all of the functionality of ultrasound processing unit 182 (shown in FIG. 1).
  • the scope is inserted into uterus or bladder.
  • the ultrasound probe is oriented in its vertical position (e.g. position 310 in
  • Rotation control wheel 264 is manipulated to rotate ultrasound probe 252 about axis
  • the steering control wheel 262 is manipulated to adjust probe head 252 to a desired angle, then the rotation control wheel 264 is manipulated to rotate ultrasound probe head 252 about axis 254
  • the distal tip 750 of flexible cannula 740 is inserted into the uterus or bladder cavity. During insertion, the ultrasound probe head 752 can be in a retracted position, where the distal tip of the probe head 752 is recessed proximally from the distal end of cannula 740.
  • Live video endoscopy images from the camera module are used to find an area where the ultrasound image should be taken.
  • the ultrasound probe is pushed distally such that probe head 752 protrudes distally from the distal tip
  • ultrasound steering control wheel 762 is used to adjust probe head to a desired angle, then ultrasound rotation control wheel 764 is manipulated so as to rotate ultrasound probe head 752 to a desired angle, thereby obtaining suitable ultrasound images.
  • FIGs. 9A-9C are diagrams illustrating further detail of the distal tip and cannula of a combined ultrasound and endoscopy probe, according to some embodiments.
  • FIG. 9 A is a schematic cross-section diagram that shows the cannula 240 including an upper lumen or channel 910 and a lower lumen or channel 920.
  • FIG. 9B is a perspective view of the distal tip
  • ultrasound probe assembly 410 deployed in the lower channel 920. Note that in the example shown in FIGs. 9A-9C, the ultrasound probe assembly 410 is being deployed in cannula
  • the cannula 240 that is configured with a single working channel (channel 920).
  • the cannula cannula
  • FIG. 9C shows a cross section of the cannula 240 having a single working channel.
  • cannula 240 has an outer wall 900 that houses four separate channels.
  • the upper channel 910 is used for cables to and from the camera module 320, LEDs 330 and 332 and possibly other electrical and/or fiber optic cable(s).
  • the two side channels 930 and 932 are used for out-flow liquid (i.e. flowing liquid from the patient’s organ or cavity out into the device).
  • the side channels 930 and 932 can be fluidly connected to the side fluid ports 244 (shown in FIGs. 2A and 3B) and 246, respectively.
  • the lower channel 920 is shared by in-flow liquid (i.e. flowing liquid into the organ or cavity), ultrasound probe 410 and possibly other surgical tools.
  • lower or working channel 920 has an inner diameter ranging from 1 mm to 4 mm.
  • the overall outer diameter of endoscope cannula 240 in the cases of a single working channel, as shown in FIGs. 9A-9C, is less than about 7 mm.
  • the uterus or bladder cavity is filled with liquid through channel 920.
  • a surgical tool can be inserted into the cavity to perform surgical procedure.
  • the surgeon can withdraw the surgical tool and insert ultrasound probe 410 through working channel 920 to measure cavity wall thickness, the shape of a surgical objective and obtain other information so that surgeon can make decision for completion of the surgical procedure.
  • FIGs. 10 A- IOC are diagrams illustrating further detail of the distal tip and cannula of a combined ultrasound and endoscopy probe, according to some embodiments.
  • the cannula 240 includes two working channels.
  • FIG. 10A is a perspective view of the distal tip 250 in the case where cannula 240 includes two working channels 920 and 1020.
  • ultrasound probe assembly 410 is deployed through working channel 920 while working channel 1020 is empty.
  • Fig. 10B is a cross-section of cannula 240.
  • the two side channels 930 and 932 are used for out-flow liquid (i.e. flowing liquid from the patient’s organ or cavity out into the device) through the side fluid ports 244 (shown in
  • the working channel 920 is used for the ultrasound probe assembly 410 while a separate working channel 1020 can be used for both liquid in-flow, and surgical tool(s).
  • the diameter of each of the working channels 920 and 1020 range from 1 mm to 4 mm, and the overall outer diameter of endoscope cannula 240 is less than about 10 mm.
  • the uterus or bladder cavity is filled with liquid through channel 1020 and the ultrasound probe 410 is inserted into the uterus or bladder cavity through channel 920. After the uterus or bladder cavity is appropriately filled with liquid (e.g. saline), the surgical tool is inserted into the uterus or bladder cavity through channel 1020.
  • the use of the surgical tool can temporarily be stopped while the ultrasound probe is moved to the surgical operation area to generate ultrasound image.
  • the ultrasound image(s) can provide guidance about uterus or bladder cavity wall thicknesses, on the shape of a surgical objective, and other information useful for making surgical decisions. If a biopsy operation is being performed, the ultrasound image can guide a biopsy tool to collect tissue samples.
  • FIGs. 11 A and 11B are schematic diagrams showing further examples of combined ultrasound and endoscopy systems (CUES), according to some embodiments.
  • ultrasound probe assembly 410 is inserted into the working channel of a conventional reusable rigid, semirigid or flexible hysteroscopes, cystoscope, or other conventional endoscopy system to form a combined ultrasound and endoscopy systems (CUES).
  • the ultrasound probe assembly 410 can be similar or identical to the ultrasound probe assemblies described elsewhere herein including controllable steering and rotating capabilities of the probe head 252.
  • CUES system 1100 is formed by inserting ultrasound probe assembly 410 through the working channel of rigid hysteroscope 1110. As can be seen in FIGs. 11 A and 11B, the shaft
  • ultrasound probe assembly 410 is inserted into the working channel of cannula 1120 such that the ultrasound probe head 252 protrudes from the distal tip 1150 of hysteroscope 1110.
  • Hysteroscope 1110 includes a proximal handle portion 1130 configured for ergonomic grasping by hand.
  • the CUES system 1100 includes two tower systems 116 and 118 similar or identical to those shown in FIG. 1C.
  • hysteroscope 1110 is attached via cable 1136 to hysteroscope unit 180 of endoscopy tower system 118. Endoscopy tower system
  • the 118 includes monitor 152 that is configured to display hysteroscopy images 156 as shown. Not shown are fluid lines which run to fluid control system.
  • the conventional hysteroscope 1110 and tower system 118 can be a conventional, stand-alone endoscopy system.
  • the ultrasound assembly 410 is connected via cable 134 to ultrasound processing unit 182 which in this case is located in ultrasound tower system 116.
  • Ultrasound tower system 116 includes monitor 150 that is configured to display hysteroscopy images 154 as shown. In this way, the ultrasound probe assembly 410, cable 134 and tower system 116 form a stand-alone ultrasound unit.
  • the CUES system 1110 can provide benefits as described elsewhere herein including: allowing the operators) to see both the surface and inside tissue of organs; and providing an ultrasound image guided by a camera image in real time thereby enhancing the effectiveness of various diagnostic and surgical procedures.
  • Examples of procedures that can be performed using the combined ultrasound and endoscopy systems (CUES) described herein include, without limitation: endometrial cancer detection, screening, and/or diagnosis; ultrasound-based surgical planning; ultrasound-based therapy planning; surgical monitoring; and uterine surface roughness assessment.
  • the combined ultrasound and endoscopy systems (CUES) described herein can be used for monitoring gynecology and urology surgeries such as: uterine wall resection; endometrial ablation; endometrial resection; submucous myoma resection; intramural myoma resection; transmural myoma resection; resection of cervix and/or cervical canal; prostate resection; and uterine myomectomy.
  • the combined ultrasound and endoscopy systems (CUES) described herein can also be used for making measurements such as: uterine wall thickness; endometrium thickness; polyp size; prostate thickness; intra uterine measurements; urethra thickness.
  • the combined ultrasound and endoscopy systems (CUES) described herein can also be used to generate three-dimensional images of various organs and body parts, such as: ovaries; fallopian tube(s); uterus; prostate; and various tumors and/or polyps.
  • the methods and apparatus as described herein can be used to treat any tissue of the body and any organ and vessel of the body such as brain, heart, lungs, intestines, eyes, skin, kidney, liver, pancreas, stomach, uterus, ovaries, testicles, bladder, ear, nose, mouth, soft tissues such as bone marrow, adipose tissue, muscle, glandular and mucosal tissue, spinal and nerve tissue, cartilage, hard biological tissues such as teeth, bone and the like, as well as body lumens and passages such as the sinuses, ureter, colon, esophagus, lung passages, blood vessels and throat.
  • any tissue of the body and any organ and vessel of the body such as brain, heart, lungs, intestines, eyes, skin, kidney, liver, pancreas, stomach, uterus, ovaries, testicles, bladder, ear, nose, mouth, soft tissues such as bone marrow, adipose tissue, muscle, glandular and mucosal
  • the embodiments disclosed herein can be combined in one or more of many ways to provide improved diagnosis and therapy to a patient.
  • the disclosed embodiments can be combined with prior methods and apparatus to provide improved treatment, such as combination with known methods of urological, or gynecological diagnosis, surgery and surgery of other tissues and organs, for example. It is to be understood that any one or more of the structures and steps as described herein can be combined with any one or more additional structures and steps of the methods and apparatus as described herein, the drawings and supporting text provide descriptions in accordance with embodiments.

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Abstract

L'invention concerne un système combiné d'ultrasons et d'endoscopie (100) comprenant une canule (240) présentant une pointe distale (250) conçue pour être insérée dans un organe interne ou une autre structure corporelle interne. La pointe distale (250) est conçue pour comprendre à la fois une tête de sonde à ultrasons (252) et un module de caméra (320). Les images d'endoscopie à vision directe et ultrasonore (154, 156) peuvent être affichées simultanément à un utilisateur sur un moniteur d'affichage (150, 152). La tête de sonde à ultrasons (252) peut être tournée et dirigée pour balayer n'importe quel emplacement dans la cavité d'organe humain. La sonde à ultrasons (410) peut être réutilisable ou à usage unique. Le système (100) peut être conçu avec une partie portative (110) qui comprend une partie de poignée réutilisable (130) et une partie d'utilisation unique (120) qui est conçue pour être jetée à la suite d'une utilisation unique. Le système (100) peut également être conçu à l'aide d'un endoscope réutilisable classique présentant des canaux de travail (920, 1020) et un système de tour de traitement d'endoscopie (112, 116, 118).
PCT/IB2020/000470 2018-02-14 2020-06-11 Ultrasons et endoscopie combinés WO2021090056A1 (fr)

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DE112020005495.0T DE112020005495T5 (de) 2019-11-08 2020-06-11 Kombination von Ultraschall und Endoskopie
GB2208340.6A GB2605317B (en) 2019-11-08 2020-06-11 Combined ultrasound and endoscopy
US17/774,656 US20220378400A1 (en) 2018-02-14 2020-06-11 Combined ultrasound and endoscopy
CN202011240759.9A CN113143188A (zh) 2019-11-08 2020-11-09 一种超声和内窥镜组合***

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DE112020005495T5 (de) 2022-09-15

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