Method and apparatus for guiding an instrument to a target in the lung

• US 20060184016A1
• Filed: 01/18/2006
• Published: 08/17/2006
• Est. Priority Date: 01/18/2005
• Status: Active Grant

• Current Assignee: Philips Electronics Limited (Koninklijke Philips N.V.)
• Original Assignee: Philips Electronics Limited (Koninklijke Philips N.V.)
• Inventors: Glossop, Neil David
• Granted Patent: US 8,611,983 B2
• Time in Patent Office: Days
• US Class Current: 600/434
• CPC Class Codes: A61B 1/2676 Bronchoscopes
• CPC Class Codes: A61B 2017/0034 adapted to be inserted through a working channel of an endoscope
• CPC Class Codes: A61B 2017/00694 with means correcting for movement of or for synchronisation with the body
• CPC Class Codes: A61B 2017/00809 Lung operations
• CPC Class Codes: A61B 2017/22038 with a guide wire
• CPC Class Codes: A61B 2034/2051 Electromagnetic tracking systems
• 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 90/36 Image-producing devices or illumination devices not otherwise provided for
• CPC Class Codes: A61M 2025/09191 made of twisted wires
• CPC Class Codes: A61M 25/00 Catheters; Hollow probes dilators A61M29/00; peritoneal catheters A61M1/285; tracheal tubes A61M16/04; for drainage A61M27/00; for uterus, vagina or rectum A61M31/00 ; for measuring or testing A61B; materials for catheters A61L29/00
• CPC Class Codes: A61M 25/0113 Mechanical advancing means, e.g. catheter dispensers
• CPC Class Codes: A61M 25/0133 Tip steering devices
• CPC Class Codes: A61M 25/0136 Handles therefor

Abstract

The invention provides methods and apparatus for navigating a medical instrument to a target in the lung. In one embodiment, the invention includes inserting a bronchoscope into the lung, inserting a catheter into the lung through the working channel of the bronchoscope, inserting a tracked navigation instrument wire into the lung through the catheter, navigating the tracked navigation instrument through the lung to the target, advancing the catheter over the tracked navigation instrument to the target, removing the tracked navigation instrument from the catheter, and inserting a medical instrument into the catheter, thus bringing the medical instrument in proximity to the target.

Claims

1. An apparatus for guiding a medical instrument to a target in a lung of a patient, wherein one or more positions of a tracked navigation instrument within the lung are sampled and used to produce a display of the tracked navigation instrument in the lung, the apparatus comprising:

a lumen for insertion into the lung;

a tracked navigation instrument for insertion into the lung through the interior of the lumen, wherein a tip of the tracked navigation instrument is advanced to the target using the display of the tracked navigation instrument in the lung, and wherein the lumen is advanced over the tracked navigation instrument to the target; and

a medical instrument for insertion through the lumen to the target.

2. The apparatus of claim 1, wherein the tracked navigation instrument includes one or more position indicating elements, and wherein the one or more positions of the tracked navigation instrument are detected by a tracking system that detects the position of the one or more position indicating elements.

3. The apparatus of claim 2, wherein the tracking system is an electromagnetic tracking system.

4. The apparatus of claim 1, wherein the lumen is within a bronchoscope.

5. The apparatus of claim 1, further comprising a motion compensation device selected from one or more of:

a dynamic referencing device, a respiratory gating device, a spirometer, a breath temperature sensor, an oxygen sensor, a carbon dioxide sensor, a signal from a respirator, an extensometer, an electrocardiograph, or a cardiac gating device.

6. The apparatus of claim 5, wherein the motion compensation device gathers motion compensation information that is used to compensate for patient motion in the display.

7. The apparatus of claim 5, wherein the motion compensation device is for application to the interior of the patient.

8. The apparatus of claim 1, wherein the tracked navigation instrument has a bent tip.

9. The apparatus of claim 8, wherein the tracked navigation instrument is navigated to the target by manipulating the bent tip to point into a passageway of the lung leading to the target while viewing a position of the bent tip on the display, and advancing the tracked guidewire into the passageway.

10. The apparatus of claim 1, wherein the target is one of a lesion, a mass, or a tumor.

11. The apparatus of claim 1, wherein the tracked navigation instrument is one of a guidewire, a catheter, a needle, a biopsy device, a brush, a laser, a grasping device, an irrigation device, a radio frequency ablation device, a bronchoscope, or an ultrasound probe.

12. The apparatus of claim 1, wherein the medical instrument is one of a catheter, a needle, a biopsy device, a brush, a laser, a grasping device, an irrigation device, a radio frequency ablation device, a bronchoscope, or an ultrasound probe.

13. A method for guiding a medical instrument to a target in a lung of a patient, the method comprising:

inserting a lumen into the lung;

inserting a tracked navigation instrument into the lung though the lumen;

navigating the tracked navigation instrument to the target using a display of the tracked navigation instrument within the lung relative to the target;

advancing the lumen over the tracked navigation instrument to the target;

navigating the medical instrument to the target through the lumen.

14. The method of claim 13, wherein the tracked navigation instrument includes one or more position indicating elements, and wherein the one or more positions of the tracked navigation instrument are detected by a tracking system that detects the position of the one or more position indicating elements.

15. The method of claim 14, wherein the tracking system is an electromagnetic tracking system.

16. The method of claim 13, wherein the lumen is within a bronchoscope.

17. The method of claim 13, further comprising applying a motion compensation device that is selected from one or more of:

a dynamic referencing device, a respiratory gating device, a spirometer, a breath temperature sensor, an oxygen sensor, a carbon dioxide sensor, a signal from a respirator, an extensometer, an electrocardiograph, or a cardiac gating device.

18. The method of claim 17, wherein the motion compensation device gathers motion compensation information that is used to compensate for patient motion on the display.

19. The method of claim 17, wherein the motion compensation device is applied to the interior of the patient.

20. The method of claim 13, wherein the medical instrument is the tracked navigation instrument.

21. The method of claim 13, wherein the tracked navigation instrument has a bent tip.

22. The method of claim 21, wherein navigating the tracked navigation instrument further comprises manipulating the bent tip to point into a passageway of the lung leading to the target while viewing a position of the bent tip on the display, and advancing the tracked navigation instrument into the passageway.

23. The method of claim 13, wherein the target is one of a lesion, a mass, or a tumor.

24. The method of claim 13, wherein the tracked navigation instrument is one of a guidewire, a catheter, a needle, a biopsy device, a brush, a laser, a grasping device, an irrigation device, a radio frequency ablation device, a bronchoscope, or an ultrasound probe.

25. The method of claim 13, wherein the medical instrument is one of a catheter, a needle, a biopsy device, a brush, a laser, a grasping device, an irrigation device, a radio frequency ablation device, a bronchoscope, or an ultrasound probe.

26. A method for guiding a medical instrument to a target in a lung of a patient, the method comprising:

performing a registration of the lung using at least one image of the lung and position information regarding one or more positioning indicating elements within the lung;

inserting a bronchoscope having a working channel into the lung;

verifying the registration;

inserting a catheter into the lung through the working channel of the bronchoscope;

inserting a tracked navigation instrument into the lung though the catheter;

navigating the tracked navigation instrument to the target using a display of the tracked navigation instrument within the lung relative to the target on the at least one image of the lung;

advancing the catheter over the tracked guidewire to the target;

navigating the medical instrument to the target through the catheter.