US20190069759A1 - Single Handled ENT Tool - Google Patents

Abstract

A tool, consisting of an enclosure and a rotatable knob retained by, and protruding from, the enclosure. The tool has a tube having a proximal end that is retained by the enclosure, and the tube has an axis of symmetry. A Geneva drive is retained within the enclosure, the Geneva drive consisting of a drive wheel fixedly attached to the rotatable knob and a driven wheel fixedly attached to the proximal end of the tube, so that an axis of rotation of the driven wheel coincides with the axis of symmetry of the tube. Thus, a continuous rotation of the rotatable knob causes the tube to rotate about the axis of symmetry in discrete angular steps.

Description

CROSS-REFERENCE TO RELATED APPLICATION
• This application claims the benefit of U.S. Provisional Patent Application 62/554,894, filed 6 Sep. 2017, which is incorporated herein by reference.
FIELD OF THE INVENTION
• This invention relates generally to surgical tools, and specifically to a surgical tool used for ENT (ear, nose, and throat) procedures.
BACKGROUND OF THE INVENTION
• In an ENT procedure involving the sinuses, the configuration of the sinuses typically restricts the freedom of movement of an ENT tool used to inspect or to operate in the sinuses. A physician may at least partially overcome the restriction by using both of his/her hands, but this requirement may be undesirable to the physician.
SUMMARY OF THE INVENTION
• An embodiment of the present invention provides a tool, including:
• an enclosure;
• a rotatable knob retained by, and protruding from, the enclosure;
• a tube having a proximal end retained by the enclosure, the tube having an axis of symmetry; and
• a Geneva drive retained within the enclosure, the Geneva drive consisting of a drive wheel fixedly attached to the rotatable knob and a driven wheel fixedly attached to the proximal end of the tube, so that an axis of rotation of the driven wheel coincides with the axis of symmetry of the tube,
• whereby a continuous rotation of the rotatable knob causes the tube to rotate about the axis of symmetry in discrete angular steps.
• In a disclosed embodiment the Geneva drive has eight different fixed positions.
• In a further disclosed embodiment the tube has a distal end having dimensions enabling it to be inserted into an orifice of a human patient. The orifice may be a nasal sinus.
• There is further provide, according to an embodiment of the present invention, a method, including:
• providing an enclosure;
• positioning a rotatable knob to be retained by, and protrude from, the enclosure;
• positioning a tube having a proximal end to be retained by the enclosure, the tube having an axis of symmetry; and
• positioning a Geneva drive to be retained within the enclosure, the Geneva drive consisting of a drive wheel fixedly attached to the rotatable knob and a driven wheel fixedly attached to the proximal end of the tube, so that an axis of rotation of the driven wheel coincides with the axis of symmetry of the tube,
• whereby a continuous rotation of the rotatable knob causes the tube to rotate about the axis of symmetry in discrete angular steps.
• The present disclosure will be more fully understood from the following detailed description of the embodiments thereof, taken together with the drawings, in which:
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a schematic illustration of an ENT (ear, nose, and throat) system, according to an embodiment of the present invention;
• FIG. 2 is a schematic diagram of an ENT tool, according to an embodiment of the present invention;
• FIG. 3 is a schematic diagram of an ENT tool, according to an alternative embodiment of the present invention;
• FIGS. 4 and 5 are schematic detail figures of a knob and its internal construction, according to an embodiment of the present invention;
• FIGS. 6, 7, 8, and 9 are schematic figures illustrating a rotation system, according to an embodiment of the present invention;
• FIG. 10 andFIG. 11 are schematic illustrations of portions of a guidewire and a balloon insertion mechanism, according to an embodiment of the present invention;
• FIG. 12 is a schematic transparent view of a manifold, according to an embodiment of the present invention; and
• FIG. 13 is a schematic sectional view of a locking mechanism, according to an embodiment of the present invention.
DETAILED DESCRIPTION OF EMBODIMENTSOverview
• An embodiment of the present invention provides a physician performing an ENT (ear nose and throat) procedure with a balloon sinuplasty tool that can be held by one hand, and wherein some of the functions of the tool can be implemented by the fingers of the hand. Specifically, while holding the tool, the physician is able to deflect the distal tip of the tool end away from the tool end axis, and independently rotate the tool end around its axis. The deflection and the rotation can be performed by the fingers of the hand holding the tool.
• In one embodiment of the present invention the tool comprises an enclosure which retains a rotatable knob, so that the knob protrudes from the enclosure. The tool also comprises a tube that has an axis of symmetry, and that has a proximal end retained by the enclosure. A distal end of the tube has dimensions enabling it to be inserted into an orifice of a patient.
• The enclosure of the tool contains a Geneva drive, which is connected so that a drive wheel is fixedly attached to the rotatable knob. In addition, a driven wheel of the Geneva drive is fixedly attached to the tube proximal end so that an axis of rotation of the driven wheel coincides with the tube axis of symmetry.
• The Geneva drive enables the tube to be rotated, by continuous rotation of the rotatable knob, by discrete angular steps into a number of discrete positions. In each of these positions, even though the knob may continue to be rotated, the Geneva drive locks the tube in place so that it does not rotate. While in any one of these discrete positions, other operations may be performed on the tube, such as deflection of the distal tip from the tool end axis, and the possibility of performing such multiple operations simultaneously and independently significantly assists the physician during a procedure.
• The tool also comprises a guidewire insertion mechanism, and a balloon insertion mechanism. The guidewire and the balloon (of their respective mechanisms) can be independently threaded through the tool end, and functions of the mechanisms can also be independently implemented. The guidewire comprises a location sensor at its distal tip and typically the physician may be able to deflect the guidewire tip.
• Typically, after the physician has manipulated the tool end to enable access to a desired sinus region, the guidewire is threaded through the tool end, and is manipulated until it is at or beyond the region. The balloon is then pushed along the guidewire to the region, at which point it may be inflated to perform sinuplasty.
• In addition to the functions listed above, the tool provides channels for suction from the distal end, for the inflation of the balloon, and for irrigation at the distal end.
• By incorporating all the above functions into one tool, and by enabling manipulation of the tool end to be implemented by the one hand holding the tool, the physician performing the procedure has substantially more freedom of movement than in prior art systems.
DETAILED DESCRIPTION
• Reference is now made toFIG. 1, which is a schematic illustration of an ENT (ear, nose, and throat)system20, according to an embodiment of the present invention. In the following description a single-handed ENT tool21 insystem20 is assumed to be used to perform a balloon sinuplasty procedure on apatient22 so that a distal end of the tool is assumed to have dimensions permitting entry to a nasal sinus of the patient. However, it will be understood that the tool may be used to perform other procedures on the patient.
• Tool21 comprises one or more magnetic sensors32A,32B, . . . , generically termedsensors32, which are typically single axis coils or a triple axis coils, that are tracked during the procedure by amagnetic tracking system23. For the tracking to be effective, insystem20 frames of reference of a CT (computerized tomography) image ofpatient22 and ofmagnetic tracking system23, are registered. While the CT image may typically comprise a magnetic resonance imaging (MRI) image or a fluoroscopic image, in the description herein the image is assumed to comprise, by way of example, a fluoroscopic CT image.
• Prior to and during the sinus procedure, amagnetic radiator assembly24, comprised in the magnetic tracking system, is positioned beneath the patient's head.Assembly24 comprisesmagnetic field radiators26 which are fixed in position and which transmit alternating magnetic fields into aregion30 wherein the head ofpatient22 is located. Potentials generated by a magnetic sensor such as a givensensor32 inregion30, in response to the magnetic fields, enable the position and the orientation of the sensor to be measured in the magnetic tracking system's frame of reference.
• By way of example,radiators26 ofassembly24 are arranged in an approximately horseshoe shape around the head ofpatient22. However, alternate configurations for the radiators ofassembly24 will be apparent to those having ordinary skill in the art, and all such configurations are assumed to be comprised within the scope of the present invention.
• Prior to the procedure, the registration of the frames of reference of the magnetic tracking system with the CT image may be performed by positioning a magnetic sensor at known positions, such as the tip of the patient's nose, of the image. However, any other convenient system for registration of the frames of reference may be used.
• Elements ofsystem20, includingradiators26 andsensors32, are under overall control of asystem processor40.Processor40 may be mounted in aconsole50, which comprises operating controls58 that typically include a keypad and/or a pointing device such as a mouse or trackball.Console50 connects to the radiators and tosensors32 via one or more cables cable and/or wirelessly. Aphysician54 uses operating controls58 to interact with the processor while performing the ENTprocedure using system20. While performing the procedure, the processor may present results of the procedure on ascreen56.
• Processor40 uses software stored in amemory42 to operatesystem20. The software may be downloaded toprocessor40 in electronic form, over a network, for example, or it may, alternatively or additionally, be provided and/or stored on non-transitory tangible media, such as magnetic, optical, or electronic memory.
• FIG. 2 is a schematic diagram oftool21, according to an embodiment of the present invention.Tool21 comprises aproximal section80 and adistal section82 which are connected together, but the distal section may be disassembled and removed from the proximal section. In some embodiments the proximal and/or distal sections are designed to be disposable, typically after one procedure has been performed.
• At its distal enddistal section82 comprises an articulatedtubular section84, which may be adjustably bent from a straight configuration86 to acurved configuration88, the latter being schematically shown in the diagram by broken lines. In the straightconfiguration tubular section84 defines an axis ofsymmetry92, which is also an axis of symmetry of atube100 to whichsection84 is connected, as described below. The adjustment from the straight to the curved configuration, and vice versa, may be performed by clockwise and counter-clockwise rotation of aribbed knob90, the construction and function of which, and of entities connected to it, are described further below with respect toFIGS. 4 and 5. U.S. patent application Ser. No. 15/155,850, filed May 16, 2016, titled “Insertion Tube with Deflectable Tip,” which is incorporated herein by reference, describes the construction and operation of a deflectable articulated section such assection84.
• Tubular section84 is fixedly connected at its proximal end totube100 which may be rotated about axis ofsymmetry92, as indicated by the double headed arrow in the figure. The rotation oftube100 may be implemented by rotating aridged knob106, the knob in turn being connected to arotation system109 housed in arotation system enclosure104.Rotation system109 is described below with respect toFIGS. 6, 7, 8 and 9.
• Tool21 comprises ahandle108 which connects to the tool by a ball-joint112. The physician holding the tool is able to adjust the handle's position according to the physician's preference, and then to lock the handle against the ball-joint by turning a lockingknob116 on the handle.
• Tube100 and articulatedsection84 comprise a central lumen which permits the passage of aguidewire115 and aballoon insertion mechanism119, fromproximal section80, through the lumen. The guidewire and the mechanism are described further below, with respect toFIGS. 10 and 11. Proximal sections of the guidewire and the insertion mechanism are held in place by a manifold127, which is described with respect toFIG. 12, and the sections may be locked in place, as required, by alocking mechanism131 which is described with respect toFIG. 13.
• FIG. 3 is a schematic diagram of atool121, according to an alternative embodiment of the present invention. Apart from the differences described below, the operation oftool121 is generally similar to that oftool21 and elements indicated by the same reference numerals in both21 and121 are generally similar in construction and in operation.
• Tool121 comprises, in place ofhandle108, aring element128 which connects to a suction tube124 (described below). Thephysician using tool121 is able to use his/her finger or thumb to holdelement128, and thus hold the tool.
• For simplicity and clarity, the remainder of the present application assumestool21 is used, and those having ordinary skill in the art will be able to adapt the description, mutatis mutandis, iftool121 is used.
• FIGS. 4 and 5 are schematic detail figures ofknob90 and its internal construction, according to an embodiment of the present invention.Knob90, which is hidden inFIG. 5, is rigidly connected bypins130 to acylinder134, and the cylinder comprises afirst groove138A and asecond groove138B at 180° to the first groove, the two grooves being configured as a double-start screw thread. Afirst pin142A and asecond pin142B at 180° to the first pin are mounted on aninternal cylinder146 so thatpin142A resides withingroove138A andpin142B resides withingroove138B. Rotation ofknob90 thus causes the knob andcylinder134 to move in a forward or backward motion parallel toaxis92.Cylinder134 is coupled by an internal element to wires (the internal element and the wires are not shown in the figures) connected todistal section84, so that the motion of the cylinder parallel toaxis92 causes the distal section to bend tocurved configuration88 or straighten to straight configuration86.
• FIGS. 6, 7, 8, and 9 are schematic figures illustratingrotation system109, according to an embodiment of the present invention.FIG. 6 illustrates a portion of the rotation system withenclosure104 hidden.FIGS. 7, 8, and 9 illustrate portions of the rotation system with a part ofenclosure104 visible.
• As illustrated inFIG. 6,rotation system109 uses aGeneva drive114, also termed aGeneva mechanism114, to rotatetube100 aroundaxis92.Knob106 is fixedly attached to adrive wheel116 of the mechanism, and the drive wheel mates with a drivenwheel120 of the mechanism.Driven wheel120 is fixedly attached to the proximal end oftube100 so that an axis of rotation of the driven wheel coincides with axis ofsymmetry92, and so that as the driven wheel rotates,tube100 rotates about its axis of symmetry.
• As shown inFIGS. 7 and 8,drive wheel116 comprises apin122, and a lune-shapedelement126.FIG. 7 illustrates drivenwheel120 as seen fromtube100, andFIG. 8 illustrates the internal construction of the driven wheel, showingindentations130 andslots134 of the driven wheel. During rotation of the Geneva drive,indentations130 are engaged by lune-shapedelement126, and pin122 engages and travels withinslots134. The engagement ofpin122 within aspecific slot134 is illustrated inFIG. 9.
• Drive114 translates continuous rotation ofknob106, typically implemented by a thumb and finger of thehand holding tool21, into intermittent rotation oftube100. It will be understood that whiletube100 is not being rotated, the engagement of lune-shapedelement126 with aspecific indentation130locks tube100 in place, so that the tube is prevented from inadvertent rotation.
• By way of example, in the illustrated embodiment drivenwheel120 has eight different fixed positions, corresponding to the eightdifferent indentations130, but it will be understood that the scope of the present invention comprises Geneva drives with other numbers of different fixed positions. Typically all the different fixed positions and their respective different indentations are distributed symmetrically about the axis of rotation of the driven wheel.
• It will be understood that continuous rotation of therotatable knob106 causestube100 to rotate about axis ofsymmetry92 in discrete angular steps. Thus, for the eight different fixed positions illustrated, by way of example, in the figures, for drivenwheel120,tube100 rotates to eight fixed positions, each fixed position separated from an adjacent fixed position by 45°. Once in one of the positions,tube100 is effectively locked in place, regardless of rotation ofknob106, until the knob has rotated sufficiently to initiate transfer of the tube to an adjacent fixed position.
• FIG. 10 andFIG. 11 are schematic illustrations of portions ofguidewire115 andballoon insertion mechanism119, according to an embodiment of the present invention. InFIGS. 10 and 11tube100 has been hidden.FIG. 10 shows a balloon150, in its nondilated state, that is attached at its proximal end to a distal end of aninsertion rod154 comprised in the mechanism. Balloon150 is attached at its distal end to a balloon holding tube160, and the tube is sealed at its proximal end to the distal tip ofrod154. Tube160 is shown in a transparent form inFIG. 11.
• Tube160 permits the passage ofguidewire115 through a lumen of the tube, and the guidewire is inserted into the tube via afirst channel164 inrod154.Channel164 is also configured to transfer fluid, such as irrigation fluid, through the channel, so that the fluid exits from a distal end of tube160.
• Guidewire115 may comprise a magnetic sensor32A at its distal end. In someembodiments rod154 may also comprise a magnetic sensor32B at the distal end of the rod. The sensors enablephysician54 to track the guidewire androd154 after they have been inserted intopatient22.
• In some embodiments the distal end of the guidewire is deflectable, typically by having wires (not shown in the figure) leading from the distal end to the proximal end, and adjustably tensioning the wires to form a desired deflection.
• Rod154 also comprises asecond channel170, that is used to convey air to the balloon so as to inflate the balloon. The channel may also be used to remove air so as to deflate the balloon.
• FIG. 12 is a schematic transparent view ofmanifold127, according to an embodiment of the present invention.Guidewire115 is supported by the manifold, but is able to slide within it. A proximal end ofrod154 is fixed within the manifold and the manifold has channels connected tofirst channel164 and second channel170 (visible inFIGS. 10 and 11) of the rod, and respectively to afluid supply tube180 and anair supply tube184.
• FIG. 13 is a schematic sectional view oflocking mechanism131, according to an embodiment of the present invention.Mechanism131 is mounted on ball-joint112, and fixedly couples suctiontube124 to the handle. As shown in the figure,suction tube124 provides a channel intoenclosure104, and so may be used by the physician for suction, thereby withdrawing material such as blood or mucus throughtube100 and the enclosure.
• Rod154 and guidewire115 both traverse the mechanism, which comprises anut192 turning on a screwedsection194. In an unlocked state of the mechanism, whennut192 is in the center of the screwed section, both the rod and the guidewire are free to move, proximally and distally, within the mechanism and thus withintube100 oftool21. Movement ofrod154 may be achieved by the physician pushing or pullingmanifold127. Movement of the guidewire may be achieved by the physician squeezing a sponge-like cylinder184 surrounding the guidewire, so as to grip the guidewire, and then moving the gripped guidewire proximally or distally.
• In a first locked state of the mechanism, which is implemented by thephysician turning nut192 of the mechanism in a first direction so as to raise the nut,rod154 is fixedly held by the locking mechanism againstknob190 whileguidewire115 is free to move.
• In a second locked state of the mechanism, which is implemented by thephysician turning nut192 in a second direction, opposite the first direction, so as to lower the nut, guidewire115 is fixedly held by the locking mechanism whilerod154 is free to move.
• During a typical sinuplasty procedure,physician54inserts tube100 andsection84 intopatient22 so that the distal end ofsection84 is in proximity to the sinuplasty site. Prior to, or during, the insertion, the physician may rotatetube100 and/or deflectsection84, as described above, so as to best position the distal end of the section.
• The physician may then use sponge-like cylinder184 tothread guidewire115 throughchannel164 ofrod154, and through the lumen oftube100, until it exits the distal end ofsection84. The physician typically positions the guidewire so that its distal end is beyond the site that is set for sinuplasty.
• With the guidewire in position, the physician may then slide the balloon insertion mechanism, i.e.,rod154, along the guidewire until the balloon of the mechanism reaches the desired location, at which stage the balloon may be locked in place by locking the balloon insertion mechanism withlocking mechanism131. Once in position, the balloon may be inflated, to achieve the sinuplasty, by passing air intochannel170.
• Once the sinuplasty procedure has been performed, the guidewire androd154 may be withdrawn from the patient by reversing the steps above.
• Although the embodiments described herein mainly address improvements in a tool for ENT, the methods and systems described herein may also be used in other, non-ENT applications, such as in neuro, gastric and other laparoscopic surgeries.
• It will be appreciated that the embodiments described above are cited by way of example, and that the present invention is not limited to what has been particularly shown and described hereinabove. Rather, the scope of the present invention includes both combinations and subcombinations of the various features described hereinabove, as well as variations and modifications thereof which would occur to persons skilled in the art upon reading the foregoing description and which are not disclosed in the prior art.

Claims (8)

1. A tool, comprising:

an enclosure;

a rotatable knob retained by, and protruding from, the enclosure;

a tube having a proximal end retained by the enclosure, the tube having an axis of symmetry; and

a Geneva drive retained within the enclosure, the Geneva drive comprising a drive wheel fixedly attached to the rotatable knob and a driven wheel fixedly attached to the proximal end of the tube, so that an axis of rotation of the driven wheel coincides with the axis of symmetry of the tube,

whereby a continuous rotation of the rotatable knob causes the tube to rotate about the axis of symmetry in discrete angular steps.

2. The tool according toclaim 1, wherein the Geneva drive has eight different fixed positions.

3. The tool according toclaim 1, wherein the tube has a distal end having dimensions enabling it to be inserted into an orifice of a human patient.

4. The tool according toclaim 3, wherein the orifice comprises a nasal sinus.

5. A method, comprising:

providing an enclosure;

positioning a rotatable knob to be retained by, and protrude from, the enclosure;

positioning a tube having a proximal end to be retained by the enclosure, the tube having an axis of symmetry; and

positioning a Geneva drive to be retained within the enclosure, the Geneva drive comprising a drive wheel fixedly attached to the rotatable knob and a driven wheel fixedly attached to the proximal end of the tube, so that an axis of rotation of the driven wheel coincides with the axis of symmetry of the tube,

whereby a continuous rotation of the rotatable knob causes the tube to rotate about the axis of symmetry in discrete angular steps.

6. The method according toclaim 4, wherein the Geneva drive has eight different fixed positions.

7. The method according toclaim 4, wherein the tube has a distal end having dimensions enabling it to be inserted into an orifice of a human patient.

8. The method according toclaim 7, wherein the orifice comprises a nasal sinus.

Images