Handheld surgical endoscope

[0001] This patent application is a division of U.S. patent application Ser. No. 14/913,867, filed Feb. 23, 2016, which is a national stage entry of PCT application no. PCT/US2016/018670, filed on Feb. 19, 2016, and claims the benefit of and incorporates by reference each of the following provisional applications:

[0002] U.S. Prov. Ser. No. 62/119,521 filed Feb. 23, 2015;

[0003] U.S. Prov. Ser. No. 62/120,316 filed Feb. 24, 2015;

[0004] U.S. Prov. Ser. No. 62/139,754 filed Mar. 29, 2015;

[0005] U.S. Prov. Ser. No. 62/254,718 filed Nov. 13, 2015;

[0006] U.S. Prov. Ser. No. 62/259,991 filed Nov. 25, 2015;

[0007] U.S. Prov. Ser. No. 62/275,222 filed Jan. 5, 2016;

[0008] U.S. Prov. Ser. No. 62/275,241 filed Jan. 6, 2016;

[0009] U.S. Prov. Ser. No. 62/279,784 filed Jan. 17, 2016; and

[0010] U.S. Prov. Ser. No. 62/287,901 filed Jan. 28, 2016.

[0011] All of the above-referenced provisional patent applications are collectively referenced herein as “the commonly assigned incorporated applications.” The entire contents of the applications identified above are hereby incorporated by reference.

[0012] This patent specification generally relates mainly to a medical device for use in tissue examinations such as in urology or endoscopic surgery. More particularly, some embodiments relate to an integrated, handheld, low-cost medical device having a single-use portion and one or more multiple-use portions.

[0013] Conventional endoscopy, or direct vision used to examine the interior of a hollow organ or cavity of the body, uses a complex lens system for transmitting the image for the distal tip of the endoscope to a viewer. The lens system is typically an objective lens plus a relay lens system in the case of rigid endoscopes or a bundle of optic fibers in the case of flexible endoscopes. In the case of both rigid and flexible conventional endoscopes, the lens or fiber optic system is relatively expensive and is intended to be re-used many times. Therefore, stringent decontamination and disinfection procedures need to be carried out after each use.

[0014] Disposable endoscopy is an emerging category of endoscopic instruments. In some cases the manufacture of endoscopes can be made inexpensive enough to be used on a single patient only. Disposable or single-use endoscopy lessens the risk of cross-contamination and hospital acquired diseases. Partially disposable endoscopy systems for hysteroscopy are discussed in U.S. Pat. No. 8,460,182, incorporated by reference herein. A hysteroscope having a disposable probe was offered by Endosee Corporation of Los Altos, Calif., and is now offered by CooperSurgical, Inc. of Trumbull, Conn., a company that acquired EndoSee Corporation.

[0015] The subject matter described or claimed in this patent specification is not limited to embodiments that solve any specific disadvantages or that operate only in environments such as those described above. Rather, the above background is only provided to illustrate one exemplary technology area where some embodiments described herein may be practiced.

[0016] According to some embodiments that are particularly suitable for fields such as urology and endoscopic surgery rather than hysteroscopy, a low-cost medical instrument for examining a patients tissue comprises an elongated, single-use portion that includes: a handle near a proximal end of the elongated portion, which handle is configured and shaped for manual gripping of the instrument while the instrument is being used to examine the tissue; a shaft having a central axis, a distal end, a proximal end, a first conduit and a second conduit, both first and second conduits passing internally through the shaft towards the distal end of the shaft, the first conduit configured to be in fluid communication with a first proximal fluid port, and the second conduit continuing proximally to provide a substantially straight working channel in the second conduit parallel to the central axis from a proximal working channel port on the proximal end of the elongated single-use portion through the handle portion; a distal tip assembly mounted on the distal end of the shaft, the assembly having a distal outer edge rounded to a radius of at least one millimeter, the tip assembly including one or more distal ports in fluid communication with the first conduit, and a distal working channel port being in fluid communication with the second conduit; a light delivery system configured to illuminate the tissues being examined; an electronic imaging module positioned within the tip assembly; one or more electrical conductors running through the shaft in electrical connection with the imaging module; and an electrical connector on the handle portion in electrical connection with the one or more conductors.

[0017] The medical instrument further comprises a multiple-use electronics and display portion including a display, configured for mounting on the electrical connector of the single-use portion, which results in the display positioned off of the central axis of the shaft.

[0018] Some embodiments of the instrument further include one of the following elements or features and other embodiments further include two, or three, or more, or all of the following elements or features: (1) the light delivery system includes at least one LED positioned within the distal tip assembly; (2) the shaft is extruded from a synthetic polymer material; (3) the working channel is dimensioned to allow a surgical implement to pass from the proximal working channel port through the second conduit and through the distal working channel port so as to be used in a surgical procedure on the patient's tissue; (4) a path through which the surgical implement can pass from the proximal working channel port to the second conduit is straight; (5) a multi-use rechargeable battery module configured to be removably mounted to said handle portion of the elongated single-use portion; (6) one or more electrical conductors are positioned at least partially within the first conduit; (7) the electrical connector is longitudinally separated from the first proximal fluid port by at least five centimeters; (8) the electrical connector is positioned proximally from the first fluid port; (9) the elongated single-use portion further comprises a second proximal fluid port in fluid communication with the second conduit; (10) the distal outer edge of the distal tip assembly is rounded to a radius of at least two millimeters; (11) a central distal surface of the distal tip assembly includes an opening through which the electronic imaging module can view tissues being examined, the central distal surface being flat or rounded to a radius of at least 5 millimeters; (12) the mounting of the multiple-use electronic and display module results in the display being rotatable about an axis perpendicular to the central axis of the shaft; (13) the mounting of the multiple-use electronic and display module results in the display being non-rotatable about any axis parallel the central axis of the shaft: (14) the mounting of the multiple-use electronics and display module results in the display being rotatable about an axis parallel to the central axis of the shaft; (15) a sensing system configured to sense rotational orientation of the display relative to the electronic imaging module; (16) the multiple-use electronics and display module includes wireless communication circuitry configured to receive video signals originating from the electronic imaging module and to display video images from the imaging module to a user while not physically mounted to the handle portion; (17) the electrical conductor makes electrical contact with the electronics and display module using male-shaped metallic protrusions that mate with female-shaped metallic recesses on the electronics and display module; and/or (18) said multiple-use electronics and display module further includes a fixing mechanism configured to attach the electronics and display module to a users arm, wrist and/or hand.

[0019] This patent specification further describes a surgical procedure carried out using the an embodiment of the instrument described above, the procedure comprising: inserting the distal tip of the elongated single-use portion into a passageway of the patient; illuminating the patient's tissues using the light delivery system; electronically imaging the patient's tissues using the electronic imaging module; and viewing real-time the electronically imaged tissues on the display. Other examples of the surgical procedure include one or more or all of the following additional steps of features: (1) using a surgical implement passing through the distal working channel port to carry out a physical intervention on the patient's tissues; (2) the surgical implement is a hypodermic needle and the physical intervention includes injecting a fluid into the patient's tissues through the hypodermic needle; (3) the hypodermic needle is positioned within the working channel before the distal tip is inserted into the passageway (4) the surgical implement is positioned within the working channel prior to a sterilization and packaging procedure of the elongated single-use portion; (5) the passageway is the patient's urethra; and (6) attaching the electronics and display module to a user's arm, wrist or hand, and rotating the elongated single-use portion about an axis parallel to the central axis while maintaining the electronics and display module in an un-rotated position.

[0020] According to some embodiments, an endoscope comprises a single-use, disposable portion and a re-usable portion. The single-use, disposable portion comprises at least the following components that are fixedly assembled into a single unit enclosed in a sterile package configured for disposal after a single use on a patient; an elongated handle shaped and dimensioned to be grasped and manipulated by a user's hand, said handle having a proximal end and a distal end and further having a mounting connector with electrical connector elements, and a battery connector; an elongated cannula made of an extruded material, passing through the handle and enclosing a first lumen extending distally from a location inside the handle and a second lumen extending through and both distally and proximally from the handle; a tip made of a molded material, secured at a distal end of the cannula; an imaging assembly and an illumination assembly mounted in the tip; at least one side-facing port in the tip in fluid flow communication with the first lumen for inflow of fluid into the first lumen; a side-facing outflow port in the first lumen, spaced proximally from the tip, configured for outflow of fluid that has entered the first lumen through the side-facing inflow port in the tip and has passed through the first lumen in the proximal direction; electrical wires running through the first lumen from the electrical connector elements in the handle to the imaging and illumination assemblies in the tip; an outflow port in the tip in fluid flow communication with the second lumen; a side-facing inflow port in the second lumen, spaced in the proximal direction from the outflow port in the tip; and a surgical implement port facing in the proximal direction, at the portion of the second lumen that extends proximally from the proximal end of the handle, configured for insertion of a surgical implement in the distal direction to the tip along a straight insertion path. The re-usable portion of the endoscope in this embodiment is configured for mounting on the handle and removal from the handle by hand, and comprises at least: a mounting structure configured to mechanically mate with the handle's mounting connector and having electrical connector elements configured to mate with and establish electrical contact with the handle's electrical connectors when the re-usable portion is mounted on the handle; a rotation coupling between the handle and the re-usable portion configured for relative rotation the re-usable portion and the single-use portion about at least one axis; and a touch-sensitive display screen with associated electronic circuitry electrically coupled with said female mating elements, said screen configured to display video provided by said imaging assembly in the tip and to respond to touch to control imaging and illumination operations at the tip and display operations on the screen.

[0021] In some embodiments; the endoscope described in the preceding paragraph further includes one or more of the following elements or features: (1) the rotation coupling is configured for relative rotation of the re-usable and single-use portions about a two axes that are transverse to each other; (2) one of the two axes is transverse to the long dimension of the handle and the other is along the long dimension of the handle; (3) tactile feedback is used an indicator of relative position between the re-usable portion and the single-use portion; (4) the handle includes a depression shaped and dimensioned to receive a clip-on battery for powering the re-usable portion and the illumination assembly when a battery in inserted into said depression and makes electrical contact with said battery connector and the re-usable portion is mounted on the handle; (5) the single-use portion further includes a battery configured for disposal with the single-use portion, said battery being secured in the sterile package in electrical contact with said battery connector to power the illumination assembly and the re-usable portion when the re-usable portion is mounted on the handle; (6) the connector elements in the handle are male elements and the connector elements in the re-usable portion are female connector elements, thereby reducing chances of contamination of the connector elements in the re-usable portion; (7) the tip has a convex end with a circumferential periphery that is more curved then a central portion to thereby ease insertion of the tip in a patient's body; (8) the distal end of the tip has a convex curvature radius of from 4 to less than 7 mm radius at a central region and from 1 to less than 4 mm radius at a peripheral area; (9) said extruded cannula is made of a multi-durometer material that is more flexible at a distal than a proximal portion of the cannula to facilitate bending the cannula near the tip; (10) the single-use portion further includes a disposable needle for injecting or withdrawing substances through said second lumen in fluid flow communication therewith, and included in said sterile package; (11) the distal end of the cannula comprises a first D-shaped portion in cross-section and a second D-shaped portion in cross-section that extends to a lesser extent in the distal direction, the first D-shaped portion contains the first lumen and the second D-shaped portion contains the second lumen; and the tip comprises a cylinder open in the proximal direction to receive the two D-shaped portions of the cannula and having an internal stop plate facilitating separation between the first and second lumens; (12) the outflow port in the first lumen is spaced at least 5 cm in the distal direction from the electrical connectors in the handle to facilitate keeping the connectors free of fluid passing through the first lumen; (13) a wiper fitted over the open end of the surgical implement port and configured to resist spillage of fluid from the second lumen in the proximal direction when the endoscope is used with a surgical implement; (14) said re-usable portion further comprises a sensor responsive to relative rotation between the re-usable portion and the single-use portion, and at least one of (i) an indicator of current relative positions of the re-usable and single-use portions, and (ii) a control changing orientation of images on the display in relation to current relative positions of the re-usable and single-use portions; and (15) said re-usable portion further comprises a fixing mechanism configured to attach the touch-sensitive display screen to a user's arm; wrist and/or hand.

[0022] This patent specification further describes an endoscopic method that comprises providing a single-use, disposable portion including the following components that are fixedly assembled into a single unit enclosed in a sterile package configured for disposal after a single use on a patient: an elongated handle shaped and dimensioned to be grasped and manipulated by a user's hand, said handle having a proximal end and a distal end and further having a mounting connector with electrical connector elements, and a battery connector; an elongated cannula passing through the handle and enclosing a first lumen extending distally from a location inside the handle and a second lumen extending through and both distally and proximally from the handle; a tip secured at a distal end of the cannula; an imaging assembly and an illumination assembly mounted in the tip; at least one inflow port in the tip in fluid flow communication with the first lumen; an outflow port in the first lumen, spaced proximally from the tip, configured for outflow of fluid that has entered the first lumen through the inflow port in the tip; electrical wires running through the first lumen from the electrical connector elements in the handle to the imaging and illumination assemblies in the tip; an outflow port in the tip in fluid flow communication with the second lumen; an inflow port in the second lumen, spaced in the proximal direction from the outflow port in the tip; and a surgical implement port facing in the proximal direction, at the portion of the second lumen that extends proximally from the proximal end of the handle, configured for insertion of a surgical implement in the distal direction to the tip along a straight insertion path. The method further comprises: removing the single-use portion from the sterile package and mounting by hand thereon a re-usable portion that comprises a touch-sensitive display screen configured to display video provided by said imaging assembly in the tip and to respond to touch to control imaging and illumination operations at the tip and display operations on the screen; and inserting the cannula tip and then the cannula into a patient's body and viewing on the screen images from the imaging assembly.

[0023] As used herein, the grammatical conjunctions “and”, “or” and “and/or” are all intended to indicate that one or more of the cases, object or subjects they connect may occur or be present. In this way, as used herein the term “or” in all cases indicates an “inclusive or” meaning rather than an “exclusive or” meaning.

[0024] As used herein the terms “surgical” or “surgery” refer to any physical intervention on a patient's tissues, and does not necessarily involve cutting a patient's tissues or closure of a previously sustained wound.

[0043] A detailed description of examples of preferred embodiments is provided below. While several embodiments are described, it should be understood that the new subject matter described in this patent specification is not limited to any one embodiment or combination of embodiments described herein, but instead encompasses numerous alternatives, modifications, and equivalents. In addition, while numerous specific details are set forth in the following description in order to provide a thorough understanding, some embodiments can be practiced without some or all of these details. Moreover, for the purpose of clarity, certain technical material that is known in the related art has not been described in detail in order to avoid unnecessarily obscuring the new subject matter described herein. It should be clear that individual features of one or several of the specific embodiments described herein can be used in combination with features of other described embodiments or with other features. Further, like reference numbers and designations in the various drawings indicate like elements.

[0044] FIG. 1 is a right side view of a handheld surgical endoscope, according to some embodiments. The endoscope 100 includes an elongated cannula 120 with a distal tip 112 for inserting into a hollow organ or cavity of the body. According to some embodiments, a separate tip sub-assembly 110 is attached to the cannula 120 which can be made from an extruded material. Sub-assembly 110 includes an imaging module and one or more LED light sources for viewing the organ or cavity into which it is inserted. The tip assembly 110 also includes one or more fluid ports, as well as a working channel opening through which a surgical device can protrude. The distal end of the cannula 120 can also be slightly bent as shown in bent region 122.

[0045] The endoscope 100 includes a handle portion 140 that is sized and shaped for easy grasping by the endoscope operator (e.g. doctor or other medical professional). According to some embodiments, the cannula 120 includes two or more fluid channels, one of which is fluidly connected to distal fluid port 132 and another that is fluidly connected to proximal fluid port 172, According to some embodiments, one of the channels within the cannula 120 can also be used as working channel and is configured to have a straight path via working channel opening 170. The example shown in FIG. 1 includes a surgical device 180 that enters the working channel via opening 170. It has been found that providing a straight proximal entry port 170 greatly enhances ease of use for inserting various surgical devices.

[0046] According to some embodiments, a re-usable display module 150 (FIG. 2) is removably mounted to the handle portion 140 using a connector (not shown), and a re-chargeable battery 160 is removably mounted on the upper side of handle portion 140 as shown. According to some embodiments, apart from the display module 150 and battery 160, the entire endoscope device is made at a relatively low-cost and is intended to be disposed of after a single-use. By making the tip, cannula, handle and ports of the device 100 all single-use, stringent decontamination and disinfection procedures as well as the risk of cross-contamination and hospital acquired diseases can be significantly lessened or avoided.

[0047] FIGS. 2 and 3 are perspective views of a handheld surgical endoscope, according to some embodiments. Visible in FIGS. 2 and 3 on endoscope 100 is the display module 150 which is removably mounted to the handle portion 140 at the connector 252. Likewise, rechargeable battery 160 is removably mounted into the handle portion 140 via battery socket 362. The connector 252 and battery socket 362 provide both mechanical and electrical connections between the handle portion 140 and the display module 150 and battery 160, respectively. According to some embodiments, a rechargeable battery is included within the display module 150 and therefore a separate battery 160 does not need to be mountable to the handle portion 140. According to yet other embodiments, non-rechargeable batteries are used instead of rechargeable battery 160.

[0048] In FIG. 3 the connector 252 is shown in more detail, According to some embodiments, the male portions (e.g. ‘pins’) 354 protrude from the handle portion 140 and the mating female portions (e.g. ‘holes’) 356 are recessed in the display module 150. Similarly, for electrical connection between the battery module 160 and handle portion 140 the male portions 364 (e.g. ridges or pins) are positioned on the handle portion 140, while the female portions 366 (slots or holes) are positioned in battery module 160. Providing the male portions of the electrical connectors on the single-use handle portion 140 and the female portions on the re-usable parts—display and battery modules 150 and 160—is beneficial for purposes of decontamination and disinfection. The handle portion 140, cannula 120 and tip 110 together form the single-use portion of the endoscope 100, which is sterilized, for example, during production and is provided to the user in a sealed sterilized packaging. The display module 150 and battery module 160 are intended to be re-used and therefore are subject to decontamination and/or disinfection procedures. In some cases, it is useful to use disposable sterile covers (e.g. clear polyethylene bags or sleeves) to cover the display module 150 and battery module 160 during a surgery or other clinical procedure. In such cases it is preferable for the male portions of the electrical connections to reside on the single-use portion which has been sterilized during manufacture and/or packaging.

[0049] FIG. 4 is a proximal view of a handheld surgical endoscope, according to some embodiments. According to some embodiments, the display module 150 includes a large central color display area 450 on which the user can view live images from the camera module mounted on the distal tip 112. According to some other embodiments, the display module 150 is rotatable about axis 452 so as to provide the user with a customizable viewing angle of the display area 450 with respect to the angle of handle 140 and cannula 120. For example, in cases where the handle 140 and cannula 120 are tipped such that the distal tip is lower than the proximal end of the endoscope, the display module 150 can be rotated in the reverse direction so as to maintain an ergonomic viewing angle of display are 450.

[0050] FIG. 5 is a right side view showing further details of a handheld surgical endoscope, according to some embodiments. The cannula 120 preferably is made such that it continues through the handle portion 140 to the proximal working channel port 170 as indicated by dashed lines 520. Electrical wires 522 are shown in dotted line which are positioned within one of the fluid channels of cannula 120, until exiting in the vicinity of electrical connector 252. The wires 522 are connected within the distal tip sub-assembly 110 to a camera module and LED light sources (not shown). The distal fluid port 132 can be fluidly connected to one of the fluid channels by way of a cut out 530 in cannula 120. According to some embodiments, the same fluid channel within cannula 120 that is fluidly connected to port 132 is used for carrying the wires 522. It will be appreciated that in this case, adequate fluid sealing should be used to ensure fluid within the shared channel does not leak into the connector 252 where bare, insulated wires, and/or metal contacts are present. Adequate fluid sealing is facilitated by the substantial longitudinal separation distance d measured between the skiving or cut out 530 as shown FIG. 5 (or other fluid exit point from which fluid could travel internally within the handle) to any bare/exposed metal connectors. According to some embodiments, the distance d is 50 mm, 75 mm or even 100 mm. According to some embodiments, the separation distance d is at least 75 mm.

[0051] FIGS. 6A-6C are perspective, right side and distal views of a distal tip sub-assembly of a handheld surgical endoscope, according to some embodiments. In this example, the distal sub-assembly 610, which can correspond to tip sub-assembly 110 in FIGS. 1-5, is shown with a spherically rounded distal tip 612. The assembly 610 includes a working channel port 630 through which a surgical instrument can pass. The tip 612 also includes a camera port 640 from which imaging module 642 can view the organ or cavity into which the endoscope is inserted. Also visible are light ports 650 and 654 through which LEDs 652 and 656 shine light to illuminate the organ or cavity being imaged using imaging module 642. According to some embodiments, illumination can be achieved using techniques other than LEDs. For example a light fiber guide or pipe can be used to transmit light from a light source in handle 140 (or some other proximal location). According to some embodiments, two lower fluid ports are provided, of which one, port 620, is visible in FIGS. 6A and 6B, In the case there are two fluid channels within cannula 120, an upper fluid channel can be combined with the working channel to provide fluid in-flow (i.e. flowing fluid out of the device and into the patient's organ or cavity). A lower fluid channel within cannula 120 can be used to provide fluid out-flow (i.e. flowing fluid out of the patient's organ or cavity and into the device) via the bottom mounted fluid ports (of which port 620 is visible). As described with respect to FIG. 5, supra, this lower fluid channel can also be used to carry wires that are connected to the imaging module 642 and LEDs 652 and 656. As mentioned, the tip 612 is spherically rounded, for example having radius close to or equal to the half the width of the cylindrical portion of the tip assembly 110. It has been found that a highly rounded, or spherical tip shape such as shown can be beneficial in providing a smooth contour which reduces or eliminates injury to to the patient's tissues in some applications.

[0052] FIG. 7 is a perspective view of a cannula and tip sub-assembly of a handheld surgical endoscope, according to some embodiments. As described, supra, cannula 120 can be extruded and contain two fluid channels. In the example shown cannula 120 has an upper lumen 720 and a lower lumen 722. Although both upper and lower lumen 720 and 722 are shown in FIG. 7 with a circular cross section, according to some embodiments other cross sections can be used. It has been found that the manufacture of a dual lumen extruded cannula is simple and straight forward. Prior to joining the lumen to the tip sub-assembly 610, a simple 90 degree cut is made in the distal end of cannula 120, leaving a “D” shaped upper half as shown. The D shaped upper half mates with a D shaped recess in the upper half of sub-assembly 610. The recess includes a stop 712. In this way the D shaped portion of the cannula 120 is “keyed” with the tip assembly 610 such that it is easy to rotationally and longitudinally align the cannula 120 and the tip sub-assembly 610. Thus the process of joining the tip 610 to cannula 120 is relatively simple and straightforward. Note that even with the dual lumens, plenty of material remains in cannula 120 to provide structural integrity. The location of the imaging module 642 is also shown in FIG. 7.

[0053] FIGS. 8A-8E are distal, proximal, cross-sectional, bottom and perspective views of a distal tip housing of a handheld surgical endoscope, according to some embodiments. The tip housing 810, for example, can be used to house the components of the distal tip subassembly 110 shown in FIGS. 1-3 and 5. The tip housing 810 has a rounded outer distal edge, such as tip 610 shown in FIGS. 6A-6C and 7. In contrast, however, the central distal portion of the tip housing 810 is flatter and less rounded than tip 610. According to some embodiments, the tip housing 810 is formed by molding and is made from a material such as acrylic, although other suitable materials can be used. FIGS. 8A and 8B are distal and proximal views, respectively, of the tip housing 810. The dimensions of the outer circumference and proximal opening 812, as well as the dimensions and positioning of the working channel port 830, camera port 840, light ports 850 and 854, and shelf 860 according to some embodiments, are shown. Note that in the example shown in FIG. 8B, the camera module is positioned in port 840 which is 1.67 mm in diameter. According to some embodiments, other camera module sizes are used, such as a 1.4 mm diameter camera module. In such cases, the space within the molded tip housing 810 is changed accordingly.

[0054] FIG. 8C is a cross sectional view of the distal tip housing along A-A′ (shown in FIG. 8B). As can be seen, the outer distal edge 870 of the tip housing 810 is rounded to a radius of 2.54 mm. According to some embodiments, the distal outer edge 870 is also rounded to be spherical in shape. It has been found that especially in the case of inserting the endoscope into and through passages such as the urethra, trachea or blood vessels, it is desirable that the outer distal edge 870 of the distal tip should be rounded since that region of the distal tip both contacts and dilates the tissue passage. In such cases, the central portion 872 of the distal tip can be made less rounded or even flat. Making the central portion 872 less rounded or flat has been found to enhance imaging characteristics over a more spherical overall tip shape (such as shown in FIGS. 6A-6C and 7) since the camera and illumination is not or significantly less impaired. In the case of a spherical overall tip shape (such as shown in FIGS. 6A-6C and 7) where the central portion of the distal tip is rounded to close the radius of the cylindrical portion of the shaft and/or tip, the camera view from the camera port and/or the illumination from the light ports can be partially blocked by the rounded distal tip. In the example shown in FIGS. 8A-8C, the central portion 872 of the distal tip is rounded spherically to a radius of about 6.6 mm. According to some embodiments, other rounding shapes are possible while still providing good tissue contact properties and good illumination and viewing properties. For example, the outer distal edge can be rounded spherically to a radius of between 1 mm to 3.5 mm, while the central portion (which includes most or all of the camera and light ports) is either flat or rounded spherically to a radius of greater than 4 mm. Also visible in FIG. 8C is the proximal opening 812 and shelf 860 which are shaped to accept the distal end of extruded cannula 120 (such as shown in FIGS. 7 and 10B). One of the two lower fluid ports 822 is also visible, which can provide fluid out-flow (flowing out of the patient and into the cannula). In FIG. 8D, the dimension and positioning of the two lower fluid ports 820 and 822 are visible. FIG. 8E is a prospective view of the molded distal tip housing 810. According to some embodiments, more than two lower fluid ports are provided for fluid out-flow (flowing out of the patient and into the cannula).

[0055] FIG. 9 is a diagram showing a handheld surgical endoscope being inserted in a tissue passageway, according to some embodiments. The distal tip 110 and cannula 120 of a surgical endoscope such as shown in FIGS. 1-5 is being inserted in passageway 910 within tissue 900. As shown the passageway 910 is being dilated by the distal tip 110. The distal tip 110 has a hybrid rounded shape such as shown in FIGS. 8A-8E such that its outer distal edge 870 is more rounded (i.e. smaller rounding radius) than the central portion 872 of the distal tip. As discussed, supra, this hybrid rounding profile allows for both good tissue contact and dilation characteristics, and good viewing and illumination characteristics.

[0056] FIGS. 10A-10C are side views showing further detail of a cannula used with a handheld surgical endoscope, according to some embodiments. FIG. 10A is a side view showing example dimensions and shape of cannula 120 used in the handheld endoscope 100 shown in FIGS. 1-5. The cannula 120 can be extruded and made of a nylon material such as nylon 12 (e.g. Grilamid® L25). The distal end of cannula 120 can include a bent region 122 which is beneficial for certain applications and can effectively increase the field of view of the camera fixed to the distal tip when the endoscope is rotated about its central longitudinal axis. FIG. 10B shows further detail of the distal end of the extruded cannula 120. As discussed with respect to FIG. 7, a simple 90 degree cut can be used to form the cut-away region 1020 while leaving a D shaped upper portion 1022, Also shown in dotted outline are the upper and lower lumens 720 and 722. FIG. 10C shows a further detail in the mid-shaft region where cut out 530 is made to make a fluid connection between lower lumen 722 and a distal fluid port (such as distal fluid port 132 shown in FIGS. 1-5), Note that while FIG. 7 shows the cannula 120 being mated to spherically tipped distal tip 610, according to some embodiments, the cannula 120, which is shown in detail in FIGS. 10A-10C and 11A-11B, can also be mated to a hybrid-rounded distal tip shape such as shown in FIGS. 8A-8E and 9. According to some embodiments, the cannula 120 can be made such that its stiffness is not constant along its length. For example, it may be useful in some clinical applications to provide a cannula that is more flexible towards the distal tip and stiffer towards the handle. In such cases the cannula 120 can be made from a multi-durometer tubing such as a multi-duro Pebax® or Grilamid®.

[0057] FIGS. 11A and 11B are cross sectional views showing further detail of cannulae used with a handheld surgical endoscope, according to some embodiments. In FIG. 11A, positions and dimensions of upper and lower lumens 720 and 722 are shown formed within cannula material 1120. Also visible are electrical wires 522 positioned within the lower lumen 722. Note at wires 522 in this case include six conductors for connection to the camera and LEDs on the distal tip sub-assembly, although other numbers of conductors could be used. In cases where a larger crossectional area of the lower lumen is desired that is not occupied by the wires 522, other shapes can be used such as shown in FIG. 11B, In FIG. 11B, the lower lumen 1122 has a non-circular cross-section so that greater fluid carrying capacity can be provided while still accommodating the wires 522.

[0058] It has been found that forming the cannula and distal tip parts separately has significant manufacturing advantages. The cannula can be extruded while the distal tip can be molded. Furthermore post-extrusion preparation of the extruded cannula is very straightforward, using only simple cuts made mid shaft (shown in FIG. 10C) and distal end (shown in FIG. 10B). Also, it has been found that using two lumens as shown in FIG. 11A or 11B, there is plenty of material remaining to provide suitable structural integrity for the cannula. Having two lumens has been found to be suitable for providing separate fluid in-flow and out-flow channels, as well as sufficient space for the video and illumination wires and a working channel.

[0059] FIGS. 12A-12D are side and perspective views illustrating a procedure in which a surgical device is pre-installed within a handheld surgical endoscope, according to some embodiments. In FIGS. 12A and 12C, a needle 1210 is shown positioned within the upper lumen 720 of endoscope 100 which is being used as a working channel. According to some embodiments, the needle 1210 is installed into the position shown in FIGS. 12A and 12C prior to insertion of the endoscope 100 into the patient. For example, the needle 1210 could be installed into the endoscope 100 in the clinic or doctor's office in preparation for the medical procedure. According to some other embodiments, the needle 1210 or other surgical implement is pre-installed in the cannula as shown during manufacture (e.g. on the production line) or otherwise, prior to sterile packaging of the single-use portion of the endoscope 100. While in the position shown in FIGS. 12A and 12C, the distal tip 110 of endoscope 100 is inserted into the patient (such as shown in FIG. 7). After the distal tip 110 is positioned in the desired location (e.g. in the desired hollow organ or cavity of the body), the needle 1210 is pushed into the patient's tissue. FIGS. 12B and 12D show side and perspective views, respectively, of the needle 1210 protruding from the working channel port 830 of the distal tip 110. In the case where needle 1210 is a hollow needle (e.g. hypodermic needle), than the needle 1210 can be used to inject substance into the penetrated tissue and/or extract fluids from it. Note that in FIGS. 12A-12D the distal tip 110 has a hybrid rounded shaped tip housing 810 such as shown in FIGS. 8A-8E, having its outer distal edge more rounded than the central portion of the distal tip. A non-circular lower lumen 1122 is shown in this case. Imaging module 642 and LEDs 652 and 656 are also shown positioned within tip 110.

[0060] FIG. 13 is a schematic diagram illustrating various aspects of a handheld surgical endoscope, according to some embodiments. The cannula 120 is shown with upper fluid lumen 720 and lower fluid lumen 722. For clarity the handle 140 is not shown in detail but is functionally marked with a dashed rectangle. As can be seen, the upper lumen 720 is in fluid communication with proximal fluid port 172, working channel opening 170 and distal working channel port 830. The upper fluid lumen 720 is configured to be used for both passage of a surgical instrument and for fluid in-flow. The fluid in-flow path is from proximal fluid port 172, through lumen 720, out of tip 110 via distal working channel port 830 and into the patient, as shown by the dashed arrows. Passage of a surgical device (e.g. a needle) through lumen 720 is via working channel opening 170. On the proximal end of surgical endoscope 100 a wiper 1340 is shown attached to working channel opening 170 and and a cap 1350 is shown attached to proximal fluid port 172. When fluid port 172 is being used for introducing fluid into the patient, a syringe or other suitable device would be connected to port 172 instead of a cap. When a surgical instrument is being introduced through opening 170 then a wiper, such as wiper 1340, can be used which has an opening to allow for passage of the instrument. According to embodiment a duckbill valve can be provided in addition to or instead of wiper 1340, although a properly sized wiper will generally form better fluid seal than a duckbill when an instrument is present. When an instrument is not present a cap, such as cap 1350 can also be used on opening 170. Note that in FIG. 13, proximal fluid port 172 is shown angled slightly upwards instead of downwards as shown in other figures such as FIGS. 1-5, 14, 15B and 16. In general, the orientation of the fluid ports 132 and 172 (downwards, upwards or to a side) is a matter of design choice depending upon ergonomic and other considerations of the expected clinical application.

[0061] The lower fluid lumen 722 is configured to be used for both carrying the wires 522 as well as for fluid out-flow. The fluid out-flow path, also shown by dotted arrows, is out of the patient, through the two lower fluid ports 820 and 822 (of which only port 820 is visible), through lower lumen 722, through cut out 530 and out through distal fluid port 132. Note that although the fluids carried by the lumens 720 and 722 is often a liquid, in some embodiments one or both lumens can be used to carry gas (e.g. CO₂) or a mixture of liquid and gas. The wires 522 pass from the camera and LEDs in the distal tip 110, through lumen 722, out through cut out 1320 to connector 252. Note that between the cut out 1320 and connector 252 the wires 522 still reside within the handle 140. According to some embodiments a sealant 1322 is used within the handle 140 to prevent any fluid from passing within the handle 140 from lumen 722 to the connector 252 where liquid could cause a short or other malfunction by contacting bare wires or un-insulated connectors. Lumen 720 is also blocked by sealant 1330 to prevent any fluid from exiting distally into the handle 140. Note that sealing, such as using sealant 1322 and 1330 is used to prevent fluid leaking from lumen 722 into internal portions of the handle 140. In general, liquid leaking inside the handle 140 towards bare/un-insulated metal contacts or wires can be more troublesome than liquid traveling outside the handle 140 (such as dripping from openings 170 or 172) since such liquid is not visible. To prevent such internal leaks, an adequate distance d is provided where the distance d is measured between internal fluid cut out 530 or other point where fluid could leak internally to bare/uninsulated metal (such as connector pins, sockets, bare wire portions) and connector 252.

[0062] FIG. 14 is a perspective view of a handheld surgical endoscope, according to some embodiments. The display module 150 is rotatable about axis 452 as shown by arrow 1452 and as depicted supra, e.g. in FIG. 4. In addition, however, in the case shown in FIG. 14 the display module 150 is also rotatable about the handle's longitudinal axis 1402 as shown by solid arrow 1404 and dotted arrows 1406 and 1408. Example alternate positions for display module 150 are shown in dotted outlines 1416 and 1418. The positioning of the display module 150 at position 1418 can be particularly ergonomic in some cases, such as where the operator is left handed. In other cases the entire endoscope 1400 is sometimes rotated about axis 1402 while performing the surgical procedure or inspecting tissues. For example, rotating the endoscope about axis 1402 can effectively increase the field of view of the camera fixed to the distal tip because of the bent section near the distal end of the cannula. When the endoscope is rotated, the display module can be moved relative to the handle 140 in order to maintain the display in a relatively stationary position, or other ergonomic position.

[0063] FIGS. 15A-15C are perspective views illustrating various aspects of a handheld surgical endoscope shown in FIG. 14. In FIG. 15A, ring 1502 is visible which wraps around spindle 1522 shown in FIG. 15B. The ring 1502 has a plurality of pins 1520 on its inner surface that make electrical contact with the plurality of contact rings 1524 on spindle 1522. O-rings are provided on either side of the electrical contact of which O-ring 1540 is visible in FIG. 15B.

[0064] Note that in cases where display module 150 is fixed to the handle (i.e. not rotatable about the main axis of the endoscope, as in endoscope 100 shown in FIGS. 1-5), the video display is always in a fixed alignment with the camera module at the tip. However in cases where display module 150 is rotatable about the main axis 1402 of the endoscope (such as with endoscope 1400 shown in FIGS. 14 and 15A-15C), the display can be out of alignment with the camera module. When the endoscope 1400 is rotatable during a surgical procedure it is therefore useful to have some feedback to the user as to the rotational position of the bent portion of the tip. In such cases the fluid ports 132 and 172 can serve as an tactile feedback to aid user. According to some embodiments, in cases where display module 150 is rotatable about the main axis 1402 of the endoscope (such as with endoscope 1400 shown in FIGS. 14 and 15A-15C), an optical sensor 1552, shown in FIG. 15C, can be used to sense the rotational position of the display module 150 with respect to the handle 140 by reading an encoded pattern 1550 on the outer surface of spindle 1524. The rotational position of the display module 150 relative to the handle 140 (and therefore also to the camera module) can be used to automatically maintain alignment between the video image being displayed on display 450 and the camera module. According to some other embodiments, the rotational position information can instead be used to display a visual marker to the user on display 450 to provide further feedback.

[0065] FIG. 16 is a perspective view of a handheld surgical endoscope, according to some embodiments. In FIG. 16 the endoscope 1600 has a removable and re-usable display module 1650, just as in the case of display module 150 in endoscopes 100 and 1400 shown in FIGS. 1-5 and 14-15C, respectively. However, in the case of endoscope 1600, the display module 1650 and the handle 140 can communicate with each other via wi-fi or other wireless connection technology. In order to minimize the single-use portion of the endoscope 1600, sensor data from the camera module is transmitted via wireless transmission module 1642 in the handle 140 to the wireless transmission module 1652 on the display module 1650. Complex video functions such as video compression and recording can be carried out by the display module 1650. Some control processing is also carried out by the handle 140 but little or no user interface functionality need to be included in handle 140. For example user interface controls for video on/off, record, lighting, and exposure controls can all be provided via a touch screen graphical user interface on display module 1650. According to some embodiments, the wireless transmission module can alternatively be positioned in battery module 160 as shown by transmission module 1644. Positioning the transmission module 1644 in the re-usable battery module 160 instead of on the single use handle 140 further decreases the cost and complexity of the single use portion of endoscope 1600.

[0066] FIG. 17 is a perspective view of a handheld surgical endoscope configured for typically one-handed operation, according to some embodiments. The endoscope 1400 has a display module 150 that is rotatable relative to the handle 140 about a main handle axis 1402 such as shown by arrow 1704. In addition, however, the display module 150 has a strap 1710 attached via mounting 1712 which is dimensioned to wrap around the hand or wrist of a user as shown in FIG. 17. By attaching the display module 150 to the hand or wrist, the user can easily use one hand to rotate the handle cannula and tip of the endoscope 1400, as shown by the dashed arrows 1706 and 1708, while maintaining the display module 150 in a fixed or relatively fixed position for easy viewing. In particular, the strap 1710 effectively prevents display module 150 from rotating about axis 1402 despite the handle 140 and cannula 120 being rotated about the main longitudinal axis of cannula 120, Note that the longitudinal axis of cannula 120 and longitudinal axis of the handle 140 (axis 1402) will be parallel to each other but not necessarily the same depending on the design of the handle 140. Furthermore, by positioning the mounting 1712 near the axis 452, the display module 150 can still be rotated about that axis, which is perpendicular to the cannula axis 1402, as shown by arrow 1752. Allowing for one-handed operation frees up the user's other hand for other tasks such as manipulating a surgical implement such as surgical device 180 shown in FIG. 17 entering the working channel via opening 170. Although the display is shown in FIG. 17 as being attached to a user's left hand, the same or similar strap or fixing mechanism can be used to attach the display to the user's right hand, According to some embodiments, other techniques can be used to attach the display module 150 to the wrist or hand of the user, including bands and/or elastic loops which can be attached via snaps or Velcro, and open or closed ended clips.

[0067] FIG. 18 is a perspective view of a handheld surgical endoscope configured for typically one-handed operation, according to some other embodiments. In FIG. 18 the endoscope 1800 has a removable and re-usable display module 1850 that communicates with the handle 140 while not attached to the handle 140 either using a wireless communication unit 1852 or a flexible cable 1860. If wireless communication is used then this unit can be similar or identical to endoscope 1600 shown in FIG. 16. The display module 1850 has two metal clips 1810 and 1812 that are dimensioned and shaped to attach to the user's forearm as shown in FIG. 18. When attached to the user's forearm, the endoscope 1800 allows for one-handed operation of the endoscope similar to as described with respect to FIG. 17, including the ability to rotate the handle, cannula and tip about the main longitudinal axis, while maintaining the display in a fixed or relatively fixed orientation. As in the case of FIG. 17, the display module can be attached to the user's right or left arm (although attachment to the left forearm is shown in FIG. 18). Furthermore, other techniques can be used to attach the display module 150 to the user's left or right forearm, including, for example, clips otherwise similar to clips 1810 and 1812 but made of a non-metallic material, straps, bands, and/or elastic loops which can be attached via snaps or Velcro.

[0068] Although the foregoing has been described in some detail for purposes of clarity, it will be apparent that certain changes and modifications may be made without departing from the principles thereof. It should be noted that there are many alternative ways of implementing both the processes and apparatuses described herein. Accordingly, the present embodiments are to be considered as illustrative and not restrictive, and the body of work described herein is not to be limited to the details given herein, which may be modified within the scope and equivalents of the appended claims.