Endoscope accessory control unit and method of use

Abstract

The medical device includes a handle including a first slot, a first control device movable within the first slot in a proximal and distal direction, and a sheath extending from the handle and having a longitudinal axis, the sheath defining a first lumen extending from the handle to a distal end of the sheath. A first tube extends within the first lumen, the first tube coupled to the first control device and movable between a first position where a distal-most end of the first tube is flush with or proximal to the distal-most end of the sheath, and a second position where the distal-most end of the first tube is positioned distal to the distal-most end of the sheath. The first slot extends parallel to the longitudinal direction of the sheath.

Description

[Technical field]

[0001] The present disclosure relates generally to endoscopic medical devices and related methods of use. More specifically, in some embodiments, the present disclosure relates to the use of one or more accessory devices or medical instruments with an endoscope, and independent articulation of a distal end of each of the endoscope and the one or more accessory devices or medical instruments. [Background technology]

[0002] Medical tools for accessing a target site within the body may be advanced through one or more lumens of the endoscope and may extend from its distal end to manipulate the target site. Shortcomings of these endoscopic systems include, for example, limited accessibility and maneuverability of tools protruding from the distal end of the endoscope. For example, in many endoscopes, medical tools extend from one or more openings in the distal end face of the endoscope, limiting the accessibility and maneuverability of these medical tools in a direction perpendicular to the distal end face. This may create difficulties in cutting and removing tissue from a target site or performing other treatments. Additionally, multiple users (e.g., a physician and one or more technicians) may be required to operate multiple tools and / or accessories of an endoscopic device. This may increase the number of people in a medical operating room, thereby increasing the risk of accidents, infections, or other complications. The present disclosure may solve one or more of these or other problems in the art. However, the scope of the present disclosure is defined by the appended claims, not the ability to solve a particular problem. Summary of the Invention

[0003] According to one aspect, a medical device includes a handle including a first slot, a first control device configured to move proximally and distally within the first slot, a sheath extending from the handle and having a longitudinal axis, the sheath defining a first lumen extending from the handle to a distal end of the sheath, and a first tube extending within the first lumen, the first tube coupled to the first control device and configured to move between a first position where a distal-most end of the first tube is flush with or proximal to the distal-most end of the sheath and a second position where the distal-most end of the first tube is positioned distal to the distal-most end of the sheath, the first slot extending parallel to the longitudinal direction of the sheath.

[0004] The first tube may be configured to move between a first position and a second position when the first control device moves distally from the proximal end of the first slot. The first control may include a locking mechanism configured to prevent movement of the first control and maintain a position of the first control relative to the handle in the proximal and distal directions.

[0005] The locking mechanism may include an annular ring extending radially outward from the first tube, the annular ring may contact a portion of the handle and increase a frictional force between the handle and the first tube, and the first control device may be configured to move within the first slot when sufficient force is applied to the first control device to overcome the frictional force of the annular ring.

[0006] The first control may include a joystick, and movement of the joystick may be configured to bend the distal end of the first tube at an angle relative to a longitudinal axis of the sheath.

[0007] The device may further include at least three articulation wires extending from the joystick to a distal end of the first tube, and a distal end of each of the at least three articulation wires may be attached to the first tube.

[0008] The first tube may include an articulation wire lumen corresponding to each of the at least three articulation wires, and each of the at least three articulation wires may extend within a corresponding articulation wire lumen.

[0009] The first tube may include a tube lumen, and the apparatus may further include a medical instrument configured to be inserted into the tube lumen, and a distal-most end of the medical instrument may be configured to extend distally of the distal-most end of the sheath.

[0010] The device may further include a rotatable locking mechanism at a proximal end of the tube lumen, the rotatable locking mechanism may be configured to fluidly seal the medical instrument within the tube lumen when the rotatable locking mechanism is in a locked position, and the medical instrument may be configured to move within the tube lumen when the rotatable locking mechanism is in an unlocked position.

[0011] The medical instrument may include a tool at its distal end, and the apparatus may further include an actuator configured to actuate the medical instrument. The tool may include a number of jaws connected by a hinge, and the actuator may include a foot pedal, and the number of jaws may be configured to move from an open position to a closed position when the foot pedal is depressed, and the number of jaws may be configured to move from the closed position to the open position when the foot pedal is released.

[0012] The device may further include a second lumen within the sheath and extending from the handle to a distal end of the sheath, and a second tube extending within the second lumen, the second tube being configured to move between a first position in which a distal-most end of the second tube may be flush with or proximal to the distal-most end of the sheath, and a second position in which the distal-most end of the second tube is positioned distal to the distal-most end of the sheath.

[0013] The device may further include a second slot and a second control configured to move within the second slot, and the second control may include a second joystick configured to bend the distal end of the second tube.

[0014] The first and second controllers may be configured to move independently of one another, and the first and second tubes may be configured to bend independently of one another.

[0015] The handle may include a first handle actuator and a second handle actuator configured to deflect a portion of the sheath. According to another aspect, a medical device includes a handle, a first control device and a second control device, a sheath extending from the handle and having a longitudinal axis, the sheath defining a first lumen and a second lumen, a first tube extending from the first control device into the first lumen, and a second tube extending from the second control device into the second lumen, the first control device configured to bend a portion of the first tube, the second control device configured to bend a portion of the second tube, and the first tube and the second tube configured to bend independently of one another.

[0016] The device may further include a first locking mechanism on the first control device and a second locking mechanism on the second control device, and the first locking mechanism and the second locking mechanism may be configured to prevent movement of the first control device and the second control device relative to the handle.

[0017] The first control device and the second control device may be configured to move longitudinally relative to the handle, and the first control device may be configured to move independently of the second control device.

[0018] According to yet another aspect, the method may include inserting a shaft of an insertion device into the body through the opening; advancing the insertion device so that a distal end of the insertion device is adjacent to the target site; deploying a first tube from the shaft of the insertion device through the opening at the distal end of the first lumen; advancing a first medical instrument through the lumen of the first tube and out the opening at the distal end of the first tube; and bending a portion of the first tube extending from the shaft at an angle relative to a longitudinal axis of the shaft.

[0019] The method may further include deploying a second tube from the shaft of the insertion device through an opening in a second lumen of the shaft, advancing a second medical instrument through the lumen of the first tube and out an opening in the distal end of the second first tube, and bending a portion of the second tube extending from the shaft at an angle relative to a longitudinal axis of the shaft, where bending the first tube may include actuating a first joystick attached to a handle extending from a proximal end of the shaft and bending the second tube may include actuating a second joystick attached to the handle, and the first tube and second tube may be configured to bend independently of one another. [Brief description of the drawings]

[0020] The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate various exemplary embodiments and, together with the description, serve to explain the principles of the disclosed embodiments. [Figure 1] 1 is a schematic diagram of a medical system according to one embodiment. [Diagram 2] FIG. 2 is a schematic diagram of the endoscopic system of FIG. 1, in accordance with one embodiment. [Diagram 3] 3 is a proximal end of the endoscopic system of FIG. 2 according to one embodiment. [Figure 4] 3 is a distal end of the endoscopic system of FIG. 2 according to one embodiment. [Figure 5A] 3 is a proximal end of the endoscopic system of FIG. 2 according to one embodiment. [Figure 5B] 3 is a diagram of the distal end of the endoscopic system of FIG. 2 in accordance with one embodiment. [Figure 5C] 3 is a diagram of the distal end of the endoscopic system of FIG. 2 in accordance with one embodiment. [Figure 5D] 2 illustrates an actuator of the medical system of FIG. 1 according to one embodiment. [Figure 5E] 3 is a diagram of the distal end of the endoscopic system of FIG. 2 in accordance with one embodiment. [Figure 5F] 3 is a diagram of the distal end of the endoscopic system of FIG. 2 in accordance with one embodiment. [Figure 6] FIG. 6 is a cross-sectional view taken along line 6-6 of FIG. 2, according to one embodiment. [Figure 7] FIG. 3 is a side view of a handle of the endoscopic system of FIG. 2 in accordance with one embodiment. [Figure 8] 3 illustrates a control device for the endoscopic system of FIG. 2 in accordance with one embodiment. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0021] The present disclosure is described with reference to exemplary medical systems and medical tools for accessing a target site, for example, from various directions and / or various angles at the distal end of an endoscope. This may provide improved medical tool functionality and / or assist medical professionals in gaining improved access to a target site to perform a medical procedure. However, it should be noted that reference to any particular device and / or any particular procedure is provided for convenience only and is not intended to limit the present disclosure. Those skilled in the art will recognize that the concepts underlying the disclosed devices and application methods may be utilized in any suitable procedure, medical or otherwise. The present disclosure can be understood with reference to the following description and the accompanying drawings, in which like elements are referred to with the same reference numerals.

[0022] For ease of description, portions of the disclosed devices and / or their components are referred to as proximal and distal portions. It should be noted that the term "proximal" is intended to refer to the portion of the device closer to the user, and the term "distal" is used herein to refer to the portion further from the user. Similarly, extending "distally" indicates that the component extends in a distal direction, and extending "proximally" indicates that the component extends in a proximal direction. Furthermore, as used herein, the terms "about," "approximately," and "substantially" indicate a range of values ​​within + / - 10% of the stated or implied value. Furthermore, terms indicating the geometry of components / surfaces refer to exact and approximate shapes.

[0023] Referring to FIG. 1, a medical system 10 according to one embodiment is shown. The medical system 10 may include a patient table 20 for supporting a patient 1000 (or a part of the patient 1000, e.g., a leg, an arm, etc.), a table 30 (or other support device) for supporting one or more actuators 30a, 30b, and a support device 40 that can support an endoscopic system 100 (e.g., an insertion device). The actuators 30a, 30b may receive one or more medical devices that can be delivered to a target site in the patient 1000, for example, via the endoscopic system 100, as described herein. A user 1100 may operate the endoscopic system 100, including actuators 40a, 40b (e.g., foot pedals that may be wireless or wired (wires not shown)), to actuate the actuators 30a, 30b and one or more portions of the endoscopic system 100, as described herein.

[0024] As shown in Fig. 2, the endoscopic system 100 includes a handle 110. The handle 110 may be supported by the support apparatus 40 of Fig. 1 via a clip, a strap (not shown), a screw (not shown) attached to a threaded member in the handle 110, or any other attachment mechanism. Although the support apparatus 40 is shown as a three-legged support member (e.g., a tripod), the support apparatus 40 may be a four-legged support member (such as a table) or any other support apparatus having any number of legs. The support apparatus 40 may support the handle 110 in a fixed manner relative to the patient 1000 and / or the table 20 to enable the user 1100 to perform one or more medical procedures on the patient 1000 as described herein.

[0025] Continuing to refer to FIG. 1, the actuators 30a, 30b may be supported on the table 30. Although two actuators 30a, 30b are shown, any number of actuators may be provided. The actuator 30a may receive a handle 150a of a first medical instrument 150 shown in FIG. 2, and the actuator 30b may receive a handle 150b of a second medical instrument 152 shown in FIG. 2. As described herein, the actuators 30a, 30b may be actuated to actuate the first medical instrument 150 and / or the second medical instrument 152 (e.g., one or more tools or end effectors at a distal end of the first medical instrument 150 and / or the second medical instrument 152). Although the actuators 30a, 30b are supported by the table 30, it will be understood that the actuators 30a, 30b may be attached to or supported by any other device of the medical system 10, including the support device 40, the patient table 20, etc.

[0026] 2, endoscopic system 100 may include a handle 110, a shaft 120 (e.g., a catheter) coupled to a distal end of handle 110, and a distal end effector 180 at the distal end of shaft 120. Shaft 120 may be flexible and formed from any medical grade material suitable for accessing tortuous pathways within the body, although the stiffness / flexibility of shaft 120 is not limited. Endoscopic system 100 may be an endoscope, colonoscope, bronchoscope, ureteroscope, duodenoscope, or other similar device (not shown).

[0027] As shown in FIG. 3, the handle 110, or a similar device for actuating or controlling the endoscopic system 100 and any tools, devices, or instruments associated therewith, includes first and second actuation devices 42, 43. The devices 42, 43 control the articulation of the shaft 20 and / or an articulation joint at or proximal to the distal end 180 of the shaft 120 in multiple directions. The devices 42, 43 may be, for example, rotatable knobs that rotate about their axes to push / pull an actuation element 126 that extends within an actuation lumen 124 ( FIG. 6 ) of the shaft 120. The actuation element 126, such as a cable or wire (e.g., medical grade plastic or metal) suitable for a medical procedure, extends distally from the proximal end of the endoscopic system 100 and couples to the shaft 120 to control its movement. Alternatively or additionally, a user may operate the actuation element 126 independently of the handle 110. The distal end of the actuation element 126 extends through the actuation lumen 124 of the shaft 120 and terminates at an actuation joint and / or distal end 180 of the shaft 120. It will be understood that the actuation joint may be part of the distal end 180 or the actuation joint may be attached to the distal end of the shaft 120 and the proximal end of the distal end 180. For example, one or more actuation elements 126 may be coupled to an articulation joint, and actuation of the actuation element 126 may control the actuation joint or distal end 180 of the shaft 120 to move in multiple directions.

[0028] One or more electrical cables (such as electrical cable 154b disposed in imaging lumen 154a or electrical cable 182b disposed in light lumen 182a, shown in FIG. 6 ) may extend from the proximal end of shaft 120 to the distal end 180 of shaft 120. The cables (e.g., cables 154b or 182b) may provide electrical control to imaging devices, lighting devices, and / or other electrical devices at the distal end 180 of shaft 120, carry imaging signals proximally or distally from imaging device 182 (e.g., a camera or other image sensor) and / or light emitting device 184 ( FIG. 5F ) at the distal end 180 of shaft 120, for example, to send signals from a user interface to imaging device 182 and / or light emitting device 184, carry signals from imaging device 182 for processing and / or display on a display, etc.

[0029] The handle 110 may also include one or more ports, such as ports 136a, 136b shown in FIG. 3 and described below, or port 200 connected to the suction / irrigation lumen 186a shown in FIG. 6. In these embodiments, the ports 136a, 136b, and 200 may be used to introduce and / or remove tools, fluids, or other substances to and / or from the patient. As described herein, the ports 136a, 136b may be used to introduce tools or instruments, such as the first and second medical instruments 150, 152, respectively. The port 200 connected to the suction / irrigation lumen 186a may be connected to an umbilicus to introduce fluids and / or suction. Additionally, the umbilicus may include wiring for electronic components (e.g., wiring connected to cables 154b and / or 182b). An opening 186 at the distal end of the suction lumen 186a is shown in FIG. 5F.

[0030] With reference to FIG. 2, the controllers 130a, 130b are coupled to the handle 110 and may move in a proximal-distal direction relative to the handle 110 as indicated by arrow B (FIG. 5A). The controllers 130a, 130b may be disposed on an outer surface of the handle 110 and oriented approximately 180 degrees from each other around the circumference of the handle 110. However, it will be understood that the handle 110 may include only one controller 130a, or may include three, four, or more controllers 130a, 130b, ... 130n, and the controllers 130a, 130b may be disposed at any location around the circumference of the handle 110. For ease of understanding, reference will be made to the controller 130a, but the description of the controller 130a applies equally to the controller 130b (and any additional controllers on the handle 110) unless otherwise noted.

[0031] 2 and 8, the control device 130a includes a joystick 132a with a ball bearing 195 attached to one end. The ball bearing 195 may be generally spherical and may be disposed within a generally spherical opening in a socket 191 of a housing 190. The ball bearing 195 is configured to move in any direction, e.g., 360 degrees, within the socket 191 when a user (e.g., the physician 1100 of FIG. 1) applies a force to the joystick 132a in any direction, as indicated by arrow D in FIG. 5A. The ball bearing 195 may be located within the housing 190 of the socket 191 and may be supported by and / or contact one or more interior walls of the housing 190. The interior walls of the housing 190 may define the direction of movement of the ball bearing 195.

[0032] The ball bearing 195 may have a number of protrusions 193 extending radially outward from the ball bearing 195. The protrusions 193 may be any element (e.g., slits, holes, openings, etc.) in the ball bearing 195 for coupling one or more actuation wires 192 to the ball bearing 195. The protrusions 193 may move within slots (unnumbered) in the socket 191 to allow the ball bearing 195 to move in any direction described herein. Each protrusion 193 has an actuation wire 192 attached to it. Although three actuation wires 192 are shown in FIG. 8, it will be understood that any number of actuation wires 192 (e.g., two, four, five, etc.) may be used based on the number of protrusions 193 extending from the ball bearing 195. Each actuation wire 192 extends distally from its respective protrusion 191 and couples to a distal end of the first tube 160 (first tube 160 shown in FIG. 4) (e.g., a working channel). In this manner, as described below, movement of the ball bearing 195 within the socket 191 can push or pull one or more of the actuation wires 192, and thus manipulate the distal end of the first tube 160. It will be appreciated that the additional wires 192 can provide improved maneuverability of the controls at the distal end of the first tube 160, as described herein. The first tube 160 can have a diameter of about 2.8 mm, but can be any size, and is not limited thereto. It will be appreciated that the first tube 160 can be sized to fit within the first lumen 122a, and is also not limited thereto. In some examples, the diameter of the first tube 160 can be about 1.0 mm to about 10.0 mm, and the diameter of the first lumen 122a can be about .010 inches larger than the diameter of the first tube 160.

[0033] 8, the proximal end of the first tube 160 extends through an opening at the distal end of the control device 130a, through a lumen (not numbered) of the control device 130a, and through an opening in a side of the control device 130a. The proximal end of the first tube 160 (identified as 138a in FIG. 8) terminates in a port 136a, which may include a collet. The collet of the port 136a may include a locking member 139a. The locking member 139a may include an opening covered by a movable membrane (not shown) that may provide a seal (i.e., form a fluid seal) between the locking member 139a and the shaft 170 (FIG. 2) of the first medical instrument 150. For example, the locking member 139a may be a threaded device and may rotate about an axis via a screw thread. When the shaft 170 of the first medical instrument 150 is inserted into the opening in the locking member 139a, the locking member 139a may be rotated in a first direction to lock the shaft 170 relative to the locking member 139a and form a seal between the shaft 170 and the locking member 139a. The locking member 139a may be rotated in a second direction opposite the first direction to unlock the shaft 170 relative to the locking member 139a.

[0034] 3 and 5A, the slots 114 may extend in a proximal-distal direction relative to a longitudinal axis A of the endoscopic system 100 (see FIG. 2 for longitudinal axis A). The slots 114 may be provided on either side of the handle 110 and may be configured to allow the controls 130a, 130b to move proximally and distally within the respective slots 114. For example, the control device 130a may be moved proximally and distally within the slot (not shown) as indicated by arrow B in FIG. 5A. The control device 130b may also move proximally and distally within the slot 114 as indicated by arrow B. Movement of the control device 130a may allow the distal end of the first tube 160 to move proximally and distally in the direction indicated by arrow C shown in FIG. 5B. For example, distal movement of the control device 130a may cause the distal-most end of the first tube 160 to extend distally of the distal-most end of the sheath 120 (shown in FIG. 4). Similarly, proximal movement of the control device 130a may cause the distal-most end of the first tube 160 to be flush with the distal-most end of the sheath 120 or extend proximally relative to the distal-most end of the sheath 120. Similar movement of the control device 130b in the proximal and distal directions may cause similar movement of the second tube 162 (e.g., working channel) attached to the control device 130b. Similar to the first tube 160, the second tube 162 may have a diameter of about 2.8 mm, but may be any size, and is not limited thereto. It will be understood that the second tube 162 may be sized to fit within the first lumen 122b, and is also not limited in size. In some examples, the diameter of the second tube 162 may be about 1.0 mm to about 10.0 mm, and the diameter of the first lumen 122b may be about .010 inches larger than the diameter of the second tube 162. In some cases, the diameters of the first tube 160 and the second tube 162 may be the same, and the diameters of the first lumen 122a and the first lumen 122b may be the same. However, it will be understood that these diameters may be different.

[0035] With reference to FIG. 7, a gasket 210, protrusion, or similar device may extend from the exterior surface of the first tube 160 at the proximal end of the first tube 160. Although not shown, the second tube 162 may also include a gasket 210 or other similar device. The gasket 210 may slide within the slot 114 and may contact one or more walls of the handle 110, thereby increasing friction between the gasket 210 and the handle 110. This increased friction may increase the force required to move the controls 130a, 130b in a proximal and distal direction. In this situation, the gasket 210 may act similar to a locking mechanism and help prevent proximal or distal movement of the controls 130a, 130b relative to the handle 110 unless sufficient proximal or distal force is applied to overcome the frictional force. In this manner, the position of the distal end of the first tube 160 and / or second tube 162 relative to the sheath 120 may be maintained during a medical procedure until a sufficient force is applied to the controllers 130a, 130b.

[0036] The gasket 210 may additionally or alternatively include additional locking members and / or additional friction increasing members. For example, a ratchet device may be provided to prevent movement of the control device 130a, 130b in the proximal and distal directions unless sufficient force is provided to overcome the force provided by the ratchet device. Additionally or alternatively, a plurality of protrusions may be provided along the outer surface of the handle 110 adjacent each of the slots 114. A strap or other device may be attached to the control device 130a, 130b or to one or more of the plurality of protrusions to prevent or reduce movement of the control device 130a, 130b in the proximal or distal direction. In this manner, the position of the first and second tubes 160, 162 in the proximal / distal direction may be maintained during the medical procedure.

[0037] As mentioned above, a cross section of the sheath 120 taken along line 6-6 in FIG. 2 is shown in FIG. 6. The sheath 120 includes a first lumen 122a and a second lumen 122b. A first tube 160 extends within the first lumen 122a from a proximal end of the sheath 120 to a distal end of the sheath 120. A second tube 162 similarly extends within the second lumen 122b from a proximal end of the sheath 120 to a distal end of the sheath 120. Each of the first tube 160 and the second tube 162 includes a plurality of actuation wires 192, respectively. As described herein, each set of actuation wires 192 may comprise any number of wires (four in FIG. 6, but the number is not limited thereto, e.g., two, three, or more). The first tube 160 may be extruded around the actuation wire 192 such that the actuation wire 192 is surrounded by the wall of the first tube 160 and coupled to the first tube 160 along its entire length. Alternatively, the actuation wire 192 may be disposed within a respective lumen 160a formed within the wall of the first tube 160, and the actuation wire 192 may be attached only to the distal end of the first tube 160. In one or more embodiments, the actuation wire 192 may be attached only at specific points along the first tube 160. The actuation wire 192 may be similarly attached within the lumen 162a of the second tube 162. In this manner, movement of the joysticks 132a, 132b may cause bending (e.g., articulation) of the distal ends of the first tube 160 and the second tube 162, respectively, as described herein.

[0038] 4 and 6, the first tube 160 may extend from the handle 110 through the first lumen 122a of the shaft 120 and may move proximally and distally within the first lumen 122a. The second tube 162 may extend from the handle 110 through the second lumen 122b of the shaft 120 and may move proximally and distally within the second lumen 122b. Movement of the first tube 160 and the second tube 162 may be controlled by the controller 130a and the controller 130b, respectively. For example, movement of the controller 130a in the distal direction as indicated by arrow B (FIG. 5A) within the slot 114 may move the first tube 160 distally within the first lumen 122a. Movement of control device 130a in the proximal direction, as indicated by arrow B, within slot 114 may cause first tube 160 to move proximally within first lumen 122a. Movement of control device 130b within slot 114 may similarly cause second tube 162 to move proximally and distally within second lumen 122b.

[0039] 5C, 5D, and 5E, one or both of the first tube 160 and the second tube 162 may be bent (e.g., articulated) at a predetermined position along the longitudinal axis of the first tube 160 or the second tube 162 by moving the corresponding joystick 132a or joystick 132b. For example, when the joystick 132a or joystick 132b is moved in the direction indicated by arrow D in FIG. 5A, the actuation wire 192 is pushed or pulled within the corresponding wire lumen 160a or 162a, respectively. This movement of the wire 192 may bend the distal end of the first tube 160 or the second tube 162. For example, the first tube 160 or the second tube 162 may be located along an axis parallel to the longitudinal axis A in a first position (e.g., a neutral position). When a user moves joystick 132a or joystick 132b, a distal end of the corresponding first tube 160 or second tube 162 can bend such that a portion of first tube 160 or a portion of second tube 162 transitions from a first position to a second position, the second position including a portion of first tube 160 or a portion of second tube 162 that extends non-parallel to longitudinal axis A. In other words, first tube 160 and second tube 162 can bend independently of one another in one or more planes, e.g., omnidirectionally movable.

[0040] 6, the first tube 160 may include a lumen 166 and the second tube 162 may include a lumen 168. With reference to FIGS. 5C, 5D, and 5E, the shaft 170 of the first medical instrument 150 (FIG. 2) may extend and move within the lumen 166 of the first tube 160 and the shaft 172 of the second medical instrument 152 (FIG. 2) may extend and move within the lumen 168 of the second tube 162. As shown in FIGS. 5C, 5D, and 5E, the distal ends of the shafts 170 and 172 may include or be coupled to a medical tool such as a grasper, a cutting device (scissors, knife, tissue resection device, electrode, etc.), an ablation tool, forceps (e.g., two jaws connected by a hinge, etc.), a snare, or any other medical tool. As described herein, shafts 170 and 172 may extend from the distal-most ends of first tube 160 and second tube 162, respectively, such that tools at the distal ends of shafts 170, 172 may be exposed at the target site. The operation of these tools, e.g., opening and closing the jaws of a grasper, is described herein.

[0041] Referring to FIG. 2, each first medical instrument 150 includes a handle 150a and each second medical instrument 152 includes a handle 152a. Although shown as plunger-type handles in FIG. 2, the handles 150a, 152a may be any medical handle for actuating a tool at the distal end of the shaft 170, 172, respectively. Each handle 150a, 152a may be attached to one of the actuators 30a, 30b shown in FIG. 1. For example, the handle 150a may be attached to the actuator 30a, and the handle 150b may be attached to the actuator 30b. Each actuator 30a, 30b may include a fixed member and a movable member. The fixed member may fix the position of the body of the handle 150a, 150b, while the movable member may fix the plunger (or movable portion) of the handle 150a, 150b. As described herein, actuation of the actuators 30a, 30b may move the movable member relative to the fixed member. In this manner, the plungers (or movable portions) of the handles 150a, 150b can move relative to the bodies of the handles 150a, 150b, thereby actuating a tool or end effector at the distal ends of the handles 150a, 150b.

[0042] Actuator 30a may be actuated via actuator 40a (either via a wired connection (not shown) or a wireless connection), and actuator 30b may similarly be actuated via actuator 40b. Although actuators 40a, 40b are shown in FIG. 1 as foot pedals, the disclosure is not so limited and actuators 40a, 40b may be, for example, buttons, levers, knobs, etc. positioned on handle 110, separate user interfaces or displays, robotic actuators, etc. Alternatively or additionally, actuators 40a, 40b may be voice-activated, actuated via a user's movement or a particular flash sequence (e.g., a user's movement captured by a camera), or any other method known in the art.

[0043] As an example, a user may depress the actuator 40a with their foot, which may move the actuator 30a and the plunger of the handle 150a. This may move the jaws of a tool at the distal end of the first medical instrument 150 from an open position to a closed position. Removing the user's foot from the actuator 40a may cause the jaws of the tool to open. As another example, the tool may include a laser fiber, whereby depressing the actuator 40a may cause laser energy to be fired, and releasing the actuator 40a may cause the firing of laser energy to stop. In some examples, depressing the actuator 40a may cause an electrode to extend into tissue and / or energize the electrode. The actuator 40b may be operated in a similar manner to the actuator 40a, which may move the plunger of the handle 152a to actuate a tool at the distal end of the second medical instrument 152. It will be understood that the tool may be any medical tool, and the handles 150a, 152a are not limited to plunger-type handles. For example, the handles 150a, 150b may include knobs or other known actuation members or tools or end effectors for the first and second medical instruments 150, 152.

[0044] A method of operating the medical system 10 will now be described. The shaft 120 may be inserted into a body, for example, the body of a patient 1000 of FIG. 1, through a natural orifice, an incision, or any other opening in the body, and advanced to a target site. A medical professional may visualize the target site using one or more light emitting elements 184 and / or a visualization device 182 at the distal end of the shaft 120, for example, the visualization device 182 being coupled to a user interface or display via an umbilicus. A first medical instrument 150 may be introduced at its proximal end into the lumen 166 of the first tube 160 through an opening in the locking member 139a of the port 136a, and a medical instrument 152 may be introduced at its proximal end into the lumen 168 of the second tube 162 through an opening in the locking member of the corresponding control device 130b. The first and second medical instruments 150, 152 may be introduced into the lumens 166, 168, respectively, at any time during a medical procedure, for example, before or after the shaft 120 is inserted into the patient 1000. The locking member 139a may be locked or unlocked by rotating the locking member clockwise or counterclockwise. The locking member 139a may be locked or unlocked at any time during a procedure to allow the first and second medical instruments 150, 152 to be moved within the lumens 166, 168, respectively.

[0045] After positioning the distal end of the shaft 120 at the target site, the user may advance one or both of the first tube 160 and the second tube 162 in a distal direction such that the distal end of the first tube 160 and / or the distal end of the second tube 162 extend distally of the distal-most end of the shaft 120, as shown by arrow C in FIG. 5B. As described herein, this distal movement of the first tube 160 and the second tube 162 relative to the shaft 120 is caused by the user moving the controls 130a, 130b in a distal direction as shown by arrow B in FIG. 5A. For example, the user may use their thumb and index finger to grasp one or both of the controls 130a, 130b and move them distally within the slot 114. In this manner, the user may move the distal ends of the first tube 160 and / or the second tube 162 distal to the distal-most end of the shaft 120.

[0046] Once the first tube 160 or the second tube 162 extends distally of the distal-most end of the shaft 120, the user may use the joystick 132a or the joystick 132b to articulate the first tube 160 or the second tube 162, respectively. For example, the user may grasp the joystick 132a of FIG. 5A using thumb and index finger (or any other finger, if desired) and move the joystick 132a in any direction indicated by arrow D in FIG. 5A. For example, the user's first hand may grasp the handle 110 while the user's second hand operates the joystick 132a or the joystick 132b. Alternatively, the handle 110 may be secured, for example, by the support device 40, thereby allowing the user to operate the joystick 130a using the first hand and the joystick 130b using the second hand. As shown in FIGS. 5C, 5E, and 5F, movement of the joystick 132a in any 360 degree direction can cause a corresponding movement of the distal end of the first tube 160. Movement of the joystick 132a or the joystick 132b can impart a similar movement to the distal end of the first tube 160 or the second tube 162. For example, if the joystick 132a is moved 30 degrees in one direction, the distal end of the first tube 160 can be bent 30 degrees in the corresponding direction. It will be understood that the bend angle of the distal ends of the first tube 160 and the second tube 162 is not limited to the degree of movement of the joystick 132a or the joystick 132b. Before, during, or after articulation of the joystick 132a, the first medical instrument 150 can be advanced distally such that the distal end of the sheath 170 and the corresponding tool extend distal to the distal-most end of the first tube 160. The user may continue to move the joystick 132a and / or move the sheath 170 within and relative to the first tube 160 so that a tool, e.g., a grasper, at the distal end of the sheath 170 is aligned with the target tissue.It will be appreciated that the user may visualize the target tissue on a monitor showing images transmitted via visualization device 182, for example on a user interface or display.

[0047] Once the tissue is properly positioned relative to the tool, the user may actuate the actuator 40a by depressing it with the user's foot. If the tool is a grasper, actuation of the actuator 40a may cause a plunger in the handle of the first medical instrument 150 to move in a first direction, causing the jaws of the grasper to close around the tissue. The user may lift their foot off the actuator 40a, which may cause a plunger (or other movable element) in the handle of the first medical instrument 150 to move in the opposite direction, thereby opening the jaws of the tool.

[0048] It will be appreciated that similar articulation of the distal end of tube 162 may be accomplished using joystick 132b. Additionally, the user may move sheath 172 of second medical instrument 152 within second tube 162 in a manner similar to that described herein (e.g., FIG. 5F). The user may press or release actuator 40b to actuate the handle of medical instrument 152. This may operate a tool at the distal end of sheath 172 (e.g., opening and closing a cutting tool, opening and closing another gripping element, deploying a device using the tool, or any similar action).

[0049] Once the user has completed the task at the target site, the user may remove the shaft 120 from the body. In some examples, one or both of the first tube 160 and the second tube 162, and / or one or both of the first medical instrument 150 and the second medical instrument 152 may extend distal to the distal-most end of the shaft 120. In one example, the first medical instrument 150 may include a grasping element for grasping tissue, and the second medical instrument 152 may include a cutting element for cutting or dissecting tissue from the body. For example, it may be desirable to remove a portion of tissue from the target site. In this case, one or more of the tools may grasp tissue distal to the distal-most end of the shaft 120, and the tissue may be removed from the body by removing the shaft 120 from the body. It will be appreciated that the user may also use knobs 42, 43 to bend or articulate shaft 120, which will cause first tube 160 and second tube 162, and any tools extending therein, to bend in the same direction as shaft 120.

[0050] Although various medical systems have been described, it will be understood that the particular arrangement of elements in these medical systems is not limited. Additionally, the size and shape of the catheter or shaft of the medical system, or the medical instruments used with the medical system, and / or the method of deploying the system are not limited. As described in the examples herein, the tubes within the lumen of the endoscope sheath may extend distally of the distal-most end of the endoscope sheath and may be independently bent or articulated to provide independent articulation for the medical instruments extending within the lumen of the tubes to improve visualization and / or access to the target site. For example, in certain procedures, accessing the target site from multiple different directions may improve the outcome of the medical procedure, may shorten the time of the medical procedure, and may improve the patient's recovery time after the medical procedure. Additionally, the individual first and second tubes 160, 162 may impart high steering forces, high lifting forces, shorter articulation radii, and high dissection forces. Additionally, providing controls (e.g., controllers 130a, 130b) on the handle 110 may allow one user to operate the medical system 10. For example, a user may use one handle to hold the handle 110 and use the other hand (along with one or both feet) to provide independent and / or simultaneous articulation, translation, and / or actuation of the medical tool. It will be appreciated that more than one operator may use the medical system 10, for example, with an assistant assisting in guiding, positioning, and / or manipulating the medical system 10 within the body.

[0051] It will be apparent to those skilled in the art that various modifications and variations can be made to the disclosed device without departing from the scope of the present disclosure. For example, the maximum bend angle, the location of the bend in the longitudinal direction of the tube, and the number of tubes extending and moving within the endoscope sheath are modified based on the desired medical treatment. Other embodiments of the present disclosure will be apparent to those skilled in the art from consideration of the specification and practice of the invention disclosed herein. It is intended that the specification and examples be considered as exemplary only, with a true scope and spirit of the invention being indicated by the following claims.

Claims

1. A handle including a first slot, a first control device configured to move proximally and distally within the first slot, a sheath extending from the handle and having a longitudinal axis, the sheath defining a first lumen extending from the handle to the distal end of the sheath, a first tube extending within the first lumen, the first tube being coupled to the first control device and configured to move between a first position where the distalmost end of the first tube is in the same plane as or proximal to the distalmost end of the sheath and a second position where the distalmost end of the first tube is positioned distal to the distalmost end of the sheath, The first slot extends parallel to the longitudinal direction of the sheath, a medical device.

2. The apparatus according to claim 1, wherein the first tube is configured to move between the first position and the second position when the first control device moves distally from the proximal end of the first slot.

3. The apparatus according to claim 1, wherein the first control device includes a locking mechanism configured to prevent movement of the first control device and maintain the position of the first control device relative to the handle in the proximal and distal directions.

4. The locking mechanism includes an annular ring extending radially outward from the first tube, the annular ring contacting a portion of the handle to increase the frictional force between the handle and the first tube, and the first control device is configured to move within the first slot when a force sufficient to overcome the frictional force of the annular ring is applied to the first control device. The apparatus according to claim 3.

5. The apparatus according to claim 1, wherein the first control device includes a joystick, and movement of the joystick is configured to bend the distal end of the first tube at an angle with respect to the longitudinal axis of the sheath.

6. The apparatus according to claim 5, further comprising at least three articulating wires extending from the joystick to the distal end of the first tube, each distal end of the at least three articulating wires being attached to the first tube.

7. The first tube includes articulation wire lumens corresponding to each of the at least three articulation wires, and each of the at least three articulation wires extends within the corresponding articulation wire lumen, the apparatus according to claim 6.

8. The first tube includes a tube lumen, and the apparatus further includes a medical instrument configured to be inserted into the tube lumen, and a distal end of the medical instrument is configured to extend distally of the distal end of the sheath, the apparatus according to claim 1.

9. The tube lumen further includes a rotatable locking mechanism at a proximal end thereof, and the rotatable locking mechanism is configured to fluid-seal the medical instrument within the tube lumen when the rotatable locking mechanism is in a locked position, and the medical instrument is configured to move within the tube lumen when the rotatable locking mechanism is in an unlocked position, the apparatus according to claim 8.

10. The medical instrument includes a tool at its distal end, and the apparatus further includes an actuator configured to operate the medical instrument, the apparatus according to claim 8.

11. The tool includes a plurality of jaws connected by a hinge, the actuator includes a foot pedal, and the plurality of jaws are configured to move from an open position to a closed position when the foot pedal is depressed, and the plurality of jaws are configured to move from the closed position to the open position when the foot pedal is released, the apparatus according to claim 10.

12. A second lumen within the sheath and extending from the handle to the distal end of the sheath; A second tube extending within the second lumen, wherein a distal end of the second tube is configured to move between a first position where the distal end of the second tube is in the same plane as the distal end of the sheath or proximal to the distal end of the sheath, and a second position where the distal end of the second tube is positioned distally of the distal end of the sheath, the apparatus according to claim 1.

13. A second slot; A second control device configured to move within the second slot, the second control device including a second joystick configured to bend a distal end of the second tube, the apparatus according to claim 12, further comprising:

14. The apparatus according to claim 13, wherein the first control device and the second control device are configured to move independently of each other, and the first tube and the second tube are configured to bend independently of each other.

15. The apparatus according to any one of claims 1 to 14, wherein the handle includes a first handle actuator and a second handle actuator configured to deflect a part of the sheath.

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