Medical systems and devices for turning or deflecting a portion of a medical device.

Abstract

This invention describes a medical device and related methods. The medical device includes a handle comprising a movable body; a shaft extending distally from the handle; a first fitting coupled to the shaft; and a second fitting located distal to the first fitting and concentrically coupled to the shaft. The second fitting includes a first hole and a second hole. The first hole receives a portion of the shaft, and the second hole is aligned with the first fitting. A third fitting surrounds the shaft, the first fitting, and the second fitting. The third fitting includes a distal side, a third hole, and a fourth hole. The third hole receives a distal portion of the shaft, and the fourth hole is aligned with the second hole and a filament. A proximal portion of the filament is coupled to the first fitting.

Description

Cross-references to related applications

[0001] This application claims priority to U.S. Provisional Application No. 63 / 624,022, filed January 23, 2024, pursuant to 35 USC §119, which is incorporated herein by reference in its entirety. Technical Field

[0002] The present invention generally relates to systems, apparatuses, and related methods that can be used in medical procedures. More specifically, the present invention relates to systems, apparatuses, and methods for turning or deflecting a portion (e.g., a distal portion) of a medical device. Background Technology

[0003] Steering medical devices typically utilize one or more drawstrings to steer or deflect the distal portion of the device, for example, through anatomical pathways within the human body, such as the stomach. The taut drawstrings are usually bent in a manner that follows a path of least resistance within the body's cavities. This tendency can cause the catheter to whiplash at its distal end, as torque accumulates in the proximal portion of the catheter and subsequently travels to the distal end. This whiplash movement can increase the likelihood of drawstring breakage and / or device malfunction. The overall trend toward minimally invasive procedures and correspondingly smaller (i.e., smaller outer diameter) catheters with lower tensile strength and torque response further exacerbates the likelihood of whiplash movement and / or breakage during medical procedures.

[0004] The systems, apparatus, and methods of the present invention can correct one or more of the above-mentioned defects or solve other aspects of the present technology. Summary of the Invention

[0005] Examples of the present invention relate to medical systems, devices, and methods configured to steer or deflect catheters or other medical devices through anatomical pathways of the human body to perform medical procedures therein. Each of the examples disclosed herein may include one or more features described in conjunction with any of the other disclosed examples.

[0006] For example, the present invention includes a medical device that may include a handle and a shaft extending distally from the handle. The handle may include a movable body. The medical device may include a first fitting coupled to the shaft, and a second fitting located distal to the first fitting and concentrically coupled to the shaft. The second fitting may include a first hole and a second hole. The first hole may receive a portion of the shaft, and the second hole may be aligned with the first fitting. The medical device may also include a third fitting surrounding the shaft, the first fitting, and the second fitting. The third fitting may include a distal side, a third hole, and a fourth hole. The third hole may receive a distal portion of the shaft, and the fourth hole may be aligned with the second hole and a filament. A proximal portion of the filament may be coupled to the first fitting. A portion of the filament may extend through the second hole, and a distal portion of the filament may extend through the fourth hole.

[0007] Any of the medical devices disclosed herein may include any of the following features. The medical device may also include a fourth accessory located proximal to the third accessory and concentrically surrounding the shaft, the first accessory, and the second accessory. The fourth accessory may include a proximal side. The proximal side may include a fifth hole for movably receiving a portion of the shaft. The fourth accessory may be fixed to the third accessory. The medical device may also include a rod coupled to the second accessory and positioned relative to the second hole. The rod may extend distally to the second accessory. The medical device may also include a hinged portion coupled to the distal side. A filament may be fixedly coupled to a portion of the hinged portion. Rotation of the handle may rotate the shaft, thereby rotating the hinged portion. Proximal axial movement may allow the filament to move independently of the third and fourth accessories and may allow the hinged portion to transition between at least a first and a second configuration. Distal axial movement may allow the filament to move independently of the third and fourth accessories and may allow the hinged portion to transition between at least a second and a first configuration. Rotational movement of the shaft relative to the third and fourth accessories may be limited by the rod interacting with the rod receiving hole disposed on the distal side. Movement of the shaft proximal to the shaft may be limited by the first fitting, which interacts with the proximal side of the fourth fitting. The shaft may include a hypodermal cannula. The third fitting may concentrically surround the shaft. The proximal side may include a tapered portion extending from the outer diameter of the distal side to approximately equal to the diameter of the shaft. The outer diameter of the filament may be less than or equal to 0.008 inches. The filament may include one of the following: (i) a cable, or (ii) a solid filament.

[0008] The present invention also includes a medical device that may include a handle. The handle may include a movable body. The medical device may also include a shaft extending distally from the handle. The shaft may be coupled to the movable body. The medical device may also include a first fitting coupled to the shaft. The medical device may also include a second fitting located distal to the first fitting and coupled to the shaft. The second fitting may include a first hole and a second hole. The first hole may receive a portion of the shaft, and the second hole may be circumferentially aligned with the first fitting. The medical device may also include a third fitting surrounding the shaft, the first fitting, and the second fitting. The third fitting may include a distal side. The distal side may include a third hole for receiving the shaft; and the distal side may also include a fourth hole circumferentially aligned with the second hole. Furthermore, the distal side may include a fifth hole opposite to the fourth hole. The medical device may also include a member coupled to the second fitting and positioned opposite the second hole. The member may be circumferentially aligned with the fifth hole. The member may extend distally from the second fitting. The medical device may also include a filament. The filament may be coupled to the first fitting and extend from the first fitting through the second hole and through the fourth hole.

[0009] The medical device may include one or more of the following features. The medical device may also include a fourth fitting located proximal to the third fitting and surrounding the shaft, the first fitting, and the second fitting. The fourth fitting may include a proximal side. The proximal side may include a sixth hole receiving the shaft. The fourth fitting may be fixed to the third fitting. The medical device may also include a hinged portion coupled to a distal side and fixed to the filament. Rotation of the handle may rotate the shaft, thereby rotating the hinged portion. Longitudinal movement of the shaft may translate the component through the third fitting. Axial distal movement (1) may allow the filament to move independently of the third and fourth fittings, and (2) may allow the hinged portion to transition between at least a first and a second configuration. Axial proximal movement (1) may allow the filament to move independently of the third and fourth fittings, and (2) may allow the hinged portion to transition between at least a first and a second configuration.

[0010] The present invention also includes a medical device comprising a handle. The handle may include a movable body. The medical device further includes a shaft extending distal to the handle and coupled to the movable body. The medical device further includes a first fitting coupled to the shaft, and a second fitting located distal to the first fitting and coupled to the shaft. The second fitting may include a first hole and a second hole. The first hole may receive a portion of the shaft, and the second hole may be aligned with the first fitting. The medical device may further include a third fitting surrounding the shaft, the first fitting, and the second fitting, the third fitting including a distal side. The distal side may include a third hole receiving a portion of the shaft; and a fourth hole aligned with the second hole. The shaft may be longitudinally movable relative to the third fitting. The medical device may further include a filament extending from the first fitting through the second hole and through the fourth hole.

[0011] The medical device may include one or more of the following features. The medical device may also include a fourth accessory located proximal to the third accessory and surrounding the shaft, the first accessory, and the second accessory. The shaft may be longitudinally movable relative to the fourth accessory. The fourth accessory may include a proximal side. The proximal side may include a sixth hole, a portion of which receives the shaft. Attached Figure Description

[0012] The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate various exemplary embodiments and, together with the description, serve to explain the principles of the invention.

[0013] Figure 1 Exemplary medical devices according to various aspects of the present invention are described.

[0014] Figure 2A Depicting Figure 1 A perspective view of a portion of an exemplary medical device, and Figure 2B Depicting Figure 1 A side view of a portion of an exemplary medical device.

[0015] Figure 3A Depicting the state of being unhinged or undeflected Figure 1 The distal part of the medical device, and Figure 3B Depicting the state of being in a hinged or deflected position Figure 1 The distal part of the medical device. Detailed Implementation

[0016] It is understood that the foregoing general description and the following detailed description are exemplary and explanatory only, and are not intended to limit the invention as defined in the claims. As used herein, the terms “comprising,” “including,” or any other variations thereof are intended to cover non-exclusive inclusion, such that a process, method, article, or apparatus that includes a list of elements includes not only those elements, but may include other elements not expressly listed or inherent to such process, method, article, or apparatus. The term “exemplary” is used in the sense of “example” rather than “exemplary.” The term “distal” refers to a direction away from the operator / towards the treatment site, while the term “proximal” refers to a direction towards the operator. The drawings may include arrows labeled “P” and “D”, indicating proximal and distal directions, respectively. The term “about” or similar terms (e.g., “approximately”) include values ​​+ / - 10% of the stated value.

[0017] Reference will now be made in detail to examples of the invention, aspects of which are shown in the accompanying drawings. Where possible, the same reference numerals will be used throughout the drawings to refer to the same or similar parts.

[0018] Various aspects of the present invention aim to improve the construction of the steering component to increase the tensile strength of the cable, reduce the breakage rate of the cable, increase the cable torque, reduce the need to remove and reintroduce the medical device into the patient, facilitate the treatment of tissues within the subject, reduce the overall size and / or cost of the medical device, and / or reduce overall surgical time, etc. In one example, various aspects of the present invention can provide users (e.g., physicians, medical technicians, or other healthcare providers) with the ability to steer the medical device with greater responsiveness and / or maneuverability, for example, through the patient's anatomical pathway.

[0019] Figure 1 A medical device 10 is depicted, comprising a handle 12 and a sheath or insertion portion 14, the sheath or insertion portion 14 including a distal end 16. The handle 12 may include a body 18 and a movable body 20. The handle 12 may also include a port 22 (e.g., a biopsy port) configured to receive fluid and / or another medical device, such as an end effector. The distal end 16 includes a distal opening 26 (…). Figure 3A and Figure 3B It can, for example, be fluidly connected to port 22 via a cavity or working channel extending through handle 12 and insertion portion 14. Insertion portion 14 includes a steerable section or steerable portion 40, for example, at a position proximal to distal end 16. Additionally, insertion portion 14 includes a control portion or torque delivery portion 42, for example, proximal to steerable portion 40. As discussed in detail below, movable body 20 is coupled to (e.g., directly or indirectly coupled to) inner shaft 24 ( Figure 2A and Figure 2B Additionally, the movement of the movable body 20 can control the movement of the inner shaft 24, for example, to control one or more aspects of the steerable portion 40 and / or the torque transmission portion 42, so that a portion of the insertion portion 14 is hinged or deflected. Although Figure 1 As not shown, but it should be understood that the inner shaft 24 may be disposed (e.g., longitudinally movable) within a portion of the handle 12 and at least a portion of the insertion portion 14.

[0020] The medical device 10 can be inserted into the body cavity of a subject via an insertion device (not shown) or separately, such that at least a portion of the insertion portion 14 can be located within the subject's body, while the handle 12 can be retained outside the subject's body. The distal end 16 can be positioned at or near a target site within the subject's body. The user can manipulate the handle 12 from outside the subject's body. Movement of the movable body 20 relative to the body 18 in a first direction (e.g., in a proximal direction) can also cause the inner shaft 24 to move in the first direction (e.g., proximal). As discussed in more detail below, the inner shaft 24 can be coupled to (e.g., directly or indirectly coupled to) one or more cables, for example, in the torque transmission portion 42. The distal ends of one or more cables are then coupled to one or more portions of the steerable portion 40. In these respects, proximal movement of the inner shaft 24 can also cause one or more cables to retract proximally, for example, to deflect or hinge the steerable portion 40 (e.g., bend in one or more directions, e.g., radially outward).

[0021] Handle 12 can be connected to a fluid source (not shown) via port 22. Port 22 can be connected via inner cavity 32 ( Figure 2B The port 22 is in fluid communication with the distal opening 26, and the lumen 32 may extend through the handle 12 and the insertion portion 14. For example, a portion of the lumen 32 extending through the insertion portion may be formed by a cavity or channel within the inner shaft 24. In some aspects, the inner shaft 24 may be a hypodermic cannula. In one aspect, the lumen 32 may extend longitudinally through the body 18 of the handle 12 and the insertion portion 14 (e.g., through the inner shaft 24) to fluidly connect the port 22 to the distal opening 26. The port 22 may be located on the proximal portion of the body 18, for example, at the proximal end of the body 18. Alternatively, the port 22 may be located on the distal or central portion of the body 18. Moreover, the port 22 may include a check valve, a Luer connector, a seal, a thread, and / or any suitable element to help maintain a secure connection between the handle 12 and the fluid source, minimize or prevent backflow (e.g., fluid flowing proximal out of the port 22), and / or minimize or prevent leakage. In one example, a one-way valve may include a housing containing an internal elastomeric member and / or a gel-like sealing member (not shown).

[0022] The handle 12 can control the movement and / or positioning of the inner shaft 24, for example, relative to the distal end 16 of the inner shaft 24. For example, the body 18 may include a slot 34, and the movable body 20 may be slidably positioned within the slot 34. The slot 34 may define the range of movement (e.g., longitudinal movement) of the movable body 20, which in turn may define the range of movement (e.g., longitudinal movement) of the inner shaft 24. The body 18 may be configured to be held by a user's hand, and the movable body 20 may be configured to be controlled by the movement of the user's thumb. For example, the side of the body 18 opposite the movable body 20 may include one or more contours 36 that can assist the user in holding the body 18. The movable body 20 may be locked in one or more positions relative to the body 18, and / or may be spring-biased in one direction (e.g., toward a position extending distally). As previously described, the movable body 20 may be coupled to the inner shaft 24. For example, the movable body 20 may extend within a portion of the main body 18 (e.g., via the slot 34) and may be directly coupled to a proximal portion of the inner shaft 24. Alternatively, the main body 18 may be indirectly coupled to the inner shaft 24. In these respects, movement of the movable body 20 may control movement of the inner shaft 24.

[0023] like Figure 1 As shown, the insertion portion 14 extends from a distal portion of the body 18 to a distal end 16. The insertion portion 14 may include a sheath that may surround or otherwise form at least a portion of the distal opening 26. The insertion portion 14 may be a tube or sheath that surrounds one or more cavities (e.g., inner cavity 32) and at least a portion of the inner shaft 24. On the other hand, the insertion portion 14 may be an extrusion that includes one or more cavities extending from the handle 12 to the distal end 16.

[0024] Figure 2A and Figure 2B Additional aspects of the torque transmission section 42 of the medical device 10 are described. Figure 2A Depicting a partially decomposed state Figure 1 A perspective view of the torque transmission section 42 of an exemplary medical device, and Figure 2B Depicting a partially decomposed state Figure 1 A side view of the torque transmission portion 42 of an exemplary medical device 10. The torque transmission portion 42 may be located near the steerable portion 40 and coupled to the steerable portion 40. Figure 1 and Figures 3A to 3B (As shown).

[0025] Now for reference Figure 2AThe torque transmission section 42 includes a proximal housing 46 and a distal housing 50, both of which may concentrically or radially surround a portion of an inner shaft 24. The inner shaft 24 may move within the proximal housing 46 and the distal housing 50 (e.g., longitudinally). The distal housing 50 may concentrically surround the inner shaft 24 in a manner substantially similar to that of the proximal housing 46. It should be understood that the proximal housing 46 and the distal housing 50 are depicted as separate components to indicate internal features.

[0026] The torque transmission section 42 may include one or more of a proximal fitting 52, a steering fitting 54, a guide element 56, and a wire 58. The proximal housing 46 and the distal housing 50 may be fixed to each other (e.g., welded, bonded, etc.) (e.g., the distal end of the proximal housing 46 is coupled to the proximal end of the distal housing 50). In these respects, the proximal housing 46 and the distal housing 50 concentrically enclose a portion of the inner shaft 24, the proximal fitting 52, the steering fitting 54, the guide element 56, and the wire 58. The proximal housing 46 and the distal housing 50 are not fixedly coupled to the inner shaft 24. In these respects, movement (e.g., longitudinal movement) of the inner shaft 24 may allow the inner shaft 24 to translate freely through or within both the proximal housing 46 and the distal housing 50.

[0027] The proximal housing 46 may be characterized by a tapered portion 48. The tapered portion 48 may define a slope between the outer diameter of the proximal housing 46 and a diameter substantially equal to the outer diameter of the inner shaft 24. In some aspects, a portion of the sheath defining the insertion portion 14 may be coupled (e.g., fixedly coupled to) a proximal side of the proximal housing 46 (e.g., the tapered portion 48). Alternatively, although not shown, one or more portions of the torque delivery portion 42 and / or the steerable portion 40 may be enclosed or surrounded by the sheath to form a corresponding portion of the insertion portion 14. The proximal housing 46 may receive the inner shaft 24 through a proximal opening 49.

[0028] The proximal fitting 52 is located distal to the proximal housing 46. The proximal fitting 52 may be welded, bonded, crimped, or otherwise securely attached to the inner shaft 24. One or more filaments 58 may be secured (e.g., welded, bonded, crimped, etc.) to the proximal fitting 52. For example, the distal side or portion of the proximal fitting 52 may include an opening for receiving the proximal portion of the filament 58. The filament 58 may extend distally from the proximal fitting 52. The outer diameter of the filament 58 may be approximately 0.008 inches or less. As previously described, the proximal fitting 52 may be positioned within the proximal housing 46 and the distal housing 50. When the inner shaft 24 is longitudinally translated (e.g., proximal or distal), the proximal fitting 52 translates with the inner shaft 24. As the inner shaft 24 translates proximally, the proximal movement of the proximal fitting 52 is restricted by a tapered portion 48, which further prevents the proximal fitting 52 from further longitudinally translating proximally. Restricting the movement of the proximal accessory 52 to the proximal side also helps to restrict the movement of the inner shaft 24 to the proximal side.

[0029] As mentioned above, the torque transmission section 42 includes a steering fitting 54, for example, located distal to the proximal fitting 52. The steering fitting 54 may be welded, crimped, bonded, or otherwise fixedly attached to the inner shaft 24. The steering fitting 54 may be concentrically positioned around the inner shaft 24. The steering fitting 54 may be characterized by a steering fitting bore 59, which is generally aligned with the proximal fitting 52. A wire 58 may be disposed through the steering fitting bore 59 such that the wire 58 is substantially parallel to the inner shaft 24. A guide element 56 may be coupled to the steering fitting 54 and may extend distally, for example, substantially parallel to the longitudinal axis of the inner shaft 24. The guide element 56 may be welded, bonded, or otherwise immovably fixed to the side of the steering fitting 54 opposite (i.e., circumferentially opposite) to the steering fitting bore 59. The guide element 56 may be a rigid or semi-rigid member disposed through the space between the inner shaft 24 and the inner diameter of the distal housing 50. The guide element 56 may also be a rod.

[0030] As the steering fitting 54 translates proximally with the inner shaft 24, the guide element 56 translates through the guide element bore 60. The guide element bore 60 may also be referred to as a rod receiving bore. The guide element bore 60 may extend through (e.g., longitudinally) the distal housing 50. The guide element bore 60 may be aligned with the guide element 56. The guide element 56 may translate within the guide element bore 60 as the inner shaft 24 translates proximally or distally along the longitudinal axis. The translation of the guide element 56 within the guide element bore 60 helps prevent the inner shaft 24 from rotating relative to the proximal housing 46 and / or the distal housing 50 during proximal and / or distal translation. The guide element 56 also helps retain the element.

[0031] The distal side 62 of the distal housing 50 may include a tapered portion 64, which may be substantially similar to a tapered portion 48. The tapered portion 64 may define a slope between the outer diameter of the distal housing 50 and a diameter substantially equal to the outer diameter of the inner shaft 24. The distal housing 50 may receive a distal portion of the inner shaft 24, for example, through a central bore 68. The central bore 68 may extend longitudinally through the distal housing 50, for example, from the proximal side to the distal side of the distal housing 50. Furthermore, the distal housing 50 may also include a wire connection hole 70, which may receive a distal portion of the wire 58.

[0032] The distal side 62 of the distal housing 50 is characterized by a wire connection hole 70. The wire connection hole 70 can be longitudinally aligned with the proximal fitting 52 and the steering fitting 54, for example, to receive the distal portion of the wire 58. The wire 58 can continue distally through the wire connection hole 70 and can be welded, bonded, or otherwise securely coupled to a portion of the steerable portion 40 (e.g., the inner diameter). Figure 1 , Figure 3A and Figure 3BThe filament 58 may include a cable or a solid filament.

[0033] Figure 2B A side view of the torque transmission section 42 is shown, with some internal components indicated by dashed lines. In one example, when the user translates the inner shaft 24 proximally, all components connected to the inner shaft 24 will similarly translate. For example, the proximal fitting 52, the wire 58, the steering fitting 54, and the guide element 56 may also translate with the inner shaft 24. As described above, the proximal fitting 52 may be connected to a portion of the steerable section 40 (e.g., the inner diameter) via the wire 58. The wire 58 may be longitudinally disposed through the steering fitting hole 59, the space between the inner shaft 24 and the inner diameter of the distal housing 50, and the wire connection hole 70.

[0034] Figure 2B The interface between the guide element 56 and the inner diameter of the distal housing 50 is also shown. As the inner shaft 24 translates proximally and / or distally, the guide element 56 similarly translates and engages the guide element orifice 60. The guide element 56 helps prevent rotation of the inner shaft 24 (and components coupled thereto) relative to the proximal housing 46 and the distal housing 50 as the inner shaft 24 moves through one or more cavities within the body. The inner cavity 32 of the inner shaft 24 can be understood as a working channel capable of receiving one or more instruments, fluids, aspiration, sharps, guidewires, contrast agent flushing, and other treatments.

[0035] The inner shaft 24 defines a portion of the inner cavity 32 through which various instruments and / or fluids can be delivered to target sites within the human body, for example, as part of an endoscopic examination procedure. The inner cavity 32 can be connected to the steerable portion 40 via a central hole 68 provided on the distal side of the distal housing 62 and a wire 58. The torque delivery portion 42 and the steerable portion 40 can be fixedly connected, for example, via a concentric weld around the central hole 68. The inner cavity 32 can continue distally through the steerable portion 40.

[0036] Figure 3A The proximal housing 46 and distal housing 50 are shown in an assembled state, wherein the steerable portion 40 is attached to the distal housing 50. Figure 3A As shown, the steerable portion 40 is in an unhinged state. The steerable portion 40 may be hinged or deflected based on the force applied by the wire 58, for example, based on the movement of the wire 58 corresponding to the movement of the inner shaft 24. Additionally, the wire 58 is depicted as anchored to the inner portion of the steerable portion 40, which is shown at the anchoring point 72.

[0037] Figure 3BThe steerable portion 40 in a hinged state is shown. Longitudinal movement of the wire 58 can cause the wire 58 to push or pull the anchor point 72 within the steerable portion 40, thereby hinged the steerable portion 40. It should be understood that, in some respects, the wire 58 may have sufficient rigidity to allow for pushing and pulling, for example, to facilitate the hinged position of the steerable portion 40 relative to... Figure 3B Hinged or deflected in the opposite direction to the indicated direction. Figure 3B It also describes, with Figure 3A In contrast, the proximal accessory 52 has moved proximally along the inner shaft 24. Rotation of the insertion portion 14 (e.g., via rotation of the handle 12) and the guide element 56 can help allow the distal end 16 to deflect by a range of motion, such as a hemispherical range of motion.

[0038] Each of the embodiments discussed herein is exemplary. For example, various configurations can be utilized such that the torque delivery section 42 can increase torque delivery and steering response in a micro-steering device, such as an endoscope. Conventional steering wires are locked to a defined position within the lumen of the endoscope. The exemplary torque delivery can reduce the likelihood of wire breakage and can help increase torque response through anatomical curvature.

[0039] While the principles of the invention have been described with reference to illustrative examples in a close-up context and for specific medical procedures, it should be understood that the invention is not limited thereto. Those skilled in the art and who are able to grasp the teachings provided herein will recognize that additional modifications, applications, and substitutions of equivalents fall within the scope of the examples described herein. Therefore, the invention should not be considered as limited to the foregoing description.

Claims

1. A medical device comprising: A handle, wherein the handle includes a movable body; A shaft extending from the distal end of the handle; The first fitting connected to the shaft; A second fitting located distal to the first fitting and concentrically connected to the shaft, the second fitting including a first hole and a second hole, wherein the first hole receives a portion of the shaft, and wherein the second hole is aligned with the first fitting; A third fitting surrounding the shaft, the first fitting, and the second fitting, wherein the third fitting includes a distal side, a third hole, and a fourth hole, wherein the third hole receives the distal portion of the shaft, and wherein the fourth hole is aligned with the second hole; and A filament, wherein a proximal portion of the filament is connected to the first fitting, wherein a portion of the filament extends through the second hole, and wherein a distal portion of the filament extends through the fourth hole.

2. The medical device according to claim 1, further comprising: A fourth fitting is located proximal to the third fitting and concentrically surrounds the shaft, the first fitting, and the second fitting, wherein the fourth fitting includes a proximal side that includes a fifth hole movably receiving a portion of the shaft.

3. The medical device according to claim 2, wherein, The fourth accessory is fixed to the third accessory.

4. The medical device according to any one of the preceding claims, further comprising: A rod connected to the second fitting and positioned relative to the second hole, wherein the rod extends distally to the second fitting.

5. The medical device according to any one of the preceding claims, further comprising: A hinged portion connected to the distal side, wherein the filament is fixedly connected to a portion of the hinged portion.

6. The medical device according to claim 5, wherein, Rotation of the handle causes the shaft to rotate, thereby causing the hinged portion to rotate.

7. The medical device according to claim 5, wherein, The axial proximal movement allows the filament to move independently of the third and fourth fittings, and allows the hinged portion to switch between at least the first and second configurations.

8. The medical device according to claim 7, wherein, The axial distal movement causes the filament to move independently of the third and fourth fittings, and causes the hinged portion to switch between at least the second and first configurations.

9. The medical device according to claim 4, wherein, The rotational movement of the shaft relative to the third and fourth fittings is limited by the rod interacting with the rod receiving hole provided on the distal side.

10. The medical device according to claim 4, wherein, The axial proximal movement is limited by the first accessory, which interacts with the proximal side of the fourth accessory.

11. The medical device according to any one of the preceding claims, wherein, The shaft includes a hypodermal injection tube.

12. The medical device according to any one of the preceding claims, wherein, The third component is concentrically positioned around the axis.

13. The medical device according to claim 2, wherein, The proximal side includes a tapered portion extending from the outer diameter of the distal side to a diameter approximately equal to that of the shaft.

14. The medical device according to any one of the preceding claims, wherein, The outer diameter of the filament is less than or equal to 0.008 inches.

15. The medical device according to any one of the preceding claims, wherein, The filament includes one of the following: (i) a cable, or (ii) a solid filament.

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