Viewing surgical scope for minimally invasive procedures

Abstract

A viewing and treatment apparatus for performing minimally invasive surgery through an opening in a patient's chest, the apparatus includes a visualization scope with an elongated portion and a distal end, and a working device such as a tissue ablation energy delivery device. The working device is encompassed within a working channel that communicates with the distal end of the scope. In one embodiment, a bronchoscope is used whose catheter shafting includes an introducer sleeve at the distal section of the scope for providing stability during introduction to a patient's chest while stabilizing the treatment and visualization distal ends of the scope at a treatment site. This embodiment can include a needle piercing assembly that cooperatively works with the work device such as for drug delivery. In a second embodiment a rigid endoscope with a viewing channel has an introducer member that is slidably disposed and detachable from the viewing channel and has a transparent convex distal tip which provides non-articulation at the distal end. This introducer member can also be used in conjunction with the first embodiment where the catheter shaft requires non-articulation. Both types of visualization scopes include a working channel in which the working device can translationally egress from the scope's distal end. Additionally, the rigid introducer member can be modified to include a movable transparent rotatable member design for varying the direction which the working devices egresses the apparatus' distal end. The preferred surgical procedure is transmyocardial revascularization and the preferred working device is an optical fiber element that is translatable from the distal end of the apparatus during the procedure. The working device can optionally include a flexible piercing needle with an internal lumen which allows translation of a working device such as an optical fiber or act as a conduit for drug delivery.

What is claimed is:  
     
         1 . A surgical procedural apparatus for visualizing and treating tissue in a minimally invasive surgical procedure, the apparatus comprising: 
 a) working means for effectuating the surgical procedure;    b) a visualization scope having a body member at the proximal end, an elongated sleeve member attached to the body member, the sleeve member provides optical viewing at the apparatus' distal end; and    c) a rigid introducer and viewing assembly having a length sufficient to effectuate both penetration by the working means' distal end and treatment at target tissue, the assembly including: 
 i) a tubular member that slidably encompasses the sleeve member,  
 ii) a working tube defining a working channel that attaches to the tubular member wherein the working means is configurabaly disposed therein and egressable at the assembly's distal end, and  
 iii) an inelastic and transparent distal tip member that encloses the tubular member's distal end wherein the working tube's distal end attaches to the tip member thereby enabling visualization of the working channel's distal end,  
   whereby the introducer and viewing assembly stabilizes the apparatus' distal end and reduces active muscular tissue movement during the procedure.    
     
     
         2 . The apparatus of    claim 1    wherein the visualization scope and sleeve member constitutes a rigid endoscope and the working channel's distal end terminates at the distal tip member.  
     
     
         3 . The apparatus of    claim 1    wherein the visualization scope is a bronchoscope, the sleeve member is a flexible catheter shaft and the introducer and viewing assembly further includes an essentially rigid outer sleeve member attached to a distal portion of the catheter shaft with a handle member at the outer sleeve member's proximal end.  
     
     
         4 . The apparatus of    claim 1    wherein the introducer and viewing assembly's tubular member and transparent distal tip member is a unitary member made of acrylic or polycarbonate material and has substantially uniform wall thickness.  
     
     
         5 . The apparatus of    claim 1    wherein the working means has an actuation means for controlling operation of the working means that is mounted to the body member, the actuation means includes a handle member with an advancement means for translating a distal portion of the working means out from the working channel's terminus at the transparent distal tip member.  
     
     
         6 . The apparatus of    claim 1    wherein the visualization scope's distal end surface is essentially normal to the axial direction of the introducer and viewing assembly's axial direction thereby providing visualization in a forward direction, and the working channel's distal end portion includes at least one bend to direct the working device's distal end at an angle essentially parallel to the introducer and viewing assembly's axial direction.  
     
     
         7 . The apparatus of    claim 1    wherein the visualization scope's distal end surface is essentially normal to the axial direction of the introducer and viewing assembly's axial direction thereby providing visualization in a forward direction, and the working channel's distal end portion includes at least one bend to direct the working device's distal end at an offset angle to the introducer and viewing assembly's axial direction.  
     
     
         8 . The apparatus of    claim 1    wherein the visualization scope's distal end surface is at an offset angle with respect to an axial direction of the introducer and viewing assembly thereby providing visualization in a direction offset to the axial direction of the introducer and viewing assembly, and the working channel's distal end portion includes at least one bend to direct the working device's distal end at an angle essentially parallel to the introducer and viewing assembly's axial direction.  
     
     
         9 . The apparatus of    claim 1    wherein the visualization scope's distal end surface is at an offset angle with respect to an axial direction of the introducer and viewing assembly thereby providing visualization in direction offset to the axial direction of the introducer and viewing assembly, and the working channel's distal end portion includes at least one bend to direct the working device's distal end at an offset angle with respect to the introducer and viewing assembly's axial direction.  
     
     
         10 . The apparatus of    claim 5    wherein the introducer and viewing assembly's distal tip member is a rotatable member with an internal channel that communicates with the working channel, the actuation means further includes means for controlling the orientation of the rotatable member thereby providing variable orientation of the distal end of the internal channel that directs of the working means' distal end.  
     
     
         11 . The apparatus of    claim 3    wherein the body member includes a handle member, the working means includes an actuation means for controlling operation of the working means and is mounted to the handle member, the actuation means includes an advancement means for translating a distal portion of the working means out from the working channel's terminus at the distal tip member.  
     
     
         12 . The apparatus of    claim 11    wherein the handle member is pivotally mounted to the body member through an articulation means for repositioning the distal end of the introducer and viewing assembly's distal tip member.  
     
     
         13 . The apparatus of    claim 1    wherein at the distal end, of the working means, a piercing needle member with an internal lumen allows translation of the working means through the internal lumen.  
     
     
         14 . The apparatus of    claim 11    wherein actuation means further includes a triggering member that interlockingly operates a spring loaded member that attaches to and advances a displacement member that attaches to a piercing needle member, the needle member has an internal lumen at the working channel's distal end.  
     
     
         15 . The apparatus of    claim 14    wherein the piercing needle member's lumen contains an optical fiber element which is a distal portion of the working means that translates independently of the piercing needle member.  
     
     
         16 . The apparatus of    claim 11    wherein the working means is an optical fiber element.  
     
     
         17 . The apparatus of    claim 1    wherein an outer surface of the introducer and viewing assembly's transparent distal tip member's outer surface is convex shaped thereby spreading and stabilizing a surface of target tissue when pressing the introducer and viewing assembly against the target tissue and enhancing viewing thereof.  
     
     
         18 . The apparatus of    claim 2    wherein the endoscope's elongated sleeve member is the endoscope's rigid visualization scope on which the introducer and viewing assembly is slidably disposed, the working means has an actuation means for controlling operation of the working means that is mounted to the body member, the actuation means includes a finger controlled trigger member connected to an advancement means for translating a distal portion of the working means out from the working channel's terminus at the distal tip member.  
     
     
         19 . The apparatus of    claim 18    wherein actuation means further includes a triggering member with a spring loaded interlocking member with the advancement means, the triggering mechanism advances a piercing needle member with an internal lumen at the working channel's distal end.  
     
     
         20 . The apparatus of    claim 19    wherein the piercing needle member's lumen contains an optical fiber which is the working means' distal portion, the fiber translates independently with respect to the piercing needle member.  
     
     
         21 . The apparatus of    claim 18    wherein the working means' distal portion is an optical fiber element.  
     
     
         22 . A surgical procedural apparatus for visualizing and treating tissue in a minimally invasive surgical procedure, the apparatus comprising: 
 working means for effectuating the surgical procedure;    a visualization scope which is an articulating bronchoscope having a body member at the proximal end, an elongated flexible catheter attached to the body member, the catheter having at least two channels wherein one channel provides optical viewing at the apparatus' distal end and a second channel is a working channel for introducing the working means to the apparatus and terminating at the distal end of the catheter;    means for deflecting the distal end portion of the catheter, a proximal end of the means for deflecting is an articulating handle member that is pivotally mounted on the body member, the handle member includes an actuation means for a) controlling operation of the working means and b) translating a distal portion of the working means out from the working channel's terminus;    actuation means includes a triggering member that interlockingly operates a spring loaded member that attaches to and advances a displacement member that attaches to a piercing needle member, the needle member has an internal lumen at the working channel's distal end; and    an essentially rigid introducer member attached and encompassing a portion of the catheter juxtaposed to the distal end portion of the catheter, the introducer member's length is sufficient to effectuate penetration by a distal end of the working means at target tissue undergoing the procedure thereby stabilizing the distal end of the working means, the introducer member includes a handle member at a proximal end thereof for the introducer member's placement within a patient, and the deflecting distal end portion of the catheter includes a flexible cup member to provide a working space for unobstructed visualization and treatment of target tissue.    
     
     
         23 . The apparatus of    claim 22    wherein the piercing needle member's lumen contains an optical fiber element which is a distal portion of the working means, the optical fiber element translates independently with respect to the piercing needle member by the advancement means.  
     
     
         24 . A surgical procedural apparatus for visualizing and treating tissue in a minimally invasive surgical procedure, the apparatus comprising: 
 working means for effectuating the surgical procedure;    a visualization scope which is an articulating bronchoscope having a body member at the proximal end, an elongated flexible catheter attached to the body member, the catheter having at least two channels wherein one channel provides optical viewing at the apparatus' distal end and a second channel is a working channel for introducing the working means to the apparatus and terminating at the distal end of the catheter;    means for deflecting the distal end portion of the catheter, a proximal end of the means for deflecting is an articulating handle member that is pivotally mounted on the body member, the handle member includes an actuation means for a) controlling operation of the working means and b) translating a distal portion of the working means out from the working channel's terminus;    actuation means for advancing the working means; and    an essentially rigid introducer member that slidably encompasses a portion of the catheter juxtaposed to the distal end portion of the catheter, the introducer member's length is sufficient to effectuate penetration by a distal end of the working means at target tissue undergoing the procedure thereby stabilizing the distal end of the working means,    the introducer member includes a twist-lock coupling handle member at a proximal end of the introducer member that lockingly attaches to a gripping member permanently attached to the catheter and the deflecting distal end portion of the catheter attaches to a flexible tube with cup member that provides a working space for unobstructed visualization and treatment of target tissue, whereby the introducer member encompasses the flexible tube with cup member advanced thereover thereby providing ease of placement within a patient's chest.    
     
     
         25 . The apparatus of    claim 24    wherein the actuation means includes a triggering member that interlockingly operates a spring loaded member that attaches to and advances a displacement member that attaches to a piercing needle member, the needle member has an internal lumen at the working channel's distal end.  
     
     
         26 . A surgical procedural apparatus for visualizing and treating tissue in a minimally invasive surgical procedure, the apparatus comprising: 
 a) working means for effectuating the surgical procedure;    b) a visualization endoscope having a body member at the proximal end, an elongated rigid sleeve member attached to the body member, the sleeve member having an optical viewing channel for viewing at the apparatus' distal end; and    c) a rigid introducer and viewing assembly having a length sufficient to effectuate both penetration by the working means' distal end and treatment at target tissue, the assembly including: 
 I) a tubular member that slidably encompasses the sleeve member,  
 ii) a working tube defining a working channel that attaches to the tubular member wherein the working means is configurabaly disposed therein and egressable at the assembly's distal end, and  
 iii) an inelastic and transparent distal tip member that encloses the tubular member's distal end wherein the working tube's distal end attaches to the tip member thereby enabling visualization of the working channel's distal end,  
   whereby the introducer and viewing assembly stabilizes the apparatus' distal end and reduces active muscular tissue movement during the procedure.    
     
     
         27 . The apparatus of    claim 26    wherein the body member includes a pistol-type gripping handle, the working means includes an actuation means for controlling operation of the working means that is mounted to the handle, the actuation means includes an advancement means for translating a distal portion of the working means out from the working channel's terminus through the transparent distal tip member.  
     
     
         28 . The apparatus of    claim 27    wherein the advancement means includes a slider member that attaches to the working means and the slider member is translates linearly and located on the handle's outer housing.  
     
     
         29 . The apparatus of    claim 27    wherein the advancement means includes a finger trigger member that operatively attaches to the working means and the trigger member is spring-biased for resetting.