Endoscopic Methods and Devices for Transnasal Procedures

• US 20120265094A1
• Filed: 04/19/2012
• Published: 10/18/2012
• Est. Priority Date: 04/21/2004
• Status: Active Grant

• Current Assignee: Acclarent Incorporated (Johnson & Johnson)
• Original Assignee: Acclarent Incorporated (Johnson & Johnson)
• Inventors: Goldfarb, Eric, Jenkins, Thomas R., Kim, Isaac J., Vo, Tom T., Wisted, Thomas J., Harfe, Daniel T.
• Granted Patent: US 9,468,362 B2
• Time in Patent Office: Days
• US Class Current: 600/562
• CPC Class Codes: A61B 1/0014 Fastening element for attaching accessories to the outside of an endoscope, e.g. clips, clamps or bands
• CPC Class Codes: A61B 1/00154 using guiding arrangements for insertion
• CPC Class Codes: A61B 1/00165 with light-conductive means, e.g. fibre optics A61B1/07 takes precedence
• CPC Class Codes: A61B 1/0051 with controlled bending of insertion part
• CPC Class Codes: A61B 1/01 Guiding arrangements therefore
• CPC Class Codes: A61B 1/018 for receiving instruments
• CPC Class Codes: A61B 1/04 combined with photographic or television appliances
• CPC Class Codes: A61B 1/0607 for annular illumination
• CPC Class Codes: A61B 1/07 using light-conductive means, e.g. optical fibres
• CPC Class Codes: A61B 1/233 for the nose, i.e. nasoscopes , e.g. testing of patency of Eustachian tubes
• CPC Class Codes: A61B 17/24 for use in the oral cavity, larynx, bronchial passages or nose for medical inspection of cavities or tubes in the body A61B1/00; Tongue scrapers
• CPC Class Codes: A61B 2017/246 for cleaning of the nose

Abstract

Medical devices, systems and methods that are useable to facilitate transnasal insertion and positioning of guidewires and various other devices and instruments at desired locations within the ear, nose, throat, paranasal sinuses or cranium. Direct viewing of such placements via an endoscope.

Claims

1. A method for positioning a guide device useful for delivering at least one working device therethrough to deliver a working end portion of the at least one working device to a desired location within the ear, nose, throat or cranium of a human or animal patient, said method comprising the steps of:

inserting an endoscope into or through an endoscope channel of the guide device that includes an elongated shaft;

inserting the guide device into an internal space of the patient; and

viewing through the endoscope to guide positioning and delivery of the guide device to an intended location in the patient.

3. The method of claim 1, wherein the endoscope has a rigid shaft.

4. The method of claim 1, wherein the endoscope has a flexible shaft.

5. The method of claim 1, wherein the endoscope is semi-rigid.

6. The method of claim 1, further comprising cleaning a lens of the endoscope using at least one of irrigation and suction, while the lens is located in the internal space of the patient.

7. The method of claim 1, further comprising:

inserting a guidewire through a working device lumen of the guide device;

advancing a distal end portion of the guidewire distally of a distal end of the working device lumen; and

viewing, via the endoscope, advancement of the guidewire distally of the guide device.

8. The method of claim 7, further comprising viewing, via the endoscope, entry of the distal end portion of the guidewire into a sinus ostium.

9. The method of claim 8, further comprising identifying the sinus ostium as a sinus ostium other than a target sinus ostium, retracting the distal end of the guidewire out of the sinus ostium, and redirecting the guidewire, wherein said identifying, retracting and redirecting steps are visualized via the endoscope.

10. The method of claim 9, further comprising viewing, via the endoscope, entry of the distal end portion of the guidewire into the target sinus ostium upon said redirecting and advancing the distal end portion of the guidewire into the target ostium facilitated by visualization through the endoscope.

11. The method of claim 7, wherein the guidewire is an illuminating guidewire.

12. The method of claim 11, wherein visualization through the endoscope is enhanced by light emitted by the illuminating guidewire.

13. The method of claim 8, further comprising advancing a working device over the guidewire and visualizing, via the endoscope, advancement of a working end portion of the working device distally of the guide device.

14. The method of claim 13 further comprising viewing, via the endoscope, entry of the working end portion of the working device into a sinus ostium.

15. The method of claim 14 wherein the working device comprises a balloon catheter and the working end portion comprises a balloon, said method further comprising visualizing, via the endoscope, inflation of the balloon to dilate the sinus ostium.

16. The method of claim 15 further comprising visualizing, via the endoscope, deflation of the balloon and retraction of the balloon from the sinus ostium.

17. The method of claim 16 further comprising visualizing, via the endoscope, the sinus ostium having been dilated by the balloon.

18. The method of claim 17 further comprising determining, after said visualizing the sinus ostium having been dilated, whether the sinus ostium has been dilated sufficiently, or whether the balloon needs to be reinserted and inflated to perform additional dilation.

2. The method of claim 2, wherein the guide device is inserted through a nostril of the patient.

19-23. -23. (canceled)

24. A method for treating a patient;

said method comprising the steps of;

inserting an endoscope into or through an endoscope channel of a guide device that includes an elongated shaft;

inserting the guide device through a nostril of the patient;

advancing a distal end portion of the guide device toward a sinus ostium of the patient;

advancing a distal end portion of the endoscope distally of the distal end portion of the guide device, and navigating the distal end portion of the endoscope through the sinus ostium, said navigating being assisted by visualization through the endoscope.

25. The method of claim 24, wherein said advancing a distal end portion of the guide device is assisted by visualization of the distal end portion through the endoscope.

26. The method of claim 24, wherein the distal end portion of the endoscope is navigated through the sinus ostium after dilation of the sinus ostium, and wherein a procedure to dilate the ostium is visualized via the endoscope.

27. The method of claim 24, wherein the distal end portion of the endoscope is navigated through the sinus ostium without first dilating the sinus ostium.

28. The method of claim 24, further comprising viewing the sinus cavity that the sinus ostium opens to, via the endoscope, to assess efficacy of a previously preformed therapy or perform a diagnosis.

29. The method of claim 24, further comprising:

inserting a working device through a working device channel of the guide device;

advancing a working end portion of the working device distally of a distal end of the guide device and into the sinus ostium; and

performing at least one therapeutic step in the sinus cavity that the sinus ostium opens to.

30. The method of claim 29, wherein the at least one therapeutic step is selected from one or more of:

local during delivery, regional drug delivery, suction, irrigation, biopsy, polyp removal, fungal ball removal, or removal of mass.

31. The method of claim 29, wherein said advancing a working end portion is visualized via the endoscope, prior to navigating the distal end of the endoscope into the sinus ostium.

32. The method of claim 29, wherein the working device is selected from at least one of:

guidewires, graspers, cutters, punches, flexible microdebriders, dissectors, electrodes, lasers, suction catheters, irrigation catheters and balloon catheters.

33. A method of visually inspecting a sinus cavity, said method comprising the steps of:

inserting an endoscope through a lumen of a working device having previously been inserted through a nostril of a patient, through a sinus ostium and into the sinus cavity; and

viewing the sinus cavity through the endoscope.

34. The method of claim 33, the working device having been inserted through a lumen of a guide device inserted through the nostril and advanced toward the sinus ostium.

35. The method of claim 33, wherein the working device is an irrigation catheter.

36. The method of claim 33, wherein the working device is a balloon catheter.

37. A method of directing a guidewire to a target location within the ear, nose, throat or cranium of a patient, said method comprising the steps of:

inserting an illuminating guidewire internally of the patient;

emitting light from a distal end portion of the guidewire; and

tracking movements of the distal end portion of the guidewire by tracking movements of an illumination spot visible externally of the patient, wherein movements of the illumination spot correspond to movements of the distal end portion of the guidewire internally of the patient.

38. The method of claim 37, further comprising confirming placement of the distal end portion of the guidewire in the target location by assessing a location of the illumination spot external of the target location.

39-65. -65. (canceled)