Endoscopic methods and devices for transnasal procedures

• US 9,468,362 B2
• Filed: 04/19/2012
• Issued: 10/18/2016
• 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.
• Primary Examiner(s): SZPIRA, JULIE ANN
• Application Number:
  US13/451,453
• Publication Number:
  US 20120265094A1
• Time in Patent Office: 1,643 Days
• US Class Current: 1/1
• 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 configured 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, wherein the guide device defines a longitudinal axis and comprises an elongated shaft including a first tube defining a first channel and a second tube defining a second channel, wherein the second tube extends along the first tube, wherein the first tube comprises a first distal tip and the second tube comprises an angled second distal tip disposed at an oblique angle relative to the longitudinal axis, wherein the angled second distal tip extends distally from the second tube to at least the first distal tip, the method comprising the steps of:

(a) inserting an endoscope into or through the first channel of the guide device;

(b) inserting the guide device into an internal space of the patient;

(c) advancing the endoscope relative to the first channel such that an end of the endoscope traverses the angled second distal tip of the second tube; and

(d) viewing the internal space via the endoscope to guide positioning and delivery of the guide device to an intended location in the patient.

2. The method of claim 1, wherein the guide device is inserted through a nostril of the patient.

3. 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.

4. The method of claim 1, further comprising:

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

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

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

5. The method of claim 4, further comprising viewing, via the endoscope, entry of the distal end portion of the guidewire into a sinus ostium.

6. The method of claim 5, 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.

7. The method of claim 6, 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.

8. The method of claim 1, further comprising:

(a) advancing a working device into the second channel,

(b) advancing the working device relative to the second channel such that an end of the working device traverses the angled distal tip of the second tube and exits from the second channel and enters the internal space, and

(c) visualizing the working device in the internal space with the endoscope.

9. The method of claim 8 further comprising viewing, via the endoscope, entry of the working end portion of the working device into a sinus ostium.

10. The method of claim 9 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.

11. The method of claim 10 further comprising:

(a) visualizing, via the endoscope, deflation of the balloon and retraction of the balloon from the sinus ostium; and

(b) folding the balloon into the second channel via the angled second distal tip.

12. The method of claim 11 further comprising visualizing, via the endoscope, the sinus ostium having been dilated by the balloon.

13. The method of claim 1, wherein the angled second distal tip extends distally from the second tube beyond the first distal tip, and advancing the endoscope further comprises advancing the endoscope relative to the first channel such that the end of the endoscope traverses the first distal tip of the first tube and then traverses the second distal tip of the second tube.

14. The method of claim 1, wherein the angled second distal tip defines a scooped tip, wherein the second tube defines a tube profile and the scooped tip defines a tip profile, and wherein the tip profile is less than the second tube profile such that the tip profile has a reduced cross-sectional area relative to the second tube profile.

15. The method of claim 1, further comprising inserting the angled second distal tip of the second tube through a sinus ostium and into the internal space of the patient without first dilating the sinus ostium.

16. The method of claim 1, further comprising introducing at least the angled second distal tip of the second tube behind an uncinate process within the head.

17. A method for positioning a guide device in a head of a patient, wherein the guide device defines a longitudinal axis and comprises an elongated shaft including a first tube defining a first channel and a second tube defining a second channel, wherein the second tube extends along the first tube, wherein the first tube comprises a first distal tip and the second tube comprises an angled second distal tip disposed at an oblique angle relative to the longitudinal axis, wherein the angled second distal tip extends distally from the second tube to at least the first distal tip, the method comprising the steps of:

(a) inserting an endoscope into or through the first channel;

(b) inserting the guide device and the endoscope into a nostril of the patient;

(c) advancing the endoscope relative to the first channel such that an end of the endoscope traverses the angled second distal tip of the second tube;

(d) visualizing an internal space via the endoscope to position the guide device at an intended location in the head of the patient;

(e) inserting a working device into the second channel;

(f) advancing the working device relative to the second channel such that an end of the working device traverses the angled second distal tip of the second tube and exits from the second channel and enters the internal space;

(g) visualizing the working device in the internal space with the endoscope; and

(h) introducing at least the angled second distal tip of the second tube behind an uncinate process within the head.

18. The method of claim 17, further comprising inserting the angled second distal tip of the second tube through the sinus ostium and into the internal space of the patient without first dilating a sinus ostium.

19. The method of claim 18, wherein the angled second distal tip extends distally from the second tube beyond the first distal tip, and advancing the endoscope further comprises advancing the endoscope relative to the first channel such that the end of the endoscope traverses the first distal tip of the first tube and then traverses the second distal tip of the second tube.

20. A method for positioning a guide device in a head of a patient, wherein the guide device defines a longitudinal axis and comprises an elongated shaft including a first tube defining a first channel and a second tube defining a second channel, wherein the second tube extends along the first tube channel, wherein the first tube comprises a first distal tip and the second tube comprises an angled second distal tip disposed at an oblique angle relative to the longitudinal axis, wherein the angled second distal tip extends distally from the second tube to at least the first distal tip, wherein the angled second distal tip is configured to provide access to a sinus ostium, the method comprising the steps of:

(a) inserting an endoscope into or through the first channel;

(b) inserting the guide device and the endoscope into a nostril of the patient;

(c) advancing the endoscope relative to the first channel such that an end of the endoscope traverses the angled second distal tip of the second tube;

(d) visualizing an internal space via the endoscope to position the guide device at or near a sinus ostium;

(e) inserting a working device into the second channel;

advancing the working device relative to the second channel such that an end of the working device traverses the angled second distal tip of the second tube and exits from the second channel and is within or adjacent to the sinus ostium;

(g) visualizing the working device relative to the sinus ostium with the endoscope; and

(h) inserting the angled second distal tip of the second tube through the sinus ostium and into the internal space of the patient without first dilating the sinus ostium.