Endoscopic methods and devices for transnasal procedures

• US 9,107,574 B2
• Filed: 12/08/2011
• Issued: 08/18/2015
• Est. Priority Date: 04/21/2004
• Status: Active Grant

• Current Assignee: Acclarent Incorporated (Johnson & Johnson)
• Original Assignee: Acclarent Incorporated (Johnson & Johnson)
• Inventors: Goldfarb, Eric, Morriss, John, Chang, John Y.
• Primary Examiner(s): KASZTEJNA, MATTHEW JOHN
• Application Number:
  US13/315,191
• Publication Number:
  US 20120136207A1
• Time in Patent Office: 1,349 Days
• Field of Search: 600/115, 600121-125, 600/151
• US Class Current: 1/1
• CPC Class Codes: A61B 1/00126 optical, e.g. for light supply cables
• CPC Class Codes: A61B 1/063 for monochromatic or narrow-band illumination
• CPC Class Codes: A61B 1/0684 using light emitting diodes [LED]
• 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
• CPC Class Codes: A61B 2018/2222 Fibre material or composition
• CPC Class Codes: A61B 2018/2244 Features of optical fibre cables, e.g. claddings
• CPC Class Codes: A61B 2034/2055 Optical tracking systems
• CPC Class Codes: A61B 2090/306 using optical fibres
• CPC Class Codes: A61B 2217/005 with suction drainage system
• CPC Class Codes: A61B 2562/228 Sensors with optical connectors
• 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 5/0084 for introduction into the body, e.g. by catheters A61B5/1459 takes precedence
• CPC Class Codes: A61B 5/061 Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body A61B1/00158 takes precedence
• CPC Class Codes: A61B 5/062 using magnetic field
• CPC Class Codes: A61B 5/064 using markers A61B5/062 takes precedence
• CPC Class Codes: A61B 5/6851 Guide wires
• CPC Class Codes: A61M 2025/0166 Sensors, electrodes or the like for guiding the catheter to a target zone, e.g. image guided or magnetically guided
• CPC Class Codes: A61M 2025/09008 : having a balloon
• CPC Class Codes: A61M 2025/09083 : having a coil around a core
• CPC Class Codes: A61M 2025/09125 : Device for locking a guide wire in a fixed position with respect to the catheter or the human body
• CPC Class Codes: A61M 2025/09166 : having radio-opaque features
• CPC Class Codes: A61M 2025/09175 : having specific characteristics at the distal tip
• CPC Class Codes: A61M 2029/025 : characterised by the guiding element
• CPC Class Codes: A61M 25/0105 : Steering means as part of the catheter or advancing means; Markers for positioning systems for detection of markers A61B
• CPC Class Codes: A61M 25/09 : Guide wires
• CPC Class Codes: A61M 29/02 : Dilators made of swellable material balloon catheters for angioplasty A61M25/104
• CPC Class Codes: G02B 23/2469 : using optical fibres
• CPC Class Codes: G02B 6/0006 : Coupling light into the fibre in general G02B6/4298
• CPC Class Codes: G02B 6/0008 : the light being emitted at the end of the fibre
• CPC Class Codes: G02B 6/04 : formed by bundles of fibres G02B6/24 takes precedence
• CPC Class Codes: G02B 6/1228 : Tapered waveguides, e.g. integrated spot-size transformers for coupling with fibres G02B6/305
• CPC Class Codes: G02B 6/125 : Bends, branchings or intersections
• CPC Class Codes: G02B 6/241 : Light guide terminations
• CPC Class Codes: G02B 6/262 : Optical details of coupling light into, or out of, or between fibre ends, e.g. special fibre end shapes or associated optical elements
• CPC Class Codes: G02B 6/4292 : the light guide being disconnectable from the opto-electronic element, e.g. mutually self aligning arrangements

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.

Claims

1. A method for locating a sinus ostium, said method comprising the steps of:

inserting an endoscope through a nostril of a patient and advancing the endoscope along a longitudinal path toward a location of the sinus ostium;

positioning the distal end of the endoscope such that a pathway toward the sinus ostium is within the field of view of the endoscope;

inserting an illuminating guidewire through the nostril and advancing a distal end portion of the illuminating guidewire distally of a distal end of the endoscope, wherein the acts of inserting the illuminating guidewire and advancing the distal end portion are performed while maintaining the longitudinal position of the endoscope along the longitudinal path to keep the pathway toward the sinus ostium within the field of view of the endoscope; and

viewing, through the endoscope, the advancement of the distal end portion of the illuminating guidewire into the field of view including the pathway toward the sinus ostium.

2. The method of claim 1, further comprising directing the distal end portion of the illuminating guidewire, under guidance facilitated by visualization of the distal end portion via the endoscope, into the sinus ostium.

3. The method of claim 2, wherein visualization through the endoscope is enhanced by light emitted by the illuminating guidewire.

4. The method of claim 2, further comprising confirming that the distal end portion of the illuminating guidewire has been inserted into a desired sinus by observing transillumination effects produced by the illumination from the distal end portion of the illuminating guidewire having been inserted through the sinus ostium and into the sinus.

5. The method of claim 2, further comprising advancing a working device over the illuminating guidewire and performing a diagnostic or therapeutic step with regard to at least one of the sinus ostium and a sinus that the sinus ostium opens to.

6. The method of claim 1, wherein the sinus ostium is a naturally occurring ostium.

7. A method for locating a sinus ostium, said method comprising the steps of:

inserting an endoscope through a nostril of a patient and advancing the endoscope toward a location of the sinus ostium;

positioning the endoscope proximate to the sinus ostium;

inserting an illuminating guidewire through the nostril and advancing a distal end portion of the illuminating guidewire distally toward the sinus ostium; and

viewing, through the endoscope, the advancement of the distal end portion of the illuminating guidewire toward the sinus ostium, wherein the act of viewing the distal end portion of the illuminating guidewire comprises viewing a paranasal passageway and the distal end portion of the illuminating guidewire simultaneously.

8. A method for locating a sinus ostium, said method comprising the steps of:

inserting an endoscope through the nostril of a patient;

advancing the endoscope longitudinally through the nostril toward the sinus ostium;

halting the advancement of the endoscope toward the sinus ostium while the endoscope is positioned within a paranasal cavity;

inserting an illuminating guidewire through the nostril;

advancing the illuminating guidewire relative to the endoscope toward the sinus ostium; and

viewing a distal end portion of the illuminating guidewire through the endoscope as the illuminating guidewire advances relative to the endoscope toward the sinus ostium.