Distal tip of a medical instrument

Abstract

A distal tip of a medical instrument includes a distal tip housing, an imaging device, an illumination element, and an elevator. A wire connected to the elevator is configured to raise or lower the elevator. The distal tip housing includes a flange. At least a portion of the wire rests on at least a portion of the flange in a configuration in which the elevator is fully lowered.

Description

Technical Field

[0001] Various aspects of this disclosure generally relate to the distal ends of medical devices. In particular, various aspects of this disclosure relate to the distal ends of duodenoscopes, etc. Background Technology

[0002] A duodenoscopy may include a handle and a sheath or shaft, the shaft being insertable into the body cavity of the object. The sheath may terminate at a distal end and may include features such as optical elements (e.g., a camera, illumination device, etc.), air / water outlets, and a working channel opening. A lift may be located at the distal end and can be actuated to change the orientation of medical instruments / tools passing through the working channel. For example, the lift may be pivotable or otherwise movable. During endoscopic retrograde cholangiopancreatography (ERCP), the operator inserts the shaft of the duodenoscopy into the body cavity and navigates the distal end to the surgical site. Such cavities may be small, which can pose challenges for the advancement of conventional devices. Summary of the Invention

[0003] Various aspects of this disclosure relate to a distal end of a medical device, the distal end including a distal end housing, an imaging device, an illumination element, and a lifter. A wire connected to the lifter is configured to raise or lower the lifter. The distal end housing includes a flange. When the lifter is in a fully lowered configuration, at least a portion of the wire rests on at least a portion of the flange.

[0004] Any aspect disclosed herein may, individually or in any combination, have any of the following features: A flange may be inclined from its proximal end to its distal end. A flange may be straight and inclined downward from its proximal end to its distal end. The distal end housing may include an arm. This arm may include the aforementioned flange. The flange may extend to the distal end of the arm. This arm may be a first arm. The distal end housing may include a second arm that houses an imaging device and an illumination element. The second arm may extend more distally than the first arm. The lifter may include a connector that defines an opening for receiving a wire. The distal surface of the connector may be the distal surface of the lifter. The connector is farther from a first lateral side of the lifter than from a second lateral side. The lifter may include a guide surface for contacting a medical instrument. The guide surface may include a longitudinally extending groove. The groove may be substantially aligned with the center of the connector. The distal end housing may include a first recess, a second recess, and an intermediate portion located between the first and second recesses. The first and second recesses are recessed relative to the intermediate portion, and to portions of the distal end housing adjacent to the first and second recesses. At least one of the first or second recesses may have a substantially flat proximal surface. The intermediate portion may have a substantially flat distal surface. In the lifting configuration of the lifter, the intermediate portion and the guide surface of the lifter may be configured to secure the medical device between them. The lifter may include a body at its proximal end. The body may define an opening. The distal end may also include a pin extending through the opening. The lifter may be configured to pivot about the pin. The distal end housing may define a recess. The body may be received in the recess. The pin may extend through a portion of the distal end housing adjacent to the recess. The body is farther from the first lateral side of the lifter than from the second lateral side. Attached Figure Description

[0005] The accompanying drawings, which are incorporated in and form a part of this specification, illustrate various aspects of this disclosure and, together with the specification, explain the principles of this disclosure.

[0006] Figure 1A and 1B An exemplary medical device is shown.

[0007] Figure 2 Is with Figure 1A and 1B An exemplary perspective view of the distal end used in conjunction with a medical device.

[0008] Figures 3A-3C It shows Figure 2 The elevator at the distal end.

[0009] Figure 4A and 4B yes Figure 2 Perspective view of the distal end in the alternative configuration.

[0010] Figure 5 yes Figure 2 Top view of the distal end.

[0011] Figure 6 It shows Figure 2 Part of the distal end.

[0012] Figure 7 It shows Figure 2 The other part of the distal end. Detailed Implementation

[0013] The distal end of a medical device, such as a duodenoscope, can be difficult to navigate through small body cavities (e.g., the body cavity of a pediatric patient or a body cavity with narrow openings). This document discloses an exemplary distal end of a medical device for such small body cavities. The disclosed distal end may have a smaller diameter / width than conventional distal ends to facilitate navigation through smaller anatomical structures. The disclosed distal end may include a lifter that can be raised or lowered to change the orientation of the medical instrument extending through the working channel of the medical device. The disclosed lifter may have a shorter length compared to lifters in larger duodenoscopes. A control line coupled to the lifter can raise or lower the lifter. The control line can be coupled to the lifter via a connector at the distal end of the lifter. The lifter can pivot about a pivot pin about a pivot body passing through the proximal end of the lifter. The connector may extend only a portion of the width of the lifter. The lifter may be asymmetrical to accommodate the small size of the distal end.

[0014] The lifter can be "locked" in an elevated configuration. In other words, when the lifter is in a fully elevated configuration, the side of the lifter can be accommodated in a recess in the housing at the distal end. This "locked" configuration allows the lifter to remain in the elevated position and can be used to secure medical instruments extending along the lifter in a deflection configuration by securing the medical instrument to the distally facing portion of the end.

[0015] As described above, the lifter can have a shorter length than conventional lifters. The lifter and the housing at the distal end can be particularly adapted to transmit the force required to raise or lower this shorter lifter. For example, connecting the wire to the distal end of the connector of the lifter facilitates the transmission of force with a greater lever length. The housing at the distal end can have a flange that supports the actuation wire. This flange may be particularly advantageous given that the connector is located at the distal end of the lifter, away from the distal opening of the lumen through which the actuation wire extends.

[0016] The distal end also has other features and advantages discussed herein.

[0017] It should be understood that the foregoing general description and the following specific description are exemplary and explanatory, and not intended to limit the claimed invention. As used herein, the terms “comprising,” “including,” “having,” “containing,” or any other variations thereof are intended to cover non-exclusive inclusion, such that a process, method, article, or apparatus that comprises a list of elements may include not only those elements but also other elements not expressly listed or inherent to such a process, method, article, or apparatus. The term “diameter” may refer to the width of an element when it is not circular. The term “distal end” refers to a direction away from the operator, and the term “proximal end” refers to a direction towards the operator. The term “exemplary” is used in the sense of “example” rather than “ideal.” The term “about” or similar terms (e.g., “substantially”) include ±10% of the stated value. The term “or” includes “and / or”.

[0018] Figure 1A An exemplary medical device 110 with a handle 112 and an insertion portion 114 is shown. Figure 1B The proximal end of the handle 112 is shown. The medical device 100 may also include an umbilical portion 116 for connecting the medical device 110 to a source such as air, water, suction, power, etc., and to an image processing and / or observation device. Although this disclosure specifically refers to duodenoscopy and endoscopy (and combined devices performing duodenoscopy and endoscopy functions), it also covers other types of devices such as bronchoscopes, gastroscopes, endoscopic ultrasound (“EUS”) endoscopes, colonoscopes, ureteroscopes, bronchoscopes, laparoscopes, cystoscopes, suction endoscopes, sheaths, catheters, or similar devices. Reference to duodenoscopy herein should be understood to cover any of the aforementioned medical devices.

[0019] The insertion portion 114 may include a sheath or shaft 118 and a distal end 120. The distal end 120 may include an imaging device 122 (e.g., a camera) and an illumination element 124 (e.g., a light-emitting diode (LED) or optical fiber). Although the term "illumination element" is used herein, it should be understood that the term "illumination element" may include multiple illumination elements (e.g., multiple LEDs or optical fibers). The distal end 120 may be laterally oriented. That is, the imaging device 122 and the illumination element 124 may be oriented radially outward, vertically, substantially vertically, or otherwise transverse to the longitudinal axis of the shaft 118 and the distal end 120 (e.g., at an angle of approximately 80 degrees to approximately 110 degrees). However, this disclosure is not limited to this arrangement.

[0020] The distal end 120 may also include a lifter 126 for changing the orientation of an accessory device or tool inserted into the working channel of the medical device 110. The lifter 126 may alternatively be referred to as a swing frame, pivot frame, lifting base, or any other suitable term. The lifter 126 may be pivoted, for example, by an actuation line extending from the handle 112 through the shaft 118 to the lifter 126 or by another control element.

[0021] The distal portion of the shaft 118, which is coupled to the distal end 120, may have a steerable section 128. The steerable section 128 may be, for example, a hinged joint. The shaft 118 and the steerable section 128 may include various structures known or possibly known in the art.

[0022] Handle 112 may have one or more actuator / control mechanisms 130. One or more control mechanisms 130 may provide control over the steerable section 128. One or more control mechanisms 130 may allow the supply of air, water, suction, etc. For example, handle 112 may include control knobs 132, 134 for left, right, up, and / or down control of the steerable section 128. For example, one of knobs 132, 134 may provide left / right control of the steerable section 128, while the other of knobs 132, 134 may provide up / down control of the steerable section 128. Handle 112 may further include one or more locking mechanisms 136 and 142 (e.g., knobs or levers) for preventing the steerable section 128 from turning and / or braking in at least one of the upward, downward, left, or right directions. Handle 112 may include a lifter control lever 138 (see [link to relevant documentation]). Figure 1B The lifter control lever 138 can raise and / or lower the lifter 126 via a connection between the lever 138 and an actuation line (which extends from the lever 138 through the shaft 118 to the lifter 126). Port 140 allows tools to enter the working channel of the medical device 110 through port 140, and through the shaft 118 to reach the distal end 120.

[0023] In use, the operator can insert at least a portion of shaft 118 into the body cavity of the patient. The distal end 120 can be navigated to the surgical site within the body cavity. For example, the operator can push or jerk the distal end 120 distally to advance it through the body cavity. The operator can insert an accessory device (not shown) into port 140 and pass it through shaft 118 to the distal end 120 via a working channel. The accessory device can exit the working channel at the distal end 120. The user can raise the lift 126 using lift control lever 138 and tilt the accessory device toward a desired location (e.g., the papilla of the pancreaticobiliary duct). The user can use the accessory device to perform medical procedures.

[0024] Figure 2A distal end 220 for use in conjunction with medical device 100 is shown. For example, distal end 220 may be used in place of distal end 120. Unless otherwise stated, distal end 220 may have any of the features of distal end 120. Distal end 220 may include a housing core 230 and a housing cover 232 that partially covers the housing core 230. Housing core 230 may accommodate an imaging device 222 (having any properties of imaging device 122) and an illumination element 224 (having any properties of illumination element 124). Although two illumination elements 224 are shown, one proximal to the imaging device 222 and one distal to the imaging device 222, this arrangement is merely exemplary.

[0025] The distal end 220 may also include a lift 226. An actuation line 234 may be coupled to the lift 226 to facilitate pivoting or rotation of the lift 226. Although the term "line" is used, the actuation line 234 may be a cable, a multi-strand wire, etc., and "line" is intended to include any such actuating element. The actuation line 234 may extend through the lumen of the shaft 118 and may travel distally through an opening 236 in the lumen within the distal end 220 that communicates with the lumen of the shaft 118. A medical instrument or device extending through a working channel of the shaft 118 may travel distally through the working channel opening 238. The instrument or device may extend along the lift 226. The actuation line 234 may be actuated (e.g., using a lift control lever 138) to raise or lower the lift 226 to change the orientation of the medical instrument or device. The lift 226 is described in more detail below.

[0026] Figures 3A-3C A lifter 226, separate from the remainder of the distal end 220, is shown separately, and details of the lifter 226 are illustrated. The lifter 226 may have a guide surface 240 for contacting and changing the orientation of a medical instrument or device. A medical instrument or device extending through the working channel opening 238 may move along and contact the guide surface 240. The guide surface 240 may include a groove 241 extending longitudinally along the length of the lifter 226. The medical device or instrument may be guided into the groove 241 and, as described below, held in place within the groove 241 when the lifter 226 is in an elevated / closed configuration. The guide surface 240 may extend from the proximal end 249 to the distal end 250 of the lifter 226.

[0027] The side of the lifter 226 opposite to the guide surface 240 may have a rear surface 242. The rear surface 242 may face the housing cover 232 and may not contact the medical device or instrument. The lifter 226 may have a first top surface 247a on a first lateral side 244 of the lifter 226. The lifter 226 may have a second top surface 247b on a second lateral side 246. The second lateral side 246 may be the side closer to the imaging device 222 and the illumination element 224. The first lateral side 244 may be the side closer to the actuation line 234. The lateral direction is... Figure 5 The coordinate system is in the "Z" direction. Top surface 247a and second top surface 247b may be adjacent to guide surface 240. Elevator 226 may have a first side surface 248a on a first lateral side 244 and a second side surface 248b on a second lateral side 246. The first top surface 247a / second top surface 247b may extend between guide surface 240 and the first side surface 248a / second side surface 248b, respectively. The first side surface 248a / second side surface 248b may extend between rear surface 242 and the first top surface 247a / second top surface 247b, respectively. Elevator 226 may have a distal surface 251 at distal end 250.

[0028] The lifter 226 includes a connector 252 at its distal end 250. The connector 252 may have a distal surface 254 continuous with the distal surface 251. In other words, the distal surface 254 may form part of the distalmost surface of the lifter 226. The connector 252 may be disposed on the rear surface 242 and may extend to the distal end of the rear surface 242. The connector 252 may define an opening 256. The opening 256 may extend substantially perpendicular to the longitudinal axis of the lifter 226 (e.g., perpendicular to the recess 241). The opening 256 may extend laterally, substantially parallel to a line drawn from the first lateral side 244 to the second lateral side 246. An actuation line 234 may extend into the opening 256 and be securely connected to the connector 252. For example, as... Figure 2 As shown, the actuation line 234 may include a bend of approximately 90 degrees, such that the farthest portion of the actuation line 234 extends into the opening 256.

[0029] The lift 226 includes a pivot 258 at its proximal end 249. The top surface 259 of the pivot 258 (a surface along the same side of the lift 226 as the guide surface 240) may be continuous with the guide surface 240 to provide a smooth surface for receiving and guiding a medical device or instrument extending from the working channel opening 238. In various respects, a recess 241 may extend along the top surface 259 of the pivot 258. The rear surface 261 of the pivot 258 may extend further away from the guide surface 240 than the rear surface 242 of the rest of the lift 226. In other words, as... Figure 3B and3C As shown, rear surface 261 extends downward from rear surface 242. Opening 260 may extend substantially perpendicular to the longitudinal axis of lifter 226 (e.g., perpendicular to recess 241). Opening 260 may extend laterally, substantially parallel to a line drawn from first lateral side 244 to second lateral side 246. Pin 262 or other shaft ( Figure 3A (As shown in the figure) can extend through opening 256, and lift 226 can pivot or rotate about pin 262 extending through opening 256.

[0030] like Figure 5 and 7 As specifically shown, the pivot 258 can be positioned in the notch 265 between the protrusions 263a and 263b of the housing core 230. Figure 7 In the middle, protrusions 263a and 263b may be adjacent to recess 265. Pin 262 may extend through protrusions 263a and 263b and through pivot body 258. Therefore, when actuation line 234 moves proximally or distally, lifter 226 may pivot about pin 262.

[0031] Figure 4A and 4B A perspective view of the distal end 220 is shown, in which the elevator 226 is in a partially raised configuration. Figure 4A ) and fully raised (closed) configuration ( Figure 4B ). Figure 5 A top view of the distal end 220 is shown, with the elevator 226 fully raised. Figure 6 The distal end 220 of the housing cover 232 is shown after removal. Figure 7 The distal end 220 shown has removed the housing cover 232 and the lifter 226 and actuation line 234 to expose various aspects of the housing core 230. (See diagram) Figure 6 and 7 As specifically shown, the housing core 230 may include a first arm 290 and a second arm 292. The imaging device 222 and the illumination element 224 may be housed within the second arm 292. For example, the imaging device 222 and the illumination element 224 may be disposed in a module 294, which may be fitted into the second arm 292.

[0032] like Figure 2 , 4AAs specifically shown in 4B and 6, flange 270 may extend longitudinally along the first arm 290 of housing core 230. For example, flange 270 may extend along the inner surface of the first arm 290 (the surface facing the second arm 292) to the distal end of the first arm 290. Flange 270 may have a proximal end 272 and a distal end 274, and may be a straight surface between these ends. Flange 270 may be inclined downward from the proximal end 272 to the distal end 274, wherein the upward direction is defined by the general direction in which the imaging device 222 and the illumination element 224 face. The upward / downward direction is Figure 5 The "X" axis (page in / out). In this way, flange 270 is angled relative to the longitudinal axis of end 220. Flange 270 can support actuation line 234. Support from flange 270 can facilitate a relatively large distance between pivot 258 and connector 252. For example, flange 270 can maintain the alignment of actuation line 234 and can limit slack in actuation line 234. As the lift 226 is fully lowered ( Figure 2 The opening 236 through which the actuation line 234 passes is higher than the opening 256 of the connector 252, thus allowing the flange 270 to tilt downwards. In the fully lowered configuration of the lifter 226 ( Figure 2 At least a portion of the actuation line 234 may rest on at least a portion of the flange 270. When the elevator 226 rises ( Figure 4A and 4B The actuation line 234 can be lifted from the flange 270.

[0033] like Figure 6 As shown, the second arm 292 may extend distally beyond the first arm 290. The first arm 290 may have a relatively shorter longitudinal length than the second arm 292 to allow the flange 270 to extend the entire length of the first arm 290 and beyond its distal end without interfering with the movement of the actuation line 234 or the lifter 226. For example, a portion of the length of the actuation line 234 may be distal to the distal end of the flange 270 (and the first arm 290). The first arm 290 may be longitudinally long enough to provide support for the actuation line 234 without inhibiting its movement.

[0034] like Figures 3A-3CAs specifically shown in Figure 5, the lifter 226 may be asymmetrical about its central longitudinal axis. For example, the groove 241 of the guide surface 240 may be closer to the second lateral side 246 than to the first lateral side 244. The groove 241 may extend substantially parallel to the central longitudinal axis of the lifter 226. In all respects, the first top surface 247a and the second top surface 247b may have approximately the same height relative to the groove 241. Therefore, the side of the guide surface 240 closer to the second lateral side 246 may be steeper than the side closer to the first lateral side 244. The connector 252 may be closer to the second lateral side 246 than to the first lateral side 244. In other words, the connector 252 may be farther from the first lateral side 244 than from the second lateral side 246. In all respects, the groove 241 may be substantially laterally centered relative to the connector 252 (the center of the connector 252 may be substantially aligned with the groove 241). The pivot 258 may also be closer to the second lateral side 246 than to the first lateral side 244. In other words, the pivot 258 can be farther from the first lateral side 244 than from the second lateral side 246. In some aspects, such as Figure 3A As specifically shown, the longitudinal centerline of the pivot 258 may be closer to the second transverse side 246 than the longitudinal centerline of the connector 252. Therefore, the groove 241 may be eccentric relative to the pivot 258.

[0035] The above arrangement is particularly suitable for the small size of the distal end 220. For example, an asymmetrical arrangement can accommodate the position and size of the opening 236 through which the actuation line 234 passes, as well as the position of the flange 270 for supporting the actuation line 234. In all respects, the width of the guide surface 240 from the first lateral side 244 to the second lateral side 246 can be approximately the same as, and can be approximately aligned with, the working channel opening 238. Figure 7 As specifically shown, the opening 236 for the actuation line 234 may laterally overlap with the working channel opening 238. In other words, the line drawn from the top to the bottom of the distal end 220 (along...) Figure 5 The X-axis shown can pass through both opening 236 and working channel opening 238. This arrangement allows the required components and lumen size to be accommodated in the smaller distal end 220. For example, opening 236 can at least partially ( Figure 5Positioned above the working channel opening 238 (shown in the X direction) to accommodate both the working channel opening 238 and opening 236 in the small distal end 220. For example, the working channel opening 238 may need to be the same or similar in size to the working channel of a conventional duodenoscope to accommodate medical instruments or devices. Therefore, the notch 265 between the protrusions 263a, 263b may be off-center relative to the working channel opening 238 (on the side of the working channel opening 238 closer to the imaging device 222 and illumination element 224) to accommodate the path of the actuation wire 234 extending along the flange 270 and the curvature of the actuation wire 234 as it enters the opening 256 of the connector 252.

[0036] The arrangement of the actuation line 234, flange 270, pivot 258 (and pin 262), and connector 252 (including opening 256) is particularly well-suited to provide the torque required to actuate the lift 226 without requiring the operator to apply excessive force to the lift control lever 138. For example, the arrangement of these elements allows the lift 226 to be actuated, and the lift 226 may have a shorter length than conventional lifts, without requiring the operator to apply inappropriate force to the lift control lever 138.

[0037] The housing core 230 and housing cover 232 may also include features to help secure an instrument or medical device inserted through the opening 236 when the lifter 226 is in the raised configuration. The housing core 230 and housing cover 232 may together define a first recess 276a and a second recess 276b. The first recess 276a and the second recess 276b may each be recessed proximally relative to the surrounding (e.g., adjacent) portions of the housing core 230 and housing cover 232. A middle portion 278 may be located between the first recess 276a and the second recess 276b. The first recess 276a and the second recess 276b may be recessed relative to the middle portion 278. The middle portion 278 may be generally longitudinally aligned with the portions of the housing core 230 and housing cover 232 surrounding the first recess 276a and the second recess 276b. In other words, the middle portion 278 does not extend or protrude more distally than the portions of the housing core 230 and housing cover 232 surrounding the first recess 276a and the second recess 276b. The housing core 230 may include a groove 296 along the middle portion 278 to engage with a complementary protrusion on the housing cover 232.

[0038] The first recess 276a and the second recess 276b may have a generally rectangular cross-sectional shape. For example, the proximal surfaces defining the first recess 276a and the second recess 276b may be generally straight or flat (e.g., planar) and may extend substantially laterally (in... Figure 5 (in the Z direction of the coordinate axis). The middle part 278 may also have a generally straight or flat (e.g., plane) distal surface.

[0039] like Figure 4B and 5 As shown, when the lift 226 is fully raised (closed), the first top surface 247a and the second top surface 247b can be accommodated in the first recess 276a and the second recess 276b, respectively. The shapes of the first top surface 247a and the second top surface 247b can be complementary to the shapes of the first recess 276a and the second recess 276b, respectively. A medical device or instrument extending through the opening 236 can be held between the groove 241 and the intermediate portion 278 of the guide surface 240. When the lift 226 is fully raised, the distance between the groove 241 and the intermediate portion 278 can be selected to accommodate a common diameter of the medical device or instrument. In other words, the intermediate portion 278 and the groove 241 can be configured to secure the medical device or instrument therebetween. Securing the medical device or instrument between the groove 241 (or another portion of the guide surface 240) and the intermediate portion 278 can be referred to as “locking” the lift 226. The arrangement of the first recess 276a, the second recess 276b, and the intermediate portion 278 is particularly suitable for the smaller-sized distal end 220 and the lifter 226 disclosed herein.

[0040] While the principles of this disclosure are described herein with reference to illustrative examples for specific applications, it should be understood that this disclosure is not limited thereto. Those skilled in the art, upon receiving the teachings provided herein, will recognize that additional modifications, applications, and substitutions of equivalents fall within the scope of the examples described herein. Furthermore, various elements in each presented example can be combined to achieve one or more of the same or similar results as in the disclosed embodiments. Therefore, the features of the examples should not be considered mutually exclusive or applicable to any particular distal end, but can be combined in any suitable manner. Consequently, the invention should not be considered limited to the foregoing description.

Claims

1. The distal end of a medical device, comprising: Distal end housing; Imaging devices; Lighting components; and A lift, wherein the lines connected to the lift are configured to raise or lower the lift; The distal end housing includes a flange, wherein, in the fully lowered configuration of the elevator, at least a portion of the line rests on at least a portion of the flange.

2. The distal end according to claim 1, wherein, The flange is inclined from the proximal end of the flange to the distal end of the flange.

3. The distal end according to claim 2, wherein, The flange is straight and slopes downward from the proximal end to the distal end of the flange.

4. The distal end according to any one of claims 1-3, wherein, The distal end housing includes an arm, the arm including the flange, and the flange extending to the distal end of the arm.

5. The distal end according to claim 4, wherein, The arm is a first arm, and the distal end housing includes a second arm that houses the imaging device and the illumination element, the second arm extending more distally than the first arm.

6. The distal end according to any one of claims 1-3, wherein, The lifter includes a connector that defines an opening for receiving the line, the farthest surface of the connector being the farthest surface of the lifter.

7. The distal end according to claim 6, wherein, The connector is farther from the first lateral side of the elevator than from the second lateral side of the elevator.

8. The distal end according to claim 7, wherein, The lifter includes a guide surface for contacting a medical instrument, the guide surface including a longitudinally extending groove, and the groove being substantially aligned with the center of the connector.

9. The distal end according to claim 1, wherein, The distal end housing includes a first recess, a second recess, and an intermediate portion between the first recess and the second recess, wherein the first recess and the second recess are recessed relative to the intermediate portion and portions of the distal end housing adjacent to the first recess and the second recess.

10. The distal end according to claim 9, wherein, At least one of the first recess or the second recess has a generally flat proximal surface.

11. The distal end according to claim 9 or 10, wherein, The middle portion has a generally flat distal surface.

12. The distal end according to claim 9 or 10, wherein, In the raised configuration of the lifter, the middle section and the guide surface of the lifter are configured to secure the medical device therebetween.

13. The distal end according to claim 1, wherein, The lifter includes a body at its proximal end, the body defining an opening, and wherein the distal end further includes: A pin extends through the opening, wherein the lifter is configured to pivot about the pin.

14. The distal end according to claim 13, wherein, The distal end housing defines a notch, the body is received in the notch, and the pin extends through a portion of the distal end housing adjacent to the notch.

15. The distal end according to claim 13 or 14, wherein, The main body is farther from the first lateral side of the elevator than from the second lateral side of the elevator.

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