Endoscopic resection cap with built-in oscillating dissector

Abstract

To provide a medical device for facilitating a minimally invasive surgical procedure.SOLUTION: An endoscopic resection cap 100 may include a housing 102 and an arm. The housing may be configured for engagement around an outer circumferential surface of an endoscope and may include a first cavity 108. The arm may include at least one cutting surface 125 and may be movably received within the first cavity. The arm may be configured to perform a first predetermined movement along at least a first plane at a predetermined frequency.SELECTED DRAWING: Figure 1

Description

[Technical Field]

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS This application claims priority to U.S. Provisional Patent Application No. 62 / 871,450, filed July 8, 2019, which is incorporated herein by reference in its entirety. [Background technology]

[0002] Endoscopic submucosal dissection (ESD) is a noninvasive technique for removing cancerous tissue or other lesions along the gastrointestinal (GI) tract. ESD can be used when the cancerous tissue or other target tissue is located within the first two inner layers of the GI wall: the mucosa and submucosa. The GI tract consists of four layers: the innermost layer is the mucosa (which may include the epithelium, lamina propria, and muscularis mucosa), followed by the submucosa, and then the outermost layers, called the muscularis propria and adventitia. The structure of these layers varies depending on the region of the digestive system. If the target tissue extends into one of the deeper layers of the GI wall, a full-thickness surgical or endoscopic resection may be necessary. The average procedure time for physicians in the Western world is approximately 1–2 hours, as physicians must carefully make multiple small incisions to completely dissect the entire area. The two major complications associated with this technique are bleeding and perforation of the muscularis propria and adventitia, and the complication rate is quite high due to the technical difficulty of the procedure.

[0003] These iatrogenic complications occur for several reasons. First, the mucosal flap may not be sufficiently elevated during resection, obstructing the surgeon's view and resulting in limited or no visibility of the resection surface. This situation can lead to physician error and unintentionally severing a blood vessel or perforating muscle. Second, although the resection surface is visible, it is narrow and the submucosal fibers are close to the muscle and / or blood vessels, forcing the surgeon to make the cut through a small window. This situation can lead to physician error and unintentionally severing a blood vessel or perforating muscle. Third, limitations of the endoscope and anatomical location can hinder the surgeon's proper positioning to make the cut, thereby making it difficult to reach the dissection surface. This situation can lead to physician error and unintentionally severing a blood vessel or perforating muscle. Fourth, existing available surgical blades are operated by electrocautery, which delivers radiofrequency energy from an electrosurgical generator. An inherent problem with the use of electrocautery is the iatrogenic risk of physicians accidentally severing tissue, such as blood vessels or muscle tissue. Summary of the Invention [Problem to be solved by the invention]

[0004] It would therefore be desirable to provide devices and methods that would improve a physician's ability to safely perform ESD, particularly devices and methods that would increase the physician's visibility of the target tissue during ESD, provide better control over tissue dissection to reduce the risk of unintended amputation, and / or reduce the ESD procedure time. [Means for solving the problem]

[0005] One general aspect of the present disclosure includes a medical device for facilitating minimally invasive surgery, comprising: a housing configured to engage around an outer periphery of an endoscope and including a first cavity; and an arm including at least one tissue ablation surface and movably received within the first cavity, the arm configured to perform a first predetermined motion at a predetermined frequency along at least a first plane corresponding to reciprocating motion of a proximal portion of the arm.

[0006] Another general aspect of the present disclosure includes a medical instrument for facilitating minimally invasive surgery, comprising: a housing having a first cavity; an arm including at least one tissue dissection surface, movably received within the first cavity, the arm including a first receiving slot and a second receiving slot; a first connecting member extending between a first distal end and a first proximal end of the first connecting member; and a second connecting member extending between a second distal end and a second proximal end of the second connecting member, wherein the first distal end of the first connecting member is slidably received within the first receiving slot and the second distal end of the second connecting member is slidably received within the second receiving slot, and wherein manipulation of the first and second proximal ends configures the arm to rotate along at least one arc relative to the housing.

[0007] Another general aspect of the present disclosure includes a medical instrument for facilitating minimally invasive surgery, including a housing having a first cavity and a third cavity; an arm movably received in the first cavity, the arm including a guide portion and a connecting portion; and a cam assembly rotatably received in the third cavity, the cam assembly including a cam track groove configured to slidably receive at least a portion of the guide portion, the arm being rotatably connected to the third portion of the housing through the connecting portion, and wherein rotation of the cam assembly causes the guide portion to slide along a predetermined path within the cam track groove, thereby urging the arm to rotate in a first plane.

[0008] Other systems, methods, features, and advantages of the embodiments disclosed herein will be or become apparent to one with skill in the art upon review of the following figures and detailed description, and all such other systems, methods, features, and advantages are intended to be included within the scope of the present invention.

[0009] The present disclosure can be better understood with reference to the following drawings and description. The components in the figures are not necessarily to scale, emphasis instead being placed upon illustrating the principles of the present disclosure, and some of the drawings are drawn to scale, so reference may be made thereto. Furthermore, in the figures, like reference numerals refer to corresponding parts throughout the various views. [Brief explanation of the drawings]

[0010] [Figure 1] FIG. 1 illustrates a perspective view of a first embodiment of an endoscopic resection cap with a built-in vibrating dissector in accordance with certain aspects of the present disclosure. [Figure 2] FIG. 2 illustrates a perspective view of a portion of the housing of the endoscopic resection cap of FIG. 1, according to certain aspects of the present disclosure. [Figure 3] 3 illustrates another perspective view of a portion of the housing of FIG. 2 according to certain aspects of the present disclosure. [Figure 4] 3 illustrates another perspective view of a portion of the housing of FIG. 2 according to certain aspects of the present disclosure. [Figure 5] FIG. 2 illustrates a perspective view of a third portion of the housing of the endoscopic resection cap of FIG. 1 according to certain embodiments of the present disclosure. [Figure 6] FIG. 2 illustrates a perspective view of a second portion of the housing of the endoscopic resection cap of FIG. 1 according to certain embodiments of the present disclosure. [Figure 7] 2 illustrates a perspective view of an arm of the endoscopic resection cap of FIG. 1 in accordance with certain aspects of the present disclosure. [Figure 8] FIG. 2 illustrates a perspective view of a cam assembly of the endoscopic resection cap of FIG. 1 in accordance with certain aspects of the present disclosure. [Figure 9]FIG. 9 illustrates another perspective view of the cam assembly of FIG. 8 according to certain aspects of the present disclosure. [Figure 10A] 2 illustrates a cross-sectional view of the endoscopic resection cap of FIG. 1 with the integrated vibrating dissector moving in a first direction, according to certain aspects of the present disclosure. [Figure 10B] FIG. 2 illustrates a cross-sectional view of the endoscopic resection cap of FIG. 1 with the integrated vibrating dissector moving in a second direction, according to certain aspects of the present disclosure. [Figure 11] FIG. 10 illustrates a perspective view of a second embodiment of an endoscopic resection cap with a built-in vibrating dissector in accordance with certain aspects of the present disclosure. [Figure 11A] FIG. 12 illustrates a perspective view of a vibration system configured to vibrate the self-contained vibratory peeler of FIG. 11 in accordance with certain aspects of the present disclosure. [Figure 11B] FIG. 12 illustrates a cross-sectional view of the endoscopic resection cap of FIG. 11 with the integrated vibrating dissector moving out of the first plane, according to certain embodiments of the present disclosure. [Figure 12] FIG. 10 shows a simplified diagram of an endoscope including a third embodiment of an endoscopic resection element (according to any embodiment disclosed herein), which may be removably positioned on and around the distal end of a separately usable endoscope, or which may be an integral component of an endoscope configured to perform endoscopic resection, among other endoscopic tasks. [Figure 12A] FIG. 1 shows a side view of an endoscopic resection element including a reciprocating dissector and a drain hole. [Figure 12B] FIG. 12B illustrates a bottom view of the endoscopic resection element of FIG. 12A. [Figure 12C] FIG. 13 shows a side view of the delaminator of the embodiment of FIGS. 12A-12B. [Figure 12D] FIG. 1D shows a rotated perspective view of the delaminator embodiment of FIGS. 12A-12C. [Figure 13A] 1A-1C are schematic diagrams showing the center, leftmost, and rightmost positions of a reciprocating stripper relative to a retaining pin, respectively. [Figure 13B]1A-1C are schematic diagrams showing the center, leftmost, and rightmost positions of a reciprocating stripper relative to a retaining pin, respectively. [Figure 13C] 1A-1C are schematic diagrams showing the center, leftmost, and rightmost positions of a reciprocating stripper relative to a retaining pin, respectively. [Figure 13D] FIG. 13B is a compilation of FIGS. 13A-13C and the schematic diagrams of the peel paths affected thereby. [Figure 14] FIG. 10 illustrates a cutaway schematic view of a fourth embodiment of an endoscopic resection cap with a built-in vibrating dissector in accordance with certain aspects of the present disclosure. [Figure 15] FIG. 10 illustrates a cutaway schematic view of a fifth embodiment of an endoscopic resection cap with a built-in vibrating dissector in accordance with certain aspects of the present disclosure. [Figure 16] FIG. 10 illustrates a perspective view of a sixth embodiment of an endoscopic resection cap with a built-in vibrating dissector and a longitudinal lumen, in accordance with certain aspects of the present disclosure. [Figure 16A] FIG. 17 illustrates a front view of an accessory tool configured to be incorporated into the endoscopic resection cap of FIG. 16, according to certain aspects of the present disclosure. [Figure 17] FIG. 1 illustrates a front view of a first embodiment of a vibrating dissector configured to be incorporated into an endoscopic resection cap, in accordance with certain aspects of the present disclosure. [Figure 18] FIG. 10 illustrates a front view of a second embodiment of a vibrating dissector configured to be incorporated into an endoscopic resection cap, in accordance with certain aspects of the present disclosure. [Figure 19] FIG. 10 illustrates a front view of a third embodiment of a vibrating dissector configured to be incorporated into an endoscopic resection cap, in accordance with certain aspects of the present disclosure. [Figure 20] FIG. 10 shows a schematic diagram of a fourth embodiment of a vibrating dissector configured to be incorporated into an endoscopic resection cap, in accordance with certain aspects of the present disclosure. [Figure 21] 10A-10C illustrate perspective and cross-sectional views of a fifth embodiment of an oscillating (and / or rotating) dissector configured to be incorporated into an endoscopic resection cap, in accordance with certain aspects of the present disclosure. [Figure 22] FIG. 10 shows a schematic diagram of a sixth embodiment of a rotary (and / or vibratory) dissector configured to be incorporated into an endoscopic resection cap, in accordance with certain aspects of the present disclosure. [Figure 23] 1A-1C show schematic diagrams of a first embodiment of arm teeth configured to be incorporated into an endoscopic resection cap, in accordance with certain aspects of the present disclosure. [Figure 24] 10A-10C show schematic diagrams of a second embodiment of arm teeth configured to be incorporated into an endoscopic resection cap, in accordance with certain aspects of the present disclosure. [Figure 25] FIG. 10 shows a schematic side view of an arm configured to be incorporated into an endoscopic resection cap, in accordance with certain aspects of the present disclosure. DETAILED DESCRIPTION OF THE INVENTION

[0011] Various embodiments are described below with reference to the drawings, in which like elements are generally identified with like numerals. The relationship and function of the various elements of the embodiments may be better understood by reference to the detailed description that follows. However, the embodiments are not limited to what is shown in the drawings or explicitly described below. It should also be understood that the drawings are not necessarily drawn to scale (although certain drawings are drawn to scale and may therefore be relied upon), and in some cases, conventional material configurations, assemblies, and the like that are not necessary for an understanding of the embodiments disclosed herein may be omitted.

[0012] To facilitate an understanding of the embodiments disclosed herein, reference will now be made to the embodiments illustrated in the drawings and specific language will be used to describe the same. Nevertheless, it should be understood that this is not intended to limit the scope of the invention in any way, and alternatives and further modifications of the illustrated devices, and other applications of the inventive principles illustrated therein, are contemplated as would normally occur to one of ordinary skill in the art to which the invention pertains. As used herein, the term "proximal" refers generally to a direction toward a physician during a medical procedure, and the term "distal" refers generally to a direction toward a target site within a patient's body during a medical procedure. The term "configured as" is used to describe in a concrete manner structural limitations requiring a particular configuration to accomplish a specified function and / or to interact or communicate with other components, and not merely to describe an intended or theoretical application. Relationship terms and broader terms such as "generally," "about," and "substantially" will be understood by those skilled in the art to provide a clear and definitive scope of the disclosure and / or claims. For example, the term "generally vertical" will be understood to include functional equivalents, not necessarily exactly 90.00 degrees relative to a reference point.

[0013] Certain aspects of embodiments of the medical device disclosed herein, configured for use in minimally invasive surgery, provide an endoscopic resection cap with an integrated vibrating dissector that can be driven by a corresponding vibration system to perform a specific motion. The vibrating motion of the dissector may be used as an alternative to, or in conjunction with, electrocautery to perform blunt tissue dissection. Various embodiments of the vibrating dissector may be driven by various corresponding embodiments of the vibration system to perform a specific motion, as described and illustrated herein. While various embodiments of the vibrating dissector are described herein as operating in conjunction with one or more corresponding embodiments of the vibration system, one of ordinary skill in the art will be able to understand, without undue experimentation, by carefully examining this specification and the drawings, how various embodiments of the vibrating dissector and / or any combination thereof may be driven by other embodiments of the vibration system and / or any combination thereof.

[0014] An endoscopic resection cap with an integrated vibrating dissector may be attached to an existing endoscope to facilitate difficult and time-consuming procedures such as endoscopic submucosal dissection (ESD). For the sake of brevity, the various embodiments of the integrated vibrating dissector disclosed herein are described and illustrated as vibrating dissectors incorporated into an endoscopic resection cap for use in ESD in the field of GI tissue resection. Those skilled in the art, by carefully reviewing the specification and drawings herein, will readily understand how the vibrating dissector may be incorporated into the same or other devices for the same or other medical and / or experimental applications, and will be able to determine with which other devices it may be suitable for use. For example, vibrating dissectors may be successfully implemented for use in peroral endoscopic myotomy (POEM), gastric peroral endoscopic myotomy (G-POEM), endoscopic mucosal resection (EMR), and other procedures requiring manual removal of tissue within the gastrointestinal tract.

[0015] 1-10B, an embodiment of an endoscopic resection cap with a built-in vibrating dissector is shown. The endoscopic resection cap 100 may include a housing 102 having a first cavity 108, a second cavity 106, and a third cavity 110. An arm 104 including a body 142 having at least one cutting surface 125 may be movably received within the first cavity 108. Unless expressly stated otherwise, for purposes of this application, the term "cutting" as used herein should be understood to refer to blunt tissue disruption for tissue dissection, rather than incision with a sharp blade of the type associated with surgical tools such as scalpel blades. In other words, the difference is that tissue dissection removes looser tissue, such as diseased tissue in the gastrointestinal mucosa, without violating or damaging the underlying muscularis propria. The second cavity 106 may be configured to engage the periphery of the outer periphery of the endoscope, and it may be secured (removably or permanently) using, for example, a friction fit, an attachment structure (adhesive, threaded connector, strap, etc.), and / or any other attachment means. A cam assembly 126 of the oscillation system 124 may be rotatably received within the third cavity 110, such that a second predetermined motion (e.g., rotation) of the cam assembly 126 causes the arm 104 to perform a first motion 128 at a predetermined frequency along at least one first plane 130.

[0016] In some embodiments, the housing 102 may include an upper portion 132 and a lower portion 114, which are interconnected at a connecting surface 120 (the upper portion 132 and the lower portion 114 may be integrally formed). The upper portion 132 may include a first portion 112, a second portion 116, and a third portion 118. The third portion 118 may be movably connected to the connecting surface 120 of the lower portion 114 (e.g., via a threaded mechanism or other suitable mechanism), such that the third portion 118 may move substantially vertically upward (e.g., up to 5 mm) relative to the connecting surface 120. The first cavity 108 and the third cavity may be located by different portions of the housing 102. The second cavity 106 may extend through at least a portion of both the upper portion 132 and the lower portion 114 of the housing 102 (e.g., as shown in FIG. 4 ) and may be configured to receive an endoscope therein via a friction fit. The housing 102 may have a generally cylindrical upper portion 132 extending to a pointed end portion 188 in the lower portion 114, with the second cavity 106 extending therethrough along the side of the housing 102 (e.g., as shown in FIGS. 1-4). It is understood that the overall configuration of the housing may vary as desired and / or needed to accommodate various configurations of instruments (e.g., endoscopes) coupled thereto without departing from the scope of the present invention.

[0017] In some embodiments, the endoscopic resection cap 100 may also include one or more longitudinal lumens (e.g., longitudinal lumen 16240 as shown in FIG. 16 ) configured to receive and direct an accessory tool (e.g., an endoscopic grasping tool and / or a dissection tool) therein. An example of an endoscopic resection cap having one or more longitudinal lumens is described in U.S. Patent Application Publication No. 2017 / 0112361 (Cook Medical Technologies LLC, Bloomington, Indiana, USA), published April 27, 2017, which is incorporated herein by reference in its entirety. In some embodiments, the accessory tool may include a suction rotation accessory tool 16300 as shown in FIG. 16A . The suction rotation accessory The accessory tool 16300 may include a catheter 16308 having a hole 16302 at its distal end that fits into the longitudinal lumen 16240. The catheter 16308 may have a vacuum 16306 applied to the user end, which may be rotatable by a drive system at the user end. During use, submucosal fibers may enter the hole 16302 via suction and may be stretched and disrupted by rotation of the catheter 16308. The configuration of the suction rotation accessory tool 16300 may vary as desired and / or needed to correspond to the configuration of the longitudinal lumen 16240 of the endoscopic resection cap.

[0018] In some embodiments, the arm 104 may include a body 142 extending between a proximal end portion 144 and a distal end portion 146 and having a first surface 138 and an opposing surface 140. One or more surfaces of the at least one cutting surface 125 may be toothed. For example, the cutting surface 125 may have a plurality of spaced apart cutouts 208 (e.g., three cutouts as shown in FIG. 1 ) to form a plurality of discrete dissecting surfaces 210 (e.g., four dissecting surfaces as shown in FIG. 1 ). The number, configuration (e.g., shape, size), and location of the plurality of cutouts 208 and dissecting surfaces 210 may vary as desired and / or needed to achieve a desired blunt cutting surface 125 for blunt dissection of tissue when the arm performs a first predetermined motion 128 (e.g., an oscillatory motion), as described in more detail below. For example, as shown in FIG. 10A , dissection surface 210a has a relatively flat surface with larger dimensions and may therefore be used to dissect tissue when the dissection plane is relatively large. Dissection surface 210b has a relatively sharp surface with smaller dimensions and may therefore be used to dissect tissue when the dissection plane is relatively small. During use, endoscopic resection cap 100 may be oriented as desired and / or needed so that the desired dissection surface 210 is directed toward the tissue to be dissected to correspond to the corresponding dissection plane. Blunt cutting surface 125 may provide the ability to safely cut tissue without the need for precision and care to avoid unintentionally cutting critical structures, thereby reducing complication rates and procedure time. Cutting portion 208 may include one or more recessed sharp cutting surfaces (not shown) in some embodiments.

[0019] Arm 104 may also include a connecting portion 134 disposed outwardly from first surface 138 adjacent proximal end portion 144 of body 142, and a guide portion 136 extending outwardly from opposite surface 140 adjacent proximal end portion 144 of body 142. Optionally, arm 104 may also include a first extension 190 disposed outwardly from opposite surface 140 adjacent proximal end portion 144 of body 142 and spaced apart from guide portion 136.

[0020] The connecting portion 134 may be configured and positioned to be rotatably received within the third portion 118 of the upper portion 132 (e.g., within the first groove 166 as shown in FIG. 5 ), thereby allowing the arms 104 to rotate within the first plane 130 (e.g., as shown in FIGS. 10A and 10B ). As the third portion 118 moves vertically upward relative to the connecting surface 120 of the lower portion 114, the arms 104 correspondingly extend (e.g., move away from the connecting surface 120) and retract (e.g., move toward the connecting surface 120) relative to the lower portion 114. Advantageously, this configuration allows for deeper tissue dissection as desired and / or needed. To that end, the arms 104 may be movable between two fixed positions, an extended position and a retracted position, which include positive stop stops to prevent over-advancement within the housing 102 and positive retraction stops to prevent trauma during insertion of the endoscopic resection cap 100 into a patient.

[0021] Optionally, first extension 190 may be rotatably received within first portion 112 of upper portion 132 (e.g., as shown in FIGS. 2 and 3) when connecting portion 134 is rotatably received within third portion 118. First extension 190 may be configured and positioned to be rotatably received (within second groove 192 so as to extend in a direction perpendicular to first plane 130). While first extension 190 is optional, connecting first extension 190 to first portion 112 may further support and stabilize arm 104 during movement of the arm. In some embodiments, connecting portion 134 and first extension 190 may each have a substantially cylindrical configuration (e.g., as shown in FIGS. 7, 10A, and 10B) extending generally perpendicular to first plane 130. It should be understood that the configuration (e.g., shape, size) and location of connecting portion 134 and first extension 190 may vary as desired and / or needed (e.g., to correspond to the configuration and location of body 142, first groove 166, and second groove 192 as shown in FIGS. 5 and 3 to provide desired support and / or reduce friction between contacting surfaces) so long as arm 104 is rotatably connected between third portion 118 and first portion 112 of housing 102 without departing from the scope of the present invention.

[0022] The guide portion 136 of the arm 104 may be configured (e.g., cylindrical as shown in Figures 7, 10A, and 10B, or of any other suitable configuration) and positioned such that the guide portion 136 is slidably received within the cam track groove 194 of the cam assembly 126 when the connecting portion 134 and the first extension 190 are received within the first groove 166 and the second groove 192, respectively, as will be described in more detail below.

[0023] In some embodiments, cam assembly 126 may be a barrel cam as shown in the drawings herein, although this disclosure will enable one skilled in the art to use other cam mechanisms within the scope of this disclosure, including its claims, such as, by way of non-limiting example, a plate cam, a face cam, and / or other cams or gears configured to translate motion of a proximal control element into oscillatory motion of an arm including any sharp and / or non-sharp stripping surface. For the example shown herein, a barrel cam is shown in FIGS. 8 and 9, and cam assembly 126 may include an upper portion 148, a lower portion 150, and an intermediate portion 152 disposed between upper portion 148 and lower portion 150. Upper portion 148 may have a first upper surface 154 and a first bottom surface 156, which may be sloped toward first upper surface 154. The lower portion 150 may have a second top surface 158 and a second bottom surface 160 , and the second top surface 158 may slope toward the second bottom surface 160 .

[0024] Cam assembly 126 may also include an upper connecting portion 162 extending upwardly from first upper surface 154 of upper portion 148. Upper connecting portion 162 may be configured to be rotatably connected to second portion 116 of upper portion 132 of housing 102 (e.g., to be received within first lumen 170 as shown in FIGS. 1 and 6). Cam assembly 126 may also include a lower connecting portion 164 extending outwardly from second bottom surface 160 of lower portion 150. Lower connecting portion 164 may be configured to rotatably engage third portion 118 of upper portion 132 of housing 102 (e.g., to be received within first cutout 168 as shown in FIGS. 1 and 5).

[0025] In some embodiments, the upper portion 148, the lower portion 150, the middle portion 152, the upper connecting portion 162, and the lower connecting portion 164 of the cam assembly 126 may be substantially cylindrical in configuration with a second lumen 178 extending therethrough. The second lumen 178 may be configured such that when the upper connecting portion 162 is received within the first lumen 170 of the second portion 116, a second extension 182 (e.g., as shown in FIG. 6 ) of the second portion 116 is rotatably received within the second lumen 178. When the cam assembly 126 is positioned within the third cavity 110, a drive system 184 may be connected to the cam assembly 126 through the first channel 122 of the lower portion 114 of the housing 102 and through wires 101 extending through at least a portion of the second lumen 178 (e.g., as shown in FIGS. 2, 3, 10A, and 10B ). The drive system 184 may be The endoscope may include any suitable type of motor located at the user end external to the endoscopic resection cap 100 or built-in within the shaft of the endoscope, configured to generate mechanical motion and / or control the vibration system. For example, proximal motion (e.g., rotational motion) at the user end of the drive system 184 may be transmitted down the length of the wire 101 to the cam assembly 126, causing the cam assembly 126 to rotate about the first axis 186 (e.g., as shown in FIGS. 9-10B) at a predetermined frequency, which is converted via the guide member 136 and arm into vibrational motion at the distal end 146 at a desired frequency, e.g., between about 25 Hz and about 200 Hz. The term "about" is defined herein to include the exact value recited, as well as any value within 5% of the exact value, including both above and below the exact value.

[0026] 8 and 9, the upper and lower portions 148 and 150 of the cam assembly 126 may have a first outer diameter 172 ranging from about 1.5 mm to about 6 mm. The upper and lower connecting portions 162 and 164 may have a second outer diameter 174 that is smaller than the first outer diameter 172 and that is ranging from about 1 mm to about 4 mm. The middle portion 152 may have a third outer diameter 176 that is smaller than the second outer diameter 174 and that is ranging from about 0.5 mm to about 4 mm.

[0027] The receiving / engaging portions of the first and third cavities 108 and 110, such as the first cutout 168 of the third portion 118 as shown in FIG. 5, the second cutout 180 of the first portion 112 as shown in FIG. 3, and the second extension 182 and first lumen 170 of the second portion 116 as shown in FIG. 6, may be configured to rotatably receive the corresponding portions of the cam assembly 126 with adequate clearance to minimize friction between the respective corresponding surfaces while providing the necessary support and stability during rotation of the cam assembly 126. It should be understood that the configurations (e.g., shape, size, arrangement) of the first, second, and third portions 112, 116, and 118 of the upper portion 132 of the housing 102 and various portions of the cam assembly 126, such as, but not limited to, the configurations (e.g., shape, size) and location of the connecting surface 120, the arm 104, the second cavity 106, the first channel 122, and whether the housing 102 includes an additional longitudinal lumen for receiving and directing an accessory tool therein, may vary to accommodate various design needs and perform the functions described herein without departing from the scope of the present invention.

[0028] In some embodiments, cam track groove 194 may be defined by first bottom surface 156, second top surface 158, and outer surface 196 of intermediate portion 152. Cam track groove 194 may be configured to slidably receive at least a portion of guide portion 136 therein, as shown in FIGS. 9-10B , such that as cam assembly 126 rotates about first axis 186, guide portion 136 of arm 104 may slide within cam track groove 194 along a predetermined trajectory 198, thereby urging arm 104 to perform a predetermined oscillatory motion 128 in first plane 130 about second axis 200 generally perpendicular to first plane 130 and first axis 186. It should be understood that the configuration of guide portion 136 may vary as desired and / or needed without departing from the scope of the present invention, so long as the outer surface of guide portion 136 engages first bottom surface 156 and second top surface 158 and the movement of guide portion 136 is controlled by rotation of cam assembly 126.

[0029] 9, the first bottom surface 156 of the upper portion 148 may be angled toward the first top surface 154 at an angle β relative to an upper plane 202 parallel to the first top surface 154. The second top surface 158 of the lower portion 150 may be angled away from the second bottom surface 160 at an angle α relative to a lower plane 200 parallel to the second bottom surface 160. The angles β and α may be the same or different, as desired and / or needed, to achieve different predetermined trajectories 198 along which the guide portion 136 of the arm 104 slides within the cam track groove 194. In some embodiments, angle β may be between about 5 degrees and about 45 degrees, and angle α may be between about 5 degrees and about 45 degrees. It should be understood that upon rotation of cam assembly 126, the angled surfaces of cam track groove 194 may cause guide portion 136 to move upwardly or downwardly along axis 186 relative to lower portion 114 of housing 102 (i.e., along a predetermined trajectory 198 relative to cam assembly 126).

[0030] It should be understood that the curve 199 shown in FIG. 9 represents the actual trajectory of the up and down movement of the guide portion 136 as the cam assembly 126 completes one rotational cycle by extending the predetermined trajectory 198 for the cam assembly 126 into a curve to illustrate a first amplitude 204 of the upward movement of the guide portion 136 and a second amplitude 206 of the downward movement of the guide portion 136 within the cam track groove 194. It should be understood that the predetermined trajectory 198 (e.g., the first amplitude 204, second amplitude 206, and shape of the curve) may be varied by varying the angles β and α, the shape of the first bottom surface 156 of the upper portion 148, and / or the shape of the second top surface 158 of the lower portion 150. For example, the larger the angles β and α, the larger the first and second amplitudes 204 and 206 may be achieved. The predetermined trajectory 198 may be configured in a variety of shapes, including (but not limited to) a curvilinear wave, a sinusoidal wave, and a continuous wave. The size and configuration of the surfaces 156, 158 directly affect the oscillatory motion of the arm in terms of both the arc length and frequency of oscillation relative to the rotation of the cam assembly 126, including the ability to provide multiple oscillations per cam revolution.

[0031] 10A and 10B, as cam assembly 126 rotates about first axis 186, thereby moving guide portion 136 upward relative to lower portion 114 of housing 102, arm 104 may be urged to rotate in a counterclockwise direction within first plane 130 (FIG. 10A). That is, as cam assembly 126 rotates, guide portion 136 of arm 104 may function as a cam follower by engaging cam track groove 194 and converting the rotational motion of cam assembly 126 into oscillatory motion of arm 104. Locating cam assembly 126 at the distal end within endoscopic resection cap 100 provides a greater mechanical advantage, as opposed to locating it at the proximal user end, which would transmit force down a long catheter and lose force transmission from the rotational motion at the user end.

[0032] As cam assembly 126 rotates about first axis 186, thereby moving guide portion 136 downward relative to bottom portion 114 of housing 102, arm 104 may be urged to rotate clockwise within first plane 130 (FIG. 10B). Continued rotation of cam assembly 126 about first axis 186 may cause arm 104 to oscillate along a predetermined arc length within first plane 130. The predetermined arc length may be varied as desired and / or needed by varying the configuration of cam track groove 194 (e.g., by varying first amplitude 204 and second amplitude 206, thereby varying angles β and α). For example, the greater the first and second amplitudes 204 and 206, the greater the arc length that may be achieved. In some embodiments, cam track groove 194 may be configured such that rotation of cam assembly 126 causes arm 104 to oscillate along an arc length of about 0.5 mm to about 7.0 mm, but up to about 30 mm, within first plane 130 in response to interaction with the rotation of the cam assembly. The oscillation frequency of arm 104 may also be predetermined via drive system 184 oscillating at a predetermined frequency, for example, between about 25 Hz and about 200 Hz.

[0033] Advantageously, such oscillatory motion (e.g., at a relatively high frequency along a relatively small arc length) of the blunt cutting surface 125 of the arm 104 allows for blunt ablation of submucosal cancerous tissue in various visible but small ablation planes, eliminating the need for the physician to carefully make multiple small cuts to completely ablate the entire area, thereby reducing the likelihood of making a mistake and accidentally severing a blood vessel or perforating muscle. The blunt dissection provided by electrocautery also avoids the inherent complications associated with electrocautery, such as bleeding and perforation.

[0034] 11-11A, another embodiment of an endoscopic resection cap with an integrated vibrating dissector is shown. The endoscopic resection cap 11100 may include a housing 11102 having an upper portion 11132 and a lower portion 11114. The housing 11102 may include a first cavity 11108 and a second cavity 11106. The first cavity 11108 may be configured and positioned such that the arm 11104 is rotatably received therein and is connected to the third portion 11118 of the upper portion 11132 through a connecting portion 11134. The second cavity 11106 may be configured to engage around the outer periphery of an endoscope. In some embodiments, the second cavity 11106 may extend through at least a portion of both the upper portion 11132 and the lower portion 11114 of the housing 11102 (similar to the configuration shown in FIG. 4) and may be configured to receive an endoscope therein via a friction fit.

[0035] The arm 11104 may include at least one cutting surface 11125 with a plurality of cutouts 11208 and a plurality of peeling surfaces 11210, as described in more detail above. In some embodiments, as shown in FIG. 11 , the arm 11104 may include a first receiving slot 11220 and a second receiving slot 11222 on the first surface 11138. The first receiving slot 11220 and the second receiving slot 11222 may be movably connected to a first connecting member 11224 and a second connecting member 11226, respectively.

[0036] The first connecting member 11224 can extend between a first distal end 11224a and a first proximal end 11224b of the first connecting member 11224. The second connecting member 11226 can extend between a second proximal end 11226a and a second proximal end 11226b of the second connecting member 11226. The first distal end 11224a of the first connecting member 11224 can be slidably received in the first receiving slot 11220 and the second distal end 11226a of the second connecting member 11226 can be slidably received in the second receiving slot 11222, such that manipulation of the first and second proximal ends 11224b and 11226b can cause the arm 11104 to rotate along at least one arc relative to the housing 11102 in the first plane 11130. In some embodiments, the first and second connecting members 11224 and 11226 may be axially tensioned pull wires, which may be constructed of flexible stainless steel wire rope, a polymer composition including, for example, UHMWPE fibers, other stainless steel or metallic constructions, or other polymer constructions, as is true for all embodiments. At least a portion of the first and second connecting members 11224 and 11226 may extend through the first and second sheaths 11228 and 11230, respectively. The first and second sheaths 11228 and 11230 may be rigid sheaths under axial compression, which may be constructed of tightly wound stainless steel springs with polymer exteriors. The first and second distal ends 11224a and 11226a may each have a cap configuration (which may be made of a polymer material) that is shaped and sized so that the first and second distal ends 11224a and 11226a may be slidably received within the first and second receiving slots 11220 and 11222, respectively, and will not come off therefrom (e.g., fall out) during rotation of the arm 11104.

[0037] The first and second connecting members 11224 and 11226 may extend through the housing 11102 such that their respective first and second proximal ends 11224b and 11226b extend out of the lower portion 11114 of the housing 11102 and are coupled to the oscillating system 11124 to guide the rotation of the arm 11104. In some embodiments, as shown in FIG. 11A , the oscillating system 11124 may include a guide member 11232 extending between a first end portion 11232a and a second end portion 11232b. 1232 may be constructed of a polymer or metal component. A first proximal end 11224b of the first connecting member 11224 may be connected to a first end portion 11232a of the guide member 11232, and a second proximal end 11226b of the second connecting member 11226 may be connected to a second end portion 11232b of the guide member 11232.

[0038] In some embodiments, the vibration system 11124 may include a first post 11234 and a second post 11236, which are coupled to the proximal ends of the first and second sheaths 11228 and 11230, respectively. The first and second posts 11234 and 11236 may each include an aperture configured to allow the first and second proximal ends 11224b and 11226b of the first and second connecting members 11224 and 1126, respectively, to pass through before being connected to the first end member 11232a and second end portion 11232b of the guide member 11232, respectively. Advantageously, the first and second sheaths 11228 and 11230 and the first and second posts 11234 and 11236 may provide support for the first and second connecting members 11224 and 11226 along at least a portion of their lengths during movement. The first and second posts 11234 and 11236 and the first and second sheaths 11228 and 11230 may also make it possible to define the plane of rotation of the arm 11104 such that when the guide member 11232 rotates within the first plane 11130, the arm 11104 rotates within the first plane 11130.

[0039] The guide member 11232 may be connected to a drive system (e.g., the drive system described above), such that the guide member 11232 may be rotatable within the first plane 11130. When the guide member 11232 rotates clockwise within the first plane 11130, one of the first and second connecting members 11224 and 11226 (e.g., the second connecting member 11226 as shown in FIGS. 11 and 11A ) may be pulled, causing the arm 11104 to rotate clockwise within the first plane 11130. When the guide member 11232 rotates counterclockwise within the first plane 11130, the other of the first and second connecting members 11224 and 11226 (e.g., the first connecting member 11224 as shown in FIGS. 11 and 11A ) may be pulled, causing the arm 11104 to rotate counterclockwise within the first plane 11130. As previously discussed, the vibration system 11124 and drive system may be biased to rotate the arm 11104 relative to the housing 11102 along a predetermined arc length (e.g., about 0.5 mm to about 7.0 mm, up to about 30 mm) at a predetermined frequency (e.g., about 25 Hz to about 200 Hz). The predetermined arc length may be made different as desired and / or needed by varying the configuration of the arm 11104 and the first and second receiving slots 11220 and 11222 without departing from the scope of the present invention.

[0040] In some embodiments, the arm 11104 may be rotatably and pivotally connected to the third portion 11118 of the upper portion 11132 through the connecting portion 11134, such that by manipulating the guide member 11132, one or two of the first and second connecting members 11224 and 11226 may pivot the arm 11104 out of the first plane 11130 within the first cavity 11108. For example, as shown in FIG. 11B , the arm 11104 may pivot into a second plane 11133 at an angle φ relative to the first plane 11130. The angle φ may be between about 0 and about 45 degrees. In this configuration, the guide member 11132 may be rotatable within the second plane 11133, such that rotation of the guide member 11132 may cause the arm 11104 to rotate within the second plane 11133.

[0041] Advantageously, this configuration allows the user to set the height of the built-in vibrating dissector to facilitate cutting closer to the tissue and to provide a better view of the edge of the cutting surface 11125. In other words, the dissector can be rotated into the physician's field of view. The arm 11104 can pivot (diagonally outward from the initial dissection plane), thereby providing a clear view of the dissection plane (e.g., closer to the center of the field of view), thereby facilitating accurate cuts. Otherwise, the cutting surface of the dissector may be near the edge of the fracture, where the cutting plane is poorly visible, and the oscillatory motion of the dissector may obstruct the surgeon's view of the dissection plane, resulting in an inaccurate cut. For example, as shown in FIG. 11B , when the arm 11104 pivots into the second plane 11133, the edge of the cutting surface 11125 is closer to the center of the field of view 11135 of the endoscope 11139, rather than the boundary 11137 of the field of view 11135, thereby ensuring a consistent view of the dissection plane and vessels. Additionally, the arm 11104's ability to pivot into and oscillate in various planes allows the arm 11104 to interact with tissue in various dissection planes, including those in difficult anatomical locations. Advantageously, a degree of flexibility is provided to accommodate various positions of the integrated vibrating dissector depending on the limitations of the endoscope, different positions of the endoscope, as well as the anatomical location of the patient.

[0042] 12-13D illustrate other embodiments of an endoscopic resection device 12100. FIG. 12 illustrates a generic, non-limiting endoscope 12311. This or any of the endoscopes may include a removably attached endoscopic resection cap (e.g., cap 12311) or may be configured with an integrated endoscopic resection element, which may employ an oscillating or reciprocating ablating element of the same type as those shown in any of the embodiments herein, including any of FIGS. 1-11B, 14-20, and 23-25. Those skilled in the art will appreciate that the endoscope 12311 includes a steerable shaft 12317 that includes steering controls 12313, at least one access port 12315, at least one visualization element (not shown, but readily apparent to those skilled in the art of endoscopic technology), and one or more end- and / or side-viewing elements (not shown) near the distal end of the shaft, as well as other structures that may be present for illumination, irrigation, passage of tools and / or agents, and other features known in the art of endoscopic technology. It should be noted that the term "reciprocating motion" is used herein to refer not only to rotation about an axis, but also to motion across a fixed axis, with or without rotation about that axis. This reciprocating structure and function, as well as the longitudinal curvature of the arms, as described below, are differences between this embodiment and that of Figure 11, but other features are similar or otherwise interchangeable, and the motion mechanism of Figure 11A may also be used in this embodiment.

[0043] As shown in FIGS. 12A and 12B , the endoscopic resection cap 12100 includes a housing 12102 having an upper portion 12132 and a lower portion 12114. It may also include a drain hole 12117 configured to aid in removing objects from the field of view of the endoscope. The housing 12102 may include an outer first cavity 12108 and an inner second cavity 12106. The first cavity 12108 may be configured and positioned such that the arm 12104 is received therein and is laterally reciprocally connected to the third portion 12118 of the upper portion 12132 via a connecting pin 12134. The second cavity 12106 may be configured to removably engage around the outer periphery of the endoscope (or may be substantially absent in embodiments in which the resection portion is configured integrally with the endoscope). In some embodiments, the second cavity 12106 may extend through at least a portion of both the upper portion 12132 and the lower portion 12114 of the housing 12102 (similar to the configuration shown in FIG. 4) and may be configured to receive an endoscope therein via a friction fit or other releasable / detachable attachment means that releasably secures the cap to the endoscope for use as an endoscope accessory tool.

[0044] The arm 12104 may include at least one cutting surface 12125, which has a plurality of cutouts 12208 and a plurality of peeling surfaces 12210, which are described in more detail below. In this embodiment, the arm 12104 has a first receiving channel 12220 and a second receiving channel 12221. The arm 12104 includes a receiving channel 12222. First receiving channel 12220 and second receiving channel 12222 provide slidable passageways for a first connecting member, embodied as a first pull wire 12224, and a second connecting member, embodied as a second pull wire 12226, respectively. FIGS. 12C-12D show side and rotated perspective views, respectively, of arm 12104, which is curved along its proximal-distal longitudinal axis and includes a curved end opposite the peeling end. The curvature in the longitudinal dimension (shown along dashed longitudinal axis line 12104b as opposed to curved phantom line 12104a) is configured to provide an effective peeling action during operation of arm 12104 by orienting its distal peeling surface 12210 toward the target tissue without significantly altering the orientation of the endoscope from its normal alignment within the body passage being accessed. The difference between the linear axis 12104b and the curvature 12104a in this embodiment of FIG. 12C (with an exemplary arm length of 0.48 inches and width of 0.28 inches) is represented by the gap C, where the illustrated radius of curvature is 2 inches and the gap C is 0.03 inches, which in embodiments may be a radius of curvature of 0.5-5 inches with a corresponding gap of 0.005-2 inches, which may vary depending on the size of the arm. Notably, the angle is provided for angulation with respect to the target tissue so that as the physician manipulates the endoscope (with a cap or integral dissector tool tip), the curve of the arm is directed toward the muscularis propria. This curvature offers an advantage over straight dissectors because it allows the physician to advance the endoscope along its major axis within the active area while aiming for the correct dissection plane. In embodiments using straight dissectors (not adjustable as taught elsewhere herein), the physician must actively tilt the endoscope with the cap (or integral tool tip) toward the muscularis propria to disrupt the overlying target tissue. This typically requires multiple fine adjustments to the endoscope's orientation. Furthermore, in the case of a linear / non-adjustable dissector aligned with a distal-viewing endoscope, the endoscopic camera trajectory is forced toward the muscularis propria, bringing the arm into contact with the target tissue, which may limit the view of the submucosal space.Thus, the curved arm 12104 provides advantages over prior art systems and devices.

[0045] A first wire 12224 extends to and is connected to one side of the arm 12104, and a second wire 12226 extends to and is connected to the other side of the arm 12104, and the first and second wires (between the cut portion and the proximal wire end, not shown) may be parallel or generally parallel for the majority of their lengths when the arm is in a neutral, centered position as shown in FIGS. 12B and 13A. A long, stadium-shaped hole 12133 through the arm 12104 between the wires allows the arm to reciprocate laterally relative to the pin 12134 (although the oval hole shown is constructed from a rectangle with parallel straight sides and a semicircular or elliptical end, the shape of the hole may be different within the scope of this application, for example, an elliptical, arcuate, or other shaped hole that allows reciprocating movement across the pin rather than simply pivoting about the pin, to vary the desired movement of the arm relative to the housing). This arrangement and attachment of the first and second wires and pins is configured such that manipulation of the first and second proximal wires causes the arms 12104 to reciprocate in a first plane 12130, thereby causing the dissector surface 12210 to describe at least an arc 12211 relative to the housing 12102, as shown in Figures 13A (centered), 13B (pulling the left wire causes the arm 12104 to move with its distal end farthest to the left and its proximal end farthest to the right), 13C (pulling the right wire causes the arm 12104 to move with its distal end farthest to the right and its proximal end farthest to the left), and 13D. The arms reciprocate back and forth across the pins in response to pulling on the corresponding wires, and simultaneously swing back and forth, with the range of motion limited by the housing 12102 and the relationship of the pins to the holes. As shown in Figure 13D, which is a composite of Figures 13A, 13B, and 13C, the distal end faces of the arms sweep a flattened arc to contact the target tissue as the proximal arm ends reciprocate back and forth relative to the pin (with some pivoting motion) and the distal arm ends correspondingly vibrate.

[0046] 14 illustrates another embodiment of an endoscopic resection cap 14100 with an integrated vibrating dissector, which may include an arm 14104, a connection guide 14136, and an oscillation system 14124. The connection guide 14136 may extend between a distal end 14136a connected to the arm 14104 and a proximal end 14136b. The oscillation system 14124 may include a cam assembly 14126 having a cam surface 14194 configured to engage the proximal end 14136b of the connection guide 14136. The cam assembly 14126 may be coupled to a drive system (e.g., a pulley system) such that the cam assembly 14126 is rotatable within a first plane 14130. In some embodiments, as shown in FIG. 14 , rotation of the cam assembly 14126 within the first plane 14130 may cause the proximal end 14136b of the connection guide 14136 to move along at least a portion of the cam surface 14194, which in response may cause the arm 14104 to perform a first predetermined motion (e.g., an oscillatory motion along a predetermined arc length) at a predetermined frequency, as described in more detail above.

[0047] 15 illustrates another embodiment of an endoscopic resection cap 15100 with an integrated vibrating dissector, wherein the vibrating system 15124 may include a gear assembly 15126 rotatably connected to the arm 15104, such that rotation of the gear assembly 15126 in a first plane 15130 causes the arm 15104 to perform a first predetermined motion (e.g., an oscillatory motion along a predetermined arc length) at a predetermined frequency in the first plane 15130, as described in more detail above. The gear assembly 15126 may be disposed within the housing of the endoscopic resection cap 15100 and may be powered by a drive system (e.g., any suitable type of motor) at the user end. In this embodiment, the arm 15104 may have a gear configuration, and gear teeth on the arm 15104 may serve as the dissecting surface 15210.

[0048] 17-19 show three embodiments of arms that can be incorporated into an endoscopic resection cap for the same or different cutting purposes. As shown in FIG. 17, the arm 17104 may have a pointed cutting surface 17125. The cutting surface 17125 may have inverted notches / barbs to facilitate tissue gripping, which may allow the arm 17104 to more efficiently disrupt fibers and shorten procedure time. As shown in FIG. 18, the arm 18104 may have a T-shaped configuration and include a relatively flat cutting surface 18125 and two relatively flat edges 18129. The T-shaped configuration may allow for tissue hooking. The two relatively flat edges 18129 may include cauterizing surfaces (e.g., electrodes) configured to cauterize blood vessels or fibrous tissue that cannot be ablated by the relatively flat cutting surface 18125. As shown in FIG. 19 , the arm 19104 can include a curved cutting surface 19125 having one or more teeth 19210 disposed between a plurality of U-shaped cutouts. Depending on the location of the cutouts, the embodiments shown in FIGS. 17 and 19 can ablate tissue with both forward (distal) and lateral (lateral to the distal-proximal axis of these embodiments) movements, while the embodiment shown in FIG. 18 can ablate tissue with a forward (distal) movement. Additionally or alternatively, in some embodiments, the cutting surface 19125 can have a roughened surface with uneven features, which can provide blunt ablation of tissue during vibration. It should be understood that any of the arm embodiments, and any variations and combinations of the above-described arm embodiments, can be incorporated into an endoscopic resection cap along with a corresponding vibration system to provide a predetermined vibration motion at a predetermined frequency.

[0049] The radius of rotation of the arms and the height of the teeth of the arms may vary as desired and / or necessary to achieve a desired arc length of rotation without departing from the scope of the present invention. For example, as shown in Figures 17-19, arms (17104, 18104, 19104) may be rotatable about axes (17141, 18141, 19141) and may have radii ( 19, one or more teeth 19210 may have a tooth height 19143 ranging from about 0.1 mm to about 2 mm, and the arc length of rotation of arm 19104 may be from about 0.5 mm to about 7.0 mm per oscillation, up to a maximum of 30 mm.

[0050] It should be understood that the tines of the arms may have a variety of configurations without departing from the scope of the present invention. For example, as shown in FIG. 23, the tines 23210 may have an entrance opening 23211 to the tine with a smaller diameter than the bottom region 23213 between the bases 23214 of the tines, thereby assisting each tine in capturing and dissecting the target tissue. As another example, as shown in FIG. 24, the tines 24210 may have protrusions of different heights to capture multiple tissue densities, i.e., larger tines (e.g., 24210a and 24210b) may capture looser tissue, and smaller tines (e.g., 24210c-24210e) may capture somewhat denser tissue but not the denser, healthy underlying tissue of the muscularis propria. In some embodiments, the edges of the teeth 25210 may be beveled, asymmetrically rounded, triangular, asymmetrically trapezoidal, or any other suitable configuration as desired and / or required, as shown in Figure 25. In each of these tooth / tooth configurations, each preferably cuts and / or tears only the soft target tissue (e.g., the intestinal mucosa and submucosa, particularly if a lesion is present), but not underlying or otherwise adjacent healthy tissue (e.g., healthy blood vessels, muscle tissue).

[0051] Other embodiments of the arm and corresponding vibration system may be contemplated to perform blunt ablation of tissue. In some embodiments, as shown in FIG. 20 , the arm 20104 may be a permanent magnet or may be directly attached to a permanent magnet. An alternating current with an adjacent inductor 20124 (e.g., a coil wound around a ferromagnetic material) may cause the arm 20104 to oscillate between a first state 20111 and a second state 20113. The power source and circuitry for the inductor 20124 may be located at the user end. This embodiment allows the arm to be incorporated as part of the vibration system, thus eliminating the need for coupling components (e.g., gears, levers) that would be required if a separate, different vibration system were used.

[0052] 21, the endoscopic resection cap 21100 may include arms 21104 (e.g., with a rotating blade configuration) behind the distal end 21117 of the cap. The distal end 21117 of the cap may include multiple holes 21115 so that connective tissue can be aspirated through the holes 21115, and the arms 21104 may rotate at speeds faster than naked eye vision, thus providing an unobstructed view. This embodiment may enable blunt dissection by safely and quickly dissecting submucosal fibers while avoiding blood vessels by preventing them from entering through the holes 21115.

[0053] In some embodiments, the arm may include two parallel arm components, one of which is fixed and the other of which oscillates relative to the fixed arm component, thereby producing a shearing action when the dynamic arm component is actuated, as will be readily understood with reference to the drawings and embodiments herein (e.g., one skilled in the art will readily envision and understand the configuration of single-tooth or multi-tooth arms for such embodiments, operating similarly to electric clippers). In some embodiments, the arm may include polymer or metal wire, string, monofilament, braid, or the like, which may be attached to a rotating mechanism, whereby tensile stress is adjusted to overcome the viscoelastic properties of connective tissue without destroying the tissue found in muscles and arteries, operating similarly to a polymer-cord grass trimmer. This embodiment allows the arm to perform blunt dissection without requiring a mechanism for oscillating motion. For example, as shown in FIG. 22, the dissector may be configured such that the arm 22104 is perpendicular to the axis of rotation (left side of FIG. 22) or rotates in a direction parallel to the cam assembly 22126. The dissector may be a replacement for a cap design that rotates and / or oscillates either parallel to the axis of rotation (right side of FIG. 22) through the catheter. In some embodiments, the dissector may include or even consist of a torque cable / tube that runs through the catheter, with an arm attached to the distal end of the torque cable / tube.

[0054] One general aspect includes a medical device in which the housing further includes a longitudinal lumen configured to receive and direct an endoscopic grasping tool, and engagement with the circumferential outer surface of the endoscope is provided by a second cavity configured to receive the endoscope through a friction fit therein.

[0055] Embodiments may include one or more of the following features: a medical device wherein the first predetermined motion comprises an oscillating motion of a distal end portion of the arm, the arc length of the oscillating motion being between about 0.5 mm and about 7.0 mm (and can be up to 30 mm), and the predetermined frequency being between about 25 Hz and about 200 Hz; a medical device wherein the arm is curved along the longitudinal axis of the arm; a medical device wherein the arm includes an elongated bore reciprocable relative to a pin attached to the housing; a medical device wherein the oscillating system includes pull wires each extending between a respective proximal end and a distal end of each pull wire, the distal ends of the pull wires attached to the arm, and wherein manipulation of the proximal ends of the pull wires causes the arm to perform the first predetermined motion; a medical device wherein the oscillating system includes a cam assembly having a cam track groove configured to receive at least a portion of a guide portion of the arm, the guide portion of the arm moving along at least a portion of the cam track groove in response to rotation of the cam assembly, causing the arm to perform the first predetermined motion. The medical device further includes a connection guide extending between a distal end and a proximal end, the distal end of the connection guide connected to the arm, and the vibration system includes a cam assembly having a cam surface configured to engage the proximal end of the connection guide, the proximal end of the connection guide moving along at least a portion of the cam surface in response to rotation of the cam assembly to cause the arm to perform a first predetermined motion. The vibration system includes a gear assembly rotatably connected to the arm, the rotation of the gear assembly causing the arm to perform the first predetermined motion. The vibration system includes an inductor to which an alternating current is applied, configured to cause the arm to perform the first predetermined motion.

[0056] One general aspect includes a medical instrument for facilitating minimally invasive surgery, the medical instrument comprising: a housing including a first cavity; an arm including at least one tissue dissection surface and rotatably received in the first cavity, the arm including a first receiving slot and a second receiving slot; a first connecting member extending between a first distal end and a first proximal end of a first connecting member; and a second connecting member extending between a second distal end and a second proximal end of a second connecting member, the first distal end of the first connecting member being slidably received in the first receiving slot and the second distal end of the second connecting member being slidably received in the second receiving slot, wherein manipulation of the first and second proximal ends causes the arm to rotate along at least one arc relative to the housing. Other embodiments of this aspect include corresponding computer systems, devices, and computer programs recorded on one or more computer storage devices, each configured to perform the operations of the method.

[0057] Embodiments may include one or more of the following features: A medical device further including a vibration system, the vibration system including a guide member extending between a first end portion and a second end portion, a first proximal end of a first connecting member connected to the first end portion and a second proximal end of a second connecting member connected to the second end portion, wherein movement of the guide member moves the first and second connecting members and rotates the arm relative to the housing, the guide member being rotatable in a clockwise and counterclockwise direction within a first plane, wherein clockwise rotation of the guide member in the first plane pulls one of the first and second connecting members, causing the arm to rotate in the clockwise direction, and counterclockwise rotation of the guide member in the first plane pulls the other of the first and second connecting members, causing the arm to rotate in the counterclockwise direction within the first plane. The arm rotates clockwise. The guide member is connected to a drive system, thereby allowing the guide member to rotate out of the first plane. The arm is rotatably and pivotally connected to a third portion of the housing, and operation of the guide member moves one or two of the first and second connecting members, causing the arm to enter the second plane at an angle relative to the first plane, and rotation of the guide member causes the arm to rotate within the second plane. The medical device is one in which the first and second connecting members are fool wires. By operating the first and second proximal ends, the arm rotates relative to the housing along an arc length of about 0.5 mm to about 30 mm at a frequency of about 25 Hz to about 200 Hz. The medical device is one in which the arm has one or more surfaces with a tooth configuration. The medical device is one in which the housing further includes a second cavity, the second cavity configured to receive an endoscope therein via a friction fit.

[0058] One general aspect includes a medical instrument for facilitating minimally invasive surgery, comprising: a housing including a first cavity and a second cavity; an arm rotatably received in the first cavity, the arm including a guide portion and a connecting portion; and a cam assembly rotatably received in the second cavity, the cam assembly including a cam track groove configured to slidably receive at least a portion of the guide portion therein, the arm being rotatably connected to a third portion of the housing through the connecting portion, and wherein rotation of the cam assembly causes the guide portion to slide along a predetermined trajectory within the arm track groove, thereby urging the arm to rotate in a first plane.

[0059] Embodiments may include one or more of the following features: A medical instrument in which a cam track groove causes rotation of the cam assembly to move the guide portion up and down, which urges the arm to rotate in a first plane; A medical instrument in which rotation of the cam assembly, thereby moving the guide portion upward, urges the arm to rotate in a counterclockwise direction in the first plane, and rotation of the cam assembly, thereby moving the guide portion downward, urges the arm to rotate in a clockwise direction in the first plane; A medical instrument in which rotation of the cam assembly about a first axis causes the arm to rotate about a second axis, the first axis being generally perpendicular to the second axis. The cam assembly includes an upper portion, a lower portion, and an intermediate portion disposed between the upper and lower portions, the upper portion having a first upper surface and a first bottom surface, the first bottom surface sloping toward the first upper surface, the lower portion having a second upper surface and a second bottom surface, the second upper surface sloping away from the second bottom surface, and the outer surfaces of the first bottom surface, second upper surface, and intermediate portion being configured such that rotation of the cam assembly causes the arm to undergo a predetermined oscillatory motion in a first plane. The upper portion, lower portion, and intermediate portion are substantially cylindrical in configuration. The arm has one or more surfaces with a teeth configuration. The cam assembly is a barrel cam. The cam assembly is connected to a drive system such that it is rotatable about a first axis. The third portion of the housing is configured to move upward relative to the lower portion of the housing. Rotation of the cam assembly causes the arm to rotate in the first plane along an arc length of about 0.5 mm to about 30 mm at a frequency of about 25 Hz to about 200 Hz.

[0060] While various embodiments of the present disclosure have been described, the present disclosure is not intended to be limited except in light of the appended claims and their equivalents. Those skilled in the art will recognize that various modifications and improvements may be made to the above-described embodiments without departing from the scope of the present invention, as defined by the appended claims, including, expressly included, that the different arm and blade configurations shown may be interchangeable between embodiments, and that removable embodiments of the resection cap may be configured as an accessory for removable attachment to an endoscope or may be included as an integral part of the endoscope. Furthermore, the advantages described herein do not necessarily imply that the present disclosure is without additional advantages, nor is it necessarily expected that each individual embodiment of the present disclosure will achieve all of the described advantages.

Claims

1. In medical devices that facilitate minimally invasive surgery, A housing, configured to engage around an outer periphery of the endoscope; A first cavity is included. Housing and a medical device comprising: an arm including at least one tissue ablation surface, the arm being movably received within the first cavity; and a distal end portion of the arm configured to perform a first predetermined motion at a predetermined frequency along at least a first plane corresponding to reciprocating motion of a proximal portion of the arm.

2. the housing further includes a longitudinal lumen configured to receive and direct an endoscopic grasping tool; the engagement with the outer peripheral surface of the endoscope is provided by a second cavity configured to receive the endoscope therein via a friction fit; The medical device of claim 1.

3. the first predetermined motion comprises an oscillatory motion of the distal end portion of the arm, the arc length of the oscillatory motion being between about 0.5 mm and about 30 mm, and the predetermined frequency being between about 25 Hz and about 200 Hz. The medical device of claim 1 or 2.

4. the arm is curved along the longitudinal axis of the arm; The medical device according to any one of claims 1 to 3.

5. the arm includes an elongated slot that is reciprocable back and forth across a pin attached to the housing; The medical device according to any one of claims 1 to 4.

6. the vibration system includes pull wires, each extending between a respective proximal end and a distal end of each pull wire; the distal end of the pull wire is attached to the arm, whereby manipulation of the proximal end of the pull wire causes the arm to perform the first predetermined movement; The medical device of claim 1.

7. a cam assembly having a cam track groove configured to receive at least a portion of the guide portion of the arm therein; the guide portion of the arm moves along at least a portion of the cam track groove in response to rotation of the cam assembly, thereby causing the arm to perform the first predetermined motion; The medical device of claim 1.

8. further including a connection guide extending between the distal end and the proximal end; the distal end of the connection guide is connected to the arm; a cam assembly having a cam surface configured to engage the proximal end of the connection guide; the proximal end of the connection guide moves along at least a portion of the cam surface in response to rotation of the cam assembly, thereby causing the arm to perform the first predetermined motion; The medical device of claim 1.

9. a gear assembly rotatably connected to said arm, whereby rotation of said gear assembly causes said arm to perform said first predetermined motion; The medical device of claim 1.

10. a steerable endoscope shaft having a control means and at least one visualization element, either integral with the steerable endoscope shaft or configured to be removably attached to the endoscope shaft for use as an endoscope accessory tool; The medical device according to any one of claims 1 to 9.

11. In medical devices that facilitate minimally invasive surgery, a housing including a first cavity; an arm including at least one tissue abrasion surface and rotatably received within the first cavity, the arm including a first receiving slot and a second receiving slot; a first connecting member extending between a first distal end and a first proximal end of the first connecting member; a second connecting member extending between a second distal end and a second proximal end of the second connecting member; Including, the first distal end of the first connecting member is slidably received within the first receiving slot, and the second distal end of the second connecting member is slidably received within the second receiving slot; The medical instrument is configured such that manipulation of the first and second proximal ends causes the arm to rotate along at least one arc relative to the housing.

12. further comprising a vibration system; the vibration system includes a guide member extending between the first end portion and the second end portion; the first proximal end of the first connecting member is connected to the first end portion, and the second proximal end of the second connecting member is connected to the second end portion; Movement of the guide member causes the first and second connecting members to move such that the arm rotates relative to the housing. The medical device of claim 11.

13. the guide member is rotatable in a clockwise and counterclockwise direction within a first plane; when the guide member rotates in the clockwise direction within the first plane, it pulls one of the first and second connecting members, thereby rotating the arm in the clockwise direction; When the guide member rotates in the counterclockwise direction within the first plane, the other of the first and second connecting members is pulled, thereby causing the arm to rotate in the counterclockwise direction within the first plane.

13. The medical device of claim 12.

14. 14. The medical instrument of claim 13, wherein the guide member is connected to a drive system that allows the guide member to rotate out of the first plane.

15. the arm is rotatably and pivotally connected to a third portion of the housing; the guide member is configured such that operation of the guide member moves one or two of the first and second connecting members, thereby causing the arm to pivot and move obliquely with respect to the first plane into a second plane; Rotation of the guide member causes the arm to rotate in the second plane.

14. The medical device of claim 13.

16. The medical device according to any one of claims 11 to 15, wherein the first and second connecting members are pull wires.

17. 17. The medical device of any one of claims 11 to 16, wherein the manipulation of the first and second proximal ends causes the arm to rotate relative to the housing along an arc length of about 0.5 mm to 30 mm at a frequency of about 25 Hz to about 200 Hz.

18. The medical device of any one of claims 11 to 17, wherein the arms have one or more surfaces in a tooth configuration.

19. the housing further includes a second cavity; the second cavity is configured to receive an endoscope therein via a friction fit; The medical device according to any one of claims 11 to 18.

20. In medical devices that facilitate minimally invasive surgery, a housing including a first cavity and a second cavity; an arm rotatably received within the first cavity, the arm including a guide portion and a connecting portion; a cam assembly rotatably received in the second cavity, the cam assembly including a cam track groove configured to slidably receive at least a portion of the guide portion therein; the arm is rotatably connected to a third portion of the housing through the connecting portion; The medical instrument wherein rotation of the cam assembly causes the guide portion to slide along a predetermined path within the cam track groove, thereby urging the arm to rotate in a first plane.

21. the cam track groove is configured such that the rotation of the cam assembly causes the guide portion to move up and down, which urges the arm to rotate in the first plane.

21. The medical device of claim 20.

22. When the cam assembly rotates, thereby moving the guide portion upward, the arm is urged to rotate counterclockwise within the first plane; When the cam assembly rotates, thereby moving the guide portion downward, the arm is urged to rotate clockwise within the first plane.

22. The medical device of claim 21.

23. rotation of the cam assembly about a first axis causes the arm to rotate about a second axis; the first axis is generally perpendicular to the second axis; 22. The medical device of claim 20 or 21.

24. the cam assembly includes an upper portion, a lower portion, and an intermediate portion disposed between the upper portion and the lower portion; The upper portion has a first top surface and a first bottom surface, the first bottom surface facing the first top surface. And it tilts, the lower portion has a second upper surface and a second bottom surface, the second upper surface sloping away from the second bottom surface; the first bottom surface, the second top surface, and the outer surface of the intermediate portion are configured such that the rotation of the cam assembly causes the arm to undergo a predetermined oscillatory motion in the first plane.

21. The medical device of claim 20.

25. 25. The medical device of claim 24, wherein the upper portion, the lower portion, and the middle portion are substantially cylindrical in configuration.

26. The medical device of any one of claims 20 to 25, wherein the cam assembly is configured as a barrel cam.

27. 21. The medical instrument of claim 20, wherein the cam assembly is connected to a drive system such that it is rotatable about a first axis.

28. 21. The medical device of claim 20, wherein the third portion of the housing is configured to move upwardly relative to the lower portion of the housing.

29. 29. The medical device of any one of claims 20 to 28, wherein the rotation of the cam assembly causes the arm to rotate in the first plane along an arc length of about 0.5 mm to about 30 mm at a frequency of about 25 Hz to about 200 Hz.

30. An endoscope, a distal end of the ... a housing including a first cavity; an arm including at least one tissue dissection surface, the arm being movably received within the first cavity, a distal end portion of the arm configured to undergo a first predetermined motion at a predetermined frequency along at least a first plane in response to reciprocating motion of a proximal portion of the arm, the arm being curved along a longitudinal axis of the arm, the arm including an oblong hole configured to reciprocate back and forth across a pin securing the arm to the first cavity, the reciprocating motion including a pivoting motion that coincides with an arc of the at least one tissue dissection surface as the arm reciprocates relative to the pin.

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