 |
Description  |
|
|
BACKGROUND OF THE INVENTION
This invention relates to endoscopes and endoscopic surgical procedures.
More particularly, this invention relates to a device and an associated
method for enhancing sterility in endoscopic surgery. Even more
particularly, this invention relates to a sheath member for an endoscope
and an associated surgical technique.
Endoscopes are surgical instruments which enable a relatively non-intrusive
visual inspection of and surgery on internal body tissues, particularly
body tissues located within the digestive tract. An endoscope includes a
long flexible tubular member which is inserted into the colon through the
anus or into the esophagus through the mouth or the nose.
The tubular insertion member of an endoscope generally includes optical
fibers for carrying light energy into the patient and for carrying
organized visual information out of the patient. The insertion member also
includes an elongate cylindrical channel for inserting a surgical
instrument into the patient.
The operating tip of a surgical instrument which is inserted through the
ancillary, biopsy, channel of an endoscope is controlled by a surgeon who
manipulates an actuator at the proximal end of the endoscope. The
operation is visually monitored via the visual feedback information
provided by the endoscope. Larger endoscopes, particularly for use in the
colon, may contain several ancillary channels, e.g., for applying suction
and for feeding water and/or air to the distal end of the endoscope's
insertion member.
Because endoscopes are expensive instruments, they are used on multiple
patients and must accordingly be sterilized after each procedure.
Sterilization generally entails soaking at least the distal end of the
endoscope's insertion member in a antibacterial and antiviral solution. In
addition, the operating channels of the insertion member must be flushed,
preferably with a sterilizing solution.
Such sterilization procedures require substantial amounts of time. Costs
are increased, not only because of the hospital personnel time involved,
but also because the endoscopes are out of use for that additional time.
Moreover, there is always the risk that sterilization is inadequate and
that renegade bacteria or viruses remain in the endoscope and may be
subsequently transferred to a patient. This risk cannot be ignored in the
present environment of AIDS and other dreaded diseases.
It is of further note that a major difficulty in performing endoscopic
surgery is that the size of the endoscope's insertion member and
consequently the number of instrument or operating channels therein is
severely limited by the internal anatomy of the patient. The smaller
passages in the gastrointestinal tract form blocks which in some cases
must be forcibly dilated to enable passage of the endoscope. Such forcible
entry causes trauma or pain to patient.
OBJECTS OF THE INVENTION
An object of the present invention is to provide a device and a related
method for facilitating sterile endoscopic surgery.
Another object of the present invention is to provide such a device and
related method which reduce the time spent on procedures to ensure
sterility of endoscopes.
Another, more particular, object of the present invention is to provide
such a device and related method which are easy to use.
A further particular object of the present invention is to provide such a
device which is simple and relatively inexpensive to manufacture.
Yet a further object of the present invention is to provide an improved
endoscopic operating procedure which facilitates the introduction of
surgical instruments into a patient.
SUMMARY OF THE INVENTION
A device utilizable with an endoscope to promote sterility comprises, in
accordance with the present invention, a substantially thin-walled
elongate tubular sheath made of a flexible material such as rubber, the
sheath having a use configuration with an inner diameter larger than an
outer diameter of an insertion member of the endoscope, whereby the sheath
may be removably disposed about such insertion member to substantially
surround same prior to insertion of the insertion member into a patient.
The device further comprises a transparent cap member and an element or
elements for attaching the cap member in a fluid tight seal to a distal
end of the sheath so that the cap member covers a distal end of the
insertion member of the endoscope.
According to another feature of the present invention, the endoscopic
device also comprises a securing component on the sheath for facilitating
attachment thereof in a fluid tight seal to the insertion member of the
endoscope and for concomitantly facilitating subsequent removal of the
sheath from the insertion member of the endoscope.
The securing component may specifically comprise at least one pair of
cooperating zip-lock elements extending longitudinally along the sheath.
More specifically, the sheath may have a longitudinally extending slit,
the cooperating zip-lock elements being disposed on opposite sides of the
slit to close the slit and thereby form the use configuration of the
endoscopic sterility enhancement device. In addition, the sheath may be
provided with an elongate membrane attached to an inner surface of the
sheath along opposite sides of the slit to define a substantially closed
elongate cylindrical chamber for receiving the insertion member of the
endoscope.
Alternatively, the securing component includes a cylindrical air-tight
chamber incorporated into the sheath and means attached to the sheath for
alternately inflating and deflating the air-tight chamber.
Pursuant to an alternative feature of the present invention, the sheath is
initially rolled back upon itself from a proximal end to the cap member at
the distal end. To install the sheath on the insertion member of the
endoscope, the sheath is unrolleld from its initial configuration to the
use configuration.
According to another feature of the present invention, the endoscopic
sterility enhancement device includes structure for defining a biopsy
channel in or on the sheath. The term "biopsy channel" is used herein to
mean any channel through which endoscopic instruments may be inserted.
Such instruments include, without limitation, biopsy forceps, graspers,
scissors, coagulators, laser fibers, staplers, injectors, clamping
forceps, irrigation and suction tubes, cauterization devices, etc.
The structure defining a biopsy channel may include an ancillary tube
attached to the sheath and extending longitudinally therealong for
receiving an endoscopic operating instrument. The ancillary tube is
preferably made of a flexible substantially elastic material.
Pursuant to a particular feature of the present invention, the ancillary
tube is initially in a collapsed state and is expandable upon insertion of
the operating instrument into the tube. Alternatively, or additionally, in
the event that the sheath is provided with a plurality of ancillary tubes
defining respective biopsy channels, the ancillary tube has a bendable but
form-maintaining substantially cylindrical wall. This structure is
especially useful in the event that suction is to be applied via the
ancillary tube.
Pursuant to another particular feature of the present invention, the
ancillary tube is disposed inside a wall of the sheath.
In accordance with yet another feature of the present invention, a fastener
is provided for attaching the sheath to the insertion member at the distal
end thereof. Specifically, the fastener includes the cap member.
A method for performing an endoscopic surgical operation comprises, in
accordance with the present invention, the steps of (a) providing an
endoscope having an insertion member with means for transmitting visual
information from a distal end of the insertion member to a proximal end
thereof, (b) providing a tubular sheath defining a main chamber, (c)
disposing the sheath about the insertion member to enclose at least a
distal end portion of the sheath in a fluid tight seal inside the chamber,
(d) providing a transparent cap member at a distal end of the sheath to
close the distal end of the chamber in a fluid tight seal, and (e)
inserting the insertion member with the sheath into a patient. The visual
information from the insertion member is then used in a susbequent step
(f) to locate a surgical site within the patient. Upon the locating of the
surgical site, a surgeon withdraws the insertion member from the patient
in a later step (g). The sheath is then removed from the insertion member
(step (h)).
Pursuant to another feature of the present invention, the sheath has an
ancillary tube which defines an elongate channel extending longitudinally
alongside the chamber. In that event, the method further comprises the
step of (i) upon the locating of the surgical site and prior to the
withdrawal of the insertion member from the patient, inserting a surgical
instrument having an elongate shaft into the channel and sliding the shaft
along the channel so that an operating tip of the surgical instrument
protrudes from the channel at the distal end of the insertion member. In a
subsequent step (j), a surgeon performs a surgical operation at the
surgical site with the surgical instrument. Upon the performance of the
surgical operation, the surgical instrument is preferably, but not
necessarily, withdrawn from the biopsy channel prior to withdrawal of the
insertion member from the patient.
As discussed hereinabove, the sheath may be disposed about the insertion
member of the endoscope by unfurling the sheath from an initial rolled-up
configuration. Preferably, the cap member is already attached to the
sheath in this particular method of applying the sheath to the endoscope's
insertion member.
Alternatively, the sheath may include a zip-lock type seal and the step of
disposing the sheath about the insertion member of the endoscope includes
the step of closing the zip-lock seal.
As yet another alternative, the sheath includes a cylindrical balloon
component about a main chamber of the sheath. Upon a sliding of the
endoscope's insertion member into the sheath, the sheath is tightened
about the insertion member by inflating the balloon component.
Preferably, the transparent cap member is attached to the sheath and
preferably also to the distal end of the endoscope's insertion member.
An endoscope sheath in accordance with the present invention and the
related method facilitates sterile endoscopic surgery. The sheath is
disposable and designed so that the outer surfaces of the sheath never
come into contact with the endoscope. Accordingly, it is no longer
necessary to subject the endoscope to sterilizing soaking procedures. The
time of hospital personnel is saved, endoscopes have reduced down times,
and costs are lowered.
An endoscope sheath in accordance with the present invention is easy to
use. Particularly, the sheath is easy to apply to an insertion member of
an endoscope.
Moreover, an endoscope sheath in accordance with the present invention is
simple and relatively inexpensive to manufacture.
It is to be further noted that the present invention will most likely
increase the useful lives of endoscopes, that is, will increase the number
of operations in which the endoscopes are used. The wear and tear on the
endoscopes arising from non-operation handling is reduced because the
endoscopes need not be handled so much outside of the operating.
Yet another advantage of the present invention is to provide an improved
endoscopic operating procedure which facilitates the introduction of
surgical instruments into a patient. Insofar as an endoscope need not have
biopsy channels and requires only the optical fibers and/or electrical
leads for the transmission of light and visual information, the diameter
of the insertion portion of the endoscope is reduced. Inasmuch as the
biopsy channels are collapsed during insertion of the endoscope and expand
only upon insertion of the endoscopic operating instruments, the width or
thickness during an initial insertion operation is reduced. Moreover, the
subsequent insertion of the operating instrument(s) involves only an
incremental widening of the internal passageways of the patient through
which the endoscope winds. This incremental insertion technique increases
the number of instruments which may be inserted simultaneously into a
patient along the endoscope path.
An endoscope sheath in accordance with the present invention thus not only
facilitates the maintenance of sterile conditions but also enhances the
reach of endoscopic surgery.
BRIEF DESCRIPTION OF THE DRAWING
FIG. 1 is a perspective view, on a fore-shortened scale, of an endoscope
sheath assembly in accordance with the present invention.
FIG. 2 is an end view of a sheath member of the endoscope sheath assembly
of FIG. 1, showing the sheath member in an opened configuration.
FIG. 3 is an end view of the sheath member of FIG. 2, showing the sheath
member in a closed, use, configuration.
FIG. 4 is a partial cross-sectional view taken transversely to a
longitudinal axis of the sheath of FIG. 1.
FIG. 5 is a perspective view of another endoscope sheath assembly in
accordance with the present invention.
FIG. 6 is a partial longitudinal cross-sectional view taken at the distal
end of an endoscope sheath assembly in accordance with the present
invention.
FIG. 7 is a perspective view, on a fore-shortened scale, of a further
endoscope sheath assembly in accordance with the present invention.
FIG. 8 is a side perspective view of the endoscope sheath assembly of FIG.
7, attached to an endoscope pursuant to the present invention.
FIG. 9 is an end elevational view of the endoscope sheath assembly of FIG.
7, showing a sheath member with collapsed biopsy channels and a deflated
cylindrical balloon-like element for attaching the sheath assembly to an
endoscope.
FIG. 10 is a view similar to FIG. 9, showing the biopsy channels expanded
and the balloon attachment element inflated.
FIG. 11 is an end elevational view of a modified endoscope sheath assembly
in accordance with the present invention.
FIGS. 12A-12C show successive stages in the securing to an endoscope of
another sheath assembly in accordance with the present invention.
FIGS. 13A and 13B show successive steps in the removal of an intestinal
polyp via an endoscopic procedure in accordance with the present invention
.
DETAILED DESCRIPTION
As illustrated in FIGS. 1-4, a disposable sheath assembly 20 for an
insertion member of an endoscope comprises a substantially thin-walled
elongate tubular sheath 22 made of a strong flexible material such as
rubber. Sheath 22 has a use configuration, shown particularly in FIG. 3,
with an inner diameter d1 larger than an outer diameter of the endoscope
insertion member, whereby the sheath may be removably disposed about the
insertion member to substantially surround the insertion member prior to
insertion thereof into a patient.
As shown in FIG. 1, sheath assembly 20 further comprises a transparent end
cap 24 provided with an annular mounting ring 26 for attaching the end cap
to the distal end of sheath 22 and the distal end of the insertion member
of an endoscope. Ring 26 serves to fasten transparent cap 24 in a fluid
tight seal to sheath 22 so that the cap covers a distal end of the
endoscope insertion member.
End cap 24 is preferably attached to a distal end of sheath 22 during
manufacture (see FIG. 5), so that an elongate cylindrical chamber defined
by sheath 22 and cap 24 for receiving the insertion member or shaft of an
endoscope is open only at a proximal end (the left hand side in FIG. 1).
Fastening ring 26 is provided on an internal surface with at least one
formation for enabling a removable attachment of end cap 24 and the distal
end of sheath 22 to the distal end of the insertion member of an
endoscope. Such a releaseable connector may take the form of a rib or
groove (see FIG. 6), a screw thread or other known structure.
Alternatively, ring 26 may be dimensioned to facilitate attachment thereof
and of cap 24 to the distal end of an endoscope insertion member via a
force-lock fit.
As shown in FIGS. 2 and 3, sheath 22 is formed with a longitudinally
extending slit 28 and is provided with an internal membrane 30 extending
longitudinally the length of the sheath. Membrane 30 is secured along its
longitudinal edges 32 and 34 to an inner surface 36 of sheath 22. Membrane
30 serves as a protective barrier to prevent bacteria and virus particles
on an outer surface of sheath 22 from coming into contact with an
endoscope during a removal of the endoscope from sheath assembly 20 upon
the completion of an endoscopic procedure.
In an alternative conceptualization of sheath assembly 20, membrane 30 and
a portion of sheath 22 extending from the joint at longitudinal edge 32 to
the joint at longitudinal edge 34 constitutes a tubular sheath member,
whereas a remaining portion of sheath 22 extending from longitudinal edge
34 constitutes a locking or closure flap 38.
Sheath 22 is provided on an inner surface of flap 38 with a pair of
longitudinally extending ribs or beads 40 and 42 which cooperate with
respective longitudinally extending grooves 44 and 46 on an outer surface
of sheath 22 opposite slit 28 to close sheath 22 in a fluid tight seal.
Ribs 40 and 42 are pressed into grooves 44 and 46 by a pressure applied
longitudinally from a distal end of sheath 22 to a proximal end thereof.
This pressure may be applied manually with a simple hand contact or may be
facilitated by the provision of a zipper mechanism (not illustrated). As
illustrated in FIG. 3, sheath 22 has a substantially smooth external
surface upon a closure stroke which presses ribs 40 and 42 into grooves 44
and 46.
Zip-lock ribs 40 and 42 and grooves 44 and 46 serve to facilitate
attachment or securement of sheath 22 to an endoscope insertion member in
a fluid tight seal prior to an endoscopic surgical operation and to
concomitantly facilitate subsequent removal of the sheath from the
insertion member of the endoscope after the termination of the operation.
Sheath 22 is provided internally with at least one longitudinally extending
channel 48 which serves as a biopsy channel, namely, as a channel through
which endoscopic instruments may be inserted during endoscopic surgery.
Such instruments include, without limitation, biopsy forceps, graspers,
scissors, coagulators, laser fibers, staplers, injectors, clamping
forceps, irrigation and suction tubes, cauterization devices, etc.
Sheath 22 is made of a strong, flexible and substantially elastic material
such as rubber. In the event that channel 48 is to be used for suction,
sheath 22 is constructed so that channel 48 maintains its tubular form.
Maintaining the form of channel 48 may be ensured, for example, by the
embedding of a reinforcing tube (not illustrated) in the material of
sheath 22. However, such a tube is not deemed to be necessary in the event
that the material of sheath 22 is sufficiently strong.
As illustrated in FIG. 5, another disposable sheath assembly 50 for
providing sanitary protection for the insertion member of an endoscope
comprises a substantially thin-walled elongate tubular sheath 52 made of a
strong flexible material such as rubber. Sheath 52 has a use configuration
with an inner diameter d2 larger than an outer diameter of the endoscope
insertion member, whereby the sheath may be removably disposed about the
insertion member to substantially surround the insertion member prior to
insertion thereof into a patient.
Sheath assembly 50 additionally comprises a transparent end cap 54 provided
with an annular mounting ring 56 which serves in part to attach the end
cap in a fluid tight seal to the distal end of sheath 52. Ring 56 also
serves to fasten the distal end of sheath 52 to the distal end of the
insertion member of an endoscope. To perform that function, ring 56 is
provided on an internal surface with at least one formation (not
illustrated) for enabling a removable attachment of end cap 54 and the
distal end of sheath 52 to the distal end of the insertion member of an
endoscope. Such a releaseable connector may take the form of a rib or
groove (see FIG. 6), a screw thread or other known structure.
Alternatively, ring 56 may be dimensioned to facilitate attachment thereof
and of cap 54 to the distal end of an endoscope insertion member via a
force-lock fit.
As further illustrated in FIG. 5, sheath 52 is formed with a longitudinally
extending slit 58 and is provided with an internal membrane 60 extending
longitudinally the length of the sheath. As described hereinabove with
reference to membrane 30 in FIGS. 1-4, membrane 60 is secured along its
longitudinal edges to an inner surface 66 of sheath 52. Membrane 60 serves
as a protective barrier to prevent bacteria and virus particles on an
outer surface of sheath 52 from coming into contact with an endoscope
during a removal of the endoscope from sheath assembly 50 upon the
completion of an endoscopic procedure.
Like sheath 22, sheath 52 is provided with one or more longitudinally
extending ribs 70 which cooperate with respective longitudinally extending
grooves 72 to close sheath 52 in a fluid tight seal. Ribs 70 are pressed
into grooves 72 by a pressure applied longitudinally from a distal end of
sheath 52 to a proximal end thereof. This pressure may be applied manually
with a simple hand contact or may be facilitated by the provision of a
zipper mechanism (not illustrated).
As depicted in FIG. 5, sheath assembly 50 incorporates a plurality of
flexible webs 74 which are attached to an outer surface of sheath 52 to
define respective, substantially tubular, biopsy channels 76 for the
deployment of endoscopic surgical instruments during an endoscopic
surgical operation. Initially, webs 74 are collapsed upon the outer
surface of sheath 52, thereby minimizing at the outset of an endoscopic
operation the effective outer diameter of an endoscopic insertion member.
This diameter minimalization facilitates deployment of the endoscope by
easing the passage of the endoscope's insertion member through smaller
internal orifices of a patient.
Upon deployment of an endoscope with an insertion member enveloped or
encased in protective sheath assembly 50, endoscopic surgical instruments
(not shown) may be forcibly inserted one at a time through respective
biopsy channels 76, the channels being expanded from their initial
collapsed or closed configuration to an opened or expanded use
configuration during the instrument insertion process. In addition, a
flexible but non-collapsible tubular member (not shown) may be inserted
through a selected channel 76 from the proximal end of sheath assembly 50
to the distal end thereof to serve as a suction channel. Alternatively,
sheath 52 is provided with an attached flexible but non-collapsible
tubular member 78 for enabling the application of suction to the space
immediately distal of end cap 54.
As illustrated in FIG. 6, sheath 52 may be attached to transparent end cap
54 via a ring or annular connector 71 provided along an inner surface 73
with an annular groove 75. During an attachment of sheath assembly 50 to
an insertion member of an endoscope, groove 75 receives an annular rib or
bead (not shown) provided on the distal end of the insertion member. A
distal end of sheath 52 is inserted and held in an annular slot 77 in
connector 71.
Other methods of attaching the distal end of sheath 52 to ring 56 (FIG. 5)
or of sheath 22 to ring 26 (FIG. 1) are possible. For example, the distal
end of sheaths 22 and 52 may be connected via an adhesive layer or an
ultrasonic bond to rings 26 and 56, respectively. In addition, rings 26,
56 and 71 may be provided with other formations for releasably connecting
the rings and their sheaths 22, 52 to insertion members of endoscopes.
Such alternative formations include various snap-lock and screw type
elements.
As depicted in FIGS. 7-10, another disposable sheath assembly 80 for an
insertion member 81 of an endoscope 83 comprises a substantially
thin-walled elongate tubular sheath 82 made of a strong flexible material
such as rubber. Sheath assembly 80 further comprises a transparent end cap
84 provided with an annular mounting ring 86 for attaching the end cap to
the distal end of sheath 82 and the distal end of insertion member 81 Of
endoscope 83. Ring 86 serves to fasten transparent cap 84 in a fluid tight
seal to sheath 82 so that the cap covers a distal end of insertion member
81.
End cap 84 is preferably attached to a distal end of sheath 82 during
manufacture, so that an elongate cylindrical chamber defined by sheath 82
and cap 84 for receiving endoscope insertion member 81 is open only at a
proximal end (the left hand side in FIG. 7).
Sheath 82 is provided on an inner side with a balloon member 88 which is
inflatable by a pressure source 90 via a tube 92. Balloon 88 is initially
in a deflated or collapsed condition. Prior to an endoscopic surgical
procedure, endoscope insertion member 81 is inserted into sheath 82,
inside balloon 88. Pressure source 90 is connected to balloon 88 via tube
92 and is activated to pressurize balloon 88, inflating the balloon to
form a snug contact with endoscope insertion member 81. Balloon 88 thus
serves to temporarily connect sheath 82 to insertion member 81.
Sheath assembly 80 includes a plurality of flexible webs 94 which are
attached to an outer surface of sheath 82 to define respective,
substantially tubular, biopsy channels 96 for the deployment of endoscopic
surgical instruments 97 (FIG. 10) during an endoscopic surgical operation.
Initially, as depicted in FIG. 9, webs 94 are collapsed upon the outer
surface of sheath 82, thereby minimizing at the outset of an endoscopic
operation the effective outer diameter of endoscope insertion member 81.
Upon deployment of endoscope 83 with insertion member 81 enveloped or
encased in protective sheath assembly 80, endoscopic surgical instruments
97 may be forcibly inserted one at a time through respective biopsy
channels 96, the channels being expanded from their initial collapsed or
closed configuration (FIG. 9) to an opened or expanded use configuration
(FIG. 10) during the instrument insertion process. In addition, a flexible
but non-collapsible tubular member 99 may be inserted through a selected
channel 96' from the proximal end of sheath assembly 80 to the distal end
thereof to serve as a suction channel. Alternatively, sheath 82 is
provided with an attached flexible but non-collapsible tubular member 98
for enabling the application of suction to the space immediately distal of
end cap 84.
Upon the withdrawal of insertion member 81 with sheath assembly 80 at the
end of an endoscopic surgical operation, balloon 88 is deflated via tube
92. Subsequently, sheath 82 is slid off of insertion member 81. A clamp or
other releasable closure (not illustrated) may be provided for closing
tube 92 and thereby maintaining balloon 88 in an inflated or pressurized
state.
FIG. 11 shows another sheath assembly 100 which is a modification of sheath
assembly 80 of FIGS. 7-10. Sheath assembly 100 includes a substantially
thin-walled elongate tubular sheath 102 made of a strong flexible material
such as rubber. Sheath 102 is provided with a plurality of elongate
longitudinally oriented indentations 104 for receiving collapsed webs or
tubes 106 in a pre-use configuration of the sheath assembly.
Sheath 102 is provided on an inner side with a balloon member 108 which is
inflatable by a pressure source (not illustrated) via a tube 110. Balloon
108 is initially in a deflated or collapsed condition. Prior to an
endoscopic surgical procedure, an endoscope insertion member is inserted
into sheath 102, inside balloon 108. Balloon 108 is then inflated to form
a snug contact with the endoscope insertion member. Balloon 108 thus
serves to temporarily connect sheath 102 to the insertion member.
Sheath 102 is provided with an attached, flexible but non-collapsible
tubular member 112 for enabling the application of suction to the space
immediately distal of the distal end of sheath 102.
As illustrated in FIG. 12A, another endoscopic sheath assembly 120
comprises a tubular member 122 attached in a rolled up configuration to a
ring member 124. Prior to an endoscopic surgical operation, ring member
124 is connected via a snap-lock fit, a force-lock fit, etc., to the
distal end of an endoscope insertion member 126, as shown in FIG. 12B.
Tubular sheath member 122 is then unfurled from the rolled up
configuration of FIG. 12A to uncover a transparent end cap 128 on ring 124
and to cover the endoscope insertion member 126 from the distal end
towards the proximal end thereof. As discussed hereinabove with respect to
other embodiments, sheath member 122 may be provided with a multiplicity
of collapsed tubular biopsy channels which are expandable by the insertion
of endoscopic surgical instruments during an endoscopic operation.
The sheath assemblies described herein provide the possibility in
endoscopic surgery of operating with more than one instrument at a time.
FIG. 13A depicts a polyp PLP in a patient's colon CLN. An endoscope 130
with a light guide 132 and an image guide 134, surrounded by a disposable
sheath 136 is inserted into the colon CLN and is used to detect and
investigate the polyp PLP. The polyp has a bent stalk SLK, which makes it
difficult to sever the polyp and remove it by conventional endoscopic
surgical techniques. Sheath 136, however, has multiple expandable biopsy
channels which enables the deployment of two grasping forceps 138 and 140,
as shown in FIG. 13A, or both grasping forceps 138 and a cauterization
snare 142, as shown in FIG. 13B. Forceps 138 and 140 are used to
manipulate polyp PLP from its original position (FIG. 13A) to a more
accessible position or orientation (FIG. 13B) which facilitates capture of
the polyp by cauterization snare 142. Snare 142 is provided with a capture
net 144, as described in commonly owned application Ser. No. 788,035 filed
Nov. 5, 1991.
Although the invention has been described in terms of particular
embodiments and applications, one of ordinary skill in the art, in light
of this teaching, can generate additional embodiments and modifications
with | | |
