Methods and appartus for delivering a medical instrument over an endoscope while the endoscope is in a body lumen

Abstract

Methods and apparatus for delivering a medical instrument over the exterior of an endoscope while the endoscope is installed in the patient's body allow the use of instruments which are too large to fit through the lumena of an endoscope. Furthermore, the invention allows the elimination of working lumena in an endoscope thereby minimizing the likelihood of contamination.

1 . An apparatus for delivering a medical instrument over an endoscope to a procedural site while the endoscope is in a body lumen, said apparatus comprising: 
 a) a collar dimensioned to fit over the endoscope and having a radial opening such that said collar may be fit over the endoscope radially;    b) a medical instrument coupled to said collar; and    c) actuation means coupled to said medical instrument for remotely operating said medical instrument.    
     
     
         2 . An apparatus according to  claim 1 , wherein: 
 said medical instrument includes a pair of opposed jaws,    said actuation means includes a flexible coil and a pull wire coupled to said jaws and a manually operable actuator coupled to said coil and pull wire.    
     
     
         3 . An apparatus according to  claim 2 , wherein: 
 said jaws have a locking cam such that they can be locked in the closed position, and    said jaws are separable from said coil and pull wire.    
     
     
         4 . An apparatus according to  claim 1 , wherein: 
 said collar includes a plurality of spaced apart resilient straps.    
     
     
         5 . An apparatus according to  claim 1 , wherein: 
 said collar is a flexible sheath and said radial opening is a reclosable seam.    
     
     
         6 . An apparatus according to  claim 5 , wherein: 
 said reclosable seam is selected from the group consisting of a zipper, a ZIPLOC™, VELCRO™, an adhesive tape, snaps, and buttons.    
     
     
         7 . An apparatus according to  claim 1 , wherein: 
 said collar is a bifurcated cylinder having a live hinge and a locking clip.    
     
     
         8 . An apparatus according to  claim 7 , wherein: 
 said collar has an interior low friction surface.    
     
     
         9 . An apparatus according to  claim 8 , wherein: 
 said low friction surface is a slippery coating.    
     
     
         10 . An apparatus according to  claim 8 , wherein: 
 said low friction surface includes a plurality of cilia.    
     
     
         11 . An apparatus for delivering a medical instrument over an endoscope to a procedural site while the endoscope is in a body lumen, said apparatus comprising: 
 a) a flexible structure having a length substantially equal to the length of the endoscope and having a radial discontinuity along substantially all of its length; and    b) a tangential sheath extending along substantially the entire length of said flexible structure and defining a lumen through said tangential sheath.    
     
     
         12 . An apparatus for delivering a medical instrument over an endoscope to a procedural site while the endoscope is in a body, said apparatus comprising: 
 a) a surface track extending along substantially the entire length of the endoscope; and    b) a medical instrument having a track engaging member which is slidable along substantially the entire length of said track.    
     
     
         13 . An apparatus according to  claim 12 , wherein: 
 said surface track is substantially inverted T shaped.    
     
     
         14 . An apparatus according to  claim 12 , wherein: 
 said surface track is defined either by the endoscope or by an overscope extending over the endoscope.    
     
     
         15 . A method for delivering a medical instrument over an endoscope to a procedural site while the endoscope is in a body lumen; said method comprising: 
 a) attaching a medical instrument to a collar dimensioned to fit over the endoscope and having a radial opening such that said collar may be fit over the endoscope radially;    b) attaching the collar to the endoscope by moving it radially over the endoscope; and    c) advancing the collar with the medical instrument along the surface of the endoscope to the procedural site.    
     
     
         16 . A method according to  claim 15 , wherein the medical instrument includes a pair of opposed jaws, said method further comprising: 
 d) opening and/or closing the jaws at the procedural site.    
     
     
         17 . A method according to  claim 16 , wherein the endoscope has a working lumen, said method further comprising: 
 e) closing the jaws onto a tissue;    f) delivering a treating instrument through the working lumen of the endoscope to the tissue; and    g) treating the tissue with the treating instrument while the tissue is grasped by the jaws of the medical instrument.    
     
     
         18 . A method according to  claim 16 , further comprising: 
 e) closing the jaws onto a tissue;    f) locking the jaws closed; and    g) detaching the jaws from the medical instrument.    
     
     
         19 . A method according to  claim 15 , wherein: 
 said collar includes a plurality of spaced apart resilient straps, and    said step of attaching the collar to the endoscope includes placing the collar with its straps open adjacent the endoscope and closing the straps over the endoscope.    
     
     
         20 . A method according to  claim 15 , wherein: 
 said collar is a flexible sheath,    said radial opening is a reclosable seam, and    said step of attaching the collar to the endoscope includes placing the endoscope into the open seam and closing the reclosable seam.    
     
     
         21 . A method according to  claim 15 , wherein: 
 said collar is a bifurcated cylinder having a living hinge and a locking clip, and    said step of attaching the collar to the endoscope includes closing the cylinder over the endoscope and locking it with the locking clip.    
     
     
         22 . A method for delivering a medical instrument over an endoscope to a procedural site while the endoscope is in a body, said method comprising: 
 a) attaching a flexible structure having a length substantially equal to the length of the endoscope to the endoscope via a radial discontinuity along substantially all of the length of the extrusion; and    b) delivering a medical instrument to a procedural site via a tangential sheath extending along substantially the entire length of the flexible structure.    
     
     
         23 . A method for delivering a medical instrument over an endoscope to a procedural site while the endoscope is in a body, said method comprising: 
 a) attaching a medical instrument having a track engaging member to a surface track extending along substantially the entire length of the endoscope; and    b) advancing the medical instrument along the track to the surgical site.