Endoscopic tool stabilization and related usage methods

Abstract

According to one aspect, a device may include a shaft having a distal end and a lumen, the lumen terminating in a distally facing opening. An instrument may be inserted through the shaft and extend through the lumen and out of the opening. The device may also include an elevator for engaging the instrument. The elevator may include an actuator extending through at least a portion of the shaft; and a body may be coupled to the actuator. A portion of the body may be configured to extend within the lumen and, when the actuator is moved, apply a force to the instrument and move the instrument into contact with a surface of the lumen.

Description

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS

[0002] This application claims priority to U.S. Provisional Application No. 62 / 874,242, filed on July 15, 2019, the entire contents of which are incorporated herein by reference. Technical Field

[0003] Various aspects of the present disclosure generally relate to endoscopic devices. More particularly, the present disclosure relates to device tips for endoscopic tool stabilization and related methods of use. Background Art

[0004] During diagnostic and therapeutic endoscopic procedures, accessory devices can be passed through the working channel of an endoscope. The outer diameter of the accessory device should be adapted to the inner diameter of the working channel. Endoscopes used only for diagnostic procedures typically have smaller working channels compared to endoscopes used for combined (diagnostic and therapeutic) or therapeutic procedures alone. For example, the inner diameters of the working channels of diagnostic and therapeutic gastroscopes are typically 2.8 mm and 3.7 mm, respectively. Accessory devices designed for diagnostic scopes are also generally compatible with therapeutic scopes. However, accessory devices designed for diagnostic scopes may be undersized when used with therapeutic scopes, resulting in a loose fit within the working channel.

[0005] This loose fit can result in accessory device instability because the endoscope is articulated throughout the procedure. Accessory device instability during the procedure can result in changes in the orientation of the device within the working channel, as seen during direct visualization. While device instability may not be an issue in some procedures, it can be an issue in more precise procedures, such as endoluminal surgery. During endoluminal surgical procedures, a cutting knife may be used to remove tissue. Some existing cutting knives do not have articulation capabilities, and the cutting motion performed by the physician is controlled by the articulation of the scope. In cases where the cutting knife is undersized relative to the inner diameter of the working channel of the endoscope, there is a loose fit between the knife and the working channel, and therefore, the knife may move unexpectedly when the physician articulates the endoscope. This introduces a degree of unpredictability for the physician performing the procedure and a potential risk to the patient. Summary of the Invention

[0006] Embodiments of the present disclosure relate particularly to mechanisms for stabilizing a medical tool within a scope or similar device.Each embodiment disclosed herein may include one or more features described in conjunction with any other disclosed embodiment.

[0007] According to one aspect, a device may include a shaft having a distal end and a lumen, the lumen terminating in a distally facing opening. An instrument may be inserted through the shaft and may extend through the lumen and out of the opening. The device may also include an elevator for engaging the instrument. The elevator may include an actuator extending through at least a portion of the shaft; and a body may be coupled to the actuator. A portion of the body may be configured to extend within the lumen to selectively position the instrument.

[0008] In other aspects of the present disclosure, the device may include one or more of the following features. A body may include a first extension, a second extension, and a proximal portion connecting the first and second extensions. An actuator may be coupled to the distal portion of the first extension, and a portion of the second extension may be configured to move within the lumen when the actuator moves proximally. When the actuator moves distally, the portion of the second extension may be configured to move out of the lumen. The longitudinal axis of the first extension may be transverse to the longitudinal axis of the second extension. The second extension may have a U-shaped body surface for engaging an instrument. When the actuator moves proximally or distally, the body may rotate about an axis positioned within the proximal portion. The body may include a first extension, a second extension, a proximal portion connecting the first and second extensions, and a pivot member. The actuator may be coupled to the pivot member and may contact a curved surface of the pivot member. When the actuator moves proximally, a portion of the first extension may be configured to move within the lumen; when the actuator moves distally, a portion of the second extension may be configured to move within the lumen.

[0009] In other aspects of the present disclosure, the device may include one or more of the following features. The radially inner surface of the first extension and the radially inner surface of the second extension may be configured to align with the radially inner surface of the lumen. The actuator may be coupled to the pivot member at a position offset from the rotational axis of the body. The longitudinal axis of the first extension and the longitudinal axis of the second extension may be parallel. The body may be positioned within a channel extending distally from an opening in the radially inner surface of the lumen. The channel may have a longitudinal axis transverse to the longitudinal axis of the lumen. When the actuator is moved proximally or distally, a surface of the body may be configured to slidably engage the channel. When the actuator is moved proximally, the body may be configured to slide proximally within the channel, move through the opening in the radially inner surface of the lumen, and enter the channel. The elevator may further include: a tab member pivotally movable relative to the lumen; and a block fixedly coupled to the shaft and including a first surface that contacts a second surface of the body. The first surface may be transverse to the longitudinal axis of the lumen; and the second surface may be configured to slidably engage the first surface when the actuator is moved proximally or distally. The body may be configured to move toward the lumen and force the tab member into the lumen. The tab member may be biased away from the lumen. The actuator may extend through a channel within the block. The lumen may be a first lumen, and the body may be a snare ring. The elevator may further include a support member including a second lumen and a channel extending circumferentially around a radially inner surface of the second lumen. The second lumen may be aligned with the first lumen. The channel may receive the snare ring; when the actuator moves proximally, the snare ring may be configured to enter the second lumen.

[0010] In other aspects, the device may include a shaft having a distal end and a first lumen, the first lumen terminating in a distally facing opening, wherein an instrument inserted through the shaft can extend through the lumen and out of the opening. The device may also include an elevator for engaging the instrument. The elevator may include a first actuator extending through at least a portion of the shaft and a rotatable plate coupled to the first actuator. The rotatable plate may be angled such that a distal portion of the rotatable plate is more distal relative to a proximal portion of the rotatable plate. The rotatable plate may include a second lumen configured to align with the first lumen and a recess. The elevator may also include a second actuator extending through at least a portion of the shaft and a sliding member coupled to the second actuator. The sliding member may be positioned within the recess and may include a third lumen configured to align with the first lumen. The elevator may also include a frame fixedly positioned within the shaft. The rotatable plate may be rotatably coupled to the frame.

[0011] In other aspects, the device may include one or more of the following features. A portion of the sliding member may be configured to extend within the first lumen and apply a force to the instrument when the second actuator moves. The sliding member may be configured to move the instrument so that the instrument contacts the radially inner surface of the first lumen. The rotatable plate may be configured to rotate relative to the frame when the first actuator moves, and rotation of the rotatable plate may cause the sliding member to rotate. The frame may include a wall, and the wall may be configured to limit movement of the sliding member within the recess of the rotatable plate.

[0012] In other aspects, a device may include: a shaft having a distal end and a lumen terminating in a distally facing opening, wherein an instrument inserted through the shaft can extend through the lumen and out of the opening; and an elevator for engaging the instrument. The elevator may include: an actuator extending through the shaft; and a body connected to the actuator and including an opening. The body may be configured to be positioned distal to the opening of the shaft and to apply a force to the instrument when the actuator is rotated about a longitudinal axis of the actuator. The body may be configured to move the instrument such that the instrument contacts a radially inner surface of the lumen.

[0013] In other aspects, the device can include one or more of the following features: The opening of the body can be configured to align with the lumen, and a biasing member can be coupled to the body and can bias the body into a position in which the opening of the body is aligned with the lumen.

[0014] It will be understood that the foregoing general description and the following detailed description are merely exemplary and illustrative, and are not intended to limit the invention as claimed. As used herein, the terms "comprise," "comprising," or any other variations thereof are intended to encompass non-exclusive inclusion, such that a process, method, article, or device that includes a list of elements does not include only those elements, but may include other elements not expressly listed or inherent to such process, method, article, or device. The term "example" is used in the sense of "example," not "ideal." The term "distal" refers to the portion of the device farthest from the user when introduced into a patient. In contrast, the term "proximal" refers to the portion of the device closest to the user when placed into the patient's body. Throughout the figures, the proximal and distal directions are indicated by arrows labeled "P" and "D," respectively. Although endoscopes are mentioned herein, reference to endoscopes or endoscopy should not be construed as limiting the possible applications of the disclosed aspects. For example, the disclosed aspects may be used with duodenoscopes, bronchoscopes, ureteroscopes, colonoscopes, catheters, diagnostic or therapeutic tools or devices, or other types of medical devices. In addition, relative terms such as "approximately," "substantially," and "about" are used to indicate a possible variation of ±10% within a stated value or range.

[0015] BRIEF DESCRIPTION OF THE DRAWINGS

[0016] The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate exemplary aspects of the disclosure and, together with the description, serve to explain the principles of the disclosure.

[0017] Figure 1 is a perspective view of an endoscope system and an enlarged view of the distal end of an endoscope of the endoscope system according to aspects of the present disclosure.

[0018] Figures 2A-2D are perspective and front views of an end portion of a device according to aspects of the present disclosure.

[0019] Figures 3A-3B are perspective and front views of components of a device tip according to aspects of the present disclosure.

[0020] Figure 4A and 4B Is used for rotation Figures 3A-3B A three-dimensional diagram of the system components.

[0021] Figure 5A and 5B are perspective and front views of an end portion of a device according to aspects of the present disclosure.

[0022] Figure 6A and 6B are perspective and front views of an end portion of a device according to aspects of the present disclosure.

[0023] Figures 7A-7C is a side view of the internal components of a device tip according to aspects of the present disclosure.

[0024] Figure 8 According to aspects of the present disclosure Figures 7A-7C A front view of some of the components at the end of the device.

[0025] Figure 9 is a perspective view of a portion of a device tip according to aspects of the present disclosure.

[0026] Figure 10 According to aspects of the present disclosure Figure 9 A perspective view of the components at the end of the device is shown.

[0027] Figures 11A-11D is a front view of components of a device tip according to aspects of the present disclosure.

[0028] Figure 12 is a perspective view of components of a device tip according to aspects of the present disclosure.

[0029] Figures 13A-13C and 14 are aspects according to the present disclosure including Figure 12 A stereoscopic view of the working channel at the end of the device showing the components.

[0030] Figure 15A and 15B is a front view of an end of a device according to aspects of the present disclosure.

[0031] Figure 16A and 16B is a perspective view of an end of a device according to aspects of the present disclosure. Specific embodiments

[0032] Reference will now be made in detail to various aspects of the present disclosure, examples of which are illustrated in the accompanying drawings. Wherever possible, the same or like reference numerals will be used throughout the drawings to refer to the same or like parts.

[0033] Embodiments of the present disclosure seek to improve the stability of accessory devices (e.g., working tools) within the lumen or working channel of a scope (e.g., an endoscope) where these tools are undersized relative to the lumen. In some embodiments, a maneuverable component may be included to provide the user with additional degrees of freedom when manipulating tools at the distal end of the scope. Embodiments of the present disclosure seek to improve a physician's ability to manipulate accessory devices within the working channel of an endoscope.

[0034] The exemplary endoscope system 100 is Figure 1 . Endoscopic system 100 may include endoscope 104. Endoscope 104 may include a handle assembly 120 and a flexible tubular shaft 102. The flexibility of shaft 102 may be sufficient to allow shaft 102 to bend, facilitating navigation of shaft 102 through a tortuous anatomical passage of a subject. Shaft 102 may terminate at a distal tip 101. Shaft 102 may include an articulating portion 122 for deflecting distal tip 101 in an upward, downward, left, and / or right direction. In one example, articulating portion 122 may provide full flexion (e.g., rotation of distal tip 101 through an arc of 180 degrees) or only partial flexion (e.g., rotation of distal tip 101 through an arc of less than 180 degrees). Endoscope 104 may also include one or more lumens extending therethrough, and one or more openings communicating with the one or more lumens. For example, one or more lumens may extend through handle assembly 120 and shaft 102, and one or more openings may be on handle assembly 120 and distal tip 101. The endoscope 104 may be any suitable member for insertion into a patient's body, such as an endoscope, a gastroscope, a ureteroscope, a nephroscope, a colonoscope, a hysteroscope, a ureteroscope, a bronchoscope, a cystoscope, a duodenoscope, a sheath, or a catheter.

[0035] One or more auxiliary devices may be operably coupled to the endoscope 104. Exemplary auxiliary devices may include a controller 106, an imaging system 108, a power source 112, a display 114, a fluid source 116, and / or a vacuum source 118, each of which is briefly described below. The controller 106 may include, for example, any electronic device capable of receiving, storing, processing, generating, and / or transmitting data according to instructions given by one or more programs. The controller 106 may be operably coupled to, or a portion of, one or more of the endoscope 104 and other auxiliary devices to control one or more aspects of their operation. The power source 112 may include any suitable power source and associated connectors (e.g., conductive wires) for providing power to the auxiliary devices and electronic components within the endoscope 104. The fluid supply assembly 116 may include a fluid reservoir, a medical flush bag, a pump, and any suitable connectors (e.g., tubing for fluidly coupling the fluid supply 116 to the endoscope 104). The pump can supply a pressurized fluid stream to one or more lumens in the endoscope 104, and the pressurized fluid stream can be emitted from the distal tip 101 and / or used to inflate an expandable member present at the distal tip 101. The vacuum source 118 can provide suction or vacuum pressure to one or more lumens of the endoscope, thereby providing a suction force to draw material toward and / or into the endoscope 104, and / or to deflate an expandable member.

[0036] The imaging system 108 may include imaging electronics to, for example, process signals received from an image sensor in the endoscope 104 , send signals for controlling the image sensor, adjust lighting levels for an area being viewed by the image sensor, and / or facilitate display of image sensor data on the display 114 .

[0037] The distal tip 101 may include one or more image sensors 129 and one or more illuminators 131, such as Figure 1 1 . An enlarged view of the distal tip 101 is shown. The one or more image sensors 129 may include a charge coupled device image sensor, a complementary metal oxide semiconductor image sensor, or the like, coupled to a cable or wire that passes through the shaft 102 of the endoscope 104. The one or more illuminators 131 may include a light emitting diode (LED), or the like.

[0038] Tool 127 can be inserted into the lumen or working channel 125 of endoscope 104 and can be withdrawn from the distal end of lumen 125. Tool 127 can include, for example, a guidewire, cutting or grasping forceps, a biopsy device, a snare loop, an injection needle, a cutting blade, scissors, a retractable basket, a retrieval device, an ablation and / or electrophysiology catheter, a stent placement device, a surgical suturing device, a balloon catheter, a laser emitting device, and / or any other suitable therapeutic or diagnostic instrument. As shown in the enlarged view of distal tip 101, tool 127 has a circumference about its longitudinal axis that is smaller than the circumference about the longitudinal axis of lumen 125 and can include a smaller cross-sectional diameter than the diameter of lumen 125. Various aspects of the present disclosure provide embodiments of a medical device tip, such as distal tip 101, that can facilitate securely coupling a tool, such as tool 127, to distal tip 101 so that when a user moves distal tip 101, tool 127 will also move in the same direction.

[0039] Figures 2A-2D A perspective view and a front view of a medical device tip 201 including an image sensor 229, illuminators 231, 233, an inner lumen or working channel 225, and an elevator 242 are shown. A tool 227 is shown positioned within the working channel 225. The elevator 242 can provide a means for securing the tool 227 to the distal tip 201 by clamping the tool 227 between the elevator 242 and the radially inner wall of the working channel 225. The elevator 242 can also move the tool 227 through the elevator 242's motion path, for example, by moving the tool 227 in a sweeping motion across the elevator 242's motion path. The path of the tool 227 when engaged with the elevator 242 can depend on the starting position of the tool 227 when the elevator 242 is not engaged with the tool 227. In some examples, the starting position of the tool 227 can be influenced by the stiffness of the tool 227, the articulation of the distal tip 201, and / or the motion path of the medical device through the patient's anatomy. In some examples, the elevator 242 can be positioned at an angle relative to the longitudinal axis of the medical device tip 201 and can be configured to adjust the position of a tool positioned within a working channel that exits the medical device tip 201 at a sidewall and has a distal working channel opening positioned proximal to the distal front end face of the medical device tip 201 (note that this configuration is not shown in the figures).

[0040] The elevator 242 can include a U-shaped surface, as will be explained in conjunction with the second extension 246, that receives the tool 227. The elevator 242 can be anchored to a portion of the distal tip 201 at a proximal portion 248 of the elevator 242. The proximal portion 248 of the elevator 242 can rotate about an axis that is substantially transverse to the longitudinal axis of the working channel 225. In some examples, the proximal portion 248 can be rotatably coupled to a portion of the distal tip 201, forming a hinge and allowing the elevator 242 to rotate about an axis extending through the proximal portion 248.

[0041] Elevator 242 may include a first extension 244 and a second extension 246, both of which may extend from proximal portion 248. In some examples, first extension 244 may be offset from second extension 246 (to one side of extension 246) and may be angled relative to second extension 246. In some examples, first extension 244 may be offset from the longitudinal axis of working channel 225 such that the first extension is outside of working channel 225. In some examples, second extension 246 is positioned adjacent to or within working channel 225. An outer surface 252 of second extension 246 may be configured to be substantially aligned with or otherwise flush with the radially inner surface of working channel 225. The radially inner surface of working channel 225 may include a recess in which second extension 246 of the elevator is positioned. In some examples, a distal portion of first extension 244 may include a securing chamber 250. Securing chamber 250 may be configured to receive a cable or actuator 240. In some examples, the distal end of the cable 240 can be rotatably coupled to the distal portion of the first extension 244 such that when the cable 240 is pulled in the proximal direction, the first extension 244 is pulled proximally and pivots about an axis passing through the proximal portion 248, and a portion of the cable 240 can rotate about an axis extending through the securing chamber 250. The cable 240 can be rigid and / or incompressible such that the cable can translate distally to move the first extension 244 distally and cause the elevator to rotate about the axis passing through the proximal portion 248. In some examples, the cable 240 can be coupled to a lever (not shown) positioned at the handle 120 or another proximal portion of the endoscope 104. In some examples, the elevator 242 can be positioned less than 20 mm from the distal front face.

[0042] In operation, the elevator 242 can be configured to Figure 2A and 2B The first configuration shown and Figure 2C and 2DThe user can pull the operating lever on the proximal portion of the endoscope 104, which can pull the cable 240 proximally. When the cable 240 is pulled proximally, the elevator 242 can rotate about an axis extending through the proximal portion 248 and can be moved from Figure 2A and 2B The first configuration shown transitions to Figure 2C and 2D In some examples, the operating lever can be in the open position when the elevator 242 is positioned such that the working channel 225 is open to allow the tool 227 to move within the working channel 225 .

[0043] When the user moves the lever from the open position to the closed position, the cable 240 can move proximally and the elevator 242 (particularly the second extension 246) can cover a portion of the working channel 225 (eg, Figure 2C and 2D When elevator 242 obscures a portion of working channel 225, second extension 246 extends within working channel 225 and can contact tool 227 to push tool 227 against the radially inner surface of working channel 225. In some examples, tool 227 can remain parallel to the longitudinal axis of medical device tip 201 and / or working channel 225 when pushed against the radially inner surface of working channel 225, and in other examples, tool 227 can be tilted at an angle relative to the longitudinal axis of medical device tip 201 and / or working channel 225 when pushed against the radially inner surface of working channel 225. A user can move the operating lever to a closed position and / or pull cable 240 proximally to rotate elevator 242 and push second extension 246 against tool 227 to hold it in place. The user can lock the operating lever in the closed position, allowing the user to move distal tip 201 and tool 227 simultaneously and in unison without having to separately hold tool 227. By pushing second extension 246 against tool 227, the user can stabilize tool 227 and prevent tool 227 from moving within working channel 225. The position of elevator 242 can be optimized to position tool 227 at any portion of the radially inner surface of working channel 225 when elevator 242 engages tool 227, such as positioning tool 227 at a specific location relative to image sensor 229 and / or illuminators 231, 233. In some examples, joystick control cable 240 can be configured to lock in a closed position to allow the user to lock elevator 242 in a position that holds tool 227 in place. When joystick control cable 240 is configured to lock in a closed position, the user may not have to grasp the proximal portion of tool 227 at the biopsy port of handle 120, thereby potentially reducing user fatigue and allowing the user to have their hands free.

[0044] Figure 3A and 3B An alternative embodiment of a lifter 302 that can be incorporated into the end of the device is shown. The lifter 302 can have any of the features previously described with respect to the lifter 242. Figure 3A , elevator 302 is shown positioned relative to a working channel 325, which can be located within endoscope 104 or a similar medical device. Elevator 302 includes a first extension 304, a second extension 306, and a proximal portion 307 connecting first extension 304 to second extension 306. First extension 304 can be opposite second extension 306, and lumen 315 can extend longitudinally along the length of elevator 302. When elevator 302 is positioned within a distal tip of a device (e.g., distal tip 101), lumen 315 can be longitudinally aligned with the device's working channel. Radially inner surfaces 310 and 312 of first and second extensions 304, 306, respectively, can be curved and configured to conform to working channel 325. Proximal portion 307 can include a connecting portion 308. Connecting portion 308 can extend radially outward from the longitudinal axis of elevator 302 and can protrude from a radially outer surface of elevator 302. The connecting portion 308 can be configured to connect to a mechanism that allows a user to rotate the elevator 302 about the connecting portion 308, such as a mechanism similar to Figures 2A-2D 308 can be positioned outside or partially outside of the working channel 325 and within the distal end portion of the medical device. A tab 316 can be positioned on the radially outer surface of the lifter 302 at a portion of the lifter 302 opposite the connecting portion 308. The tab 316 can be rotatably coupled to a portion of the distal end of the medical device and can be positioned partially outside of the working channel 325. In some examples, the first and second extensions 304, 306 can be longitudinally curved arms extending from the annular portion 307. The annular portion 307 can have a proximal opening to receive an endoscopic tool. The first and second extensions 304, 306 can define two longitudinal slots 309 therebetween. A distal opening 311 can be at the distal-most end of the lifter 302 and can be configured for the tool 325 to extend therethrough.

[0045] In some examples, the connecting portion 308 can be connected to a rotating body 452. The rotating body 452 can include a rotatable hub 454 connected to the connecting portion 308. A cable or actuator 450 positioned outside the working channel 325 can be fixedly coupled to the rotatable hub 454, longitudinally offset from the hub 454. The cable 450 can extend through a lumen in the rotating body 452 and can be coupled to an extension 461 extending from the rotatable hub 454. When a user moves the cable 450 distally, the extension 461 can rotate due to the force applied by the cable 450 to the extension 461. The rotatable hub 454 can rotate due to the movement of the extension 461, thereby rotating the elevator 302 via the connecting portion 308 and deflecting the elevator 302. In some examples, deflecting the elevator 302 can move the first extension 304 so that the first extension 304 obscures the working channel 325 and rotates toward the first side 320 of the working channel 325. When first extension 304 obscures working channel 325, first extension 304 can contact tool 325 and push tool 427 toward first side 320 of working channel 325 to retain tool 427 between first side 320 and first extension 304, thereby preventing tool 427 from moving within working channel 325. When a user moves cable 450 proximally, cable 450 can pull extension 461 and rotatable hub 454 can rotate with movement of extension 461, thereby rotating elevator 302 via connecting portion 308 and deflecting elevator 302 such that second extension 306 obscures working channel 325 and rotates toward second side 321 of working channel 325. In some examples, tool 427 can move through working channel 325 when first extension 304 or second extension 306 obstructs a portion of working channel 325.

[0046] The cable 450 can be moved by the user in the same manner as described above with respect to the cable 240. In some examples, the user can push or pull the cable 450, which will cause the extension 461 to rotate about the rotation hub 454, and the rotation of the extension 461 deflects the first extension 304 or the second extension 306 over a portion of the working channel 325. Because the elevator 302 allows the user to position the first extension 304 within the working channel 325 to hold the tool 427 toward the first side 320 of the working channel 325, and to position the second extension 306 within the working channel 325 to hold the tool 427 toward the second side 321 of the working channel 325, the elevator 302 provides the user with the ability to hold the tool 427 at a plurality of different positions within the working channel 325. In some examples, the elevator 302 can be partially positioned within the working channel 325 when the longitudinal axis of the elevator 302 is parallel to the longitudinal axis of the working channel 325, and in other examples, the elevator 302 can be completely positioned outside of the working channel 325 when the longitudinal axis of the working channel 325 is parallel to the longitudinal axis of the elevator 302. In some examples, the radially inner surfaces 310, 312 of the elevator 302 can be aligned with the radially inner surface of the working channel 325.

[0047] Figures 5A-5B 6A-6B show perspective and front views of another elevator 510 in the device tip 501. In some examples, the elevator 510 can include a U-shaped convex outer surface 511 with opposing flanges 513 extending radially outward from the bottom of the U-shaped outer surface 511. In other examples, the outer surface of the elevator 510 can be any suitable shape configured to extend through the opening 518 to contact the tool 527. The flange 513 defines the upper surface of the bottom portion 515 of the elevator 510. The bottom portion 515 can be positioned within and slide within a channel 514 extending from an opening 518 in the radially inner surface of the working channel 525. The elevator 510 and / or the channel 514 can have a longitudinal axis that is substantially transverse to the working channel 525. In some examples, the channel 514 can extend distally from the opening 518 in the working channel 525 at an angle. In other examples (not shown), the channel 514 can extend proximally from the opening 518 at an angle relative to the longitudinal axis of the working channel 525. The elevator 510 can be configured to move within the channel 514. In some examples, the channel 514 can include an opening 516 extending longitudinally within the channel 514. The opening 516 can be configured to receive a cable or actuator 550 and can allow the cable or actuator 550 to move within the opening 516. In some examples, the elevator 510 can be within an endoscope cap that can be attached to the distal tip of the endoscope.

[0048] The cable or actuator 550 can be fixedly coupled to the elevator 510 or can be rotatably coupled to the elevator 510 such that the cable can rotate about the point at which the cable 550 is coupled to the elevator 510. In some examples, the cable 550 can extend from the elevator 510 to a proximal portion of the device such that a user can move the cable 550 while the distal tip 501 is located within the patient. The cable 550 can be rigid and / or incompressible such that the cable 550 can be translated distally or proximally to move the elevator 510 distally or proximally and cause the elevator to move within the channel 514. In some examples, the cable 550 can be coupled to a joystick (not shown) positioned at the handle 120 or another proximal portion of the endoscope 104 in a manner similar to that described above with respect to the elevator 242.

[0049] Figure 5A and 5B Elevator 510 is shown fully contained within channel 514, such that elevator 510 does not extend within working channel 525. When a user translates cable 550 proximally, such as by actuating a lever on handle 120 to pull cable 550 proximally, elevator 510 can translate within channel 514 and extend within working channel 525, obscuring working channel 525. In other examples (not shown), translating cable 550 distally will move elevator 510 into working channel 525. In some examples, translating cable 550 proximally will move elevator 510 from Figure 5A and 5B The first form shown transitions to Figure 6A and 6B When tool 527 is positioned within working channel 525, tool 527 can be moved by moving elevator 510 into working channel 525. By pulling cable 550 proximally, the user can move elevator 510 within working channel 525 and clamp tool 527 between elevator 510 and the radially inner surface of working channel 525 (e.g., Figure 6A and 6B527 between the radially inner surface of the working channel 525, the tool 527 can remain in place and the user can move the distal end 501 and the tool 527 in unison without the tool 527 moving within the working channel 525. By maintaining the tool 527 in a specific position within the working channel 525, the elevator 510 can help stabilize the tool 527 within the working channel 525. In other examples, the angle, shape, and / or size of the elevator 510 can be optimized to achieve preferred elevator performance and accessory device compatibility. In some examples, the elevator 510 can be moved from a position within the working channel 525 to a position within the channel 514 outside the working channel 525 by moving the tool 527 through the working channel 525.

[0050] Figures 7A-7C Another embodiment of an elevator system 702 is shown that includes a wedge 706 positioned within a distal tip 701 of a medical device. Figures 7A-7C A side view of the distal tip 701 within the working channel 725, a tool 727 positioned within the working channel 725, a wedge 706, and an opening 709 in the radially inner surface of the working channel 725 is shown. The opening 709 connects a chamber (not shown) in which the wedge 706 is located with the working channel 725. The wedge 706 can include a pair of surfaces substantially transverse to the longitudinal axis of the working channel 725 that intersect at an edge located proximal to the wedge 706, and the pair of surfaces can form a wedge shape. In some examples, the wedge 706 can be anchored to a position positioned outside the working channel 725 by a biasing member (e.g., a spring) connected to the wedge 706 and a portion of the distal tip 701. The biasing member (not shown) can be biased to maintain the wedge 706 in a position outside the working channel 725, wherein the longitudinal axis of the elevator is substantially parallel to the working channel 725. In some examples, the wedge 706 can be biased away from the working channel 725 by a tab member 710. At least one inclined surface 712 of the wedge 706 can be configured to align with the inclined surface 708 of the block 707. In some examples, a biasing member, such as a coil spring, can be coupled to the hinge 751 and the coil spring can bias the hinge 751 toward the block 707 and / or the wedge 706, and pulling the cable or actuator 750 proximally can slide the wedge 706 toward the tab member 710 and push the tab member 710 toward the working channel 725 against the force of the biasing member.

[0051] Block 707 can be fixedly coupled to distal tip 701 such that block 707 does not move relative to wedge 706. In some examples, the position of tab member 710 does not change when wedge 706 and block 707 do not move relative to each other. Block 707 can have an inclined surface 708 that is substantially parallel to the longitudinal axis of working channel 725 and substantially transverse to the longitudinal axis of working channel 725. Surface 708 can be configured to align with a surface of wedge 706. Block 707 can include a channel 755 (e.g., Figure 8 shown). Figure 8 The block 707 including the channel 755 and the cable 750 is shown, as well as the positioning of the block 707 relative to the wedge 706 and the working channel 725. The tab member 710 is not positioned in the Figure 8 . The channel 755 can be configured to receive the cable 750 and can allow the cable 750 to translate proximally and distally through the channel 755. The channel 755 can also prevent the cable 750 from extending beyond the radially outermost portion of the block 707 so as to limit the distance that the wedge 706 can move toward the working channel 725. The cable 750 can be fixedly coupled to the wedge 706 (at Figure 8 ), such that moving the cable proximally moves the wedge 706 proximally, and moving the cable 750 distally moves the wedge 706 distally.

[0052] Tab member 710 can extend from a proximal portion to a distal portion of distal tip 701. Tab member 710 can be rigid and can include a hinge 751 located at the proximal portion of tab member 710. In other examples, tab member 710 can be flexible, and hinge 751 can be a living hinge. In some examples, hinge 751 can include a coil spring or other biasing member. The distal-most end of tab member 710 can be positioned near opening 709 such that when tab member 710 pivots about hinge 751, tab member 710 can extend within working channel 725. In some examples, tab member 710 can abut an outer surface of block 707 and an outer surface of wedge 706. Tab member 710 can be configured to contact tool 727 and retain tool 727 in position within working channel 725. Due to the hinge / coil spring 751, the tab member 710 can be biased away from the working channel 725 so that the tab member 710 moves to a position outside of the working channel 725 when no force is applied to the tab member 710. The wedge 706, tab member 710, and block 707 can be made of any suitable biocompatible material and can be sufficiently rigid to operate as described herein.

[0053] In operation, a user can move the cable 750 proximally, thereby pulling the wedge 706 proximally. As the wedge 706 moves proximally, the inclined surface 712 of the wedge 706 can slide over the inclined surface 708 of the block 707, thereby moving the wedge 706 toward the working channel 725. As the wedge 706 moves toward the working channel 725, the wedge 706 moves the tab member 710 toward the working channel 725. As the tab member 710 moves toward the working channel 725, the tab member 710 also rotates about the hinge 751. As the tab member 710 moves toward the working channel 725, the tab member 710 extends into the working channel 725 through the opening 709 and can contact the tool 727. Therefore, when the user pulls the cable 750 proximally, the tab member 710 will move into the working channel 725 and push the tool 727 toward the radially inner surface of the working channel 725. As Figure 7C As shown, after the user pulls the cable 750 proximally, the tab member 710 can hold the tool 727 against the radially inner surface of the working channel 725 and prevent the tool 727 from moving within the working channel 725. The tool 727 can be deflected by the tab member 710 extending within the working channel 725. In some examples, the joystick control cable 750 can be configured to lock in a closed position to allow the user to lock the wedge 706 in a position in which the tab member 710 holds the tool 727 against the radially inner surface of the working channel in a manner similar to that previously discussed with respect to elevators 242, 302, and 510. To release the tool 727 and allow it to move within the working channel 725, the user can move the cable 750 distally, thereby moving the wedge 706 distally. Alternatively, releasing the cable 750 from the proximal position allows the tab member 710 to pivot about the hinge 751 to automatically move the wedge 706 distally.

[0054] Although Figures 7A-7C Wedge 706 is shown positioned within distal tip 701 , but alternative embodiments (not shown) may include wedge 706 , block 707 , and a distal portion positioned distal to distal tip 701 and / or external to body 760 of distal tip 701 .

[0055] Figure 9-11D Another embodiment of an elevator assembly 902 is shown, comprising a rotating plate 930, a slider 932, and a frame 943 (positionable within the distal end 901 of a medical device. Figures 11A-11D). Plate 930 may include a circular opening or lumen 936 extending through a central portion of plate 930 and a recess 935 extending from a first side 941 of plate 930 to an opposing second side 940. In some examples, plate 930 may have a circular outer shape. A cable or actuator 931 may be fixedly coupled to plate 930. Cable or actuator 931 may be configured to move plate 930, for example, to rotate plate 930 within a recessed portion of frame 943. Recess 935 may be configured to receive slider 932 and may include opposing straight sides 941, 940 configured to slidably engage slider 932. The circumference of lumen 936 may be configured to be greater than the circumference of working channel 925 to allow working channel 925 to extend through lumen 936.

[0056] The slider 932 can have a generally circular outer shape and can include an opening or inner cavity 937 extending through a central portion of the slider 932. The slider 932 can include opposing straight edges 950, 951. The opposing straight edges 950, 951 can be configured to align with the opposing straight edges 940, 941 of the recess 935 such that the straight edges 950, 951 slidably engage the straight edges 940, 941. The slider 932 can be configured to translate within the recess 935 and be constrained by the recess 935 to move along the longitudinal axis 977 of the recess 935. In some examples, the interface between the straight edges 940, 941 and the straight edges 950, 951 can prevent the slider 932 from rotating relative to the plate 930 when a force is applied to the slider 932 via the cable 933. As Figure 9 As shown, lumen 937 can be sized to allow working channel 925 to extend through lumen 937. Slider 932 can be fixedly coupled to cable 933. In some examples, cable 933 can be rigid and can be configured to move slider 932 within recess 935. Proximal or distal translation of cable 933 can move slider 932 along longitudinal axis 977.

[0057] Figures 11A-11D The lifter assembly 902 is shown to include a plate 930, a slide 932, and a frame 943. The lifter assembly 902 is Figures 11A-11D961, 962 to allow components of the medical device (including components of the elevator assembly 902) to extend through the plurality of lumens 960, 961, 962 and move therein. For example, the frame 943 may include one or more lumens 960, 961 configured to allow cables from one or more image sensors and / or one or more illuminators to extend therethrough. In some examples, the frame 943 may be a portion of the distal end 901 of the medical device and formed within a portion of the distal end 901. The lumen 962 may be configured to align with a working channel (e.g., the working channel 925 of the device end 901). The frame 943 may be fixedly coupled to and / or incorporated into the distal end 901 of the medical device. Frame 943 can be configured to hold rotating plate 930 and slider 932 such that rotating plate 930 can rotate relative to frame 943 and slider 932 can translate within recess 935. Frame 943 can include one or more brackets 970, 971 configured to couple plate 930 and slider 932 to frame 943 while allowing movement of plate 930 and slider 932 relative to the frame. Recessed portion 976 can prevent slider 932 from moving beyond the radially outermost portion of plate 930. In some examples, frame 943 can limit the amount of rotation of plate 930 to ninety degrees, for example by configuring lumen 961 to allow cable 931 to rotate plate 930 ninety degrees and stopping rotation of plate 930 by contacting cable 931 with an edge of lumen 961. Frame 943 can be positioned at an angle relative to the longitudinal axis of distal tip 901, for example within distal tip 901. By positioning the frame 943 at an angle relative to the longitudinal axis of the distal tip 901, the user can translate the cable 931 proximally or distally to rotate the plate 930 relative to the frame 943, since the plate 930 can rotate within the frame 943 but does not translate proximally or distally relative to the frame 943. Furthermore, positioning the frame 943 at an angle relative to the longitudinal axis of the distal tip 901 can facilitate movement of the slider 932 by pushing / pulling the cable 933. For example, rotation of the cable 931 can rotate the plate 930. In some examples, a protrusion or other "hard stop" feature can be incorporated into the rotating plate 930, which can interact with a feature on the frame 943 (e.g., a protrusion on the frame 943) to limit rotation of the plate 930 beyond a desired range.

[0058] When operating a medical device having a distal tip including elevator assembly 902, a user can first rotate rotating plate 930 by moving cable 931 in a proximal or distal direction. This can cause the distal end of cable 931 to move substantially transverse to or about the longitudinal axis of distal tip 901. As the user rotates plate 930, the motion axis 977 of slider 932, which corresponds to the longitudinal axis of recess 935, rotates, and slider 932 moves to a different position relative to working channel 925. After rotating plate 930, the user can move slider 932 through recess 935 by moving cable or actuator 933. By moving slider 932, a portion of slider 932 can move within working channel 925 and contact tool 927. The user can move slider 932 so that slider 932 contacts tool 927 and pushes tool 927 against the radially inner surface of working channel 925, which can hold tool 927 against the radially inner surface of working channel 925. Figures 11A-11D Various positions are shown in which tool 927 can be held against the radially inner wall of a working channel (e.g., working channel 925) using elevator assembly 902. Figures 11A-11D As shown, the user can rotate plate 930 and translate slider 932 to position tool 927 at any point along the radially inner surface of working channel 925. In some examples, elevator assembly 902 can allow the user to move tool 927 to a desired location within working channel 925 after tool 927 has been stabilized within working channel 925, such as by rotating plate 930 after tool 927 has been secured to one side of working channel 925 via slider 932. Elevator assembly 902 can allow for the use of larger working channels and / or smaller tools because elevator assembly 902 provides a means for the user to stabilize the tool within the working channel at a user-defined location and can allow for more predictability in tool orientation.

[0059] In some examples (not shown), plate 930 can be rotated by a mechanism in which a user rotates a knob of the medical device to actuate plate 930 rotation, and slider 932 can be translated by a mechanism in which a user rotates a knob of the medical device to move slider 932. For example, rotation of an actuator about a pivot point within a handle of the medical device (e.g., handle 120) can push (distal movement) or pull (proximally movement) a cable (e.g., cable 931 or cable 933). In some examples in which the movement of plate 930 or slider 932 is controlled by translating a cable, a user can rotate an operating lever about the pivot point, which can extend or retract an arm within the handle of the medical device (e.g., handle 120), thereby pushing or pulling the cable. In other examples, the proximal end of a cable (e.g., cable 931 or cable 933) can be coupled to a turntable, and the turntable can be positioned such that rotation of the turntable rotates the cable about its longitudinal axis.

[0060] In another example, the elevator assembly can include a slider 932 and a frame 943 without a recess for receiving the plate 930 and including a recess similar to recess 935 configured to receive the slider 932. In this example, the plate 930 can be secured to the distal end of the medical device in the same manner as the elevator assembly 902, and the slider 932 can be constrained to a single axis of motion 977 because the orientation of the slider 932 and the recess in the frame are fixed. In this example of the elevator assembly, a single cable would be required to move the slider 932 within the recess in the frame.

[0061] Figure 12-14 Another embodiment of a lifter assembly 1270 is shown. The lifter assembly 1270 can include a support block 1203, a snare loop 1211, and a cable or actuator 1210 coupled to the snare loop 1211. Figure 12 The support block 1203 is shown without the snare loop 1211 or the cable 1210. The support block 1203 may include a lumen 1209 extending through a central portion of the support block 1203 and along the longitudinal axis of the support block 1203. The lumen 1209 may be configured to align with the working channel 1225 of the device tip (note that the working channel 1225 is shown in phantom for illustrative purposes). The lumen 1209 may extend from an opening in a first proximal surface 1230 of the block 1203 to an opening in a second distal surface 1231 of the block 1203. The first surface 1230 may be substantially perpendicular to the longitudinal axis of the working channel 1225, and the second surface 1231 may be substantially transverse to the longitudinal axis of the working channel 1225. In some examples, the second distal surface 1231 may be angled such that the distance between the first surface 1230 and the second surface 1231 increases as the second surface 1231 extends distally. The channel 1205 can be positioned on the radially inner surface of the inner cavity 1209 and proximate to the second surface 1231.

[0062] In some examples, the channel 1205 can be configured to receive a snare loop 1211. The channel 1205 can extend circumferentially around the radially inner surface of the lumen 1209 and can be connected to or otherwise communicate with the outlet chamber 1207. The outlet chamber 1207 can extend from the channel 1205 to an opening at the first surface 1230. The outlet chamber 1207 can be configured to receive the snare loop 1211 and / or the cable 1210. In some examples, when the positioning block 1203 causes the working channel 1225 to extend through the lumen 1209, the outlet chamber 1207 is positioned at a portion of the exterior of the working channel 1225. A gap in the radially inner wall of the working channel 1225 can be positioned adjacent to the channel 1205 to allow the snare loop 1211 to move in and out of the channel 1205. The channel 1205 can be sized to allow the snare loop 1211 to snap into and ride within the channel 1205.

[0063] Figures 13A-13C Elevator assembly 1270 is shown with snare loop 1211 housed within channel 1205 ( Figure 13A ), the snare loop 1211 partially exits the channel 1205 and is positioned within the working channel 1225 ( Figure 13B ), and the snare ring 1211 holds the tool 1227 against the radial inner surface of the lumen 1209 ( Figure 13C ). The snare loop 1211 can be coupled to the cable 1210 outside the channel 1205, the outlet cavity 1207, or the block 1203. The snare loop 1211 can be sufficiently rigid to allow a user to translate the cable 1210 proximally to move the snare loop 1211 from a position outside the channel 1205 to a position inside the channel 1205. The distal tip of the medical device can include a cavity within or adjacent to the working channel 1225 that can be configured to receive the block 1203 such that the block 1203 does not move proximally or distally relative to the distal tip.

[0064] In some examples, the cable 1210 can be coupled to an operating lever (not shown) located at a handle of the medical device (e.g., handle 120 or another proximal portion of the endoscope 104). A user can pull the operating lever at the proximal portion of the endoscope 104, which can pull the cable 1210 proximally. As the cable 1210 is pulled proximally, the snare loop 1211 can move out of the channel 1205 and into the working channel 1225. In some examples, when the snare loop 1211 is located within the channel 1205 and the working channel 1225 is open, the operating lever can be in an open position to allow the tool 1227 to move within the working channel 1225. In some examples, when the snare loop 1211 is positioned within the working channel 1225 and holds the tool 1227 against the radially inner surface of the lumen 1209, the operating lever can be in a closed position, thereby stabilizing the tool 1227 within the working channel 1225 and preventing the tool 1227 from moving within the working channel 1225.

[0065] In some examples, the cable 1210 can include a sheath portion having a lumen extending therethrough, and the snare loop can include a proximal extension positioned within the lumen. In this example, a user can pull the proximal extension proximally to deploy the snare loop 1211 within the working channel 1225, and a portion of the snare loop 1211 can be received by the sheath.

[0066] Figure 14 An alternative perspective view of the elevator assembly 1270 is shown with the snare ring 1211 positioned with the Figure 13C in the same position.

[0067] When operating a medical device having a distal tip including the elevator assembly 1270, a user can first position the tool 1227 within the working channel 1225. The user can then pull the cable 1210 proximally to pull the snare loop 1211 out of the channel 1205 and position the snare loop 1211 within the working channel 1225. As the user pulls the cable 1210 proximally, the snare loop 1211 will contact the tool 1227 as the proximal portion of the snare loop 1211 will be pulled through the exit cavity 1207. The tool 1227 can be moved through the working channel 1225 and can then be held against the radially inner surface of the working channel 1225. By resting the tool 1227 against the radially inner surface of the working channel 1225, the tool 1227 can be stabilized within the working channel 1225. When the user desires to release tool 1227 and create more space within working channel 1225, the user can move cable 1210 distally, thereby moving the snare loop within and out of channel 1205. In some examples, snare loop 1211 slides back into channel 1225 when the user moves cable 1210 proximally. In some examples, snare loop 1211 can retract or snap back into position within channel 1225 due to its inherent rigidity paired with the geometry of block 1203. In some examples, snare loop 1211 can have a curvature that facilitates placement of snare loop 1211 within channel 1225. Block 1203 can include an inclined surface that facilitates movement of snare loop 1211 into channel 1225. In other examples, a biasing member, such as a spring, can be coupled to snare loop 1211 and can push / pull snare loop 1211 within channel 1225.

[0068] In some examples, the working channel 1225 can include multiple elevator assemblies (blocks 1203, snare loops 1211, and cables 1210) positioned along the working channel 1225, with each block 1203 rotating relative to the other blocks 1203. By using multiple blocks 1203 and snare loops 1211, a user can have the ability to move the tool 1227 to different areas within the working channel 1225 and stabilize the tool 1227 in different positions.

[0069] Figures 15A-16BAnother embodiment of an elevator assembly 1502 positioned within a distal tip 1501 of a medical device is shown. Elevator assembly 1502 may include an elevator 1512 and a cable or actuator 1514. Elevator 1512 may have a generally circular shape and may be positioned at the distal front face of distal tip 1501. Elevator 1512 may include an opening or lumen 1522 extending therethrough. In some examples, the longitudinal axis of lumen 1522 may be parallel to the longitudinal axis of distal tip 1501. Lumen 1522 may be configured to align with a working channel 1525. In some examples, elevator 1512 may be positioned at distal front face 1520 such that lumen 1522 aligns with the opening of working channel 1525. Elevator 1512 may also include a chamber 1511 configured to receive and couple to cable 1514. In some examples, when cable 1514 is coupled to lifter 1512 and positioned within chamber 1511 , chamber 1511 can act as a pivot point such that lifter 1512 can rotate about the pivot point positioned in chamber 1511 when a user rotates cable 1514 about its axis.

[0070] The cable 1514 can extend from the elevator 1512 to a proximal portion of the medical device. The cable 1514 can be rigid such that rotation of the proximal portion of the cable 1514 can result in rotation of the distal portion of the cable 1514. The cable 1514 can extend through a lumen (not shown) in the distal tip 1501. The distal portion of the cable 1514 can be fixedly coupled to the elevator 1512, such as to and positioned within the chamber 1511. The proximal portion of the cable 1514 can be fixedly coupled to a knob, such as a knob positioned on the handle 120 (see Figure 1 ), and rotating the knob can cause elevator 1512 to rotate at distal tip 1501. As elevator 1512 rotates, a portion of elevator 1512 can contact tool 1527 and can move tool 1527 toward the radially inner surface of working channel 1525. Thus, rotation of elevator 1512 can provide a means for the user to move tool 1527 and rest tool 1527 against the radially inner surface of working channel 1525, thereby preventing tool 1527 from moving within working channel 1525.

[0071] In some examples, the elevator 1512, cable 1514, and / or a knob coupled to the cable 1514 can be coupled to a biasing member, such as a spring, to bias the elevator 1512 toward a position where the lumen 1255 is aligned with the working channel 1525, as shown. Figure 15A and 16AIn some examples, a biasing member can be coupled to protrusion 1529 of elevator 1512 (e.g., a spring attached to protrusion 1529 and distal surface 1520 of tip 1501). A user can rotate cable 1514, causing elevator 1512 to rotate and obscure working channel 1525, and then when the user releases cable 1514, elevator 1512 is moved by the biasing member back to a position where lumen 1522 is aligned with working channel 1525.

[0072] When operating a medical device having distal tip 1501 including elevator assembly 1502, a user may first position tool 1527 within working channel 1525. The user may then rotate cable 1514, via a knob or any other means, to rotate elevator 1512 and move a portion of elevator 1512 toward the central longitudinal axis of working channel 1525 and extend a portion of elevator 1512 through the distal opening of working channel 1525. As the user rotates cable 1514, elevator 1512 contacts tool 1527 and moves tool 1527 toward the radially inner surface of working channel 1525. Tool 1527 may move through working channel 1525 and then may be held against the radially inner surface of working channel 1525. By holding tool 1527 against the radially inner surface of working channel 1525, tool 1527 may be stabilized within working channel 1525. When the user desires to release tool 1527, the user can rotate cable 1514 in the opposite direction, thereby moving elevator 1512 to align with the distal opening of working channel 1525 and moving the portion of elevator 1512 extending through the distal opening of working channel 1525 away from the central longitudinal axis of working channel 1525.

[0073] In some examples, the cable or actuator 1514 can be prevented from rotating in a clockwise or counterclockwise direction when the lumen 1522 is aligned with the working channel 1525 by a stop feature (not shown) within the distal tip 1501 or a protrusion extending from the distal front face 1520 (not shown). Preventing the elevator 1512 from rotating in a counterclockwise or clockwise direction when the lumen 1522 is aligned with the working channel 1525 can help the user position the lumen 1522 back into alignment with the working channel 1525 after stabilizing the tool 1527 and the elevator 1512.

[0074] In some examples, the distal tip of the medical device can include multiple elevators having the same structure as elevator 1512 but with pivot points located at different locations. Using multiple elevators 1512 can allow a user to stabilize tool 1527 at multiple different locations within working channel 1525 and / or connect tool 1527 to distal tip 1501.

[0075] Any disclosed embodiment of the elevator assembly can be positioned proximate to the distal tip of an endoscope or other medical device. For example, any disclosed embodiment of the elevator assembly can be positioned proximate to an articulating joint of an endoscope and / or proximate to an articulating portion of an endoscope. Any disclosed embodiment of the elevator assembly can include an adjustable locking mechanism and / or an adjustable actuator, such as a ratchet, to adjust the position of the elevator and accommodate tools of varying sizes.

[0076] It will be apparent to those skilled in the art that various modifications and variations may be made to the disclosed apparatus and methods without departing from the scope of the present disclosure. Other aspects of the present disclosure will be apparent to those skilled in the art from consideration of the specification and practice of the features disclosed herein. It is intended that the description and examples be considered exemplary only.

Claims

1. A medical device comprising: a shaft having a distal end and a lumen terminating in a distally facing opening, wherein an instrument is extendable through the lumen and out of the distally facing opening; and a lifter for engaging the instrument, the lifter comprising: an actuator extending through at least a portion of the shaft; and a body connected to the actuator, wherein a portion of the body is configured to extend within the lumen for selectively positioning the instrument, wherein the body includes a first extension, a second extension, a proximal portion connecting the first extension and the second extension, and a pivot member; wherein the actuator is coupled to and contacts the pivot member; wherein a portion of the first extension is configured to move within the lumen when the actuator moves proximally, wherein a portion of the second extension is configured to move within the lumen when the actuator moves distally, The outer surface of the second extension is configured to be flush with or aligned with the radial inner surface of the inner cavity.

2. The medical device according to claim 1, wherein The second extension has a U-shaped body surface for engaging the instrument.

3. The medical device according to claim 1 or 2, wherein: When the actuator is moved proximally or distally, the body rotates about an axis positioned within the proximal portion.

4. The medical device of claim 1, wherein: The actuator contacts the curved surface of the pivoting member.

5. The medical device according to claim 1, wherein The radially inner surface of the first extension and the radially inner surface of the second extension are configured to be aligned with the radially inner surface of the inner cavity.

6. The medical device according to claim 1, wherein The actuator is coupled to the pivot member at a location offset from the rotational axis of the body; and wherein the longitudinal axis of the first extension and the longitudinal axis of the second extension are parallel.

7. The medical device of claim 1, wherein: the body being positioned within a passage extending distally from an opening in a radially inner surface of the lumen; The channel has a longitudinal axis transverse to the longitudinal axis of the lumen, wherein the surface of the body is configured to slidably engage the channel when the actuator is moved proximally or distally.

8. The medical device according to claim 7, wherein The body is configured to slide proximally within the passage, move through the opening in the radially inner surface of the lumen, and enter the passage when the actuator moves proximally.

Images