CN1684625A - 钢筋束驱动的内窥镜以及插入方法 - Google Patents

钢筋束驱动的内窥镜以及插入方法 Download PDF

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CN1684625A
CN1684625A CNA03823467XA CN03823467A CN1684625A CN 1684625 A CN1684625 A CN 1684625A CN A03823467X A CNA03823467X A CN A03823467XA CN 03823467 A CN03823467 A CN 03823467A CN 1684625 A CN1684625 A CN 1684625A
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tendon
endoscope
slender body
tensile part
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R·M·奥莱恩
J·M·塔尔塔利亚
A·贝尔森
A·T·罗斯
W·A·凯勒
S·C·安德森
C·A·朱利安
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Neoguide Systems Inc
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    • A61B1/00112—Connection or coupling means
    • A61B1/00121—Connectors, fasteners and adapters, e.g. on the endoscope handle
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Abstract

本文公开了一种可操纵的钢筋束驱动内窥镜。该内窥镜有细长本体，该细长本体有可人工或选择操纵远侧部分以及自动控制的分段的近侧部分。可操纵远侧部分和可控制部分的段由至少两个钢筋束来驱动。当内窥镜前进时，用户操纵远侧部分，且动作控制器驱动在分段的近侧部分中的钢筋束，以便，近侧部分采取可选择操纵远侧部分的选定曲线。通过该方法，选定曲线沿内窥镜本体传播，以便内窥镜大致与选定通路相符。当内窥镜向近侧退回时，选定曲线可以沿内窥镜本体向远侧传播。这使得内窥镜沿在身体内的器官周围和之间的所希望的通路而通过曲折曲线。

Description

钢筋束驱动的内窥镜以及插入方法
相关申请的交叉引用
本申请是美国专利申请No.09/790204(标题为“SteerableEndoscope and Improved Method of Insertion”，申请日为2001年2月20日)的部分延续，该美国专利申请No.09/790204要求美国临时专利申请No.60/194140(标题相同，申请日为2000年4月3日)的优先权，这些文献都整个被本文参引。
技术领域
本发明通常涉及内窥镜和内窥镜检查法。尤其是，本发明涉及一种便于将柔性内窥镜沿曲折通道插入的方法和装置，例如用于结肠镜检查和治疗。
背景技术
内窥镜是一种用于观察病人身体内部的医疗仪器。内窥镜可以用于各种不同诊断和插入检查法，包括结肠镜检查、支气管镜检查、胸腔镜检查、腹腔镜检查和视频内窥镜检查。
结肠镜检查是一种医疗方法，其中，柔性内窥镜或结肠镜插入病人结肠内，用于结肠的诊断检查和/或手术治疗。标准的结肠镜通常长度为135-185cm，直径为12-19mm，并包括位于仪器顶端的光纤成像集束或微型摄像机、照明光纤、一个或两个仪器槽道(该槽道也可以用于吹入或冲洗)、空气和水槽道、以及真空槽道。结肠镜通过病人的肛门插入，并通过结肠前进，从而能够直接视觉检查结肠、回盲肠瓣和回肠末端部分。
结肠镜的插入很复杂，因为结肠具有曲折和盘旋的通路。通常需要非常注意地操作结肠镜，以便使结肠镜通过结肠前进，从而使得治疗更困难和费时间，并增加了发生并发症的可能性，例如肠穿孔。可操纵的结肠镜必须设计成便于选择通过结肠曲线的正确通路。不过，当结肠镜插入结肠内越来越远时，使结肠镜沿选定通路前进将变得更困难。在每个转弯处，结肠壁都必须使结肠镜保持弯曲。结肠镜沿每个转弯处的外侧与结肠的粘膜表面摩擦。结肠镜中的摩擦和松弛在每个转弯处积累，从而使结肠镜越来越难以前进和退回，并可能导致结肠镜形成环圈。此外，抵靠结肠壁的力随着摩擦力的积累而增加。当极其曲折时，将不可能使结肠镜全程通过结肠前进。
在下面的美国专利中介绍了用于体内结构的医疗检查或治疗的可操纵内窥镜、导管和插入装置，这些专利文献整个被本文参引：4054128、4543090、4753223、4873965、5174277、5337732、5383852、5487757、5624380和5662587。
发明内容
下面介绍用于检查病人结肠、其它内部体腔或其它内部身体空间的可操纵内窥镜，该内窥镜对这些器官壁的冲击最小。本文中所述的可操纵内窥镜的一种变化形式有分段的细长本体，该细长本体有可人工或选择操纵远侧部分(至少一段)和自动控制近侧部分。通过从钢筋束(tendon)(例如索缆、金属丝等)的近端控制该钢筋束的拉力，可以沿任意方向弯曲该可选择操纵远侧部分；经过内窥镜的整个长度选择地确定这些钢筋束的路线。内窥镜的可控制近侧部分包括至少一个可独立铰接活动的段，该段也能够通过钢筋束而沿任意方向弯曲，当内窥镜向远侧前进时，该可控制近侧部分能够采取远侧段的形状。
可以沿任意方向选择地操纵(或弯曲)该可选择操纵远侧部分直到例如完全180度。光纤成像集束和一个或多个照明光纤可以通过本体从近侧部分向远侧部分延伸。优选是，照明光纤与光源(即普通光源，它可以位于某些外部位置)或者其它源(例如LED)连通。也可选择，内窥镜可以设置为具有微型摄影机(例如CCD摄像机)的视频内窥镜，该微型摄影机位于内窥镜本体的远侧部分。摄影机可以用于与照明光纤组合。也可选择，内窥镜本体也可以包括一个或两个进入管腔，该管腔可以用于例如吹入或冲洗、空气和水槽道以及真空槽道等。通常，内窥镜的本体非常柔软，这样，它能够在不弯折或扭折的情况下绕较小直径曲线弯曲，同时使各槽道保持完整无损。内窥镜可以制成为用于其它医疗和工业用途的各种尺寸和结构。
在操作中，内窥镜的可操纵远侧部分可以首先通过肛门进入病人的直肠内。内窥镜可以人工或通过马达自动地简单前进，直到到达第一弯曲处。在该点，用户(例如内科医生或外科医生)能够主动控制可操纵远侧部分，以便获得用于使内窥镜前进的最佳曲线或形状。最佳曲线或形状是与结肠壁的接触或干涉量最小的通路。在一个变化形式中，一旦确定了想要的曲线，内窥镜可以进一步前进到结肠内，这样，可控制部分的自动控制段随着远侧部分而运动，同时使得最佳曲线或形状沿可控制部分的其余段向近侧传递。因此，当器械前进时，它沿着远侧部分确定的通路行进。可控制段的操作将在后面进一步详细介绍。
钢筋束(也称为拉伸部件)可以用于使内窥镜的可控制段(包括可操纵远侧部分)进行铰接活动。合适的钢筋束实例是推拉索缆，它有柔韧性，但是可压缩性和可伸长性最小。在一个变化形式中，该钢筋束是Bowden索缆，其中，内部索缆通常由壳体或套筒同轴包围，且索缆能够通过该壳体或套筒自由运动。Bowden索缆可以用于施加拉力或压力，以便使内窥镜铰接活动，并能够被遥控驱动，以便根据需要在内窥镜的位置上传递力。
在使用Bowden推拉索缆作为钢筋束的一个变化形式中，三个钢筋束可以安装在环绕可控制内窥镜段的周边的等间隔位置处。另一变化形式也可选择使用两个钢筋束，如后面进一步介绍。Bowden索缆的套筒可以固定在段的近端，而内部索缆可以安装在相同段的远端上。向这些内部索缆中的一个施加拉力或压力将使得段沿推动或拉动索缆的方向弯曲。弯曲是连续的，并与索缆的位移成比例。因此，通过在安装于段的远端上的一个钢筋束或钢筋束组合上施加拉力或压力，段实际上可以利用钢筋束而沿任意方向弯曲。使用Bowden索缆的本发明其它变化形式可以使用四个或更多Bowden索缆，这些Bowden索缆环绕段的周边等间距布置，或者处于特定位置，该段根据所希望的铰接活动弯曲。另一变化形式甚至可以使用两个Bowden索缆与偏压元件(例如弹簧、弹性元件、活塞等)组合来铰接该段。
钢筋束的另一变化形式使用受压(而不是受拉)的不可压缩、不可伸展的推拉索缆来使得段弯曲。也可选择，可以使用处于压力和拉力下的钢筋束组合。
内窥镜的可控制近侧部分包括至少一段，优选是多段，它们能够通过远离内窥镜的控制器和/或计算机而彼此相对铰接活动。在一个变化形式中，内窥镜的大部分可插入长度包括可控制段。优选是，段不可压缩和不可伸展，因此当弯曲时沿它们的中心线保持恒定长度。表示该变化形式的实例可以参见标题为“Steerable Endoscope andImproved Method of Insertion”的美国专利申请09/790204，该美国专利申请09/790204为共同拥有，并整个被本文参引。各段可以有钢筋束，以便能够控制该段在空间中的运动。因此，调整各钢筋束的铰接活动能够使得各段在较大动作范围内进行弯曲。各钢筋束例如可以由机电马达驱动，该机电马达可操作地与钢筋束的近端连接。也可选择，气动或液压缸、气动或液压马达、螺线管、形状记忆合金丝或者电子旋转促动器可以用于驱动使用钢筋束的段。
内窥镜的另一变化形式使用环形支承件(或者脊椎件)作为控制环，以便获得可弯曲的段。段包括多个相邻相邻或堆叠的脊椎件，其中，这些脊椎件通过连接部分(例如铰接接头)而彼此连接，从而使得段具有沿任意方向的柔韧性。因此，脊椎式控制环可以通过具有通孔的凸缘而铰接在相邻脊椎件上。在一种变化形式中，铰接接头对从各脊椎件的面上垂直凸出，并能够与在近侧和远侧的相邻脊椎件的铰接接头进行连接。每对铰接接头使得能够沿一个轴线进行有限制的运动。从脊椎件的相对面凸出的铰接接头优选是位于从脊椎件的另一面上的铰接接头对旋转90度的位置。这产生了处在与第一轴线垂直的平面中的第二运动轴线。这样添加附加的脊椎件将导致段能够沿任意方向弯曲。例如，大约10个脊椎件能够进行连接，以便产生一个这样的段。其它变化形式可以是每个段有更多或更少的脊椎件。
除了铰接接头，在控制环中还包括其它特征。因此，脊椎件的内表面可以有槽道，该槽道在内窥镜中形成公共管腔，例如用于加工槽道、空气和水槽道、光纤槽道、钢筋束等。脊椎件也可以包括用于钢筋束的安装位置，该钢筋束包括Bowden索缆实施例的套筒和内部索缆。而且，控制环的外边缘可以包括用于保持控制更远侧段的钢筋束的槽道。这些槽道提供了布置和组织这些钢筋束的方法。例如，在另一变化形式中，当钢筋束朝着控制器向近侧伸出时，控制更远侧段的钢筋束螺旋缠绕在更近侧段的外表面上。该螺旋缠绕可以防止当近侧段弯曲时在控制更远侧段的钢筋束上产生意外的拉力。也可选择，钢筋束可以包括过多的“松弛”。该过多松弛也将防止近侧段受到控制更远侧段的旁路绕过钢筋束的约束。
控制环的另一变化形式省略了铰接脊椎件，而是依赖于在整个内窥镜上的柔性主链(backbone)，控制环(也称为支承环)间隔地安装在该柔性主链上。在使用Bowden索缆的一个变化形式中，钢筋束内部索缆安装在段中的最远侧控制环上，而钢筋束套筒安装在最近侧控制环处。控制环可以有允许部件通过该段的空间，且与脊椎式控制环的所述大部分特征相同。
近侧手柄可以安装在内窥镜的近端上，并可以包括与光纤成像集束连接的成像装置，用于直接观察和/或用于与摄影机或记录装置连接。手柄可以与其它装置连接，例如照明光源以及一个或多个luer锁配件(用于连接各种器械槽道)。手柄也可以与用于控制可操纵远侧部分的操纵控制机构连接。手柄可以选择有直接集成在该手柄中的操纵控制器，例如成操纵杆、使用盘或轮的普通盘控制器等形式。
当内窥镜轴向前进或退回时，深度测定装置或轴向传感器可以用于测量内窥镜的当前相对深度(轴向位置)。该轴向运动传感器可以制成多种可能结构，例如通过与内窥镜接触、向内窥镜发出信号或进行连通而工作的装置。例如，当内窥镜本体滑动通过传感器时，它产生表示内窥镜本体相对于固定参考点的轴向位置的信号。该测量值等于内窥镜在体腔内的深度。传感器也可以使用非接触方法(例如光学、电容、电阻、射频或磁测量)来测量内窥镜本体的轴向位置。
内窥镜的另一变化是在它的整个长度上都可以充分地铰接活动。因此，例如当内窥镜为180cm的标准长度时，每段10cm长的总共18段(包括可操纵远端)可以组合以便产生充分铰接活动的可控制内窥镜。在可选变化形式中，靠近自动控制近侧区域的被动区域可以由柔性管路构件制成，它能够适合形状的无限变化。
在该变化形式中，整个组件(即段、钢筋束等)可以包围在可生物相容材料(例如聚合物)的鞘或盖中，该鞘或盖优选是还进行润滑，以便在内窥镜插入病人体内和前进时的摩擦阻力最小。因为内窥镜用于医疗，因此希望该盖可拆卸、更换和/或消毒。
同样，所希望的是内窥镜容易从控制器上拆卸。从内窥镜的段向近侧伸出的钢筋束可集中在脐点(umbilicus)中，该脐点有界面，该界面与包含向钢筋束施加力的促动器(例如马达)的控制器单元连接。该界面可以是在钢筋束和控制器之间的快速拆开机构。快速拆开机构的一种变化形式是“钉头”，该钉头位于狭槽结构中，各钢筋束索缆的端头在该狭槽结构中构成例如扁平凸起。在脐点端部的该钢筋束阵列与控制器上的界面匹配。扁平钢筋束端部可以装配至确定于控制器壳体中的相应狭槽中。该相应配合使得钢筋束端部能够可拆卸地固定在它们的相应狭槽内，从而使得促动器能够向特定钢筋束施加力。而且，控制器可以根据由段的控制钢筋束施加的拉力来确定该段的形状。控制器还可以用于根据索缆相对于索缆壳体的位置来确定段的形态。而且，控制器还用于检测控制钢筋束的旋转或线性运动量，并能够根据该数据来确定段的形态。
本发明考虑了多种可选的快速拆开机构。另一种变化形式为具有插针的匹配连接器，该插针与凹形接收器连接；插针相对于接收器的运动转变成钢筋束的运动(例如利用杠杆、齿轮或齿条、或者螺纹连接器)。
普通内窥镜的直径小于20mm，不过，不同工业用途可以使用直径大于20mm的内窥镜。同样，本发明的一种变化形式也有小于20mm的径向尺寸。在本发明的另一变化形式中，更远侧段的半径以套叠状形式减小。这使得可操纵远侧部分具有比更近侧段小得多的半径，例如12.5mm。在该变化形式中，更近侧段的更大半径提供了用于远侧段的钢筋束的增大的空间。
本发明的另一可选变化形式通过使段有着不同长度而使用更少的段。因此，更远侧位置的段可以制成为更短，例如，最远侧段的长度可以为6cm，而更近侧位置的段逐渐加长，例如直到最近侧段的长度为20cm。该变化形式改变了通过内窥镜前进而传播选定曲线的方法，从而当该曲线传播时形成“平均”或平滑的曲线。在该变化形式中，专门算法能够用于协调不同尺寸的段的自动操作。
沿内窥镜本体传播可操纵顶端的选定转弯的一个方法包括：当内窥镜在体内前进或从体内退回时，使得内窥镜沿由用户选定的通路运动。该方法开始于通过自然孔或通过切口而将内窥镜的远端插入病人体内，并操纵可选择操纵远侧部分来选定所希望的通路。当内窥镜本体在病人体内进一步前进或插入时，电子控制器记录该动作，并控制内窥镜的近侧部分，以便采取当可操纵远侧顶端处于在体内的大致相同位置时由用户选择的曲线。同样，当内窥镜向近侧退回时，选定曲线自动或被动地沿内窥镜本体向远侧传播。
附图说明
图1表示了普通内窥镜在使用时的视图。
图2表示了本发明的钢筋束驱动内窥镜的变化形式。
图3A表示了由三个钢筋束驱动的本发明可控制段的运动范围。
图3B至3F表示了使用三个钢筋束来驱动在本发明的内窥镜中所用的可控制段。
图4A和4B表示了使用两个钢筋束来驱动在本发明的内窥镜中的可控制段。
图4C和4D表示了使用四个钢筋束来驱动在本发明的内窥镜中的可控制段。
图5表示了使一段弯曲的单个钢筋束的局部示意图。
图6A和6B分别表示了脊椎式控制环的端视图和侧视图，该控制环可以用于形成本发明的内窥镜的可控制段。
图6C表示了用于形成本发明的内窥镜的可控制段的、相互连接的脊椎式控制环的侧视图。
图6D和6E分别表示了脊椎式控制环的另一实施例的侧视图和透视图。
图7A表示了内窥镜装置的变化形式的透视图，其中，除去外层以便露出控制环和主链。
图7B表示了用于本发明的内窥镜的控制环的变化形式的端视图。
图8A至8C表示了本发明的钢筋束驱动内窥镜通过曲折通路前进。
图9表示了本发明的钢筋束驱动内窥镜的变化形式，它有不同直径的段。
图10表示了本发明的钢筋束驱动内窥镜的变化形式，它有不同长度的段。
图11A表示了用于将钢筋束驱动内窥镜安装在促动器上和从该促动器上拆卸的快速释放机构的变化形式，该促动器通过销来驱动钢筋束。
图11B表示了用于将钢筋束驱动内窥镜安装在促动器上和从该促动器上拆卸的快速释放机构的第二变化形式，该促动器通过钉头结构来驱动钢筋束。
图12A至12E表示了使用本发明的钢筋束驱动内窥镜而使得内窥镜通过病人的结肠前进的示例实例。
图12F表示了在使本发明的钢筋束驱动内窥镜退回时的变化。
图13表示了用于在检查过程中使得内窥镜装置初始化或重新初始化的流程图。
具体实施方式
图1表示了现有技术的结肠镜10，该结肠镜10用于病人结肠C的结肠镜检查。结肠镜10有近侧手柄16以及具有可操纵远侧部分14的细长本体12。润滑结肠镜10的本体12，并通过病人的肛门A将其插入结肠C内。利用可操纵远侧部分14进行引导，操纵结肠镜10的本体12通过病人结肠C中的多个弯角到达升结肠G。通常，这包括通过从近端进行推动、拉动和旋转结肠镜10的大量操纵，以便使它前进通过结肠C的弯角。在可操纵远侧部分14通过之后，结肠C的壁使得结肠镜10的柔性本体12在前进时保持弯曲。当结肠镜10插入时，沿结肠10的本体12形成摩擦，特别是在结肠C的各弯角处。因为该摩擦，当用户试图使结肠镜10前进时，本体12′将在各弯曲处向外运动，从而推靠结肠C的壁，这由于增加摩擦和使得结肠镜10更难前进而加剧了该问题。另一方面，当结肠镜10退回时，本体12″将在各弯曲处向内运动，从而拉紧在结肠镜10前进时形成的松弛。当病人的结肠C特别曲折时，本体12的远端不能响应用户的操纵，最终将使得结肠镜10不能再前进。除了用户所具有的困难，病人结肠的曲折也增加了并发症的危险，例如肠穿孔。
图2表示了本发明的钢筋束驱动内窥镜20的变化形式。内窥镜20有细长本体21，该细长本体21有可人工或选择操纵的远侧部分24、自动控制部分28以及柔性和被动操纵的近侧部分22(该近侧部分22可以选择从装置中省略)。可操纵远侧部分24可以用手进行铰接活动，或者由促动器通过机械辅助而进行铰接活动。自动控制部分28分段，各段能够通过全范围的可操纵动作而弯曲，远侧部分24也是可控制段。
可选择操纵远侧部分24可以选择地操纵或弯曲，最大例如沿任何方向26弯曲180°，如图所示。光纤成像集束40以及一个或多个照明光纤42可以穿过本体21从近侧部分22伸向远侧部分24。也可选择，内窥镜20可以设置为视频内窥镜，具有位于内窥镜本体21的远端24处的微型摄影机，例如CCD或CMOS摄像机。由摄影机产生的图像可以通过传输电缆或通过无线传输而传递给视频监视器，在该视频监视器处，图像可以实时观察，以及或者通过记录装置而记录在模拟记录介质(例如磁带)或数字记录介质(例如光盘、数字磁带等)上。LED或其它光源也可以用于在内窥镜的远侧顶端照明。
内窥镜20的本体21也可以包括一个或多个进入管腔38，该进入管腔可以选择用于提供光源的照明光纤、吹入或冲洗、空气和水槽道、真空槽道。通常，内窥镜20的本体21非常柔软，这样，它能够在不弯折或扭结的情况下绕很小直径的曲线而弯曲，同时保持各个槽道的完整无损。当设置成用作结肠镜时，通常内窥镜20的本体21的长度可以为135至185cm，直径为大约13-19mm。内窥镜20可以制成为各种其它尺寸和结构，用于其它医疗和工业用途。
可控制部分28包括至少一段30，优选是几段30，它们可通过离内窥镜20一定距离处的计算机和/或电子控制器(控制器)45来控制。各段30有与促动器机械连接的钢筋束，以便能够使得段30在空间中进行受控的运动。驱动钢筋束的促动器可以包括能够向钢筋束施加力的各种不同机构，例如机电马达、气动和液压缸、气动和液压马达、螺线管、形状记忆合金丝、电子旋转促动器、或者本领域已知的其它装置或方法。当使用形状记忆合金丝时，优选是它们设置成安装在控制器内的各钢筋束近端的多个合金丝束。段的铰接活动可以这样实现，即通过向各合金丝束施加能量(例如电流、热等)，以便驱动合金丝束线性运动，该合金丝束再驱动钢筋束运动。促动器在控制器内的线性平移可以设置成运动经过相对较短的距离，例如在几英寸内或者更小(例如±1英寸)，以便根据段运动和铰接活动要求的程度而实现有效铰接活动。
优选是，内窥镜的可插入部分的长度包括可控制段30，不过也可以使用被动近侧部分22。优选是，该近侧部分22是柔性管部件，它可以适合形状的无限变化，并可以由各种材料制成，例如热固性和热塑性聚合物，它们用于制造普通内窥镜的管。
优选是，各段30确定了贯穿延伸的至少一个管腔，以便提供进入槽道，丝线、光纤、空气和/或水槽道、各种内窥镜工具、或者各种装置和线可以穿过该进入槽道确定路线。聚合物盖或鞘39也可以在包括可控制部分28和可操纵远侧部分24的内窥镜21本体上面延伸。优选是，该鞘39提供了在可控制段30、可操纵远侧部分24以及近侧部分22的柔性管之间的光滑过渡。
手柄32可以安装在内窥镜的近端。手柄32可以包括与光纤成像集束42连接的目镜，该目镜用于直接观察。手柄32另外可以有连接器54，用于与视频监视器、摄像机(例如CCD或CMOS摄像机)或记录装置52连接。手柄32可以通过照明电缆44而与照明光源43连接，该照明电缆44与照明光纤42连接或连续。也可选择，一些或全部这些连接可以制成在控制器45处。Luer锁配件34可以位于手柄32上，并与各仪器槽道连接。
手柄32可以通过控制器索缆46而与动作控制器45连接。操纵控制器47可以通过第二电缆48而与动作控制器45连接，或者可以选择直接与手柄32连接。也可选择，手柄可以有直接集成在该手柄内的操纵控制机构，例如为操纵杆、普通盘式控制器(例如转盘、滑轮或齿轮)等的形式。操纵控制器47使得用户能够选择地沿想要的方向26转向或弯曲本体21的可选择操纵远侧部分24。操纵控制器47可以是图示操纵杆控制器，或者其它操纵控制机构，例如如普通内窥镜中的双转盘或旋钮、跟踪球、接触垫、鼠标或感觉手套。动作控制器45控制本体21的分段的自动控制近侧部分28。该控制器45可以使用在微计算机上运行的动作控制程序，或者使用专用动作控制器来实现。也可选择，控制器45可以使用例如神经网络控制器来实现。
向钢筋束施加力的促动器可以包含在动作控制器单元45中(如图所示)，或者可以分开布置和通过控制电缆连接。控制可操纵的远侧部分24和可控制段30的钢筋束沿内窥镜本体21的长度向下延伸，并与促动器连接。图2表示了钢筋束经过手柄32并通过快速释放连接器60而与动作控制器45直接连接的变化形式。在该变化形式中，钢筋束是控制索缆46的一部分，不过，它们也可以独立地与促动器连接，只要促动器与控制器45连通。
可以提供轴向动作传感器(也称为深度测定装置或基准(datum))49，用于测量内窥镜本体21在前进和退回时的轴向动作，即深度变化。深度测定装置49可以制成为多种可能结构。例如，图2中的轴向动作传感器49设置为可以环绕内窥镜20本体21的环49。优选是，轴向动作传感器49安装在固定参考点上，例如外科手术台或内窥镜20在病人体上的插入点。当内窥镜20的本体21滑动通过轴向动作传感器49时，它指示内窥镜本体21相对于固定参考点的轴向位置，并通过遥测装置或电缆而将信号发送给电子控制器45。轴向动作传感器49可以使用光学、电子、磁、射频或机械方法来测量内窥镜本体21的轴向位置。
当内窥镜本体21前进或退回时，轴向动作传感器49检测位置变化，并向动作控制器45发送信号。控制器可以利用该信息来沿内窥镜本体21的可控制部分28向近侧或向远侧传播选定的曲线，以便使得内窥镜主动遵循通过用户操纵远侧部分24而选定的通路。轴向动作传感器49也使得能够根据测量深度变化而增大在结肠C内的当前深度。这使得能够引导内窥镜本体21通过曲折的曲线，同时不会在结肠C的壁上施加不必要的力。
对段的变化形式的结构和操作的更详细说明可以参考美国专利申请No.09/969927(标题为“Steerable Segmented Endoscope and Methodof Insertion”，申请日为2001年10月2日)，该文献整个被本文参引。
图3A表示了所形成的段铰接的实例，该段铰接可以通过使用两个或三个钢筋束来使得可控制段(包括可操纵远侧部分)进行铰接活动。图3A表示了通过三个钢筋束(在本例中)驱动的本发明的可控制段的可能的动作范围的一个实例。处于松弛、竖直位置的段301实际上可以相对于x-y平面以任意方向弯曲。作为图示示例，图中表示了段302向下弯曲且相对于它的初始位置301成一定角度。角度α和β表示了段的弯曲。角度β给出了在x-y平面中的角度，而α是描述在x-z平面中的动作的角度。在一个变化形式中，内窥镜的可控制段能够在β角度弯曲通过整个360度，并能够在α角度弯曲至90度。大于90度的角α将导致内窥镜形成环圈。在图3A中，段表示为沿角度α弯曲大约45度。段的运动自由度部分地由铰接方法、段尺寸、它的构成材料、以及它的构成方式等来确定。其中的一些因素将在本文中介绍。
可操纵远侧部分以及内窥镜和可控制段都可弯曲，但优选是不能压缩或伸展。因此，在图3A中，松弛段301的中心线304与在弯曲后的段302的中心线306长度基本相同。
图3B至3F表示了使用三个钢筋束来驱动用于本发明内窥镜中的可控制段。在本实例中表示的钢筋束都是Bowden类型的索缆310，它有由壳体或套筒314同轴包围的内部索缆312，该索缆可在该壳体或套筒314内自由运动。Bowden索缆可以用于施加拉力或压缩力，即它们可以进行推动或拉动，以便使内窥镜进行铰接活动，并可以遥控驱动，以便根据需要在沿内窥镜的位置传递力。通过将钢筋束索缆安装在段322的远端和将钢筋束壳体314安装在段322的近端，来自钢筋束的力可以施加穿过或通过该段。图3B表示了段的顶部的视图，该顶部有用于钢筋束索缆的三个安装位置(以320表示)。
在一个变化形式中，三个钢筋束用于驱动各段(包括可操纵远端部分)，不过也可以使用四个或更多钢筋束。三个钢筋束能够可靠地使得段沿任意方向铰接活动，同时不需要使段或内窥镜绕它自身的纵向轴线旋转。优选是，三个钢筋束索缆312安装在段320的远端并靠近段的边缘，且等间距间隔开。在图3B中，钢筋束安装在两点钟、六点钟和10点钟的位置。从空间方面考虑，理想的是使用较少钢筋束，因为控制各段的钢筋束向近侧朝着促动器伸出。因此，两个钢筋束可以用于控制一个段。还理想的是包括一个或多个偏压元件例如弹簧，以便帮助段在三维中进行铰接活动。在另一变化形式中，通过控制沿两个方向的动作，同时使段绕它的纵向轴线旋转，两个钢筋束可以用于使得段在三维中进行铰接活动。
图3C表示了具有三个钢筋束的松弛段。松弛套筒314表示为在相应索缆安装位置的正下方安装在段322的近端上。图3D至3F表示了该段分别通过各控制钢筋束310的弯曲。
如图3D所示，通过拉动第一钢筋束330而施加的拉力导致沿第一钢筋束330的方向弯曲。也就是，在未弯曲段(如图3B所示)的顶部向下看时，当第一钢筋束安装在六点钟位置时，仅拉动该钢筋束将导致该段朝着六点钟位置弯曲。同样，在图3E中，只在安装于两点钟位置处的第二钢筋束332上施加拉力将导致该段朝着两点钟位置弯曲。最后，拉动十点钟位置处的钢筋束334将使得该段朝着十点钟位置弯曲。在任何情况下，该弯曲是连续的；且施加的拉力越大，弯曲程度越大(α角度，在图3A的x-z平面)。通过拉动单个钢筋束或者两个钢筋束的组合，段可以沿任意方向弯曲。因此，为了使得段沿十二点钟方向弯曲，可以用相等的力拉动第二钢筋束332和第三钢筋束334。也可选择，可以单独推动处于六点钟位置的第一钢筋束330或者组合拉动第二钢筋束332和第三钢筋束334，都可以形成相同的结构。
图4A和4B表示了段通过两个钢筋束和一个偏压元件铰接时的变化形式。图4A表示了段的俯视平面图。用于偏压元件340和两个钢筋束320的安装位置环绕段的远端周边间隔开，如图所示。在段的顶部向下看时，钢筋束320可以安装在两点钟和十点钟位置，而偏压元件340安装在六点钟位置。图4B表示了处于未弯曲结构的段的透视图。在该变化形式中，偏压元件设置成向段的侧部施加拉力，这样，该段将朝着六点钟位置弯曲。偏压元件可以为能够向该段施加压力或拉力的任何元件，例如弹簧、弹性元件、活塞等。通过从两个钢筋束上施加拉力，段保持在中间或未弯曲位置，如图4B所示。控制由钢筋束施加的拉力大小将导致该段在三维空间中弯曲。多个偏压元件可以与两个或更多钢筋束一起使用。例如，偏压元件可以位于与各钢筋束相对的位置。
也可选择，当钢筋束为推拉索缆，且各钢筋束能够施加压力和拉力时，两个钢筋束可以控制段的运动，而根本不需要任何偏压元件。
超过三个钢筋束也可以用于控制段的弯曲。图4C表示了通过安装在十一点钟、两点钟、五点钟和八点钟位置的四个钢筋束来控制的段的俯视平面图。与三个钢筋束的实施例相同，施加在一个钢筋束或多个钢筋束组合上的拉力导致段的该侧部缩短。因此，当只在安装于远侧十一点钟位置处的钢筋束355上施加拉力时，钢筋束的相应侧将缩短，且该段将沿十一点钟方向弯曲。
在所有这些变化形式中，钢筋束和/或偏压元件的周向位置为示例性，将并不局限于所述实例。而且，如本领域技术人员所知，它们可以根据想要的效果而变化。
图5表示了使段弯曲的单个钢筋束的局部示意图。为了清楚，图5中省略了整个内窥镜的其它部件(包括其它钢筋束和段)。施加在钢筋束索缆上的拉力传递到整个段上，从而形成弯曲。通过使用Bowden索缆310(该Bowden索缆310的套筒314安装在段的底部322上，并固定在近侧促动器端部403上)，只有预定段401将通过向钢筋束312施加拉力而弯曲，而更近侧的段将不受影响。钢筋束通过促动器410而产生拉力，在该变化形式中，该促动器410表示为拉动钢筋束索缆312的马达。
连接控制环可以提供构成可操纵远侧部分和可操纵段所需的柔性结构。图中表示了可以使用的控制环类型的两个实例。第一种如图6A中所示，该图6A表示了脊椎式控制环，该脊椎式控制环形成本发明的可控制段。图6A表示了单个脊椎件(vertebra)的端视图。各环形脊椎件501可以确定中心槽道或孔504或可以一起形成前述装置的内部管腔的多个孔。脊椎件可以有两对铰链：第一对铰链506从脊椎件的第一面上垂直凸出；第二对铰链508的位置为从第一对铰链环绕圆周90度，它在脊椎件的第二面(与第一面相对)上垂直地从脊椎件的该面上凸出。图6A和6B中所示的铰链为凸片形状，不过也可以使用其它形状。
图6A中的脊椎件控制环表示为有穿过脊椎件边缘的三个孔510，例如，当该脊椎件是在段中的最远侧的脊椎件时，这三个孔510可以作为钢筋束索缆312的安装位置，或者这三个孔510可以作为能够驱动段(脊椎件用于该段中)的钢筋束索缆的通道。当该脊椎件是在段中的最近侧的控制盘时，这些孔510也可以用于安装Bowden型钢筋束索缆314的套筒。也可选择，代替孔510，安装位置可以是凹口或其它特定形状。尽管图6A表示了三个孔510，但是孔的数目可以取决于用于控制段(脊椎件属于该段)的钢筋束的数目。因为孔510可以用作钢筋束的安装位置，因此，孔的数目与控制段的钢筋束的数目相同。
图6A中的脊椎件的外边缘可以开扇形凹口，以便提供用于钢筋束的钢筋束壳体的空间512，该钢筋束控制更远侧段并由旁路绕过脊椎件。这些钢筋束的旁路绕过空间优选是与使用的钢筋束的外径相适应。钢筋束的旁路绕过空间512的数目可以根据钢筋束的数目而变化。还有，当希望改变旁路绕过的钢筋束缠绕内窥镜的路线时，可以改变钢筋束的旁路绕过空间的方向。例如，在图6C中，空间512′定向成相对于脊椎件的纵向轴线成一定角度，从而使得钢筋束在向近侧伸出时能够缠绕在内窥镜的本体上。而且，钢筋束的旁路绕过空间将进行润滑或者包括润滑材料，以便于旁路绕过的钢筋束自由运动越过该段，并防止在该段弯曲和旁路绕过的钢筋束之间的干扰。
图6B和6C表示了与图6A相同的脊椎件的侧视图。图中表示了两对铰链接头508、506。铰链接头508、506优选是布置成间隔开90度和轴向延伸，以便铰链接头能够可枢轴转动地与相邻脊椎件的铰链接头配合。与相邻脊椎件的这种配合520在图6C中更清楚表示。这些铰链可以通过孔525而接合、销连接或者进行连接，如522所示。也可选择，铰链也可以由例如热塑性、形状记忆合金等材料制成。一旦铰接，各脊椎件可以在一个轴线上相对于邻接的脊椎件旋转。不过，因为脊椎件在以90度交替的方向上彼此铰接，因此，多个脊椎件的组件实际上能够沿任何方向运动。以该形式连接的脊椎件的数目越大，运动的范围越大。在一个实施例中，两个至十个脊椎件用于组成一个段，从而使得每个段的长度为4cm至10cm。脊椎件和铰链接头的尺寸可以变化，例如，当与另一脊椎件连接时，较长的铰链接头将有较大的弯曲半径。而且，每个段的脊椎件的数目可以变化，例如可以使用超过十个脊椎件。
图6D和6E分别表示了脊椎件的另一变化形式的剖视图和透视图。在图6D和6E中，旁路绕过段的钢筋束可以包含在脊椎件的本体中并在钢筋束的旁路绕过空间550内，而不是沿脊椎件的外边缘，如图6A所示。图6D和6E的脊椎件表示了四个钢筋束旁路绕过空间550，各空间能够保持大约十五个旁路绕过的钢筋束套筒。钢筋束的旁路绕过空间的数目、形状和尺寸能够变化。例如，脊椎件能够有两个钢筋束的旁路绕过空间，该旁路绕过空间能够保持超过三十五个钢筋束套筒。而且，钢筋束的旁路绕过空间也能够位于脊椎件504的中心孔或管腔内部。
尽管图6D表示了只保持单个钢筋束索缆560的钢筋束套筒，但是多个钢筋束索缆可以包含于钢筋束壳体或套筒中。例如，当三个钢筋束使得段铰接活动时，全部三个钢筋束将包含在单个钢筋束壳体中。该组合的钢筋束壳体还可以进行润滑，以便适合各钢筋束索缆独立运动；和/或可以分成隔腔，该隔腔使得钢筋束在壳体内隔离。
图6E也表示了铰链接头506、508的透视图，该铰链接头506、508能够与相邻脊椎件的铰链接头对可枢轴转动地连接。尽管图6A和6B表示了轴向凸出的两对铰链接头，但是也可以在脊椎件的各面上只使用单个铰链接头。而且，只要铰链接头能够与相邻脊椎件可枢轴转动地配合，铰链接头可以位于离脊椎件的中心不同半径的位置处。例如，图6A至6C中所示的铰链接头对比图6D和6E中的铰链接头更靠近脊椎件的中心。
图7表示了控制环的第二变化形式。图中所示的变化形式利用柔性主链601，该柔性主链601优选是由相对不可压缩和不可伸展的材料制成，控制环602间隔地安装在该柔性主链601上。该结构能够沿任意所希望的方向以连续曲线弯曲。图7A表示了该变化形式的一个可控制段的侧视图，其中除去外层，以便表示控制环和主链。多个控制环602可以定间距地安装在柔性主链上。根据所希望的铰接活动程度，可以使用更少或更多控制量来组成单个段。钢筋束索缆312安装在段的最远侧控制环604上。与脊椎式的变化形式相同，该中心主链实施例表示为通过三个钢筋束310来驱动，这三个钢筋束310安装在等间隔地环绕段604的最远侧控制环的边缘的位置处。控制该段的钢筋束索缆312穿过确定于控制环602中的空间或孔610，这些钢筋束索缆能自由穿过该空间或孔610运动。这些孔610能够进行润滑、衬有润滑材料、或者控制环602可以包括一些润滑材料，以便于索缆穿过孔610运动。优选是，钢筋束套筒在位置614处安装到段的最近侧控制环612上。当钢筋束312处于拉力下时，该力沿整个段分布。因为内部钢筋束索缆312可在钢筋束套筒314内自由滑动，且钢筋束套筒在钢筋束614的两端进行固定，因此，拉动钢筋束索缆将只使得选定的段弯曲。
图7A还表示了更近侧段的第一个控制环604′。控制更远侧段的钢筋束可以在它们向近侧伸向促动器时经过更近侧段的外部。用于柔性主链实施例的控制环的外边缘表示为具有用于使钢筋束从旁路绕过的槽道或钢筋束旁路绕过空间616，如图7B所示。与脊椎式控制环相同，这些钢筋束旁路绕过空间也可以位于控制环内，例如处于封闭的钢筋束旁路绕过空间中。
图7B表示了可以用于内窥镜的柔性主链实施例的控制环602的端视图。控制环的中心包括槽道，柔性主链601能够穿过该槽道而安装。图中还表示了穿过控制环618的多个附加槽道。这些槽道可以与相邻控制环中的槽道对齐，以便形成用于光纤成像集束、照明光纤等的内部管腔或槽道，如前所述。而且，根据所希望的弯曲或控制的程度，相邻控制环可以以相同或者不同的距离彼此相邻地间隔开。图7B表示了三个等间距的孔610，钢筋束索缆能够穿过这三个孔610；这些孔610也可以用作钢筋束索缆的安装位置，例如当控制环是段中的最远侧控制环604时，或者用作钢筋束索缆套筒的安装位置，例如当控制环是段中的最近侧控制环612时。这些孔610可以特别形成为接收钢筋束端或钢筋束套筒。其它设计的控制环也可以用于段的不同区域，或者用于不同段。
图8A至8C表示了钢筋束驱动的内窥镜操纵通过曲折通路的变化。图8A中表示了通路701。该通路例如可以表示结肠的一部分。在图8A中，装置704的远侧顶端接近指定弯曲处。图8B表示了操纵远侧顶端705，以便采取合适曲线。该操纵可以由用户(例如医生)手动进行，或者使用自动检测方法自动进行，该自动检测方法能够确定通路壁的接近。如上所述，通过在钢筋束或钢筋束的组合上施加拉力(这导致产生合适弯曲)，从而使可操纵顶端弯曲。
然后，在图8C中，该装置再次前进；且当它前进时，选定的曲线沿内窥镜的近侧长度方向传播，这样，内窥镜的弯头相对于通路701保持在相对相同的位置。这防止与壁的过度接触，并使得内窥镜更容易沿曲折通路701运动。内窥镜与动作控制器连续连通，且动作控制器可以监测内窥镜在通路内的位置(即插入深度)以及确定内窥镜通路的选定弯头或曲线的位置。可以通过例如前述轴向动作传感器49或者通过更直接的测量技术来确定深度。同样，可以通过施加给钢筋束的拉力或者通过直接测量来确定各段的形状，例如直接测量钢筋束索缆的位移。例如通过在装置向远处运动时将更近侧段的侧部长度设置为等于更远侧段的相应侧部长度，动作控制器可以在身体内传播的在特定位置或深度处的段的选定形状。控制器也可以使用该信息来自动操纵内窥镜的本体，或者用于其它目的，例如产生用于分析使用的、内窥镜通路的虚拟图。
除了测量钢筋束位移，动作控制器也可以调节钢筋束的拉伸或收缩。例如，动作控制器可以控制在钢筋束中的“松弛”，特别是在并不主动处于拉力或压力下的钢筋束中。在被动钢筋束中允许松弛将减小使得更近侧段进行铰接活动所需的力。在一种变化形式中，在内窥镜远端处的脐点可以包含空间，以便允许各钢筋束松弛。
弯曲和前进过程可以以逐步或者连续的方式来进行。当逐步进行时，例如当钢筋束前进一段的长度时，下一个近侧段706弯曲成与前一个段或可操纵远侧部分相同的形状。当钢筋束前进时，通过使得段递增弯曲，也可以形成更连续的过程。例如在段比操纵通过的曲线更小时，这可以通过计算机控制来实现。
即使在相同内窥镜中，包括可操纵远侧部分的可控制段也能够选择为具有不同尺寸，例如不同直径或长度。因为考虑到空间、柔韧性和弯曲方法，所希望的是可以有不同尺寸的段。例如，在内窥镜中的段越多，它能够在体腔内操纵得越远；不过，更多段需要更多钢筋束来控制这些段。图9和10表示了钢筋束驱动内窥镜的两种变化形式。
图9表示了具有不同直径的段800的、钢筋束驱动内窥镜的变化形式。更远侧的段可以有比更近侧段(例如802、801)更小的直径803。普通内窥镜的直径可以从例如20mm减小至例如12.5mm。在图9中所示的内窥镜表示为套叠的，因为直径以阶梯方式向远侧减小。该设计将响应例如不断变窄的内部身体结构。当来自更远侧段的旁路绕过钢筋束朝着近侧促动器前进时，该设计还将有助于容纳该钢筋束，因为更近侧段的直径更大。图9表示了四个不同尺寸的段；不过，实际上可以使用任何数目的不同尺寸段。而且，尽管段在该变化形式中表示为阶梯式，但是外表面可以逐渐变细，以便有直径朝着远端减小的光滑外表面。
图10表示了钢筋束驱动内窥镜的另一变化形式，该内窥镜有不同长度的段。使用不同长度的段可以总共需要更少的段900来构成相同长度的可铰接活动的内窥镜。如图10所示，更近侧段901比更远侧段(例如902、903)逐渐变长。例如，段的长度可以从在近侧段处的20cm减小至在最远侧段处的6cm。该长度可以以恒定系数一段接一段地逐渐减小；也可选择，根据所希望的铰接活动，长度可以以几何级数、幂指数或任意方式而减小。实际上，这导致当向近侧传播弯曲和转弯时由更远侧段形成“平均”曲线。为了实现它，动作控制器可以构造成相应地容纳不同尺寸的段。也可选择，根据用途，内窥镜可以包括不同长度和厚度的段的组合。
使得段进行铰接活动的钢筋束与促动器机械连通。不过，所希望的是使得内窥镜的可插入的远侧部分可从促动器和控制器上拆卸，例如用于清洁或消毒。在内窥镜的近端和促动器之间的快速释放机构是使得内窥镜能够很容易拆卸、更换或互换的有效方法。例如，钢筋束的近端可以形成为能够可预计地安装在相应的促动器上。钢筋束可以形成为集束、阵列或架子。该结构将使得内窥镜有其它优点，例如能够主动或被动控制内窥镜的松弛。而且，各钢筋束的近端可以变化成能够安装和操纵，例如钢筋束的端部可以保持在专门构成的鞘或外壳中。
图11A和11B表示了快速释放机构的两种变化形式，用于将钢筋束驱动内窥镜安装在促动器上和从该促动器上拆卸。图11A表示了该快速释放机构的一种变化形式。钢筋束的近端捆扎在脐点950中，且各钢筋束终止于凹面连接器962中，该凹面连接器962在连接器界面952中保持成有组织的阵列。连接器界面952与在容纳促动器970的结构(例如作为控制器箱的一部分)上的互补接收界面956匹配。促动器可以凸出“插针”960，该插针960能够与凹面连接器匹配，并从促动器向钢筋束传递力。因此，例如促动器可以使得插针960向相应凹面连接器962施加压力。凹面接收器将插针的推动转变成施加在相关钢筋束上的拉力或压力。这例如可以通过使用操纵杆来使得力的方向反向来实现。因为各插针优选是与相应接收器匹配，因此所希望的是保持连接器与内窥镜和促动器对齐。在连接器上的定向凹槽954(该定向凹槽954装配到促动器上的接收定向匹配件958上)将用于使得两个界面对齐。也可选择，插针和插座的结构可以为特定方向。
该特征并不局限于插针和插座，因为实际上用于从促动器向钢筋束传递力的任意合适机构都可以使用。图11B表示了快速释放机构的第二变化形式，用于将钢筋束驱动内窥镜安装在促动器上和从该促动器上拆卸，它依赖于钉头结构来驱动钢筋束。优选是，钢筋束终止于类似于钉头的扁平外凸起972。钉头阵列在保持内窥镜钢筋束的脐点端部处从连接器界面952中凸出，并能够与促动器机构970的界面956上的狭槽孔974匹配。因此，促动器的狭槽孔974能够通过促动器而分别退回，以便向各钢筋束施加拉力。快速释放机构还可以设计为使得用户能够从相同促动器和/或控制器单元上使用不同的钢筋束驱动内窥镜(甚至是不同结构的)。
图12A至12F表示了本发明的内窥镜100，用于病人结肠的结肠镜检查。在图12A中，润滑内窥镜本体102，并通过肛门A而插入病人结肠C内。当通过目镜或在视频监视器上观察时，内窥镜本体102的远端108通过直肠R前进，直到它到达结肠C中的第一转弯处。为了通过该转弯处，内窥镜本体102的可选择操纵方向远侧部分104由用户通过操纵方向控制而人工操纵通向乙状结肠S。由操纵方向控制传送至可选择操纵远侧部分104的控制信号通过电子动作控制器49来监测。当选择了用于使内窥镜本体102的远端108前进进入乙状结肠S内的可选择操纵远侧部分104的正确曲线时，将该曲线记入控制器45的存储器中作为参照物。该步骤可以以人工模式进行，其中，用户使用键盘指令或声音指令而向控制器45发送指令，以便记录选定曲线。也可选择，该步骤可以以自动模式进行，其中，用户通过使内窥镜本体102向远侧前进而向控制器发出已经选择了想要的曲线的信号。这样，可以产生结肠或通路的三维图，并保持用于以后使用。
在一种变化形式中，在远侧部分铰接活动成选定形状之后，通过记录可操纵远侧部分的侧部的长度变化而将曲线输入控制器的存储器中。在钢筋束是Bowden索缆的变化形式中，在操纵该远侧部分离开中间未弯曲位置之后，远侧部分的长度变化可以由钢筋束索缆的运行距离来确定。由钢筋束索缆运行的该距离可以相对于索缆壳体或者相对于位于控制器内的另一点来确定。同样，任意可控制段的侧部的长度变化可以以相同方式来确定。
当内窥镜向远侧前进时，通过将更近侧段的侧部的长度设置为等于可操纵远侧顶端的相同侧的长度(当远侧顶端处于大致相同轴向位置时)，曲线将沿内窥镜向近侧传播。在一个变化形式中，侧部的长度等于不可伸展和不可压缩的钢筋束的长度。在更近侧段中的钢筋束进行拉紧或压缩，从而使得近侧段的侧部长度近似与远侧区域的侧部的记录长度(当远侧区域处于相同位置时)相等。也可选择，当可控制段为彼此不同长度和/或与可操纵远侧顶端的长度不同时，可操纵远侧顶端的侧部的长度比例(而不是绝对长度)可以用于沿内窥镜传播选定曲线。在内窥镜退回或向近侧运动的变化形式中，控制更近侧段的钢筋束的长度可以用于设置控制更远侧段的钢筋束的长度。
不管以人工模式操作还是以自动模式操作，一旦关于可选择操纵远侧部分104选择了合适曲线，内窥镜本体102就向远侧前进。通过轴向动作传感器或数据来检测轴向动作，且通过控制器45而沿内窥镜本体102的自动控制的近侧部分106向近侧传播选定曲线，如上所述。曲线在空间中保持固定，同时内窥镜本体102通过乙状结肠S而向远侧前进。在特别曲折的结肠中，可能必须操纵可选择操纵远侧部分104通过多个曲线，以便穿过乙状结肠S。
如图12B所示，用户可以在任意点停止内窥镜100，以便检查或治疗结肠C内的粘膜表面或任何其它特征。可以沿任何方向操纵可选择操纵的远侧部分104，以便检查结肠C的内部。当用户完成乙状结肠S的检查时，朝着降结肠D沿向上方向操纵可选择操纵远侧部分104。一旦可选择操纵远侧部分104选择了所希望的曲线，内窥镜本体102向远侧前进进入降结肠D中，且第二曲线和第一曲线沿内窥镜本体102的自动控制近侧部分106而向近侧传播，如图12C所示。
当在任意时候用户判断内窥镜本体102所采取的通路需要修改或校正时，内窥镜100将向近侧退回，且控制器45发出指令，以便删除前面选择的曲线。这可以使用键盘指令或声音指令而人工进行，或者通过对控制器45编程而自动进行，以便当内窥镜本体102退回一定距离时进入修改模式。使用可选择操纵远侧部分104来选择修改或校正的曲线，且内窥镜本体102如前所述地前进。也可选择，用户可以从动作控制器选择“松弛”或“重设”模式，从而使得内窥镜的可自动控制近侧部分(可能包括可操纵远侧顶端)被动地前进或退回。
内窥镜本体102通过降结肠D前进，直到它到达结肠左(脾)曲FI。这里，在许多情况下，内窥镜本体102必须通过几乎180度的急转弯。如前所述，使用可选择操纵远侧部分104来选择所希望的曲线，且内窥镜本体102通过横结肠T向远侧前进，如图12D所示。各前面选定的曲线沿内窥镜本体102的自动控制近侧部分106而向近侧传播。在结肠右(肝)曲Fr处遵循相同的处理步骤，且内窥镜本体102的远端108通过升结肠G前进至盲肠E，如图12E所示。使用内窥镜本体102的可选择操纵远侧部分104能够从该点检查盲肠E、回盲瓣V和回肠I端部。
图12F表示了内窥镜100通过结肠C退回。当内窥镜100退回时，如上所述，通过沿自动控制近侧部分106向远侧传播曲线而使内窥镜本体102沿前面选定的曲线运动。用户可以在任意点停止内窥镜100，以便利用内窥镜本体102的可选择操纵远侧部分104来检查或治疗结肠C内的粘膜表面或任何其它特征。在任意给定时间，内窥镜100可以被退回或者被向后驱动所希望的距离。
因此，当内窥镜100向近侧退回时，每次自动控制近侧部分106向近侧运动时，都向该自动控制近侧部分106发出信号，以便采取前面占据的空间(这时它处于该空间)的形状。曲线沿内窥镜本体102的自动控制近侧部分106的长度向远侧传播，且当内窥镜本体102向近侧退回时，该形成曲线看起来象固定在空间中。也可选择，控制部分28的段可以制成为松软的，这时退回将被动进行。
为了初始化或标定内窥镜100，在使用前(甚至在使用过程中)可以标定整个系统。在内窥镜治疗(例如上述治疗)过程中，各种错误可能在控制器和/或计算机中积累。这些错误可以由多种因素产生，例如在检测索缆动作时的错误、在控制器和/或计算机中的软件错误、定位不准确等。
考虑到这些可能的错误，当内窥镜100在病人体内使用时，通过重新初始化内窥镜100和系统，在相对于如上所述的固定参考点的任意位置和/或任意插入深度的内窥镜100的位置可以用作附加参考，用于进行前进和退回。该新产生的附加参考点可以用于使得内窥镜100经过该新参考点进一步前进。这时，可选择操纵远侧部分104可以用于确定新的前进情况，如前所述。
当相对于重新初始化的参考点而使得内窥镜100退回时，远侧部分104可以保持在外科医生的控制下。近侧部分106处于计算机的控制下，并且当内窥镜100类似于前述方法退回时，近侧部分106与在各插入深度处的更近侧段的位置相符。
需要时，初始化或重新初始化可以人工进行。为此，一旦外科医生或技术人员检测到在内窥镜100操作中的过度误差积累时，或者当计算机检测到超过预定水平的误差水平时，可以根据误差积累程度来对控制器编程以周期地重新初始化，例如每几秒、每几分钟、或者每三分钟等。也可选择，同样根据误差的积累，该重新初始化的处理可以在探查或治疗过程中进行至少一次，或者它可以进行任意次。
可以设置控制器以便连续比较各段或几段的最优位置与可以获得的段位置和驱动力。当检测的偏差大于预定值时，可以进行重新初始化。
图13表示了在用于例如病人体内时初始化或重新初始化内窥镜装置100的一个变化形式的流程图1000。在步骤1002中，一旦确定初始化(例如在使用之前)或者重新初始化装置和系统时，可以发出初始化或重新初始化的指令。然后，在步骤1004中，内窥镜装置可以释放，即没有力施加在钢筋束上以便驱动该段运动，并采取装置所处于的管腔或通路的形状。
在装置采取新位置之后，段的新位置信息(和/或段的轴线)可以记入计算机中，以便以该新记入的信息代替和/或补充以前记入的信息，如步骤1006中所示。在步骤1008中，也可以重新记入插入深度。
在记入新的位置信息之后，在步骤1010中，通过检测动作来决定内窥镜100是前进还是退回，如上所述。当内窥镜100前进，在步骤1014中可以利用新记入的信息继续进行正常操作。当内窥镜100退回时，在步骤1012中，新记入的信息可以用于控制位于重新初始化参考点近侧的段，并在步骤1014中可以继续进行正常操作。
尽管本发明的内窥镜描述为用作结肠镜，但是内窥镜可以设置成用于多种其它医疗和工业用途。此外，本发明也可以设置为导管、插管、外科手术器械或导入器鞘，它们使用本发明原理，用于通过曲折的身体通道。本发明还可以用于工业用途，例如在曲折区域(例如机械、管路等)中的检查和探查。
在特别用于腹腔镜或胸腔镜治疗的方法的变化形式中，可以沿病人体腔中的器官周围和之间的合适通路而选择地操纵可操纵内窥镜。内窥镜的远端可以通过自然开口、通过手术切口、通过手术插管，导入器或者通过套管针而插入病人体腔内。可选择操纵远侧部分可以用于探查和检查病人体腔，并选择在病人器官周围和之间的通路。使用在动作控制器的电子存储器中的三维模型，动作控制器可以用于控制自动控制近侧部分，以便遵循选定通路，且需要时返回合适位置。本领域技术人员知道的、用于实现本发明的上述组件和方法的修改以及本发明方面的变化形式将处于权利要求的范围内。

Claims (48)

1.一种用于插入体腔中的装置，其包括：
细长本体，该细长本体包括多个可铰接活动的段和一个可操纵的远侧部分；
多个拉伸部件，这些拉伸部件安装在至少大部分所述段上；
通过驱动安装在各所述段上面的拉伸部件，各所述段可设置成沿任意通路采取选定形状，其中，各所述段可通过至少一个所述拉伸部件而铰接活动；
所述拉伸部件从所述段延伸至所述细长本体的近端，并与外部控制单元连接；以及
其中，当细长本体向远侧或向近侧前进时，通过驱动所述拉伸部件，彼此相邻的所述段用于采取相邻段的选定形状。
2.根据权利要求1所述的装置，其还包括：手柄，该手柄位于所述可铰接活动的段的近侧。
3.根据权利要求2所述的装置，其中：所述可操纵的远侧部分可通过位于所述手柄上的控制装置来进行设置。
4.根据权利要求1所述的装置，其中：可操纵远侧部分可通过所述外部控制单元来进行设置。
5.根据权利要求1所述的装置，其中：所述控制单元还包括计算机。
6.根据权利要求1所述的装置，其中：所述控制单元用于调节所述拉伸部件，该拉伸部件用于将压力和拉力施加给所述拉伸部件。
7.根据权利要求1所述的装置，其中：所述控制单元还包括促动器，该促动器用于施加力，以便使得所述拉伸部件铰接运动。
8.根据权利要求7所述的装置，其中，所述促动器从以下组中选择，该组包括：机电马达、气动和液压缸、气动和液压马达、螺线管、形状记忆合金丝、以及电子旋转促动器。
9.根据权利要求1所述的装置，其中：所述拉伸部件通过快速释放配件而与所述外部控制单元连接。
10.根据权利要求1所述的装置，其中：各所述段由至少两个所述拉伸部件来驱动。
11.根据权利要求10所述的装置，其还包括：至少一个偏压元件，与所述拉伸部件相反，该偏压元件用于提供偏压力。
12.根据权利要求1所述的装置，其中：当装置向远侧前进时，通过驱动所述拉伸部件，在另一段近侧的段用于采取位于更远侧的段的选定形状。
13.根据权利要求1所述的装置，其中：当装置向近侧退回时，通过驱动所述拉伸部件，在另一段远侧的段用于采取位于更近侧的段的选定形状。
14.根据权利要求1所述的装置，其中：近侧段的长度比远侧段的长度更长。
15.根据权利要求1所述的装置，其中：近侧段的直径比远侧段的直径更大。
16.根据权利要求1所述的装置，其还包括：柔性的被动管状部件，该管状部件从所述细长和分段本体向近侧延伸。
17.根据权利要求1所述的装置，其中：各所述段包括多个控制环，且所述控制环有穿过该环确定的通道，该通道包括所述管腔。
18.根据权利要求17所述的装置，其中：所述控制环还包括用于安装到相邻控制环上的铰链。
19.根据权利要求17所述的装置，其中：所述细长本体还包括柔性主链，该柔性主链轴向位于所述细长本体内，所述控制环可安装到该主链上。
20.根据权利要求17所述的装置，其中：各所述拉伸部件包括钢筋束索缆和钢筋束壳体，该钢筋束壳体径向包围所述钢筋束索缆，以便所述钢筋束索缆可在所述钢筋束壳体内自由地轴向运动。
21.根据权利要求20所述的装置，其中：各所述段的最远侧控制环还包括用于至少两个所述钢筋束索缆的安装位置；
其中，各所述段在最远侧控制环近侧的控制环还包括用于至少两个所述钢筋束索缆的通路；以及
其中，各所述段的最近侧控制环还包括用于所述钢筋束壳体的安装位置。
22.根据权利要求1所述的装置，其中：细长本体确定了一个或多个穿过该本体的管腔。
23.一种用于将装置插入体腔内的系统，其包括：
细长本体，该细长本体有近端和可选择操纵的远端，该细长本体包括多个段；
至少两个拉伸部件，该拉伸部件安装在至少大部分段的各段上，用于驱动所述段，且其中，当远端采取选定曲线时，该选定曲线可通过选择地驱动所述段的所述拉伸部件而沿细长本体传播；以及
控制单元，该控制单元与各段连通，用于选择地控制各拉伸部件，以便当选定曲线沿细长本体传播时改变段的相对位置。
24.根据权利要求23所述的系统，还包括：轴向传感器，该轴向传感器有用于测量细长本体前进进入体腔或从体腔中退回的距离的传感器。
25.根据权利要求23所述的系统，还包括：操纵控制器，该操纵控制器与可操纵远端连通，用于选择选定曲线。
26.根据权利要求25所述的系统，其中，操纵控制器包括从以下组中选择的控制器，该组包括：操纵杆、接触垫、跟踪球、鼠标控制器、感觉手套和控制轮。
27.根据权利要求26所述的系统，还包括：成像系统，用于从细长本体的远端向近端传递图像。
28.根据权利要求27所述的系统，其中：成像系统包括光纤成像集束，该光纤成像集束从细长本体的远端向近端延伸。
29.根据权利要求28所述的系统，其中：该成像系统包括CCD摄像机。
30.根据权利要求28所述的系统，其中：该成像系统包括CMOS摄像机。
31.根据权利要求23所述的系统，还包括：在细长本体上的至少一个照明源，用于提供光源。
32.根据权利要求31所述的系统，其中：该照明源包括至少一个照明光纤，该照明光纤从细长本体的远端向近端延伸。
33.根据权利要求23所述的系统，还包括：记录装置，该记录装置与细长本体连通，用于记录来自细长本体远端的图像。
34.根据权利要求23所述的系统，其中：细长本体设置为用于插入病人体内的内窥镜。
35.根据权利要求23所述的系统，其中：细长本体设置为用于插入病人结肠内的结肠镜。
36.根据权利要求23所述的系统，其中：细长本体设置为用于插入病人体腔内的腹腔镜。
37.根据权利要求23所述的系统，其中：细长本体确定了穿过该本体的一个或多个管腔。
38.一种使装置沿选定通路前进的方法，其包括：
提供细长本体，该细长本体有近端和可选择操纵远端，该细长本体包括多个段和至少两个拉伸部件，该拉伸部件与至少大部分段的各段连接，用于驱动所述段，且其中各拉伸部件可独立控制；
选择操纵该远端，以便沿所希望的通路采取第一选定曲线；以及
使得细长本体向远侧前进，同时控制器械的近端，以便采取远端的第一选定曲线。
39.根据权利要求38所述的方法，还包括：当器械向远侧前进时，测量细长体的轴向位置变化量。
40.根据权利要求39所述的方法，还包括：使当前轴向位置增加该轴向位置变化量。
41.根据权利要求40所述的方法，还包括：与各段连通，以便当细长本体前进时调节各段的位置。
42.根据权利要求38所述的方法，还包括：使细长本体向近侧前进，同时控制器械的近端，以便采取远端的第一选定曲线。
43.根据权利要求42所述的方法，还包括：当器械向近侧前进时测量细长本体的轴向位置变化量。
44.根据权利要求43所述的方法，还包括：使当前轴向位置减小该轴向位置变化量。
45.根据权利要求44所述的方法，还包括：与各段连通，以便当细长本体前进时调节各段的位置。
46.根据权利要求38所述的方法，还包括：重新初始化该装置，以便重新标定细长本体。
47.根据权利要求46所述的方法，其中：使装置重新初始化包括使得细长本体可以与任意形状相符。
48.根据权利要求47所述的方法，还包括：储存至少一段的至少一个新位置。
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CA2496574A1 (en) 2004-03-11
US6858005B2 (en) 2005-02-22
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