ENDOSCOPE WITH MOVABLE WORK CHANNEL WALL

Abstract

An endoscope comprises an elongated shaft with a distal end section comprising a distal end surface at the distal end of the elongated shaft and a recessed end face proximal to the distal end surface, a working channel extending at least partially through the elongated shaft to the recessed end face, an imaging device located in the distal end section, and an extension wall for the working channel extending from the recessed end face, wherein the extension wall is movable between a closed position and an open position.A method for obtaining tissue using a device extending from an endoscope comprises inserting the endoscope into the body of a patient, extending the device into a working channel of the endoscope to extend from the endoscope, adjusting a movable wall of the endoscope to support the device, and obtaining tissue from the body using the device.

Description

PRIORITY CLAIM

[0001] This application claims priority over the preliminary US patent application with serial number 63 / 513,661, filed on July 14, 2023, the contents of which are hereby incorporated by reference. TECHNICAL FIELD

[0002] The present disclosure relates generally to medical devices comprising elongated bodies designed to be inserted into incisions or openings in a patient's anatomy for the purpose of performing diagnostic or treatment procedures. More specifically, the present disclosure relates to endoscopes with working channels through which other instruments, such as tissue sampling devices for biopsies, can be inserted to perform a process of removing and extracting biological material. BACKGROUND

[0003] Endoscopes can be used for one or more of the following purposes: 1) to insert other instruments, such as therapeutic or tissue sampling devices, into various anatomical regions, and 2) to create images of these anatomical regions. These anatomical regions may include the gastrointestinal tract (e.g., esophagus, stomach, duodenum, pancreatic and bile ducts, intestines, colon), the renal region (e.g., kidney(s), ureter, bladder, urethra), and other internal organs (e.g., reproductive organs, sinuses, submucosal regions, respiratory tract), and the like.

[0004] Conventional endoscopes can be used in a variety of clinical procedures, including illumination, imaging, detection and diagnosis of one or more disease conditions, delivery of fluids (e.g., saline solution or other preparations via a fluid channel) to an anatomical region, provision of a passage (e.g., via a working channel) for one or more therapeutic devices for sampling or treating an anatomical region, and provision of suction passages for collecting fluids (e.g., saline solution or other preparations), and the like.

[0005] In conventional endoscopy, the distal portion of the endoscope can be configured to carry and align a therapeutic device. Some systems allow two endoscopes to work together, with a first endoscope guiding a second endoscope, inserted into it, using an elevator. Such systems can be helpful for advancing endoscopes to difficult-to-reach anatomical locations in the body. For example, some anatomical sites are only accessible with an endoscope after it has been inserted via a convoluted route.

[0006] Examples of endoscopes are described in: JP2016140574A by Matsuda entitled “Endoscope” and JP2017006313A by Matsuda et al. entitled “Endoscope and Endoscope System”. SUMMARY

[0007] The present disclosure acknowledges that problems to be solved with conventional medical devices, in particular endoscopes and duodenoscopes used to obtain biological samples from target tissue, include, among others: 1) the difficulty of navigating endoscopes and instruments inserted therein to locations in anatomical regions deep inside a patient, 2) the disadvantage that only small tissue samples can be obtained, 3) the possibility of obtaining the wrong tissue sample if the target tissue is not adequately captured, 4) the increased time and expense resulting from the need to repeatedly remove and reinsert medical devices to obtain a sufficient quantity of sample material, and 5) the limitation on the size of instruments that can be used within the working channel of an endoscope.

[0008] Such problems can arise particularly during duodenoscopy procedures (e.g., endoscopic retrograde cholangiopancreatography, hereinafter referred to as "ERCP" procedures), in which an auxiliary endoscope (also called a daughter endoscope or cholangioscope) can be attached and advanced through the working channel of a primary endoscope (also called a mother endoscope or duodenoscope). Furthermore, another instrument (e.g., a treatment or therapeutic device), such as a tissue sampling device for biopsies, can be inserted into the auxiliary endoscope. This makes the duodenoscope, the auxiliary endoscope, and the tissue sampling device increasingly smaller and more difficult to maneuver, thus complicating procedures and treatments.

[0009] The present disclosure offers solutions to these and other problems by freeing up space within the endoscope by using a larger working channel proximal to an imaging device within the endoscope than at an axial position of the imaging device. For example, imaging devices, which may include imaging sensors and illumination units, may have cross-sectional areas larger than the wires and cables used to connect the imaging device to the control unit or handpiece of the endoscope. Thus, the working channel of the endoscope proximal to the imaging device can be dimensioned based on the wiring of the imaging device and then reduced in size at the imaging device, while the corresponding imaging channel for the wires and cables at the axial position of the imaging device itself is increased in size.However, since the instruments inserted into the working channel must still exit it in order to be used, the present disclosure acknowledges that the working channel can be cut off by a proximal indentation from the imaging device in order to create an exit point from the endoscope at which the working channel has its maximum size or maximum diameter.

[0010] The present disclosure also recognizes that when an instrument is pushed out of a shortened working channel, the instrument is not supported below the imaging device, which can lead to the instrument undesirably hanging down out of the imaging device's field of view. Furthermore, due to the shortened working channel, the instrument may be less responsive to movements of the endoscope. The present application provides solutions to these and other problems by providing a movable working channel wall that can be opened to increase the size of an exit for the working channel, allowing an instrument to exit the working channel proximal to the imaging device, and that can be closed to support the instrument. By way of example, the movable working channel wall could be a pivoting plate, a flexible plate, a sliding plate, and the like.

[0011] Therefore, the present disclosure can help to solve the above-mentioned problems and other problems by 1) reducing the number of insertions and reinsertions of a tissue sampling device into the body, 2) increasing the capacity of the sample material obtained with each insertion, 3) providing a proximal working channel with a larger diameter than at the distal end of the endoscope, 4) providing an imaging channel that is subdivided into a proximal imaging channel for imaging wires and / or cables and a distal imaging unit lumen for imaging and illumination hardware, 5) providing a movable working channel wall to enlarge the working channel exit orifice, and 6) providing a movable working channel wall to support an instrument that is passed through a working channel orifice.

[0012] In one example, an endoscope may comprise an elongated shaft comprising a distal end section with a distal end face at the distal end of the elongated shaft and a recessed end face proximal to the distal end face, a working channel extending at least partially through the elongated shaft to the recessed end face, an imaging device located in the distal end section proximal to the distal end face, and an extension wall for the working channel extending from the recessed end face, wherein the extension wall is movable between a closed position and an open position.

[0013] In another example, the procedure for obtaining biological material using a biopsy device extending from an endoscope includes inserting the endoscope into a patient's body, extending the biopsy device into a working channel of the endoscope to extend from the endoscope, adjusting a movable working channel wall of the endoscope to support the biopsy device, and obtaining biological material from the body using the biopsy device.

[0014] In another example, an endoscope may comprise an elongated shaft comprising a distal end section with a distal end face at the distal end of the elongated shaft, a working channel extending through the elongated shaft to the distal end section, a movable wall configured to expose a portion of the working channel proximal to the distal end face, an imaging channel extending through the elongated shaft to the distal end section, and a lumen for an imaging device extending from the imaging channel to the distal end face, wherein the lumen for the imaging device is larger than the imaging channel, an imaging device is located in the lumen for the imaging device, and an imaging cable extends from the imaging device through the imaging channel. BRIEF DESCRIPTION OF THE DRAWINGS Fig. Figure 1 is a schematic diagram of an endoscopy system comprising an imaging system, a control system, and an endoscope, for example a duodenoscope, with which the movable working channel walls of the present disclosure can be used. Fig. Figure 2 is a schematic diagram of the imaging and control system. Fig. Figure 1 shows the imaging and control system connected to the endoscope. Fig. 3A is a schematic top view of a distal section of the endoscope made of Fig. 2, which includes a camera module with optical components for a side-viewing endoscope and an elevator mechanism. Fig. 3B is a cross-sectional view along the plane 3B - 3B from Fig. 3A, which shows the optical components. Fig. 3C is a section view along the plane 3C - 3C from Fig. 3A, which shows the elevator mechanism. Fig. 4A is an end view of a camera module with optical and functional components, suitable as an auxiliary endoscope, which is used with the endoscope made of Fig. 1 and Fig. 2 can be used. Fig. 4B is a cross-sectional view along the section line 4B - 4B from Fig. 4A, which shows the components of the camera module in an end view configuration. Fig. Figure 5 is a schematic representation of a distal section of an endoscope used to position an auxiliary endoscope near a duodenum, the auxiliary endoscope being set up to accommodate a biopsy device. Fig. Figure 6 is a schematic representation of a surgical instrument comprising a forceps protruding from an endoscope near the target tissue. Fig. Figure 7 is a schematic side view of an endoscope with a shortened working channel and a movable working channel wall. Fig. 8 is an end view of the endoscope made of Fig. 7, which shows an arc-shaped form of the movable working channel wall. Fig. 9A is a schematic side view of the endoscope made of Fig. 7 with an instrument inserted therein and a movable working channel wall in an open position. Fig. Figure 9B is a schematic side view of the endoscope made of Fig. 9A, into which an instrument is inserted and whose movable working channel wall is in a closed position. Fig. Figure 10A is a schematic side view of an endoscope with a movable working channel wall in a closed position. Fig. Figure 10B is a schematic side view of the endoscope made of Fig. 10A with the sliding working channel wall in an open position. Fig. Figure 11 is a schematic side view of an endoscope with a shortened working channel and a swiveling working channel wall. Fig. Figure 12 shows an end view of the endoscope. Fig. 11, which shows an arc-shaped form of the pivoting working channel wall. Fig. Figure 13A is a schematic side view of the endoscope made of Fig. 11, into which an instrument is inserted and whose pivoting working channel wall is in an open position. Fig. Figure 13B is a schematic side view of the endoscope made of Fig. 13A, into which an instrument is inserted and whose pivoting working channel wall is in a closed position. Fig. Figure 14A is a schematic side view of an endoscope with a swiveling working channel wall in a closed position. Fig. Figure 14B is a schematic side view of the endoscope made of Fig. 14A with the swiveling working channel wall in an open position. Fig. Figure 15A is a schematic side view in cross-section of an endoscope with a pretensioning element and a control wire with a movable working channel wall in a forward position. Fig. Figure 15B is a schematic side view in cross-section of the endoscope made of Fig. 15A with a pretensioning element and a control wire with a movable working channel wall in a retracted position. Fig. Figure 16A is a schematic side view of an endoscope with a movable working channel wall having a locking mechanism designed to interact with an instrument. Fig. Figure 16B is a schematic side view in cross-section of the endoscope made of Fig. 16A, wherein the movable working channel wall is in an actuated state. Fig. Figure 17 is a schematic perspective view of an endoscope with a swiveling working channel wall that can be retracted via elastic elements. Fig. Figure 18 is a front view of a retaining clamp for use with a pivoting working channel wall of the present disclosure. Fig. 19 Schematic side view of an endoscope with a swiveling working channel wall and an angled reentry section. Fig. Figure 20 is a block diagram illustrating procedures for extending and holding an instrument from an endoscope with a shortened working channel and a two-stage imaging channel using a movable working channel wall. DETAILED DESCRIPTION

[0015] Fig. Figure 1 is a schematic diagram of an endoscopy system 10, comprising an imaging and control system 12 and an endoscope 14. The system in Fig. Figure 1 is an illustrative example of an endoscopy system suitable for use with the systems, devices, and methods described herein, such as endoscopes with a shortened working channel and a two-stage imaging channel for use with a movable working channel wall. According to some examples, the endoscope 14 can be inserted into an anatomical region to acquire images and / or to provide a passage for one or more sampling devices for biopsies or one or more therapeutic devices for treating a disease condition associated with the anatomical region. The endoscope 14 can be advantageously connected to the imaging and control system 12. In the example shown, the endoscope 14 comprises a duodenoscope, although other types of endoscopes with the features and teachings of this disclosure may also be used.

[0016] The imaging and control system 12 can include a control unit 16, an output unit 18, an input unit 20, a light source unit 22, a liquid source 24 and a suction pump 26.

[0017] The imaging and control system 12 can include various connections for linking to the endoscopy system 10. For example, the control unit 16 can include a data input / output for receiving data from the endoscope 14 and for transmitting data to the endoscope 14. The light source unit 22 can include an output for transmitting light to the endoscope 14, for example, via a fiber optic connection. The fluid source 24 can include a connection for transferring fluid to the endoscope 14. The fluid source 24 can include a pump and a fluid tank or be connected to an external tank, container, or storage unit. The suction pump 26 can include a connection used to create a vacuum from the endoscope 14 to generate suction, for example, to aspirate fluid from the anatomical area into which the endoscope 14 is inserted.The output unit 18 and the input unit 20 can be used by an operator of the endoscopy system 10 to control functions of the endoscopy system 10 and to view the output of the endoscope 14. The control unit 16 can additionally be used to generate signals or other outputs from the treatment of the anatomical area into which the endoscope 14 is inserted. For example, the control unit 16 can generate electrical outputs, acoustic outputs, fluid outputs, and the like to treat the anatomical area, for instance, by cauterizing, cutting, freezing, and the like.

[0018] The endoscope 14 can include an insertion section 28, a functional section 30 and a handle section 32, which can be connected to a cable section 34 and a coupling section 36.

[0019] The insertion section 28 can extend distally from the handle section 32, and the cable section 34 can extend proximally from the handle section 32. The insertion section 28 can be elongated and include a bending section as well as a distal end to which the functional section 30 can be attached. The bending section can be steerable (e.g., by a control knob 38 on the handle section 32) to maneuver the distal end through tortuous anatomical passages (e.g., stomach, duodenum, kidney, ureter, etc.). The insertion section 28 can also have one or more working channels (e.g., an inner lumen), which can be elongated and allow the insertion of one or more therapeutic instruments of the functional section 30, such as the auxiliary endoscope 134. Fig. 5. The working channel may extend between the handle section 32 and the functional section 30. The working channel may be truncated at the functional section 30, as described herein. Additional features, such as fluid channels, guide wires, and pull wires, may also be provided through the introduction section 28 (e.g., via suction ports or irrigation channels, and the like). The introduction section 28 may additionally include an imaging channel to facilitate the positioning of wires and cables from imaging and illumination components within the functional section 30. The imaging channel may be subdivided into a proximal imaging channel and a distal imaging component lumen.

[0020] The handle section 32 can include a control knob 38 as well as a connection 40A and a connection 40B ( Fig. 2) The control knob 38 can be connected to a pull wire or other actuating mechanisms extending through the insertion section 28. Terminal 40A and other terminals, such as terminal 40B ( Fig. 2) may be configured to allow various electrical cables, guide wires, auxiliary endoscopes, tissue sampling or biopsy devices, fluid tubing, and the like to be connected to the handle section 32 to establish a connection with the insertion section 28. In examples, the 40A port may be used to insert an auxiliary endoscope, a cholangioscope, or a tissue duct sampling device into the insertion section 28. For example, the instrument 350 from the Fig. 9A and Fig. 9B and the instrument 556 from the Fig. 16A and Fig. 16B of the present disclosure, can be inserted directly into port 40A or into a cholangioscope inserted into port 40A.

[0021] The imaging and control system 12 can be mounted on a mobile platform (e.g. a cart 41) with shelves for accommodating the light source unit 22, the suction pump 26, the image processing unit 42 ( according to the examples. Fig. 2) etc. can be provided. Alternatively, several components of the system can be provided in the Fig. 1 and Fig. The imaging and control system 12 shown in 2 is provided directly on the endoscope 14 to make the endoscope “complete in itself”.

[0022] Functional section 30 may include components for the treatment and diagnosis of a patient's anatomy. Functional section 30 may include an imaging device, a lighting device, and an elevator, as described with reference to elevator 54 in the Fig. 3A - 3C is described in more detail. Functional section 30 may also include or be used with devices for the extraction and recovery of biological material and tissue, such as a biopsy device. The operation of some or all functions of functional section 30 is typically performed at the imaging and control system 12.

[0023] Fig. Figure 2 is a schematic diagram of the endoscopy system 10. Fig. 1, which includes an imaging and control system 12 and the endoscope 14. Fig. Figure 2 schematically shows components of the imaging and control system 12 coupled to the endoscope 14, which in the example shown comprises a duodenoscope. The imaging and control system 12 can include a control unit 16, which may contain or be coupled to an image processing unit 42, a treatment generator 44, and a drive unit 46, as well as a light source unit 22, an input unit 20, and an output unit 18. In examples, the control unit 16 can be coupled to an auxiliary endoscope 134 ( Fig. 5) be connected to or coupled with a device capable of receiving a device designed to capture tissue and to extract and store a portion of that tissue.

[0024] The coupler section 36 can be connected via cable 49 (schematically shown in Fig. (2 shown) can be connected to the control unit 16 to connect the endoscope 14 to various functions of the control unit 16, such as the image processing unit 42 and the treatment generator 44. In examples, the 40A port can be used to insert another instrument or device, such as a daughter endoscope, an auxiliary endoscope, and / or a tissue duct sampling device, into the endoscope 14. Such instruments and devices can be connected independently to the control unit 16 via cables 47. In examples, the 40B port can be used to connect the coupler section 36 to various inputs and outputs, such as video, air, light, and power connections.The control unit 16 can be configured to activate a camera to view the target tissue distal to the functional section 30, for example, when a biopsy device is positioned to extend from the insertion section 28. Likewise, the control unit 16 can be configured to activate the light source unit 22 to project light onto the surgical instrument 200. Fig. 6).

[0025] The image processing unit 42 and the light source unit 22 can each be connected to the endoscope 14 (e.g., at the functional section 30) via wired or wireless electrical connections. The imaging and control system 12 can accordingly illuminate an anatomical area, acquire signals representing the anatomical area, process signals representing the anatomical area, and display images representing the anatomical area on the output unit 18. The imaging and control system 12 can include a light source unit 22 to illuminate the anatomical area with light of a desired spectrum (e.g., broadband white light, narrowband imaging using preferred electromagnetic wavelengths, and the like). The imaging and control system 12 can be connected to the endoscope 14 (e.g., via an endoscope connector) to transmit signals (e.g.,Light from the light source, video signals from the imaging system at the distal end, diagnostic and sensor signals from a diagnostic device, and the like).

[0026] Fluid source 24 ( Fig. 1) can be connected to the control unit 16 and include one or more sources of air, saline solution, or other fluids, as well as associated fluid paths (e.g., air channels, irrigation channels, suction channels) and connectors (barbed fittings, fluid seals, valves, and the like). The fluid source 24 can be used as activation energy for an actuating device or preloading device of the present disclosure. The imaging and control system 12 can also include a drive unit 46, which may be an optional component. The drive unit 46 can include a motorized drive for advancing a distal portion of the endoscope 14, as described at least in PCT publication no. WO 2011 / 140118 A1 by Frassica et al. entitled “Rotate-to-Advance Catheterization System,” which is hereby incorporated in its entirety by this reference.

[0027] The Fig. Figures 3A - 3C illustrate a first example of functional section 30 of endoscope 14. Fig. 2. Fig. Figure 3A shows a top view of functional section 30. Fig. Figure 3B shows a cross-section of the functional section 30 along the section plane 3B - 3B. Fig. 3A. Fig. Figure 3C shows a cross-section of the functional section 30 along the section plane 3C - 3C. Fig. 3A. Fig. Figures 3A-3C show a laterally oriented endoscope camera module 50, such as can be used with a duodenoscope. In the laterally oriented endoscope camera module 50, illumination and imaging systems are positioned such that the viewing angle of the imaging system corresponds to a target anatomy that lies laterally to the central longitudinal axis A1 of the endoscope 14. The shortened working channels and two-stage imaging channels for use with movable working channel walls of the present disclosure are explained below with reference to frontally oriented endoscopes, which are described in the Fig. 4A and Fig. 4B, which are similar to frontally oriented endoscopes, can also be included in laterally oriented endoscopes.

[0028] In the example of the Fig. 3A and Fig. 3B The laterally oriented endoscope camera module 50 can comprise a housing 52, an elevator 54, a liquid outlet 56, an illumination lens 58, and an objective lens 60. The housing 52 can form a liquid-tight connection with the insertion section 28. The housing 52 can include an opening for the elevator 54. The elevator 54 can include a mechanism for moving a device inserted through the insertion section 28, for example, the auxiliary endoscope 134. Fig. 5. In particular, the elevator 54 may comprise a device that can bend an elongated device extended by the insertion section 28 along the axis A1, as described with reference to Fig. 3C will be explained in more detail. The elevator 54 can be used to bend the elongated device at an angle to the axis A1 in order to treat or reach the anatomical area next to the laterally oriented endoscope camera module 50. The elevator 54 is located next to, for example, radially outside the axis A1, the illumination lens 58 and the objective lens 60.

[0029] As in Fig. As can be seen in 3B, the introductory section 28 can include a central lumen 62 through which various components (e.g. the auxiliary endoscope 134 ( Fig. 5)) can be extended to connect the functional section 30 with the handle section 32 ( Fig. 2) to connect. For example, the illumination lens 58 can be connected to a light transmitter 64, which may include a fiber optic cable or a cable bundle leading to the light source unit 22 ( Fig. 1) extends. Likewise, the objective lens 60 can be coupled to the prism 66 and the image processing unit 67, which can be coupled to the cabling 68. Furthermore, the fluid outlet 56A can be coupled to the fluid line 56B, which can include a hose extending to the fluid source 24 ( Fig. 1) extends. Other elongated elements, e.g., hoses, wires, cables, can extend through the central lumen 62 to connect the functional section 30 to components of the endoscopy system 10, such as the suction pump 26 ( Fig. 1) and the treatment generator 44 ( Fig. 2).

[0030] Fig. 3C is a schematic cross-sectional view along the section plane 3C - 3C from Fig. Figure 3C shows the elevator 54. The elevator 54 can include a deflector 55, which can be positioned in the receiving chamber 53 of the housing 52. The deflector 55 can be connected to a wire 57, which can extend through the tube 59 to connect to the handle section 32. The wire 57 can be actuated, for example, by turning a knob, pulling a lever, or pressing a button on the handle section 32. The movement of the wire 57 can cause a rotation, for example, clockwise, of the deflector 55 from a first position around the pin 61 to a second position of the deflector 55, indicated by the deflector 55'. The deflector 55 can be actuated by the wire 57 to move the distal part of the instrument 63, which extends through the window 65 in the housing 52.

[0031] The housing 52 can include a receiving chamber 53 in which the deflector 55 is housed. The instrument 63 can include forceps, a guide wire, a catheter, or the like, extending through the central lumen 62. The instrument 63 can additionally include the auxiliary endoscope 134. Fig. 5 or the instrument 350 from Fig. 9A and Fig. 9B and the instrument 556 from Fig. 16A and Fig. 16B and other instruments, including other biopsy instruments or tissue duct sampling devices described herein. A proximal end of the deflector 55 can be attached to the housing 52 by a pin 61 provided on the laterally oriented endoscope camera module 50. A distal end of the deflector 55 can be located below the window 65 within the housing 52 when the deflector 55 is in the lowered or unactuated state. The distal end of the deflector 55 can protrude at least partially from the window 65 when the deflector 55 is raised or actuated by the wire 57. The instrument 63 can slide on the angled ramp surface 51 of the deflector 55 to initially deflect the distal end of the instrument 63 toward the window 65.The angled ramp surface 51 can facilitate the extension of the distal portion of the instrument 63, which extends from the window 65 at a first angle relative to the axis of the central lumen 62. The angled ramp surface 51 can have a groove 69, e.g., a V-shaped notch, to receive and guide the instrument 63. The deflector 55 can be actuated to bend the instrument 63 at a second angle relative to the axis of the central lumen 62, which is closer to the vertical than the first angle. When the wire 57 is released, the deflector 55 can, for example, be rotated counterclockwise back into the lowered position, either by pushing or releasing the wire 57. In examples, the instrument 63 can include a cholangioscope or an auxiliary endoscope 134 ( ). Fig. 5).

[0032] The laterally oriented endoscope camera module 50 from the Fig. 3A - 3C can include optical components (e.g., objective lens 60, prism 66, image processing unit 67, cabling 68) for collecting image signals, as well as illumination components (e.g., illumination lens 58, light transmitter 64) for transmitting or generating light. The laterally oriented endoscope camera module 50 can also include a light-sensitive element, for example, a charge-coupled sensor (“CCD sensor”) or a complementary metal-oxide-semiconductor sensor (“CMOS sensor”). In both examples, the image processing unit 67 can be connected (e.g., via wired or wireless connections) to the image processing unit 42 ( Fig. 2) be coupled to transmit signals from the light-sensitive element representing images (e.g., video signals) to the image processing unit 42, which in turn are displayed on a display such as the output unit 18. In various examples, the imaging and control system 12 and the image processing unit 67 can be configured to provide outputs with a desired resolution (e.g., at least 480p, at least 720p, at least 1080p, at least 4K UHD, etc.) suitable for endoscopic procedures.

[0033] Therefore, as an endoscope is inserted deeper into the body, the complexity with which it must be maneuvered and bent increases, as in relation to Fig. 5 described. To reach even more distant parts of the body, additional devices can also be used, e.g., the instrument 63 in the form of an auxiliary endoscope 134 ( Fig. 5) This reduces the cross-sectional area, e.g. the diameter, of the subsequently nested devices, requiring even smaller devices which may be difficult to manufacture and handle, or may not provide satisfactory results without repeated interventions (e.g. interactions with the patient).

[0034] Fig. Figure 4A shows an end view of the frontally oriented endoscope camera module 70 and Fig. Figure 4B shows a cross-section of the front endoscope camera module 70 along the section plane 4B - 4B from Fig. 4A. The Fig. 4A and Fig. Figure 4B shows the frontally oriented endoscope camera module 70, for example, for use as a gastroscope, colonoscope, cholangioscope, and the like. In the frontally oriented endoscope camera module 70, illumination and imaging systems are positioned such that the viewing angle of the imaging system corresponds to a target anatomy that is adjacent (e.g., distal) to one end of the endoscope 14 and in line with a central longitudinal axis of the endoscope 14.

[0035] The frontally oriented endoscope camera module 70 from the Fig. 4A and Fig. 4B can be used as an alternative example for functional section 30 of endoscope 14 from the Fig. 1 and Fig. 2. In addition, the frontally oriented endoscope camera module 70 can be used in a cholangioscope, for example in the auxiliary endoscope 134 from Fig. 5.

[0036] In the example of the Fig. 4A and Fig. 4B can include the frontally oriented endoscope camera module 70, a housing 72, a therapy unit 74, fluid outlets 76, an illumination lens 78, and an objective lens 80. The housing 72 can include an end cap for the insertion section 28, thereby providing a seal to the lumen 82.

[0037] As in Fig. As can be seen in 4B, the introduction section 28 can comprise a lumen 82 through which various components can be guided, for example the frontally oriented endoscope camera module 70 with the handle section 32 ( Fig. 2) to connect. For example, the illumination lens 78 can be connected to a light transmitter 84, which may include a fiber optic cable or a cable bundle leading to the light source unit 22 ( Fig. 1) extends. Likewise, the objective lens 80 can be coupled to an imaging unit 87, which can be coupled to a wiring 88. In examples, the light transmitter 84 can be located in the same lumen within the housing 72, but the light transmitter 84 and the wiring 88 can be located in separate lumens within the housing 72. As can be seen, the objective lens 80 and the imaging unit 87 can be wider or have a larger diameter than the wiring 88. According to the present disclosure, the lumen 82 can be designed to be wide in order to accommodate the objective lens 80 and the imaging unit 87, as in the lumen 314 ( Fig. 7) the imaging device, and it may be narrowed to accommodate the wiring 88, as for example in imaging channel 310 ( Fig. 7) In addition, the fluid outlets 76 can be connected to fluid lines 89 which include a hose extending to the fluid source 24 ( Fig. 1) In examples, one of the fluid outlets 76 may include an inlet connected to a fluid line 89 designed for suction, for example by connection to a vacuum to recover rinsing and irrigation fluid. Other elongated elements, e.g., hoses, wires, cables, may extend through the lumen 82 to connect the functional section 30 to components of the endoscopy system 10, such as the suction pump 26 ( Fig. 1) and the treatment generator 44 ( Fig. 2) For example, the therapy unit 74 can include a large diameter lumen to accommodate other treatment components, such as cutting devices and therapeutic devices, including tissue separation devices.

[0038] The frontally oriented endoscope camera module 70 can also contain a light-sensitive element, for example a charge-coupled sensor (CCD sensor) or a complementary metal-oxide-semiconductor sensor (CMOS sensor). In both examples, the imaging unit 87 can be connected (e.g., via wired or wireless connections) to the image processing unit 42 ( Fig. 1) be coupled to transmit signals from the light-sensitive element representing images (e.g., video signals) to the image processing unit 42, which in turn are displayed on a display such as the output unit 18. In various examples, the imaging and control system 12 and the imaging unit 87 can be configured to provide outputs with a desired resolution (e.g., at least 480p, at least 720p, at least 1080p, at least 4K UHD, etc.) suitable for endoscopic procedures.

[0039] Fig. Figure 5 is a schematic representation of the distal section of the endoscope 100 according to the present disclosure, which is positioned in the duodenum D. The endoscope 100 may comprise a functional module 102, an insertion section module 104, and a control module 106. The control module 106 may include a control unit 108. The control module 106 may include further components, such as those relating to the endoscopy system 10 ( Fig. 1) and the control unit 16 ( Fig. 2) are described. Additionally, the control module 106 can include components for controlling a camera and a light source connected to the auxiliary endoscope 134, such as an imaging unit 110, a lighting unit 112, and a power supply unit 114. The endoscope 100 can be constructed similarly to the endoscope 14 from the Fig. 1 and Fig. 2 be set up.

[0040] The duodenum (D) may include the duodenal wall (120), the sphincter of Oddi (122), the common bile duct (124), and the main pancreatic duct (126). The duodenum (D) comprises an upper part of the small intestine. The common bile duct (124) carries bile from the gallbladder and liver (not shown) and directs it through the sphincter of Oddi (122) into the duodenum (D). The main pancreatic duct (126) carries pancreatic juice from the exocrine pancreas (not shown) to the common bile duct (124). Sometimes it may be desirable to remove biological material, such as tissue, from the common bile duct (124) or the main pancreatic duct (126) for tissue analysis, for example, to diagnose diseases or conditions such as cancer.

[0041] The functional module 102 can include an elevator part 130. The endoscope 100 can further include a lumen 132 and an auxiliary endoscope 134. The auxiliary endoscope 134 can include a lumen 136. The auxiliary endoscope 134 itself can include functional components, such as a camera lens 137 and a light lens (not shown), which is coupled to the control unit 106 to facilitate navigation of the auxiliary endoscope 134 from the endoscope 100 through the anatomy and to facilitate the viewing of components extending from the lumen 132.

[0042] In certain duodenoscopy procedures (e.g., endoscopic retrograde cholangiopancreatography, hereinafter referred to as “ERCP” procedures), an auxiliary endoscope (also called a daughter endoscope or cholangioscope), such as the auxiliary endoscope 134, can be attached and inserted through the lumen 132 (or the central lumen 62 of the introduction section 28 of the endoscope 14) in Fig. 3B) of the “main endoscope” (also called the maternity scope or duodenoscope), such as the endoscope 100, can be advanced. As explained in more detail below, the auxiliary endoscope 134 can be inserted into the sphincter of Oddi 122. From there, a surgeon operating the auxiliary endoscope 134 can navigate it through the lumen 132 toward the gallbladder, liver, or other sites in the gastrointestinal tract to perform various procedures. The surgeon can navigate the auxiliary endoscope 134 past the junction 128 of the main pancreatic duct 126 and into duct 129 of the common bile duct 124 or into the junction 128. The auxiliary endoscope 134 can be used to guide an additional instrument to the anatomy for the purpose of obtaining biological material, for example, by passing it through or attaching it to the lumen 136.The additional device may have its own functional components, such as a light source, camera, tissue separators, accessories, and a biopsy channel for therapeutic interventions. The biological material can then be removed from the patient, typically by detaching the additional device from the auxiliary instrument, allowing the extracted biological material to be analyzed to diagnose one or more of the patient's conditions. According to several examples, the Endoscope 100 can be used for the removal of cancerous or precancerous material (e.g., carcinoma, sarcoma, myeloma, leukemia, lymphoma, and the like), the assessment of endometriosis, bile duct biopsies, and similar procedures.

[0043] As mentioned above, the size of the auxiliary device is typically small due to the increasingly smaller dimensions of the Endoscope 100, the Auxiliary Endoscope 134, and the auxiliary device itself. For example, the lumen 132 of the Endoscope 100 typically has a diameter on the order of about 4.0 mm, while the lumen 136 of the Auxiliary Endoscope 134 typically has a diameter on the order of about 1.2 mm. Therefore, with conventional devices, including biopsy forceps, it can be difficult to obtain a sufficiently large tissue sample to ensure an accurate diagnosis without repeatedly removing and reinserting the auxiliary device. Similarly, for various reasons, it can be difficult to visualize the desired material, such as the target tissue, including the presence of the tissue sampling device in the field of view of the auxiliary endoscope. This creates the possibility of inadvertently capturing unwanted material, such as...Non-cancerous material is extracted. However, with the systems and devices of the present disclosure, it is possible to obtain sufficiently large tissue samples with only a single insertion and removal of the additional device, for example, by using an oversized biopsy forceps. The use of an oversized biopsy forceps, compared to conventional biopsy forceps used with conventional cholangioscopes, is facilitated by the shortened working channels, two-stage imaging channels, and working channel walls of the present disclosure.

[0044] Fig. Figure 6 is a schematic representation of a surgical instrument 200 comprising forceps 202 positioned near the target tissue 254. The surgical instrument 200 may include a shaft 206 to which the forceps 202 can be attached. The surgical instrument 200 may be positioned to extend from the endoscope 230. The forceps 202 may include jaws 212A and 212B, which may be connected by a hinge 214. The jaws 212A and 212B may have teeth 213. The endoscope 230 may include a shaft 232, a working channel 234, a passage 236, and a lens 238. The field of view 240 may extend from the lens 238. The endoscope 230 may additionally include a lens 239 for projecting light into the field of view 240. Lens 238 and lens 239 can be housed together in an imaging device located in passage 236. The Fig. The 6 components and elements shown are not necessarily to scale.

[0045] As in Fig. As shown in Figure 6, the forceps 202 can be positioned in the anatomical channel 255 containing the target tissue 254. The shaft 206 can be used to guide the jaws 212A and 212B from the shaft 232 into the anatomical channel 255 to grasp the target tissue 254. The target tissue 254 may include a protrusion, such as a growth of cancerous or precancerous material. The endoscope 230 can be positioned so that the lens 238 faces the target tissue 254. Thus, the target tissue 254 can be located within the field of view 240 of the lens 238. The field of view 240 is shown with a specific viewing angle. However, the lens 238 can be configured to provide a field of view 240 with various angles up to and including 108 degrees.

[0046] When jaws 212A and 212B are rotated away from each other at the joint 214, the tissue harvesting device 204 can be moved axially toward the target tissue 254. Jaws 212A and 212B can be rotated toward each other to grasp the target tissue 254. The tissue harvesting device 204 can be moved back and forth along the axis of the shaft 206 to harvest the target tissue 254. The teeth 213 can be used to cut, saw, tear, or pull out portions of the target tissue 254 from the patient's anatomy. In some examples, only one of jaws 212A and 212B may be configured to rotate.

[0047] As in Fig. As shown in Figure 6, the forceps 202 can be extended from the shaft 232 to expose the jaws 212A and 212B to the target tissue 254. This allows the jaws 212A and 212B to be positioned within the field of view 240. The jaws 212A and 212B can be supported by parts of the shaft 232 that form the working channel 234. For example, the shaft 232 can support the shaft 206 so that the jaws 212A and 212B are within the field of view 240, allowing a surgeon to visualize the jaws 212A and 212B next to the target tissue 254 in the video image.

[0048] According to the present disclosure, the working channel 234 can be configured as a shortened working channel, wherein the working channel 234 terminates shortly before the distal end face of the shaft 232, for example by forming a recess on the underside or lower side of the shaft 232, as for example in the Fig. 7 and Fig. 11 shown. The working channel 234 can be extended by using a sliding or pivoting working channel wall element to facilitate entry into and exit from the working channel 234, as shown, for example, in the Fig. 7 and Fig. Figure 11 shows that, in examples, passage 236 can be configured to function as a two-stage imaging channel, with sections of passage 236 extending along the cables for lens 238 and lens 239 being smaller than sections of passage 236 accommodating hardware for lens 238 and lens 239, such as imaging chips and illumination elements, as shown in the Fig. 7 and Fig. Figure 11 shows that, accordingly, the size, e.g., the height H1, of jaws 212A and 212B can be increased compared to conventional biopsy forceps used with conventional cholangioscopes due to the enlargement of the working channels described here. In particular, the height H1 can be greater than the height of the working channel 234, whereas conventional forceps have a height that is less than the height of the working channel 234. Jaws 212A and 212B can be moved radially (e.g., upwards and downwards with respect to the orientation in Fig. 6) be extended to form a container for storing the extracted material. Thus, the forceps 202 can be configured in the form of oversized forceps to extract larger tissue samples, thereby reducing the procedure time and decreasing the likelihood of follow-up treatment.

[0049] Fig. Figure 7 is a schematic side view of an endoscope 300 with a movable working channel wall 302. The endoscope 300 can comprise an elongated shaft 304 with a recess 306 in which the movable working channel wall 302 can be arranged. The elongated shaft 304 can comprise a working channel 308 and an imaging channel 310. The working channel 308 can include a shortened section 312, and the imaging channel 310 can be connected to the lumen 314 of the imaging device. An internal wall structure 316 can be provided within the elongated shaft 304 to separate and / or form the working channel 308, the imaging channel 310, the shortened section 312, and the lumen 314 of the imaging device. The elongated shaft 304 can extend to the distal end surface 318. The recess 306 can include a recessed end wall 320 and a connecting wall 322.The interior wall structure 316 can comprise a lumen wall 324, a rear wall 326, and a channel wall 328. The imaging system 330 can comprise an imaging device 332 and an imaging cable 334. The movable working channel wall 302 can be connected to an actuator 336.

[0050] The imaging device 332 can be positioned in the lumen 314 of the imaging device, and the imaging cable 334 can extend proximal from the imaging device 332 through the imaging channel 310. As described below with reference to Fig. 10A and Fig. As explained in more detail in Section 10B, the imaging device 332 can have a greater height than the imaging cable 334. Therefore, for most of the length of the elongated shaft 304, it is not necessary for the imaging channel 310 to be the same size as the lumen 314 of the imaging device. Thus, the diameter of the imaging channel 310 can be reduced compared to the lumen 314 of the imaging device. However, the rear wall 326 of the lumen 314 of the imaging device can interfere with the working channel 308, forming a shortened section 312. To facilitate access to and from the working channel 308, the shortened section 312 can have a recess 306. The sliding working channel wall 302 can be configured to close and open the recess 306.The movable working channel wall 302 can be configured to extend the elongated shaft 304 from the recessed end wall 320 to the distal end surface 318. In some examples, however, the movable working channel wall 302 may terminate just before the distal end surface 318 and / or extend beyond the recessed end wall 320 in a fully retracted state. In other examples, the movable working channel wall 302 may extend beyond the distal end surface 318 and be longer than the distance between the recessed end wall 320 and the distal end surface 318.

[0051] The movable working channel wall 302 can include a movable part, plate, or door configured to move proximally to open the recess 306 and provide direct access to the working channel 308 without having to pass through the shortened section 312, or at least without passing completely or axially through the shortened section 312. An instrument can then be freely withdrawn from the working channel 308 without interference from the posterior wall 326, or at least with minimal interference. The movable working channel wall 302 can then be moved distally to close the recess 306 and support the instrument. In examples, the movable working channel wall 302 can therefore be made of a rigid material such as hard plastic or metal.In some examples, the movable working channel wall 302 can be designed to exhibit a degree of flexibility to facilitate navigation through the anatomy and instrument angulation. In some examples, the movable working channel wall 302 can be made of fluoropolymers, such as polytetrafluoroethylene.

[0052] The movable working channel wall 302 can be connected to the elongated shaft 304 by means that allow axial displacement. In some examples, the connecting means can prevent circumferential and radial displacement. In others, the movable working channel wall 302 can be attached to the elongated shaft 304 by means of rails, clamps, rollers, and the like. In the example of Fig. 7 The movable working channel wall 302 can be coupled to the elongated shaft 304 by means of clamps 329. As in Fig. As shown in Figure 8, the sliding working channel wall 302 can be slidably attached to the elongated shaft 304 via a tongue-and-groove system. The clamp 329 can be used with or without the tongue-and-groove system.

[0053] The movable working channel wall 302 can be actuated by an actuator 336. In examples, the actuator 336 can comprise a wire extending through the working channel 308 to reach a control unit or handpiece. A wire encompassing the actuator 336 can be wound around a spool that can be rotated by a user to retract the movable working channel wall 302. As explained herein, in examples, the actuator 336 can comprise a control wire received in the elongated shaft 304. In examples, a preload system can be used to return the movable working channel wall 302 to the extended position, as described with reference to the Fig. 15A and Fig. 15B explains. In examples, the movable working channel wall 302 can be advanced and retracted by intervention with a medical device guided through the working channel 308, as described in the Fig. 16A and Fig. 16B explained.

[0054] Fig. Figure 8 is an end view of the 300 endoscope. Fig. 7, which shows an arc-shaped form of the movable working channel wall 302. The endoscope 300 may comprise an elongated shaft 304, a distal end face 318, a lumen wall 324, and an imaging device 332. The imaging device 332 may comprise an objective lens 337 and an illumination lens 338. As shown in Fig. As can be seen in Figure 8, the movable working channel wall 302 can be curved to adapt to the curvature of the elongated shaft 304, and can thus include an extension of the elongated shaft 304.

[0055] In some examples, the objective lens 337 and the illumination lens 338 can be integrated into a single device comprising the imaging device 332, so that the imaging unit can occupy the entire space within the lumen 314 of the imaging device. However, in other examples, the imaging device 332 can comprise only the objective lens 337, allowing a separate illumination unit to be used to utilize the space within the lumen 314 of the imaging device.

[0056] The movable working channel wall 302 can be attached to the elongated shaft 304 by means of a fastening mechanism 340. In the illustrated example, the fastening mechanism 340 can comprise a tongue-and-groove system including rails or tongues 342 extending radially outward from the elongated shaft 304 proximal to the recessed end wall 320, and rails or grooves 344 extending radially inward from the movable working channel wall 302. However, the positions of the tongues 342 and grooves 344 can be reversed. The fastening mechanism 340 can be configured to allow axial movement of the movable working channel wall 302 but prevent rotational or pivoting movement of the movable working channel wall 302.

[0057] The movable working channel wall 302 can comprise an arc-shaped body that fits with the connecting wall 322 on the elongated shaft 304, thereby forming a continuous 360-degree body that surrounds the working channel 308 and the lumen 314 of the imaging device. In the illustrated example, the movable working channel wall 302 is positioned within the working channel 308. In other examples, the movable working channel wall 302 can be positioned outside the working channel 308 on the outer surface of the elongated shaft 304. In other examples, the movable working channel wall 302 can be configured to extend from a pocket or channel within a distal surface of the elongated shaft 304.

[0058] Fig. 9A is a schematic side view of the 300 endoscope. Fig. 7, into which the instrument 350 is inserted and whose movable working channel wall 302 is in an open position. Fig. 9B is a schematic side view of the 300 endoscope. Fig. 9A with an instrument 350 inserted therein and a movable working channel wall 302 in a closed position. The instrument 350 may include a shaft 352 and an intervention device 354. Fig. 9A and Fig. Section 9B will be explained at the same time.

[0059] As in Fig. As shown in Figure 9A, the movable working channel wall 302 can be retracted into the working channel 308, for example by an actuator 336 and / or a preload system. In such a position, the movable working channel wall 302 can minimize the size of the distal end of the endoscope 300 to facilitate insertion through the anatomy. In this way, the space between the retracted end wall 320 and the lumen wall 324 can be opened so that the interventional device 354 can be brought out of the working channel 308. As with the Fig. 10A and Fig. As explained in Figure 10B, the dimensions of the instrument 350 can be correlated with the dimensions of the recess 306, the working channel 308, the imaging channel 310, the truncated section 312, and the lumen 314 of the imaging device. For example, the intervention device 354 may be dimensioned to occupy the maximum space within the cross-section of the working channel 308 and yet still be able to pass through the recess 306. This could result in the intervention device 354 being blocked by the lumen wall 324 unless the movable working channel wall 302 could be moved out of the way of the intervention device 354 to open the recess 306.

[0060] As in Fig. As shown in Figure 9B, the movable working channel wall 302 can be extended from the working channel 308, for example by an actuator 336 and / or a preload system. In this way, the movable working channel wall 302 can be positioned below the shaft 352 to support the instrument 350 up to the end of the movable working channel wall 302. The movable working channel wall 302 can thus facilitate the positioning of the intervention device 354 within the field of view of the imaging device 332. Furthermore, the support of the instrument 350 by the movable working channel wall 302 can facilitate better movement of the intervention device 354 with the movements of the elongated shaft 304, for example by preventing the shaft 352 from slipping out of the recess 306.

[0061] Fig. Figure 10A is a schematic side view of the endoscope 300 with a movable working channel wall 302 in a closed position. Fig. Figure 10B is a schematic side view of the 300 endoscope. Fig. 10A with a sliding working channel wall 302 in an open position. Fig. 10A and Fig. Figure 10B shows a distal end section of an elongated shaft 304, which may have a proximal end section connected to a control unit or handpiece as described herein. Fig. 10A and Fig. 10B will be explained at the same time.

[0062] The working channel 308 can have a distance D1 and the imaging channel 310 can have a distance D2. The shortened section 312 can have a distance D3 and the lumen 314 of the imaging device can have a distance D4. The distance D1 is the inner diameter of the working channel 308 from the Fig. 7 and Fig. 8 proximal to the movable working channel wall 302 and to the lumen 314 of the imaging device. In examples, the inner diameter of the working channel 308 can be circular, but can also have other cross-sectional shapes, such as semicircular, elliptical, oval, arcuate, and the like. The distance D1 can be the maximum height of the working channel 308. The distance D2 is the inner diameter of the imaging channel 310 from the Fig. 7 and Fig. 8 proximal to the lumen 314 of the imaging device. In examples, the imaging channel 310 can be circular, but can also have other cross-sectional shapes, such as semicircular, elliptical, oval, arcuate, and the like. The distance D2 can include the maximum height of the imaging channel 310. The distance D3 is the distance between the bottom of the movable working channel wall 302 and the bottom of the lumen wall 324 ( Fig. 7) when the movable working channel wall 302 is extended. In examples, the shape between the underside of the movable working channel wall 302 and the underside of the lumen wall 324 can be a circular channel, but it can also have other cross-sectional shapes, such as semicircular, elliptical, oval, arcuate, and the like. The distance D3 can be the minimum height between the underside of the movable working channel wall 302 and the underside of the lumen wall 324. The distance D4 is the inner diameter of the lumen 314 of the imaging device relative to the movable working channel wall 302. In examples, the lumen 314 of the imaging device can be a circular channel, but it can also have other cross-sectional shapes, such as semicircular, elliptical, oval, arcuate, and the like. The distance D3 can be the maximum height of the lumen 314 of the imaging device.The working channel 308 can have a distance D1 that is greater than the distance D2 of the imaging channel 310. The lumen 314 of the imaging device can have a distance D4 that is greater than the distance D2 of the imaging channel 310. The truncated section 312 of the working channel 308 can have a distance D3 that is smaller than the distance D1 of the working channel 308, for example, due to the magnification of the lumen 314 of the imaging device compared to the imaging channel 310.

[0063] As in Fig. As can be seen in Figure 10A, the movable working channel wall 302 can be moved forward to extend the lower section of the working channel 308 from the recessed end wall 320 forward to the distal end face 318. An instrument inserted into the working channel 308 can have a height less than the distance D1. For example, the height H1 can be... Fig. 6, which is also the outer diameter of the intervention device 354 o Fig. 9A and Fig. 9B can be smaller than the distance D1. However, an instrument located within the working channel 308 and having a height greater than the distance D3 of the shortened section 312 would be blocked by the rear or posterior wall 326 of the lumen 314 of the imaging device. Instruments can be configured to work in conjunction with the endoscope 300 to maximize instrument size and improve performance. Therefore, the size, e.g., the height or diameter, of the interventional device 354 can be increased to the size of the working channel 308, for example. However, the lumen wall 324 may obstruct the exit of an instrument positioned within the working channel 308.Therefore, the movable working channel wall 302 can be retracted or moved posteriorly or proximally to expose the working channel 308 at the recessed end wall 320 to the outside of the elongated shaft 304, forming an opening between the posterior wall 326 and the recessed end wall 320 with a distance D3. The distance D5 can be the distance between the anterior or distal end of the elongated shaft 304 at the recessed end wall 320 and the posterior or proximal end of the lumen 314 of the imaging device. The distance D5 can be approximately the same as the distance D1, so that any instrument located within the working channel 308 can exit the endoscope 300 at the distal end. The distance D5 can be the minimum height for exiting the working channel 308 when the movable working channel wall 302 is retracted. The distance D5 can be greater than the distance D3.

[0064] The lumen 314 of the imaging device can extend by length L1 proximal to the distal end face 318. The recessed end wall 320 can be located at a length L2 proximal to the distal end face 318. Length L2 can be greater than length L1. The movable working channel wall 302 can have a length equal to length L2, but in other examples, it can also be longer or shorter than length L2.

[0065] Fig. Figure 11 is a schematic side view of an endoscope 400 with a pivotable working channel wall 402. The endoscope 400 may include an elongated shaft 404 with a recess 406 in which the pivotable working channel wall 402 may be arranged. The elongated shaft 404 may include a working channel 408 and an image channel 410. The working channel 408 may include a shortened section 412, and the image channel 410 may be connected to the lumen 414 of the imaging device. An internal wall structure 416 may be provided within the elongated shaft 404 to separate and / or form the working channel 408, the image channel 410, the shortened section 412, and the lumen 414 of the imaging device. The elongated shaft 404 may extend to the distal end face 418. The recess 406 can include a recessed end wall 420 and a connecting wall 422.The interior wall structure 416 can comprise a lumen wall 424, a rear wall 426, and a channel wall 428. The imaging system 430 can comprise an imaging device 432 and an imaging cable 434. The pivoting working channel wall 402 can be connected to an actuator 436 and a pivot point 440.

[0066] The imaging device 432 can be positioned in the lumen 414 of the imaging device, and the imaging cable 434 can extend proximal from the imaging device 432 through the imaging channel 410. As described below with reference to the Fig. 14A and Fig. As explained in more detail in Section 14B, the imaging device 432 can have a greater height than the imaging cable 434. Therefore, for most of the length of the elongated shaft 404, it is not necessary for the imaging channel 410 to be the same size as the lumen 414 of the imaging device. Thus, the diameter of the imaging channel 410 can be reduced compared to the lumen 414 of the imaging device. However, the rear wall 426 of the lumen 414 of the imaging device can interfere with the working channel 408, forming a shortened section 412. To facilitate access to and exit from the working channel 408, the shortened section 412 can have a recess 406. The pivoting working channel wall 402 can be configured to close and open the recess 406.The pivotable working channel wall 402 can be configured to extend the elongated shaft 404 beyond the recessed end wall 420 to the distal end surface 418. In examples, however, the pivotable working channel wall 402 can terminate before the distal end surface 418 or extend beyond the distal end surface 418, so that it is longer than the distance between the recessed end wall 420 and the distal end surface 418.

[0067] The pivoting working channel wall 402 can include a movable part, a plate, or a door configured to rotate outward from the endoscope 400 to open the recess 406 and provide direct access to the working channel 408 without having to pass through the shortened section 412, or at least not completely or axially through the shortened section 412. An instrument can then be freely advanced out of the working channel 408 without interference from the rear wall 426, or at least with minimal interference. The pivoting working channel wall 402 can then be rotated toward the endoscope 400 to close the recess 406 and support the instrument. Therefore, in some examples, the pivoting working channel wall 402 can be made of a rigid material such as hard plastic or metal.In some examples, the pivoting working channel wall 402 may be designed to exhibit a degree of flexibility to facilitate navigation through the anatomy and instrument angulation. In some examples, the pivoting working channel wall 402 may be made of fluoropolymers such as polytetrafluoroethylene.

[0068] The pivotable working channel wall 402 can be connected to the elongated shaft 404 by means that allow rotational movement. In examples, the connecting means can prevent circumferential displacement, radial displacement, and axial displacement. In the example of Fig. 11. The pivotable working channel wall 402 can be connected to the elongated shaft 404 via pivot points 440. In examples, the pivot points 440 can include pivot pins, hinges, springs, torsion springs, and the like. As referred to Fig. As explained in section 17, the swiveling working channel wall 402 can additionally be connected to the elongated shaft 404 by a flexible plate.

[0069] The pivoting working channel wall 402 can be actuated by an actuator 436. In examples, the actuator 436 can include a wire extending through the working channel 408 to reach a control unit or handpiece. A wire encompassing the actuator 436 can be wound around a spool that can be rotated by a user to close or open the pivoting working channel wall 402, depending on the configuration of the pivot points 440. As explained herein, in examples, the actuator 436 can include a control wire received in the elongated shaft 404. In examples, a preload system can be used to return the pivoting working channel wall 402 to the open or closed position, as described with reference to the Fig. 15A and Fig. 15B explains. In examples, the pivoting working channel wall 402 can be rotated by intervention with a medical device extended through the working channel 408, as described in the Fig. 16A and Fig. 16B explained.

[0070] Fig. Figure 12 is an end view of the 400 endoscope. Fig. Figure 11, which shows an arc-shaped form of the pivotable working channel wall 402. The endoscope 400 may comprise an elongated shaft 404, a distal end face 418, a lumen wall 424, and an imaging device 432. The imaging device 432 may comprise an objective lens 437 and an illumination lens 438. As shown in Fig. As can be seen in Figure 12, the pivoting working channel wall 402 can be curved to adapt to the curvature of the elongated shaft 304, and can thus include an extension of the elongated shaft 404.

[0071] In some examples, the objective lens 437 and the illumination lens 438 can be integrated into a single device comprising the imaging device 432, so that the imaging unit can occupy the entire space within the lumen 414 of the imaging device. However, in other examples, the imaging device 432 can comprise only the objective lens 437, allowing a separate illumination unit to be used to utilize the space within the lumen 414 of the imaging device.

[0072] The pivotable working channel wall 402 can comprise an arc-shaped body that fits with the connecting wall 422 on the long shaft 404, thereby forming a continuous 360-degree body that surrounds the working channel 408 and the lumen 414 of the imaging device. In the illustrated example, the pivotable working channel wall 402 can be axially aligned with the elongated shaft 404. In other examples, the pivotable working channel wall 402 can be positioned inside the working channel 408 on the inside of the elongated shaft 404 or outside the working channel 408 on the outside of the elongated shaft 404.

[0073] Fig. Figure 13A is a schematic side view of the 400 endoscope. Fig. 11, in which the instrument 450 is inserted and the pivoting working channel wall 402 is opened. Fig. Figure 13B is a schematic side view of the 400 endoscope. Fig. 13A, in which the instrument 450 is inserted and the pivotable working channel wall 402 is closed. The instrument 450 may include a shaft 452 and an intervention device 454. The Fig. 13A and Fig. Section 13B will be explained at the same time.

[0074] As in Fig. As shown in Figure 13A, the pivoting working channel wall 402 can be rotated away from the working channel 408, for example by an actuator 436 and / or a preloading system. In this way, the space between the recessed end wall 420 and the lumen wall 424 can be opened so that the intervention device 454 can be led out of the working channel 408. As shown below with reference to the Fig. 14A and Fig. As explained in Figure 14B, the dimensions of the instrument 450 can be correlated with the dimensions of the recess 406, the working channel 408, the imaging channel 410, the truncated section 412, and the imaging device lumen 414. For example, the intervention device 454 may be dimensioned to occupy the maximum space within the cross-section of the working channel 408 and yet still fit through the recess 406. This could result in the intervention device 454 being blocked by the lumen wall 424 unless the pivoting working channel wall 402 could be moved out of the way of the intervention device 454 to open the recess 406.

[0075] As in Fig. As shown in Figure 13B, the pivotable working channel wall 402 can be rotated toward the working channel 408, for example, by an actuator 436 and / or a preload system. In such a position, the pivotable working channel wall 402 can minimize the size of the distal end of the endoscope 400 to facilitate insertion through the anatomy. Thus, the pivotable working channel wall 402 can be positioned below the shaft 452 to support the instrument 450 up to the end of the pivotable working channel wall 402. The pivotable working channel wall 402 can therefore facilitate the positioning of the interventional device 454 within the field of view of the imaging device 432.Furthermore, the support of the instrument 450 by the pivotable working channel wall 402 can facilitate better movement of the intervention device 454 with the movements of the elongated shaft 404, for example by preventing the shaft 452 from slipping out of the recess 406.

[0076] Fig. Figure 14A is a schematic side view of the endoscope 400 with a swiveling working channel wall 402 in a closed position. Fig. Figure 14B is a schematic side view of the 400 endoscope. Fig. 14A with a swiveling working channel wall 402 in an open position. The Fig. 14A and Fig. Figure 14B shows a distal end section of an elongated shaft 404, which may have a proximal end section connected to a control unit or handpiece, as described herein. Fig. 14A and Fig. Section 14B will be explained at the same time.

[0077] The working channel 408 can have a distance D1 and the imaging channel 410 can have a distance D2. The shortened section 412 can have a distance D3 and the lumen 414 of the imaging device can have a distance D4. The distance D1 is the inner diameter of the working channel 408 from the Fig. 11 and Fig. 12 proximal to the pivotable working channel wall 402 and to the lumen 414 of the imaging device. In examples, the inner diameter of the working channel 408 can be circular, but can also have other cross-sectional shapes, such as semicircular, elliptical, oval, arcuate, and the like. The distance D1 can be the maximum height of the working channel 408. The distance D2 is the inner diameter of the imaging channel 410 in the Fig. 11 and Fig. 12 proximal to the lumen 414 of the imaging device. In examples, the imaging channel 410 may comprise a circular channel, but may also have other cross-sectional shapes, such as semicircular, elliptical, oval, arcuate, and the like. The distance D2 may comprise the maximum height of the imaging channel 410. The distance D3 is the distance between the underside of the pivotable working channel wall 402 and the underside of the lumen wall 424 ( Fig. 11) when the pivotable working channel wall 402 is closed. In examples, the shape between the underside of the pivotable working channel wall 402 and the underside of the lumen wall 424 can be a circular channel, but it can also have other cross-sectional shapes, such as semicircular, elliptical, oval, arcuate, and the like. The distance D3 can be the minimum height between the underside of the pivotable working channel wall 402 and the underside of the lumen wall 424. The distance D4 is the inner diameter of the lumen 414 of the imaging device relative to the movable working channel wall 402. In examples, the lumen 414 of the imaging device can be a circular channel, but it can also have other cross-sectional shapes, such as semicircular, elliptical, oval, arcuate, and the like. The distance D3 can be the maximum height of the lumen 414 of the imaging device.The working channel 408 can have a distance D1 that is greater than the distance D2 of the imaging channel 410. The lumen 414 of the imaging device can have a distance D4 that is greater than the distance D2 of the imaging channel 410. The shortened section 412 of the working channel 408 can have a distance D3 that is smaller than the distance D1 of the working channel 408, for example, due to the increase in the size of the lumen 414 of the imaging device compared to the imaging channel 410.

[0078] As in Fig. As can be seen in Figure 14A, the pivotable working channel wall 402 can be rotated towards the elongated shaft 404. An instrument inserted into the working channel 408 can have a height that is less than the distance D1. For example, the height H1 can be Fig. 6, which is also the outer diameter of the intervention device 454 o Fig. 13A and Fig. 13B may be smaller than the distance D1. However, an instrument within the working channel 408 with a height greater than the distance D3 of the shortened section 412 would be blocked by the rear or posterior wall 426 of the lumen 414 of the imaging device. Instruments can be configured to work in conjunction with the endoscope 400 to maximize instrument size and improve performance. For example, the size, such as height or diameter, of the interventional device 454 can be increased to the size of the working channel 408. However, the lumen wall 424 may obstruct the exit of an instrument positioned within the working channel 408.Therefore, the pivotable working channel wall 402 can be rotated away from the elongated shaft 404 to expose the working channel 408 at the recessed end wall 420 to the outside of the elongated shaft 404, forming an opening between the posterior wall 426 and the recessed end wall 420 with a distance D3. The distance D5 can be the distance between the anterior or distal end of the elongated shaft 404 at the recessed end wall 420 and the posterior or proximal end of the lumen 414 of the imaging device. The distance D5 can be approximately the same as the distance D1, so that any instrument located within the working channel 408 can exit the endoscope 400 at the distal end. The distance D5 can be the minimum height for exiting the working channel 408 when the pivotable working channel wall 402 is open. The distance D5 can be greater than the distance D3.

[0079] The lumen 414 of the imaging device can extend by length L1 proximal to the distal end face 418. The recessed end wall 420 can be located at a length L2 proximal to the distal end face 418. Length L2 can be greater than length L1. The pivotable working channel wall 402 can have a length equal to length L2, but in other examples, it can also be longer or shorter than length L2.

[0080] Fig. Figure 15A is a schematic side view in cross-section of the endoscope 500 with a movable working channel wall 502 attached to a pretensioning system 504 and a control wire 506. Fig. Figure 15A shows the movable working channel wall 502 in a forward position. Fig. Figure 15B shows the movable working channel wall 502 in a retracted state. Fig. 15A and Fig. Section 15B will be explained at the same time.

[0081] The endoscope 500 can include an elongated shaft 508 and a recess 510. The preload system 504 can include a preload element 512 and a stop 514. The endoscope 500 can be made similarly to the endoscope 300 from Fig. 7 - Fig. 10B designed, a system 504 for the pre-tensioning effect is provided and the pull wire of the actuator 336 is replaced by a control wire 506.

[0082] In the illustrated example, the preload system 504 can be configured to push the movable working channel wall 502 distally into the advanced position, and the control wire 506 can be configured to pull the movable working channel wall 502 into the retracted position. In other examples, however, the preload system 504 can be configured to pull the movable working channel wall 502 proximally, and an actuator, such as a rigid rod or wire, can be used to push the movable working channel wall 502 distally.

[0083] In the illustrated example, the preload element 512 can comprise a spring. In other examples, the preload element 512 can comprise a leaf spring, a coil spring, a flexible element, or the like. In other examples, the preload element 512 can have a rest length approximately equal to the distance between the stop 514 and the movable working channel wall 502, in order to push the movable working channel wall 502 away from the stop 514. Thus, the control wire 506 can be configured to proximally (into the Fig. 15A and Fig. (15B to the left) is pulled to displace the movable working channel wall 502 proximally and press the preloading element 512 against the stop 514. The stop 514 may comprise a flange or a projection of material extending from the elongated shaft 508 to project into the working channel 516.

[0084] The Fig. 15A and Fig. Figure 15B shows the pre-tensioning system 504 in operation with a sliding working channel wall. However, the pre-tensioning system 504 can also be configured for use with a pivoting working channel wall, for example by using a torsion spring or the like.

[0085] The control wire 506 can be configured to induce a bend in the elongated shaft 508 to facilitate the insertion of the endoscope 500 through the anatomy. Therefore, the control wire 506 can be connected at a proximal end to a roller that can be rotated by user interaction via a crank or handle to tension the control wire 506. The distal end of the control wire 506 can be attached to the elongated shaft 508, for example, by a movable working channel wall 502. The control wire 506 can be positioned loosely in a channel, lumen, or passage extending through the interior of the elongated shaft 508. Thus, pulling on the control wire 506 can cause a bend in the elongated shaft 508, as is known in the art. In the example shown, the distal end of the control wire 506 is attached to the movable working channel wall 502.In some examples, the spring force of the preload element 512 can be configured stiffly to first allow the elongated shaft 508 to bend and then allow the movable working channel wall 502 to retract. In other examples, the spring force of the preload element 512 can be configured weakly to first allow the movable working channel wall 502 to retract and then allow the elongated shaft 508 to bend.

[0086] Bending of the elongated shaft 508 can lead to interference with anatomical structures, such as a canal wall. For example, interference with anatomical structures by the elongated shaft 508 can cause the control wire 506 to be pulled further without any additional bending of the elongated shaft 508, thereby overcoming the spring force of the preload element 512 and actuating the movable working canal wall 502. Additionally, the spring force of the preload element 512 can be overcome by reaching the end or limit of the actuation of the control wire 506.

[0087] Fig. Figure 16A is a schematic side view in cross-section of an endoscope 550 with a movable working channel wall 552 with a capture system 554 designed to interact with an instrument 556. Fig. Figure 16A shows the movable working channel wall 552 in a retracted state. Fig. Figure 16B shows the movable working channel wall 552 in a forward position. Fig. 16A and Fig. Section 16B will be explained at the same time.

[0088] The endoscope 550 can include an elongated shaft 558 and a recess 560. The grasping system 554 can include a stop 562 and a stop 564. The endoscope 550 can be made similarly to the endoscope 300 from the Fig. 7 - 10B are set up, with the capture system 554 also being present. The endoscope 550 can include an actuation system, such as the pull wire of the actuator 336 ( Fig. 7) or the control wire 506 ( Fig. 15A and Fig. 15B). The instrument 556 may include a shaft 566 and an intervention device 568.

[0089] The catch system 554 can be configured to actuate the movable working channel wall 552 without the use of a special actuating system, such as a pull wire or a control wire, although an actuating system may be provided for redundancy or for additional control options. The catch system 554 can utilize the movement of the instrument 556 to push and pull the movable working channel wall 552. For example, the catch device 562 may include a projection on the instrument 556 that engages with the catch device 564 as the instrument 556 moves past the movable working channel wall 552. The catch system 554 can be configured to allow the movable working channel wall 552 to be moved either in one direction or in both directions.This means that the capture system 554 can be configured to engage only during the distal movement of the instrument 556 out of the endoscope 550 or during the proximal movement of the instrument 556 into the endoscope 550, or the capture system 554 can be configured to engage both during the distal movement of the instrument 556 out of the endoscope 550 and during the proximal movement of the instrument 556 into the endoscope. The capture system 554 can be used with a pre-tensioning mechanism, e.g., the pre-tensioning system 504 from the [reference to be added]. Fig. 15A and Fig. 15B.

[0090] In examples, the holding device 562 can comprise a forward-facing hook and the holding device 564 a rearward-facing hook. Alternatively, the holding device 562 can comprise a forward-facing hook and the holding device 564 a wire extending laterally across the movable working channel wall 552. In other examples, the hook 564 can be deformable such that, once the movable working channel wall 552 reaches the axial limit to which it can be moved, for example, by restrictions imposed by the bracket 329 or the fastening mechanism 340, the hook 564 can deform and release the hook 562. This allows the intervention device 568 to move further beyond the movable working channel wall 552.

[0091] In examples, the capture system 554 can be configured to use the swiveling working channel wall 402. Fig. 11 to be used, for example by arranging the stop 564 on a proximal side of the pivot point 440, such that a forward movement (distal movement) of the stop 562 causes a clockwise rotation of the pivotable working channel wall 402 (relative to the orientation in Fig. 11) and a backward movement (proximal movement) of the trapping device 562 causes a counterclockwise rotation of the pivotable working channel wall 402.

[0092] Fig. Figure 17 is a schematic perspective view of the endoscope 600 with a pivotable working channel wall 602, which can be retracted via elastic elements 604. The endoscope 600 can comprise an elongated shaft 606 with a main section 608, from which an imaging extension 610 extends. The imaging extension 610 can be formed by a cutout 612, as described herein. The instrument 614, comprising a shaft 616 and an intervention device 618, can extend from the endoscope 600. The endoscope 600 can be constructed similarly to the endoscope 300. Fig. 11 to 14B are constructed, with the addition of the elastic element 604 and the joint mechanism 620.

[0093] The pivoting working channel wall 602 can comprise an arc-shaped or semicircular body configured to pivot or bend near the main section 608 of the elongated shaft 606. The pivoting working channel wall 602 can be connected to the main section 608 via a hinge mechanism 620. The hinge mechanism 620 can comprise an elastic material that allows the pivoting working channel wall 602 to tilt from a closed position to an open position. The hinge mechanism 620 can comprise a section of the main section 608 or a separate material section connecting the main section 608 and the pivoting working channel wall 602. The hinge mechanism 620 can comprise an elastic material or a flexible polymer material.

[0094] The elastic elements 604 can comprise bands or material bodies that can extend between the imaging extension 610 and the pivoting working channel wall 602. The elastic elements 604 can be stretchable so that, when the pivoting working channel wall 602 is closed to come into contact with the imaging extension 610, they can contract to a small size or retract into the pivoting working channel wall 602 or the imaging extension 610.

[0095] The instrument 614 can be moved distally so that the intervention device 618 can pivot the working channel wall 602 as shown in Fig. Figure 17 shows the intervention device 618 moving past the pivoting working channel wall 602. However, after the intervention device 618 has moved past the pivoting working channel wall 602, the elastic elements 604 can pull the pivoting working channel wall 602 back into the closed position to support the shaft 616. To facilitate the movement of the intervention device 618 back into the endoscope 600, the pivoting working channel wall 602 can be angled or have a ramped surface so that the intervention device 618 can push the pivoting working channel wall 602 away from the imaging extension 610 and stretch the elastic elements 604, as shown in Figure 17. Fig. 19 shown.

[0096] Fig. Figure 18 is a front view of the retaining clip 640 for use with the swiveling working channel wall 602. Fig. 17 and other examples of the present disclosure. The retaining clip 640 can comprise a split ring with an arc-shaped body 642 having ends 644A and 644B. ​​The ends 644A and 644B can be spaced apart from each other by the arc length A. The arc-shaped body 642 can be dimensioned such that it extends around the imaging extension 610 and the pivotable working channel wall 602. Fig. 17 fits. Thus, the inner diameter of the arc-shaped body 642 can be slightly larger than the outer diameter of the elongated shaft 606. The clamp 640 can be positioned around the imaging extension 610 such that the ends 644A and 644B are positioned against the pivoting working channel wall 602. The clamp 640 can be held in place by fastening it to the imaging extension by any suitable means. When the pivoting working channel wall 602 is forced open by the engagement device 618, the clamp 640 can bend so that the ends 644A and 644B are further apart, i.e., the arc length A increases, and the arc-shaped body 642 can move away from the imaging extension 610 as the diameter of the clamp 640 increases.The initial length of the arc length A can be adjusted so that the clamp 640 does not detach from the imaging extension 610 when the pivotable working channel wall 602 is fully open, for example, by springing off. Thus, the ends 644A and 644B can continue to exert an inward force on the pivotable working channel wall 602, so that when the intervention device 618 is moved away from the pivotable working channel wall 602, the pivotable working channel wall 602 is pushed back against the imaging extension 610, and the arc-shaped body 642 can engage flush with the endoscope 600 as the diameter of the clamp 640 decreases.

[0097] Fig. Figure 19 is a schematic side view of the endoscope 600 with a swiveling working channel wall 602 and an angled reentry section 650. The endoscope 600 can be used similarly to the endoscope 400. Fig. 11 or the endoscope 600 from Fig. 17. The angled reentry section 650 can form an angled inlet with variable height D6. The angled inlet can increase in height toward the distal end of the endoscope 600. Thus, when the pivoting working channel wall 602 is closed, a gap can be provided between the pivoting working channel wall 602 and the imaging extension 610. This gap can allow an instrument, such as an interventional device 618, to partially enter the endoscope 600 before the pivoting working channel wall 602 begins to open, thereby facilitating reentry of the instrument and preventing the pivoting working channel wall 602 from being held in the closed position by an instrument attempting to reenter.The example shown depicts an angled reentry section 650 comprising an angled section of the pivotable working channel wall 602, which is located on an upper side (relative to the orientation in . Fig. 19) of the pivoting working channel wall 602. Thus, the underside of the pivoting working channel wall 602 can generally remain cylindrical so as not to project beyond the outer circumference of the endoscope 600, thereby facilitating movement of the endoscope 600 through the anatomy when the pivoting working channel wall 602 is closed. In other examples, however, the pivoting working channel wall 602 may be angled outward, such that the angled reentry section 650 includes a flange or lip of the pivoting working channel wall 602 that is angled away from the underside of the pivoting working channel wall 602.

[0098] Fig. Figure 20 is a block diagram illustrating examples of Procedure 900 for inserting an oversized biopsy device through an endoscope. Procedure 900 may include Operations 902–924, which involve the use of Surgical Instrument 200. Fig. 6 and other instruments. Method 900 can additionally be combined with the devices and systems from the Fig. 7-19 may be used. Various examples may include additional operations that are compatible with the devices, systems, methods, and processes described herein. Likewise, some of the operations 902-926 may be omitted. Additionally, operations 902-924 may be performed in a different sequence.

[0099] In procedure 902, an endoscope, for example a duodenoscope, can be inserted into a patient's anatomy and navigated through it. For example, the endoscope 14 ( Fig. 1) Use native imaging functions to guide the insertion section 28 through the patient's anatomical channels. The insertion section 28 can be bent or curved using the control knob 38 and associated pull wires or control wires to facilitate rotation of the endoscope 14.

[0100] At step 904, an auxiliary endoscope can be inserted into the endoscope to gain access to anatomical structures located further down the passageway. For example, the auxiliary endoscope 134 ( Fig. 5) into the central lumen 62 ( Fig. 3C) or the lumen 132 ( Fig. 5) are inserted to reach another anatomical passage that intersects the anatomical passage reached by the endoscope 14. The elevator 54 ( Fig. 3C) can be used to bend or twist the auxiliary endoscope 134.

[0101] In step 906, a tissue sampling device or oversized biopsy forceps may be inserted into the auxiliary endoscope to reach the target tissue. The target tissue may include tissue that is possibly diseased or otherwise indicates a medical condition in the patient. For example, the surgical instrument 200 ( Fig. 6) be inserted into the auxiliary endoscope 134 so that the tissue sampling device 204 remains inside the auxiliary endoscope.

[0102] In step 908, the endoscope, into which the tissue sampling device is inserted, can be guided to the location of the target tissue in the patient. For example, the endoscope 300 can be made of Fig. 7 or the auxiliary endoscope 400 from Fig. 11. The auxiliary endoscope is guided through an anatomical channel to the target tissue. A surgeon can advance the auxiliary endoscope axially as needed using an elevator to position the target tissue within the field of view of the auxiliary endoscope's imaging device.

[0103] In step 910, a viewing or imaging device can be activated on the auxiliary endoscope to view the patient's biological material. For example, the imaging unit 110 ( Fig. 5) be activated to view the anatomy in the field of view of the camera lens 137 ( Fig. 5) to consider.

[0104] In step 912, the target tissue can be viewed using an imaging unit and a video monitor. For example, the imaging unit 110 can use the objective lens 80 to display the target tissue on the output unit 18. The objective lens 80 can view the target tissue and the surgical instrument 200 simultaneously or sequentially. Light from a light source can be used to illuminate the target tissue. For example, the light produced by the illumination unit 112 can be directed onto the target tissue by the illumination lens 78.

[0105] In step 914, the movable working channel walls of the present disclosure can be opened to allow the oversized biopsy forceps to exit the endoscope. Once the target tissue has been identified by the surgeon, the endoscope can be prepared to allow the tissue sampling device to exit the endoscope to engage with the target tissue. For example, the movable working channel wall can be a sliding working channel wall, as shown in Fig. 7 shown, or a swiveling working channel wall, as in Fig. Figure 11 shows that the movable working channel wall can be moved or shifted to open or enlarge the most distal portion of the endoscope's working channel. In this way, the tissue sampling device can move within the endoscope around an obstruction at the distal end of the working channel, for example, an obstruction caused by the imaging device and, in particular, by the posterior wall 326 ( Fig. 7) or the rear wall 426 ( Fig. 11) is caused.

[0106] At step 915, the oversized biopsy forceps can be extended from the endoscope to grasp the target tissue. With the distal end of the working channel open, the tissue sampling device can be extended from the endoscope to bypass the obstruction. In some examples, the tissue sampling device can bypass the obstruction by moving below or beneath it from a recess created in the wall of the working channel by shifting the movable wall of the working channel.

[0107] In step 916, the movable working channel walls of this disclosure can be closed to support the oversized biopsy forceps. Once the functional part of the tissue sampling device, e.g., the tissue sampling device 204, has exited the endoscope, the movable working channel wall can be closed or advanced to support the shaft of the tissue sampling device. The shaft of the tissue sampling device may be smaller in size, e.g., in height, than the functional part, so that the obstruction within the working channel does not impede the free movement of the shaft, e.g., the shaft 206, allowing the movable working channel wall to be brought closer to the endoscope to support the tissue sampling device. In this way, the tissue sampling device can be advanced into the field of view, or a better field of view, of the imaging or viewing device, e.g., the camera, of the endoscope.Additionally, the movable working channel wall can enable the tissue sampling device to better follow the movements of the endoscope, especially up and down movements.

[0108] In step 918, a tissue sampling device can be pressed, squeezed, or otherwise brought into contact with the target tissue under pressure. For example, the oversized biopsy forceps can be moved axially back and forth or rotated to use the teeth 213 to cut, puncture, scrape, etc., one or more pieces of tissue from the patient's body. The tissue or biological material sample separated or removed from the patient in step 916 can be stored in a space within the tissue sampling device. For example, the surgical instrument 200 can be moved back and forth or rotated, allowing the separated tissue sample to be positioned in the inner pockets of jaws 212A and 212B.

[0109] In step 920, the movable working channel walls of the present disclosure can be opened so that the oversized biopsy forceps can be re-inserted into the endoscope. The movable working channel wall can be moved away from the endoscope or the obstruction within the working channel to reopen the distal end of the working channel so that the tissue sampling device can be pulled proximally to re-enter the endoscope.

[0110] In step 922, the tissue sampling device can be removed from the patient, for example, by removing it from the auxiliary endoscope, which can remain in place in the body. Additionally, the collected tissue sample can be removed from the tissue sampling device for transport to a laboratory for analysis or disposal.

[0111] In procedure 924, the auxiliary endoscope can be removed from the endoscope. For example, the auxiliary endoscope 134 ( Fig. 5) from the endoscope 14 ( Fig. 1) be pulled out.

[0112] At step 926, the endoscope can be removed from the patient. For example, the endoscope can be 100 ( Fig. 5) from the duodenum D. The patient can then be closed up accordingly or prepared for the completion of the procedure.

[0113] As such, the method illustrates 900 examples of a method for collecting biological material from the internal body cavities of a patient in sufficiently large quantities, for example using an oversized forceps of the present disclosure in conjunction with an endoscope having a shortened working channel and a two-stage imaging channel using a movable working channel wall. Examples Example 1 is an endoscope comprising: an elongated shaft comprising: a distal end section comprising: a distal end face located at the distal end of the elongated shaft; and a recessed end face located proximal to the distal end face; a working channel extending at least partially through the elongated shaft to the recessed end face; an imaging device located in the distal end section near the distal end face; and an extension wall for the working channel extending from the recessed end face, the extension wall being movable between a closed position and an open position. In Example 2, the object of Example 1 optionally includes the extension wall having an arc-shaped form to adapt to a curvature of the elongated shaft. In Example 3, the object of one or more of Examples 1-2 optionally includes an actuator to move the extension wall between the closed position and the open position. In Example 4, the subject matter of Example 3 optionally includes that the actuating device comprises a pull wire connected to the extension wall and extending at least partially through the working channel. In Example 5, the subject matter of one or more of Examples 3-4 optionally includes that the actuating device comprises a control wire extending within a wall of the elongated shaft, the control wire being configured to cause a deflection of the elongated shaft. In Example 6, the subject of one or more of Examples 1 to 5 optionally includes that the extension wall comprises a pivotable plate connected to the elongated shaft near the recessed end face. In Example 7, the object of Example 6 optionally includes an elastic element designed to pull the extension wall into the closed position. In Example 8, the subject of Example 7 optionally includes the swiveling plate being connected to the long shaft via a flexible hinge. In Example 9, the object of one or more of Examples 6 to 8 optionally comprises a split ring arranged around the elongated shaft on the extension wall, configured to enable the opening of the pivot plate and subsequently to return the pivot plate to the closed position. In Example 10, the subject of one or more of Examples 1 to 9 optionally includes that the extension wall comprises a sliding plate which is configured to extend beyond the recessed end face and to be retracted towards it. In Example 11, the subject of Example 10 optionally includes the sliding plate being attached to the elongated shaft via a rail system or clamps. In Example 12, the subject of one or more of Examples 10-11 optionally includes that the sliding plate is configured to retract into the elongated shaft in order to be located within an outer circumference of the elongated shaft. In Example 13, the object of one or more of Examples 10 to 12 optionally includes a catching device connected to the sliding plate so that an instrument guided through the working channel can actuate the actuator of the sliding plate. In Example 14, the subject of one or more of Examples 1 to 13 optionally includes that the extension wall has a beveled distal section, wherein the beveled distal section is angled relative to an axis of the elongated shaft to form a path with a cross-sectional area increasing in the distal direction. In Example 15, the subject of one or more of Examples 1 to 14 optionally includes a prestressing element to prestress the extension wall either into the closed position or into the open position. In Example 16, the subject of Example 15 optionally includes the preload element comprising a spring. In Example 17, the subject of one or more of Examples 1 to 16 optionally comprises an imaging channel extending through the elongated shaft and a lumen for an imaging sensor extending from the imaging channel to the distal end face, wherein the imaging device is positioned within the lumen for the imaging sensor and the lumen for the imaging sensor has a larger cross-sectional area than the imaging channel. Example 18 is a method for obtaining biological material using a biopsy device extending from an endoscope, comprising the procedure of: inserting the endoscope into the body of a patient; extending the biopsy device into a working channel of the endoscope so that it extends from the endoscope; adjusting a movable working channel wall of the endoscope to support the biopsy device; and obtaining biological material from the body using the biopsy device. In Example 19, the subject of Example 18 optionally includes the insertion of the biopsy device into the working channel of the endoscope to extend from the endoscope, which includes opening the movable working channel wall to increase the size of an outlet from the working channel. In Example 20, the subject of Example 19 optionally includes the working channel of the endoscope having a recessed surface located proximal to a distal end surface of the endoscope. In Example 21, the subject of Example 20 optionally includes the endoscope having an imaging channel with a lumen of the imaging device that shortens the working channel in a radial direction distal to the recessed surface. In Example 22, the subject of Example 21 optionally includes that opening the movable working channel wall involves retracting a movable working channel wall towards the endoscope. In Example 23, the subject of Example 22 optionally includes the fact that retracting the movable working channel wall towards the endoscope further includes overcoming a preload force. In Example 24, the subject matter of one or more of Examples 21 to 23 optionally includes that opening the movable working channel wall involves rotating a pivotable working channel wall away from the endoscope. In Example 25, the subject of Example 24 optionally includes the turning of the swiveling working channel wall away from the endoscope and the overcoming of a preload force. In Example 26, the subject of one or more of Examples 20 to 25 optionally includes the insertion of the endoscope into the patient's anatomy involving the closing of the movable working channel wall to minimize the size of a distal tip of the endoscope. In Example 27, the subject of Example 26 optionally includes minimizing the size of the distal tip of the endoscope by moving a movable working channel wall in a proximal direction to open the working channel exit. In Example 28, the subject matter of one or more of Examples 26-27 optionally includes adjusting the movable working channel wall of the endoscope to hold the biopsy device and operating an actuator to extend the movable working channel wall. In Example 29, the subject of Example 28 optionally includes the actuation of the actuator to extend the movable working channel wall, which involves overcoming a preload force that preloads the movable working channel wall into a closed position. In Example 30, the subject matter of one or more of Examples 18 to 29 optionally includes the adjustment of the movable working channel wall from the endoscope to hold the biopsy device, comprising the actuation of a pull wire to adjust the movable working channel wall. In Example 31, the subject matter of one or more of Examples 18 to 30 optionally includes that adjusting the movable working channel wall from the endoscope to hold the biopsy device includes actuating a control wire to adjust the movable working channel wall. In Example 32, the subject of one or more of Examples 19 to 31 optionally includes moving a movable working channel wall away from the endoscope to open the working channel exit and retracting the biopsy device into the working channel. Example 33 is an endoscope comprising: an elongated shaft comprising: a distal end section with a distal end face located at the distal end of the elongated shaft; a working channel extending through the elongated shaft to the distal end section; a movable wall configured to expose a portion of the working channel proximal to the distal end face; an image channel extending through the elongated shaft to the distal end section; and a lumen for an imaging device extending from the image channel to the distal end face, the lumen for the imaging device being larger than the image channel; an imaging device located in the lumen for the imaging device; and an imaging cable extending from the imaging device through the image channel. In Example 34, the subject of Example 33 optionally includes that the distal end section further comprises: a recessed end face located proximal to the distal end face; wherein the working channel extends to the recessed end face. In Example 35, the subject of Example 34 optionally includes a distance between the recessed end face and a rear section of the lumen of the imaging device that is at least as long as the height of the working channel. In Example 36, the subject of one or more of Examples 34-35 optionally includes that the movable wall comprises an extension wall for the working channel extending from the recessed end face, the extension wall being movable between an open position and a closed position. In Example 37, the subject of Example 36 optionally includes a distance between the recessed end face and a rear section of the lumen of the imaging device that is longer than a height between the extension wall and the lumen of the imaging device. In Example 38, the subject of one or more of Examples 36-37 optionally includes that the extension wall includes an arched swing door. In Example 39, the subject of one or more of Examples 36-38 optionally includes that the extension wall includes an arched sliding door. In Example 40, the subject of one or more of Examples 36-39 optionally comprises a biopsy forceps configured to move through the working channel, the height of the biopsy forceps being greater than the radial distance between the extension wall and the lumen of the imaging device. In Example 41, the subject of one or more of Examples 34-40 optionally includes that the recessed end face is located proximal to the lumen of the imaging device. In Example 42, the subject of one or more of Examples 34-41 optionally includes that the axial distance between the recessed end face and the distal end face is greater than the axial length of the lumen of the imaging device.

[0114] Each of these non-restrictive examples can stand alone or be combined in various permutations or combinations with one or more of the other examples. Notes

[0115] The foregoing detailed description contains references to the accompanying drawings, which form part of the detailed description. The drawings illustrate specific embodiments in which the invention can be practiced. These embodiments are also referred to herein as "examples." Such examples may include additional elements beyond those shown or described. However, the present inventor also considers examples in which only the elements shown or described are provided. Furthermore, the present inventor also considers examples that use any combination or permutation of the elements shown or described (or one or more aspects thereof), either in relation to a particular example (or one or more aspects thereof) or in relation to other examples shown or described herein (or one or more aspects thereof).

[0116] In case of discrepancies between this document and the documents referenced herein, the version used in this document shall prevail.

[0117] In this document, the terms "a" or "an" are used, as is customary in patent documents, to include one or more instances, irrespective of other instances or uses of "at least one" or "one or more". In this document, the term "or" is used to indicate a non-exclusive combination, so that "A or B" includes "A but not B", "B but not A", and "A and B", unless otherwise indicated. In this document, the terms "including" and "in which" are used as simple linguistic equivalents of the respective terms "comprising" and "in which". Furthermore, in the following claims, the terms "including" and "comprising" are open, i.e.,A system, device, article, composition, formulation, or method that includes further elements in addition to those listed in a claim following such term remains within the scope of that claim. Furthermore, in the following claims, the terms "first," "second," and "third," etc., are used merely as designations and are not intended to impose any numerical requirements on their objects.

[0118] The above description is for illustrative purposes only and is not limiting. For example, the examples described above (or one or more aspects thereof) may be used in combination. Other embodiments may also be used, for example, by a person skilled in the art after reviewing the above description. The summary is provided in accordance with 37 CFR §1.72(b) to enable the reader to quickly identify the nature of the technical disclosure. It is presented with the understanding that it is not to be used for the interpretation or limitation of the scope or meaning of the claims. Furthermore, various features may be summarized in the above detailed description to streamline the disclosure. This should not be interpreted as making an unclaimed disclosed feature essential to a claim.Rather, the inventive subject matter may consist of fewer than all features of a particular disclosed embodiment. Therefore, the following claims are hereby included in the detailed description as examples or embodiments, each claim constituting a separate embodiment, and it is intended that such embodiments may be combined with one another in various combinations or permutations. The scope of the invention should be determined with reference to the appended claims and the full scope of the equivalents to which these claims belong. QUOTES INCLUDED IN THE DESCRIPTION

[0000] This list of documents cited by the applicant was automatically generated and is included solely for the reader's convenience. The list is not part of the German patent or utility model application. The DPMA accepts no liability for any errors or omissions. Cited patent literature

[0000] US 63 / 513,661

[0001] JP 2016140574A

[0006] JP 2017006313A

[0006] WO 2011 / 140118 A1

[0026]

Claims

[1] An endoscope that includes: an elongated shaft that includes: a distal end section that includes: a distal frontal surface located at the distal end of the elongated shaft; and a recessed frontal surface located proximal to the distal frontal surface; a working channel that extends at least partially through the elongated shaft to the recessed end face; an imaging device located in the distal end section near the distal frontal surface; and an extension wall for the working channel extending from the recessed end face, wherein the extension wall is movable between a closed position and an open position. [2] The endoscope according to claim 1, wherein the extension wall has an arc-shaped form corresponding to the curvature of the elongated shaft. [3] The endoscope according to claim 1, further comprising an actuating device to move the extension wall between the closed position and the open position. [4] Endoscope according to claim 3, wherein the actuating device comprises a pull wire which is connected to the extension wall and extends at least partially through the working channel. [5] The endoscope according to claim 3, wherein the actuating device comprises a control wire extending within a wall of the elongated shaft, wherein the control wire is configured to cause a deflection of the elongated shaft. [6] The endoscope according to claim 1, wherein the extension wall comprises a pivotable plate which is connected to the elongated shaft near the recessed end face. [7] The endoscope according to claim 6, further comprising an elastic element configured to pull the extension wall into the closed position. [8] Endoscope according to claim 7, wherein the pivoting plate is connected to the elongated shaft via a flexible hinge. [9] The endoscope according to claim 6, further comprising a split ring arranged around the elongated shaft on the extension wall, wherein the split ring is configured to open the pivoting plate and then return the pivoting plate to the closed position. [10] The endoscope according to claim 1, wherein the extension wall comprises a sliding plate which is configured to extend beyond the recessed end face and to retract towards it. [11] Endoscope according to claim 10, wherein the sliding plate is attached to the elongated shaft via a rail system or clamps. [12] Endoscope according to claim 10, wherein the sliding plate is configured to retract into the elongated shaft in order to be located within an outer circumference of the elongated shaft. [13] The endoscope according to claim 10, which further comprises a capture device connected to the sliding plate so that an instrument passing through the working channel can actuate the sliding plate. [14] The endoscope according to claim 1, wherein the extension wall comprises a beveled distal section, wherein the beveled distal section is angled relative to an axis of the elongated shaft to form a path with a cross-sectional area increasing in the distal direction. [15] The endoscope according to claim 1, which further comprises a pre-tensioning element to pre-tension the extension wall either into the closed position or into the open position. [16] Endoscope according to claim 15, wherein the preload element comprises a spring. [17] The endoscope according to claim 1, further comprising: an imaging channel extending through the elongated shaft; and an imaging sensor lumen extending from the imaging channel to the distal end face; wherein the imaging device is positioned within the imaging sensor lumen and the imaging sensor lumen has a larger cross-sectional area than the imaging channel. [18] Method for obtaining biological material using a biopsy device extending from an endoscope, the method comprising: Inserting the endoscope into a patient's body; Extending the biopsy device into a working channel of the endoscope so that it extends from the endoscope; Adjusting a movable working channel wall of the endoscope to support the biopsy device; and Taking biological material from the body using the biopsy device. [19] Method according to claim 18, wherein the insertion of the biopsy device into the working channel of the endoscope to extend from the endoscope comprises opening the movable working channel wall to enlarge the size of an outlet from the working channel. [20] Method according to claim 19, wherein the working channel of the endoscope has a recessed surface arranged proximal to a distal end surface of the endoscope. [21] Method according to claim 20, wherein the endoscope has an imaging channel with an imaging device that shortens the working channel in a radial direction distal to the recessed surface. [22] Method according to claim 21, wherein opening the movable working channel wall comprises retracting a movable working channel wall towards the endoscope. [23] Method according to claim 22, wherein the retraction of the movable working channel wall towards the endoscope further comprises overcoming a preload force. [24] Method according to claim 21, wherein opening the movable working channel wall comprises rotating a pivotable working channel wall away from the endoscope. [25] Method according to claim 24, wherein rotating the pivotable working channel wall away from the endoscope further comprises overcoming a preload force. [26] Method according to claim 20, wherein the insertion of the endoscope into the patient's anatomy comprises closing the movable working channel wall to minimize the size of a distal tip of the endoscope. [27] Method according to claim 26, wherein minimizing the size of the distal tip of the endoscope comprises moving a movable working channel wall in a proximal direction to open the exit of the working channel. [28] Method according to claim 26, wherein adjusting the movable working channel wall of the endoscope to hold the biopsy device comprises actuating an actuator to extend the movable working channel wall. [29] Method according to claim 28, wherein actuating the actuator to extend the movable working channel wall comprises overcoming a preload force which preloads the movable working channel wall into a closed position. [30] Method according to claim 18, wherein adjusting the movable working channel wall from the endoscope to hold the biopsy device comprises actuating a pull wire to adjust the movable working channel wall. [31] Method according to claim 18, wherein adjusting the movable working channel wall from the endoscope to hold the biopsy device comprises actuating a control wire to adjust the movable working channel wall. [32] The method of claim 19, further comprising: Adjusting a movable working channel wall from the endoscope to open the working channel exit; and Withdraw the biopsy device into the working channel. [33] An endoscope that includes: an elongated shaft that includes: a distal end section with a distal end surface located at the distal end of the elongated shaft; a working channel extending through the working shaft to the distal end section; a movable wall designed to expose a section of the working channel proximal to the distal end face; an imaging channel extending through the elongated shaft to the distal end; and a lumen for an imaging device extending from the imaging channel to the distal end face, wherein the lumen for the imaging device is larger than the imaging channel; an imaging device located in the lumen for the imaging device; and an imaging cable that extends from the imaging device through the imaging channel. [34] Endoscope according to claim 33, wherein the distal end section further comprises: a recessed frontal surface that is positioned proximal to the distal frontal surface; the working channel extends to the recessed front face. [35] Endoscope according to claim 34, wherein the distance between the recessed end face and a rear section of the lumen of the imaging device is at least as large as the height of the working channel. [36] Endoscope according to claim 34, wherein the movable wall comprises an extension wall for the working channel extending from the recessed end face, wherein the extension wall is movable between an open position and a closed position. [37] The endoscope according to claim 36, wherein a distance between the recessed end face and a rear section of the lumen of the imaging device is greater than a height between the extension wall and the lumen of the imaging device. [38] The endoscope according to claim 36, wherein the extension wall comprises an arc-shaped pivot door. [39] The endoscope according to claim 36, wherein the extension wall comprises an arc-shaped sliding door. [40] The endoscope according to claim 36, further comprising a biopsy forceps configured to move through the working channel, wherein the height of the biopsy forceps is greater than the radial distance between the extension wall and the lumen of the imaging device. [41] Endoscope according to claim 34, wherein the recessed end face is located proximal to the lumen of the imaging device. [42] The endoscope according to claim 34, wherein an axial distance between the recessed end face and the distal end face is greater than an axial length of the lumen of the imaging device.

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