Endoscope having multiple viewing directions

Abstract

To provide a medical device having multiple viewing directions and an adjustable elevator in order to provide multiple working directions.SOLUTION: A medical device includes: a shaft having a longitudinal axis; a forward viewing image sensor; a side viewing image sensor; and an elevator movable between a first configuration and a second configuration. In the first configuration of the elevator, a central longitudinal axis of the elevator is substantially parallel to the longitudinal axis of the shaft. In the second configuration of the elevator, the central longitudinal axis has an angle relative to the longitudinal axis.SELECTED DRAWING: Figure 3

Description

[Technical Field]

[0001] The present invention generally relates to an endoscope having multiple viewing directions and an adjustable elevation mechanism to provide multiple directions of movement. [Background technology]

[0002] Endoscopic retrograde cholangiopancreatography (ERC) is a procedure used to diagnose and treat patients with pancreatic and biliary diseases. ERCP is typically performed using a side-viewing endoscope with an elevator mechanism. The side-viewing endoscope and elevator mechanism allow the physician to cannulate the duodenal papilla and navigate to the target site with instruments for diagnostic and therapeutic ERCP procedures.

[0003] Forward-viewing endoscopes are sometimes used for patients with altered anatomy, but because such endoscopes lack elevators or side-viewing image sensors, a physician's diagnostic and therapeutic capabilities may be limited compared to using a side-viewing endoscope with elevators and side-viewing image sensors. Additionally, currently available forward-viewing endoscopes may be longer than side-viewing endoscopes, which may require different cannulation methods and the use of different instruments. While certain patients with altered anatomy may be successful with commercially available forward-viewing endoscopes, their use may require a change in procedure and additional effort by the physician compared to performing ERCP with a side-viewing endoscope. Summary of the Invention

[0004] Examples of the present invention relate, inter alia, to endoscopes having multiple viewing directions and having adjustable elevation components (e.g., tubular members) to provide multiple directions of movement. Each of the examples disclosed herein may include one or more of the features described in connection with any of the other disclosed examples.

[0005] In one example, an endoscope may include a shaft having a longitudinal axis, a distally oriented first image sensor, and a laterally oriented second image sensor. The endoscope may further include a tubular member having a lumen, the lumen having a distal end opening and defining a longitudinal axis passing through a center of the lumen. The tubular member may be movable between a first position and a second position. In the first position of the tubular member, the longitudinal axis of the lumen may be parallel to the longitudinal axis of the shaft. In the second position of the tubular member, the longitudinal axis of the lumen may extend through a lateral opening in the wall of the shaft.

[0006] Any of the examples of endoscopes described herein may further include one or more of the following features: The first image sensor may be disposed on a distally facing wall of the shaft, and the second image sensor may be disposed on a laterally facing wall of the shaft. In the first position, the distal end opening may be parallel to the distally facing wall of the shaft. The distally facing wall may be disposed at the most distal end of the shaft. The first image sensor may be adjustable relative to the distally facing wall, and the second image sensor may be adjustable relative to the laterally facing wall. The laterally facing wall of the shaft may be flat, and the distally facing wall and the laterally facing wall may be perpendicular to each other. The distal and laterally directions may be approximately 90° from each other. The endoscope may further include a medical device disposed within the tubular member. In the first position, the medical device may extend from the distal end opening of the tubular member, and the first image sensor may be configured to image the medical device. In the second position, a medical device may extend from the distal end opening of the tubular member, and the second image sensor may be configured to image the medical device. The tubular member may be further movable to a third position, and in the third position, the medical device may be locked relative to the wall of the shaft. The endoscope may further include a first light source associated with the first image sensor and a second light source associated with the second image sensor. The endoscope may further include multiple light sources. The wall of the shaft may include a distally opening recess configured to receive the medical device and secure it relative to the wall of the shaft. In the first position of the tubular member, the longitudinal axis of the lumen may extend through the distal opening in the wall of the shaft. The range of motion of the tubular member may be at least 80°. Alternatively, the tubular member may translate axially relative to the shaft.

[0007] In another example, an endoscope may include a first image sensor, a second image sensor, and a tubular member, where the first image sensor is disposed on a distally facing wall of the shaft and the second image sensor is disposed on a laterally facing wall of the shaft, the tubular member having a lumen, the lumen having a distal end opening and defining a longitudinal axis passing through a center of the lumen. The tubular member may be transitionable between a first position and a second position. In the first position of the tubular member, the distal end opening may be parallel to the distally facing wall of the shaft. In the second position of the tubular member, the longitudinal axis of the lumen may extend through the laterally opening of the shaft.

[0008] Any of the examples of endoscopes described herein may further include one or more of the following features: The first image sensor may face a first direction, and the second image sensor may face a second direction, where the first direction and the second direction may be approximately 90° from each other. The endoscope may further include a first light source associated with the first image sensor and a second light source associated with the second image sensor. The laterally facing wall of the shaft may be flat, and the distally facing wall and the laterally facing wall may be perpendicular to each other. The tubular member may further be movable to a third position, in which a medical device disposed within the lumen may be locked relative to the shaft. The tubular member may translate relative to the distally facing wall and the laterally facing wall. That is, in the first position of the tubular member, the longitudinal axis of the lumen may be parallel to the longitudinal axis of the shaft.

[0009] In yet another example, a method of imaging a patient with an endoscope may include using a distally oriented first image sensor to image a first portion of the patient, transitioning a tubular member having a lumen, the lumen having a distal end opening and defining a longitudinal axis through a center of the lumen, from a first position to a second position, and using a laterally oriented second image sensor to image a second portion of the patient. In the first position of the tubular member, the longitudinal axis of the lumen may be parallel to the longitudinal axis of the shaft of the endoscope, while in the second position of the tubular member, the longitudinal axis of the lumen may extend through a lateral opening in the shaft.

[0010] Any of the methods described herein may further include one or more of the following features or steps. The method may further include disposing a medical device within the lumen of the tubular member. The method may further include transitioning the tubular member from the second position to a third position, where transitioning the tubular member from the second position to the third position locks the medical device relative to the shaft. In the first position, the distal end opening of the lumen may be parallel to the distal end wall of the shaft. That is, the step of using the second image sensor to image a second portion of the patient may be performed when the tubular member is in the second position.

[0011] 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 claimed invention. As used herein, the terms "comprises / is," "comprising / being," or any other variations thereof are intended to be non-exclusive inclusive, and thus a process, method, article, or apparatus comprising the listed elements may include not only those elements, but also other elements not expressly listed or inherent in such process, method, article, or apparatus. The term "exemplary" is used to mean "example" rather than "ideal."

[0012] The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate examples of the invention and, together with the description, serve to explain the principles of the invention. [Brief explanation of the drawings]

[0013] [Figure 1] 1 is a perspective view of the distal end of an endoscope with the tubular member in a straight position to form a front-exit working channel, according to one example. [Figure 2] 2 is a perspective view of the distal end of the endoscope of FIG. 1 with the tubular member in a bent position to form a side-exit working channel, according to one example. [Figure 3] 2 is a perspective view of the distal end of the endoscope of FIG. 1 with a medical device within the tubular member in a locked position, according to one example. [Figure 4] 2 is a distal end view of the endoscope of FIG. 1, according to an example. [Figure 5] 3 is a top view of the tip of the endoscope of FIG. 2, according to an example. DETAILED DESCRIPTION OF THE INVENTION

[0014] The present invention relates to an endoscope having multiple viewing directions. To achieve multiple imaging directions, the endoscope may have two or more image sensors. Additionally, the endoscope may have an elevator (e.g., tubular member) with an adjustable distal portion that allows the endoscope to have both a front-exit working channel and a side-exit working channel.

[0015] Referring to FIG. 1 , endoscope 2 may include an elongated, flexible tubular shaft having a distal tip 4. The distal tip 4 may bend left and right and up and down relative to a proximal portion of the tubular shaft. Endoscope 2 may further include an elevator, i.e., tubular member 6, defining a lumen 8, a forward viewing system 12, and a lateral viewing system 14. The tubular shaft (or distal tip 4) of endoscope 2 may define a longitudinal axis A extending proximally and distally through the center of distal tip 4. In other examples, longitudinal axis A may extend proximally and distally through distal tip 4 but may be eccentric. Forward viewing system 12 may include an image sensor 16, a light source 18, and a lens wash 20. Similarly, lateral viewing system 14 may include an image sensor 22, a light source 24, and a lens wash 26. Endoscope 2 may be any device used to visually examine a patient's anatomy and may be used for any suitable procedure. For example, endoscope 2 may be used to examine a patient's gastrointestinal system, vascular system, respiratory system, or urinary system.

[0016] The tubular member 6 may include an elongated tube extending from the proximal end of the endoscope 2 to the distal end of the endoscope 2. The tubular member 6 may include any suitable biocompatible material, such as a polymer, a urethane, a fluoropolymer blend, or a metal (e.g., stainless steel). The tubular member 6 may include a distal portion 28, as shown, that is bendable relative to a proximal portion (not shown) of the tubular member 6. To facilitate bending in a desired region between the proximal and distal portions 28 of the tubular member 6, the tubular member 6 may include a coiled tube section, a laser cut pattern that creates a weakened region that allows for easy bending, a hinge, or any other suitable mechanism that allows the two portions to bend relative to one another.

[0017] The tubular member 6 may have or define a lumen 8. In one example, the lumen 8 may have a circular cross-section. In other examples, the cross-section of the lumen 8 may be elliptical, polygonal, irregular, or any other suitable shape. The lumen 8 may include a distal end opening 30 at the distal end of the distal section 28. The lumen 8 (or the distal section 28 of the tubular member 6) may define a longitudinal axis B that extends through the center of the distal section 28 from the proximal end (e.g., adjacent the bendable region of the tubular member 6) to the distal end opening 30. In other examples, the longitudinal axis B may extend in a proximal-distal direction through the distal section 28, but may be eccentric. The opening 30 may provide an exit for a medical device 32, such as a guidewire or other therapeutic or diagnostic device. To position medical device 32 within lumen 8, the distal end of medical device 32 may be inserted into the proximal end of tubular member 6, through lumen 8, and out distal end opening 30, as shown in FIG.

[0018] The distal portion 28 of the tubular member 6 may be transitional between a first position shown in FIG. 1 and a second position shown in FIG. 2 . FIG. 3 illustrates the tubular member in a third position. It should be understood that the distal portion 28 may also be transitional between the first and third positions, and between the second and third positions. In the first position of FIG. 1 , the distal end opening 30 may be parallel to the distal end wall 34 of the distal tip 4. Furthermore, the longitudinal axis B of the lumen 8 may be parallel to the longitudinal axis A of the tubular shaft (or distal tip 4) of the endoscope 2. Thus, in the first position, the tubular member 6 may define a working channel (lumen 8) of the endoscope 2 having a front exit port. The front exit port may be proximate the distal end wall 34 or may be in the same plane as the distal end wall 34. When the tubular member 6 is in the first position, the forward viewing system 12 may be used to visualize an instrument, such as a medical device 32 extending from the tubular member 6 .

[0019] When the tubular member 6 is in the second position shown in FIG. 2 , the distal end opening 30 may form an angle with the distal end wall 34 of the distal tip 4. Similarly, the longitudinal axis B of the distal portion 28 of the tubular member 6 may form an angle Θ with the longitudinal axis A of the tubular shaft (or distal tip 4) of the endoscope 2. Thus, in the second position, the tubular member 6 may define a working channel (lumen 8) of the endoscope 2 having a lateral exit or a lateral exit. When the tubular member 6 is in the second position, the lateral viewing system 14 may be used to visualize instruments, such as a medical device 32, extending from the tubular member 6.

[0020] FIG. 3 illustrates the tubular member 6 in a third position, sometimes referred to as a locked position. In the third position, movement of the medical device 32 relative to the tubular member 6 may be inhibited or prevented. In one example, the third position may be a position of the tubular member 6 when the distal portion 28 of the tubular member 6 (with the medical device 32 extending from the distal end opening 30) is in a maximally bent position relative to the longitudinal axis of the distal tip 4 of the endoscope 2. That is, in the third position, the angle Θ may be greater than the angle Θ when the tubular member 6 is in the first or second positions. The distal tip 4 may include a notch or recess 36 sized to receive and secure the medical device 32 relative to the distal tip 4 of the tubular shaft. The recess 36 may open distally. When the tubular member 6 is in the third position, the medical device 32 may be clamped between the wall of the distal portion 28 and the recess 36 and may form a press fit with the distal tip 4 through the recess 36. In the third position of the tubular member 6, the medical device 32 may be held stationary while a catheter or other medical device is advanced along the medical device 32 within the lumen 8, as described further below. However, advancement of a medical implement over the device 32 may occur in any of the first, second, or third positions.

[0021] 3, 4, and 5, the wall of the distal tip 4 of the tubular shaft of the endoscope 2 may include a lateral opening 38 and a distal opening 40 (in the distal end wall 34) to allow instruments extending from the distal end opening 30 of the tubular member 6 to exit the endoscope 2. The openings 38 and 40 are connected to form a single opening in the distal tip 4 that faces both distally and laterally. The lateral opening 38 may extend proximally from the distal end wall 34. From the distal end wall 34, a first side 37 and a second side 39 of the lateral opening 38 may extend parallel to each other over a portion of the length (proximal-distal) of the lateral opening 38. From there, in the proximal direction, the two sides 37, 39 may transition toward each other toward the recess 36. The recess 36 may be part of a lateral opening 38 and may be defined proximally by a curvature in the wall of the distal tip 4 extending between a first side 37 and a second side 39 .

[0022] The distal opening 40 may be the distal end of a lumen 44 that extends longitudinally through the distal tip 4 of the tubular shaft of the endoscope 2. Referring to FIG. 4 , the distal opening 40 may extend from an upper edge of the distal tip 4 and be continuous with the lateral opening 38. From the lateral opening 38, the distal opening 40 may extend toward the opposing wall of the distal tip 4 (toward the bottom of the page when viewing FIG. 4 ). The distal opening 40 may be curved at its bottom edge (as viewed in FIG. 4 ) such that the distal end wall 34 around the distal opening 40 forms a U-shape. The U-shape of the distal opening 40 may allow the distal portion 28 of the tubular member 6 to extend in a completely straight first position, as shown in FIGS. 1 and 4 . In one example, the curvature at the bottom of the distal opening 40 may match the curvature of the outer surface of the tubular member 6.

[0023] When the tubular member 6 is transitioned from the first position to the second or third position, the medical device 32 may have a continuous path out of the endoscope 2 via the distal opening 40 and the lateral opening 38. For example, in the first position shown in FIG. 1 , the medical device 32 may trace out of the endoscope 2 through the distal opening 40. As the tubular member 6 approaches the second position shown in FIG. 2 , the medical device 32 may pass through the lateral opening 38 to extend out of the endoscope 2 from the lumen 8. Thus, the distal opening 40 and the lateral opening 38 provide a path by which instruments extending from the distal end opening 30 of the lumen 8 can trace out of the endoscope 2. In other words, when the tubular member 6 is in the first position, the longitudinal axis B of the tubular member 6 may extend through the distal opening 40. Meanwhile, in the second position of the tubular member 6, the longitudinal axis B may extend through the lateral opening 38. In the third position of the tubular member 6, if the longitudinal axis B is centered through the lumen 8 (e.g., as shown in FIG. 3), the longitudinal axis B may extend through the wall of the distal tip 4. On the other hand, if the longitudinal axis B is eccentric, the longitudinal axis B may still extend through the lateral opening 38 when the tubular member 6 is in the third position.

[0024] The tubular member 6 may be moved through its range of motion (e.g., between a first position, a second position, and a third position) by any mechanism known in the art. In one example, a wire (not shown) may be secured to the outside of the distal portion 28 (e.g., by a ring around the tubular member 6, by adhesive, by soldering, etc.) and may be passed proximally toward the proximal end of the tubular member 6. A user may pull the wire proximally to transition the distal portion 28 from the first position toward the second position or the third position. That is, proximal movement of the wire may increase the bending of the distal portion 28 relative to the distal tip 4 of the endoscope 2 (e.g., increase the angle Θ). For convenience, bending movement of the distal portion 28 that increases the angle Θ is referred to herein as “proximal” movement of the distal portion 28. Conversely, a user may push a wire or other mechanism distally to transition distal portion 28 from the second or third position toward the first position. That is, distal movement of the wire may decrease the curvature of distal portion 28 relative to distal tip 4 of endoscope 2 (e.g., decrease angle Θ) and transition distal portion 28 toward a position where longitudinal axis B is parallel to longitudinal axis A. For convenience, this straightening movement of distal portion 28, which decreases angle Θ, is referred to herein as “distal” movement of distal portion 28.

[0025] In one example, the distal portion 28 of the tubular member 6 may have a range of motion of approximately 85°. As used herein, "approximately" means ±5%. According to this example, the range of motion may be defined as the angle Θ between the first and second positions (e.g., between FIGS. 1 and 2) or the angle Θ between the first and third positions (e.g., between FIGS. 1 and 3). When the range of motion is the angle Θ between the first and second positions, the range of motion may include any position of the distal portion 28 at which the medical device 32 can freely move while protruding from the distal end opening 30 of the distal portion 28. When the range of motion is the angle Θ between the first and third positions, the range of motion may include any position of the distal portion 28 at which the medical device 32 can protrude from the distal end opening 30 of the distal portion 28, regardless of whether the medical device 32 is freely movable or locked.

[0026] In other examples, the distal portion 28 can have a range of motion of about 70°, about 75°, about 80°, or about 90°. In still other examples, the range of motion of the distal portion 28 can be at least 80°, at least 85°, at least 90°, at least 95°, less than 95°, less than 90°, less than 85°, or less than 80°. To increase the range of motion beyond that shown, the side opening 38 of the distal tip 4 can be extended proximally to allow the distal portion 28 and the medical device 32 within its lumen to flex further proximally. Alternatively, the tubular member 6 can translate, or slide, distally within the lumen 44 of the tubular shaft so that the distal portion 28 has a sufficient range of motion to accommodate the desired range of motion. To reduce the area of ​​motion, the side opening 38 of the distal tip 4 may be shortened (e.g., the recess 36 may be moved distally) to allow the distal portion 28 and the medical device 32 within the lumen to flex less proximally. Alternatively, the tubular member 6 may translate, or slide, proximally within the lumen 44 of the tubular shaft to sufficiently reduce the area of ​​motion of the distal portion 28.

[0027] FIG. 4 shows a distal end view of endoscope 2, showing forward viewing system 12, and FIG. 5 shows a top view of distal tip 4, showing lateral viewing system 14. Image sensors 16, 22 may be any sensor, such as a CMOS or CCD sensor, that detects light and transmits information to enable remote viewing of images. Light sources 18, 24 may emit any type of light to illuminate an area near an associated image sensor 16, 22. Lens washes 20, 26 may provide an outlet for water, saline, or other fluids used to clean the corresponding image sensor 16, 22 and / or light source 18, 24. Lens wash 20 may include an outlet nozzle 20a for fluid to exit lens wash 20. Similarly, lens wash 26 may include an outlet nozzle 26a for fluid to exit lens wash 26.

[0028] Referring to the distal end view of FIG. 4 , the components of the forward viewing system 12 may be disposed on the distal end wall 34 of the distal tip 4 / tubular shaft / endoscope 2. The distal end wall 34 may be perpendicular to the longitudinal axis A. The image sensor 16 may be disposed to the left of the distal opening 40. The light source 18 may be disposed below the image sensor 16 (as viewed in FIG. 4 ) and associated with the image sensor 16 by being positioned to illuminate an area proximate the image sensor 16. The lens wash 20 may be disposed above the image sensor 16 (as viewed in FIG. 4 ) and configured to emit fluid to clean the image sensor 16 and / or the light source 18. However, the image sensor 16, the light source 18, and the lens wash 20 may be disposed in any other order or configuration relative to one another. For example, two or more of these components may be disposed adjacent to one another (side by side as viewed in FIG. 4 ). Alternatively, one or more of the image sensor 16, light source 18, and lens wash 20 may be located on the opposite side of the distal opening 40 (e.g., in a portion of the distal end wall 34 to the right of the distal opening 40 as viewed in FIG. 4 , closer to the lateral viewing system 14). In another example, one or more of the image sensor 16, light source 18, and lens wash 20 may be located on a distally facing wall of the tubular shaft of the endoscope 2 that is not at the most distal end of the endoscope 2 (e.g., on the distal wall 46 (see FIG. 1 ) or another distally facing wall).

[0029] Referring to the top view of FIG. 5, the image sensor 22 may be positioned near (and proximal to) the distal end wall 34, and the light source 24 may be positioned proximal to the image sensor 22. The image sensor 22 and the light source 24 may be positioned on a lateral wall 42 of the distal tip 4 / tubular shaft / endoscope 2. The light source 24 may be associated with the image sensor 22 by being positioned to illuminate an area proximal to the image sensor 22. The lateral wall 42 may be any laterally oriented wall, and may be curved or flat. Referring to FIGS. 1-3, in one example, the lateral wall 42 may be a flat wall extending proximally from the distal end wall 34. In another example, the lateral wall 42 may be a curved outer surface of the distal tip 4. Referring again to FIG. 5, the lens wash 26 may be positioned on the distal wall 46 proximal to the light source 24. Lens wash 26 may include an outlet through which saline or other fluid may be expelled along side wall 42 to clean image sensor 22 and / or light source 24. Image sensor 22, light source 24, and lens wash 26 may be arranged in any other order or configuration relative to one another. Alternatively, one or more of these components may be located on the opposite side of side opening 38 (e.g., to the left of side opening 38 as viewed in FIG. 5).

[0030] The image sensor 16 on the distal end wall 34 may face distally and thus may be used to observe the medical device 32 and any other instruments extending from the distal end opening 30 when the tubular member 28 is in the first position and when it is transitioning proximally toward the second position. Meanwhile, the image sensor 22 on the lateral wall 42 may face laterally and thus may be used to observe the medical device 32 and any other instruments extending from the distal end opening 30 when the tubular member 28 is approaching the second position or when it is in the second or third position.

[0031] In one example, the distal end wall 34 (or any other distally oriented wall that includes the image sensor 16) and the lateral wall 42 (or any other laterally oriented wall that includes the image sensor 22) may be perpendicular to each other. The angle described herein between these two walls may correspond to the angle between the viewing directions of the image sensors 16, 22. In other examples, the distal end wall 34 and the lateral wall 42 (and the corresponding viewing directions of the image sensors 16, 22) may deviate from 90° but may be disposed at approximately 90° to each other. In other examples, the two walls may be disposed at approximately 85°, approximately 80°, or approximately 75° to each other. In still other examples, the two walls may be disposed at at least 90° or less than 90° to each other.

[0032] In one example, the viewing direction of image sensors 16, 22 can be adjusted relative to their corresponding walls. For example, the viewing direction of image sensor 16 can be adjusted to pivot along one or more axes within distal end wall 34 relative to its default position, which is aligned with distal end wall 34. Similarly, the viewing direction of image sensor 22 can be adjusted to pivot along one or more axes within lateral wall 42 relative to its default position, which is aligned with lateral wall 42.

[0033] In an exemplary procedure using the endoscope 2, during a first step of the procedure, the distal tip 4 may be inserted through the patient's mouth, esophagus, stomach, and duodenum. During the first step of the procedure, the forward viewing system 12 may be used to assist the user in navigating through the patient's anatomy. When navigating to the duodenum, the tubular member 6 may be in a first position to allow a medical device 32 (e.g., a guidewire) or other instrument to move distally beyond the distal end wall 34 of the distal tip 4. For example, a guidewire may be inserted from the stomach through the pylorus to assist in navigating the distal tip 4 from the stomach to the duodenum.

[0034] Near the duodenal papilla, the user may use the lateral viewing system 14 to assist in locating the duodenal papilla. Using guidance from the lateral viewing system 14, a medical device 32 (e.g., a guidewire) may be inserted into the patient's pancreatic duct via the duodenal papilla. To assist in inserting the medical device 32 into the duodenal papilla, the tubular member 6 may be shifted to a second position to allow the medical device 32 to extend laterally from the endoscope 2. The endoscope 2 and its distal tip 4 may be maintained in a generally straight position within the duodenum as the medical device 32 extends from the distal end opening 30 from the lateral side of the distal tip 4. Once the medical device 32 is inserted into the pancreatic duct, the tubular member 6 may be shifted to a third position to lock the medical device 32 relative to the distal tip 4 of the tubular shaft. In one example, both viewing systems 12, 14 may be used simultaneously during any portion of the procedure.

[0035] A cannula (not shown) may then be inserted over the medical device 32 and through the lumen 8 of the tubular member 6. Once the cannula reaches the distal tip 4, the tubular member 6 may be moved proximally to the second position (or past the second position toward the first position) to unlock the medical device 32. A cannula may then be passed along the medical device 32 out the distal end opening 30 and into the pancreatic duct for cannulation of the pancreatic duct. A contrast agent may be injected into the pancreatic duct, and fluoroscopic images may be obtained to examine the bile duct, gallbladder, and pancreatic duct. If desired, other instruments may be inserted through the tubular member 6 and / or the cannula into the pancreatic duct to treat pancreatic or biliary duct conditions.

[0036] (Addendum) As a preferred embodiment, the technical concept that can be grasped from the above embodiment will be described below. [Item 1] A medical device comprising: The medical device comprises a shaft having a distal end, the shaft comprising: a first opening facing a first direction; a second opening facing a second direction different from the first opening; Including, the medical device includes an elevator disposed within the shaft; the elevator is configured, in a non-actuated position, to allow a medical instrument to move outward from the shaft along the first direction through the first opening, and, in an actuated position, to actuate the medical instrument and allow the medical instrument to extend outward from the shaft along the second direction through the second opening; The elevator is fixed in the actuation position, thereby maintaining the medical instrument in the actuation position in response to the shaft engaging at least a portion of the medical instrument at the distal end. [Item 2] Item 10. The medical device of item 1, wherein the shaft includes a third opening at the distal end, the third opening facing the first direction and the second direction. [Item 3] Item 3. The medical device of item 2, wherein the third opening is sized and shaped to receive at least a portion of the medical instrument. [Item 4] 4. The medical device of claim 3, wherein the shaft is configured to secure the elevator to the distal end in response to at least a portion of the medical instrument being received in the third opening. [Item 5] Item 3. The medical device of item 2, wherein the third opening is a recess in the wall of the shaft at the distal end. [Item 6] Item 6. The medical device of item 5, wherein the recess is configured to form a press fit with at least a portion of the medical implement, thereby locking the elevator relative to the shaft. [Item 7] 3. The medical device of claim 2, wherein the third opening is configured to restrict movement of the elevator from the actuated position to the non-actuated position when at least a portion of the medical instrument is received within the third opening. [Item 8] the shaft includes a first wall and a second wall at the distal end that at least partially define the second opening; 3. The medical device of claim 2, wherein the first wall and the second wall are aligned toward each other, and the third opening is located between the first wall and the second wall. [Item 9] Item 9. The medical device of item 8, wherein the first wall and the second wall are configured to guide the medical instrument toward the third opening when the elevator moves from the inactive position to the active position to activate the medical instrument. [Item 10] Item 4. The medical device of item 3, wherein the third opening is located along the shaft proximal to the first opening and the second opening. [Item 11] Item 10. The medical device of item 1, wherein the medical instrument is configured to move past the elevator when the elevator is in the inactive position. [Item 12] The shaft a first sensor adjacent to the first opening and facing in the first direction; a second sensor adjacent to the second opening and facing in the second direction; Including, Item 1. The medical device according to item 1, wherein the medical instrument is at least partially visible to the first sensor and not visible to the second sensor when the lifting tool is in the non-operating position, and is at least partially visible to the second sensor and not visible to the first sensor when the lifting tool is in the operating position. [Item 13] Item 13. The medical device of item 12, wherein the first sensor includes an imaging element and is configured to image the medical instrument when the elevator is in a non-actuated position. [Item 14] Item 13. The medical device according to item 12, wherein the second sensor includes an imaging element and is configured to image the medical instrument when the elevator is in an actuated position. [Item 15] A medical device comprising: The medical device comprises a shaft having a distal end defined by a first surface and a second surface different from the first surface, the first surface including a first opening, and the second surface including a second opening facing in a different direction relative to the first opening; the medical device includes an elevator located within the shaft and movable relative to the first surface and the second surface, the elevator configured to move between an inactive position and an active position when moving a medical instrument received in the elevator from the inactive position to the active position; When in the non-actuated position, the elevator is configured to be able to move the medical device outward from the shaft through the first opening, and when in the actuated position, the elevator is configured to be able to actuate the medical device and to allow the medical device to extend outward from the shaft through the second opening; The medical device is configured such that the medical instrument is press-fitted onto the distally facing portion of the second surface when the elevator moves from the inactive position to the active position, thereby securing the medical instrument to the distal end and maintaining the elevator in the active position. [Item 16] the shaft includes a first sensor located on a first wall of the shaft, the first wall defining the first surface; the shaft includes a second sensor located on a second wall of the shaft different from the first wall, the second wall defining a third surface different from the first surface and the second surface; Item 16. The medical device of item 15, wherein the lifting device is configured to position the medical instrument when in the non-actuated position so that the medical instrument is at least partially visible to the first sensor and not visible to the second sensor, and when in the actuated position so that the medical instrument is at least partially visible to the second sensor and not visible to the first sensor. [Item 17] Item 16. The medical device of item 15, wherein the distally facing portion of the second surface includes a third opening disposed adjacent to the second opening, the third opening configured to secure the medical instrument to the distal end in response to the elevator moving to the actuated position. [Item 18] Item 18. The medical device of item 17, wherein the third opening is configured to restrict movement of the elevator from the actuated position to the non-actuated position when the medical instrument is received within the third opening. [Item 19] Item 18. The medical device according to item 17, wherein the elevator is configured to slidably receive the medical instrument in the inactive position and the active position. [Item A1] A medical device comprising: The medical device comprises a shaft having a longitudinal axis; the medical device comprises an image sensor; The medical device includes an elevator having a lumen, the lumen having a distal end opening and defining a longitudinal axis passing through a center of the lumen, the elevator being movable between a first position and a second position; In the first position of the elevator, the distal end opening is positioned to allow an instrument to extend from the front opening of the shaft; A medical device wherein, in the second position of the elevator, the distal end opening is positioned to allow an instrument to extend from the lateral opening of the shaft, and a portion of the shaft is positioned to cover and block at least a portion of the distal end opening of the elevator when the elevator is in the second position. [Item A2] The medical device of item A1, wherein in the first position of the elevator, the longitudinal axis of the lumen is generally parallel to the longitudinal axis of the shaft. [Item A3] The medical device of item A1, wherein the image sensor is provided on the wall of the shaft. [Item A4] The medical device of item A1, wherein the image sensor comprises a first image sensor facing a first direction and a second image sensor facing a second direction. [Item A5] The medical device of item A4, wherein the first image sensor is disposed on a distally facing wall of the shaft and the second image sensor is disposed on a laterally facing wall of the shaft. [Item A6] The medical device described in item A5, wherein in the first position of the elevator, the distal end opening is generally parallel to the distally facing wall of the shaft, and the elevator is configured to move distally of the distally facing wall of the shaft. [Item A7] The medical device of item A1, further comprising the instrument disposed within the elevator, wherein in the first position of the elevator, the instrument is configured to move distally through the front opening of the shaft. [Item A8] The medical device of item A7, wherein the shaft includes a recess sized and shaped to receive a portion of the instrument. [Item A9] The medical device of item A8, wherein the recess is configured to form a press fit with a portion of the instrument, thereby locking the elevator in the second position relative to the shaft. [Item A10] The medical device of item A8, wherein the shaft comprises a first wall and a second wall that at least partially defines the lateral opening, and the recess is disposed between the first wall and the second wall. [Item A11] The medical device of item A10, wherein the first wall and the second wall of the shaft are configured to guide the instrument into the recess in response to the elevator moving from the first position to the second position. [Item A12] The medical device of item A1, further comprising an actuation mechanism configured to move the elevator between the first position and the second position relative to the shaft. [Item A13] A medical device comprising: The medical device comprises a shaft having a longitudinal axis; the medical device comprises an image sensor; the medical device comprises an elevator disposed within the shaft, the elevator comprising a lumen having a distal end opening and defining a longitudinal axis passing through a center of the lumen; The medical device includes an actuation mechanism configured to move the elevator between a first position and a second position relative to the shaft; A medical device, wherein in the second position of the elevator, a portion of the shaft is positioned to cover and block at least a portion of the distal end opening of the elevator. [Item A14] further comprising an instrument disposed in the lumen of the elevator; In the first position, the distal end opening is positioned to allow an instrument to extend from the front opening of the shaft; The medical device of item A13, wherein in the second position of the elevator, the distal end opening is positioned to allow an instrument to extend from the lateral opening of the shaft. [Item A15] The medical device of claim A14, wherein the shaft includes a recess sized and shaped to receive a portion of the instrument. [Item A16] The medical device of item A15, wherein the recess is configured to form a press fit with a portion of the instrument, thereby locking the elevator in the second position relative to the shaft. [Item A17] The medical device of item A13, wherein the image sensor comprises a first image sensor facing a first direction and a second image sensor facing a second direction. [Item A18] The medical device of item A17, wherein the first image sensor is disposed on a distally facing wall of the shaft and the second image sensor is disposed on a laterally facing wall of the shaft. [Item A19] The medical device of item A18, wherein in the first position, the distal end opening is generally parallel to the distally facing wall of the shaft, and the elevator is configured to move distally of the distally facing wall of the shaft. [Item A20] A medical device comprising: The medical device comprises a shaft having a longitudinal axis; the medical device comprises an image sensor; the medical device comprises an elevator disposed within the shaft, the elevator comprising a lumen having a distal end opening and defining a longitudinal axis passing through a center of the lumen; The medical device includes an actuation mechanism configured to move the elevator between a first position and a second position relative to the shaft; the medical device includes an instrument disposed within the lumen of the elevator; In the first position of the elevator, the distal end opening is positioned to allow the instrument to extend from the front opening of the shaft but not extend from the side opening of the shaft; In the second position of the elevator, the distal end opening is positioned to allow the instrument to extend from the side opening of the shaft but not from the front opening of the shaft, and a portion of the shaft is positioned to cover and block at least a portion of the distal end opening of the elevator; the shaft includes a recess sized and shaped to receive a portion of the instrument; The medical device, wherein the recess is configured to form a press fit with a portion of the instrument, thereby locking the elevator in the second position relative to the shaft. While the principles of the present invention have been described herein with reference to illustrative examples of specific applications, it is to be understood that the invention is not limited to those examples. Those skilled in the art, armed with the teachings presented herein, will recognize further modifications, applications, and equivalent substitutions, all of which are within the scope of the examples described herein. Thus, the invention should not be deemed limited by the foregoing description.

Claims

1. a shaft having a longitudinal axis; a forward-looking image sensor; a side-viewing image sensor; an elevator that is movable between a first position and a second position; Equipped with In the first position of the elevator, a central longitudinal axis of the elevator is parallel to a longitudinal axis of the shaft, and in the second position of the elevator, the central longitudinal axis is at an angle to the longitudinal axis. Medical devices.

2. The medical device of claim 1 , wherein in the first position of the elevator, an instrument extending along the elevator is visible by the forward-looking image sensor.

3. The medical device according to claim 1 or 2, wherein, in the second position of the elevator, an instrument extending along the elevator is visible to the side-viewing image sensor.

4. The medical device according to claim 1 or 2, wherein in the second position of the elevator, at least a portion of a distal end opening of the elevator is blocked by the shaft.

5. The medical device of claim 4 , wherein the shaft includes a recess sized and shaped to receive a portion of a medical instrument extending along the elevator.

6. The medical device of claim 5 , wherein a press fit between the recess and the medical instrument locks the elevator relative to the shaft in the second position.

7. The medical device according to claim 1 or 2, wherein the elevator is tubular.

8. The medical device of claim 1 , wherein in the first position, the elevator is movable and in the second position, the elevator is fixed.

9. The medical device of claim 8 , wherein in the first position, the elevator is movable in the direction of a longitudinal axis of the elevator.

10. The medical device of claim 2 , wherein the elevator is configured to press the instrument against a surface of the shaft when moving from the first position to the second position.

11. The medical device according to claim 1 or 2, wherein the elevator is in a maximally bent position in the second position.

12. 3. The medical device of claim 1, wherein in the second position, a medical device extending along the elevator is press-fit onto a distally facing portion of the surface of the shaft, thereby securing the medical device to the distal end of the elevator and maintaining the elevator in the second position.

13. The medical device of claim 1 or 2, wherein the shaft includes a U-shaped distal opening.

14. 3. The medical device of claim 1, wherein the elevator has a 90° range of motion.

15. The medical device of claim 1 , wherein the forward-looking image sensor and the side-looking image sensor are perpendicular to each other.

Images