Two-pronged approach for bronchoscopy
Via a trachea ( 5 ) of the subject, an end of a first tube ( 120 ) is advanced along a first airway route ( 127 ) to an imaging site ( 20 ) within the lung ( 55 ). Independently of the first tube, an end of a second tube ( 130 ) is advanced along a second airway route ( 130 ) to a tool site ( 30 ) within the lung. While the first tube remains extended along the first route and the second tube remains extended along the second route, an imaging device ( 128 ), extended from the end of the first tube, is used to image a tool ( 138 ) extended from the end of the second tube, and a target ( 40 ) within the lung. The tool can be used to perform a procedure on the target, guided by the imaging of the target and the tool. Other embodiments are also described.
1. A method for use with a lung of a subject, the method comprising:
advancing a first tube through a trachea of the subject;
guided by a first camera disposed at an end of the first tube, advancing the end of the first tube along a first airway route to an imaging site within the lung;
advancing a second tube through the trachea independently of advancing the first tube through the trachea;
guided by a second camera disposed at an end of the second tube, and while the end of the first tube remains at the imaging site, advancing the end of the second tube along a second airway route to a tool site within the lung;
subsequently, withdrawing the first camera from the first tube and the second camera from the second tube;
subsequently, advancing:
an imaging device through the first tube to the end of the first tube, and
a tool through the second tube to the end of the second tube; and
subsequently, performing a procedure on a target within the lung using the tool while guiding the procedure by using the imaging device to observe positioning of the tool with respect to the target.
2. The method according to claim 1 , wherein performing the procedure on the target comprises performing the procedure while the target is disposed between the imaging device and the tool.
3. The method according to claim 1 , wherein advancing the end of the first tube comprises actively steering the first tube using an extracorporeal first-tube controller.
4. The method according to claim 1 , wherein the imaging device comprises an ultrasound transceiver, and wherein using the imaging device to observe the positioning of the tool with respect to the target comprises imaging the tool and the target using the ultrasound transceiver.
5. The method according to claim 1 , wherein the imaging device is a LIDAR device, and wherein using the imaging device to observe the positioning of the tool with respect to the target comprises imaging the tool and the target using the LIDAR device.
6. The method according to claim 1 , wherein the target is located within a target bronchus of the lung, and wherein advancing the end of the second tube along the second airway route to the tool site comprises advancing the end of the second tube intrabronchially along the second airway route to the target bronchus.
7. The method according to claim 1 , wherein:
the tool includes a tool element selected from the group consisting of: a needle, a blade, scissors, a suction device, jaws, a grasper, an ablation device, and an energy applicator; and
performing the procedure on the target using the tool comprises performing the procedure on the target using the tool that includes the selected tool element.
8. The method according to claim 1 , wherein performing the procedure comprises ablating the target.
9. The method according to claim 1 , wherein performing the procedure comprises excising a foreign body from the lung.
10. The method according to claim 1 , wherein:
the target is situated outside of an airway of the lung,
the tool site is within the airway,
advancing the end of the second tube along the second airway route to the tool site comprises advancing the end of the second tube along the second airway route to the tool site that is within the airway, and
performing the procedure on the target using the tool extended from the end of the second tube comprises extending the tool through a wall of the airway and into the target.
11. The method according to claim 1 , wherein:
the method further comprises advancing a sheath via the trachea toward the lung;
advancing the end of the first tube comprises extending the first tube out of the sheath; and
advancing the end of the second tube comprises extending the second tube out of the sheath independently of extending the first tube out of the sheath.
12. The method according to claim 11 , wherein:
the lung defines a fork, the at which a bronchus of the lung forks distally into a first branch and a second branch,
advancing the sheath comprises advancing a distal part of the sheath via the trachea into the bronchus, not beyond the fork, and
advancing the end of the first tube along the first airway route to the imaging site comprises advancing the end of the first tube beyond the fork, and via the first branch to the imaging site.
13. The method according to claim 12 , wherein advancing the end of the second tube along the second airway route to the tool site comprises advancing the end of the second tube beyond the fork, and via the second branch to the tool site.
14. The method according to claim 13 , wherein the imaging site is situated, along the first airway route, at a different bronchus-generational depth than is the tool site, along the second airway route.
15. The method according to claim 11 , wherein advancing comprises advancing a distal part of the sheath into a bronchus of the lung guided by binocular vision provided by the first camera and the second camera.
16. The method according to claim 1 , wherein:
performing the procedure on the target using the tool extended from the end of the second tube comprises performing a first part of the procedure on the target using the tool extended from the end of the second tube, and
the method further comprises, subsequently to performing the first part of the procedure, and while the end of the first tube remains at the imaging site:
withdrawing the imaging device from the first tube;
withdrawing the tool from the second tube;
subsequently, advancing the tool through the first tube; and
subsequently, performing a second part of the procedure on the target using the tool extended from the end of the first tube.
17. The method according to claim 16 , wherein:
the method further comprises, subsequently to withdrawing the imaging device from the first tube and the tool from the second tube, and while the end of the second tube remains at the tool site, advancing the imaging device through the second tube, and
performing the second part of the procedure comprises performing the second part of the procedure, guided by imaging of the target by the imaging device at the end of the second tube.
18. The method according to claim 1 , wherein, for each of the first camera and the second camera, the respective camera includes a light source, and advancing the end of the respective tube guided by the camera comprises advancing the end of the respective tube while the respective airway route is illuminated by the light source.
19. The method according to claim 1 , wherein using the imaging device to observe the positioning of the tool with respect to the target comprises determining a presence of the target and the tool in a field of view of the imaging device.
20. The method according to claim 19 , wherein the method further comprises, subsequently to determining the presence of the target and the tool in the field of view, repositioning the tool with respect to the imaging device and the target while retaining the tool in the field of view.
21. The method according to claim 19 , wherein the method further comprises, subsequently to determining the presence of the target and the tool in the field of view, repositioning the imaging device with respect to the tool and the target while retaining the tool in the field of view.