text:
Force feedback control system for video endoscope
A video endoscope system includes a reusable control cabinet and an endoscope that is connectable thereto. The endoscope may be used with a single patient and then disposed. The endoscope includes an illumination mechanism, an image sensor, and an elongate shaft having one or more lumens located therein. An articulation joint at the distal end of the endoscope allows the distal end to be oriented by the actuators in the control cabinet or actuators in a control handle of the endoscope. Fluidics, electrical, navigation, image, display and data entry controls are integrated into the system along with other accessories.
Latest Patents:
The present application is a continuation-in-part of U.S. patent application Ser. No. 10/811,781, filed Mar. 29, 2004, which is a continuation-in-part of U.S. patent application Ser. No. 10/406,149, filed Apr. 1, 2003, the benefits of which are claimed under 35 U.S.C. § 120 and are herein incorporated by reference.FIELD OF THE INVENTION
The present invention relates to medical devices in general and therapeutic and diagnostic endoscopes in particular.BACKGROUND OF THE INVENTION
It has become well established that there are major public health benefits from regular endoscopic examinations as an aid to the early detection and treatment of disease of internal structures such as the alimentary and excretory canals and airways, e.g., the colon, esophagus, stomach, urethra, bladder, ureter, kidney, lungs, bronchi, uterus and other organ systems. A conventional imaging endoscope used for such procedures comprises a flexible tube with a fiber optic light guide that directs illuminating light from an external light source to the distal tip where it illuminates the region (i.e., tissue, occlusive objects) to be examined. Frequently, additional optical components are incorporated to adjust the spread of the light exiting the fiber bundle and the distal tip. An objective lens and fiber optic imaging light guide communicating with a camera at the proximal end of the endoscope, or an imaging camera chip at the distal tip, produce an image that is displayed to the operator. In addition, most endoscopes include one or more working channels through which medical devices such as biopsy forceps, snares, fulguration probes, and other tools may be passed.
Navigation of the endoscope through complex and tortuous paths is critical to success of the examination with minimum pain, side effects, risk, or sedation to the patient. To this end, modern endoscopes include means for deflecting the distal tip of the endoscope to follow the pathway of the structure under examination, with minimum deflection or friction force upon the surrounding tissue, and to survey targeted examination sites. Control cables similar to bicycle brake cables are carried within the endoscope body in order to connect a flexible portion of the distal end to a set of control knobs at the proximal endoscope handle. By manipulating the control knobs, the operator is able to steer the endoscope during insertion and direct it to a region of interest, in spite of the limitations of such traditional control systems, which may be bulky, somewhat non-intuitive, and friction-limited. Common operator complaints about traditional endoscopes include their limited flexibility, limited column strength, and limited operator control of stiffness along the endoscope length.
For example, conventional, flexible endoscopes are expensive medical devices costing in the range of $25,000, and much more with the associated operator console. The endoscope is expensive because it includes expensive piece parts and requires laborious hand assembly. Because of the expense, these endoscopes are built to withstand repeated disinfections and use upon many patients. Conventional endoscopes are generally built of strong composite structures typically containing metals and plastics that do not degrade under reprocessing. These material structures decrease the flexibility of the endoscope and can compromise patient comfort. Furthermore, conventional endoscopes are complex and fragile instruments that frequently need expensive repair as a result of damage during use or during a disinfection procedure.
To overcome these and other problems, the development of a low cost endoscope would allow endoscopes to be used for a single procedure and then disposed, eliminating the need for preparation and cleaning and increasing the total volume of endoscopes required. This larger volume would enable the manufacturer to achieve economies of scale and to incorporate manufacturing methods that are not economical when used in current volumes and are only economical in large volumes (100,000 units/per year). The low cost endoscope should be packaged sterile or disinfected and be capable of being used for a single procedure without endoscope preparation and then discarded. The endoscope should include one or more of the following features: better navigation and tracking, a superior interface with the operator, improved access by reduced frictional forces upon the lumenal tissue, increased patient comfort, greater clinical productivity and patient throughput than is currently available with a conventional endoscope, a lower risk of cross-contamination and the ability to be used across more procedures.SUMMARY OF THE INVENTION
To address these and other problems in the prior art, the present invention is a video endoscope system. In one aspect, the system includes a control cabinet, a number of manual or electronic actuators that control the orientation of an endoscope and an imaging system to produce images collected by an image sensor at the distal end of the endoscope. The endoscope is connectable with the control cabinet and used to examine and/or treat a patient. After the examination procedure, the endoscope is disconnected from the control cabinet and may be disposed saving the cost and labor of cleaning and resterilization inherent in traditional reusable endoscopes.
The endoscope of the present invention includes a flexible elongate tube or shaft and an illumination source that directs light onto an examination site. An image sensor and objective lens assembly at or adjacent the distal end of the endoscope captures reflected light to produce an image of the illuminated scene. Images produced by the sensor are transmitted to a display device to be viewed by an operator. In one embodiment, an imaging assembly at the distal end of the endoscope includes an inexpensive mass-produceable assembly of components that house one or more light emitting diodes (LEDs), an image sensor such as a CMOS solid state image sensor and low cost (e.g., plastic) lens assembly. The LEDs may be thermally coupled to a heat exchanger, and air or liquid cooled in order to remove any excess heat generated by the LEDs.
The endoscope of the present invention also includes a steering mechanism such as a number of tensile control cables, which allow the distal end of the endoscope to be deflected in a desired direction. In one embodiment of the invention, the proximal end of the tensile control cables is connected to a mechanical control mechanism (e.g., knobs)—mounted in a proximal control handle. In another embodiment, the cables communicate with actuators within the control cabinet. In the latter, a directional controller generates electrical control signals which are sent via a processor within the control cabinet, which generates control signals to drive the actuators in order to orient the distal end of the endoscope in the direction desired by the operator. In another embodiment of the invention, the distal end of the endoscope is automatically steered, based on analysis of images from the image sensor. A joystick or other directional controller may include tactile, haptic or other sensory feedback to reflect the force against a tissue wall or to alert the operator that the endoscope may be looped. The distal tip housing provides a high degree of integration of parts—for example, clear windows for the LEDs are insert-molded into the distal tip housing to eliminate any secondary window sealing operations and to ensure a hermetic seal.
In one embodiment of the invention, the endoscope includes an articulation joint that is comprised of a number of low cost (e.g., machine formed, stamped or molded parts), easily mass produced components that allow the distal end of the endoscope to be bent in a desired direction by the control cables. In one embodiment of the invention, the articulation joint exerts a restoring force such that upon release of a tensioning force, the distal end of the endoscope will straighten.
In another embodiment of the invention, the endoscope has a variation in stiffness along its length that allows the distal end to be relatively flexible while the more proximal regions of the endoscope have increased column strength and torque fidelity so that an operator can navigate the endoscope with greater ease and accuracy and precision through tortuous, compliant anatomy with fewer false advances ("loops"). A preset variation in mechanical properties (e.g., column strength, bending modulus or strength, torsion) along the length can be provided, for example, by varying the durometer rating or types or dimensions of materials that comprise a shaft of the endoscope. Operator-controlled variable stiffness can be provided by control cables that can be tightened, loosened or torqued to adjust the stiffness of the shaft. In yet another embodiment, the spacing between the components that comprise the articulation joint is selected to provide a preset variation in stiffness along the length of the articulation joint.
In yet another embodiment of the invention, the endoscope is covered with a retractable sleeve that uncovers the distal end of the endoscope during use and extends over the distal end after the endoscope is removed from a patient.
In another embodiment of the invention, the endoscope surface includes a material such as a hydrophilic coating, to reduce the coefficient of friction of the endoscope. Other coatings may be used to, for example, improve the device performance, provide an indication of prior use or contamination or deliver therapeutic agents.BRIEF DESCRIPTION OF THE DRAWINGS
The foregoing aspects and many of the attendant advantages of this invention will become more readily appreciated as the same become better understood by reference to the following detailed description, when taken in conjunction with the accompanying drawings, wherein:
As indicated above, the present invention is a video endoscope system that allows an operator to access, and view internal body anatomy of a patient as well as to insert surgical instruments into the patient's body. In addition, the endoscope may include integrated diagnostic and therapeutic capabilities to allow the operator to treat the patient in a single procedure. An endoscope of the present invention can be sufficiently inexpensive to manufacture such that the endoscope can be considered a single use, disposable item.
As shown in
In the embodiment shown, the endoscope 20 also includes a breakout box 26 that is positioned approximately midway along the length of the endoscope. The breakout box 26 provides an entrance to a working channel and may include an attachment point for a vacuum collection bottle 40 that collects liquids, debris or specimens received from a lumen within the endoscope. The vacuum collection bottle 40 is controlled by a vacuum valve (not shown) that is positioned on the breakout box 26. Alternatively, the valve can be positioned within or connected to the control cabinet 50 and controlled from the handheld controller 80 (see, e.g.,
If desired, the handheld controller 80 can be secured to or incorporated into the breakout box 26 such that the two units can be moved as one. Upon completion of a patient examination procedure, the endoscope 20 is disconnected from the control cabinet 50 and disposed of. A new endoscope 20 is then connected to the control cabinet 50 for the next examination procedure to be performed.
The embodiment shown in
As discussed above, the endoscope 20 in accordance with one embodiment of the invention, has a higher torque shaft at the distal section of the endoscope and a lower torque shaft at its proximal end. The breakout box 26 positioned along the length of the endoscope shaft can be used as a handle or gripper to impart rotation of the distal end of the endoscope during a medical examination procedure. The higher torque portion of the shaft transfers rotational motion that is imparted at a location near the distal tip in order to guide the distal tip of the endoscope. The lower torque shaft portion of the endoscope intentionally does not transfer torque as well for ease of manipulation and can twist when rotational motion is applied and may include one or more rotatable couplers to aid such rotation.
In use, the operator can insert a medical device such as a biopsy forceps, snare, etc., into an entrance to the working channel 32 of the endoscope found on the breakout box 26. In alternate embodiments, the medical devices may be integrally formed into the endoscope or secured, for example, on the outside thereof. In other alternative embodiments, the entrance to the working channel lumen may be positioned further towards the proximal end of the endoscope or the endoscope may include more than one working channel having entrances located at different positions along the endoscope.
An imaging electronics subsystem 60 receives signals transmitted from the distal tip through the proximal connector 34 (not shown) and its associated electronics at the distal end of the endoscope. In one embodiment, the image data is brought up from the distal tip in a serial communication link, and the signal is reconstituted to produce a formatted image, in this case a 640×480 pixel image. This deserialization reconstructs the image into an array of 10 bit deep pixels—however, other bit depths could be used. The reconstructed image is an array of pixels corresponding to individual pixels at the imager. Each pixel at the imager is typically filtered by an R, G or B (red, green, blue) filter. Other filtering schemes such as subtractive color filters or the well-known Bayer pattern are also possible. Once reconstituted, the full color image is demosaiced using well known demosaicing techniques yielding a full 640×480×30 bit deep RGB color image. This image can then be converted to other video standard formats such at Y-Cb-Cr-422, NTSC, PAL, S-video, etc.
The imaging electronics subsystem 60 can enhance the images received or can provide video effects such as zoom, color changes, the incorporation of overlays, color balancing, gamma adjustment, highlighting, etc., or the addition of functionality such as a graphical user interface prior to display of the images on a video display (not shown). Images of the tissue may also be analyzed by the imaging electronics subsystem 60 and/or a separate processing circuit to produce control signals that are supplied to the servo motor controller 54 in order to automatically steer the distal tip of the endoscope as will be discussed in further detail below. Images produced by the imaging electronics subsystem 60 may also be printed on a digital printer, sent to a network server or store, saved to a computer readable media such as a floppy disc, CD, DVD, etc., or a video tape for later retrieval and analysis by a physician.
The imaging electronics subsystem 60 also provides electrical power to a light source such as a number of light emitting diodes (LEDs) at the distal end 22 of the imaging endoscope. The gain of the imager or the intensity of the LEDs can be altered to provide for proper exposure onto the imager. One manner of achieving appropriate exposure is to monitor the number of saturated pixels and adjust the light source intensity so that the number of saturated pixels is below a minimum threshold. Another approach is to adjust the light source so that the average pixel output is a set percentage, perhaps 50%. Still another is to use AGC algorithms that are common to the TV or video industry. Proper exposure can also be obtained either independently or in conjunction with adjusting the light source by changing the gains and/or the integration period of the imager itself. If desired, control signals from the imaging electronics subsystem 60 can adjust parameters of the imager to adjust its overall gain, color balance, and sensitivity.
The LED light source is easily modulatable allowing one to effect the exposure control by adjusting the current to the LEDs and hence their light output. Since the output of the LEDs can be readily controlled, one is also able to flicker the light source, by modulating the current to the LEDs, so as to increase its visibility. This effect, which is well known in the field of visual perception and to common experience, allows one to determine the location of the distal tip inside the body by observing the light that passes through the body to the outside world. This is called transillumination. By substantially modulating the output of the LEDs at a frequency of 8-14 Hz, the visibility of the tip is maintained using less power or greatly enhanced using the same power. Alternatively, the LEDs can be replaced with small incandescent bulbs or solid state devices such as a laser.
By pulsing the illumination sources, it is possible to visually detect the location of the distal tip of the endoscope without fluoroscopy or other external imaging means. If the image sensor is operating when the light source is pulsed, then the corresponding video display may flicker and distract the operator or impede the ability to see the distal tip. Therefore, during transillumination, it is desirable to prevent flicker on the video display by displaying a static image or disabling the image sensor or image processor in order to increase the visibility of the distal tip. If the endoscope utilizes an external light source, then the control cabinet can include a high intensity light source such as a laser or halogen lamp source that supplies light to a fiber optic illumination guide within the imaging endoscope 20 in order to illuminate an internal body organ or desired viewing area. Either power source 58 may be controlled by signals received from the handheld controller 80 when the user desires to activate the light source or adjust the intensity of light produced.
Finally, the control cabinet 50 includes valves 70 that control the delivery of insufflation air/gas to insufflate a patient's body cavity and an irrigation liquid to flush out a body cavity and/or clean one or more of the components of the optical assembly (such as the lens or cover window) at the distal end of the endoscope. The insufflation air/gas and irrigation liquid are connected to the endoscope via a connector 38 that connects to an irrigation/insufflation lumen of the endoscope 20. In one embodiment of the invention, the irrigation and insufflation functions are provided by the same lumen. However, it will be appreciated that separate irrigation and insufflation lumens could be provided if desired and if space in the endoscope permits. Furthermore, additional lumens or the irrigation and insufflation lumens may be used to deliver therapeutic or contrast substances to the patient.
In one embodiment of the invention, the processor and servo control unit 108 implement a position-to-rate control that varies the speed at which the distal tip is moved as a function of the position of the directional switch on the user input device. However, other control algorithms such as position-to-position or position-to-force could also be implemented. The servo control can also be used to vary the position of or articulate instruments that are within the endoscope.
Another function that may be performed by the processor and servo control 108 is to generate a graphical indication of the approximate articulation of the tip that is shown to the user on the video display. The processor receives feedback signals regarding the position of the servo motors from which the length of control cable shortening is determined as well as the torque required to move the cables. From these values, an approximation is made of the amount of articulation at the distal tip of the endoscope. The approximate articulation amount and the direction of articulation are displayed to the physician along with the images received from the image sensor, patient data, and/or other operating parameters of the video endoscope system.
The processor and servo control unit 108 also implement a variable braking function that allows the servo motors 110, 112 to be driven under automatic or semi-automatic control by the operator moving the distal tip within the patient's body. The variable braking is accomplished by having the operator or the processor select a variable braking force that is between 0 and the maximum torque that can be supplied by the motors. When the physician moves the endoscope, the torque on the motors is detected to see if it is greater than or equal to a variable braking threshold. If so, the processor and servo control unit 108 controls one or both of the servo motors 110, 112 such that the tip is moved to a new position so that the torque readings from the motors are less than the variable braking threshold.
In some instances, such as near delicate portions of the patient's anatomy, the variable braking threshold will be set to a low value so that little pressure is required to back-drive the motors. In other instances, the braking threshold can be set high where it is desired to maintain the shape of the endoscope for navigation, etc.
In the manual control version, a variable friction brake may also be used. The user can select the brake force required be adjusting the position of a lever or dial on the manual controller similar to conventional scopes. One embodiment might involve a separate brake for each axis or alternatively, one brake may be used for both axes.
The control cabinet 102 also includes an imaging subsystem 114 that produces images from the signals that are received from the image sensor at the distal end of the endoscope 104. The imaging subsystem 114 deserializes the digital video signal from the CMOS image sensor and performs the necessary algorithms such as demosaicing, gain control and white balance to produce a quality color image. The gain control of the system is implemented by adjusting the intensity of the illumination (current supplied to the LEDs) and adjusting the gains applied to the signals by the CMOS imager. The imaging subsystem 114 also includes isolation circuitry to prevent unacceptable radio frequency susceptibility, emissions and interference, as well as unacceptable leakage currents in the event of an electrical failure in any circuit within the control cabinet 102. The imaging subsystem 114 also includes circuitry for transmitting control signals to the image sensor and for receiving image signals from the image sensor. In one embodiment of the invention, the imaging subsystem 114 is provided on a standard "PCI" circuit board to allow the use of standard computer hardware and software.
In the embodiment shown in
In the embodiment shown, the endoscope 104 is connected to the control cabinet 102 with a connector 130. Within the connector 130 are a pair of spools 132, 134 that are engageable with the driveshafts of the servo motors 110, 112. Each spool 132, 134 drives a pair of control cables in opposite directions. One pair of control cables drives the distal tip of the endoscope in the up and down direction, while the other pair of control cables drives the distal tip of the endoscope in the left and right direction. Alternatively, a single control cable can be wrapped around a spool such that a single wire controls movement in a plane.
The connector 130 also includes a manifold 140 that controls the supply of fluid, air and vacuum to various tubes or lumens within the endoscope 104. In addition, the connector 130 includes an electrical connector 142 that mates with the corresponding electrical connector on the control cabinet 102. The connector 142 transfers signals to and from the image sensor and a thermal sensor as well as power to the illumination LEDs. Water is supplied to the endoscope with a pump 145. The pump 145 is preferably a peristaltic or isolated chamber pump that moves water though a flexible tube that extends into the proximal connector 130. Peristaltic pumps are preferred because the pump driving components do not need to come into contact with the water or other fluids within the endoscope, thus allowing the wetted component to be single use. A water reservoir 150 connected to the pump 145 or fixedly secured to the proximal connector supplies water to cool the illumination LEDs as well as to irrigate the region of examination. The water supplied to cool the LEDs is returned to the reservoir 150 in a closed loop. Waste water or other debris are removed from the patient with a vacuum line that empties into a collection bottle 160. Control of the vacuum to the collection bottle 160 is provided by a pinch valve within the proximal connector 130.
Images of the examination area produced by the image sensor within the endoscope 104 are displayed on a digital monitor. The digital monitor is driven through a multiplexer so that additional data such as patient name, address, date, other physiological parameters, heart rate, blood pressure, etc., or previously obtained images can be multiplexed onto the display for view by the operator. In addition, an external digital monitor may be coupled to the system, if desired.
The motherboard 108 also interfaces with a printer via an ethernet/USB or parallel connection, and a keyboard by a conventional PS/2 or USB connection. The handheld controller is connected to the articulation and fluidics card 109 via an RS-422 connection. A speaker is also coupled to the motherboard 108 to provide audible alarms or status signals to the operator.
The control cabinet 102 is preferably made using a standard off-the-shelf computing platform that includes a motherboard, hard drive, video card, processor, memory, etc. Each of the control cards (camera card 111, articulation and fluidics card 198, and the image processing card 114) for the system is plugged into the motherboard in a PCI slot. The motherboard also provides the standard PC type connectors: serial ports, parallel port, Ethernet port, USB ports, microphone in, sound out, etc. The two digital monitors such as LCD display panels on the control cabinet are connected to a video card that resides in the motherboard in an AGP slot. Essentially, the control cabinet includes a generic computing platform. This allows exam information to be captured electronically in a single integrated system. The types of exam information that may be captured in this integrated system includes: still images, video clips, voice recordings for annotation purposes, voice input for voice recognition, voice input for voice command and GUI navigation, text labels applied to images, drawing annotations on images, exam report information, patient discharge information, letter to the referring physician, medications given to the patient, patient vital signs, etc. The exam report can typically include entry for data elements such as the patient demographics, indication for examination, procedure(s) performed, scope(s) used in exam, instruments used in exam, procedure technique, extent of exam, complications, visualization, tolerance, findings, diagnosis, recommendations, procedure codes, diagnosis codes, interventions performed, pathology specimens collected, etc.
Patient vital signs are preferably recorded via an electronic interface. Vital sign monitors currently allow this type of digital information exchange over serial ports and Ethernet connections. As indicated, information that is typically collected is systolic blood pressure, diastolic blood pressure, mean arterial pressure, pulse from the blood pressure measurements, heart rate from an EKG, oxygen saturation, and temperature. In addition, the control cabinet can include means for electronic transfer and display of the "wavefomm" data that would allow the display of waveform signals such as the EKG, respiration, and oxygen saturation. This data is typically provided as a calibrated analog voltage output. An analog to digital converter (not shown) is used to digitize the waveform data for display on the screens.
The system allows the operator to navigate the system in a number of ways, such as keyboard, touch screen, and a multi-position GUI navigation control switch on the endoscope handle. Any of these navigation means may be used before or during an exam to allow the operator (nurse, physician, or technician) to enter exam-related information into the control cabinet during the exam. If all of the desired information is not entered during the course of the exam, the system allows the operator to complete the exam record at the end of the exam.
The control cabinet may also contain a barcode scanner or radio frequency identification (RFID) scanner. This would allow the identification of tools that are inserted into the working channel of the endoscope or otherwise used as part of the procedure. This allows tracking of the equipment or tools that were actually used during the exam. It also allows for intelligent prompting for the user through the GUI to record relevant information about the use of the items that were scanned. For example, the nurse scans a biopsy forceps before it is inserted into the working channel of the endoscope. The control cabinet GUI then automatically prompts the user with the typical interventions performed with the type of forceps that were inserted. The system would also prompt the user to enter information about the biopsy specimen(s) (location, description, pathology to be evaluated) such that information is entered in an automated fashion for a pathology requisition. The system could also prompt the user with default operating parameters for the instruments.
In addition to providing cooling, water can be selectively applied to a tube 170 that provides a high pressure lavage for irrigating a patient lumen, as well as a lens wash tube 172 that cleans contaminants from the front of an imaging lens at the distal end of the endoscope. Water can also be selectively applied to a tube 174 that is connected to a working channel tube of the endoscope to clean the working channel, if necessary. The flow of water in each of the tubes 170, 172, 174 is selectively controlled by an associated valve which allows water to be pumped through the tube if desired. A valve 180 controls the application of vacuum to a working channel tube in the endoscope to remove irrigation liquid, debris, or other contaminants from the patient, if desired. A valve 182 controls the supply of air or other bio-compatible gas to an insufflation lumen, which in an embodiment of the invention is the same tube as the lens wash tube 172 at the distal end of the endoscope. The air can be provided to the patient under a variety of pressures using solenoid valves 184, 186, 188 in line with regulators or an electronically controlled regulator or programmable array of regulators that provide air at different pressures and are connected in parallel to an air or gas source. The pressure of air delivered to the lens wash tube 172 can be adjusted by selectively opening a combination of the valves 184, 186, 188. A check or anti-siphon valve 189 is in line with the air supply line to prevent any back flow of air or liquids from the endoscope into the air delivery mechanism.
In the embodiment shown, a connector 196 is connected to the working channel to supply water to or apply vacuum to the working channel. A connector 198 is connected to the insufflation tube. A connector 200 is connected to the high pressure lavage tube in the endoscope. Connectors 204 and 206 are connected to the tubes that supply water to and return water from the heat exchanger that cools the LED illumination sources.
Water entering the manifold at the connector 190 is allowed to flow in four different paths. Fluid flow through three of the paths is selectively controlled with solenoid valves that pinch the manifold 140 at locations 208, 210, 212 that are over the passages in the manifold. In one embodiment of the invention, water is always pumped through the heat exchanger that cools the LED illumination sources. By selectively activating the solenoid valves at the locations 208, 210, 212, water can be supplied to the other tubes in the endoscope.
In addition, the manifold 140 includes a support tube or other straw-like structure that maintains the passage open between the connectors 196 and 194 such that vacuum does not collapse the manifold 140 when a solenoid valve that is at a location 214 between the connectors 194 and 196 is released. The tube or straw also includes at least one perforation (not shown) to allow liquid to flow into the working channel if desired.
After use, the manifold 140 is removed from the tubes that supply water and vacuum, etc., and is disposed of along with the rest of the endoscope. The flexible manifold bag 140 forms an inexpensive device for controlling the application of fluids or air to the endoscope while preventing the fluids from coming in contact with non-disposable portions of the video endoscope system itself.
Upon insertion of the shaft 254 into the spool 262, the brake 266 is released, thereby allowing the spool 262 to be moved by rotation of the cylinder 256. In some instances, the brake 266 may be omitted, thereby allowing the spools 262 to freely rotate when the connector 260 is not engaged with the control cabinet 250.
Positioned in an ergonomic arrangement on the handheld controller 300 are a number of electrical switches. An articulation joystick 308 or other multi-positional device can be moved in a number of directions to allow the physician to orient the distal tip of the imaging endoscope in a desired direction. In order to guide the imaging endoscope manually, the physician moves the joystick 308 while watching an image on a video monitor or by viewing the position of the distal tip with another medical imaging technique such as fluoroscopy. As the distal tip of the endoscope is steered by moving the joystick 308 in the desired direction, the physician can push, pull and/or twist the endoscope to guide the distal tip in the desired direction.
A camera button 310 is provided to capture an image of an internal body cavity or organ in which the endoscope is placed. The images collected may be still images or video clips. The images may be adjusted for contrast or otherwise enhanced prior to display or stored on a recordable media.
An irrigation button 312 activates an irrigation source to supply a liquid such as water through an irrigation lumen of the endoscope. The liquid serves to clean a window in front of an image sensor and/or the light source at the distal end of the endoscope as well as an area of the body cavity. An insufflation button 314 is provided to activate the insufflation source to supply air/gas through a lumen of the endoscope. The supply of the insufflation gas expands portions of the body cavity surrounding the distal tip of the endoscope so that the physician can more easily advance the endoscope or better see the tissue in front of the endoscope.
In one embodiment of the invention, the body 302 of the handheld controller 300 also includes a detachable joint such as a thumb screw 316 for securing the handheld controller 300 to the breakout box as indicated above. A corresponding socket or set of threads on a breakout box receive the thumb screw 316 in order to join the two parts together. One or more additional buttons 318 may also be provided to activate additional functions such as recording or printing images, adjusting light intensity, activating a vacuum control valve or providing a variable braking drag on the control cables that provide the up, down, left, right movement of the distal tip, etc., if desired.
As indicated above, in one embodiment of the invention, the servo motors implement a position-to-rate control algorithm, whereby the position of the joystick 354 is translated into a rate of change of position in a desired direction in the distal tip. Therefore, as the user presses the joystick in any direction, the return force that is applied by the force feedback mechanism 360 to the spring 362 can be varied as a function of the drive motor torque required to move the control cable and varying the force on the spring also varies the force that the spring applies to the joystick. The force that the spring applies to the joystick is felt by the user through the joystick and gives the user a tactile indication of the level of force being applied to move the distal tip in the direction being commanded by the user.
Similarly, other structures and/or materials, such as elastomers or flexural structures can be used to replace the spring entirely and a force can be applied to one area of the plastic material to create a similar force where the plastic contacts and biases the joystick. Similarly, variable torque motors can be coupled directly to the joystick and the torque of the motors adjusted in accordance with the tension of the control cables to directly transmit a force through the joystick to the user. The use of two motors with the motors acting on orthogonal respective axes of the joystick movement can create force feedback signals in response to all possible directions of joystick movement. This sort of use and arrangement of direct drive motors can be similarly used to feedback position of the distal tip. In this arrangement, position controlled motors would be used instead of torque controlled motors. The positions of the control cables or the positions of the servo motors driving these cables are used to compute the approximate position of the distal tip. The position controlled motors are driven to make the joystick position follow the computed position of the distal tip. If the operator attempted to move the tip and the motion of the tip were blocked by its environment, then the operator's movement of the joystick would be resisted by forces applied by the position controlled motors to make the joystick position correspond with the tip position.
Although the embodiment shown discloses a motor and a rack and pinion gear system to change the compression of the spring 362 that biases the joystick 354, it will be appreciated that other mechanisms including hydraulic, or magnetic actuators could be used. Alternatively, as discussed above, pseudo-fluid devices such as thermoplastics can be used. By selectively compressing a thermoplastic material, its elasticity can change and be used to apply different pressures on a spring 362.
In another embodiment, not all the forces on the wires are fed back to a user. In one embodiment, the system distinguishes the resistance of the shaft versus the resistance at the distal tip and only the resistance at the distal tip is fed back to a user.
To distinguish the forces on the shaft versus the forces at the tip, the tip is dithered in different directions. If the resistance is on the tip, then the resistance should be high only in one direction. If resistance is caused by loops in the shaft, then resistance should be equal in all directions. By comparing the forces in a processor and separating the forces required to move the distal tip, high forces can be prevented from building up at the tip. High motor torque can be used only to overcome resistance due to looping and not employed to bend the tip if it meets resistance. Therefore, higher forces are prevented from being built up on the tip, lowering the risk that the tip will perforate the anatomy or undesirably snap into position.
The breakout box 380 also includes an entrance to the working channel 386 having a cap thereon. The cap is positioned such that the entrance to the working channel does not face the physician in order to lessen the chances of the physician or nurse being sprayed by bodily fluids or other contaminants. The cap may be removable or integrated into the breakout box and may include a duck bill or tuey bohrs that enables a physician to effectively seal around a device to prevent air and fluid leakage. By removing the cap, a user can insert a tool into the working channel for receiving biopsies, applying medication, or performing other medical procedures.
Selectively coupled to the breakout box 380 is a handheld controller 388. The handheld controller includes a directional switch 390 that controls the orientation of a distal tip of the endoscope. Further buttons or controls 392 may be provided to allow the user to activate additional features of the endoscope or change operating parameters of the video endoscope system.
Other embodiments may not require the cap to be removed. The cap may consist of a duck bill valve which allows passage of the device but immediately seals itself once the device has been removed. This ensures that the user will never get sprayed if the bolus wash is applied while the cap is removed. Another design involves a screw cap which tightens down on the duck bill valve to hold the device steady at a precise location.
As shown in
In one embodiment of the invention, several simple switches are used to control water, air, suction, lens wash image management, and graphical user interface (GUI) navigation. The switches are wired to a circuit board in the handle or connector with multiple wires. A microprocessor provides the button signals to the control cabinet on a few wires. The switches can be relatively inexpensive because the switches do not need to withstand repeated use or cleaning. In addition, other functions such as debouncing, etc., that might increase the cost of the switch can be provided within the control unit by dedicated hardware or software, for example.
In one embodiment of the invention, the knobs on the handle are coupled to the control wires with a "bead chain" of the type commonly used with lamp pull-switches. The bead chain engages in a sprocket connected to the knobs. The force required to turn the knobs and the amount of rotation of the knobs required to articulate the tip can be controlled by adjusting the size of the sprocket. Larger sprockets will require more force to turn the knob but will require less rotation and will have higher force feedback. Smaller sprockets will require less force but more rotation. It is possible that a different size sprocket be used on the up/down axis than on the left/right axis. In one embodiment, the steering cables are connected directly to the bead chain. In other embodiments, the steering cables can be wrapped directly around the sprocket. In other embodiments (as shown in
A fixed stop may be placed on the sprocket, on the bead chain, on the pull cable or on the knobs to limit the rotation of the knob and avoid over articulating the tip.
An entrance to the working channel is positioned below the knobs to allow the insertion of tools into the working channel. The working channel port may be fixed to the manual controller housing or may be allow to translate along the main axis of the housing. Allowing the working channel port to translate, will prevent tensile forces from building up on the working channel when loops are created in the distal shaft.
The manual controller housing will allow space for excess length of bowden cables, electrical cables and utility tubes. This prevents tensile forces from building up on these components when loops are created in the distal shaft.
In other embodiments, the handheld controller may be fitted to a gripping mechanism that grasps the distal portion of the shaft. The operator can therefore secure the handheld controller to the shaft at various positions along its length in order to allow the physician to be closer to the patient.
Although the disclosed embodiments of the endoscope generally require an operator to control the orientation of the distal tip, the endoscope of the present invention may also be steered automatically. Images received by the imaging electronics are analyzed by a programmed processor to determine a desired direction or orientation of the distal tip of the endoscope. In the case of a colonoscopy, where the endoscope is advanced to the cecum, the processor controls the delivery of insufflation air/gas to inflate the colon. The processor then analyzes the image of the colon for a dark open lumen that generally marks the direction in which the endoscope is to be advanced. The processor then supplies control instructions to the servo controller such that the distal tip is oriented in the direction of the dark area so located.
In other modes, a processor in the control cabinet causes the distal tip of the endoscope to move in a predefined pattern. For example, as the endoscope is being withdrawn, the distal tip may be caused to move in a spiral search pattern such that all areas of a body cavity are scanned for the presence of disease. By using the automatic control of the distal tip, a physician only has to advance or retract the endoscope to perform an examination and concentrate fully on image interpretation.
As will be described in further detail below, the endoscope generally comprises a hollow shaft having one or more lumens formed of plastic materials, such as polyurethane or polyethylene, which terminate at the distal tip. The shape of the distal tip and shaft is usually cylindrical but can be made in other shapes to facilitate passage into a body cavity. In addition, the tube for the working channel may be supported with a spring in the area of the articulation joint to prevent kinking. In addition, the lumens may be reinforced with a spiral wound wrap of metal wire or polymer or glass fiber or tape. The lumens can have various cross-sectional shapes along the length such as circular, oval, asymmetrical, etc. The outsides surface of the tubes may be lubricated to help them slide relative to each other during articulation. Alternatively, 'frosted tubes' may be used to lower the coefficient of friction on the outside surface. The internal wall of all tubes will usually be smooth. One embodiment of the working channel involves a star shaped lumen rather than a circular lumen. This reduces the contact area with devices and allows devices pass through with less force. As shown in
Fitted within the camera port 406 is an image sensor (not shown) that preferably comprises a CMOS imaging sensor or other solid state imaging device and one or more glass or polymeric lenses that produces electronic signals representative of an image of the scene in front of the camera port 406. The image sensor is preferably a low light sensitive, low noise, CMOS color imager with VGA resolution or higher such as SVGA, SXGA, XGA, or UXGA, etc. If less resolution is desired, a ½ or ¼ VGA sensor could also be used. For conventional video systems, a minimum frame rate of 25 to 30 fps is required to achieve real-time video. The video output of the system is desirably transmitted to the console in a digital form, but may be in any conventional digital or analog format, including PAL or NTSC, or high definition video format.
The illumination ports 408 house one or more lenses/windows and one or more light emitting diodes (LEDs) (not shown). The LEDs may be high intensity white light sources or may comprise light sources at other wavelengths such as infrared (IR) red, green, blue or ultra-violet (UV) LEDs. With colored LEDs, images in different spectral bands may be obtained by illumination with any one or more individual colors. White light images may be obtained by the simultaneous or sequential illumination of the colored LEDs and combining individual color images at each illumination wavelength. If sequential illumination of colored LEDs is employed, as an alternative, a monochrome CMOS imager can be used. As an alternative to LEDs, the light source may be external to the endoscope and the illumination light delivered to the illumination port with a fiber optic bundle and traditional light sources. Alternatives to a LED source at the distal tip could include, for example, an incandescent lamp or lamps, or organic LEDs, photomic crystals, or laser sources.
The access port 410 is the termination point of the working channel or lumen of the endoscope. In one embodiment, the proximal end of the working channel terminates at the breakout box 26 as shown in
The directional flush port 412 includes a cap 414 that directs liquid and air supplied through an irrigation and insufflation lumen across the front face of the distal tip 400 in the direction of the camera port 406 and/or the illumination ports 408. The cap 414 thereby serves to rinse, clean and dry the camera port 406 and the illumination port 408 for a better view of the internal body cavity in which the endoscope is placed. In addition, the flushing liquid cleans an area of tissue surrounding the distal end of the endoscope.
As shown in
As best shown in
In one embodiment of the invention, the base material is copper with conductive pads 556, 558 also made of copper. The LEDs are wire bonded to the bonding pads 554, and trace 552. The rear surface of the circuit board 550 is preferably coated with a heat conductive, non-reactive biocompatible material such as gold that is directly exposed to a cooling liquid or gas which is pumped through the heat exchanger via the legs 506, 508.
In one embodiment of the invention, the LEDs 484, 486 are preferably large area die, high power, blue light LEDs coated with a phosphor material that together produce approximately 60 lumens of light. Although the embodiment shows two LEDs positioned on either side of the lens assembly 470, it will be appreciated that fewer or more LEDs could be used and corresponding changes made to the shape of the windows 460, 462 positioned in front of the LEDs.
As an alternative, the inside surface of the windows 460, 462 can be coated with a phosphor coating that produces a white light when exposed to the blue light that is produced by the LEDs. The particular phosphor or phosphor combinations selected may depend on the spectral characteristics of the LEDs employed. The phosphor or phosphors can be mixed with an epoxy adhesive that is applied to the rear surface of the windows 460, 462 and cured by exposing the distal tip 450 to an ultraviolet light source. Mixing the phosphor coating in an adhesive promotes a uniform distribution of the phosphor and is easy to manufacture. Alternatively, the phosphor could be imbibed or directly mixed into the window polymer.
An embodiment of a lens assembly 470 comprises a four-element plastic lens assembly containing several aspheric surfaces to control the image sharpness and distortion image that provide 140° field of view with nominal f-theta distortion and an f/8 aperture. The individual lenses and aperture of the lens assembly are contained in a plastic cylinder for insertion into the cylindrically shaped hole of the heat exchanger 480. The front surface of the lens assembly is adhesively sealed to the lens port 458 in the cap 450.
As indicated, for colonoscopic applications, a diagonal full-field of view of 140 degrees with acceptable f-theta distortion is preferable. Image sharpness should be consistent with FDA Guidance Documents for Endoscopes that suggests resolution of 5 line pairs per millimeter on an object surface, concentric with the entrance pupil, at an object distance of approximately 10 mm. This is consistent with the use of a VGA (640×480) pixel color imager such as those manufactured using CMOS or CCD technology by companies such as Micron, Inc. or ST Microelectronics.
The output of the imager chip is preferably of serial digital format to provide for a reduced wire count to bring the signal from the distal tip to the proximal connector. The cable connecting the proximal end to the distal tip contains power, ground, clock, differential signal, and control signal lines. Typically, 10-14 wires are required. By incorporating the serializer into the imager, a highly compact distal tip can be fabricated. Also, the cost of an imager with an integral serializer is less than the cost of a separate imager and serializer and their interconnects. Additionally, by removing the clock from the distal tip and locating the clock on the imaging electronics subsystem (60), further reduction of the size of the distal tip is possible with associated reduction of the cost of the endoscope.
For an imager with a diagonal format size of approximately 4.5 mm, the focal length of the lens is 1.8 mm in order to cover a full field of 140 degrees.
The four element plastic lens assembly 470 is depicted in
In a preferred embodiment of the invention, the image sensor 490 comprises a VGA CMOS image sensor with 640×480 active pixels and an on-chip serializer that transmits image data to the control cabinet in a serial form. Such a CMOS image sensor is available as Model No. MI-370 from Micron Electronics of Boise, Id. In order to transmit serial image data and control signals along the length of the endoscope, the data and control signals are preferably sent digitally using a low voltage differential signal (LVDS) protocol along a suitable twisted micro coaxial cable.
To construct the image assembly, the distal cap 450, including flushing port 456 is molded of ABS plastic over the LED windows 460, 462. The circuit board 550, having LEDs 482, 484 bonded thereto, is secured within the heat exchanger 480 and the CMOS sensor 490 and associated electronics 492 are secured to the rear surface 525 of the heat exchanger 480 between the legs 506, 508. The lens assembly 470 is inserted into the concave recess 482 and adjusted longitudinally until it is at the optimum position to focus light on the image sensor 490 before being cemented in place. The completed heat exchanger assembly can then be inserted into the distal tip 450 and adhesively bonded to complete the imaging assembly. The remaining tubes for the low pressure lavage bolus wash channel 454, lens wash and insufflation channel and working channel are then secured to corresponding lumens in the distal tip in order to complete the distal imaging section of the endoscope.
Variations on the components, dimensions and configuration of the components in the optical assembly are contemplated, which may depend in part on the desired performance characteristics of the endoscope. For example, issues like field of view, levels of illumination, operating temperature of the distal tip etc. affect the balance and tradeoff of a particular configuration. For example, it may be desirable to add a focusing capability to the endoscope by moving the cylindrically shaped lens assembly relative to the image sensor. If the lens assembly can be focused, a lower F# (i.e., faster) lens can be used thereby decreasing the amount of light required. If less light is required, the need for an active cooling mechanism to remove any excess heat from the illumination source is reduced or eliminated. Alternatively, it may be possible to replace the water-cooled heat exchanger with a heat pipe that is thermally coupled to the illumination sources or to fill the voids of the endoscope with a thermally conductive fluid or other substance.
Because the distance over which the lens assembly must be moved with respect to the image sensor (or vice versa) is relatively small (e.g., a few hundred microns), a focusing mechanism can be constructed of simple mechanical or electrically activated components such as magnetic, thermally activated bi-metallic components, screw-type advancers, etc. Furthermore, if the lens assembly is contained in a cylindrical recess 482 of the type shown in
The control cables 658 that move the distal tip of the endoscope are preferably made of a non-stretching material such as stainless steel or a highly oriented polyethylene-terephthalate (PET) thread string. The control cables 658 may be routed within a center lumen of the shaft 656 or, as shown in
If the control cables are routed through the center lumen of the shaft 656, the cables are preferably carried in stainless steel or plastic spiral wrapped jackets to prevent binding and a transition guide 670 such as that as shown in
A plastic spiral wrap 686 such as spiral wire wrap available from Panduit Inc. is inserted into a center lumen of the shaft 680. The spiral wrap 686 prevents the shaft 680 from crushing as it is bent around curves of a patient's anatomy.
In one embodiment of the shaft 680, the spiral wrap has a thickness of 0.060 inches and a pitch of {fraction (3/16)} inch. The spiral wrap 686 has an outer diameter of 0.500 inches and an inner diameter of 0.380 inches and is twisted into the shaft 680 to form an interference fit. However, it will be appreciated that other thicknesses of spiral wrap with a different pitch could be used to provide the desired column strength and bend modulus as well as to prevent kinking.
A metal braid is placed over the articulation joint. The braid has several functions including provides torsional strength to the articulation joint, keeps the links of the joint aligned during articulation and prevents the outer cover from being pinched between the links of the joint. The preferred design uses a metal braid but alternatively plastic braids such as PET can be used. The braid properties (such as braid angle, % coverage, # of pics per inch, etc.) can be adjusted to give the required balance between low articulating force and consistent, in-plane articulation. In other embodiments of the design, a variable braid may be used over the articulation joint to control the bending arc of the joint. A tighter braid on the proximal links of the articulation joint encourages the distal links to bend first and so the whole joint bends with a smaller bending arc. The outer plastic cover is fitted over the articulation joint portion of the shaft to prevent contaminants from entering the shaft through gaps in the braided articulation joint.
As indicated above, the proximal section of the endoscope shaft is preferably more flexible than the distal section. The proximal portion of the shaft is preferably made of a corrugated polyethylene tubing such as Model No. CLTS 50F-C available from Panduit Inc.
The more distal end 702 of the shaft 700 has a single spiral of wire 706 that is preferably wound in the same direction as the plastic spiral wrap in the center lumen of the shaft 700. Again, the torque fidelity of the proximal end of the shaft 702 can be varied by adjusting the pitch and/or direction of the wire 706 and its flexibility.
As will be appreciated, the single wire spiral 706 provides some torque fidelity but does have the same torque fidelity as the dual wire braid in the distal section of the shaft in order to allow easy manipulation for, e.g., resolution of loops. The single wire spiral 706 may be omitted from the distal portion of the shaft if even less torque fidelity is desired.
As discussed above, in order to facilitate steering the distal tip of imaging endoscope, the endoscope includes an articulation joint that allows the distal tip to be turned back on itself, i.e., over an arc of 180 degrees, by the control cables and can be directed to make that bend in any direction desired about the circumference of the distal tip. That is, the operator can select both the amount of the bend or articulation and the direction of the bend. As shown in
To facilitate bending of the articulation joint, the cylinder includes a number of living hinges 760 formed along its length. As can be seen in
Upon tensioning of a control cable, those living hinges having webs 772 that are in line with the retracting control cable do not bend. Those living hinges having webs that are not in line with the control cable will be closed, thereby bending the articulation joint in the direction of the control cable under tension.
Another advantage of the articulation joint 750 shown in
The articulation joint can be formed by extruding a cylinder with the central and control cable lumens in place and cutting the cylinder tube with a knife, laser, milling tool, water jet, or other material removal mechanism to form the living hinges. Alternatively, the articulation joint can be molded with the living hinge joints in place. As will be appreciated, the angles of the V-shaped cuts that form the hinges may be uniform or may vary along the length of the articulation joint. Similarly, the distance between adjacent living hinges may be uniform or may vary in order to tailor the bending and torque fidelity characteristics of the articulation joint. In one embodiment of the invention, each living hinge 760 has a closing angle of 30° so that six hinges are required to provide 180° of movement. The distal end of the articulation joint 750 may be counter-bored to receive the distal tip section of the endoscope, as discussed above. Similarly, the proximal end of the articulation joint 750 is adapted to receive the distal end of the shaft section of the endoscope. In the embodiment shown in
To prevent wear by the control cables as they are pulled by the actuation mechanism in the control cabinet, it may be desirable to produce the articulation joint from a material having areas of different durometers. As shown in
Each socket section can be formed with a fully formed ball section such as ball section 810 shown in
In another embodiment of an articulation joint, the articulation joint is made of a series of stacked discs that are positioned adjacent one another and move with respect to each other. As shown in
Although the discs of the articulation joints shown in
In the embodiments of the articulation joints described above each disc or segment that comprises the joint is preferably made of the same material. However, it is possible to vary the material from which the segments are made and/or the physical dimensions or spacing between adjacent segments in order to vary the flexibility and torque fidelity of the joint along its length.
In some environments, a full 180° turning radius of the distal tip of the imaging endoscope may not be necessary. In those environments, an articulation joint made of interconnected discs or segments may be replaced with a flexible member such as a braided stent.
The articulation joint 1000 shown in
As shown in
Because the link 1390 is molded of a thermoplastic material, the arcuate tabs 1394 can be press fit into the arcuate recesses 1392 of an adjacent link, thereby permitting the adjacent links to rock back and forth with respect to each other.
In some embodiments, the articulation joint is designed to exert a restoring force so that the endoscope will tend to straighten upon the release of tension from the control cables. In other cases, it may be desirable to maintain the position of the distal tip in a certain direction. In that case, a construction as shown in
During examination with the imaging endoscope, the physician may need to twist the endoscope in order to guide it in the desired direction. Because the outer surface of the endoscope is preferably coated with a lubricant and it is round, it can be difficult for the physician to maintain an adequate purchase on the shaft in order to rotate it. As such, the imaging endoscope of the present invention may include a gripper mechanism that aids the physician in grasping the shaft for either rotating it or moving the shaft longitudinally. One embodiment of a shaft gripping device is shown in
In one embodiment of the invention the endoscope has a movable sleeve that operates to keep the distal end of the endoscope clean prior to use and covers the end of the endoscope that was in contact with a patient after the endoscope has been used.
A collapsible sleeve 1598 is positioned over the distal end of the endoscope and can be retracted to expose the lubricated distal tip of the probe. In one embodiment, the sleeve 1598 is secured at its distal end to the sponge 1594 and at its proximal end to the breakout box. Moving the sponge proximally retracts the sleeve so that the endoscope is ready for use. After a procedure, the sponge 1594 is moved distally to extend the sleeve over the distal end of the endoscope. With the sleeve extended, any contaminants on the probe are less likely to contact the patient, the physician or staff performing the procedure.
In some instances, it may be desirable to limit the amount of heat that is dissipated at the distal end of the imaging endoscope. If light emitting diodes are used, they generate heat in the process of producing light for illumination. Similarly, the image sensor generates some heat during operation. In order to limit how hot the distal end of the endoscope may become and/or to provide for increased life for these components, it is necessary to dissipate the heat. One technique for doing so is to fashion a passive heat sink at the distal tip of the imaging endoscope. As shown in
In yet another embodiment of the invention, the imaging devices at the distal end of the endoscope can be cooled by air or water passed through a lumen to the end of the endoscope and vented outside the body. For example, air under pressure may be vented through an orifice near the imaging electronics. The expansion of the air lowers its temperature where it cools the imaging electronics. The warmed air is then forced to the proximal end of the endoscope through an exhaust lumen. Alternatively, the endoscope may include a water delivery lumen that delivers water to a heat exchanger at the distal tip. Water warmed by the electronic components in the distal tip is removed in a water return lumen. Air or water can be alternatively be released directly to the patient lumen if the volumes and temperatures are physiologically acceptable.
Although the present endoscope system has many uses, it is particularly suited for performing colonoscopic examinations. In one embodiment, a 10-13 mm diameter prototype having a 0.060 inner spiral wrap with a pitch of {fraction (1/4)} inch and coated with a hydrophilic coating was found to have a coefficient of friction of 0.15 compared to 0.85 for conventional endoscopes. In addition, the endoscope of the present invention required 0.5 lbs. of force to push it through a 2-inch U-shaped bend where a conventional endoscope could not pass through such a tight bend. Therefore, the present invention allows colonoscopes to be made inexpensively and lightweight so that they are more comfortable for the patient due to their lower coefficient of friction and better trackability.
In addition to performing colonoscopies, the endoscope system of the present invention is also useful with a variety of surgical devices including: cannulas, guide wires, sphincterotomes, stone retrieval balloons, retrieval baskets, dilatation balloons, stents, cytology brushes, ligation devices, electrohemostasis devices, sclerotherapy needles, snares and biopsy forceps.
Cannulas are used with the endoscope system to cannulate the sphincter of Oddi or papilla to gain access to the bile or pancreatic ducts. Guide wires can be delivered down the working channel of the endoscope and used as a rail to deliver a surgical device to an area of interest. Sphincterotomes are used to open the papilla in order to place a stent or remove a stone from a patient. Stone retrieval balloons are used along with a guide wire to pull a stone out of a bile duct. Retrieval baskets are also used to remove stones from a bile duct or other tract. Dilatation balloons are used to open up strictures in the gastrointestinal, urinary or pulmonary tracts. Stents are used to open up strictures in the GI, urinary or pulmonary tracts. Stents can be metal or plastic, self-expanding or mechanically expanded, and are normally delivered from the distal end of a catheter. Cytology brushes are used at the end of guide wires to collect cell samples. Ligation devices are used to ligate varices in the esophagus. Band ligators employ elastic bands to cinch varices. Electrohemostasis devices use electrical current to cauterize bleeding tissue in the GI tract. Sclerotherapy needles are used to inject coagulating or sealing solutions into varices. Snares are used to remove polyps from the GI tract, and biopsy forceps are used to collect tissue samples.
Examples of specific surgical procedures that can be treated with the endoscopie system of the present invention include the treatment of gastroesophageal reflux disease (GERD) by the implantation of bulking agents, implants, fundoplication, tissue scarring, suturing, or replacement of valves or other techniques to aid in closure of the lower esophageal sphincter (LES).
Another example of a surgical procedure is the treatment of morbid obesity by deploying implants or performing reduction surgery, gastric bypass and plication or creating tissue folds to help patients lose weight.
Endoscopic mucosal resection (EMR) involves the removal of sessile polyps or flat lesions by filling them with saline or the like to lift them prior to resection. The endoscope of the present invention can be used to deliver needles, snares and biopsy forceps useful in performing this procedure.
In addition, the video endoscope system of the present invention can be used to perform full-thickness resection (FTRD) in which a portion of a GI tract wall is excised and the wounds healed with staplers or fasteners. Finally, the endoscope system of the present invention can be used to deliver sclerosing agents to kill tissues or drug delivery agents to treat maladies of internal body tissues.
While the preferred embodiment of the invention has been illustrated and described, it will be appreciated that various changes can be made therein without departing from the scope of the invention. For example, although some of the disclosed embodiments use the pull wires to compress the length of the endoscope, it will be appreciated that other mechanisms such as dedicated wires could be used. Alternatively, a spring can be used to bias the endoscope distally and wires used to compress the spring thereby shortening the length of the endoscope. Furthermore, although the disclosed embodiments use rotary servo motors to drive the control cables, other actuators such as linear actuators could be used. Similarly, although the endoscope discussed in connection with the preferred embodiment includes a working channel, it will be appreciated that such a channel may be omitted and the resulting catheter used to deliver a special purpose tool such as a snare, RF ablation tip, etc., to a desired location. Alternatively, the catheter could be used solely for imaging. Finally, although the disclosed components are described as being used in a video endoscope, it will be appreciated that many components may have separate utility by themselves or in other medical devices. Therefore, the scope of the invention is to be determined from the following claims and equivalents thereof.
1. An endoscopic system, comprising:
- a housing including one or more actuators that selectively move the distal tip of an endoscope in at least one desired direction;
- an endoscope having a distal end that is inserted into the body of a patient and a proximal end that is removably coupled to the housing;
- a directional controller for directing the one or more actuators in the housing to move the distal tip of the endoscope in the desired direction;
- means for determining a force required to move the distal tip of the endoscope; and
- a feedback mechanism coupled to the directional controller for providing feedback to a user of the force required to move the distal tip of the endoscope.
2. The endoscopic system of claim 1, wherein the directional controller is a joystick and the feedback mechanism selectively adjusts the tension of a spring on the joystick.
3. The endoscopic system of claim 1, wherein the directional controller is a joystick that is movable with at least two motors and the feedback mechanism selectively adjusts the torque of the two motors.
4. The endoscopic system of claim 1, wherein the actuators selectively move the distal end of the endoscope in a plurality of directions and the force determining means comprises a processor in the housing that estimates the force required to move the distal tip, wherein the force is supplied to the feedback mechanism, and wherein the feedback is a tactile signal that is proportional to the force required to move the distal end.
5. The endoscopic system of claim 1, wherein the actuators are motors that selectively tension control cables within the endoscope and the means for determining the force required to move the distal tip of the endoscope includes a position sensor and a torque sensor on the motors.
6. The endoscopic system of claim 1, wherein the housing includes a processor that separates a force required to move a proximal portion of the endoscope from the force required to move the distal tip, and wherein the feedback is tactile feedback provided to the user that is proportional to the force required to move the distal tip.
7. The endoscopic system of claim 1, wherein the housing is a control unit including the one or more actuators and the force determining means, the actuators selectively moves the distal end in a plurality of directions and the force determining means estimates a force to move a proximal portion of the endoscope and a force to move a distal tip of the endoscope, wherein the force to move the distal tip is supplied to the feedback mechanism and the feedback is a tactile signal that is proportional to the force required to move the distal tip.
8. A system for providing feedback to a user of an endoscope, comprising:
- an endoscope having a distal end that is inserted into a patient and a proximal end that is connectable to a housing;
- control cables in the endoscope that are selectively tensioned by actuators in the housing to steer the distal end;
- sensors on the actuators that determine a force required to tension the control cables;
- a processor that directs the actuators to tension the control cables, and determines an extra force above the force to steer the distal end in a particular direction; and
- a feedback mechanism that provides an indication to a user of the extra force.
Type: Application
Filed: Sep 30, 2004
Publication Date: Jun 2, 2005
Patent Grant number: 8118732
Inventors: Michael Banik (Bolton, MA), Lucien Couvillon (Concord, MA), Dennis Boulais (Danielson, CT), Richard Wiesman (Wayland, MA), Timothy Mason (Uxbridge, MA), Neil Mehta (Jamaica Plain, MA)
Application Number: 10/955,949


text:
When I play Gnomeaggedon, it's on from the moment I enter an instance or raid.
Buffs, tables, scorch, Living bomb, Frostfire bolt, Flamestrike, Blizzard, Hotstreak, drink, loot, move, scorch….
I always assumed it was the same for the other roles, never a dull moment, but nothing that can't be handled by doing things right.
I dare say it's pretty much the same for tanks. Mark, pull, gather, pump cooldowns and specials, watch and stop the runners, take opportunities as they come up… "Rage" bar full… let's pull!
The other Extreme
It's not the same for healers, particularly Shaman healers, from my experiences (as limited as they may be) and my reading.
See we don't buff in the traditional "buff and forget" model. We plant and pluck our buffs in the form of totems. They don't go down until just before the pull.
When it comes to healing there seems to be 5 distinct states.
- Snoozefest
- Odd jobs
- At last
- Oh shit
- OMFG, you must be joking.
Snoozefest is 80%+ of a healers life. Earth Shield is up with riptide on the tank, the tanks got all the aggro, no AoE damage incoming… Time to stare at the walls, watch YouTube, redo those toolbars.
I can't get my mind around this stage… It is like logging in and sitting at the bank in Dalaran. Or going to the AH and doing an Auctioneer scan. It's automatic.
Odd Jobs
- Yay the Mage pulled Aggro!
- The DK Deathgripped the next group!
- Someone did something stupid!
Once I peel my eyes back open I go a quick assessment and click, it's done. Ok maybe there are 2 or 3 clicks. If I'm lucky Riptide or ES have dropped off the tank.
Good, something to do!
At last
Lots of manageable incoming damage.
Things are still going fine, it's all going to plan, but now I have 3 plus party members to get my regular attention.
This is more like DPS… Yes it's still reactive, but it's constant.
I get to press buttons like everyone else!
Oh shit!
I am still not the best at these, I have spent too much time in Snoozefest I think (and maybe too much time in BGs not caring exactly who lives and dies, as long as someone lives).
But when they happen it's like a DPS knowing there is 30 seconds till an enrage timer.
It's like a Fire Mage attacking a boss that's just reached 35% health.
It's pop the cooldowns, the trinkets and go balls to the wall.
It's exciting, challenging, but possible.
I don't want every moment to be like this, bit I like my adrenalin to pump occasionally as well.
Bring it on!
OMFG, you must be joking
I haven't really experienced this yet, but I've read a lot about how the Northrend encounters are made harder by putting the pressure on the healer.
No more Snoozefest 80% of the time, let's have Oh Shit 80% of the time.
Then for that final 20% let's make you wonder why you ever rolled a healer, let's make the party hate you for not keeping them alive.
From what I can work out from my reading, Blizzard has adopted a healing difficulty approach to make the encounters more challenging.
Sure there is more goo for the party to get out of, more tricks for the DPS to do/avoid, but it all amounts to one thing…
Pressure on the healer.
Yes the healer could let the goo-covered, puddle-standing DPS die to teach them a lesson, but do they let all 3 of them die?
What, the healer has to get out of the fire too? They have to run around like headless chickens finding 2.1 second windows to cast 2 second spells?
I'm loving healing and can't wait to try the Northrend instances and raids from a different "back of the room" perspective.
But, I swear if my balls get busted by Blizzard in PvE, I will camp the BGs instead.
At least there I have less attachment to the noobs going down in a rain of fiery hell.
Gnomer and Out, Squidly and Stout!
This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported License.

subset: commoncrawl


text:
Exposed: Private Leaked Footage Of Stunnaman From The Pack Ex Girlfriend "Ayana Marie"! (The Chick Who Tried To Put Him On Blast) Dancing Nekkid For Popular Celebrity!
An anonymous source sent us a few private clips of Stunnaman's ex girl "Ayana Marie" with this message in our inbox "What goes around comes around". The girl who bashed on her ex Stunnaman via http://bit.ly/aB2RCb. For a celebrity who she was messing with & they claim to have more exposed footage!
Please click the "Report" button below if the video on this page is not working properly.


text:
It's time to pay the sisters the same as the misters!
Equal pay affects everyone: the recent uni grad just starting her first job, the mum who is taking a couple of years out of paid work to raise her children, to school support and social workers.
Treat Her Right is about all of us. We still need your voice, and as many voices as possible, so we make 2017 the year that equal pay became real.
Will you join with us to make this happen?
GOAL: 10,000 signatures
- I support equal pay in every workplace.
- I want equal pay for women now.
Women work hard for the money, so let's treat them right.
It's time to pay the sisters the same as the misters!


text: IMO, this has one of the best, if not THE best China/Riders of '72 and I know portions of this show have been used at the Deadnet taper's section. Sadly, only crappy auds of it exist on the Archive. Anyone know of any circulating boards or how I can rip streams from the Taper's section?


text:
The Libyan government has pitched a tent at the swanky Westchester estate owned by Donald Trump during Moammar Kaddafy's first-ever visit to the United States -- but local officials are trying to knock it down.
A laywer for the town of Bedford, about 43 miles north of Manhattan, told The Associated Press that officials put the kibbosh on any work at the site late Tuesday.
"We believe the erection of a tent on the ... property violates several codes and laws of the town of Bedford," Attorney Joel Sachs told the AP. "There is no such thing as diplomatic immunity when it comes to complying with local laws and ordinances. This is a private piece of property and they have to comply with the laws of this municipality."
U.S. & World
Sachs said he gave the order to the property's caretaker because workers constructing the tent did not speak English. Town officials will follow up today to enforce the order.
Earlier a State Department official, who spoke on condition of anonymity because of diplomatic sensitivity and protocol concerns, said Trump's property was obtained for the duration of this weeks' U.N. General Assembly and would just be used for "entertaining." The official said no one would be staying there overnight.
Kaddafy's air-conditioned Bedouin-style tent, which he normally takes with him on international visits, hasn't been well received in any possible location.
The "entertainment" tent appeared to have finally found a home on the lavish Seven Springs property in Bedford that Trump has owned since 1995, sources said.
The Trump Organization said the estate was leased short-term to Middle Eastern partners. Trump's group says the organization is looking into whether the group was connected to Kaddafy.
Westchester County Executive Andy Spano said he was not aware of Kaddafy's plans, but isn't pleased if the tenting rumors are true.
Kaddafy has had a hard time finding a place to stay in the New York area ahead of his visit for the U.N. General Assembly. He is due to make his first-ever address at the GA on Wednesday.
Kaddafy tried to weasel his way into two upscale mansions in the Riverdale section of the Bronx, a published report said Tuesday.
An aide to the Libyan leader allegedly claimed to be a member of Sri Lanka's diplomatic delegation when calling a Riverdale developer to rent a property in Villanova heights, according to the New York Daily News.
When the would-be landlord found out who the tenant was really going to be he shut down the deal.
"It's just not good to deal with liars from terrorist countries," developer John Fitzgerald, told the paper.
Apparently, the Libyan leader's aides gave the impression they were part of the delegation from Sri Lanka.
"I asked about Sri Lanka, and he said, 'We're not from there,' but wouldn't reveal where they were from," attorney John Daly told the News.
"Eventually he said he was from the Middle East, and then he said, 'We're from Libya,' [and] that Mr. Kaddafy wanted to put up the tends so he could come up after the sessions."
That was when the deal was broken.
"I mean, the guy ultimately condones terrorism," Fitzgerald said. "We didn't think it was appropriate to rent to him."
Kaddafy, who held a massive homecoming celebration for Lockerbie bomber Abdel Baset al-Megrahi when he was released last month, had originally wanted to stay in a tent in Central Park, but when that idea was nixed he planned to pitch a tent a a home in Englewood, N.J., owned by the Libyan mission. Angry protests in the neighborhood shut down that idea as well.
He was set to rent a room at the Pierre hotel, but protests put a stop to that as well, and next planned to stay in the Libyan Mission on East 48th Street.


text:
This morning as I was pinning, I came across several great FREE items. Who doesn't love free?
- Use this search: "Lynn Farrell Stover" "Library Sparks" This generous lady shares her Library Lessons – and they are awesome! They are geared for elementary students but I have found ideas to "eduplay" with my grandsons. (Hmm…don't know if that term will catch on.)
- The Book Bug's Destiny (catalog) exercises – for elementary, but I know I can use the general idea for my high school students:https://docs.google.com/file/d/0B8Hp3hxOmva9ekZhUVdUWkZKd28/preview If you have some time, surf through her site. Treasure trove!
- Teacher Vision's Library Resources for Teachers Most of the activities are geared toward elementary and middle school students, but some can be modified for use with high school students. For example, librarians can add another level to the Dewey Relay game which divides students into teams tasked with being the quickest to locate books with a specific Dewey number. Perhaps combine this with gathering citation information to have students not only locate, but also use, library resources.
- Technology Rocks Seriously School Signs You aren't going to believe the treasure trove of colorful free signs that this teacher generously shares!
- Lizz the Librarian's "A Librarian Needs Printables" Signs, bookmarks, bookplates, and more.
- Jan Brett Library Signs Print and display – perfect for elementary school libraries.
"Remembering the Titanic" from the PDF available from Highsmith at www.highsmith.com/pdf/librarysparks/2012/lsp_mar12_ll_titanic.pdf
"Always, always, always consider the source" from Technology Rocks Seriously's Scribd. document. http://www.technologyrocksseriously.com/2012/01/blog-post.html


text:
Blog Archives
Sully Baseball Daily Podcast Archives Jan 1, 2015 – Jan 31, 2015 (Episodes 800 – 830)
Paul Francis Sullivan (please call him Sully) does a podcast 365 days a year – unless it is a leap year – then he will do another 1. He has done a show everyday since Oct.24/2012. This to date represents a streak of 1238 days consecutively!
Past the CLICK TO READ THE REST OF THIS ENTRY are episodes 800 – 830 of the Sully Baseball Daily Podcast.
We will also archive all of his podcasts to date (in coming weeks) so they are easily accessible for all his fans. Check out all his Archived info here.
Our website followers have grown larger each year for his podcast.
Follow Sully Baseball On Twitter Follow @sullybaseball
To subscribe on iTunes, click HERE.
To subscribe on SoundCloud, click HERE. Read the rest of this entry
MLB Reports State Of The Union Part 1: Sully Baseball Joins The MLB Reports!!
Like us on Facebook hereFollow @mlbreports
Wednesday, Feb.6/2013
By Chuck Booth (Lead Baseball Analyst/Website Owner): Follow @chuckbooth3024
It has been a great day at the MLB Reports.com. So much so, that I thought we would write our own State Of The Union Article. We are rapidly becoming one of the best independently owned – and fan run websites around the internet. I know this is because we have awesome readers who share the same passion as we do. I took over this website in November after writing for about 1 year. Jonathan Hacohen (Founder, previous owner) had a vision that I have continued to run with. We were searching for like-minded writers that share the same baseball passion as we do. Since November 2oth, we have added 22 MLB Team Correspondents – and several new specialist writers. We have taken a bit of a different direction but with the same model in mind. We will get to some of those people in Part 2 of the State Of The Union.
We are all here to work our tails off about spreading the game of baseball through written word. We spend countless hours researching, writing, editing, checking stats, uploading pictures, tweeting, sharing on Facebook and interacting with a lot of you – in order to operate this website. We are not making Millions, hell it really doesn't pay very much at all. We do it for the love of the game.
Having said this, we have some really exciting news to pass on. Paul Francis Sullivan (please call him Sully) Follow @sullybaseball is joining our MLB Reports team as our Lead Baseball Writer and #1 personality. Nobody works harder in the business than Sully. He will be writing several articles a week and posting daily PODCASTS. I am not lying here… Daily! Sully has put up a daily PODCAST for over 110 days in a row now. He usually talks on them for about 20 minutes or so. He will share these with you. In the last 10 months, Sully also has written over 335 articles on MLB Baseball. This man loves the game and we are ecstatic beyond belief to have him part of our team. We all hope that you support and welcome him.
Here is his quick biography:
Sully has appeared in the HBO Sports documentaries "Curse of the Bambino" and "Reverse the Curse of the Bambino" as well as on ESPN2's Cold Pizza and NESN's "Spaceman: A Baseball Odyssey." He has performed stand up comedy all across the United States and appeared on the TV show "Monk."
He is currently a producer for Wild Eyes Productions in Los Angeles. Sully has previously produced such shows as"Axe Men", "The Daily Show with Jon Stewart" and "The Bonnie Hunt Show." He received an Emmy nomination for his work on San Francisco public television.
An award-winning filmmaker, he directed the feature film "I'll Believe You" as well as many short films including "Sergi" as featured on PBS' "Independent Lens."
Sully's personal blog is here
He has been a contributing baseball writer for USA Today, Baseball Digest, The Hardball Times and Time Out New York. His videos can be found on the Sully Baseball channel on YouTube.
Quick look at Sully Baseball's Youtube Video Page:
*** The views and opinions expressed in this report are those of the author and do not necessarily reflect the views of mlbreports.com or their partners.***
Chuck Booth- Lead Baseball Analyst/Website Owner and author of the Fastest 30 Ballgames: To learn more about my "The Fastest 30 Ballgames Book" and how to purchase it, click here . You can also follow my Guinness Book of World Record Successful Bid to see all 30 MLB Park in 23 Days- click here. I am happy to be part of such an awesome Magazine-Style Baseball Website and am looking forward to talking to all of the fans of the MLB. You can reach me on Twitter here Follow @mlbreports
Please e-mail me at: email@example.com with any questions and feedback. You can follow us on Twitter and become a fan on Facebook. To subscribe to our website and have the Daily Reports sent directly to your inbox, click here and follow the link at the top of our homepage.Follow @mlbreports
Like us on Facebook here


text:
Blue Orchid
Bar soap#05019
Bar soap Blue Orchid is enriched with organic argan oil that is known as the liquid gold of Morocco.
This "life-giving elixir" is rich in vitamin A and vitamin E, which makes it an effective antioxidant.
It contains omega-6 fatty acids that account for its regenerative properties. It is a natural skin moisturizer acting as a softening and conditioning ingredient.
The argan oil makes the soap foam delicate and softens the soap effect.
Elegant design, magnetic orchid scent and fluffy foam - pleasures worth indulging in.


text:
This website uses cookies. By continuing to browse this website you are agreeing to our use of cookies.
Find out more about cookies or view our cookie policy.
Status: You are viewing the version of the handbook as on 2016-03-21.
the business of effecting or carrying out contracts of insurance.5


text:
Leica has always re-licked Panasonic's top-spec compact cameras, and the Leica V-Lux 4 is no different. Those aware of the Panasonic FZ200 will see the immediate and obvious similarities, but there are one or two sheeny Leica elements that go towards the heightened £690 asking price.
The "red dot" on the front of the camera is the most obvious, as well as the bold and silvered "Leica" text below the brow of the pop-up flash.
On the back of the vari-angle screen there's also a subtly embossed Leica logo in the plastic.
The menu system also differs. The model we had to play with at Photokina in Cologne, Germany, was - no surprises - set up in German so we weren't 100 per cent sure what was what.
As per the FZ200, which Leica has like-for-like features, the V-Lux 4's 24-600mm equivalent lens can maintain an f/2.8 aperture throughout the full focal range. Now that's top grade stuff.
In our quick test everything else felt much the same to us - a good thing, given how much we liked the FZ200.
If Leica's your thing and you've got the spare cash then this prestigious-looking re-badge ought to be right up your street. There aren't better superzooms around - if you ignore the inflated price tag.


text:
Students at Loras College in Dubuque sponsored Breast Cancer Awareness activities in collaboration with the Northeast Iowa chapter of FORCE. Women from the Loras chapter of Alpha Sigma Alpha sorority at Loras College raised $175 for FORCE by selling pink and teal ribbons door-to-door in residence halls. The women of ASA also sponsored a showing of the documentaryIn the Family.Other students from a Hope-themed residence hall brought stylists from the Amirage Salon & Day Spa to campus and raised $55 selling pink hair extensions. Both student groups helped distribute FORCE literature to the Dubuque community at a campus Health & Wellness Fair and the Loras Volleyball team's Think Pink Night.
Loras College chapter of Alpha Sigma Alpha sorority
Loras students sell hair extensions for Breast Cancer Awareness


text:
Hey if someone could help me shed some light on my code as too why it is getting the error String index out of range: -1 i would be for ever in your debt
the part of the question im stuck on is this
"At the beginning, your program should ask the user to specify a one-to-one mapping between the
characters in the above mentioned alphabet. For example, your program may display the 40 characters
in one line and ask the user to type the same set of characters in the second line, but in a different
order. After the mapping is established, your program should then ask the user to type in a sentence
using the characters from this alphabet, and then output the encrypted sentence"
The bit in red is the bit im really stuck on
package question3;
import java.util.Scanner;
public class Question3 {
private String alpha = "ABCDEFGHIJKLMNOPQRSTUVWXYZ1234567890 ,.!";
private String MAP = "";
private String Pass = "";
Scanner kb = new Scanner(System.in);
public void getString(){
System.out.println("These are the Characters that are able to be used");
System.out.println("Please input encryption");
MAP = kb.nextLine();
MAP = MAP.toUpperCase();
public void checkalpha(){
int firstIndex = 0;
int lastIndex = 0;
int count = 1;
boolean repeatedChars = false;
if(MAP.length() == 40){
for (int i = 0; count < MAP.length(); i++){
char character = MAP.charAt(i);
firstIndex = MAP.indexOf(character);
lastIndex = MAP.lastIndexOf(character);
if(firstIndex != lastIndex) {
repeatedChars = true;
if(repeatedChars == true) {
System.out.println("There were repeated characters in the string");
System.out.println("Please Do not Input the characters more than Once");
else {
System.out.println("No Repeated Characters");
if (MAP.equals(alpha)){
System.out.println("Please Do not repeat the starting characters");
else {
System.out.println("Incorrect Amount of Characters");
public void printConverted(){
char PassIndex;
System.out.println("Please Input message wanted to be converted");
Pass = kb.nextLine();
for (int i = 0; i < Pass.length(); i++){
PassIndex = MAP.charAt(Pass.indexOf(alpha.charAt(i)));
printConverted method is the one with the problem, im positive about that.
Thanks for taking a look, if you need more info about something please let me know, i am very new to java so i really want to learn what im doing wrong


text:
- This event has passed.
Location: West Valley Peoria
November 20, 2019 @ 4:00 pm - 7:00 pm
|Recurring Event (See all)
An event every week that begins at 4:00pm on Monday, Tuesday, Wednesday, Thursday and Friday, repeating indefinitely
Event Navigation
Child must be at least 4 years old and a minimum of 40lbs. Tennis shoes required. Open everyday M-F 9:00am-2:00pm & 4:00pm-7:00pm, Saturday& Sunday 9:00am-2:00pm.


text:
Paramount has signed on to release Area 51, the second film from Paranormal Activity director Oren Peli. Will box office lightning strike twice?
The movie, according to Variety, will leave little to chance; The movie, which finished shooting three weeks ago, is another low budget, high concept vehicle that will employ a similar "found footage" style to Paranormal Activity (This time focusing on three teens exploring the infamous Nevada military base). Paramount got the US domestic rights thanks to the involvement of their Film Group President Adam Goldman, one of the movers behind Dreamworks' acquisition of Activity.
The movie is due to be released next year.
Par Pacts "Area 51" with Paranormal Team [Variety]


text:
Kimberly Stewart, Rod Stewart's daughter, and Benicio del Toro are expecting a child together. His rep says, "Although they are not a couple, they are looking forward to the arrival of the baby." How romantic!
Courteney Cox chatted with Howard Stern this past week. She said one of the problems in her relationship with David Arquette is that he always wants to have sex with her. "Whenever I would need consoling from David, he could not literally put his arm around me for one second without completely getting a boner."
With legs like those, can you blame him?
PS - Hot shoes!
ScarJo has reportedly moved in with Sean Penn. Even though it looks like she's sporting a baby bump, her rep says she isn't pregnant. Why does everyone have to be pregnant if they don't have six pack abs? Maybe she's addicted to In-N-Out... the burger chain, you pervs.
Tori Spelling and hubby Dean McDermott are expecting their third child together. The pair already has two children, Liam and Stella. No, that's not her husband. I just like this picture.
If you somehow aren't sick of Hollywood remakes yet, here's another to
Speaking of Bradley Cooper, he may be dating Jennifer Aniston. This is a couple I can get on board with.
After dealing with the stress of the past year, Catherine Zeta-Jones checked in to a mental health facility to treat her Bipolar II Disorder. I appreciate someone who seeks help when they need it. Get well, CZJ!
The Talk of Tinseltown was brought to you today by...
Hayden Panettiere
Breaking News Update
Nicolas Cage was arrested for domestic abuse and disturbing the peace early Saturday morning after getting drunk in New Orleans where he's currently filming a movie. Nic stormed into a tattoo parlor wanting a tattoo right that instant. His wife dragged him from the tattoo shop. They ended up getting into a heated argument which prompted a cab driver to call police. Nic went to jail and in true celeb fashion, Dog the Bounty Hunter posted his bail.
Well, ain't that a bitch!