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Endoscope having a guide tubeRelated Patent Categories: Surgery, Endoscope, With Guide Means For Body InsertionEndoscope having a guide tube description/claimsThe Patent Description & Claims data below is from USPTO Patent Application 20070043259, Endoscope having a guide tube. Brief Patent Description - Full Patent Description - Patent Application Claims
CROSS-REFERENCE [0001] This application is a continuation of U.S. patent application Ser. No. 10/768,472 filed Jan. 29, 2004, which is a continuation of Ser. No. 10/139,289 filed May 2, 2002, now U.S. Pat. No. 6,837,846, which is a continuation-in-part of U.S. patent application Ser. No. 09/969,927 filed Oct. 2, 2001, which is a continuation-in-part of U.S. patent application Ser. No. 09/790,204 filed Feb. 20, 2001, which claims the benefit of U.S. Provisional Patent Application Ser. No. 60/194,140 filed Apr. 3, 2000, each of which is incorporated herein by reference in its entirety. FIELD OF THE INVENTION [0002] The present invention relates generally to endoscopes and endoscopic medical procedures. More particularly, it relates to a method and apparatus to facilitate insertion of a flexible endoscope along a tortuous path using a guide tube apparatus, such as for colonoscopic examination and treatment. BACKGROUND OF THE INVENTION [0003] An endoscope is a medical instrument for visualizing the interior of a patient's body. Endoscopes can be used for a variety of different diagnostic and interventional procedures, including colonoscopy, bronchoscopy, thoracoscopy, laparoscopy and video endoscopy. [0004] Colonoscopy is a medical procedure in which a flexible endoscope, or colonoscope, is inserted into a patient's colon for diagnostic examination and/or surgical treatment of the colon. A standard colonoscope is typically 135-185 cm in length and 12-19 mm in diameter, and includes a fiberoptic imaging bundle or a miniature camera located at the instrument's tip, illumination fibers, one or two instrument channels that may also be used for insufflation or irrigation, air and water channels, and vacuum channels. [0005] The colonoscope is inserted via the patient's anus and is advanced through the colon, allowing direct visual examination of the colon, the ileocecal valve and portions of the terminal ileum. Insertion of the colonoscope is complicated by the fact that the colon represents a tortuous and convoluted path. Considerable manipulation of the colonoscope is often necessary to advance the colonoscope through the colon, making the procedure more difficult and time consuming and adding to the potential for complications, such as intestinal perforation. [0006] Steerable colonoscopes have been devised to facilitate selection of the correct path though the curves of the colon. However, as the colonoscope is inserted farther and farther into the colon, it becomes more difficult to advance the colonoscope along the selected path. At each turn, the wall of the colon must maintain the curve in the colonoscope. The colonoscope rubs against the mucosal surface of the colon along the outside of each turn. Friction and slack in the colonoscope build up at each turn, making it more and more difficult to advance and withdraw the colonoscope. In addition, the force against the wall of the colon increases with the buildup of friction. In cases of extreme tortuosity, it may become impossible to advance the colonoscope all of the way through the colon. [0007] Steerable endoscopes, catheters and insertion devices for medical examination or treatment of internal body structures are described in the following U.S. patents, the disclosures of which are hereby incorporated by reference in their entirety: U.S. Pat. Nos. 4,543,090; 4,753,223; 5,337,732; 5,337,733; 5,383,852; 5,487,757 and 5,662,587. BRIEF SUMMARY OF THE INVENTION [0008] An endoscopic assembly and method of advancing the assembly which is able to traverse tortuous paths, such as the colon, without excessively contacting the walls of the colon is described herein. The assembly generally comprises a combination of an endoscope which is slidably insertable within the lumen of a guide tube. The endoscope may be any conventional endoscope having a shaft which extends from a handle. The distal end of the shaft preferably comprises a controllable distal portion which may be manipulated to facilitate the steering of the assembly through the tortuous path. The guide tube may be a conventional flexible conduit which is configured to be rigidizable along its entire length from a relaxed configuration. In the relaxed configuration, a portion of the guide tube is able to assume the shape or curve defined by the controllable distal portion of the endoscope. Having assumed the shape or curve of the endoscope, the guide tube may be rigidized by the physician or surgeon to maintain that shape or curve. [0009] Alternatively, the guide tube may also be used with an endoscope having an automatically controlled proximal portion and a selectively Steerable distal portion. Such a controllable endoscope may have a distal portion which is manually Steerable by the physician or surgeon to assume a shape to traverse an arbitrary curved path and a proximal portion which is automatically controlled by, e.g., a computer, to transmit the assumed shape along the proximal portion as the endoscope is advanced or withdrawn. More detailed examples are described in copending U.S. patent application Ser. No. 09/969,927 (now U.S. Pat. No. 6,610,007) which has been incorporated above by reference in its entirety. [0010] The guide tube may be comprised of a plurality of individual segments which are linked adjacent to one another via one or more tensioning wires or elements. These tensioning elements maybe placed circumferentially about each of the segments and preferably run throughout the length of the guide tube through each of the individual segments. When the guide tube is to be rigidized, the tensioning elements may be pulled or tightened to draw the segments together such that the entire guide tube becomes rigid. The tensioning elements may then be loosened such that the individual segments may move relative to one another. [0011] In use, e.g., in the colon, the physician or surgeon may typically first advance the distal portion of the endoscope within the body of the patient. When the first curve of the colon is approached, the user may appropriately steer the distal portion of the endoscope to assume a curve for traversing the path. At this point, the endoscope is preferably held stationary relative to the patient while the guide, in a relaxed and flexible state, is advanced over the shaft of the endoscope until the distal end of the guide tube is at, or a short distance past, the distal tip of the endoscope. Once the guide tube, or at least its distal portion, has assumed the curve formed by the controllable distal portion of the endoscope, the guide tube may then be rigidized, preferably along its length, to hold its assumed shape. Once this is done, the endoscope may be further advanced within the rigidized guide tube to traverse the curved pathway without having to place any pressure against the walls of the colon. The steps for advancing the endoscope may be repeated as necessary until the desired area within the body has been reached. [0012] At any point during the exploratory procedure, the guide tube may be removed from the colon while leaving the endoscope behind. To remove the assembly from the colon, the guide tube may first be withdrawn and the endoscope may be subsequently withdrawn. Alternatively, the above steps may be repeated in reverse order to withdraw both the guide tube and the endoscope from the region. [0013] The outer surface of the guide tube preferably has a tubular covering which covers at least a majority of the tube to prevent the entry of debris and fluids within the lumen of the guide tube between the individual segments. The covering also facilitates the advancement and withdrawal of the guide tube by preventing tissue from being pinched between the segments. To prevent tissue from being pinched between the guide tube and endoscope during assembly movement, expandable bellows or an additional covering may optionally be placed over the distal opening of the guide tube. This additional covering may simply be an integral extension of the covering over the surface of the guide tube, or it may be a separate covering attached to the distal end of the guide tube. This covering may also be attached to or near the distal end of the endoscope to maintain a seal between the endoscope shaft and the guide tube. The coverings and their variations may be attached by any conventional method as practicable. If the covering over the distal end of the guide tube is utilized, as the distal portion of the endoscope shaft is advanced distally through the guide tube, the covering preferably expands distally along with the endoscope or simply slides distally along with the endoscope. When the shaft is retracted within the guide lumen, the covering again preferably retracts proximally along with the proximal movement of the distal end of the endoscope or it may simply be retracted manually along with the endoscope. The use of the additional covering may also aid in maintaining the sterility of the internal lumen of the guide tube. BRIEF DESCRIPTION OF THE DRAWINGS [0014] FIG. 1 shows a variation of the guide tube assembly in which an endoscope is pushed through and supported by a guide tube. [0015] FIG. 2 shows a cross-sectional view of the guide tube assembly of FIG. 1. [0016] FIG. 3 shows the guide tube variation of FIG. 1 with a portion of the tube partially removed for clarity. [0017] FIG. 4 shows a variation on a steerable endoscope having a selectively steerable distal portion and an automatically controllable proximal portion which may be used with the rigidizable guide tube. [0018] FIG. 5 shows a wire frame model of a section of the automatically controllable endoscope traversing an arbitrary curve. [0019] FIG. 6A shows a variation in which the distal end of the endoscope remains unattached to the flexible covering. Continue reading about Endoscope having a guide tube... 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