There is disclosed medical apparatus of the type for use in surgery such as transanal endoscopic microsurgery, as well as methods of providing access to, inspecting and enabling surgery within a body passage. In one embodiment of the invention, medical apparatus in the form of a rectal expander (10)
There is disclosed medical apparatus of the type for use in surgery such as transanal endoscopic microsurgery, as well as methods of providing access to, inspecting and enabling surgery within a body passage. In one embodiment of the invention, medical apparatus in the form of a rectal expander (10) is disclosed, the expander (10) being adapted for location at least partly within a body passage such as the rectum (12) of a patient (14), the expander (10) having a leading end (18) and an access area in the form of an opening (20) for access from the expander (10) into the rectum (12), at least part of the opening (20) being spaced from the leading end (18), and the expander (10) being controllably movable between collapse and expansion positions, for expanding the rectum (12).
대표청구항▼
1. A medical apparatus for location at least partly within a body passage and for expanding the body passage, the apparatus comprising: a tubular guide member extending between a leading end and a trailing end, wherein the trailing end having an inlet providing access into the tubular guide member,
1. A medical apparatus for location at least partly within a body passage and for expanding the body passage, the apparatus comprising: a tubular guide member extending between a leading end and a trailing end, wherein the trailing end having an inlet providing access into the tubular guide member, the tubular guide member further having an aperture in a side wall thereof for permitting access into the body passage from the inlet at the trailing end;a handle secured to the trailing end of the guide member;an actuating device mounted to the handle rearwardly of the trailing end of the guide member; andan expansion device comprising a pair of expansion arms extending along respective edge regions of the aperture, wherein one end of each arm is secured to the leading end of the guide member and an opposite end of each arm extends rearwardly of the trailing end of the guide member to engage the actuating device, wherein the arms are configured to be moved by the actuating device between a collapse position and an expansion position by controllably elastically deforming said expansion arms to expand the body passage in the region of the aperture by pushing a wall of the body passage away from the tubular guide member, the expansion arms being uninterruptedly separated by the aperture. 2. The apparatus as claimed in claim 1, wherein the apparatus is adapted to be moved between the collapse and expansion positions in incremental steps. 3. The apparatus as claimed in claim 1, wherein the apparatus is controllably movable between fully collapsed and fully expanded positions, and is adapted to be moved to a position between the fully collapsed and fully expanded positions. 4. The apparatus as claimed in claim 1, wherein the apparatus is for use in transanal endoscopic microsurgery. 5. The apparatus as claimed in claim 1, wherein the collapse position of the apparatus is a rest position and the expansion position is a stressed position, and wherein the apparatus is adapted to move to the collapse position in the absence of an applied expansion force. 6. The apparatus as claimed in claim 1, wherein the collapse position of the apparatus is a first stressed position and the expansion position is a further stressed position, and wherein the apparatus is adapted to move to the first stressed position in the absence of an applied expansion force. 7. The apparatus as claimed in claim 1, wherein the collapse position of the apparatus is a stressed position and the expansion position is a rest position, and wherein the apparatus is adapted to move to the expansion position in the absence of an applied collapse force. 8. The apparatus as claimed in claim 1, wherein the actuating device comprises an activating member adapted for moving the apparatus between the collapse and expansion positions. 9. The apparatus as claimed in claim 8, wherein the activating member is moveable relative to a remainder of the apparatus. 10. The apparatus as claimed in claim 9, wherein the actuating device comprises a screw mechanism including a screw threaded member coupled to the activating member, rotation of the screw threaded member adapted to move the activating member relative to the remainder of the apparatus, thereby moving the apparatus between the collapse and expansion positions. 11. The apparatus as claimed in claim 9, wherein the actuating device comprises a ratchet mechanism including a slider coupled to the activating member and a locking member, movement of the slider relative to the locking member adapted to move the activating member relative to the remainder of the apparatus, thereby moving the apparatus between the collapse and expansion positions. 12. The apparatus as claimed in claim 8, wherein the actuating device comprises a motor for moving the activating member. 13. The apparatus as claimed in claim 8, wherein the expansion device is movable to the expansion position in response to a force applied by the actuating device. 14. The apparatus as claimed in claim 8, wherein the expansion device is configured to move the expansion arms simultaneously. 15. The apparatus as claimed in claim 1, further comprising a lock for locking the apparatus in a desired position. 16. The apparatus as claimed in claim 1, wherein the aperture extends from the leading end and part way along a length of the apparatus. 17. The apparatus as claimed in claim 1, wherein a distance between the access area and a trailing end of the guide member facilitates access through the opening. 18. The apparatus as claimed in claim 1, wherein the aperture is an elongate opening, of a greater dimension in a direction along a main axis of the guide member than in a direction around a perimeter of the guide member. 19. The apparatus as claimed in claim 1, wherein the aperture is an opening extending around at least half of a perimeter of the guide member. 20. The apparatus as claimed in claim 1, wherein the pair of expansion arms are mounted on and extend longitudinally with respect to the guide member. 21. The apparatus as claimed in claim 1, wherein each of the pair of expansion arms is adapted to adopt a curved shape when in an expansion position. 22. The apparatus as claimed in claim 1, wherein the pair of expansion arms are made of a shape memory alloy. 23. The apparatus as claimed in claim 22, wherein the expansion arm is adapted to be moved to the expansion position by heating the device above a transition temperature of the shape memory alloy. 24. The apparatus as claimed in claim 1, wherein the expansion device comprises a plurality of inflatable elements, the elements axially spaced with respect to a main axis of the apparatus. 25. The apparatus as claimed in claim 1, further comprising a flexible cover extending between the expansion device and the guide member, for preventing any part of the body passage from damage during movement of the expansion device between the collapse and expansion positions. 26. The apparatus as claimed in claim 1, wherein the expansion device provides a force-feedback to an operator during movement between the collapse and expansion positions. 27. The apparatus as claimed in claim 1, further comprising a device for measuring an expansion force exerted on the body passage during movement of the apparatus between the collapse and expansion positions. 28. A method of providing access to a body passage, the method comprising the steps of: inserting a medical apparatus having: a tubular guide member extending between a leading end and a trailing end, wherein the trailing end has an inlet providing access into the tubular guide member, the tubular guide member also having an aperture in a side wall thereof for permitting access into the body passage from the inlet at the trailing end;a handle secured to the trailing end of the guide member;an actuating device mounted to the handle rearwardly of the trailing end of the guide member;an expansion device comprising a pair of expansion arms extending along respective edge regions of the aperture, wherein one end of each arm is secured to the leading end of the guide member and an opposite end of each arm extends rearwardly of the trailing end of the guide member to engage the actuating device, wherein the arms are configured to be moved by the actuating device between a collapse position and an expansion position by controllably elastically deforming said expansion arms to expand the body passage in the region of the aperture, the expansion arms being uninterruptedly separated by the aperture;controllably moving the medical apparatus from the collapse position to an expansion position by controllably elastically deforming the pair of expansion arms to expand the body passage in the region of the aperture by pushing a wall of the body passage away from the tubular guide member; andaccessing the body passage through at least part of the aperture spaced from the leading end of the apparatus. 29. The method as claimed in claim 28, further comprising the step of exerting an expansion force on the medical apparatus following insertion into the body passage, to move the expansion arms to the expansion position. 30. The method as claimed in claim 28, further comprising the steps of exerting a collapse force on the medical apparatus, to move the expansion arms to the collapse position and to restrain the expansion arms in the collapse position for insertion of the medical apparatus into the body passage, and subsequently releasing the collapse force, whereupon the expansion arms move to the expansion position. 31. The method as claimed in claim 28, further comprising the steps of controllably moving the expansion arms from the expansion position to the collapse position and removing the medical apparatus from the body passage. 32. The method as claimed in claim 31, further comprising the steps of rotating the medical apparatus relative to the body passage, reinserting the medical apparatus into the body passage and returning the expansion arms to the expansion position. 33. The method as claimed in claim 28, further comprising the steps of returning the expansion arms to the collapse position, rotating the medical apparatus within the body passage, and then returning the expansion arms to the expansion position. 34. The method as claimed in claim 28, further comprising the step of viewing the body passage through the aperture. 35. The method as claimed in claim 28, further comprising the step of conducting a diagnostic procedure on the body passage.
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