Coupling device for an endoscope with an adjustable optical lens - Patents.com

Abstract

A coupler device is provided for covering and at least partially sealing a portion of the working end of the endoscope, as well as an actuator for supplying energy to the endoscope to automatically and / or manually adjust the focal length of the optical lens. The coupler device protects the scope and its components to reduce the ingress of debris, fluids and other materials, thereby reducing the risk of infection. Additionally, the coupler device provides a mechanism for providing adjustable focus and more optical power from the lens, thereby minimizing manual movement of the endoscope during operation and allowing for the design of a more compact and maneuverable endoscope.

Description

[Technical field]

[0001] (CROSS REFERENCE TO RELATED APPLICATIONS) This application claims the benefit of U.S. Provisional Application No. 63 / 137,691, filed January 14, 2021, the entire contents of which are incorporated herein by reference for all purposes. [Background technology]

[0002] Recent advances in optical imaging technology have allowed many medical procedures to be performed minimally invasively today. The evolution of more sophisticated and flexible scopes with enhanced visual capabilities has allowed access to deeper regions of the human body that were previously only achievable through invasive surgical intervention. These modern conveniences have led to an increased demand for, and an increasing number of, endoscopic, laparoscopic, arthroscopic, ophthalmoscopic, or other remote imaging visualization procedures performed annually in the United States and around the world. Although these procedures are relatively safe, they are not without risks.

[0003] For example, endoscopy is a procedure in which an illuminated visualization device called an endoscope is inserted into a patient's body to view the inside of a body cavity, lumen, organ, or combination thereof for the purposes of examination, diagnosis, or treatment. The endoscope may be inserted through a small incision or a natural orifice of the patient. In bronchoscopy, the endoscope is inserted through the mouth, while in sigmoidoscopy, the endoscope is inserted through the rectum. Unlike most other medical imaging devices, the endoscope is inserted directly into an organ, body cavity, or lumen.

[0004] Today, most endoscopes are reused. This means that after an endoscopy, the endoscope undergoes cleaning, disinfection or sterilization, and reprocessing procedures and is then returned to the field for use in another endoscopy on another patient. In some cases, endoscopes are reused several times a day on several different patients.

[0005] Although endoscope cleaning, disinfection, and reprocessing procedures are rigorous, there is no guarantee that the endoscope will be completely free of all forms of contamination. Modern endoscopes have sophisticated and complex optical visualization components inside a very small, flexible tubular body, and these features allow these scopes to be effective in diagnosing or treating patients. However, the price of these comforts is that they are difficult to clean due to the small size and large number of components of the endoscope. As these scopes are introduced deep into the body, the surface of the scope is exposed to elements that may be trapped within or adhere to the surface of the scope, such as bodily fluids, blood, and tissue, increasing the risk of infection with each repeated use.

[0006] Endoscopes used within the digestive tract, such as endoscopic ultrasound scopes (EUS) and duodenoscopes with side-viewing capabilities, are further complicated in that they are in a bacteria-rich environment. Typical duodenoscopes and EUS scopes have internal moving components, such as an elevator with a hinge attached to an actuation cable. The elevator is used to deflect and thus change the direction of the instruments passing through the working channel of the scope. This elevator is beneficial in that it allows the user to change the direction of a wire or catheter to direct it to a particular opening, turn one or more instruments to enter a particular body cavity, or penetrate or sample tissue. However, given the size, location, and movement of the elevator during use, the elevator creates cleaning challenges, including the risk of bacteria being introduced into the elevator hinge and other hard-to-clean locations on the scope. This provides an opportunity for bacteria to colonize and acquire drug resistance, putting patients at risk for serious illness and even death. This risk of infection also exists in the cable mechanism used to move the elevator mechanism back and forth, as well as in other aspects of current scope designs. Furthermore, in addition to the health risks posed by bacterial contamination, the accumulation of fluids, debris, bacteria, particulates, and other waste materials in these hard-to-clean areas of the scope also impacts the performance and shortens the useful life of these reusable scopes.

[0007] Another drawback of existing endoscopes is that conventional lens focusing systems are not suitable due to limitations in diameter and lens displacement range. Endoscopes typically include a series of fixed lenses along the optical path to provide an image of an object at one end of the endoscope to a user viewing through the other end. Each of these lenses has a fixed shape or focal length. Thus, the use of conventional lenses in an endoscope defines a specific working distance at which the object being viewed is focused. Any deviation from this working distance will cause the object to appear blurred to a user viewing it on the other side. Thus, the endoscope must remain stationary at a fixed distance from the object. Changing the working distance or focal length can be achieved by switching lenses of various refractive powers within the endoscope. However, once the endoscope is in use, it is difficult to change any of the lenses used within the endoscope. Also, with fixed lenses having a rigid shape, only discrete working distances and magnifications can be set. Thus, the endoscope operator must move and refocus the endoscope more frequently, which can increase the endoscopic procedure time and possibly increase the patient's discomfort during certain procedures.

[0008] It would therefore be desirable to provide a device that serves as a convenient accessory to currently existing endoscopes to reduce the risk of contamination and infection while also improving the performance of the endoscope. In particular, it would be desirable to provide an adjunct or companion device for an endoscope that has the ability to adjust the focal length of the optical lens of the endoscope, thereby minimizing manual movement of the endoscope during a procedure and allowing for the design of a compact, highly maneuverable endoscope that is easier to clean and sterilize. Summary of the Invention

[0009] A coupler device is provided for covering and at least partially sealing a portion of the working end of the endoscope, as well as an actuator for supplying energy to the endoscope to automatically and / or manually adjust the focal length of the optical lens. The coupler device protects the scope and its components to reduce the risk of infection by reducing the ingress of debris, fluids and other materials. Additionally, the coupler device provides a mechanism for providing adjustable focus and more optical power (i.e., zooming capabilities) from the lens, thereby minimizing manual movement of the endoscope during operation and allowing for the design of a more compact and maneuverable endoscope.

[0010] In one embodiment, a coupler device for use with an endoscope having an optical lens includes a body having a visualization section for permitting viewing of tissue by the endoscope and a proximal end configured for removably mounting to a distal end of the endoscope. The coupler device further includes an actuator disposed in operative proximity to the optical lens when the proximal end of the body is mounted to the distal end of the endoscope. The actuator is configured to change the curvature or shape of the optical lens, thereby adjusting the focal length of the lens.

[0011] The coupler device allows the operator to adjust the optical lens to obtain the additional positive power correction needed to view objects at greater distances (i.e., to focus closer to or zoom in on an object without moving the endoscope). Alternatively, the power can be corrected automatically as part of a feedback control loop. Additionally, the coupler device allows the optical lens to be adjusted continuously over a desired power range. For example, the focal length of the lens can be adjusted to substantially match the distance between the distal end of the endoscope and the desired object, allowing the operator to move the endoscope closer to or farther from the object while maintaining focus.

[0012] The coupler device also allows endoscopes to be designed with fewer optical lenses along the optical path between the viewer and the target site than traditional endoscopes. The ability to adjust at least one of the optical lenses reduces the need for multiple fixed lenses to vary the optical power of the endoscope. This allows for the design of more compact and maneuverable endoscopes, potentially improving patient comfort and allowing access to target sites within a patient that are difficult to reach with traditional scopes.

[0013] In certain embodiments, the actuator may include, for example, a controller, a power source, such as a battery or other suitable power source, and one or more coupling elements for coupling directly to the optical lens or indirectly via other elements within the endoscope. The power source provides energy to the optical lens via the coupling elements to adjust the surface profile or curvature of the lens, thereby adjusting the focus of the lens.

[0014] In certain embodiments, a power source, coupling element, or another connector in the actuator can be configured to automatically adjust the curvature of the lens to refocus the lens on the object as the endoscope moves within the patient. In these embodiments, the actuator can include an autofocus light sensor or similar device and a controller that evaluates a signal from the autofocus light sensor. The controller then automatically supplies energy to the lens as needed and adjusts the focal length of the lens until the image is in focus.

[0015] In other embodiments, the actuators can include a controller that allows an operator to manually adjust the focal length of the actuators and optical lenses when desired. The controller can be controlled from a user interface device that includes one or more input controls for sending electrical signals to the actuators in the coupler device. The user interface device can be incorporated in the handle of the endoscope or in a separate device. The electrical signals can be sent through a connector that runs through the endoscope to the coupler device, or the actuators can be controlled wirelessly by signals sent externally from the patient to the coupler device.

[0016] In other embodiments, the power source can be located external to the coupler device and / or the patient, and power or energy for adjusting the optical lens is provided wirelessly to the actuator in the coupler device (or via a connector in the endoscope). In one such embodiment, the actuator includes a receiver configured to wirelessly receive energy from the power source and transmit energy to the optical lens. Alternatively or additionally, the receiver can be configured to receive electrical signals (e.g., command inputs) from a remote source to enable an operator to control the actuator. The receiver can be located within the body or on an exterior surface of the coupler device. The energy source and / or controller can be located remotely from the coupler device, such as external to the patient. The energy can include an electromagnetic field, electromagnetic radiation, or other suitable energy that can be wirelessly transmitted from the energy source to the actuator.

[0017] In certain embodiments, the energy includes an electromagnetic field and the energy is transferred via inductive or capacitive coupling. In the former embodiment, the energy source includes one or more first magnetic coils and the actuator includes one or more second magnetic coils. In the latter embodiment, the energy source includes one or more first electrodes and the actuator includes one or more second electrodes. The first and second electrodes are configured to transfer energy through capacitive coupling from the first electrodes to the second electrodes. In either embodiment, the actuator can further include a rectifier or other suitable mechanism for converting the electromagnetic field into a DC or AC current or another form of energy suitable for adjusting the properties of the lens.

[0018] In another embodiment, the energy includes electromagnetic radiation, such as microwaves, laser beams, or the like. In these embodiments, the power source includes one or more antennas or other suitable coupling devices, and the actuator includes one or more receivers. The electromagnetic energy is wirelessly transmitted from the antennas to the receivers. The actuator can further include a rectifier or other suitable mechanism for converting the electromagnetic radiation into an appropriate energy form for adjusting the properties of the lens.

[0019] The actuator further includes one or more coupling elements positioned to be operatively proximate to the optical lens when the proximal end of the body of the coupler device is attached to the distal end of the scope. The coupling elements may be in direct contact with the optical lens (or another element of the scope in contact with the optical lens) or may be positioned sufficiently proximate to the optical lens to transfer energy to the optical lens.

[0020] In certain embodiments, the optical lens includes one or more adjustable lenses, and in some embodiments, one or more rigid or fixed lenses. The adjustable lens preferably includes a fluid lens having one or more fluids enclosed in a chamber having substantially transparent proximal and distal surfaces that allow light to pass through the fluid in the chamber. The focal length of the fluid lens can be adjusted by changing the shape or refractive index distribution of the fluid. In certain embodiments, the fluid lens is configured such that the surface profile or radius of curvature of the fluid determines the focal length of the optical lens. By changing the surface profile or radius of curvature of the fluid, the focal length of the lens can be adjusted. The surface profile of the fluid can be adjusted by applying energy directly to or through the fluid, or indirectly to other mechanisms that adjust the pressure, volume, or other properties of the fluid.

[0021] In one embodiment, the actuator includes one or more electrodes that are in operative proximity to the fluid lens when the proximal end of the coupler device is attached to the distal end of the endoscope. The actuator is configured to apply a voltage between the electrodes to change the shape or curvature of the fluid therein. In an exemplary embodiment, the chamber of the fluid lens contains at least two different immiscible liquids, such as water and oil, or other suitable liquid. The voltage changes the shape of the water within the fluid lens, changing the curvature of the lens and its focal length.

[0022] In another embodiment, the lens chamber includes a flexure that functions as a lens and a reservoir portion fluidly coupled to the flexure. The chamber is filled with a single fluid, such as water, oil, air, or any suitable fluid. The lens may further include an outer membrane that closes and seals the chamber. In this embodiment, the actuator is configured to apply pressure to the membrane to move the fluid from the reservoir to the flexure of the lens. Alternatively, the actuator may be configured to apply pressure directly to the fluid reservoir to force the fluid from the reservoir to the flexure of the lens. The actuator may be driven by various energy sources known in the art, such as electrical current, magnetic energy, mechanical energy, acoustic energy, and the like. When the membrane exerts more pressure against the chamber, the fluid is driven from the flexure to the reservoir, thereby decreasing the curvature of the lens. When this pressure is removed, the fluid is displaced to the flexure, thereby increasing the curvature of the lens.

[0023] In some embodiments, the coupler vice allows the working channel of the device to be articulated in a direction preferred by the user of the endoscope so that a wire, catheter or other instrument advanced down the working channel of the endoscope can be directed in a preferred direction different from the angle at which the instrument would exit the endoscope if the coupler vice was not in place or if the in-scope elevator was not used. This reorientation of the instrument has the advantage of aiding in navigation of the device while not allowing fluids, debris, particulate matter, bacteria and other unwanted elements to enter hard to clean areas of the endoscope, particularly the distal end of the endoscope.

[0024] In other embodiments, the coupler device includes a flexible working channel extension that extends the working or biopsy channel of the scope and is angularly adjustable. The flexible working channel extension can be adjustable by an elevator or cable that passes through the endoscope. Alternatively, the coupler device can include a native actuator, such as an elevator, cable, or similar motion means for adjusting the working channel extension and thereby articulating the device that passes through the endoscope. The actuator can be driven by any suitable energy source, such as a motor or the like. The energy source can be coupled to the actuator directly through the scope or indirectly through a magnetic, electric, or other wireless energy source. The energy source can be located within the coupler device or can be external to the coupler device (i.e., located at the proximal end of the scope or external to the patient).

[0025] In some embodiments, an actuator of the coupler device provides energy to both the articulation mechanism and the optical lens within the scope. In this manner, providing energy to the coupler device allows for articulation of instruments passing through the working channel within the scope and adjustment of the focal length of the optical lens.

[0026] In some embodiments, the coupler device can be formed of an optically clear material that covers and seals the end of the endoscope, allowing visualization of the endoscopic camera without obscuring the view through the device. The optically clear material can also cover the light guide of the endoscope, allowing light projected by the endoscope to illuminate the field of view of the endoscope. In some embodiments, the optically clear material can include navigational markers to orient a user when visualizing tissue, such as markers to identify the relative position of the scope as the user visualizes tissue through the optically clear material.

[0027] In some embodiments, the coupler device can be integrated into the scope and configured to be removable and reusable for separate cleaning, including manual cleaning, in autoclaves, ETO sterilizers, gamma sterilizers, and other sterilization methods.

[0028] In some embodiments, the coupler device can cover the entire distal end of the endoscope or can cover only those areas that are difficult to clean. In some embodiments, the coupler device can cover the distal end of the endoscope or a portion thereof, or can include a sheath attached to the coupler device that covers the entire scope that is exposed to fluids, debris, particulate matter, bacteria, and other unwanted elements.

[0029] It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the present invention. Additional features will be set forth in part in the following description or may be learned by the practice of the devices and methods described herein.

[0030] The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate several embodiments and, together with the description, serve to explain the principles of the present invention. [Brief description of the drawings]

[0031] [Figure 1] FIG. 2 is a partial cross-sectional view of a proximal portion of a representative endoscope. [Diagram 2] FIG. 1 is a perspective view of a distal end portion of a representative side-viewing endoscope. [Figure 3A] 1 is a cross-sectional view of an adjustable optical lens for use with an endoscope. [Figure 3B] 1 is a cross-sectional view of an adjustable optical lens for use with an endoscope. [Figure 4A] 1 is a perspective view of another embodiment of an adjustable optical lens for use with an endoscope; [Figure 4B]1 is a perspective view of another embodiment of an adjustable optical lens for use with an endoscope; [Figure 5A] 1 is an isometric view of an exemplary embodiment of a coupler device for use with a side viewing scope; FIG. [Figure 5B] 1 is an isometric view of an exemplary embodiment of a coupler device for use with a side viewing scope; FIG. [Figure 6A] FIG. 5B is a partial cutaway view of the coupler device of FIG. 5A used with an exemplary endoscope. [Figure 6B] FIG. 5C is a partial cutaway view of the coupler device of FIG. 5B used with an exemplary endoscope. [Figure 7] FIG. 5C is another cutaway view of the coupler device of FIGS. 5A and 5B being used with an exemplary endoscope. [Figure 8] FIG. 5C is yet another cutaway view of the coupler device of FIGS. 5A and 5B being used with an exemplary endoscope. [Figure 9] 1 is a schematic diagram of a wireless energy delivery system. [Figure 10] 1 is a schematic diagram of another embodiment of a wireless energy delivery system. [Figure 11A] FIG. 1 illustrates various components of a system for controlling aspects of a coupler device. [Figure 11B] FIG. 2 is a schematic diagram of a control system for controlling an actuator in an optical coupler. [Figure 12A] 5C is a cutaway side view of the coupler device of FIGS. 5A and 5B in a first position. FIG. [Figure 12B] 5C is a cutaway side view of the coupler device of FIGS. 5A and 5B in a second position. FIG. [Figure 13] 5C is a cutaway side view of the coupler device of FIGS. 5A and 5B in a third position. FIG. [Figure 14] FIG. 5C is an enlarged side view of the membrane of the coupler device of FIGS. 5A and 5B. [Figure 15] FIG. 13 is a side view of an alternative embodiment of an optical coupler. [Figure 16] FIG. 16 is a cross-sectional view of the optical coupler of FIG. 15. [Figure 17] 16 is a cross-sectional view of the optical coupler of FIG. 15, the optical coupler being attached to a representative endoscope. [Figure 18] FIG. 1 is a side view of the distal end of a representative endoscope. [Figure 19A] 1 is an isometric view of an exemplary embodiment of a coupler device for use with an end viewing scope; [Figure 19B] 1 is an isometric view of an exemplary embodiment of a coupler device for use with an end viewing scope; [Figure 20A] FIG. 19B is a partial cutaway view of the coupler device of FIG. 19A. [Figure 20B] FIG. 19C is a partial cutaway view of the coupler device of FIG. 19B. [Figure 21] FIG. 2 is a cutaway side view of the coupler device in a first position. [Figure 22] 11 is a cutaway side view of the coupler device in a second position. FIG. [Diagram 23] FIG. 13 is a cutaway side view of the coupler device in a third position. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0032] The present specification and the accompanying drawings show exemplary embodiments and should not be taken as limiting, and the claims define the scope of the present specification, including equivalents. Various mechanical, compositional, structural, and operational changes can be made without departing from the scope of the present specification and claims, including equivalents. In some cases, well-known structures and techniques have not been illustrated or described in detail so as not to obscure the present specification. Like numbers in one or more figures represent the same or similar elements. Furthermore, elements and related aspects described in detail with respect to one embodiment can be included in other embodiments where they are not specifically shown or described, whenever practical. For example, if an element is described in detail with respect to one embodiment and not described with respect to a second embodiment, it can still be asserted that the element is included in the second embodiment. Furthermore, the depictions in this specification are for illustrative purposes and do not necessarily reflect the actual shape, size, or dimensions of the system or illustrated components.

[0033] It should be noted that, as used in this specification and the appended claims, the singular forms "a," "an," and "the," as well as the use of the singular form of any word, include plural referents unless expressly and unambiguously limited to one referent. As used herein, the term "include" and grammatical variations thereof are intended to be open-ended, and the recitation of items in a list does not exclude other similar items that may be substituted for or added to the listed items.

[0034] Although the following is directed primarily to ancillary or coupler devices for use with reusable optical imaging endoscopes, it should be understood that the features of the coupler devices presently described can be readily adapted for use with a variety of reusable or disposable endoscopes, endoscopic instruments, and other devices.

[0035] The term "endoscope" as used herein generally refers to any scope used in medical applications involving the body (human or otherwise), including, for example, laparoscopes, duodenoscopes, endoscopic ultrasound scopes, arthroscopes, colonoscopes, bronchoscopes, enteroscopes, cystoscopes, laparoscopes, laryngoscopes, sigmoidoscopes, thoracoscopes, cardioscopes, and saphenous vein harvesters with scopes, whether robotic or not.

[0036] A variety of scopes are used when involved in remote visualization inside a patient's body. The scope used depends on the extent to which the physician needs to navigate inside the body, the type of surgical instruments used in the procedure, and the level of invasiveness appropriate for the type of procedure. For example, visualization inside the digestive tract may involve the use of endoscopes in the form of flexible gastroscopes and colonoscopes, endoscopic ultrasound scopes (EUS), and specialized duodenal scopes that can be many feet long and over one centimeter in diameter. These scopes can be turned and articulated or steered by the physician as they navigate inside the patient's body. Many of these scopes contain one or more working channels for passing and supporting instruments, fluid and irrigation channels for irrigating tissue and cleaning the scope, an insufflation channel for insufflation to improve navigation and visualization, and one or more light guides for illuminating the field of view of the scope.

[0037] Smaller, less flexible or rigid scopes, or a combination of flexible and rigid scopes, are also used in medical applications. For example, smaller, narrower and much shorter scopes are used to examine joints and perform arthroscopic procedures, such as shoulder or knee surgery. When a surgeon performs arthroscopic surgery to repair a torn meniscus in the knee, a shorter, more rigid scope is typically inserted through a small incision on one side of the knee to visualize the injury and then instruments are passed through an incision on the other side of the knee. The instruments irrigate the scope inside the knee to maintain visualization and allow the tissue to be manipulated to complete the repair.

[0038] Other scopes can be used for diagnosis and treatment using less invasive endoscopic procedures, examples of which include, but are not limited to, the use of scopes to examine and treat conditions of the lungs (bronchoscopes), mouth (enteroscopes), urethra (cystoscopes), abdomen and abdominal cavity (laparoscopes), nose and sinuses (laryngoscopy), anus (sigmoidoscopes), chest and thoracic cavity (thoracoscopes), and heart (cardioscopes). Additionally, robotic medical devices rely on scopes for remote visualization of the area the robotic device is evaluating and treating.

[0039] These and other scopes can be inserted through natural orifices (mouth, sinuses, ears, urethra, anus, vagina, etc.), as well as through incisions and port-based openings in a patient's skin, cavities, skull, joints, or other medically indicated entry points. Examples of diagnostic applications of endoscopy by visualization with these medical scopes include investigating symptoms of disease such as gastrointestinal disorders (e.g., nausea, vomiting, abdominal pain, gastrointestinal bleeding), or confirming a diagnosis (e.g., by performing a biopsy for anemia, bleeding, inflammation, cancer), or surgically treating disease (such as removing a ruptured appendix or cauterizing intragastric bleeding).

[0040] 1, an exemplary endoscope 100 for use with the devices described herein includes a proximal handle 112 adapted for manipulation by a surgeon or clinician coupled to an elongated shaft 114 adapted for insertion through a natural orifice or for endoscopic or percutaneous penetration into a body cavity of a patient. The endoscope 100 further includes a fluid delivery system 116 coupled to the handle 112 via a universal cord 115. The fluid delivery system 116 may include a number of different tubes coupled to an internal lumen within the shaft 114 for delivery of fluids such as water and air, suction, and other features that may be desired by the clinician to displace fluids, blood, debris, and particulate matter from the field of view. This allows for better viewing of underlying tissue or material for evaluation and treatment. In the exemplary embodiment, the fluid delivery system 116 includes a water jet connector 118, a water bottle connector 120, a suction connector 122, and an air pipe 124. The water jet connector 118 is coupled to an internal water jet lumen 126 that extends through the handle 112 and elongate shaft 114 to the distal end of the endoscope 100. Similarly, the water jet connector 118, the water bottle connector 120, the suction connector 122 and the air pipe 124 are each connected to internal lumens 128, 130, 132, 134, respectively, that extend through the shaft 114 to the distal end of the endoscope 100.

[0041] Endoscope 100 may further include a working channel (not shown) for passing instruments therethrough. The working channel allows for the passage of instruments down shaft 114 of endoscope 100 for evaluation and treatment of tissue and other material. Such instruments may include cannulas, catheters, stents and stent delivery systems, papillotomes, wires, other imaging devices including miniscopes, baskets, snares, and other devices for use with a scope within a lumen.

[0042] The proximal handle 112 may include various controls for the surgeon or clinician to operate the fluid delivery system 116. In an exemplary embodiment, the handle 112 includes a suction valve 135, and an air / water valve 136, and a biopsy valve 138 for extracting tissue samples from a patient. The handle 112 will also include an eyepiece (not shown) coupled to an image capture device (not shown), such as a lens and light transmission system. The term "image capture device" as used herein also need not refer to a device having only a lens or other light guiding structure. Instead, for example, the image capture device can be any device capable of capturing and relaying an image, including (i) a relay lens between the objective lens at the distal end of the scope and the eyepiece, (ii) an optical fiber, (iii) a charge coupled device (CCD), (iv) a complementary metal oxide semiconductor (CMOS) sensor. Also, the image capture device can simply be a chip for sensing light and generating an electrical signal for communication corresponding to the sensed light, or other technology for transmitting an image. An image capture device can have a viewing end where light is captured. In general, an image capture device can be any device that can view an object and capture an image and / or capture a video.

[0043] In some embodiments, the endoscope 100 includes some form of positioning assembly (e.g., a hand controller) attached to the proximal end of the shaft to allow the operator to steer the scope, in other embodiments the scope is part of a robotic element that provides maneuverability and positioning of the scope to a desired point, and for investigating and focusing the scope.

[0044] 2, the distal end of a side-viewing endoscope 150 (e.g., a duodenoscope or EUS) will now be described. As shown, the scope 150 includes an elongated flexible shaft 151 having a distal end 152 with a viewing region 154 and an instrument region 156, both of which face laterally or to the side of the longitudinal axis of the shaft 151. The viewing region 154 includes an air nozzle port 158, a camera lens 160, and a light source 162 for providing a view of a surgical site on a patient. The instrument region 156 includes an opening 164 coupled to a working channel (not shown) in the shaft 151 of the scope 150. The opening 164 is configured to allow passage of an instrument from the working channel of the scope 150 to the surgical site. The scope 150 also preferably includes an articulation mechanism for adjusting the angle at which the instrument passes through the opening 164. In the illustrative embodiment, the articulation mechanism includes an elevator 166, although one skilled in the art will recognize that the articulation mechanism can include a variety of other components designed to articulate the angle of the instrument, such as a cable extending through shaft 151.

[0045] The camera lens 160 may include one or more optical lenses disposed along the optical path to provide an image of an object to the distal end of the endoscope 150. At least one of the optical lenses is a fluid or liquid lens and includes one or more fluids enclosed in a chamber having substantially transparent proximal and distal surfaces that allow light to pass through the fluid(s) in the chamber. The focal length of the fluid lens may be adjusted by changing the shape or refractive index distribution of the fluid. In certain embodiments, the fluid lens is configured such that the surface profile or radius of curvature of the fluid determines the focal length of the optical lens. By changing the surface profile or radius of curvature of the fluid, the focal length of the lens may be adjusted. The surface profile of the fluid may be adjusted by applying energy directly to or through the fluid, or indirectly to other mechanisms that adjust the pressure, volume, or other properties of the fluid.

[0046] A lens system may include one or more fluid-filled or tunable lenses and one or more rigid or fixed lenses. Each of the rigid lenses provides a constant optical power, and the fluid-filled lenses can adjust their optical power to adjust the overall optical power of the lens system. Like traditional optical lenses made of glass, liquid lenses are single optical elements, but are composed of an optical liquid material that can change shape. The focal length of a glass lens is determined by its material and radius of curvature. The same basic principles apply to liquid lenses, but liquid lenses are unique in that their focal length can be changed by changing the radius of curvature or the refractive index distribution of the liquid. This change in radius of curvature is electronically controlled and can be changed rapidly, on the order of milliseconds.

[0047] 3A and 3B, one embodiment of a fluid lens 170 is described. As shown in FIG. 3A, the fluid lens 170 includes a housing 172 having proximal and distal surfaces 173, 174 that include a substantially transparent material, such as glass, clear plastic, or other suitable material that allows light to pass through. First and second fluids 175, 176 are contained together in the housing 172. The first fluid 175 preferably includes a material that changes shape upon application of energy, such as an electric current, an electromagnetic field, an electrostatic charge, or the like. The second fluid 176 preferably includes a material that does not mix with the first fluid 175 (i.e., the first and second fluids 175, 176 are immiscible), but fills any voids or spaces within the housing 172. A number of suitable fluids can be used for the first and second fluids 175, 176. In a preferred embodiment, the first fluid 175 includes water and the second fluid 176 includes a non-conductive oil.

[0048] The lens 170 further includes first and second electrodes 177, 178 coupled to leads, connectors, or other coupling elements that are arranged to mate with separate coupling elements (described in more detail below) of the detachable coupler device 10. Alternatively, the electrodes 177, 178 may be coupled to one or more connectors that extend through the shaft of the endoscope 100. In this embodiment, the focal length of the lens 170 may be controlled directly on the handle of the endoscope 170, as described in more detail below. The electrodes 177, 178 are configured to apply a voltage across the interface between the first and second fluids 175, 176. The lens 170 may further include third and fourth electrodes 179, 180 on opposite sides of the housing 172.

[0049] 3B, application of a voltage to the interface between fluids 175, 176 causes the shape and / or size of first fluid 175 to change, which causes second fluid 176 to fill the void left by the displacement of first fluid 175. The change in shape of fluid 176 changes the curvature and focal length of lens 170. Applying more voltage increases the overall curvature of second fluid 176, increasing the optical power of lens 170. Applying less voltage decreases the curvature of second fluid 176, decreasing the optical power of lens 170.

[0050] 4A and 4B, another embodiment of a fluid-filled lens 180 comprises a container 182 filled with a fluid, such as water, oil, air, or any suitable fluid that allows the passage of light. The container 182 includes a curved chamber 181 and a fluid reservoir 183. The lens 180 further includes a membrane 184 that closes and seals the container 182. An actuator (not shown) is coupled to the membrane 184 and configured to apply pressure to the membrane 184. Alternatively, the actuator can directly exert pressure on the fluid reservoir 183 or the curved chamber 181. The actuator can be driven by various energy sources known in the art, such as electric current, magnetic energy, mechanical energy, acoustic energy, and the like. When the membrane 184 exerts more pressure on the container 182, fluid is driven from the reservoir 183 into the chamber 181, which increases the curvature of the lens 180 (see FIG. 4B). When this pressure is removed, fluid is displaced from chamber 181 to reservoir 183, thereby decreasing the curvature of lens 180 (FIG. 4A).

[0051] Of course, one of ordinary skill in the art will recognize that the devices described herein can incorporate a variety of other fluid-filled or liquid lenses. For example, the shape of the fluid can be changed through other mechanisms known in the art, such as acousto-optic tuning, mechanical tuning, piezoelectric, etc. Alternatively, the fluid lens can include two or more fluids with different refractive indices. Changing the volume or shape of one of the fluids relative to the other fluids changes the focal length.

[0052] 5A and 5B show an exemplary embodiment of coupler device 10. Coupler device 10 functions as an attachment to currently existing endoscopes. The device seals and covers vulnerable areas of the scope to prevent the entry of debris, fluids, or other unwanted matter that can lead to bacterial contamination and reduced scope performance.

[0053] In a particular embodiment, coupler device 10 provides a flexible working channel for a device to be inserted into the scope. The flexible working channel is easily adjustable in angle. As shown, in a preferred embodiment, coupler device 10 can be used with a duodenoscope 40 or other side-viewing scope instrument. Of course, it is understood that coupler device 10 can also be adapted for use with end-viewing scopes. Additionally, coupler device 10 can be used with any type of scope for different medical applications. The duodenoscope 40 illustrated herein is for illustrative purposes only.

[0054] As shown in Figures 5A and 5B, the coupler device 10 can include a body 12, a proximal end 14 and a distal end 16, a lower surface 18, and an upper surface 20. The proximal end 14 is attached to and extends the working end of a duodenoscope 40. The upper surface 20 can include a lens and light guide 24 and a scope irrigator opening 28 that can be used to push fluids across the scope camera to clean debris from the camera, and can also be used to push air across the camera to dry the camera and insufflate the patient's digestive tract. The upper surface 20 can further include openings over the lens and light guide 24 and the scope irrigator opening 28 to facilitate visualization of the surgical site and to allow for the evacuation of fluids from the scope irrigator opening 28 to the surgical site (and / or the evacuation of air that can be passed over the light guide 24 to dry the camera or through the surgical site to insufflate a portion of the surgical site). Additionally, upper surface 20 includes a flexible working channel region 30 that includes a flexible working channel extension 34 that is surrounded by a flexible membrane 38 (see FIG. 14). This flexible membrane 138 acts as a protective hood or cover for the working end of coupler device 10, providing flexible articulation while sealing out debris, fluids, bacteria, or other contaminants.

[0055] As shown in Figures 6A and 6B, the duodenal scope 40 may include a light guide 44, an optical lens 46, and a washer opening 48. The optical lens 46 may include two or more lenses extending along the optical path, and preferably at least one of these lenses is an adjustable fluid-filled lens, such as those described above. The coupler device 10 cooperates with each of these components of the scope 40 to provide a fully functional scope. The coupler device 10 does not interfere with the ability of the scope to emit a clear image, but instead reduces the risk of contamination after each use. This advantage is achieved by providing a coupler device 10 that attaches to the working end component of the scope 40 and seals around the working end.

[0056] 5A, coupler device 10 further includes an actuator 79 in body 12 configured to adjust the focus of optical lens 46. The actuator may include, for example, a controller, a power source such as a battery or other suitable power source, and one or more coupling elements for operatively coupling to optical lens 46 directly or indirectly via other elements within the endoscope. The power source provides energy to optical lens 46 via the coupling elements to adjust the surface profile or curvature of the lens, thereby adjusting the focus of the lens (as described above). The controller operates to control the power source, and thereby the energy applied to the optical lens.

[0057] The coupler device allows the operator to adjust the optical lens to obtain the additional positive power correction needed to view more distant objects (i.e., to focus closer or zoom in on an object without moving the endoscope). Alternatively, the power correction can be automatic as part of a feedback control loop. Additionally, the coupler device allows the optical lens to be adjusted continuously over a desired power range. For example, the focal length of the lens can be adjusted to substantially match the distance between the distal end of the endoscope and the desired object, allowing the operator to move the endoscope closer to or farther from the object while maintaining focus.

[0058] In certain embodiments, the controller, power source, coupling element, or another connector in the actuator can be configured to automatically adjust the curvature of the lens to refocus the lens on the object as the endoscope moves within the patient. In other embodiments, the actuator can include a controller that allows an operator to manually adjust the actuator and the focal length of the optical lens when desired. The controller can be controlled from a user input on the handle of the endoscope (i.e., via a connector that extends through the endoscope to the coupler device). Alternatively, the actuator can be controlled wirelessly through a signal sent externally from the patient to the coupler device. For example, if an operator wants to magnify an object without moving the endoscope, the user input can be used to control the actuator to adjust the focus of the optical lens.

[0059] In other embodiments, the power source is located external to the coupler device and / or the patient, and power or energy for adjusting the optical lens is provided wirelessly to the actuator in the coupler device. In one such embodiment, the actuator comprises a receiver configured to wirelessly receive energy from the energy source and transmit energy to the optical lens. Alternatively, or in addition, the receiver can be configured to receive electrical signals (e.g., command inputs) from a remote source to allow an operator to control the actuator. The receiver can be located within the body or on an exterior surface of the coupler device. The energy source and / or controller can be located remotely from the coupler device, such as external to the patient. The energy can include an electromagnetic field, electromagnetic radiation, or other suitable energy that can be wirelessly transmitted from the energy source to the actuator.

[0060] The actuator in the coupler device can be configured to articulate an instrument passing through a working channel in the endoscope. In this embodiment, the actuator either directly contacts an instrument passing through the coupler device 10 or includes an articulation element positioned to articulate a curved working channel extension with the coupler device 10 (described in more detail below). The actuator can be configured to both articulate the instrument and provide energy to the optical lens. In certain embodiments, the coupler device includes two such actuators that can be powered by an energy source within the coupler device 10 or externally via wireless energy transmission.

[0061] As shown in Figures 5A and 5B, the coupler device 10 can include one or more receivers 75 coupled to actuators 79 via one or more connectors 81 on or inside the exterior surface of the body 12. The receivers 75 are preferably configured to receive energy and / or signals from a remote source, as described in more detail below. In one embodiment, the coupler device 10 includes at least two receivers located on a distal portion of the exterior surface and one or more of the side or lateral portions of the exterior surface. In other embodiments, the receivers 75 can also be located on the top and bottom of the exterior surface. Alternatively, the one or more receivers 75 can be located within the body 12.

[0062] As shown in FIG. 6A, the actuator 79 is coupled to one or more coupling elements 77. The coupling elements 77 are positioned such that when the proximal end 14 of the coupler device 10 is attached to the working end of the endoscope, the coupling elements 77 are operatively proximate to the optical lens 46. As defined herein, operatively proximate means that the coupling elements 77 are positioned to apply energy to the optical lens to change the focal length of the lens. The coupling elements 77 can be in direct contact with the lens 46, adjacent to the lens, or in direct contact with or adjacent to another coupling element or actuator within the endoscope. In the latter configuration, the coupling elements 77 function to transfer energy to the other coupling elements or actuators, thereby transferring energy to the lens 46 and / or to an actuator that changes the curvature of the lens 46.

[0063] In one embodiment, the coupling element 77 includes one or more electrodes arranged to apply a voltage, electromagnetic field, electrostatic charge, or the like to the optical lens 46 when the optical coupler device 10 is attached to the endoscope. As described above, this electrical signal changes the shape of one or more fluids within the lens 46, thereby changing its curvature and focal length. In another embodiment, the coupling element 77 includes one or more connectors or leads configured to transfer energy to the optical lens 46. The connectors can be configured to transfer the electrical signals to other connectors within the scope 100 or directly to electrodes (not shown) within the scope 100.

[0064] Next, with reference to Figures 9, 10, 11A and 11B, several embodiments for wirelessly transferring energy and / or electrical signals to an actuator in the coupler device 10 will be described. As shown in Figure 9, the energy delivery system 300 comprises a power source 302, a transmitter 304, such as an antenna, a magnetic field generator or an electric field generator or other suitable coupling device, a receiver 306 for receiving energy, and a converter 308 for converting the energy provided to the receiver 308 into another suitable form for use in changing the curvature or shape of an optical lens on an endoscope. The coupler device 10 may further include an energy storage unit (such as a capacitor) for storing the transmitted energy that can be used by the operator when desired. The receiver 306 and the converter 308 may be located together in the body 12 of the coupler device 10. Alternatively, one or more receivers 306 may be located on the outer surface 17 of the coupler device 10 and coupled to the converter 308 using a connector (not shown). The energy delivery system 300 may also include an energy generator or converter 310 for converting the energy generated by the power source 302 into a suitable form for transmission by the transmitter 304.

[0065] In one embodiment, the energy delivery system 300 includes a far-field or radiation system in which energy or power is transferred by a beam of electromagnetic radiation, such as microwave, radio frequency, laser beam, etc. The power source 302 and / or converter 310 convert the energy or power into a time-varying or oscillating electromagnetic field. The antenna 304 radiates the electromagnetic radiation to the receiver 306. There may be multiple antennas in different directions in an external control unit (not shown) to increase the coupling efficiency in different directions of the coupler device 10. The receiver 306 and / or converter 308 then convert the energy back into a suitable form, such as DC or AC current, for delivery to the optical lens.

[0066] The antenna 304 may also deliver electrical signals to actuators in the coupler device 10 to control the application of energy to the optical lens (described in more detail below). The energy delivery system 300 may further include a controller (see FIG. 11A) having a user input that allows an operator to control the transmission of power, energy and / or electrical signals to the coupler device 10.

[0067] 10 shows another embodiment of an energy delivery system 320 that uses primarily near-field or non-radiative mechanisms to transfer power or energy to the coupler device 10. The energy delivery system 320 comprises a power source 322, an oscillator 324 for converting energy into a time-varying or oscillating electromagnetic field, and one or more magnetic coils 326. The magnetic coils 326 transfer the electromagnetic field via inductive coupling to one or more magnetic coils 328 on the coupler device 10. The magnetic coils 326, 328 together form a transformer, inducing an alternating electromagnetic field voltage that produces an alternating current. The induced alternating current can drive a load with direct current or can be rectified by a rectifier 330 on the coupler device to a direct current that can be supplied to an optical lens.

[0068] In another embodiment, the magnetic coils 326, 328 can be replaced by electrodes (not shown) that transmit the electric field using capacitively coupled techniques well known in the art.

[0069] It should be understood that the methods and devices described herein are not limited to the above embodiments for wirelessly transmitting energy and / or electrical signals to coupler device 10. For example, wireless electrical signals can be transferred to coupler device 10 using radio waves (e.g., Bluetooth), acoustic energy, infrared or ultrasonic remote control, free space optical communication, electromagnetic induction, etc.

[0070] 11A and 11B, a control system 340 for controlling the actuator 350 in the coupler device 10 will now be described. As mentioned above, the actuator in the coupler device 10 can be configured to automatically refocus the optical lens as needed during the procedure, in which case the control system 340 may not be necessary. In these embodiments, the actuator 350 can include an autofocus light sensor (not shown) and a controller that evaluates a signal from the autofocus light sensor. The controller then automatically energizes the lens as needed and adjusts the focal length of the lens until the image is in focus. However, in certain embodiments, the control system 340 allows an operator to control the operation of the actuator 350 to change the focal length of the optical lens as desired, by controlling the supply of energy to the actuator 350 or by controlling the supply of energy from the actuator 350 to the optical lens.

[0071] 11A, the control system 340 can include a user interface device 342 and an external power source and transmitter 344 for transmitting signals, energy and / or power to the coupler device 10. The user interface device 342 includes one or more user controls, such as knobs, switches, dials, a touch screen, etc., to allow an operator to control the transmitter 344 and transmit signals and / or energy to the coupler device 10. In some embodiments, the user interface device 342 can simply include buttons or slide switches located on the handle 112 of the endoscope 100 (see FIG. 1) to provide a user-friendly interface for controlling the transmitter 344. In these embodiments, the interface device 342 can couple to an optical lens and / or connector that extends through the shaft of the endoscope to the coupler device.

[0072] 11B, an actuator 350 is present in or on the coupler device 10. The actuator 350 may include a receiver 352, such as an antenna, magnetic coil, electrode, etc., and a control unit 354 for controlling the application of energy to one or more coupling elements 356, such as electrodes, leads, or other connectors. As mentioned above, the coupling element 356 is positioned such that it is in operative proximity to an optical lens of the endoscope when the coupler device 10 is attached thereto. The control unit 354 may also be wirelessly coupled to the user interface device 342 or the transmitter 344 such that a user may control the application of energy to the coupling element 356.

[0073] In certain embodiments, the actuator 350 further includes an internal power source 360, such as a battery or the like, for generating energy within the actuator 350. In these embodiments, the energy source and transmitter 344 may not be necessary to operate the actuator 350. The power source 360 ​​generates energy and transfers the energy to the coupling element 356. This energy generation and transfer may be automatic (as described above) or can be controlled by an operator via the user interface device 344.

[0074] In other embodiments, actuator 350 includes only receiver 352, a converter (not shown), and coupling element 356. In these embodiments, energy is transferred to receiver 352, which automatically applies the energy to the optical lens via the converter and coupling element 356. Thus, in these embodiments, no separate controller is required for actuator 350.

[0075] As further shown in Figures 5A, 5B, 6A, 6B, 7 and 8, the coupler device 10 provides an extension of the working channel 42 of the scope. The working channel extension 34 of the coupler device 10 of Figures 5A and 5B is flexible and can contact the working channel 42 of the scope with a sealed connection at the proximal end 34a of the working channel extension, as shown in Figure 8. The distal end 34b of the working channel extension 34 serves as an exit portal for instruments to pass through the scope 40 to reach different areas of the body.

[0076] Additionally, coupler device 10 provides an additional seal around the elevator 50 of the scope. Because coupler device 10 seals elevator 40, the risk of debris ingress, fluids, bacteria and other material buildup behind the elevator and working channel is significantly reduced. Such debris, bacteria and other material ingress is believed to be the cause of drug-resistant infections with current scopes. While preventing ingress, coupler device 10 advantageously maintains flexibility for movement of working channel extension 34.

[0077] In use, the working channel extension 34 of the scope allows for the passage of devices down the scope working channel 42 and through and out of the working channel extension 34 of the device 40 for evaluation and treatment of tissue and other material. Such instruments can include cannulas, catheters, stents and stent delivery systems, papillotomes, wires, other imaging devices including miniscopes, baskets, snares, and other devices for use with the scope within a lumen. This working channel extension 34 is sufficiently flexible so that an elevator 50 of the scope 40 can raise and lower the working channel extension 34 so that instruments can be advanced down and out of the working channel extension distal end (or exit portal) 34b of the scope 40 at various angles, or the working channel extension 34 can be raised and lowered by cables or other means to articulate the working channel extension 34.

[0078] As Figures 12-14 show, during use, when the elevator 50 of the scope 40 is actuated, the flexible working channel extension 34 of the coupler device moves or adjusts in accordance with the actuation along direction AA. In Figure 12A, the elevator 50 rises slightly, pushing the working channel extension 34 to a corresponding angle and forming a hinged ramp or shoulder that shifts the exit portal or distal end 34b of the working channel extension to the left. In Figure 12B, the elevator has been raised higher than in Figure 12A, causing the distal end 34b of the working channel extension 34 to be similarly shifted further to the left as compared to Figure 12A, while Figure 13 shows the elevator 50 being raised even higher and the distal end 34b of the working channel extension 34 moved further to the left as compared to Figures 12A and 12B.

[0079] Of course, it will be appreciated that the instruments passing through the scope can be articulated by a variety of different mechanisms. For example, in some embodiments, the device can have multiple cables, which allows the angle of the exit to be articulated in multiple directions, including different quadrants, unlike current endoscope elevators, which can only deflect and reorient the instruments in a single axis, but cannot articulate laterally or to another quadrant, only up or down, due to the limited travel of the endoscope elevator. In some embodiments, the cables can be attached directly to the working channel extension or to other devices that can be articulated to change the exit angle of the working channel extension, including, for example, dowels encased in a device that is below the working channel extension but can be advanced and retracted to move the working channel extension as the cables are advanced and retracted. In some embodiments, the articulation capability of the coupler device can be created with an elevator embedded in the coupler device, which is disposable and thus discarded after the procedure.

[0080] Articulation of the coupler device can also be accomplished using cable-free elements, including, for example, piezoelectric materials, micromotors, organic semiconductors, and electrically activated polymers. In some embodiments, articulation of the coupler device can also be accomplished by force transfer to working channel extensions or embedded elevators via force-transmitting interlocking connectors, twisting wires, slidable sheaths, and temperature-transmitting shape-changing memory metals. These interlocking connectors can be powered by an energy source within the coupler device, such as a battery, or by wireless energy transmission, as described above.

[0081] In some embodiments, the device includes a power connector or motor to supply energy, including electromagnetic energy, to the device to cause a force transfer that changes the angle of exit from the coupler device as the instrument passes through the device or prior to passing the instrument through the device. This force transfer can include rotating the device as it exits the working channel extension. The device can be navigated and articulated directly by a user or as part of a robotic system where user input is translated through the system through a variety of means including cables, power connectors, motors, electromagnetic energy, slidable sheaths, haptics, computer guidance and instructional inputs, and other means to guide and direct the device to an intended location, including a particular diagnostic and treatment objective for the patient, or, in non-medical applications, a desired remote location. A more complete description of different embodiments of the coupler device can be found in commonly assigned, co-pending U.S. Application Serial No. 15,906,557, filed February 27, 2018, the complete disclosure of which is incorporated herein by reference for all purposes as if copied and pasted herein.

[0082] It will also be appreciated that the devices described herein are not limited to the particular coupler device described above. For example, coupler device 10 can be adapted for use with a scope that is cable actuated, eliminating the need for an elevator component. In this embodiment, coupler device 10 can include the same structural features described above, but further includes a disposable outer sheath (not shown) that can receive the actuation cable inside the scope. A more complete description of this design can be found in commonly assigned, co-pending U.S. Application Serial No. 15 / 746,196, filed July 21, 2016, the complete disclosure of which is incorporated herein by reference for all purposes as if copied and pasted herein.

[0083] Coupler device 10 may also include one or more locking elements configured to restrain and / or secure an instrument passed therethrough to ensure that the instrument remains in place at the target site and / or to facilitate instrument exchange. A more complete description of this design can be found in commonly assigned, co-pending U.S. Provisional Application Serial No. 63 / 007,461, filed April 9, 2020, the complete disclosure of which is incorporated herein by reference for all purposes as if copied and pasted herein.

[0084] The coupler device 10 may further include one or more sensors on the exterior surface of the coupler device body. The sensors may be configured to detect physiological parameters of tissue surrounding the exterior surface of the coupler device body. The physiological parameters may include, for example, tissue temperature, tissue dimensions, tissue depth, tissue topography, tissue biomarkers, tissue bioimpedance, temperature, PH, histological parameters, or other parameters that may be used to diagnose a medical condition. A more complete description of this design may be found in commonly assigned, co-pending U.S. Provisional Application Serial No. 63 / 003,656, filed April 1, 2020, the complete disclosure of which is incorporated herein by reference for all purposes as if copied and pasted herein.

[0085] The coupler device 10 may also include one or more optical layers configured to reduce the amount of reflected light from the surface and / or inhibit the condensation of water droplets on the visualization section, or both. By reducing glare and / or fogging of the visualization section, the surgeon's view of the target site through the optical coupler is significantly improved. A more complete description of this design can be found in commonly assigned, co-pending U.S. Provisional Application Serial No. 62 / 949,238, filed December 17, 2019, the complete disclosure of which is incorporated herein by reference for all purposes as if copied and pasted herein.

[0086] In other embodiments, the coupler device 10 can also include a closable port (i.e., self-sealing) to allow for the injection of anti-adhesive, anti-bacterial, anti-inflammatory, or other drugs or injectable substances that prevent bacterial adhesion or colonization on the scope. An applicator can be provided integrated into the coupler device 10 with a port for delivering the injectable substance. Alternatively, the applicator can be separate from the coupler device 10 and applied to the distal end of the scope 40. The injectable substances can include forms of silver, platinum, copper, other adhesion inhibitors, anti-bacterial agents, anti-inflammatory agents, or other drugs or injectable substances that are compatible with the materials of the scope and coupler device and biocompatible for patient use.

[0087] In one exemplary embodiment, the device includes an anti-infective material. In another exemplary embodiment, the device includes an anti-infective coating. In yet another embodiment, the device includes a hydrophobic coating. In yet another embodiment, the device is superhydrophobic. In yet another embodiment, the device is anti-infective and hydrophobic. In yet another embodiment, the device is anti-infective and superhydrophobic. In yet another exemplary embodiment, an anti-inflammatory coating is incorporated into the device. In other embodiments, the anti-inflammatory coating can be hydrophilic.

[0088] In one exemplary embodiment, the device 10 can include a silver ion coating. In another embodiment, the device 10 can have silver hydrogel applied, injected, or part of the device 10 in the area covering or surrounding the scope elevator. In addition to being antibacterial, silver is electrically conductive. Thus, in yet another embodiment, the device 10 can include electrical wires or other electrical transmission points to allow for the creation of an electric field across the silver ion coating to improve the silver ion coating's ability to prevent infection. In some embodiments, the electrical wires or other electrical transmission points can also be applied to other antibacterial and electrically conductive materials, including platinum and copper.

[0089] 15-17, an alternative embodiment of an optical coupler 200 is shown. The optical coupler 200 includes a visualization section 212 at a distal end 213 of the optical coupler 200. The visualization section 212 has a generally slightly curved, convex outer surface 214 that extends from a first outer boundary 215 to a second, opposing outer boundary 216 of the optical coupler 200. The outer surface 214 can be configured to be generally flat, but a curved outer surface 214 is preferred because the curvature helps to clear the field of view by forcing fluids or substances from the center of the outer surface 214 to the outer boundaries 215, 216. A flat outer surface 214 can be more difficult to clear because pressure is equal across the contact area and fluids can become trapped between the lens and the surface on which it is desired to observe or work. The curved outer surface 214 is also preferred to compensate for curvature distortions caused by objects that may be used with the coupler 200.

[0090] The optical coupler 200 has a proximal face 218 from which a hollow instrument channel 219 extends toward the exterior surface 214. The hollow instrument channel 219 may be configured such that the channel 219 does not extend completely through the visualization section 212 to the exterior surface 214. In such a case, a barrier 220 of material is provided between a distal end 221 of the hollow instrument channel 219 and the exterior surface 214 of the optical coupler 200. Alternatively, the instrument channel 219 may extend the entire length of the visualization section 212 and through the optical coupler 200. Such a configuration may allow for free and unhindered exchange of instruments. The proximal end of the endoscope instrument channel 219 may employ a watertight seal or valve, such as a Tuohy-Borst type valve, to prevent or minimize the flow of air, fluid, and / or foreign objects through the instrument channel 219.

[0091] Although the optical coupler 200 in Figures 15-17 is shown with an instrument channel 219, the visualization section 212 can be constructed without an instrument channel 219. In such a case, the visualization section 212 can be constructed of a material that is self-sealing and elastic enough to allow an instrument to be passed through the entire length of the visualization section 212 of the optical coupler 200, such that an instrument can be passed directly through the visualization section 212. An example of an optical coupler 200 without an instrument channel 219 is described in U.S. Patent No. 8,905,921 to Titus, the entire disclosure of which is incorporated herein by reference in its entirety for all purposes.

[0092] The optical coupler 200 also includes a mounting portion 222 connected to and extending away from the visualization section 212. The mounting portion 222 is at a proximal end 223 of the optical coupler 200. The proximal end 223 of the optical coupler may be angled to reduce the likelihood of the optical coupler 200 becoming caught on any surface when the optical coupler 200 is removed from its environment of use. In the illustrated embodiment, the mounting section 222 is in the form of a cylindrical wall 224. The proximal face 218 of the optical coupler 200 and the cylindrical wall 224 define a hollow cylindrical opening 225 of the optical coupler 200 within the sleeve-like cylindrical wall 224.

[0093] The optical coupler 200 further includes an actuator 280 configured to adjust the focus of an optical lens within the endoscope. As with the above embodiments, the actuator may include, for example, a controller, a power source, such as a battery or other suitable power source, and one or more coupling elements for coupling directly to the optical lens or indirectly via another element within the endoscope. The power source provides energy to the optical lens via the coupling elements (as described above) to adjust the surface profile or curvature of the lens, thereby adjusting the focus of the lens.

[0094] In certain embodiments, the power source, coupling element, or another connector in the actuator can be configured to automatically adjust the curvature of the lens to refocus on the object as the endoscope moves within the patient. In other embodiments, the actuator can include a controller wirelessly linked to a user input so that an operator can manually adjust the actuator when desired. For example, if an operator wishes to magnify an object without moving the endoscope, the user input can be used to control the actuator and adjust the focus of the optical lens. The controller can be controlled through wireless command capabilities or wireless supply of energy, as described in more detail below. In other embodiments, the power source can be external to the coupler device 10, and power or energy to operate the actuator is wirelessly supplied to the optical coupler 10, as described in more detail below.

[0095] In certain embodiments, the optical coupler 200 further includes one or more receivers 275 on or within the visualization section 212 and / or mounting portion 222. The receiver 275 is preferably configured to receive energy and / or command input from a remote source, as described above. The receiver 275 is coupled to an actuator 280, which is in turn coupled to one or more coupling elements 285. The coupling element 285 is positioned such that the coupling element 285 is in operative proximity to the optical lens 240 when the mounting portion 222 of the optical coupler 200 is attached to the working end of the endoscope. As defined herein, operative proximity means that the coupling element 285 is positioned to apply energy to the optical lens to change the curvature of the lens. The coupling element 285 can be in direct contact with the lens, adjacent to the lens, or in direct contact with or adjacent to another coupling element or actuator within the endoscope. In the latter configuration, coupling element 285 transfers energy to other coupling elements or actuators, which function to transfer energy to actuators that change the curvature of lens 46 and / or lens 240.

[0096] In one embodiment, coupling element 285 includes one or more electrodes arranged to apply a voltage or electrostatic charge to optical lens 240. As described above, this voltage or charge changes the shape of one or more fluids within lens 240, thereby changing its curvature. In another embodiment, coupling element 285 includes one or more connectors or leads configured to transfer energy to optical lens 240.

[0097] The optical coupler 200 may further include an ultrasound transducer or sensor (not shown) mounted on either the mounting portion 222 or the visualization section 212. The ultrasound transducer may be a transmitter, receiver or transceiver. An electrical signal may be transmitted to the ultrasound transducer via a connector that extends through the endoscope or wirelessly through the patient's body. The transducer measures the time between transmitting the sound signal and receiving an echo of the sound signal and calculates the distance between them. This data may be collected by a processor coupled to the endoscope or wirelessly directly in the optical coupler 200 to measure tissue depth and create a three-dimensional representation of the target area within the patient.

[0098] The optical coupler 200, or endoscope, may also include a laser or other optical transmitter (not shown) for transmitting ultraviolet, visible, and / or infrared light to the target tissue. In this embodiment, the sensor 275 is configured to detect the reflected light (i.e., the return time and / or wavelength of the light) and transmit a signal related to the reflected light to a processor. This data can be used to create a three-dimensional representation of the target tissue.

[0099] 17, the optical coupler 200 can be attached to an endoscope 230. The endoscope 230 has a distal end 231 that is inserted into the hollow cylindrical opening 225 of the optical coupler 200. In one embodiment, the cylindrical wall 224 of the coupler 200 has a diameter that is 1-3 millimeters larger than the endoscope 230. The endoscope 230 has a sheath 232 with an outer surface 233 that snugly engages the cylindrical wall 224 of the optical coupler 200. In a non-limiting example, the sheath 232 has an outer diameter of 7-15 millimeters. The end face 234 of the endoscope 230 sealingly engages the proximal face 218 of the optical coupler 200.

[0100] Endoscope 230 includes a first lumen 235, a second lumen 236, and a third lumen 237 that extend from end face 234 of endoscope 230 to a proximal end of the endoscope (not shown). The inner diameter of the lumens is typically 2-4 millimeters. A light guide 239 is disposed within first lumen 235 for transmitting light toward a surface area at or beyond outer surface 214 of optical coupler 200.

[0101] An objective lens 240 is disposed at a distal end of an image-bearing fiber 242, and the lens 240 is optically connected to the image-bearing fiber 242 for receiving light reflected from the surface area being viewed. The objective lens 240 and the image-bearing fiber 242 are disposed within the second lumen 236. As mentioned above, the lens 240 preferably comprises a fluid lens that is adjustable by application of energy from an actuator 280.

[0102] The third lumen 237 aligns with the hollow instrument channel 219 of the optical coupler 200 when the optical coupler 200 is attached to the endoscope 230. In the illustrated embodiment, the instrument channel 219 and the third lumen 237 have the same sized inner diameter within a tolerance of ±5%. The optical coupler 20 may also include a light emitting diode (LED) 211 near the outer surface 214 of the coupler to provide illumination before the coupler contacts a fluid, tissue or structure. The LED 211 may be powered via wires (not shown) within the endoscope 230 or from an external source.

[0103] The design of length D of optical coupler 200 must also take into account the properties of the material that makes up coupler 200, such as possible compression of coupler 200 when held against a surface. For example, if coupler 200 may be compressed by 1 millimeter when held against a surface, and endoscope 230 has a minimum depth of field distance range of 2 millimeters, then length D should be 3 millimeters or greater to compensate for this possible compression.

[0104] The optical coupler 200 can be formed from a variety of materials. In one version of the optical coupler 200, the optical coupler 200 is molded from a material selected from silicone gel, silicone elastomer, epoxy, polyurethane, and mixtures thereof. The silicone gel can be a lightly cross-linked polysiloxane (e.g., polydimethylsiloxane) fluid, where cross-linking is introduced via a multifunctional silane. The silicone elastomer can be a cross-linked fluid. Silicone elastomers have a much more complex three-dimensional structure than gels because there is little free fluid in the matrix. In another version of the optical coupler 200, the material is selected from hydrogels such as polyvinyl alcohol, poly(hydroxyethyl methacrylate), polyethylene glycol, poly(methacrylic acid), and mixtures thereof. The material of the optical coupler 200 can also be selected from albumin-based gel, mineral oil-based gel, polyisoprene, or polybutadiene. Preferably, the material is viscoelastic.

[0105] 15-17, in optical coupler 200, the material is optically transparent such that light guide 239 can transmit light through optical coupler 200 toward a surface area at or beyond outer surface 214 of optical coupler 200, and such that optical coupler 200 can transmit an optical image of the surface area being viewed back to lens 240. In one version of optical coupler 200, the material has an optical transmission greater than 80% based on test standard ASTM D-1003 (Standard Test Method for Haze and Optical Transmission of Transparent Plastics). In another version of optical coupler 200, the material has an optical transmission greater than 90% based on test standard ASTM D-1003. In another version of optical coupler 200, the material has an optical transmission greater than 95% based on test standard ASTM D-1003. In another version of optical coupler 200, the material has an optical transmission greater than 98% based on test standard ASTM D-1003. Preferably, the material has an optical absorption of less than 0.1% in the visible light range, and more preferably, the material has an optical absorption of less than 0.01% in the visible light range. The material has a refractive index of about 1.3 to about 1.7, and preferably the refractive index of the material matches or is as low as possible to the refractive index of the light guide 39.

[0106] The optical coupler 200 can also be coated with different materials to reduce adhesion. Additionally, some coatings on the optical coupler 200 improve light reflection, as discussed above. Sample coatings that can be used on the optical coupler include p-xylylene-based thermoplastic film polymers such as Parylene C, which is an optically clear, biocompatible polymer that is abrasion resistant and hydrophobic.

[0107] Optical coupler 200 can have a variety of other configurations and features, a more complete description of which can be found in U.S. Patent No. 8,905,921 to Titus, the complete disclosure of which has been previously incorporated by reference herein as if copied and pasted into this specification.

[0108] 18, the distal end of a forward or end viewing endoscope 400 (e.g., a colonoscope) will be described. As shown, the scope 400 includes an elongated flexible shaft 402 having a distal end 404 with a viewing region 406 and an instrument region 408, both of which face forward or distal to the longitudinal axis of the shaft 402. The viewing region 406 includes a fluid port 410, a camera lens 412, and a light source 414 for providing a view of a surgical site on a patient. As with the previous embodiment, the lens 412 can include one or more fluid-filled adjustable lenses and one or more rigid or fixed lenses. The instrument region 408 includes an opening 420 coupled to a working channel (not shown) in the shaft 402 of the scope 400. The opening 420 is configured to allow passage of an instrument 422 from the working channel of the scope 400 to the surgical site. The scope 400 also preferably includes an articulation mechanism for adjusting the angle at which the instrument passes through the opening 420. In the illustrative embodiment, the articulation mechanism includes a cable (not shown) extending through shaft 402, although one skilled in the art will recognize that the articulation mechanism can include a variety of other components designed to articulate the angle of the instrument, such as an elevator, etc.

[0109] 19A and 19B show an exemplary embodiment of a coupler device 450. The coupler device 450 functions as an accessory component of currently existing endoscopes. The device seals and covers the areas of the scope that are prone to infection, preventing the ingress of debris, fluids, or other unwanted matter that may lead to bacterial contamination and poor performance of the scope. Additionally, the coupler device 450 provides a flexible working channel for devices to be inserted into the scope. The flexible working channel is easily adjustable in angle. As shown, in a preferred embodiment, the coupler device 450 can be used with the end viewing scope 400 or other end viewing scope instruments. Of course, it is understood that the coupler device 450 can also be adapted for use with a side viewing scope, such as a duodenoscope. Additionally, the coupler device 450 can be used with any type of scope for various medical applications. The end viewing scope 400 shown here is for illustrative purposes only.

[0110] 19A and 19B, coupler device 450 can include a body 452 having a proximal end 454 and a distal end 456, and an exterior surface 458 surrounding body 452. Proximal end 454 attaches to and extends the working end of end viewing scope 400. Distal end 456 can include an optical lens 465 and a light guide 464, as well as a scope irrigator opening 468, which is used to push fluid across the scope camera to clean and remove debris from the camera, and also to push air across the camera to dry the camera and to insufflate the patient's digestive tract. Distal end 456 can further include an opening 462 substantially aligned with lens 465 and light guide 464, and a scope irrigator opening 468 to facilitate viewing of the anterior or distal portion of the surgical site and to allow for the evacuation of fluids through the scope irrigator opening 468 and into the surgical site (and / or the evacuation of air that can be passed over the light guide 464 to dry the camera or through the surgical site to insufflate the distal portion of the surgical site).

[0111] 29A and 20B, coupler device 450 further comprises a flexible working channel extension 474 having a proximal end 474a configured to attach to the working channel of scope 400, and an open distal end 474b. The open distal end 474b of working channel extension 474 is surrounded by a flexible membrane 478. This flexible membrane 478 acts as a protective hood or cover for the working end of coupler device 450, providing flexible articulation while sealing out debris, fluids, bacteria, or other unwanted matter.

[0112] The coupler device 450 includes one or more receivers 475 on or within the exterior of the body 452. The receivers 475 are preferably configured to receive energy and / or electrical signals from a remote source, as described above. As shown in FIG. 20B, the coupler device 450 can include an actuator (not shown) within the body 452 configured to adjust the focus of the optical lens 465. The actuator can include, for example, a controller, a power source, such as a battery or other suitable power source, and one or more coupling elements for coupling directly to the optical lens 465 or indirectly via another element within the endoscope. The power source provides energy to the optical lens 465 via the coupling elements to adjust the surface profile or curvature of the lens, thereby adjusting the focus of the lens.

[0113] As shown in Figures 20A and 20B, the receiver(s) 475 are coupled to one or more coupling elements 480. The coupling elements 480 are positioned such that when the proximal end 454 of the coupler device 450 is attached to the working end of the endoscope, the coupling elements 480 are operatively proximate to the optical lens 465. As defined herein, operatively proximate means that the coupling elements 480 are positioned to apply energy to the optical lens to change the curvature of the lens. The coupling elements 480 can be in direct contact with the lens, adjacent to the lens, or in direct contact with or adjacent to another coupling element or actuator within the endoscope. In the latter configuration, the coupling elements 480 transfer energy to the other coupling elements or actuators, which function to transfer energy to the lens 465 and / or to an actuator that changes the curvature of the lens 465.

[0114] As shown in FIGS. 20A and 20B, the end viewing scope 400 can include a light guide 464, a lens 465, and a washer opening 468. The coupler device 450 cooperates with each of these components of the scope 400 to provide a fully functional scope. The coupler device 450 does not impede the scope's ability to project a clear image, but instead reduces the risk of contamination after each use. This advantage is achieved by providing a coupler device 450 that attaches to the working end piece of the scope 400 and seals around the working end. The coupler vice 450 provides a working channel extension for the scope. The working channel extension 474 of the coupler device 450 of FIG. 20 is flexible and at the proximal end 474a of the working channel extension, it can contact the working channel of the scope by a sealed connection, as shown in FIG. 22B. The distal end 474b of the working channel extension 474 serves as an exit portal for instruments to pass through the scope 400 to reach different areas of the body.

[0115] Additionally, coupler device 400 provides an additional seal around cable 492 of scope 400 (see FIG. 21). Because coupler device 450 seals cable 492, the risk of debris ingress, fluids, bacteria and other material buildup behind the elevator and working channel is significantly reduced. Such debris, bacteria and other material ingress is believed to be a cause of drug-resistant infections with current scopes. While preventing ingress, coupler device 450 advantageously maintains flexibility for movement of working channel extension 474.

[0116] In use, the working channel extension 474 of the scope allows for the passage of devices down the scope working channel 490 and through and out of the working channel extension 474 of the device 450 for evaluation and treatment of tissue and other material. Such instruments can include cannulas, catheters, stents and stent delivery systems, papillotomes, wires, other imaging devices including miniscopes, baskets, snares and other devices for use with the scope within a lumen. This working channel extension 474 is sufficiently flexible so that instruments can be advanced from the working channel extension distal end (or exit portal) 474b of the coupler 450 at a variety of angles transverse to the longitudinal axis of the scope 400 as the cable 492 of the scope 400 can be moved down and through the working channel extension 474.

[0117] 21-23, coupler device 450 includes a disposable outer sheath 494 that can receive a scope's internal actuator cable 492. This cable 492 can be attached to a flexible working channel extension 474 of coupler device 450. Actuation of the cable affects movement of working channel extension 474, as described below. Outer sheath 494 can be configured to attach directly to scope 400, either by wrapping it around the outside of the scope or by a friction fit connection. In embodiments, multiple cables can be included in one or more sheaths to provide articulation in other quadrants than the single axis articulation using elevators in current duodenoscopes.

[0118] As Figures 21-23 show, in use, when the cable 492 of the scope 400 is actuated, the flexible working channel extension 474 of the coupler device moves or adjusts in response to the actuator, either upwards or downwards, such that devices exiting the working channel extension 474 exit at a transverse angle relative to the longitudinal axis of the scope 400. In Figure 21, the cable 492 is relaxed, allowing the working channel extension 474 to extend substantially parallel to the longitudinal axis of the scope 400. In Figure 22, the cable 492 has been withdrawn proximally such that the working channel extension 474 is elevated and the distal end 474b of the working channel extension 474 is pointed upwards. In this orientation, instruments exit the working channel extension 474 in a direction slightly upwards (relative to the drawing) from the longitudinal axis of the scope 400. FIG. 23 shows cable 492 being advanced distally to enable working channel extension 474 to be translated downward (relative to the drawing) so that instruments extend downward from distal end 474b.

[0119] Of course, it will be appreciated that other configurations are possible. For example, the scope 400 can have two cables 492, each cable disposed on either side of the working channel extension 474. In this embodiment, for example, proximal translatable movement of the upper cable will cause the working channel extension 474 to point up or above the longitudinal axis of the scope 400. Similarly, proximal movement of the lower cable will cause the working channel extension 474 to point down or below the longitudinal axis of the scope 400. In other embodiments, the scope cables can be configured to pull the working channel extension 474 left or right (relative to the drawing). In this manner, the working channel extension 474 can be oriented at any angle of 360 degrees around the longitudinal axis of the scope 400. In some embodiments, the cable(s) are attached directly to the working channel extension or to another device that is articulatable to change the exit angle of the working channel extension. In some embodiments, the articulation capability of the coupler device can be created using an actuator embedded in the coupler device that is disposable and thus discarded after the procedure. A more complete description of alternative coupler devices can be found in commonly assigned, co-pending U.S. Application Serial No. 16 / 717,804, filed December 17, 2019, the complete disclosure of which is incorporated herein by reference for all purposes as if copied and pasted herein.

[0120] All issued patents, published patent applications, and non-patent literature references mentioned in this specification are hereby incorporated by reference in their entirety for all purposes to the same extent as if each individual issued patent, published patent application, or non-patent literature was specifically and individually indicated to be incorporated by reference.

[0121] Other embodiments will be apparent to those skilled in the art from consideration of the specification and practice of the embodiments disclosed herein. It is intended that the specification and examples be considered as exemplary only, with a true scope and spirit of the embodiments being indicated by the following claims. [Explanation of symbols]

[0122] 10 Coupler Device 40 Duodenal Scope 12 Main unit 14 Proximal end 16 Distal end 18 Bottom side 20 Top side 24 Lenses and light guides 28 Scope Irrigator Opening 38 Flexible membrane 34 Flexible Working Channel Extension 30 Flexible Working Channel Region

Claims

1. 1. A device for use with an endoscope having an optical lens, comprising: a body including a visualization section for enabling viewing of tissue by the endoscope and a proximal end configured to be removably attached to a distal end of the endoscope; an actuator within the body disposed in operative proximity to the optical lens when the proximal end of the body is attached to the distal end of the endoscope, the actuator being configured to change a characteristic of the optical lens; and A device comprising:

2. 19. The device of claim 1, 17 or 18, wherein the actuator is configured to vary a focal length of the optical lens.

3. The device of claim 2 , wherein the actuator is configured to change a curvature of the optical lens.

4. 20. The device of claim 1, 17 or 18, wherein the actuator includes a receiver configured to wirelessly receive energy from an energy source and transmit the energy to the optical lens.

5. 19. The device of any one of claims 1, 17, or 18, wherein the actuator includes a power source and a coupling element coupled to the power source, the coupling element configured to transfer energy from the power source to the optical lens when the proximal end of the body is attached to the distal end of the endoscope.

6. The device of claim 3 , wherein the optical lens comprises a fluid, and the actuator is configured to change a shape of the fluid to change a curvature of the optical lens.

7. The device of claim 6 , wherein the actuator is configured to vary a pressure of the fluid.

8. The device of claim 6 , wherein the actuator is configured to change a volume of the fluid within the optical lens.

9. The device of claim 6 , wherein the actuator is configured to supply electrical energy to the fluid.

10. 10. The device of claim 9, wherein the actuator further comprises one or more electrodes coupled to the receiver and configured to contact the optical lens when the proximal end is attached to the distal end of the endoscope.

11. The device of claim 10 , wherein the receiver is configured to convert the energy into an electrical current and apply the current to the electrodes.

12. The device of claim 4 , wherein the energy comprises an electromagnetic field.

13. The device of claim 12 , wherein the receiver comprises a magnetic coil.

14. The device of claim 12 , wherein the receiver comprises an electrode.

15. The device of claim 4 , wherein the energy comprises electromagnetic radiation.

16. The device of claim 15 , wherein the receiver comprises an antenna.

17. 1. An endoscopy system comprising: an endoscope including an elongate shaft having a proximal end and a distal end and an optical lens disposed at the distal end of the shaft; A coupler device; Equipped with The coupler device comprises: a body including a visualization section for enabling viewing of tissue with the endoscope and a proximal end configured to be removably attached to the distal end of the endoscope; an actuator within the body operatively coupled to the optical lens and configured to change a property of the optical lens; 23. An endoscope system comprising:

18. 1. A device for use with an endoscope having an optical lens and a working channel, comprising: a body including a visualization section for enabling viewing of tissue with the endoscope and a proximal end configured to be removably attached to a distal end of the endoscope; an actuator within the body disposed in operative proximity to the optical lens when the proximal end of the body is attached to the distal end of the endoscope, the actuator being configured to change a characteristic of the optical lens; and Equipped with The device, wherein the actuator is configured to articulate an instrument passing through the working channel of the endoscope.

19. 20. The device of claim 18, wherein the actuator is configured to wirelessly receive energy from an energy source.

20. 20. The device of claim 18, wherein the actuator includes a power source and one or more coupling elements coupled to the power source, the coupling elements positioned such that they are in operative proximity to the optical lens when the proximal end of the body is attached to the distal end of the endoscope.

21. 20. The device of claim 18, further comprising a flexible working channel extension within the body, the flexible working channel having an open distal end and a proximal end configured to couple with a distal end of the working channel of the endoscope.

22. 22. The device of claim 21, wherein the actuator is configured to articulate the flexible working channel extension to change the angle of the open distal end relative to the coupler device.

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