Endoscope with laser fiber channel

Abstract

By way of example, a ureteroscope includes a handpiece that defines at least a working channel port and a laser fiber port. The ureteroscope also includes a catheter that includes a proximal end and a distal end opposite the proximal end. The catheter defines at least a working channel and a laser fiber channel that is separate from the working channel. In other words, the catheter defines a dedicated laser fiber channel that is separate from the working channel. The working channel and the laser fiber channel are connected (directly or indirectly) to the working channel port and the laser fiber port, respectively.

Description

[Background technology]

[0001] Small size endoscopes are desirable in many industrial and medical applications. For example, when the natural openings and lumens of the human body are small, small endoscopes are used to insert through such openings and lumens to a target location within the body. In the case of single incision laparoscopy, especially when the incision itself is of minimal dimensions, smaller endoscopes are preferred to provide an internal view of the surgical site. In some cases, the patient may feel irritation when the endoscope is inserted into the patient's body, and a smaller endoscope can reduce such an unpleasant experience and minimize trauma to the patient. In addition, physicians can improve diagnostic and surgical protocols with smaller endoscopes. For example, transnasal endoscopy may replace oral endoscopy in some cases. [Prior art documents] [Patent documents]

[0002] [Patent Document 1] U.S. Patent No. 9,942,452 [Patent Document 2] Publication of PCT / US2019 / 65616 (International Publication No. 2020 / 123588) Summary of the Invention [Means for solving the problem]

[0003] In one embodiment, a ureteroscope is disclosed. The ureteroscope comprises a handpiece defining at least a working channel port and a laser fiber port. The ureteroscope also comprises a catheter comprising a proximal end and a distal end opposite the proximal end. The catheter defines at least a working channel extending from the proximal end to the distal end of the catheter and a laser fiber channel extending from the proximal end to the distal end of the catheter. The laser fiber channel is separate from the working channel. The working channel is connected to the working channel port and the laser fiber channel is connected to the laser fiber port. The ureteroscope also comprises a laser fiber. At least one of: the laser fiber port includes a funnel structure exhibiting a lateral dimension that decreases with increasing distance from an outer surface of the handpiece, an optional fiber conduit extending from the laser fiber port to the laser fiber channel includes a funnel structure exhibiting a lateral dimension that decreases with increasing distance from an outer surface of the handpiece, or the laser fiber is preloaded into the laser fiber channel.

[0004] In one embodiment, a method of using a ureteroscope is disclosed. The method includes inserting a distal end of a ureteroscope catheter into a urethral opening of an individual. The ureteroscope comprises a handpiece defining at least a working channel port and a laser fiber port. The ureteroscope also comprises a catheter having a proximal end and a distal end opposite the proximal end. The catheter defines at least a working channel extending from the proximal end to the distal end of the catheter and a laser fiber channel extending from the proximal end to the distal end of the catheter. The laser fiber is separate from the working channel. The working channel is connected to the working channel port and the laser fiber channel is connected to the laser fiber port. The ureteroscope also comprises a laser fiber. At least one of: the laser fiber port includes a funnel structure exhibiting a lateral dimension that decreases with increasing distance from the outer surface of the hand piece; an optional fiber conduit extending from the laser fiber port to the laser fiber channel includes a funnel structure exhibiting a lateral dimension that decreases with increasing distance from the outer surface of the hand piece; or the laser fiber is pre-loaded into the laser fiber channel.

[0005] Features from any of the disclosed embodiments may be used in combination with each other without limitation.In addition, other features and advantages of the present disclosure will become apparent to those skilled in the art upon consideration of the following detailed description and accompanying drawings.

[0006] The drawings illustrate several embodiments of the present disclosure, with the same reference numbers referring to the same or similar elements or features in different figures or embodiments shown in the drawings. [Brief description of the drawings]

[0007] [Figure 1A] FIG. 1 is a side schematic view of an endoscopic system, in accordance with one embodiment. [Figure 1B] FIG. 1B is a cross-sectional view of a portion of a ureteroscope taken along plane 1B-1B, according to one embodiment. [Figure 1C] FIG. 2 is a side view of a distal end of a catheter, according to one embodiment. [Diagram 2] 1 is a cross-sectional schematic diagram of a ureteroscope, according to one embodiment. [Diagram 3] FIG. 1 is a cross-sectional view of a ureteroscope, according to one embodiment. [Figure 4] FIG. 1 is a cross-sectional view of a ureteroscope, according to one embodiment. [Diagram 5] 1 is a flow diagram of a method of operating any of the ureteroscopes disclosed herein. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0008] Embodiments are directed to a ureteroscope including a dedicated laser fiber channel and a method of using the same. By way of example, the ureteroscope includes a handpiece that defines at least a working channel port and a laser fiber port. The ureteroscope also includes a catheter that includes a proximal end and a distal end opposite the proximal end. The catheter defines at least a working channel and a laser fiber channel that is separate from the working channel. In other words, the catheter defines a dedicated laser fiber channel that is separate from the working channel. The working channel and the laser fiber channel are connected (directly or indirectly) to the working channel port and the laser fiber port, respectively.

[0009] The function of the ureteroscope is improved over a conventional ureteroscope. For example, a conventional ureteroscope includes a catheter that defines a working channel. Conventionally, a laser fiber is disposed within the working channel. Disposing the laser fiber in the working channel reduces the space within the working channel for receiving surgical instruments. Thus, disposing the laser fiber within the working channel may require inserting and removing the laser fiber from the working channel depending on which surgical instrument is inserted into the working channel. Removing the laser fiber from the working channel limits when the laser fiber can be used. Also, since the working channel often includes a curve therein, it may be difficult to insert the laser fiber into the working channel, and the laser fiber may be difficult to move through the curve, especially when the laser fiber exhibits a diameter of less than 500 μm, since such a laser fiber may bend rather than traverse such a curve. It is noted that bending the laser fiber may damage the laser fiber and may affect the ability of the laser to be reflected within the laser fiber. Furthermore, while the laser fiber is being inserted into the working channel, the laser fiber may get caught (e.g., get stuck) on a surgical instrument disposed in the working channel, which may prevent further insertion of the laser fiber into the working channel. In addition, it has been found that the laser fiber may move in the working channel. For example, shock waves generated by emitting a laser from the distal tip of the laser fiber and irradiating an object (e.g., a kidney stone) with the emitted laser may cause non-negligible movement (e.g., lateral movement) in the distal portion of the laser fiber, which may reduce the precision of the laser fiber.

[0010] The ureteroscope disclosed herein remedies these shortcomings of conventional ureteroscopes by including a dedicated laser fiber channel separate from the working channel. The laser fiber channel may be formed at least partially in a portion of the catheter that would otherwise be occupied by the body of the catheter or unoccupied space. Thus, the inclusion of the laser fiber channel may have no or little impact on the overall size of the catheter or the size of the working channel of the catheter. The laser fiber channel allows the laser fiber to remain disposed within the catheter, thereby eliminating the need to remove the laser fiber or insert the laser fiber into the catheter to accommodate different surgical instruments. The laser fiber channel is also configured to receive the laser fiber, thereby preventing movement of the laser fiber caused by the laser fiber emitting a laser or shock wave. The laser fiber channel also facilitates insertion and movement of the laser fiber when such insertion and movement is required. For example, the laser fiber channel may include one or more features (e.g., introducer element, funnel structure, actuator, etc.) configured to facilitate insertion of the laser fiber into the laser fiber channel and movement of the laser fiber through bends in the laser fiber channel. Additionally, the laser fiber channel may not contain other components (eg, surgical components) within which the laser fiber may be trapped.

[0011] FIG 1A is a side schematic view of an endoscopic system 100, according to one embodiment. Endoscopic system 100 includes a ureteroscope 101. FIG 1B is a cross-sectional view of a portion of ureteroscope 101 taken along plane 1B-1B, according to one embodiment. Ureteroscope 101 includes a handpiece 102 and a catheter 104. Handpiece 102 is attached to or integrally formed with catheter 104. Catheter 104 extends from handpiece 102.

[0012] The handpiece 102 is elongated and includes a catheter end 106 and a control end 108. The catheter end 106 is proximal to the catheter 104 and the control end 108 is opposite or distal to the catheter end 106. Because the control end 108 is opposite the catheter end 106, the control end 108 and the catheter end 106 can be at different ends of the handpiece 102 and face in different directions relative to one another. The control end 108 can include a generally spherical shape and the handpiece 102 can be tapered between the control end 108 and the catheter end 106.

[0013] The handpiece 102 includes an intermediate or central portion 110 positioned between the catheter end 106 and the control end 108, with the control end 108 opposite or distal to the catheter end 106. The central portion 110 includes a first or top surface 112, a second or bottom surface 114, and two opposing side surfaces 116 positioned between the top surface 112 and the bottom surface 114. In one embodiment, the top surface 112 and the bottom surface 114 of the central portion 110 are curved and the side surfaces 116 are substantially flat.

[0014] In one embodiment, both the catheter 104 and the handpiece 102 are disposable. In some embodiments, the catheter 104 and the handpiece 102 are manufactured as an integral part, or the catheter 104 is secured to the handpiece 102 via a handpiece-catheter connector 122. Alternatively, only the catheter 104 is disposable, and the handpiece 102 can be sterilized and reused multiple times. In this case, the catheter 104 is removably connected to the handpiece 102 and the catheter end 106 via the handpiece-catheter connector 122.

[0015] The catheter 104 includes a proximal end 118 and a distal end 120 spaced from the proximal end 118. The proximal end 118 is attached to, integrally formed with, or disposed on the catheter end 106 (e.g., a handpiece-catheter connector 122). The distal end 120 is configured to be disposed within the urethral meatus of an individual. Figure 1C is a side view of the distal end 120 of the catheter 104, according to one embodiment.

[0016] The handpiece 102 defines a working channel port 124, and the catheter 104 defines a working channel 126 (FIG. 1C). The working channel 126 extends from the proximal end 118 to the distal end 120 of the catheter 104. The working channel port 124 and the working channel 126 are connected together (directly or indirectly). The working channel port 124 and the working channel 126 are configured to engage various surgical instruments and cleaning devices as needed for operations such as stone breaking and removal. For example, various surgical instruments can be inserted through the working channel port 124 and the working channel 126 to enable various surgical instruments to be used at the distal end 120 of the catheter 104. The handpiece 102 may also include at least one of a working channel connector 128 connected or attached to the working channel port 124, or at least one working conduit 130 indirectly connecting the working channel port 124 to the working channel 126.

[0017] The working channel port 124 may be positioned near the catheter end 106 of the handpiece 102. For example, the working channel port 124 may be positioned less than half the distance from the catheter end 106 to the control end 108, less than one-third the distance from the catheter end 106 to the control end 108, less than one-quarter the distance from the catheter end 106 to the control end 108, or less than one-fifth the distance from the catheter end 106 to the control end 108. Locating the working channel port 124 near the catheter end 106 may improve the ergonomics of the handpiece 102 because the working channel port 124 and any surgical instruments extending therefrom are less likely to interfere with the use of the ureteroscope 101. Positioning the working channel port 124 near the catheter end 106 may cause at least one of the working channel port 124, a portion of the working channel 126 disposed within the catheter end 106, or optionally the working conduit 130 to exhibit an internal working curve 132 when the catheter 104 is substantially straight. Due to the proximity of the working channel port 124 to the catheter end 106, the working curve 132 may exhibit a radius of curvature of less than 10 cm. As used herein, radius of curvature refers to at least one of the radius of curvature of a single point of the curve (e.g., the working curve 132 or the fiber curve 144), the average radius of curvature along a portion of the curve, or the average radius of curvature along the entire curve.

[0018] The handpiece 102 defines a laser fiber port 134, and the catheter 104 defines a laser fiber channel 136 (FIG. 1C). The laser fiber channel 136 extends from the proximal end 118 to the distal end 120 of the catheter 104. The laser fiber port 134 and the laser fiber channel 136 are connected together (directly or indirectly). The laser fiber port 134 and the laser fiber channel 136 are configured to receive and engage a laser fiber 138. For example, the laser fiber 138 can be inserted through the laser fiber port 134 and the laser fiber channel 136 such that a distal portion 140 of the laser fiber 138 is disposed at the distal end 120 of the catheter 104. A laser can be emitted from the distal portion 140 of the laser fiber 138 toward an object (e.g., a kidney stone) adjacent or near the distal end 120 of the catheter 104. The handpiece 102 may optionally include at least one fiber conduit 142 indirectly connecting the laser fiber port 134 to the laser fiber channel 136 .

[0019] The working channel port 124 and the laser fiber port 134 are openings formed in the hand piece 102 that are directly or indirectly connected to the working channel 126 and the laser fiber channel 136, respectively. In one embodiment, the working channel port 124 and the laser fiber port 134 are separate from one another. The working channel port 124 and the laser fiber port 134 are separate from one another when the openings of the working channel port 124 and the laser fiber port 134 are spaced apart from one another. In one embodiment, the working channel port 124 and the laser fiber port 134 are not separate from one another. In other words, the working channel port 124 and the laser fiber port 134 share the same opening in the hand piece 102. When the working channel port 124 and the laser fiber port 134 are not separate, the working channel 126 and the laser fiber channel 136 extend from the same opening in the hand piece 102.

[0020] When the working channel port 124 and the laser fiber port 134 are separate from one another, the laser fiber port 134 may be located in any portion of the hand piece 102 without limitation. For example, the laser fiber port 134 can be positioned less than one-half the distance from the catheter end 106 to the control end 108, less than one-third the distance from the catheter end 106 to the control end 108, less than one-quarter the distance from the catheter end 106 to the control end 108, less than one-fifth the distance from the catheter end 106 to the control end 108, at the midpoint of the hand piece 102 (e.g., the midpoint of the central portion 110), less than one-half the distance from the control end 108 to the catheter end 106, less than one-third the distance from the control end 108 to the catheter end 106, less than one-quarter the distance from the control end 108 to the catheter end 106, less than one-fifth the distance from the control end 108 to the catheter end 106, or at the control end 108. In an example, the working channel port 124 and the laser fiber port 134 are formed in the same general location (e.g., within about 2 cm) from one another. The surgical instrument and the laser fiber 138 extend outwardly from the same general location on the hand piece 102 when the working channel port 124 and the laser fiber port 134 have the same general location. Having the surgical instrument and the laser fiber 138 extend from the same general location on the hand piece 102 improves the ergonomics of the ureteroscope over when the working channel port 124 and the laser fiber port 134 are not in the same general location, for example, by allowing additional portions of the hand piece 102 to be grasped without interfering with the surgical instrument and the laser fiber 138. In one example, the working channel port 124 and the laser fiber port 134 are located on different surfaces of the hand piece 102 and are located substantially the same general distance from the catheter end 106 of the hand piece 102. For example, the working channel port 124 may be positioned on the top surface 112 and the laser fiber port 134 may be positioned on the bottom surface 114, or vice versa, or the working channel port 124 and the laser fiber port 134 may be located on different sides 116.Locating the working channel port 124 and the laser fiber port 134 at substantially the same distance from the catheter end 106 improves the ergonomics of the ureteroscope than if the laser fiber port 134 were located further or closer to the catheter end 106 than the working channel port 124, for example, by allowing additional portions of the hand piece 102 to be grasped without interference with the surgical instruments and the laser fiber 138. Additionally, locating the working channel port 124 and the laser fiber port 134 on different sides of the hand piece 102 reduces the likelihood that manipulation of a surgical instrument (e.g., insertion, removal, or other movement of a surgical instrument) will cause movement of the laser fiber 138, and vice versa. In one example, the laser fiber port 134 is spaced closer, or more specifically, further, from the catheter end 106 than the working channel port 124. By spacing the laser fiber port 134 farther from the catheter end 106 than the working channel port 124, at least one of the laser fiber port 134, the laser fiber channel 136, or the optional fiber conduit 142 exhibits a bend 144 (hereafter referred to as a "fiber bend") when the catheter 104 is substantially straight. The fiber bend 144 may exhibit a larger radius of curvature than the working bend 132. As the radius of curvature increases, the likelihood that the laser fiber 138 will become trapped (e.g., get stuck) on the walls defining the fiber bend 144 or a buckle decreases. Thus, by positioning the laser fiber port 134 farther from the catheter end 106, the likelihood that the laser fiber 138 may become trapped in the walls defining the fiber bend 144 and that the laser fiber 138 will bend when inserted through the fiber bend 144 decreases.

[0021] The laser fiber port 134 or optional fiber conduit 142 includes a funnel structure 146. The funnel structure 146 exhibits a lateral dimension that decreases with increasing distance from an exterior surface (e.g., top surface 112, bottom surface 114, or side surface 116) of the hand piece 102. In effect, the funnel structure 146 increases the size of the opening of the laser fiber port 134 at the exterior surface of the hand piece 102 and decreases the size of the laser fiber channel 136. The increased size of the opening of the laser fiber port 134 caused by the funnel structure 146 facilitates insertion of the laser fiber 138 into the laser fiber port 134. For example, as discussed in more detail below, the laser fiber 138 may exhibit a relatively small maximum lateral dimension (e.g., about 50 μm to 500 μm). A person attempting to insert the laser fiber 138 into the laser fiber port 134 may find such insertion difficult if the laser fiber port 134 exhibits a lateral dimension comparable to the maximum lateral dimension of the laser fiber 138. Thus, the increase in size of the laser fiber port 134 caused by the funnel structure 146 facilitates the insertion of the laser fiber 138 into the laser fiber port 134. The decrease in size of the laser fiber channel 136 relative to the laser fiber port 134 caused by the funnel structure 146 prevents or at least inhibits the backflow of bodily fluids (e.g., urine) from the distal end 120 of the catheter 104 into the laser fiber port 134. For example, as discussed in more detail below, a gap may exist between the wall defining the laser fiber channel 136 and the laser fiber 138 disposed therein. Bodily fluids may flow through the gap. By reducing the size of the laser fiber channel 136, the size of the gap through which bodily fluids can flow is reduced, thus reducing or preventing bodily fluids from passing through the gap.

[0022] The funnel structure 146 is defined by one or more side walls 148. The one or more side walls 148 may be tapered or curved (e.g., concavely or convexly curved relative to the exterior surface of the hand piece 102). In other words, the side walls 148 do not have to be stepped, as the stepped side walls 148 may trap the laser fiber 138 as it is inserted into the funnel structure 146. Trapped laser fiber 138 may prevent further insertion of the laser fiber 138 into the funnel structure 146 without bending the laser fiber 138.

[0023] The laser fiber channel 136 is configured to have the laser fiber 138 disposed therein. The working channel 126 and the laser fiber channel 136 are separate from one another. The working channel 126 and the laser fiber channel 136 are separate from one another when an object (e.g., a surgical instrument or the laser fiber 138) located in one channel cannot enter the other channel. For example, the working channel 126 and the laser fiber channel 136 are separate when there is a barrier 150 between the working channel 126 and the laser fiber channel 136. In one embodiment, as shown in FIG. 1C, the catheter 104 may include a body 151 that defines both the working channel 126 and the laser fiber channel 136. In such an embodiment, the portion of the body 151 between the working channel 126 and the laser fiber channel 136 forms the barrier 150. In one embodiment, the catheter 104 is a large tube and the working channel 126 and the laser fiber channel 136 are smaller tubes disposed inside the large tube. In such an embodiment, the smaller tube forming the working channel 126 and the wall of the laser fiber channel 136 form the barrier 150 .

[0024] The laser fiber channel 136 may be formed in a portion of the catheter 104 that would otherwise be occupied or unoccupied by the body 151. Forming the laser fiber channel 136 in a portion of the catheter 104 that would otherwise be occupied or unoccupied by the body 151 prevents or at least minimizes any increase in size of the catheter 104 due to the inclusion of the laser fiber channel 136 in the catheter 104. The laser fiber channel 136 may be formed in a portion of the catheter 104 that would otherwise be occupied or unoccupied by the body 151 due to the relatively small size of the laser fiber 138, particularly when the laser fiber 138 is a thulium laser fiber (i.e., a laser fiber configured for use with a thulium laser). In one embodiment, as shown, the laser fiber channel 136 may be disposed between the working channel 126 and the optoelectronic module 152 when there is sufficient spacing between the working channel 126 and the optoelectronic module 152 for the laser fiber channel 136 to be present. In one embodiment, the laser fiber channel 136 may be positioned between the working channel 126 and the light source 154, between the working channel 126 and the outer surface 156 of the catheter 104, between the optoelectronic module 152 and the light source 154, between the optoelectronic module 152 and the outer surface 156 of the catheter 104, between the light source 154 and the outer surface 156 of the catheter 104, or any other location on the catheter 104 depending on where there is sufficient space to form the laser fiber channel 136.

[0025] In one embodiment, working channel 126, laser fiber channel 136, and opto-electronic module 152 are aligned on the same axis. Aligning working channel 126, laser fiber channel 136, and opto-electronic module 152 can facilitate use of ureteroscope 101 because the laser emanating from laser fiber channel 136 and the surgical instruments protruding from working channel 126 are aligned on display 170 of endoscope system 100. In one embodiment, laser fiber channel 136 may not be aligned on the same axis as working channel 126 and opto-electronic module 152.

[0026] As discussed above, at least one of the laser fiber port 134, the laser fiber channel 136, or the optional fiber conduit 142 includes a fiber bend 144 when the catheter 104 is substantially straight. The laser fiber 138 may resist bending as the laser fiber 138 is inserted into and moves through the fiber bend 144, which may cause the laser fiber 138 to become trapped at the wall defining the fiber bend 144. For example, the laser fiber 138 may become trapped on the wall defining the fiber bend 144 due to friction between the wall and the laser fiber 138 or the distal portion 140 of the laser fiber 138, at least partially penetrating or otherwise getting stuck in the wall defining the fiber bend 144. Forcing the laser fiber 138 through the fiber bend 144 while the laser fiber 138 is trapped on the wall defining the fiber bend 144 may cause the laser fiber 138 to bend, especially as the maximum lateral dimension decreases. In general, an increased radius of curvature of the fiber bend 144 makes it easier for the laser fiber 138 to be inserted into or moved through the fiber bend 144 without the laser fiber 138 getting caught on the walls that define the fiber bend 144. In one embodiment, the radius of curvature of the fiber bend 144 may be selected to be larger than the radius of curvature of the working bend 132, which may allow the laser fiber 138 to be inserted into and moved through the fiber bend 144 more easily than the working bend 132. The radius of curvature of the fiber bend 144 may be larger than the radius of curvature of the working bend 132 when the laser fiber port 134 is spaced farther from the catheter end 106 than the working channel port 124.

[0027] In one embodiment, the radius of curvature of the fiber bend 144 may be selected to be about 7.5 cm or more, about 10 cm or more, about 12.5 cm or more, about 15 cm or more, about 17.5 cm or more, about 20 cm or more, about 22.5 cm or more, about 25 cm or more, about 30 cm or more, about 35 cm or more, about 40 cm or more, about 45 cm or more, about 50 cm or more, or within a range from about 7.5 cm to about 12.5 cm, about 10 cm to about 15 cm, about 12.5 cm to about 17.5 cm, about 15 cm to about 20 cm, about 17.5 cm to about 22.5 cm, about 20 cm to about 25 cm, about 22.5 cm to about 30 cm, about 25 cm to about 35 cm, about 30 cm to about 40 cm, about 35 cm to about 45 cm, or about 40 cm to about 50 cm. The radius of curvature of the fiber bend 144 may be selected based on several factors. In one example, the radius of curvature of the fiber bend 144 may be selected based on the maximum lateral dimension of the laser fiber 138. For example, the radius of curvature of the fiber bend 144 may be increased when the maximum lateral dimension of the laser fiber 138 is decreased to prevent the laser fiber 138 from bending. In one example, the radius of curvature of the fiber bend 144 may be selected based on the location of the laser fiber port 134 on the hand piece 102.

[0028] The laser fiber 138 is configured to receive a laser at its proximal end and internally reflect the laser until it is emitted at its distal portion 140. The laser fiber 138 may be formed from any suitable material, such as silica. The laser fiber 138 may have a diameter of about 1 mm or less, about 750 μm or less, about 600 μm or less, about 550 μm or less, about 500 μm or less, about 450 μm or less, about 400 μm or less, about 350 μm or less, about 300 μm or less, about 250 μm or less, about 225 μm or less, about 200 μm or less, about 175 μm or less, about 150 μm or less, about 125 μm or less, about 100 μm or less, about 75 μm or less, about 50 μm or less, about 25 μm or less, or about 25 μm to about 75 μm, about 50 μm to about 100 μm, about 75 μm to about 125 μm, about 100 μm to about 150 μm, or about 25 μm to about 75 μm, about 50 μm to about 100 μm, about 75 μm to about 125 μm, about 100 μm to about 150 μm, or about 250 μm to about 2 ... The laser fiber 138 may exhibit a maximum transverse dimension (e.g., diameter) selected to be in the range of about 125 μm to about 175 μm, about 150 μm to about 200 μm, about 175 μm to about 225 μm, about 200 μm to about 250 μm, about 225 μm to about 300 μm, about 250 μm to about 350 μm, about 300 μm to about 400 μm, about 350 μm to about 450 μm, about 400 μm to about 500 μm, about 450 μm to about 550 μm, about 500 μm to about 600 μm, about 550 μm to about 750 μm, or about 600 μm to about 1 mm. The maximum transverse dimension of the laser fiber 138 may be selected based on several factors. In one example, the maximum lateral dimension of the laser fiber 138 may be selected to be as small as possible, thereby reducing the size of the laser fiber channel 136, because reducing the size of the laser fiber channel 136 makes it easier to fit the laser fiber channel 136 into the catheter 104 without substantially increasing the size of the catheter 104. In one example, the maximum lateral dimension may be selected based on the likelihood that the laser fiber 138 will bend during insertion of the laser fiber 138 into the laser fiber port 134 and the laser fiber channel 136. In particular, the maximum lateral dimension of the laser fiber 138 may be increased as the likelihood that the laser fiber 138 will bend increases.Factors that influence whether the laser fiber 138 bends include the radius of curvature of the fiber bend 144 or whether the ureteroscope 101 includes an introducer element (e.g., introducer element 278 shown in FIG. 2). In one example, the maximum lateral dimension of the laser fiber 138 may be selected based on whether the laser fiber 138 is a thulium laser fiber (e.g., a laser fiber configured for use with a thulium laser), a holmium laser fiber (e.g., a laser fiber configured for use with a holmium laser), or another laser fiber. For example, a thulium laser fiber may exhibit a relatively small lateral dimension (e.g., less than 250 μm, less than 200 μm, or less than 150 μm), while a holmium laser fiber may exhibit a relatively large maximum lateral dimension (e.g., greater than 250 μm).

[0029] The laser fiber channel 136 exhibits a maximum lateral dimension (e.g., diameter) that is equal to or greater than the maximum lateral dimension of the laser fiber 138. For example, the laser fiber channel 136 may be about 1.25 mm or less, about 1 mm or less, about 750 μm or less, about 600 μm or less, about 550 μm or less, about 500 μm or less, about 450 μm or less, about 400 μm or less, about 350 μm or less, about 300 μm or less, about 250 μm or less, about 225 μm or less, about 200 μm or less, about 175 μm or less, about 150 μm or less, about 125 μm or less, about 100 μm or less, about 75 μm or less, about 50 μm or less, about 25 μm or less, or about 25 μm to about 75 μm, about 50 μm to about 100 μm, about 75 μm to about 125 μm, about 1 In some embodiments, the nanoparticles may exhibit a maximum lateral dimension in the range from about 00 μm to about 150 μm, 125 μm to about 175 μm, about 150 μm to about 200 μm, about 175 μm to about 225 μm, about 200 μm to about 250 μm, about 225 μm to about 300 μm, about 250 μm to about 350 μm, about 300 μm to about 400 μm, about 350 μm to about 450 μm, about 400 μm to about 500 μm, about 450 μm to about 550 μm, about 500 μm to about 600 μm, about 550 μm to about 750 μm, about 600 μm to about 1 mm, or about 750 μm to about 1.25 mm. The maximum lateral dimension of the laser fiber channel 136 is typically selected based on the maximum lateral dimension, or range of maximum lateral dimensions, of the laser fiber that the laser fiber channel 136 is configured to receive.

[0030] In one embodiment, the maximum lateral dimension of the laser fiber channel 136 is selected to be greater than the maximum lateral dimension of the laser fiber 138. In such an embodiment, a gap exists between the walls defining the laser fiber channel 136 and the laser fiber 138. The gap reduces the frictional force exerted on the laser fiber 138 by the walls defining the laser fiber channel 136 during insertion of the laser fiber 138, thereby reducing the likelihood that the laser fiber 138 will bend during insertion. The gap may be from about 5 μm to about 15 μm, from about 10 μm to about 20 μm, from about 15 μm to about 25 μm, from about 20 μm to about 30 μm, from about 25 μm to about 35 μm, from about 30 μm to about 40 μm, from about 35 μm to about 45 μm, from about 40 μm to about 50 μm, from about 45 μm to about 60 μm, from about 50 μm to about 70 μm, from about 60 μm to about 80 μm, from about 70 μm to about 90 μm, from about 80 μm to about 100 μm, from about 90 μm to about 125 μm, from about 100 μm to about 150 μm, from about 125 μm to about 175 μm, from about 150 μm to about 200 μm, from about 175 μm to about 225 μm, from about 20 In one embodiment, the laser fiber 138 may exhibit a maximum lateral dimension selected to be from 0 μm to about 250 μm, from about 225 μm to about 300 μm, from about 250 μm to about 350 μm, from about 300 μm to about 400 μm, from about 350 μm to about 450 μm, from about 400 μm to about 500 μm, from about 450 μm to about 600 μm, from about 500 μm to about 700 μm, from about 600 μm to about 800 μm, from about 700 μm to about 900 μm, from about 800 μm to about 1 mm, or greater than about 1 mm (i.e., the maximum lateral dimension of the laser fiber channel 136 minus the maximum lateral dimension of the laser fiber 138). In one example, the maximum lateral dimension of the gap is selected to be as small as possible to prevent or at least minimize backflow of bodily fluids through the laser fiber channel 136 and to prevent lateral movement of the laser fiber 138 caused by the emitted laser and shock waves generated by the laser.

[0031] In one embodiment, the laser fiber 138 exhibits a length of about 0.5 m to about 1.5 m, about 1 m to about 2 m, about 1.5 m to about 3 m, about 2 m to about 4 m, about 3 m to about 5 m, about 4 m to about 6 m, about 5 m to about 7 m, about 6 m to about 8 m, about 7 m to about 9 m, about 8 m to about 10 m, or about 10 m or more. The length of the laser fiber 138 may be selected based on the length of the catheter 104 and the expected maximum distance between the laser fiber port 134 and the laser 158.

[0032] In one embodiment, the laser fiber 138 is pre-loaded into the ureteroscope 101. The laser fiber 138 is pre-loaded into the ureteroscope 101 when the laser fiber 138 is inserted into at least the laser fiber channel 136 during manufacturing of the ureteroscope 101 or when the laser fiber 138 is positioned within at least the laser fiber channel 136 before the ureteroscope 101 is packaged. Pre-loading the laser fiber 138 into the ureteroscope 101 allows the laser fiber 138 to be inserted into the laser fiber channel 136 through the laser fiber port 134 using a machine or a technician, which reduces the likelihood that the laser fiber 138 will bend due to insertion of the laser fiber 138 into the laser fiber port 134 and the laser fiber channel 136. It has also been found that pre-loading the laser fiber 138 into the ureteroscope 101 provides a more sterile environment for use of the ureteroscope 101. For example, it has been found that handling the laser fiber 138 that is not preloaded into the ureteroscope 101 has a high probability of unintentionally contacting one or more objects. In particular, the long length and small maximum lateral dimension of the laser fiber 138 make it difficult to handle the laser fiber 138 without accidentally contacting an object. Contacting the laser fiber 138 against an object, and in particular contacting the distal portion 140 of the laser fiber 138 against an object, may result in bacteria, other organisms, or other materials being deposited on the laser fiber 138, which may then be transferred to a body (e.g., a human or animal body) during use of the ureteroscope 101. However, by preloading the laser fiber 138 into the ureteroscope 101, the catheter 104 prevents a portion of the laser fiber 138 disposed therein from contacting an object, which in turn prevents or at least inhibits the transfer of bacteria, other organisms, or other materials to the laser fiber 138.

[0033] In one embodiment, the laser fiber 138 is not pre-loaded onto the ureteroscope 101. In such an embodiment, the laser fiber 138 may be included in the packaging that includes the ureteroscope 101 or may be provided from a separate source.

[0034] In one embodiment, the hand piece 102 includes a seal 160. The seal 160 is configured to fit or cover at least the laser fiber port 134. Fitting or covering the seal 160 over the laser fiber port 134 prevents or at least inhibits bodily fluids flowing through the laser fiber channel 136 from leaking out of the laser fiber port 134. For example, the seal 160 may be a stopper, a flapper valve, a check valve, thick grease, or any other device that can cover or fit over at least the laser fiber port 134. In one embodiment, the seal 160 defines a recess, slot, or hole configured to receive the laser fiber 138 such that the laser fiber 138 can pass through and exit the laser fiber port 134 even when the seal 160 covers or is disposed within the laser fiber port 134. In one embodiment, the seal 160 is resilient such that the seal 160 can bend around the laser fiber 138 extending through and out of the laser fiber port 134 .

[0035] The catheter 104 of the ureteroscope 101 may be used to image the inner surface of a tubular structure, such as a lumen, in a human or animal body. For example, the catheter 104 may be inserted through a subject's urethra to access various portions of the urinary tract. However, it should be understood that the ureteroscope 101 may be used as an industrial endoscope when the tubular structure is part of an industrial device, equipment, product, machine, manufacturing line, or the like. In some embodiments, the catheter 104 may include multiple scale markings or fiducials that may act as a tether and allow the physician to measure the distance the optoelectronic module advances into the tubular structure, such as a lumen of the body. Other structures may be built into the ureteroscope 101 as desired. For example, the handpiece 102 may include a steering controller 162 configured to control one or more steering wires 164 (FIG. 1B) connected to an active bending portion of the catheter 104 to deflect the distal end 120 to a desired location. Thus, a user may bend or curve the catheter 104 by moving the steering controller 162 on the handpiece 102.

[0036] The ureteroscope 101 may include an optoelectronic module 152 (e.g., a camera or other imager) for imaging the interior of the subject. For example, the optoelectronic module 152 and at least one light source 154 may be disposed at the distal end 120 of the catheter 104 or elsewhere in the catheter 104. The optoelectronic module 152 may include a micro-camera module having an image sensor microchip, a set of micro-lenses, and a micro-illumination module. A suitable optoelectronic module is disclosed in U.S. Patent No. 6,399,992, which is incorporated herein by reference in its entirety. In some embodiments, the optoelectronic module 152 may be positioned within a rigid or semi-rigid shell-like housing at the distal end 120 configured for insertion into a tubular structure to image the inner surface of the tubular structure. For example, the optoelectronic module 152 may be inserted into the patient's body through a natural body orifice, such as the mouth, nose, urethra, bladder, vagina, or anus. Thus, the ureteroscope 101 may have different configurations for use as a gastrointestinal, colonoscope, endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreatography, or other suitable application. Applications of the ureteroscope 101 include diagnostic observations associated with endometrial polyps, infertility, abnormal bleeding, and pelvic pain, as well as surgical procedures such as embryonic growth arrest and uterine malformations.

[0037] The ureteroscope 101 may include a communication interface 166, generally disposed on the outside of the catheter 104, for receiving signals from the image sensor in the optoelectronic module 152. The communication interface 166 may be positioned within or adjacent to the handpiece 102. At least the optoelectronic module 152 may be coupled to the communication interface 166.

[0038] The endoscopic system 100 may include one or more electronic devices for processing and displaying image data received from the optoelectronic module 152 of the ureteroscope 101. For example, the endoscopic system 100 may include one or more of a host machine 168 having a microprocessor, a computer 172 having a microprocessor, and a display 170. The host machine 168 may be connected to one or more terminals of the computer 172 and the display 170 for further processing and displaying image data from the optoelectronic module 152. The host machine 168 or the computer 172 may be programmed with image processing software that takes as input image data output from the optoelectronic module 152 of the ureteroscope 101 and generates a two-dimensional or three-dimensional reconstruction of a body lumen that can be displayed on the display 170. Thus, a processor in at least one of the host machine 168, the computer 172, or the display 170 may be programmed with software that receives as input a plurality of still images of an object generated by the optoelectronic module 152, and then outputs a three-dimensional rendering of the object for display based on the plurality of still images. Display 170 may include any suitable display and may be configured to display moving images (movies) or still images collected by the image sensor of optoelectronic module 152. Although shown in FIG. 1A as separate blocks, host machine 168, computer 172 and display 170 may comprise a single device, two devices, three devices, or four or more devices.

[0039] The endoscopic system 100 may also include a cable 174 configured to operatively couple the ureteroscope to at least one of a host machine 168, a computer 172, or a display 170. The cable 174 may electrically couple the communication interface 166 of the ureteroscope 101 to at least one of the host machine 168, the computer 172, or the display 170. The cable 174 may also enable the communication interface 166 to communicate with and receive power from the host machine 168 or other power source. The cable 174 may also be configured to enable the communication interface 166 to transmit image data captured in the optoelectronic module 152 to the host machine 168 for processing, storage, and display.

[0040] The communications interface 166 may contain, for example, one or more of a processor board, a camera board and a frame grabber, or a power supply. The processor board may be coupled to a host machine 168 by a cable 174 for storage and retrieval of images generated by the ureteroscope 101. The communications interface 166 may also be configured to communicate with and receive power from the host machine 168 or other power source via the cable 174. The communications interface 166 may also transmit image data captured at the distal end 120 to the host machine 168 for processing, storage and display.

[0041] The ureteroscope 101 may include one or more controls 176 positioned at or near the control end 108 of the handpiece 102. The one or more controls 176 may include one or more of a switch, a button, a rotatable knob, a movable tab, and the like. In some embodiments, the one or more controls 176 are configured to adjust a view presented on the display 170. For example, the one or more controls may be configured to adjust at least one of the brightness, zoom, focus, or contrast of one or more images displayed on the display 170. Thus, the one or more controls 176 allow a user to adjust a view presented on the display 170 and / or the computer 172 as needed during use of the ureteroscope 101 according to the user's preferences. In some embodiments, at least one of the controls 176 is configured to activate (e.g., turn on) or deactivate (e.g., turn off) at least one light source 154 (FIG. 1B) at the distal end 120 of the catheter 104. In some embodiments, at least one of the one or more controllers 176 is configured to activate and deactivate the optoelectronic module 152 .

[0042] The ureteroscope 101 may operate to perform or complete selected tasks manually, automatically, or a combination thereof. Some ureteroscope functions may be implemented through the use of components including hardware, software, firmware, or a combination thereof. General-purpose components such as a general-purpose computer or oscilloscope may be used in the ureteroscope 101, but dedicated or custom components such as circuits, integrated circuits, or software may also be used. For example, some functions are implemented with a number of software instructions executed by one or more data processors that are part of a general-purpose or custom computer. The one or more data processors may be in at least one of the communication interface 166, the host machine 168, the computer 172, or the display 170. In some embodiments, the data processor or computer includes volatile memory for storing instructions and / or data, and / or non-volatile storage for storing instructions and / or data, e.g., magnetic hard-170k and / or removable media. In some embodiments, the implementation includes a network connection. In some embodiments, the implementation generally includes a user interface including one or more input devices (e.g., allowing for input of commands and / or parameters) and output devices (e.g., allowing for reporting of operation and result parameters).

[0043] Alternatively, the handpiece 102 may further include a small battery module for powering the optoelectronic module 152 and the at least one light source 154. The power source in the handpiece 102 may be, for example, one or more conventional disposable dry batteries or lithium ion secondary batteries.

[0044] As discussed above, the endoscopic system 100 may include a laser 158. The laser 158 is coupled to the laser fiber 138 such that laser light emitted by the laser 158 enters the laser fiber 138 and emits from the distal portion 140 of the laser fiber 138. The laser 158 may include any suitable laser. In one embodiment, the laser 158 includes a thulium laser (e.g., a thulium fiber laser), a holmium laser (e.g., a holmium:YAG laser), or any other laser. In one embodiment, the laser 158 may be controlled by at least one of the communication interface 166, the host machine 168, the computer 172, or the controller 176.

[0045] Other examples of endoscopic systems and endoscopes are disclosed in U.S. Patent Application Publication No. 2019 / 0133634, filed December 11, 2019, the disclosure of which is incorporated herein by reference in its entirety.

[0046] The ureteroscope 101 shown in Figures 1A-1C is just one example of a ureteroscope that can be used in any of the endoscopic systems disclosed herein. Figure 2 is a cross-sectional schematic diagram of a ureteroscope 201, according to one embodiment. Except as otherwise disclosed herein, the ureteroscope 201 is the same as or substantially similar to any of the ureteroscopes disclosed herein. For example, the ureteroscope 201 can include a handpiece 202 and a catheter 204 extending from the handpiece 202. The ureteroscope 201 also includes a working channel port 224, a working channel (not shown), a laser fiber port 234, a laser fiber channel (not shown) separate from the working channel (not shown), and at least one optional conduit 242 extending from the laser fiber port 234 to the laser fiber channel 236.

[0047] At least one of the laser fiber port 234, the laser fiber channel 236, or the optional conduit 242 exhibits a fiber bend 244. As discussed above, the fiber bend 244 may prevent insertion of a laser fiber (not shown) into the laser fiber port 234 and through the laser fiber channel 236 and optional conduit 242. Accordingly, the ureteroscope 201 may include an introducer element 278 disposed at, on, or around at least a portion of the fiber bend 244. The introducer element 278 is configured to facilitate insertion of the laser fiber through the fiber bend 244.

[0048] In one embodiment, the introducer element 278 is formed in or integral with a wall that defines at least a portion of the fiber bend 244. In one example, the introducer element 278 includes at least one polished surface that exhibits a surface roughness that is less than the remainder of the surfaces that define at least one of the laser fiber port 234, the laser fiber channel 236, or the optional conduit 242. The polished surface of the introducer element 278 reduces the likelihood that the laser fiber will become trapped in the introducer element 278 and reduces the coefficient of friction (e.g., static or dynamic coefficient of friction) between the laser fiber and the introducer element 278, thereby reducing the likelihood that the laser fiber will bend during insertion. In one example, the introducer element 278 includes a material that exhibits a coefficient of friction (e.g., static or dynamic coefficient of friction) between the laser fiber and the introducer element 278 that is less than the coefficient of friction between the laser fiber and other surfaces that define at least one of the laser fiber port 234, the laser fiber channel 236, or the optional conduit 242. A lower coefficient of friction reduces the likelihood of the laser fiber bending during insertion. In one embodiment, the introducer element 278 includes a material that exhibits a greater hardness than another portion of at least one of the laser fiber port 234, the laser fiber channel 236, or the optional conduit 242. The hardness of the introducer element 278 reduces the likelihood of the laser fiber penetrating or otherwise getting caught in the introducer element 278 during insertion.

[0049] In one embodiment, the introducer element 278 is configured to move, thereby preventing or at least inhibiting the laser fiber from becoming trapped on the introducer element 278. In one example, the introducer element 278 is configured to rotate about a path along which the laser fiber moves. In one example, the introducer element 278 is configured to translate, such as to move in at least substantially the same direction as the laser fiber moves during insertion. In such an example, the introducer element 278 may comprise a conveyor belt-like mechanism, one or more small roller pins (e.g., exhibiting a radius of less than 500 μm, less than 250 μm, or less than 100 μm) with an axis of rotation oriented perpendicular to the movement of the laser fiber, or any other mechanism capable of moving in at least substantially the same direction as the laser fiber.

[0050] 1A-2, the laser fiber may be moved by grasping a portion of the laser fiber disposed on the outside of the ureteroscope and moving the laser fiber relative to the ureteroscope 101, 201. However, it should be noted that the ureteroscopes described herein (e.g., the ureteroscopes shown in FIGS. 3 and 4) may include at least one actuator that moves the laser fiber.

[0051] 3 is a cross-sectional view of a ureteroscope 301, according to one embodiment. Unless otherwise disclosed herein, the ureteroscope 301 is the same as or substantially similar to any of the ureteroscopes disclosed herein. For example, the ureteroscope 301 comprises a handpiece 302 and a catheter 304 extending from the handpiece 302. The handpiece 302 defines a laser fiber port 334, and the catheter 304 defines a laser fiber channel (not shown). The handpiece 302 may also include an optional conduit 342.

[0052] The handpiece 302 includes an actuator 380. The actuator 380 includes a first portion 382 attached to the laser fiber 338. The first portion 382 may be disposed inside the handpiece 302. The actuator 380 may include a second portion 384 disposed outside the handpiece 302. The second portion 384 is configured to be manipulated by a user of the ureteroscope 301. The actuator 380 may also include an intermediate portion 386 extending between the first portion 382 and the second portion 384 when the first portion 382 and the second portion 384 are spaced apart from one another.

[0053] The actuator 380 is configured such that manipulation of the second portion 384 by a user moves the laser fiber 338. For example, the actuator 380 is configured such that when a user manipulates the second portion 384, the second portion 384 can move further or closer to the catheter end 306 of the hand piece 302. In other words, the second portion 384 may be configured to move generally parallel to the longitudinal axis of the hand piece 302. Movement of the second portion 384 causes a corresponding movement in the first portion 382. For example, in the embodiment shown, moving the second portion 384 closer to the catheter end 306 moves the first portion 382 closer to the catheter end 306, and moving the second portion 384 farther from the catheter end 306 moves the first portion 382 farther from the catheter end 306. It should be noted that the corresponding movement of the first portion 382 relative to the second portion 384 may be reversed (e.g., inverted), for example, as the first portion 382 and the second portion 384 rotate about the pin. Movement of the first portion 382 moves the laser fiber 338 in the same manner. For example, moving the first portion 382 closer to the catheter end 306 moves the portion of the laser fiber 338 attached to the first portion 382 closer to the catheter end 306, and moving the first portion 382 farther from the catheter end 306 moves the portion of the laser fiber 338 attached to the first portion 382 farther from the catheter end 306. Moving the portion of the laser fiber 338 attached to the first portion 382 closer or farther from the catheter end 306 moves the portion of the laser fiber 338 in the laser fiber channel. For example, moving the laser fiber 338 in the laser fiber channel may cause a distal portion (not shown) of the laser fiber 338 to move relative to the distal end (not shown) of the catheter 304 .

[0054] In one embodiment, the hand piece 302 may define an opening that allows the actuator 380 to extend between an exterior surface and an interior of the hand piece 302. In the embodiment shown, the opening of the hand piece 302 may be configured to position the intermediate portion 386 therein. The opening of the hand piece 302 may be an elongated slot, such as an elongated slot that extends in a direction generally extending between the catheter end 306 and the control end 308. Such an elongated slot may allow the second portion 384 to move closer or farther from the catheter end 306.

[0055] 4 is a cross-sectional view of a ureteroscope 401, according to one embodiment. Unless otherwise disclosed herein, the ureteroscope 401 is the same as or substantially similar to any of the ureteroscopes disclosed herein. For example, the ureteroscope 401 comprises a handpiece 402 and a catheter 404 extending from the handpiece 402. The handpiece 402 defines a laser fiber port 434, and the catheter 404 defines a laser fiber channel (not shown). The handpiece 402 may also include an optional conduit 442.

[0056] The hand piece 402 comprises an actuator 480. The actuator 480 includes a generally cylindrical portion 488 configured to rotate about an axis. The generally cylindrical portion 488 may be configured to receive a portion of the laser fiber 438. For example, the laser fiber 438 may be wound around the generally cylindrical portion 488 such that the generally cylindrical portion 488 operates as a spool. When the generally cylindrical portion 488 is disposed within the hand piece 402, the actuator 480 may comprise a lever 490 or one or more other mechanical devices (e.g., gears) coupled to the generally cylindrical portion 488. The lever 490 or other mechanical device may be positioned outside the hand piece 402 such that the lever 490 or other mechanical device may be manipulated by a user. The lever 490 or other mechanical device may be configured such that manipulation by a user causes the generally cylindrical portion 488 to rotate. Rotating the generally cylindrical portion 488 may cause the generally cylindrical portion 488 to push the laser fiber 438 further toward the catheter end 406 and further into the laser fiber channel, or to pull the laser fiber 438 away from the catheter end 406 and out of the laser fiber channel.

[0057] Similar to handpiece 302 of FIG. 3, handpiece 402 may define an opening (eg, an elongated slot) for lever 490 or other mechanical device extending exteriorly of handpiece 402 .

[0058] It is noted that the actuators 380, 480 shown in Figures 3 and 4 may operate using other techniques than those shown in Figures 3 and 4. For example, the first portion 382 and / or the generally cylindrical portion 488 may be attached to a motor, and the motor is configured to move the first portion 382 and / or the generally cylindrical portion 488. The motor may be controlled by at least one of a communication interface, a host machine, a computer, or a controller (e.g., the communication interface 166, the host machine 168, the computer 172, or the controller 176 shown in Figures 1A and 1B). It is noted that the laser fiber of the ureteroscope disclosed herein may be used with actuators different from the actuators disclosed herein. It is also noted that the actuator of the ureteroscope disclosed herein may include a locking mechanism that prevents movement of the actuator when the locking mechanism is activated and allows movement of the actuator when the locking mechanism is deactivated.

[0059] 5 is a flow diagram of a method 500 of operating any of the ureteroscopes disclosed herein. Method 500 includes an act 505 of inserting, removing, or otherwise moving a laser fiber. Method 500 includes an act 510 of inserting a catheter of the ureteroscope into a patient. Method 500 also includes an act 515 of displaying one or more images collected by an image sensor of the ureteroscope on a display.

[0060] Operations 505, 510, and 515 of method 500 are for illustrative purposes. For example, operations 505, 510, and 515 of method 500 may be performed in a different order, split into multiple operations, modified, supplemented, or combined. In embodiments, one or more of operations 505, 510, and 515 of method 500 may be omitted from method 500. Any of operations 505, 510, and 515 of method 500 may include using any of the handpieces, ureteroscopes, or endoscope systems disclosed herein.

[0061] Operation 505 of method 500 includes inserting, removing, or otherwise moving a laser fiber. In one embodiment, operation 505 may include inserting a laser fiber into the ureteroscope. For example, the laser fiber may be inserted into the ureteroscope when it was not preloaded into the ureteroscope, when it was previously removed from the ureteroscope, or when a laser fiber previously disposed in the ureteroscope is replaced. Inserting the laser fiber into the ureteroscope may include inserting the laser fiber into a laser fiber port defined by the handpiece (e.g., into a funnel structure). Inserting the laser fiber into the ureteroscope may also include threading the laser fiber into the laser fiber channel and optional conduit until a distal portion of the laser fiber is near the distal end of the catheter. Inserting the laser fiber may include using one or more features disclosed herein (e.g., rotating or translating introducer element 278 of FIG. 2) to reduce the likelihood of the laser fiber bending. Inserting the laser fiber may include attaching the laser fiber to the actuator, such as attaching the laser fiber to first portion 382 of actuator 380 in FIG. 3, or wrapping or otherwise positioning the laser fiber around the generally cylindrical portion 488 of actuator 480 in FIG. 4.

[0062] In one embodiment, operation 505 may include removing the laser fiber from the ureteroscope. Operation 505 may include removing the laser fiber from the ureteroscope, for example, to increase the flexibility of the catheter, to replace a damaged (e.g., bent) or contaminated laser fiber, or to use a new laser fiber (e.g., changing the laser connected to the laser fiber may require using a different laser fiber). Removing the laser fiber may include grasping a portion of the laser fiber and pulling such portion of the laser fiber until the laser fiber is removed from the laser fiber channel, from the optional conduit, and out of the laser fiber port. In one example, removing the laser fiber may include detaching the laser fiber from the actuator.

[0063] In one embodiment, operation 505 may include moving the laser fiber, which may be moved for a variety of reasons, such as moving a distal portion of the laser fiber out of the catheter to prevent irradiation of the catheter by the laser emitted from the laser fiber, moving a distal portion of the laser fiber closer to the object to be illuminated to minimize dissipation of the laser before it illuminates the object, or moving the laser focal point or otherwise concentrating the energy of the laser relative to the object to be illuminated. Moving the laser fiber may include moving the laser fiber in small increments, such as about 1 mm or less, about 5 mm or less, about 10 mm or less, about 15 mm or less, or increments within a range of about 250 μm to about 750 μm, about 500 μm to about 1 mm, about 750 μm to about 1.5 mm, about 1 mm to about 2 mm, about 1.5 mm to about 2.5 mm, about 2 mm to about 3 mm, about 2.5 mm to about 3.5 mm, about 3 mm to about 4 mm, about 3.5 mm to about 4.5 mm, about 4 mm to about 5 mm, about 4.5 mm to about 6 mm, about 5 mm to about 7 mm, about 6 mm to about 8 mm, about 7 mm to about 9 mm, or about 8 mm to about 10 mm. In one example, moving the laser fiber may include gripping a portion of the laser fiber extending out of the handpiece and moving the gripped portion of the laser fiber towards or away from the laser fiber port. In one example, moving the laser fiber may include manipulating an actuator, such as manipulating second portion 384 shown in Figure 3 or lever 490 shown in Figure 4. It is noted that the actuators disclosed herein can be effective to controllably move the laser fiber in small increments.

[0064] The act of inserting 510 a ureteroscope catheter into a patient may include inserting a distal tip of the catheter into a lumen within a human or animal body. For example, the catheter may be inserted through the subject's urethra to access various portions of the urinary tract.

[0065] Operation 515 of displaying on a display one or more images collected by the image sensor of the ureteroscope may include displaying on the display at least one of a still image or a video stream using the one or more images collected by the image sensor. Operation 515 may also include displaying on the display a two-dimensional or three-dimensional reconstruction of the body lumen. The two-dimensional or three-dimensional reconstruction of the body lumen may be generated using at least one of a host machine or computer programmed with image processing software that takes as input image data output from the image sensor of the ureteroscope.

[0066] It should be noted that the ureteroscopes disclosed herein may be used in endoscopic procedures that do not involve the urinary tract (e.g., at least one of the urethra, bladder, ureters, or kidneys). For example, ureteroscopes may be used in endoscopic procedures involving the gastrointestinal tract, respiratory system, ear, reproductive system, abdominal or pelvic cavities, the interior of joints, thoracic organs, fetus, hand, or any other location instead of or in addition to the urinary tract.

[0067] While various aspects and embodiments are disclosed herein, other aspects and embodiments are contemplated. The various aspects and embodiments disclosed herein are intended to be illustrative and not limiting.

[0068] Degree terms (e.g., "about," "substantially," "generally," etc.) indicate structurally or functionally insignificant variations. In one example, when a degree term is included with a quantity term, the degree term is interpreted to mean ±10%, ±5%, or +2% of the quantity term. In one example, when a degree term is used to modify a shape, the degree term indicates that the shape modified by the degree term has the appearance of the disclosed shape. For example, the degree term may be used to indicate that the shape may have curved corners instead of sharp corners, may have curved edges instead of straight edges, has one or more protrusions extending therefrom, is rectangular, is the same as the disclosed shape, etc.

Claims

1. A ureteroscope, a handpiece defining at least a working channel port and a laser fiber port; 1. A catheter having a proximal end and a distal end opposite the proximal end, the catheter comprising: a working channel extending from the proximal end to the distal end of the catheter, the working channel connected to the working channel port; and a laser fiber channel separate from the working channel, the laser fiber channel extending from the proximal end to the distal end of the catheter, the laser fiber channel connected to the laser fiber port; a catheter defining at least Laser fiber and Equipped with the laser fiber port includes a funnel structure exhibiting a lateral dimension that decreases with increasing distance from an exterior surface of the handpiece; an optional fiber conduit extending from the laser fiber port to the laser fiber channel includes a funnel structure exhibiting a lateral dimension that decreases with increasing distance from an outer surface of the handpiece; or Is the laser fiber preloaded into the laser fiber channel? A ureteroscope, characterized in that it is at least one of the following:

2. 2. The ureteroscope of claim 1, the laser fiber channel exhibits a diameter of about 50 μm to about 500 μm; A ureteroscope characterized by:

3. The ureteroscope according to claim 1 or 2, the laser fiber comprises a thulium laser fiber; A ureteroscope characterized by:

4. The ureteroscope according to claim 3, the laser fiber channel exhibits a diameter that is about 50 μm to about 250 μm larger than a diameter of the laser fiber; A ureteroscope characterized by:

5. The ureteroscope according to claim 3, the laser fiber exhibits a diameter of about 150 μm or less; A ureteroscope characterized by:

6. The ureteroscope according to claim 1 or 2, the laser fiber comprises a holmium laser fiber; A ureteroscope characterized by:

7. A ureteroscope according to any one of claims 1 to 6, at least one of the laser fiber port or the optional conduit extending from the laser fiber port to the laser fiber channel includes a funnel structure exhibiting a lateral dimension that decreases with increasing distance from an exterior surface of the hand piece; A ureteroscope characterized by:

8. A ureteroscope according to any one of claims 1 to 7, the laser fiber port, the laser fiber channel, or the optional conduit includes an internal fiber bend when the catheter is substantially straight; A ureteroscope characterized by:

9. 9. The ureteroscope of claim 8, the fiber bends exhibit an average radius of curvature greater than about 10 cm; A ureteroscope characterized by:

10. 10. The ureteroscope according to claim 8 or 9, a mean radius of curvature of the fiber bend is greater than a working bend formed in at least one of the working channel port, the working channel, or at least one optional working conduit extending between the working port and the working channel; A ureteroscope characterized by:

11. 11. The ureteroscope of claim 8, further comprising an introducer element configured to facilitate bending the laser fiber along the curve.

12. The ureteroscope according to claim 11, at least a portion of the introducer element is configured to rotate; A ureteroscope characterized by:

13. 13. The ureteroscope according to claim 11 or 12, at least a portion of the introducer element is configured to move in a direction generally parallel to at least a portion of the curve; A ureteroscope characterized by:

14. 14. The ureteroscope according to any one of claims 1 to 13, characterized in that the laser fiber is preloaded in the laser fiber channel.

15. A ureteroscope according to any one of claims 1 to 14, the handpiece comprises an actuator; the actuator comprises a generally cylindrical portion disposed within the handpiece, the generally cylindrical portion configured to rotate; the generally cylindrical portion is attached to the laser fiber such that rotating the generally cylindrical portion moves the laser fiber; A ureteroscope characterized by:

16. 16. A ureteroscope according to any one of claims 1 to 15, the handpiece comprises an actuator having a first portion attached to the laser fiber and a second portion configured to be operated by a user; the second part is attached to the first part such that manipulation of the second part moves the laser fiber to the first part; A ureteroscope characterized by:

17. 17. A ureteroscope according to any one of claims 1 to 16, and further comprising a seal configured to at least one of at least partially cover and at least partially fit into the laser fiber port. A ureteroscope characterized by:

18. A method of using a ureteroscope, comprising: inserting a distal end of the ureteroscope catheter into a urethral meatus of the individual; The ureteroscope comprises: a handpiece defining at least a working channel port and a laser fiber port; The catheter comprises a proximal end and a distal end opposite the proximal end, a working channel extending from the proximal end to the distal end of the catheter, the working channel connected to the working channel port; a catheter defining at least a laser fiber channel separate from the working channel, the laser fiber channel extending from the proximal end to the distal end of the catheter and connected to the laser fiber port; a laser fiber; the laser fiber port includes a funnel structure exhibiting a lateral dimension that decreases with increasing distance from an exterior surface of the handpiece; an optional fiber conduit extending from the laser fiber port to the laser fiber channel includes a funnel structure exhibiting a lateral dimension that decreases with increasing distance from an outer surface of the handpiece; or or a laser fiber is preloaded into the laser fiber channel; The method comprising:

19. 20. The method of claim 18, further comprising moving the laser fiber within the laser fiber channel; The method comprising:

20. 20. The method of claim 19, moving the laser fiber within the laser fiber channel comprises moving the laser fiber by about 5 mm or less; The method comprising:

21. 20. The method of claim 18 or 19, moving the laser fiber within the laser fiber channel includes manipulating an actuator; The method comprising:

22. 22. The method according to any one of claims 18 to 21, comprising: further comprising removing the laser fiber from the laser fiber channel. The method comprising:

23. 23. The method according to any one of claims 18 to 22, comprising: inserting the laser fiber into the laser fiber port and the laser fiber channel until a distal portion of the laser fiber is located at or near the distal end of the catheter. The method comprising:

Images