Articulating medical instrument

Abstract

The present invention relates to an articulating medical instrument. In particular, the present invention provides a patterned tube for use with a speculum or similar medical device, which can include at least one flexible section. The at least one flexible section can include a plurality of first cuts having a first thickness, a plurality of second cuts having a second thickness. A particular second cut of the plurality of second cuts can be positioned substantially opposite a particular first cut of the plurality of first cuts. The at least one flexible section can further include a plurality of bend moment transfer portions. A particular bend moment transfer portion of the plurality of bend moment transfer portions can be located between a particular first cut of the first cuts and a particular second cut of the second cuts.

Description

[0001] Cross-reference to related applications

[0002] This application claims the benefit of priority to U.S. Provisional Patent Application No. 63 / 180,278, filed April 27, 2021, the entire contents of which are incorporated herein by reference. Technical Field

[0003] This disclosure relates to the hinge section of a medical endoscope. Background Technology

[0004] Flexible endoscopes, such as flexible endoscopic endoscopes, are used in diagnostic and therapeutic medical procedures, such as surgeries inside the digestive system or abdomen of humans or animals. Parts of the endoscope, such as its distal end, can be made flexible, allowing surgeons to bend or otherwise articulate the endoscope to access specific target anatomical structures. Summary of the Invention

[0005] Endoscopes and other similar surgical endoscopes or catheters can be used in a variety of surgical procedures, such as ear, nose, and throat (ENT) procedures like tonsillectomy and sinus surgery, or other similar procedures, digestive system procedures, or internal abdominal procedures. Catheters can be used, for example, to insert stents or balloons into arteries. Typically, during surgery, it may be desirable for at least a portion of the endoscope to be articulated to tilt (e.g., bend) from a straight zero degree to angles such as 15, 30, 45, 90, 200 degrees, or greater. The sheath or tube of the endoscope or catheter (e.g., a hypodermic tube or subcutaneous injection tube, or other tubular or non-tubular tube, with specific inner and outer diameters or similar lateral dimensions) can be made or formed from rigid materials such as surgical-grade stainless steel or alloys, or another similar material that can be made flexible and flexed or bent at an angle. This flexibility can be achieved by forming a series of incisions (e.g., laser incisions) within the tube. Different types of cuts can be used in the tube (e.g., finer or narrower cuts, coarser or wider cuts, etc.), each type of cut having its specific characteristics. For example, different types of cuts (e.g., different cut widths) can affect the degree to which the flexible part of the tube can bend, the amount of torque the tube can withstand, the compression effect under load, etc.

[0006] One approach to addressing these issues is to use a combination of coarse and fine cuts in a portion of the endoscope's tube or sheath, or in a deflectable segment of a medical device that can be attached to the endoscope to form a flexible, patterned tube. In this example, coarse and fine cuts can alternate, which helps to achieve large-angle articulation by remaining within the elastic material properties of the material and reduces or minimizes compressive effects under cut loads. The depth, width, length, and number of cuts can be varied to achieve the desired degree of articulation, articulation shape, articulation initiation, articulation range (e.g., the path the distal tip of the endoscope travels from the initiation position to the end position or the maximum articulation position), etc., at the distal end of the flexible or bendable portion. The tube's support can be divided into multiple regions, sections, or segments, each containing multiple cuts to make that region flexible. For example, the cuts can be achieved by laser-cutting a "pattern" in the region of the tube. The cut tube can then be electropolished or otherwise smoothed, which helps to remove any sharp edges and / or burrs on the edges of the cuts. Attached Figure Description

[0007] In drawings that are not necessarily drawn to scale, similar reference numerals may describe similar parts in different views. Similar reference numerals with different letter suffixes may indicate different instances of similar parts. The drawings generally illustrate the various embodiments discussed in this document by way of example rather than limitation.

[0008] Figure 1 The illustration shows an example of a support for a tube having multiple regions containing alternating fine and coarse cuts.

[0009] Figures 2A to 2D The diagram shows Figure 1 Alternative views of the tube include a view of the tube laid flat and enlarged detailed views of the cuts and folded-back members formed between the cuts.

[0010] Figures 3A to 5B The illustration shows examples of tubes with different numbers of flexible sections, the flexible sections comprising different numbers of slits, different slit widths, and different numbers of wire guides to achieve different hinge angles.

[0011] Figure 6 Examples of tubes with opposing open or closed cuts during active hinge are illustrated.

[0012] Figure 7A and Figure 7B The illustration shows examples of hinged struts with fine and coarse cuts.

[0013] Figure 8 An example of a tube with flexible sections is illustrated, which are composed of features arranged at a rotational angle relative to each other.

[0014] Figure 9 The illustration shows examples of fine-cut and coarse-cut struts incorporated into the endoscope shaft hinge performance during simulated use. Detailed Implementation

[0015] This document specifically describes an articulated medical device. For example, a system is disclosed herein for a tube with alternating fine and coarse incision articulated segments for attachment to a medical endoscope, such as an endoscope. The system may include a tube formed of a solid material (e.g., surgical stainless steel) having an inner diameter and an outer diameter. At least one deflectable segment or other flexible segment or section may be formed within the tube. Each segment may include a plurality of first slits, incisions, or other openings (e.g., coarse incisions) having a first thickness or width and a plurality of second slits, incisions, or other openings (e.g., fine incisions) having a second thickness or width. In an example, a particular coarse incision may be positioned opposite a particular fine incision (e.g., across the tube from a particular fine incision) and adjacent to a different particular fine incision. The coarse incision may have a wider width than the opposing fine incision. For example, the width of a coarse slit can be 0.015 inches or 0.016 inches, while the width of a fine slit can be 0.003 inches. The width of either a coarse or fine slit can be specified as any thickness required for the tube or a portion thereof, and the spacing between adjacent slits can be used to achieve a specific “bend” angle at the hinge.

[0016] Similarly, the tube may have multiple flexible sections as required by specific uses, processes, applications, etc., for which it will be implemented. Likewise, each section may have multiple coarse and fine slits as needed to achieve the direction of hinge (e.g., two-way hinge, four-way hinge, etc.) or a specific angle of hinge (e.g., 90 degrees, 260 degrees, 300 degrees, etc.). The coarse slits and corresponding fine slits may be formed in the tube such that, for example, a folding member (e.g., a "U-shaped" portion or bend conforming to or defining the circumference, periphery, or similar surface of the tube's support) is formed between the respective coarse slit and its corresponding fine slit. The folding member can force the opposing slits to open or close during the hinge of the tube's support.

[0017] In the example, a hinged component, such as a cable or wire, or "pull cord," can be used to pull the cut closed. In the example, one or more pull cords can be (e.g., in a slidable manner) attached to or guided into the interior of a portion of the tube (e.g., a desired or suitable wider section of the tube, the outer edge of the inner diameter, or any other internal portion). A pull cord mount can be located on the internal portion of the tube. This pull cord mount allows the associated pull cord to pass through it from the proximal end of the tube to the distal end. This can appropriately hold the pull cord in position along a flexible section, allowing the distal end to deflect or bend as the pull cord retracts via a handle or other pull cord manipulator. Multiple pull cords may be present depending on the specific device requirements, which depends in part on how many directions the device deflects or bends. For example, for a bidirectional deflectable device, two pull cords may be present on opposite sides; for a four-way deflectable device, four pull cords may be present, and so on.

[0018] In the example, during the hinge of the strut, the coarse cut can be pulled closed as the strut bends. For example, during hinge, the coarse cut can be "pulled closed" from its neutral thickness or width (e.g., 0.015 inches) to a width or thickness of 0.0077 inches. Bending moment can be transferred through a transmission member located within the strut (e.g., a central "beam"). For example, bending moment can be transferred to a return member between adjacent coarse cuts, between adjacent fine cuts, or both. When the coarse cut is pulled closed, the return member can force the fine cut to open. Conversely, when the fine cut is pulled closed, the return member can force the opposite coarse cut to open (e.g., from a neutral thickness or width of 0.015 inches to a width or thickness of 0.019 inches). Depending on how the strut of the tube is hinged, the narrow slit can be pulled open wider (e.g., from a neutral width of 0.003 inches to a width of 0.0072 inches) or forced narrower (e.g., from a neutral width of 0.003 inches to a width of 0.0020 inches). The initial or neutral width of the wide or narrow slit can vary at different locations on the tube. Similarly, the width at which the slit can be biased open or closed during strut hinge can vary. The stiffness of the central beam or other transmission members can also vary in specific adjacent sections of the strut, allowing for selection of scan path adjustment, intermediate and final positions of the endoscope tip, etc.

[0019] Forming a folding member between the coarse and fine incisions helps provide enhanced articulation of the flexible portion of the tube and allows the strut to have a smaller radius of curvature for a given strut length (compared to an uncut stainless steel strut design) without resulting in plastic deformation. This smaller radius of curvature may be desirable for endoscopes in some applications or procedures, thereby helping to improve access to specific parts of anatomical structures (e.g., the lower calyx of the kidney) using the distal portion of the endoscope.

[0020] A patterned tube that allows for articulation (bending) may include at least one flexible segment along at least a portion of the tube's length, spanning from a proximal end to a distal end. The flexible segment may include a plurality of first slits having a first slit thickness and a plurality of second slits having a second slit thickness. A particular second slit may be positioned laterally across the tube substantially opposite a particular first slit. The particular second slit may be aligned with the particular first slit, or alternatively, may be offset from the particular first slit. The particular first and second slits may be separated by a folding member.

[0021] The tube may also include one or more bending moment transmitting members located between adjacent specific first cuts in the first cut and adjacent specific second cuts in the second cut, and connecting adjacent folding members. Each of the bending moment transmitting members may include a circumferential portion extending around the outer periphery of the tube, configured to transmit bending moments to the folding member formed in the tube between a specific first cut in the first cut and a specific second cut in the second cut. The folding member may be configured to, during hinge of the tube including a portion of a specific first cut and an opposing specific second cut, widen or narrow the specific first cut and widen or narrow the opposing specific second cut, respectively. In other words, when the tube is bent or hinged, the folding member located between the first and second cuts can open one of these cuts and close the opposing cut, or close one of these cuts and open the opposing cut.

[0022] The tube may also include a hinge member, such as a cable or wire. The hinge member may be attached to an internal portion within the tube's lumen via at least one guide configured to hold the hinge member in position along a flexible section. Constrained by at least one guide, the hinge member may facilitate deflection of at least a portion of the flexible section when pulled or retracted, for example via a handle, cable, or other actuator.

[0023] The tube may include multiple flexible segments, such as a first flexible segment and a second flexible segment, wherein the second flexible segment is positioned adjacent to the first flexible segment. In the example, at least a portion of the second flexible segment may be configured to have features (e.g., a fold-back member, a cut, etc.) arranged at a rotational angle relative to similar features in the first flexible segment. In the example, the first flexible segment may be formed of a different material than the second flexible segment, such that the materials of the first and second flexible segments have different flexuralities.

[0024] In this example, the wall thickness can be varied to help provide different amounts of flexibility in different regions of the flexible section of the tube. For example, the outer diameter toward or at the distal end of the flexible section can be smaller than the outer diameter toward or at the proximal end of the flexible section. In this example, the wall thickness of the cylindrical member can be thinner at the distal end of the flexible section relative to the more proximal portion. This change in the tube wall thickness can be abrupt (e.g., a “stepped” change from “x” cm or inch thickness to 0.75x cm or inch at a certain point), or it can include a gradual tapering change, wherein the tube wall thickness begins to decrease linearly or non-linearly toward or near the distal end of the flexible section.

[0025] In addition to the flexibility provided by the cut pattern, a thinner wall at the distal end or towards the distal end can provide additional flexibility to the tube. This change in thickness can be achieved on a single piece of tube, or a similar change in flexibility can be achieved by forming two or more sections of tube with different flexibility and / or different material compositions, said two or more sections being welded or otherwise joined together (e.g., joined into adjacent sections).

[0026] Figure 1 The illustration shows an example of a tube support with multiple zones, where specific zones contain alternating fine and coarse cuts. Figure 1 An example of a patterned tube 100 having a proximal end 102 and a distal end 104 is illustrated. The patterned tube 100 includes a first flexible segment 106, a second flexible segment 108, a third flexible segment 110, a fourth flexible segment 112, a fifth flexible segment 114, and a sixth flexible segment 116. The flexible segments 106 to 116 may extend from the proximal end 102 to the distal end 104 along at least a portion of the length of the patterned tube 100. The flexible segments 106 to 116 may be positioned substantially adjacent to each other along the length of the patterned tube 100. For example, the first flexible segment 106 may be adjacent to the second flexible segment 108, the second flexible segment 108 may be adjacent to the third flexible segment 110, and so on.

[0027] The flexible sections 106 to 116 may include a plurality of (first) coarse cuts 118, 120, 122, 124, and 126 having a first cut thickness and a plurality of (second) fine cuts 128, 130, 132, 134, and 138 having a second cut thickness. A particular fine cut among the plurality of fine cuts 128 to 138 may be positioned laterally opposite to a particular coarse cut among the plurality of coarse cuts 118 to 126 across the patterned tube 100. For example, coarse cut 118 and fine cut 128 may be positioned laterally opposite to each other. Similarly, coarse cut 120 may be positioned laterally opposite to fine cut 130, and so on. Alternatively, a particular fine cut among the plurality of fine cuts 128 to 138 may be located on the patterned tube 100 but offset from a particular coarse cut among the plurality of coarse cuts 118 to 126. In the example, patterns of coarse and fine cuts can be formed on opposite sides of the cylindrical member forming the patterned tube 100, such that on one side of the cylindrical member, a specific fine cut will exist between two specific coarse cuts. The cut cylindrical member of the patterned tube can be referred to as the cylindrical support of the patterned tube. For example, as Figure 1 As shown, on one side of the tube, cut 118 is adjacent to cut 140 having a second cut thickness. Cut 118 is a specific coarse cut among a plurality of coarse cuts having a first cut thickness. Cut 140 having a second cut thickness is adjacent to cut 120 having a first cut thickness. Similarly, on the opposite side of the cylindrical member, cut 142 having a first cut thickness is located between cut 128 and cut 130, each of which has a second cut thickness. A similar pattern of cuts can be formed in each flexible segment of the flexible section.

[0028] Figures 2A to 2D The diagram shows Figure 1 Alternative views of the tube include a conceptual diagram of the tube in which the cylindrical member is conceptually cut longitudinally and “unfolded” and flattened and enlarged to provide a more detailed view of the cuts and folded-back members formed between the cuts. Figure 2A It was shown again Figure 1 A patterned tube 100 is illustrated, and an example of the patterned tube 100 is shown, which is conceptually "unfolded" and flattened, so that the patterned tube is no longer a three-dimensional cylindrical shape. The unfolded tube 200 includes a second flexible segment 108, detail A 201A marked by a circle in the second flexible segment 108, a fifth flexible segment 114, and detail B 202A marked by a circle in the fifth flexible segment 114. Detail A 201A and detail B 202A are respectively in Figure 2B and Figure 2C The image is enlarged to a 16:1 ratio. For example... Figure 2BAs shown in the enlarged view of detail A201A, the example width of the coarse cut 206 can be 0.15 inches, and the corresponding example width of the fine cut 208 can be 0.003 inches. A foldback member can be formed between the opposing first and second cuts. For example, a first foldback member 210 can be formed between the coarse cut 206 and the fine cut 208. Similarly, a second foldback member 214 can be formed adjacent to the first foldback member 210.

[0029] The unfolded folded-back member can be formed into a U-shape (e.g., a horseshoe shape), but the folded-back member can be another shape or a different shape. For example, a particular unfolded folded-back member can be triangular (e.g., a "V"), rectangular, octagonal, or any suitable shape to achieve the desired bending force or deflection degree of the corresponding cuts formed therebetween. In the example, the shape of the folded-back member on one portion of the patterned tube 100 can differ from its shape on another portion of the patterned tube 100. For example, the folded-back member can be a (unfolded) U-shape in the first flexible section 106, a (unfolded) triangle in the second flexible section 108, and a (unfolded) rectangle in the third flexible section 110. Similarly, the folded-back member can be selected or changed along the dimensions of the patterned tube 100 (e.g., the width of the folded-back shape, different radii, etc.) to facilitate the desired degree of deflection for both fine and coarse cuts.

[0030] The cut pattern described above can provide adjacent folding members that are offset from each other and oriented in opposite directions. For example, the unfolded U-shaped "bend" of the first folding member 210 can be oriented in a direction opposite to the unfolded U-shaped "bend" of the second folding member 214 (e.g., a face, a point, etc.), such that when the patterned tube 100 is as follows... Figure 2A As shown and in Figure 2B As shown in the enlarged detail A201A, when "unfolded" and flattened, the first folding member 210 can be presented as an upward concave shape, while the second folding member 214 can be presented as a downward concave shape. In another example, the distance or length of the cut-in folding section can be determined or specified to control the flexibility at that point. For example, Figure 2C The "end" of the fine cut 216 can be "y" units away from the "end" of the recessed portion of the retraction member 220. Therefore, to adjust the flexibility of the retraction member 220, the distance "y" can be modified so that the end of the cut 216 is closer to the "tip" of the recessed portion of the retraction member 220 (resulting in a greater "length" of the cut 216). The further the cut 216 is made in the retraction member 220, the greater the amount of flexibility the patterned tube 100 has at the retraction member 220.

[0031] like Figure 2BAs shown, the bending moment transmission member 212 may be located between adjacent coarse cuts and adjacent fine cuts to connect adjacent folding members, such as the first folding member 210 and the second folding member 214. The bending moment transmission member 212 may include, for example, a circumferential portion extending around the outer periphery of the patterned tube 100, and may be configured to transmit bending moments to folding members, such as to the first folding member 210 and / or the second folding member 214.

[0032] In the example, the thickness or width of a particular coarse cut can vary along the length of the patterned tube 100. For example, as... Figure 2C As shown, without bending, the coarse cut 206 in the second flexible section 108 of the patterned tube 100 can have a neutral thickness or width of 0.015 inches, and as... Figure 2C As shown, the coarse cut 218 located in the fifth flexible section 114 can have a neutral thickness or width of 0.016 inches. This can cause the dimensions of the bending moment transfer members between adjacent folding members and the width of the folding members to vary along different sections of the patterned tube 100. For example, in Figure 2B In the middle, the width of one "side" of the folding member 214 is 0.010 inches, while... Figure 2C In the middle, the width of one "side" of the reversing member 222 is 0.009 inches.

[0033] In the example, such as Figure 2D As shown, the diagram illustrates an enlarged portion 200D of the expanded tube 200, where the width of the coarse incision can vary along the length of the tube. For example, the coarse incision can be wider or thicker when encountered in the direction from the proximal end to the distal end. As shown in the enlarged portion 200D, coarse incision 232 is wider than coarse incision 230, coarse incision 230 is wider than coarse incision 228, and so on. It should also be understood that the opposing fine incisions can be made wider in a similar order or manner to the coarse incisions, or the fine incisions can maintain the same width along the length of the flexible segment and / or the length of the tube. Thus, in this example, the further the portion of the flexible segment is, the wider the "gap" or opening of the coarse incision, and therefore more articulation can be achieved. In other words, the distal portion of the flexible segment can deflect more or to a greater angle than the proximal end of the flexible segment. This can allow the distal portion to bend more sharply, thereby allowing the endoscope to access more difficult-to-reach parts of anatomical structures, such as the lower calyx of the kidney.

[0034] In an example where the width of the incision varies or changes from the proximal end to the distal end of the flexible segment, the variation can be gradual (e.g., a linear, or non-linear (e.g., exponential) change in the gap size from the first incision at the proximal end to the "nth" incision at the distal end), or a more gradual change. In another example, the variation can be abrupt, such as a sudden switch from a uniform first gap size to a larger second gap size. The gap size of coarse and / or fine incisions can vary in any way, such as where the gap size of one or more incisions in the distal portion is wider than the gap size of one or more incisions in the proximal portion.

[0035] In the example, at least one portion of a particular coarse cut or a particular fine cut may taper to adapt to a particular foldback member. For example, as shown in enlarged section 200D, coarse cuts 224, 226, 228, 230, and 232 may include tapered portions, such as tapered portion 234 on cut 224 or tapered portion 236 on cut 226. The amount of tapering may depend on the width of the cut on which the tapered portion is included.

[0036] Figures 3A to 5B The illustration shows examples of tubes with different numbers of flexible sections, the flexible sections comprising different numbers of slits, different slit widths, and different numbers of wire guides to achieve different hinge angles. Figure 3A , Figure 4A and Figure 5A A top view of each corresponding tube is shown, while Figure 3B , Figure 4B and Figure 5B A side view of each tube is shown. Figures 3A to 5B The illustrations show different representative embodiments of tubes with flexible sections of different lengths and numbers of cuts, different spacing between the flexible sections, and different placements and numbers of wire guides. Figure 3A The illustration shows an example of a 2.672-inch tube 300A and five flexible segments 302A, 304A, 306A, 308A, and 310A. The first flexible segment 302 may include a total of 15 coarse and / or fine slits (as described above) spanning 0.392 inches. In the first flexible segment 302, the width of the fine slits can vary from 0.003 inches to 0.025 inches. The distance between the slits (and therefore the width of the “beam” between the slits) can be 0.011 inches.

[0037] The second flexible segment 304A may be 0.382 inches long and may include 17 slits. Furthermore, the dimensions of the folding member (e.g., the width of tube 300A when viewed from above) may be 0.0344 inches. The second flexible segment 304A may include a total of 17 slits and span a length of 0.384 inches. The third flexible segment 306A may include a total of 18 slits and span a length of 0.408 inches. In the third flexible segment 306A, the distance between the slits (and therefore the width of the central beam between the slits) may range from 0.009 inches to 0.021 inches. The fourth flexible segment 308A may include 18 slits and span 0.408 inches of tube 300A. The fifth flexible segment 310A of tube 300A may include 14 slits and span a length of 0.364 inches. Similar to the cut size in the first flexible section 302, in the fifth flexible section 310, the cut width can vary from 0.003 inches to 0.025 inches and the beam width (or the distance between cuts) can be 0.011 inches.

[0038] like Figure 3A and Figure 3B As shown, adjacent to the flexible sections 302A to 310A and 302B to 310B, there may be articulated member wire guide positions 312A to 322A and 312B to 322B. Wire guide positions 312 to 322 may be the "thicker" portions of tubes 300A and 300B (e.g., portions of tubes 300A and 300B with fewer cuts or no cuts) that separate the flexible sections 302 to 310A, thereby allowing eyelets, loops, rings, etc., to be located inside tubes 300A and 300B, thus allowing articulated members such as pull wires to be located inside tubes 300A and 300B. The guide positions 312A to 322A and 312B to 322B can hold the hinge member in place along the inner diameter of tubes 300A and 300B, such that when the hinge member is pulled, the flexible sections 312A to 322A and 302B to 310B can cause the distal ends of tubes 300A and 300B to bend or deflect in the direction in which the hinge member is pulled. For example... Figure 3B As shown, the wire guide position 322B, which is positioned toward the distal end of tube 300B, can be located at a certain distance from the tip of tube 300B, for example, at a distance of 0.140 inches from the end of tube 300B. Figure 3A and Figure 3B The dimensions shown allow for a hinge angle of 263 degrees (e.g., at the distal ends of tubes 300A and 300B). In such an example, the bend or hinge can begin in the three intermediate sections—the second flexible section 304A, the third flexible section 306A, and the fifth flexible section 308A—which comprise a total of 53 cuts and span 1.344 inches across tube 300A.

[0039] like Figure 4A and Figure 4B As shown, the length (3.00 inches) of pipes 400A and 400B can be compared to Figure 3A and Figure 3B The example shown is long. Furthermore, tubes 400A and 400B may include six flexible segments 402A to 412A and 402B to 412B. The first flexible segment 402A and the second flexible segment 404A may each include 16 slits and be 0.360 inches long. The third flexible segment 406A may also include 16 slits, but its length may be 0.384 inches. The fourth flexible segment 408A, the fifth flexible segment 410A, and the sixth flexible segment 412A may each include 14 slits and be 0.364 inches long. This configuration essentially "divides" or separates the 300A tube into two main sections: one main section includes a first flexible segment 402A, a second flexible segment 404A, and a third flexible segment 406A, comprising 49 cuts and spanning 1.248 inches; and the second main section includes a fourth flexible segment 408A, a fifth flexible segment 410A, and a sixth flexible segment 412A, comprising 42 cuts and spanning 1.260 inches. (As follows) Figure 4A As shown, the cut width can vary, for example, from 0.021 inches between the fine cuts in the second flexible section 404A to 0.025 inches between the fine cuts in the fifth flexible section 410A. Similarly, the beam width between the cuts can vary, for example, from 0.009 inches in the second flexible section 404A to 0.011 inches in the fifth flexible section 410A.

[0040] For example Figure 4A As shown, the dimensions of the foldback component (as mentioned above) Figure 3A The dimensions (discussed) can vary along the length of tube 400A (e.g., in different flexible sections). For example, in the first flexible section 402A, the dimension of the fold-back member can be 0.0315 inches. The dimension of the fold-back member can be 0.0344 inches in the second flexible section 404A, 0.072 inches in the third flexible section 406A, 0.0315 inches in the fourth flexible section 408A, 0.0344 inches in the fifth flexible section 410A, and 0.0372 inches in the sixth flexible section 412A. The width of the cut in each section can be uniform or varied as discussed above. Tube 400A may include seven wire guide positions 414A to 426A, and tube 400B may include seven wire guide positions 414B to 426B, wherein the farthest wire guide positions 426A, 426B are positioned 0.138 inches from the tips of tubes 400A, 400B. Figure 4A and Figure 4B The dimensions shown in the diagram allow for a hinge angle of 292 degrees (e.g., at the distal ends of tubes 400A and 400B).

[0041] Figure 5A and Figure 5B The illustration shows representative struts for tubes 500A and 500B spanning 3.118 inches. Tubes 500A and 500B have struts that are flexible along the entire length forming the folding member, rather than... Figures 3A-3B and Figures 4A-4B The diagram shows sections that can be deflected or made flexible. Different sections of tubes 500A and 500B can be manufactured to have different amounts of flexibility by changing the dimensions of the deflector members and the cut widths (and therefore the width of the central beam) in different sections of tubes 500A and 500B. Figure 5A As shown, tube 500A may have cutouts in the pattern to allow for adjacent foldback members spanning 2.772 inches across the length of tube 500A. In the example, a first portion 506 of tube 500A may include 10 cutouts spanning 0.531 inches, and a second portion 508 of tube 500A may include 11 cutouts spanning 0.678 inches. In the second portion 508, the edge of the foldback member may be 0.047 inches, the width of the central beam connecting adjacent foldback members may be 0.024 inches, and the cutout width forming the foldback members may be 0.012 inches.

[0042] Further afield, tube 500A may include a third portion 510 and a fourth portion 512, wherein the third portion 510 includes eight cuts spanning 0.536 inches, and the fourth portion 512 includes eight cuts spanning 0.536 inches. In the fourth portion 512, the edge of the folding member may be 0.064 inches, the width of the central beam connecting adjacent folding members may be 0.032 inches, and the cut width forming the folding members may be 0.012 inches. The dimensions of the edge of the folding member, the width of the central beam, and the cut width may be consistent or varied as needed to achieve the desired degree of deflection of tubes 500A and 500B.

[0043] Figure 5B The diagram shows Figure 5A The tube is rotated to show a side view. (As shown) Figure 5B As shown, tube 500B may include hinged members or wire guide positions 514, 516, 518 and 520.

[0044] like Figures 3A to 5BAs shown in the examples, the tube can have any number of flexible sections or segments, any size of folding members, any slit width, or any number of wire guide positions as desired or required. For example, the tube may include five, six, or seven wire guide positions, may have slit widths of 0.003 inches, 0.0025 inches, or 0.0032 inches, and may have slit regions with different amounts of slits and different beam widths in each of the proximal, distal, or intermediate segments of the tube. For example, the tube may have: a proximal segment with 14 slits and a beam width of 0.011 inches; one or more intermediate segments with 17 or 18 slits and a beam width of 0.009 inches; and a distal segment with 15 slits and a beam width of 0.011 inches.

[0045] In one example, the tube may include a proximal section with 14 or 15 cuts and a beam width of 0.011 inches, and a distal section with 17 or 18 cuts and a beam width of 0.009 inches. In another example, the tube may include a proximal section with 14 cuts and a beam width of 0.011 inches, and a distal section with 16 or 17 cuts and a beam width of 0.009 inches. In yet another example, the tube may include a proximal section with 12 cuts and a beam width of 0.011 inches, a middle section with 13 or 14 cuts and a beam width of 0.009 inches, and a distal section with 12 cuts and a beam width of 0.011 inches. In yet another example, the tube may include a proximal section with 14 cuts and a beam width of 0.011 inches, and a distal section with 16 cuts and a beam width of 0.009 inches. The tube can be formed as needed to have multiple proximal sections, intermediate sections and distal sections, and the cut width, beam width, foldback member shape and / or size, and line guide position can be any or any combination of those described in the various examples discussed above.

[0046] Figure 6 The illustration shows an example of a tube with an open slit and an opposing closed slit during active hinge. Figure 6 The illustration shows an example of a tube 600 with alternating coarse and fine slit patterns, such as those discussed above. Figure 6As shown, the hinge member 602, such as a wire or cable, can be positioned along the interior of the tube 600 such that when the hinge member 602 is pulled or otherwise engaged, the coarse slit 604 is pulled or hinged to a width narrower than the neutral slit thickness, up to 0.0077 inches, and the fine slit 608 adjacent to the coarse slit 604 is pulled to a width of 0.0020 inches, which may be narrower than its neutral thickness. On the opposite side of the tubular section of the tube 600, the fine slit 606 opposite the coarse slit 604 can be bent or hinged to a thickness wider than the neutral initial thickness of the fine slit 606 without bending (e.g., 0.0072 inches). Similarly, the coarse slit 610 adjacent to the fine slit 606 can be hinged to a thickness wider than the neutral or initial thickness of the coarse slit 610 without bending (e.g., 0.0191 inches).

[0047] Pulling or manipulating the hinge member 602 can cause different parts of the tube 600 to move at different angles, for example... Figure 6 The angles of bending are illustrated in the figure. For example, a smaller portion of tube 600 may be bent at a smaller angle (e.g., 3.93 degrees, 3.83 degrees, etc.), and a larger portion of tube 600 may be bent at a larger angle, such as 9.37 degrees.

[0048] Generally, the wider the neutral incision width of the coarse incision, the more material moves as the tube is deflected or bent. This results in a “tighter” bend and allows the fine incision to expand (widen) to provide some “elasticity,” and allows the coarse incision to contract toward each other during the bending motion. The tubes described in this article can be designed to reach target portions of anatomical structures, such as the renal calyces of the kidney, including the inferior renal calyces, which involves sharp bends in the tube to allow the endoscope to reach the target portions of the anatomical structures. Therefore, as discussed above, different tubes can be designed with different dimensions, such as different incision widths, different numbers of incisions, etc., so that the articulated or flexible sections can be bent at angles greater than 180 degrees (e.g., 250 degrees, 270 degrees, 300 degrees, or greater).

[0049] Figure 7A and Figure 7B The illustration shows an example of a fine-cut / coarse-cut support hinge. Figure 7A and Figure 7B As shown, a hinged strut 700 (e.g., a deflectable strut, hinged tube, etc.) with an alternating coarse / fine slit pattern as described above can be attached to a non-hinged solid or more rigid component 702, such as a hysteroscope, handle, etc. The hinged strut 700 can be bent such that the tip 704 of the hinged strut 700 can be bent from a straight position (180 degrees) to... Figure 7A Angles greater than 270 degrees shown, up to Figure 7B The angle shown is more than 300 degrees.

[0050] Figure 8 An example of a tube with flexible sections is illustrated, which are configured to be arranged at a rotational angle relative to each other. Figure 8 The illustration is similar to Figure 1 An example of a patterned tube 800 having multiple flexible segments 802 to 812 is shown. Figure 8 A top view of the patterned tube 800 is also shown. Figure 8 In the example shown, at least a portion of the second flexible segment 804 may be configured to have a rotational arrangement relative to the first flexible segment 802. For example, one or more of the folding members in the second flexible segment 804 may be arranged with a rotational angle (e.g., 90 degrees, 180 degrees, etc.) relative to the folding members in the first flexible segment 802. In such an example, the folding members in the second flexible segment 804 may be positioned such that, when viewed from above, the folding members in the first flexible segment 802 are located on one side of the patterned tube 800 cylindrical member.

[0051] This pattern can be repeated along the length of the patterned tube 800. For example, the third flexible segment 806 and the fifth flexible segment 810 may have the same orientation as the first flexible segment 802, while the fourth flexible segment 808 and the sixth flexible segment 812 may have the same orientation as the second flexible segment 804. In such an example, each adjacent segment will have a feature of being rotated or offset relative to each other.

[0052] This allows the patterned tube 800 to operate similarly to a laser-cut helical spring and allows the patterned tube 800 to deflect in two separate planes (e.g., planes orthogonally oriented to each other). These segments (e.g., the first flexible segment 802, the third flexible segment 806, and the fifth flexible segment 810) in the same 90-degree line can bend or deflect in the first plane, and other segments (the second flexible segment 804, the fourth flexible segment 808, and the sixth flexible segment 812) can bend in the second plane. Additionally or alternatively, adjacent folding members in the same flexible segment can rotate relative to each other, such that a portion of each flexible segment can deflect in a separate plane.

[0053] Figure 9 The illustration shows an example of a fine-cut / coarse-cut strut incorporated into the endoscope shaft articulation performance during simulated use. (Example:) Figure 9The diagram illustrates the use of an endoscope 900 with struts employing, for example, the alternating incision pattern described herein, within a model portion of an anatomical structure 902. This model portion of the anatomical structure 902 may represent a part of a human anatomical structure, such as the renal calyces of the kidney, into which the endoscope 900 can be inserted during medical procedures such as kidney stone ablation. Figure 9 In the example, the model portion of anatomical structure 902 includes cavity 904, in which stones, tumors, etc., can be formed. The tip of endoscope 900 can be manipulated or bent around a piece of tissue represented by the elliptical segment of the model portion of anatomical structure 902, enabling surgery, such as stone ablation, to be performed in cavity 904 by emitting laser radiation from the tip of endoscope 900.

[0054] Additional notes and examples:

[0055] Example 1 is a patterned tube that allows articulation of a medical endoscope, the patterned tube comprising: at least one flexible segment located between a proximal end and a distal end of the patterned tube, the at least one flexible segment comprising: a plurality of first slits having a first slit thickness; a plurality of second slits having a second slit thickness, wherein a particular second slit among the second slits is positioned laterally across the patterned tube substantially opposite to a particular first slit among the first slits, and the particular second slit among the second slits is spaced apart from the particular first slit among the first slits by a folding member; and one or more bending moment transmission members, wherein a particular bending moment transmission member among the one or more bending moment transmission members is located between adjacent particular first slits in the first slits and also between adjacent particular second slits in the second slits, and connects adjacent folding members.

[0056] In Example 2, the subject matter of Example 1 may optionally include: wherein the one or more bending moment transmitting members correspondingly include circumferential portions extending around the outer periphery of the patterned tube and configured to transmit bending moments to a folding member formed in the patterned tube between a particular first cut in the first cut and a particular second cut in the second cut.

[0057] In Example 3, the subject matter of Example 2 may optionally include: wherein the folding member is configured to, during the hinge of a portion of the patterned tube including a particular first cut and an opposing particular second cut, widen or narrow the particular first cut and widen or narrow the opposing particular second cut.

[0058] In Example 4, the subject of Example 3 may optionally include a hinge member attached to the interior portion of the patterned tube.

[0059] In Example 5, the subject matter of Example 4 may optionally include: wherein the hinge member is attached to the inner portion of the patterned tube by at least one guide, the at least one guide being configured to hold the hinge member in position along the flexible section and configured such that at least a portion of the flexible section is deflectable when the hinge member is retracted via an actuator.

[0060] In Example 6, the subject matter of any or more of Examples 4 to 5 may optionally include: wherein the hinge member comprises a cable or wire.

[0061] In Example 7, the subject matter of any or more of Examples 1 to 6 may optionally include: wherein the neutral thickness of the plurality of first cuts and the neutral thickness of the plurality of second cuts vary along at least a portion of at least one of the flexible segments.

[0062] In Example 8, the subject matter of Example 7 may optionally include: wherein, in a neutral state, a particular first cut at the distal end of the flexible segment is wider than a particular first cut at the proximal end of the flexible segment.

[0063] In Example 9, the subject matter of any or more of Examples 7 to 8 may optionally include: wherein, in a neutral state, a particular second cut at the distal end of the flexible segment is wider than a particular second cut at the proximal end of the flexible segment.

[0064] In Example 10, the subject of any or more of Examples 1 to 9 may optionally include: a first flexible segment; and a second flexible segment positioned adjacent to the first flexible segment.

[0065] In Example 11, the subject matter of Example 10 may optionally include: wherein at least a portion of the second flexible segment is configured to have at least one cut arranged at a rotational angle relative to at least one cut in the first flexible segment.

[0066] In Example 12, the subject matter of any or more of Examples 10 to 11 may optionally include: wherein the first flexible segment is formed of a material different from that of the second flexible segment.

[0067] In Example 13, the subject matter of Example 12 may optionally include: wherein the material of the first flexible segment has a different flexibility than the material of the second flexible segment.

[0068] In Example 14, the subject matter of any or more of Examples 1 to 13 may optionally include: wherein the outer diameter of the patterned tube at the distal end of the patterned tube is smaller than the outer diameter at the proximal end of the patterned tube.

[0069] In Example 15, the subject matter of any or more of Examples 1 to 14 may optionally include: wherein at least one of a portion of a particular first cut or at least a portion of a particular second cut is tapered to accommodate a particular fold-back member located within at least a portion of said at least one.

[0070] Example 16 is a patterned tube for allowing articulation of a medical endoscope, the tube comprising: a first flexible segment; and a second flexible segment positioned adjacent to the first flexible segment; wherein the first and second flexible segments include: a plurality of first slits having a first slit thickness; a plurality of second slits having a second slit thickness, wherein a particular second slit among the second slits is positioned laterally across the tube substantially opposite to a particular first slit among the first slits, and the particular second slit among the second slits is spaced from the particular first slit among the first slits by a folding member; and one or more bending moment transmission members, wherein a particular bending moment transmission member among the one or more bending moment transmission members is located between adjacent particular first slits in the first slits and also between adjacent particular second slits in the second slits, and connects adjacent folding members.

[0071] In Example 17, the subject matter of Example 16 may optionally include: wherein the neutral thickness of the plurality of first cuts and the neutral thickness of the plurality of second cuts vary along at least a portion of at least one of the first flexible segment or the second flexible segment.

[0072] In Example 18, the subject matter of Example 17 may optionally include: wherein, in a neutral state, at least one of the following conditions exists: a particular first cut at the distal end of the first flexible segment is wider than a particular first cut at the proximal end of the first flexible segment; or a particular second cut at the distal end of the first flexible segment is wider than a particular second cut at the proximal end of the first flexible segment.

[0073] In Example 19, the subject matter of any or more of Examples 17 to 18 may optionally include: wherein, in the neutral state, at least one of the following conditions exists: a particular first cut at the distal end of the second flexible segment is wider than a particular first cut at the proximal end of the second flexible segment; or a particular second cut at the distal end of the second flexible segment is wider than a particular second cut at the proximal end of the second flexible segment.

[0074] Example 20 is a patterned deflectable portion of a medical device axis, the deflectable portion comprising: a first flexible segment; a second flexible segment positioned adjacent to the first flexible segment; and a hinge member attached to an internal portion of the deflectable portion by at least one guide, the at least one guide being configured to hold the hinge member in position along the flexible segment and configured such that at least a portion of the flexible segment is deflectable when the hinge member is retracted via an actuator, wherein the first flexible segment and the second flexible segment include: a plurality of first slits having a first slit thickness. ; a plurality of second cuts having a second cut thickness, wherein a particular second cut in the second cut is positioned substantially opposite to a particular first cut in the first cut in the lateral direction across the deflectable portion, and the particular second cut in the second cut is separated from the particular first cut in the first cut by a folding member; and one or more bending moment transmission members, wherein a particular bending moment transmission member in the one or more bending moment transmission members is located between adjacent particular first cuts in the first cut, and also between adjacent particular second cuts in the second cut, and connects adjacent folding members.

[0075] In Example 21, the subject matter of Example 20 may optionally include: wherein, in a neutral state, at least one of the following conditions exists: a particular first incision at the distal end of the first flexible segment is wider than a particular first incision at the proximal end of the first flexible segment; a particular second incision at the distal end of the first flexible segment is wider than a particular second incision at the proximal end of the first flexible segment; a particular first incision at the distal end of the second flexible segment is wider than a particular first incision at the proximal end of the second flexible segment; or a particular second incision at the distal end of the second flexible segment is wider than a particular second incision at the proximal end of the second flexible segment.

[0076] In Example 22, the subject matter of any or more of Examples 20 to 21 may optionally include: wherein at least a portion of the second flexible segment is configured to have at least one cut arranged at a rotational angle relative to at least one cut in the first flexible segment, and wherein the first flexible segment is formed of a material different from the second flexible segment.

[0077] All publications, patents, and patent documents mentioned in this document are incorporated herein by reference in their entirety, as if they were individually incorporated by reference. In the event of any inconsistency between this document and those incorporated by reference, the usage in the incorporated (one or more) references shall be considered supplementary to the usage in this document; in the event of any inconsistency, the usage in this document shall prevail.

[0078] In this document, as is common in patent documents, the terms “a” or “an” are used to include one or more, and are unrelated to any other instance or use of “at least one” or “one or more.” In this document, unless otherwise indicated, the term “or” is used to indicate a non-exclusive “or,” such that “A or B” includes “A but not B,” “B but not A,” and “A and B.” In the appended claims, the terms “including” and “in which” are used as concise English equivalents to the corresponding terms “comprising” and “wherein.” Furthermore, in the appended claims, the terms “including” and “comprising” are open-ended, meaning that a system, apparatus, article, or process that includes elements other than those listed in the claims following such terms is still considered to fall within the scope of the claims. Additionally, in the appended claims, the terms “first,” “second,” and “third,” etc., are used only as illustrative marks and are not intended to impose numerical requirements on their objects.

[0079] The above description is intended to be illustrative and not restrictive. For example, the examples (or one or more aspects of the examples) described above can be used in combination with each other. Other embodiments can be used by those skilled in the art after consulting the above description. The abstract is intended to allow the reader to quickly determine the nature of the technical disclosure, and it should be understood at the time of submission that the abstract will not be used to interpret or limit the scope or meaning of the claims. Furthermore, in the above detailed description, various features may be grouped together to simplify the disclosure. This should not be construed as making any unclaimed disclosed features necessary for any claim. Rather, the subject matter of the invention may lie in fewer than all features of a particular disclosed embodiment. Therefore, the appended claims are incorporated herein by reference, wherein each claim exists as an independent embodiment. The scope of the embodiments should be determined with reference to the appended claims together with the full scope of their equivalents.

Claims

1. A patterned tube that allows for the articulation of a medical endoscope, the patterned tube comprising: At least one flexible segment, the at least one flexible segment being located between the proximal end and the distal end of the patterned tube, the at least one flexible segment comprising: Multiple first incisions having a first incision thickness; A plurality of second cuts having a second cut thickness, wherein a particular second cut in the second cut is positioned substantially opposite to a particular first cut in the first cut in the transverse direction across the patterned tube, and the particular second cut in the second cut is separated from the particular first cut in the first cut by a folding member, wherein adjacent folding members are oriented in opposite directions relative to each other; and One or more bending moment transmission members, wherein a particular bending moment transmission member of the one or more bending moment transmission members is located between adjacent particular first cuts in the first cut and also between adjacent particular second cuts in the second cut, and connects adjacent folding members, wherein the one or more bending moment transmission members include a central beam and a circumferential portion extending around the outer periphery of the patterned tube, and the central beam and the circumferential portion are configured to engage with each other in combination to transmit bending moment to the particular folding member.

2. The patterned tube according to claim 1, wherein, The circumferential portion is configured to transmit bending moments to a folding member formed in the patterned tube between a specific first cut in the first cut and a specific second cut in the second cut.

3. The patterned tube according to claim 2, wherein, The folding member is configured to, during the hinge of the patterned tube, including a portion of a specific first cut and an opposing specific second cut, widen or narrow the specific first cut and widen or narrow the opposing specific second cut, respectively.

4. The patterned tube according to claim 3, further comprising: A hinge member is attached to the interior portion of the patterned tube.

5. The patterned tube according to claim 4, wherein, The hinge member is attached to the inner portion of the patterned tube by at least one guide, the at least one guide being configured to hold the hinge member in position along the flexible section and configured such that at least a portion of the flexible section is deflectable when the hinge member is retracted via an actuator.

6. The patterned tube according to claim 4, wherein, The hinge component includes a cable or wire.

7. The patterned tube according to claim 1, wherein, The neutral thickness of the plurality of first cuts and the neutral thickness of the plurality of second cuts vary along at least a portion of at least one of the flexible segments.

8. The patterned tube according to claim 7, wherein, In a neutral state, a specific first cut at the distal end of the flexible segment is wider than a specific first cut at the proximal end of the flexible segment.

9. The patterned tube according to claim 7, wherein, In the neutral state, a specific second cut at the distal end of the flexible segment is wider than a specific second cut at the proximal end of the flexible segment.

10. The patterned tube according to claim 1, further comprising: First flexible section; as well as The second flexible segment is positioned adjacent to the first flexible segment.

11. The patterned tube according to claim 10, wherein, At least a portion of the second flexible segment is configured to have at least one cut arranged at a rotational angle relative to at least one cut in the first flexible segment.

12. The patterned tube according to claim 10, wherein, The first flexible section is formed of a different material than the second flexible section.

13. The patterned tube according to claim 12, wherein, The material of the first flexible section has different flexibility than the material of the second flexible section.

14. The patterned tube according to claim 1, wherein, The outer diameter of the patterned tube at its distal end is smaller than the outer diameter at its proximal end.

15. The patterned tube according to claim 1, wherein, At least one of a portion of a particular first cut or at least a portion of a particular second cut is tapered to accommodate a particular fold-back member located within at least a portion of said at least one.

16. A patterned tube for allowing the articulation of a medical endoscope, the tube comprising: First flexible section; as well as The second flexible segment is positioned adjacent to the first flexible segment; The first flexible segment and the second flexible segment include: Multiple first incisions having a first incision thickness; A plurality of second cuts having a second cut thickness, wherein a particular second cut in the second cut is positioned substantially opposite to a particular first cut in the first cut in the lateral direction across the tube, and the particular second cut in the second cut is separated from the particular first cut in the first cut by a folding member, wherein adjacent folding members are oriented in opposite directions relative to each other; and One or more bending moment transmission members, wherein a particular bending moment transmission member of the one or more bending moment transmission members is located between adjacent particular first cuts in the first cut and also between adjacent particular second cuts in the second cut, and connects adjacent folding members, wherein the one or more bending moment transmission members include a central beam and a circumferential portion extending around the outer periphery of the patterned tube, and the central beam and the circumferential portion are configured to engage with each other in combination to transmit bending moment to the particular folding member.

17. The pipe according to claim 16, wherein, The neutral thickness of the plurality of first cuts and the neutral thickness of the plurality of second cuts vary along at least a portion of at least one of the first flexible segment or the second flexible segment.

18. The pipe according to claim 17, wherein, In a neutral state, at least one of the following conditions applies: A specific first incision at the distal end of the first flexible segment is wider than a specific first incision at the proximal end of the first flexible segment; or A specific second cut at the distal end of the first flexible segment is wider than a specific second cut at the proximal end of the first flexible segment.

19. The pipe according to claim 17, wherein, In a neutral state, at least one of the following conditions applies: A specific first incision at the distal end of the second flexible segment is wider than a specific first incision at the proximal end of the second flexible segment; or The specific second cut at the distal end of the second flexible segment is wider than the specific second cut at the proximal end of the second flexible segment.

20. A patterned deflectable portion of a medical device axis, the deflectable portion comprising: First flexible section; The second flexible segment is positioned adjacent to the first flexible segment; as well as A hinge member, the hinge member being attached to an internal portion of the deflectable portion by at least one guide member, the at least one guide member being configured to hold the hinge member in position along the flexible section and configured such that at least a portion of the flexible section is deflectable when the hinge member is retracted via an actuator; The first flexible segment and the second flexible segment include: Multiple first incisions having a first incision thickness; A plurality of second cuts having a second cut thickness, wherein a particular second cut in the second cut is positioned substantially opposite to a particular first cut in the first cut in the lateral direction across the deflectable portion, and the particular second cut in the second cut is separated from the particular first cut in the first cut by a folding member, wherein adjacent folding members are oriented in opposite directions relative to each other; and One or more bending moment transmission members, wherein a particular bending moment transmission member of the one or more bending moment transmission members is located between adjacent particular first cuts in the first cut and also between adjacent particular second cuts in the second cut, and connects adjacent folding members, wherein the one or more bending moment transmission members include a central beam and a circumferential portion extending around the outer periphery of the patterned tube, and the central beam and the circumferential portion are configured to engage with each other in combination to transmit bending moment to the particular folding member.

21. The patterned deflectable portion according to claim 20, wherein, In a neutral state, at least one of the following conditions applies: A specific first cut at the distal end of the first flexible segment is wider than a specific first cut at the proximal end of the first flexible segment; A specific second cut at the distal end of the first flexible segment is wider than a specific second cut at the proximal end of the first flexible segment; The specific first cut at the distal end of the second flexible segment is wider than the specific first cut at the proximal end of the second flexible segment; or The specific second cut at the distal end of the second flexible segment is wider than the specific second cut at the proximal end of the second flexible segment.

22. The patterned deflectable portion according to claim 20, wherein, At least a portion of the second flexible segment is configured to have at least one cut arranged at a rotational angle relative to at least one cut in the first flexible segment, and wherein the first flexible segment is formed of a different material than the second flexible segment.

23. A patterned tube that allows for the articulation of a medical endoscope, the patterned tube comprising: At least one flexible segment, the at least one flexible segment being located between the proximal end and the distal end of the patterned tube, the at least one flexible segment comprising: Multiple first incisions having a first incision thickness; A plurality of second cuts having a second cut thickness, wherein a particular second cut is positioned substantially opposite a particular first cut in the first cut across the patterned tube in the lateral direction, and the particular second cut is separated from the particular first cut by a folding member having a U-shaped bend; and One or more bending moment transmission members, wherein a particular bending moment transmission member of the one or more bending moment transmission members is located between adjacent particular first cuts in the first cut and also between adjacent particular second cuts in the second cut, and connects adjacent folding members, wherein the one or more bending moment transmission members include a central beam and a circumferential portion extending around the outer periphery of the patterned tube, and the central beam and the circumferential portion are configured to engage with each other in combination to transmit bending moment to the particular folding member.

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