Medical device components, assemblies, and related methods

Abstract

A lifter for a medical device may include a plurality of segments coupled together by at least one hinge, and a control element coupled to at least one of the plurality of segments. A first segment of the plurality of segments may be a discrete structure. Proximal or distal movement of the control element may be configured to move the at least one of the plurality of segments relative to another of the plurality of segments.

Description

[0001] Cross - Reference to Related Applications

[0002] This application claims the benefit of priority under 35 U.S.C. § 119 to U.S. Provisional Application No. 63 / 376,679, filed on September 22, 2022, which is hereby incorporated by reference in its entirety. Technical Field

[0003] Aspects of the present disclosure generally relate to medical device components, assemblies, and related methods. In particular, aspects of the present disclosure relate to aspects such as elevators of duodenoscopes. Background Art

[0004] A duodenoscope may include a handle and a sheath that can be inserted into a subject's body cavity. The sheath may terminate in a distal end portion that may include features such as optical elements (e.g., cameras, illumination), air / water outlets, and working channel openings. An elevator may be provided at the distal end and may be actuated to change the orientation of a medical device / tool passing through the working channel. For example, the elevator may be pivotable or otherwise movable.

[0005] Elements in the handle may control elements at the distal end. For example, buttons, knobs, levers, etc. may control elements at the distal end. The elevator may be controlled via a control mechanism (such as a lever) in the handle that may be attached to a control wire that is attached to the elevator. When an actuator (e.g., a lever) is actuated, the wire may move proximally and / or distally to raise and / or lower the elevator. Summary of the Invention

[0006] Each of the aspects disclosed herein may include one or more of the features described in connection with any of the other disclosed aspects.

[0007] In one example, an elevator of a medical device may include: a plurality of segments coupled together by at least one hinge and a control element coupled to at least one of the plurality of segments. A first segment of the plurality of segments may be a discrete structure. Movement of the control element proximally or distally may be configured to cause the at least one of the plurality of segments to move relative to another of the plurality of segments.

[0008] Additionally or alternatively, any one of the devices disclosed herein includes any one of the following features in any combination. The plurality of segments may all be discrete structures. The plurality of segments may consist of a first segment and a second segment. In a first configuration, the plurality of segments may all be arranged along a substantially straight line. The substantially straight line may be substantially parallel to the longitudinal axis of the medical device. The control element may be a first control element, and the elevator may further include a second control element coupled to at least one of the plurality of segments. Movement of the second control element proximally or distally may be configured to move at least one of the plurality of segments relative to another of the plurality of segments. Each of the plurality of segments may define a first channel for receiving the first control element. Each of the plurality of segments may define a second channel for receiving the second control element. The first control element may be coupled to a first actuator of the handle of the medical device. The second control element may be coupled to a second actuator of the handle of the medical device. The first actuator and the second actuator may be actuated independently of each other. The most distal segment of the plurality of segments may include a socket on an outer surface of the most distal segment. The socket may be configured to receive a distal end of the control element. The first segment may include a first distal surface. The second segment of the plurality of segments may include a first proximal surface and a second distal surface. The third segment of the plurality of segments may include a second proximal surface. The first distal surface of the first segment and the first proximal surface of the second segment may be separated by a first angle. The second distal surface of the second segment and the second proximal surface of the third segment may be separated by a second angle. The second angle may be different from the first angle. Each segment of the plurality of segments may include a base wall, a first side wall, and a second side wall. The first side wall of each segment may define a channel configured to receive the control element. The width of the first side wall of each segment may be greater than the width of the second side wall of each segment. At least one hinge may include a pin or a rivet. The most distal segment of the plurality of segments may include a protrusion extending distally. The control element may be attached to the protrusion. The most proximal segment of the plurality of segments may include an axle configured to rotatably couple to a distal end of the medical device. Prior to rotation of the most proximal segment of the plurality of segments relative to the distal end of the medical device, at least one of the plurality of segments may be configured to rotate relative to the most proximal segment of the plurality of segments when the control element moves distally.

[0009] In another example, an elevator of a medical device may include: a plurality of segments coupled together by at least one hinge, a first control element coupled to at least one of the plurality of segments, and a second control element coupled to at least one of the plurality of segments. Movement of the first control element proximally or distally may be configured to move at least one of the plurality of segments relative to another of the plurality of segments, and movement of the second control element proximally or distally may be configured to move at least one of the plurality of segments relative to another of the plurality of segments.

[0010] Additionally or alternatively, any of the devices described herein may include any of the following features in any combination. At least two of the plurality of segments are integrally formed with each other. Each of the plurality of segments may define a first channel for receiving a first control element. Each of the plurality of segments may define a second channel for receiving a second control element.

[0011] In another example, a lifter of a medical device may include: a first segment, a second segment, a third segment, a first hinge between the first segment and the second segment, and a second hinge between the second segment and the third segment. The first segment may include a first distal surface, the second segment may include a first proximal surface and a second distal surface, the third segment may include a second proximal surface, the first distal surface of the first segment and the first proximal surface of the second segment may be separated by a first angle, wherein the second distal surface of the second segment and the second proximal surface of the third segment may be separated by a second angle, and the second angle may be different from the first angle.

[0012] Additionally or alternatively, any of the devices described herein may include any of the following features in any combination. The first segment, the second segment, and the third segment may be integrally formed with each other.

[0013] It is to be understood that the foregoing general description and the following detailed description are merely exemplary and explanatory and do not limit the claimed invention. As used herein, the term "comprising," "including," or any other variation thereof is intended to cover a non-exclusive inclusion such that a process, method, article, or apparatus that includes a list of elements does not include only those elements but may include other elements not expressly listed or inherent to such process, method, article, or apparatus. In the case where an element is non-circular, the term "diameter" may refer to the width. The term "distal" refers to the direction away from the operator, and the term "proximal" refers to the direction toward the operator. The term "exemplary" is used in the sense of "an example" rather than "an ideal." The term "about" or a similar term (e.g., "substantially") includes the recited numerical value plus or minus 10%. BRIEF DESCRIPTION OF THE DRAWINGS

[0014] The drawings incorporated in and constituting a part of this specification illustrate aspects of the disclosure and, together with the description, serve to explain the principles of the disclosure.

[0015] Figure 1A and Figure 1B show an exemplary medical device.

[0016] Figures 2A - 2C show an exemplary lifter that may be used with Figures 1A - 1B the exemplary medical device.

[0017] Figures 3A - 3C show another exemplary lifter.

[0018] Figure 4 and Figure 5 shows Figures 2A - 3C multiple aspects of an elevator.

[0019] FIG. 6 shows another exemplary elevator.

[0020] Figures 7A - 7E Shows exemplary elevators in various configurations.

[0021] Figures 8A - 8B Shows another exemplary elevator.

[0022] Figures 9A - 9C Shows another exemplary elevator.

[0023] Figures 10A - 10C Shows another exemplary elevator. DETAILED DESCRIPTION

[0024] A duodenoscope or other medical device (e.g., an endoscopic ultrasound (“EUS”)) may include a distal end having an elevator. The elevator may be operatively connected to an actuator in the handle of the duodenoscope. When the operator activates the actuator, the elevator may be raised / lowered. When the operator inserts an accessory device (e.g., an instrument for a guidewire) into the working channel of the duodenoscope and advances the instrument through the working channel, the elevator may initially be in a lowered configuration. After the accessory device extends out of the distal opening of the working channel, the elevator may be raised to deflect the distal end of the instrument. For example, such deflection may be used for the operator to access the biliary tract of a subject and / or intubate the main papilla of the subject.

[0025] A conventional rigid elevator having a spoon-shaped guiding surface may deflect the instrument to a lowered configuration as well as a raised configuration. In other words, such an elevator may cause even the portion of the accessory device in a fully open / lowered configuration to be partially articulated / deflected. Such a rigid spoon-shaped elevator may also allow limited articulation options (e.g., only a fully open / down position or a fully closed / up position). A segmented elevator may allow the elevator to lie flat completely when in the open / down position (e.g., placed substantially parallel to the longitudinal axis of the distal end of the duodenoscope). A completely flattened elevator may allow the accessory device to extend straight out from the distal surface of the duodenoscope (e.g., substantially parallel to the central longitudinal axis of the distal end of the duodenoscope). The segmented elevator may also or alternatively facilitate incremental deflection of the accessory device. The operator may have additional control over the accessory device because the operator can gradually articulate the elevator in a segment-by-segment manner to facilitate access to anatomical structures (e.g., the bile duct and pancreatic duct). The segmented elevator may allow the operator to deflect the accessory device to multiple different angles transverse to the central longitudinal axis of the duodenoscope and maintain its deflected position.

[0026] Figure 1A An exemplary duodenoscope 10 having a handle 12 and an insertion portion 14 is shown. Figure 1B The proximal end of the handle 12 is shown. The duodenoscope 10 may also include an umbilical 16 to connect the duodenoscope 10 to a source of, for example, air, water, aspiration, power, etc., and to an image processing and / or viewing device. Although reference may be made herein to a duodenoscope, it should be understood that the present disclosure also encompasses endoscopes, bronchoscopes, gastroscopes, endoscopic ultrasounds, colonoscopes, ureteroscopes, bronchoscopes, laparoscopes, cystoscopes, aspiration scopes, sheaths, catheters, or similar devices. The reference herein to a duodenoscope should be understood to encompass any of the above medical devices.

[0027] The insertion portion 14 may include a sheath or shaft 18 and a distal end 20. The distal end 20 may include an imaging device 22 (e.g., a camera) and a light source 24 (e.g., an LED or an optical fiber). The distal end 20 may be lateral. That is, the imaging device 22 and the light source 24 may face radially outwardly, vertically, substantially vertically, or otherwise laterally with respect to the longitudinal axis of the shaft 18 and / or the distal end 20. Additionally or alternatively, the distal end 20 may include one or more imaging devices 22 that face in more than one direction. For example, a first imaging device 22 may face radially outwardly and a second imaging device 22 may face distally (substantially parallel to the longitudinal axis of the distal end 20 / shaft 18).

[0028] The distal end 20 may also include a lifter 26 to change the orientation of a tool in the working channel of the inserted duodenoscope 10. The lifter 26 may alternatively be referred to as a swing bracket, a pivot bracket, a lift base, or any other suitable term. The lifter 26 may be pivotable via, for example, an actuation wire or another control element that extends from the handle 12 through the shaft 14 to the lifter 26.

[0029] The distal portion of the shaft 18 connected to the distal end 20 may have a steerable section 28. The steerable section 28 may be, for example, a hinge joint. The shaft 18 and the steerable section 28 may include a variety of structures that are known or will be known in the art.

[0030] The handle portion 12 may have one or more actuators / control mechanisms 30. The control mechanism 30 may provide control of the steerable section 28, or may allow the provision of air, water, suction, etc. For example, the handle portion 12 may include control knobs 32, 34 for left, right, up, and / or down control of the steerable section 28. For example, rotation of one of 32, 34 may provide left / right control of the steerable section 28, and the other of the knobs 32, 34 may provide up / down control of the steerable section 28. The handle portion 12 may also include one or more locking mechanisms 36 (e.g., knobs or levers) to prevent steering and / or braking of the steerable section 28 in at least one of the up, down, left, or right directions. The handle portion 12 may include a lifter control lever 38 (see Figure 1B ). The lifter control lever 38 may raise and / or lower the lifter 26 via a connection between the lever 38 and an actuating wire that extends from the lever 38 through the shaft 18 to the lifter 26. The port 40 may allow a tool to pass through the port 40 into the working channel of the duodenoscope 10 and through the sheath 18 to the distal end 20.

[0031] In use, the operator may insert at least a portion of the shaft 18 into a body cavity of a subject. The distal end 20 may be navigated to a surgical site within the body cavity. The operator may insert an accessory device (not shown) into the port 40 and pass the accessory device through the working channel via the shaft 18 to the distal end 20. The accessory device may exit the working channel at the distal end 20. The user may use the lifter control lever 38 to raise the lifter 26 and tilt the accessory device towards a desired location (e.g., the papilla of the pancreatobiliary tract). The user may use the accessory device to perform a medical procedure.

[0032] Figures 2A - 10C An example lifter and its features are shown. Although the features may be described with reference to specific examples herein, it should be understood that the features described herein may be combined in any suitable combination. Figures 2A - 10C The lifters described herein may include a plurality of segments such that the lifter is flexible along its length (i.e., along the longitudinal direction of the disclosed lifter). Any of the lifters described herein may be used in combination with the duodenoscope 10 or another medical device and may have any of the features of the lifter 26. For purposes of convenience, the features of the duodenoscope 10 will be referred to below, but should not be construed as limiting the features of the lifters described herein.

[0033] Figures 2A - 2C A first example lifter 100 is shown. Figure 2A A perspective view of the lifter 100 is shown. Figure 2B A side view of the lifter 100 is shown, and Figure 2CShows a proximal-facing view of the elevator 100. The elevator 100 may include a first proximal segment 102 and a second distal segment 104 (only the distal segment 104 is visible in Figure 2C the view). The elevator 100 may include exactly two segments 102, 104. Figure 2A The arrows "P" and "D" in Figure 2C show the proximal direction and the distal direction. In

[0034] the distal direction extends out of the page and the proximal direction extends into the page. The first segment 102 and the second segment 104 may be joined at a hinge 110. The proximal end of the first segment 102 (e.g., the most proximal segment of the elevator 100) may include an axle 120. A control element 130 may be coupled to the second segment 104.

[0035] The first segment 102 and the second segment 104 may be joined at a hinge 110. The hinge 110 may include, for example, a living hinge. In an example, the first segment 102 and the second segment 104 may be formed from a single integral piece of material, such as a flexible piece of material. For example, the hinge 110 and / or other parts of the elevator 100 may include plastic or metal. The material of the elevator 100 / hinge 110 may be flexible and may not have shape memory characteristics. Additionally or alternatively, the hinge 110 may be overmolded or may include other attachment means to a plastic or metal wire to form a living hinge. In such configurations, the first segment 102 and the second segment 104 may be formed from separate pieces of material (not integrally formed) or may be integrally formed with the overmolded / attached additional parts. The elevator 100, including its segments and hinge, may include any suitable material, such as metal or plastic. The elevator 100 may be formed by any suitable manufacturing method, including additive or subtractive manufacturing methods, such as molding, 3D printing, engraving, or other methods.

[0035] The hinge 110 may have a smaller height (in the Figure 2B direction "A" shown, perpendicular to the proximal / distal direction) compared to the first segment 102 and the second segment 104. In other words, the elevator 100 may be thinner at the hinge 110 than at the first segment 102 or the second segment 104. The elevator 100 may optionally include a recess at the hinge 110 (e.g., one or more of the first segment 102 or the second segment 104 may include a recess). Thus, the elevator 100 may be flexible at the hinge 110. Thus, as described in more detail below with respect to Figure 4 the second segment 104 is able to articulate (rotate / pivot) relative to the first segment 102 about the hinge 110.

[0036] The distal surface 112 of the first segment 102 and the proximal surface 114 of the second segment 104 may taper such that the elevator 100 includes a notch that defines the hinge 110. The notch may have a generally V shape. Particularly asFigure 2B As shown, the notch may have a flattened V-shape, where the hinge 110 defines the flattened surface of the V-shape. For example, the distal surface 112 of the first section 102 may taper such that the height of the first section 102 decreases in the distal direction along the extent of the distal surface 112. The proximal surface 114 of the second section 104 may taper such that the height of the second section 104 increases in the distal direction along the extent of the proximal surface 114. The hinge 110 may extend between the distal surface 112 and the proximal surface 114. For example, the hinge 110 may include a strip of thin material. The hinge 110 may additionally or alternatively include any properties known or to be known for a living hinge. When the lifter 100 bends about the hinge 110 (described in more detail below), the proximal surface 114 of the second section 104 may contact / abut / match the distal surface 112 of the first section 102. Thus, the proximal surface 114 and the distal surface 112 may define the articulation / bending limit / range of the hinge 110 (i.e., bending may be limited by the interaction of the proximal surface 114 and the distal surface 112, and the articulated profile of the lifter 100 may be defined at least in part by the interaction between the proximal surface 114 and the distal surface 112). In some instances, the first section 102 may include a pair of distal surfaces 112, 113 (one on each side of the first section 102), and the second section 104 may include a pair of proximal surfaces 114, 115 (one on each side of the second section 104). The distal surface 112 may have substantially the same shape as the distal surface 113, the proximal surface 114 may have substantially the same shape as the proximal surface 115, and the proximal surface 115 may be configured to abut the distal surface 113 when the proximal surface 114 abuts the distal surface 112.

[0037] The axle 120 may be disposed at the proximal end of the first section 102. In some embodiments, the axle 120 may be integrally formed with the first section 102. The axle 120 may have a circular cross-section, as Figure 2B shown. As Figure 2A and Figure 2C shown, the axle 120 may extend beyond the first section 102 along direction B (perpendicular to direction A and the proximal / distal direction) on either side of the first section 102. In an alternative form, the axle 120 may extend beyond the first section 102 along direction B on only one side of the first section 102, or may not extend beyond the first section 102 along direction B. The axle 120 may be configured to interact with features of the distal end 20 to allow the lifter 100 to be rotatable relative to other elements of the distal end 20. For example, the distal end 20 may include complementary features for receiving the axle 120. The axle 120 may be rotatable about an axis generally parallel to direction B, but may otherwise be generally non-movable relative to the distal end 20.

[0038] The control element 130 may be coupled to the second segment 104. The control element 130 may include, for example, a wire, a cable, a rod, a chain, a filament, a cord, or other suitable structure. For example, as Figures 2A - 2C shown, the control element 130 may include a wire 132 and a protrusion 134 at the distal end of the wire 132. For example, the protrusion 134 may include a ball. Alternatively, the protrusion 134 may have other shapes (e.g., cylindrical, nail-head flat, square, rectangular, oval, hemispherical / elliptical, conical, or any other suitable shape). The protrusion 134 and the wire 132 may be formed of a single integral material (i.e., the protrusion 134 may be integrally formed with the wire 132), or the protrusion 134 and the wire 132 may include separate pieces coupled to each other (e.g., via welding, crimping, screwing, adhesive, or other suitable mechanism).

[0039] The second segment 104 may include a socket 136 configured to receive the control element 130 (e.g., the protrusion 134 and / or the wire 132). The socket 136 may protrude from the outer surface of another part of the elevator 100, such as from the outer surface of the second segment 104. In an example, the socket 136 may protrude from one side of the second segment 104 along direction B. Figures 2A - 2C The position of the socket 136 shown is merely exemplary. For example, the socket 136 may be provided on the opposite side of the elevator 100 (e.g., the opposite side of the segment 104 in direction B). In an example, the socket 136 may act as a boss. Particularly as Figure 2A shown, the socket 136 may define a channel 138 for receiving the control element 130, and the channel 138 may have a generally "U" shape. The outer wall 140 of the socket 136 may define an opening 142 for receiving the outer surface of the protrusion 134. The inner wall 144 of the socket 136 may hold the protrusion 134 in a desired position within the channel 138, be rotatably coupled to the second segment 104 and not movable proximally or distally (or along direction A or B). During assembly, the protrusion 134 may be inserted into the socket 136 along direction B, and the outer wall 140 of the socket 136 may include one or more passages (not shown, but which may be provided, for example, on the distal surface of the outer wall 140) to allow the wire 132 to pass through and then be disposed generally along the longitudinal axis of the elevator 100. Alternatively, other mechanisms may be used to hold the protrusion 134 within the socket 136.

[0040] As Figures 2A - 2CAs shown, the socket 136 may be disposed on an outer surface of the elevator 100 (e.g., the second section 104), and the control element 130 may extend beyond the first section 104 and the second section 102 (i.e., not between the walls of the elevator 100). In an alternative form, the control element 130 may extend along the inside of the elevator 100 (i.e., between the walls of the elevator 100). The control element 130 may alternatively be coupled to the elevator 100 by any suitable alternative structure (e.g., a control arm coupled to the elevator 100).

[0041] The inner surfaces of the first section 102 and the second section 104, together with the inner surface of the hinge 110, may define a guiding surface 160. An accessory device inserted into the working channel of the duodenoscope 110 may extend distally from the distal opening of the working channel and extend on / along the guiding surface 160. When the elevator 100 is lifted (e.g., using the control element 130), as discussed in more detail below, the guiding surface 160 may contact the accessory device, thereby applying a force to the accessory device to articulate it (e.g., a force in a direction radially outward from the central longitudinal axis of the duodenoscope 10). As the elevator 100 is lowered, the accessory device may return to a substantially straight configuration (i.e., not articulated).

[0042] The guiding surface 160 may have any suitable shape. As Figure 2C best shown, along the first section 102 and the second section 104, the guiding surface 160 may have a substantially "U" - shaped cross - section, having a central surface 162 ( Figure 2B and Figure 2C the lower surface in the coordinate system of Figure 2B and Figure 2C and side surfaces 164 (extending in the Figures 2A - 2C up / down direction of

[0043] As Figure 2A and Figure 2BAs shown, the proximal edge 172 of the segment 102 and the distal edge 174 of the segment 104 may be tapered. For example, the proximal edge 172 may taper inwardly in the proximal direction. The distal edge 174 may taper inwardly in the distal direction. As Figure 2B shown, the tapering of the proximal edge 172 may be more gradual than the tapering of the distal edge 174. However, such configurations are merely exemplary, and the proximal edge 172 and the distal edge 174 may have any suitable profile.

[0044] As Figures 2A - 2C shown, the elevator 100 is in an open (i.e., lowered, unarticulated, or not lifted) configuration. In the open configuration, as Figure 2A and Figure 2B best shown, the elevator 100 is generally straight and extends in the proximal / distal direction. In particular, the central surface 162 is generally flat between the proximal end of the elevator 100 and the distal end of the elevator 100 (i.e., in a cross-section of the elevator 100 taken along the longitudinal axis of the elevator 100, the central surface 162 will form a generally straight line from the proximal end of the elevator 100 to the distal end of the elevator 100). In other words, all segments of the elevator 100 may extend along a generally straight line that extends parallel to and / or is coaxial with the longitudinal axis of the elevator 100. Thus, an accessory device received by the elevator 100 in the open configuration (e.g., by the guide surface 160) may extend generally parallel to the proximal / distal direction (e.g., generally parallel to the central longitudinal axis of the duodenoscope 10). Thus, the accessory device may extend distally from the duodenoscope 10 rather than extending generally radially outward / inward. Such a configuration may be desirable for performing a medical procedure or some steps of a medical procedure with a forward-facing (i.e., distally-facing) tool. In some instances, the duodenoscope 10 may include a forward-facing (i.e., distally-facing) imaging device (e.g., a camera) and / or a lighting element to perform such forward-facing medical procedures or multiple steps of a medical procedure. More details of the closed (i.e., lifted, articulated) configuration of the elevator 100 will be discussed below (e.g., with respect to Figure 4 ).

[0045] Now turning to Figures 3A - 3C, Another exemplary lifter 200 may include any of the features of the lifter 100 described above, except as described herein. Where possible, reference numerals (i.e., including the same second and third digits) are used to refer to corresponding structures. The lifter 200 may include a first proximal segment 202 and a second distal segment 204. The first segment 202 may be a separate discrete piece / structure independent of the second segment 204. In other words, the first segment 202 and the second segment 204 may not be integrally formed from a single piece of material. Alternatively, the first segment 202 may be formed from a piece of material independent of the second segment 204, or may be formed from the same piece of material and then separated from each other. The first segment 202 and the second segment 204 may be joined at a hinge 210. For example, one or more pins 211 ( Figure 3B ) may extend through one or more portions of the first segment 202 and the second segment 204 to rotatably connect the first segment 202 to the second segment 204. In alternative forms, other types of fasteners (e.g., rivets, screws) or other types of hinges may be utilized. The distal end of the first segment 202 and the proximal end of the second segment 204 may be configured to allow the second segment 204 to articulate relative to the first segment 202 (and vice versa). For example, the shapes of the first segment 202 and the second segment 204 may be selected to accommodate such articulation.

[0046] Figure 4 The lifter 300 (having any of the properties of the lifters 100, 200) is shown in a partially closed (i.e., articulated or partially lifted) configuration. Where possible, reference numerals (i.e., including the same second and third digits) are used to refer to corresponding structures. The lifter 300 may include a first proximal segment 302 and a second distal segment 304 joined at a hinge 310. Although the first segment 302 and the second segment 304 are shown as separate elements joined by a hinge 310 similar to the hinge 210 in Figures 3A - 3C , it should be understood that the hinge 310 may have any of the properties of the hinge 110 in Figures 2A - 2C , and the first segment 302 and the second segment 304 may be integrally formed.

[0047] The axle 320 may be rotatably coupled to the distal end 20 such that it is rotatable about an axis that extends into / away from Figure 4 the page; but otherwise is generally non-movable relative to the distal end 20. Similarly, the protrusion 334 of the control element 330 may be rotatable relative to the socket 336, but is otherwise generally non-movable relative to the socket 336.

[0048] As Figure 4As shown, the control element 330 can be moved proximally by the operator (e.g., via the elevator control rod 38 of the duodenoscope 10). As the control element 330 moves proximally, the control element 330 can apply a force to the second segment 304. The control element 330 can cause the second segment 304 to rotate / pivot about the hinge 310. Thus, the second segment 304 can move relative to the first segment 302. As the control element 330 initially moves proximally, the first segment 302 cannot initially rotate about the axle 320. Thus, the first segment 302 can continue to be generally placed along the longitudinal axis of the distal end 20 (i.e., along the proximal / distal direction marked by the arrows "P" and "D" in Figure 4 ).

[0049] As Figure 4 shown, the articulation of the elevator 300 can bring the proximal surface 314 of the second segment 304 closer to the distal surface 312 of the first segment 302. For example, the proximal surface 314 of the second segment 304 can be generally parallel to the distal surface 312 of the first segment 302 and / or contact the distal surface 312 of the first segment 302. The shapes of the proximal surface 314 and the distal surface 312 (e.g., the taper angles of the proximal surface 314 and the distal surface 312) can define the articulation angle of the elevator 300, as described in more detail below with respect to Figure 5 . Alternatively, other structures of the elevator 300 (e.g., stoppers, protrusions, or features of the hinge 310) can define the degree to which the second segment 304 is articulated relative to the first segment 302.

[0050] As the control element 330 continues to move proximally, the first segment 302 can rotate about the axle 320 ( Figure 4 not shown). For example, after the second segment 304 is fully articulated relative to the first segment 302 (e.g., after further bending about the hinge 310 is impossible because, for example, the distal surface 312 abuts the proximal surface 314), the first segment 302 can rotate about the axle 320. As the first segment 302 rotates about the axle 320, the distal end 303 of the first segment 302 moves in the Figure 4 upward direction / rotates counterclockwise about the axle 320 in Figure 4 . In other words, as the first segment 302 rotates, the first segment 302 can be transverse to the longitudinal axis of the distal end 20. Features of the elevator 300, the control element 330, the elevator control rod 38 (or other features of the duodenoscope 10) can limit the range of rotation of the first segment 302 about the axle 320, thereby defining the range of motion of the elevator 300.

[0051] As the elevator 300 is articulated (i.e., opened or closed), an accessory device (not shown) can be articulated, as described above with respect to Figures 2A - 2CAs described above. In Figure 4 a partially articulated configuration, the attachment device is articulable such that a distal portion of the attachment device has a first angle relative to a more proximal portion of the attachment device. In a fully articulated configuration (where the first segment 302 has rotated about the axle 320), the distal portion of the attachment device may have a second angle relative to the proximal portion of the attachment device. The second angle may be less than the first angle such that the first angle is more open than the second angle. In other words, the attachment device may be further articulated / bent in a fully closed configuration of the elevator 300 than in a partially closed configuration.

[0052] In a partially or fully articulated configuration of the elevator 300, an operator may perform a medical procedure, such as intubating a mastoid of a subject. In some instances, the duodenoscope 10 may include a laterally facing (i.e., radially outward facing) imaging device (e.g., a camera) and / or a lighting element to perform such a medical procedure or multiple steps of a medical procedure.

[0053] By moving the control element 330 distally, the elevator 300 may move in an opposite direction (to move the elevator 300 from a closed position to an open position). The movement may occur in an order opposite to that described above, where the elevator 300 first rotates about the axle 320 (assuming the elevator 300 had previously rotated about the axle 320 to close the elevator 300) and then the second segment 304 rotates relative to the first segment 302 until the elevator 300 is flat / fully open.

[0054] Figure 5 An elevator 400 (having any of the properties of the elevators 100, 200, 300) is shown in an open configuration. Where possible, reference numerals with corresponding reference numerals (i.e., including the same second and third digits) are used to refer to corresponding structures. The elevator 400 may include a first proximal segment 402 and a second distal segment 404 joined at a hinge 410. Although the first segment 402 and the second segment 404 are shown as being integrally formed with each other and joined by a hinge 410 similar to the hinge 110 of Figures 2A - 2C it should be understood that the hinge 410 may have any of the properties of the hinge 210 of Figures 3A - 3C and the first segment 402 and the second segment 404 may be separate structures from each other.

[0055] As Figure 5 shown, the distal surface 412 of the first segment 402 may taper in a distal direction toward the hinge 410, and the proximal surface 414 of the second segment 404 may taper in a proximal direction toward the hinge 410. Figure 5 An axis Y1 is shown, which bisects the hinge 410 and is in Figure 5extends in the up / down direction perpendicular to the longitudinal axis of the elevator 400 (i.e., perpendicular to the proximal and distal directions). Each of the distal surface 412 and the proximal surface 414 may have an angle θ (having any suitable value) with respect to the axis Y1. The angle θ may be selected based on the desired final profile (e.g., curve) of the elevator 400 and the number of segments of the elevator 400. The angle θ may be selected to produce different attachment device angles as seen via the imaging device 22 when the elevator 400 is locked, e.g., the attachment device angle is configured to position the attachment device within the field of view of the imaging device 22. As discussed above, the angles of the distal surface 412 and the proximal surface 414 may define the hinge angle of the elevator 400. For example, the elevator 400 is capable of bending by an angle of approximately 2θ (i.e., the second segment 404 is capable of bending by an angle of 2θ with respect to the first segment 402) until the distal surface 412 and the proximal surface 414 are adjacent to or near each other (e.g., as Figure 4 shown with respect to the distal surface 312 and the proximal surface 314 of the elevator 300).

[0056] Figure 6A Another alternative elevator 500 is shown, which may have any of the properties of the elevators 100, 200, 300, 400, except as specified herein. The elevator 500 may include a plurality of segments 502, 504, 506, 508, 510. The segments 502, 504, 506, 508, 510 may have any of the properties of the segments described above. The segments 502 and 504 may be joined at a hinge 522, the segments 504 and 506 may be joined at a hinge 524, the hinge 506 and 508 may be joined at a hinge 526, and the hinge 508 and 510 may be joined at a hinge 528. The hinges 522, 524, 526, 528 may have any of the properties of the hinges described above. Some or all of the segments 502, 504, 506, 508, 510 may be integrally formed with some or all of the hinges 522, 524, 526, 528 (including movable hinges, such as, for example, the hinge 110). Additionally or alternatively, some or all of the segments 502, 504, 506, 508, 510 may be separately formed structures / pieces, where some or all of the hinges 522, 524, 526, 528 couple these separate structures (such as, for example, the hinge 210). A combination of integrally formed structures and separate segment pieces may be used in the elevator 500.

[0057] Axes Y2, Y3, Y4, Y5 are shown in FIG. 6 as extending through the respective midpoints of hinges 522, 524, 526, 528 perpendicular to the longitudinal axis of the elevator 500 (i.e., in the up / down direction in FIG. 6). Axes Y2, Y3, Y4, Y5 may be generally parallel to each other. Segment 502 may have a distal surface 532a, and segment 504 may have a proximal surface 532b. Segment 504 may have a distal surface 534a, and segment 506 may have a proximal surface 534b. Segment 506 may have a distal surface 536a, and segment 508 may have a proximal surface 536b. Segment 508 may have a distal surface 538a, and segment 510 may have a proximal surface 538b. Surfaces 532a, 532b may be on either side of hinge 522, surfaces 534a, 534b may be on either side of hinge 524, surfaces 536a, 536b may be on either side of hinge 526, and surfaces 538a, 538b may be on either side of hinge 528.

[0058] As described below, the surfaces of segments 502, 504, 506, 508, 510 may have different angles relative to axes Y2, Y3, Y4, Y5. These different angles may provide different articulation profiles for the elevator 500. For example, some of segments 502, 504, 506, 508, 510 may bend at a sharper angle relative to each other than other ones of segments 502, 504, 506, 508, 510. The combinations of angles described herein are merely exemplary; any suitable combination of angles may be selected to achieve the desired articulation profile of the elevator 500.

[0059] Distal surface 532a may have an angle β relative to axis Y2. Proximal surface 532b may have an angle φ relative to axis Y2. In some instances, angle β may be different from angle φ. Angles β and φ may be selected to provide the desired articulation. Distal surface 534a and proximal surface 534b may each have an angle α relative to axis Y3. Distal surface 536a may have an angle α relative to axis Y4. In some instances, angle α may be different from angles β and φ. Proximal surface 536b may have an angle θ relative to axis Y4. Angle θ may be different from angles α, β, and φ. Distal surface 538a and proximal surface 538b may each have an angle θ relative to axis Y5.

[0060] The arrangements and angles described above are merely exemplary. The angles of the surfaces around the hinges 522, 524, 526, 528 can be selected to achieve various articulated configurations. For example, the hinges 522, 524, 526, 528 can have different angles at which the adjacent link members bend relative to each other. In alternative forms, the hinges 522, 524, 526, 528 can each bend at the same angle. In addition to having end surfaces with different angles, the segments 502, 504, 506, 508, 510 can have the same or different lengths (along the longitudinal axis of the lifter 500, i.e., along the proximal / distal direction). The lengths of the segments 502, 504, 506, 508, 510 can be selected to impart a desired shape / articulated configuration to the lifter 500 when in an articulated (e.g., closed or partially closed) configuration.

[0061] Figure 6B and Figure 6C A lifter 500' is shown having any of the properties of the lifter 500, except as described herein. The reference numerals of the lifter 500' can correspond to those of the lifter 500, with a "superscript symbol" added to the end of the reference numeral of the lifter 500. The corresponding reference numerals can have corresponding properties, except as otherwise explained below.

[0062] As Figure 6B shown, the distal surface 532a' can have an angle δ relative to the axis Y2'. The proximal surface 532b' can have an angle ε relative to the axis Y2'. In some instances, the angle δ can be different from the angle ε. The angles δ and ε can be selected to provide a desired articulation. As Figure 6C shown and as discussed below with respect to Figures 6D - 6E since the angles δ and ε are different from each other (e.g., because the angle δ is greater than the angle ε), when the lifter 500' is articulated, the corner 533a of the distal surface 532a' can extend slightly above the corner 533b of the proximal surface 532b' (in the Figure 6B and Figure 6C reference frame). Such a configuration can ensure that the lifter 500' does not contact the housing or other parts of the distal end 20 when in an undesired position, or can provide other mechanical advantages. The distal surface 534a' and the proximal surface 534b' can each have an angle η relative to the axis Y3'. The distal surface 536a' and the proximal surface 534b' can each have an angle ε relative to the axis Y4'. The distal surface 538a' and the proximal surface 538b' can each have an angle ε relative to the axis Y5'. The angles δ, ε, and η can all be different from each other.

[0063] As Figure 6CAs shown, the relative angles between the surfaces of the lifter 500' can define different hinge profiles along the lifter 500'. For example, due to the smaller size of the angle η relative to the angle ε, the segments 504' and 506' can have a relatively smaller angle with respect to each other compared to the segments 506' and 508'. In other words, the angle between the longitudinal axis M along the segment 504' and the longitudinal axis N along the segment 506' can be closer to 180 degrees compared to the angle between the longitudinal axis N and the longitudinal axis O along the segment 508'. Since the angle between the segments 508' and 510' is the same as the angle between the segments 506' and 508', the angle between the longitudinal axis O along the segment 508' and the longitudinal axis P along the segment 510' can be the same.

[0064] Figure 6D and Figure 6E Figure 5 shows a lifter 500'', which has any of the properties of the lifters 500, 500' except as described herein. The reference numeral of the lifter 500'' can correspond to the reference numeral of the lifter 500, with two "superscript symbols" added to the end of the reference numeral of the lifter 500. The corresponding reference numerals can have corresponding properties, except as explained hereinafter. Although the lifter 500'' is shown as having only two segments 502'', 504'', it should be understood that the lifter 500'' can have any suitable number of segments.

[0065] As Figure 6D shown, the distal surface 532a'' can have an angle ψ with respect to the axis Y2''. The proximal surface 532b'' can have an angle λ with respect to the axis Y2''. The angle ψ can be different from the angle λ. The angles ψ and λ can be selected to provide the desired hinge. As Figure 6D shown, in the relaxed configuration, the heights H (in the Figure 6D up / down direction) of the segments 502'' and 504'' can be the same. As Figure 6E shown, since the angles ψ and λ are different from each other (e.g., since the angle λ is greater than the angle ψ), when the lifter 500'' is hinged, the corner 533a' of the distal surface 532a'' can extend over the corner 533b' of the proximal surface 532b'' (in the Figure 6E reference frame), such that a gap G is formed between the corners 533a' and 533b'. Furthermore, as Figure 6E shown, the surfaces 532a'' and 532b'' can be non-flush with each other, such that a gap is formed therebetween.

[0066] Figures 7A - 7E Figure 6 shows the lifter 600 at different hinge stages, from Figure 7A the fully open (i.e., unhinged, not lifted or lowered) stage to Figures 7B - 7D the almost fully closed (i.e., fully hinged or lifted) stage andFigure 7E The fully closed stage. The elevator 600 may have any of the features of the elevators 100, 200, 300, 400, 500 described above and may be used in combination with the duodenoscope 10. Where feasible, the corresponding reference numerals corresponding to the elevator 500 are used (i.e., reference numerals having the same second and third digits).

[0067] The segments 602, 604, 606, 608, 610 may be connected via hinges 622, 624, 626, 628. The segment 602 may be the most proximal segment, and the segment 610 may be the most distal segment. Although five segments are shown, it should be understood that any suitable number of segments may be utilized (e.g., two, three, four, six, seven or more segments). Although Figures 7A - 7E The segments 602, 604, 606, 608, 610 are shown as separate structures / components, it should be understood that the segments 602, 604, 606, 608, 610 may alternatively be formed from a single integral piece of material. Similarly, although the hinges 622, 624, 626, 628 are shown as including pins 640 (labeled with respect to Figure 7A the hinge 622 and also present on the hinges 624, 626, 628), it should be understood that the hinges 622, 624, 626, 628 may utilize any alternative connection structure and / or may include flexible hinges.

[0068] Each of the segments 602, 604, 606, 608, 610 may have a base wall 652, a first side wall 654, and a second side wall 656 (labeled with respect to Figure 7A the segment 610 and also present on the segments 602, 604, 606, 608). The base wall 652 and the side walls 654, 656 may define a guide surface 658 to contact and guide the accessory device. Each of the side walls 654 may define a channel 660 that extends generally parallel to the longitudinal axis of the elevator 600 / distal end 20 of the duodenoscope 10. A control element ( Figures 7A - 7E not shown) having any of the properties of the control elements discussed above may extend through the channels 660 of each of the side walls 654. The control element may be movable relative to the channels 660. The side walls 654 may have a greater thickness (along the axis extending between the side walls 654 and the side walls 656 of a given segment) to accommodate the channels 660.

[0069] Segment 610 (or any most distal segment) may include a fixation point 662 to fix the distal end of the control element to segment 610. For example, the control element may be fixed to the fixation point 662 via, for example, a friction fit, an adhesive, a crimp, welding, a fastener, or any other suitable mechanism. The fixation point 662 may be disposed on a protrusion 664 of the sidewall 654 of segment 610. The protrusion 664 may protrude distally from another part of the sidewall 654. Segment 610 may be longer in the proximal / distal direction (i.e., along the longitudinal axis of the elevator 600) to accommodate the protrusion 664. The sidewall 656 of segment 610 (on the side of segment 610 opposite to the sidewall 654) may have a length corresponding to the sidewall 654 of segment 610, including the protrusion 664.

[0070] Segment 602 (or any most proximal segment) may include an axle 670. In some instances, the axle 670 may be integrally formed with segment 602 from a single piece of material. In other instances, the axle 670 may be a separate component attached to segment 602. The axle 670 may have any suitable configuration. For example, the base wall 652 of segment 602 may define a notch 672, and the axle 670 may extend across the notch. The axle 670 may extend generally perpendicular to the longitudinal axis of the elevator 600, along a direction extending between the sidewalls 654, 656 of segment 602. The axle 670 may be received by an element of the distal end 20 of the duodenoscope 10. For example, the distal end 20 may include a hole or recess to receive the axle 670. Segment 602 may rotate about the axle 670 relative to the distal end 20. In an alternative form, the axle 670 may be removable, and segment 602 may be fixed / non-rotatable relative to the distal end 20.

[0071] In Figure 7A 's configuration, the elevator 600 may be in a fully open configuration. A portion of the guiding surface 658 defined by the base wall 652 may be generally planar / flattened, including along the proximal / distal direction. In other words, segments 602, 604, 606, 608, 610 may be aligned such that they are generally straight. An accessory tool inserted into the working channel of the duodenoscope 10 may extend along the guiding surface 658 in a generally unarticulated configuration, and the accessory tool extends from the distal end 20 in this unarticulated configuration generally along the longitudinal axis of the duodenoscope 10 / distal end 20.

[0072] In Figure 7B 's configuration, due to the control member moving proximally, the distal segment 610 may rotate / pivot relative to the distal segment 608. The control member may pull segment 610, causing it to pivot / rotate relative to segment 608, but without moving segments 602, 604, 606, 608. In Figure 7C 's configuration, compared to Figure 7BWith the configuration, the control member has been further moved proximally. The rotational / pivotal relationship between segments 608 and 610 at hinge 628 can be maintained, and segment 608 can rotate / pivot relative to segment 606 at hinge 626 without moving segments 602, 604, 606. At Figure 7D With the configuration, as compared to Figure 7C With the configuration, the control member can be further moved proximally. The rotational / pivotal relationships between segments 608 and 610 at hinge 628 and between segments 606 and 608 at hinge 626 can be maintained, and segment 606 can rotate / pivot relative to segment 604 at hinge 624 without moving segments 602, 604. At Figure 7E With the configuration, as compared to Figure 7D With the configuration, the control member has been further moved proximally. The rotational / pivotal relationships between segments 608 and 610 at hinge 628, between segments 606 and 608 at hinge 624, and between segments 604 and 606 at hinge 624 can be maintained, and segment 604 can rotate / pivot relative to segment 602 at hinge 622 without moving segment 602. In another configuration (not shown), as compared to Figure 7D With the configuration, the control member can be further moved proximally to cause segment 602 to rotate about the axle 670. As the control wire is moved proximally, the elevator 600 can be lowered in the reverse order as described above.

[0073] The handle 12 of the duodenoscope 10 may include a plurality of features (e.g., markings or other visual feedback, or tactile feedback) to incrementally adjust the elevator control rod 38, thereby allowing articulation to a predetermined configuration, such as Figures 7A - 7E Those shown. The handle 12 of the duodenoscope 10 may additionally or alternatively include locking / holding features to lock the elevator control rod 38 in a desired position, such as a position corresponding to Figures 7A - 7E One or more of the configurations.

[0074] Figure 8A and Figure 8B Shows another exemplary elevator 700, which has any of the features of the elevators 100, 200, 300, 400, 500, 600 described above and can be used with the duodenoscope 10. Figure 8A Shows a perspective view of the elevator 700, Figure 8B Shows a proximally facing view of the distal end of the elevator 700. Where feasible, reference numerals corresponding to those of the elevators 500, 600 are used (i.e., reference numerals having the same second and third digits). The elevator 700 may include a plurality of segments 702, 704, 706, 708, 710 connected by hinges 722, 724, 726, 728. As Figure 8AAs shown, segments 702, 704, 706, 708, 710 may be formed from a single integral piece of material, where hinges 722, 724, 726, 728 include flexible hinges. In an alternative form, segments 702, 704, 706, 708, 710 may be formed from separate pieces that are joined together at hinges 722, 724, 726, 728. For hinges 722, 724, 726, 728, any suitable type of articulation structure may be used. As described above, the number of segments / hinges shown is merely exemplary, and any suitable number of segments / hinges may be utilized.

[0075] Each of segments 702, 704, 706, 708, 710 may have a base wall 752, a first side wall 754, and a second side wall 756 (labeled with respect to Figure 8A segment 710 and also present on segments 702, 704, 706, 708). Side walls 754 may each define a channel 760a (see Figure 8B ), channel 760a extending generally parallel to the longitudinal axis of elevator 700 / distal end 20 of duodenoscope 10 (i.e., extending into / away from Figure 8B the page). Side walls 756 may each define a channel 760b (see Figure 8B ), channel 760b extending generally parallel to the longitudinal axis of elevator 700 / distal end 20 of duodenoscope 10 (i.e., extending into / away from Figure 8B the page). Channels 760a, 760b may have any of the properties of channel 660 of elevator 600 described above.

[0076] The first control element 780a (having any of the characteristics of the control elements discussed above) may extend through the channels 760a of each of the segments 702, 704, 706, 708, 710. The second control element 780b may extend through the channels 760b of each of the segments 702, 704, 706, 708, 710. The distal ends 782a of the first control element 780a and 782b of the second control element 780b may each be coupled to the distal surface (or other portion) of the segment 710 (i.e., the most distal segment). For example, the distal ends 782a, 782b may extend transversely to the more proximal portions of the first control element 780a and the second control element 780b, respectively (e.g., at an angle of approximately 90 degrees with respect to the more proximal portions of the first control element 780a and the second control element 780b). The channels 760a, 760b may be located near the edges of the side walls 754, 756 that are furthest from the base wall 752. The distal ends 782a, 782b may extend toward the base wall 752 and may be fixed to the side walls 754, 756 of the segment 710, respectively. For example, each of the side walls 754, 756 may include a protrusion 766 that may extend distally from the more proximal portion of the side walls 754, 756. The distal ends 782a, 782b may be coupled to the protrusions 766. In an alternative form, the control elements 780a, 780b may form a loop around or through the segment 710 (i.e., may be a single continuous piece). For example, the distal ends 782a, 782b may be coupled to each other so as to extend through the side walls 754, 756 and the base wall 752 of the segment 710.

[0077] As Figure 8BAs shown, the elevator 700 can be symmetric about a plane Z (i.e., the plane defined by the longitudinal axis of the elevator 700 and the axis that bisects the base wall 752 between the side walls 754, 756). The control elements 780a, 780b can be coupled to the same elevator control lever 38. For example, the proximal ends of the control elements 780a, 780b can be coupled to the elevator control lever 38, and / or can be coupled to each other or to a single control element (not shown) within the shaft 18 or the handle 12. Moving the control elements 780a, 780b proximally or distally can respectively close or open the elevator 700. Using two control elements 780a, 780b can reduce the force that needs to be applied to the elevator control lever 38 and can generate a more uniform force on the elevator 700. Alternatively, the control elements 780a, 780b can be coupled to different actuators for independent articulation, or can be coupled to a joystick-type actuator. In such configurations, the movement of one of the control elements 780a, 780b relative to the other of the control elements 780a, 780b can allow the elevator 700 to bend in a direction transverse to the longitudinal axis of the elevator 700 (e.g., side-to-side articulation, such as at the distal end of an articulable shaft of a medical device (such as a duodenoscope or other type of endoscope)), or can allow rotation of the elevator 700.

[0078] Figures 9A - 9C Another alternative elevator 800 is shown, which can have any of the properties of elevators 100, 200, 300, 400, 500, 600, 700, except as specified herein. Figure 9A A perspective view of the elevator 800 is shown, Figure 9B a proximally facing view of the distal end of the elevator 800 is shown, and Figure 9C a side view of the elevator 800. Where feasible, reference numerals corresponding to those of elevators 500, 600, 700 are used (i.e., reference numerals having the same second and third digits). The elevator 800 can include a plurality of segments 802, 804, 806, 808, 810 coupled by hinges 822, 824, 826, 828. As Figure 9A shown, the segments 802, 804, 806, 808, 810 can be formed from a single integral piece of material, where the hinges 822, 824, 826, 828 include living hinges. In an alternative form, the segments 802, 804, 806, 808, 810 can be formed from separate pieces that are joined together at the hinges 822, 824, 826, 828. Any suitable type of articulation structure can be used for the hinges 822, 824, 826, 828. As discussed above, the number of segments / hinges shown is merely exemplary, and any suitable number of segments / hinges can be utilized.

[0079] Each of segments 802, 804, 806, 808, 810 may have a base wall 852, a first side wall 854, and a second side wall 856 (labeled relative to Figure 8A segment 810, and also present on segments 802, 804, 806, 808). Each side wall 854 may define a channel 860 (see Figure 8B ), and channels 860 extend generally parallel to the longitudinal axis of elevator 800 / distal end 80 of the duodenoscope 10 (i.e., extending into / away from Figure 9B the page). Side wall 856 may not define such a channel as compared to elevator 700.

[0080] A control element 880 (having any of the characteristics of the control elements discussed above) may extend through channels 860 of each of segments 802, 804, 806, 808, 810. The distal end 882 of control element 880 may be coupled to the distal face (or other portion) of segment 810 (i.e., the most distal segment). For example, distal end 882 may extend transversely to a more proximal portion of control element 880 (e.g., at an angle of approximately 90 degrees with respect to control element 880). Distal end 882 may extend toward base wall 852 and may be fixed to side wall 854 of segment 810. For example, side wall 854 may include a protrusion 866 that extends distally from a more proximal portion of side wall 854. Distal end 882 may be coupled to protrusion 866.

[0081] Side wall 854 may be wider in direction B as compared to side wall 856 (see Figure 9B ), where direction B is perpendicular to the longitudinal axis of elevator 800 that extends between side wall 854 and side wall 856. The wider width of side wall 854 as compared to side wall 856 may be due to the width required for side wall 854 to define channel 860. For side wall 856, it may be desirable to have a smaller wall width to conserve space in distal end 20. It should be understood that the orientation of side walls 856, 854 is merely exemplary, and side walls 856, 854 may be reversed with respect to each other.

[0082] Figures 10A - 10C An alternative elevator 900 is shown, which may have any of the properties of elevators 100, 200, 300, 400, 500, 600, 700, 800, except as specified herein. Figure 10A A top view of elevator 900 is shown, Figure 10B a proximally facing view of the distal end of elevator 900 is shown, and Figure 10CA side view of the elevator 900. Where feasible, reference numerals corresponding to elevators 500, 600, 700, 800 are used (i.e., reference numerals having the same second and third digits). The elevator 900 may include a plurality of segments 902, 904, 906, 908, 910 coupled by hinges 922, 924, 926, 928. As discussed above, the number of segments / hinges shown is merely exemplary, and any suitable number of segments / hinges may be utilized.

[0083] As Figure 9A shown, the segments 902, 904, 906, 908, 910 may be formed of separate pieces that are joined together at the hinges 922, 924, 926, 928. Any suitable type of articulation structure may be used for the hinges 922, 924, 926, 928. For example, as Figure 9C shown, the hinges 922, 924, 926, 928 may include pins 990 that may extend through all or a portion of the width of the hinges 922, 924, 926, 928 (in the direction of entering / leaving Figure 9C the page). For example, the pins 990 may extend through openings in the segments 902, 904, 906, 908, 910 to form the hinges 922, 924, 926, 928. Each of the segments 902, 904, 906, 908 may include a protrusion 992 ( Figure 10A ), which may extend from the distal side of the segments 902, 904, 906, 908. The protrusion 992 may have, for example, a rectangular shape. Each of the segments 910, 908, 906, 905 may include a corresponding notch 994 ( Figure 10A ), which is formed in the proximal side of the segments 910, 908, 906, 905. The notch 994 may have, for example, a rectangular shape. The notch 994 and the protrusion 992 may have complementary shapes such that the protrusion 992 may fit within the notch 994. The protrusion 992 is capable of rotating relative to the notch 994 about the pin 990. For example, the pin 990 may extend through the outer wall of a segment (e.g., segment 910), through an opening formed in the sidewall of the notch 994, through the protrusion 992 of the proximally adjacent segment (e.g., segment 908), and through an opening formed in the other sidewall of the notch 994. The segments 910, 908 are mentioned only for exemplary purposes, and the same principle applies to other segments. In an alternative form, the protrusion may extend proximally from a segment (e.g., segment 910) of the elevator 900, and the proximally adjacent segment (e.g., segment 908) may include a corresponding notch to receive the protrusion.

[0084] While the principles of the present disclosure are described herein with reference to illustrative examples of specific applications, it should be understood that the present disclosure is not limited thereto. Those skilled in the art and those having access to the teachings provided herein will recognize that additional modifications, applications, and substitutions of equivalents fall within the scope of the examples described herein. In addition, the various elements of each of the current embodiments can be combined to achieve the same or similar results as one or more of the disclosed embodiments. Accordingly, the present invention should not be considered limited by the foregoing detailed description.

Claims

1. A lifter for a medical device, the lifter comprising: A plurality of segments joined together by at least one hinge, wherein a first segment of the plurality of segments is a discrete structure; and A control element coupled to at least one of the plurality of segments, wherein movement of the control element proximally or distally is configured to cause the at least one of the plurality of segments to move relative to another of the plurality of segments.

2. The lifter according to claim 1, wherein the plurality of segments are all discrete structures.

3. The lifter according to any one of the preceding claims, wherein the plurality of segments consists of the first segment and the second segment.

4. The lifter according to any one of the preceding claims, wherein in a first configuration, the plurality of segments are all arranged along a substantially straight line.

5. The lifter according to claim 4, wherein the substantially straight line is substantially parallel to the longitudinal axis of the medical device.

6. The lifter according to any one of the preceding claims, wherein the control element is a first control element, and the lifter further comprises a second control element coupled to at least one of the plurality of segments, wherein moving the second control element proximally or distally is configured to cause at least one of the plurality of segments to move relative to another of the plurality of segments.

7. The lifter according to claim 6, wherein each of the plurality of segments defines a first channel for receiving the first control element, and wherein each of the plurality of segments defines a second channel for receiving the second control element.

8. The lifter according to any one of claims 6 or 7, wherein the first control element is coupled to a first actuator of the handle of the medical device, and wherein the second control element is coupled to a second actuator of the handle of the medical device, wherein the first actuator can be actuated independently of the second actuator.

9. The lifter according to any one of the preceding claims, wherein the farthest segment of the plurality of segments includes a socket on an outer surface of the farthest segment, wherein the socket is configured to receive a distal end of the control element.

10. The lifter according to any one of the preceding claims, wherein the first segment includes a first distal surface, wherein the second segment of the plurality of segments includes a first proximal surface and a second distal surface, wherein the third segment of the plurality of segments includes a second proximal surface, wherein the first distal surface of the first segment and the first proximal surface of the second segment are separated by a first angle, wherein the second distal surface of the second segment and the second proximal surface of the third segment are separated by a second angle, and wherein the second angle is different from the first angle.

11. The lifter according to any one of the preceding claims, wherein each of the plurality of segments includes a base wall, a first side wall, and a second side wall, wherein the first side wall of each segment defines a channel configured to receive the control element, and wherein the width of the first side wall of each segment is greater than the width of the second side wall of each segment.

12. The lifter according to any one of the preceding claims, wherein the at least one hinge includes a pin or a rivet.

13. The lifter according to any one of the preceding claims, wherein the outermost segment of the plurality of segments includes a protrusion extending distally, wherein the control element is attached to the protrusion.

14. The lifter according to any one of the preceding claims, wherein the innermost segment of the plurality of segments includes an axle configured to be rotatably coupled to the distal end of the medical device.

15. The lifter according to claim 14, wherein at least one of the plurality of segments is configured to rotate relative to the innermost segment of the plurality of segments as the control element moves distally, before the innermost segment of the plurality of segments rotates relative to the distal end of the medical device.

Images