DEVICES AND METHODS FOR PERFORMING MEDICAL PROCEDURES IN TREE-LIKE LUMINAL STRUCTURES

• US 20100041949A1
• Filed: 03/12/2008
• Published: 02/18/2010
• Est. Priority Date: 03/12/2007
• Status: Active Grant

• Current Assignee: David Tolkowsky
• Original Assignee: David Tolkowsky
• Inventors: Tolkowsky, David
• Granted Patent: US 8,821,376 B2
• Time in Patent Office: Days
• US Class Current: 600/109
• CPC Class Codes: A61B 1/0052 Constructional details of control elements, e.g. handles
• CPC Class Codes: A61B 1/018 for receiving instruments
• CPC Class Codes: A61B 1/2676 Bronchoscopes
• CPC Class Codes: A61B 17/00491 Surgical glue applicators surgical adhesives A61L24/00; two-component delivery syringes A61M5/19
• CPC Class Codes: A61B 17/12104 in an air passage
• CPC Class Codes: A61B 17/12159 Solid plugs; being solid before insertion
• CPC Class Codes: A61B 2017/1205 Introduction devices
• CPC Class Codes: A61B 2034/105 Modelling of the patient, e.g. for ligaments or bones
• CPC Class Codes: A61B 2034/2051 Electromagnetic tracking systems
• CPC Class Codes: A61B 2090/364 Correlation of different images or relation of image positions in respect to the body
• CPC Class Codes: A61B 2090/365 augmented reality, i.e. correlating a live optical image with another image
• CPC Class Codes: A61B 2090/3735 Optical coherence tomography [OCT]
• CPC Class Codes: A61B 2090/378 using ultrasound
• CPC Class Codes: A61B 34/20 Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 5/064 using markers A61B5/062 takes precedence
• CPC Class Codes: A61B 5/066 Superposing sensor position on an image of the patient, e.g. obtained by ultrasound or x-ray imaging
• CPC Class Codes: A61B 5/7285 for synchronising or triggering a physiological measurement or image acquisition with a physiological event or waveform, e.g. an ECG signal A61B6/5205, A61B6/541, A61B8/5207, A61B8/543 take precedence
• CPC Class Codes: A61B 5/742 using visual displays A61B5/339 takes precedence
• CPC Class Codes: A61B 6/03 Computed tomography [CT] echo-tomography A61B8/14
• CPC Class Codes: A61B 6/466 adapted to display 3D data
• CPC Class Codes: A61B 6/5247 : combining images from an ionising-radiation diagnostic technique and a non-ionising radiation diagnostic technique, e.g. X-ray and ultrasound
• CPC Class Codes: A61B 6/541 : involving acquisition triggered by a physiological signal
• CPC Class Codes: A61B 8/12 : in body cavities or body tracts, e.g. by using catheters catheters per se A61M25/00
• CPC Class Codes: A61B 8/4254 : using sensors mounted on the probe
• CPC Class Codes: A61B 8/5238 : for combining image data of patient, e.g. merging several images from different acquisition modes into one image for image registration algorithms G06T7/30
• CPC Class Codes: A61B 8/543 : involving acquisition triggered by a physiological signal
• CPC Class Codes: A61B 90/36 : Image-producing devices or illumination devices not otherwise provided for
• CPC Class Codes: A61B 90/361 : Image-producing devices, e.g. surgical cameras

Abstract

Apparatus is described for use with an imaging device (31) that acquires a pre-procedure image of a portion of a subject'"'"'s body disposed at a pre-procedure position. An input unit receives from a user an indication of two or more lines within the image that correspond to respective branches of a multi-branch luminal structure. A probe (1) moves within the portion along two or more lines in the structure that respectively correspond to the two or more lines within the image. A location sensor (18) coupled to the probe senses location coordinates along the two or more lines, while the portion is at a current position. A control unit (34) registers the image of the portion with the portion'"'"'s current position by registering (a) the two or more lines within the image, with (b) the location coordinates along the two or more lines. Other embodiments are also described.

Claims

1-23. -23. (canceled)

24. Apparatus for use with (a) an airway of a subject, the airway leading to a region suffering from pulmonary disease, (b) an imaging device configured to acquire a pre-procedure image of a portion of the subject'"'"'s body that includes at least a portion of the region, and (c) a display configured to display the acquired image, the apparatus comprising:

a plug configured to be placed in the airway, the plug defining an opening therethrough that is in an open state thereof when something is inserted through the opening and is in a closed state thereof when nothing is inserted through the opening;

a tool having a distal portion configured to be inserted through the opening to a site distal to the plug and to facilitate suctioning therethrough of fluid, the fluid being disposed within the region and distal to the plug; and

a location sensor coupled to the distal portion of the tool, configured (a) to sense a location of the distal portion of the tool when the distal portion of the tool is at the site distal to the plug and (b) to facilitate location of the distal portion of the tool in the acquired image.

25. The apparatus according to claim 24, wherein the tool comprises a sheath and wherein the location sensor is attached to the sheath.

26. The apparatus according to claim 24, further comprising an endoscope configured to be inserted into the airway, the endoscope being unable to be inserted through the opening, wherein the tool is configured to be inserted through the opening by protruding from a distal end of the endoscope.

27. The apparatus according to claim 24, further comprising a sheath, wherein the tool is configured to be inserted through the sheath.

28. The apparatus according to claim 27, wherein the location sensor is attached to the distal portion of the tool.

29. The apparatus according to claim 27, wherein the location sensor is coupled to the distal portion of the tool via the sheath.

30. The apparatus according to claim 29, wherein the location sensor is attached to the sheath.

31. The apparatus according to claim 24, wherein the apparatus comprises a control unit configured to:

register the pre-procedure image of the portion with a current position of the portion, and

generate an indication of the distal portion of the tool at a location within the registered image that corresponds to the sensed location of the distal portion of the tool.

32. The apparatus according to claim 31,

wherein the tool is configured to be moved along a plurality of lines within the portion,

wherein the location sensor is configured to sense location coordinates along two or more lines along which the tool moves, while the portion is at a current position, and

wherein the control unit is configured:

to register the pre-procedure image of the portion with the current position of the portion,

by registering (c) two or more lines within the pre-procedure image that correspond to the two or more lines along which the tool moves, with (d) the location coordinates along the two or more lines along which the tool moves.

33. The apparatus according to claim 24, wherein the tool is configured to be directed toward respective single bullae of the region, and to facilitate suctioning through the tool of fluid from within the respective single bullae.

34. The apparatus according to claim 33, further comprising:

a sheath, the tool being configured to be inserted through the sheath; and

an endoluminal imaging probe configured to be inserted through the sheath and to facilitate verification of a location of the sheath with respect to the respective bullae.

35. The apparatus according to claim 33, wherein the tool is configured to suction fluid from within each of the single bullae a plurality of times.

36-88. -88. (canceled)

89. A method for use with an airway of a subject, the airway leading to a region suffering from pulmonary disease, the method comprising:

acquiring a pre-procedure image of a portion of the subject'"'"'s body that includes at least some of the region;

inserting a plug in the airway, the plug defining an opening therethrough that is in an open state thereof when something is inserted through the opening and is in a closed state thereof when nothing is inserted through the opening;

inserting a suctioning tool through the opening in the plug and toward fluid that is disposed (a) within the region and (b) distal to the plug;

generating an indication of a location of a distal portion of the tool within the pre-procedure image, when the distal portion of the tool is distal to the plug, by sensing a location of the distal portion of the tool;

directing the distal portion of the tool toward the fluid using the indication of the location of the distal portion within the pre-procedure image; and

suctioning the fluid through the tool subsequent to the directing of the distal portion of the tool toward the fluid.

90. The method according to claim 89,

further comprising inserting an endoscope into the airway,

wherein inserting the suctioning tool through the opening comprises advancing the tool via the endoscope, beyond a distal end of the endoscope, and

wherein the method does not comprise inserting the endoscope through the opening.

91. The method according to claim 89, further comprising placing the tool in the airway via a sheath.

92. The method according to claim 89, wherein generating the indication of the location of the distal portion of the tool within the pre-procedure image comprises:

registering the pre-procedure image of the portion with a current position of the portion; and

generating an indication of the distal portion of the tool at a location within the registered image that corresponds to the sensed location of the distal portion of the tool.

93. The method according to claim 92,

further comprising moving the suctioning tool along a plurality of lines within the portion,

wherein sensing the location of the distal portion of the tool comprises sensing location coordinates along two or more lines along which the tool moves, while the portion is at the current position, and

wherein registering comprises registering (c) two or more lines within the pre-procedure image that correspond to the two or more lines along which the tool moves, with (d) the location coordinates along the two or more lines along which the tool moves.

94. The method according to claim 89, wherein directing the distal portion of the tool toward the fluid comprises directing the distal portion of the tool toward respective single bullae of the region, and wherein suctioning the fluid through the tool comprises suctioning fluid through the tool from within the respective single bullae.

95. The method according to claim 94, further comprising:

inserting the suctioning tool through a sheath; and

facilitating verification of a location of the sheath with respect to the respective single bullae by endoluminal imaging.

96. The method according to claim 94, wherein suctioning the fluid comprises suctioning fluid from within each of the respective single bullae a plurality of times.

97-115. -115. (canceled)