Endoscope and method of use thereof

Abstract

An example ureteroscope includes a handpiece having a catheter end and a control end. The ureteroscope also includes a catheter extending from the catheter end of the handpiece. The ureteroscope is configured to selectively vary the stiffness of a distal end region of the catheter. For example, the ureteroscope is configured to increase the stiffness of the distal end of the catheter.

Description

[Background technology]

[0001] Small endoscopes are desirable in many industrial and medical applications. For example, small endoscopes allow insertion through small natural openings and lumens of the human body to target locations within the body. In single incision laparoscopy, a smaller endoscope is desirable to provide an internal view of the surgical site, especially when the incision itself is of minimal size. Often, a patient may experience irritation when an endoscope is inserted into his or her body, and a smaller endoscope can reduce such unpleasant experience and minimize trauma to the patient. Additionally, smaller endoscopes can allow physicians to improve diagnostic and treatment protocols. For example, transnasal endoscopy can sometimes be replaced by oral endoscopy. [Prior art documents] [Patent documents]

[0002] [Patent Document 1] U.S. Patent No. 9,942,452 [Patent Document 2] International Publication No. WO2020 / 123588 Brochure [Patent Document 3] International Patent Application No. PCT / US2022 / 015828 Summary of the Invention [Means for solving the problem]

[0003] Embodiments are directed to ureteroscopes, endoscopic systems including same, and methods of use. In one embodiment, a ureteroscope is disclosed. The ureteroscope has a handpiece. The handpiece has a catheter end, a control end, a working assembly configured to receive one or more surgical instruments, and a steering controller configured to cause at least a portion of the catheter to bend. The ureteroscope also has a catheter extending from the catheter end of the handpiece. The catheter has a proximal end region and a distal end region spaced farther from the handpiece than the proximal end region. The working assembly has a first movable part configured to move relative to the catheter end of the handpiece, or the steering controller has a second movable part configured to move relative to the catheter end of the handpiece. Movement of the first movable part relative to the catheter end of the handpiece changes the stiffness of at least a portion of the catheter. Movement of the second movable part relative to the catheter end of the handpiece changes the stiffness of at least a portion of the catheter.

[0004] In one embodiment, a method of using a ureteroscope is disclosed. In the method, a ureteroscope is provided. The ureteroscope has a handpiece. The handpiece has a catheter end, a control end, a working assembly configured to receive one or more surgical instruments, and a steering controller configured to bend at least a portion of the catheter. The ureteroscope also has a catheter extending from the catheter end of the handpiece. The catheter has a proximal end region and a distal end region spaced farther from the handpiece than the proximal end region. The working assembly has at least one of a first movable part configured to be moved relative to the catheter end of the handpiece and / or the steering controller has a second movable part configured to be moved relative to the catheter end of the handpiece. The method also includes adjusting a stiffness of at least a portion of the catheter by moving at least a portion of the first movable part and / or at least a portion of the second movable part relative to the catheter end of the ureteroscope handpiece.

[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 review of the following detailed description and accompanying drawings.

[0006] The drawings depict several embodiments of the present disclosure, with identical reference numbers in the figures indicating the same or similar elements or features in the various views and embodiments shown in the figures. [Brief description of the drawings]

[0007] [Figure 1A] FIG. 1 is an isometric schematic diagram of an endoscopic system according to one embodiment. [Figure 1B] FIG. 1B is a cross-sectional view of a portion of a ureteroscope taken along plane 1B-1B. [Figure 1C] FIG. 2 is a side elevational view of the terminus of a distal end region of a catheter according to one embodiment. [Figure 1D] 1 is a close-up view of a ureteroscope illustrating a method of selectively varying the stiffness of at least a portion of a catheter using an actuator, according to one embodiment. [Figure 1E] 1 is a close-up view of a ureteroscope illustrating a method of selectively varying the stiffness of at least a portion of a catheter using an actuator, according to one embodiment. [Figure 2A] FIG. 1 is a side elevation view of a ureteroscope configured to vary the stiffness of at least a portion of the catheter using a steering control, according to one embodiment. [Figure 2B] FIG. 1 is a side elevation view of a ureteroscope configured to vary the stiffness of at least a portion of the catheter using a steering control, according to one embodiment. [Diagram 3] FIG. 2 is a side elevational view of a catheter shaft that may be used in any of the catheters disclosed herein, according to one embodiment. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0008] Embodiments are directed to a ureteroscope, an endoscopic system including the same, and methods of use. In one example, the ureteroscope includes a handpiece having a catheter end and a control end. The ureteroscope also includes a catheter extending from the catheter end of the handpiece. The handpiece also includes a working assembly configured to retract one or more surgical instruments, and a steering controller configured to selectively bend at least a portion of the catheter. The ureteroscope is configured to selectively vary the stiffness of at least a portion of the catheter. In one example, the working channel port includes at least one of a first movable portion and a steering controller includes a second movable portion. The first movable portion and / or the second movable portion are configured to be movable relative to a portion of the handpiece (e.g., the catheter end). Moving the first movable portion and / or the second movable portion relative to the portion of the handpiece selectively varies the stiffness of at least a portion of the catheter.

[0009] Some ureteroscopes include catheters having a flexible distal end region (i.e., the region of the catheter distal to the handpiece). The flexible distal end region of the catheter allows the catheter to be moved through tortuous passages in a human or animal body. The flexible distal end region of the catheter also allows the shape (e.g., curvature) of the catheter to be selectively changed to steer the catheter through bends in the tortuous passages and to select the passageway within which the catheter is moved. However, the flexible distal end of the catheter of such ureteroscopes can kink and, due to its flexibility, can be immobilized in tight or at least partially occluded passages.

[0010] Unlike the ureteroscopes discussed in the previous paragraph, the ureteroscopes disclosed herein allow for selectively varying the stiffness of at least a portion of the catheter. For example, the ureteroscopes disclosed herein may include a catheter having a flexible distal end region during normal use. However, the stiffness of the distal end region of the catheter may be selectively increased (i.e., the flexibility of the distal end region may be selectively decreased) when a body passageway is constricted, when the passageway is at least partially blocked, or for any other reason. Increasing the stiffness of the distal end region of the catheter allows the distal end region of the catheter to push through the constricted passageway or displace an obstacle. After moving the distal end region of the catheter through the constricted passageway or displace an obstacle, the stiffness of the distal end region of the catheter may be selectively decreased (i.e., the flexibility of the distal end region may be selectively increased).

[0011] FIG 1A is an isometric schematic diagram of an endoscopic system 100 according to one embodiment. The endoscopic system 100 includes a ureteroscope 102. FIG 1B is a cross-sectional view of a portion of the ureteroscope 102 taken along plane 1B-1B. The ureteroscope 102 includes a handpiece 104 and a catheter 106 extending from the handpiece 104. The catheter 106 includes a proximal end region 108 adjacent to or within the handpiece 104 and a distal end region 110 opposite the proximal end region 108. The ureteroscope 102 is configured to selectively vary the stiffness of at least a portion of the catheter 106 (e.g., the distal end region 110 of the catheter 106).

[0012] The handpiece 104 may be elongated and have a catheter end 112 and a control end 114. The catheter end 112 is proximal to the catheter 106 and the control end 114 is opposite or distal to the catheter end 112. Because the control end 114 is opposite the catheter end 112, the control end 114 and the catheter end 112 are at separate ends of the handpiece 104 and may be oriented in different directions from one another. The control end 114 may have a generally bulbous shape and the handpiece 104 may be tapered between the control end 114 and the catheter end 112.

[0013] With the control end 114 opposite or distal to the catheter end 112, the handpiece 104 has an intermediate or central portion 116 located between the catheter end 112 and the control end 114. The central portion 116 has a first or upper surface 118, a second or lower surface 120, and two opposing side surfaces 122 located between the upper surface 118 and the lower surface 120. In one embodiment, the upper and lower surfaces 118, 120 of the central portion 116 are rounded and the side surfaces 122 are generally flat.

[0014] In some embodiments, both the catheter 106 and the handpiece 104 are disposable. In certain embodiments, the catheter 106 and the handpiece 104 are manufactured as a single piece, or the catheter 106 is secured to the handpiece 104 via a handpiece-to-catheter connector 124. Alternatively, only the catheter 106 can be disposable, and the handpiece 104 can be sterilized and reused multiple times. In this case, the catheter 106 is detachably coupled to the handpiece 104 and the catheter tip 112 via the handpiece-to-catheter connector 124.

[0015] As previously discussed, the catheter 106 has a proximal end region 108 and a distal end region 110 spaced apart from the proximal end region 108. The proximal end region 108 is attached to, integral with, or disposed within a catheter end 112 (e.g., a handpiece-to-catheter connector 124). The distal end region 110 can be configured for placement within an individual's urethral meatus. Figure 1C is a side elevational view of the terminus of the distal end region 110 of the catheter 106 according to one embodiment.

[0016] The ureteroscope 102 includes a working assembly 125. The working assembly 125 includes a working channel port 126 defined by the handpiece 104 and a working channel 127 defined by or disposed within the catheter 106. The working channel 127 extends from the proximal end region 108 to the distal end region 110 of the catheter 106. The working channel port 126 and the working channel 127 are connected together (directly or indirectly). The working channel port 126 and the working channel 127 are configured to receive various surgical instruments and irrigation devices as needed for a procedure, such as, for example, stone fragmentation and removal. For example, various surgical instruments can be inserted into the working channel port 126 and the working channel 127, and thus can be used at the distal end region 110 of the catheter 106. The working assembly 125 may also include at least one of a working channel connector 128 coupled or attached to the working channel port 126, and at least one conduit 130 indirectly connecting the working channel port 126 to the catheter 106. According to some embodiments, as shown, the conduit 130 may extend through the catheter 106, thereby defining at least a portion of the working channel 127. According to such embodiments, the conduit 130 may extend through the catheter 106 and be rigidly (e.g., immovably) attached to at least the distal end region 110 of the catheter 106. In some embodiments, the conduit 130 does not extend through the catheter 106, but rather the catheter 106 defines the working channel 127.

[0017] The working channel port 126 can be located near the catheter end 112 of the handpiece 104. For example, the working channel port 126 can be located less than ½ the distance from the catheter end 112 to the control end 114, less than ⅓ the distance from the catheter end 112 to the control end 114, less than ¼ the distance from the catheter end 112 to the control end 114, or less than ⅕ the distance from the catheter end 112 to the control end 114. Locating the working channel port 126 near the catheter end 112 can improve the ergonomics of the handpiece 104 because the working channel port 126 and any surgical instruments extending therefrom are less likely to interfere with use of the ureteroscope 102.

[0018] The ureteroscope 102 includes a steering controller 132 configured to control one or more steering wires 134 that are coupled to an effective bending portion (e.g., the distal end region 110) of the catheter 106 so that the effective bending portion of the catheter 106 can bend to a desired location. Thus, a user can use the steering controller 132 to bend or deflect the catheter 106 (e.g., to bend or deflect the distal end region 110).

[0019] The steering controller 132 may include a driver 136 coupled to the steering wires 134. The driver 136 may be configured to move the steering wires 134 to bend the catheter 106. For example, the driver 136 may be configured to rotate about a pivot axis that may extend generally perpendicular to the longitudinal axis of the handpiece 104. The steering wires 134 may be mounted on either side of the driver 136. Rotation of the driver 136 about the pivot axis may then move at least one of the steering wires 134 closer to or farther from the catheter end 112 of the handpiece 104. As an example, in an embodiment where the steering wires 134 include two steering wires 134, rotation of the driver 136 may move one of the steering wires 134 closer to the catheter end 112 while moving the other steering wire 134 away from the catheter end 112, as shown. In such an example, the steering wire 134 approaching the catheter tip 112 is non-tensioned and the steering wire 134 moving away from the catheter tip 112 is tensioned. Selectively tensioning one of the two steering wires 134 selectively bends at least a portion of the catheter 106. It is noted that the principle of selectively tensioning one or more of the steering wires 134 is by selectively bending or bowing the catheter 106, and that the ureteroscope 102 may have one or more than two steering wires 134.

[0020] According to one example, the driver 136 may have a generally cylindrical shape, allowing the driver 136 to fit within the generally bulbous control end 114. It is noted, however, that the driver 136 may have other shapes.

[0021] In one example, the driver 136 is disposed within the handpiece 104, as shown. In another example, the driver 136 is disposed at least partially on an exterior surface of the handpiece 104 or is otherwise accessible from outside the handpiece 104.

[0022] It is noted that instead of the driver 136, the steering controller 132 can include one or more elements configured to selectively move the steering wires 134 relative to the catheter tip 112. For example, the steering controller 132 can include one or more elements configured to move on a trajectory, each attached to a corresponding one of the steering wires 134. Moving the element on the trajectory moves the steering wires 134 relative to the catheter tip 112, thereby selectively bending the catheter. For the sake of simplicity and clarity, the driver 136 will be discussed exclusively herein. However, it is noted that the mechanisms for moving the driver 136 may be applied to any other elements configured to move the steering wires 134 relative to the catheter tip 112 (as discussed in more detail in connection with FIGS. 2A and 2B).

[0023] When the driver 136 is disposed within the handpiece 104, the steering control 132 may include a mechanism on the exterior of the handpiece 104 that can be manipulated by a user to rotate the driver 136. In one embodiment, as shown, the steering control 132 includes a lever 138 attached to the driver 136. The lever 138 extends along the exterior of the handpiece 104. The lever 138 is configured such that movement of the lever 138 relative to the control end 114 rotates the driver 136, thereby selectively bending at least a portion of the catheter 106. In one embodiment, the steering control 132 includes one or more gears attached to the driver 136 and configured to rotate the driver 136, instead of or in addition to the lever 138. A disk-shaped device may be at least partially exposed on the exterior of the handpiece 104, and the gears may be attached to the disk-shaped device. Rotation of the disk-like device by a user can rotate a driver 136. In one example, the steering controller 132 can include a motor instead of or in addition to the lever 138 that is attached to the driver 136 and configured to rotate the driver 136. The motor can be controlled by a host machine 146, a computer 150, a controller 154, or other device.

[0024] The catheter 106 of the ureteroscope 102 can be used to image the interior surface of a tubular structure, such as a lumen of a human or animal body. For example, the catheter 106 can be inserted through the urethra of a subject to access various portions of the urinary tract. However, it should be appreciated that the ureteroscope 102 can also be employed as an industrial endoscope, where the tubular structure is part of an industrial device, instrument, product, machine, production line, or the like. In certain embodiments, the catheter 106 can act as a tether and can include a number of scale markings or fiduits to allow a physician to measure the distance the photoelectric module 140 has advanced into the tubular structure, such as a body lumen. Other structure(s) can be fabricated into the ureteroscope 102 as desired.

[0025] The ureteroscope 102 may include a photoelectric module 140 (e.g., a camera or other imager) for imaging an object of interest. For example, the photoelectric module 140 and at least one light source 1142 may be located at the distal end region 110 of the catheter 106 or elsewhere in the catheter 106. The photoelectric module 140 may include a micro-camera module with an image sensor microchip, a set of micro-lenses, and a micro-illumination module. A suitable photoelectric module is disclosed in U.S. Pat. No. 6,399,323, which is incorporated herein by reference in its entirety. According to certain embodiments, the photoelectric module 140 may be disposed in a rigid or semi-rigid shell-like housing at the distal end region 110 configured to be inserted into a tubular structure to image the inner surface of the tubular structure. For example, the photoelectric module 140 may be inserted into a patient's body through a natural body orifice, such as the mouth, nose, urethra, bladder, vagina, or anus. The ureteroscope 102 may thus be configured in separate configurations for use as a gastrointestinal endoscope, colonoscope, endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreatography, or other suitable application, including diagnostic monitoring for endometrial polyps, infertility, abnormal bleeding, and pelvic pain, as well as surgical procedures such as embryonic growth arrest and uterine anomalies.

[0026] The ureteroscope 102 may include a communication interface 144, generally located outside the catheter 106, for receiving signals from the image sensor in the photoelectric module 140. The communication interface 144 may be located in or near the handpiece 104. At least the photoelectric module 140 may be coupled to the communication interface 144.

[0027] The endoscopic system 100 may include one or more electronic devices for processing and displaying image data received from the optoelectronic module 140 of the ureteroscope 102. For example, the endoscopic system 100 may include one or more of a host machine 146 having a microprocessor, a computer 150 having a microprocessor, and a display 148. The host machine 146 may be connected to one or more terminals of the computer 150 and the display 148 for reprocessing and displaying the image data from the optoelectronic module 140. The host machine 146 and / or the computer 150 may be programmed with image processing software that takes as input the image data output from the optoelectronic module 140 of the ureteroscope 102 and generates a two- or three-dimensional reconstruction of the body lumen that may be displayed on the display 148. Thus, a processor in at least one of the host machine 146, computer 150, and display 148 may be programmed with software to accept as input a plurality of still images of a subject generated by the photoelectric module 140 and output a three-dimensional rendering of the subject based on the plurality of still images. The display 148 may include any suitable display configured to display a movie or still images collected by the image sensor of the photoelectric module 140. Although shown as separate blocks in FIG. 1A, the host machine 146, computer 150, and display 148 may include a single device, two devices, three devices, or more than three devices.

[0028] The endoscopic system 100 may also include a cable 152 configured to operably couple the ureteroscope 102 to at least one of a host machine 146, a computer 150, and a display 148. The cable 152 may electrically couple the communication interface 144 of the ureteroscope 102 to at least one of the host machine 146, the computer 150, and the display 148. The cable 152 may also enable the communication interface 144 to communicate with and receive power from the host machine 146 or another power source. The cable 152 may also be configured to enable the communication interface 144 to transmit image data captured by the photoelectric module 140 to the host machine 146 for processing, storage, and display.

[0029] For example, one or more of a processor board, a camera board, and a frame grabber, and a power supply may be incorporated within the communications interface 144. The processor board may be coupled to the host machine 146 by a cable 152 for storage and playback of images generated by the ureteroscope 102. The communications interface 144 may also be configured to communicate with and receive power from the host machine 146 or other power sources via the cable 152. The communications interface 144 may also transmit image data captured at the distal tip region 110 to the host machine 146 for processing, storage, and display.

[0030] The ureteroscope 102 may have one or more controls 154 located at or near the control end 114 of the handpiece 104. The one or more controls 154 may include one or more of a switch, a button, a rotatable knob, a movable table, etc. In certain embodiments, the one or more controls 154 may be configured to adjust a view presented on the display 148. For example, the one or more controls 154 may be configured to adjust at least one of the brightness, zoom, focus, and contrast of one or more images displayed on the display 148. The one or more controls 154 may thus allow a user to adjust the view presented on the display 148 and / or computer 150 according to their preferences and needs during use of the ureteroscope 102. In certain embodiments, at least one of the one or more controllers 154 is configured to activate (e.g., turn on) or deactivate (e.g., turn off) at least one light source 1142 (FIG. 1C) at the distal end region 110 of the catheter 106. In certain embodiments, at least one of the one or more controllers 154 is configured to activate and deactivate the photoelectric module 140.

[0031] The ureteroscope 102 may be operated to perform or complete selected tasks manually, automatically, or a combination thereof. Some ureteroscopy functions may be implemented using components comprising hardware, software, firmware, or a combination thereof. General purpose components, such as a general purpose computer or oscilloscope, may be used in the ureteroscope 102, while dedicated or custom components, such as circuits, integrated circuits, or software, may also be used. For example, some functions may be implemented by executing software instructions on one or more data processors that are part of a general purpose or custom computer. The one or more data processors may reside in at least one of the communication interface 144, the host machine 146, the computer 150, and the display 148. In certain embodiments, the data processor or computer 150 may include volatile memory for storing instructions and / or data, and / or non-volatile storage, such as a magnetic hard disk and / or removable media, for storing instructions and / or data. In certain embodiments, network connections are incorporated into the implementation. In certain embodiments, the implementation incorporates a user interface, typically having one or more input devices (e.g., that allow for input of commands and / or parameters) and output devices (e.g., that allow for notification of operation parameters and results).

[0032] Alternatively, the handpiece 104 can further include a compact battery module that powers the photovoltaic module 140 and the at least one light source 1142. The power source within the handpiece 104 can be, for example, one or more conventional disposable dry cell batteries or a lithium ion battery.

[0033] Other examples of endoscopic systems and endoscopes are disclosed in Patent Document 2, published on June 18, 2020, and Patent Document 3, filed on February 9, 2022, the entire disclosures of which are incorporated herein by reference.

[0034] As discussed above, the ureteroscope 102 is configured to selectively vary the stiffness of at least a portion of the catheter 106. For example, the ureteroscope 102 is configured to selectively vary the stiffness of the distal end region 110 of the catheter 106. In the illustrated embodiment, the ureteroscope 102 is configured to increase the stiffness of at least a portion of the catheter 106 using a working assembly 125. As discussed in more detail below, the working assembly 125 has a first movable portion. As used herein, the term "first movable portion" refers to portions of the working assembly 125 that can be moved relative to the handpiece 104, e.g., relative to the catheter end 112 of the handpiece 104. The first movable portion may include all or a portion of the working assembly 125. The first movable portion of the working assembly 125 is configured to be moved relative to at least the catheter end 112 of the handpiece 104. At least a portion of the working assembly 125 can be placed in tension by moving the first moveable portion of the working assembly 125 relative to the catheter tip 112. When at least a portion of the working assembly 125 is placed in tension, a compressive force is applied to the catheter 106 at the working channel 127 (e.g., the distal end region 110 of the catheter 106 is pulled directly back towards the handpiece 104). The compressive force applied to the catheter 106 increases the stiffness of at least a portion of the catheter 106. For example, the compressive force applied to the catheter 106 causes at least a portion of the catheter 106 at or near the distal end region 110 to exhibit a higher stiffness.

[0035] The handpiece 104 includes an actuator 156 coupled (e.g., mounted) to a portion of the working assembly 125. The actuator 156 is configured to move relative to the remainder of the handpiece 104 (e.g., relative to the catheter tip 112) in response to manipulation by a user. Movement of the actuator 156 relative to the catheter tip 112 also causes at least a portion of the working assembly 125 to move relative to the handpiece 104. For example, movement of the actuator 156 may move at least one of at least a portion of the working channel port 126, at least a portion of the working channel 127, at least a portion of the working channel connector 128, and at least a portion of the conduit 130, relative to at least a portion of the handpiece 104. A first moveable portion of the working assembly 125 includes the actuator 156 and other portions of the working assembly 125 that are moved by movement of the actuator 156.

[0036] The actuator 156 may be in a first (or initial) position relative to the rest of the handpiece 104. An individual may manipulate (e.g., turn, push, pull, etc.) the actuator 156 to move the actuator 156 to a second position, different from the first position, relative to a portion of the handpiece 104 (e.g., the catheter tip 112). The second position may be further or closer to a portion of the handpiece 104 (e.g., further or closer to the catheter tip 112) than the first position. After moving the actuator 156 to the second position, the user may further manipulate the actuator 156 at will to return the actuator 156 to the first position or to one or more additional positions different from the first and second positions.

[0037] According to one example, a first moving portion of the working assembly 125 may be in a first (or initial) state when the actuator 156 is in the first position. When the first moving portion is in the first state, at least a portion of the working assembly 125 may be substantially free of tension or may be tensioned. By moving the actuator 156 from the first position to the second position, the first moving portion is switched to a second state different from the first state. When the first moving portion is in the first state, at least a portion of the working assembly 125 may be tensioned by the first moving portion in the second state. When the first moving portion is in the first state, at least a portion of the working assembly 125 may be tensioned by a different tension (e.g., a greater or lesser tension) or may be substantially free of tension by the first moving portion in the second state. The first motion portion may assume one or more additional states when the actuator 156 is moved to one or more additional positions. It is noted that, as used herein, the first state, the second state, and the one or more additional states may refer to different positions of and / or pulling forces of the first motion portion relative to a component of the handpiece 104 (e.g., relative to the catheter tip 112).

[0038] In some embodiments, at least a portion of the actuator 156 is readily accessible to a user of the ureteroscope 102. At least a portion of the actuator 156 may be readily accessible when, for example, at least a portion of the actuator 156 is disposed on or extending from an exterior surface of the handpiece 104. If at least a portion of the actuator 156 is readily accessible, the user may be able to directly manipulate (e.g., turn, push, pull, etc.) the actuator 156. Manipulation of the actuator 156 by the user causes the actuator 156 to move relative to the remainder of the handpiece 104. According to some examples, as shown, at least a portion of the actuator 156 may be attached to, reside within, or otherwise coupled to the working channel port 126. Because the working channel port 126 is disposed on an exterior surface of the handpiece 104, at least a portion of the actuator 156 may be readily accessible by positioning the actuator 156 to be attached to, reside within, or otherwise coupled to the working channel port 126.

[0039] In some embodiments, the actuator 156 is not readily accessible. An example of an actuator 156 not being readily accessible is when the actuator 156 is disposed within the handpiece 104 (e.g., at least a portion of the actuator 156 is attached to, resides within, or is otherwise coupled to the working channel 127 or optional conduit 130). Even if the actuator 156 is not readily accessible, the actuator 156 can still be indirectly operated by a user. Indirect operation of the actuator 156 can include control of the actuator 156 through the use of one or more components of the endoscopic system 100 (e.g., the host machine 146, the computer 150, or the controller 154). For example, operation of a component of the endoscopic system 100 (e.g., pressing a key on the computer 150, pressing the controller 154, or actuating it in some other manner) can indirectly move the actuator 156 relative to the rest of the handpiece 104.

[0040] The actuator 156 may include any actuator configured to move relative to a portion of the handpiece 104. In one example, the actuator 156 may be a threaded element attached to a portion of the handpiece 104, as shown. In such an example, the actuator 156 may include rotating an accessible portion of the actuator 156 relative to the handpiece 104. Rotating the actuator 156 in a first direction (e.g., counterclockwise) may move the actuator 156 away from the remainder of the handpiece 104, while rotating the actuator 156 in a second direction (e.g., clockwise) may move the actuator toward the remainder of the handpiece 104. In one example, not shown, the actuator 156 may include a plunger that may be pulled out of or pushed into a portion of the handpiece 104. In one example, the actuator 156 may include an element attached to a track along which the element is moved when the actuator 156 is moved relative to the portion of the handpiece 104. In some examples, actuator 156 may include a motor, a pneumatic press, a hydraulic press, or other actuator.

[0041] 1D and 1E are close-up views of the ureteroscope 102 illustrating a method of selectively varying the stiffness of at least a portion of the catheter 106 using an actuator 156, according to one embodiment. Referring to FIG. 1D, the actuator 156 may be initially positioned in a first position, where the actuator 156 may be fully threaded into the working channel port 126, bringing the actuator 156 as close as possible to the catheter tip 112. The actuator 156 may be attached to at least one or more of the working channel connector 128 and optional conduit 130, as depicted (in FIG. 1B). Referring to FIG. 1E, the actuator 156 may be rotated (e.g., counterclockwise) to move the actuator 156 to a second position, which in this embodiment is away from a portion of the handpiece 104 (e.g., away from the catheter tip 112). Moving the actuator 156 to the second position transitions the first moving portion of the working assembly 125 (e.g., the working channel connector 128, at least a portion of the optional conduit 130, and optionally at least a portion of the working channel 127) from the first state to the second state. In the illustrated embodiment, transitioning the first moving portion to the second state increases the tensile force applied to the working assembly 125, which in turn applies a compressive force from the working channel 127 to the catheter 106, thereby increasing the stiffness of at least a portion of the catheter 106. Returning the actuator 156 to the first position can switch the first moving portion of the working assembly 125 back to the first state, thereby decreasing the stiffness of at least a portion of the catheter 106.

[0042] Other portions of the ureteroscopes disclosed herein, other than or in addition to the working assembly 125, may be used to vary the stiffness of the catheter. For example, Figures 2A and 2B are side elevational views of a ureteroscope 202 configured to vary the stiffness of at least a portion of the catheter 206 using a steering controller 232, according to one embodiment. Except as otherwise disclosed herein, the ureteroscope 202 may be the same as or similar to any of the ureteroscopes disclosed herein. For example, the ureteroscope 202 may include a handpiece 204, a catheter 206, a working assembly 225 (e.g., at least a working channel port 226 and a working channel), and a steering controller 232. The ureteroscope 202 may be used in any of the endoscope systems disclosed herein.

[0043] As discussed above, the ureteroscope 202 is configured to selectively change the stiffness of at least a portion of the catheter 206 (e.g., the distal end region of the catheter 206). For example, the ureteroscope 202 is configured to increase the stiffness of at least a portion of the catheter 206 using at least a portion of the steering control 232. As discussed in more detail below, the steering control 232 has a second movable portion. As used herein, the "second movable portion" refers to the portions of the steering control 232 that are movable relative to the handpiece 204. The second movable portion may include all or a portion of the steering control 232. The first movable portion of the steering control 232 is configured to be movable relative to the catheter end 212 of the handpiece 204. Moving the second movable portion of the steering control 232 relative to the catheter tip 212 moves at least a portion of the steering control 232, which can place at least a portion of the steering wire (shown in FIG. 1B) under tension. The steering wire is rigidly (i.e., indeterminately) attached to the distal end region of the catheter 206. Thus, placing at least a portion of the steering wire under tension exerts a compressive force on the catheter 206 from the steering wire (e.g., pulling the distal end region of the catheter 206 straight back toward the handpiece 204). The compressive force on the catheter 206 increases the stiffness of the catheter 206.

[0044] 1A-1E, except as otherwise disclosed herein. For example, the actuator 256 is coupled (e.g., attached) to a portion of the steering control 232. The actuator 256 is configured to move relative to the remainder of the handpiece 204 (e.g., relative to the catheter tip 212) in response to manipulation by a user. Movement of the actuator 256 also moves at least a portion of the steering control 232. For example, movement of the actuator 256 may move at least one of at least a portion of the steering wire, at least a portion of the driver, at least a portion of the lever 238, and any other components of the steering control 232. A second movable portion of the steering control 232 includes the actuator 256 and other portions of the steering control 232 that are moved by movement of the actuator 256.

[0045] The actuator 256 may be in a first (or initial) position relative to the remainder of the handpiece 204, as shown in FIGURE 2A. An individual may manipulate the actuator 256 to move the actuator 256 to a second position, different from the first position, relative to the remainder of the handpiece 204, as shown in FIGURE 2B. The second position may be further or closer to a portion of the handpiece 204 (e.g., further or closer to the catheter tip 212) than the first position. After moving the actuator 256 to the second position, the user may further manipulate the actuator 256 at will to return the actuator 256 to the first position or to one or more additional positions different from the first and second positions.

[0046] Moving the actuator 256 relative to the catheter tip 212 moves at least a portion of the steering control 232. In other words, moving the actuator 256 moves a second moveable portion of the steering control 232 relative to the handpiece 204. The second moveable portion of the steering control 232 can be in a first (or initial) state when the actuator 256 is in a first position and can be in a second state, separate from the first state, when the actuator 256 is in a second position. The second moveable portion can also assume one or more additional states when the actuator 256 is in one or more additional positions, as discussed above.

[0047] In some embodiments, at least a portion of the actuator 256 is readily accessible to a user of the ureteroscope 202. At least a portion of the actuator 256 may be readily accessible when, for example, at least a portion of the actuator 256 is disposed on or extends from an exterior surface of the handpiece 204. In some examples, as shown, the actuator 256 may have a knob 258 disposed on an exterior surface of the handpiece 204, and thus the knob 258 may be readily accessible. In some embodiments, the actuator 256 is not readily accessible. When, for example, the actuator 256 is disposed within the handpiece 204 (e.g., at least a portion of the actuator 256 is attached to, internal to, or otherwise coupled to a driver), the actuator 256 may be indirectly operated by a user.

[0048] As previously discussed, in some embodiments, the actuator 256 includes a knob 258. The knob 258 may be directly attached to the second motion portion and may include at least one additional element extending from the knob 258 to the steering control 232. The portions of the actuator 256 that are attached to the steering control 232 may be pivotally attached to the steering control 232 to rotate a driver (not shown). A slot 260 may be formed in the handpiece 204 to allow for lateral movement of the knob 258. Lateral movement of the knob 258 along the slot 260 may cause the actuator 256 to move at least a portion of the steering control 232. In some embodiments, the actuator 256 may include any of the other actuators disclosed herein, such as a threaded attachment, a plunger that may be pulled outwardly or pushed into a portion of the handpiece 204, a motor, a pneumatic press, a hydraulic press, or other actuator.

[0049] According to FIG. 2A, the actuator 256 can be initially primed in a first position. According to FIG. 2B, the actuator 256 can be moved to a second position, which in this embodiment is further from the catheter tip 212. Moving the actuator 256 to the second position transitions the second motion section of the steering controller 232 from the first state to the second state. Transitioning the second motion section to the second state increases the tensile force on the steering wire. The steering wire applies a compressive force to the catheter 206, increasing the stiffness of at least a portion of the catheter 206. Returning the actuator 256 to the first position can switch the second motion section of the steering controller 232 back to the first state, thereby decreasing the stiffness of at least a portion of the catheter 206.

[0050] It is noted that other components of the disclosed ureteroscope may also be used to vary the stiffness of at least a portion of the catheter. According to an example, the disclosed ureteroscope may include one or more actuators configured to apply a pulling force directly to the steering wires with or without moving the steering control. According to an example, the disclosed ureteroscope may include one or more actuators configured to apply a pulling force to the wires extending from the photoelectric module 140 and / or the light source 142 of FIG. 1C to apply a compressive force to the catheter. According to an example, the disclosed ureteroscope may include a laser fiber and / or a laser fiber channel configured to receive the laser fiber, as disclosed in U.S. Patent Application Publication No. 2020 / 0139999, filed on February 9, 2022, the disclosure of which was previously incorporated herein. In such an example, the one or more actuators may be configured to apply a pulling force to the laser fiber and / or the laser fiber channel to apply a compressive force to the catheter.

[0051] A catheter shaft is often provided at least at the distal end region of the catheter. Providing a catheter shaft on the catheter can provide support for that region of the catheter and allow better control over bending of the catheter. In some embodiments, the catheters disclosed herein can have a catheter shaft configured to facilitate changing its stiffness. For example, FIG. 3 is a side elevational view of a catheter shaft 370 that can be used in any of the catheters disclosed herein according to one embodiment. The catheter shaft 370 includes a number of links 372. The links 372 can be substantially hollow (e.g., generally annular) to allow for placement of a working channel, steering wire, or other catheter component therethrough. The links 372 can be pivotally attached to adjacent ones of the links 372 to allow the catheter shaft 370 to pivot as the catheter bends. For example, each of the links 372 can include a body 374. At least some of the links 372 also have an attachment portion 376 extending from the body 374. The attachment portion 376 may be attached to the adjacent body 374 in a manner that allows the adjacent bodies 374 to move (e.g., pivot) relative to one another. According to one example, the attachment portion 376 may be attached to the adjacent body 374 using a hinge 377, as shown. In one example, the attachment portion 376 may be integral with or rigidly attached to the body 374 of the adjacent link 372. In one example, the attachment portion 376 may be resilient such that the adjacent bodies 374 can pivot relative to one another as the attachment portion 376 deforms.

[0052] At least a portion of each of adjacent links 372 is separated from the other by a gap 378. For example, the gap 378 can be located between adjacent bodies 374. The catheter shaft 370 can be configured to vary the size of the gap 378 between adjacent links 372 (i.e., the distance between adjacent links 372). In one example, as shown, the attachment portion 376 is formed with an elongated slot 380 configured to vary the size of the gap 378. Specifically, a hinge 377 is disposed within the slot 380 and can move back and forth within the slot 380 to increase or decrease the size of the gap 378. According to one example, the attachment portion 376 can be configured to deform to vary the size of the gap 378.

[0053] Varying the size of the gap 378 can make the catheter shaft 370 more or less stiff. For example, movement between the links 372 can be limited by adjacent bodies 374 contacting each other. Increasing the size of the gap 378 increases the amount of movement between adjacent bodies 374 before they contact each other. In other words, increasing the size of the gap 378 increases the amount of allowable movement between adjacent bodies 374, making the catheter shaft 370 less stiff (i.e., more flexible). Conversely, decreasing the size of the gap 378 decreases the amount of allowable movement between adjacent bodies 374 before they contact each other. In other words, decreasing the size of the gap 378 increases the amount of allowable movement between adjacent bodies 374, making the catheter shaft 370 more stiff (i.e., less flexible).

[0054] The size of the gap 378 can depend on whether or not a compressive force is applied to the catheter. For example, when a compressive force is applied to the catheter, the size of the gap 378 decreases, thereby increasing the stiffness of the catheter shaft 370. Increasing the stiffness of the catheter shaft 370 increases the stiffness of the portion of the catheter in which the catheter shaft 370 resides. Reducing or eliminating the compressive force applied to the catheter can increase the size of the gap 378, thereby decreasing the stiffness of the catheter shaft 370 and the portion of the catheter in which the catheter shaft 370 resides.

[0055] The catheter shaft 370 can be configured to increase the size of the gap 378 when the compressive force on the catheter is reduced or eliminated. According to one example, the catheter shaft 370 can have a spring 382 (as shown diagrammatically in FIG. 3 ) connected to one or more of the links 372 (e.g., connected to the link 372 at the end of the catheter shaft 370). The spring 382 can exert a biasing force to push the links 372 apart when the compressive force on the catheter is reduced or eliminated. In one example, the catheter shaft 370 is springless. In such an example, the size of the gap 378 is increased without a spring due to the resiliency (i.e., tendency to return to an original shape) of the catheter shaft 370 and / or the catheter in which the catheter shaft 370 is included.

[0056] It is noted that the ureteroscopes disclosed herein can be used in endoscopic procedures that do not involve the urinary tract (e.g., urethra, bladder, ureters, and / or kidneys), for example, the ureteroscopes can be used in endoscopic procedures involving the digestive tract, respiratory tract, ear, reproductive system, abdominal or pelvic cavities, the interior of joints, chest organs, a fetus, the hand, or any other body part instead of or in addition to the urinary tract.

[0057] Various aspects and embodiments have been disclosed herein, and other aspects and embodiments are contemplated. The various aspects and embodiments of the present disclosure are intended to be illustrative and are not to be construed as limiting.

[0058] Degree indicators (e.g., "almost," "substantially," "generally," etc.) indicate structural or functional insignificant variation. In examples where a degree indicator is accompanied by a quantity indicator, the degree indicator is interpreted as meaning ±10%, ±5%, or +2% of the quantity indicator. In examples where a degree indicator is used to modify a shape, the degree indicator indicates that the shape modified by the degree indicator has the appearance of the disclosed shape. For example, degree indicators can be used to indicate that the shape may have rounded corners instead of sharp corners, curved edges instead of straight edges, one or more protrusions extending therefrom, be oval, be the same as the disclosed shape, etc.

Claims

1. A ureteroscope, Catheter tip, Control end, a working assembly configured to receive one or more surgical instruments; and a steering controller configured to cause bending of at least a portion of the catheter; A handpiece having a the catheter extending from the catheter end of the handpiece, the catheter having a proximal end region and a distal end region spaced farther from the handpiece than the proximal end region; Equipped with the working assembly having a first movable part configured to be movable relative to the catheter end of the handpiece, movement of the first movable part relative to the catheter end of the handpiece altering the stiffness of a portion of the catheter; or the steering control having a second movable part configured to be movable relative to the catheter end of the handpiece, movement of the second movable part relative to the catheter end of the handpiece varying stiffness of a portion of the catheter; At least one of the following: ureteroscope.

2. The ureteroscope of claim 1, A ureteroscope in which the distal end region of the catheter increases in stiffness as at least one of at least a portion of the first movable portion and at least a portion of the second movable portion moves away from the catheter end.

3. The ureteroscope according to claim 1 or 2, A ureteroscope, the working assembly having the first moveable part.

4. The ureteroscope according to claim 3, The ureteroscope has an actuator on the first movable part, movement of the actuator causing the first movable part to move relative to the catheter tip.

5. The ureteroscope according to claim 4, The actuator includes a threaded actuator that is threadedly attached to the handpiece, and turning the threaded actuator increases or decreases the distance measured from the actuator to the catheter end of the handpiece.

6. A ureteroscope according to any one of claims 1 to 5, The steering control includes the second moveable portion.

7. 7. The ureteroscope according to claim 6, The second movable part has an actuator, movement of the actuator causing the second movable part to move relative to the catheter tip.

8. The ureteroscope according to claim 7, The actuator includes a knob extending from at least a portion of the steering control.

9. A ureteroscope according to any one of claims 1 to 8, A ureteroscope, wherein the catheter has a catheter shaft, the catheter shaft having a plurality of links, each of the plurality of links pivotally attached to an adjacent one of the plurality of links, and at least a portion of the adjacent ones of the plurality of links separated by a gap.

10. 10. The ureteroscope of claim 9, A ureteroscope, wherein the plurality of links are configured such that the gap between adjacent ones of the plurality of links becomes smaller when at least a portion of the first movable part or at least a portion of the second movable part moves away from the catheter end.

11. The ureteroscope according to claim 9 or 10, The catheter shaft has at least one spring attached to at least some of the plurality of links.

12. A method of using a ureteroscope, comprising: Preparing the ureteroscope and placing the ureteroscope in the Catheter tip, Control end, a working assembly configured to receive one or more surgical instruments; and a steering controller configured to cause bending of at least a portion of the catheter; A handpiece having a the catheter extending from the catheter end of the handpiece, the catheter having a proximal end region and a distal end region spaced farther from the handpiece than the proximal end region; Equipped with the working assembly having a first moveable part configured to be movable relative to the catheter end of the handpiece; or the steering control having a second movable part configured to be movable relative to the catheter end of the handpiece; The ureteroscope must be at least one of the following: adjusting a stiffness of a portion of the catheter by moving at least one of at least a portion of the first movable portion and at least a portion of the second movable portion relative to the catheter end of the handpiece of the ureteroscope; The method includes:

13. 13. The method of claim 12, A method for increasing stiffness of the distal end of the catheter by moving at least one of at least a portion of the first movable part and at least a portion of the second movable part relative to the catheter end of the handpiece, thereby moving the first movable part or the second movable part away from the catheter end.

14. 14. The method according to claim 12 or 13, A method for reducing stiffness at the distal end of the catheter by moving at least a portion of the first movable part and at least a portion of the second movable part relative to the catheter end of the handpiece, by moving at least a portion of the first movable part or at least a portion of the second movable part toward the catheter end.

15. 15. The method according to any one of claims 12 to 14, comprising: A method of moving at least a portion of the first movable part relative to the catheter end of the handpiece, the method comprising: moving at least a portion of the first movable part relative to the catheter end; and moving at least a portion of the second movable part relative to the catheter end of the handpiece.

16. 16. The method of claim 15, Rotating a threaded actuator attached to the handpiece to move at least a portion of the first moveable portion relative to the catheter tip.

17. 17. The method according to any one of claims 12 to 16, comprising: The method of claim 1, wherein moving at least one of at least a portion of the first movable portion and at least a portion of the second movable portion relative to the catheter end of the handpiece comprises moving at least a portion of the second movable portion relative to the catheter end.

18. 20. The method of claim 17, Moving at least a portion of the second moveable portion relative to the catheter tip comprises moving a knob coupled to the steering control relative to the catheter tip.

19. 19. The method according to any one of claims 12 to 18, comprising: The method further includes reducing the gap between adjacent ones of a plurality of links on a catheter shaft disposed within the catheter, each of the plurality of links being pivotally mounted to an adjacent one of the plurality of links.

20. 20. The method according to any one of claims 12 to 19, comprising: The method further includes increasing the gap between adjacent ones of a plurality of links on a catheter shaft disposed within the catheter, each of the plurality of links being pivotally mounted to an adjacent one of the plurality of links.

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