Endoscope comprising shovel

Abstract

The invention provides a spatula for attachment to a distal edge of an endoscope and protruding from a lower portion of the distal edge. The invention provides an endoscope. The endoscope includes a spatula attached to a distal edge of the endoscope. Other embodiments of spreaders and endoscopes including spreaders are disclosed herein.

Description

Cross-references

[0001] This application claims priority to U.S. Provisional Patent Application No. 63 / 358,181, filed on July 4, 2022, the entire contents of which are incorporated herein by reference. Technical Field

[0002] The present application relates to endoscopes. More particularly, the present application relates to endoscopes including a shovel. Background Art

[0003] Dissecting and removing tissue, such as tumors, tissue suspected of being tumors, such as polyps, etc., from an organ of a patient is a procedure known in the art. For simplicity, the tissue to be operated on will be referred to as "target tissue" hereinafter. Manipulation of target tissue, especially target tissue that is slightly protruding, slightly recessed and / or slightly different from the tissue surface, is difficult, especially when the target tissue is located in a cavity of the body. For example, in order to dissect or cut the target tissue, the target tissue must be raised. Therefore, it is generally difficult to operate and cut, especially to cut soft target tissue, especially when it is desired to operate the target tissue by less invasive procedures, such as endoscopic surgery, polypectomy, etc. It is also difficult to operate the target tissue when the target tissue is asymmetric.

[0004] Several types of manipulations of the target tissue are challenging, such as close imaging of all sides of the target tissue, injection of substances into all sides of the submucosal layer of the target tissue, dissection and ablation of all sides of the target tissue, such as by polypectomy and / or ablation and / or tissue separation, and combinations of the above. Summary of the invention

[0005] Unless otherwise defined, all technical and scientific terms used herein have the same meaning as those commonly understood by those of ordinary skill in the art to which this application belongs. Although methods and materials similar or equivalent to those described herein may be used in the practice or testing of this application, suitable methods and materials are described below. In the event of a conflict, the patent specification (including definitions) shall prevail. In addition, the materials, methods and examples are illustrative only and are not intended to be limiting.

[0006] According to one aspect of the present application, there is provided a shovel for being attached to a distal edge of an endoscope and protruding from a lower portion of the distal edge.

[0007] According to another aspect of the present application, an endoscope is provided, the endoscope comprising the scoop connected to a distal edge of the endoscope.

[0008] According to one embodiment, the scoop has a generally concave configuration.

[0009] According to one embodiment, the spatula further comprises a connector for connecting the spatula to the distal edge of the endoscope.

[0010] According to one embodiment, the shovel further comprises a shovel rail extending along the width direction of the shovel and substantially perpendicular to the length direction of the endoscope, wherein the shovel rail is used to allow the carrier to move along the shovel rail, thereby allowing the carrier to move along the width direction of the shovel.

[0011] According to one embodiment, the endoscope further comprises a clamp connected to a distal edge of the endoscope, wherein the clamp is used to clamp the target tissue near the spatula.

[0012] According to one embodiment, the shovel further includes a shovel cover including a covering element for covering the shovel from above and allowing a tool to protrude from the shovel.

[0013] According to one embodiment, the scoop cover includes an opening at a front side relative to the distal edge of the endoscope, the opening being configured to allow a tool to protrude therefrom.

[0014] According to one embodiment, the scoop cover permanently covers the scoop.

[0015] According to one embodiment, the scoop cover is detachable.

[0016] According to one embodiment, the scoop cover is connected to a cap connector for connecting the scoop cover to the distal edge of the endoscope.

[0017] According to one embodiment, the cap connector is in the form of a sleeve that engages with the distal edge of the endoscope.

[0018] According to one embodiment, the cover connector is adapted to be permanently connected to the distal edge.

[0019] According to one embodiment, the cover connector is adapted to be detachably connected to the distal edge.

[0020] According to one embodiment, the covering element is at least partially foldable.

[0021] According to one embodiment, the shovel is axially connected to the connector by a transverse shaft, which is located at the bottom of the connector, allowing the shovel to be rotated upward or downward or upward and downward.

[0022] According to one embodiment, the shovel is axially connected to the connector by a longitudinal axis, which is located at the connection between the shovel and the connector, and which allows the shovel to turn to the right or to the left or to the right and to the left.

[0023] According to one embodiment, the shovel further comprises a rotating sub-shovel 403 located above or below the shovel, and the rotating sub-shovel 403 is used to rotate to one side, thereby allowing the width of the shovel to extend.

[0024] According to one embodiment, the spatula further comprises a multi-tube cutting tool, wherein the multi-tube cutting tool comprises a plurality of tubes disposed on the spatula.

[0025] According to one embodiment, a lifting element for lifting the target tissue is further included, wherein the lifting element is configured to be in a raised state and a lowered state.

[0026] According to one embodiment, the lifting element comprises a tissue engaging element for engaging the target tissue while lifting the target tissue.

[0027] According to one embodiment, the tissue engaging element has a high coefficient of friction, thereby allowing the tissue engaging element to tightly engage the target tissue and preventing the target tissue from slipping off the tissue engaging element during lifting of the target tissue.

[0028] According to one embodiment, the shovel further comprises a suction lifting element, which is used to engage with the target tissue and lift or move the engaged target tissue through a suction force, wherein the suction lifting element has a nozzle-shaped structure.

[0029] According to one embodiment, the suction and lifting element includes a tissue suction element located at the distal end of the nozzle-like structure of the suction and lifting element, and the suction and lifting element is hollow. The tissue suction element is an opening at the distal end of the suction and lifting element, and the tissue suction element is used to engage with the target tissue. Then, the suction force in the suction and lifting element forms a vacuum force in the tissue suction element, so that the target tissue is clamped by the suction and lifting element.

[0030] According to one embodiment, the suction lifting element further comprises at least one protrusion on the top side or the bottom side of the suction lifting element, or at least one protrusion on the top side and the bottom side of the suction lifting element, wherein the at least one protrusion enables engagement with the target tissue. BRIEF DESCRIPTION OF THE DRAWINGS

[0031] The embodiments are only illustrated herein with reference to the accompanying drawings. With specific reference now to the drawings, it should be emphasized that the details shown in the drawings are only examples for illustrative discussion of the preferred embodiments, and are intended to provide the most practical and easy-to-understand description of the principles and concepts of the embodiments. For this reason, the specification does not show structural details beyond those required for basic understanding, and the description in conjunction with the drawings should make it clear to those skilled in the art how to put several implementation forms into practice.

[0032] In the attached picture:

[0033] Figure 1 Surface tissue and target tissue according to an exemplary embodiment are schematically shown.

[0034] Figure 2 A perspective view of a prior art endoscope approaching a target tissue according to an exemplary embodiment is schematically shown.

[0035] Figure 3A The distal edge of an endoscope according to an exemplary embodiment is schematically shown, the endoscope including a scoop and a first mechanism for facilitating movement of a carrier along a width direction of the scoop.

[0036] Figure 3B The distal edge of an endoscope according to an exemplary embodiment is schematically shown, the endoscope including a scoop and a second mechanism for facilitating movement of a carrier in a width direction of the scoop.

[0037] Figure 4A-4B Schematically illustrating views of a distal edge of an endoscope at two different angles according to an exemplary embodiment, the endoscope including a scoop and a third mechanism for facilitating movement of a carrier along the width direction of the scoop.

[0038] Figure 5 Two positions of an endoscope including a spatula for cutting target tissue according to an exemplary embodiment are schematically shown.

[0039] Figure 6A-6B Perspective views schematically illustrate a folded state and an unfolded state of a holder connected to an endoscope including a shovel according to an exemplary embodiment, respectively.

[0040] Figure 7 Another structural embodiment of a gripper and a manipulator arm based on the exemplary embodiment is schematically shown.

[0041] Figure 8 An endoscope according to an exemplary embodiment is schematically shown, the endoscope comprising a scoop, a gripper and a manipulator arm, the manipulator arm also comprising a rearward imaging device.

[0042] Fig. 9 The field of view of a rearward imaging device according to an exemplary embodiment is schematically illustrated.

[0043] Fig.10 A side view of an endoscope according to an exemplary embodiment is schematically shown, the endoscope including a scoop that images a rear view of target tissue grasped by a gripper within a cavity.

[0044] Fig.11A side view of an endoscope according to an exemplary embodiment is schematically shown, the endoscope including a spatula and a clamp for clamping a target tissue.

[0045] Fig.12 An endoscope according to an exemplary embodiment is schematically shown, the endoscope including a scoop and a scoop cover.

[0046] Figures 13A-13C Various embodiments of the size and shape of the scoop cover based on an exemplary embodiment are schematically shown.

[0047] Fig.14A A side perspective view of a foldable scoop cover in an unfolded state according to an exemplary embodiment is schematically shown.

[0048] Figures 14B-14C Side views of a foldable scoop cover in an unfolded state and a folded state according to an exemplary embodiment are schematically shown respectively.

[0049] Fig.14D A side view of a scoop cover being folded according to an exemplary embodiment is schematically shown.

[0050] Figures 15A-15B A side perspective view of a shovel-up rotation and a shovel-down rotation according to an exemplary embodiment is schematically illustrated.

[0051] Fig.16A A front perspective view of a shovel for lateral rotation according to an exemplary embodiment is schematically shown.

[0052] Fig. 16B A side perspective view of a spatula for rotating to the right, or to the left, or to the right and to the left to cut a target tissue according to an exemplary embodiment is schematically illustrated.

[0053] Figures 17A-17B A front perspective view of a foldable shovel according to an exemplary embodiment is schematically shown in a folded state and an unfolded state, respectively.

[0054] Figures 18A-18C Schematically illustrated are front perspective views of three states of a shovel including a rotating sub-shovel according to an exemplary embodiment.

[0055] Figures 19A-19B A front perspective view of an endoscope including a spatula and a multi-tube cutting tool according to an exemplary embodiment, and a side detail view of the spatula and the multi-tube cutting tool are schematically shown, respectively.

[0056] Fig. 20 A front perspective view of an endoscope including a spatula, a multi-tube cutting tool, and a spatula cover according to an exemplary embodiment is schematically illustrated.

[0057] Fig.21 A side perspective view of an endoscope including a spatula, a multi-barrel cutting tool, and a spatula cover according to an exemplary embodiment is schematically illustrated, the endoscope being used to cut a target tissue.

[0058] Fig. 22 An endoscope according to an exemplary embodiment is schematically shown, the endoscope comprising a circular spatula and a circular multi-tube cutting tool, and the endoscope is used for cutting target tissue.

[0059] Fig.23 A side perspective view of an endoscope including a scoop and a lifting element according to an exemplary embodiment is schematically shown.

[0060] Figures 24A-24B A side perspective view of an endoscope according to an exemplary embodiment is schematically shown, the endoscope including a scoop and a lifting element, the lifting element being in a lowered state and a raised state for lifting a target tissue, respectively.

[0061] Fig.25 A side perspective view of an endoscope according to an exemplary embodiment is schematically shown, the endoscope including a suction lifting element.

[0062] Figures 26A-26B Schematically illustrated are side perspective views of an endoscope according to an exemplary embodiment, the endoscope including a suction lift element engaged with target tissue, the suction lift element being in a lowered state and a raised state, respectively.

[0063] Fig. 27 A system for allowing controlled manipulation of all sides of raised tissue within a patient's body according to an exemplary embodiment is schematically illustrated.

[0064] Fig.28 A guide rail surrounding a tissue being lifted according to an exemplary embodiment is schematically shown, the guide rail protruding from an endoscope inserted into a cavity of a patient's body.

[0065] Fig.29 A guide rail proximate to the tissue to be lifted according to an exemplary embodiment is schematically shown, the guide rail passing through the multi-lumen.

[0066] Fig. 30A A perspective view of a guide rail including a guide rail and a plurality of sleepers extending from the guide rail according to an exemplary embodiment is schematically shown.

[0067] Fig. 30B Schematically shows an exemplary embodiment of Figure 5 A magnified view of the track shown.

[0068] Fig. 30C Schematically shows an exemplary embodiment of Figure 5 A is an enlarged view of the track and sleepers shown.

[0069] Fig.31 A perspective view of a guide rail based on an exemplary embodiment is schematically shown, the guide rail comprising a rail and a plurality of sleepers extending from the rail, the guide rail passing through an endoscope and surrounding the lifted tissue, at which time the carrier is located on or moves along the guide rail and cuts the lifted tissue.

[0070] Fig.32 A top view of a guide rail according to an exemplary embodiment is schematically shown, wherein the guide rail comprises a rail and a plurality of sleepers extending from the rail, the guide rail passes through an endoscope, and has different deployment stages.

[0071] Fig.33 A side view of a tool including a sheath according to an exemplary embodiment is schematically shown.

[0072] Fig.34 A top view of a cutting tool including a dynamic tissue remover according to an exemplary embodiment is schematically shown. DETAILED DESCRIPTION

[0073] Before explaining at least one embodiment in detail, it should be understood that the subject matter of the present application is not limited to the construction details and the layout of components shown in the following description or drawings. The present application can be implemented or executed in other embodiments or in various ways. In addition, it should be understood that the words and terms used herein are for descriptive purposes and should not be considered as limiting. In the discussion of the various figures described herein, like numbers represent like parts. Figure 1 Generally not drawn to scale.

[0074] The present application provides a shovel for attaching to the distal edge of an endoscope. The present application also provides an endoscope including a shovel. The endoscope including the shovel is used to operate tissue, preferably, target tissue. Compared with the endoscope of the prior art, the endoscope including the shovel has several advantages. For example, the tool used is stabilized during the operation of the endoscope including the shovel to treat the raised tissue. In another example, compared with the endoscope of the prior art, the shovel can cut or inject a large area of ​​the target tissue, for example, without moving the endoscope. For example, the endoscope of the prior art allows the cutting or injection of a portion of approximately 2-3mm of the target tissue without moving the endoscope, while the endoscope including the shovel allows the cutting or injection of a much larger portion of the target tissue without moving the endoscope, for example, up to approximately 50mm or more. In addition, the attachment of the shovel to the endoscope allows more stable and controlled operations, such as cutting the target tissue, and prevents uncontrolled random movement of the carrier and the tool when the carrier carrying the tool moves along the guide rail of the shovel. Other advantages of endoscopes including scoops are described throughout the specification of the inventive subject matter.

[0075] Reference now Figure 1 . Figure 1 Surface tissue and target tissue according to an exemplary embodiment are schematically shown. Figure 1 An exemplary target tissue 520 is shown extending from a surface tissue 510, or in other words, a tissue being lifted 520. The surface tissue 510 is any type of tissue present in a patient's body, such as the surface tissue 510 of an organ, or a cavity in the body, such as the colon, also known as the large intestine, as shown. Figure 1 as shown, or any other type of tissue that may be subjected to surgery or any other manipulation by any tool.

[0076] The target tissue 520 can be any type of tissue that is desired to be manipulated, for example, dissecting and separating the target tissue 520 from the surface tissue 510, and in some embodiments, removing the dissected and separated target tissue 520 from the patient's body; performing close-up imaging of each side of the target tissue 520 from an appropriate angle; injecting substances into each side of the submucosal layer of the target tissue 520; cutting and / or coagulating and / or ablating each side of the target tissue 520 as required by the clinical procedure, or a combination thereof. The use of the term "side" is also intended to refer to all curves that form the shape of the target tissue 520.

[0077] Some exemplary target tissues 520 include: tumors, tissues suspected of being tumors, such as polyps, lesions, or combinations thereof. The target tissue 520 can be symmetrical or asymmetrical. The target tissue 520 can be hard or soft. The target tissue 520 can be a large and distinct tissue that is easy to manipulate, such as peeling and separating from the surface tissue 510. Alternatively, the target tissue 520 can be slightly elevated from the surface tissue 510, making its manipulation more challenging.

[0078] The present application provides a shovel for attaching to the distal edge of an endoscope. The present application also provides an endoscope including the shovel. The endoscope including the shovel is used to treat tissue, preferably, target tissue 520.

[0079] According to one embodiment, an endoscope including a spatula is configured to allow various tools to enter tissue, particularly target tissue 520. Some exemplary tools include: dissection tools, coagulation tools, ablation tools, grasping tools, imaging tools, injection tools, and the like.

[0080] In some embodiments, an endoscope including a shovel of the present application allows the target tissue 520 to be peeled off and separated from the surface tissue 510 in the patient's body. In some other embodiments, an endoscope including a shovel of the present application also allows the separated target tissue 520 to be removed from the patient's body. In some additional embodiments, an endoscope including a shovel of the present application allows other operations to be performed on the target tissue 520 and its surroundings.

[0081] According to one embodiment, the spatula facilitates the dissection of the target tissue 520. When cutting the target tissue 520, the spatula can enter the incision in the cut target tissue 520. This allows the target tissue 520 to be stabilized during dissection, and allows the operator of the endoscope including the spatula to view the incision line and better control the dissection process.

[0082] According to one embodiment, the spatula allows the surface tissue 510 to stretch near the bottom of the target tissue 520. This embodiment allows an operator of an endoscope including the spatula to manipulate the target tissue 520 with enhanced stability and accuracy.

[0083] According to one embodiment, the shovel is configured to prevent a tool carried by an endoscope including the shovel from falling below the level of the shovel. This embodiment prevents the tool from causing damage to the healthy surface tissue 510 below the target tissue 520.

[0084] According to one embodiment, the scoop is used to allow measurement of the target tissue and any point in the vicinity of the scoop. This is because when using an endoscope including the scoop, the scoop can be used as a length reference during imaging.

[0085] According to one embodiment, the patient is an animal, in particular a vertebrate. According to another embodiment, the patient is a human.

[0086] The term "tool" as disclosed herein refers to any type of tool used when manipulating tissue within a patient's body. Some exemplary types of tools include: a dissection tool for dissecting tissue; a grasping tool for grasping tissue; a storage tool for storing an object, such as a piece of tissue, such as when removing the object from a patient's body; an imaging tool for acquiring images within a patient's body; a lighting tool for lighting within a patient's body; an injection tool for injecting a substance into tissue; a burning tool for burning a portion of tissue, or any combination thereof, etc.

[0087] Reference now Figure 2 . Figure 2 A perspective view of a prior art endoscope approaching a target tissue according to an exemplary embodiment is schematically shown. Figure 2 An internal cavity is shown having a surface tissue 510 and a target tissue 520 extending above the surface tissue 510. The prior art endoscope 60 inserted into the cavity includes a distal edge 62. The distal edge 62 is the edge of the endoscope 60 inserted into the patient's body, wherein at least one channel, such as channel 601 and channel 602, is opened to allow a tool delivered through the at least one channel to pass through. For example, Figure 2 The cutting tool 300 is shown passing out of the channel 601 .

[0088] Reference now Figure 3A . Figure 3A The distal edge of an endoscope is schematically shown based on an exemplary embodiment. The endoscope includes a scoop and a first mechanism that facilitates movement of a carrier along the width direction of the scoop. Figure 3A The distal edge 62 of the endoscope 60 is shown. According to one embodiment, the endoscope 60 includes a shovel 402 connected to the distal edge 62 or configured to be connected to the distal edge 62 of the endoscope 60. The shovel 402 has a generally concave structure and protrudes from a lower portion of the distal edge 62. In other words, when the endoscope 60 is moved over the surface tissue 510, the shovel 402 at least occasionally contacts the surface tissue 510.

[0089] According to one embodiment, the bottom surface of the scoop 402 is configured to slide across the surface tissue 510, such as when the endoscope is moved within the lumen 550. This embodiment is advantageous over the prior art endoscope 60 that does not include the scoop 402, which may have difficulty moving within the lumen 550.

[0090] Other advantages of the shovel 402 relate to the manipulation of the target tissue 520 and are mentioned in the description below. Briefly, according to one embodiment, the shovel 402 is used to flatten wrinkles on the surface tissue 510 during the movement of the endoscope 60, thereby facilitating the smooth movement of the endoscope 60 including the shovel 402 within the cavity 550. According to another embodiment, the shovel 402 is used to push the target tissue 520, for example, during the manipulation of the target tissue 520. According to yet another embodiment, the shovel 402 is used to protect the surface tissue 510 and the target tissue 520 from errors that may occur when manipulating the target tissue 520. For example, the shovel 402 can prevent the cutting tool 300 from being inserted into the target tissue 520, or prevent the cutting tool 300 from penetrating into the target tissue 520 at too small an angle, thereby potentially damaging non-target tissue areas, etc. In other words, the shovel 402 can prevent or limit unwanted movement of the endoscope 60 including the shovel 402 when operating the target tissue 520, or can prevent or limit unwanted movement of a tool such as the cutting tool 300.

[0091] According to one embodiment, the shovel 402 is an integral part of the endoscope 60. According to this embodiment, the shovel 402 is manufactured at the distal edge 62 of the endoscope 60. According to another embodiment, the shovel 402 is configured to be connected to the distal edge 62 of the endoscope 60. According to this embodiment, the shovel 402 includes a connector 404 for connecting the shovel 402 to the distal edge 62. Any mechanism by which the connector 404 is connected to the distal edge 62 of the endoscope 60 is within the scope of the present application. Figure 3A The exemplary connector 404 shown has a cylindrical structure and is configured to be disposed on and grasp the distal edge 62 of the endoscope 601. This embodiment allows the spatula 402 to be mounted on an existing endoscope 60.

[0092] According to one embodiment, the scoop 402 includes a mechanism to facilitate movement of the carrier 120 along the width of the scoop 402. This embodiment is advantageous over the prior art endoscope 60 because it allows tools, such as the cutting tool 300, to access a wider area of ​​the target tissue 520 than tools carried by prior art endoscopes. The first such mechanism is Figure 3A Therefore, according to one embodiment, the shovel 402 includes a shovel rail 113 extending along the width direction of the shovel 402. According to another embodiment, the shovel rail 113 is substantially perpendicular to the length of the endoscope 60. The shovel rail 113 is used to allow the carrier 120 to move along the shovel rail 113, thereby allowing the carrier 120 to move along the width direction of the shovel 402. Figure 3AAs shown, the carrier 120 protrudes from the channel 601 of the endoscope 60 and engages with the shovel rail 113. Arrow 902 shows that the carrier 120 can move along the shovel rail 113, that is, along the shovel rail 13 from one side to the other side, along the width direction of the shovel 402 and perpendicular to the length direction of the endoscope 60.

[0093] According to one embodiment, a tool, such as a cutting tool 300, is attached to the carrier 120. Thus, according to Figure 3A As shown, the endoscope 60 including the shovel 402 is configured to dissect the target tissue 520 in the following manner: inserting the endoscope 60 including the shovel 402 and the shovel rail 113 near the target tissue 520; inserting the carrier 120 carrying the cutting tool 300 into the endoscope 60; engaging the carrier 120 with the shovel rail 113, so that the shovel 402 is close to the bottom of the target tissue 520; Figure 3A As shown by the arrow 902 in the figure, the carrier 120 is moved forward and backward along the shovel rail 113, and the cutting tool 300 is started at the same time; and when the target tissue 520 is cut by the cutting tool 300, the endoscope 60 including the shovel 402 is further pushed toward the target tissue 520 to allow the cutting tool 300 to further cut the target tissue 520.

[0094] Reference now Figure 3B . Figure 3B The distal edge of an endoscope according to an exemplary embodiment is schematically illustrated, the endoscope including a spatula and a second mechanism for facilitating movement of a tool along the width direction of the spatula. Figure 3B Shown with Figure 3AThe shovel 402 shown in FIG. 4 is similar to the shovel 402 shown in FIG. 4 , and the shovel 402 includes a second mechanism for facilitating movement of the carrier 120 in the width direction of the shovel. According to one embodiment, the second mechanism includes: a screw 124 disposed on the shovel 402, for example, near the distal edge of the shovel 402, along the width direction of the shovel 402, a bolt 126 connected to the carrier 120 and tightened on the screw 124, and a motor 122 disposed generally near one side of the shovel 402, wherein the screw 124 is connected to the motor 122, and the motor 122 is used to rotate the screw 124. Since the motor 122 and the screw 124 are fixed in place, and the carrier 120 connected to the bolt 126 is moving, the rotation of the screw 124 by the motor 122 causes the bolt 126 to move along the screw 124, thereby causing the carrier 120 to move along the screw 124. Since the screw 124 is positioned along the width of the shovel 402, turning the screw 124 causes the carrier 120 to move along the width of the shovel 402. The screw 124 moves the bolt 126 and the carrier 120 toward the motor 122 in a first direction, such as a clockwise direction, while the screw 124 moves the bolt 126 and the carrier 120 in a second direction, such as a counterclockwise direction, such as away from the motor 122.

[0095] Reference now Figure 4A-4B . Figure 4A-4B Views of the distal edge of the endoscope from two different angles are schematically shown based on an exemplary embodiment. The endoscope includes a shovel and a third mechanism for facilitating the movement of the tool along the width direction of the shovel. In the third mechanism, according to one embodiment, the carrier 120 also includes a wheel motor 127 attached to the carrier 120 and a drive wheel 125 attached to the wheel motor 127, the drive wheel 125 being rotated by the wheel motor 127 and used to drive the carrier 120 during rotation. In other words, the drive motor 127 is used to rotate the drive wheel 125 clockwise or counterclockwise. In addition, the shovel 402 also includes a wheel track 115 corresponding to the drive wheel 125 of the carrier 120 and extending along the width direction of the shovel 402. Therefore, the drive wheel 125 is used to move along the wheel track 115 corresponding to the rotation direction of the drive wheel 125. According to another embodiment, the drive wheel 125 has gear teeth, and the wheel track 115 also has gear teeth. This embodiment allows the drive wheel 125 to be firmly attached to the wheel rail 115, preventing the drive wheel 125 from sliding from the wheel rail 115. It should be noted that the embodiment of the toothed drive wheel 125 and the corresponding toothed wheel rail 115 is merely exemplary and should not be considered to limit the scope of the present application. Any type, structure and mechanism of connecting the drive wheel 125 to the wheel rail 115 is within the scope of the present application.

[0096] exist Figure 4A-4B The cutting tool 300 attached to the carrier 120 can also be seen. Figure 3A The shovel rail 113 shown is also present in Figure 4A-4B The shovel 402 is shown in the bucket 402 and is configured to support the cutting tool 300 when the cutting tool 300 moves with the carrier 120. According to one embodiment, this is achieved by a protrusion 129 protruding from the carrier 120 or from the cutting tool 300 to the shovel rail 113. According to another embodiment, the protrusion 129 is used to engage with the shovel rail 113 and slide along the shovel rail 113. This embodiment stabilizes the cutting tool 300 during the movement of the carrier 120 in the width direction of the shovel 402.

[0097] Continue to refer Figure 4A-4B . According to one embodiment, the shovel rail 113 has a low coefficient of friction. In other words, the shovel rail 113 is smooth, thereby allowing the carrier 120 or the tool or the protrusion 129 to slide along the shovel rail. Any mechanism that makes the shovel rail 113 have a low coefficient of friction or smooth is within the scope of the present subject matter. For example, the surface of the shovel rail 113 is made of a material with a low coefficient of friction. An advantage of this embodiment is that the shovel rail 113 allows the carrier 120 or the tool or the protrusion 129 to slide quickly along the shovel rail 113 without the need to invest high energy to move the carrier 120 or the tool.

[0098] According to another embodiment, the shovel rail 113 has a high coefficient of friction. In other words, the shovel rail 113 is rough so that the carrier 120 or the tool or the protrusion 129 is stabilized when it moves along the shovel rail 113. Any mechanism that makes the shovel rail 113 have a high coefficient of friction or roughness is within the scope of the present application. For example, the surface of the shovel rail 113 is made of a material with a high coefficient of friction. In another example, the surface of the shovel rail 113 includes bumps or bulges or teeth to prevent the carrier 120 or the tool or the protrusion 129 from sliding smoothly along the shovel rail 113. The advantage of this embodiment is that the rough shovel rail 113 stabilizes the carrier 120 or the tool when it moves along the shovel rail 113.

[0099] Figure 4A-4B Another embodiment shown in relates to transmitting power to the carrier 120 and tools, such as the cutting tool 300, and transmitting data from the tool or imaging device, etc., through the endoscope 60. According to one embodiment, the transmission of power to components on or near the shovel 402 through the endoscope 60 is implemented by at least one cable 652, such as a power cable 652. According to another embodiment, the transmission of data to, from, or bidirectionally to the shovel 402 or components near the shovel 402 is implemented by at least one cable 652, such as a data transmission cable 652. According to yet another embodiment, as Figure 4A-4B A plurality of cables 652 are shown bundled in a cable braid 65 .

[0100] Reference now Figure 5 . Figure 5 Two positions of an endoscope including a spatula for cutting target tissue are schematically shown according to an exemplary embodiment. Figure 5 The endoscope 60 is shown, which includes a shovel 402 at a first position 60-I near a target tissue 520. In this position, a cutting tool 300 carried by a carrier 120 protruding from the endoscope 60 cuts a first incision 522-I on the basis of the target tissue 520. Since the endoscope 60 includes the shovel 402, the carrier 120 moves left and right along the width direction of the shovel 402, such as in the previous Figure 3A-3B and Figure 4A-4B Thus, the length of the first incision 522-I on the basis of the target tissue 520 is designated as line 522-I, and since the movement of the carrier 120 carried by the endoscope 60 of the prior art is limited, the length of the first incision 522-I is greater than the incision of the endoscope 60 of the prior art that lacks the shovel 402. Compared with the prior art endoscope 60 without the shovel 402, this embodiment shows an advantage of the endoscope 60 of the present application including the shovel 402.

[0101] After making the first incision 522-I, the endoscope 60 moves to the second position 60-II, and the cutting tool 300 makes a second incision 522-II on the target tissue 520 as a continuation of the first incision 522-I. In this way, the entire target tissue 520 can be cut and removed.

[0102] Figure 5 A virtual border 523 between the first incision 522-I and the second incision 522-II is shown. The border 523 specifies the location on the target tissue 520 where the first incision 522-I ends and the second incision 522-II begins. In this embodiment, the second incision 522-II begins at the first incision 522-I. Therefore, the length of the second incision 522-II can be approximately equal to the length of the first incision 522-I, for example, when the endoscope 60 is in the first position 60-I, the first incision 522-I can be achieved, and then the endoscope 60 is moved to the second position 60-II and the second incision 522-II is cut substantially starting at the point where the first incision 522-I ends.

[0103] However, according to another embodiment, the first incision 522-I and the second incision 522-II may overlap. For example, when the endoscope 60 is located at the first position 60-I, it can be achieved through the first incision 522-I. Then, the endoscope 60 is moved to the second position 60-II and begins to cut the second incision 522-II at a point within the first incision 522-I.

[0104] It should be noted that Figure 5 The embodiment shown only involves cutting the target tissue 520 as an example. This embodiment can be related to any operation of the target tissue 520 that requires the tool to move along the width direction of the shovel 402, such as injecting a substance into the target tissue, imaging a specific location on the target tissue 520, etc.

[0105] Reference now Figure 6A-6B . Figure 6A-6B Based on an exemplary embodiment, perspective views of a folded state and an unfolded state of a holder respectively connected to an endoscope including a shovel are schematically shown. Figure 6A-6B An endoscope 60 is shown, which includes a scoop 402 and further includes a gripper 702. Thus, according to one embodiment, the endoscope 60 includes the scoop 402, and the scoop 402 also includes a gripper 702 attached to the distal edge 62 of the endoscope 60. The gripper 702 is used to grasp the target tissue 520 near the distal edge 62 of the endoscope 60, or more specifically, grasp the target tissue 520 near the scoop 402 of the endoscope 60. According to another embodiment, the gripper 702 is attached to the distal edge 62 by a manipulator arm 704. According to yet another embodiment, as Figure 5 As shown in FIG. 2B , the operating arm 702 is fixed and extends in a manner to form a distance 750 between the clamp 702 and the distal edge 62 of the endoscope 60, or between the clamp 702 and the shovel 402 attached to the endoscope 62. The clamp 702 may have any size and shape that enables the clamp 702 to grasp the target tissue 502. When the clamp 702 is used, the target tissue 502 is clamped in the middle by the distance 750 between the clamp 702 and the distal edge 62 or the shovel 402.

[0106] According to another embodiment, the operating arm 704 is expandable. Therefore, the operating arm 704 can be in two states: a folded state and an unfolded state. Fig. 6A For example, when the endoscope 60 is passed through the patient's body toward a target site, such as a target tissue 520 to be treated, the folded state of the operating arm 704 is used. In the folded state of the operating arm 702, as shown Fig. 6A As shown, the clamp 704 is near the distal edge 62 of the endoscope 60, or near the scoop 402 attached to the distal edge 62 of the endoscope 60.

[0107] The operating arm 704 in the deployed state is as shown in FIG. Figure 6BFor example, when it is necessary to clamp the target tissue 520, such as during cutting of the target tissue 520, the operating arm 702 is extended. Arrow 904 shows possible movement directions of the extendable operating arm 704 and the gripper 702 attached to the extendable operating arm 704, that is, the extendable operating arm 702 and the gripper 702 attached to the extendable operating arm 704 move in a continuous direction of the length of the endoscope 60, away from the endoscope 60, or away from the shovel 402, or toward the distal edge 62 of the endoscope, or toward the shovel 402.

[0108] Reference now Figure 7 . Figure 7 Another structural embodiment of a gripper and a manipulator arm based on the exemplary embodiment is schematically shown. Figure 7 The functions of the illustrated gripper 702 and operating arm 704 are similar to those of the embodiments described in conjunction with the Figures. Figure 7 The structures of the clamp 702 and the operating arm 704 shown are different in that the clamp 702 and the operating arm 704 are made of one component, such as a bent wire. The elongated portion of the wire forms the operating arm 704, and the bent portion of the wire forms the clamp 702.

[0109] According to another embodiment, the operating arm 704 is used to attach to the endoscope 60. According to yet another embodiment, the operating arm 704 also includes an operating arm connector 706 for connecting the operating arm 704 to the endoscope 60. Any type of operating arm connector 706 is within the scope of the present application. Exemplary embodiments of the operating arm connector 706 are as follows: Figure 7 As shown. According to this embodiment, the operating arm connector 706 is attached to the operating arm 704, and is used to embrace the endoscope 60 in a manner of connecting the operating arm 704 to the endoscope 60. According to an exemplary embodiment, the operating arm connector 706 has a sleeve structure, and the sleeve is configured to accommodate the endoscope 60 and provide axial movement to the operating arm of the clamp 702, and the operating arm of the clamp 702 leaves the distal tip transmission position to avoid the distal side of the elevated target tissue. According to another embodiment, the operating arm connector 706 has a coil structure, such as Figure 7 A. The coil structure is used to accommodate the endoscope 60. According to another embodiment, the connector 706 has a structure of a flexible stent tube.

[0110] According to one embodiment, the manipulator arm connector 706 has a shape memory that tends to pull the manipulator arm 704 and the gripper 702 toward the endoscope 60. According to another embodiment, the manipulator arm 704 and the gripper are configured to be pushed away from the endoscope 60 by the operator of the endoscope 60. Any mechanism can be used to push the manipulator arm 704 and the gripper 702 away from the endoscope 60, such as by manually pushing with a cable, or by pushing by at least one motor. These embodiments allow the gripper 702 to easily grasp the target tissue 520. For example, when the endoscope 60 reaches the target tissue 520, when the target tissue 520 is located between the shovel 402 and the gripper, the manipulator arm 704 and the gripper 702 are pushed away from the rear side of the target tissue 520 in a manner that pushes the gripper 702 away from the endoscope 60, while the manipulator arm 704 is located above the target tissue 520. Then, the push of the manipulator arm 704 and the gripper 702 is released, and due to the shape memory of the manipulator arm connector 706, the manipulator arm 704 and the gripper are moved toward the endoscope 60. This causes the gripper 702 to grasp the target tissue 520, and the gripper 702 to lift the target tissue 520, for example, when it is desired to lift the target tissue 520.

[0111] Reference now Figure 8 . Figure 8 An endoscope according to an exemplary embodiment is schematically shown, the endoscope comprising a scoop, a gripper and a manipulator arm, the manipulator arm also comprising a post-imaging device. Figure 8 In the illustrated embodiment, the endoscope 60 includes a scoop 402, a gripper 702, and an operating arm 704, and also includes a rear imaging device 720 for acquiring images from the opposite side of the target tissue 520 grasped by the gripper 702. The rear imaging device 720 is located near the gripper 702, connected to the operating arm connector 706, or directly connected to the endoscope 60, and has an imaging device operating arm 722. According to one embodiment, the imaging device operating arm 722 is used to connect the rear imaging device 720 to the endoscope 60. According to another embodiment, the imaging device operating arm 722 is used to connect the rear imaging device 720 to the operating arm connector 706. However, according to yet another embodiment, the rear imaging device 720 is attached to the gripper 702. According to yet another embodiment, the imaging device operating arm 722 includes wires for transmitting signals through the endoscope to an input device located outside the patient's body, and for acquiring signals from the rear imaging device 720 and processing the signals. However, according to another embodiment, the rear imaging device 720 is wirelessly connected to the input device, and thus the imaging device operating arm 722 may not include wires.

[0112] According to one embodiment, the rear imaging device 720 is adapted to be moved by an operator of the endoscope 60. Any type of movement of the rear imaging device 720 and mechanisms for moving and controlling the movement of the rear imaging device 720 are within the scope of the present application. For example, the rear imaging device 720 is adapted to rotate sideways or up and down, etc. The movement of the rear imaging device 720 can be achieved mechanically, such as by a cable, or by at least one motor, etc.

[0113] Reference now Fig. 9 . Fig. 9 The field of view of a rear imaging device according to an exemplary embodiment is schematically illustrated. Fig. 9 The endoscope 60 shown includes a shovel 402, a gripper 702, an operating arm 704, a rear imaging device 702 and an imaging device operating arm 722, which are substantially similar to Figure 8 Same as shown. Fig. 9 Also shown is a field of view 725 of the rear imaging device 720. The field of view 725 has a three-dimensional funnel-like shape extending from the rear imaging device 720. Any object located within the field of view 725 is imaged by the rear imaging device 720. Figure 8 and 9 In the embodiment shown, the rear imaging device 720 is directed toward the endoscope 60. Therefore, any object located between the rear imaging device 720 and the endoscope 60, or more specifically, an object located between the rear imaging device 702 and the shovel 702 and falling within the field of view 725 of the rear imaging device 720, can be imaged. Advantages of this embodiment include: Fig.10 shown.

[0114] Reference now Fig.10 . Fig.10 Schematically illustrates a side view of an endoscope including a scoop that images a rear view of a clamped target tissue within a cavity according to an exemplary embodiment. Fig.10 As shown, an endoscope 60 including a shovel 402 is inserted into a cavity 550 in a patient's body, such as the intestine, to image a rear view of a target tissue 520. The endoscope 60 also includes a holder 702 and a rear imaging device 720, such as Figure 8-9 As shown. The prior art endoscope 60 includes a prior art imaging device attached to the front side of the endoscope 60 for imaging the view in front of the endoscope 60. Fig.10 In the illustrated scenario, when a prior art endoscope 60 is used, the prior art imaging device of the prior art endoscope 60 only images a portion of the target tissue 520 facing the endoscope 60. The side of the target tissue 520 opposite to the endoscope 60 cannot be imaged by the prior art imaging device of the prior art endoscope 60 because it is not disclosed to the prior art imaging device of the prior art endoscope 60.

[0115] However, if Fig.10 As shown, the rear imaging device 720 is directed toward the endoscope 60, and when the rear imaging device 720 is located in front of the rear side of the target tissue 520, as shown in FIG. Fig.10 As shown, the rear side of the target tissue 520 is located within the field of view 725 of the rear imaging device 720 , thereby achieving rear side imaging of the target tissue 520 .

[0116] According to one embodiment, Fig.10 In the scenario shown, the gripper 702 may be used to grasp the target tissue 520 at the opposite side of the target tissue 520 , or even lift the target tissue 520 , thereby facilitating imaging of the opposite side of the target tissue 520 .

[0117] Fig.10 Another advantageous feature of the illustrated spatula 402 relates to the depth of the incision 522 formed in the target tissue 520. When using the prior art endoscope 60, the depth of the incision 522 is limited to the length of the protruding portion of the cutting tool 300. This is because the width of the endoscope 60 is large and the endoscope cannot penetrate the incision 522 in the target tissue 500. However, the height of the spatula 402 is less than the height of the endoscope 60, thereby allowing the spatula 402 to penetrate into the incision 522, thereby increasing the depth of the incision 522 in the target tissue 520. Fig.10 As shown, the shovel 402 passes through the incision 522, resulting in a portion 520-U of the target tissue 520 being located above the shovel 402. This situation can interfere with the function of the endoscope 60, such as the field of view of the imaging device of the endoscope 60, or expose components on the shovel 402, such as the carrier 120, tools, etc., to direct contact with tissue and moisture. A solution to this situation, such as in the following Figure 12-1 Described in 3.

[0118] Reference now Fig.11 . Fig.11 Schematically illustrates a side view of an endoscope according to an exemplary embodiment, the endoscope including a shovel and a clamp that clamps a target tissue. Fig.11As shown, an endoscope 60 including a shovel 402 is inserted into a cavity 550 in a patient's body, such as an intestine, to cut a target tissue 520. The endoscope 60 also includes a holder 702 similar to the holder 702 described above. According to the above embodiment, the cutting tool 300 is located on the shovel 402. When the cutting tool 300 dissects the target tissue 520, the holder 702 grasps the target tissue 520 at the opposite side relative to the cutting tool 300. This is because the operating arm 704 holds the holder 702 at a distance from the shovel 702. Therefore, the holder 702 stabilizes the target tissue 520 and allows the target tissue 520 to be cut more easily and accurately. As a result, the incision 522 in the target tissue 520 can be formed with high accuracy in terms of the position of the incision 522 in the target tissue 520 and the width and length of the incision 522. This is another advantage of using the clamp 702 in combination with the spatula 402, because when dissecting the target tissue 520 with the prior art endoscope 60 including the cutting tool 300, the target tissue 522 is not grasped and stabilized, and because the target tissue 520 is soft and pale in nature, the accuracy of the position and the width and length of the incision 522 is limited.

[0119] Reference now Fig.12 , Fig.12 An endoscope according to an exemplary embodiment is schematically shown, the endoscope including a scoop and a scoop cover. However, before describing various embodiments of the scoop cover 80, Fig.12 An embodiment of a second mechanism for facilitating movement of the carrier 120 in the width direction of the shovel 402 is shown. Figure 3B shown. Fig.12 The screws 124 are shown arranged along the width direction of the shovel 402. However, Fig.12 Not shown is a bolt 126 mounted on the carrier 120 and screwed on the screw 124, and a motor 122 generally close to one side of the shovel 402, wherein the screw 124 is mounted on the motor 122 and the motor 122 is configured to rotate the screw 124, as described above. Figure 3B Described in detail in the description.

[0120] According to one embodiment, Fig.12 As shown, the endoscope 60 including the shovel 402 also includes a shovel cover 80, which is used to cover the shovel 402 from above and allow the tool to protrude from the shovel 402. Fig.12 As shown, the shovel cover 80 covers the shovel 402, the carrier 120, and the tool on the shovel 402 that is similar in form to the cutting tool 300. In addition, the shovel cover 80 includes an opening 805 on the front side relative to the distal edge 62 of the endoscope. The opening 805 is used to allow the tool to protrude from the shovel 402. Therefore, Fig.12The illustrated cutting tool 300 can be used to dissect the target tissue 250 by protruding through the opening 805 of the spatula cover 80 .

[0121] Another embodiment of the shovel cover 80 is that the shovel cover is used to protect the shovel 402 and parts on the shovel 402, such as the carrier 120, tools, etc.; to prevent physical damage that may occur when the endoscope 60 is inserted into the patient's body, and to prevent body fluids that may damage the parts, such as blood, mucus, etc.

[0122] According to yet another embodiment, the scoop cover 80 is substantially transparent. Thus, the carrier 120 is partially visible through the scoop cover 80, such as Fig.12 This embodiment of the transparent scoop cover 80 allows for imaging of prior art imaging devices located at the distal edge of the endoscope 60, such as next to the carrier 120. Therefore, in order to obtain an image of the prior art imaging device of the endoscope 60, the scoop cover 80 does not need to be removed or opened, nor does it need to protrude the imaging device through the opening 805 of the scoop cover 80.

[0123] Any mechanism for attaching the scoop cover 80 to the scoop 402 is within the scope of the present application. According to one embodiment, the scoop cover 80 permanently covers the scoop 402. According to another embodiment, the scoop cover 80 is removable. According to an exemplary embodiment, as shown in FIG. Fig.12 As shown, a cover connector 807 is attached to the scoop cover 80 and is used to connect the scoop cover 80 to the endoscope 60 or the distal edge 62 of the endoscope 60. For example, the cover connector 807 is in the form of a sleeve that engages with the distal edge 62 of the endoscope 60. The connection with the distal edge 62 can be permanent or removable.

[0124] Any size and shape of the scoop cover 80 is within the scope of the present application. Fig.12 As shown, the scoop cover 80 is inclined from the distal edge 62 toward the opening 805 and is concave. This exemplary embodiment of the shape of the scoop cover 80 allows moisture and dirt to slide off the scoop cover 80, for example, allowing the endoscope 60 to be viewed through the transparent scoop cover 80 with a prior art imaging device despite the accumulation of moisture and dirt on the scoop cover 80 because they would slide off the scoop cover 80. This exemplary embodiment of the shape of the scoop cover 80 allows body fluids and dirt to slide off the scoop cover 80, for example, allowing the endoscope 60 to be viewed through the transparent scoop cover 80 with a prior art imaging device despite the accumulation of body fluids and dirt on the scoop cover 80, but also slide off the scoop cover 80. Other embodiments of the size and shape of the scoop cover 80, for example, Figures 13A-13C shown.

[0125] Reference now Figures 13A-13C . Figures 13A-13C Various embodiments of the size and shape of the scoop cover based on an exemplary embodiment are schematically shown. Figures 13A-13CAll of the scoop covers 80 shown in the drawings include a cover connector 807. Since the cover connector 807 is configured to engage with the distal edge 62 of the endoscope 60, or to engage with the endoscope 60, the size and shape of the scoop connector 807 are Figures 13A-13C The scoop covers 80 are substantially similar in all types shown. However, it should be noted that the shape and size of the cover connector 807 can be different, such as to accommodate various types of endoscopes 60 or the distal edge of the endoscope 60.

[0126] according to Figures 13A-13C In another embodiment shown, the shovel cover further includes a covering element 809. Therefore, according to this embodiment, the shovel cover 80 includes a covering element 809 configured to cover the shovel 402, and a cover connector 807 attached to the covering element 809 and configured to connect the shovel 80 to the endoscope 60 or the endoscope 62. According to the above embodiment, the covering element 809 is substantially transparent, and according to another embodiment, the covering element 809 is opaque, in other words, opaque.

[0127] Any size and shape of the cover element 809 is within the scope of the present application. It should be noted that Figures 13A-13C The various covering elements 809 shown in the figure are merely exemplary and should not be considered to limit the scope of the present application. Fig.13A As shown. The covering element is substantially cylindrical, and its diameter is substantially similar to the diameter of the endoscope 60. According to another embodiment, as shown in FIG. 13B, the covering element 809 is substantially inclined, having a height similar to the height of the endoscope 60 at the edge adjacent to the endoscope 60, and having a height lower than the height of the endoscope 60 at the distal end of the endoscope 60. According to yet another embodiment, as shown in FIG. Fig. 13C As shown, the cover element 809 is substantially rectangular. According to yet another embodiment, the height of the rectangular cover element 809 is lower than the height of the endoscope 60.

[0128] Another embodiment and Figures 13A-13C All of the scoop covers 80 shown are similar and include an opening 805 at the distal edge of the endoscope 60. As described above, the opening 805 is used to allow, for example, a tool to protrude from the scoop 402, such as Fig.12 According to another embodiment, the opening 805 allows imaging using a prior art imaging device of the endoscope 60. The opening 805 can have any size and shape. For example, Fig.13A The scoop cover shown includes a large opening 805 having a semi-cylindrical shape, the diameter of which is substantially similar to the diameter of the endoscope 60. In contrast, the scoop 80 is Figures 13B-13CAs shown, a smaller opening 805 is included, which has a rectangular shape and a height that is less than the height of the endoscope 60. The size and shape of the opening 805 can be adapted to the type, size, and shape of the tool being used, for example.

[0129] Reference now Fig.14A . Fig.14A Schematically shows a side perspective view of a foldable scoop cover in an unfolded state according to an exemplary embodiment. According to one embodiment, the covering element 809 of the scoop cover 80 is at least partially foldable. According to this embodiment, as Fig.14A The cover element 809 of the illustrated shovel cover 80 includes a first cover 8092 and a second cover 8094. The first cover 8092 is deployed between the first frame 801 and the second frame 802, and the second cover 8094 is deployed between the second frame 802 and the cover connector 807. According to one embodiment, the first frame 801 and the second frame 802 are axially attached to the shovel 402 with a cover shaft 803. The cover shaft 803 can be placed at any position of the shovel 402. According to one embodiment, as shown in FIG. Fig.14A The covering axis 803 is shown to be located at the distal edge of the shovel 402. According to one embodiment, the first frame 801 is configured to rotate about the covering axis 803. According to another embodiment, the second frame 802 is configured to rotate about the covering axis 803. According to yet another embodiment, the first frame 801 and the second frame 802 are configured to rotate about the covering axis 803.

[0130] Reference now Figures 14B-14C . Figures 14B-14C A side view of a foldable scoop cover in an unfolded state and a folded state according to an exemplary embodiment is schematically shown. Fig. 14B The foldable shovel cover 80 and Fig.14A The foldable scoop cover is similarly shown in an unfolded state. The first frame 801 is rotated forward, away from the endoscope 62, so that the first cover 8092 covers the front of the scoop 402. In this state, the second frame is positioned approximately vertically relative to the scoop 402, and the second cover 8094 covers the middle and rear of the scoop 402.

[0131] According to one embodiment, the foldable scoop cover 80 is in an unfolded state and is configured to allow the endoscope to move smoothly and easily within the cavity 550. Figures 14A-14B For example, this is done by Fig. 14B The shape of the foldable scoop cover 80 shown in the figure is realized, especially the shapes of the first cover 8092 and the second cover 8094. According to another embodiment, the foldable scoop cover 80 in the unfolded state has a curved shape, similar to the shape of fluid dynamics, which allows the front part of the endoscope 60 to pass through the tissue smoothly, especially through the cavity 550.

[0132] Fig. 14CThe foldable scoop cover 80 is shown in a folded state, with the first frame 801 and the second frame 802 both rotated rearwardly toward the endoscope 60. As a result, the first cover 8092 covers the central portion of the scoop 402, the second cover 8094 covers the rear side of the scoop, and the front of the scoop 402 is uncovered.

[0133] In addition, Fig. 14b-C shows a frame operating arm 870 for being manipulated by the operator of the endoscope 60, and pushes the first frame 801 forward or backward as needed. According to one embodiment, one end of the frame operating arm 870 is attached to the first frame 801, and the other side of the frame operating arm 870 is directly or wired or wirelessly connected to a control panel or handle operated by the operator of the endoscope 60. Pushing the frame handle 870 forward moves the first frame 801 forward, and pulling the frame handle 870 backward moves the first frame backward.

[0134] It should be noted that the embodiment of the frame operating arm 870 connected to the first operating arm 801 is as follows: Figures 14B-14C shown. Figures 14B-14C This is merely exemplary and should not be considered as limiting the scope of the present application. According to another embodiment, the frame operating arm 870 is connected to the second cover 8094 for pulling the second frame 802 forward or backward.

[0135] According to one embodiment, the first cover 8092 is made of a folded material, such as a folded sheet of nylon or fabric, etc. According to another embodiment, the first cover 8092 is rigid.

[0136] According to one embodiment, the second cover 8094 is made of folded, such as a folded sheet of nylon or fabric, etc. According to another embodiment, the second cover 8094 is rigid.

[0137] According to an embodiment of the first cover 8092 made of folded material, when the first frame 801 is rotated away from the endoscope 60, the first cover 8092 is unfolded. Figures 14A-14B According to the embodiment of the first cover 8092 made of a rigid material, when the first frame 801 deviates from the endoscope 60 and rotates, the first cover 8092 is gathered, as shown in FIG. Figures 14A-14B shown.

[0138] According to an embodiment of the second cover 8094 made of folded material, when the second frame 802 is rotated away from the endoscope, the second cover 8094 is unfolded, such as Figures 14A-14B According to an embodiment of the second cover 8094 made of a rigid material, when the second frame 802 is rotated away from the endoscope, the second cover 8094 converges. Figures 14A-14B shown.

[0139] According to one embodiment, in Fig. 14CAccording to an embodiment of the second cover 8094 made of a folding material, when the second frame 802 is rotated toward the endoscope 60, the second cover 8094 is folded or converged. According to an embodiment of the second cover 8094, when the second frame 802 is rotated toward the endoscope 60, the second cover 8094 is pushed into the endoscope, or under the cover connector 807.

[0140] Reference now Fig.14D . Fig.14D A side view of a folded shovel cover according to an exemplary embodiment is schematically shown. According to the illustrated embodiment. The shovel cover 80 includes a cover frame 806 and a folding cover 8096, wherein one side of the folding cover 8096 is connected to the cover frame 806, and the other side of the folding cover 8096 is connected to the cover connector 807. When the cover frame 806 is rotated toward the endoscope 60, as shown in FIG4D, the folding cover 8096 is folded, and the shovel 402 is not covered, that is, exposed. When the cover frame 806 is rotated away from the endoscope 60, the folding cover 8096 expands, and the shovel 402 is covered. According to Fig.14D Another embodiment shown in FIG. The shovel cover 80 also includes a frame operating arm 870. Fig. 14B -C describes an embodiment of the frame operating arm 870. According to another embodiment, Fig.14D The folding cover 8096 shown in the figure is mounted on two frames, similar to the shovel cover 80 shown in the figure.

[0141] According to one embodiment, the foldable shovel cover 80 includes any embodiment of the foldable shovel cover 80 described above for manipulating the target tissue 520. Any type of operation of the target tissue 520 that can be performed by the foldable shovel cover 80 is within the scope of the present application. According to one embodiment, the foldable shovel cover 80 is used to lift the target tissue 520. According to another embodiment, the foldable shovel cover 80 is used to push the target tissue 520. According to yet another embodiment, the foldable shovel cover 80 is used to perform any operation of the target tissue 520 that allows the target tissue 520 to be visualized using an imaging device. According to yet another embodiment, the foldable shovel cover 80 is used to perform any operation of the target tissue 520 that allows the target tissue 520 to be accurately cut, for example, using a cutting tool 300. In general, the foldable shovel cover 80 is used to assist in controlling the position and state of the target tissue 520 during the operation of the target tissue 520. According to another embodiment, the first frame 801 of the foldable shovel cover 80 is used to perform the above-mentioned embodiments involving controlling the position and state of the target tissue 520.

[0142] Reference now Figures 15A-15B . Figures 15A-15BSchematically illustrates a side perspective view of a scoop rotating upward and a scoop rotating downward, respectively, according to an exemplary embodiment. The foregoing figures show a scoop 402 that is consistent with the length of the endoscope 60. Figures 15A-15B In FIG. 6 , dotted line 910 represents the length of endoscope 60. According to one embodiment, as Figures 15A-15B As shown, the shovel 402 is axially connected to the connector 404, and the transverse shaft 450 is located at the bottom of the connector 404. The transverse shaft 450 allows the shovel 402 to rotate up or down or up and down.

[0143] Fig.15A A scoop 402 is shown for use in an upward rotation. Fig.15A In the figure, the dotted line 912 represents the length line of the shovel 402 when the shovel 402 is rotated upward, and the angle 913 is the angle formed by the endoscope length line 910 and the dotted line 912.

[0144] Fig. 15B A scoop 402 is shown for use in a downward rotation. Fig. 15B , dotted line 914 represents the length line of the shovel 402 when the shovel 402 is rotated downward, and angle 915 is the angle formed between the endoscope length line 910 and the dotted line 914.

[0145] According to another embodiment, the shovel 402 is used as follows: Fig.15A As shown, turn upward, Fig. 15B Rotate downward as shown. Figures 15A-15B The illustrated embodiment provides flexibility in the function of the tool and increases the area of ​​target tissue 520 that can be manipulated with the tool without moving the endoscope 60.

[0146] Reference now Fig.16A . Fig.16A Based on an exemplary embodiment, a front perspective view of a shovel for lateral rotation is schematically shown. Dashed line 910 represents the length line of endoscope 60. According to one embodiment, as Fig.16A As shown, the shovel 402 is axially connected to the connector 404, and the longitudinal axis 470 is located at the intersection between the shovel 402 and the connector 404. The longitudinal axis 470 allows the shovel 402 to rotate to the right or left or both.

[0147] Fig.16A The shovel 402 is shown for turning to the right. Fig.16AIn the figure, the dotted line 916 represents the length line of the shovel 402 when the shovel 402 is rotated to the right, and the angle 917 is the angle formed between the line 910 of the endoscope length and the line 917 of the shovel length rotated to the right. Similarly, according to another embodiment, the shovel 402 is configured to rotate to the left, forming an angle between the endoscope length line 910 and the endoscope length line 910 after the shovel is rotated to the left. Even if this specific embodiment is not shown, it is easy to implement an embodiment in which the shovel 402 rotates to the left, based on the shovel 402 rotating to the right, such as Fig.16A The advantages of the shovel 402 for turning right or left or right and left are as follows Fig. 16B As shown below.

[0148] Reference now Fig. 16B According to an exemplary embodiment, a side perspective view of a spatula is schematically shown, the spatula being used to rotate to the right or to the left or to the right and to the left to separate the target tissue. Fig. 16B The great advantage of a shovel 402 for rotating to the right or to the left or to the right and to the left is shown. The present embodiment significantly increases the area that can be affected by the tools carried by the endoscope 60, which includes a shovel 402 for rotating to the right or to the left or to the right and to the left. For example, when the tool is a cutting tool 300, the ability of the shovel 402 to rotate to the side significantly increases the size of the incision 522 that can be made in the target tissue 520 compared to an endoscope 60 including a fixed shovel 402 as described above, and particularly compared to a prior art endoscope that does not include a shovel 402. As described above, the shovel 402 allows a tool, such as a cutting tool 300, to move freely within the width of the shovel 402 without moving the endoscope 60. This is an advantage over the prior art endoscope 60 that does not include a shovel 402, and therefore, the cutting tool 300 is fixed and the entire endoscope 60 needs to be moved from side to side to achieve a long, continuous incision 522. To this end, as shown in FIG. Figures 16A-16B The illustrated embodiment further increases the area of ​​influence of the tool, for example significantly increasing the size of the incision 522 , without requiring movement of the endoscope 60 .

[0149] Reference now Figures 17A-17B . Figures 17A-17B A front perspective view of a folding shovel is schematically shown in a folded state and an unfolded state according to an exemplary embodiment. Fig.17A The endoscope 60 is shown inserted into the cavity 550 and directed toward the target tissue 520. The endoscope 60 includes a foldable shovel 402 in a folded state within the endoscope 60. During the transition of the endoscope from the cavity 550 to the target tissue 520, the foldable shovel 402 remains in the folded state. When the endoscope 60 approaches the target tissue 520, the foldable shovel 402 is moved out of the endoscope 60 and unfolded or opened to form a foldable shovel. Fig. 17BIn the open state, the foldable scoop 420 extends beyond the width of the endoscope 60. Any folding mechanism of the foldable scoop 402 is within the scope of the present subject matter. According to an exemplary embodiment, as Fig. 17B As shown, the foldable shovel includes at least one shovel axis. Fig. 17B A folding shovel 402 is shown. Fig. 17B Includes two shovel axes - a first shovel axis 4027 and a second shovel axis 4029. According to one embodiment, the foldable shovel 402 is used to fold at the at least one shovel axis. Therefore, as described above, when the endoscope 60 is conveyed into the cavity 550, for example, in order to prevent the shovel 402 from contacting the tissue during the conveyance of the endoscope 60, the foldable shovel 402 is folded and maintained inside the endoscope 60. When the endoscope 60 reaches the target tissue 520, the foldable shovel 402 is moved out of the endoscope 60 and opened, for example, to dissect the target tissue 520, or to perform any other operation using the foldable shovel 402 in the open state. After the operation on the target tissue 520 is completed, the foldable shovel 402 is folded back to the closed state and pushed back into the endoscope 60, as shown. Fig.17A Any mechanism for moving the foldable scoop 402 to the outside and inside of the endoscope 60 and any mechanism for opening the foldable scoop 402 and returning the foldable scoop to the closed state are within the scope of the present application.

[0150] Reference now Figures 18A-18C . Figures 18A-18C Schematically shows a front perspective view of a shovel including a rotating sub-shovel according to an exemplary embodiment, in three states. According to one embodiment, as Figures 18A-18C As shown, the shovel 402 further includes a rotating sub-shovel 403 located above or below the shovel 402, and the rotating sub-shovel 403 is used to rotate to one side. The advantage of this embodiment is that the shovel 402 is allowed to extend in the width direction, for example, outside the width of the endoscope 60, thereby increasing the area that can be operated by the tool, such as the cutting tool 300. Fig.18A The shovel 402 as described above is shown, and the rotating sub-shovel 403 is placed on the shovel 402. In this position, the rotating sub-shovel 403 does not extend beyond the shovel 402. Fig.18B , the rotating sub-shovel 403 rotates to the right, thereby extending to the right side of the shovel 402. Fig.18C, the rotating sub-shovel 403 rotates to the left, thereby extending to the left side of the shovel 402. According to one embodiment, when the width of the rotating sub-shovel 403 is similar to the width of the shovel 402, the rotating sub-shovel 403 can expand the operating width of the shovel 402 to three times. In other words, in one embodiment, for example, using the cutting tool 300, when the rotating sub-shovel 403 is first rotated to the right and then to the left, while the endoscope 60 is fixed in place, the rotating sub-shovel 404 can increase the length of the incision 522 formed by the cutting tool 300 to three times.

[0151] from Fig.18B -C, the rotating sub-shovel 403 is similar to the push rod 402. For example, the rotating sub-shovel 403 includes a shovel track 113, similar to the shovel 402. As a result, when the rotating sub-shovel 403 is rotated to the right, a tool, such as a cutting tool 300, can be moved along the shovel track 113 of the shovel 402 and the shovel track 113 of the rotating sub-shovel frame 403, as shown in FIG18B, or to the left, as shown in FIG18B. Fig.18C shown.

[0152] As described above, according to one embodiment, Fig.18A As shown, the rotating sub-shovel 403 is located below the shovel 402. According to another embodiment, the rotating sub-shovel 403 is located above the shovel 402. Although the rotating sub-shovel 403 located on the shovel 402 is not shown in the figure, Figures 18A-18C This embodiment can be easily understood.

[0153] Reference now Figures 19A-19B . Figures 19A-19B According to an exemplary embodiment, a front perspective view of an endoscope including a spatula and a multi-tube cutting tool and a side perspective view of the spatula and the multi-tube cutting tool are schematically shown, respectively. Fig.19A An endoscope 60 is shown, which includes the shovel-shaped 402 as described above and a cutting tool 300 in the form of a multi-tube cutting tool 300. According to this embodiment, the cutting tool 300 is a radio frequency (RF) cutting tool 300 or a diathermic cutting tool 300. Such a cutting tool 300 is used to dissect tissue by heating the tissue by radio frequency or by high temperature. In addition, the cutting tool 300 described above, for example Figures 18A-18CThe cutting tool 300 shown in the figure may be an RF cutting tool 300 or a diathermic cutting tool 300. The cutting tool 300 includes a single tube that can emit RF or heat tissue. As a result, as described above, the cutting tool 300 needs to be moved along the shovel 402 in order to dissect the target tissue 520. However, the advantage of the shovel 402 is that it allows the use of a multi-tube cutting tool 300. According to the present embodiment, the multi-tube cutting tool 300 includes a plurality of tubes 302 disposed on the shovel 402. When it is necessary to dissect the target tissue, for example, at least one tube 302 located on one side of the shovel 402 is actuated, for example, to transmit RF or heat to the target tissue 520. Therefore, the target tissue 520 is dissected at the area of ​​the actuated at least one tube 302. Then, in order to continue to cut the target tissue 520, the at least one tube 302 is closed, and the at least one tube 302 located beside the first at least one tube 302 is actuated, thereby cutting the target tissue 520 at a position beside the first incision. Therefore, in this manner, the incision can be made along the width direction of the shovel 402 by alternately actuating the tubes 302 as described above. As previously described, the multi-tube cutting tool 300 of this embodiment offsets the mechanical movement of the cutting tool 300, thereby making the stripping of the target tissue 520 more rapid and accurate.

[0154] Reference now Fig. 20 . Fig. 20 Schematically illustrates a front perspective view of an endoscope according to an exemplary embodiment, the endoscope including a spatula and a multi-tube cutting tool and a spatula cover. Fig. 20 The endoscope 60 shown includes a shovel 402 and a multi-tube cutting tool, similar to Figures 19A-19B The embodiment shown, and the shovel cover 80, such as Fig.12 According to one embodiment, the scoop cover 80 is transparent and can be imaged using an endoscopic imaging device of the prior art.

[0155] Reference now Fig.21 . Fig.21 Schematically illustrates a side perspective view of an endoscope according to an exemplary embodiment, the endoscope including a shovel and a multi-tube cutting tool and a shovel cover, the shovel cover cutting the target tissue. Figures 19A-19B As described above, the target tissue 520 is dissected using the multi-tube cutting tool 300. During the dissection of the target tissue 520, a portion of the target tissue slides on the shovel cover 80, so compared with the endoscope 60 of the prior art, on the one hand, the target tissue 520 can be dissected in a spoon-like manner, and on the other hand, the components of the endoscope (such as the shovel 402 and the multi-tube cutting tool 300) can be prevented from contacting the tissue.

[0156] Reference now Fig. 22, which schematically shows an endoscope based on an exemplary embodiment, the endoscope includes a circular shovel and a circular multi-tube cutting tool, the cutting tool cutting the target tissue. According to one embodiment, as Fig. 22 As shown, the shovel 402 is a circular shovel 402-C extending from the distal edge of the endoscope 60. According to another embodiment, the multi-barrel cutting tool 300 is attached to the circular shovel 402-C, so that the multi-barrel cutting tool 300 becomes a circular multi-barrel cutting tool 300-C. The circular shovel 402-C and the circular multi-barrel cutting tool 300-C are capable of stripping the entire target tissue 520 while keeping the endoscope 60 fixed in place. During the stripping process of the target tissue 520, it is necessary to move the endoscope or the cutting tool 300 of the prior art. This is a huge advantage over the prior art endoscope 60 that cannot dissect the entire target tissue 520 while keeping the endoscope 60 fixed in place.

[0157] like Fig. 22 As shown, the endoscope 60 is inserted into the cavity 550, the circular scoop 402-C extends from the endoscope 60, and the circular multi-barreled cutting tool 300-C dissects the entire portion of the target tissue 520 while holding the endoscope 60 fixed in place. Fig. 22 Another embodiment shown involves the field of view 725 of the imaging device of the endoscope 60. According to one embodiment, the entire circular push rod 302-C, as well as the entire circular multi-barrel cutting tool 300-C, is in the field of view 725 of the imaging device of the endoscope 60. This embodiment allows the operator to visually inspect the entire peeling process of the target tissue 250 as described above.

[0158] Reference now Fig.23 , which schematically illustrates a side perspective view of an endoscope including a shovel and a lifting element based on an exemplary embodiment. According to one embodiment, the shovel 402 also includes a lifting element 26, which is used to lift the target tissue 520, for example, during manipulation of the target tissue 520. According to another embodiment, the lifting element 26 includes a tissue engaging element 262, which is used to engage with the target tissue 520 when lifting the target tissue 520. According to another embodiment, the tissue engaging element 262 has a high coefficient of friction. This embodiment is important so that the tissue engaging element 262 is tightly engaged with the target tissue 520 and avoids the target tissue 520 from slipping off the tissue engaging element 262 during the lifting of the target tissue 520.

[0159] According to one embodiment, the lifting element 26 is configured to be in a raised state or a lowered state. Any mechanism for lifting and lowering the lifting element 26, and more specifically, the tissue engaging element 262, is within the scope of the present application. Such exemplary mechanisms include Fig.23Therefore, according to one embodiment, the lifting element 26 includes at least one lifting arm 264, such as Fig.23 Two lifting arms 264 are shown, one side of the lifting arms 264 is attached to the tissue engaging element 262, and the opposite side is axially connected to the endoscope 60 or the distal edge 62 of the endoscope or the connector 404 of the shovel 402. According to another embodiment, the lifting element 26 is directly or indirectly connected to the operator of the endoscope 60 through a lifting cable 266 (for example, via a motor). According to one embodiment, the lifting cable 266 is attached to the tissue engaging element 262, such as Fig.23 According to another embodiment, the lifting cable 266 is attached to the at least one lifting arm 264 .

[0160] Reference now Figures 24A-24B . Figures 24A-24B Based on an exemplary embodiment, a side perspective view of an endoscope is schematically shown, the endoscope including a scoop and a lifting element, the lifting element being in a lowered state and a raised state for lifting a target tissue, respectively. Fig.24A The endoscope 60 is shown positioned adjacent to the target tissue 520 as the cutting tool 300 forms an incision 522 in the target tissue 520, with the result that a portion of the target tissue 520 is positioned over the spatula 402 and the connector 404. Additionally, the lifting element 26 is in a lowered state, and the tissue engaging element 262 is positioned in the incision 522 below the portion of the target tissue 520 that is positioned over the spatula 402 and the connector 404.

[0161] exist Fig. 24B The lifting element 26 is in a lifting state. This can be achieved by pulling the lifting cable 266. Fig.23 and 24A -B is attached to the tissue engaging element 262. When the lifting element 26 is in the lifting state, the tissue engaging element 262 engages the target tissue 520, especially the portion of the target tissue 520 located on the shovel 402 and the connector 404, and lifts the target tissue 520. Fig. 24B The embodiment shown in FIG. shows the advantages of the lifting element 26. By lifting the target tissue 520, the cutting tool 300 can be used to further dissect the target tissue and further expand the incision 522 in the target tissue 520. In addition, the use of the lifting element 26 allows the removal of tissue that can prevent the endoscope 60 from moving within the cavity 550.

[0162] Reference now Fig.25, which schematically shows a side perspective view of an endoscope based on an exemplary embodiment, the endoscope including a suction lifting element. According to one embodiment, the shovel 402 includes a suction lifting element 27, which is used to engage with the target tissue 520 through a suction force and lift or move the engaged target tissue 520 to one side. According to one embodiment, the suction lifting element 27 has a nozzle-like structure attached to the endoscope 60. According to another embodiment, the suction lifting element is attached to the shovel cover 80 or the connector 404 of the shovel 404. Even if these embodiments are not described in detail, the invention can be used to improve the quality of the endoscope. Fig.25 As shown in Fig.25 Understand.

[0163] According to one embodiment, the suction lifting element 27 is adapted to be moved or tilted in various directions, wherein Fig.25 752 designates that the suction lifting element 27 is used to move forward and backward along the length of the endoscope 60. Arrow 754 designates that the suction lifting element 27 is used to rotate left and right relative to the length of the endoscope 60. Arrow 756 designates that the suction lifting element 27 is used to move up and down. This versatility in the movement capabilities of the suction lifting element 27 provides a great deal of freedom in engaging the target tissue 520 from different positions, and also provides a great deal of freedom in the movement of the target tissue 520 after engagement with the suction lifting element 27.

[0164] According to one embodiment, the suction lifting element 27 includes a tissue attraction element 272 located at the distal end of the nozzle-like structure of the suction lifting element 27. The suction lifting element 27 is hollow, and the tissue attraction element 272 is an opening at the distal end of the suction lifting element. The tissue attraction element 272 is used to engage with the target tissue 520, and then the suction action in the suction lifting element 27 causes a vacuum force to be formed in the tissue attraction element 272, so that the target tissue 520 is held by the suction lifting element 27. When it is necessary to remove the target tissue 520 from the tissue attraction element 272, the suction action is terminated by the suction lifting element 27, resulting in the vacuum force in the tissue attraction element 272 being dissipated, and the target tissue 520 is removed from the tissue attraction element 272. The figures of these embodiments are shown below. Figures 26A-26B Given in.

[0165] According to one embodiment, the suction lifting element 27 further comprises at least one protrusion 274 on the top side of the suction lifting element 27. The at least one protrusion 274 allows for contact with the target tissue 520 in a manner similar to Fig.23 and 24A -The tissue engaging element 262 is engaged in the manner described in -B.

[0166] Reference now Figures 26A-26B . Figures 26A-26B Schematically illustrated are side perspective views of an endoscope according to an exemplary embodiment, the endoscope including a suction lift element engaged with target tissue, the suction lift element being in a lowered state and a raised state, respectively. Fig.26A The endoscope 60 is shown positioned adjacent to the target tissue 520 while the target tissue 520 is dissected using the cutting tool 300, thereby forming an incision 522 in the target tissue 520. Additionally, the suction lifting element 27 is lowered, and the tissue attraction element 272 engages the target tissue 520.

[0167] exist Fig.26B In the embodiment, after the target tissue 520 is attracted by the tissue attraction element 272, the suction lifting element 27 is lifted to the raised position. This allows the cutting tool 300 to further deepen the incision 522 in the target tissue 520. It should be noted that even if Fig.26B The figure also only shows a bottom view of the target tissue 520 being sucked by the suction lifting element 27. It should be understood that the suction lifting element 27 is configured to move in any desired direction, such as Fig.25 As shown, the target tissue 520 being aspirated can also be moved in any desired direction.

[0168] Other embodiments involve at least one protrusion 274. According to one embodiment, the at least one protrusion 274 is located on the top side of the suction lifting element 27, such as Fig.25 According to another embodiment, the at least one protrusion 274 is located on the bottom side of the suction lifting element 27. Fig.26B According to yet another embodiment, the at least one protrusion 274 is located on the top side and the bottom side of the suction lifting element 27 .

[0169] According to one embodiment, the at least one protrusion 274 has a high coefficient of friction and is used to engage with the target tissue 520 in a manner that keeps the target tissue engaged with the at least one protrusion 274 without causing the target tissue 520 to slip off the at least one protrusion 274. According to another embodiment, the at least one protrusion 275 is made of a material having a high coefficient of friction on the surface, such as silicon or a material similar to silicone.

[0170] Fig.26B The advantage of the at least one protrusion 274 in removing the target tissue 520 using the suction lifting element 27 is shown in FIG. Fig.26BThe suction lifting element 27 is shown being engaged with the target tissue 520 by suction of the tissue suction element 272. The engagement with the target tissue 520 occurs within the incision 522 formed in the target tissue 520. Then, in the process of lifting the target tissue 520 by lifting the suction lifting element 27, a portion of the target tissue 520 engages with the at least one protrusion 274 located on the bottom side of the suction lifting element 27. Since the target tissue remains engaged with the at least one protrusion 274, the target tissue 520 can be lifted and folded upward and pushed forward, for example, to access the cutting tool 300, for example, to further deepen the incision 522.

[0171] The present application also provides some improvements to the system that allows tools to enter all sides of the tissue being lifted 520. Below is a general description of the system that allows tools to enter all sides of the tissue being lifted, followed by a detailed description of some improvements in the system. For simplicity, the system that allows tools to enter all sides of the tissue being lifted 520 may occasionally be referred to as "system 1" hereinafter.

[0172] According to one embodiment, the system 1 is configured to allow various tools to access all sides of the elevated tissue 520. Some exemplary tools include: dissection tools, grasping tools, imaging tools, injection tools, combustion tools, and the like.

[0173] In some embodiments, the system 1 of the present application allows for the peeling and separation of the lifted tissue 520 from the surface tissue 510 in the patient's body. In some other embodiments, the system 1 of the present application also allows for the removal of the separated lifted tissue 520 from the patient's body.

[0174] According to one embodiment, the patient is an animal, in particular a vertebrate. According to another embodiment, the animal is a human.

[0175] The term "tool" as disclosed herein refers to any type of tool used when manipulating tissue within a patient's body. Some exemplary types of tools include: a dissection tool for dissecting tissue; a grasping tool for grasping a piece of tissue; a storage tool for storing an object, such as a piece of tissue, such as when removing the object from a patient's body; an imaging tool for acquiring images within a patient's body; a lighting tool for lighting within a patient's body; an injection tool for injecting a substance into tissue; a burning tool for burning a portion of tissue, or a combination thereof, etc.

[0176] Reference now Fig. 27 , which schematically illustrates a system based on an exemplary embodiment for allowing controlled manipulation of all sides of a raised tissue within a patient's body by a tool. Fig. 27Components of a system 1 are shown for allowing controlled manipulation of all sides of a tissue 520 being lifted in a patient's body, the system 1 comprising: A guide rail 110 for enclosing the lifted tissue 520 within the patient; and At least one carrier 120 is used to move along the guide rail 110 and carry at least one tool for operating the lifted tissue.

[0177] According to one embodiment, the carrier 120 is accompanied by at least one connector 122 for connecting at least one tool to the carrier 120 .

[0178] According to one embodiment, the tool is an integral part of the carrier 120. According to another embodiment, the tool is separate from the tool and is intended to be connected to the carrier 120.

[0179] like Fig. 27 As shown, the surface tissue 510 is a part of a cavity in a patient's body, and the lifted tissue 520 extends from the surface tissue 510. The guide rail 110 surrounds the lifted tissue 520, and the carrier 120 rests on the guide rail 110 or moves along the guide rail 110. Since the guide rail 110 surrounds the lifted tissue 520, and the carrier 120 is configured to move along the guide rail 110, the carrier 120 can surround the lifted tissue 520. Therefore, the system 1 allows the carrier 120 to enter at least a portion of the lifted tissue 520, up to all sides of the lifted tissue 520, thereby allowing tools connected to the carrier 120 to operate the lifted tissue 520.

[0180] Fig. 27 Also shown in the enlarged image of the circle in FIG. 1 is at least one connector 122 connected to the carrier 120. Thus, the system 1 allows any tool connected to the connector 122 to manipulate at least a portion of the tissue 520 being lifted, up to all sides of the tissue 520 being lifted.

[0181] According to one embodiment, the guide rail 110 and the carrier 120 are used for insertion into the patient's body. According to another embodiment, the guide rail 110 and the carrier 120 are used for insertion into a cavity in the patient's body. According to yet another embodiment, the guide rail 110 and the carrier 120 are used for manual insertion into the patient's body, or into a cavity in the patient's body. According to yet another embodiment, the guide rail 110 is used for insertion into the patient's body or a cavity of the patient's body through an endoscope. According to yet another embodiment, the carrier 120 is used for insertion into the patient's body or a cavity of the patient's body through an endoscope. According to yet another embodiment, both the guide rail 110 and the carrier 120 are configured to be inserted into the patient's body or a cavity of the patient's body through an endoscope. According to another embodiment, the insertion of the guide rail 110 or the carrier 120 or the guide rail 110 and the carrier 120 can be manual or autonomous, i.e., by a robotic mechanism. According to another embodiment, the rail 110 or the carrier 120, or both the rail 110 and the carrier 120, are configured to be inserted into a cavity in a patient's body or body through a multi-lumen conveyed by an endoscope.

[0182] Reference now Fig.28 , which schematically illustrates a guide rail surrounding a lifted tissue according to an exemplary embodiment, the guide rail protruding from an endoscope inserted into a cavity of a patient's body. Fig.28 Endoscope 60 is shown inserted into a cavity of a patient's body. Thus, surface tissue 510 is the tissue of the cavity. Fig.28 As shown, the endoscope 60 has a tubular structure and includes at least one channel, but preferably includes a plurality of channels 601, 602, 603, through which the guide rail 110, tools, or a combination of the guide rail 110 and tools can be transmitted. Fig.28 The guide rail 110 further shown in FIG. 1 exits the channel 601 of the endoscope 60 and surrounds the lifted tissue 520 extending above the surface tissue 510. In other words, Fig.28 An exemplary embodiment of a guide rail 110 is shown, which is configured to be inserted into a patient's body or a cavity in the patient's body through an endoscope 60, such as through a multi-lumen 70. In this embodiment, when the endoscope 60 is inserted into the patient's body, the guide rail 110 is located in a channel 601 of the multi-lumen 70 into which the endoscope 60 is inserted. When the endoscope 60 approaches the vicinity of the tissue 520 to be lifted, the multi-lumen 70 can leave the endoscope, such as Fig.29 As shown, the guide rail 110 can leave the channel 601 where the guide rail 110 is located and surround the tissue 520 being lifted.

[0183] Reference now Fig.29 , which schematically illustrates a guide rail approaching a tissue to be lifted according to an exemplary embodiment, the guide rail passing through a multi-lumen. Fig.29An internal cavity having a surface tissue 510 and a lifted tissue 520 extending above the surface tissue 510 is shown. Also shown is a multi-lumen 70 protruding from an endoscope 60 and approaching the vicinity of the lifted tissue 520. When the endoscope 60 is inserted into the cavity, the multi-lumen 70 is located in a working channel 601 of the endoscope 60, and the guide rail 110 is located in the multi-lumen 70 in the working channel 601 of the endoscope 60. When the endoscope 60 approaches the vicinity of the lifted tissue 520, the guide rail 110 can pass out from the channel 601 of the multi-lumen 70 toward the lifted tissue. Fig.29 The edge of the guide rail 110 passing through the channel 601 of the endoscope 60 is shown. After the guide rail 110 passes through the channel 601, the guide rail 110 is used to surround the lifted tissue 520. It should be noted that the guide rail 110 will be mentioned below as being located inside the endoscope 60. This description includes all embodiments of object storage in an endoscope, such as the working channel 601, the multi-lumen 70, etc.

[0184] It should be noted again that the guide rail 110 is inserted into the body near the lifted tissue 520 through the endoscope 60, and the presence or absence of the multiple lumens 70 in the endoscope 60 is only exemplary and should not be considered as limiting the scope of the present invention. The guide rail 110 can also be brought to the vicinity of the lifted tissue 520 by any other mechanism, such as manually during open surgery or by any other means, such as robotic arms, forceps, and combinations thereof.

[0185] According to one embodiment, the system 1 is disassembled. A capsule containing at least one component of the system 1 can be transferred to a target site in a patient's body through an endoscope, detached from the endoscope and left at the target site. Then, the components stored in the capsule, such as guides, tools, tools attached to a carrier, etc., can be exited from the capsule and operated at the target area.

[0186] The following are some improvements to the guide rail 110.

[0187] Reference now Fig. 30A . Fig. 30A A perspective view of a guide rail including a guide rail and a plurality of sleepers extending from the guide rail according to an exemplary embodiment is schematically shown. Fig. 30A A guideway 110 is shown including a guideway 102 and a plurality of sleepers 104 extending from the guideway 102. According to one embodiment, the guideway 102 is used to allow a vehicle 120 to move along the guideway 102. In other words, the vehicle 120 is used to contact the guideway 102 and move along the guideway 102.

[0188] Reference now Fig. 30B . Fig. 30B The schematic diagram shows the Fig. 30A An enlarged view of the track of the exemplary embodiment shown. According to one embodiment, as Fig. 30B As shown, the rail 102 may have a substantially U-shaped profile configured to contact the carrier 120 and allow the carrier 120 to move along the rail 102 .

[0189] return Fig. 30A When the guide rail 110 is in the unfolded state as shown in the figure, the majority of the guide rail 110 is substantially circularly folded. In this state, the substantially circularly folded portion of the guide rail 110 is configured to surround the tissue 520 being lifted, substantially as shown in FIG. Figure 2 , 3. According to one embodiment, the substantially circular folded state of the guide rail 110 is the default state of the guide rail 110. In other words, the guide rail 110 always tends to be in the substantially circular folded state. When the guide rail 110 is stored in the endoscope 60, the guide rail 110 is forced to adapt to the shape of the endoscope 60 and is thus forced to assume a shape determined by the shape of the endoscope 60, such as a linear shape. However, when the guide rail 110 is pushed out of the endoscope 60, for example, near the tissue 520 being lifted, as shown in FIG. Fig.29 As shown, the figure shows that in the early stages of the track 110 leaving the endoscope 60, the track 110 tends to return to its generally circular folded default state, thereby surrounding the lifted tissue 520.

[0190] Still refer to Fig. 30A . As described above, the guide rail 110 includes a plurality of sleepers 104 extending from the guide rail 102. According to one embodiment, the sleepers 104 extend substantially perpendicularly relative to the guide rail 102. According to another embodiment, the sleepers 104 extend from a portion of the guide rail 102 that is configured in a substantially circular folded state, i.e., a portion of the guide rail 102 that is configured to surround the lifted tissue 520. According to yet another embodiment, the sleepers 104 extend from both sides of the guide rail 102. In other words, there are sleepers 104 extending toward the inner circle of the guide rail 110, toward the lifted tissue surrounded by the guide rail 110; and the sleepers 104 extend out of the circular guide rail 110, away from the raised tissue 520 surrounded by the guide rail 110.

[0191] According to one embodiment, the sleepers 104 are configured to stabilize the rails 110 when the rails 110 surround the tissue 520 being lifted. This embodiment is achieved by increasing the contact area of ​​the rails 110 with the tissue. In addition, the single sleepers 104 in contact with the tissue are somewhat anchored in the tissue, thereby further stabilizing the rails 110. According to another embodiment, the sleepers 104 are configured not to harm the tissue they contact. For example, the edges of the sleepers are blunted to avoid stabbing the tissue. Another example can be that the sleepers 104 are elastic so that the sleepers 104 bend when the sleepers 104 press the tissue.

[0192] Reference now Fig. 30C Based on an exemplary embodiment, it is schematically shown Fig. 30A An enlarged view of the track and sleepers shown in . Fig. 30A Some dimensions of the sleeper 104 are shown. The sleeper 104 has a length 104-L, which is the distance between the guide rail 102 from which the sleeper 104 extends and the distal edge 104-E of the sleeper 104; Fig. 30C Width 104-W, height 104-H are shown. According to one embodiment, the size of the sleepers 104 and the type of material from which the rail 110 is made determine the level of elasticity and rigidity of the rail 110, particularly in a default portion of the rail 110 having a generally circular folded state.

[0193] Reference now Fig.31 , which schematically shows a perspective view of a guide rail based on an exemplary embodiment, the guide rail includes a track and a plurality of sleepers extending from the track, the guide rail passes through an endoscope and surrounds the lifted tissue, at which time the carrier is located on the guide rail or moves along the guide rail and cuts the lifted tissue. Fig.31 The guide rail 110 is shown extending out of the endoscope 60 and surrounding the lifted tissue 520. The figure well shows how the rail sleepers 104 of the guide rail 110 contact the surface tissue 510 and the lifted tissue 520, thereby stabilizing the guide rail 110 in the appropriate position. Fig.31 As shown, the carrier 120 is stationary on the guide rail 110 or moves along the guide rail 110 while cutting the tissue being lifted. The circular arrow 910 represents an exemplary path 910 of the carrier 120 along the guide rail 110. The dotted line 521 represents a predetermined or pre-planned cutting line 521 of the lifted tissue 520, which will be cut by the cutting tool attached to the carrier 120.

[0194] In use Fig. 27 In experiments conducted with the guide rail 110 (excluding the sleepers 104) and the carrier 120 shown, it was found that the tissue 520 being lifted, especially soft tissue 520 being lifted, tended to sag on the guide rail 110 and prevent the carrier 120 from moving along the guide rail 110, thereby interfering with the cutting of the lifted tissue. However, in similar experiments conducted with the guide rail 110, including the guide rail 102 and a plurality of sleepers 104 extending from the guide rail 104, as shown in FIG. Fig.31As shown, it is found that the sleeper 104 removes the lifted tissue 520 from the guide rail 102, thereby allowing the carrier 120 to move freely along the guide rail 110 and cut the lifted tissue 520 without interference. Therefore, according to one embodiment, the sleeper 104 is used to remove the tissue from the guide rail 110 and allow the carrier 120 to move along the guide rail 110 without interference. More specifically, the sleeper 104 is used to remove tissue on both sides of the guide rail 110, one side of the guide rail 110 is in contact with the lifted tissue 520, and the sleeper 104 extends away from the lifted tissue 520. This clears the way on both sides of the guide rail 110 to allow the carrier 120 to move smoothly along the guide rail 110.

[0195] Another feature of the sleeper 104 is that the sleeper 104 increases the contact area between the guide rail 110 and the tissue, thereby improving the stability of the guide rail 110. The high stability of the guide rail 110 is particularly important when manipulating the lifted tissue 520, such as when cutting the lifted tissue 520.

[0196] Furthermore, it was found that when the tissue to be lifted is asymmetrical in nature, the sleeper 104 facilitates the formation of the lifted tissue having a symmetrical structure. It is advantageous for the lifted tissue 520 to be a symmetrical structure because it allows for more accurate cutting of the lifted tissue 520. Furthermore, it was found that the sleeper 104 facilitates the formation of the lifted tissue 520 having a clear mushroom-like shape, which is a preferred shape of the target tissue in the patient's tissue anatomy.

[0197] Furthermore, it has been found that the sleeper 104 creates a linear path on the tissue, even in cases where the tissue is not planar, but folded, or not straight in nature, such as in the stomach or intestines. This linear path is advantageous because it provides a linear path for the vehicle 120 to move smoothly, even on folded tissue.

[0198] Reference now Fig.32 , which schematically shows a top view of a guide rail based on an exemplary embodiment, the guide rail comprising a track and a plurality of sleepers extending from the track, the guide rail passing through an endoscope and having different deployment stages. Fig.32 The guide rail 110 is shown passing through the endoscope 60 and assumes the default substantially circular state as described above. During the process of cutting the lifted tissue 520 by the cutting tool 300 connected to the carrier 120 traveling along the guide rail 110, the diameter of the lifted tissue 520 at the cutting line 521 is reduced (see Fig.31). Therefore, in order to allow the cutting tool 300 to continue to contact the lifted tissue 520 at the cutting line 521, the diameter of the circle formed by the guide rail 110 must be correspondingly reduced to further cut the lifted tissue 520. This is achieved by pulling the guide rail 110 back into the endoscope 60 during the cutting of the lifted tissue 520 to reduce the diameter of the annular guide rail 110.

[0199] During the cutting of the lifted tissue 520, the operation of pulling the rail 110 back to the endoscope 60 is performed by the operator of the system 1. According to one embodiment, the operator can obtain a visual image of the lifted tissue 520 dissected during the cutting process through the camera of the endoscope 60, and determine when and to what extent the guide rail 110 needs to be pulled to strengthen its grasp of the lifted tissue 520 based on the image. For example, the operator can compare the visual image of the lifted tissue with the pre-planned image of the operation stage to determine when and how to pull the guide rail 110. The operator can also determine the distance between the edge to the lifted tissue 520 and the guide rail 102 or the sleeper 104. When the distance is greater than a certain predetermined value, it is necessary to pull the guide rail 110 until the distance is close enough. In addition, the operator can see the coverage level of the lifted tissue 520 on the sleeper 104. When the sleeper 104 is at least partially covered by the lifted tissue 520, this indicates that the guide rail 110 is sufficiently close to the lifted tissue 520, and there is no need to pull the guide rail 110. On the other hand, when the sleeper 104 is exposed, this indicates that the guide rail 110 is far away from the lifted tissue 520, and it is necessary to pull the guide rail 520 in order to fasten the lifted tissue 520 by the guide rail 110.

[0200] According to another embodiment, a pressure sensor or a contact sensor may be attached to the guide rail 110, for example, to the sleeper 104. When the pressure sensor detects pressure, or when the contact sensor detects contact, it indicates that the sleeper 104 is covered by the tissue 520 being lifted, and there is no need to pull the guide rail 110. On the other hand, when a lower pressure on the pressure sensor is sensed, or when the contact sensor does not detect contact, it indicates that the guide rail is disconnected from the tissue 520 being lifted, and it is necessary to pull the guide rail 110 to bring the guide rail 110 closer to the tissue 520 being lifted.

[0201] According to yet another embodiment, the operator can feel the force he is using to pull the guide rail 110. When the guide rail 110 is away from the tissue 520 being lifted, the resistance to the pulling force applied to the guide rail 110 is lower. This indicates to the operator that the guide rail 110 needs to be pulled further until the guide rail 110 contacts the tissue 520 being lifted and the resistance to the pulling force applied to the guide rail 110 increases.

[0202] Dashed lines 110-A, 110-B, and 110-C represent various positions of the guide rail 110 during the process of cutting the lifted tissue 520. Line 110-A represents the initial state, when the guide rail 110 just surrounds and lifts the lifted tissue 520, and line 110-B represents the intermediate state, when the lifted tissue 520 is partially cut, and the diameter of the cutting line 521 of the lifted tissue 520 is reduced. At this stage, the guide rail 110 is partially pulled into the endoscope 60, and as a result, the circle of the guide rail 110 now corresponds to the dashed line 110-B. When the lifted tissue 520 is almost completely cut, line 110-C represents the final state, and the diameter of the cutting line 521 of the lifted tissue 520 is further reduced. At this stage, the guide rail 110 is further pulled into the endoscope 60, and as a result, the circle of the guide rail 110 now corresponds to the dashed line 110-C. Fig.32 As shown, a portion of the guide rail 110 is pulled back into the endoscope 60, which is shown in a transparent view.

[0203] Still refer to Fig.32 . According to one embodiment, the sleeper 104 is foldable and can be in two states: an unfolded state and a folded state, wherein in the unfolded state, the sleeper extends substantially perpendicular to the guide rail 102; in the folded state, the sleeper 104 is folded and parallel to the guide rail 102 and is substantially tightly connected to the guide rail 102. According to another optional embodiment, the unfolded state is the default state of the sleeper 104. In other words, the sleeper 104 naturally tends to extend from the guide rail 102. When the guide rail 110 is free, that is, not inside the endoscope 60, the sleeper 104 extends. As a result, when the sleeper 104 is forced to do so, for example when the guide rail 110 is inside the endoscope 60, the sleeper 104 assumes a folded state. Any mechanism that allows the connection state to be changed between the unfolded state and the folded state belongs to the scope of the present application. Some exemplary mechanisms include: the sleeper 104 is pivotally attached to the guide rail 102; the guide rail 102 and the sleeper 104 are made of memory material, and the shape memory design makes the default state of the sleeper 104 be the unfolded state, etc. Another mechanism involves the use of a string 106, as shown below:

[0204] Still refer to Fig.32 , the straps of the guide rail 110 extending to the same side of the guide rail 104 are connected by at least one string 106. Fig.32As shown, the sleepers 104 extending toward the inner circle of the guide rail 110 or the lifted tissue 520 surrounded by the guide rail 110 are connected to the string 106; and the sleepers 104 extending outward from the circle or away from the lifted tissue 520 are connected to the string 106. However, it should be noted that according to some other embodiments, only the sleepers 104 extending toward the lifted tissue 520 are connected to the string 106, or only the sleepers 104 extending away from the lifted tissue 520 are connected to the string 106.

[0205] According to one embodiment, the string 106 passes through the endoscope 60 and can be operated by a user or operator of the guide rail 110. In other words, the pushing and pulling of the string 106 is performed by the user or operator of the guide rail 110. For example, the string 106 can be pulled to change the sleeper 104 from the deployed state to the folded state, or pushed to change the sleeper 104 from the folded state to the deployed state. In an embodiment where the sleeper 104 has a shape memory of the deployed state, the string 106 is also applicable. In this embodiment, the string 106 can be pulled to force the extended sleeper 104 to fold, or the string 106 can be released to allow the sleeper 104 to return to the default deployed state.

[0206] According to one embodiment, the guide rail 110 generally has three states: a storage state, when the shape of the guide rail 110 is defined by the shape of the endoscope 60, the guide rail 110 is in a storage state within the endoscope 60; an expanded state, the guide rail 110 passes out of the endoscope 60 and assumes a default generally circular folded state, thereby surrounding the tissue being lifted; a working state, the lifted tissue 520 is processed by a tool attached to the carrier 120 moving along the guide rail 110, when the tool is a cutting tool 300, the guide rail 110 is gradually pulled back into the endoscope 60, thereby reducing the diameter of the circle of the guide rail 110; and a completion state, after the lifted tissue 520 is processed, the entire guide rail 110 is pulled back into the endoscope 60 and is forced to assume a shape similar to the endoscope 60. The completion state essentially returns the guide rail 110 to the storage state.

[0207] Some improvements to the tool are as follows:

[0208] Reference now Fig.33 , which schematically shows a side view of a tool including a sheath according to an exemplary embodiment. Fig.33 The guide rail 110 as described above is shown, which includes a track 102, a sleeper 104, a vehicle 120 that moves or is stationary along the guide rail 110, and a tool attached to the vehicle 120, such as a cutting tool 300. Fig.33, the cutting tool 300 cuts the lifted tissue 520 surrounded by the guide rail 110. In experiments using the cutting tool 300, without any additional components, during the cutting process, the lifted tissue was found to tend to collapse on the cutting tool 300, thereby hindering the movement of the carrier 120 carrying the cutting tool 300, hindering the insertion of the cutting tool 300 into the lifted tissue 520 to be dissected to further cut the lifted tissue 520, and also causing the cutting tool 300 to bend if the cutting tool 300 is not rigid enough. The sheath 310 that at least partially envelops the cutting tool 300 overcomes the above challenges.

[0209] According to one embodiment, the cutting tool 300 includes a sheath 310 that at least partially wraps around the cutting tool 300. According to another embodiment, the sheath 310 is used to support the cutting tool 300 and prevent the cutting tool 300 from bending. According to yet another embodiment, the sheath 310 is configured to remove the collapsed tissue 520 from the cutting tool 300, thereby allowing the cutting tool 300 to freely cut the lifted tissue 520, and also allowing the carrier 120 carrying the cutting tool 300 to move along the guide rail 110 without interference.

[0210] According to one embodiment, Fig.33 As shown, the sheath 310 is made of a plurality of ribs 3102 arranged around at least a portion of the cutting tool 300 and parallel to the cutting tool 300 when there are gaps between adjacent ribs 3102. According to another embodiment, the sheath 310 is a complete cylinder that at least partially encapsulates the cutting tool 300.

[0211] According to one embodiment, the sheath 310 has a width 310-W. According to another embodiment, the width 310-W of the sheath 310 is large enough to effectively remove the collapsed lifted tissue 520 from the cutting tool 300. For example, the width 310-W of the sheath 310 is substantially 1.5 mm.

[0212] According to one embodiment, the edge of the sheath 310 that contacts the collapsed, lifted tissue 520 is straight, such as Fig.33 Even though the edge of the sheath 310 may have any other shape, such as a circle, it is preferred that the edge be in a straight shape in terms of effectively removing the collapsed lifted tissue 520 from the cutting tool 300 .

[0213] Reference now Fig.34 , which schematically shows a top view of a cutting tool including a dynamic tissue remover based on an exemplary embodiment. Another method of removing the collapsed lifted tissue 520 from the cutting tool 300 is to use a Fig.34 The dynamic tissue remover 340 is shown. According to one embodiment, the dynamic tissue remover 340 includes a slider 342, which is attached to the cutting tool 300 and is used to slide along the cutting tool 300, a first operating arm 344 is pivotally attached to one side of the slider 342, and a second operating arm 346 is pivotally attached to the opposite side of the slider 342. Fig.34 Two states of the dynamic tissue remover 340 are shown. The dynamic tissue remover 340, drawn in white, is in a dormant state 340-R and the dynamic tissue remover 340, drawn in black, is in a pushed state 340-P. In the dormant state 340-R, the slider 342 is positioned far away from the edge 300-E of the cutting tool 300 and the first operating arm 344 and the second operating arm 346 are pulled away from the lifted tissue 520 cut by the cutting tool 300. In the dormant state 340-R, no tissue is removed from the cutting tool 300. In order to bring the dynamic tissue remover 340 to the pushed state 340-P, the slider 342 is pushed toward the edge 300-E of the cutting tool 300. As a result, the first operating arm 344 and the second operating arm 366 are pushed toward the lifted tissue 520 and, as a result, the lifted tissue 520 is removed from the edge 300-E of the cutting tool 300, thereby allowing undisturbed cutting of the lifted tissue 520 and free movement of the carrier 120 carrying the cutting tool 300.

[0214] According to one embodiment, the dynamic tissue remover 340 further includes an elastic member 348, such as a spring 348, which presents one of the states of the dynamic tissue remover 340 as a default value. According to one embodiment, the spring 348 presents the dormant state 340-R by default. According to another embodiment, the spring 348 sets the push state 340-P as a default value. When the dynamic tissue remover 340 is placed in a non-default corresponding state, the dynamic tissue remover 340 automatically returns to the default state when released.

[0215] A system is provided for allowing controlled access of tools to all sides of elevated tissue of a patient's body, the system comprising: A guide rail for surrounding the tissue to be lifted; and at least one carrier, adapted to move along the guide rail and carry at least one tool for manipulating the lifted tissue; The guide rail includes a track and a plurality of sleepers extending from the track.

[0216] According to one embodiment, the patient is an animal.

[0217] According to one embodiment, the animal is a vertebrate.

[0218] According to one embodiment, the animal is a human.

[0219] Also provided is a system for allowing a cutting tool to controllably access all sides of elevated tissue within a patient, the system comprising: A guide rail for surrounding the tissue to be lifted; and At least one carrier is used to move along the guide rail and carry at least one cutting tool, wherein the cutting tool includes a blade for cutting the lifted tissue.

[0220] According to one embodiment, the patient is an animal.

[0221] According to one embodiment, the animal is a vertebrate.

[0222] According to one embodiment, the animal is a human.

[0223] According to one embodiment, the cutting tool comprises a sheath at least partially wrapping around the cutting tool.

[0224] According to one embodiment, the sheath is made of a plurality of ribs arranged around at least a portion of the cutting tool and parallel to the cutting tool when there are gaps between adjacent ribs.

[0225] According to one embodiment, the enclosure is a complete cylinder at least partially enclosing the cutting tool.

[0226] According to one embodiment, the cutting tool comprises a dynamic tissue remover.

[0227]

[0013] Also provided is a system for allowing controlled access of a tool to all sides of tissue being elevated in a patient's body, as described herein in conjunction with the accompanying drawings.

[0228] It should be understood that, for clarity, certain features of the subject matter described in separate embodiments may also be provided in combination in a single embodiment. Conversely, for brevity, various features of the subject matter described in a single embodiment may also be provided separately or in any suitable sub-combination.

[0229] Although the present application has been described in conjunction with its specific embodiments, it is obvious to those skilled in the art that many substitutions, modifications and changes will be apparent to those skilled in the art. Accordingly, the present invention is intended to accept all such substitutions, modifications and changes that fall within the spirit and broad scope of the appended claims.

Claims

1. A shovel, characterized in that: For attachment to the distal edge of an endoscope and protruding from a lower portion of the distal edge.

2. An endoscope, characterized in that: The endoscope includes the spatula of claim 1 attached to a distal edge of the endoscope.

3. The shovel according to any one of claims 1 to 2, characterized in that: The scoop has a generally concave configuration.

4. The shovel according to any one of claims 1 to 3, characterized in that: Also included is a connector for connecting the spatula to the distal edge of the endoscope.

5. The shovel according to any one of claims 1 to 4, characterized in that: It also includes a shovel rail extending along the width direction of the shovel and substantially perpendicular to the length direction of the endoscope, wherein the shovel rail is used to allow the carrier to move along the shovel rail, thereby allowing the carrier to move along the width direction of the shovel.

6. The endoscope according to any one of claims 2 to 5, characterized in that: Also included is a clamp connected to a distal edge of the endoscope, wherein the clamp is used to clamp target tissue adjacent to the spatula.

7. The shovel according to any one of claims 1 to 6, characterized in that: The shovel further includes a shovel cover including a covering element for covering the shovel from above and allowing a tool to protrude from the shovel.

8. The shovel according to claim 7, characterized in that: The scoop cover includes an opening at a front side relative to the distal edge of the endoscope, the opening being configured to allow a tool to protrude therefrom.

9. The shovel according to any one of claims 7 to 8, characterized in that: The shovel cover permanently covers the shovel.

10. The shovel according to any one of claims 7 to 8, characterized in that: The shovel cover is detachable.

11. The shovel according to any one of claims 7 to 10, characterized in that: The scoop cover is connected to a cap connector for connecting the scoop cover to the distal edge of the endoscope.

12. The shovel according to claim 11, characterized in that: The cap connector is in the form of a sleeve that engages the distal edge of the endoscope.

13. The shovel according to any one of claims 11 to 12, characterized in that: The cover connector is adapted to be permanently connected to the distal edge.

14. The shovel according to any one of claims 11 to 12, characterized in that: The cover connector is adapted to be removably connected to the distal edge.

15. The shovel according to any one of claims 7 to 14, characterized in that: The covering element is at least partially foldable.

16. The shovel according to any one of claims 4 to 15, characterized in that: The shovel is axially connected to the connector by a transverse shaft, which is located at the bottom of the connector and allows the shovel to rotate upward, or downward, or both upward and downward.

17. The shovel according to any one of claims 4 to 16, characterized in that: The shovel is axially connected to the connector by a longitudinal axis, which is located at the connection between the shovel and the connector, and the longitudinal axis allows the shovel to rotate to the right, or to the left, or to the right and left.

18. The shovel according to any one of claims 1 to 17, characterized in that: It also comprises a rotating sub-shovel (403) located above or below the shovel, and the rotating sub-shovel (403) is used to rotate sideways, thereby allowing the width of the shovel to be extended.

19. The shovel according to any one of claims 1 to 18, characterized in that: Also included is a multi-tube cutting tool, wherein the multi-tube cutting tool includes a plurality of tubes disposed on the spatula.

20. The shovel according to any one of claims 1 to 19, characterized in that: Also included is a lifting element for lifting the target tissue, wherein the lifting element is configured to be in a raised state and a lowered state.

21. The shovel according to claim 20, characterized in that The lifting element includes a tissue engaging element for engaging the target tissue while lifting the target tissue.

22. The shovel according to claim 21, characterized in that The tissue engaging element has a high coefficient of friction, thereby allowing the tissue engaging element to closely engage with the target tissue and preventing the target tissue from slipping off the tissue engaging element during lifting of the target tissue.

23. The shovel according to any one of claims 1 to 19, characterized in that: Also included is a suction and lifting element, which is used to engage with the target tissue and lift or move the engaged target tissue through suction force, wherein the suction and lifting element has a nozzle-shaped structure.

24. The shovel according to claim 23, characterized in that The suction and lifting element includes a tissue suction element located at the distal end of the nozzle-like structure of the suction and lifting element, and the suction and lifting element is hollow. The tissue suction element is an opening at the distal end of the suction and lifting element, and the tissue suction element is used to engage with the target tissue. The suction force of the suction and lifting element forms a vacuum force in the tissue suction element, so that the target tissue is clamped by the suction and lifting element.

25. The shovel according to any one of claims 23-24, characterized in that: The suction lifting element further comprises at least one protuberance on the top side or the bottom side of the suction lifting element, or at least one protuberance on the top side and the bottom side of the suction lifting element, wherein the at least one protuberance enables engagement with the target tissue.

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