Hinge sleeve assembly

Abstract

A hinged sleeve assembly is described. The hinge sleeve assembly includes: a handpiece; a proximal housing over the handpiece; a cannula extending distally from the proximal housing, the cannula including a hinge section; and a trigger that, when actuated, extends or retracts the hinge section. The proximal housing can be removably coupled to the handpiece. The proximal housing can include an endoscope attachment structure for removably securing a proximal portion of an endoscope.

Description

[0001] Cross - Reference to Related Applications

[0002] This application claims the benefit of U.S. Provisional Patent Application No. 63 / 216,209, filed on June 29, 2021, titled "Articulating Sheath with Endoscopic Attachment", which is hereby incorporated by reference in its entirety. Background Art

[0003] An endoscope is an illuminated tubular instrument with an eyepiece, a camera, or a camera chip, which is used to observe the interior of body cavities in a routine / procedure called endoscopy. During a medical routine performed using an instrument inserted into a patient's body cavity, an endoscope can be used to visualize the medical instrument and the body cavity during the routine. For example, an endoscope can be used to allow a doctor to observe tissues or other substances within a cavity or an anatomical space in a patient while using a suction forceps or a grasping forceps to remove tissue from the space.

[0004] In routines where a medical instrument is used in combination with an endoscope, the endoscope is typically a rigid or flexible tool that is manipulated separately from the medical instrument. During the routine, a medical staff member holds and guides the rigid or flexible endoscope with one hand and holds the instrument for treating the patient with the other hand. Depending on the anatomical space to be visualized, a doctor will use a rigid or flexible endoscope. For example, pulmonologists and gastroenterologists use flexible endoscopes, orthopedic surgeons typically use rigid endoscopes, and otolaryngologists use rigid or flexible endoscopes depending on the surgical application. When using an endoscope together with other surgical instruments in a confined space, there is often interference between the endoscope and the instrument when trying to manipulate them within the same anatomical space. This is sometimes referred to as "sword fighting" and can make the surgery technically more difficult and sometimes require another incision or access port to overcome. This is especially true in orthopedic arthroscopic examinations.

[0005] Current rigid endoscope implementations have significant limitations in visualizing a patient's body cavity during a routine. When a surgeon tries to perform a task in an area that is difficult to reach with the instrument, they are often hindered by the rigidity and visual angle of the endoscope. Even when an angled rigid scope is available for observation, the surgeon can still be hindered. In addition, especially in pediatric cases, there is not enough space to insert multiple instruments into the nasal cavity or sinus openings simultaneously. Moreover, angled rigid scope observations tend to distort the surgeon's perspective and are cumbersome to use in combination with secondary instruments such as forceps in small cavities.

[0006] Similarly, current embodiments of flexible endoscopes also have their own set of problems. In some flexible endoscope systems on the current market, tools need to be passed through tiny instrument channels integrated within the flexible endoscope. In such systems, the size of the tools is limited to the diameter of the endoscope channel, and thus greatly restricts the tool options available for endoscopic tissue manipulation. Attaching a flexible endoscope externally to a surgical instrument or device is difficult because it is hard to stabilize the endoscope. The endoscope hangs on the back of the instrument, and it is not easy to connect or transfer the endoscope from one instrument to another. Using currently available flexible endoscopes requires two hands: one hand to manipulate tip flexion and the other hand to stabilize the tip of the flexible shaft as the flexible shaft enters the anatomical opening.

[0007] The visibility of the endoscope is often affected by the contamination and clouding of the lens surface by body fluids or tissue debris. Over the years, many medical device manufacturers have tried to use irrigation / aspiration sleeves and pump / aspiration systems to remove such debris from the lens. These systems are cumbersome, expensive, and often insufficient to achieve their intended purpose. These types of systems are mainly designed for rigid scopes rather than flexible scopes. Some flexible scopes, such as bronchoscopes and colonoscopes, have channel lumens capable of aspiration and irrigation, but flexible endoscopes without internal channels cannot remove debris from the lens.

[0008] With the advent of robotic surgery, many types of articulated surgical forceps have been designed to be used through surgical ports under endoscopic visualization. However, robotic surgery is expensive and impractical for many surgical routines. In addition, introducing an endoscope and one or more instruments into the anatomical space typically requires more than one surgical port for access. This requires longer incisions or multiple incisions, increasing scarring, surgical time, and patient discomfort, while making it more difficult to perform surgery in an office setting. Summary of the Utility Model

[0009] Some embodiments described herein relate to an articulated cannula assembly. The assembly can have a removable endoscope attachment.

[0010] In one embodiment, the articulated cannula assembly includes: a handpiece; a proximal housing located above the handpiece; a cannula extending distally from the proximal housing, the cannula including an articulated section; and a trigger that, when actuated, causes the articulated section to extend or contract.

[0011] In some embodiments, the proximal housing will be removably coupled to the handpiece.

[0012] In some embodiments, the handpiece is a balloon pump handpiece that includes a connection port for fluidly coupling to a balloon catheter; the balloon pump handpiece includes a controller for inflating a distal balloon of the balloon catheter; and a top portion of the balloon pump handpiece includes a mechanism for removably coupling to a proximal housing.

[0013] In some embodiments, the proximal housing includes a port connected to a cannula; the port is configured to receive the distal balloon of the balloon catheter; and after the distal balloon is received at the port, the distal balloon will pass through the cannula.

[0014] In some embodiments, one of the handpiece or the proximal housing includes a T-shaped attachment structure; one of the handpiece or the proximal housing includes a T-shaped track; and the handpiece is removably coupled to the proximal housing by sliding the T-shaped attachment structure in the T-shaped track.

[0015] In some embodiments, the proximal housing includes a first port and a second port connected to the cannula; and the first port is for receiving a first instrument passing through the cannula; and the second port is for receiving a second instrument passing through the cannula.

[0016] In some embodiments, the articulated cannula assembly further includes: a first tube that connects the first port to the cannula and passes through at least a portion of the cannula; and a second tube that connects the second port to the cannula and passes through at least a portion of the cannula, wherein the first instrument will pass through the first tube and the second instrument will pass through the second tube.

[0017] In some embodiments, the first tube and the second tube terminate within the cannula or after the distal end of the cannula, respectively. In some embodiments, the first tube and the second tube merge into a single channel within the cannula.

[0018] In some embodiments, the first port and the second port are located on opposite sides of the proximal housing.

[0019] In some embodiments, the proximal housing includes a third port connected to the cannula, the third port for receiving a third instrument passing through the cannula, the first port and the second port are located on the left and right sides of the proximal housing, and the third port is located on the rear side of the proximal housing.

[0020] In some embodiments, the proximal housing includes a first port connected to the cannula, the first port located on the rear side of the proximal housing and for receiving one or more instruments passing through the cannula.

[0021] In some embodiments, the cannula further includes a rotatable section located distal to the articulated section, the rotatable section rotating independently of the remainder of the cannula.

[0022] In some embodiments, the articulated section includes a plurality of notches that widen or close when the trigger is actuated. In some embodiments, the articulated cannula assembly further includes: a pulley incorporated into the proximal housing; and one or more wires coupling the articulated section to the pulley.

[0023] In some embodiments, the articulated section includes a flexible coating disposed over the plurality of notches.

[0024] In some embodiments, the proximal housing includes a first endoscope attachment structure for removably securing a proximal portion of the endoscope.

[0025] In some embodiments, the first endoscope attachment structure includes an open channel having a sidewall and a distal hole extending from a distal end of the open channel to a distal end of the proximal housing; and the endoscope is removably secured to the first endoscope attachment structure by passing an axis of the endoscope through the distal hole and securing a proximal portion of the endoscope within the open channel.

[0026] In some embodiments, the articulated cannula assembly further includes a second endoscope attachment structure for securing an exterior of the cannula to an axis of the endoscope.

[0027] In some embodiments, the second endoscope attachment structure is incorporated into a distal portion of the cannula.

[0028] In some embodiments, the cannula further includes a rotatable section distal to the articulated section, the rotatable section including the second endoscope attachment structure and being rotatable independently of the remainder of the cannula.

[0029] In one embodiment, the articulated cannula assembly includes a proximal housing that includes a coupling mechanism for removably coupling to a top portion of a handpiece; a cannula extending distally from the proximal housing, the cannula including an articulated section; and a trigger that, when actuated, causes the articulated section to extend or contract.

[0030] Other features and aspects of the disclosed technology will become apparent from the following detailed description taken in conjunction with the accompanying drawings, which illustrate, by way of example, features of embodiments of the disclosed technology. This summary is not intended to limit the scope of any utility described herein as defined by the claims and their equivalents.

[0031] It should be understood that all combinations of the above concepts (so long as these concepts are not mutually inconsistent) are contemplated as part of the utility subject matter disclosed herein. In particular, all combinations of the claimed subject matter appearing at the end of this disclosure are considered part of the utility subject matter disclosed herein. BRIEF DESCRIPTION OF THE DRAWINGS

[0032] In accordance with one or more embodiments, the present disclosure will be described in detail with reference to the following drawings. These drawings are provided for illustrative purposes only and depict example embodiments. Additionally, it should be noted that for clarity and ease of illustration, the elements in the figures are not necessarily drawn to scale.

[0033] Some of the drawings included herein illustrate various embodiments of the disclosed technology from different perspectives. Although the accompanying descriptive text may refer to views such as "top-down", "bottom-up", or "side" views, these references are merely descriptive and do not imply or require that the disclosed technology be implemented or used in a particular spatial orientation, unless otherwise explicitly stated.

[0034] Figure 1 A left perspective view of an articulated cannula assembly with an endoscope coupled thereto is shown in accordance with some embodiments of the present disclosure.

[0035] Figure 2 A left side view of an articulated cannula assembly with an endoscope coupled thereto is shown in accordance with some embodiments of the present disclosure.

[0036] Figure 3 A side top-down perspective view of an articulated cannula including a mechanism for coupling an endoscope is shown in accordance with some embodiments of the present disclosure.

[0037] Figure 4 A right perspective view of an articulated cannula assembly with an endoscope coupled thereto (including a suction adapter that can be coupled to a port of the assembly) is shown in accordance with some embodiments of the present disclosure.

[0038] Figure 5 A right perspective view of an articulated cannula assembly with an endoscope coupled thereto (including a suction adapter that can be coupled to a port of the assembly) is shown in accordance with some embodiments of the present disclosure.

[0039] Figure 6 Shows Figure 5 A right perspective view of an articulated cannula assembly, where a suction adapter is coupled to a port of the assembly.

[0040] Figure 7 A top view of an articulated cannula assembly with an endoscope coupled thereto (including a suction adapter that can be coupled to a port of the assembly) is shown in accordance with some embodiments of the present disclosure.

[0041] Figure 8 Shows Figure 7 A side top-down view of an articulated cannula assembly, where a suction adapter is coupled to a port of the assembly.

[0042] Figure 9Shows a left perspective view of an articulated cannula assembly according to some embodiments of the present disclosure, with no endoscope coupled thereto.

[0043] Figure 10 Shows a rear and top view of an articulated cannula assembly according to some embodiments of the present disclosure, with no endoscope coupled thereto.

[0044] Figure 11 Shows the distal end of an endoscope shaft fixed to the distal end of a cannula of an articulated cannula assembly according to some embodiments of the present disclosure, the cannula including an articulated section covered by a flexible coating.

[0045] Figure 12 Shows the distal end of an endoscope shaft fixed to the distal end of a cannula of an articulated cannula assembly according to some embodiments of the present disclosure, the cannula including an exposed articulated section.

[0046] Figure 13 Shows a perspective view of a cannula of an articulated cannula assembly according to some embodiments of the present disclosure, the distal end of the cannula including a flexible band for fixing the distal end of an endoscope shaft.

[0047] Figure 14 Shows the distal end of an endoscope shaft fixed to Figure 13 the distal end of a cannula by a flexible band.

[0048] Figure 15 Shows an internal, left perspective view of an articulated cannula assembly with a coupled endoscope according to some embodiments of the present disclosure.

[0049] Figure 16 Shows an internal, left perspective view of an articulated cannula assembly with a coupled endoscope according to some embodiments of the present disclosure.

[0050] Figure 17 Shows an internal, left perspective view of the proximal housing of an articulated cannula assembly according to some embodiments of the present disclosure, which includes a pulley mechanism contained therein.

[0051] Figure 18 Shows an internal, left view of the proximal housing of an articulated cannula assembly according to some embodiments of the present disclosure.

[0052] Figure 19 Shows an internal, perspective view of components contained within the proximal housing of an articulated cannula assembly according to some embodiments of the present disclosure.

[0053] Figure 20Shows an internal perspective view of components included within the proximal housing or cannula of an articulating cannula assembly, in accordance with some embodiments of the present disclosure.

[0054] Figure 21 Shows a left side view of an articulating cannula assembly having an endoscope coupled thereto, the assembly configured to be removably coupled to a handpiece.

[0055] Figure 22 Shows, in accordance with some embodiments of the present disclosure Figure 21 a T-shaped attachment structure of the housing of an articulating cannula assembly, the attachment structure configured to slide into a T-shaped track of a handpiece.

[0056] Figure 23 Shows Figure 21 a rear side view of an articulating cannula assembly.

[0057] Figure 24 Shows Figure 21 a rear and side elevation view of an articulating cannula assembly.

[0058] Figure 25 Shows a flexible balloon catheter that can be used with an articulating cannula assembly, in accordance with some embodiments of the present disclosure.

[0059] Figure 26 Shows a suction line and irrigation line assembly that can be used with an articulating cannula assembly, in accordance with some embodiments of the present disclosure.

[0060] Figure 27 Shows, in accordance with some embodiments of the present disclosure Figure 21 a balloon pump handpiece to which an articulating cannula assembly can be removably coupled.

[0061] These figures are not exhaustive and do not limit the present disclosure to the precise forms disclosed. Detailed Description

[0062] Attaching an endoscope to an articulating and non-articulating instrument or cannula will reduce the number of independent surgical devices vying for space within the same anatomical space. For example, in orthopedics, current arthroscopic techniques use a multi-port approach that relies solely on a rigid endoscope for visualization. By attaching an endoscope to a surgical instrument or a hollow cannula, the number of access ports required will be reduced, and this may allow for single-port surgery and better patient outcomes. In other areas of surgical specialties, using a flexible or hybrid endoscope attached to an articulating cannula or instrument will allow for minimizing instruments within a limited space, increasing visualization, and easier tissue manipulation, and thus lead to better, simpler, cheaper, more efficient, and more tolerable surgeries and outcomes.

[0063] To this end,Figures 1 - 20 Shown is an articulated cannula assembly 100 in accordance with some embodiments of the present disclosure. Figures 1 - 14 Various external views of the articulated cannula assembly 100 are shown, and Figures 15 - 20 various internal views or cross-sectional views of the articulated cannula assembly 100 are shown. The assembly 100 can be used in a variety of endoscopic applications, including applications that require dilation or use of instruments within a human cavity, such as within the sinuses, trachea, esophagus, bladder, uterus, abdomen, joint space, or other anatomical locations. For example, the assembly 100 can be used as an esophageal dilator or a tracheal dilator. The assembly 100 can also be used during single-port arthroscopic examinations. Additionally, the assembly 100 can be used in transnasal, transoral, urological, neurosurgical, and general surgical / robotic surgical procedures.

[0064] The assembly 100 includes a handpiece 110, a proximal housing 120 located above the handpiece 110, a cannula 130 extending distally from the proximal housing 120, and a trigger 140 extending distally from the housing 120. Each of the handpiece 110, the housing 120, and / or the cannula 130 can be disposable and / or reusable.

[0065] The top portion of the housing 120 includes an open channel 111 configured to receive an endoscope 200 removably coupled to the assembly 100. The endoscope 200 can be secured to the housing 120 by: i) passing a flexible endoscope shaft 220 through a hole or channel 114 extending from the distal end of the channel 111 through the distal end of the housing 120; and ii) securing the proximal endoscope head 210 within the open channel 111. For example, the endoscope 200 can be slid into the open channel 111 in a top-down manner. In this embodiment, the open channel 111 includes sidewalls 112 and tabs 113 extending from the sidewalls 112. The sidewalls 112 can secure the sides of the endoscope head 210, and the tabs 113 can be bent to provide additional pressure against the sides of the endoscope head 210 (e.g., to prevent it from slipping out). The material and thickness of the tabs 113 can be adjusted to optimize the force required to bend them into the appropriate position.

[0066] The housing 120 may include some other removable attachment mechanisms capable of enabling removable attachment of the endoscope. For example, the housing 120 may utilize a magnetic attachment mechanism, a snap attachment mechanism, an up-and-down ratchet mechanism, an insertion ratchet mechanism, and / or an insertion torsion mechanism, as further described in U.S. Patent No. 10,512,391, which is incorporated herein by reference in its entirety. Accordingly, it should be noted that the present disclosure is not limited to the specific mechanisms for removably coupling the endoscope 200 described and illustrated herein, and other mechanisms for removably coupling the endoscope 200 may be envisioned. Additionally, although an endoscope 200 having a flexible (e.g., bendable) shaft 220 is described in the present disclosure, in other embodiments, the assembly 100 may be adapted to receive an endoscope having a rigid shaft or a shaft that is partially rigid and partially flexible (hybrid). In some embodiments, the endoscope shaft may be extensible, magnetic, articulated, detachable / removable, disposable, reusable, or permanently fixed to the endoscope housing 210.

[0067] The housing 120 may also include ports 121a and 121b located on the left and right sides of the housing 120, respectively. The ports 121a and 121b are coupled to tubes 122a and 122b, respectively. The tube 122a or 122b may be combined into a single hollow channel 122c passing through the cannula 130 in a "Y" configuration, or alternatively, remain separated from each other when they pass through the cannula 130 independently. For example, port 121a may be directly connected to the lumen of the cannula 130 or the proximal end of tube 122a, and port 121b may be directly connected to the lumen of the cannula 130 or the proximal end of tube 122b. Tubes 122a and 122b may be joined to form tube 122c, which terminates at, before, or after the distal end of the cannula 130. Alternatively, tubes 122a and 122b may terminate at, before, or after the distal end of the cannula 130, respectively. Terminating the tubes separately may provide the advantage of facilitating the independent insertion and removal of flexible instruments via ports 121a and 121b. The cannula 130 may be rigid, extensible, flexible, or articulated and have a sufficient caliber to internally accommodate any combination of tubes 122a, 122b, and 122c. Various flexible instruments may pass through or be moved through ports 121a, 121b, and tubes 122a, 122b. For example, a balloon catheter, a suction tool, a microdebrider, a flexible drill, a flexible injection needle, an instrument tool, or other articulated instruments may be advanced through tubes 122a and 122b. Ports 121a and 121b may also be used for suction and irrigation purposes, which may be required in orthopedic arthroscopic or urological cases. Although ports 121a and 121b are incorporated in the respective sides of the housing 120, the ports may be placed in some other suitable location in the housing 120. Alternatively, port holes or a single port may be placed on the proximal rear end of the housing 120 to allow instruments to pass through the inner housing 120 and the cannula 130 in a straight line. The rear-end port location will facilitate the passage of rigid instruments through the cannula and may or may not require or involve separate tubes 122a or 122b that terminate at or pass through the cannula 130.

[0068] With the configuration shown including ports 121a and 121b, the ergonomics of component 100 can be improved by allowing the ports 121a, 121b to be customized for various routines. With a dual-port having separate tubes extending into (and in some embodiments through) cannula 130, different instruments can pass through each tube in the order preferred by the doctor. Additionally, the doctor can choose from which direction (e.g., left, right, or posterior) to pass the instrument. In some embodiments, a third port hole can be placed in the housing (e.g., on the proximal posterior end of housing 120) and coupled to a third tube extending into cannula 130 to allow an instrument to pass through inner housing 120 and cannula 130 in a straight line.

[0069] Figures 6 - 8 Shown is a suction adapter 160 that can be independently coupled to either port 121a or 121b. The configuration of suction adapter 160 allows it to receive and attach to the end of a suction hose. Suction adapter 160 will secure itself to the port on housing 120 by a press fit, threaded fit, snap fit, or other type of connector mechanism. Other types of adapters that can be coupled to the side ports of component 100 can be envisioned. Such adapters may include connectors to assist with securing instruments, irrigation, electrical (e.g., cautery), pressure gauges, balloon catheters, guide wires, endoscopes, etc.

[0070] As Figures 11 - 13 shown, the distal end of endoscope shaft 220 can be secured to the distal end of cannula 130 via a flexible band 350. In some embodiments, flexible band 350 can be integrated into the distal end of cannula 130. Alternatively, flexible band 350 can be a separate component. Although the illustrated example shows flexible band 350 for securing endoscope shaft 220 to cannula 130, other attachment mechanisms can also be used. For example, in some embodiments, cannula 130 can incorporate additional channels outside the inner tube for guiding and / or removably coupling to endoscope shaft 220. The additional channels can extend parallel to cannula 130 and can be open or closed, flexible or rigid. Other example mechanisms or other tools for attaching endoscope shaft 220 to cannula 130 can include single or multiple clamps, tubes, wire loops, flexible open channels, slidable ducts, clamps, magnets, suction devices, and adhesives, some of which are described in U.S. Patent No. 10,512,391, which is incorporated herein by reference in its entirety.

[0071] In some embodiments, to provide additional flexibility when imaging a patient's lumen at different angles, a section 138 of the cannula 130 that includes the flexible band 350 (or other distal endoscope attachment mechanism) and extends beyond the articulated section 135 of the cannula 130 may be rotatable independently of the remainder of the cannula 130. As Figure 11 shown by the arrow in, section 138 is capable of rotating with the coupling tip / distal end of the endoscope shaft 220, thereby enabling imaging at different angles / orientations. To enable such rotation, the endoscope shaft 220 can be flexible.

[0072] Now referring to the articulation mechanism of the articulated cannula assembly 100, the cannula 130 is shown in Figures 11 - 12 as having an articulated section 135. The articulated section 135 includes a plurality of notches 136 that widen or close depending on how the trigger 140 is actuated (e.g., pulled or released). To effect this action, a wire 142 extends from the articulated section to a pulley 141 incorporated into the housing 120. Depending on how the trigger 140 is actuated, the pulley 141 can be configured to rotate (e.g., clockwise / counterclockwise), translate along a surface (e.g., move laterally along the plane in which it lies), or some combination thereof. For example, in Figure 17 and Figure 19 a particular embodiment shown, the pulley can rotate while moving forward or backward along the channel 149. In one embodiment, the trigger 140 can be in the shape of a loop positioned along the lower surface of the articulated cannula assembly 100. In other embodiments, the articulated section 135 can be actuated by a trigger located at other positions along the surface of the articulated cannula assembly 100, such as on either side of the housing. The trigger can be in the form of a loop, lever, button, dial, or electrical connector.

[0073] It should be noted that although the articulated section 135 is shown as being near the distal end of the cannula 130, it can be implemented closer to the proximal end of the cannula 135. In some embodiments, there can be multiple articulated sections along the cannula 130 that are operated by one or more triggers or similar types of actuation mechanisms.

[0074] In some embodiments, a flexible coating 137 can cover the articulated section 135, including the notches 136, such that gaps are not exposed during articulation. The flexible coating 137 can be a removable or permanent part of the cannula 130. In some embodiments, the portion of the cannula 130 remote from the articulated section 135 can be rotatable.

[0075] In some embodiments, the cannula 130 and / or the handpiece 110 can be integrated with the housing 120, as Figures 1 - 20as shown in the example. In other embodiments, the cannula and / or the handpiece may be removably coupled to the housing 120. In such an embodiment, the removable connection may be achieved via a press fit, snap fit, friction fit, magnetic coupling, clamp, threaded collar, one or more dovetails, or some other suitable mechanism. Due to the removable handpiece connection, the housing 120 may be used with different handpieces, including the balloon pump handpiece further discussed below with reference to Figure 27 or alternative types of handpieces, such as but not limited to, a flush syringe, an infusion syringe, an electric handpiece, an endoscopic handpiece, etc. For example, Figures 21 - 24 shows an articulated cannula assembly 500 having a housing 520 configured to be removably coupled to a handpiece. In this example, the lower portion of the housing 520 includes a T-shaped attachment structure 521 configured to slide into a T-shaped track of the handpiece. The T-shaped track may be incorporated into the top portion of the handpiece. A release lever or some other suitable mechanism (not shown) can fix the handpiece to the articulated cannula assembly in a reversible manner.

[0076] Figure 25 shows an example flexible balloon catheter 1695 that may be used with the assembly 100. The flexible balloon catheter 1695 may be particularly suitable for esophageal dilation. Patients with cervical esophageal strictures or dysphagia secondary to chronic cricopharyngeal spasm typically require esophageal dilation. Esophageal dilation is rarely performed in an office setting and is almost always performed by a gastroenterologist under sedation anesthesia. Esophageal dilation is typically performed concurrently with esophagogastroduodenoscopy (EGD). Although EGD is sometimes necessary, it is not required every time a patient needs dilation. This is especially true for patients who require multiple dilations over time after radiotherapy or related to chronic laryngopharyngeal reflux. Current techniques for esophageal dilation may involve sequential dilation using bougie catheters and esophageal balloon catheters of gradually increasing size.

[0077] The flexible balloon catheter 1695 has an inflatable balloon 1696 at its distal end. When the balloon 1696 is in the deflated state, the balloon catheter 1695 can be inserted through port 121a or 121b and advanced through the hollow tube 122a or the hollow tube 122b. The flexible balloon catheter 1695 can have a sufficient length to allow the balloon to extend beyond the distal end of the cannula 130. The esophageal balloon catheter itself can have a hollow core, with the balloon fixed around the hollow core, and a small guide wire can be inserted through the hollow core. During operation, the endoscope 200 can be used to visualize the balloon 1696, the balloon catheter 1695, and in some cases the balloon catheter guide wire as they enter the cervical esophagus from the distal end of the cannula 130. Small markers on the catheter proximal to the balloon 1696 can be used to assist in approaching the proper distance for inserting the catheter 1695 into the esophagus via the endoscope before balloon inflation. The system shown enables simple, low-cost, safe, and effective cervical balloon esophageal dilation, which can be performed under endoscopic guidance in an office setting and does not require anesthesia or an accompanying EGD procedure. Depending on the patient's anatomy and tolerance of the procedure, this implementation can be used transnasally or transorally to achieve similar results.

[0078] Figure 26 Shown is a suction line and a flush line assembly 1300 that can be used with the assembly 100. The assembly 1300 includes a suction line 1338 and a flush line 1339, which can be attached proximally to a detachable insert 1333. To minimize excess tubing and entanglement, the flush line 1338 and the suction line 1339 converge at the junction 1341 into a smaller caliper dual line 1340, which serves as a single line extending from the detachable insert 1333 and pointing away from the handpiece 110. Within the wall of the insert 1333, one or more hollow channels can be incorporated through which suction 1336 or flush 1337 can be delivered to the distal endoscope, lens, or instrument tool component. The assembly 1300 can be externally applied to the cannula 130 via a dual open channel scope / cannula attachment mechanism ( Figures 25 - 26 , cross-section A-A). Alternatively, a different embodiment of 1300 that does not have a dual scope / cannula attachment channel and only has flush and suction channels can be inserted through port 121a or 121b and advanced through the hollow tube 122a or the hollow tube 122b to converge or independently pass through the hollow extensions at the distal end of the assembly 1300 (e.g., cross-section A-A) to a point at the distal end of the cannula 130 or beyond the distal end of the cannula 130.

[0079] Figure 27Depicts a balloon pump handpiece 7300 according to an embodiment of the present disclosure. The articulated cannula assembly 500 can be removably coupled to the balloon pump handpiece 7300 via an attachment structure 521 of the housing 520. For example, the attachment structure can be slidably coupled to a channel 7900 located at the top end of the handpiece 7300. Although the channel 7900 is depicted as an open channel to which the structure 521 is attached in this example, the channel can include any suitable mechanism for removably coupling to the housing 520.

[0080] The balloon pump handpiece 7300 includes a pump handle 7374 that, when actuated, pumps pressurized air or liquid (such as water or saline) through a balloon connection port 7380 and into the proximal end of a connected flexible balloon catheter 1695. The balloon connection port 7380 can be positioned along the base of the balloon pump handpiece or at some other location along the surface of the handpiece 7300. Then, the deflated distal balloon can be inserted into port 121a or 121b and through the cannula 130). When the balloon is finally inflated, the pressure can be measured by a pressure gauge 7390 incorporated into the balloon pump handpiece 7300. The balloon pump handpiece 7300 also includes a button 7391 that, when actuated, can release the pressure from the distal balloon.

[0081] The pressurized fluid can be stored in a chamber (not shown) incorporated into the balloon pump handpiece 7300. In some embodiments, the chamber is a fluid syringe that can be snapped into the body of the handle, or the syringe can be part of the handle. The chamber can be removable. The chamber can be pre-filled or refillable via the port 7380 or via another port located separately on the handpiece.

[0082] Although described above in accordance with various example embodiments, it should be understood that the various features, aspects, and functions described in one or more of the individual embodiments are not limited to their applicability to the particular embodiments in which they are described, but can be applied singly or in various combinations to one or more other embodiments of the present application, whether or not those embodiments are described and whether or not those features are presented as part of the described embodiments. Accordingly, the breadth and scope of the present application should not be limited by any of the above example embodiments.

[0083] To the extent applicable, unless expressly stated otherwise herein, the terms "first," "second," "third," etc. in this document are used only to distinguish the individual objects described by these terms as separate entities and do not imply a sense of chronological order.

[0084] Unless otherwise expressly stated, the terms and phrases used in this document and their variants shall be construed as open-ended rather than limiting. As examples of the foregoing: the term "comprising" should be understood to mean "including but not limited to" and the like; the term "exemplary" is used to provide some instances of the item under discussion, rather than an exhaustive or limiting list thereof; the term "a" or "an" should be understood to mean "at least one", "one or more", and the like; and adjectives such as "conventional", "traditional", "normal", "standard", "known" and terms of similar import should not be construed as limiting the item described to a given time period or to items available as of a given time, but should be understood to include conventional, traditional, normal or standard techniques that are available or known at any time, present or future. Similarly, where this document refers to techniques that would be obvious or known to one of ordinary skill in the art, such techniques encompass those that are obvious or known to one of ordinary skill in the art at any time, present or future.

[0085] In some cases, the presence of expansive words and phrases such as "one or more", "at least", "but not limited to" or other similar phrases should not be construed as meaning that a narrower case is desired or required where such an expansive phrase may not be present.

[0086] Although various embodiments of the present disclosure have been described above, it should be understood that they are presented by way of example and not limitation. Similarly, the various figures may depict example architectures or other configurations for the present disclosure, and doing so is to assist in understanding the features and functions that can be included in the present disclosure. The present disclosure is not limited to the example architectures or configurations shown, but can be implemented using a variety of alternative architectures and configurations to achieve the desired features. Additionally, with respect to flowcharts, operational descriptions, and method claims, unless the context otherwise requires, the order in which steps are presented herein should not be construed as mandating that various embodiments be implemented in the same order to perform the recited functions.

Claims

1. An articulated sleeve assembly, characterized in that, The articulated cannula assembly includes: A handpiece; A proximal housing located above the handpiece; A cannula extending distally from the proximal housing, the cannula including an articulated section having a plurality of notches that widen or close when a trigger is actuated; and The trigger that extends or contracts the articulated section when actuated.

2. The articulated sleeve assembly according to claim 1, wherein The proximal housing is removably coupled to the handpiece.

3. The articulated cannula assembly according to claim 2, wherein: The handpiece is a balloon pump handpiece including a connection port for fluidly coupling to a balloon catheter; The balloon pump handpiece includes a controller for inflating a distal balloon of the balloon catheter; And A top portion of the balloon pump handpiece includes a mechanism for removably coupling to the proximal housing.

4. The articulated cannula assembly according to claim 3, wherein: The proximal housing includes a port connected to the cannula; The port is configured to receive the distal balloon of the balloon catheter; And After the distal balloon is received at the port, the distal balloon will be passed through the cannula.

5. The articulated cannula assembly according to claim 2, wherein: One of the handpiece or the proximal housing includes a T-shaped attachment structure; One of the handpiece or the proximal housing includes a T-shaped track; And The handpiece is removably coupled to the proximal housing by sliding the T-shaped attachment structure in the T-shaped track.

6. The articulated cannula assembly according to claim 1, wherein: The proximal housing includes a first port and a second port connected to the cannula; and The first port is for receiving a first instrument passing through the cannula; and The second port is for receiving a second instrument passing through the cannula.

7. The articulated sleeve assembly according to claim 6, wherein It further includes: A first tube connecting the first port to the cannula and passing through at least a portion of the cannula; and A second tube connecting the second port to the cannula and passing through at least a portion of the cannula, wherein the first instrument is to pass through the first tube and the second instrument is to pass through the second tube.

8. The articulated sleeve assembly according to claim 7, wherein, The first tube and the second tube terminate either within the cannula or after the distal end of the cannula.

9. The articulated sleeve assembly according to claim 7, wherein, The first tube and the second tube merge into a single channel within the cannula.

10. The articulated sleeve assembly according to claim 6, wherein, The first port and the second port are located on opposite sides of the proximal housing.

11. The articulated cannula assembly according to claim 10, wherein: The proximal housing includes a third port connected to the cannula for receiving a third instrument passing through the cannula, The first port and the second port are located on the left and right sides of the proximal housing, and The third port is located on the rear side of the proximal housing.

12. The articulated sleeve assembly according to claim 1, wherein The proximal housing includes a first port connected to the cannula, the first port being located on the rear side of the proximal housing and for receiving one or more instruments passing through the cannula.

13. The articulated sleeve assembly according to claim 1, wherein, The cannula further includes a rotatable section distal to the articulated section, and the rotatable section rotates independently of the remainder of the cannula.

14. The articulated sleeve assembly according to claim 1, wherein It further includes: a pulley, the pulley being incorporated into the proximal housing; and one or more wires that couple the articulated section to the pulley.

15. The articulated sleeve assembly according to claim 1, wherein, The articulated section includes a flexible coating disposed over the plurality of notches.

16. The articulated sleeve assembly according to claim 1, wherein, The proximal housing includes a first endoscope attachment structure for removably securing a proximal portion of the endoscope.

17. The articulated cannula assembly according to claim 16, wherein: The first endoscope attachment structure includes an open channel having side walls and a distal hole extending from a distal end of the open channel to a distal end of the proximal housing; and The endoscope is removably secured to the first endoscope attachment structure by passing an axis of the endoscope through the distal hole and securing the proximal portion of the endoscope within the open channel.

18. The articulated sleeve assembly according to claim 16, wherein, It further includes: a second endoscope attachment structure for securing an exterior of the cannula to an axis of the endoscope.

19. The articulated sleeve assembly according to claim 18, wherein, The second endoscope attachment structure is incorporated into a distal portion of the cannula.

20. The articulated sleeve assembly according to claim 18, wherein The cannula further includes a rotatable section distal to the articulated section, the rotatable section including the second endoscope attachment structure, and the rotatable section rotates independently of the remainder of the cannula.

21. An articulated sleeve assembly, characterized in that, The articulated cannula assembly includes: a proximal housing, the proximal housing including a coupling mechanism for removably coupling to a top portion of a handpiece; a cannula, the cannula extending distally from the proximal housing, the cannula including an articulated section; and a trigger that, when actuated, extends or contracts the articulated section.

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