Steering handle with multi-channel manifold

Abstract

To provide a steering handle with a manifold that enables an operator to configure an endoscopic system in situ for a variety of tasks, including irrigation, aspiration, or both.SOLUTION: The disclosed endoscopic system facilitates rapid reconfiguration of the location of a laser fiber optic within a catheter assembly. For example, the laser fiber optic can be removed from an irrigation channel of the endoscopic system and reinserted in an aspiration channel during a laser lithotripsy procedure. In some embodiments, the removal and reinsertion can be performed in situ, without removing the catheter from a patient or an organ to be treated. These aspects of the disclosed system reduce the time required to perform laser lithotripsy procedures, with less trauma for the patient.SELECTED DRAWING: Figure 10

Description

[Technical field]

[0001] Related Applications This application claims the benefit of U.S. Provisional Patent Application No. 62 / 794,328, filed January 18, 2019, and U.S. Provisional Patent Application No. 62 / 868,271, filed June 28, 2019. The disclosures of these provisional patent applications are incorporated herein by reference in their entireties.

[0002] The present disclosure relates generally to a steering handle for a flexible catheter, and more particularly to a steering handle for a laser lithotripsy ureteroscope having a multi-channel manifold. [Background technology]

[0003] Kidney stones affect 1 in 500 Americans each year, causing significant pain and increasing healthcare costs. Surgical options for patients with symptomatic kidney stones include extracorporeal shock wave lithotripsy (ESWL), ureteroscopy, and percutaneous nephrolithotripsy (PCNL). Human renal anatomy, stone composition, and body habitus all play a major role in determining outcome and surgical approach.

[0004] During the past decade, the role of ureteroscopy has improved with smaller diameter flexible catheter shafts, improved steering and bending capabilities, video imaging, smaller baskets and instruments, and advances in lithotripsy (stone destruction) techniques with the advent of Holmium (Ho):YAG, Thulium (Tm):YAG, and Thulium fiber lasers. Currently, over 45% of kidney stone surgical procedures are performed with the use of miniature ureteroscopic techniques and lasers.

[0005] Ureteroscopy involves the use of a small flexible or rigid device called a ureteroscope to directly view and treat the stone. This ureteroscope device, which has a small "working" channel capable of video imaging, is inserted into the bladder and up the ureter until it encounters the stone. The stone can then be destroyed with laser energy transmitted to the target site via optical fiber, or extracted using a small basket inserted into the working channel.

[0006] The advantage of this type of surgery is that no incision is required as a body orifice is used for access.

[0007] Ureteroscopy is often a good option for small stones in the ureter or kidney. The success rate of ureteroscopy in removing these types of stones is generally higher than that of shock wave lithotripsy. However, compared to shock wave lithotripsy, ureteroscopy is sometimes associated with greater postoperative discomfort. Summary of the Invention [Problem to be solved by the invention]

[0008] The discomfort associated with laser lithotripsy correlates with the time the ureteroscope remains inside the patient. A laser endoscopy system that allows for a reduction in procedure time would be desirable. [Means for solving the problem]

[0009] Various embodiments of the present disclosure include a steering handle with a manifold that allows an operator to configure the endoscopic system in situ for various tasks, including irrigation, aspiration, or both. Additionally, the disclosed endoscopic system facilitates rapid repositioning of the laser optical fiber within the catheter assembly. That is, for example, the laser optical fiber can be removed from the irrigation channel and reinserted into the aspiration channel of the endoscopic system during a laser lithotripsy procedure. In some embodiments, this removal and reinsertion can be performed in situ without removing the catheter from the patient or the organ being treated. In some embodiments, multiple working devices can be used simultaneously through multiple working channels. These aspects of the presently disclosed system reduce the time required to perform a laser lithotripsy procedure and are less traumatic to the patient.

[0010] In some embodiments, the manifold may be configured to divert irrigation from a first or primary working channel to a second or secondary working channel. Similarly, some embodiments allow for suction to be diverted from one working channel to the other. Additionally, some embodiments allow for both working channels to be configured for either an "irrigation only" or "suction only" mode of operation. The ability to reconfigure the endoscopic surgical system in these manners allows the operator to make flow and / or suction adjustments in the field. For example, if a working device is disposed in a working channel used for irrigation, the working device may obstruct the working channel to a location where irrigation is insufficient. The ability to divert irrigation from an occupied working channel to an unoccupied working channel (or to irrigate using both working channels) may allow the operator to "tune" irrigation to suction, e.g., temporarily, to improve poor conduit for irrigation. Similarly, if a working device is disposed within a working channel used for suction and obstructs the working channel to a point where suction is insufficient, some embodiments may allow suction to be adjusted relative to irrigation by configuring the manifold in an "suction only" configuration. The ability to maintain balanced irrigation and aspiration flows over time increases the stone-free rate of endoscopic procedures (i.e., the probability that there will be no residual stones in the patient at a certain benchmark time point post-procedure).

[0011] The above aspects are realized in a compact manifold that may be disposed within a catheter steering handle, and thus may literally be used in the palm of an operator's hand. The disclosed system thus provides a quick and easily implemented remedy to an unfolding situation, which may be performed voluntarily by the operator, without the need for time-consuming reconfiguration of irrigation and / or suction source connections while the catheter is left in place.

[0012] Structurally, various embodiments of the present disclosure illustrate and describe an endoscopic surgical system comprising a catheter shaft defining a central axis extending from a proximal end portion through a distal end portion of the catheter shaft, the catheter shaft comprising a main working channel extending parallel to the central axis and a secondary working channel extending parallel to the central axis, and a steering handle comprising a manifold, the manifold comprising a main working channel output port in fluid communication with the main working channel and a secondary working channel output port in fluid communication with the secondary working channel, the manifold configured to receive optical fibers for selective routing through the main working channel via the main working channel output port and through the secondary working channel via the secondary working channel output port. In some embodiments, the manifold comprises a main working channel input port for passing the optical fiber into the main working channel via the main working channel output port. The manifold may also comprise a second optical fiber input port for passing the optical fiber into the secondary working channel via the secondary working channel output port. In some embodiments, the catheter shaft is flexible. The laser optical fiber may be pre-installed at the factory. In some embodiments, one of the main working channel and the secondary working channel permanently houses the laser optical fiber. The optical fiber may be disposed in one of the main working channel and the secondary working channel via a manifold. In some embodiments, a laser system is operably coupled to the optical fiber. The laser system may be an ablation laser system and may comprise one of a Holmium:YAG laser, a Thulium fiber laser, a Thulium:YLF laser, and a Thulium:YAG laser.

[0013] In some embodiments, the manifold comprises an irrigation force port and a suction input port, and the manifold is configured to selectively isolate the secondary working channel from the irrigation force port and the suction input port. The manifold may be configured to selectively isolate the main working channel from the irrigation force port. The endoscopic surgical instrument may also comprise an irrigation source in fluid communication with the irrigation force port and a suction source in fluid communication with the suction input port.

[0014] In various embodiments of the present disclosure, an endoscopic surgical instrument is disclosed that includes a steering handle with a housing that receives a manifold, the manifold including an irrigation force port, an auxiliary working channel input port, a main working channel input port, a main working channel output port, and an auxiliary working channel output port, the manifold including one or more valves for selectively isolating the irrigation force port from the main working channel output port and the auxiliary working channel output port. In some embodiments, the manifold includes a plurality of valves for selectively establishing fluid communication between the irrigation force port and the main working channel output port, and between the irrigation force port and the auxiliary working channel output port. In some embodiments, the plurality of valves are configurable to selectively establish fluid communication between the main working channel input port and the main working channel output port, and between the auxiliary working channel input port and the auxiliary working channel output port. In some embodiments, the irrigation force port is selectively isolated from the main working channel output port by a first one of the plurality of valves, and the irrigation force port is selectively isolated from the auxiliary working channel output port by a second one of the plurality of valves.

[0015] In some embodiments, the main working channel circuit includes a main working channel input port and a main working channel output port, the main working channel circuit configured to pass an optical fiber therethrough. The main working channel circuit may include a third of the plurality of valves to selectively block the main working channel input port from the main working channel output port. In some embodiments, the main working channel circuit includes a compression fitting proximal to the main working channel input port. In some embodiments, the secondary working channel circuit includes a secondary working channel input port and a secondary working channel output port, the secondary working channel circuit configured to pass a working device therethrough. The secondary working channel circuit may be configured to pass any one of an optical fiber, a basket, a guidewire, and a biopsy forceps as a working device. In some embodiments, the secondary working channel circuit includes a third of the plurality of valves to selectively block the secondary working channel input port from the secondary working channel output port. The secondary working channel circuit may include a compression fitting proximal to the secondary working channel input port, such as a TUOHY BORST adaptor. In some embodiments, the manifold comprises a suction input port, and the secondary working channel input port and the suction input port are selectively blocked from the secondary working channel output port by a third of the plurality of valves.

[0016] In some embodiments, the first one of the plurality of valves, the second one of the plurality of valves, and the third one of the plurality of valves are multi-position valves coupled to and selectively positioned by the multi-position switch. The multi-position switch may include a stem, the stem rotating about a stem axis and coupling the multi-position valves to the multi-position switch, each of the multi-position valves being rotatable about the stem axis. In some embodiments, the multi-position switch is a three-position switch and the multi-position valves are three-position valves.

[0017] The manifold may include a suction input port in fluid communication with the secondary working channel output port, and a fourth of the plurality of valves selectively isolates the suction input port from the secondary working channel output port, hi some embodiments, each of the plurality of valves includes a stem and a manual actuator extending through the housing.

[0018] In some embodiments of the present disclosure, a flexible catheter shaft includes a proximal end portion and a distal end portion and defines a central axis extending from the proximal end portion to the distal end portion. The flexible catheter shaft defines a main working channel extending parallel to the central axis and a secondary working channel extending parallel to the central axis, the secondary working channel output port of the manifold is in fluid communication with the secondary working channel and the main working channel output port of the manifold is in fluid communication with the main working channel. The main working channel may extend through a distal face of the distal end portion of the flexible catheter shaft.

[0019] Various embodiments of the present disclosure provide a method for changing the position of a laser optical fiber located at a distal end of a catheter. The method includes providing a steering handle operably coupled to a flexible catheter and providing instructions for use on a tangible non-transitory medium. The instructions include removing the laser optical fiber from a first fluid circuit of the steering handle and the flexible catheter, the first fluid circuit extending through the distal end of the flexible catheter, and inserting the laser optical fiber into a second fluid circuit of the steering handle and the flexible catheter, the second fluid circuit extending through the distal end of the flexible catheter. The first fluid circuit is separate and distinct from the second fluid circuit. In some embodiments, the instructions include uncoupling the laser optical fiber from a first compression fitting of the first fluid circuit prior to the removing step, and sealing the fiber laser in a second compression fitting of the second fluid circuit after the inserting step. The instructions may also include placing a distal end of the flexible catheter in the body organ prior to the removing and inserting steps, and leaving the distal end of the flexible catheter in the body organ during the removing and inserting steps. In some embodiments, isolating one or both of the first and second fluid circuits from an irrigation source after the placing step and prior to the removing and inserting steps. The instructions may also include isolating one or both of the first and second fluid circuits from a suction source after the placing step and prior to the removing and inserting steps. The body organ may be one of the bladder, ureter, and kidney.

[0020] In various embodiments of the present disclosure, a method for changing a flow direction through at least one lumen of a catheter includes providing a steering handle having a manifold attached thereto, the manifold being operatively coupled to the catheter, and providing instructions for use on a tangible, non-transitory medium, the instructions including isolating a first lumen of the catheter from one of an aspiration source and an irrigation source by closing a first valve of the manifold, the first valve being accessible on the steering handle, and fluidly connecting the first lumen of the catheter to the other of the aspiration source and the irrigation source by opening a second valve of the manifold, the second valve being accessible on the steering handle. In some embodiments, opening the second valve isolates the irrigation source from the second lumen of the catheter. In some embodiments, the first valve and the second valve are actuated using a single changeover switch accessible on the steering handle.

[0021] The instructions may further include removing the working device from the first lumen through a working device input port of the manifold, the working device input port being in fluid communication with the first lumen and accessible on the steering handle. The instructions may include sealing the working device input port after removing the working device from the first lumen. In some embodiments, the instructions include blocking the working device input port from the first lumen with a third valve of the manifold, the third valve being accessible on the steering handle.

[0022] In some embodiments, the instructions include fluidly connecting the first lumen and a working device input port of the manifold with a third valve of the manifold, the third valve being accessible on the steering handle. The instructions may include inserting a working device into the first lumen with the working device input port, the working device input port being in fluid communication with the first lumen and accessible on the steering handle. In some embodiments, the instructions include sealing the working device input port around the working device after inserting the working device into the first lumen. The instructions may include coupling a suction source to a working channel input port of the manifold of the steering handle, the working channel input port being in fluid communication with the first channel.

[0023] In various embodiments of the present disclosure, a method for selectively increasing irrigation flow through a catheter includes providing a steering handle having a manifold attached thereto, the manifold being operably coupled to the catheter, and providing instructions for use on a tangible, non-transitory medium, the instructions including coupling an irrigation source to an irrigation port on the manifold, the irrigation port being accessible on the steering handle, establishing irrigation flow from the irrigation source through the irrigation port and through a first lumen of the catheter, and opening a valve on the manifold to establish fluid communication between a second lumen of the catheter and the irrigation port, the second valve being accessible on the steering handle. [Brief description of the drawings]

[0024] [Figure 1] 1 is a schematic diagram of an endoscopic system according to one embodiment of the present disclosure. [Diagram 2] FIG. 1 is a schematic diagram of a first manifold having a "W" shape operably coupled to an external system and a catheter according to an embodiment of the present disclosure. [Diagram 3] FIG. 13 is a schematic diagram of a second manifold operably coupled to an external system and a catheter according to an embodiment of the present disclosure. [Figure 4] FIG. 13 is a schematic diagram of a third manifold operably coupled to an external system and a catheter according to an embodiment of the present disclosure. [Diagram 5] FIG. 5 is a schematic diagram of one configuration of three-position valving of the third manifold of FIG. 4 in accordance with one embodiment of the present disclosure. [Figure 6] FIG. 5 is a schematic diagram of one configuration of three-position valving of the third manifold of FIG. 4 in accordance with one embodiment of the present disclosure. [Figure 7] FIG. 13 is a schematic diagram of a fourth manifold operably coupled to an external system and a catheter according to an embodiment of the present disclosure. [Figure 8] FIG. 11 is a schematic diagram of a fifth manifold operably coupled to an external system and a catheter according to an embodiment of the present disclosure. [Figure 9A] 1 is a flow diagram of a method for repositioning a working device within a catheter of an endoscopic system according to one embodiment of the present disclosure. [Figure 9B] 1 is a flow diagram of a method for reversing flow in a catheter of an endoscopic system according to an embodiment of the present disclosure. [Figure 9C] 1 is a flow diagram of a method for selectively increasing irrigation flow through a catheter of an endoscopic system according to one embodiment of the present disclosure. [Figure 10] FIG. 3 is a perspective view of a first steering handle with a first manifold of the schematic diagram of FIG. 2 according to one embodiment of the present disclosure. [Figure 11] FIG. 4 is a perspective view of a second steering handle with a second manifold of the schematic diagram of FIG. 3 according to one embodiment of the present disclosure. [Figure 12] FIG. 5 is a perspective view of a third steering handle including the third manifold of the schematic diagram of FIG. 4 according to one embodiment of the present disclosure. [Figure 13] FIG. 8 is a perspective view of a fourth steering wheel including the fourth manifold of the schematic diagram of FIG. 7 according to one embodiment of the present disclosure. [Figure 14] FIG. 9 is a perspective view of a fifth steering wheel including the fifth manifold of the schematic diagram of FIG. 8 according to one embodiment of the present disclosure. [Figure 15] 11 is a partial side view of the housing of FIG. 10 with the actuated valve in an open configuration according to one embodiment of the present disclosure. [Figure 15A] FIG. 1 is a perspective view of a standalone two-position valve actuator with a lever actuator according to one embodiment of the present disclosure. [Figure 15B] 15B is a cross-sectional view of the two-position valve actuator of FIG. 15A in a first rotational orientation within a housing according to one embodiment of the present disclosure. [Figure 15C] 15B is a cross-sectional view of the two-position valve actuator of FIG. 15A in a second rotational orientation within a housing according to one embodiment of the present disclosure. [Figure 16] 11 is a partial side view of the housing of FIG. 10 with the actuated valve in a closed configuration according to one embodiment of the present disclosure. [Figure 17] 11 is a partial side view of the housing of FIG. 10 with an alternative actuated valve in an open configuration according to an embodiment of the present disclosure. [Figure 18] 11 is a partial side view of the housing of FIG. 10 with an alternative actuated valve in a closed configuration according to an embodiment of the present disclosure. [Figure 19] FIG. 2 is a perspective view of a changeover switch actuator according to one embodiment of the present disclosure; [Figure 19A] FIG. 20 is a partial perspective view of the changeover switch of FIG. 19 in an assembly in a manifold according to one embodiment of the present disclosure. [Figure 20A] FIG. 14 is a partial elevational view of the steering wheel of FIG. 13 with a changeover switch in a first position according to one embodiment of the present disclosure. [Figure 20B] FIG. 20B is a partial view of the changeover switch of FIG. 20A in a first position with the housing removed according to an embodiment of the present disclosure. [Figure 20C] FIG. 20B is a schematic cross-sectional view of the three-position valve of FIG. 20A in a first position according to one embodiment of the present disclosure. [Figure 21A]14 is a partial elevational view of the steering wheel of FIG. 13 with the changeover switch in a second position according to one embodiment of the present disclosure. [Figure 21B] FIG. 21B is a partial view of the changeover switch of FIG. 21A in a second position with the housing removed according to an embodiment of the present disclosure. [Figure 21C] 21B is a schematic cross-sectional view of the three-position valve of FIG. 21A in the second position of FIG. 20A according to one embodiment of the present disclosure. FIG. [Figure 22A] FIG. 14 is a partial elevational view of the steering wheel of FIG. 13 with the changeover switch in a third position according to one embodiment of the present disclosure. [Figure 22B] FIG. 22B is a partial view of the changeover switch of FIG. 22A in a second position with the housing removed according to an embodiment of the present disclosure. [Figure 22C] 22A in a third position according to an embodiment of the present disclosure. FIG. 21B is a schematic cross-sectional view of the three-position valve of FIG. 22A in a third position according to an embodiment of the present disclosure. [Figure 23] FIG. 3 illustrates a solid model of a conduit of the first manifold of the schematic of FIG. 2 in accordance with one embodiment of the present disclosure. [Figure 24] 24 is an enlarged partial view of the first steering handle of FIG. 10 with the housed conduit of FIG. 23 shown in phantom in accordance with one embodiment of the present disclosure. [Diagram 25] FIG. 3 is an elevational view of a manifold embodying the schematic of FIG. 2 according to one embodiment of the present disclosure. [Figure 26] FIG. 26 is a partial perspective view of the manifold of FIG. 25 mounted to a housing according to one embodiment of the present disclosure. [Figure 27] FIG. 4 illustrates a solid model of the conduits of the manifold of the schematic of FIG. 3 according to one embodiment of the present disclosure. [Figure 28] 28 is an enlarged partial view of the steering wheel of FIG. 11 with the housed conduit of FIG. 27 shown in phantom according to one embodiment of the present disclosure. [Figure 29] FIG. 4 is a perspective view of a manifold embodying the schematic of FIG. 3 according to one embodiment of the present disclosure. [Diagram 30]FIG. 8 is a cross-sectional view of a manifold embodying the schematic of FIG. 7 according to one embodiment of the present disclosure. [Figure 30A] FIG. 31 is an enlarged partial cross-sectional view of the manifold of FIG. 30. [Diagram 31] 31 is an enlarged partial view of the steering wheel of FIG. 13 with the housed conduit of FIG. 30 shown in phantom in accordance with one embodiment of the present disclosure. [Diagram 32] FIG. 8 is a perspective view of a manifold embodying the schematic of FIG. 7 according to one embodiment of the present disclosure. [Diagram 33] FIG. 9 is a perspective view of a manifold embodying the schematic of FIG. 8 with a push / pull actuator according to one embodiment of the present disclosure. [Diagram 34] FIG. 34 is an end view of the manifold of FIG. 33 with the push / pull actuator configured in a first irrigation only configuration according to an embodiment of the present disclosure. [Figure 34A] FIG. 35 is a cross-sectional view taken along plane AA of FIG. 34 according to one embodiment of the present disclosure. [Diagram 35] FIG. 34 is an end view of the manifold of FIG. 33 with the push / pull actuator configured in a second irrigation only configuration according to an embodiment of the present disclosure. [Figure 35A] FIG. 36 is a cross-sectional view taken along plane AA of FIG. 35 according to one embodiment of the present disclosure. [Diagram 36] FIG. 34 is an end view of the manifold of FIG. 33 with the push / pull actuator configured in a suction only configuration in accordance with an embodiment of the present disclosure. [Figure 36A] FIG. 37 is a cross-sectional view taken along plane AA of FIG. 36 according to one embodiment of the present disclosure. [Figure 37] FIG. 34 is an end view of the manifold of FIG. 33 with the push / pull actuator configured in an aspiration+irrigation configuration in accordance with an embodiment of the present disclosure. [Figure 37A] FIG. 38 is a cross-sectional view taken along plane AA of FIG. 37 according to one embodiment of the present disclosure. [Figure 38] FIG. 34 is an end view of the manifold of FIG. 33 with the push / pull actuator configured in a first irrigation only configuration according to an embodiment of the present disclosure. [Figure 38A] FIG. 39 is a cross-sectional view taken along plane AA of FIG. 38 according to one embodiment of the present disclosure. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0025] Referring to FIG. 1, a schematic diagram of an endoscopic system 40 for laser lithotripsy according to one embodiment of the present disclosure is shown. The endoscopic system 40 includes a steering handle 42 coupled to a catheter 44 and various external systems 46. The steering handle 42 includes a manifold 48 configured to couple to at least some of the external systems 46. In some embodiments, the manifold 48 receives various inputs from and / or sends various outputs to an irrigation system 52, a suction or aspiration system 54, and a laser system 56 (e.g., an ablation laser system), which may include, for example, a Holmium:YAG laser source, a Thulium fiber laser source, a Thulium:YLF laser source, or a Thulium:YAG laser source. Other external systems 46 may also be routed through the steering handle 42, but not necessarily through the manifold 48 (e.g., the optical system 62 and imaging system 64 shown). The catheter 44 includes a catheter shaft 66 having a central axis or catheter shaft 68 that extends from a proximal end portion 72 through a distal end portion 74 of the catheter shaft 66. In some embodiments, the catheter 44 includes a distal head portion 76 that is coupled to the distal end portion 74 of the catheter shaft 66. In some embodiments, the catheter 44 and the catheter shaft 66 are flexible (see figures).

[0026] 2, a schematic diagram 80 of an irrigation system 52, an aspiration system 54, a laser system 56, and a manifold 48a operably coupled to a proximal end portion 72 of a catheter shaft 66 and a catheter 44 according to one embodiment of the present disclosure is shown. The manifold is referred to herein generally or collectively by reference numeral 48 and individually or specifically by reference numeral 48 followed by a letter suffix (e.g., "manifold 48a"). The manifold 48a includes a plurality of input ports 92 in fluid communication with a plurality of output ports 94 via a plurality of conduits 90. A plurality of shut-off valves 96 are operably coupled to the plurality of conduits 90 of the manifold 48a. In some embodiments, each of the plurality of shut-off valves 96 is coupled to a respective one of the plurality of conduits 90. The shut-off valves 96 may be "two-position" or binary valves that are either "on" (e.g., allowing flow) or "off" (e.g., blocking or preventing flow). One or more of the input ports 92 may include a compression fitting 98 .

[0027] In some embodiments, the plurality of input ports 92 may comprise a main working channel input port 102, an irrigation force port 104, and a secondary working channel input port 106. The plurality of output ports 94 of the manifold 48a comprises a main working channel output port 122 and a secondary working channel output port 124. The main working channel input port 102 may be operably coupled to the ablation laser system 56. The irrigation force port 104 may be coupled to the irrigation system 52. The secondary working channel input port 106 may be coupled to the aspiration system 54. In some embodiments, the secondary working channel input port 106 corresponds to a working device 148 instead of the aspiration system 54. As used herein, a "working channel" may be configured to accommodate a working tool, such as a laser fiber and basket, or may be configured to accommodate an irrigation flow or an aspiration flow or both, or any combination thereof.

[0028] A plurality of fluid circuits 110 are defined by unique combinations of input ports 92, conduits 90, output ports 94, and catheter lumens 140, and are enabled by opening respective shut-off valves 96. In the case of manifold 48a, the plurality of circuits 110 include a main working channel circuit 112, a first irrigation circuit 114, a secondary working channel circuit 116, and a second irrigation circuit 118. The main working channel circuit 112 is comprised of a main working channel input port 102, a main working channel conduit 90a, a main working channel output port 122, and a main working channel 142, which are selectively connected via shut-off valve 96a. The first irrigation circuit 114 is comprised of an irrigation power port 104, a first irrigation conduit 90b, a main working channel output port 122, and a main working channel 142, which are selectively connected via shut-off valve 96b. The secondary working channel circuit 116 consists of the secondary working channel input port 106, the secondary working channel conduit 90d, the secondary working channel output port 124, and the secondary working channel 144, which are selectively connected via shut-off valve 96d. The second irrigation circuit 118 consists of the irrigation power port 104, the second irrigation conduit 90c, the secondary working channel output port 124, and the secondary working channel 144, which are selectively connected via shut-off valve 96c.

[0029] The multiple fluid circuits 110 and shut-off valves 96 can be manipulated to selectively establish fluid communication between the multiple input ports 92 and the multiple output ports 94. In some embodiments, the multiple shut-off valves 96 are configured to selectively establish fluid communication between the main working channel input port 102 and the main working channel output port 122, between the irrigation force port 104 and the main working channel output port 122, between the irrigation force port 104 and the secondary working channel output port 124, and between the secondary working channel input port 106 and the secondary working channel output port 124.

[0030] In some embodiments, the plurality of conduits 90 comprises four conduits 90a-90d and the plurality of shut-off valves 96 comprises four corresponding shut-off valves 96a-96d. In these embodiments, the main working channel input port 102 is selectively isolated from the main working channel output port 122 by a first shut-off valve 96a of the plurality of shut-off valves 96, the irrigation power port 104 is selectively isolated from the main working channel output port 122 by a second shut-off valve 96b of the plurality of shut-off valves 96, the irrigation power port 104 is selectively isolated from the secondary working channel output port 124 by a third shut-off valve 96c of the plurality of shut-off valves 96, and the secondary working channel input port 106 is selectively isolated from the secondary working channel output port 124 by a fourth shut-off valve 96d of the plurality of shut-off valves 96. Alternatively, a single three-position valve (not shown) may be used in place of the two shut-off valves 96b and 96c, which three-position valve places the irrigation port in fluid communication with either or both of the main working channel output port 122 and the secondary working channel output port 124.

[0031] The catheter 44 includes multiple lumens 140 that extend through the catheter 44 and at least the length of the catheter shaft 66 and are parallel to the central axis 68. The multiple lumens 140 include a primary working channel 142 and a secondary working channel 144, respectively. In some embodiments, the catheter shaft 66 defines the primary working channel 142 and the secondary working channel 144. Each of the primary working channel 142 and the secondary working channel 144 extends through the distal end portion 74 of the catheter shaft 66.

[0032] In some embodiments, the optical fiber input port 102 comprises a first compression fitting 132 in the compression fittings 98 configured to receive a laser optical fiber 150 operably coupled to a laser source of the ablation laser system 56. The first compression fitting 132 may be mounted between the optical fiber input port 102 and the shut-off valve 96a (see drawings). Alternatively, the shut-off valve 96a may be mounted between the optical fiber input port 102 and the first compression fitting 132. In some embodiments, the first compression fitting defines the optical fiber input port 102. One or more of the compression fittings 98 may be TUOHY BORST adapters configured for use with one or more working devices 148. In some embodiments, the secondary working channel input port 106 corresponds to an alternative configuration, where the secondary working channel input port 106 is coupled to either the aspiration system 54 or a second compression fitting 134 in the compression fittings 98. The second compression fitting 134 may be configured with one of a variety of working devices 148, such as a basket, a guidewire, or a biopsy forceps (none shown). The second compression fitting may also be configured to receive an optical fiber 150 (see drawings) as the working device 148.

[0033] In some embodiments, the steering handle 42 and catheter 44 are pre-assembled or factory-installed with the laser optical fiber 150 in place. The factory-installed optical fiber 150 may be removable as disclosed herein or may be permanently installed, with one of the working channels 142, 144 dedicated to housing the laser optical fiber 150.

[0034] Functionally, the steering handle 42 incorporates various external components or systems 46 for control and delivery purposes to the catheter 44. A number of shut-off valves 96 enable the manifold 48a to be configured to selectively shut off the secondary working channel 144 from the irrigation force port 104 and / or the suction input port 106, and enable the manifold 48a to be configured to selectively shut off the primary working channel 142 from the optical fiber input port 102 and / or the irrigation force port 104. The compression fittings 98 enable the passage of the laser optical fiber 150 or other working device 148, while preventing irrigation and / or aspiration liquid from leaking around the working device 148 during operation. This freedom to introduce working devices 148 other than the laser optical fiber 150 allows the endoscopic system 40 to be implemented for uses other than ablation treatments. An embodiment having the option of providing compression fittings 132 and 134 for both the optical fiber input port 102 and the secondary working channel input port 106 allows the laser optical fiber 150 to be selectively configured to access the target zone from either the main working channel 142 or the secondary working channel 144 of the catheter 44.

[0035] In operation, the plurality of shutoff valves 96 may be manipulated to define a plurality of operational configurations, each of which exhibits a unique input / output combination. Example valve combinations for manifold 48a are tabulated in Table 1 and described below.

[0036] In a first configuration of manifold 48a, isolation valves 96a, 96b, and 96c are open, isolation valve 96d is closed, and laser optical fiber 150 is inserted through isolation valve 96a and first compression fitting 132. This first configuration is an "irrigation only" configuration that allows irrigation through both the primary working channel 142 and the secondary working channel 144, with laser optical fiber 150 located within the primary working channel 142.

[0037] [Table 1]

[0038] In a second configuration of manifold 48a, shut-off valves 96b, 96c, and 96d are open, shut-off valve 96a is closed, and optical fiber 150 is threaded through shut-off valve 96d. In this second configuration, aspiration system 54 may be disconnected and second compression fitting 134 may be coupled to the secondary working channel input port 106. The second configuration is also an "irrigation only" configuration, allowing irrigation via both the main working channel 142 and the secondary working channel 144, but with the laser optical fiber 150 located in the secondary working channel 144.

[0039] In a third configuration of manifold 48a, isolation valves 96a, 96b, and 96d are open, isolation valve 96c is closed, and laser optical fiber 150 is inserted through isolation valve 96a and first compression fitting 132. This third configuration is an “irrigation / aspiration” configuration, in which both irrigation and aspiration are enabled for catheter 44, and laser optical fiber 150 is located within main working channel 142.

[0040] In a fourth configuration of manifold 48a, shut-off valves 96a and 96d are open and shut-off valves 96b and 96c are closed. This fourth configuration is an “aspiration only” configuration, in which laser optical fiber 150 is located within main working channel 142.

[0041] In a fifth configuration of manifold 48a, shut-off valves 96b and 96c are closed, while the positions of shut-off valves 96a and 96d are variable and unspecified. This fifth configuration is a "transition" configuration, in which catheter 44 and manifold output port 94 are shut off from irrigation system 52 and aspiration system 54, while fiber optic input port 102 and secondary working channel input port 106 may be opened or closed. As described below in connection with FIG. 7, the transition configuration may be implemented, for example, when switching optical fiber 150 (or other working device 148) from main working channel circuit 112 to secondary working channel circuit 116, or when switching optical fiber 150 (or other working device 148) from secondary working channel circuit 116 to main working channel circuit 112.

[0042] In a sixth configuration of manifold 48a, all of isolation valves 96a-96d are closed and laser optical fiber 150 is retracted. This sixth configuration is a "closed" configuration that completely isolates catheter 44 from irrigation system 52, aspiration system 54, and ablation laser system 56.

[0043] 3, there is shown a schematic diagram 180 of the irrigation system 52, the aspiration system 54, the ablation laser system 56, and the manifold 48b operatively coupled to the proximal end portion 72 of the catheter 44 according to one embodiment of the present disclosure. The manifold 48b includes many of the same components and attributes as the manifold 48a of FIG. 2, which components and attributes are indicated with the same numerical reference characters.

[0044] Additionally, manifold 48b includes a dedicated suction port 182 as one of a plurality of input ports 92. In some embodiments, both secondary working channel input port 106 and suction port 182 access the same conduit 90 (i.e., secondary working channel conduit 90d). Manifold 48b may also include a shutoff valve 96e as one of a plurality of shutoff valves 96. The shutoff valve 96d may be attached between the secondary working channel input port 106 and a second compression fitting 134 (see drawings). Alternatively, the second compression fitting 134 may be attached between the secondary working channel input port 106 and the shutoff valve 96d. In some embodiments, the second compression fitting 134 defines the secondary working channel input port 106.

[0045] In the case of manifold 48b, the plurality of fluid circuits 110 includes an aspiration circuit 184. The aspiration circuit 184 consists of an aspiration port 182, a secondary working channel conduit 90d, a secondary working channel output port 124, and a secondary working channel 144, which are selectively connected via a shut-off valve 96e.

[0046] Functionally, the dedicated suction port 182 allows the working device 148 to access the secondary working channel 144 without compromising suction. As such, the secondary working channel 144 can accommodate the working device 148 (e.g., the laser optical fiber 150) and also act as a suction channel.

[0047] In operation, the plurality of shutoff valves 96 can be manipulated to define a plurality of operational configurations, each of which exhibits a unique input / output combination. Example valve combinations for manifold 48b are tabulated in Table 2 and described below.

[0048] In a first configuration of manifold 48b, isolation valves 96a, 96b, and 96c are open, isolation valves 96d and 96e are closed, and laser optical fiber 150 is inserted through isolation valve 96a and first compression fitting 132. This first configuration is an "irrigation only" configuration that allows irrigation through both the main working channel 142 and the secondary working channel 144, with laser optical fiber 150 located within the main working channel 142.

[0049] In a second configuration of manifold 48b, shut-off valves 96b, 96c, and 96d are open, shut-off valves 96a and 96e are closed, and optical fiber 150 is threaded through shut-off valve 96d and second compression fitting 134. This second configuration is also an "irrigation only" configuration, allowing irrigation through both the primary working channel 142 and the secondary working channel 144, but with the laser optical fiber 150 located in the secondary working channel 144.

[0050] [Table 2]

[0051] In a third configuration of manifold 48b, isolation valves 96a, 96b, and 96e are open, isolation valves 96c and 96d are closed, and laser optical fiber 150 is inserted through isolation valve 96a and first compression fitting 132. This third configuration is an “irrigation / aspiration” configuration, in which both irrigation and aspiration are enabled for catheter 44, and laser optical fiber 150 is located within main working channel 142.

[0052] In a fourth configuration of manifold 48b, isolation valves 96b, 96d, and 96e are open, isolation valves 96a and 96c are closed, and laser optical fiber 150 is inserted through isolation valve 96d and second compression fitting 134. This fourth configuration is also an “irrigation / aspiration” configuration in which both irrigation and aspiration are enabled for catheter 44, but laser optical fiber 150 is located within the secondary working channel 144.

[0053] In a fifth configuration of manifold 48b, shut-off valves 96a and 96e are open and shut-off valves 96b, 96c, and 96d are closed. This fifth configuration is an “aspiration only” configuration, in which laser optical fiber 150 is located within main working channel 142.

[0054] In a sixth configuration of manifold 48b, shut-off valves 96d and 96e are open and shut-off valves 96a, 96b, and 96c are closed. This sixth configuration is an “aspiration only” configuration, in which laser optical fiber 150 is located within secondary working channel 144.

[0055] In a seventh configuration of manifold 48b, isolation valves 96b, 96c, and 96e are closed, while the positions of isolation valves 96a and 96d are variable and unspecified. This seventh configuration is a "transition" configuration, in which catheter 44 and manifold output port 94 are isolated from irrigation system 52 and aspiration system 54, while fiber optic input port 102 and secondary working channel input port 106 may be opened or closed. As described below in connection with FIG. 7, the transition configuration may be implemented, for example, when switching optical fiber 150 (or other working device 148) from main working channel circuit 112 to secondary working channel circuit 116, or when switching optical fiber 150 (or other working device 148) from secondary working channel circuit 116 to main working channel circuit 112.

[0056] In an eighth configuration of manifold 48b, all of isolation valves 96a-96e are closed and laser optical fiber 150 is retracted. This eighth configuration is a "closed" configuration that completely isolates catheter 44 from irrigation system 52, aspiration system 54, and ablation laser system 56.

[0057] 4-6, a schematic diagram 200 is shown of an irrigation system 52, an aspiration system 54, an ablation laser system 56, and a manifold 48c operatively coupled to the proximal end portion 72 of the catheter 44 according to one embodiment of the present disclosure. The manifold 48c includes many of the same components and attributes as the manifold 48b of FIG. 3, which components and attributes are indicated with the same numerical reference characters.

[0058] Manifold 48c includes a changeover switch 202 for actuating some or all of the plurality of shutoff valves 96. In the case of manifold 48c, changeover switch 202 includes a link 204 coupled to shutoff valves 96b, 96c, and 96e. Changeover switch 202 may be a three-position switch (see drawings), and each of shutoff valves 96b, 96c, and 96e may be a three-position valve 206 (again, see drawings) that may be configured into three unique flow / shutoff orientations. These three positions of changeover switch 202 are indicated in the drawings as 1, 2, and 3. In each position, each three-position valve 206 either shuts off or enables a respective circuit 110.

[0059] Functionally, similar to manifold 48b, dedicated suction port 182 of manifold 48c allows working device 148 to access secondary working channel 144 without compromising suction. A changeover switch 202 actuates shut-off valves 96b, 96c, and 96e simultaneously, while shut-off valves 96a and 96d are actuated individually. Each position of changeover switch 202 corresponds to one of the respective positions of three-position valve 206.

[0060] In operation, the transfer switch 202 and the shutoff valves 96a and 96d can be manipulated to define a number of operating configurations, each of which exhibits a unique input / output combination. Example valve combinations for manifold 48c are tabulated in Table 3 and described below.

[0061] In a first configuration of manifold 48c, changeover switch 202 is set to position 1, which corresponds to an "irrigation only" configuration 212, in which shut-off valves 96b and 96c are configured in an open configuration and shut-off valve 96e is configured in a closed configuration. This irrigation only configuration 212 is shown in FIG. 4. Shut-off valve 96a is open, shut-off valve 96d is closed, and laser optical fiber 150 is threaded through shut-off valve 96a and first compression fitting 132. In this first configuration, irrigation is enabled through both the primary working channel 142 and the secondary working channel 144, and laser optical fiber 150 is located in the primary working channel 142.

[0062] [Table 3]

[0063] In a second configuration of manifold 48c, the transfer switch is set to the same irrigation only effect as the first configuration in position 1. Isolation valve 96d is opened, isolation valve 96a is closed, and laser optical fiber 150 is threaded through isolation valve 96d and second compression fitting 134. In this second configuration, irrigation is enabled through both the primary working channel 142 and the secondary working channel 144, with laser optical fiber 150 located in the secondary working channel 144.

[0064] In a third configuration of manifold 48c, changeover switch 202 is set to position 3, which corresponds to an "irrigation+aspiration" configuration 214, in which shut-off valves 96b and 96e are configured in an open configuration and shut-off valve 96d is configured in a closed configuration. Irrigation+aspiration configuration 214 is shown in FIG. 6. Isolation valve 96a is open, shut-off valve 96d is closed, and laser optical fiber 150 is threaded through shut-off valve 96a and first compression fitting 132. In this third configuration, both irrigation and aspiration are enabled for catheter 44, and laser optical fiber 150 is located within main working channel 142.

[0065] In a fourth configuration of manifold 48c, the transfer switch is set to position 3, which corresponds to the same irrigation + aspiration effect as the third configuration. Isolation valve 96d is opened, isolation valve 96a is closed, and laser optical fiber 150 is threaded through isolation valve 96d and second compression fitting 134. In this fourth configuration, both irrigation and aspiration are enabled for catheter 44, and laser optical fiber 150 is located in the secondary working channel 144.

[0066] In a fifth configuration of manifold 48c, shut-off valves 96b, 96c, and 96e are closed, while the positions of shut-off valves 96a and 96d are variable and unspecified. This fifth configuration is a "transition" configuration, in which catheter 44 and manifold output port 94 are shut off from irrigation system 52 and aspiration system 54, while fiber optic input port 102 and secondary working channel input port 106 may be opened or closed. As described below in connection with FIG. 7, the transition configuration may be implemented, for example, when switching optical fiber 150 (or other working device 148) from main working channel circuit 112 to secondary working channel circuit 116, or when switching optical fiber 150 (or other working device 148) from secondary working channel circuit 116 to main working channel circuit 112.

[0067] In a sixth configuration of manifold 48c, the transfer switch is set to position 2, closing isolation valves 96b, 96c, and 96e. Isolation valves 96a and 96d are closed, and laser optical fiber 150 is retracted. This sixth configuration is a "closed" configuration that completely isolates catheter 44 from irrigation system 52, aspiration system 54, and ablation laser system 56.

[0068] 7, there is shown a schematic diagram 230 of an irrigation system 52, an aspiration system 54, an ablation laser system 56, and a manifold 48d operatively coupled to the proximal end portion 72 of the catheter 44 in accordance with one embodiment of the present disclosure. The manifold 48d includes many of the same components and attributes as the manifold 48c of FIGS. 4-6, which are indicated with the same reference numbers.

[0069] Unlike manifold 48c, manifold 48d does not include shut-off valves 96a and 96d. Instead of blocking the optical fiber input port 102 and the secondary working channel input port 106, compression fittings 132 and 134 are sealed off either by the presence of a working device 148 (e.g., optical fiber 150, as shown at the optical fiber input port 102) or with a cap or plug 232 (shown at the secondary working channel input port 106).

[0070] In operation, the changeover switch 202 is operated as described in connection with Figures 4-6. The fiber optic input port 102 and the secondary working channel input port 106 are either occupied by an optical fiber 150 (or other working device 148) or selectively sealed with a cap or plug 232. Example valve combinations for manifold 48d are tabulated in Table 4 and described below.

[0071] [Table 4]

[0072] In a first configuration of manifold 48d, the changeover switch 202 is set to position 1, which corresponds to an "irrigation only" configuration 212 (FIG. 7). The first compression fitting 132 is occupied and sealed by a working device 148 (e.g., laser optical fiber 150 as shown). The second compression fitting 134 is sealed with a cap or plug 232. In this first configuration, irrigation is permitted through both the primary working channel 142 and the secondary working channel 144, with the working device 148 located in the primary working channel 142.

[0073] In the second configuration of manifold 48d, the transfer switch is set to position 1 for irrigation only effect, identical to the first configuration. The second compression fitting 134 is occupied and sealed by a working device 148 (e.g., laser optical fiber 150). The first compression fitting 132 is sealed with a cap or plug 232. In this second configuration, irrigation is allowed through both the primary working channel 142 and the secondary working channel 144, with the working device 148 located in the secondary working channel 144.

[0074] In a third configuration of manifold 48d, the changeover switch 202 is set to position 3, which corresponds to an "irrigation + aspiration" configuration 214 (FIG. 6). The first compression fitting 132 is occupied and sealed by the working device 148 (e.g., laser optical fiber 150). The second compression fitting 134 is sealed with a cap or plug 232. In this third configuration, both irrigation and aspiration are enabled for the catheter 44, and the laser optical fiber 150 is located within the main working channel 142.

[0075] In the fourth configuration of manifold 48d, the changeover switch 202 is set to position 3, which corresponds to the same irrigation + aspiration effect as the third configuration. The second compression fitting 134 is occupied and sealed by the working device 148 (e.g., laser optical fiber 150). The first compression fitting 132 is sealed with a cap or plug 232. In this fourth configuration, both irrigation and aspiration are enabled for the catheter 44, and the laser optical fiber 150 is located in the secondary working channel 144.

[0076] In a fifth configuration of manifold 48d, shut-off valves 96b, 96c, and 96e are closed, while the positions of shut-off valves 96a and 96d are variable and unspecified. This fifth configuration is a "transition" configuration, in which catheter 44 and manifold output port 94 are shut off from irrigation system 52 and aspiration system 54, while fiber optic input port 102 and secondary working channel input port 106 may be opened or closed. As described below in connection with FIG. 7, the transition configuration may be implemented, for example, when switching optical fiber 150 (or other working device 148) from main working channel circuit 112 to secondary working channel circuit 116, or when switching optical fiber 150 (or other working device 148) from secondary working channel circuit 116 to main working channel circuit 112.

[0077] In a sixth configuration of manifold 48d, transfer switch 202 is set to position 2, closing isolation valves 96b, 96c, and 96e (FIG. 5). Compression fittings 132 and 134 are sealed with caps or plugs 232, and laser optical fiber 150 is withdrawn. This sixth configuration is a "closed" configuration which completely isolates catheter 44 from irrigation system 52, aspiration system 54, and ablation laser system 56.

[0078] 8, there is shown a schematic diagram 240 of an irrigation system 52, an aspiration system 54, an ablation laser system 56, and a manifold 48e operatively coupled to the proximal end portion 72 of the catheter 44 according to one embodiment of the present disclosure. The manifold 48e includes many of the same components and attributes as the manifold 48d of FIG. 7, which components and attributes are indicated with the same numerical reference characters.

[0079] Like manifold 48d, manifold 48e does not include shutoff valves 96a and 96d, but has an alternative configuration for circuit interruption as described in connection with Figure 7. Unlike manifold 48d, the remaining shutoff valves 96b, 96c, and 96e are not coupled to a single changeover switch. Instead, shutoff valves 96b, 96c, and 96e are individual two-position valves akin to schematic 180 of Figure 3.

[0080] In operation, each of the shutoff valves 96b, 96c, and 96e are operated individually. The fiber optic input port 102 and the secondary working channel input port 106 are either occupied by an optical fiber 150 (or other working device 148) or selectively sealed with a cap or plug 232. Example valve combinations for manifold 48e are tabulated in Table 5 and described below.

[0081] In a first configuration of manifold 48e, shut-off valve 96b is open, shut-off valve 96e is closed, and shut-off valve 96c may be opened or closed. When shut-off valve 96c is closed, only first irrigation circuit 114 is filled with irrigation fluid, and when shut-off valve 96c is opened, irrigation circuits 114 and 118 may be filled with irrigation fluid. First compression fitting 132 is occupied and sealed with working device 148 (e.g., laser optical fiber 150 as shown). Second compression fitting 134 is sealed with cap or plug 232. In this first configuration, irrigation is permitted through both main working channel 142 and secondary working channel 144, with working device 148 located in main working channel 142.

[0082] [Table 5]

[0083] In the second configuration of manifold 48e, shut-off valves 96b, 96c, and 96e are configured in the same manner as in the first configuration, second compression fitting 134 is occupied and sealed by working device 148 (e.g., laser optical fiber 150), and first compression fitting 132 is sealed with plug or cap 232. This second configuration is also an "irrigation only" configuration, allowing irrigation via primary working channel 142 and / or secondary working channel 144, but with laser optical fiber 150 located in secondary working channel 144.

[0084] In a third configuration of manifold 48e, shut-off valves 96b and 96c are closed and shut-off valve 96e is open. A working device 148 (e.g., laser optical fiber 150) is located within first compression fitting 132 and second compression fitting 134 is sealed with cap or plug 232. This third configuration is an "aspiration only" configuration, in which only aspiration circuit 184 is enabled and working device 148 is located within main working channel 142.

[0085] In a fourth configuration of manifold 48e, shut-off valves 96b, 96c, and 96e are configured the same as in the second configuration, second compression fitting 134 is occupied and sealed by working device 148 (e.g., laser optical fiber 150), and first compression fitting 132 is sealed with plug or cap 232. This second configuration is also an "irrigation only" configuration, allowing irrigation via primary working channel 142 and / or secondary working channel 144, but with laser optical fiber 150 located in secondary working channel 144.

[0086] In a fifth configuration of manifold 48e, isolation valves 96b and 96e are open and isolation valve 96c is closed. A working device 148 (e.g., laser optical fiber 150) is located within first compression fitting 132 and second compression fitting 134 is sealed with cap or plug 232. This fifth configuration is an “irrigation / aspiration” configuration, in which both irrigation and aspiration are enabled for catheter 44 and working device 148 is located within main working channel 142.

[0087] In a sixth configuration of manifold 48e, isolation valves 96b and 96e are open, isolation valve 96c is closed, second compression fitting 134 is occupied and sealed by working device 148 (e.g., laser optical fiber 150), and first compression fitting 132 is sealed with plug or cap 232. This sixth configuration is also an “irrigation / aspiration” configuration, in which both irrigation and aspiration are enabled for catheter 44, and laser optical fiber 150 is located in the secondary working channel 144.

[0088] In a seventh configuration of manifold 48e, isolation valves 96b, 96c, and 96e are closed, while the arrangement of compression fittings 132 and 134 is variable and unspecified. This seventh configuration is a "transition" configuration, where catheter 44 and manifold output port 94 are isolated from irrigation system 52 and aspiration system 54, while one of first compression fitting 132 and second compression fitting 134 is occupied by a working device 148 (e.g., laser optical fiber 150) and the other of second compression fitting 134 and first compression fitting 132 is occupied by a plug or cap 232. This transition configuration may be implemented, for example, when switching working device 148 from the main working channel circuit 112 to the secondary working channel circuit 116, or from the secondary working channel circuit 116 to the main working channel circuit 112.

[0089] In an eighth configuration of manifold 48b, all of isolation valves 96a-96e are closed and laser optical fiber 150 is retracted. This eighth configuration is a "closed" configuration that completely isolates catheter 44 from irrigation system 52, aspiration system 54, and ablation laser system 56.

[0090] 9A, 9B, and 9C, methods 250 of operating an endoscopic system 40 according to an embodiment of the present disclosure are shown. Method 250a relates to changing the position of a working device 148 (e.g., laser optical fiber 150) located at the distal end portion 74 of the catheter 44. Method 250b relates to reversing flow within the catheter 44. Method 250c relates to selectively increasing irrigation flow through the catheter 44. Although these methods 250 are described with reference to the endoscopic system 40 of the present application, any catheter and appropriately equipped steering handle may be used with these methods 250.

[0091] The method 250 may be embodied in the form of a kit 252, in which the steering wheel 42 and catheter 44 are provided with instructions 254 for use on a tangible, non-transitory medium 256 (FIG. 1). Non-limiting examples of the tangible, non-transitory medium 256 include paper documents (see drawings) or computer readable media including compact discs and magnetic storage devices (e.g., hard disks, flash drives, cartridges, floppy drives). These computer readable media may be locally attached or accessible via the Internet. The instructions 254 may be complete on a single medium or split among two or more media. For example, the kit 252 may include instructions 254 written on a paper document that instructs an operator to access one or more of the steps of the method 250 via the Internet, with these Internet accessible steps stored on a computer readable medium. These instructions 254 may be in the form of written text, graphics, and / or video displays. Method 250 may be performed without the aid of instructions 254 or without the provision of kit 252. Thus, steps 261, 271, and 281 of method 250 are considered optional, since method 250 may be performed on a steering wheel and pre-prepared catheter.

[0092] 9A, method 250a may include placing a distal end portion 74 of catheter 44 within a body organ (step 262) and leaving the distal end portion 74 within the body organ during the remaining steps of method 250a. Examples of body organs into which the distal end portion 74 may be inserted include the bladder, ureter, and kidney. Step 262 is optional because method 250a may be performed outside the body organ.

[0093] The method 250a includes isolating one or both of the first and second fluid circuits from one or both of the irrigation and suction sources (step 263). With respect to the endoscope system 40, the first fluid circuit corresponds to either the first irrigation circuit 114 or the suction circuit 116. The second fluid circuit may correspond to the other of the suction circuit 116 or the first irrigation circuit 114. Also, with respect to the endoscope system 40, the irrigation source corresponds to the irrigation system 52, and the suction The suction source corresponds to the suction system 54. Examples of configurations for step 263 are shown in Table 1. ~The "Migration" configuration in Table 4 is included. Step 263 is optional because For example, the method 250 may involve catheters and stems that are not connected to an irrigation and / or suction source. This is because the above-mentioned adjustment may be performed on the steering handle.

[0094] In some embodiments, method 250a includes disengaging the working device from a first compression fitting of the first fluid circuit (step 264). With respect to endoscope system 40, the working device corresponds to working device 148 (e.g., laser optical fiber 150) and the first compression fitting corresponds to compression fitting 98 (e.g., first compression fitting 132 or second compression fitting 134) in which working device 148 is located at the start of method 250a. Step 264 is optional because method 250a may be performed on a system that does not include a compression fitting.

[0095] The working device 148 is removed from the steering handle and the first fluid circuit of the catheter (step 265). With respect to the endoscopic system 40, the working device 148 is removed from either the main working channel circuit 112 or the suction circuit 116 in which the working device 148 was located at the start of the method 250a.

[0096] The working device 148 is inserted into the second fluid circuit of the steering handle and catheter (step 266). With respect to the endoscopic system 40, the working device 148 is inserted into either the main working channel circuit 112 or the suction circuit 116 in which the working device 148 is not located at the start of the method 250a.

[0097] In some embodiments, method 250a includes sealing the working device 148 at a second compression fitting of the second fluid circuit (step 267). With respect to endoscopic system 40, the second compression fitting corresponds to compression fitting 134 or 132 of secondary working channel circuit 116 or main working channel circuit 112 in which working device 148 is not located at the start of method 250a. Step 267 is optional because method 250a may be performed on a system that does not include a compression fitting.

[0098] Functionally, the method 250a allows the working device of a suitably equipped steering handle and catheter to be modified at the distal end portion 74 of the catheter 44. This may allow the operator to change the approach and impingement angle of the ablative laser beam at the target. Such freedom may improve surgical outcomes. In the case of an endoscopic system with visual capabilities at the distal end portion 74 of the catheter 44, this may also improve the operator's viewing of the working device and the laser beam impingement at the target zone. In the case of embodiments that allow for the modification to be performed while the catheter 44 is inserted within the human body, this modification may be performed while reducing or avoiding the additional time and trauma associated with removing and reinserting the catheter 44.

[0099] 9B, a method 250b of reversing flow within the catheter 44 is shown. The method 250b may include coupling a suction source 54 to a working channel input port 102 of a manifold 48 of the steering handle 42 (step 272). Some embodiments include a dedicated suction input channel 182 (e.g., manifold 48b), thus eliminating the need for this step. Thus, step 272 is an optional step associated with embodiments in which the suction source 54 and working device 148 alternatively share a working channel input port 102 (e.g., manifold 48a).

[0100] In some embodiments, reversing the flow through a first one of the lumens 140 of the catheter 44 involves two steps: closing a first one of the plurality of shut-off valves 96 of the manifold 48, thereby isolating the lumen 140 from either the irrigation source 52 or the suction source 54 (step 273), and opening a second one of the plurality of shut-off valves 96 of the manifold 48, thereby fluidly connecting the first one of the lumens 140 to either the irrigation source 52 or the suction source 54 (step 274).

[0101] For example, referring to manifold 48a (FIG. 2), to reverse flow in secondary working channel 144 from aspiration flow to irrigation flow, shut-off valve 96d is closed at step 273 and shut-off valve 96c is opened at step 274. To reverse flow in secondary working channel 144 from irrigation flow to aspiration flow, shut-off valve 96c is closed at step 273 and shut-off valve 96d is opened at step 274.

[0102] Functionally, the ability to reverse the flow in one of the catheter's lumens allows for the remedy of imbalances between irrigation and aspiration flows. For example, if the aspiration flow rate exceeds the irrigation flow rate, the treated organ may contract, which may cause pain and damage. In this example, the ability to reverse the aspiration flow and introduce irrigation flow allows for the irrigation mass to be "adjusted" relative to the aspiration mass (e.g., by placing the endoscopic system 40 in an "irrigation only" configuration). Once the irrigation mass has been sufficiently adjusted relative to the aspiration mass, the flow can be reversed again (e.g., by placing the endoscopic system 40 in an "irrigation + aspiration" or "aspiration only" configuration) to avoid overfilling the organ. This freedom allows the operator to work during periods of flow imbalance, for example due to obstructions caused by the working device 148 placed in the aspiration channel or the presence of stone fragments. Reversing the flow can also serve to displace obstructing stone fragments.

[0103] 9C, a method 250c of increasing irrigation flow in catheters 44 is shown. Method 250c may include coupling irrigation source 52 to irrigation power port 104 of manifold 48 of steering handle 42 (step 282). In some embodiments, increasing the flow in a first one of lumens 140 of catheters 44 involves two steps: a baseline irrigation flow is established from irrigation source 52 through first one of lumens 140 of catheters 44 via irrigation port 104 (step 283), and opening one of a plurality of shutoff valves 96 of manifold 48 to fluidly connect second one of lumens 140 of catheters 44 to irrigation source 52 (step 284).

[0104] For example, referring to manifold 48a (FIG. 2), to increase irrigation flow through catheter 44, flow is first established through first irrigation circuit 114 and primary working channel 142, at step 283. At step 284, shut-off valve 96c is opened to establish flow through second irrigation circuit 118 and secondary working channel 144 via irrigation power port 104.

[0105] Functionally, the ability to increase the irrigation flow through the catheter also allows for imbalances between irrigation and aspiration flows to be remedied. Again, if the aspiration flow rate exceeds the irrigation flow rate, the organ being treated may contract, which may cause pain and damage. In this example, the ability to increase the irrigation flow rate allows for the irrigation mass to be "adjusted" relative to the aspiration mass (e.g., by placing the endoscope system 40 in an "irrigation only" configuration). Once the irrigation mass is adjusted or exceeded relative to the aspiration mass, the irrigation flow can be returned to a baseline flow rate. This freedom allows the operator to work during periods of flow imbalance, such as caused by an obstruction caused by the presence of the working device 148 in the irrigation channel.

[0106] 9A-9C may be performed together, such as simultaneously, sequentially, or any combination thereof. For example, flow reversal method 250b or irrigation flow increase method 250c may be performed in combination with working device repositioning method 250a. Similarly, flow reversal method 250b may be accompanied by irrigation flow increase method 250c. Thus, steps of method 250 may be combined in ways other than those shown and described in FIGS. 9A-9C.

[0107] 10-14, there are shown steering handles 42a-42e, respectively, according to one embodiment of the present disclosure, which accommodate manifolds 48a-48e, respectively, of Figures 2-8. Steering handles are referred to herein generally or collectively by reference numeral 42, and individually or specifically by reference numeral 42 followed by a letter suffix (e.g., "steering handle 42a").

[0108] The steering handle 42 includes a housing 302 having a head assembly 304 and a base portion 306 separated by a body portion 308. The body portion 308 has a handle axis 310 along which the head portion 304, body portion 308, and base portion 306 are disposed. The head assembly 304 is located proximal to the body portion 308 and the base portion 306 is located distal to the body portion 308. As used herein, in the context of the steering handle 42, "proximal" refers to a direction 312 toward the head assembly 304 along the catheter axis 68 and handle axis 310, and "distal" refers to a direction 314 away from the head assembly 304 along the catheter axis 68 and handle axis 310. The head assembly 304 may include a thumb lever 316 for articulating the distal end 74 of the catheter 44 and one or more push button actuators 318 for actuating features of the endoscopic system 40.

[0109] The base portion 306 may include a bulkhead 332 through which the primary and secondary working channel input ports 102, 106 are routed for interfacing with an external system 46. In some embodiments, the irrigation force port 104 and the suction port 182 extend distally through the base portion 306 to the bulkhead 332 (FIGS. 10 and 11), but may also be routed through the bulkhead 332 (FIGS. 12-14). Optionally, the irrigation force port 104 or the suction port 182 (or both) may be configured to be compatible with a LUER taper fitting. In some embodiments, the irrigation force port 104 or the suction port 182 (or both) may include an external valve, such as a stopcock valve. The base portion 306 may include a catheter port 334 to which the catheter 44 is coupled, and an electrical port 336 for routing electrical wiring.

[0110] Steering handles 42a, 42b, and 42c include a plurality of rotary two-position valve actuators 338 for operating shutoff valves 96. In some embodiments, the valve actuators 338 extend through the base portion 306 of the housing 302. Steering handles 42c and 42d include a changeover switch actuator 360 for the changeover switch 202 illustrated with respect to manifolds 48c and 48d in FIGS. 4-7. Steering handle 42d also includes a cap or plug 232 for sealing the secondary working channel input port 106. Steering handle 42e includes a plurality of push button two-position translational valve actuators 340 for operating shutoff valves 96.

[0111] 15-17, a rotary two-position valve actuator 338 is shown according to an embodiment of the present disclosure. For steering handles 42a and 42b, all of the shutoff valves 96 are two-position or binary valves 342, e.g., rotary stopcock valves 344. For steering handle 42c, only shutoff valves 96a and 96d are two-position valves 342. The rotary two-position valve actuators 338 and input ports 92 may be color coded for ease of identification (e.g., orange for irrigation, blue for working device, and white for suction, etc.). Alternatively or additionally, each valve actuator 338 and / or input port 92 may be identified by print on the housing 302.

[0112] As shown in FIGS. 15A-15C and 15, the rotary two-position valve actuator 338 may extend through the housing 302 and may include a lever actuator 346 for rotational manipulation by an operator. The lever actuator 346 may be coupled to a stem 348 (FIG. 15A) and oriented to be parallel to the flow direction through a flow orifice 349 of the shutoff valve 96. The flow orifice 349 is defined in the stem 348. The stem 348 is inserted into a valve body 343 that may be integral or unitary with the housing 302. In some embodiments, each lever actuator 346 includes a flange 345 that partially surrounds the stem 348 and cooperates with a stop 347 formed on the valve body 343 or the housing 302 to limit the rotation of the rotary two-position valve actuator 338 to a fixed angle (such as 90 degrees as shown in FIGS. 15B and 15C).

[0113] In the illustrated embodiment, the manifold 48 is oriented such that the fluid circuit 110 extends generally in a proximal direction 312 and a distal direction 314. As such, the illustrated shut-off valve 96 is "open" (i.e., a flow-enabling orientation) when the lever actuator 346 extends substantially parallel to the proximal and distal directions 312, 314 (FIG. 15), and is "closed" (i.e., a flow-blocking orientation) when the lever actuator 346 extends substantially perpendicular to the proximal and distal directions 312, 314 (FIG. 16).

[0114] 17 and 18, the stop valve 344 may define a tool receptacle 350 for actuating the shut-off valve 96 with a tool (not shown). The tool receptacle 350 may be, for example, a slot (not shown) for inserting a flat head screw driver (not shown). The stop valve 344 with the tool slot 350 may be located inside the housing 302 or may be accessible by removing a portion of the housing 302 (see drawings) or through an access aperture formed on the housing 302 (not shown).

[0115] 19, a changeover switch actuator 360 is shown according to one embodiment of the present disclosure. The changeover switch actuator 360 includes a handle portion 362 and a stem portion 364, the stem portion 364 having a rotation axis 366. The changeover switch actuator 360 may include a valve core 368 for the shutoff valves 96b, 96c, and 96e, and an end bearing 368 defining a tangential groove 372 configured to receive a retaining clip 374 (FIG. 30). The changeover switch actuator 360 may also include a cam 376. The valve core 368 defines a flow orifice 382 having a flow axis 384. The flow axis 384 extends orthogonally to and is offset outwardly from the rotation axis 366.

[0116] Referring to FIG. 20, the changeover switch actuator 360 is shown in assembly according to one embodiment of the disclosure. In FIG. 20, the handle portion 362 of the changeover switch actuator 360 has been removed for clarity. The changeover switch actuator 360 is disposed within a changeover switch body 386 that may be integral with the manifolds 48c, 48d. In some embodiments, the manifolds 48c, 48d include a feature 388 that extends outwardly and surrounds a cam 370 of the changeover switch actuator 360. The cam 370 interacts with the feature 388 to snap-retain the changeover switch actuator 360 in one of three positions of the changeover switch 202, thereby retaining the valve core 368 in a desired rotational orientation. The feature 388 may include a stop 392 against which the cam 370 is aligned to prevent further rotation of the changeover switch actuator 360 in a given direction.

[0117] Functionally, the changeover switch actuator 360 cooperates with the changeover switch body 386 and features 388, 392 of the manifolds 48c, 48d to define a three-position changeover switch 394. The positions of the three-position changeover switch 394 as shown correspond to "irrigation only", "closed" and "irrigation + aspiration" configurations of the manifolds 48c and 48d.

[0118] 20A-22C, the operation of three-position switch 394 and three-position valve 206 is shown in accordance with one embodiment of the present disclosure. Steering handle 42c is shown in these figures with the understanding that the same operation also applies to steering handle 42d. "Position 1," as described in connection with 200 and 230 above, is shown in FIGS. 20A-20C, which corresponds to the "irrigation only" configuration as marked on housing 302. In position 1, cam 370 engages a first of features 388 and one of stop features 392 (FIG. 20B).

[0119] 20C, 21C, and 22C, schematic cross sections 396a-396c (collectively and generally referred to as cross sections 396) correspond to a valve core 368 within a valve changer switch body 386. The valve core 368 in cross section 396 shows two flow orifices 382 and 382', with flow orifice 382' being optional and shown in phantom. By way of example, cross sections 396a-396c correspond to a three-position configuration of shutoff valves 96b and 96e as shown and described with respect to manifolds 48c and 48d. Optional flow orifice 382' is present in the case of shutoff valve 96b and is absent in the case of shutoff valve 96e. At cross section 396, the changeover switch body 386 partially defines the conduits 90 of the manifolds 48c, 48d which extend therethrough at a location that is offset outwardly from the axis of rotation 366 of the changeover switch actuator 360 and aligned with the flow orifices 382 when the three-position valve 206 is in the flow-enabling configuration (FIG. 22A).

[0120] "Position 2," as described above in connection with diagrams 200 and 230, is shown in Figures 21A-C and corresponds to a "closed" configuration as marked on housing 302. Cam 370 engages a second one of features 388 to lock changeover switch actuator 360 in position 2 (Figure 21B). At cross section 396b, valve core 368 occludes conduit 90, thereby blocking conduit 90 and interrupting circuit 110.

[0121] "Position 3," as described above in connection with schematics 200 and 230, is shown in Figures 22A-22C, which corresponds to a "closed" configuration as marked on the housing 302. The cam 370 engages a third one of the features 388 and one of the stop features 382 to lock the changeover switch actuator 360 in position 3 (Figure 22B). At cross section 396c, the valve core 368 either blocks or allows flow through the conduit 90 depending on whether the optional flow orifice 382' is present (Figure 20C). That is, for the shutoff valve 96b having two flow orifices 382 and 382', flow is allowed in Figure 22C. For the shutoff valve 96e having only one flow orifice 382, ​​flow is blocked in Figure 22C. The operation of shut-off valve 96c is the inverse of that of shut-off valve 96b (ie, in position 1 it is in the shut-off configuration and in position 3 it is in the flow allowing configuration).

[0122] In this manner, the switch actuator 360 cooperates with the changeover switch body 386 and the features 388, 392 of the manifolds 48c, 48d to provide the three-position valve 206 for the manifolds 48c and 48d.

[0123] 23-26, the layout and structure of manifold 48a are shown illustrating various aspects of schematic 180 in the physical domain according to one embodiment of the disclosure. In FIG. 23, a solid model representation 420 of conduit 90 to manifold 48a is shown. In FIG. 24, the path from the conduit to housing 302 is shown in hidden lines. In FIGS. 23 and 24, conduit 90 of manifold 48a resembles the letter W with three input ports 102, 104, and 106 located at the top of the W and output port 94 located at the bottom tip of the W. Manifold 48a is shown alone (with fittings) in FIG. 25 and installed in FIG. 26. Also in FIGS. 24-26, valve actuators 338 are individually identified as valve actuators 338a-d along with corresponding shutoff valves 96a-d.

[0124] 27-29, the layout and structure of manifold 48b are shown illustrating various aspects of schematic 200 in the physical domain according to one embodiment of the disclosure. In FIG. 27, a solid model representation 440 of conduit 90 to manifold 48b is shown. In FIG. 28, the path from the conduit to housing 302 is shown in hidden lines. In FIG. 29, manifold 48b is shown in isolation. In the illustrated embodiment, manifolds 48a, 48b include a matrix structure 424 through which conduit 90 passes and which supports valve 96. Bulkhead 332, conduit 90, and matrix structure 424 may be standalone. Also, in FIGS. 28 and 29, valve actuators 338 are individually identified as valve actuators 338a-338e along with corresponding shutoff valves 96a-96e.

[0125] With respect to manifolds 48a and 48b, conduits 90, and specifically working channel conduits 90a and 90d of main working channel circuit 112 and secondary working channel circuit 116, feature gradual bends. Conduits 90 also pass through bulkhead 332. Functionally, the gradual bends of main working channel conduit 90a of main working channel circuit 112 and secondary working channel conduit 90d of secondary working channel circuit 116 prevent crimping of working device 148 and allow smooth insertion. The absence of sharp corners in irrigation conduits 90b and 90c reduces pressure drop within irrigation circuits 114 and 118. Matrix structure 424 provides manifold 48 with sufficient strength and attachment features and is amenable to three-dimensional printing manufacturing techniques.

[0126] 30-32, the layout and structure of manifold 48d is shown illustrating various aspects of schematic 230 in the physical domain according to one embodiment of the present disclosure. In FIG. 30, a cross-sectional view 460 of conduits 90b, 90c, and 90e routed through a three-position changeover switch 394 is shown. In FIG. 31, the path of conduit 90 through housing 302 is shown in hidden lines. In FIG. 32, manifold 48d is shown in isolation. Manifold 48d also includes a matrix structure 424 through which conduit 90 passes and which supports valve 96. Bulkhead 332, conduits 90, and matrix structure 424 may be unitary.

[0127] The primary working channel 142 has an inner diameter 462 and an outer diameter 464 (FIG. 30A). Similarly, the secondary working channel 144 has an inner diameter 466 and an outer diameter 468. In some embodiments, one of the working channels 144, 142 has a larger inner diameter 466 than the inner diameter 462 of the other of the working channels 142, 144. In the illustrated embodiment, the secondary working channel 144 has the larger inner diameter 466 and the primary working channel 142 has the smaller inner diameter 462. However, this configuration may be reversed or negated by having the inner diameters 462, 466 be substantially equally sized. In some embodiments, the inner diameter 466 is within the range of 1.0 millimeters to 1.4 millimeters, inclusive. In some embodiments, the inner diameter 462 is within the range of 0.6 millimeters to 0.8 millimeters, inclusive. Each outer diameter may correspond to a wall thickness within the range of 0.08 millimeters to 0.1 millimeters, inclusive. This configuration is illustrated with respect to manifold 48d, but may be implemented with any of the manifolds 48 of the present disclosure.

[0128] The main working channel conduit 90a of the main working channel circuit 112 and the secondary working channel conduit 90d of the secondary working channel circuit 116 bypass three-position switch 394 (FIG. 32). Manifold 48c is similar to manifold 48d except that manifold 48c includes shut-off valves 96a and 96d on the main working channel input port 102 and the secondary working channel input port 106.

[0129] 33-38A, there is shown the layout and structure of manifold 48e illustrating in the physical domain various aspects of schematic diagram 240 as embodied in FIG. 14 according to one embodiment of the disclosure. Manifold 48e includes many of the same components and attributes as manifold 48d, which are identified with the same numerical references. Instead of a changeover switch 202 or a rotary two-position valve actuator 338 with a rotary lever actuator 346, manifold 48e includes a plurality of two-position valves 342 with two-position (push / pull) translational valve actuators 340. The two-position valves 342 are slide valves 472 that, in some embodiments, block each circuit 110 when the translational valve actuator 340 is pulled outward (away from manifold 48e) and enable each flow circuit 110 when the translational valve actuator 340 is pushed inward (toward manifold 48e). In some embodiments, the push / pull action of the slide valve 472 may be reversed, i.e., the slide valve 472 may be configured to allow flow by pulling the translation valve actuator 340 and to block flow by pushing the translation valve actuator 340.

[0130] Each of Figures 34-38 illustrates a translating valve actuator 340 in combination to configure manifold 48e in one or more of the configurations of Table 5. Figures 34A-38A are cross-sectional views of manifold 48e of the corresponding Figures 34-38, respectively. These cross-sectional views show conduit 90 and slide valve 472. With respect to Table 5, Figures 34-34A and 35-35A illustrate the "irrigation only" combination of configurations (1) and (2), Figures 36-36A illustrate the "aspiration only" combination of configurations (3) and (4), Figures 37-37A illustrate the "irrigation + aspiration" combination of configurations (5) and (6), and Figures 38-38A illustrate the "transition" and "closed" combinations of configurations (7) and (8).

[0131] Functionally, by using multiple two-position valves 342 instead of the changeover switch 202, the operator has more combinations for operation. One example is a "suction only" configuration, which is not the configuration of the changeover switch 202 as shown herein. The larger inner diameter 466 and the smaller inner diameter 462 provide a larger diameter throughput extending through the lumen 140 of the catheter 44 to one of the working channels 144 (see drawing) or 142. For a given cross-sectional area of ​​the catheter shaft 66, the allocation of the larger inner diameter 466 and the smaller inner diameter 462 provides a larger clearance in one of the working channels 142, 144 than would be obtained if both inner diameters 462 and 466 were of equal diameter. The larger inner diameter 466 can provide a larger clearance or at least less interference between the working device 148 and the lumen 140, making it easier to insert the working device 148. The larger clearance also allows for better flow within the annulus defined between the working device 148 and the walls of the lumen 140. Furthermore, when a larger inner diameter 462 is used in the aspiration circuit 116, the catheter 44 is less likely to become blocked or clogged due to the size of the stone fragments being aspirated.

[0132] Each of the additional features and methods disclosed herein can be used separately or in combination with other features and methods to realize, make and use improved devices and methods. Thus, the combinations of features and methods disclosed herein may not be essential to the practice of the disclosure in its broadest sense, but rather are merely disclosed to illustrate exemplary and preferred embodiments.

[0133] The following references are incorporated herein by reference in their entirety, except for the claims and phraseology definitions contained therein: U.S. Provisional Patent Application No. 62 / 868,105, filed June 28, 2019, and owned by the assignee hereof; International Patent Application entitled "Efficient Multi-Functional Endoscopic Instrument" to Altshuler et al., filed on the same day, and owned by the owner hereof; International Application PCT / US19 / 42491 to Altshuler et al., filed July 18, 2019, and owned by the owner hereof; and U.S. Patent No. 9,775,675 to Irby, III. Any incorporation by reference into this application is subject to the limitation that no subject matter that is inconsistent with what is expressly disclosed herein is incorporated.

[0134] Various modifications to these embodiments will be apparent to those skilled in the art upon reading this disclosure. For example, those skilled in the relevant art will understand that the various features described with respect to the various embodiments can be appropriately combined, decombined, or newly combined with other features, either alone or in various combinations. Similarly, any of the various features described above should be considered as exemplary embodiments, without limiting the scope or spirit of the disclosure.

[0135] Those skilled in the relevant art will appreciate that various embodiments may comprise fewer features than those illustrated in the above-described embodiments. The embodiments described herein are not intended to be an exhaustive representation of the manner in which various features may be combined. Thus, the embodiments are not mutually exclusive of combinations of features, but rather the claims may comprise any combination of various features selected from the various embodiments as would be understood by one skilled in the art.

[0136] Unless otherwise indicated, references contained herein to "embodiments," "disclosure," "the disclosure," "embodiments of the disclosure," "embodiments of the disclosure," and the like are references to the specification (text and drawings, including the claims) of this patent application which are not admitted prior art.

[0137] In interpreting the claims, it is expressly intended that the provisions of 35 U.S.C. 112(f) not be violated unless the specific phrase "means for" or "step for" is used in each claim. [Explanation of symbols]

[0138] 40 Endoscope System 42 Steering wheel 42a Steering handle 42b Steering handle 42c steering wheel 42d Steering wheel 42e Steering wheel 44 Catheter 46 External Systems 48 Manifold 48a Manifold 48b Manifold 48c manifold 48d manifold 48e Manifold 52 Irrigation systems, irrigation sources 54 Suction system, suction source 56 Ablation laser system, laser system 62 Optical Systems 64 Imaging Systems 66 Catheter shaft 68 Central shaft, catheter shaft 72 Proximal end portion 74 Distal end portion, distal end 76 Distal Head Part 90 Conduit 90a Main Working Channel Conduit 90b First irrigation conduit 90c Second irrigation conduit 90d Side Working Channel Conduit 90e conduit 92 input ports 94 Output Ports 96 Shut-off valve 96a Shut-off valve 96b Shut-off valve 96c Shut-off valve 96d Shut-off valve 96e Shutoff valve 98 Compression Fittings 102 Main working channel input port, optical fiber input port 104 Irrigation port, irrigation port 106 Secondary working channel input port, suction input port 110 Fluid circuit, flow circuit 112 Main Working Channel Circuit 114 First irrigation circuit 116 Side working channel circuit, suction circuit 118 Second Irrigation Circuit 122 Main working channel output port 124 Sub-working channel output port 132 First compression joint 134 Second Compression Joint 140 Catheter Lumen 142 Main Working Channel 144 Secondary Working Channel 148 Work Devices 150 Laser Optical Fiber 182 Dedicated suction port, dedicated suction input channel 184 Suction circuit 202 Changeover switch 204 Link 206 3-position valve 212 Irrigation only configuration 214 Irrigation + Suction Configuration 232 Plugs, caps 252 Kit 254 Command 256 Tangible non-transitory media 302 Housing 304 Head assembly, head part 306 Base part 308 Main body part 310 Handle shaft 312 Proximal 314 Distal 316 Thumb Lever 318 Push Button Actuator 332 Bulkhead 334 Catheter Port 336 Electrical Port 338 Valve Actuator 338a Valve Actuator 338b Valve Actuator 338c Valve Actuator 338d Valve Actuator 338e Valve Actuator 340 Parallel valve actuator 342 Binary Valve 343 Valve body 344 Rotary stop valve 345 Flange 346 Rotary Lever Actuator 347 Stopper 348 Stem 349 Flow Orifice 350 Tool Receptacle, Tool Slot 360 Changeover Switch Actuator 362 Handle part 364 Stem part 366 Rotation Axis 368 Valve core, end bearing 370 Cam 372 Tangential Groove 374 Retaining Clip 376 Cam 382 Flow Orifice 384 Flow Axis 386 Changeover switch body, valve changeover switch body 388 Features 392 Stopper, stopper feature 394 3-position changeover switch 396 Section 396a Cross Section 396b cross section 396c cross section 420 Solid Model Representation 424 Matrix Structure 440 Solid Model Representation 462 Inner diameter 464 Outer diameter 466 Inner diameter 468 Outer diameter 472 Slide valve

Claims

1. 1. An endoscopic surgical instrument comprising: a steering handle comprising a housing containing a manifold, the manifold comprising a main working channel input port in fluid communication with a main working channel output port and a secondary working channel input port in fluid communication with a secondary working channel output port; Equipped with The manifold includes one or more valves configured to selectively isolate irrigation force ports from the main working channel output port or the secondary working channel output port and control delivery of irrigation fluid, thereby: the irrigation fluid is directed through the irrigation power port to the main working channel output port; or The irrigation fluid is directed through the irrigation force port to the secondary working channel output port.

2. 2. The endoscopic surgical instrument of claim 1, wherein the one or more valves are configured to isolate the irrigation force port from the main working channel output port, a main working channel circuit including the main working channel input port and the main working channel output port, the main working channel circuit configured to pass at least one working device therethrough.

3. The endoscopic surgical instrument of claim 2 , wherein the at least one working device is at least one of a laser optical fiber, a basket, a guidewire, and a biopsy forceps as a working device.

4. an irrigation source in fluid communication with the irrigation power port; and a suction source in fluid communication with the main working channel input port; The endoscopic surgical instrument of claim 3 further comprising:

5. 2. The endoscopic surgical instrument of claim 1, wherein the one or more valves are configured to isolate the irrigation force port from the secondary working channel output port, and the secondary working channel circuit includes the secondary working channel input port and the secondary working channel output port, the secondary working channel circuit configured to pass at least one working device therethrough.

6. The endoscopic surgical instrument of claim 5 , wherein the at least one working device is at least one of a laser optical fiber, a basket, a guidewire, and a biopsy forceps as a working device.

7. a catheter shaft having a proximal end portion and a distal end portion and defining a central axis extending from the proximal end portion to the distal end portion, the catheter shaft defining a main working channel extending parallel to the central axis and a secondary working channel extending parallel to the central axis, the secondary working channel output port of the manifold being in fluid communication with the secondary working channel and the main working channel output port of the manifold being in fluid communication with the main working channel; The endoscopic surgical instrument of claim 1 , comprising:

8. The endoscopic surgical instrument of claim 7 , wherein the main working channel extends through the distal end portion of the catheter shaft.

9. the one or more valves are configured to isolate the irrigation power port from the main working channel output port; and an irrigation source in fluid communication with the irrigation force port and the secondary working channel; and a suction source in fluid communication with the main working channel input port and the main working channel; The endoscopic surgical instrument of claim 8 further comprising:

10. 1. An endoscopic surgical system comprising: a catheter shaft defining a central axis extending from a proximal end portion through a distal end portion of the catheter shaft, the catheter shaft including a primary working channel and a secondary working channel each extending parallel to the central axis; a steering handle containing a manifold, the manifold including a main working channel output port in fluid communication with the main working channel and a secondary working channel output port in fluid communication with the secondary working channel, the manifold configured such that at least one working device is routed through the main working channel via the main working channel output port; One or more valves configured to control the delivery of irrigation fluid, thereby the irrigation fluid is directed through the main working channel; or The irrigation fluid is directed through the secondary working channel. One or more valves configured as described above; An endoscopic surgical system comprising:

11. The endoscopic surgical system of claim 10, wherein the manifold comprises a main working channel input port for passage of the at least one working device through the main working channel via the main working channel output port.

12. The endoscopic surgical system of claim 11 comprising a laser optical fiber as the at least one working device.

13. The endoscopic surgical system of claim 12 , wherein the main working channel permanently houses the laser optical fiber.

14. The endoscopic surgical system of claim 12, wherein the one or more valves are configured to direct the irrigation fluid through the secondary working channel, the endoscopic surgical system further comprising an irrigation force port in fluid communication with an irrigation source and the secondary working channel.

15. The endoscopic surgical system of claim 14, further comprising a suction source and a suction input port in fluid communication with the main working channel.

16. The endoscopic surgical system of claim 10, wherein the manifold includes an irrigation force port and a suction input port, and the one or more valves are configured to block one of the secondary working channel and the main working channel from the irrigation force port.

17. an irrigation source in fluid communication with the irrigation power port; and a suction source in fluid communication with the suction input port; The endoscopic surgical system of claim 16 further comprising:

18. 18. The endoscopic surgical system of claim 17, wherein the one or more valves are configured such that the main working channel is blocked from the irrigation force port, the irrigation fluid is directed through the secondary working channel, and the suction source is in fluid communication with the main working channel through the suction input port.

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